Acupuncture in Medicine

In the treatment of post-stroke depression (PSD), acupuncture has emerged as a therapeutic option; however, the exact mechanisms underlying its efficacy remain unclear. Prior research suggests acupuncture may improve PSD symptoms by regulating M1/M2 microglial polarization, reducing the release of inflammatory factors and inflammatory-associated damage.

The aim of the present study was to explore whether manual acupuncture (MA) can mediate microglial polarization via the silence information regulator/nuclear factor κB (Sirt1/NF-κB) pathway, thereby reducing inflammatory responses in the brains of rats exhibiting PSD and improving depressive behavior.

Thirty male rats were divided into a middle cerebral artery occlusion (MCAO) group, PSD group, PSD + MA group, PSD + MA + Sirt1 inhibitor group, and PSD + MA + NS (normal saline) group. Acupuncture was applied 6 days a week for 4 weeks at GV26, GV20 and bilateral PC6 and SP6. In the PSD + MA + Sirt1 inhibitor group, nicotinamide (NAM), a specific inhibitor of Sirt1, was slowly injected into the frontal lobe with a stereotactic injector 1 h before acupuncture. Behavioral tests were conducted after modeling and intervention, including the sucrose preference test (SPT) and open field test (OFT), and body weight was monitored. Following the tests, specimens of the dorsolateral frontal lobe were taken to evaluate molecular markers. Immunofluorescence staining was employed to determine the expression levels of M1 microglial markers CD16/Iba1 and M2 microglial markers CD206/Iba1 in the dorsolateral prefrontal cortex. mRNA expression of CD16/intrinsic nitric oxide synthase (iNOS) and CD206/arginase (Arg)-1 was detected by q-RT-PCR. Western blot analysis was used to quantify protein expression of Sirt1, total p65 and phosphorylated p65 (p-p65) proteins. Interleukin (IL)-1β, IL-6, IL-10 and tumor necrosis factor (TNF)-α levels were quantified using ELISA.

Depression-like behavior of PSD model rats was reduced by MA. Acupuncture promoted transformation of microglia from M1 to M2 in the prefrontal lobe, thereby decreasing expression of pro-inflammatory factors (IL-1β, IL-6 and TNF-α) and increasing expression of anti-inflammatory IL-10 after PSD. In addition, expression of Sirt1 in the prefrontal lobe increased following MA, while expression of p65/p-p65 was reduced, indicating activation of the Sirt1/NF-κB pathway. These findings suggest that M1 to M2 microglial polarization was closely related to Sirt1/NF-κB pathway activation following MA.

MA promoted the transformation of microglia from M1 to M2 in the prefrontal lobe of PSD rats, reduces the inflammatory response and improves depression-like behavior in rats. These effects were associated with activation of the Sirt/NF-κB pathway.

Postherpetic neuralgia (PHN) is a prevalent and painful complication following herpes zoster infection, impacting patient quality of life and posing significant treatment challenges. Current pharmacological approaches often result in adverse effects. The aim of this study was to develop a clinical prediction model for selecting PHN patients for electroacupuncture (EA) treatment and to determine the prognostic outcomes after two sessions.

We conducted a retrospective observational cohort analysis on adults diagnosed with PHN between 2010 and 2017. All participants had undergone at least two acupuncture sessions. Data analysis included demographic, clinical and treatment variables to identify predictors of treatment outcomes. Treatment success was defined using the numeric rating scale (NRS), with failure characterized by an NRS score >3. Predictive modeling and internal validation employed bootstrap resampling.

Among 243 patients included in the study, the treatment failure rate was 20.6%. Key predictive factors for treatment outcome were the presence of diabetes mellitus, use of carbamazepine and high initial NRS scores. The accuracy of the prediction model was reflected by an area under the receiver operating characteristic (ROC) curve of 0.80 after the first session and 0.88 following the third session, indicating a robust predictive capability.

In this study, we successfully developed and internally validated a clinical prediction model for EA in PHN patients. We anticipate that this model may guide clinicians in personalized patient care, optimizing the selection process for EA treatment, and predicting treatment response early in the treatment cycle.

The aim of this study was to evaluate the therapeutic effect of electroacupuncture (EA) in a rat model of stress urinary incontinence (SUI) induced by vaginal distension (VD). The potential mechanisms underlying this process were also explored.

Virgin Sprague-Dawley rats underwent VD (to model SUI) or a sham operation, followed by EA or no treatment. Cystometry and leak point pressure (LPP) testing were employed to demonstrate the impact of EA on the micturition reflex and urethral closure function. mRNA expression of α_1A and α_1D adrenoceptors and 5-hydroxytryptamine (5-HT)_2C and 5-HT_2A receptors were examined in spinal segments using real-time qRT-PCR, Western blotting and immunohistochemistry (IHC). The individual role of 5-HT_2A and 5-HT_2C receptors were distinguished with selective antagonists (MDL 100907 and SB 242084, respectively).

EA treatment successfully reversed the decrease of LPP induced by VD without any significant effect on the micturition reflex in this rat model of SUI. VD did not change bladder basic pressure (BP), voided volume or bladder contraction. Multiple approaches including qRT-PCR, Western blotting and IHC revealed over-expression of 5-HT_2C and 5-HT_2A receptors but not α_1A or α_1D adrenoceptors in the L6-S2 spinal cord of these rats. Administration of the 5-HT_2C antagonist (SB 242084) largely eliminated EA-mediated mitigation of the decrease in LLP caused by VD, while the 5-HT_2A antagonist (MDL 100907) had no effect under these conditions.

EA improves impaired urethral closure capacity induced by VD in female rats, and it appears that the 5-HT_2C receptor plays a critical role in this effect. It is reasonable to speculate that EA represents a promising treatment for SUI caused by childbirth trauma.

Patients with ankylosing spondylitis (AS), who suffer from inflammatory back pain, spend about two times more on healthcare than the general population. However, current treatments are unsatisfactory. The aim of this single-armed pilot study was to assess the feasibility of using electroacupuncture (EA) to manage AS pain that is not adequately controlled by analgesics. We hypothesized that, after 6 weeks of treatment, at least 10% of the subjects would experience a 30% reduction in their pain severity numerical rating scale (NRS) score when compared to baseline.

Twenty AS subjects who were experiencing moderate to severe pain despite usual care were recruited between March 2016 and August 2017 in Hong Kong, with two patients ultimately dropping out. Semi-standardized EA was performed on the 20 subjects twice a week for 6–10 weeks. Outcome measures were mainly examined at baseline and at weeks 6, 10 and 18. These measures included: pain severity NRS, medication use, Bath ankylosing spondylitis functional index, Bath ankylosing spondylitis disease activity index, Bath ankylosing spondylitis global index, short-form 36, Bath ankylosing spondylitis metrology index, chest expansion, swollen and painful joint count, C-reactive protein and erythrocyte sedimentation rate.

A one-sided exact binomial test showed that at least 10% of the subjects achieved a 30% pain reduction at week 6 (p = 0.002).

AS pain was decreased after 6 weeks of EA treatment. However, a randomized controlled trial with an adequate sample size is needed to confirm this finding.

NCT02697968 (ClinicalTrials.gov)

The aim of this study was to explore the potential role of microRNA (miR)-133a, the nucleotide-binding oligomerization domain, leucine-rich repeat family pyrin domain-containing 3 (NLRP3) inflammasome and Sirtuin1 (SIRT1) in the effects of electroacupuncture (EA) on disuse muscular atrophy in mice.

C2C12 cells were analyzed for protein expression of NLRP3, SIRT1, myogenin (MyoG) and myosin heavy chain protein (MyHC) after being transfected with a miR-133a-1 mimetic or miR-133a-3p inhibitor. Disuse muscular atrophy was induced in mice by tail suspension, and the mice either remained untreated (DA group) or received EA (frequency 20 Hz, intensity 1 mA, 15 min per day). The morphology of skeletal muscle was measured by muscle/body weight ratios, muscle fiber cross-sectional area (CSA) and expression of Atrogin-1 and Muscle RING finger-1 (MuRF1). miR-133a, NLRP3, apoptosis-associated speck-like protein (ASC), caspase-1 and SIRT1 were detected sequentially. Differentiation of skeletal muscle was examined by measurement of MyoG and MyHC.

In our in vitro experiments, overexpression of miR-133a downregulated the expression of NLRP3 and SIRT1, and upregulated the expression of MyoG and MyHC. In our in vivo experiments, EA effectively ameliorated muscle wet weight and fiber CSA in the mouse model of disuse muscular atrophy, and decreased Atrogin-1 and MuRF1. EA also significantly increased the expression of miR-133a, inhibited the expression of NLRP3, ASC, caspase-1 and SIRT1, and increased the expression of MyoG and MyHC.

These results indicate that EA-induced reductions of disuse muscular atrophy may be related to miR-133a. First, miR-133a may inhibit NLRP3 inflammasome activation to reduce muscle loss. Second, miR-133a may regulate SIRT1 expression to induce skeletal muscle differentiation and potentially promote muscle tissue recovery.

This aim of the study was to investigate whether electroacupuncture (EA) can mitigate osteoporosis (OP) in an ovariectomy (OVX)-induced rat model by affecting the ferroptosis-related pathway.

Thirty-two 12-week-old female Sprague-Dawley rats were randomly allocated into four groups: CONTROL, SHAM, OVX and EA. We examined the effects of OVX and EA on markers of bone resorption and formation, iron content, malondialdehyde (MDA) levels, and the expression of ferritin heavy chain 1 (FTH1), solute carrier family 7 member 11 (SLC7A11) and glutathione peroxidase 4 (GPX4). In addition, femoral morphology and immunofluorescence were analysed.

The OVX group exhibited a significant increase in bone resorption markers, iron and MDA levels, with a notable decrease in alkaline phosphatase (ALP) levels, FTH1, SLC7A11 and GPX4 expression, and impaired trabecular architecture. EA significantly reduced bone resorption markers, iron and MDA content while substantially elevating ALP levels and FTH1, SLC7A11 and GPX4 expression. At the same time, EA improved trabecular architecture.

EA ameliorated OVX-induced OP by decreasing iron accumulation and activating the SLC7A11/GPX4 axis.

Electroacupuncture (EA) pretreatment can alleviate cerebral ischemia/reperfusion (I/R) injury and mitochondrial impairment. However, the potential protective mechanism associated with mitophagy has not been well elucidated. The aim of this study was to investigate the effect of EA on FUN14 domain-containing protein 1 (FUNDC1) and mitophagy in unc-51 like kinase 1 (ULK1) knockout mice after cerebral I/R injury.

EA pretreatment was conducted at GV20 and GV26 before ischemia for 30 min over 5 consecutive days in ULK1 knockout mice that underwent modeling of cerebral I/R injury. Neurological function of the mice was assessed using Longa neurological deficit scoring. The area of cerebral infarction was measured by 2,3,5-triphenyltetrazolium (TTC) staining. Mitochondrial structural alterations were observed under transmission electron microscopy, while the mitochondria were stained using MitoTracker Green and the lysosomes were stained with Lyso Tracker Red. Changes in mitochondrial membrane potential were detected by JC-1 staining, and alterations in autophagy-related protein or gene expression were examined using Western blot analysis, qRT-PCR and immunohistochemistry.

EA-pretreated mice exhibited significantly decreased neurological deficit scores, cerebral infarct volumes and edema compared with the untreated I/R group of mice. EA pretreatment also reversed I/R-induced mitochondrial structural abnormalities and loss of mitochondrial membrane potential. Furthermore, EA pretreatment upregulated p-mTORC1 compared with no treatment. Protein and mRNA expression of ULK1, FUNDC1 and mTORC1 did not significantly differ between the groups.

EA pretreatment at GV20 and GV26 alleviated cerebral I/R injury and mitochondrial impairment in ULK1 knockout mice. Knockout of ULK1 did not completely eliminate the regulatory effect of EA.

Some complementary and integrative health (CIH) therapies are recommended for the management of chronic musculoskeletal pain, but little research has evaluated how these alternatives affect downstream healthcare utilization, including imaging costs.

Using US Department of Veterans Affairs (VA) Veterans Health Administration electronic health record data, we conducted propensity score modeling, allocating 2,215,231 Veterans with chronic pain using the VA from 2018 to 2022 into two therapy exposure groups – acupuncture with and without movement therapies (yoga or Tai Chi/Qigong) – compared with conventional care, or primary care management alone, to examine differences in imaging costs during a 6-month period following indexing. We calculated the probability of treatment in either exposure group based on demographic and clinical characteristics, and applied a nearest neighbor matching algorithm for subsequent estimation of average treatment effects.

Veterans using acupuncture with or without movement therapies had sizable baseline clinical needs and healthcare utilization. After matching, we found that imaging costs and visits were higher among Veterans using acupuncture with CIH movement therapies (cost difference $140, 95% confidence interval (CI) $97–$183; visit difference 0.37; 95% CI 0.30–0.45) and without CIH movement therapies (cost difference $155, 95% CI $147–$163; visit difference 0.34; 95% CI 0.33–0.35) during the 6-month follow-up period, compared with those using conventional care.

Veterans using acupuncture with or without CIH movement therapies had greater imaging costs than those using conventional care, possibly reflecting higher usage of healthcare among integrative therapy patients. These results also suggest unobserved patterns of comorbidity, recovery or access and/or radiology inefficiencies leading to an imaging loop effect as potential considerations for future investigation.

To describe attitudes towards acupuncture and expectations regarding potential treatment outcomes among women with self-reported primary dysmenorrhoea (PD) residing in Australia.

A cross-sectional, descriptive online survey was conducted to assess attitudes and treatment expectancy using an adapted version of previously published complementary and alternative medicine (CAM) attitude scale and a validated acupuncture expectancy scale (AES). Data were analysed descriptively, with exploratory analysis conducted to support the interpretation of response patterns. Ethical approval was obtained from the Edith Cowan University Human Research Ethics Committee (2023-04471-LIU) and participants provided electronic informed consent.

A total of 247 responses were received. Participants were mainly aged 25–30 years and largely from Western Australia. Many reported having experienced PD for more than 6 months and a range of related symptoms. Item-level analysis suggested generally favourable attitudes towards acupuncture, with 81% expressing interest in acupuncture. Treatment expectancy was moderate overall. Sensitivity and exploratory stratified analyses showed broadly comparable descriptive patterns across demographic and clinical subgroups.

Women with self-reported PD showed generally favourable attitudes towards acupuncture and moderate expectancy. Of note, this was found to be a self-selected sample with higher educational attainment that was predominantly interested in acupuncture. Findings reflect perceived acceptability rather than clinical effectiveness or population-level perspectives and should not be generalised. As attitudes were assessed using an adapted, non-validated instrument, results should be interpreted cautiously as indicative of response tendencies. Future research is needed among women not interested in acupuncture and those with a lower educational level to further explore the contextual and experiential factors that potentially shape how acupuncture is perceived and utilised.

Metformin (Met) is a first-line pharmacological treatment for type 2 diabetes mellitus (T2DM). The potential effect of combining electroacupuncture (EA) at ST25 (Tianshu) with Met in ameliorating intestinal injury remains largely unexplored.

We established wild-type (Control) and diabetic model groups that remained untreated (Model), received EA only (EA), received Met treatment only (Met) or received EA combined with Met (EA + Met), and compared markers of intestinal injury and insulin resistance, as well as effects on signal transducer and activator of transcription (STAT) proteins and microRNAs.

EA and Met treatment (alone and in combination) had positive effects on fasting plasma glucose, fasting insulin levels, Homeostatic Model Assessment–insulin resistance (HOMA-IR) indices and stool number, while fecal water content was positively impacted by EA treatment (with or without concurrent Met) but not Met alone. Hematoxylin-eosin staining demonstrated that both EA alone and EA in combination with Met appeared to repair intestinal damage in the jejunum, ileum and colon. In addition, enzyme-linked immunosorbent assay revealed that serum interleukin 10 levels were restored in all treatment groups. Furthermore, quantitative real-time polymerase chain reaction (PCR) analysis revealed that EA at ST25 resulted in the activation of STAT5A in the jejunum, as well as STAT5A, STAT5B and STAT6 in the ileum. Notably, in the EA + Met group, there was a specific enhancement of STAT2, STAT3 and STAT5B in the colon, indicating segment-specific activation within distinct regions of the intestine.

EA at ST25 may ameliorate intestinal injury via the Janus kinase (Jak)/STAT signaling pathway and is closely related to jejunal and ileal segments. These findings provide a theoretical basis for EA combined with medication.

Neurogenic bladder (NB) is a neurological bladder dysfunction characterized by increased contraction of the detrusor muscle. Adenosine triphosphate (ATP)-P2X receptor signaling influences muscle contraction. The aim of this study was to determine whether ATP-P2X signaling affects the mechanism by which electroacupuncture (EA) influences excessive detrusor muscle contraction in a rat model of NB.

Forty-eight rats were divided into CON (n = 8), SHAM (n = 8) and MODEL (n = 32) groups. After the latter group underwent model establishment, 24 successfully modeled rats were randomly divided into the NB, pyridoxalphosphate-6-azophenyl-2′,4′-disulfonic acid (PPADS; P2X_1/2 receptor antagonist) and EA groups (n = 8 each). The NB model was established using a modified Hassan Shaker spinal cord transection method. One week after EA treatment, urodynamic tests were used to assess bladder function, morphological changes were evaluated in hematoxylin and eosin stained bladder sections, enzyme-linked immunosorbent assays were used to measure ATP concentrations, and Western blotting was used to analyze the protein levels of P2X₁, P2X₂, phosphorylated myosin light chain kinase (p-MLCK) and phosphorylated myosin light chain (p-MLC).

NB treatment led to morphological abnormalities, impaired urodynamics, increased ATP/P2X₁/P2X₂/p-MLC levels (p < 0.01) and decreased p-MLCK protein levels (p < 0.01). EA treatment significantly improved the morphological abnormalities and impaired urodynamics. Compared with NB, both EA and PPADS significantly reduced ATP/P2X1/P2X2/p-MLC levels (p < 0.01) and increased the expression of p-MLCK (p < 0.01).

The ATP-P2X signaling pathway may be involved in the mitigating effect of EA on excessive detrusor contractions in this rat model of NB.