Effect of Moxibustion on Dopaminergic and Serotonergic Systems of Rat Nucleus Accumbens

Metabolic Response in Rats following Electroacupuncture or Moxibustion Stimulation

Electroacupuncture and moxibustion are traditional Chinese medicine practices that exert therapeutic effects through stimulation of specific meridian acupoints. However, the biological basis of the therapies has been difficult to establish; thus the current practices still rely on ancient TCM references. Here, we used a rat model to study perturbations in cortex, liver, and stomach metabolome and plasma hormones following electroacupuncture or moxibustion treatment on either stomach meridian or gallbladder meridian acupoints. All treatment groups, regardless of meridian and mode of treatment, showed perturbation in cortex metabolome and increased phenylalanine, tyrosine, and branched-chain amino acids in liver. In addition, electroacupuncture was found to increase ATP in cortex, creatine, and dimethylglycine in stomach and GABA in liver. On the other hand, moxibustion increased plasma enkephalin concentration, as well as betaine and fumarate concentrations in stomach. Furthermore, we had observed meridian-specific changes including increased N-acetyl-aspartate in liver and 3-hydroxybutyrate in stomach for gallbladder meridian stimulation and increased noradrenaline concentration in blood plasma following stimulation on stomach meridian. In summary, the current findings may provide insight into the metabolic basis of electroacupuncture and moxibustion, which may contribute towards new application of acupoint stimulation.

The Evidence on Acupuncture for Knee Osteoarthritis – Editorial Summary on the Implications for Health Policy

Decisions on whether a health service should provide a particular treatment are based on the evidence on three questions: 1) whether the treatment can work, ie it is biologically active; 2) whether the treatment is safe and effective in daily practice; and 3) whether it is economically worthwhile. Evidence presented at the Kyoto conference shows that acupuncture for osteoarthritis of the knee has a biological effect, has a large clinical effect in practice, has negligible risk, and has a cost effectiveness which is well within the usual acceptable limit. On the present evidence, acupuncture is likely to offer an alternative to treatment with non-steroidal anti-inflammatory drugs (NSAIDs).

Comparison of the Effectiveness of Six and Two Acupuncture Point Regimens in Osteoarthritis of the Knee: A Randomised Trial

Background

Although substantial data have supported the effectiveness of acupuncture for treating knee osteoarthritis (OA), the number of points used has varied. The objective of this study was to compare the effectiveness of six and two acupuncture points in the treatment of knee OA.

Methods

A randomised trial of knee OA patients was conducted. Patients were randomly allocated into two groups of 35. The “six point group” received treatment at six acupuncture points, ST35, EX-LE4 ( Neixiyan), ST36, SP9, SP10 and ST34, while the “two point group” received treatment at just the first pair of points, ST35 and EX-LE4. Both groups received twice weekly electroacupuncture on 10 occasions. Electrical stimulation was carried out at low-frequency of 3 Hz to all points, with the intensity as high as tolerable. Both groups were allowed to take a 200 mg celecoxib capsule per day for intolerable pain. Patients were assessed at baseline, week 5, week 9 and week 13, using a Thai language version of the Western Ontario and McMaster Osteoarthritis Index (WOMAC). Global assessment of change after 10 treatments was also recorded.

Results

Acupuncture at both six and two acupuncture points was associated with significant improvement. Mean total WOMAC score at weeks 5 and 13 of patients in both groups showed no significant difference statistically (p = 0.75 and p = 0.51). Moreover, the number of celecoxib capsules taken, global assessment of global change and body weight change of both groups also showed no statistical difference.

Conclusion

This evidence suggests that electroacupuncture to two local points may be sufficient to treat knee OA, but in view of some limitations to this study further research is necessary before this can be stated conclusively.

Electroacupuncture plus moxibustion therapy for patients with major depressive disorder: study protocol for a randomized controlled trial

Background

Major depressive disorder (MDD) is one of the most prevalent mental health disorders and has a significant societal economic burden. Antidepressants and cognitive behavioral therapy are two primary interventions for the standardized treatment of MDD. However, their weaknesses, such as a low response rate, a high risk of adverse events from medication, and the high cost of cognitive behavioral therapy, have resulted in a need for complementary and alternative medicine (CAM). Among the various therapeutic interventions in CAM, electroacupuncture and moxibustion have been widely used to treat various mental illnesses, including MDD. The aim of this study is to evaluate the feasibility of conducting a full-scale randomized controlled trial to investigate the efficacy and safety of electroacupuncture plus moxibustion therapy for MDD.

Methods/design

We will include patients between the ages of 19 to 65 years with MDD. A total of 30 participants will be recruited, and they will be randomly allocated into two groups at a 1:1 ratio. Patients in the treatment and control groups will, respectively, receive real and sham electroacupuncture/moxibustion treatments, for a total of 20 sessions over 8 weeks. The primary outcome will be the Hamilton Rating Scale for Depression, and the secondary outcomes will be Beck’s Depression Inventory, the Insomnia Severity Index, the State-Trait Anxiety Inventory, the EuroQol 5-Dimension Index, the Measure Yourself Medical Outcome Profile version 2, and electroencephalography. Adverse events will be monitored at each visit to assess safety. All outcomes will be assessed and analyzed by researchers blinded to the treatment allocation.

Discussion

This is a two-armed, parallel-design, patient-assessor blinded, multicenter, randomized, sham-controlled pilot clinical trial. Data will be analyzed before and after treatment and during a 4-week follow-up. The results of the trial will provide a basis for further studies assessing the efficacy and safety of electroacupuncture plus moxibustion treatment for MDD.

Trial registration

Korean Clinical Trial Registry, CRIS-KCT0001810. Registered on 5 February 2016 (retrospectively registered; date of enrollment of the first participant to the trial: 2 December 2015).

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-016-1741-2) contains supplementary material, which is available to authorized users.

Was acupuncture developed by Han Dynasty Chinese anatomists?

Anatomical dissection has begun to reveal striking similarities between gross anatomical structures and the system of nomenclature used in traditional Chinese acupuncture. This paper argues that acupuncture point nomenclature is rooted in systematic anatomical investigation of cadaveric specimens, and that acupuncture points and meridians are purposefully named to reflect observable physical form. Two types of evidence are compared: observations of physical structures based on anatomical dissection, and translation and analysis of original Chinese texts. Evidence is contextualized through in-depth practical understanding of acupuncture. Points designated as [Chinese character] tian (heavenly/superior), [Chinese character] xia (below/inferior), [Chinese character] liao (bone-hole), [Chinese character] fei (flying), [Chinese character] wei (bend), and [Chinese character] xi (mountain stream/ravine) are investigated. These acupuncture point names: (a) specify position; (b) reflect function and/or form; (c) indicate homologous structures; (d) mark unusual structures; and/or (e) describe the physical appearance of a deep (dissected) structure by likening it to a homologous everyday object. Results raise intriguing possibilities for developing an understanding of acupuncture points and meridians firmly based in the material and functional anatomy of the human body. Such an understanding has the potential to open new fields of thought about functional anatomy. It also has implications for future investigations into the mechanisms of acupuncture, and gives some insights into the possible origins of this iconic area of Chinese medicine.

Characterizing heat-sensitization responses in suspended moxibustion with high-density EEG

OBJECTIVE

We have reported "heat-sensitization" responses during suspended moxibustion, whose occurrence is associated with significantly better therapeutic effects. The present study aimed to characterize the electrophysiological features of this interesting phenomenon with high-density electroencephalography (EEG).

METHODS

We performed EEG recording in a group of patients with chronic low back pain before, during, and after moxibustion treatment at DU3.

RESULTS

12 out of 25 subjects experienced strong heat-sensitization during moxibustion, which was accompanied by increased power spectral densities (PSDs) at the theta, alpha, and beta frequency bands. The scalp topographies of averaged power indicated that the theta and beta PSD changes were most obvious in fronto-central regions, whereas those of the alpha band were more global. In addition, nonsensitized and sensitized groups showed distinct activity patterns, with heat-sensitization inducing increased phase coherence at the theta and beta ranges.

CONCLUSIONS

These data were the first objective evidence of heat-sensitization responses during suspended moxibustion, which were characterized by widespread oscillatory changes in scalp EEG.

Efficacy and Safety of Moxibustion for Relieving Pain in Patients With Metastatic Cancer: A Pilot, Randomized, Single-Blind, Sham-Controlled Trial

BACKGROUND

Moxibustion has been traditionally used to manage pain related to chronic diseases, including cancer. This study aims to investigate the efficacy and safety of moxibustion for relieving cancer pain in patients with metastatic cancer.

METHODS

A total of 16 patients were randomly divided into a true moxibustion (TM) group or a sham moxibustion (SM) group. In both groups, moxibustion was applied for 10 minutes, once daily for 7 consecutive days. In the SM group, the moxa cone was removed earlier than in the TM group, so as not to deliver heat stimulation completely into the skin. The changes of pain severity using the Brief Pain Inventory (BPI) and quality of life measured by the Functional Assessment of Cancer Therapy-General (FACT-G) were observed. A blinding credibility test was done to validate the sham moxibustion procedure.

RESULTS

The total BPI score significantly decreased in the TM group compared with the SM group (TM vs SM: -0.97 ± 1.05 vs 0.35 ± 0.60,P= .025). The 2 subsets of BPI, pain intensity score and pain interference score, also significantly decreased in the TM group (TM vs SM: intensity, -0.82 ± 0.93 vs 0.46 ± 0.87,P= .020; interference, -1.12 ± 1.31 vs 0.24 ± 0.61,P= .047). Even after adjusting for the values of opioid consumption, these results remained significant. FACT-G did not significantly improve in the TM group. The blinding to sham moxibustion was credible and no serious adverse events occurred.

CONCLUSION

We suggest that moxibustion could be a safe and potential modality for cancer-related pain in patients with metastatic cancer. With the limitation of small sample size, a larger and long-term follow-up study is necessary to determine more definitely the efficacy of moxibustion.

How do acupuncture and moxibustion act? - Focusing on the progress in Japanese acupuncture research -

The mechanisms of action of acupuncture and moxibustion as reported by Japanese researchers are reviewed. The endogenous opioid-mediated mechanisms of electroacupuncture (EA) as used in China are well understood, but these are only one component of all mechanisms of acupuncture. These studies emphasize the similarity of the analgesic action of EA to various sensory inputs to the pain inhibition mechanisms. In Japanese acupuncture therapy, careful detection of the acupuncture points and fine needling technique with comfortable subjective sensation are considered important. The role of polymodal receptors (PMR) has been stressed based on the facts that PMRs are responsive to both acupuncture and moxibustion stimuli, thermal sensitivity is essential in moxibustion therapy, and the characteristics of acupuncture points and trigger points are similar to those of sensitized PMRs. Acupuncture and moxibustion are also known to affect neurons in the brain reward systems and blood flow in skin, muscle, and nerve. Axon reflexes mediated by PMRs might be a possible mechanism for the immediate action of acupuncture and moxibustion. Reports on the curative effects of acupuncture on various digestive and urological disorders are also reviewed briefly.