Differences in the microcirculatory effects of local skin surface contact pressure stimulation between acupoints and nonacupoints: possible relevance to acupressure

Effects of acupuncture and acupressure of the acupoint compared to the tendon on the blood circulation of human tendon in vivo

PURPOSE

The purpose of this study was to compare the effects of acupuncture and acupressure of acupoints on tendon blood circulation with those of both types of stimulation of tendon itself.

METHODS

Before, during (except for acupressure), and after acupuncture and acupressure of the tendon and acupoint, blood circulation of the Achilles tendon was measured using red laser lights.

RESULTS

The blood volume of the treated and non-treated tendons increased after acupuncture of the tendon (effect of time p = 0.030), whereas that tended to increase after acupuncture of the acupoint (effect of time p = 0.063). In addition, no significant difference in the increases in blood volume was found among the four conditions, i.e., after acupuncture stimulation of the tendon and acupoint for the treated and non-treated tendons (p = 0.492). The blood volume of the treated tendon significantly increased after acupressure of the tendon (effect of time p < 0.001), but not of the acupoint (effect of time p = 0.260), whereas that of the non-treated tendon did not change after acupressure of both the tendon and acupoint.

CONCLUSION

These results suggested that acupuncture of the tendon and acupoint acted centrally to enhance blood circulation of both the treated and non-treated tendons during the recovery period, whereas acupressure of the tendon locally increased blood circulation of the treated tendon only, but not the non-treated tendon and both the treated and non-treated tendons after acupressure of acupoint.

Machine-Learning Classification of Pulse Waveform Quality

Pulse measurements made using wearable devices can aid the monitoring of human physiological condition. Accurate estimation of waveforms is often difficult for nonexperts; motion artifacts may occur during tonometry measurements when the skin-sensor contact pressure is insufficient. An alternative approach is to extract only high-quality pulses for use in index calculations. The present study aimed to determine the effectiveness of using machine-learning analysis in discriminating between high-quality and low-quality pulse waveforms induced by applying different contact pressures. Radial blood pressure waveform (BPW) signals were measured noninvasively in healthy young subjects using a strain-gauge transducer. One-minute-long trains of pulse data were measured when applying the appropriate contact pressure (67.80 ± 1.55 mmHg) and a higher contact pressure (151.80 ± 3.19 mmHg). Eight machine-learning algorithms were employed to evaluate the following 40 harmonic pulse indices: amplitude proportions and their coefficients of variation and phase angles and their standard deviations. Significant differences were noted in BPW indices between applying appropriate and higher skin-surface contact pressures. The present appropriate contact pressure could not only provide a suitable holding force for the wearable device but also helped to maintain the physiological stability of the underlying tissues. Machine-learning analysis provides an effective method for distinguishing between the high-quality and low-quality pulses with excellent discrimination performance (leave-one-subject-out test: random-forest AUC = 0.96). This approach will aid the development of an automatic screening method for waveform quality and thereby improve the noninvasive acquisition reliability. Other possible interfering factors in practical applications can also be systematically studied using a similar procedure.

Acupressure in patients with seasonal allergic rhinitis: a randomized controlled exploratory trial

BACKGROUND

Acupuncture has shown beneficial effects for seasonal allergic rhinitis (SAR); however, it is time and cost intensive. We investigated feasibility and effects of self-administered body acupressure as a self-care technique that stimulates acupuncture points with manual pressure in SAR patients.

METHODS

We conducted a two-armed randomized controlled exploratory trial to compare effects of self-administered acupressure over 4 weeks at five acupuncture points plus rescue medication (RM) with cetirizine compared to RM alone in SAR patients. Among other outcome parameters, we assessed disease-related quality of life (Rhinitis Quality of Life Questionnaire [RQLQ]), overall SAR symptoms by a visual analogue scale (VAS) and a rescue medication score (RMS) after 4 and 8 weeks.

RESULTS

Forty-one SAR patients (mean age 38.5 ± 10.0 years, n = 21, 51.2% women) were randomized. Compared to RM alone (n = 21), acupressure plus RM (n = 20) was associated with relevant improvements after 4 weeks, shown by the difference between groups in adjusted means of RQLQ: - 0.9 points (95% CI - 1.6 to - 0.2; p = 0.011) and VAS overall SAR symptoms: - 21.6 mm (95% CI - 36.3 to - 6.8; p = 0.005). The RMS was lower in the acupressure group than in the control group: 1.9 points (95% CI - 3.8 to - 0.1; p = 0.120). Group differences decreased slightly until week 8. The acupressure was feasible and safe.

CONCLUSION

Results of this exploratory study indicate that self-applied acupressure is feasible, may improve disease-specific quality of life and reduce disease-related symptoms as well as anti-allergic medication intake in SAR patients. High-quality confirmatory studies including a sham-control group are needed in the future. Trial registration DRKS-ID: DRKS00014310. Date of registration in DRKS: 2018/04/24. Investigator sponsored/initiated trial (IST/IIT): yes. Ethics approval/approval of the ethics committee: Approved (leading) Ethics Committee No. EA1/033/18, Ethik-Kommission der Charité -Universitätsmedizin Berlin. URL: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00014310.

Traditional Chinese medicine foot bath combined with acupoint massage for the treatment of diabetic peripheral neuropathy: A systematic review and meta-analysis of 31 RCTs

In this study, we aim to evaluate the efficiency and safety of traditional Chinese medicine foot bath combined with acupoint massage for the treatment of diabetic peripheral neuropathy. A total of eight online databases were searched to collect studies published up to February 2019. Study quality of each included article was evaluated by the Cochrane Collaboration risk of bias tool. Systematic reviews and meta-analyses were conducted based on the Cochrane systematic review method by using the RevMan 5.3 software. Traditional Chinese medicine foot bath combined with acupoint massage was the main therapy in experimental group. Interventions in control groups include western medicine, oral traditional Chinese medicine, other symptomatic treatment of western medicine, and blank control. Primary outcomes in this study include sensory nerve conduction velocity (SNCV), motor nerve conduction velocity (MNCV), total effective rate, and neuropathic syndrome score. Finally, 31 trials involving 3284 participants were included. The results of systematic reviews and meta-analyses showed that traditional Chinese medicine foot bath combined with acupoint massage was significantly better compared with the control groups in terms of the total effective rate, SNCV, MNCV, and neuropathic syndrome score. No case of adverse effect was reported. These findings show that traditional Chinese medicine foot bath combined with acupoint massage may be safer and more effective for the treatment of DPN. However, due to the low methodological quality, further research with randomized controlled trials (RCTs) of higher quality is required to prove its efficacy and better evidence for clinical treatment.

Acupuncture- and Intermittent Compression-Induced Changes in Blood Circulation of Tendon

Objective: The purpose of this study was to compare changes in blood circulation (blood volume and oxygen saturation [StO₂]) of tendon by acupuncture (insertion depth of the needle was 4 mm) and intermittent compression. Subjects: Thirteen healthy volunteers (12 males and 1 female; age: 26.9 ± 9.8 years) participated in this study. Methods: Before the treatments (10 min for acupuncture, 3 min for intermittent compression, and 10 min for control condition) and the recovery period (40 min), the blood volume (total hemoglobin [THb]) and StO₂ of treated and nontreated Achilles tendons were measured using red laser lights. Results: Regarding the acupuncture-induced changes in blood circulation of tendons, THb and StO₂ of the treated tendon suddenly increased during acupuncture with up-and-down manipulation, and those of the treated and nontreated tendons gradually increased after removal of the needle. The authors were not able to present the measured variables during intermittent compression, since obvious noises were observed. After acupuncture and intermittent compression, THb and StO₂ of the treated tendon remained high during the recovery period and those of the nontreated tendon gradually increased during the latter half of the recovery period. There were no differences in the mean changes of THb or StO₂ of the treated and nontreated tendons during the recovery period between acupuncture and intermittent compression. Under the control condition, no significant changes were noted in the measured variables. Conclusion: These results suggest that intermittent compression to the tendon brought about increases in tendon blood circulation similar to those induced by acupuncture.

Contemporary acupressure therapy: Adroit cure for painless recovery of therapeutic ailments

Since time immemorial, complementary and alternative medicines (CAM) have played a significant role in human health care. CAM is known to have a strong reputation and reliability within every culture to provide basic health care treatment for patients. CAM acts as a better therapeutic option in human being for treating various diseases and improving quality of life with apt consideration to the economic aspects. Acupressure, one of the known CAM, originated in ancient China is based on the principal of acupoints activation across the meridians which correct the imbalance between Qi. Activation of specific points on the meridians is known to facilitate reduction of pain at the local sites. It also reduces the pain from other body parts. This review outlines various types, devices and mechanisms involved in the acupressure treatment.

Acupoint Activation: Response in Microcirculation and the Role of Mast Cells

BACKGROUND

According to Traditional Chinese Medicine (TCM) theory, acupuncture effects are based on the integrity function of meridians. Meridians are thought to regulate body function through the normal flow of qi and/or blood. Disturbances in this flow are thought to cause disease, and acupuncture techniques are believed to cure disease by regulating this flow. However, it is still difficult to understand the exact meaning of qi and to evaluate the activation of meridians. Thus, more and more attention has been focused on the relationship of acupuncture and circulation.

METHODS

In this narrative review, the authors focus on the state of the art in acupoint activation, microcirculation response, and on investigation of mast cells, based on current literature research.

RESULTS

Altogether, 52 references are cited and discussed critically. A schematic diagram of the relationship between acupuncture stimulation, changes of microcirculation and mast cells is presented as result.

CONCLUSION

The block diagram presented in this review article shows that mast cells might play an important role in circulation response after acupoint stimulation.

Microcirculation perfusion monitor on the back of the health volunteers

Objective. To observe the dermal microcirculation blood perfusion characterization of meridians channels (acupoints). Methods. 20 healthy human subjects were monitored using Pericam Perfusion Speckle Imager (PSI) for the changes in dermal microcirculation blood perfusion on governor meridian and other respective dermal regions as a control. Result. The microcirculation blood perfusion on Governor Meridian is higher than its control area. Conclusion. The dermal microcirculation blood perfusion on certain parts of Governor Meridian of healthy human subjects showed specifics.

Pilot study of blood perfusion coherence along the meridian in forearm

Background

Many studies have explored the relationship between skin microcirculation and meridian activation. However, few studies have examined blood perfusion coherence along the meridians, and other studies have suggested that the skin vasodilator response relates to age. This study investigated blood perfusion coherence characteristics along the meridian of the forearm in healthy volunteers.

Methods

A total of 15 young subjects (25.53 ± 2.20) and 15 middle-aged subjects (50.07 ± 3.37) were recruited for this study. Before experiments, each subject was placed in a temperature-controlled room for 60 min. Skin blood perfusion from five points was recorded simultaneously using a full-field laser perfusion imager before and after inflatable occlusion. The five points comprised three points located on the pericardium meridian, and two points from different locations. Coherence analysis between these points was performed at different frequency intervals from 0.0095 to 2 Hz.

Results

In young subjects, the coherence value was unchanged before and after occlusion, and there was no significant difference in coherence value between meridian-meridian points (M-M) and meridian-parameridian points (M-P). In middle-aged subjects, the coherence value increased significantly in both M-M and M-P at frequency intervals of 0.14-0.4 Hz, 0.4-1.6 Hz, and 1.6-2 Hz. However, there was no significant difference in coherence values between M-M and M-P.

Conclusions

Inflatable occlusion can increase middle-aged subjects’ blood perfusion coherence value of the forearm. However, there is no specificity in meridian location.

Time-scheduled delivery of computer health animations: “Installing” healthy habits of computer use

The development of modern technology brings convenience to our lives but removes physical activity from our daily routines, thereby putting our lives at risk. Extended computer use may contribute to symptoms such as visual impairment and musculoskeletal disorders. To help reduce the risk of physical inactivity and promote healthier computer use, this study developed a time-scheduled delivery of health-related animations for users sitting in front of computers for prolonged periods. In addition, we examined the effects that the program had on the computer-related health behavior intentions and actions of participants. Two waves of questionnaires were implemented for data collection before and after intervention. The results showed that the animation program indeed had a positive effect on participants’ healthy computer use actions in terms of breathtaking, body massages, and body stretches. It also helped to bridge the intention–action gap of the health behaviors. The development and evaluation were documented, and users’ experiences/suggestions were discussed at the end.

The influence of skin microcirculation blood perfusion at zusanli acupoint by stimulating with lift-thrust reinforcing and reducing acupuncture manipulation methods on healthy adults

Background. In traditional Chinese medicine acupuncture manipulation is one of the key factors that affect the curative results of acupuncture and more and more researches focus on how the different acupuncture manipulation techniques influence microcirculation nowadays. In this paper we demonstrate the different influences of lift-thrust reinforcing and reducing on blood perfusion. Method. The acupuncture manipulations of lift-thrust reinforcing and reducing were, respectively, applied to the 15 healthy subjects at the Zusanli acupoint and the changes of blood perfusion were monitored by Pericam Perfusion Speckle Imager (PSI). Conclusion. Both of the manipulations of lift-thrust reinforcing and reducing increase blood perfusion at Zusanli acupoint while the increasing amount of blood perfusion in the reinforcing group is significantly higher than in the reducing group.

Acupressure at the Meridian Acupoint Xiyangguan (GB33) Influences Near-Infrared Spectroscopic Parameters (Regional Oxygen Saturation) in Deeper Tissue of the Knee in Healthy Volunteers

Up to now, it is still unknown whether microcirculation of deeper peripheral tissue (knee) can be modulated by acupuncture or acupressure on a meridian acupoint. The goal of this pilot study was to investigate possible effects of acupressure at the Xiyangguan acupoint (GB33) on the regional oxygen saturation of the deeper knee tissues by near-infrared spectroscopy (NIRS). Twelve healthy volunteers with a mean age of 23.8 ± 1.6 years were investigated. Acupressure stimulation was performed for 5 minutes at the Xiyangguan acupoint. The results of the controlled study showed a significant increase of the values of regional oxygen saturation on the stimulated side of the knee (P = 0.033), whereas the opposite side on the same knee showed insignificant changes. These results may serve as a valuable basis for monitoring a possible therapeutic effect (e.g., after Khalifa therapy) in patients with knee problems.

Evaluate laser needle effect on blood perfusion signals of contralateral hegu acupoint with wavelet analysis

Our previous studies suggested that the MBF in contralateral Hegu acupoint (IL4) increased after ipsilateral Hegu acupoint was stimulated with manual acupuncture. In this study, twenty-eight (28) healthy volunteers were recruited and were randomly divided into Hegu acupoint stimulation group and Non-Hegu stimulation group. All subjects received the same model stimulation of the laser needle for 30 min in right Hegu acupoint and Non-Hegu acupoint, respectively. MBF of left LI4 was measured by the laser Doppler perfusion imaging system. The original data dealt with morlet wavelet analysis and the average amplitude and power spectral density of different frequency intervals was acquired. The results indicated that right Hegu stimulation with the laser needle might result in the increase of left Hegu acupoint MBF. 40 min later after ceased stimulation, the MBF is still increasing significantly, whereas the MBF has no significantly change in Non-Hegu stimulation group. The wavelet analysis result suggested that compared to Non-Hegu stimulation, stimulated to right Hegu acupoint might result in the increase of average amplitude in frequency intervals of 0.0095-0.02 Hz, 0.02-0.06 Hz, and 0.06-0.15 Hz, which might be influenced by the endothelial, neurogenic, and the intrinsic myogenic activity of the vessel wall, respectively.

Change of blood perfusion in Hegu acupoint after contralateral Hegu acupoint was stimulated

OBJECTIVES

The objective of this study was to investigate the change of mean blood flux in Hegu acupoint after contralateral Hegu acupoint was stimulated.

METHODS

Healthy volunteers (N=140) were placed in a temperature-controlled room as a resting state for 60 minutes. Then the measurements of skin blood flow were carried out in pre- and postacupuncture stimulation every 30 minutes over a total of 180 minutes using a Moor full-field laser perfusion imager. The change ratio of mean blood flux in Hegu acupoint was used to evaluate the contralateral stimulation effect in different groups.

RESULTS

After acupuncture of the right Hegu acupoint (AR), the change ratio of mean blood flux in the left Hegu acupoint was increased significantly compared with the control group 60 minutes after acupuncture stimulation (p<0.01). Then the blood flow in the AR group was sustained at a higher level compared with that of the control group (p<0.05). However, the change ratio of mean blood flux in the right Hegu acupoint increased significantly in the 30 minutes after contralateral acupuncture stimulation (p<0.01). From that point on, the change ratio was sustained at a higher level in the AR group than in the control group until 150 minutes after stimulation (p<0.05).

CONCLUSIONS

On stimulation of either the left or right side of Hegu acupoint, the change ratio of mean blood flux was increased in the contralateral Hegu acupoint in a period from 30, 60, to 150 minutes after stimulation, respectively.

System identification algorithm analysis of acupuncture effect on mean blood flux of contralateral hegu acupoint

Background. Acupoints (belonging to 12 meridians) which have the same names are symmetrically distributed on the body. It has been proved that acupoints have certain biological specificities different from the normal parts of the body. However, there is little evidence that acupoints which have the same name and are located bilaterally and symmetrically have lateralized specificity. Thus, researching the lateralized specificity and the relationship between left-side and right-side acupuncture is of special importance. Methodology and Principal Findings. The mean blood flux (MBF) in both Hegu acupoints was measured by Moor full-field laser perfusion imager. With the method of system identification algorithm, the output distribution in different groups was acquired, based on different acupoint stimulation and standard signal input. It is demonstrated that after stimulation of the right Hegu acupoint by needle, the output value of MBF in contralateral Hegu acupoint was strongly amplified, while after acupuncturing the left Hegu acupoint, the output value of MBF in either side Hegu acupoint was amplified moderately. Conclusions and Significance. This paper indicates that the Hegu acupoint has lateralized specificity. After stimulating the ipsilateral Hegu acupoint, symmetry breaking will be produced in contrast to contralateral Hegu acupoint stimulation.

Assessing the microcirculatory response following oral administration of Liuwei Dihuang formula by spectral analysis of skin-surface laser Doppler signals

OBJECTIVE

This study aimed to assess the skin-surface microcirculatory effects of oral administration of Liuwei Dihuang (LW) formula by analyzing the frequency content of laser-Doppler skin blood-flow signals at important acupoints.

METHODS

Laser-Doppler signals were measured in male healthy volunteers in two groups of experiments: the LW experiment (n=42; aged (27.8±3.8) years) and the control experiment (n=28; aged (27.3±3.4) years). Each experiment involved a 20-minute baseline-data sequence and three following sets of effects data: recorded on the same day after oral administration of 250 mL water (28 degrees centigrade) accompanied with 5 g of LW formula (herbal extract granules), and recorded on the second day after taking other two doses of LW formula.

RESULTS

During the second day, the increases in the mean and pulsatile components of the flux signal were the most prominent, and the relative energy contribution at 0.02 to 0.06 Hz was significantly decreased at Taixi (KI3). There were no any other significant changes in these parameters at other measurement sites.

CONCLUSION

The redistribution of skin-surface microcirculatory blood flow following oral LW administration observed here can be attributed to different changes in sympathetic neural activities and thus the different perfusion resistance through the arteriolar openings of the peripheral vascular beds at different measurement sites. The developed noninvasive and real-time monitoring technique could form part of an evidence-based method for studying the physiological effects and the underlying mechanisms of traditional Chinese medicine herbs.

Effects of different contacting pressure on the transfer function between finger photoplethysmographic and radial blood pressure waveforms

Background: The blood pressure (BP) waveform is suggested to reflect the whole-body blood supply distribution, but its non-invasive assessment is not sufficiently user friendly for practical applications. The present authors studied the correlation between BP and photo-plethysmography (PPG) waveforms, with the aim of determining the optimal range for contact pressure stimulation (PS) to produce a reliable transfer function in their harmonic parameters. Methods: Finger PPG and radial-artery BP signals were measured simultaneously and non-invasively on healthy volunteers ( n = 45). PS of 0–200 mmHg was applied to the finger, and 1 min data sequences were recorded. In frequency-domain analysis, linear regression was applied to the calculated amplitude ratios or the first five harmonics between BP and PPG waveforms. Results: In the 60 mmHg-PS group, the BP–PPG regression of amplitude ratios was highest, and the agreements between them were also the best verified by Bland–Altman analysis. Conclusion: In the present study, frequency-domain analysis was performed to study the correlation between BP and PPG waveforms. Differences in pressure-induced-vasodilation responses underlie the different BP-PPG waveform correlations obtained by applying different PSs. The non-invasively derived PPG parameters might help to provide an easier method to acquire the radial-artery BP waveform, and hence broaden the application of BP waveform analysis.