Progress of Acupuncture Therapy in Diseases Based on Magnetic Resonance Image Studies: A Literature Review

Disease-Related Factors Associated with Acupuncture Response in Patients with Chronic Tension-Type Headache: A Secondary Analysis of A Randomized Controlled Trial

OBJECTIVE

To explore the demographic and disease-related factors associated with acupuncture response in patients with chronic tension-type headache (CTTH).

METHODS

Using data from a randomized clinical trial (218 cases) consisting of 4 weeks of baseline assessment, 8 weeks of treatment, and 24 weeks of follow-up, participants were regrouped into responders (at least a 50% reduction in monthly headache days at week 16 compared with baseline) and non-responders. Twenty-three demographic and disease-related factors associated with acupuncture response in 183 participants were analyzed by multivariable logistic regression.

RESULTS

One hundred and nineteen (65.0%) participants were classified as responders. Four factors were significantly independently associated with acupuncture response, including treatment assignment, headache intensity at baseline, and 2 domains [general health (GH) and social functioning (SF)] from the 36-Item Short Form Health Survey quality of life questionnaire. Treatment assignment was associated with non-response: participants receiving true acupuncture were 3-time more likely to achieve a CTTH response than those receiving superficial acupuncture [odds ratio (OR) 0.322, 95% confidence interval (CI) 0.162 to 0.625, P=0.001]. Compared with patients with mild-intensity headache, patients with moderate-intensity headache were twice as likely to respond to acupuncture (OR 2.001, 95% CI 1.020 to 4.011, P=0.046). The likelihood of non-response increased by 4.5% with each unit increase in the GH grade (OR 0.955, 95% CI 0.917 to 0.993, P=0.024) while decreased by 3.8% with each unit increase in the SF grade (OR 1.038, 95% CI 1.009 to 1.069, P=0.011).

CONCLUSIONS

Greater headache intensity, lower GH score, and higher SF score were associated with better acupuncture responses in CTTH patients. These 3 factors require independent validation as predictors of acupuncture effectiveness in CTTH.

A multimodal MRI study of XNKQ acupuncture for limb dysfunction after ischemic stroke: a randomized controlled study protocol

Introduction

Limb motor dysfunction is one of the challenges in rehabilitation after cerebral ischemic stroke (CIS) and greatly affects the quality of life of patients. This study aims to investigate the central mechanisms of the curative effect with multimodal magnetic resonance imaging (MRI), which will provide additional evidence to support the application of Xingnao Kaiqiao (XNKQ) acupuncture.

Methods and analysis

This trial is a randomized controlled trial. Patients who meet the criteria will be recruited and randomly divided into 2 groups. One group will receive acupuncture treatment and another group will not receive acupuncture treatment. Both groups will receive conventional treatment. In addition, 20 healthy individuals will be recruited who will not receive any treatment. The total course of treatment is 14 days. The primary outcome is multimodal MRI analysis. For safety assessment, adverse events will be observed and recorded.

Ethics and dissemination

The study involving human subjects was reviewed and approved by the Ethics Committee of IRB of The First Teaching Hospital of Tianjin University of TCM (TYLL2023[K]031). This study complied with the Declaration of Helsinki. Written informed consent about this study was provided by the participants. The results of this study will be published in a peer-reviewed journal.

Clinical trial registration

Chinese Clinical Trial Registration Center (ChiCTR2300078315) https://www.chictr.org.cn/.

Electroacupuncture blocked motor dysfunction and gut barrier damage by modulating intestinal NLRP3 inflammasome in MPTP-induced Parkinson's disease mice

Parkinson's disease (PD) is a neurodegenerative disorder commonly accompanied by gut dysfunction. EA has shown anti-inflammatory and neuroprotective effects. Here, we aim to explore whether EA can treat Parkinson's disease by restoring the intestinal barrier and modulating NLRP3 inflammasome. We applied 1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) to establish a PD mouse model and EA at the GV16, LR3, and ST36 for 12 consecutive days. The open-field test results indicated that EA alleviated depression and behavioral defects, upregulated the expressions of tyrosine hydroxylase (TH) and brain-derived neurotrophic factor (BDNF), and blocked the accumulation of α-synuclein (α-syn) in the midbrain. Moreover, EA blocked the damage to intestinal tissues of PD mice, indicative of suppressed NLRP3 inflammasome activation and increased gut barrier integrity. Notably, the antibiotic-treated mouse experiment validated that the gut microbiota was critical in alleviating PD dyskinesia and intestinal inflammation by EA. In conclusion, this study suggested that EA exhibited a protective effect against MPTP-induced PD by alleviating behavioral defects, reversing the block of motor dysfunction, and improving the gut barrier by modulating intestinal NLRP3 inflammasome. Above all, this study could provide novel insights into the pathogenesis and therapy of PD.

Objectivization study of acupuncture Deqi and brain modulation mechanisms: a review

Deqi is an important prerequisite for acupuncture to achieve optimal efficacy. Chinese medicine has long been concerned with the relationship between Deqi and the clinical efficacy of acupuncture. However, the underlying mechanisms of Deqi are complex and there is a lack of systematic summaries of objective quantitative studies of Deqi. Acupuncture Deqi can achieve the purpose of treating diseases by regulating the interaction of local and neighboring acupoints, brain centers, and target organs. At local and neighboring acupoints, Deqi can change their tissue structure, temperature, blood perfusion, energy metabolism, and electrophysiological indicators. At the central brain level, Deqi can activate the brain regions of the thalamus, parahippocampal gyrus, postcentral gyrus, insular, middle temporal gyrus, cingulate gyrus, etc. It also has extensive effects on the limbic-paralimbic-neocortical-network and default mode network. The brain mechanisms of Deqi vary depending on the acupuncture techniques and points chosen. In addition, Deqi 's mechanism of action involves correcting abnormalities in target organs. The mechanisms of acupuncture Deqi are multi-targeted and multi-layered. The biological mechanisms of Deqi are closely related to brain centers. This study will help to explore the mechanism of Deqi from a local-central-target-organ perspective and provide information for future clinical decision-making.

Effects of anterior sciatic nerve acupuncture on lower limb paralysis after cerebral infarction: study protocol for a randomized controlled trial

Stroke is the main cause of disability in the middle and old age. Hemiplegia, especially lower limb paralysis, often leads to the loss of self-care ability and a series of secondary injuries. The main method to improve hemiplegic limb movement is exercise therapy, but there are still many patients with disabilities after rehabilitation treatment. As one of the non-pharmacological therapies for stroke, acupuncture has been recognized to improve motor function in patients. Here, we propose a new method, anterior sciatic nerve acupuncture, which can stimulate both the femoral nerve and the sciatic nerve. We designed this study to determine the effect of this method on lower limb motor function. Sixty participants recruited with hemiplegia after cerebral infarction will be randomly assigned to the test group or control group in a 1:1 ratio. The control group will receive Xingnao Kaiqiao acupuncture, and the test group will receive anterior sciatic nerve acupuncture on this basis. All participants will get acupuncture treatment once a day, 6 times a week for 2 weeks. The primary outcome is Fugl-Meyer Assessment of Lower Extremity and the secondary outcomes are Modified Ashworth Scale and Modified Barthel Index. Data will be collected before treatment, 1 week after treatment, and 2 weeks after treatment, and then statistical analysis will be performed. This study can preliminarily verify the effect of anterior sciatic nerve acupuncture on improving lower limb motor function in patients with cerebral infarction, which may provide an alternative approach for clinical treatment of hemiplegia.

Immediate neural effects of acupuncture manipulation time for stroke with motor dysfunction: a fMRI pilot study

Introduction

Acupuncture is widely utilized as a beneficial intervention for the treatment of motor dysfunction after stroke, and its effectiveness depends on the stimulation dose. Manipulation time is an important factor affecting the dose. This trial aimed use fMRI to explore the immediate neural effects in stroke patients with motor dysfunction by different acupuncture manipulation times, to reveal the neural mechanism of acupuncture manipulation.

Methods

Thirty participants were divided into three groups according to different acupuncture times. Each group received the same acupoint prescription, although the continuous manipulation time of each acupoint in three groups was 1-min, 2-min, and 3-min, respectively. The NIHSS, FMA and fMRI-BOLD in each participant we obtained before and after acupuncture manipulation. Then, we used the regional homogeneity (ReHo) algorithm to analyze the changes of brain function and to compare the neural effects at different acupuncture manipulation times.

Results

There were no significant differences in NIHSS and FMA scores between and within groups. Longitudinal analysis of ReHo values indicated that the right inferior frontal gyrus was activated in the 1-min group, the right insula in the 2-min group, and the right inferior temporal gyrus in the 3-min group. Compared with the 1-min group, the 2-min group showed the ReHo values of the right precentral gyrus was decreased, and the 3-min group showed the left cerebellum posterior lobe was increased, the right posterior cingulate gyrus and the right anterior cingulate gyrus were decreased. Compared with the 2-min group, the 3-min group showed the ReHo values of the right cerebellum anterior lobe was increased.

Conclusion

Our findings suggest that acupuncture at different manipulation times caused different changes of the neural effects in stroke patients, and the volume of activated voxel clusters is positively correlated with the manipulation time. Longer acupuncture manipulation could drive SMN and DMN in stroke patients, which may be the potential neurological mechanism of acupuncture manipulation affecting the recovery of motor dysfunction.

Cortical functional networks of transcutaneous electrical stimulation at acupoints on the pericardial meridian

To explore the relationship between pericardial meridian acupoints and brain, the electroencephalogram (EEG) signals were collected synchronously during transcutaneous electrical stimulation at PC3, PC5, PC7, and PC8 on the pericardial meridian in 21 healthy subjects. The cerebral cortex functional networks were constructed by standard low-resolution electromagnetic tomography (sLORETA), phase-locking value (PLV) and complex network methods. The prefrontal cortex (BA10), the orbitofrontal cortex (BA11), the middle temporal gyrus (BA21), the temporal gyrus (BA22), the temporal pole (BA38), the triangular part (BA44), the dorsolateral prefrontal cortex (BA46), and the inferior frontal cortex (BA47) were activated by electrical stimulation at PC3, PC5, PC7, and PC8 on the pericardium meridian. These activated brain regions are able to modulate both local and remote emotion and cognitive networks. Acupoint stimulation of pericardium meridian mainly activated the frontal and the temporal lobes. Compared with non-acupoint stimulation, the node degree in the frontal lobe of electrical stimulation at PC3 (p < 0.05), PC5 (p < 0.05), PC7 (p < 0.01), PC8 (p < 0.05) and the temporal lobe of PC3 (p < 0.05), PC5 (p < 0.05), PC7 (p < 0.05), PC8 (p < 0.01) were significantly increased. The clustering coefficient in the frontal lobe of the stimulation at PC3 (p < 0.05), PC5 (p < 0.05), PC7 (p < 0.01), PC8 (p < 0.05) and the temporal lobe of PC3 (p < 0.05), PC5 (p < 0.05), PC7 (p < 0.01), PC8 (p < 0.05) were significantly increased. The characteristic path length decreased and the global efficiency increased during acupoint stimulation. The changes of functional network of stimulated pericardium meridian through cerebral cortex may provide theoretical support for the specificity of meridian and acupoints.

Acupuncture Alters Brain's Dynamic Functional Network Connectivity in Stroke Patients with Motor Dysfunction: A Randomised Controlled Neuroimaging Trial

Objectives

Neuroimaging studies have confirmed that acupuncture can promote static functional reorganization in poststroke patients with motor dysfunction. But its effect on dynamic brain networks remains unclear. This study is aimed at investigating how acupuncture affected the brain's dynamic functional network connectivity (dFNC) after ischemic stroke.

Methods

We conducted a single-center, randomised controlled neuroimaging study in ischemic stroke patients. A total of 53 patients were randomly divided into the true acupoint treatment group (TATG) and the sham acupoint treatment group (SATG) at a ratio of 2 : 1. Clinical assessments and magnetic resonance imaging (MRI) scans were performed on subjects before and after treatment. We used dFNC analysis to estimate distinct dynamic connectivity states. Then, the temporal properties and strength of functional connectivity (FC) matrix were compared within and between the two groups. The correlation analysis between dynamic characteristics and clinical scales was also calculated.

Results

All functional network connectivity (FNC) matrices were clustered into 3 connectivity states. After treatment, the TATG group showed a reduced mean dwell time and found attenuated FC between the sensorimotor network (SMN) and the frontoparietal network (FPN) in state 3, which was a sparsely connected state. The FC between the dorsal attention network (DAN) and the default mode network (DMN) was higher after treatment in the TATG group in state 1, which was a relative segregated state. The SATG group preferred to increase the mean dwell time and FC within FPN in state 2, which displayed a local tightly connected state. In addition, we found that the FC value increased between DAN and right frontoparietal network (RFPN) in state 1 in the TATG group after treatment compared to the SATG group. Correlation analyses before treatment showed that the Fugl-Meyer Assessment (FMA) lower score was negatively correlated with the mean dwell time in state 3. FMA score showed positive correlation with FC in RFPN-SMN in state 3. FMA-lower score was positively correlated with FC in DAN-DMN and DAN-RFPN in state 1.

Conclusions

Acupuncture has the potential to modulate abnormal temporal properties and promote the balance of separation and integration of brain function. True acupoint stimulation may have a more positive effect on regulating the brain's dynamic function. Clinical Trial Registration. This trial is registered with Chinese Clinical Trials Registry (ChiCTR1800016263).

Artificial intelligence in acupuncture: A bibliometric study

This study aimed to provide a panorama of artificial intelligence (AI) in acupuncture by characterizing and visualizing the knowledge structure, hotspots and trends in global scientific publications. Publications were extracted from the Web of Science. Analyses on the number of publications, countries, institutions, authors, co-authorship, co-citation and co-occurrence were conducted. The USA had the highest volume of publications. Harvard University had the most publications among institutions. Dey P was the most productive author, while lczkowski KA was the most referenced author. The Journal of Alternative and Complementary Medicine was the most active journal. The primary topics in this field concerned the use of AI in various aspects of acupuncture. "Machine learning" and "deep learning" were speculated to be potential hotspots in acupuncture-related AI research. In conclusion, research on AI in acupuncture has advanced significantly over the last two decades. The USA and China both contribute significantly to this field. Current research efforts are concentrated on the application of AI in acupuncture. Our findings imply that the use of deep learning and machine learning in acupuncture will remain a focus of research in the coming years.

Artificial intelligence-directed acupuncture: a review

Acupuncture is widely used around the whole world nowadays and exhibits significant efficacy against many chronic diseases, especially in pain-related diseases. With the rapid development of artificial intelligence (AI), its implementation into acupuncture has achieved a series of significant breakthroughs in many areas of acupuncture practice, such as acupoints selection and prescription, acupuncture manipulation identification, acupuncture efficacy prediction, and so on. The paper will discuss the significant theoretical and technical achievements in AI-directed acupuncture. AI-based data mining methods uncovered crucial acupoint combinations for treating various diseases, which provide a scientific basis for acupoints prescription in clinical practice. Furthermore, the rapid development of modern TCM instruments facilitates the integration of modern medical instruments, AI techniques, and acupuncture. This integration significantly improves the quantification, objectification, and standardization of acupuncture as well as the delivery of clinical personalized acupuncture therapy. Machine learning-based clinical efficacy prediction of acupuncture can help doctors screen patients who may benefit from acupuncture treatment. However, the existing challenges require additional work for developing AI-directed acupuncture. Some include a better understanding of ancient Chinese philosophy for AI researchers, TCM acupuncture theory-based explanation of the knowledge discoveries, construction of acupuncture databases, and clinical trials for novel knowledge validation. This review aims to summarize the major contribution of AI techniques to the discovery of novel acupuncture knowledge, the improvement for acupuncture safety and efficacy, the development and inheritance of acupuncture, and the major challenges for the further development of AI-directed acupuncture. The development of acupuncture can progress with the help of AI.

Sensorimotor Responses in Post-Stroke Hemiplegic Patients Modulated by Acupuncture at Yanglingquan (GB34): A fMRI Study Using Intersubject Functional Correlation (ISFC) Analysis

Motor dysfunction is common in patients with stroke. Acupuncture has become an acceptable alternative method for stroke rehabilitation. Previous studies have shown various functional connectivity changes activated by acupuncture. We introduced intersubject correlation (ISC) and intersubject functional correlation (ISFC) analyses into the functional magnetic resonance imaging (fMRI) for ischemic stroke to seek a common activation and suppression pattern triggered by acupuncture. In this study, 63 ischemic stroke patients with motor dysfunction and 42 normal controls were analyzed. Three functional scans were conducted during the resting state, motor task, and acupuncture at Yanglingquan (GB34) task. Twenty-two sensory, motor, and movement-imagination cortices in the bilateral hemispheres were selected as the region of interest (ROI). We performed ISC and ISFC analyses among these ROIs in three fMRI runs on patients and controls. Subgroup analyses by course or severity were also conducted. The results showed that acupuncture at GB34 triggered ISFC among upper limb motor, upper limb/hand/face, lower limb, tongue/larynx sensory, and movement imagination regions in the patient group. Subgroup ISC and ISFC analyses showed that patients tended to have increasing responses in the early stage of stroke (within 1 month) and decreasing responses afterward (1–3 months). Patients with mild clinical functional damage (NIHSS 2–4) tended to generate more responses via acupuncture than those with moderate damage (NIHSS 5–15). Our findings may help understand the clinical effects and modulatory features of acupuncture based on the group-level post-stroke neuroplasticity.

Methodological issues of the central mechanism of two classic acupuncture manipulations based on fNIRS: suggestions for a pilot study

Background: Acupuncture reinforcing-reducing manipulation (ARRM) is a necessary procedure of traditional Chinese acupuncture and an essential factor affecting the therapeutic effect of acupuncture. Shaoshanhuo reinforcing method (SSH) and Toutianliang reducing method (TTL) are the most representative ARRMs. They integrate six single ARRMs and pose distinguished therapeutic effects of acupuncture. However, due to the complexity, diversity, and variation, investigating the mechanism of these two classic manipulations is insufficient. The neuroimaging technique is an important method to explore the central mechanism of SSH and TTL. This study attempted to design a randomized crossover trial based on functional near-infrared spectroscopy (fNIRS) to explore the mechanism of SSH and TTL, meanwhile, provide valuable methodological references for future studies. Methods: A total of 30 healthy subjects were finally included and analyzed in this study. fNIRS examination was performed to record the neural responses during the two most representative ARRMs. The cortical activation and the inter-network functional connectivity (FC) were explored. Results: The results found that SSH and TTL could elicit significant cerebral responses, respectively, but there was no difference between them. Conclusion: Neuroimaging techniques with a higher spatiotemporal resolution, combinations of therapeutic effects, and strict quality control are important to neuroimaging studies on SSH and TTL.