The FMRI Comparative Study On Cutaneous And Routine Needling In Acupoints Waiguan (SJ5) And Zhigou (SJ6)

ObjectiveAcupuncture and Moxibustion is one of the essences of Traditional Chinese Medicine.The research into the mechanism of acupuncture's curative effect has always been a hot topic in acupuncture study.As is known to us all,acupuncture and moxibustion is mainly performed through needling at certain acupoints.Of the 361 meridian acupoints and some extraordinary acupoints,each one has its specificity, with the function and major curing effect being somewhat different.Therefore, acupoints are selected in light of the syndromes,on the basis of the guidance of the Zangfu study and meridian theory and in line with the principle of selecting acupoints along meridians.The key point is selecting acupoints along meridians related to a certain disease,which is a kind of prescribing principle.On the basis of this,we treat diseases along the involved meridians."Treatment should be done where the meridians pass." best sums up the principle.Exploration into this principle plays an important role in unveiling the mechanism of the acupuncture's curative effect,improving the clinical therapeutically efficacy,and establishing its scientific therapeutic value and standing in the mainstream medicine.Acupoints compatibility seeking,an application of the principle of selecting acupoints along meridian,refers to choosing and matching two or more acupoints for needling,a practice aimed at improving the synergistic effect and thus the clinical curative effect.As a clinical acupuncturing program,the compatibility or incompatibility of the compatibility seeking has direct bearing on the curative effect. So ensuring acupoint compatibility is an important and indispensable link in syndrome differentiating treatments.In this study,the two acupoints of Waiguan(SJ5) and Zhigou(SJ6) were chosen as the target points.The functional Magnetic Resonance Imaging(fMRI),a dynamic detection technique developed in recent years,is,with its rapidity and non-intervention, finding increasingly wide application in the study of the mechanism of needling.The aim of this technique is to find transactivation domains when single point,non-point, combination points are separately needled,and thus the relationship between brain, target organ and needled acupoints.MethodsClinical observations were made in the Chinese People's Armed Police Hospital between July,2007 and Dec.,2008.Acupuncturing method:Eight volunteers received stimulation by means of cutaneous needling at SJ5 and SJ6 on the 1st day,and two weeks later,the routine needling in the same acupoints.Routine acupuncturing method:After the two acupoints were sterilized,Waiguan(SJ5) was needled first and then Zhigou(SJ6). Then the two acupoints were needled simultaneously.The acupuncturing procedure was formulated according to the Block method,with the needle being twisted and turned equably.Cutaneous needling method:The acupoint locating,sterilizing and needling were performed the same way as above.Waiguan(SJ5) was needled first, in accordance with the model of Block.Shallow puncturing was done in the skin area of the acupoint with the needle tip slightly pressed against the skin.And then the same operation was performed at Zhigou(SJ6). fMRI detection and observation method:volunteers were asked to take a rest and keep calm for ten minutes,then offered the cerebral fMRI scan by the superconducting magnetic resonance imaging system GE 1.5T.After that,by means of Functool of GE Signal,the state of activation of the following ROIs was processed:bilateral frontal lobes,parietal lobes,temporal lobes,occipital lobes,and hippocampuses,cingulated grouses,basal ganglia,as well as cerebellum. Observation indexes included activation probability,activation counts,and activation intensity.The statistical software SAS9.13 was employed in this study.ResultsAmong the 8 healthy volunteers,cutaneous and routine needling at the right Waiguan(SJ5) and Zhigou(SJ6) both caused activation in multiple bilateral cerebral areas.Cutaneous needling mainly activated left parietal lobe,bilateral frontal lobe, right parietal lobe,left occipital lobe,bilateral temporal lobe,right occipital lobe, basal ganglia,right cingulated gyrus,and cerebellum,shallow puncturing did not activated hippocampus,left cingulated gyrus,while routine needling mainly activated left parietal lobe,bilateral frontal lobe,and then activated right parietal lobe,bilateral occipital lobe,cerebellum,bilateral temporal lobes,basal ganglia,left cingulated gyrus,right cingulated gyrus,and right hippocampus,but did not activate left hippocampus.As far as the activation in the left frontal lobe was concerned,the activated points produced by cutaneous needling numbered more than twice than those produced by routine needling.As for the activation in the bilateral occipital lobe,cerebellum,and right basal ganglia regional,however,the activated points produced by routine needling registered more than twice than those produced by cutaenous needling.Though differences as stated above existed in the activation probability and the activation counts of the two groups,they,as was revealed by the statistical analysis,had no statistical significance(P＞0.05).Cutaneous needling had the greatest activation intensity in left parietal lobe and bilateral frontal lobe,with that in right parietal lobe,bilateral parietal lobe,right basal ganglia region being less and that in hippocampus,cingulated gyrus and left basal ganglia region being zero.Routine needling exhibited the highest activation intensity in bilateral frontal lobe,right temporal lobe,bilateral occipital lobe,right hippocampus,left cingulated gyrus,right basal ganglia region,and cerebellum,and lower activation intensity in bilateral parietal lobes and left temporal lobe,with the intensity in left hippocampus,right cingulated gyrus,and left basal ganglia region being zero.In left parietal lobe,the activation intensity caused by cutaneous needling was stronger than that by regular needling,but as far as the activation intensity in right occipital lobe and cerebellar is concerned,routine needling was a little stronger than cutaneous needling.For all the tendency for differences above,the statistical analysis of the differences showed no statistical significance(P＞0.05).ConclusionNo striking differences exist between cutaneous and routine needling in terms of the activation they caused in related ROIs,but there does exist some difference in the acting trend,which indicates that the clinical functions of needling to SJ5 and SJ6 are related with the comprehensive adjusting of the brain.Though the differences in activation probability,activation counts,and activation intensity of the two methods of needling have no statistical significance, the results observed show that cutaneous needling activates left frontal lobe relatively specifically,and routine needling can relatively specifically activate bilateral occipital lobes,cerebellum and right basal ganglia region.Waiguan(SJ5) and Zhigou(SJ6) are respectively the collateral acupoint and Jing-River of the Sanjiao Meridian of Hand-Shaoyang(SJ).Needling at the two acupoints,whether it be cutaneous or routine,can activate frontal lobe,parietal lobe, temporal lobe,occipital lobe,hippocampus,hippocampus,basal ganglia region and cerebellum.This demonstrates that the integrating function of the brain plays a certain role between stimulation activation and clinical curative effect.The result also suggests that the coetaneous needling of Waiguan(SJ5) and Zhigou(SJ6) can specifically activate frontal lobe,and the routine needling of the two acupoints tends to have an activating role for occipital lobe,cerebellum and basal ganglia.Modern medicine study indicates that frontal lobe is related with body movement,language, memory and emotions,occipital lobe is related with vision,and temporal lobe with auditory perception,cerebellum is concerned with equilibrium,muscle tonus and voluntary movement,voluntary movement region with movement disorders in extra pyramidal system.Hence it can be presumed initially that when applying Waiguan(SJ5) and Zhigou(SJ6) needling in treating diseases concerning movement,language,memory and emotions,coetaneous needling should be the first choice,while when applying this technique in treating diseases related to vision, auditory perception,equilibrium,extra pyramidal system,routine needling should receive priority.