Resonancia y PET en Acupuntura

Evidencia científica sobre la Acupuntura. Scientific Evidence in Aucupuncture. 

 1: J Altern Complement Med. 2007 Jul-Aug;13(6):603-16.

Neuroimaging acupuncture effects in the human brain.

Dhond RP, Kettner N, Napadow V.

Massachusetts General Hospital/Massachusetts Institute of Technology/Harvard Medical School, Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA 02129, USA. Esta dirección electrónica esta protegida contra spam bots. Necesita activar JavaScript para visualizarla

Acupuncture is an ancient East Asian healing modality that has been in use for more than 2000 years. Unfortunately, its mechanisms of action are not well understood, and controversy regarding its clinical efficacy remains. Importantly, acupuncture needling often evokes complex somatosensory sensations and may modulate the cognitive/affective perception of pain, suggesting that many effects are supported by the brain and extending central nervous system (CNS) networks. Modern neuroimaging techniques such as functional magnetic resonance imaging, positron emission tomography, electroencephalography, and magnetoencephalography provide a means to safely monitor brain activity in humans and may be used to help map the neurophysiological correlates of acupuncture. In this review, we will summarize data from acupuncture neuroimaging research and discuss how these findings contribute to current hypotheses of acupuncture action.

PMID: 17718643 [PubMed - indexed for MEDLINE]

1: Can J Vet Res. 2003 May;67(2):94-101.

Different central manifestations in response to electroacupuncture at analgesic and nonanalgesic acupoints in rats: a manganese-enhanced functional magnetic resonance imaging study.

Chiu JH, Chung MS, Cheng HC, Yeh TC, Hsieh JC, Chang CY, Kuo WY, Cheng H, Ho LT.

Institute of Traditional Medicine, National Yang-Ming University, Number 155, Section 2, Li-Nong Street, Peitou, Taipei, 112 Taiwan, Republic of China. Esta dirección electrónica esta protegida contra spam bots. Necesita activar JavaScript para visualizarla

Acupuncture analgesia is an important issue in veterinary medicine. This study was designed to elucidate central modulation effects in response to electroacupuncture (EA) at different acupoints. Manganese-enhanced functional magnetic resonance imaging was performed in Sprague-Dawley rats after sham acupuncture, sham EA, or true EA at somatic acupoints. The acupoints were divided into 3 groups: group 1, analgesic acupoints commonly used for pain relief, such as Hegu (LI 4); group 2, nonanalgesic acupoints rarely used for analgesic effect such as Neiguan (PC 6); and group 3, acupoints occasionally used for analgesia, such as Zusanli (ST 36). Image acquisition was performed on a 1.5-T superconductive clinical scanner with a circular polarized extremity coil. The results showed that there was no neural activation caused by EA at a true acupoint with shallow needling and no electric current (sham acupuncture). When EA at a true acupoint was applied with true needling but no electric current (sham EA), there was only a slight increase in brain activity at the hypothalamus; when EA was applied at a true acupoint with true needling and an electric current (true EA), the primary response at the hypothalamus was enhanced. Also, there was a tendency for the early activation of pain-modulation areas to be prominent after EA at analgesic acupoints as compared with nonanalgesic acupoints. In conclusion, understanding the linkage between peripheral acupoint stimulation and central neural pathways provides not only an evidence-based approach for veterinary acupuncture but also a useful guide for clinical applications of acupuncture.

PMID: 12760473 [PubMed - indexed for MEDLINE]

1: Neurosci Lett. 2005 Aug 5;383(3):236-40.

Acupoint-specific fMRI patterns in human brain.

Yan B, Li K, Xu J, Wang W, Li K, Liu H, Shan B, Tang X.

Key Laboratory of Nuclear Analysis Techniques, Institute of High Energy Physics, Chinese Academy of Sciences, 19 Yu Quan Road, Beijing 100049, China.

Specific central nervous system (CNS) responses to acupuncture have recently attracted attention. It is important to understand the differences in fMRI images of the brain evoked by acupuncture at an acupoint and at a nearby "sham" point. Here, we report analyses of fMRI images of the brains of 37 healthy volunteers in response to acupuncture at Liv3 (Taichong) and LI4 (Hegu) versus their sham points. We found common activation areas in response to Liv3 or LI4 acupuncture in the middle temporal gyrus and cerebellum, along with deactivation areas in the middle frontal gyrus and inferior parietal lobule, compared with the effects of acupuncture at sham points. Acupuncture at Liv3 evoked specific activation at the postcentral gyrus, posterior cingulate, parahippocampal gyrus, BA 7, 19 and 41, but deactivation at the inferior frontal gyrus, anterior cingulate, BA 17 and 18, compared with acupuncture at its sham point. Acupuncture at LI4 evoked specific activation at the temporal pole, but deactivation at the precentral gyrus, superior temporal gyrus, pulvinar and BA 8, 9 and 45, compared with acupuncture at its sham point. These observations reveal that acupuncture at acupoints induces specific patterns of brain activity, and these patterns may relate to the therapeutic effects of acupuncture.

PMID: 15876491 [PubMed - indexed for MEDLINE]

1: Neuroimage. 2002 Aug;16(4):1028-37.

Neuronal specificity of acupuncture response: a fMRI study with electroacupuncture.

Wu MT, Sheen JM, Chuang KH, Yang P, Chin SL, Tsai CY, Chen CJ, Liao JR, Lai PH, Chu KA, Pan HB, Yang CF.

Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan, Republic of China.

Recently, neuronal correlates of acupuncture stimulation in human brain have been investigated by functional neuroimaging. The preliminary findings suggest that acupuncture at analgesic points involves the pain-related neuromatrix and may have acupoint-brain correlation. Although multiple models of control stimulations have been applied to address the specificity of the needling effect clinically, their impacts have not been evaluated by functional neuroimaging. With the advantage of objective parameter setting, electroacupuncture (EA) was used in this study to devise three distinct controls for real EA, i.e., mock EA (no stimulation), minimal EA (superficial and light stimulation), and sham EA (same stimulation as real EA) applied at nonmeridian points. Fifteen healthy volunteers received real EA at analgesic point Gallbladder 34 (Yanglinquan), sham EA, and one of either mock EA or minimal EA over the left leg in counter-balanced orders. Multisubject analysis showed that sham EA and real EA both activated the reported distributed pain neuromatrix. However, real EA elicited significantly higher activation than sham EA over the hypothalamus and primary somatosensory-motor cortex and deactivation over the rostral segment of anterior cingulate cortex. In the comparison of minimal EA versus mock EA, minimal EA elicited significantly higher activation over the medial occipital cortex. Single-subject analysis showed that superior temporal gyrus (encompassing the auditory cortex) and medial occipital cortex (encompassing the visual cortex) frequently respond to minimal EA, sham EA, or real EA. We concluded that the hypothalamus-limbic system was significantly modulated by EA at acupoints rather than at nonmeridian points, while visual and auditory cortical activation was not a specific effect of treatment-relevant acupoints and required further investigation of the underlying neurophysiological mechanisms.

PMID: 12202090 [PubMed - indexed for MEDLINE]

1: J Altern Complement Med. 2006 Oct;12(8):813-5.

Comment in:

J Altern Complement Med. 2006 Oct;12(8):707-8.

Effects of contralateral electroacupuncture on brain function: a double-blind, randomized, pilot clinical trial.

Woo YM, Lee MS, Nam Y, Cho HJ, Shin BC.

Department of Acupuncture and Moxibustion, National Medical Center, Seoul, Republic of Korea.

OBJECTIVES: The aim of this study was to ascertain the effects of contralateral acupuncture on brain function using blind-spot mapping. DESIGN AND PARTICIPANTS: Forty (40) healthy volunteers in whom the right-side blind spot was larger than the left-side one-which indicates lower left-brain function-were randomly assigned into the following two groups in which electroacupuncture was applied to: (1) the contralateral ST36 acupuncture point (right side), and (2) the ipsilateral ST36 acupuncture point (left side). OUTCOME MEASURE: Blind-spot perimetry length was the outcome measure. RESULTS: Electroacupuncture to the contralateral side decreased the blind-spot perimetry length by 5.0 (-9.3 to 0.9) [median (interquartile range, IQR)], whereas that to the ipsilateral side increased the length by 4.5 (-3.7 to 7.8) [median, IQR]. There was significant difference in this length between the two groups (p < 0.05). CONCLUSIONS: These results suggest that electroacupuncture application increased or decreased the brain function- as assessed by changes to the blind spot-depending on the treatment side: Contralateral-side treatment has a better effect than ipsilateral-side treatment on brain function. However, further randomized studies that include both right- and left-side-enlarged subjects with a sham needle are needed to convincingly show the effects of contralateral acupuncture on brain function.

PMID: 17034288 [PubMed - indexed for MEDLINE]

1: Chin J Integr Med. 2007 Jun;13(2):103-8.

Comparative study of the specificities of needling acupoints DU20, DU26 and HT7 in intervening vascular dementia in different areas in the brain on the basis of scale assessment and cerebral functional imaging.

Huang Y, Lai XS, Tang AW.

TCM College of Nanfang Medical University, Guangzhou, 510515, China.

OBJECTIVE: Using methods of clinical scale assessment and cerebral functional imaging to compare the relative specificity of needling acupoints Baihui (DU20), Shuigou (DU26) and Shenmen (HT7) in intervening vascular dementia (VD) in different areas in the brain. METHODS: Fifty patients with VD were randomized into 5 groups. Needling on conventionally used acupoints of hand and foot three Yang-meridians aiming at hemiplegia was applied to the patients in Group A, and needling on DU20 to Group B, on DU26 to Group C, on HT7 to Group D and on all the three to Group E was applied additionally. Assessments of Mini Mental State Examination (MMSE), Activities of Daily Living (ADL) and Family Attitude Questionnaire (FAQ) were made. And the positron emission computerized tomography (PET) and single photon emission computerized tomography (SPECT) examinations were conducted in 5 selected patients from each group before and after treatment. RESULTS: Needling on conventional acupoints plus DU20 could effect the inner temporal system, thalamencephalon system and prefrontal cortical system to improve memory and executive capacity of VD patients; conventional acupoints plus DU26 could effect more to the prefrontal cortical system to obviously elevate the executive capacity; that plus HT7 would reveal an effect similar to but rather weaker than plus DU20, and effect more to memory; and that plus all the three simultaneously could effect rather roundly multiple aspects of the nervous system related to intellectual activities, to elevate the recognition and enhance the executive capacity. CONCLUSION: Needling on various acupoints like DU20, DU26 and HT7 have effects on different brain areas.

PMID: 17609907 [PubMed - indexed for MEDLINE]

1: Am J Chin Med. 2004;32(5):789-94.

Needling of the extra 1 point decreases BIS values and preoperative anxiety.

Paraskeva A, Melemeni A, Petropoulos G, Siafaka I, Fassoulaki A.

Department of Anesthesiology, St Savas Hospital, Athens, Greece.

Acupuncture has anxiolytic effects. We investigated the effect of acupuncture on the Bispectral Index (BIS) values and anxiety. Fifty patients were randomly assigned to group A to receive acupuncture for 15 minutes on the extra 1 point (yintang) or to group C, where they received the same treatment on a control point located 2 cm lateral to the end of the right eyebrow. BIS values were recorded before acupuncture; during acupuncture every 30 seconds for 15 minutes and every 30 seconds for 90 seconds when the acupuncture treatment was accomplished. Anxiety level was assessed before and after acupuncture by a verbal score scale (VSS) (0 = no anxiety, 10 = worst anxiety). BIS values were significantly decreased during acupuncture when applied on the extra 1 point (p = 0.0001) but not on the control point. Acupuncture application significantly decreased the VSS values within the A group (p = 0.027) and in the C group (p = 0.0001), when compared to the baseline (pre-acupuncture) VSS values. However, no differences were found between the two groups regarding BIS or VSS values. In conclusion, needling the extra 1 point preoperatively significantly decreases the BIS values and the VSS for anxiety but needling of a control point decrease only VSS values.

PMID: 15633813 [PubMed - indexed for MEDLINE]

: Hum Brain Mapp. 2000;9(1):13-25.

Acupuncture modulates the limbic system and subcortical gray structures of the human brain: evidence from fMRI studies in normal subjects.

Hui KK, Liu J, Makris N, Gollub RL, Chen AJ, Moore CI, Kennedy DN, Rosen BR, Kwong KK.

MGH-NMR Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston 02129, USA. Esta dirección electrónica esta protegida contra spam bots. Necesita activar JavaScript para visualizarla

Acupuncture, an ancient therapeutic technique, is emerging as an important modality of complementary medicine in the United States. The use and efficacy of acupuncture treatment are not yet widely accepted in Western scientific and medical communities. Demonstration of regionally specific, quantifiable acupuncture effects on relevant structures of the human brain would facilitate acceptance and integration of this therapeutic modality into the practice of modern medicine. Research with animal models of acupuncture indicates that many of the beneficial effects may be mediated at the subcortical level in the brain. We used functional magnetic resonance imaging (fMRI) to investigate the effects of acupuncture in normal subjects and to provide a foundation for future studies on mechanisms of acupuncture action in therapeutic interventions. Acupuncture needle manipulation was performed at Large Intestine 4 (LI 4, Hegu) on the hand in 13 subjects [Stux, 1997]. Needle manipulation on either hand produced prominent decreases of fMRI signals in the nucleus accumbens, amygdala, hippocampus, parahippocampus, hypothalamus, ventral tegmental area, anterior cingulate gyrus (BA 24), caudate, putamen, temporal pole, and insula in all 11 subjects who experienced acupuncture sensation. In marked contrast, signal increases were observed primarily in the somatosensory cortex. The two subjects who experienced pain instead of acupuncture sensation exhibited signal increases instead of decreases in the anterior cingulate gyrus (BA 24), caudate, putamen, anterior thalamus, and posterior insula. Superficial tactile stimulation to the same area elicited signal increases in the somatosensory cortex as expected, but no signal decreases in the deep structures. These preliminary results suggest that acupuncture needle manipulation modulates the activity of the limbic system and subcortical structures. We hypothesize that modulation of subcortical structures may be an important mechanism by which acupuncture exerts its complex multisystem effects.

PMID: 10643726 [PubMed - indexed for MEDLINE]

1: Anesth Analg. 2007 Aug;105(2):499-506.

Acupuncture-induced blood oxygenation level-dependent signals in awake and anesthetized volunteers: a pilot study.

Wang SM, Constable RT, Tokoglu FS, Weiss DA, Freyle D, Kain ZN.

Center for Advancement of Perioperative Health, Department of Anesthesiology, Yale University School of Medicine, New Haven, CT 06510, USA. Esta dirección electrónica esta protegida contra spam bots. Necesita activar JavaScript para visualizarla

BACKGROUND: There are conflicting data regarding clinical efficacy of acupuncture applied while patients are under general anesthesia. We hypothesize that these conflicting data are a result of the inhibitory effect of anesthesia on acupuncture-induced central nervous system activity that can be demonstrated using magnetic resonance imaging. METHODS: Using a crossover study design, volunteers received standardized Stomach 36 manual acupuncture in two experimental conditions: while undergoing a propofol-based general anesthetic, and while awake. Functional magnetic resonance imaging was conducted during both experimental sessions. Paired-t-test analyses were performed to examine the differences in acupuncture-induced blood oxygenation level-dependent (BOLD) signals between awake and anesthesia conditions. A secondary analysis was performed to account for the changes in regional cerebral blood flow at six regions of interest (thalamus, red nucleus, insula, periaqueductal gray, retrosplenial cingular gyri, and the inferior temporal region). RESULTS: Using BOLD, we found significant differences between the two experimental sessions in brain areas, including postcentral gyri, retrosplenial cingular area, left posterior insula, bilateral precuneus, thalamus, red nuclei, and substantia nigra (cluster 100, P < 0.01). A secondary analysis correcting for background cerebral blood flow found that BOLD signal differences between experimental conditions were not directly caused by changes in regional blood flow. DISCUSSION: Propofol-based anesthesia reduces the neurophysiological response to acupuncture stimulation as measured by acupuncture-induced BOLD signals. Further work should be conducted to determine the clinical significance of these findings.

PMID: 17646512 [PubMed - indexed for MEDLINE]

1: J Cereb Blood Flow Metab. 2003 Apr;23(4):472-81.

Regional cerebral blood flow and BOLD responses in conscious and anesthetized rats under basal and hypercapnic conditions: implications for functional MRI studies.

Sicard K, Shen Q, Brevard ME, Sullivan R, Ferris CF, King JA, Duong TQ.

Center for Comparative NeuroImaging, Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts, U.S.A.

Anesthetics, widely used in magnetic resonance imaging (MRI) studies to avoid movement artifacts, could have profound effects on cerebral blood flow (CBF) and cerebrovascular coupling relative to the awake condition. Quantitative CBF and tissue oxygenation (blood oxygen level-dependent [BOLD]) were measured, using the continuous arterial-spin-labeling technique with echo-planar-imaging acquisition, in awake and anesthetized (2% isoflurane) rats under basal and hypercapnic conditions. All basal blood gases were within physiologic ranges. Blood pressure, respiration, and heart rates were within physiologic ranges in the awake condition but were depressed under anesthesia (P < 0.05). Regional CBF was heterogeneous with whole-brain CBF values of 0.86 +/- 0.25 and 1.27 +/- 0.29 mL. g-1. min-1 under awake and anesthetized conditions, respectively. Surprisingly, CBF was markedly higher (20% to 70% across different brain conditions) under isoflurane-anesthetized condition compared with the awake state (P < 0.01). Hypercapnia decreased pH, and increased Pco(2) and Po(2). During 5% CO(2) challenge, under awake and anesthetized conditions, respectively, CBF increased 51 +/- 11% and 25 +/- 4%, and BOLD increased 7.3 +/- 0.7% and 5.4 +/- 0.4%. During 10% CO(2) challenge, CBF increased 158 +/- 28% and 47 +/- 11%, and BOLD increased 12.5 +/- 0.9% and 7.2 +/- 0.5%. Since CBF and BOLD responses were substantially higher under awake condition whereas blood gases were not statistically different, it was concluded that cerebrovascular reactivity was suppressed by anesthetics. This study also shows that perfusion and perfusion-based functional MRI can be performed in awake animals.

PMID: 12679724 [PubMed - indexed for MEDLINE]

1: Radiology. 1999 Jul;212(1):133-41.

Central nervous pathway for acupuncture stimulation: localization of processing with functional MR imaging of the brain--preliminary experience.

Wu MT, Hsieh JC, Xiong J, Yang CF, Pan HB, Chen YC, Tsai G, Rosen BR, Kwong KK.

Department of Radiology, Kaohsiung Veterans General Hospital, Taiwan.

PURPOSE: To characterize the central nervous system (CNS) pathway for acupuncture stimulation in the human brain by using functional magnetic resonance (MR) imaging. MATERIALS AND METHODS: Functional MR imaging of the whole brain was performed in two groups of nine healthy subjects during four stimulation paradigms: real acupuncture at acupoints ST.36 (on the leg) and LI.4 (on the hand) and control stimulations (minimal acupuncture and superficial pricking on the leg). Stimulations were performed in semirandomized, balanced order nested within two experiments. Psychophysical responses (pain, De-Qi effect [characteristic acupuncture effect of needle-manipulation sensation], anxiety, and unpleasantness) and autonomic responses were assessed. Talairach coordinates-transformed imaging data were averaged for a group analysis. RESULTS: Acupuncture at LI.4 and ST.36 resulted in significantly higher scores for De-Qi and in substantial bradycardia. Acupuncture at both acupoints resulted in activation of the hypothalamus and nucleus accumbens and deactivation of the rostral part of the anterior cingulate cortex, amygdala formation, and hippocampal complex; control stimulations did not result in such activations and deactivations. CONCLUSION: Functional MR imaging can demonstrate the CNS pathway for acupuncture stimulation. Acupuncture at ST.36 and LI.4 activates structures of descending antinociceptive pathway and deactivates multiple limbic areas subserving pain association. These findings may shed light on the CNS mechanism of acupuncture analgesia and form a basis for future investigations of endogenous pain modulation circuits in the human brain.

PMID: 10405732 [PubMed - indexed for MEDLINE]

 

1: Acupunct Med. 2007 Sep;25(3):87-99.

Acupuncture--self-appraisal and the reward system.

Lundeberg T, Lund I, Näslund J.

Rehabilitation Medicine, UniversityClinic, Danderyds Hospital, Stockholm, Sweden. Esta dirección electrónica esta protegida contra spam bots. Necesita activar JavaScript para visualizarla

Acupuncture is an ancient therapy with a variety of different explanatory models. A cascade of physiological effects has been reported, both in the peripheral and the central nervous system, following the insertion of a needle or light tapping of the skin. Clinical trials testing the specific claims of acupuncture have generally tried to focus on testing the efficacy of applying specific techniques and/or specified points. However, different conditions may respond differently to different modes of stimulation. Recently, it was demonstrated that both superficial and deep needling (with de qi/Hibiki) resulted in amelioration of patellofemoral pain and unpleasantness. The pleasurable aspect of the acupuncture experience has largely been ignored as it has been considered secondary to its pain alleviating effects. This aspect of acupuncture treatment is likely to be related to activation of self-appraisal and the reward system. When a patient seeks a therapist there are expectations of a specific effect. These expectations are partly based on self-relevant phenomena and self-referentia introspection and constitute the preference. Also, when asked about the effect of the treatment, processes that orientate pre-attentive anticipatory or mnemonic information and processes that mediate self-reflection and recollection are integrated together with sensory detection to enable a decision about the patient's perception of the effect of acupuncture treatment. These 'self-appraisal' processes are dependent on two integrated networks: a ventral medial prefrontal cortex-paralimbic-limbic 'affective' pathway and a dorsal medial prefrontal cortex-cortical-hippocampal 'cognitive' pathway. The limbic structures are implicated in the reward system and play a key role in most diseases and illness responses including chronic pain and depression, regulating mood and neuromodulatory responses (eg sensory, autonomic, and endocrine). The pleasurable and neuromodulatory aspects of acupuncture as well as 'placebo needling' may partly be explained by the activation or deactivation of limbic structures including the hippocampus, amygdala, and their connections with the hypothalamus. In patients with patellofemoral pain, the effects of superficial and deep needling remained for six months. These long term pain-alleviating effects have been attributed to activation of pain inhibiting systems in cortical and subcortical pathways. When considering long term effects the cortical-cerebellar system needs to be taken into account. The cortical-cerebellar system is probably central to the development of neural models that learn and eventually stimulate routinely executed (eg motor skills) and long term (eg pain alleviation) cognitive processes. These higher order cognitive processes are initially mediated in prefrontal cortical loci but later shift control iteratively to internal cerebellar representations of these processes. Possibly part of the long term healing effects of acupuncture may be attributed to changes in the cerebellar system thereby sparing processing load in cortical and subcortical areas. As cortical and subcortical structures are activated and/or de-activated following stimulation of receptors in the skin, disregarding site, 'placebo or sham needling' does not exist and conclusions drawn on the basis that it is an inert control are invalid. 'Self' may be seen as a shifting illusion, ceaselessly constructed and deconstructed, and the effect of acupuncture may reflect its status (as well as that of the therapist).

PMID: 17906602 [PubMed - indexed for MEDLINE]

Related Links

·       Are reviews based on sham acupuncture procedures in fibromyalgia syndrome (FMS) valid? [Acupunct Med. 2007]

·       Relevance to self: A brief review and framework of neural systems underlying appraisal. [Neurosci Biobehav Rev. 2007]

·       Connections underlying the synthesis of cognition, memory, and emotion in primate prefrontal cortices. [Brain Res Bull. 2000]

·       Central nervous pathway for acupuncture stimulation: localization of processing with functional MR imaging of the brain--preliminary experience. [Radiology. 1999]

·       The integrated response of the human cerebro-cerebellar and limbic systems to acupuncture stimulation at ST 36 as evidenced by fMRI. [Neuroimage. 2005]

·       » See all Related Articles...

 

 

 

 

cpherson H, Green G, Nevado A, Lythgoe MF, Lewith G, Devlin R, Haselfoot R, Asghar AU.

Department of Health Sciences, University of York, YO10 5DD, United Kingdom.

Brain imaging of acupuncture: Comparing superficial with deep needling.

The difference between superficial and deep needling at acupuncture points has yet to be mapped with functional magnetic resonance imaging (fMRI). Using a 3T MRI, echo planar imaging data were acquired for 17 right-handed healthy volunteer participants. Two fMRI scans of acupuncture needling were taken in random order in a block design, one for superficial and one for deep needling on the right hand at the acupuncture point LI-4 (Hegu), with the participant blind to the order. For both scans needle stimulation was used. Brain image analysis tools were used to explore within-group and between-group differences in the blood oxygen level dependent (BOLD) responses. The study demonstrated marked similarities in BOLD signal responses between superficial and deep needling, with no significant differences in either activations (increases in BOLD signal) or deactivations (decreases in BOLD signal) above the voxel Z score of 2.3 with corrected cluster significance of P=0.05. For both types of needling, deactivations predominated over activations. These fMRI data suggest that acupuncture needle stimulation at two different depths of needling, superficial and deep, do not elicit significantly different BOLD responses. This data is consistent with the equivalent therapeutic outcomes that are claimed by proponents of Japanese and Chinese styles of acupuncture that utilise superficial and deep needling, respectively.

PMID: 18294772 [PubMed - as supplied by publisher]

 

J Altern Complement Med. 2002 Aug;8(4):399-401.

A pilot study of functional magnetic resonance imaging of the brain during manual and electroacupuncture stimulation of acupuncture point (LI-4 Hegu) in normal subjects reveals differential brain activation between methods.

Kong J, Ma L, Gollub RL, Wei J, Yang X, Li D, Weng X, Jia F, Wang C, Li F, Li R, Zhuang D.

Institute of Acupuncture and Moxibustion, China Academy of Traditional Chinese Medicine, Beijing, People's Republic of China. Esta dirección electrónica esta protegida contra spam bots. Necesita activar JavaScript para visualizarla

OBJECTIVES: To characterize the brain activation patterns evoked by manual and electroacupuncture on normal human subjects. DESIGN: We used functional magnetic resonance imaging (fMRI) to investigate the brain regions involved in electroacupuncture and manual acupuncture needle stimulation. A block design was adopted for the study. Each functional run consists of 5 minutes, starting with 1-minute baseline and two 1-minute stimulation, the interval between the two stimuli was 1 minute. Four functional runs were performed on each subject, two runs for electroacupuncture and two runs for manual acupuncture. The order of the two modalities was randomized among subjects. During the experiment, acupuncture needle manipulation was performed at Large Intestine 4 (LI4, Hegu) on the left hand. For each subject, before scanning started, the needle was inserted perpendicular to the skin surface to a depth of approximately 1.0 cm. Electroacupuncture stimulation was delivered using a continuous rectangular wave form (pulse width 30 ms) at a frequency of 3 Hz. For manual acupuncture, the needle was rotated manually clockwise and counterclockwise at a rate of about 180 times per minute (3 Hz). SUBJECTS: Eleven right-handed, normal, healthy volunteer adults, 6 male and 5 female, ages 21-64 participated in the experiment. RESULTS: Results showed that electroacupuncture mainly produced fMRI signal increases in precentral gyrus, postcentral gyrus/inferior parietal lobule, and putamen/insula; in contrast, manual needle manipulation produced prominent decreases of fMRI signals in posterior cingulate, superior temporal gyrus, putamen/insula. CONCLUSION: These results indicate that different brain networks are involved during manual and electroacupuncture stimulation. It suggests that different brain mechanisms may be recruited during manual and electroacupuncture.

PMID: 12230901 [PubMed - indexed for MEDLINE]

Chin J Integr Med. 2007 Mar;13(1):10-6.

Study on the regulatory effect of electro-acupuncture on hegu point (LI4) in cerebral response with functional magnetic resonance imaging.

Wang W, Liu L, Zhi X, Huang JB, Liu DX, Wang H, Kong XQ, Xu HB.

Radiology Department, Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan.

OBJECTIVE: To study, through blood oxygen level dependent functional magnetic resonance imaging (BOLD fMRI), the cerebral activated areas evoked by electro-acupuncturing (EA) the right Hegu point (L14) or non-acupoint points on the face, and through comparing their similarities and differences, to speculate on the specific cerebral areas activated by stimulating L14, for exploring the mechanism of its effect in potential clinical application. METHODS: EA was applied at volunteers' right L14 (of 9 subjects in the L14 group) and facial non-acupoint points (of 5 subjects in the control group), and whole brain 3-dimensional T1 anatomical imaging of high resolution 1 x 1 x 1 mm(3) used was performed with clustered stimulatory mode adopted by BOLD fMRI. Pretreatment and statistical t-test were conducted on the data by SPM2 software, then the statistical parameters were superimposed to the 3-dimensional anatomical imaging. RESULTS: Data from 3 testees of the 9 subjects in the L14 group were given up eventually because they were unfit to the demand due to different causes such as movement of patients' location or machinery factors. Statistical analysis showed that signal activation or deactivation was found in multiple cerebral areas in 6 subjects of L14 group and 5 subjects of the control group (P<0.01). In the L14 group, the areas which showed signal activation were: midline nuclear group of thalamus, left supra marginal gyrus, left supra temporal gyrus, right precuneous lobe, bilateral temporal pole, left precentral gyrus and left cerebellum; those which showed signal deactivation were: bilateral hippocampus, parahippocampal gyrus, amygdala body area, rostral side/ audal side of cingulate gyrus, prefrontal lobe and occipital lobe as well as left infratemporal gyrus. In the control group, areas which showed signal activation were: bilateral frontal lobe, postcentral gyrus, Reil's island lobe, primary somato-sensory cortex, cingulate gyrus, superior temporal gyrus, occipital cuneiform gyrus and/or precuneus gyrus and right brainstem; and the area that showed deactivation was left median frontal lobe. CONCLUSION: The effects of EA L14 in regulating cerebral activities could be displayed and recorded through BOLD fMRI, the distribution of signally deactivated area evoked by EA L14 was similar to the known distribution of anatomical orientation of pain in brain, and closely related to the anatomic structure of limbic system, which areas are possibly the acupuncture analgesic effect's cerebral regulating area. Furthermore, activated portion of left central anterior gyrus, which represent the movement of oral facial muscles, and the activated portion of cerebellum are possibly related with the effect of using EA L14 in treating facial palsy and facial muscle spasm. As for the mechanism of signal deactivation of cerebral activities exhibited in the present study that is unable to be elucidated, it awaits for further research.

PMID: 17578311 [PubMed - indexed for MEDLINE]

1: Neuroimage. 2002 Aug;16(4):1028-37.

Neuronal specificity of acupuncture response: a fMRI study with electroacupuncture.

Wu MT, Sheen JM, Chuang KH, Yang P, Chin SL, Tsai CY, Chen CJ, Liao JR, Lai PH, Chu KA, Pan HB, Yang CF.

Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan, Republic of China.

Recently, neuronal correlates of acupuncture stimulation in human brain have been investigated by functional neuroimaging. The preliminary findings suggest that acupuncture at analgesic points involves the pain-related neuromatrix and may have acupoint-brain correlation. Although multiple models of control stimulations have been applied to address the specificity of the needling effect clinically, their impacts have not been evaluated by functional neuroimaging. With the advantage of objective parameter setting, electroacupuncture (EA) was used in this study to devise three distinct controls for real EA, i.e., mock EA (no stimulation), minimal EA (superficial and light stimulation), and sham EA (same stimulation as real EA) applied at nonmeridian points. Fifteen healthy volunteers received real EA at analgesic point Gallbladder 34 (Yanglinquan), sham EA, and one of either mock EA or minimal EA over the left leg in counter-balanced orders. Multisubject analysis showed that sham EA and real EA both activated the reported distributed pain neuromatrix. However, real EA elicited significantly higher activation than sham EA over the hypothalamus and primary somatosensory-motor cortex and deactivation over the rostral segment of anterior cingulate cortex. In the comparison of minimal EA versus mock EA, minimal EA elicited significantly higher activation over the medial occipital cortex. Single-subject analysis showed that superior temporal gyrus (encompassing the auditory cortex) and medial occipital cortex (encompassing the visual cortex) frequently respond to minimal EA, sham EA, or real EA. We concluded that the hypothalamus-limbic system was significantly modulated by EA at acupoints rather than at nonmeridian points, while visual and auditory cortical activation was not a specific effect of treatment-relevant acupoints and required further investigation of the underlying neurophysiological mechanisms.

PMID: 12202090 [PubMed - indexed for MEDLINE]

1: Chin J Integr Med. 2007 Mar;13(1):10-6.

Study on the regulatory effect of electro-acupuncture on hegu point (LI4) in cerebral response with functional magnetic resonance imaging.

Wang W, Liu L, Zhi X, Huang JB, Liu DX, Wang H, Kong XQ, Xu HB.

Radiology Department, Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan.

OBJECTIVE: To study, through blood oxygen level dependent functional magnetic resonance imaging (BOLD fMRI), the cerebral activated areas evoked by electro-acupuncturing (EA) the right Hegu point (L14) or non-acupoint points on the face, and through comparing their similarities and differences, to speculate on the specific cerebral areas activated by stimulating L14, for exploring the mechanism of its effect in potential clinical application. METHODS: EA was applied at volunteers' right L14 (of 9 subjects in the L14 group) and facial non-acupoint points (of 5 subjects in the control group), and whole brain 3-dimensional T1 anatomical imaging of high resolution 1 x 1 x 1 mm(3) used was performed with clustered stimulatory mode adopted by BOLD fMRI. Pretreatment and statistical t-test were conducted on the data by SPM2 software, then the statistical parameters were superimposed to the 3-dimensional anatomical imaging. RESULTS: Data from 3 testees of the 9 subjects in the L14 group were given up eventually because they were unfit to the demand due to different causes such as movement of patients' location or machinery factors. Statistical analysis showed that signal activation or deactivation was found in multiple cerebral areas in 6 subjects of L14 group and 5 subjects of the control group (P<0.01). In the L14 group, the areas which showed signal activation were: midline nuclear group of thalamus, left supra marginal gyrus, left supra temporal gyrus, right precuneous lobe, bilateral temporal pole, left precentral gyrus and left cerebellum; those which showed signal deactivation were: bilateral hippocampus, parahippocampal gyrus, amygdala body area, rostral side/ audal side of cingulate gyrus, prefrontal lobe and occipital lobe as well as left infratemporal gyrus. In the control group, areas which showed signal activation were: bilateral frontal lobe, postcentral gyrus, Reil's island lobe, primary somato-sensory cortex, cingulate gyrus, superior temporal gyrus, occipital cuneiform gyrus and/or precuneus gyrus and right brainstem; and the area that showed deactivation was left median frontal lobe. CONCLUSION: The effects of EA L14 in regulating cerebral activities could be displayed and recorded through BOLD fMRI, the distribution of signally deactivated area evoked by EA L14 was similar to the known distribution of anatomical orientation of pain in brain, and closely related to the anatomic structure of limbic system, which areas are possibly the acupuncture analgesic effect's cerebral regulating area. Furthermore, activated portion of left central anterior gyrus, which represent the movement of oral facial muscles, and the activated portion of cerebellum are possibly related with the effect of using EA L14 in treating facial palsy and facial muscle spasm. As for the mechanism of signal deactivation of cerebral activities exhibited in the present study that is unable to be elucidated, it awaits for further research.

PMID: 17578311 [PubMed - indexed for MEDLINE]

: Neurosci Lett. 2005 Aug 5;383(3):236-40.

Acupoint-specific fMRI patterns in human brain.

Yan B, Li K, Xu J, Wang W, Li K, Liu H, Shan B, Tang X.

Key Laboratory of Nuclear Analysis Techniques, Institute of High Energy Physics, Chinese Academy of Sciences, 19 Yu Quan Road, Beijing 100049, China.

Specific central nervous system (CNS) responses to acupuncture have recently attracted attention. It is important to understand the differences in fMRI images of the brain evoked by acupuncture at an acupoint and at a nearby "sham" point. Here, we report analyses of fMRI images of the brains of 37 healthy volunteers in response to acupuncture at Liv3 (Taichong) and LI4 (Hegu) versus their sham points. We found common activation areas in response to Liv3 or LI4 acupuncture in the middle temporal gyrus and cerebellum, along with deactivation areas in the middle frontal gyrus and inferior parietal lobule, compared with the effects of acupuncture at sham points. Acupuncture at Liv3 evoked specific activation at the postcentral gyrus, posterior cingulate, parahippocampal gyrus, BA 7, 19 and 41, but deactivation at the inferior frontal gyrus, anterior cingulate, BA 17 and 18, compared with acupuncture at its sham point. Acupuncture at LI4 evoked specific activation at the temporal pole, but deactivation at the precentral gyrus, superior temporal gyrus, pulvinar and BA 8, 9 and 45, compared with acupuncture at its sham point. These observations reveal that acupuncture at acupoints induces specific patterns of brain activity, and these patterns may relate to the therapeutic effects of acupuncture.

PMID: 15876491 [PubMed - indexed for MEDLINE]

1: Neuroimage. 2006 Feb 15;29(4):1080-91. Epub 2005 Dec 1.

Mode and site of acupuncture modulation in the human brain: 3D (124-ch) EEG power spectrum mapping and source imaging.

Chen AC, Liu FJ, Wang L, Arendt-Nielsen L.

Center for Functional Human Brain Mapping, Capital University of Medical Sciences, Beijing, China. Esta dirección electrónica esta protegida contra spam bots. Necesita activar JavaScript para visualizarla

This study determined: (a) if acupuncture stimulation at a traditional site might modulate ongoing EEG as compared with stimulation of a control site; (b) if high-frequency vs. low-frequency stimulation could exert differential effects of acupuncture; (c) if the observed effects of acupuncture were specific to certain EEG bands; and (d) if the acupuncture effect could be isolated at a specific scalp field, with its putative underlying intracranial source. Twelve healthy male volunteers (age range 22-35) participated in two experimental sessions separated by 1 week, which involved transcutaneous acupoint stimulation at selected acupoint (Li 4, HeGu) vs. a mock point at the fourth interosseous muscle area on the left hand in high (HF: 100 Hz) vs. low-frequency (LF: 2 Hz) stimulation by counter-balanced order. 124-ch EEG data were used to analyze the Delta, Theta, Alpha-1, Alpha-2, Beta, and Gamma bands. The absolute EEG powers (muv2) at focal maxima across three stages (baseline, stimulation, post) were examined by two-way (condition, stage) repeated measures ANOVA. The activity of the Theta power significantly decreased (P = 0.02), compared with control during HF but not LF stimulation at acupoint stimulation, however, there was no study effect at the mock point. A decreased Theta EEG power was prominent at the frontal midline sites (FCz, Fz) and the contralateral right hemisphere front site (FCC2h). In contrast, the Theta power of low-frequency stimulation showed an increase from the baseline as those in both controlled mock point stimulations. The observed high-frequency acupoint stimulation effects of Theta EEG were only present during, but not after, simulation. The topographic Theta activity was tentatively identified to originate from the intracranial current source in cingulate cortex, likely ACC. It is likely that short-term cortical plasticity occurs during high-frequency but not low-frequency stimulation at the HeGu point, but not mock point. We suggest that HeGu acupuncture stimulation modulates limbic cingulum by a frequency modulation mode, which then may damp nociceptive processing in the brain.

PMID: 16325429 [PubMed - indexed for MEDLINE]

 

1: Neuroimage. 2006 Feb 15;29(4):1080-91. Epub 2005 Dec 1.

Mode and site of acupuncture modulation in the human brain: 3D (124-ch) EEG power spectrum mapping and source imaging.

Chen AC, Liu FJ, Wang L, Arendt-Nielsen L.

Center for Functional Human Brain Mapping, Capital University of Medical Sciences, Beijing, China. Esta dirección electrónica esta protegida contra spam bots. Necesita activar JavaScript para visualizarla

This study determined: (a) if acupuncture stimulation at a traditional site might modulate ongoing EEG as compared with stimulation of a control site; (b) if high-frequency vs. low-frequency stimulation could exert differential effects of acupuncture; (c) if the observed effects of acupuncture were specific to certain EEG bands; and (d) if the acupuncture effect could be isolated at a specific scalp field, with its putative underlying intracranial source. Twelve healthy male volunteers (age range 22-35) participated in two experimental sessions separated by 1 week, which involved transcutaneous acupoint stimulation at selected acupoint (Li 4, HeGu) vs. a mock point at the fourth interosseous muscle area on the left hand in high (HF: 100 Hz) vs. low-frequency (LF: 2 Hz) stimulation by counter-balanced order. 124-ch EEG data were used to analyze the Delta, Theta, Alpha-1, Alpha-2, Beta, and Gamma bands. The absolute EEG powers (muv2) at focal maxima across three stages (baseline, stimulation, post) were examined by two-way (condition, stage) repeated measures ANOVA. The activity of the Theta power significantly decreased (P = 0.02), compared with control during HF but not LF stimulation at acupoint stimulation, however, there was no study effect at the mock point. A decreased Theta EEG power was prominent at the frontal midline sites (FCz, Fz) and the contralateral right hemisphere front site (FCC2h). In contrast, the Theta power of low-frequency stimulation showed an increase from the baseline as those in both controlled mock point stimulations. The observed high-frequency acupoint stimulation effects of Theta EEG were only present during, but not after, simulation. The topographic Theta activity was tentatively identified to originate from the intracranial current source in cingulate cortex, likely ACC. It is likely that short-term cortical plasticity occurs during high-frequency but not low-frequency stimulation at the HeGu point, but not mock point. We suggest that HeGu acupuncture stimulation modulates limbic cingulum by a frequency modulation mode, which then may damp nociceptive processing in the brain.

PMID: 16325429 [PubMed - indexed for MEDLINE]

 

1: J Altern Complement Med. 2006 Sep;12(7):615-23.

Changes in FMRI in the human brain related to different durations of manual acupuncture needling.

Li K, Shan B, Xu J, Liu H, Wang W, Zhi L, Li K, Yan B, Tang X.

Key Laboratory of Nuclear Analysis Techniques, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, People's Republic of China.

OBJECTIVES: The present study is aimed at evaluating the effects of manual acupuncture with different durations on the human brain using functional magnetic resonance imaging. MATERIALS AND METHODS: Eighteen healthy right-handed volunteers were divided into three groups randomly. Each group received only one kind of acupuncture on the right LI4 (Hegu) point, which lasted 30 sec, 60 sec, or 180 sec, respectively. Fix-effect and conjunction analysis were used to compare the effects of the three kinds of acupunctures. RESULTS: The results indicated that the stimulation of manual acupuncture with different durations could induce different effects in the central nervous system on the human brain. The longer duration of manual acupuncture might induce more significant areas. CONCLUSIONS: The present study provided not only neuroimaging evidence for manual acupuncture, but also a useful guide for clinical applications of acupuncture. In addition, the results might be helpful to understand the relationship between the central nervous system responses and the durations of acupuncture.

PMID: 16970531 [PubMed - indexed for MEDLINE]

 

[Influence of needling at yin-yang meridian points on cerebral glucose metabolism]

[Article in Chinese]

·    Dong JC,

·    Li J,

·    Zuo CT.

Affiliated Huashan Hospital to Fudan University, Shanghai 200040.

OBJECTIVE: To study the different effect of needling at different meridian points (MP) on different cerebral functional regions by using positron emission tomography and cerebral function tracer 18F-fluorodeoxy glucose to observe the effect of electro-acupuncture (EA) stimulation at Yin MP or Yang MP on local cerebral glucose metabolism in 30 healthy volunteers. METHODS: The thirty subjects were randomly divided into 2 groups, the 12 subjects in the Yang MP group treated by needling at Hegu (LI4), Quchi (LI11), Zusanli (St36) and Shangjuxu (St37), the 18 subjects in the Yin MP group treated by needling at Neiguan (Pc6), Chize (Lu5), Sanyinjiao (Sp6) and Yinlingquan (Sp9). All the needling was conducted at one side of body. RESULTS: After needling at Yang MP, the cerebral glucose metabolism was elevated in bilateral cross region of frontal lobe and temporal lobe, parietal lobe, thalamus and basal ganglia, and in contralateral cerebellum and hippocampus. After needling at Yin MP, the cerebral glucose metabolism was lowered in bilateral cross region of frontal and temporal lobe, contralateral temporal lobe, cerebellum and thalamus, and was elevated in homolateral hippocampus and caudate nucleus. CONCLUSION: Under physiological condition, the regulatory effects of acupuncture on central nervous system would be different when needling at different MP.

PMID: 12585145 [PubMed - indexed for MEDLINE]

 

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