Influence of the Intensity, Components, and Spreading of the Deqi Sensation on the Analgesic Effect of SP6 Needling in Primary Dysmenorrhea Patients: A Secondary Analysis of a Randomised Controlled Trial

When sng meets acupuncture -- a paradigm-shift biomarker for translational research

The sensation of sng (pronounced/səŋ/, the Romanization form of or soreness in Taiwanese Southern Min) associated with de qi, a composite of unique sensations, is a novel phenotype for acupoint stimulation. It is perceived by test participants but also by experienced practitioners as a sensation of "taking the bait" (by fish when fishing), a characteristic heavy and tight sensation from the needle. Here, we propose that sng is a powerful biomarker for de qi associated with successful manual acupuncture. Sngception (sng-ception), a specific somatosensory function of acid-sensation or tether-mode mechano-sensation, may serve as the ideal molecular and physiological link between sng perception and needle manipulation (e.g., lifting, thrusting, and twisting). To explain how manual acupuncture can induce de qi, we constructed a hypothetical model of manual needling-driven sngception. In acupoints (e.g., ST36), an acupuncture needle can easily stick to extracellular matrix (ECM) proteins (e.g., fibronectin and laminin). While the acupuncture needle is manually twisted, it mingles with ECM and delivers a pulling force to ECM-tethered mechanically sensitive ion channels (e.g., acid-sensing ion channels) on somatosensory nerves to induce sngception. The concept of sng and sngception represents an emerging field for research into the peripheral mechanisms of acupuncture.

Effect of Sanyinjiao (Spleen-6) Acupoint for Pain Management in Primary Dysmenorrhea: An Updated Systematic Review and Meta-Analysis

Objectives

Available literature highlights the effectiveness of Acupuncture or Acupressure on the Spleen 6 acupoint (Sanyinjiao or SP-6) for pain management in primary dysmenorrhea (PD). The objective of the current systematic review and meta-analysis is to provide an updated assessment of available randomized and non-randomized controlled trials and to compare the effectiveness of acupressure and acupuncture stimulation of Sanyinjiao among patients with PD.

Methods

We conducted a comprehensive literature search on various electronic databases including Embase, PubMed, and the Cochrane Library from January 1990 to March 2023 to identify the comparative studies (randomized and non-randomized controlled trials) that assessed the effects of acupressure or acupuncture on the Sanyinjiao acupoint in patients with PD. We assessed the studies' risk of bias in accordance with the Cochrane Handbook for Systematic Reviews of Interventions, and certainty of evidence using the Grading of Recommendations Assessment. Subsequently, a fixed-effects meta-analysis was performed using the Der-Simonian and Laird method to combine intervention effects from the included studies. The primary outcome of interest was a reduction in pain.

Results

We included 19 studies (9 acupressure and 10 acupuncture) with 1171 PD patients. This meta-analysis showed a significant (Standardized Mean Difference, SMD: -0.29, 95% confidence interval -0.41 to -0.17, p < 0.001) reduction in pain, for both acupressure and acupuncture at Sanyinjiao acupoint with considerable heterogeneity. Acupressure was found to be more effective than acupuncture stimulation in reducing pain associated with PD (SMD: -0.52, 95% confidence interval -0.71 to -0.33, p < 0.001).

Conclusion

The findings of this updated systematic review and meta-analysis suggest that both acupuncture and acupressure on Sanyinjiao acupoint could effectively reduce pain associated with PD. Acupressure stimulation, in particular, was found to be more effective than acupuncture stimulation of the acupoint in reducing pain associated with PD.

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.

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.

Influence of Psychological Factors in Primary Dysmenorrhea Patients on De qi: a Secondary Analysis of a Randomized Controlled Trial

Background

De qi , the needling sensation, is important in acupuncture treatment. Almost all studies believe that deep needling and manipulation could achieve a significant de qi sensation. However, relatively few studies have examined the effect of psychological factors on de qi, and those that did often reached different conclusions.

Objectives

To explore the influence of psychologic factors on de qi in patients with primary dysmenorrhea (PD).

Methods

Sixty-eight PD patients with cold and dampness stagnation were randomly allocated to de qi (deep insertion using thick needles, with manipulation, n=17) and non-de qi groups (shallow insertion using thin needles, without manipulation, n=51). Both groups received bilateral needling at Sanyinjiao (SP6) for 30 min. De qi was assessed using the Acupuncture De qi Clinical Assessment Scale (ADCAS). The patients' acupuncture-related anxiety and their expectations of the relationship between needle sensation and curative effect were evaluated using a five-point and four-point scale, respectively.

Results

Within the de qi group, all patients experienced the de qi sensation, although anxiety levels were unrelated to de qi. Patients' expectations correlated negatively with de qi timing, and positively with electric sensation. Within the non-de qi group, 59.5% of patients experienced de qi. Between those who experienced it and those who did not, no significant differences were found in anxiety levels, although patients' expectations differed significantly. Among patients who experienced de qi sensations in the non-de qi group, anxiety and throbbing were positively correlated. Additionally, patients' expectations correlated positively with de qi intensity, as well as coldness, and numbness.

Conclusion

Psychological factors should be considered when studying de qi since PD patients' expectations could influence the de qi sensation at SP6.

Neuroimaging studies of acupuncture on Alzheimer's disease: a systematic review

BACKGROUND

Acupuncture effectively improves cognitive function in Alzheimer's disease (AD). Many neuroimaging studies have found significant brain alterations after acupuncture treatment of AD, but the underlying central modulation mechanism is unclear.

OBJECTIVE

This review aims to provide neuroimaging evidence to understand the central mechanisms of acupuncture in patients with AD.

METHODS

Relevant neuroimaging studies about acupuncture for AD were retrieved from eight English and Chinese medicine databases (PubMed, Embase, Cochrane Library, Web of Science, SinoMed, CNKI, WF, VIP) and other resources from inception of databases until June 1, 2022, and their methodological quality was assessed using RoB 2.0 and ROBINS - I. Brain neuroimaging information was extracted to investigate the potential neural mechanism of acupuncture for AD. Descriptive statistics were used for data analysis.

RESULTS

Thirteen neuroimaging studies involving 275 participants were included in this review, and the overall methodological quality of included studies was moderate. The approaches applied included task-state functional magnetic resonance imaging (ts-fMRI; n = 9 studies) and rest-state functional magnetic resonance imaging (rs-fMRI; n = 4 studies). All studies focused on the instant effect of acupuncture on the brains of AD participants, including the cingulate gyrus, middle frontal gyrus, and cerebellum, indicating that acupuncture may regulate the default mode, central executive, and frontoparietal networks.

CONCLUSION

This study provides evidence of the neural mechanisms underlying the effect of acupuncture on AD involving cognitive- and motor-associated networks. However, this evidence is still in the preliminary investigation stage. Large-scale, well-designed, multimodal neuroimaging trials are still required to provide comprehensive insight into the central mechanism underlying the effect of acupuncture on AD. (Systematic review registration at PROSPERO, No. CRD42022331527).

An infrared thermographic analysis of the sensitization acupoints of women with primary dysmenorrhea

OBJECTIVE

To explore the sensitization acupoints of women with primary dysmenorrhea (PD) by comparing infrared radiation temperatures between acupoints and non-acupoints.

METHODS

We tested 10 acupoints of every woman with PD and healthy subjects on premenstrual, menstrual, and postmenstrual days using an infrared imaging device. The primary outcome was the absolute value of body surface temperature difference (AVTD) between the left and right sides of the same testing point.

RESULTS

A total of 58 PD patients and 57 healthy volunteers completed the test from May 2016 to May 2017. Compared with the healthy group, we observed a significant reduction and increase in the AVTD in Taichong (LR3) and Sanyinjiao (SP6), respectively, during menstrual days in the PD group (= 0.01; = 0.04); while during postmenstrual days, all AVTDs of Shuiquan (KI5), Diji (SP8), and Xuehai (SP10) were diminished in the PD group (= 0.01; = 0.03; = 0.01, respectively). No significant differences in AVTD were detected at any other points or testing times.

CONCLUSIONS

Compared with the healthy group, the AVTDs of Taichong (LR3), Sanyinjiao (SP6), Shuiquan (KI5), Diji (SP8), and Xuehai (SP10) at menstruation-relevant points of PD patients were sensitized, providing a reference for the selection of acupoints in the treatment of PD.

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.

Immediate Analgesic Effect of Acupuncture in Patients With Primary Dysmenorrhea: A fMRI Study

Primary dysmenorrhea (PDM) is a common gynecological disease characterized by lower abdominal pain. Acupuncture is considered a good alternative therapy for PDM. However, the central mechanism of the analgesic effect of acupuncture is largely unknown. In this study, eligible patients were randomized into the real and sham acupuncture groups using a computer-generated, permuted block randomization method. The study cohort comprised 34 patients: 19 in the real acupuncture group and 15 in the sham acupuncture group. The clinical characteristics of the patients during their menstrual period were collected, and imaging scans were performed during the first 3 days of the patients' menstrual period. We analyzed task and resting functional magnetic resonance imaging (fMRI) data to investigate the potential central mechanism of the immediate effect of acupuncture intervention on the intensity of PDM pain. The task fMRI study found that the rostral anterior cingulate cortex (rACC) and right supplemental motor area were activated during real acupuncture. Using the resting-state functional connectivity (FC) method, we found a post- versus pre-treatment change in the FC of the rACC and left precentral gyrus in the comparison of real acupuncture versus sham acupuncture. In addition, the FC of the rACC-left precentral gyrus at baseline was negatively correlated with short-term analgesia, while the change in the FC of the rACC-left precentral gyrus was positively correlated with short-term analgesia after acupuncture treatment. These findings support the importance of rACC-left precentral gyrus resting-state FC in the modulation of the intensity of PDM pain through acupuncture, which may shed light on the central mechanism of acupuncture in the treatment of PDM.

Effect of an Acupuncture Technique of Penetrating through Zhibian (BL54) to Shuidao (ST28) with Long Needle for Pain Relief in Patients with Primary Dysmenorrhea: A Randomized Controlled Trial

Background

Primary dysmenorrhea (PD) is the commonest gynecological disorder in young women of reproductive age, and there is not always satisfactory relief of pain treated by common medications. Therefore, acupuncture has been used as an alternative therapy to relieve the symptoms of PD. In clinical practice, a penetrating method of acupuncture with long needle has been shown to be particularly effective for improving primary dysmenorrhea. This study was conducted to evaluate the effectiveness of this technique for pain relief in patients with primary dysmenorrhea as compared with a conventional pain medication.

Methods

The present study is a perspective, randomized, ibuprofen-controlled trial. Sixty-two eligible participants were randomly assigned in a 1 : 1 ratio to receive either acupuncture treatment or ibuprofen administration. The treatment lasted for three menstrual cycles for both groups. The primary outcome was the intensity of menstrual pain measured by using the visual analogue scale at the completion of treatment. Secondary outcomes included the severity of symptoms associated with menstrual pain, responder rate, and safety of acupuncture treatment. The clinical outcomes were measured on each menstrual cycle at baseline, treatment course (3 cycles), and follow-up period.

Results

Sixty-four patients of primary dysmenorrhea were recruited, and 62 subjects were included in the final analysis. At trial completion, acupuncture was shown to be associated with a significantly lower pain intensity and decreased symptom severity of primary dysmenorrhea as compared with ibuprofen (p < 0.05). A significantly higher responder rate was found in the acupuncture group as compared with the control group (p < 0.05). No serious adverse events were reported by patients in either group.

Conclusions

The penetrating method of acupuncture with long needle may be an effective and safe therapy for pain relief in patients with primary dysmenorrhea. This trial was registered with the Chinese Clinical Trial Registry (ChiCTR-IOR-17012621).