Dorsal root ganglion: the target of acupuncture in the treatment of asthma

Electroacupuncture reduced airway inflammation by activating somatosensory-sympathetic pathways in allergic asthmatic rats

BACKGROUND

Electroacupuncture (EA) treatment is efficacious in patients with respiratory disorders, although the mechanisms of its action in lung-function protection are poorly understood. This study aimed to explore the neuroanatomical mechanisms of EA stimulation at the BL13 acupoint (Feishu, EA-BL13) improvement in asthma.

METHODS

Allergic asthma was induced by intranasal 2.0% ovalbumin (OVA) instillation combined with intraperitoneal injection of the 10.0% OVA. The levels of interleukin (IL)-4 and IL-5 were detected by enzyme-linked immunosorbent assay. Hematoxylin and eosin and periodic acid-schiff stain were used to evaluate inflammatory cell infiltration and mucus secretion. Cellular oncogene fos induction in neurons after EA stimulation was detected by immunofluorescent staining. The mRNA expression levels of adrenergic receptors were quantified with real-time polymerase chain reaction.

RESULTS

EA improved airway inflammation and mucus secretion mainly by activating somatosensory-sympathetic pathways (P <0.001). Briefly, the intermediolateral (IML) nuclei of the spinal cord received signals from somatic EA stimulation and then delivered the information via the sympathetic trunk to the lung. Excited sympathetic nerve endings in lung tissue released large amounts of catecholamines that specifically activated the β2 adrenergic receptor (β2AR) on T cells (P <0.01) and further decreased the levels of IL-4 and IL-5 (P <0.001) through the cyclic adenosine monophosphate/protein kinase A signaling pathway.

CONCLUSION

This study provided a new explanation and clinical basis for the use of EA-BL13 as a treatment for allergic asthma in both the attack and remission stages and other respiratory disorders related to airway inflammation.

Analysis of acupoint selection and combinations in acupuncture treatment of asthma based on data mining

OBJECTIVE

Using data mining, the present study aimed to discover the most effective acupoints and combinations in the acupuncture treatment of asthma.

METHODS

The main acupoints prescribed in these clinical trials was collected and quantified. A network analysis was performed to uncover the interconnections. Additionally, hierarchical clustering analysis and association rule mining were conducted to discover the potential acupoint combinations.

RESULTS

Feishu (BL13), Dingchuan (EX-B1), Dazhui (GV14), Shengshu (BL23), Pishu (BL20), and Fengmen (BL12) appeared to be the most frequently used acupoints for asthma. While the Bladder Meridian of Foot Taiyang, the Governor Vessel, and the Conception Vessel, compared to other meridians, were found to be the more commonly selected meridians. In the acupoint interconnection network, Feishu (BL13), Fengmen (BL12), Dingchuan (EX-B1), and Dazhui (GV14) were defined as key node acupoints. Association rule mining analysis demonstrated that the combination of Pishu, Shenshu, Feishu, and Dingchuan, as well as that of Feishu, Dazhui, and Fengmen were potential acupoint combinations that should be selected with priority in asthma treatment.

CONCLUSION

This study provides valuable information regarding the selection of the most effective acupoints and combinations for clinical acupuncture practice and experimental study aimed at the prevention and treatment of asthma.

Acupuncture for Asthma: Its Potential Significance in Clinical Practice

Acupuncture has been used for the prevention and treatment of asthma. However, the mechanisms underlying the effects of acupuncture in asthma are not fully understood. This article discusses the possible mechanisms underlying the effects of acupuncture in the prevention and treatment of asthma. Existing evidence has shown that acupuncture might facilitate the prevention and treatment of asthma via its anti-inflammatory effects. Acupuncture has been shown to modulate Th1/Th2 balance, block inflammatory cells and mediators, improve airway remodeling, and regulate hypothalamic-pituitary-adrenal axis function. Acupuncture appears to exert its antiasthmatic properties through multiple pathways.

Association between skin reactions and efficacy of summer acupoint application treatment on chronic pulmonary disease: A prospective study

OBJECTIVE

To examine the variations in the prevalence of skin reactions and the association between skin reactions and efficacy of summer acupoint application treatment (SAAT) on chronic pulmonary disease (CPD).

METHODS

A total of 2,038 patients with CPD were enrolled at 3 independent hospitals (defined as Groups A, B and C, respectively) in China. All patients were treated by SAAT, as applying a herbal paste onto the acupoints of Fengmen (BL 12) and Feishu (BL 13) on the dog days of summer, according to the lunar calendar, in 2008. Ten days after treatment, skin reaction data (no reaction, itching, stinging, blistering, and infection) were obtained via face-to-face interviews. Patients were retreated in the same hospital one year later, thereby allowing doctors to assess treatment efficacy based on the patients' symptoms, the severity of the spirometric abnormalities, and the concomitant medications used.

RESULTS

A large number of patients (85.3%) displayed reactive symptoms; however, the marked associations between reactive symptoms and age or gender were not observed. An increased number of patients from Group B (99.3%) and Group C (76.5%) displayed reactive symptoms due to the increased mass of crude Semen Sinapis Albae. The effective rate of SAAT was as high as 90.4% for patients of Group B, which was followed by Group A (70.9%) and Group C (42.2%). Using stratified analyses, a convincing association between reactive symptoms and therapeutic efficacy was observed for patients with asthma [itching: odds ratio (OR)=2.17, 95% confidence interval (CI): 1.49 to 3.14; blistering: OR=0.43, 95% CI: 0.25 to 0.73; and no reaction: OR=0.56, 95% CI: 0.35 to 0.90]. However, the same tendency was not observed for patients with chronic bronchitis and chronic obstructive pulmonary disease.

CONCLUSIONS

SAAT can induce very mild skin reactions for patients with CPD, among which patients with asthma displayed a strong association between skin reactions and therapeutic efficacy. The skin reactions may be induced by the crude Semen Sinapis Albae.

Additional Effects of Back-Shu Electroacupuncture and Moxibustion in Cardioprotection of Rat Ischemia-Reperfusion Injury

Many preclinical studies show that electroacupuncture (EA) on PC6 and ST36 can reduce infarct size after ischemia-reperfusion (IR) injury. Yet studies to enhance the treatment effect size are limited. The purpose of this study was to explore whether EA has additional myocardial protective effects on an ischemia-reperfusion (IR) injury rat model when back-shu EA and moxibustion are added. SD rats were divided into several groups and treated with either EA only, EA + back-shu EA (B), or EA + B + moxibustion (M) for 5 consecutive days. Transthoracic echocardiography and molecular and immunohistochemical evaluations were performed. It was found that although myocardial infarct areas were significantly lower and cardiac function was also significantly preserved in the three treatment groups compared to the placebo group, there were no additional differences between the three treatment groups. In addition, HSP20 and HSP27 were expressed significantly more in the treatment groups. The results suggest that adding several treatments does not necessarily increase protection. Our study corroborates previous findings that more treatment, such as prolonging EA duration or increasing EA intensity, does not always lead to better results. Other methods of increasing treatment effect size should be explored.

Neuroanatomical basis of acupuncture treatment for some common illnesses

The acupuncture treatment formulae for some common conditions are reviewed. These conditions include low back pain, sciatica, trigeminal neuralgia, facial nerve palsy, asthma, nausea and vomiting, gastritis and dysmenorrhoea. It is found that in many cases, the acupuncture points traditionally used for the treatment have a neuroanatomical significance from the viewpoint of Western medicine. And from that one can hypothesise a plausible mechanism of action as to how acupuncture achieves its therapeutic effects in terms of contemporary Western medicine. These mechanisms of action include intramuscular stimulation for treating muscular pain and nerve stimulation for treating neuropathies. The sympathetic ganglion may be involved in the acupuncture treatment of asthma. Somato-autonomic reflex may be responsible for the acupuncture effect on gastritis.

A randomized pilot study of acupuncture as an adjunct therapy in adult asthmatic patients

OBJECTIVE

This trial aimed to evaluate the feasibility of estimating the effectiveness of acupuncture on asthmatic patients under conventional medical management. PARTICIPATIONS AND METHODS: A prospective randomized, patient/assessor-blinded, sham acupuncture-, and waiting list-controlled pilot trial was conducted. Forty-five eligible asthmatic participants underwent a 1-week run-in period and were then randomized into one of three groups: an active acupuncture group, a sham acupuncture group, and a waiting list group. They were instructed to maintain the use of antiasthmatic medications. Needling was administered three times per week for 4 weeks with a 2-week follow-up in the active and sham acupuncture groups. The primary outcome was daily morning peak expiratory flow (PEF) and the secondary outcomes included forced expiratory volume one second (FEV(1)), quality of life questionnaire for adult Korean asthmatics (QLQAKA), transition dyspnea index (TDI), serum eosinophil count, and total serum immunoglobulin E (IgE).

RESULTS

No significant differences in the between- or within-group values of weekly average PEF (recorded daily in the morning) and FEV(1) were found. For QLQAKA and TDI, the active acupuncture group showed a significant improvement over the waiting list group at 2, 4, and 6 weeks after randomization.

DISCUSSION

Acupuncture as an adjunct therapy to conventional medical care does not seem to affect pulmonary function in asthmatic patients. However, 12 sessions of acupuncture treatment during 4 weeks showed a favorable effect on the quality of life in adult asthmatic patients. Further large trials assessing the effectiveness of acupuncture on the quality of life and symptoms in asthmatic patients are needed.