Xiao-Yu Wang

Transcutaneous auricular vagus nerve stimulation as a complementary therapy for pediatric epilepsy: a pilot trial.

OBJECTIVE We investigated the safety and efficacy of transcutaneous auricular vagus nerve stimulation (ta-VNS) for the treatment of pediatric epilepsy. METHODS Fourteen pediatric patients with intractable epilepsy were treated by ta-VNS of the bilateral auricular concha using an ear vagus nerve stimulator. The baseline seizure frequency was compared with that after 8weeks, from week 9 to 16 and from week 17 to the end of week 24, according to the seizure diaries of the patients. RESULTS One patient dropped out after 8weeks of treatment due to lack of efficacy, while the remaining 13 patients completed the 24-week study without any change in medication regimen. The mean reduction in seizure frequency relative to baseline was 31.83% after week 8, 54.13% from week 9 to 16 and 54.21% from week 17 to the end of week 24. The responder rate was 28.57% after 8weeks, 53.85% from week 9 to 16 and 53.85% from week 17 to the end of week 24. No severe adverse events were reported during treatment. CONCLUSION Transcutaneous auricular VNS may be a complementary treatment option for reducing seizure frequency in pediatric patients with intractable epilepsy and should be further studied.

Auricular Acupuncture and Vagal Regulation

Auricular acupuncture has been utilized in the treatment of diseases for thousands of years. Dr. Paul Nogier firstly originated the concept of an inverted fetus map on the external ear. In the present study, the relationship between the auricular acupuncture and the vagal regulation has been reviewed. It has been shown that auricular acupuncture plays a role in vagal activity of autonomic functions of cardiovascular, respiratory, and gastrointestinal systems. Mechanism studies suggested that afferent projections from especially the auricular branch of the vagus nerve (ABVN) to the nucleus of the solitary tract (NTS) form the anatomical basis for the vagal regulation of auricular acupuncture. Therefore, we proposed the “auriculovagal afferent pathway” (AVAP): both the autonomic and the central nervous system could be modified by auricular vagal stimulation via projections from the ABVN to the NTS. Auricular acupuncture is also proposed to prevent neurodegenerative diseases via vagal regulation. There is a controversy on the specificity and the efficacy of auricular acupoints for treating diseases. More clinical RCT trials on auricular acupuncture and experimental studies on the mechanism of auricular acupuncture should be further investigated.

Are Primo Vessels (PVs) on the Surface of Gastrointestine Involved in Regulation of Gastric Motility Induced by Stimulating Acupoints ST36 or CV12

Previous studies showed primo vessels (PVs), which were referred to as Bonhan ducts (BHDs) and a part of circulatory system by Kim, located in different places of the body. The BHDs system was once considered as the anatomical basis of classical acupuncture meridian but not clearly identified by other investigators. In the present study, we tried to address the relationship between PVs and meridians through detecting the modulation of gastric motility by stimulating the PVs on the surface of stomach or intestine, as well as acupoints Zusanli (ST36) and Zhongwan (CV12). The results showed electric stimulation of the PVs had no effect on the gastric motility. While stimulating CV12 inhibited gastric motility significantly in PVs-intact and PVs-cut rats, there is no significant difference between the inhibition rate of the PVS-intact and the PVS-cut rats. Stimulating at ST36 increased gastric motility significantly in both the PVs-intact and the PVs-cut rats, yet there was no significant difference between the facilitation rate of the both groups. Taken together, the PVs on the surface of stomach or intestine did not mediate the regulation of gastric motility induced by stimulating at the acupoints ST36 or CV12.

Laser Acupuncture: Two Acupoints (Baihui, Neiguan) and Two Modalities of Laser (658 nm, 405 nm) Induce Different Effects in Neurovegetative Parameters

There are only few scientific publications dealing with the basic investigation of the effects of only one or two acupoints or comparing one single point with another single point, using different stimulation methods in the same persons. The aim of this needle-controlled, randomized crossover study was to investigate the neurovegetative parameters heart rate (HR) and heart rate variability (HRV) using two different acupoints, Baihui (GV20) and Neiguan (PC6), in separate sessions. We investigated 11 healthy volunteers (3 m, 8 f) with a mean age ± SD of 22.9 ± 2.8 years. The two acupoints were stimulated for 10 minutes each with manual needle acupuncture, red laser acupuncture (658 nm), and violet laser acupuncture (405 nm), in randomized order. Needle and red laser stimulation of the Baihui acupoint decreased HR significantly. Only violet laser stimulation at the Neiguan acupoint induced a significant increase of total HRV. Further studies using other neurovegetative parameters and more volunteers are necessary to confirm the preliminary results.

Intravenous Laser Blood Irradiation, Interstitial Laser Acupuncture, and Electroacupuncture in an Animal Experimental Setting: Preliminary Results from Heart Rate Variability and Electrocorticographic Recordings

This is the first study to investigate intravenous (i.v.) laser blood irradiation, interstitial (i.st.) laser acupuncture, and electroacupuncture (EA) in combination with heart rate variability (HRV) and electrocorticogram. We investigated 10 male anesthetized Sprague-Dawley rats under the three conditions mentioned previously in Beijing, China, and data analysis was performed in Graz, Europe. For i.v. laser stimulation in the femoral vein and i.st. laser acupuncture at Neiguan (PC6), we used a European system (Modulas needle, Schwa-Medico, Germany; 658 nm, 50 mW, continuous wave mode), and for EA at Neiguan, a Chinese system (Hanshi-100A; Nanjing Jisheng Medical Technology Company, China; 15 Hz, 1 mA). HR, HRV, and electrocorticogram were recorded using a biophysical amplifier AVB-10 (Nihon-Kohden, Japan). HR changed significantly during i.st. laser acupuncture stimulation of Neiguan in anesthetized rats. Total HRV increased insignificantly during i.v. and i.st. laser stimulation. The LF/HF ratio showed significant changes only during i.v. laser blood irradiation. Integrated cortical EEG (electrocorticogram) decreased insignificantly during EA and i.v. laser blood irradiation. Further studies concerning dosage-dependent alterations are in progress.

Intensity-response effects of electroacupuncture on gastric motility and its underlying peripheral neural mechanism.

The aim of this study was to explore the “intensity-response” relationship between EAS and the effect of gastric motility of rats and its underlying peripheral neural mechanism by employing ASIC3 knockout (ASIC3−/−), TRPV1 knockout (TRPV1−/−), and C57BL/6 mice. For adult male Sprague-Dawley (n = 18) rats, the intensities of EAS were 0.5, 1, 3, 5, 7, and 9 mA, respectively. For mice (n = 8 in each group), only 1 mA was used, by which C fiber of the mice can be activated. Gastric antrum motility was measured by intrapyloric balloon. Gastric motility was facilitated by EAS at ST36 and inhibited by EAS at CV12. The half maximal facilitation intensity of EAS at ST36 was 2.1–2.3 mA, and the half maximal inhibitory intensity of EAS at CV12 was 2.8 mA. In comparison with C57BL/6 mice, the facilitatory effect of ST36 and inhibitive effect of CV12 in ASIC3−/− mice decreased, but the difference was not statistically significant (P > 0.05). However, these effects in TRPV1−/− mice decreased significantly (P < 0.001). The results indicated that there existed an “intensity-response” relationship between EAS and the effect of gastric motility. TRPV1 receptor was involved in the regulation of gastric motility of EAS.

Manual Acupuncture and Laser Acupuncture for Autonomic Regulations in Rats: Observation on Heart Rate Variability and Gastric Motility

This study focused on the effects of laser acupuncture (LA) and manual acupuncture (MA) at different acupoints on gastric motility and heart rate variability (HRV) simultaneously to elucidate the site specific effects of acupoints and the correlation between changes of gastric motility and low frequency/high frequency (LF/HF) ratio. Gastric motility and HRV were recorded before and during MA or LA. Stimulating PC-6 or ST-36 significantly enhanced gastric motility, while BL-21 caused no changes. In contrast, MA or LA at CV-12 significantly suppressed gastric motility. Stimulating PC-6 or ST-36 significantly increased heart rate (HR), while CV-12 or BL-21 induced no significant changes of HR. Stimulating PC-6 significantly increased LF/HF, while ST-36, CV-12, or BL-21 induced no significant effects. These results indicated that there was acupoint specificity in the effects of acupuncture on gastric motility and HRV. The stimulatory effect of MA and LA at PC-6 and ST-36 on HR was associated with sympathetic activity. The stimulatory effect of MA or LA at PC-6 or ST-36 on gastric motility was associated with vagal activity. Laser needle can be used as an alternative stimulation therapy.

Local cutaneous nerve terminal and mast cell responses to manual acupuncture in acupoint LI4 area of the rats.

Previous studies have shown that the effects of manual acupuncture (MA) are contributed by collagen fibers and mast cells in local acupoints, at which acupuncture stimulation causes various afferent fiber groups to be excited. However what happens in local nerve fibers and mast cells after MA remains unclear. The aim of this study was to examine the response of cutaneous nerve fibers and mast cells to MA stimulation in acupoint Hegu (LI4). The contralateral LI4 of the same rat was used as a non-stimulated control. Immnohistochemistry analysis were carried out to observe the expression of histamine (HA), serotonin (5-HT) and nociceptive neuropeptides, calcitonin gene-related peptide (CGRP) and substance P (SP), in the LI4 area. Mast cells were labeled with anti-mast cell tryptase antibody and simultaneously with HA or 5-HT primary antibodies to observe their co-expression. Our results showed that SP and CGRP were expressed more highly on the cutaneous nerve fibers of LI4 after MA stimulation than that of the control. Mast cells aggregated in close proximity to the blood vessels in intra-epidermis and dermis and some of them with degranulation in the lower dermis and subcutaneous tissue of LI4. Both mast cells and their granules appeared with HA (+) and 5-HT (+) expression at stimulated L14 sites, while a few intact mast cells with a little expression of 5-HT and HA were distributed in areas of non-stimulated L14. The results indicated that local cutaneous nerve terminals and mast cells responded to MA with higher expression of SP and CGRP in nerve fibers, as well as with aggregation and degranulation of mast cells with HA and 5-HT granules at acupoint LI4. These neuroactive substances may convey signals to certain pathways that contribute to the effects of acupuncture.

Effectiveness of Interstitial Laser Acupuncture Depends upon Dosage: Experimental Results from Electrocardiographic and Electrocorticographic Recordings

The purpose of this study was to evaluate the influence of the duration of interstitial laser acupuncture therapy effects on neurovegetative and neurobioelectrical parameters like heart rate (HR), heart rate variability (HRV), and electroencephalogram (EEG). We investigated 6 male Sprague-Dawley rats. They underwent 10 min, 20 min, and 30 min interstitial laser acupuncture (in randomized order, with a break of at least 30 min between the different measurement conditions) at the acupoint Neiguan. HR changed significantly only during 20 min red laser stimulation, whereas 10 and 30 min stimulation did not induce significant changes. HRV did not change significantly during any of the different durations; however, an increase was found during 20 min irradiation. Neither the LF/HF ratio of HRV nor the integrated EEG showed significant changes. In this study, it could be experimentally proved that some effects of laser acupuncture are time dependent, and therefore the dosage, as well known from theory, also depends on the time factor. We could especially demonstrate that different treatment times lead to different effects on neurovegetative and neurobioelectrical parameters. Further studies are needed to verify or refute these results.

Somatosensory Nerve Fibers Mediated Generation of De-qi in Manual Acupuncture and Local Moxibustion-Like Stimuli-Modulated Gastric Motility in Rats

The aim of this study was to reveal the somatosensory nerve fibers mediated generation of De-qi in manual acupuncture stimuli (MAS) and local moxibustion-like stimuli (LMS). The effects of strong and slight MAS, as well as 41°C, 43°C, and 45°C LMS at ST36 and CV12 on gastric motility were observed in rats. Gastric motility was continuously measured by an intrapyloric balloon, and the average amplitude, integral, and frequency of gastric motility during LMS were compared with those of background activity. Gastric motility was facilitated by MAS and LMS at ST36 and inhibited at CV12. The modulatory effects induced by strong MA with potent De-qi (needle grasp feeling) were markedly higher than those by slight MA with mild De-qi sensation (P < 0.05). The nociceptive 43°C and 45°C LMS, rather than nonnociceptive 41°C LMS, produced significant regulatory effects on gastric motility. Based on the afferent fibers activated in the present study, these results support the hypothesis that Aδ- and C-afferent fibers were more likely to be involved in the generation of De-qi sensation.