Commonality and Specificity of Acupuncture Action at Three Acupoints as Evidenced by fMRI

Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, USA.
The American Journal of Chinese Medicine (Impact Factor: 2.76). 07/2012; 40(4):695-712. DOI: 10.1142/S0192415X12500528
Source: PubMed


Previous work from our team and others has shown that manual acupuncture at LI4 (hegu), ST36 (zusanli), and LV3 (taichong) deactivates a limbic-paralimbic-neocortical brain network, and at the same time activates somatosensory regions of the brain. The objective of the present study was to explore the specificity and commonality of the brain response to manual acupuncture at LI4, ST36, and LV3, acupoints that are located on different meridians and are used to treat pain disorders. We used functional magnetic resonance imaging (fMRI) to monitor the brain responses to acupuncture at three different acupoints; we examined 46 healthy subjects who, according to their psychophysical responses, experienced deqi sensation during acupuncture. Brain responses to stimulation at each of the acupoints were displayed in conjunction with one another to show the spatial distribution. We found clusters of deactivation in the medial prefrontal, medial parietal and medial temporal lobes showing significant convergence of two or all three of the acupoints. The largest regions showing common responses to all three acupoints were the right subgenual BA25, right subgenual cingulate, right isthmus of the cingulum bundle, and right BA31. We also noted differences in major sections of the medial prefrontal and medial temporal lobes, with LI4 predominating in the pregenual cingulate and hippocampal formation, ST36 predominating in the subgenual cingulate, and LV3 predominating in the posterior hippocampus and posterior cingulate. The results suggest that although these acupoints are commonly used for anti-pain and modulatory effects, they may mobilize the same intrinsic global networks, with substantial overlap of common brain regions to mediate their actions. Our findings showing preferential response of certain limbic-paralimbic structures suggests acupoints may also exhibit relative specificity.

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    • "A number of fMRI studies on healthy subjects including ours have consistently revealed that acupuncture with deqi induced extensive negative BOLD signal change (deactivation) of a limbic-paralimbic-neocortical network (LPNN) and positive BOLD signal change of somatosensory regions of the brain [9, 14–16, 19, 20]. Both commonality and specificity were observed in brain responses to acupuncture at different acupoints [16, 17, 21]. It was reported that the sensation of sharp pain and overall deqi were associated with separate patterns of brain activity [9, 14–16, 22]. "
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    ABSTRACT: Deqi response, a psychophysical response characterized by a spectrum of different needling sensations, is essential for Chinese acupuncture clinical efficacy. Previous neuroimaging research works have investigated the neural correlates of an overall deqi response by summating the scores of different needling sensations. However, the roles of individual sensations in brain activity and how they interact with each other remain to be clarified. In this study, we applied fMRI to investigate the neural correlates of individual components of deqi during acupuncture on the right LV3 (Taichong) acupoint. We selected a subset of deqi responses, namely, pressure, heaviness, fullness, numbness, and tingling. Using the individual components of deqi of different subjects as covariates in the analysis of percentage change of bold signal, pressure was found to be a striking sensation, contributing to most of negative activation of a limbic-paralimbic-neocortical network (LPNN). The similar or opposite neural activity in the heavily overlapping regions is found to be responding to different needling sensations, including bilateral LPNN, right orbitofrontal cortex, and bilateral posterior parietal cortex. These findings provide the neuroimaging evidence of how the individual needle sensations interact in the brain, showing that the modulatory effects of different needling sensations contribute to acupuncture modulations of LPNN network.
    Evidence-based Complementary and Alternative Medicine 08/2013; 2013:483105. DOI:10.1155/2013/483105 · 1.88 Impact Factor
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    • "Different cerebral areas were activated during Deqi and non-Deqi at the same point. Claunch et al. 2012 [30] LI4, ST36, LR3 fMRI AWD at all three points deactivated the right subgenual, the right subgenual cingulate, the right isthmus of the cingulum bundle, and the right BA31. Asghar et al. 2010 [31] LI4 fMRI Marked deactivation of the brain area was observed during Deqi in contrast to the occurrence of a mixture of activations and deactivations in the acute pain group. "
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    ABSTRACT: Objective. Despite the systematic literature review of the current evidence, we aim to answer the question " is Deqi an indicator of clinical effects in acupuncture treatment?" Methods. We systematically searched CNKI, VIP, Wanfang Data, PubMed, Embase, and the CENTRAL for three types of study: (1) empirical research probing into the role of Deqi in acupuncture; (2) mechanism studies examining the effect of Deqi on physiological parameters in animal models and human subjects; (3) clinical studies that compared the outcome of acupuncture with Deqi with that of acupuncture without Deqi. Two reviewers independently extracted data, undertook qualitative or quantitative analysis, and summarized findings. Results. The ancient Chinese acupuncturists valued the role of Deqi as a diagnostic tool, a prognosis predictor, and a necessary part of the therapeutic procedure. Findings from modern experimental research provided preliminary evidence for the physiological mechanism that produced Deqi. Few clinical studies generated conflicting evidence of the comparative effectiveness of acupuncture with Deqi versus acupuncture without Deqi for a variety of conditions. Conclusion. The current evidence base is not solid enough to draw any conclusion regarding the predicative value of natural Deqi for clinical efficacy or the therapeutic value of manipulation-facilitated Deqi.
    Evidence-based Complementary and Alternative Medicine 07/2013; 2013:750140. DOI:10.1155/2013/750140 · 1.88 Impact Factor
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    • "That seemed quite not sufficient for the explanation of acupuncture Deqi mechanism, for the potential involvement of the subcortical gray structures and cerebellum. The structural basis of the CNS in response to acupuncture Deqi is commonly accepted as the limbic-paralimbic-neocortical network to date [19] [22] [36] [43]. Deactivated brain regions above involving the limbic systems are in agreement with Hui's finding on Deqi for the same acupoints. "
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    ABSTRACT: Acupuncture as an oriental natural healing therapy with prolonged history has been extensively utilized in the management of great numbers of disorders. Deqi, a renowned acupuncture needling sensation, is profoundly regarded as the predictor and also the prerequisite of a preferable acupuncture treatment efficacy. Till now, there is still no consistency being reached towards the mechanism of acupuncture Deqi as a result of the discrepancy for publicly acknowledged evidence. Recent visualized research on Deqi using modern technologies has demonstrated possible central mechanism towards it. However, there is a conspicuous paradox underway in the research of cerebral response to acupuncture Deqi. This paper provided a view of up-to-date studies using visualized tools to characterize the brain response to acupuncture Deqi, such as functional magnetic resonance imaging (fMRI) and positron emission tomography/computed tomography (PET/CT). The paradox was extruded to highlight certain reasons from a TCM view. It is hypothesized that acupoints located at different dermal sites, state of participant, and needling manipulation can all contribute to the current paradox. Hence, further studies on acupuncture Deqi should pay more attention to the strategy of experiment design with generalized measurement, valid sham control methods, and more to subjects in diseased condition.
    Evidence-based Complementary and Alternative Medicine 07/2013; 2013:894750. DOI:10.1155/2013/894750 · 1.88 Impact Factor
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