The Application And Evaluation Of Brain FMRI In The Acupuncture Of Zi-Wu-Liu-Zhu

Objective:To explore the functional localization and its distributing orderliness of the central nervous system(CNS)reaction on acupuncturing the two acupoints of stomach meridian of foot-yangming(ST),two acupoints of kidney meridian of foot-Shaoyin(KI),and two false acupoints near the acupoints of the meridians mentioned above respectively,using magnetic resonance imaging(MRI),blood oxygenation level dependent(BOLD)of echo planar imaging(EPI)sequence,and to explore the exist and mechanism of the acupuncture of Zi-Wu-Liu-Zhu.Materials and methods:Forty right-handed volunteers without any symptom and sign of the central nervous system(male 22,female 18;age ranged 21 to 30 years old,average 23)who were studying on campus as students or postgraduates were selected in our studies.All of them had no history of taking drug and acupuncture within one week.Female volunteers were asked to avoid acupuncture test during menses.Every persion of these 40 volunteers was performed our acupuncture studied 4 times(160 totally).20 persons was acupunctured Zusanli(ST36)and Shangjuxu(ST37)in the different time,and two false acupuncture as the compare.20 persons was acupunctured Taixi(KI3)and Fuliu(KI7)in the different time,and two false acupuncture as the compare,All acupuncture tests were performed on the right leg.The order of test was determined randomly.Images were required on a 1.5-T unit(63 SP Magnetom Sonata Maestro Class;Siemens Medical Systems;gradient strength,40 mT/m/s). In each subject,after a sagittal scout sequence was performed,35 slices axial images of the entire area of the whole brain paralleled to the AC-PC line were obtained.Imaging sequences included spin echo(SE) T₁WI,gradient field mapping,and EPI(BOLD)were performed.The parameters of MR imaging included:slice thickness,3 mm;slice gap, 0.3 mm;FOV,200 mm.T₁WI:TR=600 ms,TE=15 ms;Matrix,256×256;FA,70°;Bandwidth,130Hz/Px;Scan time,4 minutes and 54 seconds.Gradient field map:TR=483 ms,TE=5.19 ms;NEX,1;FA, 60°;Matrix,64×100;Bandwidth,260 Hz/Px;Scan time,1 min and 4 seconds.T₂WI of BOLD:TR=3000 ms,TE=50 ms;NEX,1;FA,90°; Matrix,64×100;Bandwidth,2604 Hz/Px,Scan time,12 minutes and 21 seconds;Measurements,245.For acupuncture,a Multi-purpose Health Device G6805-2(made in Shanghai)was used.The parameters of it consisted of wave,continuous; frequency,2 Hz;voltage,6 volt;electric current,0.8 mAs-1.4 mAs.The stainless no-magnet acupuncture needles we used were brand of "Huatuo"(made in Suzhou,Φ0.35 mm×40 mm).The experiments were designed as"rest-acupuncture-rest".From the first measurement to the 85th was called No.1 rest,the 86th to the 165th measurement was acupuncture period,and the 166th to the 245th was called the second rest.The stimulation with electric current were started at the 86th measurement and stopped at the end of the 165th measurement. Electric needles were taken out at the beginning of the 166th measurement.The blood pressure,frequency of breath,and pulse were measured before test for every volunteer.Data were analyzed by using Statistical Parametric Mapping software (SPM99;Wellcome Department of Cognitive Neurology,London,UK) implemented in Matlab 6.0(Mathworks Inc,Sherborn,MA).The datasets were normalized to a standard space(Montreal Neurologic Institute space,MNI)within SPM99.This space was based on a template T1-weighted dataset,a close analog of Talairach space developed by the MNI.The temporal datasets were smoothed by using an isotropic Gaussian filter kernel having a full-width at half maximum of 8×8×8 mm the normalized voxel size.Statistical parametric maps were generated by using the general linear model to characterize regionally specific effects in the imaging data.Terms in the model included the activity condition(acupuncture)and the globle mean value of each temporal dataset.A boxcar reference waveform convolved with a kernel that approximates the hemodynamic response curve was used to test specific hypotheses,resulting in at value at each voxel.For all studies,statistical thresholding at significance level of p<0.001 and k≥30 was initially used to determine significant activation for each vexol.Results:In the"open" group of the ST,20 volunteers have the feeling of "De-Qi".In the"close" group of the ST,20 volunteers have the feeling of"De-Qi" except 4 volunteers felt no"De-Qi" in one acupoint.While the feeling of other haven't the difference.The fMRI activation data of the ST are summarized as follows.In the"open" time of the Stomach meridian of foot-yangming(ST): Signal increase elicited by acupuncture stimulating was demonstrated in Broadmann4,6,3-1-2,9,24,and habenular trigone,bilaterally;left Broadmann 47,19;right Broadmann 46,7,and cerebellum.Signal decrease was shown in Broadmann 11,38,39,and 40,bilaterally;and right Broadmann 47,21,18,46,and tapetum.In the"close" time of the Stomach meridian of foot-yangming(ST): Signal increase elicited by acupuncture stimulating was demonstrated in Broadmann4,6,3-1-2,24,bilaterally;left Broadmann 47,19,7;right cerebellum.Signal decrease was shown in Broadmann 11,38,bilaterally; left Broadmann 21;and right Broadmann 47,39.In the"open" group of the KI,20 volunteers have the feeling of "De-Qi".In the"close" group of the ST,20 volunteers have the feeling of"De-Qi" except 5 volunteers felt no"De-Qi" in one acupoint.While the feeling of other haven't the difference.The fMRI activation data of the KI are summarized as follows.In the"open" time of the Kideny meridian of foot-shaoyin(KI): Signal increase elicited by acupuncture stimulating was demonstrated in Broadmann4,6,3-1-2,19,24,47,and paracentral lobule,bilaterally; left Broadmann 13,and thalamus;right Broadmann 7.Signal decrease was shown in Broadmann 11,22,38,and 47,bilaterally;and left Broadmann 46,and hippocampal gyrus;right Broadmann 8,17,36.In the"close" time of the Kideny meridian of foot-shaoyin(KI): Signal increase elicited by acupuncture stimulating was demonstrated in Broadmann4,6,3-1-2,26,cerebellum and paracentral lobule,bilaterally; left Broadmann 47,13,22;right Broadmann7a.Signal decrease was shown in Broadmann 11,38,and hippocampal gyrus bilaterally;left Broadmann 47;right Broadmann 17,30,36,and cerebellum.In the control study,20 volunteers have the feeling of"De-Qi" both in the"open" and"close" group.While the feelings of them haven't the differences.The fMRI activation data of the control group are summarized as follows.There aren't different both the active and deactivate area when acupuncture the nonacupoint in the"open" and"close" time.Signal increase elicited by acupuncture stimulating was demonstrated in Broadmann 24,30,cerebellum,and thalamus bilaterally;left Broadmann 22,post of 6,and insula.Signal decrease was diffused.Conclusions1.fMRI can delineate the different reaction of the CNS.It testify exist of the acupuncture of Zi-Wu-Liu-Zhu objectively and directly.While it isn't exist when you acupuncture the nonacupoint.2.The active,deactivate area(signal increase and decrease)the most active and deactivate area are different when acupuncture the meridian ST or KI.The number and extent of the active and deactivate area when acupuncture the meridian in the"open" time are more and wider then in the"close" time.These maybe one of the reason why it is different when acupuncture the meridian in the different time.3.There are both same and different when acupuncture the ST or KI in the different time.The whole active and reflect feedback routein can found when acupuncture in the"open" time,while the"close" time isn't. These give us the answer of why the therapeutic effect is juxtaposition and obviously distinction.4.Multiple brain regions where were shown signal increase and signal decrease elicited by acupuncture stimulating are belonged to the "splanchnic brain".This result prompts that the clinical effect of ST and KI might be accomplished by adjusting the"splanchnic brain".The analgesia effect induced by acupuncturing the ST and KI may cause by the active and deactivate balance of"splanchnic brain".This is coincidence with the Chinese traditional medicine"yin" and"yang" balance.5.The most active and most deactivate are right precentral gyrus and right medial orbital gyri when acupuncture the ST in the"open" time, the most active when acupuncture in the"close" time is same as the "open" time.While the most deactivate is right gyrus rectus.The most active and most deactivate are bilateral cingulate gyrus and right medial orbital gyri when acupuncture the KI in the"open" time,The most active and most deactivate are left cerebellum and right medial orbital gyri when acupuncture the KI in the"close" time.The most active and deactivate area are different.These maybe one of the reason why it is different when acupuncture the same meridian in the different time.6.Right Broadmann 7 area is activated in the study when acupuncture the ST in the"open" time,while left Broadmann 7 is activated when acupuncture in the"close" time.Broadmann 7 areas aren't activated in the study when acupuncture the KI both in the"open" and"close" time. These maybe one of the reason why it is different when acupuncture the same meridian in the different time.This maybe one of the reason why it is different when acupunctures the different meridian.These reflect of different meridian to the Zi-Wu-Liu-Zhu is different.