The Needling Sensations And Brain Effects Elicited By Different Needling Manipulations At ST36

BACKGROUNDDeqi is a special status when the patients feel soreness,numbness,fullness,heaviness,pressure or other sensations and the doctor feel tightness during acpuncture.Deqi is the key to acquire curative effect.We judge the quantity of Qi and prognosis,choose the right acupoint and needling manipulation depending on it.Many researchers have had preliminary results on the qualitative and quantitative analysis of Deqi,the relationship between Deqi and effect and the brain effect of Deqi by fMRI.But there are some controversies about the results.Some studies worked on the mechanism of Deqi,showing that Deqi is related to the skin,muscle or connective tissue.Most of the studies have showed that more than one tissue participate in Deqi.While the exact mechanism haven't been known very well.The needling manipulations are important factors to Deqi.There are two basic manipulations:lifting-thrusting method and twirling method.Needle manipulation is not only an important part of the acupuncture process,but also an important method to get Qi.Acupuncture clinical experiences indicate that the curative effect is always better with needling manipulations than non-manipulation and different manipulations produce different effects.Studies showed that the power on the needle is different with different manipulations,which means the sensations produced by different manipulations are different.So far,it is not clear that which manipulation is more likely to produce Deqi response and which manipulation produces which sensation.Brain effect is an important pathway to reach curative effect by acupuncture.With the rapid development of the brain imaging technologies like EEG,MEG and PEC,the studies of Deqi based on brain science are more and more popular.Especially in the last 20 years,functional Magnetic Resonance Imaging(fMRI)was widely used on the brain mechanism of acupuncture because of its no damaging,no radiation and high space and time resolution.However,it is not clear whether the different acupuncture manipulations elicit different brain effects or not.OBJECTIVEThe aim of the present study was to investigate the needling sensations,surface myoelectricity around the acupoint and brain effects caused by different acupuncture manipulations at right ST36 on healthy subjects by using fMRI and Surface Electromyography(sEMG).It would provide a scientific basis for the biological mechanism of different needling manipulations to treat diseases.METHODS45 healthy subjects accepted three needling manipulations stimulating at right ST36 every seven days.After acupuncture,the subjects and doctor were asked to record the needling sensations on MGH Acupuncture Sensation Scale(MASS).Among the subjects,13 subjects were recorded the surface electromyography around ST 36 during the process of the trial.Another 17 subjects accepted brain fMRI scanning during acupuncture.The needling sensations were analyzed by SPSS23.0.The IEMG,MPF and MF were calculated by LabChart8.0 and analyzed by SPSS23.0.The functional imaging datas were processed by SPM8 in order to analyze the positive and negative activation in the brain induced by different acupuncture manipulations.This present study is designed to explore the differences of the Deqi sensations,surface myoelectricity and brain effect among different acupuncture manipulations.RESULTS1?The results of needling sensationsThe individual needling sensations showed no significant statistical difference among the three manipulations.Fullness and soreness were easily to occur in the three groups.MASS index showed that Lifting-thrusting>Twirling plus Lifting-thrusting>Twirling.There were positive correlation between fullness of subjects and tightness of the doctor,especially in the groups of twirling and twirling plus lifting-thrusting.2?The results of sEMGThe IEMG of three groups were all higher during needling manipulation than that before inserting the needle(P<0.05),especially the Lifting-thrusting group(P<0.01).After withdrawing the needle,the IEMG of group Lifting-thrusting was still higher than that before inserting the needle(P<0.05),while the IEMG of group Twirling and Twirling plus Lifting-thrusting came back to the baseline(P>0.05).Intergroup comparison showed no significant statistical differences of IEMG among three groups in different periods(P>0.05).The MPF of groups Lifting-thrusting and Twirling plus Lifting-thrusting during needling manipulations were lower than that before inserting the needle(P<0.05),especially the Lifting-thrusting group(P<0.01),while group Twirling showed no significant statistical differences(P>0.05).When keeping the needle and after withdrawing the needle,the MPF of all the three groups came back to the baseline(P>0.05).Intergroup comparison showed significant statistical differences between Lifting-thrusting and Twirling,Twirling plus lifting-thrusting during needling manipulations(P>0.05).There were no significant statistical differences among three groups in other periods(P>0.05).The MF of groups Lifting-thrusting and Twirling plus Lifting-thrusting during needling manipulations were lower than that before inserting the needle(P<0.05),especially the Lifting-thrusting group(P<0.01),while group Twirling showed no significant statistical differences(P>0.05).When keeping the needle and after withdrawing the needle,the MF of all the three groups came back to the baseline(P>0.05).Intergroup comparison showed no significant statistical differences among the three groups(P>0.05).3?The results of fMRILifting-thrusting activated left premotor cortex,left postcentral,right middle frontal gyrus,left inferior frontal gyrus,right lingual gyrus,left insula,right putamen,bilateral cingulate gyrus and right cerebellum;deactivated bilateral hippocampe and left caudatum.Twirling activated bilateral orbital middle frontal gyrus,left opercular and triangular inferior frontal gyrus and right middle occipital gyrus;deactivated bilateral precuneus,right amygdala,left anterior cingulate gyrus,right inferior temporal gyrus,right middle frontal gyrus,right supplementary motor gyrus,left postcentral;Twirling plus Lifting-thrusting activated bilateral postcentral,left inferior occipital gyrus,left insula,left thalamus,left cingulate gyrus and right putamen,deactivated right superior frontal gyrus,right superior parietal gyrus,right temporal gyrus,right middle occipital gyrus,right insula and left lingual gyrus.The pair comparisons of the three groups showed that the signals induced by Lifting-thrusting were the strongest,especially in limbic system,followed by Twirling plus Lifting-thrusting,Twirling was the weakest.CONCLUSION1?The individual needling sensations showed no significant statistical difference among the three manipulations.Fullness and soreness were the most easily to occur in the three groups.MASS index showed that Lifting-thrusting>Twirling plus Lifting-thrusting>Twirling.2?Fullness of subjects and tightness of needling operator may be related to muscle activities during needling manipulations.All the three manipulations can elicit myoelectricity,which suggests that muscle may be one of the main tissues to produce Deqi.The intensity of stimulation by different needling manipulations may be different so that the types of muscle fibers activated may be different.The lifting-thrusting method may induce the strongest intensity of stimulation and stimulate more slow muscle fibers.3?The three needling manipulations all similarly activated the areas associated with somatosensory,vision,cognition,emotional regulation more or less.This showed the complicated regulation effects on the brain functional network.The results provide the scientific basis of the great diversity of acupuncture effectiveness in clinical practice.Lifting-thrusting activated the brain areas extensively and strongly,and the salient feature was the limbic-paralimbic-neocortical network(LPNN)modulation.Twirling deactivated the limbic system significantly.This phenomenon reveals the relative specificity of brain effects induced by specific needling manipulation.According to the brain signal intensity,the method of Lifting-thrusting may cause the strongest intensity,Twirling is weakest.When the intensity is stronger,there may be more activated areas in brain,otherwise there may be more deactivated areas.