Effect of Acupuncture at Nei-Kuan on Left Ventricular Function in Patients with Coronary Artery Disease

Ho, Feng-Ming; Huang, Pei‐Hsin; Lo, Huey‐Ming; Lee, Fung-Kwan; Chern, Tser-Haw; Chiu, Tsan-Wang; Liau, Chiau‐Suong

doi:10.1142/s0192415x99000197

Cited by 30 publications

(21 citation statements)

References 6 publications

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“…Interest in application of acupuncture as an alternative medical management in the western countries has increased over the last two decades. Acupuncture at the NeiguanJianshi acupoints (P5-P6, overlying the median nerve) is used specifically to treat cardiovascular diseases, one of greatest causes of death around the world (Ho et al, 1999;Li et al, 1998;Lin et al, 2001). Our previous studies have demonstrated that electrical stimulation of the P5-P6 acupoints significantly attenuates sympathoexcitatory pressor responses elicited by chemical and mechanical stimulation of viscera, such as gallbladder and stomach (Li et al, 2001 and, suggesting that electroacupuncture (EA) exerts its influence by modulating sympathetic activity (Tjen-A- Looi et al, 2003).…”

Section: Introductionmentioning

confidence: 99%

Expression of c-Fos in arcuate nucleus induced by electroacupuncture: Relations to neurons containing opioids and glutamate

Guo

Longhurst

2007

Brain Research

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Electroacupuncture (EA) at the Neiguan-Jianshi acupoints (P5-P6, overlying the median nerve) attenuates sympathoexcitatory reflexes probably through affecting the opioid system. The arcuate nucleus (ARC) within hypothalamus is an important brain area that produces opioid peptides. Current physiological studies have demonstrated that the predominant response to EA is excitation in the ARC and that excitatory projections from the ARC to the ventrolateral periaqueductal gray during EA at P5-P6 contribute to inhibition of sympathoexcitatory cardiovascular reflexes. These data imply that ARC neurons activated by EA also may contain excitatory neurotransmitters. Thus, the present study evaluated activation of the ARC induced by EA at P5-P6, in relation to the opioid system and glutamate, by detecting c-Fos, an immediate early gene, opioid peptides and vesicular glutamate transporter 3 (VGLUT3). To enhance detection of perikarya containing the opioid peptides, colchicine (90-100 µg/kg) was administered in cats 28-30 hours before EA or the sham-operated control. EA was performed at P5-P6 for 30 min. Compared to controls (n=5), c-Fos positive cells and neurons double-labeled with c-Fos and β-endorphin, enkephalin or VGLUT3 in the ARC were significantly increased in EA-treated cats (n=6; all P<0.05). Moreover, neurons triple-labeled with c-Fos, β-endorphin and VGLUT3 were noted in this region following EA stimulation, but not in controls. Thus, EA at P5-P6 activates neurons in the ARC, some of which contain opioids as well as glutamate or both. The results imply that EA at P5-P6 has the potential to influence ARC neurons containing multiple neuronal substances that subsequently modulate cardiovascular function.

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Section: Introductionmentioning

confidence: 99%

Expression of c-Fos in arcuate nucleus induced by electroacupuncture: Relations to neurons containing opioids and glutamate

Guo

Longhurst

2007

Brain Research

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“…Clinically, EA at the NeiguanJianshi (P5-6) acupoints has been used to treat cardiovascular diseases in Eastern and, more recently, Western countries (5,21,41). We and others have demonstrated that EA at P5-6 acupoints overlying the median nerve on the wrist modulate blood pressure elevation evoked by gastric distension (GD) in rats (27) or by gallbladder stimulation in cats (50) through a long-loop neural pathway, extending from the arcuate nucleus (ARC) in the hypothalamus to the ventrolateral periaqueductal gray (vlPAG) in the midbrain and, ultimately, to the rostral ventrolateral medulla (rVLM) (13,26,50,58).…”

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confidence: 99%

Electroacupuncture modulates vlPAG release of GABA through presynaptic cannabinoid CB₁ receptors

Fu¹,

Longhurst²

2009

Journal of Applied Physiology

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Fu L-W, Longhurst JC. Electroacupuncture modulates vlPAG release of GABA through presynaptic cannabinoid CB1 receptors. J Appl Physiol 106: 1800 -1809, 2009. First published April 9, 2009 doi:10.1152/japplphysiol.91648.2008.-Previous studies have demonstrated that electroacupuncture (EA) attenuates sympathoexcitatory reflex responses by activating a long-loop pathway involving the hypothalamic arcuate nucleus (ARC), midbrain ventrolateral periaqueductal gray (vlPAG), and rostral ventrolateral medulla (rVLM). Neurons in the ARC provide excitatory input to the vlPAG, whereas the vlPAG inhibits neuronal activity in the rVLM. ␥-Aminobutyric acid (GABA) and glutamate (Glu) have been identified in the vlPAG. Endocannabinoids (ECs), acting as atypical neurotransmitters, inhibit the release of both neurotransmitters in the hypothalamus and midbrain through a presynaptic cannabinoid type 1 (CB1) receptor mechanism. The EC system has been observed in the dorsal but not in the vlPAG. Since it is uncertain whether ECs influence GABA and Glu in the vlPAG, the present study tested the hypothesis that EA modulates the release of these neurotransmitters in the vlPAG through a presynaptic CB1 receptor mechanism. We measured the release of GABA and Glu simultaneously by using HPLC to assess samples collected with microdialysis probes inserted unilaterally into the vlPAG of intact anesthetized rats. Twenty-eight min of EA (2 Hz, 2-4 mA, 0.5 ms) at the P5-6 acupoints reduced the release of GABA by 39% during EA and by 44% 15 min after EA. Thirty-five minutes after EA, GABA concentrations returned to pre-EA levels. In contrast, sham EA did not change the vlPAG GABA concentration. Blockade of CB1 receptors with AM251, a selective CB1 receptor antagonist, reversed the EA-modulated changes in GABA concentration, whereas microinjection of vehicle into the vlPAG did not alter EA-modulated GABA changes. In addition, we observed no changes in the vlPAG Glu concentrations during EA, although the baseline concentration of Glu was much higher than that of GABA (3,541 Ϯ 373 vs. 33.8 Ϯ 8.7 nM, Glu vs. GABA). These results suggest that EA modulates the sympathoexcitatory reflex responses by decreasing the release of GABA, but not Glu, in the vlPAG, most likely through a presynaptic CB1 receptor mechanism. somatic afferents; sympathoexcitatory reflex; cannabinoid type 1 receptor; microdialysis ELECTROACUPUNCTURE (EA), a potent alternative to manual acupuncture, has been suggested to be effective in treating certain cardiovascular diseases including hypertension, arrhythmias, and angina pectoris (5, 6, 41). Clinically, EA at the NeiguanJianshi (P5-6) acupoints has been used to treat cardiovascular diseases in Eastern and, more recently, Western countries (5, 21, 41). We and others have demonstrated that EA at P5-6 acupoints overlying the median nerve on the wrist modulate blood pressure elevation evoked by gastric distension (GD) in rats (27) or by gallbladder stimulation in cats (50) through a long-loop neural pathway, extending from the arcuate...

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“…Chinese and European physicians have suggested that EA is effective in alleviating certain cardiovascular diseases and their symptoms, including hypertension, arrhythmias, and angina (1,12,19,26,48,49,56). One well-recognized set of acupoints, Jianshi-Neiguan (located along the pericardial meridian, P5-P6), is positioned directly over the median nerve on the wrist and is used frequently to treat symptomatic coronary heart disease (12,26,37). Our laboratory has developed a feline model of a partial coronary artery occlusion to study the mechanism of EA's cardiovascular influence during stimulation of the P5-P6 acupoints as well as the median nerve directly.…”

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confidence: 99%

Medullary substrate and differential cardiovascular responses during stimulation of specific acupoints

Tjen‐A‐Looi

Longhurst

2004

American Journal of Physiology-Regulatory, Integrative and Comp

109

173

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Electroacupuncture (EA) at P5-P6 acupoints overlying the median nerve reduces premotor sympathetic cardiovascular neuronal activity in the rostral ventral lateral medulla (rVLM) and visceral reflex pressor responses. In previous studies, we have noted different durations of influence of EA comparing P5-P6 and S36 -S37 acupoints, suggesting that point specificity may exist. The purpose of this study was to evaluate the influence of stimulating P5-P6 (overlying the median nerve), LI4 -L7 (overlying branches of the median nerve and the superficial radial nerve), LI6 -LI7 (overlying the superficial radial nerve), LI10 -LI11 (overlying the deep radial nerves), S36 -S37 (overlying the deep peroneal nerves), or K1-B67 (overlying terminal branches of the tibial nerves) specific acupoints, overlying deep and superficial somatic nerves, on the excitatory cardiovascular reflex and rVLM responses evoked by stimulation of chemosensitive receptors in the cat's gallbladder with bradykinin (BK) or direct splanchnic nerve (SN) stimulation. We observed point-specific differences in magnitude and duration of EA inhibition between P5-P6 or LI10 -LI11 and LI4 -L7 or S36 -S37 in responses to 30-min stimulation with low-frequency, low-current EA. EA at LI6 -LI7 and K1-B67 acupoints as well as direct stimulation of the superficial radial nerve did not cause any cardiovascular or rVLM neuronal effects. Cardiovascular neurons in the rVLM, a subset of which were classified as premotor sympathetic cells, responded to brief (30 s) stimulation of the SN as well as acupoints P5-P6, LI10 -LI11, LI4 -L7, S36 -S37, LI6 -LI7, or K1-B67, or underlying somatic pathways in a fashion similar to the reflex responses. In fact, we observed a significant linear relationship (r 2 ϭ 0.71) between the evoked rVLM response and reflex change in mean arterial blood pressure. In addition, EA stimulation at P5-P6 and LI4 -L7 decreased rVLM neuronal activity by 41 and 12%, respectively, for Ͼ1 h, demonstrating that prolonged input into the medulla during stimulation of somatic nerves, depending on the degree of convergence, leads to more or less inhibition of activity of these cardiovascular neurons. Thus EA at acupoints overlying deep and superficial somatic nerves leads to point-specific effects on cardiovascular reflex responses. In a similar manner, sympathetic cardiovascular rVLM neurons that respond to both visceral (reflex) and somatic (EA) nerve stimulation manifest graded responses during stimulation of specific acupoints, suggesting that this medullary region plays a role in site-specific inhibition of cardiovascular reflex responses by acupuncture. somatic afferents; electroacupuncture; visceral afferents; rostral ventral lateral medulla; prolonged neuronal inhibition ALTERNATIVE MEDICINE is used with increasing frequency in the United States and most other countries. In particular, manual acupuncture and the potent alternative, electroacupuncture (EA), are used primarily for treatment of chronic ailments, including cardiovascular disease. Chinese and ...

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Effect of Acupuncture at Nei-Kuan on Left Ventricular Function in Patients with Coronary Artery Disease

Cited by 30 publications

References 6 publications

Expression of c-Fos in arcuate nucleus induced by electroacupuncture: Relations to neurons containing opioids and glutamate

Expression of c-Fos in arcuate nucleus induced by electroacupuncture: Relations to neurons containing opioids and glutamate

Electroacupuncture modulates vlPAG release of GABA through presynaptic cannabinoid CB₁ receptors

Medullary substrate and differential cardiovascular responses during stimulation of specific acupoints

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