New findings of the correlation between acupoints and corresponding brain cortices using functional MRI

Changes in cerebral blood flow under the prone condition with and without massage

To investigate changes in regional cerebral blood flow (rCBF) under the prone condition with and without light massage on the back, we measured rCBF quantitatively in healthy human subjects using positron emission tomography with H(2)15O. Biochemical tests showed that the light massage (palm-pressure) reduced levels of stress-related serum cortisol and salivary stress protein chromogranin-A measured after the PET examination. Absolute rCBF significantly increased in the parietal cortex (precuneus) under the prone condition compared with the supine condition, and this rCBF increase was in parallel with comfortable sensation and slowing heart rate during the massage. Correlation analysis in statistical parametric mapping showed that the amygdalar and basal forebrain rCBF correlated with parasympathetic function (heart rate reduction), indicating involvement of the forebrain-amygdala system in mediating activities in the autonomic nervous system in the presence of comfortable sensation. To conclude, prone posture itself can stimulate the precuneus region to raise awareness, and the light massage on the back may help accommodate the brain to comfortable stimulation.

Beyond paradigm: Making transcultural connections in a scientific translation of acupuncture

This paper examines the ways in which the acupuncture phenomenon is translated into scientific language through the mobilization of functional magnetic resonance imaging. In doing so, it explores how differences between science and traditional medicine are bridged and negotiated through an open-ended tuning process among heterogeneous elements. By showing the constructive interaction between traditional medicine and science, I aim to refute a conception of East Asian medicines as culturally bounded and to provide an interpretation of transculturalism that emphasizes its diverse and hybrid formations. Particularly, in order to explain the scientific translation of acupuncture, I refer to Andrew Pickering's "mangle of practice" as an alternative to Thomas Kuhn's paradigm. Adopting a performative perspective rather than a representational one with regard to science, I read the scientific interpretation of acupuncture as an interactive stabilization between the acupuncture phenomenon, neurological theory, and the material procedure of the MRI machine.

Neural substrates, experimental evidences and functional hypothesis of acupuncture mechanisms

OBJECTIVES

Although acupuncture therapy has demonstrated itself to be effective in several clinical areas, the underlying mechanisms of acupuncture in general and the analgesic effect in particular are, however, still not clearly delineated. We, therefore, have studied acupuncture analgesic effect through fMRI and proposed a hypothesis, based on the obtained result, which will enlighten the central role of the brain in acupuncture therapy.

METHODS

The proposed model, termed as a broad sense hypothalamus-pituitary-adrenal (BS-HPA) axis, was based on our observed neuroimaging results. The model incorporates the stress-induced HPA axis model together with neuro-immune interaction including the cholinergic anti-inflammatory model.

RESULTS

The obtained results coupled with accumulating evidence suggest that the central nervous system is essential for the processing of these effects via its modulation of the autonomic nervous system, neuroimmune system and hormonal regulation.

CONCLUSIONS

Based on our fMRI study, it appears that understanding the effects of acupuncture within a neuroscience-based framework is vital. Further, we have proposed the broad sense-HPA axis hypothesis which incorporates the experimental results.

Electroacupuncture modulates cortical activities evoked by noxious somatosensory stimulations in human

A noninvasive high-resolution imaging technique of cerebral electric activities has been developed to directly link scalp potential measurement with the magnetic resonance images of the subjects, which is very helpful for the elucidation of the cortical processing following various stimulations. Here, we used a 64-channel Neuroscan ESI-128 system to explore the specific cortical activities elicited by electroacupuncture (EA) acupoint in normal volunteers and the modulatory effect of EA on cortical activities evoked by noxious somatosensory stimulation. A specific later-latency somatosensory-evoked potential (SEP, P150) located in bilateral anterior cingulated cortex was observed after EA acupoint but not non-acupoint. Two pain-specific SEP components (P170 and N280), located in bilateral suprasylvian operculum and anterior cingulated cortex respectively were observed following painful median nerve stimulation. Binding EA acupoint with painful median nerve stimulation, the amplitudes of P170 and N280 appeared to be attenuated significantly, 2D topography exhibited tremendous decrease of cortical activation between 120 ms and 296 ms in latency, and visual analogue scale (VAS) changes also showed a similar pattern to the change of amplitude. The bilateral anterior cingulated cortex recruited following acupoint stimuli might, to some extent, suggest that EA has the specific physiological effects. Decrease of pain-induced cortical activation by EA acupoint was considered to be mainly due to an interaction of the signals in anterior cingulated cortex ascending from the pain stimulation and EA.

Short- and long-term modulation of upper limb motor-evoked potentials induced by acupuncture

The aim of this study was to investigate in humans the effects of acupuncture upon upper-limb motor-evoked potentials (MEPs), elicited by transcranial magnetic stimulation of the primary motor cortex. It is known that peripheral sensory stimulation can be used to induce short- and long-term changes in motor cortex excitability. Data show that the simple insertion of the needle is an adequate somatosensory stimulus to induce a significant modulation of MEP amplitude, the sign of which (facilitation or inhibition) is specific to the investigated muscle and to the point of needle insertion. Moreover, MEP changes in upper-limb muscles are also observed following needling of lower-limb sites, revealing the presence of long-distance effects of acupuncture. Finally, the modulation in muscle excitability considerably outlasts the time period of needle application, demonstrating the induction of long-term plastic changes in the central nervous system. In addition, results have shown that the effects on muscle excitability are not restricted to the stimulation of well-coded acupoints, as described in traditional Chinese medicine, but they can also be induced by needling of nonacupoints, normally not used for therapeutic purposes. The possible neuronal mechanisms underlying the observed effects of acupuncture are discussed in relation to the available neurophysiological data regarding the interlimb reflexes and the changes in the representational cortical maps induced in humans by a prolonged somatosensory stimulation.

Functional MRI of the kidney: tools for translational studies of pathophysiology of renal disease

Magnetic resonance imaging (MRI) provides exquisite anatomic detail of various organs and is capable of providing additional functional information. This combination allows for comprehensive diagnostic evaluation of pathologies such as ischemic renal disease. Noninvasive MRI techniques could facilitate translation of many studies performed in controlled animal models using technologies that are invasive to humans. Such a translation is being recognized as essential because many proposed interventions and drugs that prove efficacious in animal models fail to do so in humans. In this article, we review the state-of-the-art functional MRI technique as applied to the kidneys.

Effect of acupuncture on the outcome of in vitro fertilization and intracytoplasmic sperm injection: a randomized, prospective, controlled clinical study

OBJECTIVE

To determine the effect of luteal-phase acupuncture on the outcome of IVF/intracytoplasmic sperm injection (ICSI).

DESIGN

Randomized, prospective, controlled clinical study.

SETTING

University IVF center.

PATIENT(S)

Two hundred twenty-five infertile patients undergoing IVF/ICSI.

INTERVENTION(S)

In group I, 116 patients received luteal-phase acupuncture according to the principles of traditional Chinese medicine. In group II, 109 patients received placebo acupuncture.

MAIN OUTCOME MEASURE(S)

Clinical and ongoing pregnancy rates.

RESULT(S)

In group I, the clinical pregnancy rate and ongoing pregnancy rate (33.6% and 28.4%, respectively) were significantly higher than in group II (15.6% and 13.8%).

CONCLUSION(S)

Luteal-phase acupuncture has a positive effect on the outcome of IVF/ICSI.

Effect of acupuncture treatment on vascular dementia

OBJECTIVE

Recent studies have suggested that acupuncture can ameliorate some symptoms commonly associated with vascular dementia (VaD). The study was carried out to observe the clinical therapeutic effects for VaD of 'yi qi tiao xue, fu ben pei yuan' acupuncture method (supplementing vital force-matter and regulating blood, supporting the root and fostering the source).

METHODS

Sixty inpatients with VaD were randomly assigned to the treat group (TG) or control group (CG). Both the TG and the CG received routine treatment as other inpatients with VaD, including medication and traditional acupuncture treatment. After that, the TG was given the treatment of 'yi qi tiao xue, fu ben pei yuan' acupuncture, which included five body acupoints, namely, tanzhong (CV17), zhongwan (CV12), qihai (CV6), zusanli (ST36) and xuehai (SP10). The Treatment was performed once daily for 6 weeks. The mini-mental status examination (MMSE), the revised Hasegawa's dementia scale (HDS-R) and activities of daily living (ADL) exam were carried out before and after the experiment, to evaluate therapeutic effects of the acupuncture method.

RESULTS

The MMSE, HDS-R and ADL scores were significantly improved in the TG and CG (p<0.001). But the overall scores of MMSE and HDS-R for the subjects in the TG were notably higher than those in the CG (p<0.05). Patients in the TG showed remarkable improvement in memory, orientation, calculation and self-managing ability in daily living after treatment. The total effective rate was 80.0% in the TG versus 46.7% in the CG, where significant difference between the two groups exhibited (p<0.05).

CONCLUSIONS

These results suggested that 'yi qi tiao xue, fu ben pei yuan' acupuncture method had significant therapeutic effects and well tolerated in ameliorate the key clinical symptoms of VaD.

Acupuncture-induced cerebral blood flow responses in dystonia

OBJECTIVE

The effect of acupuncture (ACP) on regional cerebral blood flow (rCBF) is unclear. Single-photon emission computed tomography studies on three patients with dystonia were performed before and after ACP treatment to test the contention that ACP affects rCBF.

METHODS

Pre-ACP and post-ACP CBF study were performed on the same day; 99mTc ethyl cysteinate dimer was injected for each study. rCBF images were analyzed using a three-dimensional stereotaxic ROI template (3DSRT) to objectively measure rCBF. We evaluated rCBF bilaterally in five segments related to the pathophysiology of dystonia (1, superior frontal; 2, middle and inferior frontal; 3, primary sensorimotor; 4, lenticular nucleus; and 5, thalamus). More than 10% left-right asymmetry in rCBF over three continuous slices was defined as significant laterality. Post-ACP rCBF and laterality were evaluated with the pre-ACP rCBF study acting as a control in each subject.

RESULTS

The clinical effect of ACP was remarkable in all patients and rCBF increased in most segments. Pre-ACP rCBF exhibited significant laterality in eight segments of the three patients. Laterality reversed in seven of these segments and resolved in the remaining segment after ACP. Pre-ACP rCBF laterality was not preserved in any segment after ACP. The remaining five segments exhibited laterality only after ACP. In total, after ACP, 13 of 15 segments demonstrated a change in CBF that was greater unilaterally.

CONCLUSIONS

ACP results in an increase in CBF that is greater unilaterally. We think that unilateral change in CBF may be correlated with the action of ACP on the central nervous system in patients with dystonia.

Acupuncture--a critical analysis

Even though widely used in today's clinical practice, acupuncture has remained a controversial subject. Many reviews are currently available but most lack a critical stance and some are overtly promotional. The aim of this overview is to provide a balanced, critical analysis of the existing evidence. Some of the original concepts of traditional acupuncture are not supported by good scientific evidence. Several plausible theories attempt to explain how acupuncture works but none are proved beyond doubt. The clinical effectiveness of acupuncture continues to attract controversy. Many controlled clinical trials and numerous systematic reviews of these studies have been published. Considerable problems are encountered when interpreting these data. Heterogeneity is a significant drawback of both clinical trials and systematic reviews. Some of the controversies may be resolved through the use of the new 'placebo needles' which enable researchers to adequately control for placebo effects of acupuncture. The majority of studies using such devices fails to show effects beyond a placebo response. Acupuncture has been associated with serious adverse events but most large-scale studies suggest that these are probably rare. Nonserious adverse effects occur in 7-11% of all patients. In conclusion, acupuncture remains steeped in controversy. Some findings are encouraging but others suggest that its clinical effects mainly depend on a placebo response.

Electron microscopic study of novel threadlike structures on the surfaces of mammalian organs

The ultrastructures of novel threadlike structures (NTSs) and corpuscles on the surfaces of internal organs of rats were investigated using electron microscopy. The samples were studied in situ by using a stereomicroscope and were taken for further morphological analysis. Scanning electron microscope (SEM) images revealed a bundle structure of threadlike tissue, which was composed of several 10-micro m-thick subducts. The surfaces of the corpuscles were rather coarse and fenestrated. The corpuscles had cucumber-like shapes with an average length of about 2 mm and a thickness of about 400 micro m. Transmission electron microscope (TEM) images disclosed disordered collagen fibers, which formed the extracellular matrix of the threadlike tissue, and immune-function cells, like macrophages, mast cells, and eosinophils. Sinuses of various diameters, which were thought to be cross-sections of the lumens of the subducts, were observed in the TEM, cryo-SEM and focused-ion-beam SEM images. These SEM images were obtained for the first time to reveal the detailed structure of the NTSs that were only recently discovered.

Spinal effects of acupuncture stimulation assessed by proton density-weighted functional magnetic resonance imaging at 0.2 T

Signal changes can be detected by proton density-weighted functional imaging in both the brain and the spinal cord. These are attributed to changes in extravascular water proton (signal enhancement by extravascular protons) density during neuronal activation. In this study, we used this technique to detect correlations between acupoint stimulation and neural activity in the spinal cord. Stimulation of acupoints associated with treatment of sensorimotor deficits (LI4 and LI11) was performed on 11 volunteers. During stimulation, 8 of the 11 subjects had consistent functional activations in C6/C7. A bilateral activation pattern was common. Our findings show that acupoint stimulation modulates activity in the spinal cord.

Effect of acupuncture on behavioral hyperactivity and dopamine release in the nucleus accumbens in rats sensitized to morphine

Acupuncture as a therapeutic intervention has been used for the treatment of many functional disorders including substance abuse. However, there are still many unanswered question about the basic mechanism underlying acupuncture's effectiveness in the treatment of drug addiction. Repeated injection of psycostimulants or morphine can produce behavioral and neurochemical sensitization and have been used as a model for studying drug addiction. The present study was designed to investigate the effect of acupuncture on repeated morphine-induced changes in extracellular dopamine levels using in vivo microdialysis and repeated morphine-induced behavioral changes. Male Sprague-Dawley rats were treated with saline or increasing doses of morphine (10, 20 and 40 mg/kg, s.c., twice daily for 3 days). Following 15 days of withdrawal, acupuncture was applied at bilateral Shenmen (HT7) points for 1 min after the systemic challenge with morphine HCl (5 mg/kg, s.c.). Results showed that acupuncture at the specific acupoint HT7, but not at control points (TE8 and tail) significantly decreased both dopamine release in the nucleus accumbens and behavioral hyperactivity induced by a systemic morphine challenge. These results suggest that the therapeutic effect of acupuncture on morphine addiction occurs through inhibition of neurochemical and behavioral sensitization to morphine.

Simultaneous assessment of motor and language areas with a single functional MR imaging paradigm: feasibility

The purpose of this study was to test a hybrid multitask paradigm in healthy subjects and in a patient at preoperative functional magnetic resonance (MR) imaging. In this new paradigm, tasks related to different centers of brain function (motor and language) are performed in alternation during a single functional MR imaging examination, without the typical rest period, to improve time efficiency without compromising the quality of activation maps. The institutional review board approved the study, and all participants gave informed prior consent. The study complied with the Health Insurance Portability and Accountability Act. Seven healthy right-handed volunteers (four men, three women; age range, 22-40 years) were studied first. In both individual and group analyses, there was no statistically significant difference in results between assessment with the multitask design and that with the traditional block design. An advantage of the new paradigm was substantial time savings because the subject was engaged during the entire examination. Finally, the multitask design was tested in a patient undergoing preoperative evaluation, with similar results; therefore, use of the multitask design is feasible in a clinical setting.

Acupuncture For Patients With Glaucoma

CONTEXT

Research of the effects of one acupuncture method for patients with glaucoma, focusing on intraocular pressure (IOP) and visual acuity.

OBJECTIVE

To explore the possibility of using acupuncture for patients with glaucoma.

DESIGN

Pilot study utilizing a one-group preintervention, postintervention design.

SETTING

Eleven patients with glaucoma were recruited through advertisement at the clinic for glaucoma.

INTERVENTION

Acupuncture was carried out twice a week over 5 weeks.

OUTCOME MEASURES

IOP, visual acuity, and subjective symptoms were observed at 15 minutes before and after acupuncture once a week and in a four-week follow-up.

RESULTS

IOP was significantly improved at 15 minutes after acupuncture, at one week, two weeks, and five weeks and tended to be lower weekly. Uncorrected visual acuity was significantly improved at three weeks, four weeks, and five weeks, and best corrected visual acuity was significantly improved at five weeks. However at the four-week follow-up, significance remained only in uncorrected visual acuity.

CONCLUSIONS

Although these results should be interpreted cautiously, acupuncture can be used to supplement the conventional therapy for glaucoma.

ORIGINAL RESEARCH—FEMALE SEXUAL DYSFUNCTION: Assessment of Cerebrocortical Regions Associated with Sexual Arousal in Premenopausal and Menopausal Women by Using BOLD‐Based Functional MRI

PURPOSE

The aim of this study was to compare the cerebral regions associated with sexual arousal between premenopausal and menopausal women by using functional magnetic resonance imaging (f MRI).

MATERIALS AND METHODS

Ten premenopausal and 10 menopausal women underwent fMRI on a 1.5T MR scanner using the blood oxygen level dependent technique. To identify the activated brain regions associated with sexual response, brain activation was assessed during 1 minute of a nonerotic film, followed by 4 minutes of an erotic film.

RESULTS

The overall activation ratios of the premenopausal women were greater than those of the menopausal women by approximately 8% on average. The limbic, temporal association areas, and parietal lobe showed greater enhancement of signal intensities in premenopausal women. However, signal enhancement in the genu of the corpus callosum and superior frontal gyrus was dominant in menopausal women.

CONCLUSIONS

The activated brain center associated with visually evoked sexual arousal showed qualitative and quantitative differences between premenopausal and menopausal women.

Investigating acupuncture using brain imaging techniques: the current state of play

We have systematically researched and reviewed the literature looking at the effect of acupuncture on brain activation as measured by functional magnetic resonance imaging and positron emission tomography. These studies show that specific and largely predictable areas of brain activation and deactivation occur when considering the traditional Chinese functions attributable to certain specific acupuncture points. For example, points associated with hearing and vision stimulates the visual and auditory cerebral areas respectively. Pain, however, is a complex matrix that is intimately intertwined with expectation. Acupuncture clearly affects this matrix in both specific and non-specific manner that is consistent with its specific clinical effects, as well as the effects of expectation on pain relief. This article summarizes the current imaging literature.

Acupoint-specific fMRI patterns in human brain

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.

The effect of acupuncture on motor cortex excitability and plasticity

Acupuncture has been used extensively in facilitating motor recovery after stroke. Its mechanism of action remains uncertain. In this sham-controlled study, we demonstrate for the first time that acupuncture has a real and enduring effect on motor cortex functional changes, in terms of cortical excitability and output mapping using transcranial magnetic stimulation.

Expectancy and belief modulate the neuronal substrates of pain treated by acupuncture

Both specific and non-specific factors may play a role in acupuncture therapy for pain. We explored the cerebral consequences of needling and expectation with real acupuncture, placebo acupuncture and skin-prick, using a single-blind, randomized crossover design with 14 patients suffering from painful osteoarthritis, who were scanned with positron emission tomography (PET). The three interventions, all of which were sub-optimal acupuncture treatment, did not modify the patient's pain. The insula ipsilateral to the site of needling was activated to a greater extent during real acupuncture than during the placebo intervention. Real acupuncture and placebo (with the same expectation of effect as real acupuncture) caused greater activation than skin prick (no expectation of a therapeutic effect) in the right dorsolateral prefrontal cortex, anterior cingulate cortex, and midbrain. These results suggest that real acupuncture has a specific physiological effect and that patients' expectation and belief regarding a potentially beneficial treatment modulate activity in component areas of the reward system.

Laser acupuncture induced specific cerebral cortical and subcortical activations in humans

As recent studies demonstrated, acupuncture can elicit activity in specific brain areas. This study aims to explore further the central effect using laser acupuncture. We investigated the cerebral effects of laser acupuncture at both acupoints GB43 with functional magnetic resonance imaging (fMRI). As a control condition the laser was mounted at the same acupoints but without application of laser stimulation. The group results showed significant brain activations within the thalamus, nucleus subthalamicus, nucleus ruber, the brainstem, and the Brodmann areas 40 and 22 for the acupuncture condition. No significant brain activations were observed within the placebo condition. The activations we observed were laser acupuncture-specific and predominantly ipsilateral. This supports the assumption that acupuncture is mediated by meridians, since meridians do not cross to the other side. Furthermore, we could show that laser acupuncture allows one to design a pure placebo condition.

Effects of electroacupuncture versus manual acupuncture on the human brain as measured by fMRI

The goal of this functional magnetic resonance imaging (fMRI) study was to compare the central effects of electroacupuncture at different frequencies with traditional Chinese manual acupuncture. Although not as time-tested as manual acupuncture, electroacupuncture does have the advantage of setting stimulation frequency and intensity objectively and quantifiably. Manual acupuncture, electroacupuncture at 2 Hz and 100 Hz, and tactile control stimulation were carried out at acupoint ST-36. Overall, electroacupuncture (particularly at low frequency) produced more widespread fMRI signal increase than manual acupuncture did, and all acupuncture stimulations produced more widespread responses than did our placebo-like tactile control stimulation. Acupuncture produced hemodynamic signal increase in the anterior insula, and decrease in limbic and paralimbic structures including the amygdala, anterior hippocampus, and the cortices of the subgenual and retrosplenial cingulate, ventromedial prefrontal cortex, frontal, and temporal poles, results not seen for tactile control stimulation. Only electroacupuncture produced significant signal increase in the anterior middle cingulate cortex, whereas 2-Hz electroacupuncture produced signal increase in the pontine raphe area. All forms of stimulation (acupuncture and control) produced signal increase in SII. These findings support a hypothesis that the limbic system is central to acupuncture effect regardless of specific acupuncture modality, although some differences do exist in the underlying neurobiologic mechanisms for these modalities, and may aid in optimizing their future usage in clinical applications.

Acupuncture: A Clinical Review

This article summarizes the research base, probable mechanism of actions, and clinical applications of acupuncture. It offers the clinician a deeper understanding of appropriate conditions for which acupuncture may be useful, outlines how to integrate acupuncture into a clinical practice, and describes referral and training issues.

Laser acupuncture: past, present, and future

Laser acupuncture is defined as the stimulation of traditional acupuncture points with low-intensity, nonthermal laser irradiation. Although the therapeutic use of laser acupuncture is rapidly gaining in popularity, objective evaluation of its efficacy in published studies is difficult because treatment parameters such as wavelength, irradiance, and beam profile are seldom fully described. The depth of laser energy transmission, likely an important determinant of efficacy, is governed not only by these parameters, but also by skin properties such as thickness, age, and pigmentation-factors which have also received little consideration in laser acupuncture. Despite the frequently equivocal nature of the published laser studies, recent evidence of visual cortex activation by laser acupuncture of foot points, together with the known ability of laser irradiation to induce cellular effects at subthermal thresholds, provides impetus for further research.

Pseudoparadoxical dissociation of cerebral oxygen saturation and cerebral blood flow velocity after acupuncture in a woman with cerebrovascular dementia: a case report

Acupuncture can increase both cerebral oxygen saturation and cerebral blood flow velocity. We describe a 77-year-old woman with cerebrovascular dementia in whom acupuncture reproducibly induced an increase of blood flow velocity but a decrease of regional oxygen saturation. At four of 11 acupuncture sessions, blood flow velocity was measured in the middle cerebral artery with transcranial Doppler sonography and cerebral regional oxygen saturation (rSO(2)) with transcranial near infrared spectroscopy. Cerebral blood flow velocity increased by an average of 20% (range: 7-27%) at all four study points whereas rSO(2) consistently decreased by an average of 7% (range: 4-13%). Clinical status and cognitive function improved. These findings in a patient with vascular dementia may suggest increased oxygen extraction by activated neuronal structures.

A birdcage model for the Chinese meridian system: Part V: Applications to animals and plants

Since we all belong to the Kingdom Animalia, it is not surprising that animals in general benefit from the healing art of acupuncture that helps humans. Consequently, any proposed mechanism of Qi and acupuncture for humans based on animal physiology is probably applicable to animals as well, yet none is capable of explaining most of the complicated physiological effects observed. Not much attention was paid to the effects of Qi and acupuncture on plants (Kingdom Plantae) and on enoki mushrooms (Kingdom Fungi) by the TCM community, probably because they cannot be explained in terms of neurochemistry or connective tissue structures. However, our transmission and birdcage model is in principle applicable across Kingdom boundaries, because it is based on physical properties underlying the biological structure, thus its explanatory power is not restricted by categories of biology. We estimate several possible parameters of the birdcage model for animals and plants and give a possible interpretation for the sound fertilization phenomenon.

Novel threadlike structures (Bonghan ducts) inside lymphatic vessels of rabbits visualized with a Janus Green B staining method

A staining method has been developed for in situ and in vivo observation of a threadlike tissue afloat inside the lymphatic vessels of rabbits without adherence to the vessel wall. The existence of this novel structure was not noticed previously because it is extremely difficult to detect it by microscopic inspection of lymphatic vessels. We have found a method that utilizes Janus Green B (JGB), which stained heavily the novel structure. The tissue was studied by confocal laser scanning microscopy (CLSM), light microscopy, and cryoscanning electron microscopy (cryo-SEM). The CLSM image obtained by acridine orange staining of the novel tissue revealed its characteristic nuclei distribution: rod-shaped nuclei of 10-20 microm length aligned in a broken-line/striped fashion. Hematoxylin and eosin staining revealed the threadlike structure passing through a lymphatic valve as histologically distinct from lymphatic vessels and valves. The cryo-SEM image showed the threadlike structure inside a collapsed lymphatic vessel. There were spherical globular structures observable inside sinuses in a rapidly frozen sample, which suggests liquid flowing through the longitudinal ductules in the threadlike structure. The specific staining of the JGB suggests that these threadlike structures inside lymphatic vessels have a high density of mitochondria in their cells and/or nerve-like properties, either of which may provide important clues to their physiological function.

The role of acupuncture in pain management

This article reviews the theories and applications of acupuncture to musculoskeletal pain management. First, Chinese theories of acupuncture are discussed briefly. Next, current understanding of nociception and central pain modulation is discussed in detail,followed by discussion of the physiologic effect of acupuncture analgesia. Other theories of acupuncture analgesia are presented based on neuromodulation of the central nervous system. Finally,the efficacy of acupuncture for many musculoskeletal pain syndromes,including spine-related pain, soft tissue pain, neuropathic pain, arthritis of the knee, and upper extremity tendinitis, is reviewed. The article concludes with a discussion of methodologic issues related to conducting randomized, placebo-controlled trials of acupuncture and goals for future research in this area of pain management.

Modulation of cerebellar activities by acupuncture stimulation: evidence from fMRI study

Recent neuroimaging studies have revealed that acupuncture stimulation modulates human central nervous system including cerebral limbic/paralimbic and subcortical structures. Due to the wide and intricate connections with cerebrum, we hypothesized that anatomically specific areas in human cerebellum are also modulated by acupuncture stimulation beyond classical involvement of cerebellum in motor coordination. Functional MRI (fMRI) was used to investigate neural substrates responding to the acupuncture stimulation of Pericardium 6 (PC6, Neiguan), an acupoint relevant for the management of nausea including vestibular-related motion sickness. Sham stimulation near the acupoint and tactile stimulation on the skin of the acupoint were given as separate conditions. Psychophysical scores as well as the heart and respiratory rates were measured during each condition. Acupuncture manipulation on PC6, in comparison to the sham acupuncture and tactile stimulation conditions, selectively activated left superior frontal gyrus, anterior cingulate gyrus, and dorsomedial nucleus of thalamus. Acupuncture-specific neural substrates in cerebellum were also evident in declive, nodulus, and uvula of vermis, quadrangular lobule, cerebellar tonsil, and superior semilunar lobule. Negative MR signal changes, often seen during the acupuncture of analgesic points, were not observed in the present study. Our data suggest that cerebellum serves as important activation loci during the acupuncture stimulation of PC6, and clinical efficacy of PC6 may be mediated by the cerebellar vestibular neuromatrix.

Suppression of IgE production and modulation of Th1/Th2 cell response by electroacupuncture in DNP-KLH immunized mice

Effects of electroacupuncture (EA) on Th1/Th2 cell response were investigated in BALB/c mice immunized intraperitoneally with 2,4-dinitrophenylated keyhole limpet protein (DNP-KLH). Successive electroacupuncture stimulation on the ST36 acupoint was performed just after immunization. Serum levels of antigen-specific IgE and total IgE were significantly decreased compared with non-acupunctured controls. Production of the Th2-specific cytokines IL-4 and IL-13 in the anti-CD3 mAb-activated splenocytes was significantly suppressed in ST36 electroacupunctured mice compared with non-acupunctured mice. These results imply that successive electroacupuncture on ST36 can decrease the serum level of antigen-specific IgE and total IgE by suppression of the Th2 lineage development.

Cortical activations upon stimulation of the sensorimotor-implicated acupoints

Sixty-seven healthy right-handed subjects were studied using a 1.5-T MRI. Activations, which were absent during stimulation of the adjacent nonacupoints over the right arm or leg, were consistently seen over the right premotor area during stimulation of the sensorimotor-implicated acupoints over the left arm or leg. The left premotor area was also activated during stimulation of the arm or leg acupoints. The right precentral and postcentral gyri showed activations during stimulation of the arm acupoints. The volume and location of activations vary when different combinations of the arm acupoints were stimulated. Our results indicate the existence of sensorimotor-implicated acupoints as sensitive sites to obtain somatotopic activations over the sensory cortices with co-activation of the motor cortices.

Acupuncture suppresses intrastriatal hemorrhage-induced apoptotic neuronal cell death in rats

Intracerebral hemorrhage is one of the most devastating types of stroke. In the present study, the effect of acupuncture on intrastriatal hemorrhage-induced neuronal cell death in rats was investigated via Nissl staining, terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling assay, and immunohistochemistry for caspase-3. The present results showed that lesion size and apoptotic neuronal cell death in the striatum were significantly increased following intrastriatal hemorrhage in rats and that acupunctural treatment at the Zusanli acupoint suppressed the hemorrhage-induced increase in lesion size and apoptotic neuronal cell death in the striatum. In the present study, it can be suggested that acupunctural treatment, especially at the Zusanli acupoint, may aid in the recovery following central nervous system sequellae following intracerebral hemorrhage.

Acupuncture using laser needles modulates brain function: first evidence from functional transcranial Doppler sonography and functional magnetic resonance imaging

Acupuncture using laser needles is a new totally painless stimulation method which has been described for the first time. This paper presents an experimental double-blind study in acupuncture research in healthy volunteers using a new optical stimulation method. We investigated 18 healthy volunteers (mean age +/- SD: 25.4 +/- 4.3 years; range: 21-30 years; 11 female, 7 male) in a randomized controlled cross-over trial using functional multidirectional transcranial ultrasound Doppler sonography (fTCD; n = 17) and performed functional magnetic resonance imaging (fMRI) in one volunteer. Stimulation of vision-related acupoints resulted in an increase of mean blood flow velocity in the posterior cerebral artery measured by fTCD [before stimulation (mean +/- SE): 42.2 +/- 2.5; during stimulation: 44.2 +/- 2.6; after stimulation: 42.3 +/- 2.4 cm/s, n.s.]. Mean blood flow velocity in the middle cerebral artery decreased insignificantly. Significant changes (p < 0.05) of brain activity were demonstrated in the occipital and frontal gyrus by fMRI. Optical stimulation using properly adjusted laser needles has the advantage that the stimulation cannot be felt by the patient (painless and no tactile stimulation) and the operator may also be unaware of whether the stimulation system is active. Therefore true double-blind studies in acupuncture research can be performed.

Acupuncture attenuates repeated nicotine-induced behavioral sensitization and c-Fos expression in the nucleus accumbens and striatum of the rat

Repeated injections of nicotine can produce behavioral sensitization, as evidenced by an enhanced locomotor response to a subsequent injection of the drug. Behavioral sensitization has been suggested as a model for studying drug addiction. Acupuncture as a therapeutic intervention is widely used for treatment for many functional disorders, such as substance abuse and mental dysfunction. We examined the effect of acupuncture on nicotine-induced behavioral locomotor activity and c-fos expression in the nucleus accumbens and striatum utilizing the immunocytochemical detection of the Fos protein. The rats were given repeated daily nicotine injections (0.4 mg/kg s.c., twice daily for 7 days) followed by one challenging injection on the 4th day after the last daily injection. Acupuncture at zusanli (ST36), but not control, significantly attenuated expected increase in nicotine-induced locomotor activity and Fos-like-immunoreactivity in the nucleus accumebns and striatum to subsequent nicotine challenge. These findings suggest that acupuncture has a therapeutic effect on nicotine addiction, possibly by modulating postsynaptic neuronal activity in the nucleus accumbens and the striatum.

Evidence from brain imaging with fMRI supporting functional specificity of acupoints in humans

We tested whether the stimulation of acupoints in the same spinal segments could induce different central responses with functional magnetic resonance imaging (fMRI) study. Stimulation of acupoints ST36/SP6 (Zusanli/Sanyinjiao) or GB34/BL57 (Yanglingquan/Chengshan) both activated primary and secondary somatosensory area, insula, ventral thalamus, parietal Brodmann Area 40, temporal lobe, putamen, and cerebellum, while de-activated amygdala. Nevertheless, ST36/SP6 stimulation specifically activated orbital frontal cortex and de-activated hippocampus. Alternatively, stimulation of GB34/BL57 activated dorsal thalamus and inhibited those of primary motor area and premotor cortex. Thus, stimulation of acupoints in the same spinal segments induced distinct though overlapped cerebral response patterns, which indicated the existence of acupoint specificity.

Implementing A Research Agenda for Complementary and Alternative Medicine

Complementary and alternative medicine (CAM) consists of diverse clinical interventions that are practiced because of their popularity rather than the prior demonstration of safety and efficacy required for conventional agents. CAM therapies can be grouped into five categories: biologically based therapies, manipulative and body-based interventions, mind-body interventions, "energy" therapies, and alternative medical systems. The present evidence that individual CAM interventions are efficacious is largely anecdotal, but hundreds of small trials have yielded positive results. For a few modalities, existing data are either very encouraging or else sufficient to conclude that they are ineffective. CAM interventions are presumed to be safe, yet they may not be, particularly in the case of botanical agents with inherent toxicities, significant drug interactions, or potent adulterants. The public health questions regarding CAM can only be addressed through a research agenda that defines which interventions have favorable therapeutic indices. Implementation of this agenda involves adequate characterization and standardization of the product or practice, with rigorous investigation to demonstrate its safety, mechanism of action, and efficacy.

Consciousness and Quantum Information Processing: Uncovering the Foundation for a Medicine of Light

Great progress has been made by Russian and German researchers in recent years (Popp, Voeikov, and others) to examine the biophysical aspects of biophotonic processes in humans. This paper suggests that there is a many-body reality to the way biophysical light interacts with the human self-organization of information that may be achieved by means of biomolecular, metabolic, or neural communication. These systems may merge as mobile energy relay systems similar to what is seen as qi processes in acupuncture science, suggesting a "holomovement" that seeks to confirm itself and increasingly retrieves and uses only the information that serves its exchanges with the environment. This coevolution of evolutionary process levels, expressed in process terms, can be seen as a foundation for a Medicine of Light integrating hidden variables in consciousness studies with functional differentiation and new findings in the biologic sciences.

Electro-acupuncture preconditioning abrogates the elevation of c-Fos and c-Jun expression in neonatal hypoxic-ischemic rat brains induced by glibenclamide, an ATP-sensitive potassium channel blocker

This study aimed to clarify the neuroprotective mechanism of electro-acupuncture (EA) preconditioning on hypoxic-ischemic brain injury (HIBI). Using Western blot, the expression of c-fos protein (c-Fos) and c-jun protein (c-Jun) induced by glibenclamide, an ATP-sensitive potassium (K(ATP)) channel blocker was examined from cerebral cortical and hippocampal samples in neonatal hypoxic-ischemic rats, with or without EA preconditioning. EA was performed on Hegu (LI4), a well-known acupoint commonly used in Oriental medicine for the treatment of neuronal injury resulting from hypoxia-ischemia (HI). Preconditioned rats were treated with either diazoxide, a K(ATP) channel opener, glibenclamide, or sterile saline injected into the left lateral ventricle (i.c.v.), with or without EA administration before HI insult. Interestingly, low c-Fos and c-Jun expressions were found both in diazoxide and EA groups, 24 h after HI. Furthermore, significant differences in relative optical density (ROD) were found between glibenclamide and HI control groups (P< or =0.05), as well as between the group administered glibenclamide after EA and the HI control group (P< or =0.05). However, the level of c-Fos and c-Jun expression in the group administered glibenclamide after EA was significantly lower than in the glibenclamide group (P< or =0.05). The present findings indicate that the effectiveness of EA preconditioning against HIBI may be mediated via the opening of K(ATP) channels.

Acupuncture, electrostimulation, and reflex therapy in dermatology

Acupuncture is an old therapeutic method that includes both needle and nonneedle acupuncture. Nonneedle acupuncture includes moxibustion, cupping, and acupressure. In the field of dermatology, acupuncture has been reported to be beneficial for the treatment of acne, postherpetic neuralgia, psoriasis, atopic dermatitis, and urticaria. In acupuncture treatment of dermal diseases, both the filiform needle and the cutaneous needle are powerful tools. In the treatment of refractory dermal diseases, cutaneous needle acupuncture is usually followed by cupping to intensify the therapeutic effect. In cases where needle acupuncture is not possible, acupuncture-like transcutaneous electrical nerve stimulation (TENS) is a good alternative. In addition, reflex therapy based on foot reflex areas may also be an alternative. A lack of controlled studies is the main drawback for the methods mentioned above. However, the experiences from experts in this field may offer us new ideas to resolve refractory disorders in dermatology.

Availability of acupuncture in the hospitals of a major academic medical center: a pilot study

BACKGROUND

Acupuncture is widely used by the American public, but little is known about its availability and use in academic medical settings. We performed a pilot study to compare acupuncture services provided by hospitals affiliated with a major academic teaching institution, and a parallel survey of services provided through an acupuncture school in one city in New England.

METHODS

Between December 2000 and July 2001, a telephone survey was conducted of the 13 hospitals affiliated with Harvard Medical School, and the clinics affiliated with the New England School of Acupuncture.

RESULTS

Acupuncture was available in 8 of the 13 hospitals. Acupuncture was provided in ambulatory clinics in all eight hospitals, but was available to inpatients in only one hospital. Six hospitals delivered acupuncture through an outpatient pain treatment service, one through a women's health center, one through an HIV clinic, and one hospital delivered acupuncture through two services; a program in the anesthesia department and a multi-disciplinary holistic program in a primary care department. In contrast, the acupuncture school clinics provided services through an on-site clinic at the school, through acupuncture departments at two community-based hospitals, and through a network of 12 satellite acupuncture-dedicated clinics operating throughout the state.

CONCLUSION

Acupuncture is available on a limited basis in a majority of the teaching hospitals in this city. At the acupuncture school clinics, there are few barriers to care. Future health care studies will need to examine the role of acupuncture in diverse geographic settings and to examine its impact on quality of care, teaching and its role in research in academic centers.

Chinese medicinal herbs Muh-Shiang Bin-Lang-Wan increases the motility of sphincter of Oddi in anesthetized rabbits through activation of M1 muscarinic receptors

The sphincter of Oddi (SO) plays an important role in regulating the bile flow into the duodenum. This study was designed to investigate the effect of Chinese Medicinal Herbs Muh-Shiang-Bin-Lang-Wan (MSBLW) and their mechanism of action on regulating the motility of SO in rabbits. The activity of SO in anesthetized rabbits was measured by using a continuously perfused open-tip manometric method. The rabbits were administered with different doses of MSBLW through naso-gastric tubes. The SO motility before and after the administration of MSBLW were recorded, and analyzed with a computer equipped with an off line analysis software. The results showed that the SO activity, in terms of tonic pressure and phasic contraction pressure, were significantly changed. A significant lower tonic pressure and a higher phasic contraction pressure were noticed 40-60 min after administration of MSBLW with a peak response at 0.5-1.0 gm range. The responses were blocked by pretreatment of muscarinic receptors (M1) antagonist, pirenzepine (10 mg/kg, orally). We conclude that MSBLW is effective in increasing the SO motility in rabbits through activation of M1 muscarinic receptors. However, potential application of MSBLW in the treatment of human biliary disorders needs further evaluation.