Manual acupuncture for neuromusculoskeletal disorders: The selection of stimulation parameters and corresponding effects.

As a minimally invasive method of physical stimulation, manual acupuncture (MA) is used globally as a sort of therapy for neuromusculoskeletal disorders. In addition to selecting appropriate acupoints, acupuncturists should also determine the stimulation parameters of needling, such as the manipulation (lifting-thrusting or twirling), needling amplitude, velocity, and stimulation time. At present, most studies focus on acupoint combination and mechanism of MA, the relationship between stimulation parameters and their therapeutic effects, as well as the influence on mechanism of action are relatively scattered, and lack of systematic summary and analysis. This paper reviewed the three types of stimulation parameters of MA, their common options and values, corresponding effects and potential mechanisms of action. The purpose of such efforts is to provide a useful reference for the dose-effect relationship of MA and the quantification and standardization of its clinical treatment of neuromusculoskeletal disorders to further promote the application of acupuncture in the world.

[Study on the quantitative evaluation parameter system for basic acupuncture manipulations based on 3D motion tracking technology].

OBJECTIVE: To establish a quantitative evaluation parameter system for basic acupuncture manipulations based on 3D motion tracking technology, and to further analyze the characteristics of acupuncture manipulation. METHODS: The motion tracking system Simi Motion Ver.8.5 was used to collect parameters of acupuncture manipulations, so as to establish a quantitative evaluation system mainly in spatial control parameters, time control parameters and stability parameters. Based on the evaluation parameter system, data of acupuncture manipulations (even reinforcing-reducing manipulation using lifting-thrusting technique and twirling technique) were collected from 19 teachers majored in acupuncture-moxibustion, of which the characteristics were analyzed and were compared with the results tested by traditional ATP-Ⅱ acupuncture manipulation parameter determination apparatus (ATP-Ⅱ). RESULTS: The evaluation parameter system could quantitatively analyze the basic acupuncture manipulations in 3 aspects, i.e. space, time and stability. Acupuncture manipulations were performed by shifting the needle body in a certain range along X, Y and Z axes. The amplitude and speed of thumb movement were greater than those of index finger. The time-history of lifting was similar to thrusting, while the time-history of twirling to left was similar to twirling to right in even reinforcing-reducing manipulation. The coordinate-time curve of finger movement of the evaluation system had consistent wave pattern compared with the voltage-time curve generated by ATP-Ⅱ. CONCLUSION: The quantitative evaluation parameter system based on 3D motion tracking technology can objectively evaluate basic acupuncture manipulations, and show the characteristics of different manipulations and the movement details of finger joints.

New Proposals for Application of Terahertz Imaging Technique in Chinese Medicine.

The rapid development of terahertz technology promotes the realization of various terahertz imaging systems. Terahertz technology features terahertz waves as good non-invasive illumination sources due to their high spectral resolution, penetration and safety. The terahertz imaging technique (TIT) has gradually been extended from the biomedical field to the field of Chinese medicine (CM), and it has become a powerful tool for seeking scientific evidence for CM theories with the use of modern science and technology. This paper reviews the current application of TITs in the field of CM research, and most importantly offers novel proposals for the application of TITs in CM research from the perspective of CM syndrome objectification and acupuncture research and cites existing reports as reference to the feasibility of these new proposals.

Three-dimensional Finger Motion Tracking during Needling: A Solution for the Kinematic Analysis of Acupuncture Manipulation.

Three-dimensional (3D) motion tracking has been used in many fields, such as the researches of sport and medical skills. This experiment aimed to use 3D motion tracking technology to measure the kinematic parameters of the joints of fingers during acupuncture manipulation (AM) and establish three technical indicators "amplitude, velocity and time". This method can reflect the operation characteristics of AM and provide quantitative parameters along three axes of multiple finger joints. The current evidence shows that the method has great potential for future applications such as the study of the dose-effect relationship of acupuncture, teaching, and learning of AM, and the measurement and preservation of famous acupuncturists' AM.

[Development of handshape tuina-cupping instrument based on pulsating airflow technology].

A new type of handshape tuina-cupping instrument is developed to overcome the shortcomings of traditional cupping therapy, such as indentation and pain, and simulates the tuina manipulation, so as to realize the combination of cupping therapy and tuina manipulation. The handshape tuina-cupping instrument has a trumpet-shaped, silica gel edge. At the same time, the finger-belly shape is added at the cupping edge to simulate the shape of fingers during tuina. Under the action of air suction and deflation of pulsating airflow, the purpose of simulating tuina manipulation is achieved, and the indentation and pain caused by the handshape tuina-cupping instrument is significantly less than that of the traditional cupping instrument.

[Conduction pathway and function of physical signals of moxibustion stimulus].

By reviewing the relevant literature in recent years, this paper analyzes the transformation and conduction of moxibustion physical signals, and explores the action mechanism of moxibustion. It is found that the different molecular targets activated by moxibustion photothermal signal are the keys to transform stimulation signal into biological signal. Photothermal signal transmits signal through neuroendocrine immune system and produces a series of biological reactions, thus regulating the functions of various systems of the body.

Increased Level of Systolic Blood Pressure in Hepatocellular Carcinoma Patients with Diabetes Mellitus.

BACKGROUND: More than 50% of patients with type 2 diabetes mellitus (DM) also have hypertension. Moreover, hypertension has been regarded as one paraneoplastic phenomenon of hepatocellular carcinoma (HCC). Our study was designed to determine the relationship between blood pressure and DM in HCC patients. PATIENTS AND METHODS: A total of 879 HCC patients were included and 151 (17.2%) were diagnosed with DM. Multivariable logistic regression analysis was used to determine the relationship and the results were expressed as adjusted odds ratios (AORs) and their 95% confidence intervals (CIs). Considering the effect of potential confounders, sub-group analysis was performed. We would further study the association of systolic blood pressure (SBP) with fasting glucose, and the association between DM duration/treatment and SBP level. RESULTS: Compared with non-diabetic patients, the diabetic patients had increased levels of SBP (133.7±18.5 mmHg vs 128.3±15.2 mmHg, P=0.001) and fasting blood glucose (9.13±3.04 mmol/L vs 5.18±1.08 mmol/L, P<0.001), an elder age (58.5±10.2 years vs 55.3±11.2 years, P=0.001), a higher percentage of cirrhosis diagnosis (60.9% vs 48.2%, P=0.004), lower percentages of drinking (18.5% vs 30.8%, P=0.002) and smoking (30.5% vs 43.7%, P=0.003), and decreased levels of GGT (median/interquartile-range 88/53-177 U/L vs 117/58-248 U/L, P=0.037), platelet count (121.4±76.6 ×109/L vs 151.2±82.8 ×109/L, P<0.001) and hemoglobin (124.3±25.5 g/L vs 133.6±24.2 g/L, P<0.001). Multivariable analysis showed that, statistically significant differences were found for SBP ≥140 mmHg (AOR=2.101; 95% CI, 1.424-3.100; P<0.001), smoking (AOR=0.637; 95% CI, 0.415-0.979; P=0.040), hemoglobin (AOR=0.990; 95% CI, 0.983-0.998; P=0.010) and platelet count (AOR=0.996; 95% CI, 0.994-0.999; P=0.009). For the relationship between SBP and DM, the positive result was supported by most (10/14) of the subgroup analyses. CONCLUSION: SBP level was increased in HCC patients with diabetes mellitus.

[Design and implementation of a method for temperature parameter collection inside acupoint].

OBJECTIVE: To realize real-time measurement and recording of temperature parameters inside acupoints during acupuncture treatment. METHODS: The fine wire thermocouple was embedded in hollow needle body as acupoint detection probe. According to the structure of acupoint temperature signal processing circuit, the Agilent 34420A nanovolt/micro-eurometer was used to design the technology method of acupoint temperature data acquisition, and an acupoint temperature collection platform was established. In addition, a verification experiment was conducted to verify the feasibility and stability of the system. RESULTS: The contrast experiment with mercury thermometer measurement showed that the temperature measurement curve of the designed acupoint temperature data collection platform was highly consistent with that of the standard thermometer, which verified the stability and reliability of the designed temperature measurement platform. The experiment of animal in-vivo measurement showed that the acupoint temperature probe had good feasibility for in-vivo acupoint temperature measurement. CONCLUSION: Acupoint temperature probe and acupoint temperature data collection technology can measure the temperature inside acupoints, and ensured the accuracy and veracity of the results. As an experimental method of acupoints temperature parameter collection, it can quantitatively record the temperature changes during the acupuncture treatment.

Electroacupuncture Promoting Axonal Regeneration in Spinal Cord Injury Rats via Suppression of Nogo/NgR and Rho/ROCK Signaling Pathway.

PURPOSE: To observe the changes of Nogo/NgR and Rho/ROCK signaling pathway-related gene and protein expression in rats with spinal cord injury (SCI) treated with electroacupuncture (EA) and to further investigate the possible mechanism of EA for treating SCI. METHODS: Allen's method was used to create the SCI rat model. Sixty-four model rats were further subdivided into four subgroups, namely, the SCI model group (SCI), EA treatment group (EA), blocking agent Y27632 treatment group (Y27632) and EA+blocking agent Y27632 treatment group (EA+Y), according to the treatment received. The rats were subjected to EA and/or blocking agent Y27632 treatment. After 14 days, injured spinal cord tissue was extracted for analysis. The mRNA and protein expression levels were determined by real-time fluorescence quantitative PCR and Western blotting, respectively. Cell apoptosis changes in the spinal cord were evaluated by in situ hybridization. Hindlimb motor function in the rats was evaluated by Basso-Beattie-Bresnahan assessment methods. RESULTS: Except for RhoA protein expression, compared with the SCI model group, EA, blocking agent Y27632 and EA+blocking agent Y27632 treatment groups had significantly reduced mRNA and protein expression of Nogo-A, NgR, LINGO-1, RhoA and ROCK II in spinal cord tissues, increased mRNA and protein expression of MLCP, decreased p-MYPT1 protein expression and p-MYPT1/MYPT1 ratio, and caspase3 expression, and improved lower limb movement function after treatment for 14 days (P<0.01 or <0.05). The combination of EA and the blocking agent Y27632 was superior to EA or blocking agent Y27632 treatment alone (P < 0.01 or <0.05). CONCLUSION: EA may have an obvious inhibitory effect on the Nogo/NgR and Rho/ROCK signaling pathway after SCI, thereby reducing the inhibition of axonal growth, which may be a key mechanism of EA treatment for SCI.

Motion video-based quantitative analysis of the 'lifting-thrusting' method: a comparison between teachers and students of acupuncture.

OBJECTIVE: To compare objective measures of needle manipulation between students and teachers of acupuncture using motion video analysis technology, to help support instructional acupuncture education. METHODS: A total of 30 teachers and 60 students participated in this study. Acupuncture needles were inserted at LI11 and motion videos were recorded for three subtypes of 'lifting-thrusting' manipulation: (1) 'mild reinforcing-attenuating'; (2) 'reinforcing'; and (3) 'attenuating'. The videos were analysed using Simi Motion 3D software to acquire the movement parameters of four trace marks: 'thumb tip'; 'forefinger tip'; 'forefinger middle joint'; and 'forefinger base joint'. Differences between the two groups were compared using t-tests, X2 tests and/or rank-sum tests. RESULTS: Changes in the near-end interphalangeal joint were positively associated with a range of movement along the X axis. Motion parameters for the thumb tip, the proximal interphalangeal (PIP) joint of the forefinger and the X axis shaft swing near the end of the forefinger in the teacher group were higher than those in the student group. The teacher group featured smaller trough dispersion and smaller crest dispersion during 'reinforcing' and 'attenuating' manipulations, respectively. CONCLUSIONS: The 'lifting-thrusting' manipulation could be simplified as a fixed-axis rotation using metacarpophalangeal joints in the thumb and forefinger as the shaft centre. Teachers opened at a larger angular variation for the PIP during the lifting and thrusting processes with better spatial control. Temporal control was similar between groups and therefore appears easier to grasp. Repetitive training might be helpful for improving athletic and spatial stability during needle manipulation.

Lutein prevents alcohol-induced liver disease in rats by modulating oxidative stress and inflammation.

OBJECTIVE: Oxidative stress and inflammation play an important role in pathogenesis of alcohol-induced liver injury. The present study was designed to investigate the protective role of Lutein against alcohol-induced liver injury. TREATMENT: Wistar rats weighing 150-200 g were divided into 3 groups, control, EtOH treatment, Lutein followed by EtOH treatment. Ethanol-treated rats received EtOH [5 g/kg body weight] by gavage every 12 hours for a total of 3 doses. For Lutein pre-treatment, Lutein at a dose of 40 mg/kg was dissolved in the EtOH and gavaged 30 mins before EtOH treatment. METHODS: Oxidative stress markers-(reactive oxygen species, lipid peroxidation, protein carbonyls and sulfhydryls content), liver markers (ALT, AST, ALP and LDH) were determined. Antioxidant enzyme activities and its master regulator Nrf-2 expression were analyzed. Further, inflammatory proteins NF-κB, COX-2, iNOS and inflammatory cytokines (TNF-α, MCP-1, IL-1ß, IL-6) were analyzed. RESULTS: The results showed significant decrease in oxidative stress markers and liver markers in the lutein pre-treatment. Lutein treatment down regulated inflammatory proteins and cytokines with concomitant up regulation in Nrf-2 levels and antioxidant enzymic activities. CONCLUSION: The present study showed that Lutein treatment exerted potent antioxidant and anti-inflammatory property and offered significant cytoprotection against alcohol-induced liver injury.

[Effects of different acupuncture and moxibustion methods on ultrastructure of gastrocnemius in rats].

OBJECTIVE: To explore the efficacy differences in early intervention of different acupuncture and moxibustion methods on gastrocnemius fatigue in rats induced by electrical stimulation. METHODS: Fifty male SD rats were randomly divided into a control group, a model group, a hand acupuncture group, an electroacupuncture group and a moxibustion group, 10 rats in each group. Electrical stimulation of the sciatic nerve was given in the control group and gastrocnemius fatigue test was induced by electrical stimulation of the sciatic nerve in the model group after anesthesia without other treatment, but just take 6 times interval stimulation in the control group. The hand acupuncture group, the electroacupuncture group and the moxibustion group were treated with the corresponding acupoints stimulation method respectively for 20 min before gastrocnemius fatigue test, and Dazhui (GV 14) and Zusanli (ST 36) were selected. Immediately after gastrocnemius fatigue test, three or four gastrocnemius tissues at the same site on the right side were quickly taken for making specimen for transmission electron microscope (TEM). The changes of skeletal muscle ultrastructure of myofibrils, mitochondria, sarcoplasmic reticulum, glycogen particles were observed under TEM. RESULTS: (1) Muscle fibers disorder, partial mitochondrial vacuolization and glycogen particles smaller were shown in the model group. (2) No abnormalities were shown in the hand acupuncture group and the moxibustion group with mitochondrial morphology and number, which better than that in the model group, and glycogen particles increased. (3) Abnormal changes in morphology were shown in the electroacupuncture group with part of the muscle fibers derangement, Z line malalignment and a few mitochondria vacuolization. CONCLUSION: Hand acupuncture, electroacupuncture and moxibustion have the different effects on ultrastructure of gastrocoemius in rats. Acupuncture and moxibustion have shown good effects on the prevention and treatment of exercise-induced skeletal muscle cell and organelle damage and delaying exercise-induced fatigue.

[Electroacupuncture therapy and corrosion of acupuncture needle].

During the process of electroacupuncture (EA) therapy, whether there being a corrosive effect in ac- upuncture needles was observed. Acupuncture needles were inserted into a rabbit's acupoint to perform a 12-hour electrical stimulation with three types of common EA waveform; additionally two needles were put in 0.9% sodium chloride solution with 12-hour direct current. Afterwards, environmental scanning electron microscope was applied to detect the surface physical characteristics of acupuncture needles. As a result, after a 12-hour continued electri- cal stimulation with three types of common EA waveform in the rabbit, there was no corrosive effect in acupunc- ture needles; but the direct current could cause severe corrosion in acupuncture needles. It is believed that there is no corrosion effect on acupuncture needles in current EA treatment, and some accidents reported in literature may be related to quality of EA device or improper manipulation during the treatment.

[Effect of quantitative acupuncture manipulation on the skin temperature of acupoints].

OBJECTIVE: To verify the effect of lifting-thrusting reinforcing manipulation at Hegu (LI 4) of the right side on skin temperature on the Large Intestine Meridian. METHODS: Thirty healthy volunteers were needled at Hegu (LI 4) on the right side with lifting-thrusting reinforcing manipulation at the depth of 5 - 8 mm, 100 times/min in freqency for 1 min. With PowerLab 8/30 eight-channel high-speed recorders and specially equipped skin temperature detector, the temperatures of Shangyang (LI 1) on the bilateral side, Hegu (LI 4) and Kouheliao (LI 19) on the left side were tested at the time 30 min before the needling, 1 min during the needling and 30 min after the needling. RESULTS: After the lifting-thrusting reinforcing manipulation on the right Hegu (LI 4), the average skin temperature (27.89 +/- 3.56) degrees C before the needling at the left Hegu (LI 4) was increased to (28.30 +/- 2.81) degrees C, the temperature of right Shangyang (LI 1) (24.57 +/- 4.29) degrees C was increased to (26.30 +/- 4.32) degrees C, left Shangyang (LI 1) (25.13 +/- 5.07) degrees C to (26.58 +/- 4.92) degrees C and left Kouheliao (LI 19) (32.11 +/- 1.68) degrees C to (32.25 +/- 2.15) degrees C, all of which were significantly improved to different degrees (P < 0.01, P < 0.05). CONCLUSION: The lifting-thrusting reinforcing manipulation has an effect of increasing skin temperature of acupoints, and the temperature changes after needling are along meridians and have specificity of acupoins.

[Study on dose-effect relationship of electroacupuncture with different current intensities alleviating tibial cancer pain and inhibition of expression of spinal GFAP in rats].

OBJECTIVE: To observe the dose-effect relationship of electroacupuncture of different current intensities combined with Morphine of different dosage on alleviating the rats' tibial cancer pain, and explore the possible mechanism, which could provide the experiment basis for alleviating the tibial cancer pain by electroacupuncture combined with Morphine. METHODS: One hundred female Wistar rats were randomly divided into a normal group, a model group and eight treatment groups, 10 cases in each group. The rats in the treatment groups were treated by combined therapies of electroacupuncture of different intensities with 2 Hz /100 Hz dense-disperse wave on "Jiaji"(EX-B 2)and different dosage Morphine in 2 factor 3 level conditions, once a day for 6 days. The pain thresholds were observed before the treatment and 0 min, 1 h, 2 h and 5 h after the first treatment as well as after 3 and 6 times of treatments. The glial fibrillary acidic protein (GFAP) expression was determined by immunohistochemical method. RESULTS: The rats' pain thresholds were significantly increased with electroacupuncture of 2 mA and 1 mA (all P < 0.01) on the 0 min, 1 h and 2 h of the first treatment, between which there were no significant differences (all P > 0.05). The pain threshold was still increased by electroacupuncture of 2 mA on the 5 h of the treatment (P < 0.01), while that of 1 mA failed to take effect (P > 0.05). After 3 and 6 times of treatments, both electroacupuncture of 2 mA and 1 mA had the effect of increasing the pain threshold (all P < 0.01), and the effect of 2 mA was superior to that of 1 mA (P < 0.05), had the synergistic effect with 5 mg/(kg x d) Morphine (P < 0.05). After 6 times of treatments, both electroacupuncture of 2 mA and 1 mA could inhibit the expression of GFAP (both P < 0.01), and there was no significant difference between them (P > 0.05). Both of 5 mg/(kg x d) and 2.5 mg/(kg x d) of Morphine, however, didn't bring about inhibition effect (P > 0.05). CONCLUSION: There is a does-effect relationship on electroacupuncture of different current intensity for alleviating the tibial cancer pain in rats. The electroacupuncture with 2 mA, which is better than that with 1 mA, has the synergistic effect with 5 mg/(kg x d) of Morphine. The electroacupuncture can inhibit the expression of GFAP to cooperate with Morphine for the purpose of alleviating the rats' tibial cancer pain.

[Advances of studies on relieving of exercise-induced fatigue by transcutanclus electrical acupoint stimulation].

The occurrence of exercise-induced fatigue can be delayed and exercise endurance can be strengthened by removing lactic acid, decreasing serum creatine kinase, elevating hemoglobin, maintaining blood glucose, eliminating free radical, regulating amino acid metabolism and retaining heart rate with transcutanclus electrical acupoint stimulation (TEAS). Problems in the above researching field are generalized in this paper. For instance, the point selection is relatively simple; the selection of wave band, frequency and duration during the application of TEAS apparatus are not unified; and observation indices mainly remained in the aspect of biochemistry. It also prospects the future directions of TEAS relieving exercise-induced fatigue including selecting acupuncture point by differentiation of symptoms and signs, setting uniform standards for TEAS, and studying the mechanisms of TEAS relieving exercise-induced fatigue by testing gonadal axis, adrenal axis, gene and protein.

[Analysis on resistance testing and technological research of acupoints].

In order to summarize and analyze the progresses and problems of resistance testing and technology research on acupoints, investigate the related solutions, articles on resistance testing from 1990 to 2011 were collected, and advantages and shortcomings of different types of testing instruments were discussed in this article as well. Detection technology of acupoint impedance has under updating changes, which are often applied on locating acupoints and clinical diagnosis. The progresses of those technologies are mainly embodied in improvement of circuit model, which enable a longer testing duration, less media interference and so on. The previous studies often focus on resistance testing of the skin. Since dermal resistance does not equal to acupoint resistance, the designation of equivalent circuit does not embody the condition of cells, tissues and nerves at acupoints, and testing technology is often affected by factors such as polarization of electrodes, contact medium and anatomical characteristics of acupoints, the resistance of acupoints can not be taken as the effective framework of the diagnostic standard and judgement of therapeutic effect in clinic. Based on the key problems in resistance testing of acupoints, it is proposed by the article that the techniques and designation of circuit model should be reformed, and mathematical model should be established in the study to meet the requirement of the life system. Inductance of human body should be considered in resistance research of acupoints, and interference factors should be eliminate as far as possible in designation of equipments. Thus, the change law of acupoint resistance in the inner part of the body can be fully embodied by the designation of experiments.

[Effects of 650 nm laser and moxibustion pretreatment on enteric nervous system and medullary visceral zone in rats with visceral traction pain].

OBJECTIVE: To explore effects of 650 nm laser and moxibustion pretreatment on visceral traction pain (VTP) and its mechanism. METHODS: Forty male SD rats were randomly devided into a sham operation group (group A), a VTP group (group B), a 650 nm laser pretreatment group (group C), a moxibustion pretreatment group (group D). Rats in group A and group B were not treated except sham operation or VTP model. In group C and D, the VTP models were produced immediate after 650 nm laser irradiation or moxibustion at "Zusanli" (ST 36), respectively. The changes of pain score and systolic pressure were investigated and the activity of AChE, the content of SP and leu-enkephaline (LEK), and the positive index of c-Fos protein and glial fibrillary acidic protein (GFAP) were detected by biochemistry, radio-immunity method and immunohistochemistry, respectively. RESULTS: Compared with group A, the pain score, systolic pressure, the activity of AChE, the content of SP, and the positive index of c-Fos protein and GFAP of group B increased significantly (all P < 0.05); compared with group B, the pain score, AChE activity, the content of SP and the positive index of c-Fos protein and GFAP of both group C and group D decreased significantly (all P < 0.05); compared with group B, the content of LEK increased and systolic pressure decreased significantly in group C (both P < 0.05). CONCLUSION: Both 650 nm laser and moxibustion pretreatment can inhibit VTP and the mechanism may be related to reducing the activity of AChE and the content of SP, and increasing the activity of LEK and decreasing the expression of c-Fos protein and GFAP.

[Thinking and status of research on acupoint temperature sensor needle].

ABSTRACT Based on acupoint temperature sensor needle related literatures, the development and the applications of temperature sensor needle and the measuring instrument which is used for measuring the temperature of acupoints are introduced in the present paper. This paper summarizes the basic structure and measuring principle of temperature sensor needle; it also summarizes the hardware and measuring procedures of the measuring instrument. According to the characteristics of the temperature sensor needle, this paper states its broad applications and development trend.

[Compilation experience of national standard Standardized Manipulation of Acupuncture and Moxibustion, Part 11, Electroacupuncture].

The main structure and content of the national standard Standardized Manipulation of Acupuncture and Moxibustion, Part 11, Electroacupuncture are analyzed in retrospection of its compilation process. Discussions are made concerning arguments on the central idea and problems appeared during the compilation. Meanwhile, key points which should be noticed in clinical application are advanced as well.