Efficacy and safety of acupuncture as a complementary therapy for sepsis: a systematic review and meta-analysis.

BACKGROUND: Sepsis is a life-threatening organ dysfunction caused by dysregulation of the host response to infection. Acupuncture is used for treatment of inflammatory diseases; however, its effectiveness and safety as a complementary therapy for sepsis has not been fully explored. METHODS: Data were retrieved from eight databases. Randomized controlled trials (RCTs) that compared acupuncture plus conventional therapies versus conventional therapies alone were included. Pre-specified primary outcomes were mortality at 28 days and Acute Physiologic and Chronic Health Evaluation (APACHE) II scores. RESULTS: A total of 17 studies with 1099 participants were included in this study. In terms of the primary outcomes, acupuncture plus routine therapy reduced mortality at 28 days (risk ratio (RR)): 0.69, 95% confidence interval (CI): 0.52 to 0.91, p < 0.001) and APACHE II scores (mean difference (MD): -2.84, 95% CI: -4.09 to -1.58, p < 0.001) at day 7 after treatment compared with routine therapy alone. In terms of secondary outcomes, acupuncture plus routine therapy reduced white blood cell counts and levels of procalcitonin (PCT), tumor necrosis factor (TNF)-α, interleukin (IL)-6 and lactic acid and intra-abdominal pressure (IAP), and improved CD3+, CD4+ and monocytes of human leukocyte antigen (HLA)-DR at day 7 after treatment compared with routine therapy alone. However, acupuncture plus routine therapy had no significant effects on levels of IL-10, C-reactive protein (CRP), CD8+ and CD4+/CD8+ ratios compared with routine therapy alone. Quality of evidence was low to very low for all parameters (GRADE). CONCLUSION: The available evidence showed that combination of acupuncture and routine therapy may have benefit for sepsis compared with use of routine therapy only. Due to the low degree of certainty regarding its effects, further research is required. TRIAL REGISTRATION NUMBER: ICRD42019141491 (PROSPERO).

Acupuncture for emotional symptoms in patients with functional gastrointestinal disorders: A systematic review and meta-analysis.

BACKGROUND: Patients with functional gastrointestinal disorders (FGIDs) also often have emotional symptoms, such as anxiety and depression. The main drugs used for the treatment of FGIDs mainly target single gastrointestinal symptoms and are not effective in regulating emotional symptoms. Evidence has shown that acupuncture can relieve gastrointestinal symptoms in FGIDs patients, but there is no high-quality evidence to show that acupuncture can relieve psychological symptoms in these patients. OBJECTIVES: To systematically evaluate the clinical efficacy and safety of acupuncture for emotional symptoms in patients with FGIDs. METHODS: Randomized controlled trials (RCTs) published from database inception through July 31, 2021, were retrieved from three English-language databases (PubMed, the Cochrane Central Register of Controlled Trials, and Embase) and five Chinese-language databases (the China National Knowledge Infrastructure, Wanfang, VIP, Chinese Biomedical, and TCM Literature Analysis and Retrieval databases). RCTs that compared acupuncture with sham acupuncture and pharmacotherapy were included in this study. The score on the depression or anxiety scale after treatment were considered as primary outcomes. The 'meta' package (version 4.19-0) in RStudio 1.1.463 was used to analyse the data. RESULTS: A total of 2151 patients from 24 RCTs were included in this study. Compared with sham acupuncture, acupuncture was not significantly better at relieving anxiety (standardized mean difference [SMD] -0.35, 95% CI -1.05 to 0.33) and depression (SMD -0.32, 95% CI -0.71 to 0.07) symptoms. Compared with pharmacotherapy, acupuncture was significantly better at relieving anxiety (SMD -0.64, 95% CI -0.93 to -0.35) and depression (SMD -0.46, 95% CI -0.69 to -0.22) symptoms. CONCLUSIONS: This meta-analysis found that acupuncture can alleviate emotional symptoms in FGID patients better than pharmacotherapy. However, it is not clear whether this effect is based on the placebo effect, specific effect or nonspecific effect of acupuncture. The evidence should be proven by rigorously designed RCTs in the future. PROSPERO REGISTRATION NUMBER: CRD42021271899.

Efficacy of acupuncture for melasma: A protocol of systematic review and meta-analysis.

BACKGROUND: Melasma is a common acquired hyperpigmentation of the skin. The clinical manifestations are light brown or dark brown patches symmetrically distributed on the cheeks, forehead, and mandibular with different shades and unclear borders. The treatment of melasma is extremely challenging due to its easy relapse and hard to cure. As a classical method of traditional Chinese medicine, acupuncture has been used to treat melasma in clinical practice. However, there is no systematic review and meta-analysis of acupuncture on melasma. This study aims to assess the efficacy of acupuncture for melasma. METHODS: We will perform a comprehensive retrieval in the following electronic databases: PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure (CNKI), Wan Fang Database, VIP database, Chinese Biomedical Literature Service System (SinoMed), Chinese Biomedicine (CBM) database, and TCM Literature Analysis from inception to July 1, 2021, to identify any eligible study. We include all randomized controlled trials (RCTs) without any limitation of blinding or publication language, and exclude cohort studies and case reports. The meta-analyses will be conducted by using the Stata16. We will use the Cochrane risk of bias tool for randomized trials to assess the risk of bias of included studies. The X2 and I2 tests will be utilized to assess the statistical heterogeneity of evidence. We will conduct a meta-analysis if the studies can be combined. Otherwise, a narrative synthesis will be performed. Article screening and data extraction will be independently evaluated by 2 reviewers trained in methodology according to the established selection criteria. Any disagreements between the 2 reviewers will be resolved by reaching a consensus with the other authors (the third reviewer). RESULTS: This study will systematically evaluate the clinical efficacy of acupuncture for melasma. CONCLUSION: The conclusion of this study will provide evidence to ensure the efficacy of acupuncture for melasma, so as to provide an objective and scientific basis for clinical practice. ETHICS AND DISSEMINATION: No ethical approval will be required because the data used are not linked to individual patient. The results of this review will be published in a peer-reviewed journal. REGISTRATION NUMBER: INPLASY2021110097.

Acupuncture for headache in COVID-19: A protocol for systematic review and meta-analysis.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is an acute respiratory infectious disease which making people difficult to breathe and often accompanied with headache. Acupuncture have been proved the therapeutic effect on headache, but there has been no high-quality evidence on acupuncture for the headache in COVID-19. This study is designed to evaluate the effectiveness and safety of acupuncture for headache in COVID-19. METHODS: Randomized controlled trials from December 2019 to July 2021 will be included without restrictions on language or publication date. PubMed, EMBASE, Cochrane Library, Web of Science, Chinese Biomedical Databases, China National Knowledge Infrastructure, Wanfang database, and VIP database will be searched. Two researchers will independently select studies, extract data and evaluate study quality. Cochrane risk of bias tool for randomized trials will be used to assess the risk of bias of included studies. Statistical analyses will be performed using the Review Manager V.5.3 and stata 14.0. ETHICS AND DISSEMINATION: This study will not involve personal information. Ethical approval will not be required. We will publish the results in a peer-reviewed journal. PROSPERO TRIAL REGISTRATION NUMBER: CRD42021270722.

[Effect of umbilical moxibustion on phlegm damp constitution and intestinal flora].

OBJECTIVE: To observe the effect of umbilical moxibustion on phlegm damp constitution and intestinal flora, and explore the mechanism of umbilical moxibustion in improving phlegm damp constitution. METHODS: A total of 60 subjects with phlegm damp constitution were randomly divided into an observation group and a control group, 30 cases in each group. The control group was given TCM health guidance, such as diet and exercise; on the basis of the control group, umbilical moxibustion was applied in the observation group, 7 moxa cones each time, 2 times a week for 8 weeks. Before and after intervention, the indexes (transformation score of phlegm damp constitution, body mass, body mass index [BMI], waist circumference, hip circumference, heart rate and blood pressure) related to phlegm damp constitution were recorded in the two groups. The intestinal flora was detected with 16S rDNA sequencing technology in the two groups. RESULTS: After intervention, the transformation score of phlegm damp constitution, body mass, BMI, waist circumference and hip circumference were decreased compared before intervention in the observation group (P<0.001, P<0.01, P<0.05), the transformation score of phlegm damp constitution and waist circumference were decreased compared before intervention in the control group (P<0.001, P<0.05); the transformation score of phlegm damp constitution and waist circumference in the observation group were lower than the control group (P<0.001, P<0.05). After intervention, the relative abundance of Eubacterium hallii in the observation group was increased (P<0.01), the relative abundance of Blautia in the control group was decreased (P<0.05). CONCLUSION: Umbilical moxibustion may reshape the intestinal flora by up-regulating the relative abundance of Eubacterium hallii, thus improving phlegm damp constitution.

Acupuncture for Subthreshold Depression: Study Protocol for a Randomized Controlled Trial.

BACKGROUND: Subthreshold depression refers to a state of mental sub-health that has depressive symptoms but does not meet the diagnostic criteria for major depressive disorder. It is a strong risk factor for depression and is related to an increase in suicide and mortality. Studies suggest that acupuncture may be effective in the treatment of subthreshold depression, but no evidence has proven that the efficacy of acupuncture for subthreshold depression is a specific therapeutic effect or a placebo effect. METHODS: This will be a prospective, randomized, controlled, and double-blind study of 64 patients with subthreshold depression. They will be randomly assigned as verum or minimal acupuncture group members. Patients in the verum acupuncture group will receive acupuncture at the acupoints, and those in the minimal acupuncture group will receive minimal acupuncture at non-acupoints. The interventions will be delivered over an 8-week period. The primary outcome measure will be the Hamilton Depression Scale-17 (HAMD-17). The secondary outcome measures will be the 9-item Patient Health Questionnaire (PHQ-9), 7-item Generalized Anxiety Disorder (GAD-7), and SF-12v2 Health Survey. The assessments will occur at baseline, 4 weeks, 8 weeks, and during a follow-up period. DISCUSSION: The protocol uses a randomized controlled trial to examine the effectiveness of acupuncture for subthreshold depression and to further study the mechanisms of its effect.

Jiaji (EX-B2)-Based Electroacupuncture Preconditioning Attenuates Early Ischaemia Reperfusion Injury in the Rat Myocardium.

BACKGROUND: Acupuncture preconditioning was able to reduce the extent of ischaemia reperfusion (I/R) injury. Previous studies have shown that electroacupuncture (EA) pretreatment at T4-T5 Jiaji (EX-B2) acupoints had cardioprotective effects against myocardial I/R injury. However, the molecular mechanism remains inconclusive. METHODS: Wistar rats were pretreated with electroacupuncture for 7 days at the Neiguan (PC6), T4-T5 Jiaji (EX-B2), Yanglingquan (GB34), and Quchi (LI11) acupoints, which belong to different meridians. Then, we investigated the genome-wide gene expression profiles of rats prestimulated at these acupoints after I/R injury. RESULTS: Our study revealed previously unknown cardioprotective roles of T4-T5 Jiaji (EX-B2) acupoints in the I/R progression. The extent of myocardial injury was significantly decreased in the Jiaji group compared with the I/R group. In addition, our data are among the first to link the EA preconditioning at Neiguan (PC6) acupoints and circadian rhythm in the I/R model. Also, for the first time, we explored the meridian and acupoint specificity involved in EA pretreatment at the heart meridian, in which Yanglingquan and Quchi acupoints were selected as the control group for heart-divergent-meridian and nonheart-meridian acupoints. CONCLUSIONS: The present study suggested that EA pretreatment at Jiaji alters genome-wide gene expression and protects the rat myocardium against I/R injury, which are most likely through neurohumoral regulation.

Effects of acupuncture for nonalcoholic fatty liver disease: A protocol for systematic review and meta-analysis.

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is a multisystem disease, which may develop gradually into nonalcoholic steatohepatitis, liver fibrosis, and cirrhosis. As a classical method of traditional Chinese medicine, acupuncture has been used to treat NAFLD in clinical practice. However, there is no systematic review and meta-analysis of acupuncture on NAFLD. There is an urgent need to evaluate the clinical efficacy of acupuncture for NAFLD. METHODS: We will perform a comprehensive retrieval in the following electronic databases: MEDLINE, Embase, Cochrane Library Central Register of Controlled Trials, PubMed, Science Citation Index Expanded (Web of Science), Epistemonikos, China National Knowledge Infrastructure (CNKI) database, Wanfang Data Knowledge Service Platform, Chinese Scientific Journals Database (VIP), Chinese Biomedical Literature Service System (SinoMed), and other databases from their inception to October 2020. We will select the qualified studies for data extraction and assess the quality and risk of bias, independently. The meta-analyses will be conducted by using the RevMan 5.3. RESULTS: This study will provide a reliable basis for the treatment of NAFLD with acupuncture. CONCLUSION: The findings will be an available reference to evaluate whether acupuncture is an effective intervention for patient with NAFLD. OSF REGISTRATION NUMBER: 10.17605/OSF.IO/VFYXH.

Efficacy and safety of acupuncture as a complementary therapy for sepsis: A protocol of systematic review and meta-analysis.

INTRODUCTION: Sepsis is a physiological, pathological, and biochemical syndrome caused by infection. Acupuncture may be useful for sepsis. This systematic review aims to assess the efficacy and safety of acupuncture as a complementary therapy for sepsis. METHODS AND ANALYSIS: We will search PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure (CNKI), Wan Fang Database, Chinese Biomedicine (CBM) database, VIP database, and TCM Literature Analysis and Retrieval Database from inception to October 31, 2019 to identify any eligible study. We include all randomized controlled trials (RCTs) without any limitation of blinding or publication language, exclude cohort studies and case reports. Two reviewers will independently select studies, extract and manage data. The primary outcomes include the mortality at 28 days, acute physiology, and chronic health evaluation II scores. The secondary outcomes include the tumor necrosis factor α (TNF-α) counts, interleukin 6 (IL-6) counts, interleukin 10 (IL-10) counts, procalcitonin (PCT), lactic acid, the level of T cell subsets (CD3+, CD4+, CD8+, CD4+/CD8+), monocytes of human leukocyte antigen DR (HLA-DR), C-reactive protein (CRP), the numeration of leukocyte, intra-abdominal pressure, and adverse events or reactions. Statistical analyses will be performed using the Review Manager V.5.3 and R packages Metafor. We will use the Cochrane risk of bias tool for randomized trials to assess the risk of bias of included studies. ETHICS AND DISSEMINATION: This study will not involve personal information. Ethical approval will not be required. We will publish the results in a peer-reviewed journal. PROSPERO TRIAL REGISTRATION NUMBER: CRD42019141491.

[Effect of "Jiaji" (EX-B2)-electroacupuncture preconditioning on expression of myocardial cytochrome P450 enzyme in rats with acute myocardial ischemia-reperfusion injury].

OBJECTIVE: To investigate the effect of "Jiaji"(EX-B2)-electroacupuncture(EA) preconditioning on structural changes of myocardium and expression of cytochrome P450 (CYP450) enzymes in acute myocardial ischemia-reperfusion injury (MIRI) rats. METHODS: Sixty male Wistar rats were randomly divided into sham operation, model, EX-B2, Neiguan (PC6), Yanglingquan(GB34) and Quchi (LI11) groups (n＝10 in each group). The MIRI model was established by occlusion of the descending anterior branch of the left coronary artery for 30 min, followed by reperfusion for 30 min. EA preconditioning (2 Hz/100 Hz, 1 mA) was respectively applied to EX-B2, PC6, GB34, and LI11 for 30 min, once daily for 7 days. Morphological changes of myocardium were observed by H．E. staining. The ultrastructure of myocardial cells was observed by transmission electron microscope (TEM). The protein expression levels of myocardial CYP450 (CYP1A1, CYP2B2, CYP2C11 and CYP4A2) were detected by Western blot. RESULTS: In MIRI rats, myocardial pathological changes as swollen, disorganized arrangement, and partially ruptured myocardial fibers with unclear limit and necrosis and infiltration of lots of inflammatory cells under microscope, and focal myofilament degeneration, dissolution and necrosis with interstitial edema, vague mitochondria with swelling and vacuolation, ruptured and disorganized arrangement of crests under TEM were found in the ischemic area, which was obviously milder in rats of both EX-B2 and PC6 groups. After modeling, the expression of myocardial CYP1A1 and CYP2B2 protein were significantly up-regulated in the model group relevant to the sham operation group (P<0.05). In EA preconditioning groups, the expression levels of CYP1A1 and CYP4A2 proteins in the EX-B2, PC6 and GB34 groups were obviously down-regulated (P<0.01), and those of CYP2B2 and CYP2C11 proteins in both EX-B2 and PC6 groups were markedly up-regulated relevant to the model group (P<0.01). Compared with the EX-B2 group, the expression levels of CYP1A1, CYP4A2 proteins in the LI11 group were significantly up-regulated (P<0.05), and CYP2B2, CYP2C11 proteins were significantly down-regulated (P<0.05). No significant differences were found between the model and sham operation groups in the expression levels of myocardial CYP2C11 and CYP4A2 proteins, between the LI11 and model groups in the expression of CYP1A1, CYP2B2, CYP2C11 and CYP4A2, between the GB34 and model groups in the expression of CYP2B2, CYP2C11 (all P>0.05)．. CONCLUSION: EA preconditioning at EX-B2 and PC6 can suppress MIRI induced up-regulation of myocardial CYP450 ω-hydroxylase CYP1A1 and CYP4A2 expression and further up-regulate the expression of myocardial epoxygenase CYP2B2 and CYP2C11 proteins in acute MIRI rats, thus playing a role in myocardial protection.

[Protective effect of acupuncture preconditioning on oxidative stress injury induced by myocardial ischemia-reperfusion injury in rats].

OBJECTIVE: To observe the protective effect of acupuncture preconditioning at "Jiaji" (EX-B 2) on acute myocardial ischemia-reperfusion injury (MIRI) in the rats and explore the mechanism. METHODS: Fifty Wistar rats were randomly divided into a control group, a model group, a Jiaji group, a Neiguan group and a Quchi group, 10 rats in each one. In the Jiaji group, the Neiguan group and the Quchi group, electroacupuncture was given for preconditioning at "Jiaji" T4~T5 (EX-B 2), "Neiguan" (PC 6) and "Quchi" (LI 11) for 7 days before modeling. In the control group and the model group, the regular feeding was given, without any acupuncture. At the end of acupuncture, except the control group, ligating the left anterior descending coronary artery (LAD) was adopted to duplicate MIRI models in the rest groups. Electrocardio-gram (ECG) was monitored and ST-segment shift was analyzed. HE staining method was adopted to observe the morphology of cardiac tissue in the rats of the groups. The transmission electron microscope was used to observe myocardial cell ultrastructure. WST-1 method was used to determine the activity of serum superoxide dismutase (SOD), TBA method was used to determine the content of serum malondialehyde (MDA) and the real-time fluorescent quantitative PCR method to determine the expressions of Nrf 2 in ischemic myocardial tissue and downstream HO-1 gene. RESULTS: Compared with the control group, after LAD ligation, ST-segment was elevated and depressed in ECG apparently after reperfusion in the rest groups (all P<0.05). The ST-segment elevation in the Jiaji group and the Neiguan group was less than that in the model group (both P<0.05). Compared with the model group, SOD activity was increased apparently in the Jiaji group and the Neiguan group (both P<0.05), and MDA content was reduced apparently (both P<0.05). The effects in the Jiaji group were better than those in the Neiguan group (both P<0.05). Pathologically, "Jiajia" (EX-B 2) and "Neiguan" (PC 6) all improved the morphology of cardiac tissue and cell ultrastructure. The effects in the Jiaji group were much more significant and the improvements in the Quchi group were not apparent. Compared with the control group, the expressions of Nrf 2 and HO-1 gene in myocardial tissue were down-regulated in the model group (both P<0.05). Those were up-regulated apparently in the Jiaji group and the Neiguan group as compared with the model group (P<0.05, P<0.01). The up-regulation times of the expressions of Nrf 2 and HO-1 gene in the Jiajia group were the highest in comparison. CONCLUSIONS: Acupuncture preconditioning at "Jiaji" (EX-B 2) has the protective effect on cardiac ischemia and reperfusion damage, which is probably relevant with the up-regulation of Nrf 2-ARE pathway expression, the activation of endogenous anti-oxidative pathway, the improvement of oxygen free radical scavenging capacity and the alleviation of lipid peroxide damage.

[Effect of "Jiaji"(EX-B 2)-electroacupuncture Preconditioning on Expression of Cytochrome P 450 Signaling Pathways in Myocardial Ischemia-reperfusion Rats].

OBJECTIVE: To investigate the effect of "Jiaji"(EX-B 2)-electroacupuncture(EA) preconditioning on the myocardium and expression of cytochrome P 450 signaling pathways of myocardial cells in myocardial ischemia-reperfusion injury(MI/RI) rats. METHODS: Sixty male Wistar rats were randomly divided into sham operation, model, Jiaji, Neiguan(PC 6), Yanglingquan(GB 34) and Quchi(LI 11) groups (n=10 in each group). MI/RI model was established by occlusion of the descen-ding anterior branch of the left coronary artery. EA preconditioning was respectively applied to EX-B 2, PC 6, GB 34 and LI 11 for 30 min, once daily for 7 days. The ECG-ST segment was detected before and after the modeling. The contents of serum creatine kinase-MB(CK-MB) and lactate dehydrogenase(LDH) were detected by ELISA and microplate method separately. The expression levels of myocardial CYP 450 related genes cyp 1 a 1, cyp 2 b 2, cyp 2 c 11, cyp 4 a 2 were detected by Real-time PCR. RESULTS: Thirty minutes after ligation the changes of ECG-ST segment displacement of the Jiaji group and Neiguan group were signifi-cantly lower than that of the model group(P<0.01), and the change was significantly lower in the Neiguan group than in the model group(P<0.01) 30 minutes after reperfusion. Compared with the sham operation group, the activities of serum CK-MB and LDH were significantly increased in the model group(P<0.01). Compared with the model group, the activities of serum CK-MB and LDH were significantly decreased in the Jiaji, Neiguan and Yanglingquan groups (P<0.01). Compared with the Jiaji group, the activity of serum LDH was significantly increased in the Quchi group, while the activities of serum CK-MB were significantly increased in the Quchi and Yanglingquan groups (P<0.05). Compared with the sham operation group, the expression levels of myocardial cyp 1 a 1 and cyp 2 b 2 mRNAs were significantly higher in the model group(P<0.01), while the expression of cyp 2 c 11 mRNA was lower(P<0.01). Compared with the model group, the expression levels of cyp 1 a 1 and cyp 4 a 2 mRNAs were lower in the Jiaji, Neiguan and Yanglingquan groups (P<0.01), while the expressions of cyp 2 b 2 and cyp 2 c 11 mRNAs were higher(P<0.01). Compared with the Jiaji group, the expression of cyp 1 a 1 mRNA was lower in the Neiguan group, while the expression of cyp 2 b 2 mRNA was higher(P<0.05). CONCLUSIONS: EA preconditioning at Jiaji(EX-B 2) can reduce serum myocardial enzymes of myocardial ischemia-reperfusion rats, lower the ST segment of electrocardiogram, up-regulate myocardial CYP 450 epoxygenase cyp 2 b 2 and cyp 2 c 11 mRNAs expression, down-regulate ω-hydroxylase cyp 1 a 1 and cyp 4 a 2 mRNAs expression, thus play a role in myocardial protection.

[Progress on the Relationship Between the Regulation of Gastrointestinal System Function by Acupuncture and Central Nuclei].

Acupuncture has a good curative effect in the treatment of gastrointestinal system diseases, such as functional dyspepsia, ulcerative colitis, and constipation. The central nuclei which are involved in the mechanism of acupuncture in regulating the gastrointestinal system have become a research hotspot in recent years. In the present paper, the authors summarized the effect of acupuncture and the central nervous system on gastrointestinal function regulation. It was found that the regulation of gastrointestinal function by acupuncture involved many brain regions such as the amygdala, paraventricular nucleus, locus coeruleus, raphe nucleus, and dorsal nucleus of the vagus nerve. Of these, the limbic brain region had the closest relation. However, the included studies were animal experiments, which involved less research on nuclear group interactions. The role of central nuclei in the regulation of gastrointestinal function by acupuncture is unclear. Thus, the introduction of more advanced brain imaging techniques to observe brain dysfunction of central nuclei and the relativity of acupuncture in regulating gastrointestinal function will be the focus in the future study, which will contribute to determining the effective mechanism of acupuncture and moxibustion.

Specific Correlation between the Hegu Point (LI4) and the Orofacial Part: Evidence from an fMRI Study.

Acupoint specificity is a foundational concept in acupuncture theory. It is closely related to the function of the acupoint. In this study, we sought to probe the central mechanisms of the specific correlation between LI4 and orofacial part in Bell's palsy patients. In total, 36 patients with left Bell's palsy were divided into three groups in random order, and each group received transcutaneous electrical acupoint stimulation (TEAS) at only one of three acupoints (LI4, ST6, and a sham point). A single-block fMRI design paradigm was applied to separately detect neural activity related to different stages of TEAS (prestimulation resting state, stimulation, and poststimulation resting state). Functional magnetic resonance imaging data were acquired during TEAS. There were extensive neuronal activities in the LI4 and ST6 groups and significant differences between stimulation at real and sham points. Brain regions were activated more by real acupoint TEAS than by sham point TEAS. Brain regions that were activated with LI4 and ST6 were broadly overlapping and adjacent. Our results provide supplementary neuroimaging evidence for the existence of acupoint specificity. These results may confirm the central mechanisms of the specific correlation between the Hegu point and the orofacial part.

[Study on "Hegu (LI 4) regulates face and mouth" based on palmomental reflex].

OBJECTIVE: To explore the correlation between hand and face-mouth, so as to provide nerve reflex basis for the theory "Hegu (LI 4) regulates face and mouth". METHODS: Seven hundred and sixty-three participants who met the inclusive criteria were divided into different age groups. The skin around participants' thenar eminence was gently scraped to be observed whether there was an involuntary movement around the face or mouth, which was palmomental reflex. The results of palmomental reflex were recorded. RESULTS: The total occurrence rate of palmomental reflex was 46.26%. For those who were 0 to 1 years old, the palmomental reflex was all positive; for those who were 21 to 36 years old, the positive rate was 20.45%, which was the lowest; for those who were 65 to 85 years old, more than half of them were positive. The majority of those who were 0 to 2 years old were bilateral positive palmomental reflex, while the majority of those who were 65 to 85 years old were unilateral positive palmomental reflex. CONCLUSION: There is a certain connection between hand and face-mouth. The occurrence rate of palmomental reflex changes from high to low over age increasing, and then changes from low to high with the aging, presenting a "high-low-high" U-shaped curve, which is possible related to the growth and recession of nervous system.

[Effects of electroacupuncture at "Jiaji" (EX-B 2) on myocardial apoptosis and the expression of Bcl-2 and Bax in rats with ischemia-reperfusion injury].

OBJECTIVE: To explore the protective mechanism of acupuncture on myocardial ischemia-reperfusion injury. METHODS: Fifty Wistar rats were randomly divided into a sham-operation group, a model group, a Jiaji group , a Neiguan group and a Yanglingquan group, 10 rats in each group. The model of myocardial ischemia-reperfusion injury was duplicated by ligating the left anterior descending coronary artery (LADCA) in the later four groups, and the LADCA was not ligated in the sham-operation group. The rats in the treatment groups were treated with electroacupuncture at "Jiaji" (EX-B 2), "Neiguan" (PC 6) and "Yanglingquan" (GB 34) on both sides, respectively, once a day for 7 days. No interventions were produced in the sham-operation group and model group. Myocardial apoptosis were examined by the TUNEL method. The expressions of Bcl-2 and Bax proteins were measured by immunohistochemical method. RESULTS: Apoptosis index(AI) was significantly lower in the Jiaji group, Neiguan group and sham-operation group compared with model group (P < 0.01). Compared with the sham-operation group, AI were significantly increased in other groups (all P < 0.01). There was no significant difference in AI between Jiaji and Neiguan group (P > 0.05). Compared with the model group, the expression of Bcl-2 was significantly increased and Bax protein was significantly decreased in Jiaji group and Neiguan group (both P < 0.01). The expressions of Bcl-2 and Bax proteins were significantly increased in other groups compared with the sham-operation group (all P < 0.01). There was no significant difference in the expression of Bcl-2 and Bax proteins between Jiaji and Neiguan group (P > 0.05). CONCLUSION: Electroacupuncture at both Jiaji (EX-B 2) and Neiguan (PC 6) has protective effects on myocardial ischemia-reperfusion injury, and the mechanism is closely related to inhibiting myocardial apoptosis by adjusting the expression of Bcl-2 and Bax.

[Impacts of electroacupuncture at Lingtai (GV 10) and Shendao (GV 11) on premature heartbeat].

OBJECTIVE: To observe the specific clinical efficacy of electroacupuncture at Lingtai (GV 10) and Shendao (GV 11) on premature heartbeat. METHODS: Seventy-two cases of premature heartbeat were randomized into an observation group and a control group. In the observation group, electroacupuncture was applied at Lingtai (GV 10) and Shendao (GV 11). In the control group, electroacupuncture was applied at bilateral Xuanzhong (GB 39). The treatment was given once a day and 10 times made one session in both groups. Respectively, the dynamic electrocardiogram detection was done before treatment and after one session of treatment in each group. RESULTS: The total effective rate was 47.1% (16/34) in the observation group and 6.5% (2/31) in the control group. The efficacy in the observation group was superior to that in the control group, presenting the statistical significant difference in comparison (P < 0.05). CONCLUSION: Electroacupuncture at Lingtai (GV 10) and Shendao (GV 11) has specific clinical efficacy on premature heartbeat.

NMDA Receptor-Dependent Synaptic Activity in Dorsal Motor Nucleus of Vagus Mediates the Enhancement of Gastric Motility by Stimulating ST36.

Previous studies have demonstrated the efficacy of electroacupuncture at ST36 for patients with gastrointestinal motility disorders. While several lines of evidence suggest that the effect may involve vagal reflex, the precise molecular mechanism underlying this process still remains unclear. Here we report that the intragastric pressure increase induced by low frequency electric stimulation at ST36 was blocked by AP-5, an antagonist of N-methyl-D-aspartate receptors (NMDARs). Indeed, stimulating ST36 enhanced NMDAR-mediated, but not 2-amino-3-(5-methyl-3-oxo-1,2-oxazol-4-yl)propanoic-acid-(AMPA-) receptor-(AMPAR-) mediated synaptic transmission in gastric-projecting neurons of the dorsal motor nucleus of the vagus (DMV). We also identified that suppression of presynaptic µ-opioid receptors may contribute to upregulation of NMDAR-mediated synaptic transmission induced by electroacupuncture at ST36. Furthermore, we determined that the glutamate-receptor-2a-(NR2A-) containing NMDARs are essential for NMDAR-mediated enhancement of gastric motility caused by stimulating ST36. Taken together, our results reveal an important role of NMDA receptors in mediating enhancement of gastric motility induced by stimulating ST36.

[Mast cell and substance P are involved in the process of acupoint sensitization induced by acute gastric mucosal injury].

OBJECTIVE: To observe changes of mast cells (MCs) number and morphology, and substance P (SP) expression in Evans blue (EB) extravasated region around acupoint "Pishu" (BL 20) and "Weishu" (BL 21) after acute gastric mucosal injury (AGMI) so as to investigate the mechanism underlying visceral problems-induced acupoint activation. METHODS: Thirty adult Wistar rats were randomly divided into normal control (n = 15) and AGMI groups (n = 15). AGMI model was duplicated by perfusing the rats with 0.5 mol/L HCl (1 mL/100 g) after fasting for 20 h. Five hours after AGMI, the rats were treated by tail-intravenous injection of EB dye (5 mg/100 g, 50 mg/mL in normal saline) for inducing dye-plasma extravasation in the skin around BL 20, BL 21 regions, etc. at the back. The rats of the normal control group were treated with tail-intravenous injection of 0.9% NaCl. The skin and subcutaneous tissues (2 mmx 2 mm) of extravasated EB dye points (BL 20 or BL 21 region) and those 2 mm lateral to the extravasated EB dye points in the model group and the corresponding points in the normal control group were sampled (followed by fixing them in 4% paraformaldehyde), sectioned and stained by toluidine blue (for labeling MCs). The expression of SP in the extravasated EB dye skin and subcutaneous tissues was detected by immunohistochemistry (n = 5) and western blot (n = 5) respectively. The number of MCs in these samples was counted and the degranulation rate of MCs calculated. RESULTS: The total number of MCs and the number of degranulated MCs were significantly more in the EB extravasation points (corresponding to BL 20/BL 21 area) of AGMI group than those in the control spots of AGMI group and than those in the normal control group (P < 0.05, P < 0.001). The degranulation rate of MCs was significantly higher in the EB extravasation points of AGMI group than those in the control spots of AGMI group and in the normal control group (P < 0.01). In comparison with normal control group, the SP expression level was increased consideraly in the control spots of AGMI group and AGMI group (P < 0.01). CONCLUSION: After AGMI, the numbers of MCs and the degranulated MCs, and the SP expression level in BL 20/BL 21 area were increased significantly, suggesting an involvement of MCs and SP in the process of AGMI-induced activation of acupoints.