Cerebro-cerebellar Activities By Acupuncture Stimulation At Waiguan（SJ5）:Evidence From¹⁸F-FDG PET, PET/CT Study

Part One Effect of Acupuncture at Waiguan（SJ5） on Cerebellum:an Positron-emission tomography studyObjective Clinical and experimental data indicate that most acupuncture clinical results are mediated by the central nervous system, but the specific effects of acupuncture on the human brain remain unclear. Specific central nervous system （CNS） responses to acupuncture have recently attracted attention. Still less is known about its effects on the cerebellum. Several studies indicate that the cerebellum might play a role in the specific effects of acupuncture, but it remains to be determined whether there is a distinction between positive and negative activities, and, if so, which specific parts of the cerebellum are involved in these types of effects. It is important to understand the differences in images of the cerebellum evoked by acupuncture at an acupoint and at a nearby "sham" point.The purpose of the present study was to investigate cerebellar glucose metabolism with Positron-emission tomography（PET） induced by acupuncture stimulation at the right Waiguan（SJ5） acupoints. Methods Form January2007to September2010, in a randomized,sham acupuncture controlled,subject blinded trail,a total of24healthy volunteers were randomized into four groups. All volunteers were right handed.The group consisted of sixteen males and eight females, mean age23.5±2.06years（rang20-27）.Group A received acupuncture at Waiguan accompanied by the manual twisting of needles and obtaining of qi （the subjects experienced sensations of soreness, numbness,swelling and heaviness, while the acupuncturist experienced a sensation of needle resistance）,whereas Group C did not receive any treatment.Group A for verum acupuncture and Group B for non-penetrating placebo needles at Waiguan（SJ5）, Group D for verum acupuncture at the sham acupoint near the Waiguan acupoint（10mm right laterals from Waiguan acupoint）. Acupuncture stimulation was applied to Waiguan acupoint as well as to sham acupoint. The imaging data were preprocessed using a slice-timing correction,3-D motion correction, and3-D spatial smoothing using a8-mm Gaussian kernel.All the imaging data were analyzed using statistical parametric mapping software（SPM8） implemented in Mathworks Matlab₇.11.Two sample t tests were performed for each comparison.All teats were thresholded at P<0.01with uncorrected and a mini cluster size of10voxels.Results Compared with the control group（Group C）,no activities area in the cerebellum by non-penetrating placebo needles at the SJ5（Group B） and acupuncture at the sham acupoint（Group D）. Acupuncture at Waiguan （Group A）evoked specific activation at tuber of left cerebellum, cerebellar tonsil of left cerebellum, dentate of left cerebellum and declive of right cerebellum, compared with the control group（Group C）. Acupuncture at Waiguan （Group A）evoked specific activation at culmen of left cerebellum and inferior semi-lunar lobule of right cerebellum, compared with non-penetrating placebo needles at the SJ5（Group B）.Acupuncture at Waiguan （Group A）evoked specific activation at declive of right cerebellum, inferior semi-lunar lobule of left cerebellum, cerebellar tonsil of left cerebellum, tuber of left cerebellum and culmen of bilateral cerebellum, compared with acupuncture at its sham point（Group D）.Conclusion These observations reveal that acupuncture at acupoints induces specific patterns of cerebellum activity, and these patterns may relate to the therapeutic effects of acupuncture.Acupuncture at SJ5activated the anterior and posterior lobe of the cerebellum which might be helpful to demonstrate the mechanism of acupuncture.Part Two Effects of acupuncture at Waiguan（SJ5） in the chronic stage after ischemic stroke:an Positron-emission computer tomography studyObjective Traditional Chinese medicine （TCM）, which is fundamentally different from Western medicine, has been widely investigated using various approaches.Insight into the processes of TCM at the cellular and molecular changes and the ability to image these processes will enhance our understanding of various diseases of TCM and will provide new tools to diagnose and treat patients.18F-fluorodeoxyglucose（FDG） Positron-emission computer tomography（PET/CT） was used to investigate glucose metabolism by acupuncture Waiguan（SJ5） acupoint in the chronic stage after ischemic stroke.Methods A total of28stroke patients were were randomly divided into four groups. All patients were right handed,and there were no differences in the degree of acupuncture sensation experienced.All patients had a first stroke within12months; infraction location was limited to left basal ganglia.The group consisted of twenty one males and seven females, mean age61.9±7.1years（rang50-77）. Group A received acupuncture at Waiguan accompanied by the manual twisting of needles and obtaining of qi （the subjects experienced sensations of soreness, numbness,swelling and heaviness, while the acupuncturist experienced a sensation of needle resistance）,whereas Group C did not receive any treatment. Group B received sham stimulation the Waiguan（SJ5） acupoint and tactile stimulation on the skin of the acupoint were given as separate conditions. Group D for verum acupuncture at the sham acupoint near the Waiguan acupoint（10mm right laterals from Waiguan acupoint）. The imaging data were preprocessed using a slice-timing correction,3-D motion correction, and3-D spatial smoothing using a8-mm Gaussian kernel.All the imaging data were analyzed using statistical parametric mapping software（SPM8） implemented in Mathworks Matlab₇.11.Two sample t tests were performed for each comparison.All teats were thresholded at P<0.05with uncorrected and a mini cluster size of30voxels.Results Acupuncture at Waiguan（Group A）evoked specific activation at bilateral superior temporal gyrus（BA38）, right superior frontal gyrus（BA9）, right cingulate gyrus（BA24）, left culmen of cerebellum, left pyramis of cerebellum and right cerebellar tonsil of cerebellum, compared with the control group（Group C）.Sham acupuncture at Waiguan（Group B）evoked specific activation at bilateral uncus of limbic lobe（BA34,BA36,BA38）, right middle temporal gyrus（BA21）, left precuneus of parietal lobe（BA7）, left lingual gyrus of occipital lobe （BA17）, bilateral cuneus of occipital lobe（BA17,BA30）,left superior frontal gyrus（BA6）,left insula（BA13）, compared with the control group（Group C）. Acupuncture at sham acupoint（Group D）evoked specific activation at bilateral superior frontal gyrus（BA6,BA9,BA10）, bilateral middle frontal gyrus（BA6,BA10）, bilateral uncus of limbic lobe （BA36,BA38）,left cingulate gyrus of limbic lobe （BA24,BA31）,left precentral gyrus of frontal lobe（BA4）, left inferior parietal lobule of parietal lobe （BA40）,left angular gyrus of parietal lobe（BA39）, left precuneus of parietal lobe（BA7）, left lingual gyrus of occipital lobe （BA18）, compared with the control group（Group C）.Acupuncture at Waiguan（Group A）evoked specific activation at right superior temporal gyrus（BA22）,bilateral parahippocampal gyrus（BA30）,right anterior cingulate（BA24）, right posterior cingulate（BA23）, left insula（BA13）, right middle frontal gyrus（BA10）, right inferior frontal gyrus（BA47）,left middle frontal gyrus（BA10） and left cerebellar tonsil of cerebellum, compared with non-penetrating placebo needles at the SJ5（Group B）. Acupuncture at Waiguan（Group A）evoked specific activation at right superior temporal gyrus（BA22）,left superior temporal gyrus（BA38）, right inferior frontal gyrus（BA47）,left culmen of cerebellum and left cerebellar tonsil of cerebellum, compared with acupuncture at its sham point（Group D）.Conclusion These observations reveal that acupuncture at acupoints induces specific patterns of brain activity in the chronic stage after ischemic stroke patients, and these patterns may relate to the therapeutic effects of acupuncture.