Questioning the Fundamentals of Jiao's Scalp Acupuncture: Point-positioning Based on the Hypothesis of the Cerebral Cortex's Functional Zone.

Context: Shunfa Jiao, the founder of the major school of scalp acupuncture (SA), and several other authors, have speculated that SA can effectively treat diseases or disorders through needling of the external scalp zones projected from the cerebral cortex's internal function zones that are directly underneath. Objective: The review intended to analyze and discuss the historical development of Jiao's SA system, the composition of Jiao's SA stimulation zones, and the projection of the cerebral cortex's function zones on the scalp, to correct the shortcomings and inaccuracies of Jiao's hypothesis and accelerate the development of SA and its clinical application based on solid evidence. Design: The research team performed a narrative review based on the literature currently available. The research team searched PubMed, Cochrane, Webscience, CNKI (China National Knowledge Infrastructure), Wangfang, Google Scholar and Baidu Scholar databases. The search used the keywords: "Scalp acupuncture, head acupuncture, Jiao Shunfa, functional zone of cerebral cortex, history" in both English and Chinese. Setting: The study was conducted in Shanghai Bailing Tianshou Clinic of Chinese Medicine, Shanghai, People's Republic of China, and McLean Center for Complementary and Alternative Medicine, Vienna, VA, USA. Results: The nineteen stimulation zones in Jiao's SA system are actually a mixture of Jiao's speculation on SA and other authors' clinical experiences, and are confusing. The five zones on the forehead and the nasopharyngeal-mouth-tongue, madness control, spirit-emotional zones as well as the balance zone, chore-tremor control zone, and vascular movement center-more than 57% of the zones-aren't related to the projection on the scalp of the cerebral cortex's function zones directly underneath. Jiao didn't discover the five zones on the forehead through his findings of acupuncture-sensation transmission to organs, but rather Yunpeng Fang identified them in his study of SA. The nasopharyngeal-mouth-tongue, madness control, spirit-emotional zones are also others' finding. Jiao's projection of the cerebral cortex's function zones on the scalp was merely an adoption of a series of brain-surgery marks that surgeons draw before neurosurgery, which correlate external skull locations with underlying cortical areas. That Jiao believed that needling those lines could treat cerebrovascular diseases or disorders was an unfounded guess on his part. In fact, the effects of stimulating such functional zones to treat such diseases that Jiao found weren't ideal. Furthermore, Jiao's SA system has nothing to do with the integration of Chinese and Western medicine. Conclusion: Scientific evidence hasn't confirmed Jiao's hypothesis nor has that hypothesis followed from the development of neuroscience. Jiao insistence on his hypothesis seriously hindered the research and development of SA therapy. Clinical trials and experimental studies on acupuncture, especially using an fMRI, are warranted to evaluate SA's therapeutic value and to identify the functional changes of various parts of the brain that acupuncture on the scalp can cause.

Baduanjin exercise ameliorates motor function in patients with post-stroke cognitive impairment: A randomized controlled trial.

BACKGROUND AND PURPOSE: As a traditional Chinese mind-body exercise, Baduanjin has been documented to have a positive effect on cognitive and physical function in a wide range of populations, but it is unclear whether it helps improve motor function in patients with post-stroke cognitive impairment (PSCI). The aim of this two-arm, randomized, parallel controlled study was to explore the rehabilitation effect of Baduanjin exercise on motor function in patients with PSCI. MATERIALS AND METHODS: Forty-eight patients with PSCI were randomly assigned to control and intervention groups. The control group received health education sessions on stroke prevention and rehabilitation. The intervention group received Baduanjin training in addition to the health education intervention. Before and after the 24-week intervention, both groups completed the Fugl-Meyer Assessment (FMA), Berg Balance Scale (BBS), Manual Muscle Test (MMT), Modified Ashworth Scale (MAS), and Three-Dimensional Gait Analysis (3DGA). RESULTS: After the 24-week intervention, both groups showed significant improvements in the FMA, BBS, MMT and MAS test results, but the Baduanjin group exhibited significantly better FMA, BBS and MMT test results than the control group (all P < 0.05). Furthermore, the Baduanjin exercise group showed significant improvements in spatial gait parameters, including the step length, walking speed and cadence, which were significantly better than the control group (all P < 0.05). No adverse events were reported during the study period. CONCLUSION: The 24-week Baduanjin exercise training may improve the limb motor function, balance, muscle strength and gait function of individuals with PSCI.

Effect of Baduanjin exercise on the cognitive function of middle-aged and older adults: A systematic review and meta-analysis.

BACKGROUND: Age-related cognitive decline is a pervasive problem in the ageing population. Baduanjin training is a mind-body exercise with the characteristics of traditional Chinese medicine, and increasing numbers of studies have reported its usefulness in modulating the cognitive performance of various populations. However, no systematic review has evaluated the effect of Baduanjin training on cognition in middle-aged and older adults. OBJECTIVE: To systematically evaluate the effects of Baduanjin on the global cognitive function and specific cognitive domains of middle-aged and elderly people. METHODS: Four literature databases (PubMed, Cochrane library, EMBASE, and Web of Science) and four Chinese databases (Wanfang, China National Knowledge Infrastructure, Chinese Science and Technology Periodical and China Biology Medicine) were searched from inception through May 2020. Randomized controlled trials (RCTs) examining the effect of Baduanjin exercise on the cognitive function of middle-aged and elderly people were included. Assessment of the risk of bias for the included studies and data synthesis were conducted using the software Review Manager 5.3 based on the methods given in the Cochrane Handbook. RESULTS: Baduanjin training showed significant benefit for global cognitive function and parts of specific domains of cognition, including general memory and its sub-domains (i.e., immediate memory and delayed memory), executive function, and processing speed, but no significant difference was found in attention function, visual-spatial ability or long-term memory (a sub-domain of memory). No related adverse events were reported in the included studies. CONCLUSIONS: The findings of this review suggest that Baduanjin is safe and effective in enhancing global cognitive function and memory in middle-aged and older adults and potentially beneficial to parts of the other specific domains of cognition, including executive function and processing speed. However, additional trials with larger sample sizes and a more rigorous design are needed before more definitive conclusions can be drawn.

Rapid analysis and identification of dianthrone glycosides in Polygoni Multiflori Caulis based on enrichment of macroporous absorbent resin and UPLC-Q-TOF-MS/MS.

INTRODUCTION: Polygoni Multiflori Caulis (PMC) has been used as a traditional Chinese medicine for a long time in China. However, hepatotoxic events of PMC have been reported in recent years, but the potential toxic compounds have remained unclear. Dianthrones as the secondary plant metabolites were revealed to potential hepatotoxicity in a previous study. However, no reports focused on dianthrones in PMC. OBJECTIVE: In the quest for exploring potential hepatotoxic compounds in PMC, the aim of this work was to undertake a comprehensive characterisation of dianthrones in PMC. METHODS: A simple and effective macroporous absorbent resin column chromatography method was established in this study to enrich the minor dianthrones from PMC extracts. Exploration and characterisation of dianthrones in PMC was conducted by an ultra-high-performance liquid chromatography-quadrupole time-of-flight tandem mass spectrometry (UPLC-QTOF-MS/MS) method and information dependent acquisition (IDA) mode. The aglycones of dianthrone glycosides were further verified by acid hydrolysis method. RESULTS: Seventy-two dianthrone glycosides and their five aglycones were discovered and tentatively characterised in PMC for the first time, of which 29 dianthrones were identified as potential new compounds. Dianthrone glycosides could be classified into three types according to their aglycone structures, and their fragmentation pathway rules and diagnosed ions were also summarised comprehensively. CONCLUSION: This was the first comprehensive investigation on dianthrones in PMC. The result would help to fully understand the phytochemical constituents and toxic components in PMC, and highlight the need for further toxicological investigations of the dianthrones in PMC due to their potential hepatotoxicity correlation.

Structural differences of polysaccharides from Astragalus before and after honey processing and their effects on colitis mice.

Honey-processed Astragalus is a dosage form of Radix Astragali processed with honey, which exhibits better efficacy of tonifying Qi than the raw product. Polysaccharides are its main water-soluble active components. This work was designed to study the structural differences of homogeneous honey-processed Astragalus polysaccharides (HAPS3a) and Astragalus polysaccharides (APS3a) and their effects on colitis mice. The results showed that HAPS3a (Mw = 2463.5 kDa) and APS3a (Mw = 3373.2 kDa) differed in molecular weight, monosaccharide compositions, glycosidic bonds and degree of branching (DB). Notably, the molar ratios of galactose and galacturonic acid in HAPS3a were 22.66% and 33.24%, while those in APS3a were 11.87% and 49.55%, respectively. The uronic acid residues 1,4-ß-GalpA and 1,6-α-GlcpA of the backbone in APS3a were converted into the corresponding neutral residues in HAPS3a after honey processing. The different DB of HAPS3a (15.35%) and APS3a (25.13%) suggested that the chain conformation became smoother. The anti-inflammatory effects on colitis mice revealed that HAPS3a exhibited better effects than APS3a by protecting intestinal mucosa, regulating the expression of cytokines and influencing microbiota diversity. Taken together, the differences in anti-inflammatory activity might be related to structural differences caused by honey processing. Our findings have laid a foundation for the processing mechanism of Astragalus.

Optimal exercise parameters of tai chi for balance performance in older adults: A meta-analysis.

BACKGROUND: Tai chi is considered a safe and low-cost treatment for improving balance ability among an older population. However, there is no existing evidence on the optimal exercise parameters of tai chi for improving balance in older adults. OBJECTIVES: To investigate the optimal parameters of a tai chi intervention to improve balance performance of older adults. DESIGN: Systematic review and meta-analysis of randomized controlled trials (RCTs). SETTING: PubMed, Embase, Cochrane Library, Web of Science, Scopus, China National Knowledge Infrastructure, Wanfang, Chinese Science and Technology Periodical and China Biology Medicine were searched from inception until November 30, 2020. PARTICIPANTS: Adults aged 60 years and over. MEASUREMENTS: Two reviewers independently extracted the data and assessed the quality of the included studies according to the Physiotherapy Evidence Database (PEDro) scale. Subgroup analyses and meta-regressions were conducted to elucidate the impact of tai chi training programs on balance measures. RESULTS: Twenty-six eligible RCTs were included in the meta-analysis. Pooled results showed that tai chi has moderate effects for improving proactive balance (weighted mean standardized mean differences [SMDwm ] = 0.61, 95% CI 0.33-0.89) and static steady-state balance (SMDwm  = 0.62, 95% CI 0.30-0.95) and small effects for improving dynamic steady-state balance (SMDwm  = 0.38, 95% CI 0.03-0.73) and balance test batteries (SMDwm  = 0.47, 95% CI 0.13-0.81) in adults over 60 years of age. The practice frequency could predict the effects of tai chi on static steady-state balance, and the 24-form simplified Yang style tai chi (45-60 min/session, more than four sessions per week and at least 8 weeks) was the most optimal. CONCLUSIONS: Tai chi is effective at improving the balance ability of adults over 60 years of age. A medium duration and high frequency of 24-form tai chi may be the optimal program for improving balance, but this evidence should be recommended with caution due to limitations of the methodology and small sample sizes.

Comparison of Traditional Chinese Exercises and Nontraditional Chinese Exercise Modalities on Cognitive and Executive Function in Community Middle-Aged and Older Adults: A Cross-Sectional Study.

BACKGROUND: Current evidence indicates that regular exercise can have a positive impact on cognitive function in older adults, but whether different exercise modalities may induce differential protective effects in different cognitive domains is uncertain. OBJECTIVE: To compare the effect of traditional Chinese exercise (TCE) modalities and non-traditional Chinese exercise (non-TCE) modalities on cognitive and executive function in community middle-aged and older adults through a cross-sectional study. METHODS: A total of 350 community middle-aged and older adults aged over 55 years participated in this study. Information on demographic characteristics, lifestyle and behavioural habits, and regular exercise was collected by a self-designed questionnaire. Global cognitive ability and executive function were assessed using the Montreal Cognitive Assessment (MoCA) scale, the clock drawing test (CDT), the animal naming test (ANT), and the trail making test (TMT). Eligible subjects were categorized into the no regular exercise (no-RE), non-TCE, or TCE groups according to their self-reported exercise information. Comparisons of global cognitive and executive function among the three groups were conducted using ANOVA or the general linear model with adjustment for potential confounding factors. RESULTS: The results showed that for the non-TCE or TCE groups, the MoCA and CDT scores were significantly higher, and the TMT-A test time was significantly shorter than those in the no-RE group (all P < 0.05), but no significant difference was observed for the TMT-B and ANT tests. After adjustment for potential confounding factors, the MoCA, the CDT, and TMT-A scores in the TCE group were significant compared to those in the no-RE group. In addition, subgroup analysis showed that in the TCE group, the MoCA scores were significantly higher than those in the non-TCE group. Furthermore, in the TCE group, the CDT scores for those with an exercise duration of <5 years were higher and the TMT-A test time for those with an exercise duration of ≥5 years was shorter than those in the non-TCE group. CONCLUSIONS: Both TCE and non-TCE have potential protective effects on global cognitive and executive function in community middle-aged and older adults. Compared to the non-TCE modality, the TCE modality may have a more positive association with these protective effects. Furthermore, prospective studies are needed to confirm these findings.

A metabonomics and lipidomics based network pharmacology study of qi-tonifying effects of honey-processed Astragalus on spleen qi deficiency rats.

Honey-processed Astragalus is a dosage form of radix Astragali processed with honey, which is deemed to contain better qi-tonifying effects in traditional Chinese medicine theroy. Our previous study has demonstrated that honey-processed Astragalus exhibited a better effect on reinforcing qi (vital energy) and immune improvement toward spleen qi deficiency compared with radix Astragali. However, the detailed mechanisms related to qi-tonifying effects of honey-processed Astragalus is still unclear. In this study, we evaluated the qi-tonifying effects of honey-processed Astragalus on spleen qi deficiency rats and predicted the mechanisms by aggregating metabonomics, lipidomics and network pharmacology. The results revealed that body weights, symptom scores, the levels of red blood cell, white blood cell, lymphocyte, spleen and thymus indexes, and three cytokines (TNF-α, IL-6, IFN-γ) in honey-processed Astragalus treated rats were improved in comparison with spleen qi deficiency rats. In parallel, based on the 26 biomarkers screened in metabonomics and lipidomics, we inferred that glycerophospholipid metabolism significantly regulated in pathway analysis was connected with qi-tonifying effects. Moreover, the network pharmacology analysis concluded that the compounds targets of honey-processed Astragalus CDK2, NOS3, MAPK14, PTGS1 and PTGS2 interacted with markers targets PLA2G(s) family and LYPLA1 could be responsible for regulation of glycerophospholipid metabolism to develop qi-tonifying effects. What's more, the above processes were possibly through VEGF signaling and MAPK signaling pathways.

Strategies for determining the bioactive ingredients of honey-processed Astragalus by serum pharmacochemistry integrated with multivariate statistical analysis.

Honey-processed Astragalus is a widely used traditional Chinese medicine that has a better effect on reinforcing "Qi" (vital energy) than the raw one. A comparative study of metabolites analysis between them in rat serum for finding the bioactive ingredients was carried out using serum pharmacochemistry and multivariate statistical analysis. The blood collection methods and time were optimized first. Then the prototypes and metabolites in serum samples after oral administration were investigated by ultra-high-performance liquid chromatography coupled with electrospray ionization quadrupole time-of-flight mass spectrometry integrated with principal component analysis and orthogonal partial least squares discriminant analysis. The contents of metabolites were also analyzed to evaluate the metabolic profile differences. As a result, nine prototypes and 36 metabolites were identified. Only two prototypes and 15 metabolites were different between raw and honey-processed Astragalus. Their biotransformation reactions contained the process of oxidation, demethylation, and hydrolysis in phase I and glucuronide conjugation or sulfate conjugation in phase II. Most of the detected metabolites were transformed from isoflavones and isoflavanes. Our results expand the knowledge about the influence of honey-processing on Astragalus and suggest the different curative effects between raw and honey-processed Astragalus might due to their therapeutic material discrepancy.

Preparation, Characterization and Pharmacokinetics Evaluation of the Compound Capsules of Ibuprofen Enteric-Coated Sustained-Release Pellets and Codeine Phosphate Immediate-Release Pellets.

The objective of this study was to prepare ibuprofen enteric-coated sustained-release pellets (IB-SRPs) and codeine phosphate immediate-release pellets (CP-IRPs) to play a synergistic role in analgesia. The pellets were developed by extrusion-spheronization and fluidized bed coating technology. The single-factor investigation was used to determine the optimal prescription and process. The sustained-release membrane of IB-SRPs was water-insoluble ethyl cellulose (EC), triethyl citrate (TEC) was used as plasticizer, and hydroxypropyl methylcellulose (HPMCP) was chose as porogen. Besides, the immediate-release layer of CP-IRPs was gastric-soluble coating film. The ibuprofen and codeine phosphate compound capsules (IB-CP SRCs) were prepared by IB-SRPs and CP-IRPs packed together in capsules with the optimum doses of 200 and 13 mg, respectively. The prepared pellets were evaluated by scanning electron microscopy and dissolution test. Pharmacokinetic studies in beagle dogs indicated that the optimized IB-CP SRCs had smaller individual differences and better reproducibility comparing with commercial available tablets. Additionally, IB-CP SRCs achieved consistency with in vivo and in vitro tests. Therefore, IB-CP SRCs could play a great role in rapid and long-term analgesic.

[The discovery, application and enlightenment of Lanwei (EX-LE 7)].

The discovery and application of Lanwei (EX-LE 7) was reviewed to elaborate its enlightenment on the inheritance and innovation of acupuncture. Literature published before April of 2017 was searched in CNKI and VIP database with"Lanwei (EX-LE 7)"and"acupuncture"as key words. Related references and publications were retrieved. According to the purpose, literature was screened and key information was extracted to perform systematic review and analysis. The results indicated Lanwei (EX-LE 7), reflection of relationship between organ and body surface under the guidance of acupuncture and meridians theory, was not a point, but an area. The discovery and application of Lanwei (EX- LE 7) was the product of western and Chinese combination. The best indication was simple appendicitis, but operation should be applied once adhesion, purulent and perforation occurred. It is indicated to improve clinical efficacy and avoid accident, the reasoned core of theory system should be insisted and the communication with modern medicine should be reinforced.

Preparation, Characterization and In Vitro / In Vivo Evaluation of Oral Time-Controlled Release Etodolac Pellets.

The objective of this study was to prepare time-controlled release etodolac pellets to facilitate drug administration according to the body's biological rhythm, optimize the drug's desired effects, and minimize adverse effects. The preparation consisted of three laminal layers from center to outside: the core, the swelling layer, and the insoluble polymer membrane. Factors influenced the core and the coating films were investigated in this study. The core pellets formulated with etodolac, lactose, and sodium carboxymethyl starch (CMS-Na) were prepared by extrusion-spheronization and then coated by a fluidized bed coater. Croscarmellose sodium (CC-Na) was selected as the swelling agent, and ethyl cellulose (EC) as the controlled release layer. The prepared pellets were characterized by scanning electron microscopy and evaluated by a dissolution test and a pharmacokinetic study. Compared with commercial available capsules, pharmacokinetics studies in beagle dogs indicated that the prepared pellets release the drug within a short period of time, immediately after a predetermined lag time. A good correlation between in vitro dissolution and in vivo absorption of the pellets was exhibited in the analysis.