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      Acupuncture points can be identified as cutaneous neurogenic inflammatory spots

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          Abstract

          Acupuncture, a traditional medical procedure practised for over 2000 years in Asia, stimulates specific but poorly defined sites called acupoints. To date, no unique anatomical acupoint structures have been found. However, noxious sensory signals from visceral organs produce hypersensitive spots on the skin (neurogenic spots), caused by cutaneous neurogenic inflammation, in the dermatome that overlaps with visceral afferent innervations. Here, we show that an acupoint is one form of neurogenic inflammation on the skin. Various studies have demonstrated that acupoints show mechanical hypersensitivity and have high electrical conductance. Stimulation of acupoints produces needling sensations caused by the activation of small diameter afferent nerve fibres and therapeutic effects on the associated visceral organs, which is likely due to the release of endogenous opioids. The present study provides experimental evidence that neurogenic spots exhibit all the characteristics of the acupoints listed above. In addition, the stimulation of neurogenic spots by electrical, mechanical, or chemical means alleviated pathological conditions in rat colitis and hypertension models via the endogenous opioid system. Our results suggest that acupoints associated with internal organs may be identical to neurogenic inflammatory spots on the skin, which are produced by activation of somatic afferents in abnormal conditions of visceral organs.

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          Characterization of the "deqi" response in acupuncture

          Background Acupuncture stimulation elicits deqi, a composite of unique sensations that is essential for clinical efficacy according to traditional Chinese medicine (TCM). There is lack of adequate experimental data to indicate what sensations comprise deqi, their prevalence and intensity, their relationship to acupoints, how they compare with conventional somatosensory or noxious response. The objective of this study is to provide scientific evidence on these issues and to characterize the nature of the deqi phenomenon in terms of the prevalence of sensations as well as the uniqueness of the sensations underlying the deqi experience. Methods Manual acupuncture was performed at LI4, ST36 and LV3 on the extremities in randomized order during fMRI in 42 acupuncture naïve healthy adult volunteers. Non-invasive tactile stimulation was delivered to the acupoints by gentle tapping with a von Frey monofilament prior to acupuncture to serve as a sensory control. At the end of each procedure, the subject was asked if each of the sensations listed in a questionnaire or any other sensations occurred during stimulation, and if present to rate its intensity on a numerical scale of 1–10. Statistical analysis including paired t-test, analysis of variance, Spearman's correlation and Fisher's exact test were performed to compare responses between acupuncture and sensory stimulation. Results The deqi response was elicited in 71% of the acupuncture procedures compared with 24% for tactile stimulation when thresholded at a minimum total score of 3 for all the sensations. The frequency and intensity of individual sensations were significantly higher in acupuncture. Among the sensations typically associated with deqi, aching, soreness and pressure were most common, followed by tingling, numbness, dull pain, heaviness, warmth, fullness and coolness. Sharp pain of brief duration that occurred in occasional subjects was regarded as inadvertent noxious stimulation. The most significant differences in the deqi sensations between acupuncture and tactile stimulation control were observed with aching, soreness, pressure and dull pain. Consistent with its prominent role in TCM, LI4 showed the most prominent response, the largest number of sensations as well as the most marked difference in the frequency and intensity of aching, soreness and dull pain between acupuncture and tactile stimulation control. Interestingly, the dull pain generally preceded or occurred in the absence of sharp pain in contrast to reports in the pain literature. An approach to summarize a sensation profile, called the deqi composite, is proposed and applied to explain differences in deqi among acupoints. Conclusion The complex pattern of sensations in the deqi response suggests involvement of a wide spectrum of myelinated and unmyelinated nerve fibers, particularly the slower conducting fibers in the tendinomuscular layers. The study provides scientific data on the characteristics of the 'deqi' response in acupuncture and its association with distinct nerve fibers. The findings are clinically relevant and consistent with modern concepts in neurophysiology. They can provide a foundation for future studies on the deqi phenomenon.
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            Sham acupuncture may be as efficacious as true acupuncture: a systematic review of clinical trials.

            This study sought to determine whether sham acupuncture is as efficacious as true acupuncture, as defined by traditional acupuncture theories. A systematic review was conducted of clinical trials that used sham acupuncture controls with needle insertion at wrong points (points not indicated for the condition) or non-points (locations that are not known acupuncture points). This study used a convenience sample of 229 articles resulting from a PubMed search using the keyword "acupuncture" and limited to "clinical trials" published in English in 2005 or 2006. Studies were categorized by use of wrong points versus non-points and the use of normal insertion and stimulation versus superficial insertion or minimal stimulation. Thirty-eight acupuncture trials were identified. Most studies (22/38 = 58%) found no statistically significant difference in outcomes, and most of these (13/22 = 59%) found that sham acupuncture may be as efficacious as true acupuncture, especially when superficial needling was applied to non-points. The findings cast doubt on the validity of traditional acupuncture theories about point locations and indications. Scientific rationales for acupuncture trials are needed to define valid controls, and the theoretical basis for traditional acupuncture practice needs to be re-evaluated.
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              Paradoxes in Acupuncture Research: Strategies for Moving Forward

              In November 2007, the Society for Acupuncture Research (SAR) held an international symposium to mark the 10th anniversary of the 1997 NIH Consensus Development Conference on Acupuncture. The symposium presentations revealed the considerable maturation of the field of acupuncture research, yet two provocative paradoxes emerged. First, a number of well-designed clinical trials have reported that true acupuncture is superior to usual care, but does not significantly outperform sham acupuncture, findings apparently at odds with traditional theories regarding acupuncture point specificity. Second, although many studies using animal and human experimental models have reported physiological effects that vary as a function of needling parameters (e.g., mode of stimulation) the extent to which these parameters influence therapeutic outcomes in clinical trials is unclear. This White Paper, collaboratively written by the SAR Board of Directors, identifies gaps in knowledge underlying the paradoxes and proposes strategies for their resolution through translational research. We recommend that acupuncture treatments should be studied (1) “top down” as multi-component “whole-system” interventions and (2) “bottom up” as mechanistic studies that focus on understanding how individual treatment components interact and translate into clinical and physiological outcomes. Such a strategy, incorporating considerations of efficacy, effectiveness and qualitative measures, will strengthen the evidence base for such complex interventions as acupuncture.
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                Author and article information

                Contributors
                chyang@dhu.ac.kr
                hykim@dhu.ac.kr
                Journal
                Sci Rep
                Sci Rep
                Scientific Reports
                Nature Publishing Group UK (London )
                2045-2322
                9 November 2017
                9 November 2017
                2017
                : 7
                : 15214
                Affiliations
                [1 ]ISNI 0000 0004 1790 9085, GRID grid.411942.b, College of Korean Medicine, Daegu Haany University, ; Daegu, 42158 Korea
                [2 ]ISNI 0000 0000 8749 5149, GRID grid.418980.c, Acupuncture, Moxibustion & Meridian Research Center, Division of Standard Research, Korea Institute of Oriental Medicine, ; Daejeon, 34054 Korea
                [3 ]ISNI 0000 0001 2171 7818, GRID grid.289247.2, Department of Physiology, School of Medicine, Kyung Hee Universirty, ; Seoul, 02447 Korea
                [4 ]ISNI 0000 0004 0533 4755, GRID grid.410899.d, Department of Physiology, School of Medicine, Wonkwang University, ; Iksan, 54538 Korea
                [5 ]ISNI 0000 0004 0533 4755, GRID grid.410899.d, Department of Meridian & Acupoint, College of Korean Medicine, Wonkwang University, ; Iksan, 54538 Korea
                [6 ]ISNI 0000 0004 1808 3289, GRID grid.412613.3, School of Mental Health, Qiqihar Medical University, ; Qiqihar, 161006 China
                [7 ]ISNI 0000 0001 1547 9964, GRID grid.176731.5, Department of Neuroscience and Cell Biology, University of Texas Medical Branch, ; Galveston, TX 77555 USA
                Author information
                http://orcid.org/0000-0001-5686-579X
                Article
                14359
                10.1038/s41598-017-14359-z
                5680247
                29123119
                30ffd575-8521-49b5-819e-fc5f69df9b79
                © The Author(s) 2017

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 24 May 2017
                : 10 October 2017
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