Hsin Hsiu

Microcirculatory characteristics of acupuncture points obtained by laser Doppler flowmetry

Acupuncture points (acupoints) form part of the meridian system that constitutes the most fundamental concept in oriental medicine, but their physiological basis has not been clarified. In this study we employed laser Doppler flowmetry (LDF) to extract the microcirculatory characteristics of acupoints and their surrounding tissues, and we interpreted the results from the viewpoint of microcirculatory physiology. Three groups of measurements were performed focusing on the following two important acupoints in oriental medicine in healthy volunteers (n = 13 for group A and n = 9 for groups B and C, respectively): Hoh-Ku (Li4, on the hand) and Ching-Ku (B64, on the foot). The two groups of measurements around Hoh-Ku (Groups A and B) were so designed as to examine the effect of the direction of the nonacupoint away from the acupoint, whereas comparison between the Hoh-Ku and the Ching-Ku measurements was to verify whether the phenomenon was consistent in the upper and the lower extremities. We found that the mean LDF signals were significantly larger at the acupoints than in their surrounding tissues (all p < 0.05), which indicates a larger blood supply into the microvascular beds of acupoints. The results indicate that the physical properties of the vascular structure of acupoints may affect the perfusion resistance, and thereby modulate the microcirculatory perfusion in accordance with tissue needs. This finding facilitates the localization of acupoints, helps in identifying the connection between microcirculatory physiology and responses to acupoint stimulation, and introduces an objective research method for understanding the mechanisms that underlie oriental medicine.

Assessing the Effects of Acupuncture by Comparing Needling the Hegu Acupoint and Needling Nearby Nonacupoints by Spectral Analysis of Microcirculatory Laser Doppler Signals

We aimed to assess the effects of acupuncture by analyzing the frequency content of skin blood-flow signals simultaneously recorded at the Hegu acupoint and two nearby nonacupoints following acupuncture stimulation (AS). Laser Doppler flowmetry (LDF) signals were measured in male healthy volunteers in two groups of experiments: needling the Hegu acupoint (n = 13) and needling a nearby nonacupoint (control experiment; n = 10). Each experiment involved recording a 20 min baseline-data sequence and two sets of effects data recorded 0–20 and 50–70 min after stopping AS. Wavelet transform with Morlet mother wavelet was applied to the measured LDF signals. Needling the Hegu acupoint significantly increased the blood flow, significantly decreased the relative energy contribution at 0.02–0.06 Hz and significantly increased the relative energy contribution at 0.4–1.6 Hz at Hegu, but induced no significant changes at the nonacupoints. Also, needling a nearby nonacupoint had no effect in any band at any site. This is the first time that spectral analysis has been used to investigate the microcirculatory blood-flow responses induced by AS, and has revealed possible differences in sympathetic nerve activities between needling the Hegu acupoint and its nearby nonacupoint. One possible weakness of the present design is that different De-Qi feelings following AS could lead to nonblind experimental setup, which may bias the comparison between needling Hegu and its nearby nonacupoint. Our results suggest that the described noninvasive method can be used to evaluate sympathetic control of peripheral vascular activity, which might be useful for studying the therapeutic effects of AS.

Microcirculatory effect of different skin contacting pressures around the blood pressure

We used laser Doppler flowmetry (LDF) and spectrum analysis to investigate the microcirculatory responses to pressure stimulation (PS) of the skin surface. A control group without PS applied, and four groups with different PS (20, 60, 100 and 160 mmHg in groups PS(20), PS(60), PS(100) and PS(160), respectively) were formed from seven volunteers. Each experiment involved recording a 20 min baseline and two effect data recorded at 0-20 and 50-70 min after stopping PS. The relative energy contribution (REC) in five frequency bands revealed by Morlet-wavelet transformation was calculated. At the pressed site, the dc component of the flux signal in the second effect increased significantly only in group PS(60) compared with the control values. The REC was significantly increased in a myogenic-related band in groups PS(60), PS(100) and PS(160), and was significantly decreased in a nerve-related band only in group PS(160). Different PS magnitudes compress vessels to different extents. The proposed vessel-pressing model-which is supported by the results of spectral analysis of flux signals-might help to elucidate the underlying mechanism. The study results indicate that an improved perfusion was sustained for the longest time when applying 60 mmHg PS. This might aid the development of techniques for improving skin microcirculatory perfusion.

Acupuncture stimulation causes bilaterally different microcirculatory effects in stroke patients.

The aim of this study was to determine the effects of acupuncture stimulation (AS) in stroke patients by analyzing the pulsatile waveform and frequency content of skin blood-flow signals recorded simultaneously on the bilateral skin surface of the head. Laser Doppler flowmetry (LDF) signals were obtained in 18 stroke patients. Each assessment involved a 20-min baseline recording, a 20-min AS, and a further 20-min recording. Significant bilateral differences in LDF parameters were noted following AS, with an increased pulsatile component of the microcirculatory blood flow (MBF), decreased blood-flow resistance, and decreased MBF variability in the vascular beds on the stroke-affected side. Spectral analysis revealed that the vasodilation on the stroke-affected side could be partly attributed to decreased sympathetic neural activity. This is the first study to demonstrate the feasibility of evaluating the cerebral MBF conditions induced by AS in stroke patients by noninvasive LDF measurement. The present skull-intact measurement setup could aid the development of noninvasive detection techniques for determining bilateral differences in the cerebral MBF, and could thus become useful for the efficacy evaluation of treatment techniques for stroke. It might also promote understanding of the mechanisms underlying the responses and possible treatment efficacy of AS as applied to stroke patients.

Differences in the microcirculatory effects of local skin surface contact pressure stimulation between acupoints and nonacupoints: possible relevance to acupressure

In the present study, laser Doppler measurement was used to quantitatively investigate the microcirculatory effects of contact pressure stimulation (PS) underneath the Hoku acupoint and its nearby nonacupoint, to improve the understanding of the mechanisms underlying acupressure therapy. A control group (no PS applied) and three experimental groups with different applied PS (group A, 60 mmHg on the Hoku acupoint; group B, 60 mmHg on a nearby nonacupoint; group C, 50 mmHg on a nearby nonacupoint) were studied. Each experiment involved recording data of a 20 min baseline and two periods of effects after stopping PS. The relative energy contribution (REC) in five frequency bands, as revealed by Morlet wavelet transformation, was calculated. At the pressed site, the average value of the laser Doppler flux signal was increased only in group A, and coefficient of variance of the amplitude sequence was only significantly decreased during measurement (M1: 0 to 20 min) in group B. The RECs of the myogenic-related band were significantly increased in groups A and C, whereas there were no significant changes found in group B. The improved microcirculatory blood-flow perfusion at Hoku may partly explain why acupressure can exert better therapeutic effects than PS applied to other sites. The laser Doppler spectra responses illustrated that the induced pressure-induced vasodilation can be attributed mainly to the myogenic response. Laser Doppler measurement and analysis therefore represent a noninvasive method of examining the microcirculatory efficacy of acupressure therapy.

Organ‐specific ligation‐induced changes in harmonic components of the pulse spectrum and regional vasoconstrictor selectivity in Wistar rats

It has been shown previously that the amplitudes of the harmonic components of the pulse spectrum vary in specific patterns when the arteries leading to different organs are ligated, with the variations in the harmonics being linearly additive. Since ligation can be regarded as a vast increase in organ resistance, the present study examined the potential of using these ligation‐induced variations in the pulse spectrum as reference parameters for an increase in vascular resistance and for regional vasoconstrictor selectivity. A vasoconstrictor, either arginine vasopressin (AVP) or angiotensin II (Ang II), was infused into anaesthetized Wistar rats via the femoral vein for 1 h. The distinct harmonic‐specific drug effects on the pulse spectrum were simulated by combining renal artery and superior mesenteric artery ligations in different ratios, the ratio with the lowest mean square difference determining the regional drug selectivity. The ratios indicated that the effect of AVP on the pulse spectrum was attributable to the combined effect of ligating the renal and superior mesenteric arteries, while the effect of Ang II was attributable to ligation of the renal artery. The results are comparable with those of investigations of regional vascular resistance performed using traditional methods. Our findings indicate that the ligation‐induced variations in the pulse spectrum can be used to determine regional increases in vascular resistance. This implies that blood pressure can be used as the sole parameter to determine which arterial bed has been affected by the vasoconstrictor, and how seriously.

Connection between RR-interval length and the pulsatile microcirculatory flow

The present study used laser Doppler flowmetry (LDF) to investigate the connection between skin microcirculatory flow and the length of the RR interval (LRR). Local heating was performed on healthy volunteers to further elucidate its effect on LDF index. ECG and LDF signals were measured in 102 trials on seven volunteers. Each experiment involved a 5 min control and a 5 min heating-effect sequence. Each laser Doppler flux pulse was categorized into four groups according to its LRR compared with the 5 min average LRR. Synchronized averaging analysis was applied to the four groups of pulses to obtain their averaged waveforms, from which four flux parameters were calculated. The ac component of the flux increased significantly with increasing LRR, and the differences therein between the groups with LRR more than 4% smaller and more than 4% larger than the average LRR increased from 15.8% during the control period to 23.9% during the heating period. Understanding of the different flux responses between the control and local-heating experiments may aid the development of a new index, which helps to avoid LDFs main drawback of providing only qualitative measurement.

Relations Between Beat-to-Beat Microcirculatory Blood Flow and Variations Therein

OBJECTIVE Analyzing the beat-to-beat cardiovascular variability (e.g., heart-rate variability analysis) provides important information regarding circulatory autonomic control. The present study aimed to use laser Doppler flowmetry (LDF) and beat-to-beat analysis to elucidate changes in the microcirculatory blood flow (MBF) and variations (MBFV) therein induced by local heating stimulation. METHOD For each experiment, we applied nonpainful local heating and recorded a 20-min heating effect, which was segmented into four measurements separated by 5 min as M1-M4. DCflux (average LDF flux) was calculated for each pulse, and the coefficient of variance of DCflux (DCCV) was then calculated to evaluate the beat-to-beat MBFV. RESULTS In the linear regression analysis of the M2-M4 data sequence, the slope between relative changes (compared with M1 values) in DCCV and DCflux, and those between the proceeding DCCV and the subsequent DCflux, were negative (R(2) > 0.40 for all; p < 0.05). CONCLUSION This is the first study to reveal a possible time-domain relationship between changes in MBF and MBFV parameters. Our results suggest that MBFV evaluated from the beat-to-beat LDF waveform is useful for monitoring the microcirculatory regulatory activities of arteriolar openings, and might therefore be particularly meaningful when evaluating treatment techniques or drugs aimed at improving microcirculatory perfusion.

Microcirculatory Changes by Laser Doppler after Infrared Heating over Acupuncture Points – Relevance to Moxibustion

BACKGROUNDS Moxibustion is a commonly used treatment in traditional Chinese medicine (TCM) that involves the application of local heating (LH) at acupoints. OBJECTIVE We used laser Doppler flowmetry (LDF) and spectrum analysis to investigate differences in the microcirculatory responses to the application of homogeneous LH at Hoku and two nearby nonacupoints. METHODS Thirty-four trials were performed on 10 male healthy volunteers. For each experiment, we recorded a 20-minute baseline data sequence, then applied LH by an infrared-radiation lamp and recorded another 20-minute heating-effect sequence. The relative energy contributions (RECs) for LDF periodic oscillations in five characteristic frequency regions from 0.0095 to 1.6 Hz (segmented into FR1-FR5) were calculated by wavelet analysis. RESULTS The flux increased significantly following LH. Decreases in RECs of FR2 and FR3, increases in RECs of FR1 and FR5, and the flux increase following LH were all largest at Hoku. CONCLUSION Our results suggest that the application of LH to acupoints induces larger therapeutic effects. This might partly account for the physiological mechanism of moxibustion, and could contribute to optimizing the microcirculatory improvement by applying LH treatments. Frequency-band analysis appears to be a promising tool for studying microcirculatory responses induced by various TCM treatments.

Effects of different contacting pressure on the transfer function between finger photoplethysmographic and radial blood pressure waveforms

Background: The blood pressure (BP) waveform is suggested to reflect the whole-body blood supply distribution, but its non-invasive assessment is not sufficiently user friendly for practical applications. The present authors studied the correlation between BP and photo-plethysmography (PPG) waveforms, with the aim of determining the optimal range for contact pressure stimulation (PS) to produce a reliable transfer function in their harmonic parameters. Methods: Finger PPG and radial-artery BP signals were measured simultaneously and non-invasively on healthy volunteers (n = 45). PS of 0–200 mmHg was applied to the finger, and 1 min data sequences were recorded. In frequency-domain analysis, linear regression was applied to the calculated amplitude ratios or the first five harmonics between BP and PPG waveforms. Results: In the 60 mmHg-PS group, the BP–PPG regression of amplitude ratios was highest, and the agreements between them were also the best verified by Bland–Altman analysis. Conclusion: In the present study, frequency-domain analysis was performed to study the correlation between BP and PPG waveforms. Differences in pressure-induced-vasodilation responses underlie the different BP-PPG waveform correlations obtained by applying different PSs. The non-invasively derived PPG parameters might help to provide an easier method to acquire the radial-artery BP waveform, and hence broaden the application of BP waveform analysis.