| Acupuncture is the method of inserting needles into specific physiological acupoints with the purpose of addressing therapeutic requirements guided by the theory of traditional Chinese medicine(TCM).Acupuncture has been practiced clinically in China and Eastern Asia for more than 2000 years.In 1997,a National Institutes of Health consensus conference was held to assess the clinical use and effectiveness of acupuncture as a standalone or adjunct therapy for indications such as postoperative and chemotherapy-induced nausea and other conditions.This panel called for the conduct of additional high-quality randomized controlled trials of acupuncture.Since then,there has been an explosion of basic research studies and clinical applications of acupuncture around the world.Indeed,in 2014,the World Health Organization reported the use of acupuncture in a total of 183 countries.TCM purports that the therapeutic effects of acupuncture are mediated by the ability of acupoint stimulation to adjust an individual's qi and blood balance.However,this theory of balance regulation is not entirely compatible with contemporary biomedical information.Accordingly,the exact underlying biological mechanisms of acupuncture remain unclear.Functional magnetic resonance imaging(f MRI)has been applied to explore relationships between acupuncture stimulation and functional areas of the brain cortex,and this knowledge has opened a new window for researchers to investigate the central mechanisms of acupuncture.The acupuncture f MRI studies are mainly divided into the acupuncture specific mechanism research and acupuncture efficacy mechanism research.According to the existing research directions,we will focus on several questions like the central mechanism of deqi sensations,the brain activity synchronization of acupuncture immediate effect,aberrant spontaneous brain activity of primary dysmenorrhea and the abnormal brain responses to immediate acupuncture stimulation in primary dysmenorrheabased on f MRI.Details of the studies are as following:(1)The central mechanism of deqi sensations.Development of non-deqi control is still a challenge.This study aims to set up a potential approach to non-deqi control by using lidocaine anesthesia at ST36.Forty healthy volunteers were recruited and they received two f MRI scans randomly.One scan was accompanied with manual acupuncture at ST36(DQ group),and another was associated with both local anesthesia and manual acupuncture at the same acupoint(LA group).Comparing to DQ group,more than 90 percent deqi sensations were reduced by local anesthesia in LA group.The mainly activated regions in DQ group were bilateral inferior frontal gyrus(IFG),postcentral gyrus(S1),primary motor cortex,inferior parietal lobule(IPL),thalamus,insula,claustrum,cingulate gyrus,putamen,superior temporal gyrus,and cerebellum.Surprisingly only cerebellum showed significant activation in LA group.Compared to the two groups,bilateral S1,insula,ipsilateral IFG,IPL,claustrum,and contralateral anterior cingulate gyrus(ACC)were remarkably activated.Local anesthesia at ST36 is able to block most of the deqi feelings and inhibit brain responses to deqi,which would be developed into a potential approach for non-deqi control.Bilateral S1,insula,ipsilateral IFG,IPL,claustrum,and contralateral ACC which were mainly included in the sensory transduction and integration network and salience network might be the key brain regions responding to deqi.(2)The brain activity synchronization of acupuncture immediate effect.This study aimed to introduce a promising analytical method named intersubject synchronization(ISS)to evaluate the brain activities of acupuncture immediate effect.30 healthy volunteers were recruited in the present study.The BLOCK-designed manual acupuncture stimuli were delivered at acupoint SP6 and deqi sensations were measured after acupuncture stimulation.All subjects underwent an f MRI scanning during the acupuncture stimuli.The f MRI data were separately analyzed by ISS and traditional General linear model(GLM)methods.All subjects experienced deqi sensations.The results of ISS analysis produced a wider range of activations when compared with GLM analysis.The results of ISS analysis showed that the activated regions during acupuncture simulation at SP6 were mainly divided into 5 clusters based on the time courses.The time courses of Cluster 1 and 2 were in line with the acupuncture stimulation pattern and the active regions were mainly involved in sensorimotor system and salience network.Cluster 3,4 and 5 displayed almost contrary time course relative to the stimulation pattern.The activations were included in default mode network,descending pain modulation pathway and visual cortices.The ISS analysis considered the sustained effect of acupuncture and uncovered additional information not shown by GLM analysis.Then we suggest that ISS may be a suitable approach to investigate the brain responses of acupuncture immediate effect.(3)Aberrant spontaneous brain activity of primary dysmenorrhea.Primary dysmenorrhea(PD)is an indication of acupuncture therapy.This study aimed to investigate the regional spontaneous brain activity changes in primary dysmenorrhea(PD)patients in different phases of the menstrual cycle by regional homogeneity(Re Ho)analysis.Thirty-three PD patients and 32 healthy controls(HCs)separately received resting-state functional magnetic resonance imaging during menstrual phase and follicular phase(non-menstrual phase).The Re Ho values of the PD patients were increased in left midbrain and hippocampus,right posterior cingulate cortex(PCC),insula and middle temporal cortex(MTC)and decreased in left dorsolateral prefrontal cortex and right medial prefrontal cortex(m PFC)in menstrual phase.In non-menstrual phase,enhanced Re Ho values were found in bilateral S1 and precuneus,left S2 and MTC,and reduced Re Ho values were observed in left m PFC and orbital frontal cortex.The clinical symptom scores positively correlated with Re Ho values of midbrain and negatively correlated with m PFC and PCC.Our results suggested that PD is accompanied by dynamic regional spontaneous activity changes across the menstrual cycle,and the altered regions were involved in descending pain modulation,default mode network and sensory modulation.These abnormal activations might contribute to maintain the menstrual pain.(4)The abnormal brain responses to immediate acupuncture stimulation in primary dysmenorrhea.Primary dysmenorrhea has a high level of incidence and no special treatment drugs.A large number of clinical reports had been proved that acupuncture treatment was effective,but acupuncture treatment mechanism was unknown.This study will enroll patients with primary dysmenorrhea and healthy subjects.While giving acupuncture stimulation,the brain image data was simultaneous collected.Independent component analysis method was used for the data analysis.The results suggested that the patients with primary dysmenorrhea showed abnormal brain responses to acupuncture stimulation when comparing with healthy subjects.Abnormal brain regions are mainly located in the default default network(medial prefrontal cortex,posterior cingulate,angular and middle temporal gyrus),visual networks(cuneus and calcarine fissure),salience network(insula and anterior cingulate)and the central executive network(dorsal lateral prefrontal cortex).The results suggest that the analgesia effect of acupuncture on dysmenorrhea might implement through regulating the above abnormal networks.In summary,the brain activities evoked by immediateacupuncture are dominated by activation.Deqi sensations are closely related to sensorimotor network and salience network.The preventive analgesia of immediate acupuncture might be achieved through adjusting the pain-related brain network such as default default network,salience network and the central executive network. |
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