| Objective:In a previous literature review, we raised the hypothesis that acupoints are of specific effects, which are related to meridians and collections of meridian Qi. Based on this hypothesis, migraine was selected, as a typical disease of Shaoyang pattern, to clarify the differences of clinical efficacy between specific acupoints of Shaoyang meridian, non-specific acupoints of Shaoyang meridian, specific acupoints of Stomach meridian and non-acupoints. Besides, differences in cerebrovascular flow caused by the above mentioned acupoints were explored and discussed.Methods:The research consists of two parts. First, a large sample size multi-center randomized controlled trial was conducted to testify the hypothesis. Second, on the basis of the clinical study, Transcranial Doppler (TCD) was used to detect the differences in cerebrovascular flow caused by different acupoints and non-acupoints.1. In the clinical trial,480 migraineurs were randomly assigned to four groups using central randomization:specific acupoints of Shaoyang meridian group (group A), non-specific acupoints of Shaoyang meridian group (group B), specific acupoints of Stomach meridian group (group C) and non-acupoints (group D), Fengchi (GB20), Waiguan (TE5), Yanglingquan (GB34) and Qiuxu (GB40) were punctured in group A; Luxi (TE19), Sanyangluo (TE8), Xiyangguan (GB33), Diwuhui (GB42) were punctured in group B; Touwei (ST8), Pianli (LI6), Zusanli (ST36), Chongyang (ST42) were punctured in group C; four predefined non-acupoints were punctured in group D. Both acupoints and non-acupoints were punctured laterally, with left or right side alternatively used. Acupuncture treatments were given for once a day, five times a course and last for 4 courses, with a 2-days rest between each course. Each acupuncture session lasted for 30 minutes. The following outcome measurements were assessed at 0,2,4,8 and 16 weeks after randomization:days with migraine attack and differences from baseline, frequency of migraine attack and differences from baseline, headache intensity score and differences from baseline, VAS score differences from baseline, etc. 2. Patients and interventions were the same as the above mentioned trial. The following vessels were measured by Transcranial Doppler before and after acupuncture:basilar artery (BA), left and right vertebral artery (L/R-VA), left and right middle cerebral artery (L/R-MCA), left and right anterior cerebral artery (L/R-ACA) plus left and right posterior cerebral artery (L/R-PCA). These arteries were measured for mean flow velocity (MFV), pulse index (PI) and resistance index (RI).Results:1. The following outcomes in group A, B and C were statistically different from those in group D:days with migraine attack and differences from baseline, frequency of migraine attack and differences from baseline, headache intensity score and differences from baseline, VAS score and differences from baseline, etc. The three treatment groups were better than non-acupoint group.2. Group A and B were statistically different from group C in lost work days due to migraine. Additionally, group A was also statistically different from group C in headache intensity score and differences from baseline, VAS score differences from baseline, etc.3. Group A was statistically different from group B in headache intensity score and differences from baseline, VAS score and differences from baseline, etc.4. After acupuncture treatment, MFV of BA, R-VA, L-VA and R-MCA were statistically lower than before treatment (P<0.05). Changes of PI were different across vessels. PI of BA, R-VA and R-ACA were lower than before treatment, while PI of L-VA, R-MCA, L-MCA and R-PCA were higher than before treatment. However, there were no statistically differences between before and after treatment. RI was higher after treatment, however, no statistical differences were found.5. Acupoints of Shaoyang meridian were different from non-acupoints in MFV and RI (P<0.05). Specific acupoints of Stomach meridian were different from non-acupoints in MFV (P<0.05). Specific acupoints of Shaoyang meridian were different from specific acupoints of Stomach meridian in MFV (P<0.05). Non-specific acupoints of Shaoyang meridian were different from specific acupoints of Stomach meridian in RI (P<0.05). Conclusions:1. Acupoints are more efficacious than non-acupoints in managing migraine in reducing headache frequency, relieving headache intensity and reducing headache accompanying symptoms. And acupoints of Shaoyang meridians are more efficacious than acupoints of Stomach meridian in relieving headache intensity and reducing headache accompanying symptoms. In addition, specific points of Shaoyang meridians are more efficacious than non-specific points in relieving headache intensity.2. Acupuncture can lower the MFV of BA, R-VA, L-VA and R-MCA in migraineurs in headache free interval. Acupoints of Shaoyang meridian seem to achieve greater effect in regulating vascular state in migraineurs, than acupoints of other meridians and non-acupoints. Further researches are warranted.
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