Microcurrent Stimulation at Shenmen Acupoint Facilitates EEG Associated with Sleepiness and ...

12 Pages·2015·2 MB·English

Hindawi Publishing Corporation
Evidence-Based Complementary and Alternative Medicine
Volume 2015, Article ID 182837, 11 pages
http://dx.doi.org/10.1155/2015/182837
Research Article
Microcurrent Stimulation at Shenmen Acupoint
Facilitates EEG Associated with Sleepiness and Positive Mood:
A Randomized Controlled Electrophysiological Study
Mei-chunCheung,1AgnesS.Chan,2,3andJoanneYip4
1DepartmentofSocialWork,TheChineseUniversityofHongKong,NewTerritories,HongKong
2DepartmentofPsychology,TheChineseUniversityofHongKong,NewTerritories,HongKong
3ChanwuyiResearchCentreforNeuropsychologicalWell-Being,TheChineseUniversityofHongKong,NewTerritories,HongKong
4InstituteofTextilesandClothing,TheHongKongPolytechnicUniversity,HungHom,HongKong
CorrespondenceshouldbeaddressedtoMei-chunCheung;[email protected]
Received14August2014;Revised5December2014;Accepted9December2014
AcademicEditor:HyunsuBae
Copyright©2015Mei-chunCheungetal. This is an open access article distributed under the Creative Commons Attribution
License,whichpermitsunrestricteduse,distribution,andreproductioninanymedium,providedtheoriginalworkisproperly
cited.
ToexaminetheelectrophysiologicaleffectsofmicrocurrentstimulationattheShenmenacupoint,40healthynormalsubjectswere
randomly assigned to a placebo group (sham stimulation) and an experimental group (bilateral electrocutaneous stimulation
at the Shenmen). The following two electroencephalographic indicators were used to measure brain activity. (1) Arousal level
was measured with reference to log-transformed absolute alpha power and power source and analyzed using low-resolution
electromagnetic tomography and(2)frontalalpha asymmetry was usedas anindicator ofmood. After real stimulationfor 10
minutes,absolutealphapowerwasgloballyreducedintheexperimentalgroup,particularlyintheanteriorandcentrotemporal
regions of the brain. This indicates a decline in the brain activity associated with arousal. Moreover, the reduction was more
prominent in the left frontal region, as compared to the right frontal region, resulting in significant increase from negative
to positive frontal alpha asymmetry scores and reflecting an increase in the brain activity associated with enhanced mood.
However,theplacebogroupexhibitednosignificantchangesintwoindicatorsaftershamstimulation.Thisstudyprovidesinitial
electrophysiological evidence of changes in brain activity associated with reduced arousal (and thus greater sleepiness) and
enhancedmoodaftermicrocurrentstimulationattheShenmenacupoint.
1.Introduction It is also used as an adjunct treatment for patients with
fibromyalgia [28–30] and in the management of diabetes
Regarded as a novel and alternative treatment modality, mellitus and hypertension, which are well controlled after
microcurrentstimulationhasbeenusedfordecadestotreat severalmonths’stimulation[31,32].
various physical and psychological problems [1]. Applying However, despite ample evidence of the therapeutic
a low-intensity, direct current that delivers monophasic or effectsofmicrocurrentstimulation,itsmechanismofaction
biphasicpulsedmicroamperagecurrentsacrossthebrainhas remains unclear. Some researchers have speculated that
beenfoundtoreduceanxiety,depression,andsleepproblems microcurrentstimulationaffectsenergythathasaninterac-
[2–7]andimprovecognitivefunction[8–13].Inaddition,the tive and regulatory function in the body’s communication
therapeuticeffectsofmicrocurrentstimulationonpainman- systems [33]. Therefore, this kind of stimulation may be an
agement[14–22]andmuscle[23]andwound[24,25]healing effective treatment for various physical and psychological
havebeendemonstrated.Recently,microcurrentstimulation problems. Although more empirical investigation is neces-
hasbeenshowntorelievethesideeffectsofradiationtherapy sary to identify its underlying mechanism of action, the
[26]andmyocontractureinchildrenwithcerebralpalsy[27]. benefits of microcurrent stimulation have been commonly
2 Evidence-BasedComplementaryandAlternativeMedicine
observed in traditional Chinese medicine (TCM), and the abnormal brain activity. Patients with insomnia have been
principlesofTCMmayshedsomelightonthisissue.Accord- found to exhibit hyperarousal [84] or greater global brain
ing to TCM practitioners, our health and well-being are metabolismwhileawake,ascomparedtosleepstate[85].In
closelyrelatedtoourinternalenergyandphysicalandpsy- particular,theirrestingEEGactivityinboththealphaband
chologicalproblemsareduetoimbalancesininternalenergy andthenonalphabandishigherthanthatofnormalsubjects,
orblockagesofenergyflow.Aninterconnectingnetworkof andthereisasignificantpositivecorrelationbetweenhyper-
numerousacupointsislocatedonthe14mainmeridiansof arousal scores and alpha activity on the left side when
thehumanbody[34],andeachacupointhasadefinedthera- patients’eyesareopen[86].Therefore,increasedEEGalpha
peuticfunction[35].Stimulationoftheseacupoints,whether activityseemstobeassociatedwithhyperarousalinpatients
administered by acupuncture [36], acupressure [37, 38], with insomnia. The results of previous EEG studies also
oranelectricaldevice[39–41],canbalanceorunblockinter- indicate thatsubjectivesleepiness negativelycorrelateswith
nal energy. Therefore, such stimulation has been found to absolutealphapoweratallscalplocationswhenawake[87,
correlate with various therapeutic effects [42, 43], such as 88]andthatareductioninalphapowermayreflectareduc-
pain reduction [44–46], alleviation of headaches [47–49], tion of activation in the subcortical brain structures with
and management of sleep disturbance [50, 51]. Recently, general cortical activation properties, such as brain stem,
researchers have also sought to determine the efficacy of midbrain,hypothalamus,andotherpartsofthelimbicsystem
acupointstimulationinclinicalpopulations.Itappearstobe [88].Itisthereforespeculatedthatmicrocurrentstimulation
effective in treating various kinds of physical and psycho- attheShenmenacupointhelpsreduceabsolutealphapower,
logical problems, such as back pain [52–54], chronic pain therebyloweringtheindividual’sarousallevelandencourag-
[55–57], asthma [58–60], stroke [61, 62], insomnia [63–65], ingsleepiness.
anxiety disorders [66], and smoking addiction [67–69]. If AnumberofEEGstudies[89–100]haveinvestigatedthe
microcurrent stimulation is capable of restoring an unim- relationshipbetweenEEGsignalsandmoodandreporteda
peded flow of energy through the body, as conceptualized link between asymmetry in the alpha-frequency band and
by TCM practitioners, more insight can be gained into its mood.TheresultsoftheseEEGstudieshavesuggestedthat
observed therapeutic effects on a variety of physical and differentemotionsareassociatedwithdifferentEEGpatterns
psychologicalproblems. in the frontal regions of the brain. Specifically, alpha asym-
With the advent of neuroimaging techniques such as metryintheanteriorfrontalregionbetweenthetwohemi-
functionalmagneticresonanceimagingandEEG,itispossi- spheresofthebrainisregardedasaneffectiveindexofpos-
bletoexploretheneuralorelectrophysiologicalmechanisms itive or negative emotion. Positive emotions such as happi-
ofTCMandinternalenergyinamorescientificmanner[70– nessareassociatedwithrelativelygreaterleft-sidedactivation
76].TCMpractitionershaveemphasizedtheroleoftheShen- [95, 97, 99, 101], and negative emotions such as disgust
men acupoint, located at the wrist crease on the radial side are accompanied by relatively greater right-sided activation
oftheflexorcarpiulnaristendon,betweentheulnaandthe [96, 98]. As alpha power is inversely associated with brain
pisiformbones,inreducingsleepdisturbance[64,77,78]and activationinthefrontalcorticalregion[102,103],apositive
improving mood [77, 78]. Consequently, this acupoint has asymmetryscoredenotinggreateralphapowerontheright
receivedparticularattentioninrecentneuroimagingstudies andlessalphapowerontheleftsuggestsrelativelygreaterleft-
[79]andclinicalstudies[37,38,80–82].Stimulationadmin- sidedactivation,thatis,amorepositiveemotionalresponse.
istered to the Shenmen acupoint by acupuncture results in Incontrast,anegativescoredenotinggreateralphapoweron
functional activation in various brain regions [79], such as theleftandlessalphapowerontherightrepresentsrelatively
therightpostcentralgyrus(BA1andBA2),theleftpostcentral greater activation on the right side, suggesting a more neg-
gyrus (BA43), the left inferior frontal gyrus (BA47), the ativeemotionalresponse.Ourempiricalandclinicalstudies
left superior temporal gyrus (BA22), and the right inferior [90–92] have shown that frontal alpha asymmetry provides
parietal gyrus (BA40). Administering magnetic stimulation an effective and reliable means of distinguishing between
to the Shenmen acupoint makes EEG signals less chaotic, positiveandnegativeemotions.Greaterleft-sidedactivation
suggesting that the brain is calmer and more ordered as a isalsoassociatedwithreducedanxietyandfeelingsofwell-
resultofthistreatment[83].Positiveresultssuchasimproved being[90–94,98,100].Therefore,ifmicrocurrentstimulation
sleepquality[37],betterqualityoflife[38],reducedinsomnia attheShenmenacupointleadstoanimprovementinmood,a
instrokepatients[81,82],andthereductionofpsychological changeinbrainactivitymeasuredbyfrontalalphaasymmetry
stress[37]havebeenreportedinclinicaltrials.Ifmicrocur- may be observed after stimulation and the reduction in
rentstimulationhasasimilarmechanismofactionbyrestor- absolute alpha power should be more prominent in the left
ing the flow of internal energy, the use of microcurrent to frontalregion,ascomparedtothefrontalregionintheright
stimulatetheShenmenacupointisalsoexpectedtoincrease hemisphere,resultinginapositivefrontalalphaasymmetry
sleepinessandenhancemood. scoreafterstimulation.
To investigate the effects of microcurrent stimulation
at the Shenmen acupoint, two electrophysiological indices,
namely,absolutealphapowerandfrontalalphaasymmetry, 2.SubjectsandMethods
wereusedinthisstudytoexaminechangesinbrainactivity
associated with sleepiness and mood, respectively. Sleep 2.1.Participants. FortyuniversitystudentsfromtheInstitute
research indicates that insomnia is highly associated with of Textiles and Clothing at The Hong Kong Polytechnic
Evidence-BasedComplementaryandAlternativeMedicine 3
Eligible university students
(n=40)
Baseline EEG recording with eye
open for 3 minutes
Randomization in group
assignment
Experimental group (n=20) Placebo group (n=20)
to receive real stimulation over to receive sham stimulation over
Shenmen acupoint for 10 minutes Shenmen acupoint for 10 minutes
Poststimulation EEG recording
with eye open for 3 minutes
Figure1:Diagramofstudydesign.
Universitywererecruitedtothestudyandrandomlyassigned (ElPaso,TX,USA)wasusedastheconductingmedium.The
intotheplacebo(𝑁=20,age:20.90±1.17;yearsofeducation: signalswereamplifiedwithaNeuroscanSynAmps2amplifier
15.05±0.22,GPA:3.02±0.33)andexperimental(𝑁=20,age: unit(ELPaso,TX,USA)withabandpassof0.05to200Hz
20.63±0.83;yearsofeducation:15.11±0.32,GPA:3.20±0.43) anddigitizedatasamplingrateof1000Hz.
groups.Twogroupswerematchedintermsofage,education,
and GPA. They reported a negative history of neurologi-
cal and psychiatric problems. The study was conducted in 2.3. Experimental Procedure. All of the participants were
accordance with the Helsinki Declaration of the World testedindividuallyinasound-andlight-isolatedroom.The
MedicalAssociationAssembly,andtheresearchprotocolwas experimental procedure was explained to each participant
approved by the Human Subjects Ethics Subcommittee beforetheexperimentbegan.Thedesignofthestudyisshown
(HSESC)ofTheHongKongPolytechnicUniversity.Allofthe in Figure1. Measurements were obtained for a 3-minute
students participated voluntarily and were required to sign baseline period during which the participants rested while
informed-consent forms prior to the study, in accordance awakewiththeireyesopen.Themembersoftheexperimental
withinstitutionalguidelines. groupreceiveda10-minutenoninvasivestimulationadmin-
isteredbyapreprogrammedpulsegenerator.Thisdevicepro-
2.2.EEGRecording. TheEEGwasmadeusing64Ag/AgCl- ducedconstantcurrentsquarewaveelectricalstimulation.A
sintered electrodes mounted in a stretch-lycra Quik-Cap symmetrical monophasic square wave with a frequency of
(Neuroscan, El Paso, TX, USA) with electrode placement 20kHzwasmodulatedbya1500Hzsymmetricalmonophasic
inaccordancewiththeinternational10-10system[104–106]. square wave, yielding a 20kHz pulse signal that was only
A ground electrode was placed on the forehead of each activatedata50%dutycycle(0.3ms)duringthefullcycleof
participantanteriortoFz.Thestandardreferenceelectrodeof the1500Hzwave.Thepolarityofthissignalwaslaterreversed
thecap,placedbetweenCzandCPz,wasusedduringacqui- periodicallyatafrequencyof100Hz,withnopainfulstimula-
sition.Measurementsofverticalelectrooculography(VEOG) tionappliedtotheskinattheShenmenacupoint(HT7)after
were taken between electrodes placed on the supraorbital the baseline EEG measurement. EEG activity was recorded
and suborbital regions of the left eye, and measurement of for another 3 minutes after the 10-minute stimulation, with
horizontal electrooculography (HEOG) was taken between the participants’ eyes open. The same procedure (baseline
electrodesplacedontheoutercanthioftheleftandrighteyes. EEG measurements, stimulation, and poststimulation EEG
The impedance of the electrode was less than 10kΩ and measurements)wasusedwiththeplacebogroup,exceptthat
homologous sites were within 1kΩ of each other. Quik-Gel its members received a sham stimulation, as the electrical
4 Evidence-BasedComplementaryandAlternativeMedicine
stimulation was turned off during the second phase. Sham Table1:Meanandstandarddeviationforlog-transformedabsolute
stimulation and real stimulation were randomly adminis- alphapowerduringbaselineandafterstimulationfortheplacebo
tered, and the participants were blind to the group assign- andexperimentalgroups(𝜇V2).
ment; that is, they did not know which type of stimulation
Experimental
theyhadreceived. Placebogroup
Region (𝑁=20) (𝑁gro=u2p0)
2.4.EEGAnalysis. ArtifactswereremovedfromtheEEGdata Anterior
duringofflineprocessing, and the data were remontagedto Baseline 0.696(0.193) 0.725(0.166)
createalinked-earsreferencescheme,usingtheNeuroGuide Afterstimulation 0.675(0.220) 0.657(0.178)∗
softwareprogram(NeuroGuide,v.2.5.2).Split-halfreliability
Centrotemporal
testsandtest-retestreliabilitytestswereusedtoexaminethe
Baseline 0.357(0.254) 0.375(0.210)
selectedEEGsegments.Onlysegmentswithatleast1minute
of artifact-free data and >90% reliability were used in the Afterstimulation 0.329(0.245) 0.308(0.177)∗
subsequentspectralanalysis.FastFouriertransformationwas Posterior
used to translate the signals to the frequency domain. The Baseline 0.736(0.275) 0.862(0.319)
EEG data were analyzed over 64 electrode positions in the
Afterstimulation 0.712(0.256) 0.742(0.247)
alpha(8–12Hz)frequencyband,asthealphabandhasbeen
Global
foundtobecloselyassociatedwithmood[107,108].
Baseline 0.556(0.232) 0.611(0.221)
Datawithabsolutealphapowerwerenormalizedbylog-
transformation. The normalized absolute alpha values were Afterstimulation 0.531(0.235) 0.527(0.184)∗
averaged to generate one global and three regional mean ValuesinthetablearemeanswithSDinparentheses.
values corresponding to the anterior (Fp1, Fp2, AF3, AF4, Within-groupcomparisonbetweenbaselineandafterstimulation∗𝑃<0.05.
F1, F2, F3, F4, F5, F6, F7, F8, FPz, and Fz), centrotemporal
(FC1,FC2,FC3,FC4,FC5,FC6,FT7,FT8,C1,C2,C3,C4,C5,
C6,T7,T8,CP1,CP2,CP3,CP4,CP5,CP6,TP7,TP8,FCz, fortheplaceboandexperimentalgroups(𝜇V2).Thebaseline
Cz,andCPz),andposteriorregions(P1,P2,P3,P4,P5,P6, measurementsrevealednosignificantdifferencesinabsolute
P7,P8,PO3,PO4,PO5,PO6,PO7,PO8,O1,O2,Pz,POz,and alpha power in the anterior, centrotemporal, and posterior
Oz).Thesourceoftheabsolutealphapowerbandcomputed regionsbetweentheplaceboandexperimentalgroups(𝑃 >
from the measurements of scalp electrical potential was 0.05). However, the experimental group demonstrated a
furtheranalyzedusingLORETA[109,110]andexpressedin global decrease in absolute alpha power from the baseline
terms of three-dimensional cortical current density, using afterstimulation,𝑡(19) = 2.192,𝑃 = 0.041.Specifically,the
Talairach Brain Atlas coordinates. To ascertain whether the reductionwassignificantintheanterior(𝑡(19) = 2.670,𝑃 =
scalp EEG sources of the alpha band differed between the 0.015)andcentrotemporal(𝑡(19)=2.179,𝑃=0.042)regions
experimentalandplacebogroups,within-groupcomparison butnotintheposteriorregion(𝑡(19)=1.841,𝑃=0.081).In
was conducted between the baseline and poststimulation contrast,nosignificantchangeinabsolutealphapowerfrom
measurements using paired-sample 𝑡-tests of 2394 voxels the baseline measurement was found in the placebo group
withsubject-wisenormalization[111–114]. aftershamstimulation.
Withregardtoalpha-powerasymmetry,thefrontalasym-
metryindexwasused,asinpreviousstudiesliterature[89–
3.2. SourceAnalysis ofAbsoluteAlphaPower. TheLORETA
99],tomeasurechangesinasymmetricactivationatthemid- voxel-by-voxelpaired𝑡-testwithsubject-wisenormalization
frontal pair of electrode sites (F3 and F4) between the two
wasusedtoexaminethelog-transformedalphapowersepa-
groups(Group:placeboversusexperimental)beforeandafter
ratelyfortheexperimentalandplacebogroups.Asrepeated
stimulation(Time:baselineversuspoststimulation).Positive
testswereperformed,theBonferroniadjustmentwasusedto
emotionisassociatedwithincreasedfrontalalphaasymme-
setthealphalevelto0.025,withacorrespondingsignificant
try. Each score was computed by subtracting the left-sided 𝑡-valueof2.539(df=19).Intheexperimentalgroup,LORETA
log-transformed alpha power value (F3) from the value for
analysis revealed a significant and consistent decline in
therightside(F4).Apositivescoreduetoarelativelyhigher
absolutealphapowerinboththefrontalandcentrotemporal
alpha power value in the right frontal region was taken to
regionsaftermicrocurrentstimulationattheShenmenacu-
indicate that left-sided brain activity exceeded right-sided
point,comparedwiththeequivalentbaselinemeasurements
brain activity, suggesting mood enhancement, whereas a
(Figure2(a)). The reduction was bilaterally in the superior
negative score indicated the opposite brain-activitypattern, frontal gyrus (BA 11, left: 𝑋 = −10, 𝑌 = 66, and 𝑍 =
suggestingadeclineinmood. −13; BA 10, right: 𝑋 = 9, 𝑌 = 66, and 𝑍 = −10), medial
frontalgyrus(BA10,left:𝑋 = −8,𝑌 = 66,and𝑍 = 4;right:
3.Results 𝑋=11,𝑌=66,and𝑍=−4),andinferiorfrontalgyrus(BA
47,left:𝑋 = −42,𝑌 = 23,and𝑍 = −13;right:𝑋 = 35,𝑌 =
3.1. Changes in Absolute Alpha Power. Table1 shows the 18, and 𝑍 = −13). Other brain regions included the right
meansandstandarddeviationsofthelog-transformedabso- superior(BA38,𝑋 = 50,𝑌 = 16,and𝑍 = −13)andmiddle
lutealphapowervaluesatthebaselineandafterstimulation temporal gyrus (BA 21, 𝑋 = 60, 𝑌 = 2, and 𝑍 = −13),
Evidence-BasedComplementaryandAlternativeMedicine 5
2.539
L R (Y) (X,Y,Z)=(−10,66,−13)(mm); (−8.13E+0) TF=3 LORETA-key
5 A P L R
1.270
(Z) (Z)
0 5 5
e
0.000 u
−5 0 0 val
t
−10 −5 −5 −1.270
(Y) 5 0 −5 −10 −5 0 5 (X)
−5 0 5 (X)
(cm) (cm)
(cm) −2.539
(a)
2.539
L R (Y) (X,Y,Z)=(67,−32,15)(mm); (1.6E+0) TF=3 LORETA-key
5 A P (Z) L R (Z) 1.270
0 5 5
0.000 ue
−5 0 0 al
v
t
−10 −5 −5 −1.270
−5 0 5 (X) (Y) 5 0 −5 −10 −5 0 5 (X)
(cm) (cm)
(cm)
−2.539
(b)
Figure2:Reducedabsolutealphapowerin(a)theexperimentalgroupafterstimulationascomparedtothebaselinebutnot(b)theplacebo
group.AfterstimulationatShenmenacupoint,significantreductionoccurredbilaterallyinthesuperiorfrontalgyrus(BA11,left:𝑋=−10,
𝑌 = 66,𝑍 = −13;BA10,right:𝑋 = 9,𝑌 = 66,𝑍 = −10),medialfrontalgyrus(BA10,left:𝑋 = −8,𝑌 = 66,𝑍 = 4;right:𝑋 = 11,𝑌 = 66,
𝑍=−4),andinferiorfrontalgyrus(BA47,left:𝑋=−42,𝑌=23,𝑍=−13;right:𝑋=35,𝑌=18,𝑍=−13),aswellasintherightsuperior
temporalgyrus(BA38,𝑋=50,𝑌=16,𝑍=−13),rightmiddletemporalgyrus(BA21,𝑋=60,𝑌=2,𝑍=−13),anteriorcingulate(BA32,
𝑋 = −10,𝑌 = 45,𝑍 = −6),andcingulategyrus(BA24,𝑋 = −10,𝑌 = −20,𝑍 = 42).Themostpronounceddecreasewasfoundintheleft
superiorfrontalgyrus(BA11,𝑋=−10,𝑌=66,𝑍=−13).Bluecolorindicatesthelocationsofsignificantlyreducedabsolutealphapowerin
theexperimentalgroup.
anteriorcingulate(BA32,𝑋 = −10,𝑌 = 45,and𝑍 = −6), 𝑃=0.725.Therefore,thechangeinfrontalalphaasymmetry
andcingulategyrus(BA24,𝑋=−10,𝑌=−20,and𝑍=42). was not due to baseline differences, and the results suggest
that the experimental group experienced greater left-sided
frontalbrainactivation,associatedwithpositivemood,after
3.3.ChangeinFrontalAlphaAsymmetry. Toinvestigatethe stimulationattheShenmenacupoint.
changes in frontal (F3 and F4) alpha asymmetry, repeated-
measures analysis of variance was conducted. The results
revealed a significant Time × Group interaction effect: 4.Discussion
𝐹(1,38) = 11.253, 𝑃 = 0.002. The results of subsequent
paired-sample𝑡-testsdemonstratedasignificantincreasein Microcurrentstimulationhasbeenusedasanovelalternative
thefrontalalphaasymmetryscorefromthebaselinetopost- treatmentfordecades[1].However,itsmechanismofaction
stimulationintheexperimentalgroup,𝑡(19) = −3.531,𝑃 = remains unclear. The aim of this study was to investigate
0.002. However, this effect was not observed in the placebo the electrophysiological effects associated with microcur-
group,𝑡(19)=1.668,𝑃=0.112(Figure3).Anindependent𝑡- rent stimulation at the Shenmen acupoint (HT7), using
testrevealedthattherewasnosignificantdifferencebetween quantitative EEG measurement. Two objective electrophys-
thebaselinemeasurementsforthetwogroups,𝑡(38)=0.354, iological indices, namely, absolute alpha power and frontal
6 Evidence-BasedComplementaryandAlternativeMedicine
0.03 ascendingreticularactivatingsystemandtheanteriorcingu-
∗∗ lateandthemedialprefrontalcortices[85].Theirfunctional-
0.02 neuroimaging study provides objective evidence of hyper-
z) arousalinpatientswithinsomniaandidentifiesbrainregions
H
2V/ 0.01 thatmayassistinfacilitatingsleepinessinsuchpatients.The
𝜇 resultsofEEG-basedLORETAsourceanalysisinthepresent
er ( 0 study indicated that a reduction in absolute alpha power
w
po was found in these brain regions, including the bilateral
a
h −0.01 medial prefrontal cortex and the anterior cingulate, after
p
L al stimulation at the Shenmen acupoint. These encouraging
og −0.02 findings shed some light on the electrophysiological effects
L
− localized at particular brain regions after stimulation at the
R
g −0.03 Shenmen acupoint. However, as the study sampled nor-
o
L mal participants without insomnia, further investigation of
Experimental group
−0.04 patients with insomnia will be necessary to determine
whetherstimulationattheShenmenacupointcanreallyhelp
−0.05 Placebo group tolowerEEGarousallevelsinthebrainregionsidentifiedas
elevatedinpatientswithinsomnia.ApartfromchangingEEG
Baseline arousal activity, microcurrent stimulation at this acupoint
After stimulation was also found to lead to enhanced mood, as measured
by frontal alpha asymmetry. This change was significant in
Figure 3: Frontal alpha asymmetry (F3-F4) at baseline and after
the experimental but not the placebo group. These results
stimulationfortheplaceboandexperimentalgroups.Asignificant
are consistent with the explanation provided by TCM of
increaseinthefrontalalphaasymmetryscorefromthebaselineto
poststimulation was found in the experimental group, suggesting Shenmen’s therapeutic effects. TCM practitioners regard
greater left-sided frontal brain activation associated with positive Shenmenasthegatetothespiritandclaimthatstimulationat
mood,afterstimulationattheShenmenacupoint(∗∗𝑃<0.01). theShenmenacupointcanrestorespiritualharmony.Recent
studies on patients with insomnia after stroke reveal that
acupuncture on Shenmen is able to lower the level of sym-
pathetic activity, resulting in a significant decrease in heart
alpha asymmetry, were used to measure the EEG activities ratevariability[81,82].Thepossiblemechanismseemstobe
associatedwitharousalorsleepinessandmood. related to specific afferent nerve signals sending to the
The results of previous studies have suggested that centralnervoussystemtolowerthesympatheticactivity[115].
insomnia is due to hyperarousal in the brain [84] and that In addition, an increase the serum level of serotonin in
patientswithinsomniaexhibitEEGbrainactivitythatclearly depressedpatientswithinsomniaisshownafterstimulation
distinguishes them from people without insomnia. Alpha onShenmenforfourweekswithaperiodof15minutestwice
activity,asaconcomitantindexofwakefulnessandalertness, aweek.Thoughtheunderlyingmechanismfortheincrease
positively correlates with level of hyperarousal [86] and of serotonin requires further extensive investigation, the
negatively correlates with subjective sleepiness [88]. Due to enhancedmoodoftheparticipantswhoparticipatedinthis
prolongedelevatedalphaactivityinthebrain,patientswith study thus provides further empirical electrophysiological
insomnia have difficulty falling asleep and tend to remain datainsupportofTCMobservationsrelatedtoShenmenin
awake for extended periods. The results of this study reducingsleepdisturbance[64,77,78]andimprovingmood
indicated that the participants in the experimental group [77,78]overmanyyears.
experienced a reduction in absolute alpha power after Although this randomized controlled study provides
microcurrent stimulation at the Shenmen acupoint for 10 some initial insights into the electrophysiological effects of
minutes. The reduction was particularly significant in the microcurrent stimulation at Shenmen, that is, its potential
anterior and centrotemporal brain regions. However, this to lower arousallevel, therebyfacilitatingsleepiness, andto
effectwasnotobservedintheplacebogroup,whosemembers enhancepositivemood,thestudyhascertainlimitationsthat
receivedshamstimulation.Therefore,theresultssuggestthat should be addressed. In this study, only alpha activity was
microcurrent stimulation at the Shenmen acupoint affects used as measures for arousal level and emotional response.
EEGalphaactivity,helpingtoreducearousallevelandthus Apart from alpha power, theta and beta power are typi-
activity.Thesepositivefindingsofferinitialelectrophysiolog- cally involved as an index of arousal as well [88, 116–118].
icalevidencetoexplaintheimprovementinsleepobserved Specifically,significantlylowerthetapowerandhigherbeta
inclinicalpopulationsandsupporttheclaimmadebyTCM arefoundinpatientswithinsomniaandpositivelycorrelated
practitioners that the meridian system is a pathway with a with their hyperarousal level [118]. It has been already
connectiontothebrain. proposedthatincreaseinbetapowermayreflecttheactivity
Researchers using positron emission tomography have of brain structures involving in attentive behavior, leading
found that compared with normal subjects, patients with to arousal [117, 119, 120]. Thus, in addition to using alpha
insomniashowasmallerdeclineinrelativemetabolismdur- power, future studies might be necessary to compare non-
ingthetransitionfromwakingtonon-REMsleepstatesinthe alpha bands, such as theta and beta bands, before and after
Evidence-BasedComplementaryandAlternativeMedicine 7
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