[Exploration on acupuncture regulation pathways based on neurovascular coupling].

On the basis of the consensus that acupuncture can regulate functional activities of nerves and blood vessels, we, in the present paper, discussed the physiological significance of the functional interactions between the two, and put forward a suitability between neurovascular coupling and acupuncture research, and held that the neurovascular coupling may be involved in 3 key links of the peripheral afferent process of acupuncture signals, central integration and regulation of target organs. Based on the differences in the expression of neurovascular coupling in different tissues, we proposed a feasibility of study on the diffe-rence of acupoint efficacies from acupoint-neurovascular coupling-acupuncture effect, and stimulationmethods-neurovascular coupling-acupuncture effect.

[Effect characteristics and mechanism of acupuncture in autonomic nerve regulation].

OBJECTIVE: To investigate the effect characteristics and mechanism of acupuncture in autonomic nerve regulation through a comprehensive literature analysis. METHODS: CNKI and PubMed databases were searched for the studies on acupuncture in autonomic nerve regulation in the past 30 years, and Excel was used to perform a descriptive analysis of research subjects, intervention methods, intervention sites (acupoint selection), intervention parameters, and effect mechanism of acupuncture. RESULTS: A total of 202 studies were included, among which there were 51 clinical studies, mostly on the nervous system and the circulatory system; Neiguan (PC6), Zusanli (ST36), Fengchi (GB20), and Hegu (LI4) were the most frequently used acupoints, manual acupuncture was the most common intervention method, most of the acupoints selected were in the extremities, head, face, and neck, and heart rate variability was the main parameter for evaluation. Among the 151 animal experimental studies, there were many studies on the digestive system and the circulatory system; "Zusanli" (ST36), "Neiguan" (PC6), and "Shenmen" (HT7) were the most frequently used acupoints, electroacupuncture was the most common intervention method, most of the acupoints selected were in the extremities, and the main effect mechanism was to regulate the central vagus nerve activity and the cholinergic anti-inflammatory pathway (CAP). CONCLUSION: Acupuncture has a good effect on autonomic nerve regulation. The acupoints in extremities, head, and face are mainly used in studies. The main action pathways are central vagus nerve activity and CAP, as demonstrated in the animal experiments. Acupuncture has specific effect characteristics, which are closely associated with the acupoints, methods, and parameters of stimulation.

Additional value of auricular intradermal acupuncture alongside selective serotonin reuptake inhibitors: a single-blinded, randomized, sham-controlled preliminary clinical study.

BACKGROUND: To evaluate the antidepressant effects of auricular intradermal acupuncture (AIA) of areas innervated by both the auricular branch of the vagus nerve and the trigeminal nerve. METHODS: Forty-nine patients with depression were randomly allocated into an AIA group (n = 25) and a sham AIA group (n = 24). Both groups received selective serotonin reuptake inhibitors (SSRIs) as conventional treatment. The AIA group received AIA stimulation, and the sham AIA group received sham AIA, which constituted being subjected to an attached needle that did not penetrate the skin. The needles were retained for 4 h each session, with five sessions a week for a total duration of 2 weeks. The outcomes were assessed by the 17-item Hamilton depression rating scale (HAMD-17), five factors (sleep disorder, retardation, cognitive dysfunction, anxiety/somatization, and weight) and self-rating depression scale (SDS) at weeks 0, 1, and 2. RESULTS: Fifty-four patients were randomly assigned to the AIA (n = 27) and sham AIA group (n = 27), of whom 25 patients in the AIA and 24 patients in the sham AIA group were analyzed. AIA-treated patients displayed a significantly greater reduction from baseline in HAMD-17 scores (p = 0.03) and SDS scores (p = 0.02) at week 2 compared to patients receiving sham AIA. The AIA intervention also produced a higher rate of clinically significant responses in sleep disorders (p = 0.07) compared to sham AIA. No adverse events occurred in either group. CONCLUSION: According to the findings of this preliminary study, AIA appears to have additional value compared to SSRIs alone in treating patients with depressive disorder.

Evoking the Withdrawal Reflex via Successive Needle-Pricking on the Plantar and Dorsal Aspect of the Foot Increases the FMA of the Lower Limb for Poststroke Patients in Brunnstrom Stage III: A Preliminary Study.

The withdrawal reflex is a defensive reaction to nociceptive stimuli and can be used to regulate locomotor gait during rehabilitation. We investigated the effect of successive needle-pricking of the plantar and dorsal foot surfaces on poststroke lower limb function. Thirty-five hemiplegic patients, within one month after primary stroke, with an affected lower limb (Brunnstrom stage III) were randomly divided into intervention and control groups. Both groups received routine drug treatment, rehabilitation training, and upper limb acupuncture treatment on the hemiplegic side. The control group also received routine acupuncture on the hemiplegic side of the lower limb, while the intervention group received successive needle-pricking on the sole and instep of both the unaffected and affected side feet. Outcomes were assessed before inception (D0) and after three (D3) and six (D6) treatment days, using Brunnstrom stage (Ueda assessment), total Fugl-Meyer lower extremity assessment (FMA-LE) and its subscores (FMA-LE-ss), active lower limb range of motion (AROM-LL), Modified Ashworth Scale Score (MAS-LL), and manual muscle testing (MMT-LL). The Brunnstrom stage was better in the intervention group than in the control group at both D3 and D6 (P < 0.01). The total FMA-LE score and sections B, C, D, and G FMA-LE-ss were significantly better in the intervention group than in the control group at D3 and D6 (P < 0.05). The AROM-LL hip and knee flexion and hip extension improved more in the intervention group than in the control group (P < 0.05). In the intervention group, MAS-LL hip flexion significantly improved at D6 (P < 0.01). Improvement in lower limb joints on the MMT-LL in the intervention group exceeded that in the control group at D6 (P < 0.01). Successive needle-pricking on the plantar and dorsal foot aspects of Brunnstrom stage III in poststroke patients contributed to rapid lower limb motor function improvement via the withdrawal reflex. This trial is registered with ChiCTR1900020633.

Traditional Chinese medicine (TCM) massage for the treatment of congenital muscular torticollis (CMT) in infants and children: A systematic review and meta-analysis.

BACKGROUND AND PURPOSE: Congenital muscular torticollis (CMT) is a musculoskeletal condition occurring in infants and children. This systematic review is conducted to summarize the current evidence on the effects and safety of TCM massage therapy for the treatment of CMT in infants and children. METHODS: We searched for randomized controlled trials (RCTs) and quasi-RCTs on TCM massage for CMT in PubMed, Embase, CENTRAL, CINAHL, AMED, PsycINFO, Ovid MEDLINE, TCMLARS, ICTRP, CSTJ, CNKI, Wanfang Data, CBM, Taiwan Electronic Periodical Services, and the Index to Taiwan Periodical Literature System. Two reviewers conducted the data collection and analysis separately. Cochrane's collaboration tool was used to assess the risk of bias, and GRADEpro was used to assess the overall quality of the evidence. RevMan 5.3 software was used for data analysis with a random-effect model. RESULTS: A systematic review of six RCTs and one quasi-RCT was conducted with a meta-analysis of two of the RCTs. Pooled analysis showed that TCM massage has similar effects to those of stretching therapy on CMT symptoms in terms of effective rate (risk ratio: 1.00, 95% CI: 0.94-1.06; I2 = 0%; P = 0.99). CONCLUSION: Evidence suggests that TCM massage therapy is beneficial for treating CMT in infants and children. Further clinical trials with high-quality methodologies need to be conducted.

Auricular Electroacupuncture for Late Posttraumatic Epilepsy after Severe Brain Injury: A Retrospective Study.

BACKGROUND: Posttraumatic epilepsy (PTE) is a common complication of traumatic brain injury (TBI), which seriously affects patients' survival and recovery. Vagus nerve stimulation (VNS) is a nonpharmacological therapy for epilepsy. The auricular branch of the vagus nerve (ABVN) is the only peripheral branch and has antiepileptic effects, but the efficacy of ABVN stimulation as treatment of late PTE is uncertain. We retrospectively analyzed the clinical efficacy of ABVN stimulation by auricular electroacupuncture for the treatment of late PTE, and investigated the influence of sodium valproate and edaravone on the anti-PTE effects of auricular electroacupuncture. METHOD: Univariate and multivariate logistic regression analyses were used to investigate the relationship of age, cause of PTE, use of auricular electroacupuncture, sodium valproate, and edaravone with the incidence of late PTE. To compare the curative effects of auricular electroacupuncture, 89 cases of late PTE were divided into an auricular electroacupuncture and a control group according to whether they were treated with auricular electroacupuncture. We further analyzed the influence of sodium valproate and edaravone on the effects of the treatment of PTE with auricular electroacupuncture. RESULTS: Among age, cause, use of auricular electroacupuncture, sodium valproate, and edaravone, the use of auricular electroacupuncture was associated with significantly reduced incidence of late PTE (P < 0.05). Compared with the control group, there were more seizure-free cases in the auricular electroacupuncture group (P < 0.01). The total effective rate of the auricular electroacupuncture group was 90%. The seizure-free rate among patients treated with auricular electroacupuncture was significantly reduced, regardless of the use of sodium valproate or edaravone (P < 0.05). CONCLUSION: Auricular electroacupuncture can reduce the incidence of late PTE and is a safe and economical therapy for late PTE.

[Parameters and connotations of quantity of mild moxibustion stimulation].

The quantity of mild moxibustion stimulation is an important factor affecting clinical therapeutic effect. In the present study, we collected related literature by using key word "moxibustion stimulation quantity" from CNKI Database and make a summary about its concept. The quantity of mild moxibustion stimulation has two common characters, namely thermal intensity and cumulative stimulating quantity, and contains 6 components (parameters), including thermal energy, thermal stimulus, heated area of the skin, and stimulating duration, intensity and frequency. According to the facts mentioned above, we hold that the mild moxibustion quantity actually has 3 dimensions, i．e., the duration of stimulation, the stimulating quantity of one treatment session, and the total stimulating quantity of multiple treatment sessions. Accurately grasping and rationally using the basic term of the quantity of mild moxibustion is not only conductive to control clinical moxibustion operation, but also conforms to the basic requirements for quantitative control of intervention measures in experimental researches.

[Effects of Electroacupuncture on Hippocampal nNOS Expression in Rats with Anxiety-like Behavior].

OBJECTIVE: To compare the effects of electroacupuncture (EA) preconditioning and post-conditioning on hippocampal neuronal nitric oxide synthase (nNOS) expression in rats with anxiety-like behavior, so as to explore the reasonable EA intervention time. METHODS: Forty-two SD rats were randomly divided into 6 groups:normal 1, normal 2, anxiety model 1, an-xiety model 2, EA-pre-conditioning and EA-post-conditioning. The anxiety model was established by giving the rats with repeated foot shock stimulation (0.8 mA, 2-25 s/time, 10 times in 5 min) combined with isolation-raising. Before or after modeling, EA stimulation was applied to "Baihui" (GV 20) and "Yintang" (GV 29) for 20 min, once a day for 7 days. Elevated plus maze (EPM) tests were performed to determine the percentages of time spent in the open arms and the percentages of entries into the open arms in 5 min for evaluating the animals' anxiety-like behavioral activities. The reverse transcriptase polymerase chain reaction (RT-PCR) was used to detect hippocampal nNOS mRNA expression and the immunohistochemical staining adopted to detect the expression of nNOS protein in the hippocampal CA 1 and CA 3 areas, respectively. RESULTS: Compared with their own normal control group 1 and 2, both the percentage of time spent in the open arms and the percentage of entries into the open arms were significantly decreased in model group 1 and 2 (P<0.05, P<0.01). After pre- and post-conditioning of EA, the decreased proportions of time spent and entries into the open arms were considerably increased (P<0.05), suggesting an improvement of anxiety-like behavior activities after EA intervention. The expression levels of hippocampal nNOS mRNA and nNOS protein in the hippocampal CA 3 region were significantly higher in the model group 1 and 2 than in their own normal control group 1 and 2 (P<0.01), but those of nNOS protein in the CA 1 area were markedly lower in the model group 1 and 2 than in their own normal control group 1 and 2 (P<0.01). Following pre- and post-conditioning of EA, the increased expression levels of nNOS mRNA and protein of CA 3 area and the decreased level of nNOS protein of CA 1 area were all notably reversed (P<0.05, P<0.01). CONCLUSIONS: Both pre- and post-conditioning of EA can improve anxiety-like behavior in anxiety rats, which may be associated with its effects in down-regulating hippocampal nNOS expression.

[Effects of warm moxibustion on CD40-CD40L axis in rabbits with atherosclerosis].

OBJECTIVE: To explore effects and action mechanism of warm moxibustion on regulation of blood lipids and anti-atherosclerosis. METHODS: Forty-one male Japanese big-ear white rabbits were randomly divided into a blank group (10 rabbits), a model group (10 rabbits), a moxibustion group (10 rabbits) and a medication group (11 rabbits). Normal diet was applied in the blank group while high-cholesterol diet combined with injection of bovine serum albumin were applied in the rest groups to establish rabbit model of atherosclerosis. After establishment, the model group was not intervened and warm moxibustion was applied in the moxibustion group at "Zusan-li" (ST 36) and "Shenque" (CV 8), 10 min per acupoint per day for continuous 4 weeks. The medication group was treated with intragastric administration of lovastatin capsule (3.6 mg/kg) for continuous 4 weeks. The level of blood lipids, such as total cholesterol (TC), triglyceride (TG), and content of CD40 ligand (CD40L), soluble CD40 ligand (sCD40L) and expression of nuclear factor NF-kappaB were tested after 4 weeks. RESULTS: Compared with the model group, the moxibustion group and medication group could effectively reduce the contents of TC and low density lipoprotein (all P < 0.05), lower the level of sCD40L [(8.310 +/- 1.221) ng/mL in the model group, (7.097 +/- 0.846) ng/mL in the moxibustion group and (7.354 +/- 0.631) ng/mL in the medication group], reduce expression of CD40L [(0.235 +/- 0.179) mm2 in the model group, (0.072 +/- 0.079) mm2 in the moxibustion group and (0.039 +/- 0.015) mm2 in the medication group] and NF-kappaB [(0.145 +/- 0.052)mm2 in the model group, (0.052 +/- 0.012) mm2 in the moxibustion group and (0.036 +/- 0.013) mm2 in the medication group], indicating the significant difference (P < 0.05, P < 0.001). There was no statistical difference between the moxibustion group and medication group (all P > 0.05). CONCLUSION: The warm moxibustion has great effect on regulation of blood lipids and anti-atherosclerosis, in which lowering expression of CD40-CD40L could be one of possible mechanisms to take effect of anti-atherosclerosis.

[Anti-inflammatory: effect mechanism of warming-dredging in moxibustion].

The universality of anti-inflammation in moxibustion is analyzed in this article from its adaptation disease and ancient documentary records. The specificity of anti-inflammation in moxibustion is pointed out from its disease series research and scientific fact that moxibustion could be used for heat syndrome. The integrity of anti-inflammation in moxibustion is explained by series research result that four basic circulations of moxibustion for chronic inflammation are all effective. The two-way characteristic of moxibustion anti-inflammation is explained from the fact that moxibustion has regulation function both for excess and insufficiency of inflammation to demonstrate the effect mechanism of warming-dredging in moxibustion lies in its anti-inflammation. At last, the relevant possible mechanism between moxibustion anti-inflammation and transient receptor potential vanilloid (TRPV) is proposed. The effect mechanism of warming-dredging in moxibustion lies in anti-inflammation, which could provide theoretic basis for prevention and treatment of moxibustion for serious diseases.

Research on effects of the thermal stimulation by moxibustion at different temperatures on cardiac function in rats and on mast cells in the local site of moxibustion.

Objective. To observe effects of the thermal stimulation by moxibustion at different temperatures on cardiac function in brachycardia rat model and on mast cells in the local site of moxibustion at the Ximen Acupoint and to compare the differences of the effects of moxibustion at different temperatures. Method. Establish the brachycardia rat model with propranolol and observe effects of the thermal stimulation by moxibustion at different temperatures (38°C and 46°C). Results. The thermal stimulation by moxibustion at 2 temperatures may increase HR, MAP, LVSP, and +dp/dtmax and reduce t-dp/dtmax in brachycardia rats; the 46°C moxibustion group shows greater regulating effects on cardiac function in rats than that in the 38°C moxibustion group (P < 0.05). The thermal stimulation by moxibustion at 2 temperatures may promote degranulation of mast cells in the local site of moxibustion at the Ximen Acupoint; the degranulation rate in the 46°C moxibustion group is higher than that in the 38°C moxibustion group (P < 0.05). Conclusion. There is a certain association between the effect on the target organ and the effect in the local site of moxibustion. The moxibustion effect possibly resulted from local mast cells degranulation and different thermoreceptors activated by the thermal stimulation at different temperatures.

Effects of Moxibustion Temperature on Blood Cholesterol Level in a Mice Model of Acute Hyperlipidemia: Role of TRPV1.

Objectives. To compare the effects of moxibustion at two different temperatures (38°C and 46°C) on the blood cholesterol level in a mice model of acute hyperlipidemia, to detect the different expression levels of transient receptor potential vanilloid subfamily 1 (TRPV1) in the dorsal root ganglions of the wild mice, and to explore the correlation between TRPV1 and moxibustion's cholesterol-lowering effects. Method. Two different mice models were used: C57BL/6J wild type (WT) and TRPV1 gene knockout (TRPV1-/-). Each model was randomly divided into control group and model group with three subgroups after acute hyperlipidemia was established: model control group, 38°C moxibustion group, and 46°C moxibustion group. The mice in 38°C group and 46°C group were subject to moxibustion. After the therapy, the cholesterol concentration in serum was measured, and the expression of TRPV1 was quantified. Results. In WT mice, moxibustion caused a decrease in blood cholesterol level and upregulation of TRPV1 at the mRNA level, which was significantly greater in the 46°C group. In contrast, in TRPV1-/- mice, the differences of cholesterol-lowering effects of moxibustion were lost. Conclusions. Temperature is one of the important factors affecting the effects of moxibustion, and the cholesterol -lowering effect of moxibustion is related to the activation of TRPV1.

[Anti-depression effect of acupunctrue and moxibustion based on SSRIs medication].

OBJECTIVE: To verify the anti-depression effect of acupuncture and moxibustion based on the medication with selective serotonin reuptake inhibitors (SSRIs). METHODS: Eighty cases of depression were randomly divided into an acupuncture-moxibustion-medication group (25 cases), an acupuncture-medication group (25 cases) and a medication group (30 cases). SSRIs medication was administered in all of the three groups. Complementarily, in acupuncture-moxibustion-medication group, the needling technique of qi conduction in the Governor Vessel was applied to Baihui (GV 20), Fengfu (GV 16), Dazhui (GV 14), etc. Additionally, mild moxibustion was added at Dazhui (GV 14) and Baihui (GV 20). In acupuncture-medication group, acupuncture for qi conduction in the Governor Vessel was only adopted. Hamilton Depression Scale (HAMD) was used for the evaluation of the total score, the score of each factor before and after treatment separately, and the therapeutic effects were observed among 3 groups. RESULTS: Compared with medication group, the scores of the factors as retardation, sleep, and anxiety/somatization, as well as the total score were all apparently improved in the other two groups (P < 0.05, P < 0.01). Compared with acupuncture-medication group, the scores of sleep and cognition factors as well as the total score in HAMD were much improved in acupuncture-moxibustion-medication group (P < 0.05, P < 0.01). The remarkable effective rates were 100.0% (25/25), 84.0% (21/25) and 56.7% (17/30) in the three groups separately, in which, the result in acupuncture-moxibustion-medication group was superior to acupuncture-medication group (P < 0.05), and the results of these two groups were superior to medication group (both P < 0.01). CONCLUSION: Either acupunctrure or moxibustion has a definite anti-depression effect based on SSRIs medication, but the coordination of acupuncture and moxibustion achieves a superior efficacy as compared with simple acupuncture therapy.

[Clinical observation on governor vessel Daoqi method for treatment of dyssomnia in the patient of depression].

OBJECTIVE: To explore clinical therapeutic effects of Governor Vessel Daoqi needling method combined with antidepressants on dyssomnia in the patient of depression. METHODS: depression with dyssomnia were randomly divided into a treatment group (n=23) and a control group (n=22). The treatment group were treated with Governor Vessel Daoqi needling method and oral administration of antidepressants, with Shenting (GV 24), Baihui (GV 20), Dazhui (GV 14), Shendao (GV 11) and Zhiyang (GV 9) selected as main acupoints; and the control group with simple antidepressants. They were treated for 4 weeks. Changes of scores for Hamilton Depression Rating Scale (HAMD) and Pittsburgh Sleep Quality Index (PSQI) were investigated in the two groups. RESULTS: Significant differences before and after treatment in the scores for HAMD (P < 0.01) in both the two groups, and a significant difference before and after treatment in the score for PSQI only in the treatment group (P < 0.01) were found; after treatment, there were significant differences between the two groups in the scores of HAMD and PSQI (P < 0.01). CONCLUSION: The combined therapy of Governor Vessel Daoqi needling method and antidepressants can significantly improve dyssomnia in the patient of depression.

[Study on acupuncture and moxibustion treatment of cerebrovascular diseases based on the theory of collaterals].

OBJECTIVE: To explore the theoretical basis and clinical methods for treatment of cerebrovascular diseases according to the collateral theory. METHODS: Conjecture the construction components of the brain collaterals from relative description in Huangdi's Internal Classic and Classic on 81 Medical Problems; and illustrate mechanisms and the pathway of acupuncture and moxibustion in treatment of cerebrovascular diseases according to the theory of collaterals by means of relative theories and conclusions of experimental studies. CONCLUSION: (1) Brain collaterals are composed of collaterals of The Yangming, The Taiyang and The Governor Channels and The Changqian Collateral; (2) rich qi and blood are physiological characteristics of the brain collaterals, and pathological changes of the brain collaterals are a part of collaterals in whole body, "deficiency, toxicity, blood stasis" are pathological basis of lesion of the brain collaterals, "blood stasis" is an important pathological link of lesion of the brain collaterals; (3) acupuncture at relative acupoints of channels, pricking blood therapy at Jing points and blood-letting puncture therapy, low energy laser intravascular irradiation are clinically three effective methods for treatment of cerebrovascular diseases based on the theory of collaterals.