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Objectives: To observe whether acupuncture up-regulates chemokine CXC ligand 1 (CXCL1) in the brain to play an analgesic role through CXCL1/chemokine CXC receptor 2 (CXCR2) signaling in adjuvant induced arthritis (AIA) rats, so as to reveal its neuro-immunological mechanism underlying improvement of AIA., Methods: BALB/c mice with relatively stable thermal pain reaction were subjected to planta injection of complete Freund adjuvant (CFA) for establishing AIA model, followed by dividing the AIA mice into simple AF750 (fluorochrome) and AF750+CXCL1 groups ( n =2 in each group). AF750 labeled CXCL1 recombinant protein was then injected into the mouse's tail vein to induce elevation of CXCL1 level in blood for simulating the effect of acupuncture stimulation which has been demonstrated by our past study. In vivo small animal imaging technology was used to observe the AF750 and AF750+CXCL1-labelled target regions. After thermal pain screening, the Wistar rats with stable pain reaction were subjected to AIA modeling by injecting CFA into the rat's right planta, then were randomized into model and manual acupuncture groups ( n =12 in each group). Other 12 rats that received planta injection of saline were used as the control group. Manual acupuncture (uniform reinforcing and reducing manipulations) was applied to bilateral "Zusanli" (ST36) for 4×2 min, with an interval of 5 min between every 2 min, once daily for 7 days. The thermal pain threshold was assessed by detecting the paw withdrawal latency (PWL) using a thermal pain detector. The contents of CXCL1 in the primary somatosensory cortex (S1), medial prefrontal cortex, nucleus accumbens, amygdala, periaqueductal gray and rostroventromedial medulla regions were assayed by using ELISA, and the expression levels of CXCL1, CXCR2 and mu-opioid receptor (MOR) mRNA in the S1 region were detected using real time-quantitative polymerase chain reaction. The immune-fluorescence positive cellular rate of CXCL1 and CXCR2 in S1 region was observed after immunofluorescence stain. The immunofluorescence double-stain of CXCR2 and astrocyte marker glial fibrillary acidic protein (GFAP) or neuron marker NeuN or MOR was used to determine whether there is a co-expression between them., Results: In AIA mice, results of in vivo experiments showed no obvious enrichment signal of AF750 or AF750+CXCL1 in any organ of the body, while in vitro experiments showed that there was a stronger fluorescence signal of CXCL1 recombinant protein in the brain. In rats, compared with the control group, the PWL from day 0 to day 7 was significantly decreased ( P <0.01) and the expression of CXCR2 mRNA in the S1 region significantly increased in the model group ( P <0.05), while in comparison with the model group, the PWL from day 2 to day 7, CXCL1 content, CXCR2 mRNA expression and CXCR2 content, and MOR mRNA expression in the S1 region were significantly increased in the manual acupuncture group ( P <0.05, P <0.01). Immunofluorescence stain showed that CXCR2 co-stained with NeuN and MOR in the S1 region, indicating that CXCR2 exists in neurons and MOR-positive neurons but not in GFAP positive astrocytes., Conclusions: Acupuncture can increase the content of CXCL1 in S1 region, up-regulate CXCR2 on neurons in the S1 region and improve MOR expression in S1 region of AIA rats, which may contribute to its effect in alleviating inflammatory pain.

" Acupuncture Anesthesia in the People's Republic of China： A Trip Report of the American Acupuncture Anesthesia Study Group " ( Report for short) is the first extraterritorial systematic investigation and evaluation report in the history of acupuncture anesthesia in China. After Report was released to the public, it has not drawn much attention in China. At the moment when acupuncture anesthesia is extended to perioperative treatment, by reviewing the Report , the differences in understanding acupuncture anesthesia were analyzed from a foreign perspective. Report involves the clinical observation of surgery under acupuncture anesthesia, the analysis on the factors of acupuncture anesthesia in therapeutic effects and the relevant mechanisms, and the differences in the research methods and foci on the recognition of acupuncture anesthesia between China and foreign countries. In association with the development of acupuncture anesthesia during the past 65 years and the conclusion in Report , the paper briefly describes the development and perfection of acupuncture anesthesia, the historical verification to the conclusions in Report and the limitations in modern acupuncture anesthesia. It provides some inspiration for the development of acupuncture anesthesia, acupuncture-moxibustion medicine and life science in the future.

Objective To observe the clinical efficacy of acupuncture trigger point, nerve block and pulse radiofrequency in the treatment of postherpetic neuralgia (PHN). Methods A total of 60 cases with PHN were randomly divided into 3 groups: acupuncture trigger point therapy (group A, N = 20), epidural nerve block (group B, N = 20) and selective dorsal root ganglion (DRG) pulse radiofrequency (group C, N = 20). All patients in 3 groups took gabapentin orally at the same time after treatment. Numerical Rating Scale (NRS) was used to record the degree of pain in 3 groups before and after treatment (2, 4 and 12 weeks after operation). Results Compared with before treatment, NRS scores in 3 groups were significanthly decreased at 2, 4 and 12 weeks after operation (P = 0.000, for all). There was no significant difference on NRS scores among 3 groups before treatment (P > 0.05, for all). Two weeks after operation, NRS scores in group B and C were significantly lower than that in group A (P = 0.013, 0.000), and NRS score in group C was significantly lower than that in group B (P = 0.000). Up to 4 and 12 weeks after operation, NRS score in group C was significantly lower than that in group A (P = 0.000, 0.000) and B (P = 0.000, 0.000), while there was no significant difference on NRS scores between group A and B (P > 0.05). Conclusions Selective dorsal root ganglion pulse radiofrequency is effective in the treatment of PHN, which can relieve the pain quickly and improve the work and life quality of patients.

The endocannabinoid system, an important biological network for maintaining and balancing various functions of the human body, is involved in many physiological functions such as pain, emotion, learning and memory, etc. Among which the endocannabinoid receptors ［including type I (CB1) and type II (CB2) receptors］ play an important role in the regulation of pain and have become an important target in the mechanism research of acupuncture analgesia. CB1 is mainly distributed in the central nervous system, including the spinal cord, cerebral cortex, amygdala, insular cortex, and basal ganglia, etc. CB2 is mainly distributed in peripheral immune tissues, such as spleen, bone, skin, etc. In the central and peripheral nervous systems, acupuncture can activate CB1 and CB2 receptors respectively, which is involved in the transmission of central nociceptive signals and related transmitters as well as the peri-pheral pro-nociceptive inflammatory response, thereby alleviating the nociceptive hypersensitivity in animal models. In this paper, we systematically summarize the roles of the above mechanisms in different types of animal models (inflammatory pain, neuropathological pain, visceral pain, etc.), so as to provide new ideas for the study of the underlying mechanisms of acupuncture analgesia.

Modern acupuncture anesthesia is the application of acupuncture-related therapies to optimize the perioperative management which is based on the combined acupuncture-medicine anesthesia technology, and building a perioperative acupuncture anesthesia accelerated rehabilitation system. Based on the thoracic surgery, this paper analyzes and summarizes the application effects of modern acupuncture anesthesia, focusing on preoperative anxiety relief and advanced analgesia； reduce the dosage of anesthetics, stable respiration and hemodynamics, anti-stress and organ protection during surgery； postoperative analgesia, prevention of nausea, vomiting and cognitive impairment, improvement of gastrointestinal function, prevention of cognitive impairment, and enhancement of immunity. It is anticipated that this review may provide a basis for the further promotion and application of modern acupuncture anesthesia in clinical practice.

Objective To observe the clinical efficacy of acupuncture trigger point, nerve block and pulse radiofrequency in the treatment of postherpetic neuralgia (PHN). Methods A total of 60 cases with PHN were randomly divided into 3 groups: acupuncture trigger point therapy (group A, N = 20), epidural nerve block (group B, N = 20) and selective dorsal root ganglion (DRG) pulse radiofrequency (group C, N = 20). All patients in 3 groups took gabapentin orally at the same time after treatment. Numerical Rating Scale (NRS) was used to record the degree of pain in 3 groups before and after treatment (2, 4 and 12 weeks after operation). Results Compared with before treatment, NRS scores in 3 groups were significanthly decreased at 2, 4 and 12 weeks after operation (P = 0.000, for all). There was no significant difference on NRS scores among 3 groups before treatment (P > 0.05, for all). Two weeks after operation, NRS scores in group B and C were significantly lower than that in group A (P = 0.013, 0.000), and NRS score in group C was significantly lower than that in group B (P = 0.000). Up to 4 and 12 weeks after operation, NRS score in group C was significantly lower than that in group A (P = 0.000, 0.000) and B (P = 0.000, 0.000), while there was no significant difference on NRS scores between group A and B (P > 0.05). Conclusions Selective dorsal root ganglion pulse radiofrequency is effective in the treatment of PHN, which can relieve the pain quickly and improve the work and life quality of patients. [ABSTRACT FROM AUTHOR]

To explore the regulating effect of acupuncture on pain based on the three dimensions of pain (pain sensation, pain emotion and pain cognition). The pain sensation is related to the body, the pain emotion is related to the seven emotions, the pain cognition is related to the mind of the five zang , and the three dimensions of pain interact with each other. Through the two ways of "regulating qi to treat mind" and "treating mind to regulate qi ", acupuncture comprehensively acts on pain sensation, pain emotion and pain cognition to achieve comprehensive regulation of pain.

The paper reviewed the relevant studies on dyspnea treated with acupuncture over the past 20 years, as well as the underlying neuroendocrine mechanism from the perspective of central and peripheral vagus nerves, neurotransmitter, respiratory muscle function and anti-depression-anxiety function. It revealed that the central response area was regulated by acupuncture in treatment of dyspnea, which is similar to the area affected in acupuncture analgesia. Additionally, acupuncture generates its therapeutic effects on dyspnea through promoting the release of endogenous opioid peptides and the regulation of autonomic nerve, amygdale and hypothalamic-pituitary-adrenal axis.

Relief of the chronic pain, as the negative reinforcement of pain, is recognized as a reward and it activates related brain's reward circultries. Brian's reward circuits not only relate to rewards, but also participate in pain process. Currently, the reward effect of acupuncture on chronic pain relief and the mechanism of brain's reward circuits involved in acupuncture analgeisa have not been revealed adequately yet. This paper reviewed the conceptual features of analgesia reward and the new progression of brain's reward circuits and function, expounded the valuable clinical and scientific significance of the researches for the reward effect of acupuncture analgesia and related brain's reward circuits, proposed the ideas and suggestions on many questions in the study of reward effect of acupuncture analgesia and related brain's reward circuits, and then, determined the multi-dimensional characteristis and positive regulation of acupuncture analgesia. Focusing on the reward effect of acupuncture and related brain's reward circuits for chronic pain relief, the research on the regulatory effect of acupuncture analgesia will be conductive to deepen the understanding of acupuncture analgies in clinical practice and innovate a research concept of acupuncture analgeis. Eventually, a new approach can be provided to further elaborate neurobiolgical mechanism of acupuncture analgesia.

Objective: To observe the effect of electroacupuncture (EA) on the expression of lumbar spinal κ-opioid receptor (KOR) and Toll-like receptor 4(TLR4) in microglia in neuropathic pain rats, so as to explore the role of cross-talk between KOR and TLK4 in EA-induced alleviation of chronic neuropathic pain., Methods: Wistar male rats were randomized into control, model, EA and EA plus KOR inhibitor (EA+inhibitor) groups ( n =18 in each group). The neuropathic pain model was established in rats by ligature of the right sciatic nerve. EA was applied at bilateral "Zusanli"(ST36) and "Yanglingquan"(GB34) for 30 min, once daily for 5 days. JDTic dihydrochloride (a KOR inhibitor) was administrated by intraperitoneal injection before EA intervention. The difference value of paw withdrawal thermal latency (PWLD) of the bilateral hind-limbs was used as the thermal pain reaction level. At the end of experiments, the rat's lumbar spinal cord (L2-L4) was taken for detecting the expression of CD68 mRNA (a marker of the activated microglia) and Iba-1 (a marker for the activated and resting microglia) immunoactivity, and dynorphin content, and KOR mRNA and TLR4 protein (in immunomagnetic microbead method separated microglia) by using fluorescence quantitative PCR, immunofluorescence, radioimmunoassay and Western blot, separately., Results: Compared with the control group, a strong thermal hyperalgesia was induced, the expression levels of Iba-1 and CD68 mRNA in the spinal cord, TLR4 protein of the spinal microglia were significantly increased( P <0.01) in the model group. The microglia were characterized by somatic hypertrophy and thickened branches in the model group. After EA intervention, the PWLD, the expression of Iba-1, CD68 mRNA and TLR4 protein of the microglia were significantly decreased( P <0.05), while the content of spinal dynorphin and the expression of KOR mRNA of the microglia increased in the EA group relative to the model group( P <0.05). The hypertrophic microglia shrinked slightly in the EA group. After injection of KOR inhibitor, the PWLD and expression levels of Iba-1, CD68 mRNA and TLR4 protein were significantly increased( P <0.05), and the expression of KOR mRNA was significantly decreased( P <0.05) in the EA+inhibitor group in comparison with the EA group., Conclusion: The analgesia effect of EA may partly mediated by spinal microglial KOR and the activation of KOR of microglia may be a target for inhibition of microglial TLR4-induced pro-inflammatory signaling.

Objective: To observe the effect of electroacupuncture (EA) on the expression of Toll like receptor 4(TLR4)and heat shock protein 90(HSP90) in the spinal cord of rats with chronic constriction injury (CCI) of sciatic nerve, so as to explore the mechanism of spinal cord TLR4 and HSP90 in alleviating chronic neuropathic pain by EA., Methods: Male Wistar rats were randomized into control, model, EA, HSP90 inhibitor (inhibitor) and EA+ inhibitor groups ( n =10 in each group). The neuropathic pain model was established by ligature of the right sciatic nerve to induce CCI. EA (1 mA，2 Hz/15 Hz)was applied at bilateral "Zusanli"(ST36) and "Yanglingquan"(GB34) for 30 min, once daily for 5 days. Rats of the inhibitor and EA+inhibitor groups were given a subcutaneous injection of HSP90 inhibitor geldanamycin (50 μg/kg) at the neck before daily EA. The paw withdrawal latency (PWL) of the bilateral hind-limbs was detected by using an algesia-detector. The contents of interleukin 1β (IL-1β) and tumor necrosis factor α (TNF-α) in the lumbar spinal cord (L2-L4) tissue were detected by enzyme-linked immunosorbent assay. The relative expression levels of HSP90 and TLR4 proteins in the lumbar spinal cord (L2-L4) were detected using Western blot and immunofluorescence double labeling, respectively., Results: Following CCI, a strong thermal hyperalgesia, an apparent up-regulation of expression of HSP90 and TLR4 proteins and TLR4 in microglia, and increasing levels of IL-1β and TNF-α in the spinal cord were induced in the model group relevant to the control group ( P <0.01， P <0.05). Five sessions of EA intervention or inhibitor injection significantly attenuated hyperalgesia, reversed the increase of IL-1β and TNF-α, and down-regulated the expression of TLR4 in microglia ( P <0.05). Compared with the model group, the expression of HSP90 was further increased ( P <0.05), and those of TLR4 in microglia and neurons were significantly decreased and increased, respectively in the EA group ( P <0.05). Compared with the EA group, the levels of PWLD,TLR4 and HSP90 expression, and the proportions of neuronal nuclei antigen（NeuN） and TLR4, and ionized calcium binding adapter molecule （Iba1） and TLR4 co-expressed cells were significantly decreased in the inhibitor group and EA+inhibitor group ( P <0.05). The proportion of NeuN and TLR4 co-expression cells in the EA+inhibitor group was significantly higher than that of the inhibitor group ( P <0.05)., Conclusion: EA stimulation of ST36 and GB34 can alleviate thermal hyperalgesia in CCI rats, which is closely associated with its effect in regulating the expression of TLR4 in the spinal cord neurons and microglia. HSP90 in the spinal cord may be a co-stimulatory molecule for EA induced relief of neuropathic pain by regulating TLR4.

Acupuncture is effective for the management and treatment of pain related diseases. At present, the patients'subjective evaluations were often used to measure the effect of acupuncture analgesia in clinical research, but it lacks objectivity and accuracy. In recent years, some studies had tried to analyze the magnetic resonance images of patients' brains using magne-tic resonance imaging and machine learning methods before and after acupuncture intervention, so as to identify specific neural markers. These markers not only helped explain the brain mechanism of acupuncture analgesia, but also provided objective indicators for the analgesic effect of acupuncture. This article analyzes the significance and feasibility of pain biomarkers research based on magnetic resonance imaging and machine learning technology, summarizes its research status in acupuncture analgesia, and makes suggestions in the future study.

Objective: To observe the clinical effect of single acupoint [Yaotu (extra)] electroacupuncture (EA) therapy on lumbar intervertebral disc herniation (LIDH) and its promotion and application in community medical institutions., Methods: This research adopted a three-level promotion model, and used multi-center collaboration topics as a platform. A total of 240 patients with LIDH were divided into a group A (top three hospital, 80 cases, 3 cases dropped off), a group B (secondary hospital, 80 cases, 8 cases dropped off), and a group C (community health center, 80 cases, 7 cases dropped off). All groups were treated with EA at a single acupoint [Yaotu (extra)] under the guidance of a unified experimental protocol. The EA was given 60 min each time and performed 3 times a week for a total of 2 weeks. The changes of visual analogue scale (VAS) scores of three groups before and after each treatment were compared, and the clinical efficacy was evaluated., Results: Compared with before each treatment, the VAS scores of three groups after each treatment decreased ( P <0.05). Except for the second and fifth treatments, the immediate effect in the group A was higher than that in the group B and C ( P <0.05). The total effective rate of group A, group B, and group C respectively was 90.9% (70/77), 93.1% (67/72), 86.3% (63/73), and there was no statistically significant difference among the three groups ( P >0.05)., Conclusion: The single acupoint EA therapy has a significant effect in the treatment of LIDH, can quickly relieve the pain symptoms, and has the characteristics of simple operation and easy control, suitable for promotion and application in primary hospitals.

This article reviews the clinical studies on the application of acupuncture anesthesia in thyroid surgery over the past 5 years. Starting from the principle of acupuncture anesthesia, the authors explore the application of acupuncture anesthesia in thyroid surgery, its advantages and development. The summarized findings showed that acupuncture anesthesia has a better analgesic effect in thyroid surgery, which can reduce the occurrence of stress reactions, adverse reactions and complications, and is conducive to postoperative recovery. However, there is a lack of standardized operations. In the future, standardized operations can make acupuncture anesthesia more widely used and popularized.

Objective: To investigate the anesthetic effect of combined acupuncture-medicine anesthesia in microwave ablation of benign thyroid nodules and its effect on serum β-endorphin., Methods: A total of 60 patients who met the inclusion criteria and received microwave ablation of benign thyroid nodules were randomly divided into the treatment group and the control group, with 30 patients in each. The patients in the treatment group were given combined acupuncture-medicine anesthesia, and those in the control group were given intravenous anesthesia. The two groups were compared in terms of the sedative and analgesic effects of anesthesia, amount of anesthetics used, incidence rate of intraoperative snore and respiratory depression, and change in serum β-endorphin level before anesthesia, before surgery, and after the surgery., Results: Both groups obtained satisfactory anesthetic effects. Compared with the control group, the sedation score, the amounts of fentanyl and propofol used, the incidence rates of intraoperative snore and respiratory depression in the treatment group were obviously lower ( P <0.05, P <0.01). The treatment group had an increase in serum β-endorphin level before surgery and at the end of surgery ( P <0.05), while the control group showed no significant change in serum β-endorphin level at each time point., Conclusion: In microwave ablation of benign thyroid nodules, combined acupuncture-medicine anesthesia has good sedative and analgesic effects and can reduce the amounts of anesthetics used as well as the incidence rates of intraoperative snore and respiratory depression. The analgesic effect of acupuncture anesthesia is associated with increased β-endorphin secretion.

Objective: To compare the analgesic effect of manual acupuncture(MA) stimulation of "Zusanli" (ST36) in rats with inflammatory pain under unrestrained conscious, restrained and general anesthesia conditions, so as to explore the applicability of unrestrained conscious model in the evaluation of acupuncture analgesia effect., Methods: Male SD rats were divided into 5 groups: blank control ( n =9), pain model ( n =7), unrestrained conscious conditions+MA ( n =6), restrained conditions+MA ( n =6), and general anesthesia (GA)+MA( n =6). The acute pain model was established by injection of complete Freund's adjuvant (CFA) into the left ankle joint 48 h ahead of acupuncture. Subsequently, a single 20 min session of MA was applied to the left ST36. The mechanical and thermal pain thresholds (MPT and TPT) were determined before and after injection of CFA, and after MA stimulation. In order to evaluate the autonomic behavior activities, rats were randomly divided into blank control ( n =11), pain model ( n =11) and conscious-unrestrained conditions +MA ( n =12) groups. The rats' exploratory movements were assessed by open field tests., Results: Both MPT and TPT were significantly decreased after injection of CFA in the model group relevant to the blank control group ( P <0.001), and significantly higher in the three MA groups than in the model group ( P <0.001). Comparison among the three MA groups showed that both MPT and TPT were significantly higher in the conscious unrestrained conditions+MA group than in the restrained conditions+MA and GA+MA groups ( P <0.05, P <0.01). Open filed tests showed that the total moving distance in the open field and wall climbing times were significantly lower in the model group than in the blank control group ( P <0.01), and the wall climbing times were obviously more in the unstrained conditions+MA group than in the model group ( P <0.05). The central area resistance time was significantly shorter in the model group than in the control group ( P <0.05), and was moderately increased after MA despite no evident significance ( P >0.05). No significant changes were found in the total moving distance after MA and in the central area moving distance after modeling and MA ( P >0.05)., Conclusion: MA has a better therapeutic effect in relieving pain and pain-induced depression-like behavior in conscious unrestrained rats than in restrained and GA rats, implying a higher applicability of unrestrained conscious pain model to the assessment of acupuncture analgesia.

The research progress of acupuncture analgesia in recent years is analyzed to summarize the analgesic mechanism of acupuncture on neuropathic pain. The analgesic mechanism of acupuncture on neuropathic pain is discussed from peripheral level and central level, including peripheral sensitization and immune inflammatory response, changes of ion channel, central sensitization, regulation of cell signal pathway, activation of spinal glial cells, etc. It is suggested that the focus of future research should include conducting in-vitro studies with the help of multi-omics technology to detect the changes of metabolic substances and signal pathway molecules in patients with neuropathic pain before and after acupuncture to further clarify the mechanism of acupuncture analgesia.

Pain, especially chronic pain, can cause multiple changes including sensory-discriminative, emotional-affective, and cognitive-behavior changes and thus greatly affects patients' physical and mental health and quality of life. Therefore, multi-dimensional regulation of paralgesia, cognitive impairment, and negative emotion in patients with chronic pain has become a hot spot in recent studies. The brain regions in the limbic system are involved in the formation and expression of "pain sensation-emotion-cognition". Existing evidence suggests that acupuncture has a multi-dimensional comprehensive regulatory effect on chronic pain, and the brain regions in the limbic system also mediate the analgesic effect of acupuncture. However, further studies are still needed to explore the role and mechanism of action of these brain regions in the multi-dimensional regulation of chronic pain by acupuncture. This article reviews the research advances in the neural mechanism of the limbic system in chronic pain and the role of the limbic system in mediating acupuncture analgesia and mainly elaborates on the mechanism of action of the brain regions in the limbic system in the multi-dimensional regulation of chronic pain.

Objective: To observe the auxiliary analgesic effect of wrist-ankle acupuncture on patients undergoing transforaminal endoscope surgery., Methods: A total of 64 patients with lumbar disc herniation who underwent percutaneous lateral transforaminal endoscope surgery were randomly divided into an observation group and a control group, 32 cases in each group. The patients in the control group were treated with injection of 1% lidocaine for routine local infiltration anesthesia. The patients in the observation group were treated with wrist-ankle acupuncture at lower 5 area and lower 6 area for 30 min, 5 min before routine local infiltration anesthesia; immediately, 15 min, 30 min after insertion the left-right technique, up-down technique, and rotation technique were applied for six times, respectively. The mean arterial pressure (MAP), heart rate (HR), blood oxygen saturation (SpO 2 ) and pain visual analogue scale (VAS) were compared between the two groups at the time points of intraoperative puncture (T 1 ), circular saw grinding (T 2 ), and placement of working channel (T 3 ). The intention of reoperation was recorded immediately after operation and 24 h after operation. The expectation and treatment credibility scale (ETCS) was used to evaluate the relationship between patients' expectation and efficacy 5 min before operation and immediately after operation., Results: At T 2 and T 3 during the operation, the MAP and HR in the obserrvation group were lower than those in the control group, while SpO 2 was higher than that in the control group ( P <0.05). At T 1 , there was no significant difference of MAP, HR and SpO 2 between the two groups ( P >0.05). At T 2 , the peak VAS and average VAS in the observation group were lower than those in the control group ( P <0.05), but there was no significant difference at T 1 and T 3 ( P >0.05). The intention of reoperation in the observation group was higher than that in the control group both immediately after operation and 24 h after operation ( P <0.05). In the observation group, the scores of each item in ETCS immediately after operation were higher than those 5 min before operation ( P <0.05), while in the control group there was no significant difference between immediately after operation and 5 min before operation ( P >0.05). The scores of ETCS1, ETCS2 and ETCS3 immediately after operation in the observation group were higher than those in the control group ( P <0.05)., Conclusion: The wrist-ankle acupuncture has positive auxiliary analgesic effect on lumbago during transforaminal endoscope surgery, and strengthens the patients' confidence on the operation effect.

Objective: To investigate the efficacy of acupoint injection of Ropivacaine for labor analgesia and its effect on breastfeeding and prolactin secretion., Methods: A total of 80 primipara who asked to receive labor analgesia were randomized into epidural analgesia group ( n ＝35) and acupoint injection group ( n ＝36), and other 36 primipara who refused to receive labor analgesia were subjected to the control group. The labor analgesia began to be performed when the puerpera's uterine orifice opened about ≥3 cm (the first stage of labor), including puerpera controlled epidural analgesia (PCEA, Sufentainil ＋ 0.1% Ropivacaine hydrochloride, 5 µg/mL at L3-L4 interspace, till the birth of fetus) or acupoint injection of Ropivacaine (0.2%, 1 mL/acupoint) at bilateral Hegu (LI4) and Sanyinjiao (SP6). The delivery situations such as the duration of labor, and number of cases who used oxytocin, obstetric-forceps-aided delivery, cesarean delivery were recorded. The serum prolactin concentration was assayed by using ELISA. The visual analogue scale (VAS) scores at the time points of T 0 (about 3 cm widening of the orifice of uterus and before performing analgesia), T 1 (30 min after labor analgesia), T 2 (about 10 cm widening of the orifice of uterus) and T 3 (coming out of fetal head). The duration of labor, ratio of use of oxytocin, onset time of breastfeeding, and times of breastfeeding within 24 postpartum hours were recorded accordingly., Results: The VAS scores at time-points of T 1, T 2 and T 3 were significantly lower in both epidural analgesia and acupoint injection groups in comparison with their own T 0 and the control group ( P <0.05), and were also considerably higher in the acupoint injection group than in the epidural analgesia group ( P <0.05). The duration of the 2 nd stage of labor (from complete opening of the uterus orifice to complete birth of the fetus) was significantly longer, ( P <0.05) and the number of oxytocin-using puerpera was obviously bigger in the epidural analgesia group than in the control group ( P <0.05). After partum, the 1 st breastfeeding time was obviously earlier and the frequency of breastfeeding notably increased in both epidural analgesia and acupoint injection groups than in the control group ( P <0.05), the serum prolactin content was remarkably higher in the acupoint injection group than in the epidural analgesia group ( P <0.05). No significant differences were found between the acupoint injection and the control groups in the duration of the 1 st and 2 nd stages of labor, and in the numbers of oxytocin-using puerpera, obstetric forceps-aided birth and cesarean delivery ( P >0.05), and between the epidural analgesia group and control group in the serum prolactin levels ( P >0.05)．., Conclusion: Injection of Ropivacaine at LI4 and SP6 is effective for labor analgesia and raising prolactin level, and favorable to breastfeeding in the early postpartum period.

Objective: To observe the relationship between the analgesic effect of balance acupuncture and functional changes in brain in patients with migraine without aura., Methods: A total of 40 cases of migraine without aura were equally randomized into a headache-acupoint group and a sham-acupoint group. When acupuncture given, a filiform needle was inserted into the headache-acupoint (the midpoint of the depression region anterior to the juncture of the first and second metatarsal bones on the dorsum of the foot) or the sham point (the midpoint of the depression region anterior to the juncture site between the 3 rd and 4 th metatarsal joints of the dorsum of the foot) about 25-40 mm deep and manipulated for a while till the patient experienced feelings of electric shock and numbness, then withdrawn immediately. The treatment was conducted once daily for 4 weeks. The visual analogue scale (VAS) was used to evaluate the severity of pain, and the regional homogeneity (ReHo) analysis of resting state functional magnetic resonance imaging (fMRI) was used to assess changes of the spontaneous brain activity., Results: After acupuncture, the analgesic effect of headache-acupoint was better than that of the sham-acupoint in both intervention stage and the follow-up stage ( P < 0.05), and was also stronger in the intervention stage than in the follow-up stage ( P <0.05). There was no significant difference in the analgesic effect between the intervention stage and the follow-up stage in the sham-acupoint group ( P >0.05). Compared with pre-intervention, 4-weeks' intervention at the headache-acupoint showed an increase of ReHo values in the anterior cingulate gyrus, anterior central gyrus, superior orbital frontal gyrus, insula, inferior lobule, left anterior cingulate gyrus, ventral lateral nucleus and ventral posteromedial nucleus of the thalamus, pontine nucleus, cerebellar tonsils and orbital frontal inferior gyrus of the brain ( P <0.05), and a decrease of ReHo values in the right brain bridge, central posterior gyrus, posterior cingulate gyrus, left central anterior gyrus, posterolateral nucleus of thalamus, and hippocampus ( P <0.05), separately. In the sham-acupoint group, the ReHo value was increased in the right tongue gyrus, the left anterior lobe, the anterior cingulate gyrus and the lower occipital gyrus of the brain ( P <0.05), and reduced in the left ventral posterolateral nucleus of the thalamus, separately ( P <0.05)., Conclusion: Balance acupuncture stimulation of headache acupoint has an analgesic effect in migraine patients without aura, which may be related to its effect in regulating resting state brain function of the limbic-system-dominated multiple brain regions.

Pain is inherently unpleasant and has the characteristic of protecting the body by promoting motivation and learning. Relief from aversion (including pain relief) is rewarding. The aversion to pain and reward from pain relief are encoded by brain mesocorticolimbic circuits characterized by reward/motivation. This paper reviews the research findings about the effect of pain and acupuncture on reward/motivation circuits derived from animal models and human neuroimaging. It is further suggested that neuroimaging techniques may be used to track brain regions that mediate acupuncture effect, and the response of reward/motivation circuits to acupuncture could be used as an objective indicator of analgesic efficacy. It may provide help for further study on the brain mechanism of acupuncture in improving chronic pain.

The clinical research articles relevant with Fu 's subcutaneous needling therapy (FSN) were retrieved from CNKI, WANFANG, CBM and PubMed databases till January 2018 since the establishment of database. According to the general international criteria of disease classification, the diseases involved in the articles were classified and summarized. In terms of the clinical application and research of FSN, the questions were extracted and commented through expert's consultation. As a result, 412 articles were included. The statistical results of disease spectrum indicated that FSN was adopted in 65 kinds of diseases in 11 systems. Of these diseases, the relevant somatic pain disorders in the musculoskeletal system were the most appropriate. Professor FU Zhong-hua explained that the clinical physicians of FSN should select the muscle-related disorders as the clinical research subject and treat them with normalized manipulation of FSN. The research on FSN is still at the preliminary stage. It needs more high-quality clinical and basic researches to provide the evidences for the therapeutic effects of FSN.

Objective: To observe the therapeutic effect of electroacupuncture (EA) at Zusanli (ST 36) and Neiguan (PC 6) on stress responses of patients undergoing gastrointestinal surgery., Methods: A total of 40 patients undergoing gastrointestinal surgery were randomized into conventional treatment group (control) and EA group ( n ＝20 in each group). Patients of the EA group received conventional treatment (pre- and post-surgical fasting, measures for gastrointestinal decompression, parenteral nutrition support, and patient controlled analgesia pump, etc.) and EA stimulation (2 Hz, 30 min) of bilateral ST 36 and PC 6 (twice after surgery, at an interval of 6 h), and patients of the control group received conventional treatment only. The visual analogue scale (VAS) score was used to assess the patients' pain severity and the blood glucose levels were detected once every 4－6 h within 24 h after operation. Serum cortisol (Cort) and adrenocorticotropic hormone (ACTH) levels were detected by chemiluminescence method, and serum D-lactic acid level (for assessing gastrointestinal mucosal injury) was assayed by ELISA., Results: After the treatment, the levels of serum Cort, ACTH, D-lactate acid and the highest blood glucose were significantly lower in the EA group than those in the control group ( P <0.05, P <0.01), suggesting a reduction of stress reactions after EA. But no significant difference was found between the control and EA groups in the VAS score ( P >0.05)., Conclusion: EA at ST 36 and PC 6 can alleviate stress responses and reduce intestinal mucosal damage in patients undergoing gastrointestinal surgery.

Objective: To investigate the effect of electroacupuncture (EA) at different time-points on postoperative gastrointestinal function in patients undergoing colorectal cancer surgery., Methods: Eighty patients with colorectal cancer undergoing laparotomy were randomly assigned to intravenous anesthesia, EA A, EA B, and EA C groups ( n ＝20 cases in each group). All the patients in the four groups received intravenous anesthesia with midazolam, sufentanil, cisatracurium besylate and Propofol, postoperative gastrointestinal decompression and drug analgesia. EA (2－3 mA, 2 Hz) was applied to Zhongwan (CV 12) and Tianshu (ST 25), Neiguan (PC 6), Zusanli (ST 36), Shangjuxu (ST 37), Xiajuxu (ST 39) on the right side for 30 min, once (one day before surgery) in the EA A group, twice (one day and 30 min before surgery) in the EA B group, and 3 times (one day, 30 min before and one day after surgery) in the EA C group. The acupoints used after surgery were PC 6, ST 36, ST 37 and ST 39. The time of postoperative ventilation, defecation, food-intake and water drinking, stomach tube removal and abdominal drainage tube removal, the volumes of stomach tube drainage and abdominal drainage, and postoperative adverse reactions were recorded., Results: The first ventilation time, after surgery in the EA C group was significantly earlier than those in the intravenous anesthesia, EA A and EA B groups ( P <0.05); and the water intake and abdomicnal drainage tube removal time after surgery in the EA C group were significantly earlier than those in the intravenous anesthesia group ( P <0.05). No significant differences were found among the 4 groups in the time of defecation, food intake, stomach tube removal, stomach tube drainage and abdominal drainage volumes, and numbers of patients with nausea, vomiting, fever and other adverse reactions ( P >0.05)．., Conclusion: EA treatment combined with intravenous anesthesia conducted before and after surgery is effective in promoting the recovery of gastrointestinal function in patients undergoing colorectal cancer laparotomy, and is obviously better than simple pre-operative EA.

Acupuncture anesthesia (AA) is an anesthetic method created by medical workers and researchers in China during medical practice in 1950s. As a paragon of integrated traditional Chinese and Western medicine, AA clinical practice and basic theoretic research have gained continuous improvement and progress, and obtained a series of outstanding achievements in the past 60 years. Consequently, the theory of traditional Chinese medicine was enriched, and the acupuncture therapy was pushed forward to the world. The present paper reviews the course of formation and development of clinical application of AA from the late years of 1950s up to now, including the initial stage (1958-1966), rapid propulsion stage (1967-1979), consolidation period (1980-2004) and newly developing period (2005-now). The AA has experienced flexural pathway from simple acupuncture analgesia, to acupuncture-drug compound anesthesia (or acupuncture-assisted anesthesia), and to the application of whole perioperative period. Nowadays, it keeps unceasing development and innovation from simple analgesia and sedation to organ protection during perioperative period and reduction of post-operative complications. The AA possesses unique prosperous vitality, and also has a plenty room for improvement, being worthy of further popularization and research.

Objective: To observe the effect of electroacupuncture (EA) on the expression of high mobility group box 1 (HMGB 1) and its receptor CD 24 proteins and β-endorphin (β-EP) content in "Zusanli" (ST 36) region in rats with chronic constriction injury (CCI), so as to explore its mechanisms underlying pain relief., Methods: Thirty male Wistar rats were rando-mized into control, CCI model and EA groups ( n ＝ 10 rats in each). The neuropathic pain model was established by ligature of the left sciatic nerve to induce CCI in the model and EA groups, and sham operation was performed in rats of the control group. Paw with drawal latency (PWL, thermal pain threshold) of the bilateral hind-limbs was detected by using an algesia-detector. Eight days after CCI operation, EA was applied to bilateral "Zusanli" (ST 36) and "Yanglingquan" (GB 34) for 30 min, once daily for 5 days. The acetylated-HMGB 1 expression was determined by immunoprecipitation, and the expression of HMGB 1 and toll like receptor 4 (TLR 4) proteins and CD 24 mRNA were detected using Western blot and fluorescent quantitative real time-PCR, respectively, and the content of β-EP in the acupoint region was assayed by enzyme linked immunosorbent assay (ELISA). Anti-CD 24 neutralizing antibody (200 µL, 100 µg/mL) was injected into ST 36 region once daily for 3 days for verifying the involvement of HMGB 1/CD 24 signaling in EA analgesia., Results: Compared with the control group, the bilateral PWL difference values in the other two groups were significantly increased ( P <0.05), meaning an occurrence of hyperalgesia after CCI. In comparison with the CCI model group, the hyperalgesia in the EA group was obviously decreased ( P <0.05). After CCI, the expression levels of HMGB 1 and TLR 4 proteins were considerably increased compared with those in the control group ( P <0.05). After 5-times' EA, the acetylated-HMGB 1, the expression of CD 24 mRNA, and the content of β-EP were notably up-regulated ( P <0.05), and there were no obvious changes in the expression levels of HMGB 1 and TLR 4 proteins ( P >0.05). After local injection of anti-CD 24 antibody, EA-induced increases of β-EP content and reduction of thermal pain threshold were significantly suppressed ( P <0.05)., Conclusion: EA of ST 36 and GB 34 can alleviate neuropathic pain in CCI rats, which is associated with its effects in up-regulating β-EP content, and HMGB 1 protein and CD 24 mRNA expression levels in ST 36 region. The activated HMGB 1/CD 24/β-EP signaling contributes to EA-ST 36 induced analgesia.

Objective: To observe the differences in the clinical effects on cervical spondylosis with neck pain between the grain-moxibustion combined with acupuncture and simple acupuncture., Methods: Eighty-eight cervical spondylosis patients with neck pain who met the inclusion criteria were randomly divided into an observation group and a control group, 44 cases in each one. The patients in the control group were treated with conventional acupuncture, and grain-moxibustion was applied on the basis treatment of the control group in the observation group. The treatment was given 3 times a week, once every other day, 10 times as one course, and followed up after 6 months. Northwick Park neck pain inventory (NPQ) and the McGill pain questionnaire (MPQ) of the two groups before and after treatment and 6 months follow-up were observed. The clinical efficacy was compared., Results: After one course of treatment in both groups, the effective rate was 84.1% (37/44) in the control group and 86.4% (38/44) in the observation group; after 6 months follow-up, the effective rate was 79.5% (35/44) in the control group, and 81.8% (36/44) in the observation group. There was no significant difference in overall efficacy between the two groups (both P >0.05). Compared before treatment, the NPQ scores and MPQ scores were decreased at the end of one course of treatment and after 6 months follow-up in the two groups (all P <0.05). There was no significant difference in NPQ scores and MPQ scores between the two groups after one course of treatment (both P >0.05), but the NPQ scores and MPQ scores in the observation group were significantly lower than those in the control group after 6 months follow-up (both P <0.05)., Conclusion: The immediate efficacy of grain-moxibustion combined with acupuncture for cervical spondylosis with neck pain is similar to that of simple acupuncture, however, the long-term curative effect is better.

Although acupuncture, especially electroacupuncture (EA) is widely used to treat pain, its mechanisms have not been completely understood. In the present paper, we review the development of researches on the underlying mechanisms of EA in relieving inflammatory pain in recent years from a)peripheral inflammation-mediated immune response and neuro-immune interaction of receptors on primary nociceptors, b) crosstalk of neurotransmitters or neuromodulators, cellular signaling pathways, other related bioactive molecules, as well as glial activation in the dorsal horns of spinal cord, and c) supraspinal modulation of both sensory and affective components of pain. Inflammatory pain involves complex neuro-immune networks of neurons and non-neurons, various inflammatory mediators, neurotransmitters, neuromodulators and cellular signaling molecules in the peripheral and central nervous systems. Therefore, the analgesic mechanism of acupuncture still needs to be studied in depth at multi-levels and multi-targets, for instance, the reciprocal actions of peripheral opioid peptide, adenosine and TRPV 1 (which have been demonstrated to be involved in EA analgesia individually), the roles of spinal cord adenosine A 1 receptor (A 1 R) and A 2 R (for which fewer studies have been conducted), the interactions of classical neurotransmitters/neuromodulators/neuropeptides and their receptors, changes of intracellular molecules at transcriptional and translation levels, etc. during acupuncture analgesia. Furthermore, the mechanisms underlying reciprocal actions of neurotransmitters, neuromodulators and their receptors complicated in acupuncture-induced relief of pain affection in the higher brain regions also need to be explored further.

Along with advances in pain medicine, people have a deep understanding about pain. It is now considered that pain is a complex activity of the nerve system, particularly the high nerve centers, and is composed of sensory, affective, cognitive, and social interaction. By the help of new techniques and instruments of brain science, the neural circuits involved in pain generation have been understood intensively, partially explaining why pain is composed of multiple components and how the sensation, emotion and cognition of pain are influenced each other. Acupuncture analgesia is widely used in clinical treatment and has a definite therapeutic effect. Along with the revision of definition of pain, the research of acupuncture analgesia needs to accommodate the so-called multiple dimensions and their interactions, will effectively deepen its connotation and denotation, and expand its application range, opening up a wider clinical prospect.

Since the invention of optogenetic technology, it has greatly promoted the development of neuroscience. Currently, optogenetic approaches have been mostly used to map neural circuits and new neuropharmacology but are rarely seen in the research field of acupuncture analgesia. The mechanism of neural circuits contributing to acupuncture analgesia, an important research hotspot in recent years, has not been fully determined. The optogenetic techniques can be used to modulate and control specific cells, provides highly precise spatial and temporal resolution, is repeatable, and may functionally dissect neuronal networks in vivo. The neuronal activities and their information transmission, processing and storage in intercluster neural networks in different brain regions, and the correlation between behavioral changes and electrical activities of neurons in vivo studies are mainly captured by the implanted microelectropode array, etc. If these two (or more) approaches are combined together, it is definitely and highly helpful to reveal the driving dynamics of neural circuits, plasticity and temporal-spatial activity mode of neurons, as well as behavioral reactions of animals with chronic pain during acupuncture analgesia and may open a new prospect for the application of acupuncture analgesia study.

Post-incision pain often occurs after surgery and is emergent to be treated in clinic. It hinders the rehabilitation of patients and easily leads to various types of postoperative complications. Acupuncture-combined anesthesia (ACA) is the combination of traditional acupuncture and modern anesthesia, which means acupuncture is applied at acupoints with general anesthesia. It was testified that ACA strengthened the analgesic effect and reduced the occurrence of postoperative pain, but its mechanism was not clear. Numerous reports have shown that chemokine receptor CX3CR1 is involved in the development and progression of many pathological pains. The present study was aimed to reveal whether ACA played the analgesic roles in the post-incision pain by affecting CX3CR1. A model of toe incision pain was established in C57BL/6J mice. The pain threshold was detected by behavioral test, and the expression of CX3CR1 protein was detected by immunohistochemical method and Western blot. The results showed that the significant mechanical allodynia and thermal hyperalgesia were induced by paw incision in the mice. Mechanical allodynia was significantly suppressed by ACA, but thermal hyperalgesia was not changed. CX3CR1 was mainly expressed in microglia in the spinal cord dorsal horn, and its protein level was significantly increased at 3 d after incision compared with that of naïve C57BL/6J mice. ACA did not affect CX3CR1 protein expression at 3 d after incision in the toe incision model mice. Paw withdrawal threshold was significantly increased at 3 d after incision in CX3CR1 knockout (KO) mice compared with that in the C57BL/6J mice. But the analgesic effect of ACA was disappeared in CX3CR1 KO mice. Accordingly, it was also blocked when neutralizing antibody of CX3CR1 was intrathecally injected (i.t.) 1 h before ACA in the C57BL/6J mice. These results suggest that CX3CR1 in microglia is involved in post-incision pain and analgesia of ACA.

Objective: To examine the effects of different sensitivities on the effectiveness of acupuncture analgesia by observing activation change characteristics of cerebral areas resulting from the influences of constitutions on analgesia effects and to discuss the response mechanism of central nervous system (CNS) to determine the factor of constitutions on acupuncture efficacy using cerebral functional magnetic resonance imaging arterial spin labeling (fMRI-ASL)., Methods: Participants with different sensitivities were assessed according to standard screening and grouped into two groups: insensitivity group ( n ＝24) and sensitivity group ( n ＝22). All participants were given acupuncture at the left-sided Zusanli point. Pressure pain threshold (PPT) of their body surface was determined before and after the acupuncture, and the two groups were subsequently compared in terms of analgesic effects and PPT rate of change; cerebral fMRI-ASL was performed; software such as SPM 8 and ASLtbx were utilized to preprocess the results, and correlation between regional cerebral blood flow (rCBF) and visual analog scale (VAS) score was determined using Pearson's correlational analysis., Results: VAS score in the sensitivity group was significantly higher than that in the insensitivity group ( P < 0.05); after acupuncture, PPT rate of change in the sensitivity group was higher than that in the insensitivity group ( P < 0.05). The analyses revealed that there was a negative correlation between rCBF and VAS score for the right-sided anterior cingulate cortex in the insensitivity group and superior frontal gyrus in the sensitivity group (| r |>0.3 and P <0.05)., Conclusion: Different sensitivity to acupuncture is one of the crucial factors influencing analgesia effects. The sensitivity group had superior analgesia effect than the insensitivity group. Acupuncture might deactivate cerebral functional areas to generate analgesic effects.The superior frontal gyrus and bilateral anterior cingulate cortex, because of deactivation, play a positive role in sensitive patients, which is probably one of the CNS cerebral areas responding to acupuncture analgesia of people who are sensitive to acupuncture.

"The opening-closing-pivoting theory" recorded in Neijing ( Internal Classic ) visualizes the qi activity of six meridians and indicates the relationship among the six meridians in physiology and pathology. Through the analysis on the classic medical works and modern literature of TCM by the modern medical masters, a specific relationship is discovered among the hand and foot meridians of the same name and among the zangfu organs. The qi is corresponded and interacted among the hand and foot meridians of the same name. Except the exterior and interior relationship among the zangfu organs, the related communication is also existing. Both meridians and zangfu organs are closely related to "the opening-closing- pivoting" theory. This discovery is the inheritance and development of "the opening-closing-pivoting theory" and plays the important role in the guidance of the acupoint selection of clinical acupuncture analgesia.

Objective: To observe the analgesic effect of deqi induced by needling at Sanyinjiao (SP 6) on primary dysmenorrheal (PD) patients with cold damp stagnation syndrome (CDSS)., Methods: A total of 64 PD patients with CDSS experiencing abdominal pain (≥40 mm in visual analogue scale ，VAS) were randomly assigned into deqi -expectation(DE) group( n ＝15) and no- deqi -expectation(NDE) group( n ＝49). On the first day of abdominal pain attack, bilateral SP 6 were punctured respectively with thicker needles with deeper insertion for deqi -expectation patients and thin filiform needles with shallow insertion for no- deqi -expectation patients. The needles were removed after 30 minutes, a deqi scale was used to evaluate the deqi condition. According to the results, patients in the DE group were further divided into deqi DE group and no- deqi DE group, patients in the NDE group were also divided into deqi NDE group and no- deqi NDE group. The VAS was used to evaluate the patients' abdominal pain severity before treatment and 0, 10, 20, 30 min after acupuncture needle withdrawal., Results: The rate of deqi in the DE group was higher than that in the NDE group( P <0.05). The VAS scores of abdominal pain in the four groups were decreased at all time-points after needle withdrawal compared with those before treatment ( P <0.01), while the VAS score in the deqi DE group were lower than in the no- deqi NDE group 30 min after needle withdrawal ( P <0.05)., Conclusion: The intervention method of thick needle, deep insertion and some manipulation is easier in inducing deqi than that of thin needle, shallow insertion and no manipulation. The analgesic effect of deqi is better than that of no- deqi for PD patients with CDSS.

Objective: To observe the effects of conventional western medication and joss stick moxibustion combined with pricking and cupping for herpes zoster in acute stage, and to explore its analgesic mechanism., Methods: Seventy patients with acute herpes zoster were randomized into an observation group (33 cases after 2 dropping) and a control group (34 cases after 1 dropping). Patients in the observation group were treated with joss stick moxibustion combined with pricking and cupping at local ashi points for 7 times, once every other day. Oral acyclovir, vitamin B 1 and mecobalamin tablets were applied in the control group for continuous 14 days, and interferon injection was used for continuous 6 days, etc. The herpes evaluation indexes of blister stopping time, scab time and decrustation time as well as pain intensity were observed before and after treatment. Peripheral serum substance P (SP) content of herpes local situation was detected. The comprehensive effects were evaluated., Results: The blister stopping time, scab time and decrustation time in the observation group were shorter than those in the control group (all P <0.05). There was no statistical significance for pain relief degree between the two groups ( P >0.05). The pain beginning to ease time and duration time in the observation group were better than those in the control group (both P <0.05). The contents of SP in the two groups decreased after treatment (both P <0.01), and it was better in the observation group ( P <0.05). The total effective rate of the observation group after treatment was 87.9% (29/33), and that of the control group was 85.3% (29/34), which were not statistically significant ( P >0.05). The cured rate of the observation group was better than that of the control group [66.7% (22/33) vs 58.8% (20/34), P <0.05]., Conclusion: Joss stick moxibustion combined with pricking and cupping are effective for herpes zoster, which have quicker and good analgesic effects than conventional western medication. Its mechanism may be related to reducing the content of SP more fast and to a larger degree.

It has been known for thousands of years that acupuncture can relieve pain. However, the efficacy of acupuncture analgesia (AA) now has to be reconsidered due to negative reports from western countries. In the present study, the possible correlation between caffeine and the difference in AA in China and western countries was determined using the following factors:1) caffeine and pain; 2) adenosine, adenosine receptor and caffeine; 3) AA and caffeine. As a non-selective antagonist of the adenosine receptor, caffeine at low doses can be used as an adjuvant analgesic, and can augment antinociception combined with other analgesics. Caffeine can act as an important neural modulator, and adenosine can produce antinociception when combined with the A 1 receptor located in spinal, supraspinal and peripheral tissue. A preclinical study demonstrated that caffeine at moderate doses could inhibit AA efficacy following plantar incision surgery in a mouse model. Caffeine is present in various foods, especially coffee, and approximately 85% of adults in western countries consume coffee regularly. Therefore, by reconsidering the correlation between caffeine, adenosine receptor and AA, and by determining the possible relationship between caffeine intake habits and AA efficacy, these findings will demonstrate the differences in AA between Chinese and western populations.

Objective: To observe the regulatory effects of acupoint electric stimulation on the analgesic substances and the relevant indices of nerve-immunity-endocrine system in the patients undergoing general anesthesia anorectal operation., Methods: One hundred and fifty-six patients undergoing hemorrhoids and anal fistula operation were randomized into three groups, 146 cases were included in the analysis. In the No.1 group (48 cases), the conventional intravenous general anesthesia was applied. In the No.2 group (50 cases), besides the conventional intravenous general anesthesia, the acupoint transcutaneous electric stimulation was combined at Neiguan (PC 6), Shenmen (HT 7), Shangliao (BL 31) and Ciliao (BL 32). operation in the No.2 and No.3 groups were lower apparently than that in the No.1 group ( P <0.05, P <0.01)., Conclusions: During the general anesthesia anorectal operation, the acupoint transcutaneous electric stimulation achieves analgesic anesthesia through effectively promoting the release of body analgesic substance and reducing the stress level in the operation. With the comprehensive acupoint selection as Neiguan (PC 6) and Shenmen (HT 7) and the local acupoints, the therapeutic effects are better in comparison with the simple selection of local acupoints. In the No.3 group (48 cases), besides the conventional intravenous general anesthesia, the acupoint transcutaneous electric stimulation was combined at Shangliao (BL 31) and Ciliao (BL 32). The electric stimulation was maintained till the end of operation. The patients' saliva was collected 0.5 h before operation and 1 h after operation separately. The indices that reflect the body pain regulation and nerve-immune-endocrine secretion were detected, such as opiophin protein (OPI), secretory immunoglobulin A (SIgA), saliva amylase (sAA), cortisol (Cor) and tumor necrosis factor α (TNF-α). The pain degree was observed 1 h after operation., Results: In the No.2 group, OPI after operation was higher than that before operation ( P <0.05). The difference value of OPI in the No.2 group was higher apparently than that in the No.1 group and the No.3 group (both P <0.05). SIgA after operation was higher than that before operation in the No.1 group ( P <0.05). The difference values of SIgA, sAA, Cor in the No.2 group were lower apparently than those in the No.1 group ( P <0.05, P <0.01). TNF-αbefore and after operation and its difference value among the groups were not significant statistically (all P >0.05). The pain degrees in 1 h after.

Objective: To discuss the clinical therapeutic effects of electroacupuncture at Neimadian (Extra) and Neiguan (PC 6) on the analgesic effect of thoracic perioperative stage and its effect mechanism., Methods: Sixty cases of esophageal cancer with elective radical resection under general anesthesia were divided into an observation group and a control group according to the operation sequence, 30 cases in each one. In the control group, the general anesthesia was simply applied and sufentanil was administered for patient controlled intravenous analgesia (PCIA) after operation. In the observation group, on the basis of the scheme as the control group, the electroacupuncture was used at Neimadian (Extra) and Neiguan (PC 6) 30 min before anesthesia induction and after operation, with continuous wave, tolerable intensity, lasting for 30 min. Separately, before acupuncture (T1) and 2h (T2), 12h (T3), 24h (T4) and 48h (T5) after operation, the plasma β-endorphin (β-EP), 5-hydroxytryptamine (5-HT) and prostaglandin E 2 (PGE 2 ) were determined. During operation, under the same state (from 50 to 60) of bispectrum of EEG (BIS), the intraoperative anesthetic dose was recorded. Using visual analogue scale (VAS), the pain degree was evaluated at T2, T3, T4 and T5 separately and the grade assessment of the therapeutic effects and safety were recorded at each time point., Results: ①The total dosage of sufentanil in the observation group was less than that in the control group[(1.83±0.56) mg vs (2.54±0.62) mg, P <0.05]. ②VAS scores at T2, T3 and T4 in the patients of the observation group were all lower than those in the control group (all P <0.05). ③The levels of plasma β-EP at T3, T4 and T5 in the observation group were increased significantly as compared with those in the control group (all P <0.05) and the levels of plasma 5-HT and PGE 2 at T2, T3 and T4 were reduced significantly as compared with those in the control group (all P <0.05). ④ The excellent analgesia rates 2h、12h and 24h after operation in the observation group were better than those in the control group (all P <0.05). ⑤The rate of the A grade safety in the observation group was higher than that in the control group ( P <0.05)., Conclusions: Electroacupuncture at Neimadian (Extra) and Neiguan (PC 6) provides the safe and effective postoperative anesthesia of thoracic surgery and reduces the dosage of analgesics during the operation, which is possibly related to the increase of endogenous β-EP and the inhibition on the release of 5-HT and PGE 2 .

Objective: To compare the effects for tooth extraction between acupuncture anesthesia and drug local block anesthesia., Methods: Sixty patients were randomly assigned into an acupuncture group and a drug group, 30 cases in each one. Acupuncture was applied at Hegu (LI 4), Neiting (ST 44) and the affected side Xiaguan (ST 7), and Jiache (ST 6), etc. Arrachement was used after deqi and the needles were retained for 10 min after tooth extraction in the acupuncture group. Compound articaine hydrochloride injection was used to conventional local anesthesia, after which tooth extraction was implemented in the drug group. The effects of anesthesia and analgesia were compared between the two groups with pain rating index (PRI) and visual analogue scale (VAS). Besides, the bleeding amounts and adverse reaction rates during the operation and the blood pressure, pulse, and respiration before and after operation were observed., Results: Tooth extraction was completed, and the excellent rates, PRI and VAS scores were not significantly different in the two groups (all P >0.05). The bleeding amounts and adverse reaction rates in the acupuncture group were lower than those in the drug group ( P <0.01, P <0.05).The blood pressure, pulse and respiratory during surgery remained normal without significance between the two groups (all P >0.05)., Conclusions: The effect of acupuncture anesthesia for tooth extraction is equal to that of drug anesthesia. Its analgesia is complete with stable vital signs and less adverse reactions. It is worthy of popularizing.

The acupuncture direction is closely related with the efficacy of acupuncture analgesia. In this article, the relationship between efficacy of acupuncture analgesia and factors, such as whether the needle towards disease location, whether the needle towards meridian direction, whether the needle following spinal cord direction and whether the needle following muscle direction, were analyzed. The previous clinical and literature research indicated that the needle towards disease location was superior to reverse direction, however, the efficacy of analgesia between needle following and reversing meridian, needle towards and at disease location, needles following and reversing spinal cord direction, needles following and reversing muscle direction was controversial. Therefore, the solutions to these problems will benefit the optimized acupuncture treatment plan for pain disorders.

Objective: To observe the effect of electroacupuncture (EA) on expression of synaptic plasticity-related glutamate N-methyl-D-aspartate (NMDA) receptor subunit NR 1, gamma-aminobutyric acid (GABA) receptor subunits (Aβ 2, B 1), etc. in the amygdala in chronic neuropathic pain negative affection (CNPPNA) rats, so as to reveal its mechanism underlying pain relief., Methods: Male Wistar rats were randomized into normal control, CNPPNA model, EA, and anesthesia+EA (AEA)groups ( n =14 in each group, 8 for quantitative RT-PCR and 6 for immunofluorescence staining). The CNPPNA model was established by ligation of the left sciatic nerve and repeated electrical stimulation of the hindpaw plantar skin in the pain-paired compartment. EA was applied to bilateral "Zusanli"(ST 36)and "Yanglingquan"(GB 34)for 30 min, once daily for 7 days.Thermal pain threshold (paw withdrawal latency, PWL)of the bilateral paws was measured by using a Tail-Flick Unit. The conditioned place aversion (CPA) was determined by using a CPA-paired compartment. The expression levels of GABAAβ 2, GABAB 1, NMDA receptor subunit NR 1, postsynaptic density-95 protein(PSD-95), Piccolo genes in the right amygdala area were determined using quantitative RT-PCR, and the immunoactivity of metabotropic glutamate receptor subunit 1 (mGluR 1) and GABAB 2 in the basolateral amygdala (BLA) nucleus was detected using immunofluorescence staining., Results: After modeling, PWL difference (PWLD) values of the model group were significantly increased ( P <0.001),and the time spent in the CPA-paired compartment was considerably decreased compared with the control group ( P <0.001).After EA intervention for 3 and 7 days, the PWLD levels of both EA and AEA groups were apparently decreased( P <0.05),and the time spent in the CPA-paired compartment was apparently increased in the EA and AEA groups( P <0.05),suggesting a pain relief and an improvement of the negative affection after EA intervention. Additionally, following EA, the apparently-decreased expression levels of GABAAβ 2,GABAB 1,PSD-95,Piccolo genes and the reduced numbers of GABAB 2 positive cells and NMDA-NR 1 mRNA as well as mGluR 1 positive fiber numbers were remarkably increased in the EA group ( P <0.05, P <0.001).The expression levels of Piccolo gene, GABAB 2 and mGluR 1 positive cells/fiber numbers were apparently lower in the AEA group than in the EA group ( P <0.001). No significant differences were found between the EA and AEA groups in the PWLD, time spent in the CPA-paired compartment, and the expression levels of NMDA-NR 1, GABAAβ 2, GABAB 1 and PSD-95 genes ( P >0.05)., Conclusions: Repeated EA stimulation of ST 36-GB 34 has a role in relieving both sensory and affection dimensions of chronic pain in CNPPNA rats, which Feb be respectively related to its effects in up-regulating the expression of GABAAβ 2, GABAB 1, NMDA-NR 1, PSD-95 and Piccolo genes, and in promoting the expression of mGluR 1 and GABAB 2 proteins and Piccolo gene in the amygdala.

With the development of pain study, researchers gradually recognized that pain is composed of three main dimensions, namely "sensory-discriminative" "affective-motivational" and "cognitive-evaluative" which influence each other and are also independent from each other. Pain study has shifted away from focusing on the single mode of nociception to the multi-dimensional mode of sensory-affection-cognition. It is held early in traditional Chinese medicine that "when there is a stoppage, there is a pain" and a worsening disease Feb induce depression, which has already shown a multi-dimensional recognition about pain. Acupuncture therapy has been considered to be an effective adjuvant approach for relieving pain. In the present paper, the authors introduced applicability of acupuncture analgesia by modulating the abovementioned multi-dimensions of pain from the following 4 aspects:1) multi-dimensions of pain and related brain regions; 2) recognitions of traditional Chinese medicine about pain; 3) development of researches on acupuncture analgesia, including a) balancing activities of endogenous analgesic and algogenic substances, and triggering intracellular mitogen-activated protein kinase (MAPK) signaling to reduce algesia, b) improving psychological symptoms of patients with depression, anxiety, insomnia, etc., c) modulating functional activities of some common brain regions (as hippocampus, anterior cingutate, frontal lobe of cerebral cortex, etc.) sharing both pain information and learning-memory processing. Hence, the authors hold that if the clinical study and application and experimental researches conducted on the underlying mechanisms of acupuncture analgesia extend towards the multi-dimensions of pain, a series of new concepts or thoughts will be brought out, thereby possibly opening a bright applicable prospect for acupuncture analgesia.

Objective: To observe the clinical effects on analgesia, tranquilization and prevention of abortion syndrome of artificial abortion operation treated with transcutaneous electrical acupoint stimulation (TEAS) with different acupoint combination and explore the optimal acupoint combination of TEAS in artificial abortion operation., Methods: Two hundred patients intended to artificial operation were randomized into No.1 group[Sanyinjiao (SP 6) + Zusanli (ST 36)], No.2 group[Sanyinjiao (SP 6) + Diji (SP 8)], No.3 group[Sanyinjiao (SP 6) + Taichong (LR 3)], No.4 group (cervical blockage anesthesia with lidocaine) and No.5 group (blank group, without any analgesia measure applied), 40 cases in each one. In the No.1, No.2 and No.3 groups, Sanyinjiao (SP 6) was the main acupoint, combined with Zusanli (ST 36), Dijin (SP 8) and Taichong (LR 3) respectively. TEAS was given 30 min before the operation till the end of operation. Mean arterial pressure, heart rate and oxygen saturation during operation, as well as bleeding amount were observed in the five groups. The visual analogue scale (VAS) score was observed during and 30 min after operation, and Ramsay score was observed during operation. Cervical relaxation degree and the incidence of artificial abortion syndrome were recorded., Results: For VAS score during and 30 min after operation and Ramsay score during operation, the differences were significant statistically in the No. 1, No.2, No.3 and No.4 groups as compared with the No.5 group ( P <0.01, P <0.05). The results in the No.2 group were better than those in the No.1, No.3 and No.4 groups (all P <0.05). For cervical relaxationdegree, the result in the No.2 group was better than that in each of the rest groups ( P <0.01, P <0.05). For artificial abortion syndrome, the incidences in the No.2 and No.3 groups were lower than those in the No.4 and No.5 groups (all P <0.05). For bleeding amount and hemodynamic changes, the differences were not significant statistically among the five groups (all P >0.05)., Conclusions: TEAS apparently reduces pain score during and 30 min after artificial abortion operation and achieves the satisfactory tranguilization effects. The combination of Sanyinjiao (SP 6) and Diji (SP 8) achieves the optimal effect of analgesia, tranquilization, dilating cervix and preventing from artificial abortion syndrome in the operation.

Cytokines are closely related to the occurrence and development of rheumatoid arthritis(RA). Acupuncture exerts anti-inflammatory and analgesic effects via elevating anti-inflammatory cytokine level and reducing pro-inflammatory cytokine level and regulating Th 1/Th 2 balance, which reflects the dual directional regulatory effect of acupuncture. However, problems exist in the current researches, such as inadequate depth, limited breadth and not so up-to-date research focus. The mediocre research level and the phenomena of some contradictory results among studies also need being concerned. Therefore, progress may be attained if a holistic, dynamic and networked study is conducted on the influence of acupuncture on cytokines by combining the latest progress in the mechanisms of network of cytokines and neuroendocrine immune network, and high throughput cytokine capture assay. In this way, the mechanism of cytokines in multi-targets (such as local joints, peripheral blood circulation, central nervous system) involving the effects of acupuncture in improving RA will be known more.

Neuropathic pain is one of the common chronic syndromes in clinical practice. It has been demonstrated that the chronic neuropathic pain and glial cells in the central nervous system are closely related to each other. When inducing analgesic effect in neuropathic pain, EA suppressed OX-42 labeled activation of microgliacytes in dorsal horns of the spinal cord, down-regulated release of nitric oxide (NO), expression of P 2 X 4 receptor, intracellular mitogen-activated protein kinase (MAPK), extracellular regulated protein kinases (ERK), proinflammatory cytokines IL-1 β, IL-6, TNF-α, interferon (IF)-γ and up-regulated neurotrophin-3 expression in neuropathic pain rats. In regard to spinal astrocytes, acupuncture suppressed peripheral nerve injury induced activation of GFAP-labeled astrocytes, down-regulated the expression levels of macrophage inflammatory proteins (MIP)-1, MIP-1 β, MIP-3 α, TNF-α mRNA and IL-1 β mRNA, etc. in the dorsal horns of the spinal cord. Up to now, the underlying me-chanisms of acupuncture in regulating activities of glia cells, and interaction between neurons and glia cells, and the related pathways in the peripheral and central systems remain unclear. The effects of some related protein and gene expressions involving in acupuncture analgesia need being confirmed by adopting different approaches.

Objective: To explore the anti-inflammatory and analgesia mechanism of electroacupuncture (EA) device of point injection (PI) on rats of inflammatory pain., Methods: 48 Sprague Dawley (SD) rats were randomly assigned into a control group, a model group, an EA+PI group, an EA device of PI (EAPI) group, an EA group and a PI group, eight rats in each one. The rats in the control group were subcutaneously injected with 50 μL of liquid paraffin oil solvent into the dorsum of left hindpaw, while rats in the remaining groups were treated with 50 μL of complete freund's adjuvant (CFA) at identical location to induce the model of inflammatory pain. After model establishment, the rats in the EA+PI group, EAPI group, EA group and PI group were treated with EA+PI,EA device of PI, EA and PI, respectively, once every other day (the 2nd day, 4th day and 6th day). Each treatment was given for 30 min. The mechanical withdrawal threshold, thermal withdrawal threshold and foot swelling before and 1 d to 6 d after model establishment were observed; the western blotting method was applied to measure IL-1β expression in inflammatory tissue of skin., Results: After model establishment, compared with the control group, the mechanical withdrawal threshold and thermal withdrawal threshold were reduced (all P <0.05) and the foot swelling was increased in the rest groups (all P <0.05). After treatment, the mechanical withdrawal threshold and thermal withdrawal threshold in the EAPI group were significantly increased compared with those in the EA+PI group, EA group and PI group (all P <0.05), but the foot swelling was reduced (all P <0.05). The IL-1β expression in the model group was higher than that in the control group ( P <0.05); after treatment, the IL-1β expression in the EAPI group was lower than that in the model group, EA group and PI group (all P <0.05), but no significantly different from that in the EA+PI group ( P >0.05)., Conclusions: The efficacy of EA device of PI on inflammatory pain is superior to EA combined with PI, EA alone and PI alone, which is suitable for further popularization and application.

Objective: To observe analgesic and sedative effect of acupuncture combined with medicine (ACM) on patients undergiong cardiac surgery., Methods: A total of 50 patients with cardiac surgery from January 2012 to October 2014 were randomly assigned to the conventional analgesia group (group A) and the ACM analgesia group (group B), 25 in each group. Patients in group A were subjected to analgesia and sedation by injecting dexmedetomidine, while patients in group B were subjected to analgesia and sedation by electro-acupuncture [EA, Shenting (GV24); Yintang (EX-HN3)] combined with injection of dexmedetomidine. Morphine hydrochloride injection was performed when analgesia and sedation effect was ineffective in the two groups. The indicators of patients at different time points in the two groups were observed, such as static and dynamic VAS scores, SAS scores, mean arterial pressure (MAP), heart rate (HR), oxygen saturation (SpO2). The injection dosage of dexmedetomidine and morphine hydrochloride, analgesia satisfaction rate, sedation satisfaction rate, the incidences of adverse reactions during treatment such as bradycardia and low blood pressure, mechanical ventilation time, ICU time, and hospitalization expense were observed and recorded in the two groups., Results: There was no statistical difference in static and dynamic VAS scores, SAS score, MAP, HR and SpO2 between the two groups at different time points (P > 0.05). The injection dosage of dexmedetomidine and morphine hydrochloride was significantly reduced in group B than in group A (P < 0.05). The analgesia satisfaction rate of patients in group B was much higher than that in group A (P < 0.05). The incidence of bradycardia also obviously decreased more in group B than in group A (P < 0.05). There was no statistical difference in patients' sedation satisfaction rate, incidences of low blood pressure, delirium, vomiting; mechanical ventilation time, ICU time, or hospitalization expense between the two groups (P > 0.05)., Conclusion: The analgesia method of ACM could reduce the dosage of traditional analgesic drugs and the occurrence of partial adverse reactions.

The efficacy of acupuncture for pain diseases is significant, however, the unified understanding re garding mechanisms of acupuncture analgesia has not been fully reached. In this paper, it is believed that uncoordi nated muscle movement is one of the important causes for pain, while acupuncture could enhance the contact of nerve cells and improve the synergy of muscle movement, so as to achieve the aim of pain relief and even cure.

Objective: To study whether the dose of controlling antihypertensive drug is reduced by transcutaneous electrical acupoint stimulation (TEAS) and the anesthetics, as well as the control of blood pressure (BP) and heart rate (HR) in endoscopic endonasal surgery with general anesthesia., Methods: Sixty patients for selective endoscopic endonasal surgery with general anesthetics and controlling antihypertension involved were selected and randomized into a TEAS group, a sham-TEAS group, 30 cases in each one. The electric pads were attached to bilateral Hegu (LI 4), Zusanli (ST 36), Sanyinjiao (SP 6) and Quchi (LI 11), stimulated with Hans-200 apparatus, 3 to 5 mA, 2 Hz/100 Hz in the TEAS group based on the patients' response to comfort. No electric stimulation was applied to the sham-TEAS group. The general anesthesia started after 30 min intervention and lasted till the end of surgery. The BP and HR were observed and recorded at the end of monitoring in operation room, 10 min after tranquilization (T0), 30 min after intervention (Tj, after induction~of general anestiesa (T2), 30 min after surgery start (T3), 60 min after surgery start (T4) and 30 min after extubation (T5). The doses of vecuronium bromide, propofol and nitroglycerin were recorded statistically in surgery, as well as the operative bleeding volume, the operative time, the resuscitation time and the visual analogue scale (VAS) score after resuscitation., Results: Compared with that at T0, the mean arterial pressure (MAP) at T2, T3, T4 and T5 in the TEAS group and at T3 and T4 in the sham-TEAS group was all reduced, indicating the significant difference (all P < 0.01). MAP at T2 and T5 in the TEAS group was lower than that in the sham-TEAS group (both P < 0.01). Compared, with that at T5, except at T2 in the TEAS group (P<0. 05), HR was not different significantly at the rest time points (all P > 0.05). HR was different at T2 to Ts in the sham-TEAS group statistically (all P < 0.01). The doses of vecuronium bromide, propofol and nitroglycerin, the operative bleeding volume, the operative time, the resuscitation time and VAS after resuscitation were not different significantly between the two groups (all P > 0.05)., Conclusion: The general anesthesia with TEAS and anesthetics involved for controlling antihypertension contributes to the control of BP and HR in the patients in endoscopic endonasal surgery. The impacts are not obvious on the doses of antihypertensive drug, the general anesthetics, the operative bleeding volume, the time of resuscitation and the postoperative analgesia.