[Effect of Daoqi Tongjing needling method on intra-uterine residue after drug abortion from the perspectives of Hegu (LI 4) and Sanyinjiao (SP 6)]

The paper introduces professor ZHUANG Li-xing's clinical experience in treatment of intra-uterine residue and lochia after drug abortion. Professor ZHUANG believes that this disorder is related to "dysfunction of the thoroughfare vessel and the conception vessel, qi deficiency and blood stagnation, and retention of turbid qi in the uterus" in pathogenesis. The treating principle should focus on "regulating the functions of the thoroughfare vessel and the conception vessel, tonifying qi and eliminating stasis, as well as promoting qi movement". Besides Hegu (LI 4) and Sanyinjiao (SP 6), the acupoints are added from the conception vessel. The Daoqi Tongjing needling technique (the specific technique for directing qi and preserving essence) is exerted flexibly instead of traditional reinforcing and reducing technique of acupuncture to tonify qi and remove stasis.

[The sensitization phenomena and regularity of Hegu (LI 4) based on bibliometrics]

The sensitization phenomena and regularities of Hegu (LI 4) were preliminarily explored. The relevant literature regarding Hegu (LI 4) sensitization were collected by computer retrieval at Cochrane Library, Pubmed, Embase (OvidSP), China Journal Full Text Database (CNKI), China Biomedical Literature Database (CBM), VIP and Wanfang (WF) databases as well as manual searching, and a modern literature database of Hegu (LI 4) sensitization was established. The information of disease type, sensitization type, detection method and index were collected. Frequency statistics method was used for analysis. As a result, 47 literatures were included, of which heat sensitivity was the most common type of sensitization, and diseases of liver and gallbladder, limb meridians, lung system, and spleen-stomach system were the most common types of diseases. The detection method of sensitization was various, among them, potassium ion introduction method and hot-water tail-flick method were mainly used for pain sensitivity, while acupoint resistance measuring instrument was mainly used for electric sensitivity, while thermal infrared imager was mainly used for heat sensitivity, while infrared spectrometric analyzer was mainly used for light sensitivity, while pressing pain measuring instrument was used for pressing sensitivity. Detection index was different, pain sensitivity detected pain threshold, electric sensitivity mainly detected acupoint resistance, heat sensitivity mainly detected temperature, light sensitivity detected average sharpness and average energy of infrared radiation, pressing sensitivity detected pressing-pain threshold. In conclusion, the regularities of sensitization of Hegu (LI 4) were preliminarily summarized, which involved five sensitization types: heat sensitivity, electric sensitivity, pain sensitivity, pressing sensitivity and light sensitivity. The sensitization of Hegu (LI 4) was commonly seen in facial paralysis, bronchial asthma, allergic rhinitis, tinnitus, ulcerative colitis. The temperature, pain threshold, pressing-pain threshold, average sharpness and average energy of infrared radiation of Hegu (LI 4) in pathological condition were lower than those in healthy subjects, and the resistance value was higher than that of healthy subjects.

[Clinical observation on the treatment of hand dysfunction after stroke with chicken-claw needling at Shangbaxie (Extra) and Hegu (LI 4) combined with acupuncture at Houxi (SI 3)]

OBJECTIVE

To observe the difference in clinical efficacy between chicken-claw needling at Shangbaxie (Extra) and Hegu (LI 4) combined with acupuncture at Houxi (SI 3) and the conventional acupuncture at the 3 points for the treatment of hand dysfunction after stroke.

METHODS

Forty-two patients were divided into an observation group and a control group according to the random number table, 21 cases in each one. The chicken-claw needling was used at Shangbaxie (Extra) and Hegu (LI 4) on the affected side combined with acupuncture at Houxi (SI 3) in the observation group. The conventional acupuncture was performed at the same point as the observation group in the control group, once a day, 6 days for a course, 1 day of interval after a course, and the therapeutic effect was observed after 5 courses. The simplifying Fugl-Meyer Motor Function Rating Scale (FMA), the modified Barthel index and the Brunnstrom grading criteria were used to evaluate the hand function of the two groups before and after treatment.

RESULTS

The FMA score, Barthel index and Brunnstrom grade were improved after treatment in the two groups (all P<0.05), and the FMA score, Barthel index and Brunnstrom grade in the observation group were better than those in the control group (all P<0.05).

CONCLUSION

Chicken-claw needling at Shangbaxie (Extra) and Hegu (LI 4) combined with acupuncture at Houxi (SI 3) can effectively treat hand dysfunction after stroke, and the curative effect is better than the conventional acupuncture at the 3 points.

[Effects of perioperative transcutaneous electrical acupoint stimulation on postoperative analgesia in patients undergoing shoulder arthroscopic surgery]

OBJECTIVE

To observe and evaluate the effects of transcutaneous electrical acupoint stimulation (TEAS) at different time points on postoperative analgesia in perioperative period in patients undergoing shoulder arthroscopic surgery, and to explore the optimal time to use TEAS for shoulder arthroscopic surgery.

METHODS

A total of 120 patients undergoing unilateral shoulder arthroscopy under general anesthesia, graded withⅠtoⅡaccording to ASA criteria were randomly divided into 3 groups, 40 patients in each one. The patients in the group A were treated with preoperative TEAS at sham acupoints combined with postoperative TEAS at Hegu (LI 4) and Neiguan (PC 6); the patients in the group B were treated with preoperative TEAS at Hegu (LI 4) and Neiguan (PC 6) combined with postoperative TEAS at sham acupoints; the patients in the group C were treated with TEAS at sham acupoints before and after operation. The parameters of TEAS were dilatational wave, 2 Hz/100 Hz in frequency, 30 min. When the resting-state visual analogue scale (VAS) of incision was more than 3 points, the patient-controlled intravenous analgesia (PCIA) pump of sufentanil was administered to maintain the VAS no more than 3 points. The time point when PCIA pump was firstly used, the used dose of sufentanil and effective pressing number of PCIA pump within 24 hours after surgery were recorded. Intraoperative anesthetic doses were recorded in the three groups. The resting-state and task-state VAS were evaluated at 0, 6, 12, 24 hours after surgery; the patient's satisfaction rate and adverse effects were recorded.

RESULTS

The time when PCIA pump was firstly used in the group A and the group B was significantly longer than that in the group C, and the used dose of sufentanil and effective pressing number of PCIA pump within 24 hours after surgery in the group A and group B were significantly less than those in the group C (all P<0.05); the incidence of postoperative nausea-vomiting and sore throat was reduced (all P<0.05). The time when PCIA pump was firstly used in the group A was significantly longer than that in the group B, and the used dose of sufentanil and effective pressing number of PCIA pump within 24 hours after surgery in the group A were significantly less than those in the group B (all P<0.05); no significant difference of the incidence of postoperative nausea-vomiting and sore throat was observed between the group A and group B (both P>0.05). There were no statistically significant difference in VAS score at different postoperative time points and postoperative analgesia satisfaction rate between the two groups (all P>0.05).

CONCLUSION

Perioperative TEAS could improve the postoperative analgesia in patients undergoing arthroscopic shoulder surgery, delay the time when PCIA pump is firstly used, reduce the dosage of postoperative analgesics and adverse events. Compared before surgery, postoperative TEAS has better analgesia.

[Transcutaneous electrical acupoint stimulation on inflammatory response and intestinal permeability in perioperative period of laparoscopic intestinal surgery]

OBJECTIVE

To observe the effect of transcutaneous electrical acupoint stimulation (TEAS) on the inflammatory response and intestinal permeability after laparoscopic radical surgery for colon cancer, so as to explore the protective mechanism for perioperative organs.

METHODS

Sixty patients with laparoscopic intestinal resection were randomly assigned into an observation group and a control group, 30 cases in each group. TEAS at Zusanli (ST 36), Neiguan (PC 6) and Hegu (LI 4) was used in the observation group on the day of operation and within 3 days after surgery, 2 Hz, within 2 mA. The interventions in the control group were the same as those in the observation group, except opening the current source. Central venous blood was collected before TEAS and 12 h, 24 h, 48 h, 72 h after surgery. The level of the inflammatory indexes of tumor necrosis factor-α(TNF-α), interleukin-1 (IL-1), interleukin-6 (IL-6) and intestinal mucosal barrier response indexes of endotoxin (LPS) and D-lactate were detected.

RESULTS

Compared with the control group, the levels of IL-1, IL-6 and TNF-α decreased in the observation group 24 h, 48 h and 72 h after surgery (all P<0.05). The concentrations of D-lactate and LPS were not statistically different between the two groups (both P>0.05).

CONCLUSION

TEAS can reduce the inflammatory reaction after laparoscopic radical surgery for colon cancer, but has no effect on the intestinal permeability.

[Effects of transcutaneous electrical acupoint stimulation on quality of recovery during early period after laparoscopic cholecystectomy]

OBJECTIVE

To evaluate the effect of transcutaneous electrical acupoint stimulation (TEAS) on the quality of recovery during the early period after laparoscopic cholecystectomy and the dosage of anesthetic and analgesic.

METHODS

One hundred patients who received laparoscopic cholecystectomy with gradeⅠand Ⅱ of American Society of Anesthesiologists (ASA) criteria were randomly assigned into an observation group and a control group according to random number table, 50 cases in each group. The patients in the two groups were treated with conventional endotracheal intubation anesthesia, anesthesia induction and maintenance. The patients in the observation group were treated with TEAS (2 Hz/100 Hz, 8 to 12 mA) at bilateral Hegu (LI 4) and Neiguan (PC 6), as well as Zusanli (ST 36) and the non-acupoint 2 cun outboard from Zusanli (ST 36) from 30 min before anesthesia induction to the end of operation. The patients in the control group were applied by stimulation electrode in the corresponding points without electrical stimulation. The dosage of intraoperative remifentanil and the analgesic dosage of dezocine for postoperation were recorded. The recovery time, extubation time, the changes of heart rate (HR) and mean arterial pressure (MAP) during extubation were recorded. The quality of recovery was assessed by the quality of recovery-40 questionnaire (QoR-40) 1 day before surgery (T₀)，and 4 h (T₁), 8 h (T₂), 24 h (T₃), 48 h (T₄) after surgery. The patient's cognitive function was assessed by mini-mental state examination (MMSE) scale at the 5 time points. The incidences of postoperative nausea and vomiting were recorded at T₁ through T₄.

RESULTS

The dosages of intraoperative remifentanil and dezocine in the observation group were less than those in the control group; the recovery time and extubation time were shorter than those in the control group; the HR of extubation was lower than that in the control group (all P<0.05). There was no statistic difference about MAP between the two groups (P>0.05). Compared with T₀, the total scores of QoR-40 decreased in the two groups at T₁, T₂, T₃ (all P<0.05), and the total scores in the observation group were higher than those in the control group (all P<0.05). The emotional state, physical comfort, psychological support, self-care ability, pain scores at T₁ in the observation group and at T₁, T₂, T₃ in the control group were lower than those at T₀ (all P<0.05). The emotional state, physical comfort, psychological support, self-care ability, pain scores in the observation group were higher than those in the control group at T₁, T₂, T₃ (all P<0.05). Compared with T₀, the MMSE scores in the two groups decreased at T₁ and T₂ (all P<0.05). At T₁, T₂, T₃, the MMSE scores in the observation group were higher than those in the control group (all P<0.05). At T₁ and T₂, the incidence rates of nausea and vomiting were 22.0% (11/50), 12.0% (6/50) respectively in the observation group, which were lower than 32.0% (16/50) and 24.0% (12/50) in the control group (both P<0.05). At T₃ and T₄, the incidence rates of nausea and vomiting were 6.0% (3/50), 2.0% (1/50) respectively in the observation group, which were not significantly different from 8.0% (4/50) and 4.0% (2/50) in the control group (both P>0.05).

CONCLUSION

TEAS can improve the quality of recovery during the early period after laparoscopic cholecystectomy and reduce the dosage of anesthetic and analgesic.

Effect of electroacupuncture at Ximen (PC 4) and Hegu (LI 4) on expression of Akt in rats with myocardial ischemia-reperfusion injury

OBJECTIVE

To investigate the effect of electroacupuncture (EA) at acupoints on the pericardium meridian on the expression of phosphorylated Akt (p-Akt) protein in rat myocardium after ischemia and reperfusion.

METHODS

Seventy Wistar rats were evenly randomized into seven groups: the sham operation group (group A), ischemia-reperfusion model Ⅰ group (group B), ischemia-reperfusion model Ⅱ group (group C), EA at Neiguan (PC 6) group (group D), EA at Ximen (PC 4) group (group E), EA at Hegu (LI 4) group (group F), and LY294002 + EA at Neiguan (PC 6) group (group G). All processes were monitored by electrocardiography. In group A, the left anterior descending coronary artery was only threaded without ligation for 100 min. In group B, the left anterior descending coronary artery was ligated for 40 min and reperfused for 60 min. The left anterior descending coronary artery in group C was ligated for 40 min and reperfused for 100 min. Groups D, E, and F received EA for 20 min before undergoing ischemia for 40 min, and then received EA for 20 min before undergoing reperfusion for 60 min. Before modeling, group G was injected with LY294002 (0.3 mg/kg) into the tail vein, and then underwent the same intervention as the other EA groups. After reperfusion, myocardial tissue from the left cardiac ventricle was collected to enable Western blot analysis of the p-Akt level, and analysis of electrocardiographic changes.

RESULTS

In groups B and C, electrocardiography showed obvious elevation of the ST-segment Ⅱ lead (ECG-STⅡ), while the ECG-ST Ⅱ values were significantly lower in groups D, E, and G (P < 0.01). The p-Akt levels in groups D and E were significantly greater than those in groups B and C (P < 0.01). Compared with all other groups, group G showed a significantly different expression of p-Akt (P < 0.01).

CONCLUSION

The expression of p-Akt protein in cardiomyocytes was significantly greater in rats that were injected with LY294002 and received EA at Ximen (PC 4) compared with all other groups. This suggests that EA at Ximen (PC 4) resulted in activation of the phosphoinositide 3-kinase/Akt signaling pathway and phosphorylation of Akt.

[Analysis on mechanism of acupuncture with three needles at Hegu (LI 4) and its clinical application]

Inverted horse acupuncture (acupuncture with three needles) at Hegu (LI 4) is different from triple needling, a traditional needling method. Based on DONG's warming yang and tonifying qi by simultaneous acu-puncture at Linggu (Extra) and Dabai (Extra), we palpate points along the large intestine meridian of hand-yangming, and Linggu (Extra), Hegu (LI 4), and Dabai (Extra) are pricked perpendicularly to smooth triple energizer directly. Thus, functions of zangfu organs are holistically adjusted and clinical effect is better. We believe that Hegu (LI 4) is located on the radialis side of the forefinger, and changeable according to the body function states. While Linggu (Extra) and Dabai (Extra), two radialis points of the second metacarpal,are related to Hegu (LI 4) when it is moving pathologically. According to Sizongxuege (a verse about the four general acupoints), Hegu (LI 4) is effective for face and mouth diseases, which reveals the close relationship between the acupoint and head and face. Acupuncture with three needles achieves better long-term effect than simple acupuncture at Hegu (LI 4) for face and mouth diseases, including mimetic convulsion.