Similarities between Ashi acupoints and myofascial trigger points: Exploring the relationship between body surface treatment points

Needling trigger points for treating myofascial pain syndrome: A systematic review and meta-analysis

BACKGROUND

Myofascial pain syndrome (MPS) is a widespread musculoskeletal disorder characterized by myofascial trigger points. Needling trigger points is one of the most common therapeutic interventions to treat MPS. However, it is unclear whether needling trigger points is superior to other non-pharmacological interventions.

METHODS

Randomized clinical trials (RCTs) which compared the effectiveness of needling trigger points and other non-pharmacological therapies for treating MPS, were searched in the databases of PubMed, Web of Science, Embase, Cochrane Library, CNKI, WanFang, VPCS, and Sinomed, from their inception to August 25th, 2024. Two independent reviewers extracted relevant data on study characteristics and assessed the risk of bias using the Cochrane Risk of Bias Tool.

RESULTS

Of the 1968 articles initially screened, 13 RCTs were included. Needling trigger points treatment were more efficacious than non-pharmacological therapies in reducing Visual Analog Scale (VAS) scores (MD = -1.32; 95 % CI = -1.84 to -0.81; P < 0.0001) and the Roland-Morris Disability Questionnaire (RMDQ) scores (MD = -2.77; 95 % CI = -3.58 to -1.97; P < 0.0001).

CONCLUSION

This systematic review has shown that needling trigger points could be a more effective option than other non-pharmacological therapies to improve the symptoms of MPS. Clinical trials of robust quality are required to promote further the evidence-based application of needling trigger points for MPS.

Mechanisms of acupuncture at Zusanli (ST36) and its combinational acupoints for stress gastric ulcer based on the correlation between Zang-fu and acupoints

Gastric ulcer (GU) is a common digestive system disease. Acupuncture, as one of the external treatments of traditional Chinese medicine (TCM), has the characteristics of multi-target, multi-pathway and multi-level action in the treatment of GU. The relationship between meridian points and Zang-fu is an important part of the theory of TCM, which is crucial for the diagnosis and treatment of diseases. There is an external and internal link between acupoints and Zang-fu. The pathological reaction of Zang-fu can manifest as acupoint sensitization, while stimulation of acupoints can play a therapeutic role in the internal Zang-fu. Therefore, the acupoint has the functions of reflecting and treating diseases. This review explores the tender points on the body surface of patients with GU and the rules of acupoint selection. In addition, Zusanli (ST36), as one of the most used acupoints of the stomach meridian, was selected to show the mechanisms behind acupoint stimulation in the treatment of GU in greater detail, specifically in the well-studied model of the stress GU (SGU). Hence, the mechanisms of acupuncture at ST36 and points commonly used in combination with ST36 to treat SGU are discussed further. Treatment effects can be achieved through anti-inflammatory and antioxidant activities, gastric mucosal injury repair, and interaction with the brain-gut axis. In summary, this review provides evidence for a comprehensive understanding of the phenomena and mechanism of acupoint functions for GU. Please cite this article as: He M, Lim XY, Li J, Li L, Zhang T. Mechanisms of acupuncture at Zusanli (ST36) and its combinational acupoints for stress gastric ulcer based on the correlation between Zang-fu and acupoints. J Integr Med. 2025; 23(1): 1-11.

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.

Electroacupuncture at Traditional Acupoints or Myofascial Trigger Points for Chronic Nonspecific Low Back Pain: High or Alternated Frequency? A Double-Blinded Randomized Controlled Trial

Background

Chronic nonspecific low back pain (cNLBP) can be effectively treated by electroacupuncture (EA) at traditional acupoints (TAPs) and myofascial trigger points (MTrPs). However, the optimal type and frequency of stimulation (alternated frequency [AF] and high frequency [HF]) remain unclear. This study aimed to explore this.

Methods

A double-blinded randomized controlled trial was conducted with four treatment groups: EA using AF at MTrPs (MTP-AF group), HF at MTrPs (MTP-HF group), AF at TAPs (TAP-AF group), and HF at TAPs (TAP-HF), each with 40 middle-aged cNLBP patients. The AF was 2/100 Hz and HF was 100 Hz. Pain-visual analog scale (pain-VAS), paracetamol requirement, Oswestry disability index (ODI) score, global improvement, and adverse effects (AEs) were monitored.

Results

After 4 weeks, groups of EA targeting MTrPs and TAPs with the same frequency showed no significant differences. Groups using AF demonstrated significantly superior pain-VAS and ODI percentage score reductions compared with HF groups, extending at least 4 weeks post-EA. All groups showed consistent results in paracetamol use, global improvement, and safety. Subgroup analysis indicated that EA with AF at MTrPs provided better results in patients aged ≥60-65 years.

Conclusions

EA at MTrPs and TAPs demonstrated similar effects on cNLBP. However, an AF proves more effective than an HF, potentially maintaining this trend in the short term. Older patients may respond better to EA at MTrPs with AF. Future studies may explore combined MTrPs and TAPs for cNBLP treatment with a broader age range and more diverse demographic groups.

The Efficacy of Acupuncture, Exercise Rehabilitation, and Their Combination in the Treatment of Knee Osteoarthritis: A Randomized Controlled Trial

Objective

To assess the effectiveness of acupuncture, exercise rehabilitation, and their combination in treating knee osteoarthritis (KOA).

Methods

This randomized controlled trial was done on patients with KOA, who were randomly allocated to three groups: acupuncture (AP), exercise rehabilitation (ER), or a combination of acupuncture and exercise rehabilitation (AE). The study lasted 12 weeks with 4 weeks of treatment and 8 weeks of follow-up. The primary outcome was the response rate, which was determined by the percentage of participants who experienced a significant improvement in pain and function by the fourth week. The primary analysis utilized a Z test for proportions in the modified intent-to-treat population, consisting of all randomized participants with at least one post-baseline measurement.

Results

Out of the 120 patients initially enrolled in the study, 110 completed the trial and were included in the intention-to-treat analysis. Response rates at week 4 were 65.7% (23 out of 35), 58.3% (21 out of 36), and 83.3% (32 out of 39) in the AP, ER, and AE groups, respectively. The response rate in the AE group was found to be significantly higher than that in the ER group at week 4. No significant differences were observed in the overall response rates between the AP and ER groups, as well as between the AP and AE groups.

Conclusion

Our research indicates that both acupuncture and exercise rehabilitation can effectively enhance pain relief, functional improvement, and joint mobility in individuals aged 45 to 70 with moderate to severe chronic KOA. Furthermore, the AE group demonstrated the highest response rate. These beneficial outcomes were sustained for a minimum of 8 weeks post-treatment. The combination of acupuncture and exercise rehabilitation appears to enhance the overall therapeutic efficacy for KOA patients, suggesting a synergistic effect that may be particularly advantageous for those with moderate to severe symptoms.

Exploratory Study of Biomechanical Properties and Pain Sensitivity at Back-Shu Points

OBJECTIVES

Hypersensitive acupoints in specific body areas are associated with corresponding internal or visceral disorders. Back-shu points are clinically significant for the diagnosis of visceral organ disease, according to the biomechanical characteristics of the acupoints. In this study, we assessed the biomechanical characteristics and pain sensitivities of five back-shu points linked to five visceral organs in healthy participants.

METHODS

The study included 48 volunteer participants. A myotonometry was used to assess muscle tone and muscle stiffness at five back-shu points associated with visceral organs. Pressure was monitored using a microcontroller and a force sensor. Pain sensitivity was assessed in response to deep pressure pain produced by a constant force.

RESULTS

Substantial differences in muscle tone and stiffness were observed at the five back-shu points; muscle tone was highest at BL15, whereas muscle tone and muscle stiffness were lowest at BL23. Moreover, pain sensitivity was significantly different among the acupoints; pain sensitivity was highest at BL23. There was a significant negative correlation between muscle tone and pain sensitivity.

CONCLUSIONS

We found significant differences in muscle tone, muscle stiffness, and pain sensitivity among five back-shu points associated with visceral organs, which may be attributable to anatomical variations at each point. Our findings suggest that differences at back-shu points should be considered to ensure the accurate diagnosis of visceral disease.

Using the right design controls for acupuncture trials: Methodological rigor and validity in research

Acupuncture treatment can be defined as a medical procedure with an acupuncture needle at acupoints. Establishing suitable control settings is essential, based on the target elements of the acupuncture therapy. In order to properly design a clinical trial or an experiment, a control group must be established. Here, we overview the significance of the control group and its limitations in acupuncture research. Clinical trials have employed a variety of study designs and controls for acupuncture treatment in order to compare the effects of actual treatments with control groups that include no treatment or treatment as usual, sham acupuncture at true acupoints, real acupuncture at non-acupoints, and sham acupuncture at non-acupoints. In order to determine the point-specificity of acupuncture, real acupuncture at non-acupoints should be taken into consideration, whereas sham acupuncture at the same true acupoints should be used to determine the needling-specific effect of acupuncture. It is crucial to choose the optimum control for acupuncture treatments depending on the study's main goal and to interpret the results in accordance with the research design.

Western Medical Acupuncture Perception and Use for Pain Management Among Athletes: A Systematic Review

Purpose

This systematic review aims to assess the use and perception of "Western" medical acupuncture-based on conventional biomedical mechanisms and evidence-based medicine for diagnosis and needle placement-for pain management among athletes and their healthcare providers.

Methods

A systematic review is reported based on the PRISMA guidelines. PubMed, Web of Science, SPORTDiscus, Allied and Complementary Medicine databases, and Google Scholar were searched (search: from database inception to July 2023). Two authors independently conducted multi-stage screening, data extraction, and quality assessment. The outcomes of interest were prevalence of acupuncture prescriptions by healthcare professionals, prevalence of acupuncture use by athletes, and perceptions related to acupuncture effectiveness among healthcare professionals and athletes. Only studies wherein "Western" medical acupuncture was used for pain management were included.

Results

Our review included 11 observational studies and clinical trials. The prevalence of "Western" medical acupuncture prescription varied from 15.4% (UK) to 58.4% (US) among sports medicine healthcare professionals. Prevalence of acupuncture use among athletes ranged from 2.2% among college athletes in Palestine to 61% among professional football players in the Netherlands. Acupuncture was used for managing delayed-onset of soreness and pain due to various types of musculoskeletal injuries. Both athletes and their healthcare providers reported positive perceptions of acupuncture.

Conclusion

Our systematic review identifies a notable research gap in evaluating the practice and perception of "Western" medical acupuncture among healthcare professionals and athletes. Our findings suggest that "Western" medical acupuncture is not only prescribed by sport medicine professionals and used by athletes for diverse musculoskeletal pains but is also generally perceived positively for its effectiveness. Given the positive clinical experience of health professionals, athletes' favorable perception, and acupuncture's well-established safety profile, acupuncture should be given serious consideration-as a complementary approach-in the overall management of pain.

Registration

Open Science Framework (https://osf.io/qb9gc).