A PET Cerebral Functional Imaging Study On Specificity Of Waiguan(SJ5)

As one of the most original and advantageous subjects of traditional Chinese medicine（TCM）,acupuncture,is widely used for its long history,systemic theory, unique methods and exact efficacy.It’s a non-specific stimulation but a method of specific regulatory and therapeutic effect,based on the specific function and use of points.Meridian theory,the key of which is reasonable point selection,is an important guidance of clinical acupuncture practice,therefore,it’s essential to correctly recognize and grasp the specific rules of meridian.To prove the existence of the essence of acu-points,master its basic law and scientifically explain it,it’s the need to explain the mechanism of acupuncture treatment,improve clinical efficacy, establish its scientific value and promote its position in mainstream medicine.Based on the hypothesis that specificities of acu-points are related with the function of brain,this study is to further study and scientifically explain the essence of Waiguan（SJ5）,according to the properties of brain image of the healthy volunteers needled in Waiguan（SJ5） by positron emission tomography（PET）,hoping to provide new ideas and methods of research of the essence of acu-points.Object（1） To observe PET cerebral functional imaging of healthy volunteers who received needling in Waiguan,needling in a sham point,sham needling in Waiguan, sham needling in a sham point or non-acupuncture and analyze relative specificity of Waiguan in healthy people through changes in glucose metabolism of different brain function areas.（2） To scientifically explain the specificity of Waiguan,objectively distinguish between an acu-point and a sham point and promote the research on specificities and the essence of acu-points through scientific and rational design.（3） To explore the scientificity of the hypothesis that specificities of acu-points are related with the function of brain.Method30 young healthy volunteers including 15 males and 15 females were randomly and averagely divided into 5 groups and received needling in Waiguan,needling in a sham point,sham needling in Waiguan,sham needling in a sham point or non-acupuncture.Waiguan was located between ulna and radius,2 inches superior to wriest crease on the line connecting Yangchi and olecranon in right hand.The sham point was located on the same horizontal line with Waiguan and at the middle point of the connecting line between the Triple Energizer Meridian and the Triple Energizer Meridian in right hand.The process of acupuncture was as follows:First, conventionally disinfect needle into the acupuncture zone with iodine and alcohol; secondly,insert the needle of special acupuncture needle sets provided by British Acupuncture DONGBANG AcuPrime Instruments Ltd.and gently tap the needle handle with the index finger to make it through the skin;thirdly,vertically insert the needle to the depth from 13 mms to 17 mms until the needling sensation appears; finally,in use of Even Reinforcing and Reducing Movement,uniformly twirl the needle with an amplitude from 180 to 360,at the frequency of 60 times per minute with an interval of 5 minutes each 3 minutes,lasting for 24 minutes.The process of sham acupuncture was as follows:The preparation before scanning including the location and disinfection of the point was the same with acupuncture mentioned above.First,insert a sham needle matching true needle with its tip 1mm out of the cannula and stick it to the skin of the volunteer;after 3 minutes,gently lift the needle handle to move its tip away form the skin surface;after 5 minutes,screw down the handle again to the original state and lightly stimulate the skin.Repeat 3 times,and draw the sham needle in the 24^th minute.Volunteers in the control group receive the same pre-scanning preparation including the location and disinfection with true needling,but they weren’t given any needling stimulation except that the special needle base was sticked to the planned site.One and half minutes after the beginning of stimulation,operate bolus injection via peripheral vein on the volunteer with ¹⁸F-FDG at the quantity of 110μCi/Kg and start PET scanning after his 40-minunte lying,with his eyes closed and ears stuffed,in the way that he’s lying evenly on the PET scanning bed with his head immobile on the fixed head-support and position on the brain with laser line,both the upper line and lower line parallel to OM line and brain as well as cerebellum included.Keep silent and temperature between 20 centigrade to 24 centigraed in the process of scanning.Three-dimensional acquisition mode was applied to collect signals,first emission collection for 6 minutes and then transmission collection for 4minutes.Filtered backprojection and attenuation correction were applied to reconstruct the image.Adopt Hanning as filter function of cross-sectional layer and cut-off frequency of 6.0;adopt Ramp as axial filter function and cut-off frequency at 10.0,thickness at 2mm.OM line as benchmarks,reconstruct horizontal,coronal,sagittal image.Statistical parametric mapping（SPM2） and Matlab6.1 were applied to process data.First,realine is used to correct slight head movement.Secondly,the images were standardized to the MNI standard brain template and smoothed with gaussian kernel of the specification 15mm×3mm×3mm. Thirdly,generalized linear models were used to analyze the PET image per-pixel and two-sample unilateral t test was used to analyze statistically to work out the t value of each pixel and draw a statistical parametric mapping according to t values.Those Volume data were reserved whose P value was smaller than 0.01 and connected pixels more than 30（P≤0.01,k≥30voxels）.Finally,3D image of activation areas was achieved by integrating brain areas of significant difference of red color into the average brain template which demonstrates brain structure of separate volunteer.And then further determine the activation site according to Talariach coordinate values, and activate targeted brain regions according to Broadmann area（BA）.Result（1）Compared to non-acupuncture control group,Brodmann area（BA） 7、13、 18、19、21、22、27、38、40、42、45,bilateral parietal lobe,occipital lobe and cuneate lobe were activated in Waiguan true needling group.The reaction of the left temporal cortex is significantly more than the fight lobe,while deep reaction of the left side was more than the right side.（2） Compared to non-acupuncture control group,BA 4,67,19,22,41,bilateral frontal lobe,temporal lobe were activated in Waiguan sham needling group.The reaction of bilateral frontal lobe and temporal lobe was symmetrical distributed;reaction points were concentrated in the cerebral cortex,while cerebellum and deep brain were not significantly activated.（3） Compared to sham needling group,BA 13,42 and cerebellum were activated in Waiguan true needling group,mainly concentrated in left temporal lobe,insular lobe and cerebellum.（4） Compared to non-point needling group,BA7、13、21、22、39、40、45、46,bilateral cerebellum,right hippocampus and substania nigra were activated in Waiguan true needling group.（5） Compared to non-point needling group, BA2,4,6,7,21,24,3 7,39,40,43 and limibic lobe were activated in Waiguan true needling group,mainly concentrated in right parietal lobe,frontal lobe,temporal lobe and postcentral gyrus.（6） In this study,the difference of activated area between needling and sham needling,between needling in Waiguan and non-point were most focused on.It’s found that BA13,42 and cerebellum,which were specifically activated in Waiguan true needling group compared to Waiguan sham needling group, were closely related to hearing,cardiovascular function,regulation of cardiac autonomic nerve function and upper limb disease.What were specifically activated in Waiguan true needling groups compared to non-point true needling group included BA 45,46 and substantia nigra which were related to somatic motor,BA 7 and 39 which were related to somatic sense,BA 21 which was related to vision,BA 22 which was related to hearing,BA22,39,40,45 which were related to language,and BA 13, 22,46 and hippocampus which were related to Emotional and mental activity.These brain areas were closely related to the treatment of Waiguan,including exogenous diseases,febrile diseases,diseases of regions along the meridian such as deafness, tinnitus,swelling and pain of eyes,costal pain,local diseases of upper limbs such as upper limb paralysis,pain of arms and shoulders,unfavorable flexion and extension of elbow,and internal disease related to the Pericardium Channel of Hand-Jueyin such as cardiovascular disease and hypertension.The results have shown that as the highest central,brain shows specialty of reaction of needling,or rather,different needling methods will activate different brain regions,whose function were closely related to the main indications of relevant acu-points.Conclusion（1） Activated brain areas were different between Waiguan true needling and sham needling,between Waiguan true needling and non-point true needling,and the regulatory functions of the brain areas activated by Waiguan true needling were closely related to the treatment of Waiguan.We conclude that the treatment of Waiguan was in close relation to brain function and that through needling a peripheral acu-point which will specifically activate relevant function areas of brain central and via central integration and re-conditioning effect,it will act on peripheral effectors and generate needling effects.Therefore,it’s the key to get well needling curative effect to accurately select the acu-points and feel the arrival of Qi.（2） Waiguan needling in healthy people can cause changes of regional cerebral glucose metabolism. PET brain function imaging was an effective method of researching the specificity of acupuncture.