Electroacupuncture improves gut barrier dysfunction in prolonged hemorrhagic shock rats through vagus anti-inflammatory mechanism

AIM: To investigate whether electroacupuncture (EA) at Zusanli (ST36) prevents intestinal barrier and remote organ dysfunction following prolonged hemorrhagic shock through a vagus anti-inflammatory mechanism.

METHODS: Sprague-Dawley rats were subjected to about 45% of total blood volume loss followed by delayed fluid replacement (DFR) with Ringer lactate 3h after hemorrhage. In a first study, rats were randomly divided into six groups: (1) EAN: EA at non-channel acupoints followed by DFR; (2) EA: EA at ST36 after hemorrhage followed by DFR; (3) VGX/EA: vagotomy (VGX) before EA at ST36 and DFR; (4) VGX/EAN: VGX before EAN and DFR; (5) α-bungarotoxin (α-BGT)/EA: intraperitoneal injection of α-BGT before hemorrhage, followed by EA at ST36 and DFR; and (6) α-BGT/EAN group: α-BGT injection before hemorrhage followed by EAN and DFR. Survival and mean arterial pressure (MAP) were monitored over the next 12 h. In a second study, with the same grouping and treatment, cytokine levels in plasma and intestine, organ parameters, gut injury score, gut permeability to 4 kDa FITC-dextran, and expression and distribution of tight junction protein ZO-1 were evaluated.

RESULTS: MAP was significantly lowered after blood loss; EA at ST36 improved the blood pressure at corresponding time points 3 and 12 h after hemorrhage. EA at ST36 reduced tumor necrosis factor-α and interleukin (IL)-6 levels in both plasma and intestine homogenates after blood loss and DFR, while vagotomy or intraperitoneal injection of α-BGT before EA at ST36 reversed its anti-inflammatory effects, and EA at ST36 did not influence IL-10 levels in plasma and intestine. EA at ST36 alleviated the injury of intestinal villus, the gut injury score being significantly lower than that of EAN group (1.85 ± 0.33 vs 3.78 ± 0.59, P < 0.05). EA at ST36 decreased intestinal permeability to FITC-dextran compared with EAN group (856.95 ng/mL ± 90.65 ng/mL vs 2305.62 ng/mL ± 278.32 ng/mL, P < 0.05). EA at ST36 significantly preserved ZO-1 protein expression and localization at 12 h after hemorrhage. However, EA at non-channel acupoints had no such effect, and abdominal vagotomy and α-BGT treatment could weaken or eliminate the effects of EA at ST36. Besides, EA at ST36 decreased blood aminotransferase, MB isoenzyme of creatine kinase and creatinine vs EAN group at corresponding time points. At the end of 12-h experiment, the survival rate of the EA group was significantly higher than that of the other groups.

CONCLUSION: EA at ST36 attenuates the systemic inflammatory response, protects intestinal barrier integrity, improves organ function and survival rate after hemorrhagic shock via activating the cholinergic anti-inflammatory mechanism.

Electro-acupuncture at Acupoint ST36 Ameliorates Inflammation and Regulates Th1/Th2 Balance in Delayed-Type Hypersensitivity

Increasing evidence indicates anti-allergic and anti-inflammatory effects of electro-acupuncture (EA) therapy. However, its underlying mechanism on delayed-type hypersensitivity (DTH), a classic allergic inflammatory disease, still remains unclear. In this study, we aimed to explore the immunomodulatory mechanism of EA intervention in a mouse model of ovalbumin (OVA)-induced DTH. Mice were randomly divided into four groups: Control, OVA-DTH, DTH + EA, DTH + Sham. "Zusanli" acupoint (ST36) was used for DTH + EA, whereas a non-acupoint (localized 5 mm below the "Zusanli" acupoint) was selected for DTH + Sham. Footpad thickness was checked, and the infiltration of inflammatory cells was estimated by hematoxylin and eosin staining. Levels of IgG and IgE in serum of different groups and inflammatory cytokines in the supernatants from homogenized footpads, including IFN-γ, TNF-α, IL-4, and IL-5, were determined by ELISA. Cell proliferation of spleen lymphocytes was assayed by 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-H-tetrazolium bromide (MTT). The frequency of CD4⁺IFN-γ⁺ and CD4⁺IL-4⁺ T cells was analyzed with flow cytometry. In addition, the mRNA and protein expression of T-bet and GATA-3 were evaluated by real-time PCR and Western blotting, respectively. Our data showed EA treatment at acupoint ST36 relieved the pathological progression of DTH responses via reduction in footpad swelling, infiltration of inflammatory cells, levels of IgG and IgE as well as decreased production of IFN-γ and TNF-α in homogenized footpad tissue. Moreover, detailed studies were performed revealing that EA attenuated the percentage of CD4⁺IFN-γ⁺ T cells and prevented Th cells differentiation into Th1 cells, and this results from inhibiting secretion of IFN-γ and suppressing expression of T-bet, an IFN-γ transcription factor. The results indicated that EA treatment improved Th1-mediated allergic skin inflammation via restoring Th1/Th2 balance by curbing Th1 differentiation. These findings suggested that EA at acupoint ST36 might be a useful and promising therapeutic for allergic inflammatory as well as Th1-mediated inflammation response.

Electro-Acupuncture at Zusanli Acupoint (ST36) Suppresses Inflammation in Allergic Contact Dermatitis Via Triggering Local IL-10 Production and Inhibiting p38 MAPK Activation

Acupuncture has shown beneficial effect in the treatment of multiple dermatologic conditions including dermatitis, pruritus, urticaria, and hyperhidrosis; however, the detailed mechanisms are still kept unclear. This study aimed to investigate if electro-acupuncture (EA) treatment prevents 2,4-dinitrofluorobenzene (DNFB)-induced allergic contact dermatitis (ACD) in rats and explore its underlying mechanisms. ACD was induced by sensitizing and challenging with DNFB topically. Rats were treated daily following bilateral subcutaneous stimulation of EA at Zusanli acupoint (ST36) for 1 week. Ear swelling and serum IgE levels were measured. The ear biopsies were obtained for histology. Inflammatory cytokines on the dermatological ear and local acupoint tissue were assayed. Spleen lymphocytes and the homogenized supernatant of local acupuncture area were used to co-culture for flow cytology and immune analysis, respectively. EA treatment at ST36 notably inhibited ear swelling and inflammatory cell infiltration on DNFB-induced ACD. EA also decreased serum IgE concentrations and alleviated the production of inflammatory cytokines in dermatological ear. Additionally, EA treatment attenuated the percentage of CD4⁺IFN-γ⁺ and CD4⁺IL-4⁺ T cells associated with ACD. Interestingly, secretion of interleukin (IL)-10 in the local acupoint tissue following EA stimulation was increased and showed suppressive function when co-cultured with the spleen lymphocytes from DNFB group. Lastly, EA treatment demonstrably suppressed p38 MAPK activation in DNFB-treated rats. Our findings suggest that EA treatment at ST36 may ameliorate inflammation associated with DNFB-induced ACD via triggering local IL-10 production and inhibiting p38 MAPK activation, which provide an alternative and promising therapy for ACD.

Effect of Electroacupuncture on the NTS is modulated primarily by acupuncture point selection and stimulation frequency in normal rats

Background

The effect of electroacupuncture (EA) is affected by both the acupuncture point selection and the frequency of stimulation. However, little is known regarding acupuncture point and simulation frequency selection. Neuronal activation of the nucleus of the solitary tract (NTS) is one of the important targets of EA for modulating gastrointestinal function. This study investigated the effects of various combinations of EA frequencies and acupuncture points on NTS neurons.

Methods

Rats were randomly divided into normal, 2 Hz EA, 100 Hz EA and the alternate 2/100 Hz EA groups. Then rats in each group were randomly divided into the following two subgroups according to the acupuncture point: ST 36 group and ST 25 group. All the rats underwent electrode implantation surgery. Rats in all EA groups received one treatment with EA (a constant square wave at, 2 Hz,100 Hz or 2/100 Hz frequencies with intensities ranging from 1 to 2 mA), and NTS neuronal activation was recorded before and after EA treatment. Finally, to confirm the effect of EA on the NTS, minimal acupuncture was administered and its effect on NTS was detected.

Results

ST 36 stimulated with 2 Hz EA significantly increased the population of excited NTS neurons and spike frequency. However, ST 36 stimulated with 100 Hz or 2/100 Hz EA produced only a transient effect on the activity of NTS neurons and did not induce any effect on the spike frequency. Furthermore, the excitatory effect of 100 Hz or 2/100 Hz EA on NTS neurons in the ST 36 group was lower than 2 Hz EA at the same point. When applied to ST 25, 2 Hz EA had no significant excitatory effect on NTS neurons or spike frequency. However, 100 Hz EA or 2/100 Hz EA at ST 25 decreased both NTS neuronal excitability and spike frequency. By comparing the effects of different EA combinations, it was shown 2 Hz EA applied to ST 36 had the strongest excitatory effect on NTS neurons, while 100 Hz EA applied to ST 25 had the greatest inhibitory effect. Minimal acupuncture stimulation produced no effect on NTS neurons.

Conclusion

EA’s effects on NTS were mainly affected by the acupuncture point selection, but the frequency of EA also played a role. Different combinations of acupuncture points and frequency selection may lead to different EA effects on NTS neuronal excitability.

Association of high expression in rat gastric mucosal heat shock protein 70 induced by moxibustion pretreatment with protection against stress injury

AIM: To study the effect of moxibustion on Zusanli or Liangmeng point on gastric mucosa injury in stress-induced ulcer rats and its correlation with the expression of heat shock protein 70 (HSP70).

METHODS: Sixty healthy SD rats (30 males, 30 females) were divided into control group, injury model group, Zushanli point group, Liangmeng point group. Stress gastric ulcer model was induced by binding cold stress method. Gastric mucosa ulcer injury (UI) index was calculated by Guth method. Gastric mucosa blood flow (GMBF) was recorded with a biological signal analyzer. Protein content and gene expression in gastric mucosal HSP70 were detected by immunohistochemistry (IHC) and reverse transcription polymerase chain reaction (RT-PCR). Thiobarbital method was used to determine malondialdehyde (MDA) content. Gastric mucosal endothelin (ET) and prostaglandin E₂ (PGE₂) were analyzed by radioimmunoassay.

RESULTS: High gastric mucosal UI index, high HSP70 expression, low GMBF and PGF₂, elevated MDA and ET were observed in gastric mucosa of rats subjected to cold stress. Moxibustion on Zusanli or Liangmeng point decreased rat gastric mucosal UI index, MDA and ET. Conversely, the expression of HSP70, GMBF, and PGE₂ was elevated in gastric mucosa after pretreatment with moxibustion on Zusanli or Liangmeng point. The observed parameters were significantly different between Zusanli and Liangmeng points.

CONCLUSION: Pretreatment with moxibustion on Zusanli or Liangmeng point protects gastric mucosa against stress injury. This protection is associated with the higher expression of HSP70 mRNA and protein, leading to release of PGE₂ and inhibition of MDA and ET, impairment of gastric mucosal index.

Zusanli (ST36) Acupoint Injection for Diabetic Peripheral Neuropathy: A Systematic Review of Randomized Controlled Trials

Background: Acupuncture point (acupoint) injection is a common practice in China. Some trials showed that Chinese herbal extracts and/or conventional medication are injected at the Zusanli (ST36) acupoint for the treatment of diabetic peripheral neuropathy (DPN). The study aimed to assess the effectiveness and safety of acupoint injection for DPN at the ST36 by systematically evaluating the evidence published to date. Methods: Six databases were searched for randomized controlled trials (RCTs) of ST36 injection for DPN with primary outcome of pain, global symptom improvement, and quality of life. Methodological quality was assessed by the Cochrane risk of bias (ROB) tool. Data were analyzed using RevMan 5.3. Results: Fourteen RCTs involving 1,071 participants with DPN were included. All RCTs were assessed as unclear or high ROB. Few RCTs adequately reported methodology-related items and needling details according to Consolidated Standards of Reporting Trials (CONSORT) and Standards for Reporting Interventions in Controlled Trials of Acupuncture (STRICTA) statement. Medications injected at ST36 included conventional medications (11 RCTs) and Chinese herbal extracts (3 RCTs). The authors of this study did not perform any meta-analysis due to the heterogeneity of medications used for injections. Two individual RCTs favored ST36 injection in relieving pain compared with intramuscular injection of the same medication. For global symptom measured by Toronto clinical scoring system, one RCT showed that ST36 injection of Fufang Danggui was more effective than intramuscular injection of vitamin B₁₂, two RCTs demonstrated that ST36 injection of mecobalamin or Danhong with cointervention was superior, while one RCT showed no significant differences between ST36 injection and intramuscular injection of mecobalamin. For improving nerve conduction velocity (NCV), three of four individual RCTs showed that ST36 injection was better than intramuscular or intravenous injection of the same medication, two RCTs favored ST36 injection with cointervention, and one RCT favored ST36 injection without cointervention. Four RCTs reported monitoring adverse events, all of which showed no significant difference between groups. Conclusions: Limited evidence suggests that ST36 injection appears to be safe, and potentially effective in reducing pain score and improving NCV compared with intramuscular injection of the same medication. However, poor methodological and reporting quality reduced confidence in the findings. Rigorously designed and well-reported RCTs evaluating the effectiveness of ST36 injection for DPN are warranted.

Transcutaneous Electrical Nerve Stimulation at the Acupuncture Points to Relieve Pain of Patients Under Mechanical Ventilation: A Randomized Controlled Study

BACKGROUND AND OBJECTIVE

Electrical stimulation and acupuncture points as nonpharmacological methods have been the focus of pain reduction in different patients. This study is aimed at determining the effects of transcutaneous electrical nerve stimulation (TENS) on the acupuncture points of pain in patients under mechanical ventilators.

MATERIALS AND METHODS

This randomized double-blind clinical trial study was conducted on 50 patients undergoing mechanical ventilation in intensive care units of Imam Reza hospital in Kermanshah, Iran, in 2017. The patients were randomly allocated into intervention and placebo groups. In the intervention group, TENS electrodes were placed on points Hegu and Zusanli. Pain severity was measured using the Care Pain Observation Tool scale, and the dosages of narcotics and sedation intake were recorded. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) software, version 19.

RESULTS

The level of pain in patients decreased in the intervention group in comparison with the sham group, and this decline was significant during certain hours (p < 0.05). The amount of analgesic and sedation drugs used was less significant in the intervention group than in the sham group (p = 0.01; p = 0.04).

CONCLUSION

The results showed that the use of TENS on acupuncture points can decrease the level of pain and opioid consumption in intubated patients under a mechanical ventilator.

Effects of electro-acupuncture at Zusanli point on the expression of proinflammatory cytokines, the activity of diamine oxidase and the rate of water content in the small intestine in rats with sepsis

AIM: To investigate the inhibitory effects of electro-acupuncturing (EA) at Zusanli (ST36) against proinflammatory cytokine-induced intestinal injury in rats with sepsis.

METHODS: Thirty-two male Sprague-Dawley rats were subjected to cecal ligation and puncture (CLP) to develop a rat model of sepsis. The rats were then randomly divided into four groups (n = 8 each): CLP plus EA group, CLP plus sham EA (SEA) group, vagotomy (VA) plus CLP group and VA plus CLP plus EA group. An electroacupuncture at Zusanli point (ST36) was performed at constant voltage (2-100 Hz, 2 mA for 1.5 h) immediately after CLP surgery. Rats in the VA plus CLP group and the VA plus LPS plus EA group were abdominally vagotomized. All animals were sacrificed at 6 h after CLP to collect jejunal specimens. The contents of tumor necrosis factor-α (TNF-α) and nitric oxide (NO), the activity of myeloperoxidase (MPO) and diamine oxidase (DAO), as well as the rate of water content (ratio of dry weight to wet weight) were determined.

RESULTS: The levels of TNF-α and NO, the activity of MPO and the rates of water content in the jejunum in the CLP plus EA group were significantly lower than those in the other three groups, while the activity of DAO at 6 h after CLP in the CLP plus EA group was significantly higher than that in the other three groups (all P < 0.05). The levels of TNF-α and NO and the activity of MPO in the VA plus CLP group and the VA plus CLP plus EA groups were significantly higher (748.80 ± 112.45 pg/g protein and 737.58 ± 100.56 pg/g protein vs 560.23 ± 82.25 pg/g protein; 1.32 ± 0.15 μmol/g protein and 1.12 ± 0.24 μmol/g protein vs 0.97 ± 0.12 μmol/g protein; 0.57 ± 0.06 U/g and 0.61 ± 0.12 U/g vs 0.45 ± 0.07 U/g, all P < 0.05) than those in the CLP plus SEA group, while the activity of DAO in the VA plus CLP group and the VA plus CLP plus EA groups was significantly lower than that in the CLP plus SEA group (0.07 ± 0.02 U/L and 0.06 ± 0.04 U/L vs 0.12 ± 0.04 U/L, both P < 0.05). There were no significant differences in all of the above parameters between the VA plus CLP plus EA group and the VA plus CLP group.

CONCLUSION: Electro-acupuncture at Zusanli point significantly lowers the elevated levels of proinflammatory factors in the small intestine and alleviate tissue edema and mucosal dysfunction in rats undergoing CLP.

Effects of electroacupuncturing at Zuyangming and Zushaoyang Jingxue on stomach and gallbladder kineses and related brain-gut peptide in rabbits

AIM: To investigate the correlation between the meridians and zang-fu as well as the specific effect of the points on their related zang-fu.

METHODS: Atropine was intravenously injected in the rabbits to inhibit the myoelectric activities of the stomach and the sphincter of oddi (SO). After electroacupuncturing at Zusanli and Yanglingquan points, the myoelectric activities of the stomach and SO were observed, and the levels of motilin (MTL) and cholcystokinin (CCK) in the antrum, SO and plasma were measured.

RESULTS: After atropine injection, the mean amplitudes for the high activity of myoelectric slow wave and fast wave were significantly decreased (P = 0.028, P = 0.001). Moreover, the average frequency of myoelectric slow wave was not significantly changed. The mean amplitudes for the myoelectric slow wave and fast wave were enhanced to some extent after electroacupuncturing at Zusanli and Yanglingquan points. The levels of MTL (P = 0.000) and CCK (P = 0.001) in the antrum, SO and plasma were increased markedly after electroacupuncturing at Zusanli and Yanglingquan points. The levels of MTL in the antrum (P = 0.020) and plasma (P = 0.001) and CCK in plasma (P = 0.001) were obviously increased after electroacupuncturing at Zusanli point, whereas the levels of MTL in SO and CCK in the antrum and SO were notably increased after electroacupuncturing at Yanglingquan point. There was a positive effect on the release of MTL and CCK after electroacupuncturing at the points.

CONCLUSION: The inhibition for the myoelectric activities of the stomach and SO are improved after electroacupuncturing at Zusanli and Yanglingquan points. The possible mechanism may be that the acupuncture influences the release of MTL and CCK, so as to regulate the activity of the alimentary canal.

Electroacupuncture at Zusanli (ST36) promotes gastric emptying and mucosal blood flow during oral resuscitation of scalded rats with a pyruvate-enriched ORS

AIM

The aim of this study was to investigate the effect of electroacupuncture at ST36 (EA ST36) on gastric emptying and mucosal blood flow during intragastric resuscitation with pyruvate-enriched oral rehydration solution (Pyr-ORS) in scalded rats.

METHODS

The rats were subjected to a 35% total body surface area (TBSA) of scald injury and randomly divided into five groups (N=24) and two subgroups (n=12) in each group. The Pyr-ORS was delivered intragastrically according to the Parkland formula immediately after scalding at a dose of 1 mL kg(-1) %TBSA(-1) in 1 h. In these animals, the bilateral Zusanli points (ST36) were electroacupunctured at a constant voltage (2 mA and 2-100 HZ) for 0.5 h immediately after intragastric resuscitation. At 2 and 4 h after scalding, the gastric emptying rate (GER) and gastric mucosal blood flow (GMBF) were determined, and the motilin levels of the plasma and gastric tissues were also analyzed at two time points, respectively.

RESULTS

GER and GMBF were markedly decreased in groups with scalding and resuscitation, compared with the sham groups at two time points (P<0.05), but they were greatly improved in groups byEAST36 at 2 and 4 h after sustaining scald injuries (P<0.05). Bilateral vagotomy further aggravated the reduction of GER and GMBF in scalded rats. EA after gastric vagotomy failed to raise GER and GMBF. Neither EA nor vagotomy had effects on the reduced motilin levels of plasma and gastric tissues in animals after scalding.

CONCLUSION

EA ST36 has a significant effect on improving gastric emptying and mucosal ischemia in the oral resuscitation of burn injury, possibly through the activation of a cholinergic nerve-dependent mechanism. In addition, EA ST36 showed no effects on motilin levels, but requires further investigations.

Effects of moxibustion on expression of HSP70 protein and mRNA in stress-induced gastric ulcer of rats

AIM: To explore the mechanism of moxibustion on the acupoints of Foot-Yangming Meridian in protecting gastric mucosa by observing the effects of moxibustion pretreatment at Zusanli (ST36) and Liangmen (ST21) on HSP70 protein and mRNA expression in the stress-induced gastric ulcer of rats.

METHODS: Sixty Sprague Dawley rats were averagely randomized into blank group (A), model group (B), Zusanli and Liangmen-moxibustion group (C) and control group (D). The expression of HSP70 protein and mRNA of gastric mucosa were determined by immunohistochemistry and reverse transcriptase polymerase chain reaction (RT-PCR). The content of endothelin (ET) and prostaglandin E₂ (PGE₂) in gastric mucosa were detected by radioimmunoassay.

RESULTS: The ulcerative index (UI) was significantly different between group B and group A, C (P = 0.000, P = 0.001), as well as between group D and grop A, C (P = 0.001). Moxibustion on Zusanli and Liangmen relieved gastric mucosal injury obviously. The content of PGE₂ was markedly lower in group A than that in group B and D (P = 0.011, P = 0.028), but it was notably higher in group C (P = 0.020, P = 0.048). PGE₂ content was up-regulated after Moxibustion pretreatment. Meanwhile, Moxibustion lowered the content of ET (C vs B, P = 0.020), significantly. The expression of HSP70 protein and mRNA were increased in stress-induced gastric ulcer of rats (P = 0.039, P = 0.008), but Moxibustion pretreatment enhanced the up-regulated expression of HSP70 distinctly (C vs B, D: P = 0.003, P = 0.035; P = 0.000, P = 0.001 for protein and mRNA, respectively).

CONCLUSION: Moxibustion on Zusanli and Liangmen can protect gastric mucosa through inducing high expression of HSP70 protein and mRNA, with the relative specificity of the acupoints.

Relation of the infrared radiation on Zusanli, Liangmen and Weishu area with chronic gastric pain and its application

AIM: To study correlation of infrared radiation on such acupoints as Zusanli (ST36), Liangmen (ST21), Weishu (BL21) with chronic gastralgia.

METHODS: One hundred and twenty patients with chronic gastralgia received infrared radiation on such acupoints as Zusanli (ST36), Liangmen (ST21), Weishu (BL21). Forty patients with lung diseases characterized by cough and 40 healthy people were taken as controls.

RESULTS: The numerical values of infrared radiation on bilateral acupoints of healthy people were balanced. The numerical values of infrared radiation on bilateral acupoints and back shu acupoints of the patients with chronic gastralgia were asymmetric (P < 0.05 or 0.01). Infrared radiation on three acupoints were closely related to chronic gastralgia, which on bilateral acupoints were asymmetric (P < 0.05 or 0.01); the numerical values of infrared radiation on the two acupoints Zusanli (ST36) and Liangmen (ST21) were bilaterally lower than healthy people (P < 0.01).

CONCLUSION: Infrared radiation detection on acupoints can be used as a method of acupuncture efficacy research. Acupuncture treatment can increase the reduced infrared radiation, which can restore channel Qi to normal.

[Effect of electro-acupuncture at Zusanli acupoint on postoperative T cell immune function in rats]

OBJECTIVE

To study the effect of electro- acupuncture at Zusanli acupoint in regulating perioperative cell immune functions in rats.

METHODS

Forty-two SD rats were divided into blank control group (n=6), model group (n=18), and electroacupuncture group (n=18). The rats in the latter two groups underwent thigh incision and femoral dissection under anesthesia; the rats in electro-acupuncture group received electro-acupuncture at bilateral Zusanli acupoint for 15 min before anesthesia and 1 h after the surgery. The rats in the model group and electro-acupuncture group were sacrificed at 6 h, 24 h, and 72 h after the operation and blood samples were taken from the ventricle for analyzing CD3, CD4, and CD8 T cell subpopulations and calculation of CD4/CD8 using flow cytometry. ELISA was used to detect the levels of interleukin-1 (IL-1) and IL-6.

RESULTS

The CD3 T cell subpopulation was significantly lower in the model group and electro-acupuncture group than in the blank group at 6 h and 24 h after the operation. At 72 h after the operation, CD3 subpopulation levels still remained low in the model group, but recovered the control level in electro-acupuncture group. At each time point of measurement, CD3 level was significantly lower in the model group than in the electro-acupuncture group. CD4 level in the model group was significantly lowered at 6 h and 24 h after the operation, and recovered the control level at 72 h. In the electro-acupuncture group, CD4 level was significantly lowered at 6 h after the operation, but recovered the control level at 24 h. At 24 h and 72 h, the levels of CD4 were significantly lower in the model group than in the electro-acupuncture group. CD8 level underwent no significant changes after the operation in either the model group or electro-acupuncture group. CD4/CD8 was significantly lowered at 24 h and 72 h after the operation in the model group but showed no significant variation in the electro-acupuncture group. Compared with that in the control group, IL-1 level was significantly lowered in both the model group and electroacupuncture group at 6 h, 24 h, and 72 h after the operation, and was significantly lower in the model group than in the electroacupuncture group at these time points. IL-6 level increased significantly in the model group and the electro- acupuncture group at 6 h and 24 h. at 72 h, IL-6 level was obviously lowered in the electro-acupuncture group but remained elevated in the model group.

CONCLUSIONS

Electro-acupuncture alleviates postoperative immune suppression and promotes recovery of the immune function in rats, suggesting a protective effect of electro-acupuncture at Zusanli acupoint on cellular immune function after surgery.

Progress in treatment of gastrointestinal functional disorders by electroacupuncture at Zusanli

Electroacupuncture at human acupuncture points has an important impact on gastrointestinal motility. Zusanli, the He-sea point of the Stomach Meridian of Foot-Yangming, is one of the most common points for electroacupuncture. Electroacupuncture at Zusanli at a specific frequency can improve gastrointestinal functional diseases, such as gastroesophageal reflux, functional dyspepsia, and irritable bowel syndrome. Although there is still controversy over the efficacy of electroacupuncture at Zusanli for gastrointestinal functional diseases, many studies support the notion that electroacupuncture at Zusanli plays an important role in modulating gastrointestinal functional diseases. In this paper we review the recent progress in the treatment of gastrointestinal functional diseases by electroacupuncture at Zusanli.

Effect of bilateral needling at an acupuncture point, ST-36 (Zusanli) on blood glucose levels in type 2 diabetes mellitus patients: A pilot randomized placebo controlled trial

Background Diabetes mellitus is one of the major current public health problems. Electro-acupuncture at ST-36 showed a significant reduction in plasma glucose levels in diabetic rats. There are lacks of studies reporting its hypoglycemic effect in humans and thus, the present study was conducted to evaluate the effect of needling at ST-36 (Zusanli) on blood glucose levels in patients with type 2 diabetes mellitus (T2DM). Methods Sixty T2DM participants were recruited and randomized into acupuncture group (n=30) and placebo control group (n=30). The participants of the acupuncture group received needling at ST-36 (one finger breadth lateral to the inferior border of the tibial tuberosity), and the participants those in the placebo control group received needling at placebo point (midpoint between the apex of the patella and tibial tuberosity). For both the groups, needles were retained for 30 min. Baseline and post-test assessments were performed prior to and after each intervention. Statistical analysis was performed using SPSS version 16. Results The present study showed a significant reduction in random blood glucose levels in the acupuncture group compared to the placebo control group. Conclusion This study suggests that 30 min of bilateral acupuncture needling at ST-36 with manual stimulation is effective in reducing blood glucose levels in T2DM patients.

Comprehensive evaluation of gene expression signatures in response to electroacupuncture stimulation at Zusanli (ST36) acupoint by transcriptomic analysis

Background

Electroacupuncture (EA) has been applied to treat and prevent diseases for years. However, molecular events happened in both the acupunctured site and the internal organs after EA stimulation have not been clarified.

Methods

Here we applied transcriptomic analysis to explore the gene expression signatures after EA stimulation. Mice were applied EA stimulation at ST36 for 15 min and nine tissues were collected three hours later for microarray analysis.

Results

We found that EA affected the expression of genes not only in the acupunctured site but also in the internal organs. EA commonly affected biological networks involved in cytoskeleton and cell adhesion, and also regulated unique process networks in specific organs, such as γ-aminobutyric acid-ergic neurotransmission in brain and inflammation process in lung. In addition, EA affected the expression of genes related to various diseases, such as neurodegenerative diseases in brain and obstructive pulmonary diseases in lung.

Conclusions

This report applied, for the first time, a global comprehensive genome-wide approach to analyze the gene expression profiling of acupunctured site and internal organs after EA stimulation. The connection between gene expression signatures, biological processes, and diseases might provide a basis for prediction and explanation on the therapeutic potentials of acupuncture in organs.

Effect of electroacupuncture at Zusanli on gastric electric rhythm in functional dyspepsia rats

AIM: To observe the influence of electroacupuncture at Zusanli on gastric electric rhythm in functional dyspepsia rats.

METHODS: Forty-eight SD rats were randomly divided into 4 groups: a blank group, a model group, an electroacupuncture group, and a domperidone group, with 12 rats in each group. Functional dyspepsia in rats was induced by moderately stimulating the tail of the rats. After 10 d of treatment, electrogastrograms were obtained in rats in hungry (30 min per rat).

RESULTS: The dominant frequency, dominant power and the percentage of normal slow waves in rats in the electroacupuncture group and domperidone group were significantly higher than those in the model group (dominant frequency: 59.89 ± 2.930 vs 40.50 ± 2.317, 49.14 ± 3.901 vs 40.50 ± 2.317, P < 0.05 or P < 0.01; dominant power: 0.758 ± 0.101 vs 0.413 ± 0.086, 0.612 ± 0.041 vs 0.413 ± 0.086, P < 0.05 or P < 0.01; percentage of normal slow waves: 66.72 ± 1.573 vs 55.44 ± 2.129, 66.35 ± 1.534 vs 55.44 ± 2.129, P < 0.05 or P < 0.01). The percentage of tachygastria and bradygastria in rats in the electroacupuncture group and domperidone group were significantly lower than those in the model group (percentage of tachygastria: 10.24 ± 0.931 vs 21.07 ± 0.951, 9.853 ± 1.057 vs 21.07 ± 0.951, P < 0.05 or P < 0.01; percentage of bradygastria: 12.41 ± 0.503 vs 14.90 ± 0.572, 12.88 ± 0.302 vs 14.90 ± 0.572, P < 0.05 or P < 0.01).

CONCLUSION: Electroacupuncture at Zusanli could increase the dominant frequency, dominant power and the percentage of normal slow waves, and reduce the percentage of tachygastria and bradygastria in functional dyspepsia rats.

High-frequency electroacupuncture at Zusanli point promotes colonic propulsive motility in rats

AIM: To observe the changes of colonic propulsive movement in rats after high-frequency electroacupuncture stimulation (EAS) at Zusanli (ST-36).

METHODS: A total of 33 adult male Sprague-Dawley rats were randomly and averagely divided into Zusanli acupuncture, sham EAS, and Zusanli EAS group, named A, B, and C, respectively. The parameters of EAS were set at 100 Hz, 3 mA. In the experiment, one plastic bead (3 mm in diameter) was pushed 3 cm into the rats' rectum with a slender tube, and the time for bead excretion was recorded in all the rats.

RESULTS: The time for bead excretion under EAS condition was shortened about 27% in group C as compared with that under normal condition, and there was significant difference (1142.8 ± 123.9 s vs 1563.5 ± 155.9 s, P < 0.01). However, the time in group A and B were not significantly different before and after stimulation (P > 0.05).

CONCLUSION: Colonic propulsive movement can be obviously promoted by high-frequency EAS at ST-36.

Effect of moxibustion on mitochondrial ultrastructure and contents of mitochondrial enzymes in the intestinal epithelium of spleen-deficiency rats

AIM: To observe the effect of moxibustion on symptom scores, mitochondrial ultrastructure, contents of succinodehydrogenase (SDH) and cytochrome oxidase (CCO), expression of COX I in the jejunal epithelium of spleen-deficiency rats and to explore the mechanism by which moxibustion reinforces the spleen-stomach.

METHODS: Forty healthy Sprague-Dawley rats were randomly assigned into four groups: A (blank group; normal rats), B (model group; spleen-deficiency rats), C (moxibustion group; spleen-deficiency rats intragastrically given Sijunzi Decoction) and D (herbs group; spleen-deficiency rats receiving moxibustion at Zusanli, Zhongwan, Guanyuan, Pishu and Weishu points). An animal model of spleen-deficiency was established by intragastric administration of Chinese Rhubarb Infusion. Common symptoms were recorded. Mitochondrial ultrastructure of the jejunal epithelium was observed by electron microscopy. Enzyme-linked immunosorbent assay was used to detect the contents of SDH and CCO. The expression of COX I was detected by Western blot.

RESULTS: Compared to group A, symptom score increased significantly (P < 0.01), the contents of SDH and CCO and expression of COX I decreased significantly (P < 0.05 or 0.01), and the mitochondrial ultrastructure of the jejunal epithelium was terribly destroyed in group B. Compared to group B, the mitochondrial ultrastructure of the jejunal epithelium was only mildly destroyed, and the contents of SDH and CCO and expression of COX I increased significantly (0.387 ± 0.076, 0.343 ± 0.053 vs 0.277 ± 0.037; 0.246 ± 0.058, 0.231 ± 0.038 vs 0.167 ± 0.021; 0.941 ± 0.204, 1.040 ± 0.214 vs 0.481 ± 0.131, P < 0.05 or 0.01) in groups C and D. There were no significant differences in the above parameters between groups C and D.

CONCLUSION: Moxibustion could warm and reinforce the spleen-stomach and relieve symptoms of spleen-deficiency possibly by promoting the recovery of mitochondrial ultrastructure of the intestinal epithelium and increasing the contents of respiratory chain enzymes.

Effect of acupuncture at Zusanli (ST36) point on antral contraction function under ultrasound guidance: study protocol of a randomized controlled trial

BACKGROUND

Although the relationship between deqi sensations and curative effect has always been controversial, deqi sensations has been regarded as the key indicator of clinical efficacy of acupuncture therapy. There is little evidence for standardization or visualization of the mechanism of acupuncture's therapeutic effect. This trial aims to evaluate the effect of needling at Zusanli (ST36) on antral contraction function as visualized by ultrasound.

METHODS

This is a two-arm, single-blind, randomized, controlled trial. A total of 116 acupuncture-naïve healthy subjects will be randomly allocated to the acupuncture group or sham acupuncture group in a 1:1 ratio. Participants in the acupuncture group will receive manual acupuncture at Zusanli (ST36) with the needling depth at crural interosseous membrane. Those in the sham acupuncture group will be given penetrating needling depth at the superficial fascia layer. The primary outcome will be the changes in antral contraction frequency (ACF) before and after acupuncture. The secondary outcomes will be the changes in the thermal infrared spectrum of gastric area skin, the antral contraction amplitude (ACA), the antral movement index (AMI), and the scores on the Chinese version of Massachusetts General Hospital Acupuncture Sensation Scale (C-MASS). The adverse events will be evaluated and recorded in detail.

DISCUSSION

This study may provide visual and objective evidence regarding the safety and efficacy of manual acupuncture at Zusanli (ST36). In addition, the results of this study will help to identify the role of Zusanli (ST36)in the inducing deqi.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2000040686 . Registered on 8 December 2020.

Electroacupuncture at Zusanli regulates the pathological phenotype of inflammatory bowel disease by modulating the NLRP3 inflammasome pathway

BACKGROUND

This study sought to explore the effect of electroacupuncture (EA) intervention at Zusanli (ST36) acupoint on modulating the NLRP3 inflammasome pathway for treating inflammatory bowel disease (IBD).

METHODS

C57BL/6 mice were administrated with 3% dextran sulfate sodium (DSS) to construct the IBD model. DSS mice were then administrated with EA (10 Hz, 1.5 mA) at ST36 for 7 days or intragastric administration of sulfasalazine (SASP) each day during the entire course. The control group animals were administered with distilled water. Then, partial least squares discriminant analysis revealed differences in the relative content of metabolites. The pathological changes of colon and spleen tissues were observed by H&E and immunohistochemistry (IHC) staining. qPCR determined the mRNA expression levels, while ELISA and western blot analysis determined the protein expression.

RESULTS

Compared with the control groups, DSS-induced decreases of body weight were reversed after EA stimulation at ST36 or SASP treatment. The DAI of DSS mice was significantly higher relative to the control groups, whereas the DAI of DSS mice were decreased after EA stimulation at ST36 or SASP treatment. The intestinal weight/length ratio increased significantly in DSS groups; however, EA at ST36 significantly improved the macroscopic/microscopic characteristics and the weight and length of the colon. EA reversed inflammation and leukocyte infiltration and normalized the elevated levels of IL-1β, IL-18, and NLRP3. Furthermore, EA improved the expression levels of ZO-1, occludin, and claudin 1, exhibiting normalization of the colon's tight junctions.

CONCLUSIONS

EA at Zusanli acupoint of colon tissue significantly improved the pathological phenotype, showing a therapeutic effect on IBD.

Effect of electroacupuncturing Zusanli point on stress-induced gastric mucosal injury and and its relationship with receptors in nucleus tractus solitaries

AIM: To investigate the relationship between the effect of electroacupuncturing (EA) Zusanli point on the stress-induced gastric mucosal injury and the receptors in nucleus tractus solitarius (NTS) in rats.

METHODS: Fifty-six male SD rats were randomly divided into 8 groups, and gastric ulcer was induced in all the rats by constraint cold method. Except those in model group, the rats were treated with EA, NS+EA, prazisin+EA, yohimbine+EA, propranolol+EA, atropine+EA, and naloxone+EA, respectively. The ulcer indexes were observed after microinjection of various receptor antagonists into NTS.

RESULTS: In comparison with that in model group, the UI was significantly reduced in NS+EA or EA group (26.3 ± 3.5, 25.4 ± 3.1 vs 37.5 ± 4.2, t = 5.42, t = 6.13, both P < 0.01). In comparison with that NS+EA stree group, the UI was markedly increased in prazisin+EA or tropine+EA group (34.6 ± 3.4, 33.1 ± 3.7 vs 26.3 ± 3.5, t = 4.50, t = 3.53, both P < 0.01), but it was not notably different from that in yohimbine+EA, propranolo+EA and naloxone-EA group.

CONCLUSION: Electroacupuncture plays a protective role in gastric mucosa against stress-induced injury in rats, which is partly mediated by α₁ and M type receptors, but not related to α₂, β and opioid receptors.

Advances in acupuncture at Zusanli point on esophageal motor function

Acupuncture at Zusanli point can affect esophageal motor function, but its mechanism is still not clear. Most researchers consider that its action is associated with neurohumoral factors. This article reviews recent advancement of acupuncture at Zusanli (ST 36) point on esophageal motor function, including acupoints hierarchical structure and dissection characteristics, neural conduction mechanism, neurotransmitters regulation, etc. Acupuncture at ST 36 point might lead to wholesome regulation on esophagus, which was of notably significant for dynamic esophageal disease therapy.

Effects of intra-abdominal pressure after orthotopic liver transplantation by injecting neostigmine at the Zusanli acupuncture point

AIM: To explore an effective method for decreasing intra-abdominal pressure after orthotopic liver transplantation with abdominal distension.

METHODS: Twenty patients with abdominal distension after orthotopic liver transplantation were injected with neostigmine at the Zusanli acupuncture point. The time of defecation or aerofluxus was recorded after injection. Intra-abdominal pressure and bowel tones were measured 5 min before and 60 min after injecting neostigmine.

RESULTS: The time of defecation or aerofluxus was 43 ± 7.21 min after injection. Intra-abdominal pressure decreased from 19.62 ± 5.31 to 15.27 ± 4.61 cmH₂O, and bowel tones were increased from 0.85 ± 0.08 to 6.12 ± 2.08 times/min after injecting neostigmine at the Zusanli acupuncture point (P < 0.05).

CONCLUSION: Injecting neostigmine at the Zusanli acupuncture point is an effective method for improving enterokinesia and decreasing intra-abdominal pressure.

NTPDase1-ATP-P2Y2Rs axis in the sciatic nerve contributes to acupuncture at "Zusanli" (ST36)-induced analgesia in ankle arthritis rats

BACKGROUND

The efficacy of acupuncture at Zusanli (ST36) in alleviating lower-limb pain is widely acknowledged in clinical practice, while its underlying mechanism remains incompletely elucidated. Our previous research had revealed that the prompt analgesia induced by needling-ST36 was accompanied by expression alterations in certain exco-nucleotidases within the sciatic nerve. Building upon this finding, the current work focused on NTPDase1, the primary ecto-nucleotidase in the human body, which converts ATP into AMP.

METHODS

A 20-min acupuncture was administered unilaterally at the ST36 on rats with acute ankle arthritis. The pain thresholds of the injured hind paws were determined. Pharmacological interference was carried out by introducing the corresponding reagents to the sciatic nerve. ATP levels around the excised nerve were measured using a luciferase-luciferin assay. Live calcium imaging, utilizing the Fura 2-related-F340/F380 ratio, was conducted on Schwann cells in excised nerves and cultured rat SCs line, RSC96 cells.

RESULTS

The analgesic effect induced by needling-ST36 was impaired when preventing ATP degradation via inhibiting NTPDase1 activities with ARL67156 or Ticlopidine. Conversely, increasing NTPDase1 activities with Apyrase duplicated the acupuncture effect. Similarly, preventing the conversion of AMP to adenosine via suppression of NT5E with AMP-CP hindered the acupuncture effect. Unexpectedly, impeded ATP hydrolysis ability and diminished NTPDase1 expression were observed in the treated group. Agonism at P2Y2Rs with ATP, UTP, or INS365 resulted in anti-nociception. Contrarily, antagonism at P2Y2Rs with Suramin or AR-C 118925xx prevented acupuncture analgesia. Immunofluorescent labeling demonstrated that the treated rats expressed more P2Y2Rs that were predominant in Schwann cells. Suppression of Schwann cells by inhibiting ErbB receptors also prevented acupuncture analgesia. Finally, living imaging on the excised nerves or RSC96 cells showed that agonism at P2Y2Rs indeed led to [Ca2+]i rise.

CONCLUSION

These findings strongly suggest that the analgesic mechanism of needling-ST36 on the hypersensation in the lower limb partially relies on NTPDase1 activities in the sciatic nerve. In addition to facilitating adenosine signaling in conjunction with NT5E, most importantly, NTPDase1 may provide an appropriate low-level ATP milieu for the activation of P2Y2R in the sciatic nerve, particularly in Schwann cells.