Monotherapy often falls short in treating complex diseases effectively， prompting the emergence of integrated treatment models such as acupuncture-medicine combination therapy， which has gained recognition as a significant strategy to improve clinical efficacy while minimizing adverse effects. This paper systematically examines the necessity of integrating acupuncture with pharmacotherapy. By constructing a theoretical framework centered on supplementation and regulation， it delineates the operational principles of acupuncture-medicine combination therapy. It explores the mechanisms underlying the enhanced efficacy of acupuncture-medicine combination therapy from the perspectives of synergy and complementarity， and analyzes its characteristics in toxicity reduction via counteracting mechanisms. The aim of this paper is to provide a theoretical foundation and future directions for research on acupuncture-medicine combination therapy.

Objective Sham acupuncture control is essential for evaluating the specific efficacy of acupuncture. However, the complex nature of acupuncture components presents challenges in designing an inert sham acupuncture control while maintaining blinding. Currently, no standardized guidance exists for the design of sham acupuncture controls. This study aimed to propose guidelines for optimizing the design of sham acupuncture in randomized controlled trials. Methods The initial draft of the guidelines was developed through a literature review and expert interviews. The items in the guidelines were revised and finalized through consensus meetings. Results The resulting Recommendations for the DesIgn of sham acupuncture in RandomizEd Controlled Trials (the DIRECT guidelines) include issues to consider prior to adopting a sham acupuncture control, a five-stage framework for designing sham acupuncture, which addresses feasibility, risks, and recommendations for the implementation of sham acupuncture in clinical trials. Conclusion These guidelines offer practical recommendations for establishing appropriate sham acupuncture controls and optimizing their implementation in randomized controlled trials of acupuncture.Please cite this article as: Chen Y, Liu XY, Liu ZS, Guo Y, Zhou KH, Bian ZX, Wu M, Tian RH, Yang F, Zhang LY, Lu Y, Lao LX, He LY, Liu CZ, Liu BY, Yan SY. Recommendations for the DesIgn of sham acupuncture in RandomizEd Controlled Trials (the DIRECT guidelines). J Integr Med. 2026; Epub ahead of print.

OBJECTIVES:To investigate the effect of prior acupuncture experience on the clinical efficacy of acupuncture for discogenic sciatica. METHODS:A secondary analysis was conducted on a multicenter, randomized controlled trial. A total of 216 patients with discogenic sciatica were randomly divided into an acupuncture group and a sham acupuncture group, with 108 patients in each group. The acupuncture group received a semi-standardized treatment protocol based on meridian pattern differentiation for acupoint selection, and manual manipulation was applied to achieve the deqi sensation. The sham acupuncture group received needling at non-acupoints without manipulation or the pursuit of deqi. Each session lasted for 30 min. The treatment continued for 4 weeks, with 3 sessions per week for the first 2 weeks and 2 sessions per week for the subsequent 2 weeks. The visual analog scale (VAS) score for leg pain and the Oswestry disability index (ODI) score for lumbar function were recorded at baseline and after 4 weeks of treatment. The differences in VAS and ODI scores from baseline to week 4 were used as the primary outcome measures to evaluate the efficacy. Subgroup analysis were performed to compare the efficacy between the acupuncture and sham acupuncture groups based on the presence or absence of previous acupuncture experience. RESULTS:Among the 216 patients, 81 had prior acupuncture experience and 135 had no prior acupuncture experience. In the subgroup with prior acupuncture experience or without previous acupuncture experience, the changes of VAS score for leg pain and the ODI score for lumbar function in the acupuncture group were significantly higher than those in the sham acupuncture group after 4 weeks of intervention (P<0.001, P<0.01). Interaction analysis showed that there was no interaction effect between prior acupuncture experience and intervention factors on the changes in VAS and ODI scores. CONCLUSIONS:Acupuncture has a favorable effect on improving leg pain and lumbar dysfunction in patients with discogenic sciatica, regardless of prior acupuncture experience.

This paper systematically reviews the development trajectory of acupuncture-moxibustion classics in higher education over the past 40 years from a historical research perspective, employing literature analysis and comparative research methods to reveal the evolution patterns and underlying contradictions of textbook curricula. The construction of modern textbook curricula for acupuncture-moxibustion classics has gone through 3 stages: the initial stage of multiple explorations (1980-1987), the trial stage of path differentiation (1984-2002), and the integration and re-differentiation stage of innovative breakthrough (2003-2024). It started from Zhenjiu Yiji Xuan (Selected Medical Texts on Acupuncture and Moxibustion), the triple frame, "classics-treatises-poetries" and Gejia Zhenjiu Xueshuo (Diverse Theories on Acupuncture and Moxibustion), and it was differentiated to be textbooks with "classics" and "treatises" separated each other. Followed by this, the structures of textbook were merged by the beginning of the 21st century to be a quadrant frame, "classics-treatises-poetries-medical cases" and Gejia Zhenjiu Xueshu, in which, the innovation was advanced with classics and medical cases presenting independently. The curriculum textbooks for undergraduate and postgraduate influence each other and also affect the intermediate and college-level correspondence curricula. The source of core problems, such as cognitive discrepancies in acupuncture-moxibustion classics and controversies over textbook models, lies in the secondary positioning of acupuncture-moxibustion discipline. It is proposed that the objective laws and scientific connotations of non-pharmacological therapies in acupuncture-moxibustion discipline should be respected, and the curriculum system of acupuncture-moxibustion classics and medical history literature should be reconstructed from the perspective of the upgrade of acupuncture-moxibustion discipline. Such system can be estabilished by integrating education with research to establish four dimensions (history, intangible cultural heritage, four classics and masterpieces) of acupuncture and moxibustion, and to build up two-tier (undergraduate and postgraduate) higher education curricula; and emphasizing the fountainhead of centrality of Lingshu (Miraculous Pivot), the status of subjectivity of Huangdi Neijing (The Yellow Emperor's Inner Classic) in acupuncture-moxibustion theories, and the classical standing of Zhenjiu Jiayi Jing (The Systematic Classic of Acupuncture and Moxibustion). The industry-education integration is advocated for the active development of artificial intelligence (AI) curricula for acupuncture-moxibustion classics. The foundation of the curricula of acupuncture-moxibustion classics and theories should be consolidated for talent development to address the suzerain of acupuncture and moxibustion, international discourse power, and the crisis of international research challenges.

Most traditional parametric analysis systems for manual acupuncture manipulation (MAM) fail to solve multimodal MAM recognition problems, due to the absence of robust MAM recognition models integrating both hand visual information and tactile feedback from the needle-holding (NH) fingers during MAM operations. This study attempts to fill this gap by constructing an explainable multimodal MAM recognition network using MAM video data captured by a binocular camera and tactile data from a self-developed wearable tactile array finger cot, which is worn on the acupuncturist's fingers to collect tactile feedback during MAM operations. For this recognition model, we designed feature extraction methods for two tactile (dual-channel PVDF film piezoelectric signals and accelerometer signals) and two visual (joint motion data and RGB image data of the NH hand) submodalities. Next, we constructed a tactile-visual multimodal feature fusion frame, including a gating mechanism-based feature self-interaction memory strategy for each branch submodality of respective tactile and visual modalities, an interaction attention-based fusion method to generate the corresponding respective entire features of tactile and visual modality, and a tactile and visual multimodal feature fusion method using a lowrank fusion technique. Finally, we developed a feature element fine-tuning-based interpretability mechanism for the multimodal MAM recognition model. Thirty acupuncturists from TCM medical institutions in China validated the proposed multimodal MAM acquisition system and recognition model for four typical MAM techniques. Satisfactory results were obtained, proving the proposed method's feasibility and effectiveness.

Expectation is an important psychological factor affecting clinical treatment outcomes in chronic diseases; however, its underlying neural basis remains unclear. The aim of this study is to explore the neurofunctional mechanisms of expectation and investigate how expectations influence acupuncture treatment efficacy in the brains of patients with knee osteoarthritis (KOA). A total of 90 patients diagnosed with KOA were enrolled in this study. The acupuncture group (AG, age 45–65) and sham acupuncture group (SG, age 48–65) received either 12 sessions of 30-min acupuncture treatment or sham acupuncture treatment, whereas the waiting-list group (WG, age 45–65) did not receive any interventions. Patients’ baseline positive expectations were assessed. Neuroimaging, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and other clinical data were collected at baseline and after treatment (week 4). Correlation analyses between the brain imaging and clinical data were performed. Baseline expectations and improvements in WOMAC function were associated with fractional amplitude of low-frequency fluctuation (fALFF) changes in the posterior cingulate cortex (PCC)/precuneus and increased PCC/precuneus–medial prefrontal cortex (mPFC) connectivity in the AG, but not in the SG or WG. Both altered fALFF in the PCC/precuneus and enhanced PCC/precuneus–mPFC connectivity were neural correlates of the association between positive expectations and the therapeutic efficacy of acupuncture.

BACKGROUND:Vascular cognitive impairment (VCI) is a prevalent and heterogeneous condition, both clinically and pathophysiologically, that still lacks approved treatment. Peripheral electrical nerve stimulation (PENS) shows promise for VCI management, yet its underlying neurobiological mechanisms are not well understood. METHODS:VCI was induced in rats via permanent bilateral common carotid artery occlusion. Cognitive function was assessed using the Morris water maze, Y-maze, and novel object recognition. Synaptic plasticity was evaluated through long-term potentiation recordings and Golgi staining. The nucleus tractus solitarius (NTS)-medial septum-hippocampus circuit was dissected using fiber photometry recording, immunofluorescence multiplex labeling, in vivo multichannel recordings, anterograde/retrograde tracing, and chemogenetic manipulation. RESULTS:We found that PENS at Zusanli (ST36) acupoint significantly elevated hippocampal acetylcholine levels, enhanced synaptic plasticity, and rescued spatial and nonspatial memory deficits in VCI rats. Chemogenetic activation of cholinergic neurons in the NTS enhanced the cognitive function of VCI rats, whereas chemogenetic inhibition of these neurons counteracted the cognitive benefits of PENS. The NTS sends cholinergic projections to the hippocampal cornu ammonis 1 region through the medial septum. Specific inhibition of NTSChAT-medial septumChAT-cornu ammonis 1 circuit reversed the enhancement of spatial memory observed in VCI rats treated with PENS, while leaving the nonspatial memory unaffected. CONCLUSIONS:Our findings identify the NTS-medial septum-cornu ammonis 1 cholinergic circuit as a critical mechanism mediating PENS-induced reversal of spatial memory deficits in VCI, revealing a novel and spatially selective therapeutic target for VCI.

Background and AimsElectroacupuncture (EA) has been reported to have a therapeutic potential for visceral hypersensitivity. Recent studies have highlighted the crucial role of the duodenum in visceral hypersensitivity, suggesting it as a potential therapeutic target. This study investigates how EA regulates visceral hypersensitivity in the duodenum.MethodWe established a visceral hypersensitivity model in rats by intragastric administration of iodoacetamide. Various parameters were evaluated, including electromyographic recordings in vivo, mesentery afferent nerve spontaneous discharge, mechanical sensitivity, and chemical sensitivity. Western blotting and immunofluorescence were employed to detect the protein expression of nociceptor transient receptor potential vanilloid 1 (TRPV1) and to assess eosinophil infiltration by labeling eosinophil major basic protein (EMBP). We examined whether the effect of EA was mediated by TRPV1, using the agonist capsaicin and the antagonist SB366791. Eosinophils were counted, and their activation and degranulation status were assessed. We explored the impact of eosinophils on the neuron fibers of the intestine.ResultsEA decreased firing of visceral afferent action potentials including spontaneous, mechanosensitive and chemosensitive mesentery afferent discharge, and attenuated visceromotor electromyographic activity. The above effects of EA were reversed by intraperitoneal injection or in vitro enteric nerve administration of TRPV1 agonist capsaicin. EA substantially reduced the area of neuron fibers and the TRPV1 expression. Furthermore, in vitro experiments using primary cell cultures indicated that eosinophils' degranulation with different doses could stimulate neuron fibers. EA at ST36 was found to reduce both the number of duodenal eosinophil-positive cells and the levels of their degranulation products.ConclusionThese results suggested that EA at ST36 alleviates visceral hypersensitivity by inhibiting eosinophils degranulation and TRPV1 expression in the duodenum.

Acupoint sensitization is a key manifestation of disease response and plays a critical role in determining the effectiveness of acupuncture treatment. Chronic atrophic gastritis, characterized by persistent and pronounced acupoint sensitization, serves as an ideal model for studying this phenomenon. We aim to link local molecular alterations at sensitized acupoints with the pain-sensitization phenotype, thereby elucidating the comprehensive molecular mechanisms underlying acupoint sensitization and ultimately providing mechanistic guidance for how acupuncture exerts therapeutic effects in the clinical treatment of CAG. This study will recruit and sampling 30 patients with chronic atrophic gastritis who are aged between 40 and 65 years and whose CV12 and non-acupoint pain threshold are greater than 10N, aiming to explore the local metabolomics and proteomics changes in the acupoint in these patients. The non-acupoint located in the lateral abdomen, corresponding to the same spinal segment as the CV12 acupoint, will serve as the control group. We expect to find that, compared with the non-acupoint group, the content of pain-related metabolites and proteins in the tissue fluid of the CV12 acupoint will increase. These changes are anticipated to be correlated with the pain sensitization phenotype. The study will comply with the Declaration of Helsinki and has been approved by the Ethics Committee of Beijing University of Chinese Medicine (No. 2024BZYLL1006). All participants will undergo standardized training on the study protocol, and informed consent will be obtained from all patients.Trial registration: ITMCTR2025000156; International Traditional Medicine Clinical Trial Registry (https://itmctr.ccebtcm.org.cn/mgt/project/user/user-project-view/C96AC314-9A6A-44A4-ABD1-B602A84F5792).

Introduction:Knee osteoarthritis (KOA) is a chronic degenerative joint disease marked by pain, cartilage degradation, and limited mobility. Existing treatments remain suboptimal due to limited efficacy and adverse effects, highlighting the urgent need for safer, mechanism-based therapies. Electroacupuncture (EA) has demonstrated clinical benefits in KOA, yet its underlying molecular mechanisms remain unclear. Methods:A KOA rat model was established via intra-articular injection of monosodium iodoacetate (MIA). EA was applied at Dubi (ST35) and Neixiyan (EX-LE5) acupoints. We assessed the effect of EA on nociceptive behavior in rats with KOA using von Frey filament testing, weight-bearing asymmetry measurements, and spontaneous pain assays. Cartilage degeneration was analyzed via toluidine blue staining, while immunofluorescence staining quantified protein expression levels in cartilage and dorsal root ganglia (DRG). Inhibitor and agonist injections were employed to evaluate the specific involvement of the NGF/TrkA pathway in EA-mediated effects. Results:EA significantly reduced mechanical allodynia (p < 0.001), weight-bearing asymmetry (p < 0.001), spontaneous pain (p < 0.001). EA decreased macroscopic chondropathy score (p < 0.01) and cartilage degeneration score (p < 0.001). EA inhibited MMP13 expression (p < 0.05), suppressed NGF (p < 0.001) and TrkA (p < 0.05) expression, decreased PGP9.5 overexpression (p < 0.05), and downregulated pro-inflammatory cytokines IL-1β (p < 0.01) and TNF-α (p < 0.01). Pharmacological inhibition of NGF/TrkA mimicked EA's effects, while activation of this pathway counteracted its analgesia. EA selectively downregulated TrkA in CGRP+ (p < 0.01), but not IB4+ (p > 0.05) or NF200+ (p > 0.05) DRG neurons subtypes. Conclusion:Our results demonstrate that EA alleviates KOA, possibly via inhibiting NGF/TrkA pathway activation in knee joints and reducing TrkA expression in CGRP+ sensory neurons, supporting the therapeutic potential of EA for KOA.

Myocardial ischemia (MI) remains a major clinical challenge, and the therapeutic potential of electroacupuncture (EA) is constrained in practice by repeated needle insertion, poor repeatability of acupoint localization, and limited long-term patient compliance. To overcome these barriers, we developed a minimally invasive implantable EA (IEA) system based on carbon nanotube fiber (CNTF) electrodes via a minimally invasive, ultrasound-guided procedure to establish a 'single-implantation, long-term stimulation' strategy, delivering both sustained mild stimulation and conventional EA at the Neiguan (PC6) acupoint. Results demonstrated that CNTFs with a diameter of 20-30μm, a conductivity of (2.64 ± 0.95) × 105S m-1, a charge storage capacity of 13.09 ± 2.79 mC cm-2, and an impedance of 133.48 ± 69.88 Ω at 1 kHz represented the balanced trade-off for performance. Within the 14 d observation period, CNTF implantation at PC6 did not induce obvious local inflammatory infiltration or pathological tissue alterations. In a rat model of isoproterenol-induced MI, the IEA system markedly improved cardiac electrophysiology attenuated cardiac remodeling and reduced serum cTnT levels demonstrating superior therapeutic effects compared with conventional EA. Kinetic analysis of electrophysiological data revealed that daily IEA facilitated faster effect accumulation and consolidation, favoring acute- or subacute-phase management, whereas alternate-day IEA achieved a higher therapeutic ceiling, suggesting its superiority for maximizing long-term functional recovery. These results provided a rationale for session-frequency-personalized therapy. Furthermore, the cardioprotective effect was mediated through the downregulation of the FXR/SHP apoptotic pathway, validated by pharmacological inhibition. This work established a safe, effective, and stable platform that merged advanced bioelectronic materials with traditional acupuncture theory, providing a promising translational solution for the chronic, home-based rehabilitation of heart disease or other diseases, particular for elderly, paralyzed, or those with limited mobility and access to clinical care.

BACKGROUND: Connectional “diaschisis” theory indicates that the remote functional network disconnection resulting from focal white matter damage contributes to the cognitive dysfunction in vascular cognitive impairment and dementia (VCID). Acupuncture has been reported to attenuate white matter lesions and improve cognitive dysfunction of VCID individuals. However, whether these benefits are associated with the connectional diaschisis remains unclear. METHODS: Here, 12-time acupuncture treatment was administered to the rat model of VCID. After behavioral tests, functional and diffusion magnetic resonance imaging were performed to analyze the connectivity of brain networks and white matter integrity. Pathological changes in myelin loss, axon injury, and glial activation were also observed. To clarify the interrelation of function and structure, correlation and mediation analyses were conducted. RESULTS: Acupuncture ameliorated spatial working memory loss, reconnected the disruption of the default mode network, and prevented myelin and axon in the corpus callosum from the inflammatory attack. The association between restored corpus callosum integrity and spatial working memory was partially mediated by the increased functional connectivity of the anterior cingulate cortex. CONCLUSIONS: These evidence suggest that rewiring the corpus callosum-anterior cingulate cortex axis may be an integrated mechanism for the acupuncture effects on brain structure and function in VCID.

AIMS:This study aimed to elucidate the potential mechanism, especially neural circuit mechanisms, through which electroacupuncture (EA) mitigates cognitive decline in a rat model of vascular cognitive impairment (VCI). METHODS:Using a rat two-vessel occlusion (2VO) model, we assessed the therapeutic impact of EA on spatial and non-spatial memory. We integrated in vivo fiber photometry and immunofluorescence to monitor neuronal activities in the dentate gyrus (DG) and supramammillary nucleus (SuM), while Golgi staining was employed to evaluate hippocampal synaptic plasticity. Viral tracing and chemogenetic manipulations were utilized to characterize the functional necessity of the SuMGlu-DG circuit. RESULTS:EA at ST36 significantly restored learning and memory function. This functional recovery was accompanied by improved synaptic plasticity and heightened neuronal activity in the DG. Fiber photometry revealed that EA specifically activated glutamatergic neurons in the SuM, a key upstream regulator of the DG. Notably, targeted chemogenetic inhibition of the SuMGlu-DG circuit abolished the cognitive improvements typically induced by EA. CONCLUSION:Our findings demonstrate that EA ameliorates learning and memory deficits in VCI through regulating the SuMGlu-DG circuit.

OBJECTIVE:To assess the impact of body mass index (BMI) on the effectiveness of acupuncture in treating postprandial distress syndrome (PDS). METHODS:Data from 278 patients enrolled in a prior multicenter, randomized, sham-controlled trial were analyzed in this secondary study. Patients were classified into three groups according to baseline BMI: low, normal, and high. The primary outcome was the response rate after 4 weeks of treatment. The χ2 test was used to examine the effect of BMI on acupuncture efficacy. After multiple imputation for missing data, logistic regression analysis was performed to evaluate this association. A sensitivity analysis was conducted by combining the low and normal BMI groups. In addition, BMI was analyzed as a continuous variable using logistic regression to explore its relationship with treatment efficacy in the acupuncture group. RESULTS:The χ2 test revealed a statistically significant difference, with the acupuncture group demonstrating a markedly higher response rate than the sham group (82.91% vs51.79%, χ2 = 25.34, P <0.001). In both the normal and high BMI categories, the response rate in the acupuncture group (82.91%) was higher than that in the sham acupuncture group (48.21%) (χ2 = 25.34, P <0.001). Following multiple imputation, logistic regression analysis demonstrated a significant overall association between BMI category and treatment response (P <0.001). Acupuncture showed superior efficacy compared with sham acupuncture [OR =1.97, 95% CI(1.34, 2.90), P <0.001]. At week 4, response rates were 68.4% in the low BMI group, 81.7% in the normal BMI group, and 96.3% in the high BMI group (χ2= 6.303, P =0.043). A significant difference was observed only between the low and high BMI groups (χ2 = 6.717, P =0.010). Sensitivity analysis showed that the high BMI group achieved significantly better outcomes than the non-high BMI group in elimination rates at week 8 and week 12 (χ2 = 4.571, P =0.033; χ2 = 4.589, P =0.032). Logistic regression analysis indicated that BMI was an independent predictor of response rate at week 4 [OR =1.186, 95% CI(1.010, 1.394), P =0.038] and elimination rate at week 12 [OR =1.126, 95% CI(1.002, 1.265), P =0.047], whereas no significant associations were observed at other follow-up points. CONCLUSION:This subgroup analysis indicated that acupuncture improved PDS symptoms across different BMI categories. Acupuncture was suggested as a viable therapeutic option for patients with PDS, particularly those with a higher BMI.

Pain perception arises from integrated corticospinal circuits, yet most neuroimaging biomarkers are brain centric. We develop the Corticospinal Pain Intensity Pattern, a multivariate model trained and validated on 330 simultaneous corticospinal fMRI data. Across independent datasets, the model predicts pain intensity more accurately than cortical signatures and generalizes to electrical pain, while remaining insensitive to itch and observed pain. The model further tracks analgesia induced by transcutaneous electrical nerve stimulation in healthy participants. In a chronic pain cohort, corticospinal model expression derived from low-frequency spontaneous activity predicts baseline pain and longitudinal changes closely mirror treatment-induced pain relief. A corticospinal hidden Markov model reveals that dynamic transitions between pro- and anti-nociceptive states underpin static spectral abnormalities. Together, these findings establish a corticospinal biomarker that bridges experimental and clinical pain by linking task-evoked and spontaneous neural activity.

AIM:Patients suffering from neuropathic pain often experience sympathetic dysfunction. Acupuncture has shown promise in alleviating pain and modulating the activity of the autonomic nervous system. This study aims to explore the potential mechanism through which electroacupuncture (EA) modulates sympathetic nerves to alleviate neuropathic pain. METHODS:Spared nerve injury (SNI) was utilized to induce neuropathic pain. EA was administered at acupoints Huantiao and Yanglingquan for 30 min every other day after SNI. Pain behavior was evaluated using paw withdrawal thresholds (PWTs) and spontaneous pain scores. Various techniques including immunofluorescence, viral tracing, electrophysiology, and chemogenetic manipulations were employed to investigate the impact of EA on the sympathetic nerves and pain behaviors, specifically through the nucleus tractus solitarii (NTS)Glu-rostral ventrolateral medulla (RVLM) circuit. RESULTS:In SNI rats, EA alleviated both mechanical and spontaneous pain, diminished sympathetic nerve excitability, and inhibited sympathetic nerve sprouting within the dorsal root ganglia (DRG), reduced the excitability of glutamatergic neurons in the NTS which project to the RVLM. Chemogenetic inhibition of the NTSGlu-RVLM circuit produced the same effect as EA in spontaneous pain, sympathetic nerve excitability, extracellular discharge frequency in RVLM, but not in mechanical pain. Similarly, chemogenetic activation of the NTSGlu-RVLM circuit negated the analgesic effects of EA on spontaneous pain while not affecting mechanical pain. CONCLUSIONS:This study suggested that EA alleviates spontaneous pain rather than mechanical pain by regulating the sympathetic nerve activity via the NTSGlu-RVLM circuit.

Objective: To investigate the relationship between the composition of traditional Chinese medicine (TCM) and depression/anxiety/sleep disturbances (D/A/S) in patients with chronic pain. Methods: This cross-sectional study was conducted at 13 tertiary hospitals across China, enrolling patients who experienced chronic pain between November 2023 and May 2024. The Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Pittsburgh Sleep Quality Index, and TCM constitution categories were used to assess the patients. The association between the TCM constitution and the D/A/S ratio was analyzed using multivariable logistic regression. Results: A total of 1107 patients (63.2% women) were analyzed. Compared with those with a balanced constitution, patients who had qi-deficiency and yin-deficiency were at a higher risk of depression. Qi-deficiency and yin-deficiency were associated with anxiety. Sleep disturbances were common in patients with qi-deficiency constitution (odds ratio [OR]: 2.32, 95% confidence interval [CI]: 1.42–3.81), yang-deficiency constitution (OR: 1.94, 95% CI: 1.26–2.98), yin-deficiency constitution (OR: 2.03, 95% CI: 1.24–3.32), blood stasis constitution (OR: 2.07, 95% CI: 1.01–4.22), and qi-stagnation constitution (OR: 2.66, 95% CI: 1.35–5.25). Conclusion: In patients with chronic pain, specific TCM constitutions may be associated with D/A/S. Further longitudinal studies are needed to clarify the potential causal relationships between TCM constitution types and these conditions.

The expanding knowledge on the involvement of the autonomic nervous system in regulating digestive tract homeostasis is shedding new light on the therapeutic potential of acupuncture. This review aims to evaluate the effectiveness and autonomic nervous system associated mechanisms of acupuncture in gastrointestinal dysmotility in both laboratory and clinical settings, guiding future studies. Mechanistically, studies with animal models and human subjects demonstrated that acupuncture, as a non-invasive somatosensory stimulation, can help improve gastrointestinal dysmotility via directly modulating the activation of autonomic nervous system. Additionally, acupuncture has been found to suppress inflammatory response and alter the secretion of gastrointestinal hormones via different somatic autonomic reflex pathways. Importantly, the therapeutic effects of acupuncture are affected by, and even rely on, the selected acupoints, the frequency and intensity of stimulation, type of gastrointestinal disorders, and the treatment frequency. Meanwhile, clinical studies indicated that acupuncture shows promise in alleviating gastrointestinal dysmotility from the esophagus to the colon, including conditions like gastroparesis, functional dyspepsia, postoperative ileus, irritable bowel syndrome, and chronic functional constipation. We argued against a narrow classification of abdominal and hindlimb acupoints as solely activating sympathetic or vagal nerve to decrease or increase gastrointestinal motility, respectively. Lastly, incorporating new technologies will assist to reveal central autonomic network changes in response to acupuncture stimulation.

Subjective cognitive decline (SCD) is a potential early marker of cognitive decline and dementia. The amygdalohippocampal structure and function are closely related to cognitive decline, but few studies have investigated large-scale amygdalohippocampal brain functional network connectivity in individuals with SCD. Here, we aim to explore how the dynamic functional network connectivity (dFNC) between the amygdalohippocampal complex and other brain networks contributes to the understanding of early cognitive decline. Independent component analysis (ICA) and dFNC analysis were applied to functional magnetic resonance imaging (fMRI) data from 66 individuals with SCD to extract the amygdalohippocampal complex and identify distinct connectivity states. Cognitive performance was assessed through a composite Z score derived from a battery of neuropsychological tests. Correlation analyses were performed to examine the associations between the dFNC patterns and cognitive performance. Three distinct dFNC states were identified, each characterized by varying levels of within- and inter-network connectivity, with occurrences of 65%, 18%, and 17% respectively. Cognitive function, measured using a composite Z score, was positively correlated with amygdalohippocampal-sensorimotor network (SM) and amygdalohippocampal-visual network (VI) dFNC in State 2. Significant correlations were observed between the amygdalohippocampal complex and the left precentral gyrus ( r  = 0.517, FDR-corrected p  = 0.005), postcentral gyrus ( r  = 0.487, FDR-corrected p  = 0.034), and multiple visual network regions, including the lingual gyrus and lateral occipital cortex (all P s < 0.05, FDR-corrected). These associations remained significant after adjusting for sex and age. These findings extend the current understanding of amygdalohippocampal dysfunction in cognitive decline and demonstrate that cognitive function is associated with distinct large-scale amygdalohippocampal network dynamics.

Breast cancer is the most prevalent cancer worldwide, and nearly 30