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16 Pages·2012·0.58 MB·English

HindawiPublishingCorporation
Evidence-BasedComplementaryandAlternativeMedicine
Volume2012,ArticleID543943,16pages
doi:10.1155/2012/543943
Review Article
A Review of Acupoint Specificity Research in China:
Status Quo and Prospects
LingZhao,1JiChen,2Cun-ZhiLiu,3YingLi,1Ding-JunCai,1YongTang,1
JieYang,1andFan-RongLiang1
1ChengduUniversityofTraditionalChineseMedicine,Sichuan,Chengdu610075,China
2ForeignLanguagesSchool,ChengduUniversityofTraditionalChineseMedicine,Sichuan,Chengdu610075,China
3BeijingHospitalofTraditionalChineseMedicineAffiliatedtoCapitalMedicalUniversity,Beijing100010,China
CorrespondenceshouldbeaddressedtoFan-RongLiang,[email protected]
Received15April2012;Revised17September2012;Accepted19September2012
AcademicEditor:WolfgangSchwarz
Copyright©2012LingZhaoetal.ThisisanopenaccessarticledistributedundertheCreativeCommonsAttributionLicense,
whichpermitsunrestricteduse,distribution,andreproductioninanymedium,providedtheoriginalworkisproperlycited.
Thetheoryofacupointspecificityisthebasisforelucidatingtheactionsofacupointsasemployedinclinicalpractice.Acupoint
specificityhasbecomeafocusofattentionininternationalresearcheffortsbyscholarsintheareasofacupunctureandmoxibustion.
In2006,theChineseMinistryofScienceapprovedandinitiatedtheNationalBasicResearchProgram(973Program),onearea
ofwhichwasentitledBasicResearchonAcupointSpecificityBasedonClinicalEfficacy.Usingsuchapproachesasdatamining,
evidence-basedmedicine,clinicalepidemiology,neuroimaging,molecularbiology,neurophysiology,andmetabolomics,fruitful
researchhasbeenconductedintheformofliteratureresearch,clinicalassessments,andbiologicalstudies.Acupointspecificityhas
beenprovedtoexist,anditfeaturesmeridian-propagated,relative,persistent,andconditionaleffects.Preliminarilyinvestigations
havebeenmadeintothebiologicalbasisforacupointspecificity.
1.Introduction as a core scientific problem with respect to the practice
of acupuncture. In 2010, the American Association of
Forover2500yearsinChina,acupuncturehasbeenpracticed Acupuncturereportedinawhitepaperthatacupointspeci-
to treat diseases and maintain well-being. Some traditional ficitywasoneoftheparadoxesofacupunctureresearch[17].
theories relating to acupuncture adopt non-Western con- In2006,theChinesegovernmentlaunchedtheNational
cepts, and so they would appear to be incompatible with Basic Research Program (973 Program), one area of which
modern medical practice. Nevertheless, acupuncture has was entitled Basic Research on Acupoint Specificity Based
gradually won acceptance in Western countries as an alter- on Clinical Efficacy, which aimed to obtain more accurate
native or complementary treatment for various conditions. data on acupoint specificity. By means of multisubject
Manyreliablestudies,includingsystematicreviewsandran- collaboration, traditional research methods were combined
domizedcontrolledtrials,haveindicatedthatacupunctureis with modern approaches to examine clinical improvement
safeandeffectiveintreatingawiderangeofdiseases[1–6]. and the biological basis for acupuncture. As a result, major
Anumberofneuroimagingstudieshaveexaminedtheneural progress was made with regard to acupoint specificity after
correlatesofacupunctureaswellasitsotherbiologicalmech- fiveyearsofthisresearchprojectinChina.
anisms[7–11].Recently,thedoubtfuleffectsofacupuncture
with respect to acupoints and nonacupoints have been
investigated in clinical research [12–14], and neuroimaging 2.AdvanceintheLiteratureResearchof
results have also raised questions regarding the existence of AcupointSpecificity
acupointspecificity[15,16].AttheSocietyforAcupuncture
Research(SAR)internationalsymposiumheldinNovember Using data mining and computer-processing technology,
2007,therewasintensedebateamongscholarsfromdifferent over 2,600,000 pieces of ancient and modern texts relat-
countries about acupoint specificity, and it was regarded ing to migraine, functional dyspepsia (FD), uterus-related
2 Evidence-BasedComplementaryandAlternativeMedicine
disorders, and dysmenorrhea were collected and compiled trialthatamongthethreegroups,significantdifferenceswere
by scholars in China. Following the ideas and approaches observed in pain relief, relapse, or aggravation as well as
of evidence-based medicine, this database was filtered and in general evaluations (P < 0.05) within 24 hours after
assessed.Acupunctureprescriptionswereexaminedasakey treatment. Significant decreases in visual analogue scale
element, and the data relating to the acupoint effect were (VAS) scores from baseline were observed in the 4th hour
extracted; in this way, a database with regard to acupoint aftertreatmentamongpatientsinallthreegroups(P<0.05).
specificity based on the historical literature was established TheVASscoresinthe4thhouraftertreatmentdecreasedby
[18].Onthebasisofthis,usingMicrosoft.NETasthesystem a median of 1.0cm, 0.5cm, and 0.1cm, respectively, in the
developmenttool,C#languageasthedevelopmentlanguage, verumacupuncturegroup,shamacupuncturegroup1,and
andSQLServer2005developedbyMicrosoftasthedatabase- shamacupuncturegroup2.Similarly,therewasasignificant
management system, we established the Data Excavation difference in the change in VAS scores from baseline in
Platform of Acupoint Specificity. With this platform, we the 2nd hour after treatment among the three groups
were able to carry out multidimensional and multilayer (P<0.05). However, in the 2nd hour after treatment, only
associationanalysisusingthefollowingfourmajorfunctions: patientstreatedwithverumacupunctureshowedsignificant
standardization of acupuncture prescription; standardiza- decreasesinVASscoresfrombaselinebyamedianof0.7cm
tion of moxibustion prescription; analysis of acupoints; (P < 0.01). These findings support the contention that
analysisofmeridians[19]. specific physiological effects are produced from genuine
Data mining of the literature revealed that acupoints acupointsratherthanfromnonacupoints[26].
on the Shaoyang meridian were the ones chiefly selected In the next RCT on the long-term analgesic effect
for migraine; second, the most commonly selected were of acupuncture on migraine, 480 participants from three
acupoints on the Yangming meridian. Fengchi (GB20) and clinical centers were centrally randomized into treatment
Waiguan (TE5) on the Shaoyang meridian were most fre- group 1 (Shaoyang-specific acupuncture), treatment group
quentlyusedformigraine,thoughTouwei(ST8)andZusanli 2 (Shaoyang-nonspecific acupuncture), treatment group 3
(ST36) on the Yangming meridian were also by doctors to (Yangming-specific acupuncture), and the control group
treatmigraine[20,21].Theacupointsonthemeridianofthe (nonacupoint group). The left and right acupoints were
footYangmingweretheprimechoicefortreatingFD;among employed alternatively using needles connected to Han’s
them, Zusanli (ST36) and Liangqiu (ST34) were especially acupoint nerve stimulator (HANS, Model LH 200A TENS,
employed. In addition, Zhongwan (CV12) and Weishu Nanjing, China) for 30 minutes. Treatments were admin-
(BL21) as the alarm and transport (Fu and Mu) points of istered once a day for 5 continuous days followed by a
the stomach were frequent points of application [22, 23]. 2-day rest interval. Patients in the acupuncture treatment
The acupoints employed for uterus-related disorders and groups and the nonacupoint control group received a total
dysmenorrheaweremainlyonthespleenmeridian,theRen of20treatmentsovera4-weekperiod.Theprimaryoutcome
meridian,andthekidneymeridian;amongthese,Sanyinjiao was the number of days when the subjects experienced
(SP6),Guanyuan(CV4),andTaixi(KI3)were,respectively, a migraine during weeks 5–8 after randomization. Sec-
the ones most frequently employed for each meridian [24, ondaryoutcomesincludedthefrequencyofmigraineattacks,
25]. These findings indicate that acupoint specificity is migraine intensity, and Migraine-Specific Quality-of-Life
closelyrelatedtothepathsofthemeridians;thisisbecause Questionnaire.Resultsshowedthatcomparedwithpatients
the meridian is the prerequisite for achieving acupoint in the control group, patients in the acupuncture groups
specificity.Furthermore,acupointspecificitywascorrelated reported fewer days with a migraine during weeks 5–8;
withthedegreeofconvergenceofthemeridian’sqi. however, the difference between the treatments was not
significant (P > 0.05). There was a significant reduction in
thenumberofdayswithamigraineduringweeks13–16in
3.AdvancesinClinicalStudiesof all acupuncture groups compared with control (Shaoyang-
AcupointSpecificity specific acupuncture versus control, P < 0.01; Shaoyang-
nonspecificacupunctureversuscontrol,P<0.01;Yangming-
In accordance with the concepts and methods of evidence- specific acupuncture versus control, P < 0.05). There was
based medicine, the principles of clinical epidemiology, a significant, but not clinically relevant, benefit for almost
andgoodclinicalpractice,2429participantswithmigraine, all secondary outcomes in the three acupuncture groups
FD, primary dysmenorrheal (PD), and ischemic stroke compared with the control group. There were no relevant
wererecruitedforastudy.Sevenmulticenteredrandomized differencesamongthethreeacupuncturegroups[27].
controlled trials (RCTs) were carried out to verify acupoint Inall,712patientswithFDincluded inthemulticenter
specificity(Table1). RCT of acupuncture were centrally randomized into six
In an RCT on the immediate effect of treating acute groups:group1,specificacupointsofthestomachmeridian;
migraine with acupuncture, 180 participants were centrally group 2, nonspecific acupoints of the stomach meridian;
randomized into the verum acupuncture group (acupoints group 3, specific acupoints of the alarm and transport (Fu
on the Shaoyang meridian), sham acupuncture group 1 andMu)points;group4,specificacupointsofthegallbladder
(somefixedpointsonadistantnonmeridianreportedinthe meridian; group 5, sham acupuncture of nonacupoints;
literature), and sham acupuncture group 2 (points located group6,itopride.Han’sacupointnervestimulatorwasused
halfway between the two meridians). It was clear from the for the electroacupuncture stimulation of each acupoint
Evidence-BasedComplementaryandAlternativeMedicine 3
Table1:RCTstudiesofacupointspecificityinChina.
Research Primary
Trial Samplesize Groups Result
object outcome
Verumacupuncturegroup:Waiguan(TE5),Yanglingquan(GB34),
Qiuxu(GB40),Jiaosun(TE20),Fengchi(GB20)
Shamacupuncturegroupone:(1)Atthemedialarmontheanterior
borderoftheinsertionofthedeltoidmuscleatthejunctionofthe
deltoidandbicepsmuscles;(2)Halfwaybetweenthetipoftheelbow
andtheaxillae;(3)Ulnarside,halfwaybetweentheepicodylus
medialisofthehumerusandtheulnarsideofthewrist;(4)Theedge
ofthetibia1-2cmlateraltotheZusanli(ST36)horizontally;(5)The
Patients
insideofthemid-thighregion2cmlateraltohalfthedistancefrom
withacute Pain(VAS
Lietal.[26] 180 theanteriorsuperioriliacspinetothelateralsuperiorcornerofthe +
migraine scores)
patellaontherectusfemoris;
attacks
Shamacupuncturegrouptwo:(1)locatedhalfwaybetweenthetriple
energizerandsmallintestinemeridianslateraltoWaiguan(TE5)
horizontally;(2)halfwaybetweenthelinefromQiuxu(GB40)to
Jiexi(ST41);(3)halfwaybetweenthegallbladderandbladder
meridianslateraltoYanglingquan(GB34)horizontally;(4)halfway
betweenthelinefromJiaosun(TE20)toShuaigu(GB8);(5)halfway
betweenthelinefromFengchi(GB20)toAnmian(extrapoint)
bilaterally
Groupone:Waiguan(TE5),Yanglingquan(GB34),Qiuxu(GB40),
Fengchi(GB20)
Grouptwo:Luxi(TE19),Sanyangluo(TE8),Xiyangguan(GB33),
Diwuhui(GB42)
Groupthree:Touwei(ST8),Pianli(LI6),Zusanli(ST36),Chongyang
Numberof
Migraine (ST42)
Lietal.[27] 480 dayswitha −
patients Groupfour:(1)Atthemedialarmontheanteriorborderofthe
migraine
insertionofthedeltoidmuscleatthejunctionofthedeltoidand
bicepsmuscles;(2)Halfwaybetweenthetipoftheelbowandthe
axillae;(3)Ulnarside,halfwaybetweentheepicodylusmedialisofthe
humerusandtheulnarsideofthewrist;(4)Theedgeofthetibia
1-2cmlateraltotheZusanli(ST36)horizontally
Groupone:Chongyang(ST42),Fenglong(ST40),Zusanli(ST36),
Liangqiu(ST34)
Grouptwo:Tiaokou(ST38),Dubi(ST35),Yinshi(ST33),Futu
(ST32)
Maetal. Groupthree:Weishu(BL21),Zhongwan(CV12)
FDpatients 712 SIDscores +
[29] Groupfour:Qiuxu(GB40),Guangming(GB37),Yanglingquan
(GB34),Waiqiu(GB36)
Groupfive:thesamewithgroupfourinmigrainestudy(samplesize:
480)
Groupsix:itopride(takeorally)
Yuetal. Treatmentgroup:Sanyinjiao(SP6)
PDpatients 66 PI,RI,A/B +
[30] Controlgroup:Xuanzhong(GB39)
Acupointgroup:Sanyinjiao(SP6)
Unrelatedacupointgroup:Xuanzhong(GB39)
Liuetal. Pain(VAS
PDpatients 200 Non-acupointgroup:lateralsideoflowerleg,3inchesabovethetip −
[31] scores)
ofexternalmalleolus,1.5inchesbehindanteriorcrestofthetibia
Noacupuncturegroup
Acupointgroup:Sanyinjiao(SP6)
Unrelatedacupointgroup:Xuanzhong(GB39) Pain(VAS
Liu,Ma PDpatients 501 +
Non-acupointgroup:lateralsideoflowerleg,3inchesabovethetip scores)
ofexternalmalleolus,1.5inchesbehindanteriorcrestofthetibia
Acupointgroup:basicacupoints-Neiguan(PC6),Shuigou(DU26),
Patients Global
Sanyinjiao(SP6);additionalacupoints-Jiquan(HT1),Weizhong
Shenetal. with symptoms
290 (BL40),Chize(LU5) +
[34] ischemic (BI,relapse
Non-acupointgroup:located3mmapartfromacupointsmentioned
stroke rate,
above
Notes:“+”referstothetrialdetecteddifferentoutcomesbetweenacupointandnon-acupoint/inactiveacupoint;“−”denotesthatthetrialdidnotdetect
differentoutcomesbetweenacupointandnon-acupoint/inactiveacupoint.
PI:pulsatilityindex;RI:resistanceindex;BI:barthelindix.
4 Evidence-BasedComplementaryandAlternativeMedicine
or nonacupoint after needle insertion for 30 minutes. All nodifferenceswereobservedbetweenacupointacupuncture
patients received a total of 20 treatments over a 4-week and nonacupoint acupuncture [31]. The third RCT was
period. The treatments were administered once a day for implemented based on the results of the second trial. The
5 continuous days followed by a 2-day rest interval. This sample size was expanded to 501 participants with PD,
trialincludedbotha4-weekanda12-weekfollowupperiod. who were randomized into an acupoint group (Sanyinjiao,
The outcomes were the patient’s response, improvement in SP6),anunrelatedacupointgroup(Xuanzhong,GB39),and
symptomsmeasuredusingtheSymptomIndexofDyspepsia a nonacupoint group [31, 32]. Electro-acupuncture was
(SID),andquality-of-life(QOL)improvementbasedonthe appliedfor30minutesonthe1stdayofthemenstrualperiod
Nepean Dyspepsia Index (NDI) [28]. The results indicated whentheVASscoresweregreaterthan40mm.Thetreatment
that acupuncture was effective in the treatment of FD and wasadministeredoncedailyfor3continuousdays.Withthe
superior to nonacupoint treatment. All the groups showed firstsessionoftreatment,animmediateanalgesiceffectwas
animprovementinSIDandQOLattheendofthetreatment, observedbyassessingtheVASscorebeforetreatmentand5
andtheimprovementwassustainedfor4and12weeks.The and10minutesafterbeingconnectedtotheHan’sacupoint
overallresponseratewassignificantlyhigherinacupuncture nerve stimulator; the VAS score was also recorded imme-
group 1 and lower in the sham acupuncture group than diately after and 30 minutes after withdrawing the needles.
in the itopride and other acupuncture groups (P < 0.05). With the second and third sessions of treatment, VAS was
Similarly,thedifferenceinsymptomsandQOLimprovement employedbeforetreatmenttoconfirmthecumulativeanal-
wassignificantbetweengroup1andtheotheracupuncture gesiceffect;thesamescoringmethodwasconductedonthe
groups(P<0.05)[29]. last day of treatment and before the next menstrual period
Threeclinicaltrialswereconductedtoexaminetheeffect to observe the cumulative and persistent analgesic effects.
of acupuncture on PD. The first trial included 66 patients The results demonstrated that the immediate, cumulative,
with PD, who were randomized into two groups by means and persistent analgesic effects after the first, second, and
of a random-number table. The treatment group received third treatment sessions induced by Sanyinjiao (SP6) were
manual acupuncture bilaterally at Sanyinjiao (SP6) for 5 significantlysuperiortothoseinducedbyXuanzhong(GB39)
minutes after needling sensation (deqi) was elicited during andnonacupointtreatment(P<0.05).
theperiodofmenstrualpain;inthecontrolgroup,theneedle TheseventhRCTconsistedof290patientswithischemic
was bilaterally at Xuanzhong (GB39) for 5 minutes during strokefromfourclinicalcenterswhowererandomizedinto
the period of menstrual pain. Compared with the control acupoint and nonacupoint groups. They received “resusci-
group, patients in the treatment group showed significant tation therapy” (“Xing Nao Kai Qiao”) on acupoints and
reductions 5 minutes after treatment in terms of changes nonacupoints once a day continuously for 4 weeks. The
in menstrual pain scores (P < 0.001), values of pulsatility Barthel Index, National Institute of Health Stroke Scale,
index(P < 0.001),resistanceindex(P < 0.01),andratioof and Chinese Stroke Scale were used to assess the outcomes
thesystolicanddiastolicpeaks(A/B)intheuterinearteries aftertreatment.Comparedwiththenonacupointgroup,the
(P < 0.01). These trials suggest that needling at SP6 can primary outcome of the mean values for the Barthel index
immediatelyimproveuterinearterialbloodflowinpatients up to 6 months in the acupoint group showed a significant
with PD, whereas GB39 did not achieve these effects [30]. increase (P < 0.01), and the relapse rate was significantly
In the second RCT, 200 eligible participants with PD were reduced in the acupoint group (P < 0.001). However,
recruited. Patients were randomly assigned to the acupoint there was no difference in the death rate between the two
group, unrelated acupoint group, nonacupoint group, or groups (P > 0.05). Additionally, acupuncture resulted in
no-acupuncturegroup.Acupunctureandshamacupuncture a significant difference between the two groups for the
wereadministeredonceadayfor3dayswithelectroacupunc- National Institute of Health Stroke Scale—not at 2 weeks
ture at Sanyinjiao (SP6), which was specifically intended to (P>0.05),butat4weeks(P<0.01).Therewasaremarkable
treat PD, at an unrelated acupoint (Xuanzhong, GB39), or differenceintheChineseStrokeScaleat4weeks(P <0.001)
at a nonacupoint location. The primary outcome was pain and the Stroke-Specific QOL Scale at 6 months (P < 0.01)
intensity as measured by VAS at baseline and at 5, 10, 30, betweentheacupointandnonacupointgroups[33,34].
and 60 minutes after the start of the first intervention. The
secondary outcomes were the Cox retrospective symptom
scale,verbalratingscale,paintotaltime,andproportionof 4.ProgressinAcupointSpecificityon
participants using analgesics during three menstrual cycles. BiologicalStructures
The primary comparison of the VAS scores demonstrated
that patients receiving acupuncture (P < 0.001), unrelated Anatomicalstructuresactasthechiefbasisforactiononthe
acupoint(P<0.001),andnonacupoint(P<0.01)treatment acupoints. Though no unique structures corresponding to
presentedsignificantimprovementscomparedwiththeno- themeridiansoracupointshavebeendiscovered,thepoints
acupuncture group. There were no significant differences arealwayslocatedonregionsthatareabundantinnervesand
amongthefourgroupswithrespecttosecondaryoutcomes bloodandlymphvessels;thisiswherenerveendings,nerve
(P > 0.05). These trials indicated that acupuncture was receptors,bloodvessels,mucopolysaccharides,andmastcells
superiortonoacupunctureinrelievingdysmenorrhealpain. aredenselydistributed.
However, no differences were detected between acupoint By means of histological methods, Chinese researchers
acupunctureand unrelatedacupoint acupuncture;likewise, haveconductedanimalexperimentstoevaluatetheanalgesic
Evidence-BasedComplementaryandAlternativeMedicine 5
effectofacupunctureandanalyzedthenumberofmastcells emissionsofCa,Fe,Cu,andZnatfourdifferentacupuncture
and their proportion in degranulation at both acupoints points: Jianshi (PC5), Ximen (PC4), Tiaokou (ST38), and
and nonacupoints areas. In addition, intensive systematic Xiajuxu (ST39) as well as in the surrounding tissues.
research has been conducted using morphological and The X-ray fluorescence analysis was used to study human
molecular biological methods to determine the relation tissue samples, and proton-induced X-ray emission and
between the mast cells and acupoint effects; these studies synchrotron X-ray fluorescence analysis were employed to
have involved local anesthesia injections into the acupoint, detecttissuecomposition.Thestudydetermineddifferences
patch clamps, and confocal laser scanning microscopy in in structure between acupoint and nonacupoints; with the
additiontoothertechniques. former, there were high concentrations of mast cells as
well as somewhat greater accumulation of microvessels.
4.1. Degranulation of Mast Cells—Positive Correlation with The contents of Ca, Fe, Cu, and Zn were significantly
Acupoint Specificity. Increased degranulation of mast cells higher at three out of four acupoints examined than in
has been observed at acupoint areas [35]. These granules the nonacupoint tissue, with closely similar ratios of Cu to
would appear to stimulate the acupoint receptor to form Fe at points Jianshi (PC5), Tiaokou (ST38), and Xiajuxu
an analgesic signal; the granules also appear to be dif- (ST39), but not Ximen (PC4). Each acupoint seemed to be
fused peripherally and participate in such phenomena as elliptical, with the long axis along the meridian. Therefore,
propagated sensation along the meridian. When cromolyn it was assumed that reduction in the mineral content from
sodiumwasusedtopreventdegranulationofthemastcells acupointstosurroundingareasproceededmoreslowlyinthe
attheacupoint,theanalgesiceffectinducedbyacupuncture meridiandirection[40].
wasremarkablyreduced.Therefore,degranulatedmastcells
appear to be involved in acupuncture analgesia, which is
positivelycorrelatedwithacupointspecificity.Degranulation 5.SpecificReactionsofAcupointsand
of mast cells is one of the starting signals of acupuncture BiophysicalProperties
analgesia[35–37].
Studies examining biophysical properties, involving electri-
4.2. Activation of Mast Cells—Related to Collagen Fiber cal and temperature features, have been used to investigate
at Acupoints. At acupoints, collagen fibers are intertwined acupoint specificity. One study on the volt-ampere (V-
and form a three-dimensional net-like tissue. When an A) characteristics of human acupoints indicated that there
acupuncture needle is inserted into such points using a is a characteristic, nonlinear V-A curve associated with
lifting,thrusting,ortwistingtechnique,theneedlestimulates these points. Compared with control points, low electrical
theconnectivetissueatdenselayerofthedermis,producing resistance was frequently found at acupoints. A cosine
deformity of the collagen fibers, which in turn brings analysis and an amplitude test on acupoints on the six yin
about mast cell degranulation. However, after the collagen meridiansofhealthyparticipantsshowedthattheacupoints
fibers have been damaged, the needling manipulations are underwent clear circadian changes, which reflected changes
no longer able to produce this effect on the fibers; thus, inbodytemperaturecircadianrhythms[41].
acupunctureanalgesiabecomesreducedowingtodecreased The skin temperature of uterine-related acupoints on
mastcelldegranulation[38]. three foot yin meridians, a uterine-relevant acupoint, and
The analgesic effect was investigated in terms of the a nonpoint in 49 healthy female university students on the
contrastintheafferentmechanismbetweenhandacupunc- 1stdayofmenstruationandthe3rddayaftermenstruation
ture and electroacupuncture on Zusanli (ST36) in rats. werecomparedtoexaminethespecificresponseofacupoints
PreprocessingoftypeIcollagenaseorcromolynsodiumsig- to menstruation (Table2). The uterine-related acupoints
nificantlyreducedtheanalgesiceffectwithhandacupuncture Xuehai(SP10),Diji(SP8),Zhongdu(LR6),Sanyinjiao(SP6),
(P<0.05),butthiswasnotaffectedwithelectroacupuncture Taixi (KI3), Taibai (SP3), Taichong (LR3), and Shuiquan
(P > 0.05). With the above two processing methods, (KI5), the uterine-unrelated acupoint Xuanzhong (GB39),
the degranulation rate of mast cells induced by both andthenearbynonmeridianpointXuanzhong (GB39)were
handacupunctureandelectroacupuncturewassignificantly selected. The results showed that the temperature at Taixi
inhibited(P <0.05)[39].Theresultsindicatedthatcollagen (KI3)—the yuan-source point of the kidney meridian of
fibers, as the recipient of the mechanical force with hand the foot, Shaoyin—on the 1st day of menstruation was
acupuncture, played an important role in peripheral signal significantlylowerthanonthe3rddayafterthemenstruation
transduction.Itcouldbethattheinitiatingsignalcausedby (P<0.01).Therewerenosignificanttemperaturedifferences
thehandacupunctureneedleismainlymediatedbycollagen atothermeasurementpointsbetweenthose2days(P>0.05)
fibersandmastcellactivation;inthisway,theacupuncture [42].
information is transmitted to the central nervous system. One hundred healthy undergraduates were randomized
However, the signal with the electroacupuncture needle is into10groups.Zusanli(ST36),Fenglong(ST40),Chongyang
directly mediated by the nerves through activation of the (ST42), Yinlingquan (SP9), Gongsun (SP4), Taibai (SP3),
peripheralnervereceptors. Guangming (GB37),Qiuxu(GB40),andnonacupointswere
acupunctured for 20 minutes, and gastric function before
4.3. Location of Regional Elements—Acupoint Specificity. In andafteracupuncturewasmonitoredbyelectrogastrogram.
one study, researchers measured the characteristic X-ray The results indicated that there were significant differences
6 Evidence-BasedComplementaryandAlternativeMedicine
Results Taixi(KI3)hasspecificresponseofmenstruation. Zusanli(ST36)hasgreatestimpactongastricfunction.Acupointsofstomachandspleenmeridianhavecloselyrelationwithstomach. LeftTaiyuan(LU9)canreflectthepulmonaryfunction. Shenmen(HT7)andDaling(PC7)canreflectthepathologicalstateofmyocardialischemia. ffWaiguan(TE5)hasrelativespecificeectintreatingdysfunctionofear,cardiovasculardisorders,upperlimbsparalysis,andbloodpressurefluctuation.
inChina. PrimaryindicatorSkintemperatureofacupoint/non-acupointatthe1stdayofmenstruationandthe3rddayaftermenstruation. Changesofaverageamplitudeofgastricelectricalactivity. FEV1,MVV Detecttheinfraredradiationinthespectralµrangeof1.5–16m. CerebralresponsesbyPET-CTorfMRIdetected.
y
Table2:Biologicalbasisstudiesofacupointspecificit Groups Xuehai(SP10),Diji(SP8),Zhongdu(LR6),Sanyinjiao(SP6),Taixi(KI3),Taibai(SP3),Taichong(LR3),Shuiquan(KI5),Xuanzhong(GB39),non-acupoint:locatedhalfwaybetweenthestomachandgallbladdermeridianslateraltoXuanzhong(GB39)horizontally Zusanli(ST36),Fenglong(ST40),Chongyang(ST42),Yinlingquan(SP9),Gongsun(SP4),Taibai(SP3),Guangming(GB37),Qiuxu(GB40)andnon-acupoint:theedgeofthetibia1-2cmlateraltotheZusanli(ST36)horizontallyBilateralTaiyuan(LU9),Neiguan(PC6),Daling(PC7),non-acupointone:locateshalfwaybetweenTaiyuan(LU9)andDaling(PC7),non-acupointtwo:locatedhalfwaybetweenthepericardiumandlungmeridianslateraltoNeiguan(PC6)horizontally Taiyuan(LU9),Shenmen(HT7),Daling(PC7) Waiguan(TE5);shamneedlinginTE5;overtplaceboneedlinginTE5;non-acupoint:locatedatthesamelevelasWaiguan(TE5)andonthemidlinebetweentheTriplewarmermeridianofhand-Shaoyangandthesmallintestinemeridianofhand-Taiyan
e
z
si
e
pl
m 0 4
a 9 0 0 0 6
S 4 1 1 5 3
s
r
e
Studycarrier Healthyfemale Healthyundergraduates Volunteers Patientswithcoronaryheartdisease Healthyvolunte
Trial Sheetal.[42] Chenetal.[43] Dengetal.[44] Liuetal.[49] Laietal.[50],Zhangetal.[51],Huangetal.[52]
Evidence-BasedComplementaryandAlternativeMedicine 7
ResultsWaiguan(TE5)canspecificactivatemotorexecutionandvision-relatedcerebralregionsinthehealthyhemisphereandthelimbicsystemoftheffaectedhemisphere;canremarkabledeactivatethemotorexecution-relatedcerebralregion,emotionareaandffcognitionregionoftheaectedhemisphereforischemicstrokepatients. Themoreremarkablemodulationontheffhomeostaticaerentnetwork,includingtheinsula,ACC,andhypothalamus,mightbethespecificmechanismofstomach-specificacupuncturefortreatingFD.
y
b
T
r es C
Primaryindicato CerebralresponsPET-CTorfMRIdetected. CerebralglycometabolismchangesbyPET-examined.
y of
Table2:Continued. Groups Waiguan(TE5)needlinggroup,Waiguan(TE5)shamneedlinggroup,shampointneedlinggroup,shampointshamneedlinggroupandnon-needlinggroup Acupointsofstomachmeridian:Liangqiu(ST34),Zusanli(ST36),Fenglong(ST40)andChongyang(ST42);Non-acupoints:(1)Atthemedialarmontheanteriorborderoftheinsertionofthedeltoidmuscleatthejunctionofthedeltoidandbicepsmuscles;(2)Halfwabetweenthetipoftheelbowandtheaxillae;(3)Ulnarside,halfwaybetweentheepicodylusmedialisofthehumerusandtheulnarsideofthewrist;(4)Theedgethetibia1-2cmlateraltotheZusanli(ST36)horizontally aryventilation.
nt
size volu
ple mal
m xi
Sa 55 20 ma
V:
V
M
e me;
k
Studycarrier Ischemicstropatients FDpatients expiratoryvolu
d
e
c
] or
6 f
getal.4] etal.[5 FEV1:1s
Trial Huan[53,5 Zeng Notes:
8 Evidence-BasedComplementaryandAlternativeMedicine
in the rate of change of the gastric electrical area between Acute gastric mucosal injury (AGMI) was modeled in
needling acupoints and needling nonacupoints as well as therat,andtheplasmaextravasatedEvansblue(EB)points
between needling acupoints on different meridians (P < on the skin of the whole body were observed after removal
0.05).Therewasasignificantdifferenceinneedlingdifferent of hair. The extravasated EB points showed the following
acupoints on different meridians on the rate of change of distribution: 47.5% of the points were located at Geshu
thegastricelectricalarea(P <0.05).Zusanli(ST36)showed (BL17), 58.82% at Jizhong (GV6), 88.23% at Pishu (BL20),
thestrongestrolewithrespecttogastricfunction(P <0.05) 82.35%atWeishu(BL21),17.64%atZhongwan(CV12),and
[43]. 5.88% at Shangwan (CV13). The plasma extravasation of
A total of 104 volunteers were subjected to infrared the EB points seldom appeared in normal control rats, and
radiationatbilateralTaiyuan(LU9),Neiguan(PC6),Daling fewer points were observed in rats administered with 0.9%
(PC7), and nonacupoints as part of an investigation into saline. Significant differences were found between model
pulmonary function. The results indicated that there was and normal control groups and also between model and
a correlation between infrared radiation and pulmonary normal saline groups in the number of extravasated EB
function at six of the ten points. There was a correlation points(P<0.01,P<0.05).ThenumberofextravasatedEB
betweenthelevelofinfraredradiationand1-secondforced points was related to the phase of gastric mucosal injury,
expiratory volume and between infrared radiation and being greatest on the 2nd and 3rd days after modeling and
maximal voluntary ventilation at the left Taiyuan (LU9) disappearing gradually along with the natural repair of the
(P<0.001orP<0.01). Thus, infrared radiation at the left AGMI[47].
Taiyuan (LU9) was best able to reflect pulmonary function A comparison was made between 31 patients with
[44]. coronary artery disease and 31 healthy people to observe
differencesintheinfraredspectraoftheleftNeiguan(PC6);
significant differences in the wavelengths at 1.5–3.3µm,
6.CorrelationbetweenAcupoint 10.7–12.5µm, and 14.1–15.9µm were found (P < 0.01)
SpecificityandFunctionalState [48]. In another study, 47 healthy subjects and 50 patients
with coronary artery disease were compared to detect the
Acupoints can be used diagnostically to reveal the presence infrared radiation at the yuan-source acupoint on the yin
of pathogens and indicate therapies for curing disease. meridians of hand in the spectral range of 1.5–16µm.
This diagnostic ability varies with changes in the body’s Through a comparison of the spectral shape analysis and
constitution, which is manifest as an alternation between theinfraredintensity,therewasnosignificantdifferenceon
being physiologically “silent” or pathogenically “active.” A eithersideofthesamebilateralacupointsintermsofinfrared
number of researchers maintain that when some internal radiation intensity in healthy people (P > 0.05); there
organsareaffectedbydisease,acupointsensitizationhasthe were, however, significant differences in infrared radiation
potentialforexertingdynamicfunctionalchanges,reflecting intensity at Daling (PC7) and Shenmen (HT7) in patients
acupointspecificity[45]. withcoronaryheartdisease(P<0.05)[49].
Injectingmustardoilintotheintragastricmucousmem-
brane in rats resulted in massive mucous inflammation, as
evidenced by histological examination, which revealed that 7.NeuroimagingResearchon
theintragastricmucosahadbecomeedematousandshowed AcupointSpecificity
dilated blood vessels, and that there was ulceration of the
endogastric lining. In all six rats that received the mustard Inonestudy,36healthyvolunteersparticipatedintwoneu-
oil injections into the intragastric mucosa, small blue dots roimagingexperiments,whichfocusedoncerebralresponses
appeared on the skin over the whole abdomen, but mainly followingneedlingatWaiguan(TE5)ontherighthand.The
in the perimidline upper and middle abdomen, and the first part of the study examined the effect of true, sham,
middlebackinadditiontoafewonthethighandgroin.The andovertplaceboneedlingatWaiguan(TE5)onmetabolic
numberanddistributionofthebluedotsvariedconsiderably changes in cerebral regions by means of positron emission
amongtherats.Thedotsstartedtoappearabout20minutes tomography (PET). This study showed that compared with
after injecting the mustard oil, and the majority of dots sham acupuncture, the left temporal lobe (Brodmann area
were visible within 50 minutes. The dots were very small, 42, BA42), insula (BA13), and cerebellum were activated
usuallyrangingfrom1to3mmindiameter.However,several bytrueacupuncture.Comparedwithplaceboneedling,BAs
dots were more elongated and had a length of 3–6mm. In 13, 7, and 42, both parietal lobes, the occipital lobes, and
contrast, two of the four control rats that received saline cuneuswereactivatedbytrueacupuncture.Cerebralglucose
injections into the intragastric mucous membrane showed metabolism was changed by sham needling compared with
noskincolorchangesatall.Theremainingtwocontrolrats placebo, mainly in the primary and supplementary motor
showed only three to five small blue dots over the middle cortex(BA4,BA6)andassociativevisualcortex(BA19)[50,
abdomen; this extravasation restricted to the abdominal 51]. The second part of the study observed the regional
skin in these two control rats may have been associated cerebral activation of the Waiguan (TE5) following true
with the abdominal surgical incision. It may be speculated needling,shamneedling,andtrueneedlingatashampoint
that cutaneous distribution of the blue dots reflected the using functional magnetic resonance imaging (fMRI). The
distributionofgastricsegmentalinnervations[46]. results demonstrated that compared with sham needling,
Evidence-BasedComplementaryandAlternativeMedicine 9
trueneedlingactivatedtherightsuperiorfrontalgyrus(BA8) pons,insula,andanteriorfrontalgyrusarepossiblythetarget
and the left cerebellum. Compared with needling at the points of the analgesic effect for chronic migraine induced
sham point, true needling activated the right parietal lobe, byacupunctureattheShaoyang meridian.Thereductionin
the left cerebellum, and the right inferior semilunar lobule metabolism in the bilateral temporal lobes is possibly the
[52]. These results showed that the brain responses to true mechanismbywhichacupunctureatpointsontheShaoyang
needlingatWaiguan(TE5)weresignificantlydifferentfrom meridianworksinthetreatmentofmigraine[55].
the responses to needling at sham points or sham needling Neuroimaging studies have confirmed that compared
ontrueacupoints.Itiswellknownthattheinsularegulates with nonacupoints, acupoints had a much more extensive
impulsive and aggressive behavior and that the temporal influence on brain functions in patients with FD, and that
loberegulatesauditoryfunctions.Theparietallobereceives acupoint specificity was regulated by the central nervous
nervoussensationfromtheoppositesideofthebody,andthe system.Inonestudy,40patientswithFDand20healthypar-
superiorfrontalgyrusisinvolvedinsuchactivitiesaswriting ticipantswerescannedbyPET-computedtomography(CT).
andmovementoftheupperlimbs.Thecerebellumregulates The outcome showed that compared with healthy subjects,
activitiesofthetrunkmusclesandplaysanimportantrolein patients with FD had higher levels of glycometabolism in
maintainingbalanceandposture.Thesepreliminaryresults thebilateralinsula,anteriorcingulatecortex(ACC),middle
providesomeevidenceforWaiguan(TE5)inthetreatment cingulate cortex (MCC), cerebellum, thalamus, prefrontal
ofeardysfunctions,cardiovasculardisorders,paralysisofthe cortex,precentralgyrus,postcentralgyrus,middletemporal
upperlimbs,andbloodpressureproblems. gyrus, superior temporal gyrus, putamen, right parahip-
In one study, 43 ischemic stroke patients with damage pocampalgyrus,claustrum,andleftprecuneus(P < 0.001).
to the right hemisphere were randomly divided into a ThesignalincreaseintheACC,insula,MCC,andcerebellum
Waiguan(TE5)needlinggroup,shamneedlinggroup,sham was positively correlated with symptom index of dyspepsia
point needling group, sham point sham needling group, scores(P < 0.01)andnegativelycorrelatedwithNDIscores
and nonneedling group. PET was used to detect cerebral (P<0.01).Therefore,itwasconcludedthattheACC,insula,
functional regions during the needling process. Compared thalamus, MCC, and cerebellum are closely related to the
with the nonneedling group, the acupoint needling group severity of FD [57]. In another study, 20 patients with FD
showed activation of BA30. Sham needling at the sham were randomly assigned to receive either acupuncture or
point led to deactivation in BA6. Compared with sham shamacupuncturetherapy,andtheywereexaminedbyPET-
needling at the acupoint, needling at TE5 activated BA13, CTscanbeforeandaftertreatment.TheNDIandSIDwere
19, and 47. Compared with needling at the sham point, used to evaluate the therapeutic effect. Acupuncture was
needling at the acupoint had a deactivating effect on BA9 performedonacupointsofthestomachmeridian:Liangqiu
[53].AnotherfMRIstudyinvolvedananalysisof12ischemic (ST34), Zusanli (ST36), Fenglong (ST40), and Chongyang
stroke patients who showed typical right-sided hemiplegia; (ST42). The sham acupuncture was performed on four
they were randomly assigned to two groups: one group nonacupoints, which were the same as in the FD clinical
underwentshamneedlingandtrueneedlingatWaiguan(TE trial mentioned above. The results indicated that acupunc-
5) in the healthy upper limb; the other group underwent ture and sham acupuncture exerted different responses on
sham and true needling at a sham point. Compared with the brain. In the acupuncture group, deactivation of the
sham needling at TE 5, true needling deactivated BA 4, 6, brainstem, ACC, insula, thalamus, and hypothalamus were
24,and32areas.Inaddition,comparedwithneedlingatthe largelyrelatedtothedecreaseinSIDscoreandtheincrease
sham point, true needling at TE 5 deactivated the bilateral in NDI score (P < 0.05, corrected) after treatment. In the
hypothalamus [54]. In general, TE5 in stroke patients was shamacupuncturegroup,deactivationofthebrainstemand
abletoactivatemotorexecution-andvision-relatedcerebral thalamus tended to be associated with an increase in NDI
regions in the healthy hemisphere and the limbic system score(P<0.1,corrected)[56].
of the affected hemisphere; it was also able to deactivate
the motor execution-related cerebral region, emotion area,
andcognitionregionoftheaffectedhemisphere.Thiswould 8.MetabolomicStudyof
appeartopointtoakeymechanismintheclinicaltreatment AcupointSpecificity
ofischemicstroke.
Sixcasesofchronicmigraineweretreatedwithacupunc- A study was made of patients with FD, in whom plasma
ture at Fengchi (GB20), Waiguan (TE5), and Yanglingquan metabolitesweremeasuredbymeansof1Hnuclearmagnetic
(GB34) on the shaoyang meridian. PET was used for scan- resonance(NMR)spectroscopyafterthetreatmentatspecific
ning,andStatisticalParametricMappingsoftware2wasused acupointsofthestomachmeridian,nonspecificacupointsof
toanalyzethedataandcomparewithhealthyhumanbrain the stomach meridian, specific acupoints of the gallbladder
functionimagingandalsotoinvestigatechangesincerebral meridian,ornonacupoints.Theacupointsandnonacupoints
glucosemetabolisminthemigrainepatientsbeforeandafter wereselectedinthesamemannerasintheFDclinicaltrial
acupuncture. The results suggested that after acupuncture, discussed in the previous section. The latent biomarkers,
excitedareasofthebrain,suchasthebrainstemandinsula, plasma phosphatidylcholine and leucine/isoleucine, were
were obviously reduced, and brain areas with a lower level related to the NDI scores of patients with FD. Acupoints
ofglycometabolismchangedfromtherighttemporallobeto exerted a better effect on regulating the key metabolic
the bilateral temporal lobes (P < 0.005). Such areas as the substances than nonacupoints, and the specific acupoints
10 Evidence-BasedComplementaryandAlternativeMedicine
onthedisease-pertinentmeridian(stomachmeridian)were the therapeutic effects of acupoint specificity. Thus, a full
superiortononspecificacupointsoracupointsontheother analysis of the various clinical effects should be made at
meridian (gallbladder meridian) [58, 59]. In metabolic the following three levels: acupoints versus nonacupoints;
terms,theresultsconfirmedthatacupointsexertedastrong, different acupoints possessing the same property on dif-
targeted regulatory effect, whereas nonacupoints had a ferent meridians; different acupoints from one meridian.
weakereffectandanarrowregulatoryscope. Currently, properly controlled methods for studying acu-
point specificity can be generalized into three categories:
9.Discussion nonacupoints; minimal acupuncture (superficial needling);
placebo needling (noninvasive needling). Comparisons are
Asacriticaltheoreticalfoundation,acupointspecificityisof seldom made among acupoints on the same meridian or
primeimportanceinpointselectioninacupunctureclinics, acupointshavingthesamepropertyondifferentmeridians.
anditinvolvesspecificityintermsofclinicaleffect,biological Although minimal acupuncture is widely adopted in
structure,andbiophysics.Thespecificityoftheclinicaleffect investigationsofacupointspecificity,ithastobequestioned
is the basis of acupoint specificity, and therefore currently whether it can be used as a control. Minimal acupuncture
itiswidelydiscussedbothinChinaandoverseas.Acupoint has a long history and is characterized by limited insertion
specificityfocusesondifferencesintheindicativerangeand of needles into the epidermis, dermis, or subcutaneous
curativeefficacybetweenrealacupointsandnonacupointsas tissue. According to the theory of acupuncture, the place
wellasamongrealacupoints.Inadditiontoacomparisonof whereminimalacupunctureexertsitseffectsisthecutaneous
acupoints and nonacupoints, great attention has been paid region (pi bu), which has definite divisions with respect
to different acupoints and their meridian tropism. Thus, in to the system of the 12 regular meridians. A number of
some basic research efforts, the various effects of different reports have verified that stimulating the cutaneous region
acupointsthatmayberelatedtothesamemeridianhavebeen canachievespecificcurativeeffects[12,61,62].Somebasic
investigated.Withtheirparticularcharacteristics,acupoints studieshavealsodemonstratedthatbothverumacupuncture
fromonemeridiancanexertdifferentimpactsontheorgan andminimalacupuncturemayinduceactivationofsensory
with which they are related. In different clinical situations, afferents, which amounts to objective evidence of the
physicians perform meridian, regional, or visceral differen- clinical efficacy of minimal acupuncture [63–66]. However,
tiation, and they carefully select the points on the affected in a study on the cardiovascular response to minimal
regions, points corresponding to meridian terminals, or acupuncture, some researchers viewed this procedure as a
those with particular curative effects. If only the traveling valid control method [67]. We believe that it is important
pathway of the meridians and character of acupoints are to examine such investigations in terms of the following
taken into consideration, acupuncture is likely to achieve questions.Wasminimalacupunctureappropriatelyusedfor
favorable results in clinical treatment. However, some non- thecontrolgroup?Whatisthecorrelationbetweenminimal
Chinesestudieshaverevealedthatacupointspecificitydoes acupunctureandthediseasebeingtreatedandthestimulated
notexistsinceallpartsofthebodycanobtaincurativeeffects partofthebody?However,minimalacupuncturecannotbe
as a result of acupuncture. According to their hypothesis, prioritizedoverothercontrolmethodsinstudiesofacupoint
nonacupointsexertidenticaltherapeuticeffectstoacupoints specificity.
whenstimulated.
In recent years, many non-Chinese clinical and experi- 9.2.ObjectsofStudies. Studiesonacupointspecificity,espe-
mental studies have paid close attention to acupoint speci- cially those conducted overseas using neuroimaging, have
ficity, and they have produced mixed results. According to been carried out on healthy participants [11, 15, 68–70].
a systematic review of clinical trials on acupoint specificity Studiesonthecorrelationbetweenthestatusandspecificity
from 1998 to 2009, six of the 12 studies positively pointed ofacupointshavedemonstratedthefollowing:acupointsare
to the existence of acupoints; the other six were unable relatively“silent”undernormalphysiologicalconditions,yet
to confirm the existence of acupoints, and they suggested they are relatively “sensitive” under pathological conditions
thatconventionalacupuncturewasnotdifferentfromsham [71].Withrespecttothetransmissionofpathogens,manifest
acupuncture [60]. It is indisputable that positive reports syndromes, regulatory organs, and balancing yin and yang,
aboutacupointspecificityfromChinafaroutnumberthose acupuncture plays its therapeutic role under pathological
fromothercountries.Itisdifficulttoaccountforthedifferent conditions,notnormalphysiologicalconditions.Asaresult,
results obtained in China and overseas without examining there are limitations to acupoint studies of physiological
issuesofbiasandthequalityofthestudies. conditionsthatarenotaconcernwithstudiesofpathological
conditions.
9.1. Design of Controls. In the opinion of the present Since it is widely acknowledged that acupuncture is
authors,acupointsexerttheireffectsinthreeways:themain effective in relieving pain, there have been many studies
functionsandindicationsoftheacupoints;themanipulation on acupoint specificity with respect to migraine [6, 12, 26,
techniquesemployedinneedling;placeboeffects,suchasthe 61, 72], fibromyalgia [14, 73, 74], lumbago [62, 75–77],
interactionsbetweendoctorsandpatients;theexpectationof osteoarthritis [1, 78, 79], and other painful diseases. These
thepatientsthemselves. studiesproducedmixedresults.Painisanobjectivesensation
Thecharacteristicsoftheacupointanditsrelatedmerid- that is inevitably subject to individual variability; as such it
ian should be taken into consideration when examining canleadtostudybias.Someresearchershavesuggestedthat