Nitric oxide modulation of norepinephrine production in acupuncture points

Stimuli-evoked NOergic molecules and neuropeptides at acupuncture points and the gracile nucleus contribute to signal transduction of propagated sensation along the meridian through the dorsal medulla-thalamic pathways

Numerous studies from different international groups have demonstrated that sensations can be propagated along acupuncture channel pathways. The propagated sensation along the channel pathway (PSCP) can be elicited by electroacupuncture (EA), transcutaneous electrical nerve stimulation (TENS), manual acupuncture (MA), and heat applied to distal acupuncture points (acupoints). Nitric oxide (NO) levels were reported to be elevated in the gracile nucleus and skin regions near to the EA sites, with higher levels at acupoints associated with an enhanced expression of NO synthase and transient receptor potential vanilloid type 1. The stimuli, EA, MA, TENS, and heat, have been used to elicit axonal reflexes, which increase local release of NO and neuropeptides such as calcitonin gene related peptide. Furthermore, the sensation of PSCP along the body surface occurs only ipsilaterally to the stimulated acupoints in various human studies, which does not support the involvement of the spinal-thalamic pathway, which would involve cross over transmission of the signals. The gracile nucleus receives ascending input from the sciatic nerve and responds to somatosensory stimulation mainly on the ipsilateral side via the dorsal column pathway. EA at Zusanli (ST36) increases NO release and expression of NO synthase mainly in the ipsilateral side of the gracile nucleus, while the cardiovascular effects and analgesic responses to EA at ST36 are changed by influences of l-arginine-derived NO synthesis in the ipsilateral gracile nucleus in rats. The stimuli-induced release of NOergic molecules and neuropeptides exist high levels in the acupoints, which contain rich neuronal components and blood vessels. Enhanced NOergic molecules at acupoints cause axon reflexes during the stimuli, which elevate cutaneous blood flow. Elevated NOergic molecules and local blood flow may spread over acupoints one after another along the meridian lines differing from nerve pathways following the stimuli to induce PSCP. The same types of stimulation also elicit NO release in the gracile nucleus, which contributes to the somatosensory signal transduction of PSCP through the dorsal medulla-thalamic pathways. Other substances such as serotonin and catecholamines are proposed to mediate responses and certain effects of acupuncture-like stimulation but their mechanisms are poorly-understood. In this review we summarize the current understanding of the neurobiological processes of PSCP research with an emphasis on recent developments of NO mediating stimulation-evoked axon reflexes and somatosensory signal transduction for PSCP perceptions through the dorsal medulla-thalamic pathways. Please cite this article as: Ma SX. Stimuli-evoked NOergic molecules and neuropeptides at acupuncture points and gracile nucleus contribute to signal transduction of propagated sensation along the meridian through the dorsal medulla-thalamic pathways. J Integr Med. 2024; Epub ahead of print.

Stimuli-induced NOergic Molecules and Neuropeptides Mediated Axon Reflexes Contribute to Tracers along Meridian Pathways

An abundance of studies from different international groups have demonstrated tracers along linear pathways resembling meridians over the body surface of humans. All experiments of the studies have been conducted by injection of a radiotracer solution or tracer dyes in a volume of solution into acupuncture points (acupoints). The solution injected into acupoints produces much stronger mechanical stimuli than acupuncture, which causes axon reflex. Anatomical studies have demonstrated that acupoints/meridians exist higher number of small nerve fibers and blood vessels with rich nitric oxide (NO) and neuropeptides in the cutaneous tissues as structures for the biomolecules mediated axon reflexes. Recent advances have determined that NO and calcitonin generelated peptides play crucial roles in the comprehension of the axon reflex. The stimuli-evoked axon reflex and NOergic biomolecules/neuropeptides increase local blood flow with higher levels in acupoints/meridians, which move radioactive substances or tracer dyes in the skin and subcutaneous tissue under a linear path resembling acupoints and meridians, the important phenomena of meridians induced by the stimuli. The evidence and understanding of the biomolecular processes of the tracers along linear pathways resembling meridians have been summarized with an emphasis on recent developments of NO and neuropeptides mediating stimuli-evoked axon reflexes to increase local blood flow with higher levels in acupoints/meridians, which move radioactive substances or tracer dyes in the skin and subcutaneous tissue contributing to tracers along linear pathways resembling meridians in this mini-review.

A "4D" systemic view on meridian essence: Substantial, functional, chronological and cultural attributes

The term Jingluo, translated as meridian or channel, is a core component of traditional Chinese medicine (TCM) and has played a fundamental role in guiding the clinical practice of acupuncture for thousands of years. However, the essence of the meridian remains elusive and is a source of both confusion and debate for researchers. In this study, a "4D" systemic view on the essence of the meridian, namely substantial, functional, chronological, and cultural dimensions, was proposed based on a review of the ancient medical classics, recent research developments, and results from clinical practice. Previous studies have primarily focused on the substantial dimension of the meridian system, with scant interpretation about its functional domain. Neither systemic data nor evaluations have been adequately documented. Additionally, a limited but increasing number of studies have focused on the chronological and cultural dimensions. More investigations that embody the holistic concept of TCM and integrate the systemic modes and advanced techniques with dominant diseases of TCM need to be performed to obtain a more comprehensive understanding of the essence of meridians. The goal of this study is to yield useful information in understanding the essence of meridians and provide a reference and perspective for further research.

Low Electrical Resistance Properties of Acupoints: Roles of NOergic Signaling Molecules and Neuropeptides in Skin Electrical Conductance

Early studies from several independent laboratories demonstrated that acupoints possess the characteristics of low electrical resistance. New devices are developing to increase the reliability of electrical skin impedance measurements for counteracting the factors including skin dryness, skin thickness, size of the sensing electrode, pressure applied on the electrode, interelectrode distance, room temperature, and humidity. Morphological studies have identified that blood vessels, hair follicles, and nervous components are enhanced in the meridians/acupoints, which represent areas of potentially high neuronal activity. Recent evidence shows that nitric oxide (NO) concentrations are enhanced in skin acupoints/meridians. L-arginine-derived NO synthesis modifies skin norepinephrine (NE) synthesis/release in acupoints/meridians, and NO-NE activations play an important role in mediating the skin conductance responses to electrical stimulation. NOergic signaling molecules interact with gap junction and transient receptor potential vanilloid type-1. Other studies reported that the high conductance at acupoints is a result of the release of the neuropeptides substance P and calcitonin gene-related peptide during neurogenic inflammation in the referred pain area. Pathological body conditions caused considerable changes in skin conductance or impedance at acupoints. Although systematic research with an improved equipment and research design to avoid the influencing factors are requested for a definite answer in this field, the results from anatomical and biochemical studies consistently show that acupoints exist higher levels of nervous components, and NOergic signaling molecules and neuropeptides involved in the skin low resistance at acupoints. The increased interest in the acupoints/meridians has led to an open-minded attitude towards understanding this system, which is fundamental important to establish the valid aspects of scientific basis of Chinese medicine mechanisms and therapies.

Skin fibroblasts' alteration after Acupuncture on LI11 in Rabbits with bacteria endotoxin induced fever

Objectives: To study the mechanism of acupuncture manipulation (AM) based on the secretion function and morphological variation of fibroblasts in acupoint region.<br/> Methods: 40 rabbits were randomly divided to normal group (N), model group (M), needle retaining group (A), and acupuncture manipulation group (AM), each group consist of 10 rabbits. The animal model of Rabbits with Bacterium Endotoxin Induced Fever (BEIF) was established by intravenous injection of bacterial endotoxin. Groups A and AM were treated with 'Qu Chi'(LI11) acupuncture after modeling, and acupuncture manipulations were conducted in group AM. The serum heat factors IL-1β, IL-6, and TNF-α content were assayed conducted in group AM. The serum heat factors IL-1β, IL-6, and TNF-α content were assayed by Elisa after acupuncturet; the morphological changes of fibroblasts in acupoint area were observed by Vimentin staining; the fibroblasts of subcutaneous connective tissue in acupoint area were isolated and cultured in vitro, and the contents of PEG2, NO and ATP in supernatant were assayed.<br/> Results: There was no significant difference in fibroblasts cytomorphology among groups M, A, and N. Fibroblasts in group AM were stretched and aligned in almost one direction. Comparing with group N, the content of serum IL-1β, IL-6, and TNF-α was significantly higher in group M, along with higher NO and ATP content in the cell culture supernant; Comparing with group M, content of IL-6 and TNF-α was lower in group A, content of serum IL-1β, IL-6 and TNF-α was higher in group AM, along with higher PEG2, NO and ATP content in both groups, while group AM demonstrated more significant changes in the above indicators than group A.<br/> Conclusion: Acupuncture had therapeutic effects on BEIF rabbits, the application of acupuncture manipulation can further improve its therapeutic effects. The mechanism may be related to the influence on fibroblasts cytomorphology in acupoint region and facilitation of fibroblasts-derived PEG2, NO, and ATP, which together promote the acupoint vitality.

Peripheral receptors and neuromediators involved in the antihyperalgesic effects of acupuncture: a state-of-the-art review

The present study aims to describe state-of-the-art of preclinical studies that have investigated peripheral receptors and neuromediators involved in the antihyperalgesic effects of acupuncture. The PubMed, Scopus, and Web of Science databases were searched using the integrative review method. Preclinical articles that involved the study of peripheral receptors and neuromediators on the pain control effects of acupuncture in rats or mice were selected using a predefined search strategy. From this search, 456 articles were found, and 29 of them met the inclusion criteria of the study. The selected articles addressed the following peripheral receptors: opioid (n = 9), adenosine (n = 5), cannabinoid (n = 5), transient receptor potential vanilloid (TRPV) (n = 3), histamine (n = 2), adrenergic (n = 1), muscarinic (n = 1), corticotrophin-releasing factor (CRF) (n = 2), IL-1 (n = 1), and endothelin (n = 1) receptors. The peripheral neuromediators correlated with the peripheral pain control effect were as follows: opioid peptides (n = 4), adenosine (n = 3), histamine (n = 1), substance P (n = 1) calcitonin gene-related peptide (CGRP) (n = 1), anandamide (n = 1), nitric oxide (n = 1), and norepinephrine (n = 1). This review summarizes the methods used to investigate the peripheral effects of acupuncture and discusses the main findings on each family of receptors and neuromediators. Ten families of peripheral receptors and 8 types of neuromediators were correlated with the antihyperalgesic effects of acupuncture in preclinical studies. Considering the benefits of a better understanding of the role of peripheral receptors and neuromediators in the context pain management, the findings of the present study highlight the importance of deepening the exploration of the peripheral mechanisms of acupuncture.

Transcutaneous Electrical Stimulation Increased Nitric Oxide-Cyclic GMP Release Biocaptured Over Skin Surface of Pericardium Meridian and Acupuncture Points in Humans

OBJECTIVES

The purpose of this study was to consecutively capture and quantify nitric oxide (NO) and cGMP, the second messenger of NO, over the skin surface of acupuncture points (acupoints), meridian line without acupoint, and non-meridian control regions of the Pericardium meridian (PC) in humans, and investigate their response to transcutaneous electrical nerve stimulation (TENS) . DESIGN, SETTING, AND MAIN OUTCOME MEASURES: Adhesive biocapture tubes were attached to the skin surface along PC regions and injected with 2-Phenyl-4,4,5,5-tetramethylimidazoline-3-oxide-1-oxyl solution, an NO-scavenging compound, contacting the skin surface for 20 minutes each during 4 consecutive biocapture intervals. TENS (1.0 mA, 6 Hz, 1.0 msec duration) was applied over acupoints PC 8 and PC 3 during the 2nd biocapture for 20 min. Total nitrite and nitrate (NO(x)-), the stable metabolic products of NO, and cGMP in biocaptured samples were quantified using chemiluminescence and ELISA.

RESULTS

NO(x)- levels in the 1st biocapture over PC regions are almost two fold higher compared to subsequent biocaptures and are higher over PC acupoints versus non-meridian control region. Following TENS, NO(x)- concentrations over PC regions were significantly increased, and cGMP is predominantly released from the skin surface of PC acupoints.

CONCLUSIONS

TENS induces elevations of NO-cGMP concentrations over local skin region with a high level at acupoints. The enhanced signal molecules improve local circulation, which contributes to beneficial effects of the therapy.

What is the Acupoint? A preliminary review of Acupoints

BACKGROUND

According to traditional Chinese medicine (TCM) theory, acupoints are specifically chosen sites of acupuncture manipulation, and also the basis for studying the mechanism of acupuncture. Stimulating different acupoints on the body surface could provide various therapeutic benefits. However, what is the acupoint? This question is not clear.

REVIEW SUMMARY

We focuse on examining the function of acupoints from different perspectives, including the local and the systemic effects of stimulating acupoints. For example, acupoints may release certain substances or incur some changes, which could adjust the function of organs, maintain homeostasis. Furthermore, the therapeutic effects of verum acupoints versus sham acupoints were discussed. However, due to insufficience in evidence and in current methodologies, research into mechanisms of acupuncture is still incomplete.

CONCLUSION

This review might explain, to some extent, what an acupoint is. Further research into the identity of acupoints is warranted, and multidisciplinary methods using novel technologies may yield significant advances over existing knowledge.

Specificity study on concentration of monoamine transmitters at acupoint and effect of acupuncture on its distribution

To investigate the distribution of monoamine transmitters at acupoints and effect of acupuncture on it. Take this experiment by means of microdialysis. Twenty rabbits were randomly assigned to two groups (Group A: acupuncture Guanyuan (RN4), Group B: acupuncture nonacupoint which is besides Guanyuan (RN4) 1 cm). Before and after acupuncture was taken, tissue fluids both at Zhongwan (RN12) which is on the same meridian as Guanyuan and at a nonacupoint 1 cm away from Zhongwan were collected through microdialysis, respectively. The collected samples were analyzed to determine concentrations of monoamine transmitters. Epinephrine and 5-HT were detected. An unknown substance was found. Its concentration at acupoint was significantly higher than that at nonacupoint and decreased after acupuncture. Its significant specificity at acupoints suggests that it may play an important role in meridian's activity.

Acupoints Initiate the Healing Process

Background: As an important modality of Traditional Chinese Medicine, acupuncture has been widely accepted by the Western world in the past 4 decades because of this modality's efficacy and safety. A vast amount of acupuncture research has been done. However, the mechanisms of acupuncture actions are still elusive. It is believed that the effects of acupuncture treatment begin from the moment of needle insertion. Methods: This review focuses on the acupuncture points and the three major reactions at the acupuncture points when needling is performed. These initial reactions may be the beginning of the healing process that initiates downstream effects through neuronal and humoral pathways. In addition to the physical reactions, this article also discusses the possibility of the effects of acupuncture on the healing process through a holistic pathway. Conclusions: Needling is the first step of traditional acupuncture therapy. Needling reactions- neuronal, biophysical, and biochemical-are the beginning of healing. The messengers of the three reactions involved may include neurotransmitters, cytokines, hormones, and inflammatory factors. Healing may be potentiated through these messengers in neuronal and humoral pathways. The reactions manifest as erythema and De Qi-both of which are common phenomena used as positive signs in acupuncture treatment. Acupuncture may also play a role in the healing process through the holistic pathway, which needs further study.

A single case study: treating migraine headache with acupuncture, chinese herbs, and diet

Background:

Acupuncture is an often sought-out treatment modality for migraine. The World Health Organization lists headache as one of the several conditions treated effectively by acupuncture.

Case Description:

This single case reports on a 32-year-old woman who presented with a 10-year history of migraine.

Methods:

The patient was treated with acupuncture, dietary modifications, and Chinese herbal medicine enemas over a course of 2 months.

Results:

The patient experienced pain relief that resulted in several months without any migraine.

Conclusion:

This article may aid in expanding practitioners’ treatment options to include a more diverse set of modalities such as Chinese herbal enemas. More research is needed to investigate the role of Oriental medicine and Chinese herbal enemas in the treatment of pain conditions.

Neural acupuncture unit: a new concept for interpreting effects and mechanisms of acupuncture

When an acupuncture needle is inserted into a designated point on the body and mechanical or electrical stimulation is delivered, various neural and neuroactive components are activated. The collection of the activated neural and neuroactive components distributed in the skin, muscle, and connective tissues surrounding the inserted needle is defined as a neural acupuncture unit (NAU). The traditionally defined acupoints represent an anatomical landmark system that indicates local sites where NAUs may contain relatively dense and concentrated neural and neuroactive components, upon which acupuncture stimulation would elicit a more efficient therapeutic response. The NAU-based local mechanisms of biochemical and biophysical reactions play an important role in acupuncture-induced analgesia. Different properties of NAUs are associated with different components of needling sensation. There exist several central pathways to convey NAU-induced acupuncture signals, Electroacupuncture (EA) frequency-specific neurochemical effects are related to different peripheral and central pathways transmitting afferent signals from different frequency of NAU stimulation. More widespread and intense neuroimaging responses of brain regions to acupuncture may be a consequence of more efficient NAU stimulation modes. The introduction of the conception of NAU provides a new theoretical approach to interpreting effects and mechanisms of acupuncture in modern biomedical knowledge framework.

Catecholamine-storing cells at acupuncture points of rabbits

Recent studies have shown that specific sites of the skin related to the acupoints contain a high concentration of catecholamines, especially noradrenaline (NA). Considering this newly discovered property of the acupoints we assumed that heterogeneous distribution of cutaneous catecholamines could be associated with a specific location of catecholamine-storing cells in acupoint sites. In the present work we used an immunohistochemical method and confocal laser scanning microscopy to examine the presence of catecholamine-storing cells at acupoints of rabbits. Double immunofluorescence staining with antibodies against adrenaline and NA revealed only the cells storing NA in the dermal layer of rabbit skin. NA-storing cells were randomly scattered as single cells as well as existing in small clusters in a globular tissue formation surrounded by blood vessels and capillaries. Microscopic analysis of histological sections also revealed that the distribution of NA-storing cells was closely associated with the location of acupoints. Thus results from our study strongly suggest that acupoint areas of rabbit skin contain catecholamine-storing cells which can release a high level of NA during acupuncture stimulation.

Responses of nitric oxide-cGMP release in acupuncture point to electroacupuncture in human skin in vivo using dermal microdialysis

OBJECTIVES

The aim of this study was to examine the release of nitric oxide (NO) and cGMP in response to electroacupuncture (EA) stimulation in the acupuncture point (acupoint), compared to the non-meridian control area.

METHODS

Thirty samples of dermal microdialysis data were collected from 24 volunteers at pericardium (PC) 4 and control area. EA was applied to PC 3 by using a 5-V pulse with a duration of 1.0 milliseconds at 10 Hz for 15 minutes. Dialysate samples were continuously collected 20 minutes each before, during, and after EA for two hours. Total nitrite and nitrate (NO(x)(-)) and cGMP in the dialysate were quantified in a blinded fashion.

RESULTS

Dialysate NO(x)(-) concentrations were decreased during a 120-minute dialysis in all groups, but reduced NO(x)(-) levels were attenuated predominantly in PC 4 acupoint at 20-40 minutes after EA PC 3. cGMP concentrations were significantly enhanced in acupoint PC 4 by EA PC 3, but not in the non-meridian area.

CONCLUSION

We suggest that the attenuation of NO(x)(-) reduction during dialysis reflects an increase in NO release induced by EA stimulation in acupoint and that cGMP mediates the signaling functions of NO to improve local microcirculation, which, at least in part, contributes to the effects of acupuncture.

Evidence of enhanced non-enzymatic generation of nitric oxide on the skin surface of acupuncture points: An innovative approach in humans

The present study quantified total nitrate and nitrite (NOx-) collected from the skin surface along acupuncture points (acupoints) and determined whether non-enzymatic reduction of nitrate by bacteria is involved in chemical generation of nitric oxide (NO) on acupoints. A small plastic tube (0.5 x 7 cm) cut in half lengthwise was taped to the forearm or leg in 50 healthy volunteers. NO-collecting solutions with NO-scavenging compounds, hemoglobin or 2-phenyl-4,4,5,5-tetramethylimidazoline-1-oxyl 3-oxide, was placed inside the tubing attached to the skin surface for 20 min. The concentrations of NOx- in the collected samples were quantified by using chemiluminescence. NOx- concentration was significantly enhanced in four acupoints on the pericardium meridian and in two acupoints on the bladder meridian compared with those collected on non-meridian control areas. The time intervals of NOx- levels were significantly higher at the first 20 min of acupoint collection, but the concentrations were similar among the study groups collected at 20-40, 40-60, and 60-80 min. NOx- concentrations and numbers of bacteria colonies detected on the skin surface were markedly reduced by pretreatment of skin with sodium hypochlorite compared to water treatment. This is the first evidence showing that NO has been successfully quantified on skin acupoints by a non-invasive device in humans. We conclude that NO is physiologically released from the skin surface with a higher level at acupoints, and that the non-enzymatic reduction of nitrate by bacteria is involved in chemical generation of NO on skin acupoints in addition to l-arginine-derived NO synthesis.