Research Of The Relevant Sensitized Acupoints On The Body Surface In Chronic Superifical Gastritis

1 BACKGROUNDTraditional Chinese medicine believes that acupoints are the specific sites on the body surface in which qi of zangfu organs and meridians and collaterals is infused. They are the reflections of the physiological functions and pathological states of zangfu organs and also the sites for promoting qi and blood circulation and adjusting zangfu functions through acupuncture and moxibustion. Acupoints are the essential link in the relationship between meridian-collateral and zangfu organs. The interconnection between meridian points and internal organs had been recognized over two thousand years ago by ancient scholars. It was said in Lingshu:Jiuzhen Shieryuan (《灵枢·九针十二原》:Miraculous Pivot:Nine Needle and Twelve Primary Points) that " the disorders of five zang organs are reflected on twelve Yuan-primary points; the observation on the twelve Yuan-primary points may understand the disorders of five zang organs ". Through long-term clinical practice of acupuncture and moxibustion, it has been found that the abnormal manifestations on acupoints may be adopted for the disease diagnosis. Clinical physicians often make a diagnosis or determine a treatment of disease by the node-like or stripe-like findings palpated on the acupoints, or the tenderness and sensitive reaction on the acupoints, as well as the papules or pitting reaction on the acupoints observed. For example, in the patients with gastroptosis, commonly, the stripe-like finding presents on Zusanli (ST36) and a node-like finding on Zhongwan (CV12). The eminent expert of history science, Joseph Needham said:"the disclosure of the secret for the necessary connection between the reactions of the human body surface and the changes in the internal organs is the great discovery in terms of physiology in Medieval China". The modern medicine research has also proved the corresponding reactions of the internal organ disorders on the human body surface. For example, the radiating pain (like referred pain) on the body surface is manifested in pain of internal organ; fibromyalgia is manifested in irritable bowel syndrome; proctectasia and ectacolia may induce fibromyalgia of gastrocnemius muscle, etc. Over 100 years ago, Head, the physician of western medicine discovered that the spontaneous pain threshold or skin sensitivity increased on the specific sites on the body surface when the internal organs were dysfunctional of the human body. Hyperalgesia is an increased sensitivity to pain under the stimuli on the human body, including pain induced by the subthreshold stimulus that may not cause pain in normal state and much drastic pain induced by the suprathreshold stimulus as compared with normal state. According to the interpretation in modern anatomy, this reaction is due to that the afferent nerve fiber of the sick internal organ and the afferent nerve in the referred site of the trunk enter the spinal cord from the same posterior root and are converged on the same spinothalamic tract neurons. This reaction is based on the segmental connection. On the contrary, the lesion or injury on the body surface also causes some disorders of internal organ. For example, acute injury of the body surface stimulus may sensitize the neurons in response to the internal organ in the spinal cord; the injection of acid solution to gastrocneumus may lead to proctectasia and ectacolia; electric stimulation on acupoints may cause neural inflammatory reaction of internal organ via dorsal root reflex. It shows that acupoints and internal organs are correlated and this connection is very close under pathological state especially. It means that acupoint state is closely correlated with the functional state of internal organs and its characteristics under pathological state are different . from those under physiological state.The understandings on acupoint specificity were just limited in the literature records and clinical experiences in the past, without adequate scientific foundation. The researches on acupoint structure and function have commonly laid the stress on the relationship between acupoints and internal organ functions under normal state as well as the adjustment of zangfu organs. But, in recent years, the scholars have generalized that the functional activity of acupoint is a kind of dynamic concept. When the functions of internal organ are abnormal, the acupoints may transfer from a "silence" state to a "sensitization" state. Hence, it much enhances the functions of acupoint area on reflecting disease and treating disease, which is totally different from the physiological state in characteristics. Such characteristic is termed as acupoint sensitization. This sensitization is the concrete manifestation of acupoint on reflecting disease and is the core for the guidance of clinical acupoint selection and the improvement of clinical efficacy. Currently, in the aspect of experimental research, the research has been developed to the impacts of single acupoint on the functional activity of several organs rather than the observation of it on a single organ. The researches have been performed on the functional adjustment of some organ by several acupoints of the same meridian or via different meridians as well as the adjustment of acupoints and placebo points on the internal organ activity. As a result, the research on the corresponding specificity of meridian point functions has been conducted. The research on organ-cell level has been deepened to the analysis of the mechanism in terms of the cellular molecular activity adjustment of internal organ so that the adjustment of meridian points to the internal organ activity can be elaborated from different aspects. The researches on genomics and proteomics have been undergoing, as well as the research on the peripheral approach and central approach of the correlation between acupoints and internal organs.Even though, the specificity of meridian acupoint effect can be explored and summarized from the ancient and modem literatures and be searched from the animal trials, it is still required to be back to clinical experiment for verification. At present, the clinical research report on acupoint sensitization is very rare. This research project aimed to have the clinical verification on the sensitization of the relevant acupoints and have a preliminary exploration on the different reactions of acupoints under physiological state and pathological state through the observation on pain threshold changes on the relevant acupoints in the patients with chronic superficial gastritis. It is expected that this research may provide some idea for clinical diagnosis and acupoint selection in treatment.2 OBJECTIVETo verify clinically whether the acupoints are sensitized or not under pathological state and elaborate the dynamic characteristics of acupoint function as well as the mechanism on the transportation of acupoint from a "silence" state to a "activation" state under pathological condition as well as acupoint sensitization. This sensitization is the concrete presentation of the acupoints reflecting disease and also the core in the guidance of clinical acupoint selection and the improvement of clinical efficacy.3 METHODSIn accordance with the endoscopic diagnostic evidence in National consensus opinions on chronic gastritis issued in September 2006, Shanghai, and the diagnostic standard of chronic gastritis in Clinical guideline of new drugs for traditional Chinese medicine,60 cases of chronic superficial gastritis and 30 cases of healthy subjects were enrolled.3.160 cases of chronic superficial gastritis were included.2390-Von Frey Pain Detection Instrument manufactured in American IITC Company were adopted to determine the mechanical pressure value on Zusanli (ST 36), Shangjuxu (ST37) and Xiajuxu (ST39) in the lower extremities ofot-yangming meridian, and Zhongwan (CV12) and Shangwan (CV13) on the abdomen and Pishu (BL21) and Weishu (BL21) on the back. The measurement was performed once every 5min, totally 3 measurements were required. The mean was calculated to be pain threshold of the acupoint.3.2 The control points were selected,2.5cm lateral to the above acupoints and the mechanical pressure values were measured for 3 times. The mean was calculated to be pain threshold of the control points.3.330 healthy subjects were selected as a control group. The mechanical pressure values were determined on Zusanli (ST 36), Shangjuxu (ST37) and Xiajuxu (ST39) in the lower extremities ofoi-yangming meridian, and Zhongwan (CV12) and Shangwan (CV13) on the abdomen and Pishu (BL21) and Weishu (BL21)on the back. 3.4 The control points were selected,2.5cm lateral to the above acupoints and the mechanical pressure values were measured for 3 times with the above method.The mean was calculated to be pain threshold of the control points. Origin 7.5 software was adopted for the statistical analysis on the comparison of pain threshold between the acupoints in the healthy subjects and pains and the control points as well as the change percentage (pain threshold of control point-pain threshold of acupoint/pain threshold of acupoint x100%). The data were expressed as Mean±SD (M±S). t-test was used for the comparison between two groups, one-way ANOVA was adopted for the comparison among groups.0.05 was taken as the test level to calculate the statistical value and corresponding P value. P<0.05 indicated statistical significance and P<0.01 showed extremely statistical significance.4 RESULTS4.1 Determination of mechanical pressure values on acupoints and lateral control points in the patients with chronic superficial gastritis4.1.1 The statistical analysis presented the significant differences in the comparison of mechanical pressure values on Zusanli (ST36), Shangjuxu (ST37) and Xiajuxu (ST39) in the lower extremities (P<0.01).4.1.2 The statistical analysis presented the significant differences in the comparison of mechanical pressure values on Zhongwan (CV12), Shangwan (CV13) and lateral control points on the abdomen (P<0.01).4.1.3 The statistical analysis presented the significant differences in the comparison of mechanical pressure values on Pishu (BL20), Weishu (BL21) and lateral control points on the back (P<0.01).4.2 Determination of mechanical pressure values on acupoints and lateral control points in the healthy subjects4.2.1 The statistical analysis did not present the significant differences in the comparison of mechanical pressure values on Zusanli (ST36) and Shangjuxu (ST37) as compared with lateral points, and on Xiajuxu (ST39) as compared with lateral control point in the lower extremities (P>0.05).4.2.2 The statistical analysis did not present the significant differences in the comparison of mechanical pressure values on Zhongwan (CV12) and xiawan (CV13) in the abdomen as compared with lateral points (P>0.05).4.2.3 The statistical analysis did not present the significant differences in the comparison of mechanical pressure values on Pishu (BL20) and Weishu (BL21) on the back as compared with lateral points (P>0.05).4.3 Comparison of change percentage in pressure thresholds on the acupoints between the patients with chronic superficial gastritis and healthy subjects4.3.1 In statistical analysis, the change percentages in pressure thresholds on Zusanli (ST36), Shangjuxu (ST37) and Xiajuxu (ST39) in the lower extremities were significantly different between the patients with chronic superficial gastritis and healthy subjects (P<0.01). It showed that Zusanli (ST36), Shangjuxu (ST37) and Xiajuxu (ST39) had been sensitized. The mechanical pressure thresholds on the sensitized acupoints were lower remarkably than those on the lateral sites and the change percentages were higher than those in normal persons.4.3.2 In statistical analysis, the change percentages in pressure thresholds on Zhongwan (CV12) and Shangwan (CV13) on the abdomen were significantly different between the patients with chronic superficial gastritis and healthy subjects (P<0.01). It showed that Zhongwan (CV12) and Shangwan (CV13) had been sensitized. The mechanical pressure thresholds on the sensitized acupoints were lower remarkably than those on the lateral sites and the change percentages were higher than those in normal persons.4.3.3 In statistical analysis, the percentage changes in pressure thresholds on Pishu (BL20) and Weishu (BL21) on the back were significantly different between the patients with chronic superficial gastritis and healthy subjects (P<0.01). It showed that Zhongwan (CV12) and Shangwan (CV13) had been sensitized. The mechanical pressure thresholds on the sensitized acupoints were lower remarkably than those on the lateral sites and the change percentages were higher than those in normal persons.4.4 Comparison of change percentages of pressures thresholds on the acupoints of the same meridian4.4.1 In statistic analysis, the change percentages of pressure thresholds were different among Zusanli (ST36), Shangjuxu (ST37) and Xiajuxu (ST39) in the lower extremities in the patients with chronic superficial gastritis (P<0.05). It showed that on the same meridian, the sensitization degree on Zusanli (ST36) was higher than that on either Shangjuxu (ST37) or Xiajuxu (ST39).4.4.2 In statistic analysis, the change percentages of pressure thresholds were not remarkably different between Zhongwan (CV12) and Shangwan (CV13) on the abdomen in the patients with chronic superficial gastritis (P>0.05). It showed that there was not obvious difference in the sensitization degree between two acupoints.4.4.3 In statistic analysis, the change percentages of pressure thresholds were not remarkably different between Pishu (BL20) and Weishu (BL21) on the back in the patients with chronic superficial gastritis (P>0.05). It showed that there was not obvious difference in the sensitization degree between two acupoints.4.5 It was found in the determination of pain threshold on Zusanli (ST36) that with the up-grading of inflammation, the change percentage of acupoint pain threshold increased in tendency.5 CONCLUSION5.1 The pain thresholds on relevant acupoints of the body surface for chronic superficial gastritis decreased remarkably. It indicates that the acupoints have been sensitized and the results have verified preliminarily that the acupoints are transferred into an "activation" state from a "silence" state under pathological condition.5.2 The different acupoints on the same meridian (stomach meridian of foot-yangming) were sensitized to different extents. It suggests that there is a relevant specificity among different meridian points.5.3 It was found in the determination of pain threshold on Zusanli (ST36) that the change percentage of acupoint pain threshold increased in tendency with the up-grading of inflammation. Since the sample size was small in the research. It is concluded preliminarily that the more serious the disease is, the higher the acupoint sensitization is. It is required to conduct a further research with a large sample size involved so as to prove this conclusion.