Jaung-Geng Lin

Acupuncture Analgesia: A Review of Its Mechanisms of Actions

The mechanism of acupuncture analgesia (AA) has been widely explored since the 1970s. Early studies investigated the relationship between acupuncture and endogenous opiates (beta-endorphin, enkephalin, endomorphin and dynorphin). Before the 1990s, most experts agreed on the concept that in normal animal models, lower frequency electroacupuncture (EA) stimulates the release of beta-endorphin, enkephalin and endomorphin, which in turn activates the mu- and delta-opioid receptors, and that higher frequency EA stimulates dynorphin which activates the kappa-opioid receptor. Besides endogenous opiates, our studies have focused on serotonin. The serotoninergic descending inhibitory pathway is suggested to be an important mechanism of acupuncture analgesic, collaborating with endogenous opiates. Many efforts have been made to clarify these mechanisms, but to date no satisfactory consensus has been reached. In the late 1990s, researchers began to focus on the different analgesic effects of EA between normal and hyperalgesic animal models. Published data from these studies imply that normal and hyperalgesic animals respond differently to EA. Results from experiments on the anti-hyperalgesia effect of EA have raised a new issue about the influences of EA on receptors to excitatory amino acid in the spinal cord level. Results from various studies have shown that these receptors play a role in the mechanism of AA. Recently, research on the autonomic nervous system (ANS) seem to indicate its connection with acupuncture. The inflammatory reflex (via the ANS) might be a crucial part of anti-hyperalgesia elicited by acupuncture, and this reflex, which regulates the immune system in the organism, can elucidate not only the mechanism of AA but also the mechanism of acupuncture applied to other inflammatory conditions. Innovation of functional image study enables us to analyze the responses of cortex on living human body to acupuncture. However, results of these experiments are still controversial. After 30 years of acupuncture research, there are still many puzzles left to be solved regarding the mechanism of AA.

The Central Serotonergic System Mediates the Analgesic Effect of Electroacupuncture on Zusanli (ST36) Acupoints

Evidence in the past decade indicates that the mechanisms of anti-nociception of electroacupuncture (EAc) involve actions of neuropeptides (i.e., enkephalin and endorphin) and monoamines (i.e., serotonin and norepinephrine) in the central nervous system. Our present results using a subcutaneous injection of formalin to test pain sensation in mice provide further understanding of the involvement of serotonin in the actions of EAc-induced analgesia. Our observations show that (1) EAc at three different frequencies (2, 10 and 100 Hz) elicited an anti-nociceptive effect as determined by behavioral observations of reduced hindpaw licking; (2) exogenously intracerebroventricular administration of 5-hydroxytryptamine (5-HT) exhibited an analgesic effect, which partially mimicked the analgesic actions of EAc; (3) the anti-nociception of EAc at different frequencies was attenuated after reduced biosynthesis of serotonin by the administration of the tryptophan hydroxylase inhibitor, P-chlorophenylalanine, and (4) the 5-HT(1A) and 5-HT(3) receptor antagonists, pindobind-5-HT(1A) and LY-278584, respectively, blocked three different frequencies of EAc-induced analgesic effects, but the anti-nociceptive effect of 100 Hz EAc was potentiated by the 5-HT(2) receptor antagonist, ketanserin. These observations suggest that 5-HT(1A) and 5-HT(3) receptors partially mediate the analgesic effects of EAc, but that the 5-HT(2) receptor is conversely involved in the nociceptive response.

Effects of severity of degeneration on gait patterns in patients with medial knee osteoarthritis

This study tested the hypothesis that patients with mild and severe medial knee osteoarthritis (OA) adopt different compensatory gait patterns to unload the deseased knee, in not only the frontal plane but also the sagittal plane. Fifteen patients with mild and 15 with severe bilateral medial knee OA, and 15 normal controls walked while the kinematic and kinetic data were measured. Compared to the normal group, both OA groups had significantly greater pelvic anterior tilt, swing-pelvis list, smaller standing knee abduction, as well as smaller standing hip flexor and knee extensor moments during stance. The severe group also had greater hip abduction, knee extension and ankle plantarflexion. The mild group successfully reduced the extensor moment and maintained normal abductor moment at the diseased knee mainly through listing and anterior tilting the pelvis. With extra compensatory changes at other joints and increased hip abductor moment, the severe group successfully reduced the knee extensor moment but failed to reduce the abductor moment. These results suggest that, apart from training of the knee muscles, training of the hip muscles and pelvic control are essential in the rehabilitative intervention of patients with knee OA, especially for more severe patients.

Effects of Berberine on Arylamine N-Acetyltransferase Activity in Human Colon Tumor Cells

Berberine was used to determine loss of viable cells and inhibition of arylamine Nacetyltransferase (NAT) activity in a human colon tumor (adenocarcinoma) cell line. The viable cells were determined by trypan blue exclusion under a light microscope. The NAT activity was measured by high performance liquid chromatography for the amounts of N-acetyl-2-aminofluorene (AAF), N-acetyl-p-aminobenzoic acid (N-Ac-PABA), and the remaining 2-aminofluorene (AF) and p-aminobenzoic acid (PABA). The viability and NAT activity in a human colon tumor cell line was inhibited by berberine in a dose-dependent manner, i.e., the higher the concentration of berberine, the higher the inhibition of NAT activity and cell death. The NAT activities measured in the intact human colon tumor cells were decreased over 50% by AAF and NAc-PABA production from acetylation of AF and PABA. The apparent values of Kmoff and Vmax of NAT from colon tumor cells were also inhibited by berberine in cytosols and in intact cells. This report is the first to show that berberine did affect human colon tumor cell NAT activity.

Using Acupressure and Montessori-Based Activities to Decrease Agitation for Residents with Dementia: A Cross-Over Trial

OBJECTIVES: To explore the effectiveness of acupressure and Montessori‐based activities in decreasing the agitated behaviors of residents with dementia.

Probable Mechanisms of Needling Therapies for Myofascial Pain Control

Myofascial pain syndrome (MPS) has been defined as a regional pain syndrome characterized by muscle pain caused by myofascial trigger points (MTrPs) clinically. MTrP is defined as the hyperirritable spot in a palpable taut band of skeletal muscle fibers. Appropriate treatment to MTrPs can effectively relieve the clinical pain of MPS. Needling therapies, such as MTrP injection, dry needling, or acupuncture (AcP) can effectively eliminate pain immediately. AcP is probably the first reported technique in treating MPS patients with dry needling based on the Traditional Chinese Medicine (TCM) theory. The possible mechanism of AcP analgesia were studied and published in recent decades. The analgesic effect of AcP is hypothesized to be related to immune, hormonal, and nervous systems. Compared to slow-acting hormonal system, nervous system acts in a faster manner. Given these complexities, AcP analgesia cannot be explained by any single mechanism. There are several principles for selection of acupoints based on the TCM principles: “Ah-Shi” point, proximal or remote acupoints on the meridian, and extra-meridian acupoints. Correlations between acupoints and MTrPs are discussed. Some clinical and animal studies of remote AcP for MTrPs and the possible mechanisms of remote effectiveness are reviewed and discussed.

Acute effect of electroacupuncture at the Zusanli acupoints on decreasing insulin resistance as shown by lowering plasma free fatty acid levels in steroid-background male rats

BackgroundInsulin sensitivity has been enhanced by electroacupuncture (EA) in rats, but the EA phenomenon in an insulin resistant state is still unclear. This study reports the use of a large dose of prednisolone to evaluate the effects of EA in a state of insulin resistance.MethodsThe plasma levels of free fatty acids (FFAs) were estimated in steroid-background rats (SBRs) and compared with those in healthy rats treated with normal saline. In addition, plasma glucose and endogenous insulin levels were assayed to calculate the homeostasis model assessment (HOMA) index. Intravenous glucose tolerance test (IVGTT) was carried out to compare glucose tolerance. The SBRs were randomly divided into EA-treatment and non-EA treatment groups and 15-Hz EA was applied to the bilateral Zusanli acupoints to investigate its effects on insulin resistance. In addition to an insulin challenge test (ICT) and IVGTT, the plasma levels of FFAs were measured and western blot was performed to help determine the effects of EA on the insulin resistant state.ResultsThe plasma levels of FFAs increased markedly in SBRs, the HOMA index was markedly higher, and glucose tolerance was impaired. EA improved glucose tolerance and insulin sensitivity by decreasing the plasma levels of FFAs. Further, the insulin signaling proteins (IRS1) and glucose transporter isoform protein (GLUT4) in skeletal muscle inhibited by prednisolone recovered after EA.ConclusionInsulin resistance was successfully induced by a large dose of prednisolone in male rats. This insulin resistance can be improved by 15 Hz EA at the bilateral Zusanli acupoints, as shown by decreased plasma levels of FFAs.

A Clinical Study of Acupuncture and SSP (Silver Spike Point) Electro-therapy for Dry Eye Syndrome

The present study was designed as a clinical trial to assess the efficacy of acupuncture and silver spike point (SSP) electro-therapy on dry eye syndrome. A total of 43 dry eye syndrome patients participated in the present study. Subjects were divided into control, acupuncture and SSP electro-therapy groups. The three groups were all given artificial tears treatment. Patients in the treatment groups were given two 20-minute treatments of either acupuncture or SSP. Assessment was carried out using the Basal Schirmer test, tear break-up time (BUT), visual analog scale (VAS) and an overall score of eye condition. After four weeks of treatment, both the acupuncture and SSP treatment groups showed improvements over the control group, in Schirmer tests of the left eye and average tearing of both eyes. After 8 weeks of treatment, both treatment groups showed improvements over the control group both in Schirmer tests and VAS. For the right eye, treatment groups showed significant improvements in Schirmer test and VAS versus the control group averages for both eyes. There was no significant difference in BUT at any time. Comparing scores before and after treatment, the acupuncture and SSP groups showed a significant improvement compared to the control group. The acupuncture group showed a greater 8-week improvement in Schirmer tests scores compared to the SSP group. However, the SSP group patients used fewer applications of artificial tears. Acupuncture and SSP electro-therapy were effective in increasing tear secretion in patients with dry eye syndrome. The SSP electro-therapy not only alleviated dry eye syndrome, but also reduced the number of applications of artificial tears necessary.

Effects of Electroacupuncture Treatment on Impaired Cognition and Quality of Life in Taiwanese Stroke Patients

BACKGROUND Osteopathic physicians believe that the birthing process causes cranial dysfunction that may be manifested in somatic symptoms, one of which is excessive crying of infancy. Cranial dysfunction can be determined by assessing the cranial rhythmic impulse (CRI). OBJECTIVE The objective of this study is to examine whether an abnormal CRI is associated with excessive crying of infancy. DESIGN Full-term infants in the well-baby nursery of an urban public hospital in the Bronx, New York were enrolled. Two (2) osteopathic physicians independently measured the CRI in infants before discharge. One (1) osteopath repeated the CRI measurement at 2 weeks. At 6 weeks, an investigator blinded to the CRI and birth data assessed infant crying using the modified Ames Cry Score via telephone interview with the primary caretaker. The caretaker was also asked about maternal stress, use of home or cultural remedies, and the infants diet. The main outcome measure was the presence of excessive crying. RESULTS One hundred and thirty-nine (139) patients were included in the final sample. The overall incidence of excessive crying was 41.7%. Excessive crying was associated with an abnormal CRI at 2 weeks (p < 0.001) but not with the CRI at birth (p = 0.23). Infants with an abnormal CRI at 2 weeks were 6.8 times (95% confidence intervals 2.2, 20.6) more likely to develop excessive crying than infants with a normal CRI. Infant diet was independently associated with excessive crying. Inter-rater agreement for CRI measurement was 0.70 using the kappa statistic. CONCLUSIONS These data suggest that an abnormal CRI at 2 weeks of age may be associated with excessive crying.

Effects of electroacupuncture in reducing weight and waist circumference in obese women: a randomized crossover trial

OBJECTIVE:To compare the effects of weight control on simple obese women between electroacupuncture and sit-up exercise.DESIGN:Randomized and crossover trial conducted from 1 January 2002 to 31 December 2002. The subjects were randomly divided into groups A and B. Group A received electroacupuncture treatment first while group B received sit-up exercise treatment first. After 6 weeks of treatment and 7 days of washout, group A switched to sit-up exercise treatment and group B received electroacupuncture treatment for another 6 weeks.PATIENTS:In total, 54 simple obese women, with waist circumference (WC)>90 cm and body mass index (BMI)>30 kg/m2, and who had not received any other weight control maneuver within the last 3 months.MEASUREMENT:The measurements of body weight (BW), BMI and WC were performed at the beginning, 6, 8 and 13 weeks. The data at different time periods were compared and expressed as % reductions.RESULTS:Electroacupuncture (n=46) showed significant differences in the % reductions in BW (P=0.001), BMI (P=0.003) and WC (P=0.005) compared with sit-up exercise. At the end of 13 weeks, there were no significant difference between groups A (n=24) and B (n=22) in all the measurements. At the end of the study, groups A and B showed significant differences in the % reductions in BW (P=0.004; 0.001), BMI (P=0.003; 0.021) and WC (P≤0.001; 0.001) compared with the initial values.CONCLUSIONS:Electroacupuncture treatment is more effective than sit-up exercise in reducing weight and WC, making it an alternative treatment option for weight and WC control on obese women.