Progress of fMRI-based research in recent 10 years / 中国针灸

<p><b>OBJECTIVE</b>The research regarding the central mechanism of acupuncture (arrival of ) based on functional magnetic resonance imaging (fMRI) in recent 10 years was analyzed to summarize existing research achievements and experience.</p><p><b>METHODS</b>The literature regarding fMRI-based research published from January of 2007 through December of 2016 in CNKI and PubMed databases was collected. The research content and methods, including research design, inclusion criteria, acupoint selection and evaluation, were analyzed.</p><p><b>RESULTS</b>Totally 18 articles regarding the central mechanism of acupuncture based on fMRI was included. According to research content, the literature was divided into two categories: research and sensation research. In research, the differences of and not on brain functional activity were compared to summarize the central response pattern of ; in sensation research, the differences of different sensations and intensities of on central response were compared to explore the effects of different sensations and intensities of on brain functional activity. In recent 10 years, the number of research gradually increased, and the type of design was various, mainly RCT and paired design. The majority of participants was healthy people, and single acupoint was the focus of researches, including Zusanli (ST 36), Waiguan (TE 5), Hegu (LI 4), etc. The evaluation of was based on visual analogue scale (VAS). The research contents were mainly the effects of and not and different sensations on brain function activities. The present studies confirmed that and not as well as different sensations had different impacts on brain functional effects, and different acupoints had specific activated brain areas. There was a positive correlation between the degree of and the intensity of the activation of brain regions. Furthermore, tingling sensation was not included to sensations.</p><p><b>CONCLUSION</b>The number and quality of fMRI-based research need to be improved; the research content is simple, and research method is in exploratory stage. The results obtained in the literature are the phenomena of in the central level, and it is imperative to summarize the essential link between and the central effect through these phenomena to reveal the mechanism of . The specific impact of for brain function needs more clinical exploration.</p>

Impact ofon acupoint effects in patients with primary dysmenorrhea:a systematic review of randomized controlled trials / 中国针灸

The effects of(arrival of) on acupoint effects in patients with primary dysmenorrhea (PD) were evaluated.Ten literature databases,including China National Knowledge Infrastructure (CNKI),VIP Database,Wanfang Database,Chinese Biomedical Literature Database (CBM),Cochrane Library CENTRAL,MEDLINE,Embase,AMED, CINAHL Plus,PsycINFO were selected.In addition,5 registers of ongoing trials,the reference lists of included articles and grey literature website OpenGrey were added.The search time was from date of database establishment to August 2016;no restrictions were made on language or status of publication.All randomized controlled trials (RCTs) and quasi-randomized controlled trials (q-RCTs) which compared the effects ofand non-on PD or compared the effects of differentelements on PD were included.The research quality was assessed according to Cochrane bias risk evaluation tool 5.1.0.The RevMan 5.3.5 was applied for quantitative analysis if insignificant clinical heterogenicity with≤ 75%,otherwise the results was summarized by qualitative analysis.As a result,6 RCTs involving 645 patients were included.Because of considerable clinical heterogeneity,only qualitative analysis was performed,which indicated ① acupuncture could reduce pain and anxiety regardless of,and the effects ofon pain relief were superior or equivalent to that of none-,and the effects ofon anxiety relief were similar to that of none-;② the more intensity ofand higher number of acupoints selected,the better effects on pain alleviation,symptom relief and pain duration;③ the higher rate ofhad a better acupoint effect on alleviating anxiety,but was not on pain relief;④appeared early and propagated to affected area could lead to faster onset on pain relief;⑤ the effects on relieving pain and symptoms was better when warm sensation inorreaching affected area.Due to the few number,low quality and potential bias of included studies,it was not sufficient to draw clear conclusion regarding the effects ofon PD patients.This study protocol was registered in PROSPERO (CRD42016038518).

Effects of needling depth on clinical efficacy of lumbar disc herniation: a systematic review / 中国针灸

<p><b>OBJECTIVE</b>To evaluate the effects of needling depth on clinical efficacy of lumbar disc herniation (LDH).</p><p><b>METHODS</b>Ten electronic databases, including China National Knowledge Infrastructure (CNKI), VIP Database, Chinese Biomedical Literature Database (CBM), Wanfang Database, MEDLINE, CENTRAL, CINAHL PLUS, AMED, Embase, PsycINFO, and 6 registry platforms of clinical trials were searched. All randomized controlled trials (RCTs) that compared the effect of needling depth on clinical efficacy of LDH were collected; in addition, the reference lists of the studies included were hand searched. Data were extracted independently by two reviewers. RevMan 5.3 was applied to carry out statistical analysis.</p><p><b>RESULTS</b>Totally 8 716 articles were retrieved, and 10 RCTs were included after screening, involving 1 116 patients. The results showed the effects of deep acupuncture onrelievingpain, reducing the Oswestry disability index (ODI), improving total effective rate and Japanese Orthopaedic Association (JOA) were superior to those of shallow acupuncture in patients with LDH.</p><p><b>CONCLUSION</b>It is preliminarily indicated that deep acupuncture is helpful to improve the therapeutic effect of LDH; however, due to the low research quality and small sample size, the evidence is insufficient, and more high-quality researches are needed to further confirm the results.</p>

Efficacy of filiform needle manipulation on primary dysmenorrhea:a systematic review / 中国针灸

The paper is a systematic review on the efficacy of acupuncture manipulation on primary dysmenorrhea. Ten medical literatures database at home and abroad were retrieved, including CNKI, VIP, CBM, WANFANG, MEDLINE, Cochrane, CENTRAL, CINAHL PLUS, EMBASE, AMED and PsycINFO, as well as 6 clinical trial registration platforms. All of randomized controlled trials (RCTs) on primary dysmenorrhea treated with different acupuncture manipulations were collected. The data were extracted by two persons. Finally, RevMa 5.3 software was used for statistical analysis. Totally, 5 148 pieces of literature were retrieved and 8 pieces on RCTs were screened with 644 cases included. According to the results of statistical analysis on the total effective rate and other indicators of pain degree, it was showed that the effects of the manipulation with filiform needle, deep puncture with strong stimulation, and specific reinforcing and reducing needling technique were better than those without manipulation applied or with shallow puncture and weak stimulation and even needling technique in the treatment of primary dysmenorrhea. It is believed initially that acupuncture manipulation contributes to the improvement of the therapeutic effects of primary dysmenorrheal, but much higher quality studies are required for the further confirmation. Protocol registration number:PROSPERO:CRD42016038515.

How to determine the qi arrival and its strength in clinical research / 中国针灸

Qi arrival is the meridian qi response to acupuncture stimulation. Through analyzing the relevant concepts of qi arrival and summarizing the general understanding of it in clinic and on the basis of the collection of the relevant literature at home and abroad on the determination of qi arrival and its strength, the characteristics are analyzed on the present method and the method for the determination of qi arrival and its strength is discussed in terms of the results in the needling sensation scale. It is believed that the needling sensation and its strength can be used to determine whether the qi is arrived or not and its strength. The components of different types of needling sensation are much better applicable for the analysis on the characteristics and rules on the influence on qi arrival. This method is in compliance not only with the theoretic connotation of qi arrival, but also with the clinical general understanding, which lays the foundation for the analysis on the scale results.

Effect of Acupuncture at Sanyinjiao (SP6) on the Infrared Temperature of Guanyuan (CV4) and Sanyinjiao in Dysmenorrhea Patients / 上海针灸杂志

Objective By using infrared thermal imager (Flir-SC620), to observe the effect of needling Sanyinjiao (SP6) on the skin temperature at Guanyuan (CV4) and Sanyinjiao in patients with primary dysmenorrhea (PD) of cold and dampness stagnation pattern, and to explore the probability of using infrared thermal imaging for diagnosis and as an objective index for evaluating the action and needling qi of acupuncture. Method Thirty-six subjects were recruited and divided into four group, a health control group (group A), a control group of PD of cold and dampness stagnation pattern (group B), a needling-qi-expected group (group C) and a needling-qi-unexpected group (group D). Group A and B were not given acupuncture treatment, while group C and D were treated with acupuncture at bilateral Sanyinjiao with needles retained for 30 min, and the needling sensations were recorded. The infrared thermal imager was used to detect the skin temperature at Guanyuan and bilateral Sanyinjiao for 40 min for each group, and the temperature was recorded every 10 min. The temperature during different periods of time, 0-10 min, 20-20 min, 20-30 min, 30-40 min, 0-30 min, and 0-40 min were then calculated. In group C, those obtained the needling qi sensation were further grouped into C-1 and those didn’t obtain the sensation were into C-2; in group D, those obtained needling qi sensation were further grouped into D-1 and those didn’t obtain the sensation were into D-2. SPSS 17.0 was adopted for data processing, and the data were analyzed by using MANOVA of repeated measuring. Result Compared to group A (6 cases), the temperature at Guanyuan in group B (6 cases) was significantly decreased during 0-30 min and 0-40 min (P<0.05), the temperature at the left Sanyinjiao during 0-40 min in group B was significantly decreased (P<0.05), and the temperatures at bilateral Sanyinjiao during 30-40 min in group B significantly dropped (P<0.05). Compared to group B, the temperatures at Guanyuan during 0-30 min and 0-40 min in group C1 (12 cases) and group D1 (11 cases) were significantly increased (P<0.05), the temperature at left Sanyinjiao during 0-40 min in group D1 was significantly increased (P<0.05), and the temperatures at bilateral Sanyinjiao during 30-40 min in group D1 were significantly increased (P<0.05). There was no case in group C2 and only 1 case in group D2, hence, the data were not enough for analysis. Conclusion Decrease of the infrared temperature at Guanyuan and Sanyinjiao can be taken as one of the diagnostic criteria for dysmenorrhea of cold stagnation pattern. Increase of the infrared temperature at Guanyuan can be regarded as one of the objective evidences for the along-meridian transmission characteristic in needling Sanyinjiao.

Analysis of the Relation between Uterine Position and the Effect of Sanyinjiao (SP6) in Patients with Primary Dysmenorrhea / 上海针灸杂志

ObjectiveTo explore the relation between the uterine position and acupoint effect by analyzing the data of a clinical trial of electroacupuncture in treating primary dysmenorrhea.MethodThe uterine position was detected by ultrasonic examination;Visual Analogue Scale (VAS) was used to evaluate the pain degree before and after intervention; Retrospective Symptom Scale (RSS) was adopted to determine the improvement of symptoms.ResultThere were no significant differences in comparing the VAS score, real-time effect and post-treatment effect, and effective rate among different uterine positions (P>0.05). Electroacupuncture at Sanyinjiao (SP 6) can produce a real-time effect in releasing abdominal pain and relevant symptoms of dysmenorrhea in patients with anteversion of uterus, a less significant effect was shown in patients with retroposition of uterus, while no effect was shown in patients with uterus at middle position.ConclusionElectroacupuncture at Sanyinjiao possibly has a specific effect in releasing abdominal pain and relevant symptoms of dysmenorrhea at anteversion of uterus, and the uterine position may be related to the corresponding meridians and Zang-fu organs. The current statistical result indicates that there is no relation between the uterine position and the effect of Sanyinjiao, but this conclusion still needs proving by prospective randomized controlled clinicaltrials.

Thinking of the Qualitative and Quantitative Measurement of Needling Qi / 上海针灸杂志

Acupuncture-moxibustion theory believes that needling sensation is a crucial factor in influencing acupuncture efficacy. Judgment of occurrence of needling qi (qualitative measurement) and the intensity of needling qi (quantitative measurement) is the key section in studying the relationship between needling qi and efficacy. According to the relevant literatures, the judgment of the occurrence of needling qi mostly depended on the needling sensations, while a small amount of researches mentioned self-determined threshold or range of needling qi; the quantity of needling qi was measured by factor analysis, Massachusetts General Hospital Acupuncture Sensation Scale (MASS) based on exponential smoothing method, weighted average, addition of needling sensation score, etc. This article holds that the needling qi should be divided into two parts: overall needling qi and needling sensation components, the former referring to the occurrence and intensity of needling qi, and the latter for judging the different sensations and intensity. Currently, the studies on needling qi and efficacy should begin with single treatment at single point and multiple treatments at multiple points, to generally estimate the quality and quantity of needling qi, for seeking a qualitative and quantitative measurement in accordance with both acupuncture-moxibustion theory and clinical practice.

Analysis on regulating deqi in the ancient works of the late dynasties / 中国针灸

From the time of Neijing (Internal Classic) and Nanjing (Classic of Medical Problems) till the end of Qing dynasty, the medical scholars of each dynasty had taken the recognition of deqi as the subject in the stud- ies. Through the historical analysis, the content of regulating deqi was further understood in relevant ancient liter- ature. By checking the ancient works of acupuncture in each dynasty till the end of Qing dynasty, in reference to the evidences in over 10 works, such as Zhenjiu Dacheng (Great Compendium of Acupuncture and Moxibustion) , Zhenjing Zhinan (Instruction of Acupuncture Canon), Zhenjiu Daquan, and in association with the academic views of acupuncture masters in modern time, it was discovered that the medical scholars after the time of Neijing and Nanjing had enriched the understandings of deqi, such as the connection of cold and heat reaction, radiation to the affected site, reinforcing and reducing purpose in qi regulation. The methods of deqi regulations had, been explored till the end of Qing dynasty since the time of Neijing and Nanjing and the understandings of it were vari- ous among scholars.

Quantification of Deqi (arrival of qi) by Short-latency Somatosensory Evoked Potentials：A Randomized Crossover Controlled Trial Plan / 上海针灸杂志

Objective To explore the feasibility of using short-latency somatosensory evoked potentials (SLSEP) to quantitate Deqi.Methods A randomized crossover controlled trial was carried out. Healthy subjects were enrolled and allocated to treatment (thick needle, deep insertion and manipulation for Deqi) and control (thin needle, shallow insertion and no manipulation without Deqi) groups. Somatosensory evoked potentials were recorded before, during and after acupuncture. Deqi was assessed using the score scale in the subjets. The effects of Deqi and no Deqi at point Sanyinjiao (SP 6) on the potentials were observed.Results The preliminary exploration of the feasibility by the trial test showed that the effect of Deqi on short-latency somatosensory evoked potentials had certain regularity. It was worthy to be observed.Conclusion The plan is feasible. The formal test can be conducted.