| Objective:Based on the effect evaluation of He-Mu-point combination for functional dyspepsia(FD)the study aims to explore the central mechanism of its synergistic effect partly,thus providing experimental evidence for the scientific intension of He-Mu point combination.Methods:A randomized and controlled trial was designed.40 functional dyspepsia patients who matched the inclusion criteria were randomly divided into 3 groups,group A,B and C.Each group was administered puncturing in different points: Group A with stomach Mu point(RN12),Group B with Low-He point(ST36)and Group C with the He-Mu-point combination(RN12 and ST36),acupuncture was done once a day and totally for 20 days.Clinical evaluation and resting state BOLD-fMRI scans were performed before and after treatment.The Nepean dyspepsia Index(NDI)and dyspepsia symptom score were used to evaluate the clinical efficacy;the self-rating depression scale(SDS)and self-rating anxiety scale(SAS)were used to evaluate the emotional state.The change of regional homogeneity of gastric sensation matrix in each group before and after treatment were investigated,and the correlation analysis between clinical effects and the regional homogeneity change of “orbitofrontal cortex,cerebellum,anterior cingulate,cingulate gyrus and insula” were detected to explore the critical area of different acupuncture treatment for FD and central response characteristics of He-Mu-point combination.Results:1.The efficacy evaluation of acupuncture for FD with different acupoints are as follows:(1)Base line:The three groups are comparable with the same base line(P>0.05).(2)Dyspepsia symptom: the score of Nepean dyspepsia symptom index(NDSI),dyspepsia symptom score and postprandial fullness of three groups are all significantly improved after the treatment(P<0.01).The score of epigastrium calcination of group A,the score of early satiety and abdominal pain of group B and the score of early satiety of group C are all significantly improved after the treatment(P<0.05).The changes in the postprandial fullness score of Group C very significantly differed from Group A and Group B(P<0.05).(3)Quality of life: the Individual and average scores of Nepean dyspepsia life quality index(NDLQI)are all significantly improved after the treatment(P<0.05).The changes in the interference and cognitive control field score of Group C very significantly differed from Group A(P<0.05).The changes in the sleep field score of Group C very significantly differed from Group B(P<0.05).The changes of NDLQI average score of Group C very significantly differed from Group A and B(P<0.05).No significantly difference of three groups in food and drink field score(P>0.05).(4)Emotion: the SAS of group B and C,the SDS of three groups are all significantly improved after the treatment(P<0.05).The changes in the SAS and SDS of Group B very significantly differed from Group A(P<0.05),but not from Group C(P>0.05).2.The results of regional homogeneity of the brain after puncturing in different acupoints:(1)Group A: the regional homogeneity of brain regions was increased: bilateral medial frontal gyrus(BA9).bilateral orbit inferior frontal gyrus(BA47).left precentral gyrus(BA6).bilateral middle temporal gyrus(BA42/21).bilateral cerebellar peduncle 2 area.bilateral cerebellar 6 area.left midbrain.right anterior cingutate gyrus(BA11).And the regional homogeneity of brain regions was lowered: right orbital superior frontal gyrus(BA23).bilateral postcentral gyrus(BA4/3).right medulla.Moreover,the group A can also adjust other FD abnormal brain regions,such as precuneus,within a large range.(2)Group B: the regional homogeneity of brain regions was increased: left orbital superior frontal gyrus(BA11).right orbital middle frontal gyrus(BA47).right orbital inferior frontal gyrus(BA47).left precentral gyrus(BA6).bilateral middle temporal gyrus(BA21/39).left cerebellar peduncle 1 area.left middle cingulate gyrus.And the regional homogeneity of brain regions was lowered: vermis 4.5(BA30).bilateral insula(BA48).right thalamus.The range of adjustment for FD abnormal brain regions of group B is limited.(3)Group C: the regional homogeneity of brain regions was increased: bilateral medial frontal gyrus(BA10).bilateral Orbital frontal medial gyrus(BA11).left orbital inferior frontal gyrus(BA47).bilateral cerebellar peduncle 1 area.right cerebellar peduncle 2 area.right cerebellar 6 area.bilateral cerebellar 8 area.bilateral cerebellar 9 area.bilateral anterior cingutate gyrus(BA11).And the regional homogeneity of brain regions was lowered: bilateral paracentral lobule(BA4).bilateral postcentral gyrus(BA4).left insula.Group C can adjust focus on cerebellum,orbitofrontal cortex and anterior cingutate gyrus.(4)The analysis of correlation between regional homogeneity of the brain and clinical effects: The change of ReHo in right cerebellum was positively correlated with NDLQI score improvements in Group A(P<0.005).The change of ReHo in left cerebellum,orbital superior frontal gyrus and middle cingulate gyrus was positively correlated with NDLQI score improvements in Group B(P<0.01).The change of ReHo in left cerebellum,orbital medial frontal gyrus and anterior cingulate gyrus was positively correlated with NDLQI score improvements in Group C(P<0.005).Conclusions:1.Three methods of acupuncture all can adjust the gastric sensation matrix and improve the symptoms,quality of life and emotional state.Cerebellum is the common adjustment region for three groups.2.He-Mu-point combination can improve the life quality of patients and postprandial fullness more significantly and adjust the brain function more intensively.The adjustment in orbitofrontal cortex and anterior cingutate gyrus,the key regions in gastrointestinal regulation and FD pathological changes,probably is the specific central mechanism in He-Mu-point combination for FD.3.Mu point can adjust the FD abnormal brain regions within a large range,but the Low-He point can adjust the key regions of FD more intensively.4.The central response of He-Mu-point combination gastrointestinal regulation effect is not same exactly compared with single point,and not the superposition of single point simply. |
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