Chronic neuropathic pain has been one of the prominent causes of disability, and acupuncture has shown promise in treatment. The present study aimed to characterize acupuncture modulation of chronic neuropathic pain and explore the related functional brain changes. Sixty chronic sciatica patients were divided into acupuncture group or sham acupuncture group and received 10 sessions of treatment during 4 weeks. The Visual Analog Scale (VAS) for leg pain, Oswestry Disability Index (ODI), and resting-state functional magnetic resonance images were assessed at baseline and after treatment. Then, fractional amplitudes of low-frequency fluctuations (fALFF) and support vector regression (SVR) analyses were performed. Compared to sham acupuncture, acupuncture significantly improved symptoms, including VAS for leg pain and ODI. In addition, acupuncture exhibited increased fALFF of the right superior parietal lobule (SPL) and right postcentral gyrus (PoCG). Furthermore, the actual 4-week ODI values were positively correlated with the SVR predicted values based on the right SPL fALFF and baseline clinical measurements. These results indicate that the spontaneous neural activity of the right SPL and right PoCG may be involved in the modulation of acupuncture in chronic neuropathic pain. In addition, the spontaneous neural activity of the right SPL might be used as the predictor of response to acupuncture therapy. Trial registration number Chinese Clinical Trial Registry, ChiCTR2100044585, http://www.chictr.org.cn Perspective This clinical neuroimaging study elucidated the neural basis of acupuncture in chronic sciatica. Neurological indicators and clinical measurements could be used as potential predictors of acupuncture response. This study combines neuroimaging and artificial intelligence techniques to highlight the potential of acupuncture for the treatment of chronic neuropathic pain.

Arrival of qi, as a major issue in the study on meridian essence and acupuncture theory system, is one of the core issues in the development of the acupuncture discipline.Arrival of qi is not only the premise of the acupuncture effect but also the key factor of treatment.With the development of modern scientific research on traditional Chinese medicine, modern science and technology such as molecular biology technology, mechanical technology, and artificial intelligence will be introduced in the future and combined with verification of arrival of qi, and objective evaluation will be conducted and combined with acupuncture effect and clinical diagnosis and treatment, so as to detail research on arrival of qi, build an evaluation system of arrival of qi by acupuncture, and jointly promote the development of acupuncture discipline.In this paper, the concept of arrival of qi, original state of acupoints, acupoint sensitization mechanism, subjective and objective evaluation, influencing factors, and the dose-effect relationship between arrival of qi and acupuncture effect are discussed.

目的:通过基于复杂网络的图论分析方法探讨慢性肩周炎患者(CSP)的脑功能连接及拓扑结构的变化.方法:选择37例CSP患者(CSP组),同期选择年龄、性别及教育程度与其相匹配的24例健康志愿者为对照组;获取2组静息态fMRI数据,采用图论分析方法分析2组大脑功能网络的差异;将2组具有显著差异的功能连接与视觉模拟量表(VAS)评分行Spearman相关分析.结果:CSP组拓扑结构参数中聚类系数和局部效率显著低于对照组(t=-3.461,P=0.001;t=-2.502,P=0.015).通过对功能连接(复杂网络的边)进行统计分析发现,与对照组相比,CSP组右侧眶内额上回与左侧枕中回、右侧前扣带和旁扣带脑回与左侧枕中回之间的功能连接增强(均P<0.05);左侧眶部额上回与右侧回直肌、左侧眶部额中回与右侧眶部额中回、左侧回直肌与右侧回直肌、左侧楔叶与右侧梭状回之间的功能连接降低(均P<0.001).CSP组左侧楔叶与右侧梭状回的功能连接值与VAS评分呈正相关(r=0.368,P=0.025).结论:CSP患者脑网络拓扑结构及功能连接发生了改变,可能与其疼痛的发生发展机制有关.

目的 基于数据挖掘技术,通过文献分析探讨针灸治疗心律失常的用穴规律及特点,为临床治疗心律失常提供一定的参考依据.方法 检索中国知网(CNKI)、万方数据库(Wangfang)、维普数据库(VIP)、PubMed、Embase、Cochrane、中国生物医学文献数据库(CBM)7个数据库,一共检索到6448篇相关文献,通过纳入、排除标准筛选得到166篇文献.采用Excel表统计针灸治疗心律失常所用腧穴的使用频次、归经、分布频次;然后运用SPSS Modeler 14.0软件进行关联规则分析并绘制网状图,最后借助SPSS 22.0软件绘制聚类分析树状图.结果 总共纳入166篇研究文献,涉及50个腧穴,使用频次前3位的腧穴由高到低依次是内关、心俞、神门,经脉选用以手厥阴心包经(176次)、手少阴心经(62次)、足太阳膀胱经(87次)为主,单个穴位使用频次最高的为内关穴,2个穴位联合使用频次最多为内关穴和心俞穴;选取的特定穴多于非特定穴,特定穴中以络穴、八脉交会穴和五输穴为主,主穴以心包经腧穴为主,配穴多选取膀胱经背俞穴;部位以四肢、胸腹部为多,关联分析结果以内关—神门、内关—心俞、内关—足三里为主,对高频穴位进行聚类分类得到三个聚类群,分别是内关为一类;心俞、神门、足三里、三阴交为一类;曲泽、下脘、间使、膈俞、涌泉、通里、大陵、百会、中脘、巨阙、关元、膻中、郄门、神道、灵台、厥阴俞、气海为一大类.结论 通过数据挖掘针灸治疗心律失常的腧穴使用规律,为临床治疗心律失常的腧穴选择提供一定的参考依据.

PURPOSE:Acupuncture has been widely used in the treatment of knee osteoarthritis (KOA), but the selection of acupoints is indeterminate and lacks biological basis. The skin temperature of acupoints can reflect the state of local tissue and may be a potential factor for guiding acupoint selection. This study aims to compare the skin temperature of acupoints between KOA patients and the healthy population.STUDY DESIGN AND METHODS:This is a protocol for a cross-sectional case-control study with 170 KOA patients and 170 age- and gender-matched healthy individuals. Diagnosed patients aged 45 to 70 will be recruited in the KOA group. Participants in the healthy group will be matched with the KOA group based on mean age and gender distribution. Skin temperature of 11 acupoints (ST35, EX-LE5, GB33, GB34, EX-LE2, ST34, ST36, GB39, BL40, SP9, SP10) will be extracted from infrared thermography (IRT) images of the lower limbs. Other measurements will include demographic data (gender, age, ethnicity, education, height, weight, BMI) and disease-related data (numerical rating scale, pain sites, duration of pain, pain descriptors, pain activities).DISCUSSION:The results of this study will provide biological evidence for acupoint selection. This study is a precondition for follow-up studies, in which the value of optimized acupoint selection will be verified.TRIAL REGISTRATION:ChiCTR2200058867.

Importance:Renal colic is described as one of the worst types of pain, and effective analgesia in the shortest possible time is of paramount importance. Objectives:To examine whether acupuncture, as an adjunctive therapy to analgesics, could accelerate pain relief in patients with acute renal colic. Design, Setting, and Participants:This single-center, sham-controlled, randomized clinical trial was conducted in an emergency department in China between March 2020 and September 2020. Participants with acute renal colic (visual analog scale [VAS] score ≥4) due to urolithiasis were recruited. Data were analyzed from October 2020 to January 2022. Interventions:After diagnosis and randomization, all patients received 50 mg/2 mL of diclofenac sodium intramuscular injection immediately followed by 30-minute acupuncture or sham acupuncture. Main Outcomes and Measures:The primary outcome was the response rate at 10 minutes after needle manipulation, which was defined as the proportion of participants whose VAS score decreased by at least 50% from baseline. Secondary outcomes included response rates at 0, 5, 15, 20, 30, 45, and 60 minutes, rescue analgesia, and adverse events. Results:A total of 115 participants were screened and 80 participants (66 men [82.5%]; mean [SD] age, 45.8 [13.8] years) were enrolled, consisting of 40 per group. The response rates at 10 minutes were 77.5% (31 of 40) and 10.0% (4 of 40) in the acupuncture and sham acupuncture groups, respectively. The between-group differences were 67.5% (95% CI, 51.5% to 83.4%; P < .001). The response rates of acupuncture were also significantly higher than sham acupuncture at 0, 5, 15, 20 and 30 minutes, whereas no significant difference was detected at 45 and 60 minutes. However, there was no difference between the 2 groups in rescue analgesia rate (difference 2.5%; 95% CI -8.8% to 13.2%; P > .99). No adverse events occurred during the trial. Conclusions and Relevance:These findings suggest that acupuncture plus intramuscular injection of diclofenac is safe and provides fast and substantial pain relief for patients with renal colic compared with sham acupuncture in the emergency setting. However, no difference in rescue analgesia was found, possibly because of the ceiling effect caused by subsequent but robust analgesia of diclofenac. Acupuncture can be considered an optional adjunctive therapy in relieving acute renal colic. Trial Registration:Chinese Clinical Trial Registry: ChiCTR1900025202.

疼痛是膝骨关节炎(knee osteoarthritis,KOA)的主要症状,也是病人寻求医疗帮助的最主要原因.近年来,关于KOA疼痛的机制研究越来越多,发现KOA疼痛的发生与炎症相关生物活性物质的释放,外周和中枢敏化密切相关.疼痛的主要分子机制包括局部免疫系统改变或机械刺激,激活伤害感受器上的受体和离子通道,导致外周敏化;脊髓免疫细胞浸润和胶质细胞的活化,使中枢神经系统发生可塑性变化,形成中枢敏化.本文通过对KOA临床前研究进行总结,简述KOA疼痛产生和维持的机制,以及现有治疗方法的镇痛原理,以期为缓解KOA疼痛提供可选择的靶点.

In order to explore the application of "patient and public involvement" (PPI) in acupuncture clinical research, the connotation, reporting standards and research status of PPI at home and abroad are collated, and the key problems of PPI encountered in acupuncture clinical research are deeply considered and summarized. It is suggested that the short-form checklist of the Guidance for Reporting Involvement of Patients and the Public (GRIPP) of the 2nd edition should be applied to acupuncture clinical research. PPI provides a new perspective for acupuncture clinical research. It is beneficial for each stage of research, contributes to the improvement of acupuncture medical service mode and increases the success rate and cost-effectiveness of research so that the innovation and development of acupuncture science can be promoted.

目的:观察针刺对主观认知下降(SCD)患者认知功能和脑局部一致性的影响.方法:纳入16例SCD患者,分为针刺治疗组与空白对照组,每组8例.针刺治疗组在相关腧穴进行针刺操作,每周2次,共12周.空白对照组不接受任何治疗.采用简易智力状态检查量表(MMSE)和蒙特利尔认知评估量表(MoCA)评分评估总体认知功能,采用静息态功能磁共振成像(fMRI)的局部一致性(ReHo)分析观察脑区功能改变.结果:与空白对照组比较,针刺治疗组能显著改善SCD患者的总体认知功能(P＜0.05).fMRI分析结果显示,与空白对照组比较,针刺治疗组能够降低前额叶皮层ReHo值,抑制前额叶皮层的活动.结论:针刺通过减弱SCD患者前额叶皮层的异常活动,发挥对SCD患者认知功能的改善作用.

近年来,随着微生物组学的飞速发展,现代医学提出了"肠-关节"轴概念."肠-关节"轴在肠道微生物和关节疾病中扮演着重要角色.肠道微生物的紊乱导致慢性系统性低度炎症,进而加重骨关节炎的病理进程.调节肠道微生物的平衡可能会通过抑制胃肠或膝关节局部的免疫炎症反应来改善膝骨关节炎的症状.笔者基于"肠-关节"轴探讨肠道微生物对膝骨关节炎的潜在影响,以及肠道微生物治疗膝骨关节炎的可行性.

Metabolic syndrome (MS) is a clinical syndrome with multiple metabolic disorders. As the diagnostic criteria for MS still lacking of imaging laboratory method, this study aimed to explore the differences between healthy people and MS patients through infrared thermography (IRT). However, the observation region of the IRT image is uncertain, and the research tried to solve this problem with the help of knowledge mining technology. 43 MS participants were randomly included through a cross-sectional method, and 43 healthy participants were recruited through number matching. The IRT image of each participant was segmented into the region of interest (ROI) through the preprocessing method proposed in this research, and then the ROI features were granulated by the K-means algorithm to generate the formal background, and finally, the two formal background were separately built into a knowledge graph through the knowledge mining method based on the attribute partial order structure. The baseline data shows that there is no difference in age, gender, and height between the two groups ( P > 0.05). The image preprocessing method can segment the IRT image into 18 ROI. Through the K-means method, each group of data can be separately established with a 43 × 36 formal background and generated a knowledge graph. It can be found through knowledge mining and independent-samples T test that the average temperature and maximum temperature difference between the chest and face of the two groups are statistically different ( P < 0.01). IRT could reflect the difference between healthy people and MS people. The measurement regions were found by the method of knowledge mining on the premise of unknown. The method proposed in this paper may add a new imaging method for MS laboratory examinations, and at the same time, through knowledge mining, it can also expand a new idea for clinical research of IRT.

目的 探索针刺治疗膝骨关节炎(KOA)试验中患者期望对于临床疗效的影响及期望相关因素,为控制相关研究影响因素及提高临床疗效提供借鉴.方法 对一项针刺治疗KOA的多中心、随机对照试验进行二次分析.将480例KOA受试者按照1∶1∶1的比例随机分为电针组、手针组和假针组.各组受试者均每周治疗3次,共治疗8周,治疗结束后随访18周.第一次针刺治疗结束后,通过可信度/期望调查问卷进行评估各组患者期望值.治疗前,治疗第4、8周,随访第8、18周进行临床指标评定,包括前期研究中的数字评价量表(NRS)评分、西安大略和麦克马斯特大学骨关节炎指数(WOMAC)功能亚表评分、总体有效率、NRS有效率和WOMAC功能亚表有效率.采用Spearman相关分析判定患者期望值与不同评价时间点临床指标的相关性.采集的可能对期望值产生影响的因素,包括治疗分组、研究中心、患者基本信息和KOA疾病相关因素,对期望值的影响因素进行单因素分析,将单因素分析结果中有统计学意义的因素应用多因素线性回归分析方法进行统计分析.结果 纳入442例受试者数据.各组间期望值差异无统计学意义(P＞0.05),因此将总体期望值与各指标进行相关分析.期望与总体有效率、WOMAC功能亚表有效率在各个时间点的相关性分析结果均未显示显著相关性(P＞0.05).期望与随访18周的疼痛NRS评分有效率呈正相关(P＜0.05);与各时间点的NRS评分呈负相关(P＜0.05);与治疗前WOMAC功能亚表评分呈正相关,与其他时间点呈负相关(P＜0.05).单因素分析结果表明,研究中心、Kellgren-Lawrence(KL)放射学分级和治疗前NRS评分这3个因素与期望值有关(P＜0.2).进一步多因素线性回归分析结果显示,针刺治疗KOA的期望与KL分级、研究中心有关(P＜0.05).KOA放射学分级越高,受试者期望越低;非北京地区的受试者期望值高于北京地区.结论 针刺治疗中期望与整个研究期间KOA受试者的NRS评分相关,且相关性可随时间延长而增加,而KL分级和研究中心为受试者期望水平的影响因素,值得研究者与临床医生予以关注.

Introduction Sciatica is a pain disorder often caused by the herniated disk compressing the lumbosacral nerve roots. Neuroimaging studies have identified functional abnormalities in patients with chronic sciatica (CS). However, few studies have investigated the neural marker of CS using brain structure and the classification value of multidimensional neuroimaging features in CS patients is unclear. Methods Here, structural and resting-state functional magnetic resonance imaging (fMRI) was acquired for 34 CS patients and 36 matched healthy controls (HCs). We analyzed cortical surface area, cortical thickness, amplitude of low-frequency fluctuation (ALFF), regional homogeneity (REHO), between-regions functional connectivity (FC), and assessed the correlation between neuroimaging measures and clinical scores. Finally, the multimodal neuroimaging features were used to differentiate the CS patients and HC individuals by support vector machine (SVM) algorithm. Results Compared to HC, CS patients had a larger cortical surface area in the right banks of the superior temporal sulcus and rostral anterior cingulate; higher ALFF value in the left inferior frontal gyrus; enhanced FCs between somatomotor and ventral attention network. Three FCs values were associated with clinical pain scores. Furthermore, the three multimodal neuroimaging features with significant differences between groups and the SVM algorithm could classify CS patients and HC with an accuracy of 90.00%. Discussion Together, our findings revealed extensive reorganization of local functional properties, surface area, and network metrics in CS patients. The success of patient identification highlights the potential of using artificial intelligence and multimodal neuroimaging markers in chronic pain research.

We thank Y.M. Li for his interest in our research. (1) We agree with that there are many differences between hard acupuncture which is mainly used in China by traditional practitioners and soft acupuncture used in the West. However, our perspective is that hard acupuncture may be superior to soft acupuncture in the majority of diseases. It is valuable to carry out comparative effectiveness research about hard acupuncture and soft acupuncture.

Background Current evidence suggests that acupuncture is an effective adjunctive therapy that can bring potential benefits to patients with cardiac arrhythmias. However, there are relevant gaps in the optimal therapeutic strategy, which may cause uncertainties on the best practice of acupuncture treatment for arrhythmia. We aim to develop consensus-based recommendations for clinical guidance on acupuncture treatment of cardiac arrhythmias. Methods A multidisciplinary panel of specialists was invited to participate in a two-round semi-open clinical issue investigation. Meanwhile, relevant literature reviews were searched in 3 databases to provide evidence. Subsequently, an initial consensus voting list on acupuncture as an adjunctive therapy for cardiac arrhythmias was derived from the clinical investigation and literature review. Finally, 30 authoritative experts reached a consensus on the key issues of the voting list by a three-round modified Delphi survey. Consensus was defined when >80% agreement was achieved. Results Following the three-round Delphi survey, there were 32 items (91.43%) finally reaching consensus, including the following 5 domains: (I) the benefits of acupuncture for the appropriate population; (II) the general therapeutic principle; (III) the acupuncture strategy; (IV) the relevant adverse events; (V) others. Conclusions Consensus was achieved on some key elements. Given the lack of guidelines and the substantial heterogeneity of previous studies, these recommendations are of value in providing guidance for clinical practice of acupuncturists and in assisting patients with arrhythmia to obtain standardized acupuncture treatment. It also pointed out some problems that need to be carefully explored in future studies.

The aim of this trial was to evaluate the feasibility and effect of home-based transcutaneous electrical acupoint stimulation (TEAS) in patients with hypertension. In this randomized pilot trial, patients with hypertension were randomly assigned to the TEAS group or the usual care group. Participants in the usual care group were instructed to continue taking their antihypertensive drugs and received education on lifestyle modifications. In addition, participants in the TEAS group received 4 weekly sessions of noninvasive acupoint stimulation for 12 weeks at home. The primary outcome was the change in office systolic blood pressure at week 12 from baseline. Withdrawal from the study and adverse events associated with TEAS were also recorded. Sixty patients were randomized, with 30 patients in the TEAS group, of whom 1 was lost at week 36, and 30 patients in the usual care group, of whom 3 were lost by week 12. The reduction in systolic blood pressure at week 12 was greater in the TEAS group (−8.53 mm Hg; 95% CI [−13.37, −3.70 mm Hg]) than in the usual care group (−1.70 mm Hg; 95% CI [−4.29, −0.89 mm Hg]), with a between-group difference of −6.83 mm Hg (95% CI, [−12.23, −1.43 mm Hg]; P = 0.014). No TEAS-related adverse events occurred. In conclusion, home-based TEAS added to usual care for patients with hypertension was acceptable and safe and may be a potential treatment option. A larger randomized controlled trial of this intervention is warranted.

Objective: Acupuncture therapy is an effective non-drug therapy for sciatica, but it has not yet formed an effective treatment strategy and recommendations. Our objective was to establish an expert consensus on acupuncture treatment of sciatica for clinical guidance based on the improved Delphi survey. Methods: A group of 80 clinical specialists was invited to participate in two rounds of semi-open clinical issue investigation. At the same time, the PubMed, Embase, and Cochrane Library databases were searched for systematic reviews on acupuncture treatment of sciatica, and the quality of evidence was evaluated. Then the three-round Delphi survey was undertaken with 30 experts based on the clinical issue investigation and systematic reviews. Results: In round 1 of the Delphi survey, the experts evaluated 17 items identified from the results of the clinical investigation and literature review. The criterion for achieving consensus was a threshold of 80% agreement. After the three-round Delphi survey, 16 items (94.12%) achieved consensus, including 5 domains: the principle of acupuncture treatment for sciatica; the "dose" of acupuncture; the clinical effects of acupuncture; the adverse effects, and others. Conclusion: This Delphi survey achieved an expert consensus on key items in the management of sciatica for acupuncture, which provides the current opinions in China. We trust that these treatment recommendations may facilitate their implementation in the future.

BACKGROUND:Sympathetic activation leads to elevated blood pressure. Neuronal nitric oxide synthase (nNOS) inhibits sympathetic nervous system activity, thereby decreasing blood pressure (BP). nNOS is highly expressed in the arcuate nucleus (ARC) and ventrolateral periaqueductal gray (vlPAG), which play essential roles in the regulation of the cardiovascular and sympathetic nervous systems.OBJECTIVE:This study was designed to verify the hypothesis that acupuncture exerts an antihypertensive effect via increasing the expression of nNOS in ARC and vlPAG of spontaneously hypertensive (SHR) rats.METHODS:Rats without anesthesia were subject to daily acupuncture for 2 weeks. BP was monitored by the tail-cuff method. nNOS expressions in the ARC and vlPAG were detected by western blot and immunofluorescence. BP was measured after 7-Nitroindazole (7-NI), a specific nNOS inhibitor, was microinjected into ARC or vlPAG in SHR rats treated with acupuncture.RESULTS:Acupuncture for 14 days significantly attenuated BP, and the Taichong (LR3) acupoint was superior to Zusanli (ST36) and Fengchi (GB20) in lowering BP. In addition, acupuncture at Taichong (LR3) induced an increase of nNOS expression in ARC and vlPAG, whereas microinjection of 7-NI into ARC or vlPAG reversed the antihypertensive effect of acupuncture.CONCLUSIONS:This study indicates that acupuncture at Taichong (LR3) induces a better antihypertensive effect than at Zusanli (ST36) or at Fengchi (GB20) in SHR rats, and enhancement of nNOS in ARC and vlPAG probably contributes to the antihypertensive effect of acupuncture.

BACKGROUND:Constipation is known as a common adverse effect of antipsychotics. Advice for its management remains inadequate. This study is designed to investigate the efficacy and safety of electro-acupuncture (EA) for antipsychotic-related constipation.METHODS:This is a single-centric, parallel-group, randomized controlled trial with blinded participants, outcome assessor, and statistician. One hundred twelve participants will be randomly assigned into the EA group or sham acupuncture (SA) group in a 1:1 ratio. The study will last for 22 weeks for each participant, including a 2-week baseline assessment period, an 8-week treatment period, and a follow-up for 12 weeks. The primary outcome is the change of mean weekly complete spontaneous bowel movements (CSBMs) during weeks 1 to 8 from baseline. Secondary outcomes include the change from baseline of mean weekly CSBMs during the follow-up period, mean weekly spontaneous bowel movements (SBMs), overall CSBM response rate, scores on Bristol Stool Form Scale (BSFS), straining level, Patient Assessment of Constipation Symptoms (PAC-SYM), Patient Assessment of Constipation Quality of life questionnaire (PAC-QOL), and Brief Psychiatric Rating Scale (BPRS). Adverse events and medicine use will be recorded as well.DISCUSSION:The study is designed based on a rigorous methodology to evaluate the efficacy and safety of EA for antipsychotic-related constipation. The finding will be published in peer-reviewed journals as reliable evidence.TRIAL REGISTRATION:ClinicalTrials.gov ChiCTR2000032582. Registered May 3, 2020, with the Chinese Clinical Trial Registry.