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Wang R, Zhu L, Gao H, Zhang M, Fan Y, Lin C, Shen P, Gao H. Dorsomedial hypothalamus-raphe pallidus-cardiac sympathetic pathway mediates electroacupuncture intervention of stress-induced tachycardia. J Neurophysiol 2024; 131:589-597. [PMID: 38416698 DOI: 10.1152/jn.00036.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/20/2024] [Accepted: 02/25/2024] [Indexed: 03/01/2024] Open
Abstract
Electroacupuncture at Neiguan point (PC6) effectively ameliorates tachycardia. However, very little is known about the neural pathway mechanism underlying the effect of electroacupuncture at PC6 in stress-induced tachycardia. Here, we investigate whether there exists a dorsomedial hypothalamus (DMH)-raphe pallidus (RP)-heart pathway to mediate the effect of electroacupuncture at PC6. The virus tracing results show that the heart is innervated by the neurons in DMH and RP, and the neurons of DMH project to RP. Chemogenetic inhibition of RP projecting DMH neurons reverses the cardiac autonomic imbalance and tachycardia induced by stress. Of note, immunofluorescence results show that the neural activity of DMH and RP is inhibited by electroacupuncture at PC6 accompanied with improved cardiac autonomic imbalance and tachycardia under stress. Moreover, chemogenetic inhibition of RP projecting DMH neurons cannot affect autonomic nervous activity and heart rate of stress rats after administrating electroacupuncture at PC6.NEW & NOTEWORTHY Our study suggests that this dorsomedial hypothalamus (DMH)-raphe pallidus (RP)-cardiac sympathetic pathway involves in the improvement of cardiac dysfunction associated with stress by administrating electroacupuncture at PC6, thus providing beneficial information for the development of therapeutic strategies to prevent stress-induced cardiovascular diseases, and insight into neural pathway basis for electroacupuncture at PC6 intervention of cardiac dysfunction.
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Affiliation(s)
- Ruwen Wang
- School of Acupuncture and Tuina, Anhui University of Chinese Medicine, Hefei, People's Republic of China
| | - Li Zhu
- School of Acupuncture and Tuina, Anhui University of Chinese Medicine, Hefei, People's Republic of China
| | - Heyuan Gao
- Department of Pediatrics, The First Hospital of Qinhuangdao, Qinhuangdao, People's Republic of China
| | - Mengting Zhang
- Department of Integrated Traditional Chinese and Western Medicine, Anhui University of Chinese Medicine, Hefei, People's Republic of China
- CAS Key Laboratory of Brain Function and Disease, and School of Life Sciences, University of Science Technology of China, Hefei, People's Republic of China
| | - Yuyang Fan
- School of Acupuncture and Tuina, Anhui University of Chinese Medicine, Hefei, People's Republic of China
| | - Chuanbo Lin
- School of Acupuncture and Tuina, Anhui University of Chinese Medicine, Hefei, People's Republic of China
| | - Ping Shen
- School of Acupuncture and Tuina, Anhui University of Chinese Medicine, Hefei, People's Republic of China
| | - Heren Gao
- School of Acupuncture and Tuina, Anhui University of Chinese Medicine, Hefei, People's Republic of China
- Research Institute of Acupuncture and Meridian, Anhui Academy of Chinese Medicine, Hefei, People's Republic of China
- Anhui Province Key Laboratory of Meridian Viscera Correlationship, Hefei, People's Republic of China
- CAS Key Laboratory of Brain Function and Disease, and School of Life Sciences, University of Science Technology of China, Hefei, People's Republic of China
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2
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Maharjan A, Peng M, Russell B, Cakmak YO. Investigation of the Optimal Parameters of Median Nerve Stimulation, Using a Variety of Stimulation Methods, and Its Effects on Heart Rate Variability: A Systematic Review. Neuromodulation 2022; 25:1268-1279. [DOI: 10.1016/j.neurom.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 11/30/2022]
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3
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Maharjan A, Peng M, Cakmak YO. The effects of frequency-specific, non-invasive, median nerve stimulation on food-related attention and appetite. Appetite 2021; 169:105807. [PMID: 34798222 DOI: 10.1016/j.appet.2021.105807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 11/11/2021] [Accepted: 11/12/2021] [Indexed: 12/17/2022]
Abstract
Median nerve stimulation (MNS) in the existing literature has been used for treating gastrointestinal disorders and amelioration of nausea and vomiting. Recently, studies have shown that MNS can also exert effects on olfactory performances and corresponding anatomical regions through the activation of vagal pathways. This study aimed to test effects of specific frequencies of MNS on food-related attention and appetite. The experiment used an odourised, dot probe task for testing food-related attention and a combination of behavioural (i.e., visual analogue scales; VAS) and physiological approaches (i.e., electrocardiograph; ECG - root mean square of successive differences between normal heartbeats-RMSSD: parasympathetic nervous system activation (RMSSD), stress index-SI: sympathetic nervous system activation) for measuring hunger, appetite, and satiation. Twenty-four healthy, male adults completed a VAS and dot probe task before and after receiving either 40 Hz-, 80 Hz-, 120 Hz MNS or sham (control) across four different sessions with continuous ECG recording throughout each session. Data from the dot probe task were analysed using repeated-measures ANOVA, while pair-wise tests were used for ECG recordings and VAS. Improvements on the dot probe task, not specific to odour-food congruence were found after 40 Hz MNS (p-value = 0.048; strong effect size (0.308 partial eta squared)) while increased ratings of hunger (VAS) (p-value = 0.03, small effect size (0.47 Cohen-D)) and RMSSD scores (p-value < 0.001; medium effect size (0.76 Cohen-D)) were found after 120 Hz MNS. These findings implore further testing of MNS frequency parameters on improving RMSSD, a characteristic marker of measuring parasympathetic/autonomic nervous system activation pertaining to the vagal network. Furthermore, improving sympathovagal balance is associated with cardiovascular benefits in numerous health-related conditions such as obesity, hypertension and diabetes.
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Affiliation(s)
- Ashim Maharjan
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Mei Peng
- Sensory Neuroscience Laboratory, Department of Food Science, University of Otago, Dunedin, New Zealand
| | - Yusuf O Cakmak
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand; Brain Health Research Centre, Dunedin, New Zealand; Medical Technologies Centre of Research Excellence, Auckland, New Zealand.
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Fan H, Yang JW, Wang LQ, Huang J, Lin LL, Wang Y, Zhang N, Liu CZ. The Hypotensive Role of Acupuncture in Hypertension: Clinical Study and Mechanistic Study. Front Aging Neurosci 2020; 12:138. [PMID: 32523527 PMCID: PMC7261879 DOI: 10.3389/fnagi.2020.00138] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 04/23/2020] [Indexed: 01/03/2023] Open
Abstract
As a component of traditional Chinese medicine (TCM), acupuncture has the potential to lower blood pressure (BP) in patients with hypertension. Emerging evidence indicates that the acupuncture-induced inhibition of high BP occurs through the activation of the pathway in the afferent, central, and efferent pathways. An increasing number of studies have demonstrated that acupuncture not only activates distinct brain regions under conditions of hypertension caused by an imbalance between the sympathetic and parasympathetic systems but also modulates neurotransmitters in related brain regions to alleviate the autonomic response. The activity of these pathways can be assessed by injecting agonists or inhibitors or by performing neurotomy. This review focuses on the clinical and mechanistic studies of acupuncture in modulating BP, which might provide a neurobiological foundation for the effects of acupuncture. Although many mechanisms underlying the effects of acupuncture on cardiovascular function have been identified, further investigation is warranted.
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Affiliation(s)
- Hao Fan
- Acupuncture Research Center, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China.,Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing, China
| | - Jing-Wen Yang
- Acupuncture Research Center, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Li-Qiong Wang
- Acupuncture Research Center, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Jin Huang
- Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing, China
| | - Lu-Lu Lin
- Acupuncture Research Center, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Yu Wang
- Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing, China
| | - Na Zhang
- School of Acupuncture-Moxibustion and Tuina, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Cun-Zhi Liu
- Acupuncture Research Center, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
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Guo ZL, Malik S. Acupuncture activates a direct pathway from the nucleus tractus solitarii to the rostral ventrolateral medulla. Brain Res 2019; 1708:69-77. [PMID: 30529283 PMCID: PMC6378112 DOI: 10.1016/j.brainres.2018.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 11/05/2018] [Accepted: 12/05/2018] [Indexed: 12/12/2022]
Abstract
Our previous studies have shown that electroacupuncture (EA) at the Jianshi-Neiguan acupoints (P5-6, overlying the median nerve) attenuates sympathoexcitatory responses through its influence on neuronal activity in the rostral ventrolateral medulla (rVLM). The nucleus tractus solitarii (NTS) receives input from somatic nerve stimulation. Connections between the NTS and the rVLM during EA stimulation have not been investigated and thus were the focus of the present study. Seven to ten days after unilateral microinjection of a rhodamine-conjugated microsphere retrograde tracer (100 nl) into the rVLM, rats were subjected to EA or sham-EA without electrical stimulation. EA was performed for 30 min at the P5-6 acupoints bilaterally. Perikarya containing the microsphere tracer were found in the NTS of both groups. Compared to controls (needle placement without electrical stimulation, n = 7), c-Fos immunoreactivity and neurons double-labeled with c-Fos, an immediate early gene, and the tracer were significantly increased in the NTS of EA-treated rats (all P < 0.05; n = 8), particularly, in the medial and lateral subdivisions of NTS at subpostremal and obex levels. These results suggest that EA at the P5-6 acupoints activates NTS neurons. Furthermore, EA-activated NTS neurons directly project to the rVLM and likely influence the rVLM activity.
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Affiliation(s)
- Zhi-Ling Guo
- Department of Medicine and Susan Samueli Integrative Health Institute, School of Medicine, University of California, Irvine, Irvine, CA 92697, USA.
| | - Shaista Malik
- Department of Medicine and Susan Samueli Integrative Health Institute, School of Medicine, University of California, Irvine, Irvine, CA 92697, USA
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Min S, Kim KW, Jung WM, Lee MJ, Kim YK, Chae Y, Lee H, Park HJ. Acupuncture for Histamine-Induced Itch: Association With Increased Parasympathetic Tone and Connectivity of Putamen-Midcingulate Cortex. Front Neurosci 2019; 13:215. [PMID: 30914919 PMCID: PMC6423085 DOI: 10.3389/fnins.2019.00215] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 02/25/2019] [Indexed: 12/19/2022] Open
Abstract
Previous studies have suggested that acupuncture is effective for ameliorating itch intensity. However, factors associated with the antipruritic effects of acupuncture have yet to be clarified. In a randomized, sham-controlled, crossover trial, we investigated the antipruritic effects of acupuncture against histamine-induced itch in healthy volunteers. Autonomic changes using heart rate variability (HRV) and brain connectivity using functional magnetic resonance imaging (fMRI) were also assessed to identify physiological factors associated with the acupuncture response. Acupuncture significantly reduced itch intensity and skin blood perfusion as assessed by laser Doppler perfusion imaging compared to sham control, indicating the antipruritic effects of acupuncture. In responder and non-responder analysis, the power of normalized high frequency (HF norm) was significantly higher, while the power of normalized low frequency (LF norm) and LF/HF ratio were significantly lower in responders compared to non-responders, suggesting the acupuncture response involved parasympathetic activation. In fMRI analysis, the putamen and the posterior part of the midcingulate cortex (pMCC) were positively connected to itch and negatively correlated with itch intensity in responders. These results suggest that parasympathetic activity and functional connectivity of the putamen and pMCC could be associated with antipruritic response to acupuncture.
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Affiliation(s)
- Seorim Min
- Department of Science in Korean Medicine, Graduate School, College of Korean Medicine, Kyung Hee University, Seoul, South Korea.,Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, South Korea
| | - Koh-Woon Kim
- Department of Korean Rehabilitation Medicine, College of Korean Medicine, Kyung Hee University, Seoul, South Korea.,East-West Medical Research Institute, Kyung Hee University, Seoul, South Korea
| | - Won-Mo Jung
- Department of Science in Korean Medicine, Graduate School, College of Korean Medicine, Kyung Hee University, Seoul, South Korea.,Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, South Korea
| | - Min-Jung Lee
- Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, South Korea
| | - Yu-Kang Kim
- Department of Science in Korean Medicine, Graduate School, College of Korean Medicine, Kyung Hee University, Seoul, South Korea.,Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, South Korea
| | - Younbyoung Chae
- Department of Science in Korean Medicine, Graduate School, College of Korean Medicine, Kyung Hee University, Seoul, South Korea.,Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, South Korea
| | - Hyangsook Lee
- Department of Science in Korean Medicine, Graduate School, College of Korean Medicine, Kyung Hee University, Seoul, South Korea.,Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, South Korea
| | - Hi-Joon Park
- Department of Science in Korean Medicine, Graduate School, College of Korean Medicine, Kyung Hee University, Seoul, South Korea.,Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, South Korea
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7
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Tjen-A-Looi SC, Fu LW, Guo ZL, Longhurst JC. Modulation of Neurally Mediated Vasodepression and Bradycardia by Electroacupuncture through Opioids in Nucleus Tractus Solitarius. Sci Rep 2018; 8:1900. [PMID: 29382866 PMCID: PMC5789879 DOI: 10.1038/s41598-018-19672-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 01/04/2018] [Indexed: 11/29/2022] Open
Abstract
Stimulation of vagal afferent endings with intravenous phenylbiguanide (PBG) causes both bradycardia and vasodepression, simulating neurally mediated syncope. Activation of µ-opioid receptors in the nucleus tractus solitarius (NTS) increases blood pressure. Electroacupuncture (EA) stimulation of somatosensory nerves underneath acupoints P5–6, ST36–37, LI6–7 or G37–39 selectively but differentially modulates sympathoexcitatory responses. We therefore hypothesized that EA-stimulation at P5–6 or ST36–37, but not LI6–7 or G37–39 acupoints, inhibits the bradycardia and vasodepression through a µ-opioid receptor mechanism in the NTS. We observed that stimulation at acupoints P5–6 and ST36–37 overlying the deep somatosensory nerves and LI6–7 and G37–39 overlying cutaneous nerves differentially evoked NTS neural activity in anesthetized and ventilated animals. Thirty-min of EA-stimulation at P5–6 or ST36–37 reduced the depressor and bradycardia responses to PBG while EA at LI6–7 or G37–39 did not. Congruent with the hemodynamic responses, EA at P5–6 and ST36–37, but not at LI6–7 and G37–39, reduced vagally evoked activity of cardiovascular NTS cells. Finally, opioid receptor blockade in the NTS with naloxone or a specific μ-receptor antagonist reversed P5–6 EA-inhibition of the depressor, bradycardia and vagally evoked NTS activity. These data suggest that point specific EA stimulation inhibits PBG-induced vasodepression and bradycardia responses through a μ-opioid mechanism in the NTS.
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Affiliation(s)
- Stephanie C Tjen-A-Looi
- Susan Samueli Integrative Health Institute, School of Medicine, University of California, Irvine, CA, 92697-4075, USA.
| | - Liang-Wu Fu
- Susan Samueli Integrative Health Institute, School of Medicine, University of California, Irvine, CA, 92697-4075, USA
| | - Zhi-Ling Guo
- Susan Samueli Integrative Health Institute, School of Medicine, University of California, Irvine, CA, 92697-4075, USA
| | - John C Longhurst
- Susan Samueli Integrative Health Institute, School of Medicine, University of California, Irvine, CA, 92697-4075, USA
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Longhurst JC, Tjen-A-Looi SC. Evidence-based blood pressure reducing actions of electroacupuncture: mechanisms and clinical application. SHENG LI XUE BAO : [ACTA PHYSIOLOGICA SINICA] 2017; 69:587-597. [PMID: 29063107 PMCID: PMC6033058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Hypertension is a serious world-wide health problem as it increases cardiovascular atherosclerotic risk, stroke and attending morbidity and mortality. Both systolic and diastolic blood pressures and particularly systolic pressure increase with aging. The downsides from pharmacological therapy have led to consideration of additional treatments, including acupuncture, which evokes endogenous neural-hormonal systems to lower blood pressure. Using basic science studies to guide clinical approaches to research, it is apparent that low frequency, low intensity electroacupuncture reduces sympathetic outflow in approximately 70% of patients with mild to moderate hypertension who are off antihypertensive drugs. Systolic and, to a lesser extent, diastolic arterial blood pressures can be lowered over two to four weeks for prolonged periods, lasting as long as one month, after cessation of an eight weeks of once weekly stimulation. Many questions about long-term therapy, treatment of resistant patients and efficacy in patients on medication remain to be studied. Current data, however, suggest that there may be a role of acupuncture in treatment of hypertension.
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Affiliation(s)
- John C Longhurst
- Susan Samueli Center for Integrative Medicine; Departments of Medicine, Physiology and Biophysics and Pharmacology, University of California, Irvine, Irvine, CA 92697, USA.
| | - Stephanie C Tjen-A-Looi
- Susan Samueli Center for Integrative Medicine; Departments of Medicine, Physiology and Biophysics and Pharmacology, University of California, Irvine, Irvine, CA 92697, USA
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10
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Electroacupuncture Alleviates Headache and Reduces Cerebral Blood Flow Velocity in Aneurysmal Subarachnoid Hemorrhage. Med Acupunct 2016. [DOI: 10.1089/acu.2015.1127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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11
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Cheng L, Li P, Tjen-A-Looi SC, Longhurst JC. What do we understand from clinical and mechanistic studies on acupuncture treatment for hypertension? Chin Med 2015; 10:36. [PMID: 26628909 PMCID: PMC4666174 DOI: 10.1186/s13020-015-0070-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 11/20/2015] [Indexed: 11/25/2022] Open
Abstract
The outcome of acupuncture on hypertension treatment is inconclusive. This study aims to evaluate the influence of acupuncture on hypertension, based on findings from mechanistic studies over the course of decades particularly those conducted at the University of California, Irvine. Low-current and low-frequency electroacupuncture (EA) at P5-6 (overlying the median nerve) and S36-37 (overlying the deep peroneal nerve) reduced high blood pressure in a subset of patients (~70 %) with mild-to-moderate hypertension, in a slow-onset (4-8 weeks) but long-lasting (1-2 months) manner. EA inhibited cardiovascular sympathoexcitatory neurons through activation of neurons in the arcuate nucleus of the hypothalamus, the ventrolateral periaqueductal gray in the midbrain and the nucleus raphe pallidus in the medulla, through inhibiting the activity of premotor sympathetic neurons in the rostral ventrolateral medulla (rVLM). Several neurotransmitters such as glutamate, acetylcholine, opioids, GABA, nociceptin, serotonin and endocannabinoids were involved in this EA-induced hypotensive response. The long-lasting inhibition of hypertension induced by EA was related to opioids and GABA in the rVLM, neural circuitry between the arcuate and ventrolateral periaqueductal gray, and prolongation of the increase in preproenkephalin mRNA levels and enkephalin levels in the rVLM and arcuate. Moreover, the long-lasting inhibition of sympathetic activity by EA was confirmed in EA-treated hypertensive patients with decreased levels of norepinephrine, renin and aldosterone.
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Affiliation(s)
- Ling Cheng
- />Department of Acupuncture, East Hospital, Shanghai, China
| | - Peng Li
- />Susan-Samueli Center for Integrative Medicine, School of Medicine, University of California, Irvine, USA
| | | | - John Charles Longhurst
- />Susan-Samueli Center for Integrative Medicine, School of Medicine, University of California, Irvine, USA
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Tjen-A-Looi SC, Guo ZL, Longhurst JC. GABA in nucleus tractus solitarius participates in electroacupuncture modulation of cardiopulmonary bradycardia reflex. Am J Physiol Regul Integr Comp Physiol 2014; 307:R1313-23. [PMID: 25231352 PMCID: PMC4254943 DOI: 10.1152/ajpregu.00300.2014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 09/16/2014] [Indexed: 11/22/2022]
Abstract
Phenylbiguanide (PBG) stimulates cardiopulmonary receptors and cardiovascular reflex responses, including decreases in blood pressure and heart rate mediated by the brain stem parasympathetic cardiac neurons in the nucleus ambiguus and nucleus tractus solitarius (NTS). Electroacupuncture (EA) at P5-6 stimulates sensory fibers in the median nerve and modulates these reflex responses. Stimulation of median nerves reverses bradycardia through action of γ-aminobutyric acid (GABA) in the nucleus ambiguus, important in the regulation of heart rate. We do not know whether the NTS or the neurotransmitter mechanisms in this nucleus participate in these modulatory actions by acupuncture. We hypothesized that somatic nerve stimulation during EA (P5-6) modulates cardiopulmonary inhibitory responses through a GABAergic mechanism in the NTS. Anesthetized and ventilated cats were examined during either PBG or direct vagal afferent stimulation while 30 min of EA was applied at P5-6. Reflex heart rate and blood pressure responses and NTS-evoked discharge were recorded. EA reduced the PBG-induced depressor and bradycardia reflexes by 67% and 60%, respectively. Blockade of GABAA receptors in the NTS reversed EA modulation of bradycardia but not the depressor response. During EA, gabazine reversed the vagally evoked discharge activity of cardiovascular NTS neurons. EA modulated the vagal-evoked cardiovascular NTS cellular activity for 60 min. Immunohistochemistry using triple labeling showed GABA immunoreactive fibers juxtaposed to glutamatergic nucleus ambiguus-projecting NTS neurons in rats. These glutamatergic neurons expressed GABAA receptors. These findings suggest that EA inhibits PBG-evoked bradycardia and vagally evoked NTS activity through a GABAergic mechanism, likely involving glutamatergic nucleus ambiguus-projecting NTS neurons.
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Affiliation(s)
- Stephanie C Tjen-A-Looi
- Susan Samueli Center for Integrative Medicine, School of Medicine, University of California, Irvine, California
| | - Zhi-Ling Guo
- Susan Samueli Center for Integrative Medicine, School of Medicine, University of California, Irvine, California
| | - John C Longhurst
- Susan Samueli Center for Integrative Medicine, School of Medicine, University of California, Irvine, California
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13
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Aquino CI, Nori SL. Complementary therapy in polycystic ovary syndrome. Transl Med UniSa 2014; 9:56-65. [PMID: 24809037 PMCID: PMC4012377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 03/24/2014] [Indexed: 10/27/2022] Open
Abstract
Polycystic Ovary Syndrome (PCOS) is an endocrine disease. PCOS afflicts 5 to 10 % of women of reproductive age. The symptoms are: amenorrhea, oligomenorrhea, hirsutism, obesity, infertility, chronic hyperandrogenic anovulation and acne. OTHER RISK FACTORS AGGRAVATE THIS CONDITION insulin resistance, obesity, hypertension, dyslipidemia, inflammation and subclinical cardiovascular disease. Anxiety, depression and reduced quality of life are also common. This review highlights the mechanisms and the beneficial effects of acupuncture, exercise and resveratrol on animal models and on humans affected by PCOS.
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Effects of Acupuncture on 1-Chloro-2,4-dinitrochlorobenzene-Induced Atopic Dermatitis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:982095. [PMID: 23997805 PMCID: PMC3755411 DOI: 10.1155/2013/982095] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 07/03/2013] [Accepted: 07/05/2013] [Indexed: 11/18/2022]
Abstract
Though the effects of acupuncture in atopic dermatitis have been proven in clinical studies, its mechanism remains unclear. In this study, we investigate the effectiveness and mechanism of action for acupuncture treatment on the LI11 meridian point for treatment of allergic contact dermatitis. BALB/c mice received 1-chloro-2,4-dinitrobenzene (DNCB) application to induce skin inflammation. Acupuncture treatment on LI11 significantly inhibited cutaneous hyperplasia, serum IgE levels, and expression of proinflammatory cytokine (IL-4, IL-8, and TNF- α ) mRNA and NF- κ B, ERK1/2, JNK, and p38 proteins. Acupuncture treatment of local points also inhibited cutaneous hyperplasia and serum IgE levels; however, it was not effective in regulating proinflammatory cytokines and proteins. In addition, LI11 treatment is more effective at reducing serum IgE levels and pro-inflammatory cytokines and proteins than local point treatment. These results suggest that acupuncture treatment is effective in alleviating allergic contact dermatitis by reducing pro-inflammatory cytokines and proteins.
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Acupuncture effect and central autonomic regulation. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:267959. [PMID: 23762116 PMCID: PMC3677642 DOI: 10.1155/2013/267959] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 04/03/2013] [Accepted: 04/03/2013] [Indexed: 02/07/2023]
Abstract
Acupuncture is a therapeutic technique and part of traditional Chinese medicine (TCM). Acupuncture has clinical efficacy on various autonomic nerve-related disorders, such as cardiovascular diseases, epilepsy, anxiety and nervousness, circadian rhythm disorders, polycystic ovary syndrome (PCOS) and subfertility. An increasing number of studies have demonstrated that acupuncture can control autonomic nerve system (ANS) functions including blood pressure, pupil size, skin conductance, skin temperature, muscle sympathetic nerve activities, heart rate and/or pulse rate, and heart rate variability. Emerging evidence indicates that acupuncture treatment not only activates distinct brain regions in different kinds of diseases caused by imbalance between the sympathetic and parasympathetic activities, but also modulates adaptive neurotransmitter in related brain regions to alleviate autonomic response. This review focused on the central mechanism of acupuncture in modulating various autonomic responses, which might provide neurobiological foundations for acupuncture effects.
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Abstract
Over the last several decades, there has been an explosion of articles on acupuncture, including studies that have begun to explore mechanisms underlying its analgesic and cardiovascular actions. Modulation of cardiovascular function is most effective during manual and low-frequency, low-intensity electroacupuncture (EA) at a select set of acupoints situated along meridians located over deep somatic nerves on the upper and lower extremities. Stimulation at these acupoints activates underlying sensory neural pathways that project to a number of regions in the central nervous system (CNS) that ultimately regulate autonomic outflow and hence cardiovascular function. A long-loop pathway involving the hypothalamus, midbrain, and medulla underlies EA modulation of reflex increases in blood pressure (BP). Actions of excitatory and inhibitory neurotransmitters in the supraspinal CNS underlie processing of the somatic input and adjustment of autonomic outflow during EA. Acupuncture also decreases elevated blood pressure through actions in the thoracic spinal cord. Reflexes that lower BP likewise are modulated by EA through its actions on sympathetic and parasympathetic nuclei in the medulla. The autonomic influence of acupuncture is slow in onset but prolonged in duration, typically lasting beyond the period of stimulation. Clinical studies suggest that acupuncture can be used to treat cardiac diseases, such as myocardial ischemia and hypertension, associated with overactivity of the sympathetic nervous system.
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Affiliation(s)
- John Longhurst
- Samueli Center for Integrative Medicine, University of California, Irvine , Irvine, CA
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Lee EJ, Warden S. The Effect of Acupressure on Chemotherapy-induced Nausea. EVIDENCE-BASED NON-PHARMACOLOGICAL THERAPIES FOR PALLIATIVE CANCER CARE 2013. [DOI: 10.1007/978-94-007-5833-9_4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Benharash P, Zhou W. Neuromodulation in treatment of hypertension by acupuncture: A neurophysiological prospective. Health (London) 2013. [DOI: 10.4236/health.2013.54a009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Longhurst JC, Tjen-A-Looi S. Acupuncture regulation of blood pressure: two decades of research. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2013; 111:257-71. [PMID: 24215927 DOI: 10.1016/b978-0-12-411545-3.00013-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Although mechanisms underlying acupuncture regulation of pain have been studied by a number of laboratories in many countries, much less is known about its ability to modulate cardiovascular function. In the last two decades, our laboratory has systematically investigated the peripheral and central neural mechanisms underlying acupuncture regulation of blood pressure. These observations account for acupuncture's distant actions and, to some extent, its local actions, with respect to the site of needling. Four fundamental findings have advanced our knowledge. First, point-specific effects of acupuncture underlie its cardiovascular actions. Second, variable regions in the supraspinal and spinal central nervous system that receive input from somatic afferent stimulation account for acupuncture's ability to modulate blood pressure. Thus, depending on the underlying situation, for example, high or low blood pressure, acupuncture modifies autonomic outflow by reducing activity in brain stem nuclei that participate in the primary response. Third, repetitive acupuncture through a molecular mechanism can cause prolonged cardiovascular effects that far outlast acupuncture stimulation. Fourth, there is a range of cardiovascular responsiveness to acupuncture that depends, at least in part, on interactions between neural modulators that synaptically regulate autonomic function in the brain stem. Thus, acupuncture has the capability of profoundly regulating cardiovascular function in patients with disease, for example, hypertension, and the experimental laboratory is directing best approaches to study its actions in humans.
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Affiliation(s)
- John C Longhurst
- Department of Medicine, Physiology and Biophysics, and Pharmacology, School of Medicine, University of California, Medical Sciences, Irvine, California, USA.
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Li P, Tjen-A-Looi SC. Mechanism of the inhibitory effect of electroacupuncture on experimental arrhythmias. J Acupunct Meridian Stud 2012; 6:69-81. [PMID: 23591002 DOI: 10.1016/j.jams.2012.11.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 09/21/2012] [Indexed: 01/21/2023] Open
Abstract
Clinical observations reported that acupuncture can alleviate several kinds of arrhythmias. To explore its efficacy and mechanism, we have studied the electroacupuncture (EA) inhibition on experimental arrhythmias in rabbits since 1980s and analyzed its mechanism. These studies were mostly conducted in the Department of Physiology, Shanghai Medical University; recently the mechanism of acupuncture's effect on arrhythmias was analyzed in the School of Medicine, University of California, Irvine, which involves the following: (1)the inhibitory effect of EA on ventricular extrasystoles can be induced by hypothalamic defense area stimulation: a low-current and low-frequency stimulation of the median nerve underneath acupoints P 5 or deep peroneal nerve underneath S 36 can activate arcuate nucleus-ventral periaqueductal gray -nuclei raphe pathway and release endorphin, enkephaline, gamma-aminobutyric acid (GABA), 5-hydroxytryptamine (5-HT), etc., thus inhibiting the rostral ventrolateral medulla (rVLM), decreasing sympathetic outflow, and alleviating ventricular extrasystoles; (2) the bradycardia induced by stimulation of aortic depressor nerve can be blocked by stimulation of superficial radial nerve (underneath LI 6-7) or superficial peroneal nerve (underneath G37-39): these stimulations activate the rVLM release opioids and GABA to inhibit nucleus tractus solitarius and vagal nuclei, and block vagal bradycardia. These experimental data explore the mechanism of acupuncture's effect on arrhythmias and are useful for clinical application.
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Affiliation(s)
- Peng Li
- School of Medicine, University of California, Irvine, CA 92697, USA.
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Pfab F, Kirchner MT, Huss-Marp J, Schuster T, Schalock PC, Fuqin J, Athanasiadis GI, Behrendt H, Ring J, Darsow U, Napadow V. Acupuncture compared with oral antihistamine for type I hypersensitivity itch and skin response in adults with atopic dermatitis: a patient- and examiner-blinded, randomized, placebo-controlled, crossover trial. Allergy 2012; 67:566-73. [PMID: 22313287 DOI: 10.1111/j.1398-9995.2012.02789.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2011] [Indexed: 12/14/2022]
Abstract
BACKGROUND Itch is the major symptom of atopic dermatitis (AD). Acupuncture has been shown to exhibit a significant effect on experimental itch in AD. Our study evaluated acupuncture and antihistamine itch therapy (cetirizine) on type I hypersensitivity itch and skin reaction in AD using a patient and examiner-blinded, randomized, placebo-controlled, crossover trial. METHODS Allergen-induced itch was evaluated in 20 patients with AD after several interventions in separate sessions: preventive (preceding) and abortive (concurrent) verum acupuncture (VAp and VAa), cetirizine (10 mg, VC), corresponding placebo interventions (preventive, PAp, and abortive, PAa, placebo acupuncture; placebo cetirizine pill, PC) and a no-intervention control (NI). Itch was induced on the forearm and temperature modulated over 20 min, using our validated model. Outcome parameters included itch intensity, wheal and flare size and the D2 attention test. RESULTS Mean itch intensity (SE: 0.31 each) was significantly lower following VAa (31.9) compared with all other groups (PAa: 36.5; VC: 36.8; VAp: 37.6; PC: 39.8; PAp: 39.9; NI: 45.7; P < 0.05). There was no significant difference between VAp and VC (P > 0.1), although both therapies were significantly superior to their respective placebo interventions (P < 0.05). Flare size following VAp was significantly smaller (P = 0.034) than that following PAp. D2 attention test score was significantly lower following VC compared with all other groups (P < 0.001). CONCLUSIONS Both VA and cetirizine significantly reduced type I hypersensitivity itch in patients with AD, compared with both placebo and NI. Timing of acupuncture application was important, as VAa had the most significant effect on itch, potentially because of counter-irritation and/or distraction. Itch reduction following cetirizine coincided with reduced attention.
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Affiliation(s)
| | - M.-T. Kirchner
- Division of Environmental Dermatology and Allergy; Helmholtz Zentrum München/TUM; ZAUM-Center for Allergy and Environment; Munich; Germany
| | | | - T. Schuster
- Institute for Medical Statistics and Epidemiology; Technische Universität München; Munich; Germany
| | - P. C. Schalock
- Department of Dermatology; Harvard Medical School; Massachusetts General Hospital; Boston; MA; USA
| | | | - G. I. Athanasiadis
- Department of Dermatology and Allergy; Technische Universität München; Munich; Germany
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Tjen-A-Looi SC, Li P, Li M, Longhurst JC. Modulation of cardiopulmonary depressor reflex in nucleus ambiguus by electroacupuncture: roles of opioids and γ-aminobutyric acid. Am J Physiol Regul Integr Comp Physiol 2012; 302:R833-44. [PMID: 22204951 PMCID: PMC3330773 DOI: 10.1152/ajpregu.00440.2011] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Accepted: 12/23/2011] [Indexed: 11/22/2022]
Abstract
Stimulation of cardiopulmonary receptors with phenylbiguanide (PBG) elicits depressor cardiovascular reflex responses, including decreases in blood pressure and heart rate mediated in part by the brain stem parasympathetic cardiac neurons in the nucleus ambiguus (NAmb). The present study examined NAmb neurotransmitter mechanisms underlying the influence of electroacupuncture (EA) on the PBG-induced hypotension and bradycardia. We hypothesized that somatic stimulation during EA modulates PBG responses through opioid and γ-aminobutyric acid (GABA) modulation in the NAmb. Anesthetized and ventilated cats were studied during repeated stimulation with PBG or cardiac vagal afferents while low-frequency EA (2 Hz) was applied at P5-6 acupoints overlying the median nerve for 30 min and NAmb neuronal activity, heart rate, and blood pressure were recorded. Microinjection of kainic acid into the NAmb attenuated the PBG-induced bradycardia from -60 ± 11 to -36 ± 11 beats/min. Likewise, EA reduced the PBG-induced depressor and bradycardia reflex by 52 and 61%, respectively. Cardiac vagal afferent evoked preganglionic cellular activity in the NAmb was reduced by EA for about 60 min. Blockade of opioid or GABA(A) receptors using naloxone and gabazine reversed the EA-related modulation of the evoked cardiac vagal activity by 73 and 53%, respectively. Similarly, naloxone and gabazine reversed EA modulation of the negative chronotropic responses from -11 ± 5 to -23 ± 6 and -13 ± 4 to -24 ± 3 beats/min, respectively. Thus EA at P5-6 decreases PBG evoked hypotension and bradycardia as well as the NAmb PBG-sensitive preganglionic cardiac vagal outflow through opioid and GABA neurotransmitter systems.
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Li J, Li J, Chen Z, Liang F, Wu S, Wang H. The influence of PC6 on cardiovascular disorders: a review of central neural mechanisms. Acupunct Med 2012; 30:47-50. [PMID: 22378585 PMCID: PMC3298663 DOI: 10.1136/acupmed-2011-010060] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2012] [Indexed: 11/26/2022]
Abstract
PC6 is a classic acupuncture point in traditional Chinese medicine. It is considered to be effective when treating cardiovascular disorders. In the present review the authors have focused on the neurophysiological bases of the effects of PC6 stimulation on cardiovascular mechanisms. Experimental studies have shown that the hypothalamic rostral ventrolateral medulla, arcuate nucleus and ventrolateral periaqueductal gray are involved in acupuncture attenuation of sympathoexcitatory cardiovascular reflex responses. This long-loop pathway also appears to contribute to the long-lasting, acupuncture-mediated attenuation of sympathetic premotor outflow and excitatory cardiovascular reflex responses. Acupuncture of PC6 modulates the activity in the cardiovascular system, an effect that may be attributed to attenuation of sympathoexcitatory cardiovascular reflex responses.
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Affiliation(s)
- Jia Li
- Department of Acupuncture and Moxibustion, Hubei University of Chinese Medicine, Wuhan, China
| | - Jing Li
- Department of Traditional Chinese Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zebin Chen
- Department of Acupuncture and Moxibustion, Hubei University of Chinese Medicine, Wuhan, China
| | - Fengxia Liang
- Department of Acupuncture and Moxibustion, Hubei University of Chinese Medicine, Wuhan, China
| | - Song Wu
- Department of Acupuncture and Moxibustion, Hubei University of Chinese Medicine, Wuhan, China
| | - Hua Wang
- Department of Acupuncture and Moxibustion, Hubei University of Chinese Medicine, Wuhan, China
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Pain modulation by meditation and electroacupuncture in experimental submaximum effort tourniquet technique (SETT). Explore (NY) 2012; 7:239-45. [PMID: 21724157 DOI: 10.1016/j.explore.2011.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Indexed: 11/20/2022]
Abstract
CONTEXT Although acupuncture and meditation are widely utilized in the clinical treatment of pain, trials to evaluate their efficacy and modes of action under experimental conditions have yielded equivocal results. OBJECTIVE This feasibility study investigated whether electroacupuncture (EA) and meditation effectively relieve pain within a well-established ischemic pain paradigm (submaximum effort tourniquet technique, SETT). DESIGN In this semirandomized trial, experienced meditators were compared with nonmeditators. The nonmeditating subjects were randomly assigned to either an EA group or a nontreatment group. SETTING The trial was conducted at the Department of Complementary and Integrative Medicine, University of Duisburg-Essen, Essen, Germany. PARTICIPANTS Eight Vipassana meditators (mean experience hours = 2,626.8 ± 1,602.3 hours SD) and 40 control subjects were enrolled. INTERVENTIONS SETT (250 mm Hg, time limit = 30 minutes, pain rating limit = 10) was applied twice (baseline vs treatment) on the nondominant arm; EA was applied to the contralateral acupoints LI4 and LI10 (stimulation 20 minutes prior to and throughout the SETT); meditators were asked to meditate throughout the whole experimental procedure. MAIN OUTCOME MEASURE Pain ratings were obtained every three minutes on a numerical rating scale (0-10). The ratio of the tolerated time to the ratings served as the pain tolerance index. RESULTS At baseline, meditators exhibited significantly greater pain tolerance than the other two groups. During the second or treatment session, pain sensitivity did not change significantly in the nontreatment group, whereas pain tolerance significantly increased and pain ratings decreased to the level of meditation-induced analgesia in the EA group. Electroacupuncture induced no additional pain control benefit for meditators.
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Guo ZL, Li M, Longhurst JC. Nucleus ambiguus cholinergic neurons activated by acupuncture: relation to enkephalin. Brain Res 2012; 1442:25-35. [PMID: 22306033 DOI: 10.1016/j.brainres.2012.01.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 12/23/2011] [Accepted: 01/04/2012] [Indexed: 11/27/2022]
Abstract
Acupuncture regulates autonomic function. Our previous studies have shown that electroacupuncture (EA) at the Jianshi-Neiguan acupoints (P5-P6, underlying the median nerve) inhibits central sympathetic outflow and attenuates excitatory cardiovascular reflexes, in part, through an opioid mechanism. It is unknown if EA at these acupoints influences the parasympathetic system. Thus, using c-Fos expression, we examined activation of nucleus ambiguus (NAmb) neurons by EA, their relation to cholinergic (preganglionic parasympathetic) neurons and those containing enkephalin. To enhance detection of cell bodies containing enkephalin, colchicine (90-100 μg/kg) was administered into the subarachnoid space of cats 30 h prior to EA or sham-operated controls for EA. Following bilateral barodenervation and cervical vagotomy, either EA for 30 min at P5-P6 acupoints or control stimulation (needle placement at P5-P6 without stimulation) was applied. While perikarya containing enkephalin were observed in some medullary nuclei (e.g., raphé), only enkephalin-containing neuronal processes were found in the NAmb. Compared to controls (n=4), more c-Fos immunoreactivity, located principally in close proximity to fibers containing enkephalin was noted in the NAmb of EA-treated cats (n=5; P<0.01). Moreover, neurons double-labeled with c-Fos and choline acetyltransferase in the NAmb were identified in EA-treated, but not control animals. These data demonstrate for the first time that EA activates preganglionic parasympathetic neurons in the NAmb. Because of their close proximity, these EA-activated neurons likely interact with nerve fibers containing enkephalin. These results suggest that EA at the P5-P6 acupoints has the potential to influence parasympathetic outflow and cardiovascular function, likely through an enkephalinergic mechanism.
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Affiliation(s)
- Zhi-Ling Guo
- Susan-Samueli Center for Integrative Medicine and Department of Medicine, School of Medicine, University of California, Irvine, Irvine, CA 92697, USA.
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Neuroendocrine mechanisms of acupuncture in the treatment of hypertension. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2011; 2012:878673. [PMID: 22216059 PMCID: PMC3246758 DOI: 10.1155/2012/878673] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2011] [Accepted: 09/06/2011] [Indexed: 01/11/2023]
Abstract
Hypertension affects approximately 1 billion individuals worldwide.
Pharmacological therapy has not been perfected and often is associated with
adverse side effects. Acupuncture is used as an adjunctive treatment for a
number of cardiovascular diseases like hypertension. It has long been
established that the two major contributors to systemic hypertension are the
intrarenal renin-angiotensin system and chronic activation of the sympathetic
nervous system. Recent evidence indicates that in some models of
cardiovascular disease, blockade of AT1 receptors in the rostral ventrolateral
medulla (rVLM) reduces sympathetic nerve activity and blood pressure,
suggesting that overactivity of the angiotensin system in this nucleus may play a role
in the maintenance of hypertension. Our experimental studies have shown that
electroacupuncture stimulation activates neurons in the arcuate nucleus,
ventrolateral gray, and nucleus raphe to inhibit the neural activity in the rVLM in a
model of visceral reflex stimulation-induced hypertension. This paper will
discuss current knowledge of the effects of acupuncture on central nervous
system and how they contribute to regulation of acupuncture on the endocrine
system to provide a perspective on the future of treatment of hypertension with
this ancient technique.
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Acupuncture as treatment of hot flashes and the possible role of calcitonin gene-related Peptide. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2011; 2012:579321. [PMID: 22110545 PMCID: PMC3205728 DOI: 10.1155/2012/579321] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/01/2011] [Accepted: 08/29/2011] [Indexed: 11/18/2022]
Abstract
The mechanisms behind hot flashes in menopausal women are not fully understood. The flashes in women are probably preceded by and actually initiated by a sudden downward shift in the set point for the core body temperature in the thermoregulatory center that is affected by sex steroids, β-endorphins, and other central neurotransmitters. Treatments that influence these factors may be expected to reduce hot flashes. Since therapy with sex steroids for hot flashes has appeared to cause a number of side effects and risks and women with hot flashes and breast cancer as well as men with prostate cancer and hot flashes are prevented from sex steroid therapy there is a great need for alternative therapies. Acupuncture affecting the opioid system has been suggested as an alternative treatment option for hot flashes in menopausal women and castrated men. The heat loss during hot flashes may be mediated by the potent vasodilator and sweat gland activator calcitonin gene-related peptide (CGRP) the concentration of which increases in plasma during flashes in menopausal women and, according to one study, in castrated men with flushes. There is also evidence for connections between the opioid system and the release of CGRP. In this paper we discuss acupuncture as a treatment alternative for hot flashes and the role of CGRP in this context.
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Rostral ventromedial medulla μ, but not κ, opioid receptors are involved in electroacupuncture anti-hyperalgesia in an inflammatory pain rat model. Brain Res 2011; 1395:38-45. [PMID: 21565329 DOI: 10.1016/j.brainres.2011.04.037] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Revised: 04/17/2011] [Accepted: 04/20/2011] [Indexed: 01/14/2023]
Abstract
It has been reported that intracerebroventricular injection of a μ receptor antagonist blocked 2 but not 100Hz electroacupuncture (EA)-produced analgesia in an uninjured animal model. Because persistent pain changes neural response to external stimulation, we hypothesized that the mechanisms of EA anti-hyperalgesia may be different in persistent pain than in health. Hyperalgesia, decreased paw withdrawal latency (PWL) to a noxious thermal stimulus, was induced by subcutaneously injecting complete Freund's adjuvant (CFA) into the hind paws of rats. Selective antagonists against μ (CTOP: D-Phe-Cys-Tyr-D-Trp-Orn-Thr-Pen-ThrNH2, 6.25 nmol) and κ (Nor-BIN: nor-binaltorphimine, 10 nmol) opioid receptors were infused into the rostral ventromedial medulla (RVM) 10 min before a 30-min EA treatment at acupoint Huantiao (GB30) 1h 30 min post-CFA. PWL was measured before and 2.5 post-CFA. Both 10 Hz and 100 Hz EA-produced anti-hyperalgesia were blocked by intra-RVM μ, but not κ, receptor antagonists. Double immunofluorescence staining demonstrated that μ receptor-containing neurons were GABAnergic and that GABAa receptor-containing neurons were serotonergic in the RVM. The results demonstrated an involvement of RVM μ, but not κ, receptors in EA-produced anti-hyperalgesia. In summary, EA may induce release of endogenous endomorphins that activate μ opioid receptors in GABAnergic neurons to suppress the release of GABA. This removes the tonic inhibition of GABA on serotonergic neurons in the RVM, and activation of these serotonergic neurons inhibits pain. EA may be used as complementary treatment for inflammatory pain.
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Huang W, Kutner N, Bliwise DL. Autonomic activation in insomnia: the case for acupuncture. J Clin Sleep Med 2011; 7:95-102. [PMID: 21344045 PMCID: PMC3041619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Current conceptualizations of the biological basis for insomnia typically invoke central nervous system and/or autonomic nervous system arousal. Acupuncture may represent a unique avenue of treatment for poor sleep by virtue of its direct effects on peripheral nerves and muscles, which, in turn, modulate autonomic tone and central activation. In this review, we summarize both basic and clinical research indicating that acupuncture exerts profound influences via a wide variety of potential neural and/or hormonal mechanisms that have great relevance for the modulation of sleep and wakefulness. We illustrate principles of acupuncture intervention applied to cases of otherwise intractable insomnia that document successful application of this component of Traditional Chinese Medicine to the treatment of poor sleep. Our review indicates the necessity for further research in the relationship between the effects of acupuncture on insomnia and autonomic regulation, which might guide better selective use of this treatment modality for insomnia.
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Affiliation(s)
- Wei Huang
- Atlanta VA Medical Center
- Department of Rehabilitation Medicine Emory University School of Medicine
| | - Nancy Kutner
- Department of Rehabilitation Medicine Emory University School of Medicine
| | - Donald L. Bliwise
- Department of Neurology, Psychiatry/Behavioral Sciences Emory University School of Medicine
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Li A, Zhang Y, Lao L, Xin J, Ren K, Berman BM, Zhang RX. Serotonin Receptor 2A/C Is Involved in Electroacupuncture Inhibition of Pain in an Osteoarthritis Rat Model. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2011; 2011:619650. [PMID: 21799685 PMCID: PMC3139987 DOI: 10.1093/ecam/neq016] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Accepted: 02/08/2010] [Indexed: 01/14/2023]
Abstract
Osteoarthritis currently has no cure. Acupuncture can benefit patients with knee osteoarthritis by providing pain relief, improving joint function and serving as an effective complement to standard care. However, the underlying mechanisms of its effects are still not completely understood. The present study, an investigation of the effectiveness and mechanisms of electroacupuncture (EA) in attenuating osteoarthritis pain in a rat model, is focused on the involvement of 5-hydroxytryptamine 2A/C (5-HT2A/C) receptors, which play an important role in pain modulation at the spinal level. Osteoarthritis was induced under isoflurane anesthesia by a single intraarticular injection of monosodium iodoacetate (3 mg/50 μL/rat) into one hind leg of each rat. EA was given at acupoints GB 30 and ST 36 on days 1–4 after the injection. Vehicle or ketanserin, a 5-HT2A/C receptor antagonist, was given intraperitoneally (1 mg kg−1) or intrathecally (5 μg or 10 μg/10 μL), 30 min before each EA treatment. Assessment of weight-bearing difference between injected and uninjected hind legs was done on days 0, 1–4 and 7. Fos /serotonin and serotonin/Fluorogold double labeling were performed to determine EA activation of serotonergic neurons in the nucleus raphe magnus (NRM) that project to spinal cord. The results showed that EA significantly decreases weight-bearing difference compared to sham EA. Ketanserin pretreatment blocked the analgesic effect of EA but did not influence weight bearing in sham EA control rats. EA also activated serotonergic NRM neurons that project to the spinal cord. These data show that EA inhibits osteoarthritis-induced pain by enhancing spinal 5-HT2A/2C receptor activity.
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Affiliation(s)
- Aihui Li
- Center for Integrative Medicine, School of Medicine, University of Maryland, Baltimore, MD 21201, USA
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Choi KE, Musial F, Amthor N, Rampp T, Saha FJ, Michalsen A, Dobos GJ. Isolated and combined effects of electroacupuncture and meditation in reducing experimentally induced ischemic pain: a pilot study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2010; 2011:950795. [PMID: 20953399 PMCID: PMC2952335 DOI: 10.1155/2011/950795] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2010] [Revised: 06/21/2010] [Accepted: 08/07/2010] [Indexed: 11/18/2022]
Abstract
Acupuncture and meditation are promising treatment options for clinical pain. However, studies investigating the effects of these methods on experimental pain conditions are equivocal. Here, the effects of electroacupuncture (EA) and meditation on the submaximum effort tourniquet technique (SETT), a well-established, opiate-sensitive pain paradigm in experimental placebo research were studied. Ten experienced meditators (6 male subjects) and 13 nonmeditators (6 male subjects) were subjected to SETT (250 mmHG) on one baseline (SETT only) and two treatment days (additional EA contralaterally to the SETT, either at the leg on ST36 and LV3 or at the arm on LI4 and LI10 in randomized order). Numeric Rating Scale (NRS) ratings (scale 0-10) were recorded every 3 min. During baseline, meditation induced significantly greater pain tolerance in meditators when compared with the control group. Both the EA conditions significantly increased pain tolerance and reduced pain ratings in controls. Furthermore, EA diminished the group difference in pain sensitivity, indicating that meditators had no additional benefit from acupuncture. The data suggest that EA as a presumable bottom-up process may be as effective as meditation in controlling experimental SETT pain. However, no combined effect of both the techniques could be observed.
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Affiliation(s)
- Kyung-Eun Choi
- Chair of Complementary and Integrative Medicine, University of Duisburg-Essen, 45276 Essen, Germany
| | - Frauke Musial
- Chair of Complementary and Integrative Medicine, University of Duisburg-Essen, 45276 Essen, Germany
| | - Nadine Amthor
- Chair of Complementary and Integrative Medicine, University of Duisburg-Essen, 45276 Essen, Germany
| | - Thomas Rampp
- Chair of Complementary and Integrative Medicine, University of Duisburg-Essen, 45276 Essen, Germany
| | - Felix J. Saha
- Chair of Complementary and Integrative Medicine, University of Duisburg-Essen, 45276 Essen, Germany
| | - Andreas Michalsen
- Department of Integrative and Complementary Medicine, Institute for Social Medicine, Epidemiology and Health Economics, Immanuel Hospital Berlin, Charité University Medical Center Berlin, 14109 Berlin, Germany
| | - Gustav J. Dobos
- Chair of Complementary and Integrative Medicine, University of Duisburg-Essen, 45276 Essen, Germany
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Li P, Tjen-A-Looi SC, Longhurst JC. Nucleus raphe pallidus participates in midbrain-medullary cardiovascular sympathoinhibition during electroacupuncture. Am J Physiol Regul Integr Comp Physiol 2010; 299:R1369-76. [PMID: 20720173 DOI: 10.1152/ajpregu.00361.2010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We have shown that electroacupuncture (EA) inhibits sympathoexcitatory rostral ventrolateral medulla (rVLM) neurons and reflex responses following activation of a long-loop pathway in the arcuate nucleus and ventrolateral periaqueductal gray (vlPAG). Additionally, EA at P 5-6 acupoints (overlying the median nerve) activates serotonin-containing neurons in the nucleus raphé pallidus (NRP), which, in turn, inhibit rVLM neurons. Although direct projections from the vlPAG to the rVLM exist, it is uncertain whether an indirect pathway through the NRP serves an important role in vlPAG-rVLM cardiovascular modulation. Therefore, the splanchnic nerve (SN) was stimulated to induce cardiovascular sympathoexcitatory reflexes, and EA was applied at P 5-6 acupoints in α-chloralose-anesthetized cats. A single-barreled recording electrode was inserted into the NRP or rVLM. Microinjection of DL-homocysteic acid (DLH) into the vlPAG increased the NRP neuronal response to SN stimulation (5 ± 1 to 12 ± 2 spikes/30 stim). Likewise, EA at P 5-6 for 30 min increased the NRP response to SN stimulation (3 ± 1 to 10 ± 2 spikes/30 stim), an effect that could be blocked by microinjection of kynurenic acid (KYN) into the caudal vlPAG. Furthermore, the reflex increase in blood pressure induced by application of bradykinin to the gallbladder and the rVLM cardiovascular presympathetic neuronal response to SN stimulation was inhibited by injection of DLH into the vlPAG, a response that was reversed by injection of KYN into the NRP. These results indicate that EA activates the vlPAG, which excites the NRP to, in turn, inhibit rVLM presympathetic neurons and reflex cardiovascular sympathoexcitatory responses.
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Affiliation(s)
- Peng Li
- Susan Samueli Center for Integrative Medicine, Department of Medicine, School of Medicine, University of California, Irvine, Irvine, California 92697-4075, USA.
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Pfab F, Huss-Marp J, Gatti A, Fuqin J, Athanasiadis GI, Irnich D, Raap U, Schober W, Behrendt H, Ring J, Darsow U. Influence of acupuncture on type I hypersensitivity itch and the wheal and flare response in adults with atopic eczema - a blinded, randomized, placebo-controlled, crossover trial. Allergy 2010; 65:903-10. [PMID: 20002660 DOI: 10.1111/j.1398-9995.2009.02284.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Itch is a major symptom of allergic skin disease. Acupuncture has been shown to exhibit a significant effect on histamine-induced itch in healthy volunteers. We investigated the effect of acupuncture on type I hypersensitivity itch and skin reaction in a double-blind, randomized, placebo-controlled, crossover trial. METHODS An allergen stimulus (house dust mite or grass pollen skin prick) was applied to 30 patients with atopic eczema before (direct effect) and after (preventive effect) two experimental approaches or control observation: acupuncture at points Quchi and Xuehai [verum acupuncture (VA), dominant side], 'placebo-point' acupuncture (PA, dominant side), no acupuncture (NA). Itch intensity was recorded on a visual analogue scale. After 10 min, wheal and flare size and skin perfusion (via LASER-Doppler) were measured at the stimulus site, and the validated Eppendorf Itch Questionnaire (EIQ) was answered. RESULTS Mean itch intensity was significantly lower in VA (35.7 +/- 6.4) compared to NA (45.9 +/- 7.8) and PA (40.4 +/- 5.8) regarding the direct effect; and significantly lower in VA (34.3 +/- 7.1) and PA (37.8 +/- 5.6) compared to NA (44.6 +/- 6.2) regarding the preventive effect. In the preventive approach, mean wheal and flare size were significantly smaller in VA (0.38 +/- 0.12 cm(2)/8.1 +/- 2.0 cm(2)) compared to PA (0.54 +/- 0.13 cm(2)/13.5 +/- 2.8 cm(2)) and NA (0.73 +/- 0.28 cm(2)/15.1 +/- 4.1 cm(2)), and mean perfusion in VA (72.4 +/- 10.7) compared to NA (84.1 +/- 10.7). Mean EIQ ratings were significantly lower in VA compared to NA and PA in the treatment approach; and significantly lower in VA and PA compared to NA in the preventive approach. CONCLUSIONS Acupuncture at the correct points showed a significant reduction in type I hypersensitivity itch in patients with atopic eczema. With time the preventive point-specific effect diminished with regard to subjective itch sensation, whereas it increased in suppressing skin-prick reactions.
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Affiliation(s)
- F Pfab
- Department of Dermatology and Allergy, Technische Universität München, Munich, Germany.
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Neural mechanism of electroacupuncture's hypotensive effects. Auton Neurosci 2010; 157:24-30. [PMID: 20444652 DOI: 10.1016/j.autneu.2010.03.015] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Accepted: 03/23/2010] [Indexed: 02/07/2023]
Abstract
EA at P 5-6 and S 36-37 using low current and low frequency may be able to reduce elevated blood pressure in a subset of patients (∼70%) with mild to moderate hypertension. The effect is slow in onset but is long-lasting. Experimental studies have shown that EA inhibition of cardiovascular sympathetic neurons that have been activated through visceral reflex stimulation is through activation of neurons in the arcuate nucleus of the hypothalamus, vlPAG in the midbrain and NRP in the medulla, which, in turn, inhibit the activity of premotor sympathetic neurons in the rVLM. The arcuate also provides direct projections to the rVLM that contain endorphins. Glutamate, acetylcholine, opioids, GABA, nociceptin, serotonin and endocannabinoids all appear to participate in the EA hypotensive response although their importance varies between nuclei. Thus, a number of mechanisms underlying the long-lasting effect of EA on cardiovascular function have been identified but clearly further investigation is warranted.
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Moazzami A, Tjen-A-Looi SC, Guo ZL, Longhurst JC. Serotonergic projection from nucleus raphe pallidus to rostral ventrolateral medulla modulates cardiovascular reflex responses during acupuncture. J Appl Physiol (1985) 2010; 108:1336-46. [PMID: 20133441 PMCID: PMC2867542 DOI: 10.1152/japplphysiol.00477.2009] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2009] [Accepted: 02/03/2010] [Indexed: 11/22/2022] Open
Abstract
We have demonstrated that stimulation of somatic afferents during electroacupuncture (EA) inhibits sympathoexcitatory cardiovascular rostral ventrolateral medulla (rVLM) neurons and reflex responses. Furthermore, EA at P5-P6 acupoints over the median nerve on the forelimb activate serotonin (5-HT)-containing neurons in the nucleus raphe pallidus (NRP). The present study, therefore, examined the role of the NRP and its synaptic input to neurons in the rVLM during the modulatory influence of EA. Since serotonergic neurons in the NRP project to the rVLM, we hypothesized that the NRP facilitates EA inhibition of the cardiovascular sympathoexcitatory reflex response through activation of 5-HT1A receptors in the rVLM. Animals were anesthetized and ventilated, and heart rate and blood pressure were monitored. We then inserted microinjection and recording electrodes in the rVLM and NRP. Application of bradykinin (10 microg/ml) on the gallbladder every 10 min induced consistent excitatory cardiovascular reflex responses. Stimulation with EA at P5-P6 acupoints reduced the increase in blood pressure from 41+/-4 to 22+/-4 mmHg for more than 70 min. Inactivation of NRP with 50 nl of kainic acid (1 mM) reversed the EA-related inhibition of the cardiovascular reflex response. Similarly, blockade of 5-HT1A receptors with the antagonist WAY-100635 (1 mM, 75 nl) microinjected into the rVLM reversed the EA-evoked inhibition. In the absence of EA, NRP microinjection of dl-homocysteic acid (4 nM, 50 nl), to mimic EA, reduced the cardiovascular and rVLM neuronal excitatory reflex response during stimulation of the gallbladder and splanchnic nerve, respectively. Blockade of 5-HT1A receptors in the rVLM reversed the NRP dl-homocysteic acid inhibition of the cardiovascular and neuronal reflex responses. Thus activation of the NRP, through a mechanism involving serotonergic neurons and 5-HT1A receptors in the rVLM during somatic stimulation with EA, attenuates sympathoexcitatory cardiovascular reflexes.
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Affiliation(s)
- Ali Moazzami
- Susan Samueli Center for Integrative Medicine, Department of Medicine, Medical Science 1 C240, School of Medicine, University of California, Irvine, CA 92697-4075, USA
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Zhao CH, Stillman MJ, Rozen TD. Traditional and Evidence‐Based Acupuncture in Headache Management: Theory, Mechanism, and Practice. Headache 2008; 45:716-30. [PMID: 15953304 DOI: 10.1111/j.1526-4610.2005.05139.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Acupuncture, traditional Chinese needle therapy, has become widely used for the relief of headache. The history of the practice of acupuncture in the United States and the theoretical framework for acupuncture in Chinese medicine are reviewed. The basic scientific background and clinical application of acupuncture in the headache management are discussed.
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Affiliation(s)
- Chong-Hao Zhao
- Division of Orofacial Pain Medicine, School of Dentistry, University of California-Los Angeles, Los Angeles, CA, USA
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