Study on Cerebral Blood Flow Regulatory Features of Acupuncture Stimulation at Various Acupoints

Abstract

Background:

Acupuncture therapy is widely used for treating cerebrovascular diseases, including chronic cerebral artery insufficiency, poststroke, and vertebrobasilar artery insufficiency (VBI). To improve the effect of acupuncture for treating cerebral vascular diseases, it is necessary to clarify the effect of the individual acupoints on the cerebral hemodynamic indices and prescribe the acupoints according to their functional features.

Objective:

The goal of this research was to observe the influence of acupuncture stimulation at some acupoints of the Gallbladder and Bladder Meridians on cerebral hemodynamic indices.

Materials and Methods:

For this study, 249 patients with cerebrovascular diseases, including VBI, poststroke, and chronic cerebral artery insufficiency were observed. All participants were outpatients in the Pyongyang Medical College Hospital of Kim Il Sung University, in Pyongyang City, of the Democratic People's Republic of Korea, from January of 2012 to October of 2014. Various hemodynamic indices, such as artery compliance, hemodynamic resistance, and blood flow quantity were recorded using a Cerebral Vascular Disease Diagnosis System (CVD 3000) before and after acupuncture stimulation at individual acupoints of the Gallbladder and Bladder Meridians, respectively. Values of each parameter after stimulation were compared with those before stimulation.

Results:

The effects of acupuncture stimulation on various hemodynamic indices were different in each point group. Particularly, stimulation at acupoints located on the front and middle of the head reduced hemodynamic resistance of the anterior cerebral arteries and middle cerebral arteries significantly, and stimulation at acupoints located on the back of the head reduced the resistance of the posterior cerebral arteries most significantly.

Conclusions:

Stimulation at acupoints on the head could more improve the cerebral blood flow remarkably, more so than acupoints on the legs, and the systematical specificity of the Gallbladder Meridian and Bladder Meridian was indefinite.

Introduction

Today, acupuncture therapy for treating cerebrovascular diseases is being applied widely in the world, as the combination of acupuncture and modern medicine can markedly increase the preventive and therapeutic effects on cerebrovascular diseases, such as stroke and vertebrobasilar artery insufficiency (VBI), with fewer recurrences and residual symptoms.^1–3

In the past, acupuncture therapy for cerebrovascular diseases was performed mainly depending on the ancient theories of traditional medicine while using many acupoints of the 14 meridians distributed across the body.⁴

In order to improve the efficacy of acupuncture for treating cerebrovascular diseases further, it must be applied on the basis of the scientific and experimental studies on the effects of various acupoints on the different physiologic functions of the brain—including cerebral microcirculation and hemodynamics—not just based on ancient theories and practical experiences.

However, according to the previous reports relevant to the effect of acupuncture on cerebral blood flow, only a few acupoints were investigated, not various acupoints of different meridians.^5,6

At present, it is essential to clarify the specificity of acupoints and meridians for regulating the function of internal organs for improvement of acupuncture treatment results.⁷

Various kinds of mathematical methods and software techniques are recently being applied to rheoencephalography (REG) in order to raise the sensitivity of evaluation of cerebral blood flow (CBF).⁸

The influences of acupuncture stimulation were investigated at different acupoints to observe cerebral hemodynamics, using a Cerebral Vascular Diseases Diagnosis System (CVD 3000), which was invented to develop REG.

The CVD 3000 can show blood flow condition through compliance, hemodynamic resistance, and blood flow quantity, etc., measured at individual branches of brain arteries.

The purpose of this study was to find and provide the scientific principle that would offer the best effective acupuncture prescription for cerebrovascular diseases by clarifying the CBF regulatory characteristics of acupuncture stimulation at some head and leg acupoints that belong to the Gallbladder and Bladder Meridians.

Materials and Methods

Participants

This study involved 249 patients with cerebrovascular diseases—including VBI, poststroke, and chronic cerebral artery insufficiency—who complained of headache and dizziness. The patients were divided into individual acupuncture point groups by randomized blocks.

All of the patients were outpatients in the Pyongyang Medical College Hospital of Kim Il Sung University, in Pyongyang City, of the Democratic People's Republic of Korea, from January of 2012 to October of 2014 and volunteers who agreed to participate in the trial examination (Table 1).

Table 1.

Composition of Subjects According to Sex and Age (%)

Total cases		20s		30s		40s		≧50
Male	Female	Male	Female	Male	Female	Male	Female	Male	Female
101 (40.6)	148 (59.4)	8 (40.0)	12 (60.0)	16 (38.1)	26 (61.9)	34 (40.0)	51 (60.0)	43 (42.2)	59 (57.8)
249		20 (8.0)		42 (16.9)		85 (34.1)		102 (41.0)

The sexual composition of the subjects was 101 males and 148 females; thus there were more females than males, and the ages ranged from 23 to 76, with the majority of the subjects in the 40–50 age group.

Selection of Acupoints

The points selected on the Gallbladder meridian were Yangbai (GB 14), Muchuang (GB 16), and Fengchi (GB 20) on the head; and Yanglingquan (GB 34), Qiuxu (GB 40), and Linqi (GB 41) on the legs. The following points were chosen on the Bladder meridian: Meichong (BL 3), Tongtian (BL 7), and Tianzhu (BL 10) on the head; and Weizhong (BL 40), Shenmai (BL 62), and Jinggu (BL 64) on the legs.

Stimulation Method

Filiform needles with a diameter of 0.30 mm were inserted into the selected points and retained for 15 minutes without any manipulation after needling sensation occurred.

The needle insertions were as follows: Yangbai (GB 14), Muchuang (GB 16), Meichong (BL 3), and Tongtian (BL 7), horizontally ∼10 mm in depth; Fengchi (GB 20) obliquely toward the nose tip ∼20 mm in depth; Tianzhu (BL 10) obliquely ∼15 mm in depth; Yanglingquan (GB 34) and Weizhong (BL 40) perpendicularly ∼20 mm in depth; and Qiuxu (GB 40), Linqi (GB 41), Shenmai (BL 62), and Jinggu (BL 64) perpendicularly ∼10 mm in depth.

Equipment and Examination Method

A cerebrovascular disease diagnosis system (the CVD 3000) was used in this study. Figure 1 is a photograph of the interface of CVD 3000. The interface automatically displays the normal range of individual indices, such as compliance (C), resistance (R), and blood flow (Q), as well as measurement values of the bilateral sides of different brain arteries in a patient. During the examination, the CVD 3000 probes are placed on the frontal, temporal, and occipital parts of the patient's head.

FIG. 1.

Measurement interface of the CVD 3000.

Medications, including aspirin, that could affect the cerebral circulation, were prohibited for 48 hours prior to the study.

On the day of examination, each subject was asked to have a rest in bed for 10 minutes prior to the first examination and then acupuncture stimulation was applied bilaterally at a single acupoint. The second examination was conducted 10 minutes after withdrawing the needle.

Observation Indices

Compliance (mL/mm Hg), hemodynamic resistance (mm Hg/L), and blood flow quantity (mL/s) were observed.

Compliance and hemodynamic resistance were measured in the places corresponding to the bilateral anterior cerebral arteries (ACA), middle cerebral arteries (MCA), posterior cerebral arteries (PCA), and blood flow quantity in the places corresponding to the bilateral internal carotid arteries (ICA) and vertebral arteries (VA).

Statistical Analysis

The SPSS 10.0 software package was used in statistical analysis of all the data. The data were expressed as mean ± standard error ( \documentclass{aastex}\usepackage{amsbsy}\usepackage{amsfonts}\usepackage{amssymb}\usepackage{bm}\usepackage{mathrsfs}\usepackage{pifont}\usepackage{stmaryrd}\usepackage{textcomp}\usepackage{portland, xspace}\usepackage{amsmath, amsxtra}\pagestyle{empty}\DeclareMathSizes{10}{9}{7}{6}\begin{document} $${ \overline {X}} \pm SE$$ \end{document} ). A paired t-test was used for the comparison before and after acupoint stimulation in each parameter.

Results

Comparison of the Values of Hemodynamic Indices Before and After Acupuncture Stimulation at Points of the Gallbladder Meridian

Comparison of the values of compliance

Table 2 shows that compliance values of ACA and MCA in the Yangbai (GB 14) point group, ACA in the Muchuang (GB 16) point group, and ACA, MCA, and PCA in the Fengchi (GB 20) point group increased significantly after stimulation than before stimulation. There were no remarkable changes in the Yanglingquan (GB 34), Qiuxu (GB 40), and Linqi (GB 41) point groups.

Table 2.

Comparison of Compliances of Brain Arteries Before and After Acupuncture at Some Points of the Gallbladder Meridian ^a

			ACA		MCA		PCA
Points	Cases	Number of arteries	Before	After	Before	After	Before	After
Yangbai (GB 14)	20	40	1.29 ± 0.16	1.72 ± 0.19^*	1.33 ± 0.14	1.81 ± 0.2^*	1.53 ± 0.08	1.41 ± 0.09
Muchuang (GB 16)	21	42	1.33 ± 0.12	1.68 ± 0.15^*	1.31 ± 0.13	1.47 ± 0.15	1.55 ± 0.08	1.43 ± 0.10
Fengchi (GB 20)	25	50	1.20 ± 0.14	1.44 ± 0.14^*	1.15 ± 0.14	1.42 ± 0.16^*	1.48 ± 0.11	2.05 ± 0.19^***
Yanglingquan (GB 34)	20	40	1.75 ± 0.18	1.79 ± 0.21	1.98 ± 0.26	2.08 ± 0.28	2.02 ± 0.36	1.89 ± 0.18
Qiuxu (GB 40)	20	40	1.18 ± 0.11	1.34 ± 0.19	1.41 ± 0.24	1.50 ± 0.23	1.53 ± 0.17	1.63 ± 0.20
Linqi (GB 41)	20	40	1.23 ± 0.10	1.40 ± 0.16	1.36 ± 0.15	1.37 ± 0.16	1.57 ± 0.17	1.67 ± 0.20

\documentclass{aastex}\usepackage{amsbsy}\usepackage{amsfonts}\usepackage{amssymb}\usepackage{bm}\usepackage{mathrsfs}\usepackage{pifont}\usepackage{stmaryrd}\usepackage{textcomp}\usepackage{portland, xspace}\usepackage{amsmath, amsxtra}\pagestyle{empty}\DeclareMathSizes{10}{9}{7}{6}\begin{document} $${ \overline {X}} \pm SE$$ \end{document} , mL/mm Hg.

Compared with the value before acupuncture:^* P < 0.05, ^***P < 0.001.

ACA, anterior cerebral arteries; MCA, middle cerebral arteries; PCA, posterior cerebral arteries, SE, standard error.

Comparison of hemodynamic resistance

Table 3 shows that resistance values of ACA and MCA in the Yangbai (GB 14) point group, ACA in the Muchuang (GB 16) point group, and PCA in the Fengchi (GB 20) and Yanglingquan (GB 34) point groups decreased significantly after stimulation than before stimulation. There were no remarkable changes in the Qiuxu (GB 40) and Linqi (GB 41) point groups.

Table 3.

Comparison of Hemodynamic Resistance of Brain Arteries Before and After Acupuncture at Some Points of the Gallbladder Meridian ^a

			ACA		MCA		PCA
Points	Cases	Number of arteries	Before	After	Before	After	Before	After
Yangbai (GB 14)	20	40	0.75 ± 0.07	0.60 ± 0.05^**	0.73 ± 0.07	0.62 ± 0.06^*	0.62 ± 0.08	0.63 ± 0.07
Muchuang (GB 16)	21	42	0.75 ± 0.07	0.63 ± 0.05^*	0.74 ± 0.07	0.69 ± 0.08	0.62 ± 0.07	0.59 ± 0.06
Fengchi (GB 20)	25	50	0.80 ± 0.08	0.92 ± 0.09	0.81 ± 0.06	0.85 ± 0.07	0.67 ± 0.05	0.57 ± 0.05^*
Yanglingquan (GB 34)	20	40	0.75 ± 0.12	0.66 ± 0.06	0.76 ± 0.12	0.67 ± 0.06	0.81 ± 0.09	0.72 ± 0.09^*
Qiuxu (GB 40)	20	40	0.93 ± 0.13	1.01 ± 0.12	0.94 ± 0.13	1.00 ± 0.12	0.88 ± 0.11	0.82 ± 0.07
Linqi (GB 41)	20	40	0.92 ± 0.11	0.79 ± 0.07	0.81 ± 0.06	0.82 ± 0.07	0.80 ± 0.09	0.75 ± 0.07

Compared with the value before acupuncture: ^* P < 0.05; ^** P < 0.01.

ACA, anterior cerebral arteries; MCA, middle cerebral arteries; PCA, posterior cerebral arteries; SE, standard error.

Comparison of blood flow quantity

Table 4 shows that blood flow quantity values of ICA in the Yangbai (GB 14) point group, ICA and VA in the Fengchi (GB 20) point group, and VA in the Yanglingquan (GB 34) point group increased significantly after stimulation than before stimulation. There were no remarkable changes in the other groups.

Table 4.

Comparison of Blood Flow Quantity of Brain Arteries Before and After Acupuncture at Some Points of the Gallbladder Meridian ^a

			ICA		VA
Points	Cases	Number of arteries	Before	After	Before	After
Yangbai (GB 14)	20	40	2.22 ± 0.22	2.72 ± 0.27^*	1.49 ± 0.10	1.38 ± 0.11
Muchuang (GB 16)	21	42	2.20 ± 0.20	2.34 ± 0.21	1.53 ± 0.10	1.50 ± 0.10
Fengchi (GB 20)	25	50	1.68 ± 0.05	2.07 ± 0.03^*	1.38 ± 0.17	1.89 ± 0.19^**
Yanglingquan (GB 34)	20	40	2.50 ± 0.24	2.62 ± 0.26	1.94 ± 0.24	2.26 ± 0.26^*
Qiuxu (GB 40)	20	40	1.65 ± 0.16	1.75 ± 0.25	1.42 ± 0.18	1.25 ± 0.19
Linqi (GB 41)	20	40	1.80 ± 0.15	1.84 ± 0.22	1.62 ± 0.18	1.40 ± 0.16

Compared with the value before acupuncture: ^* P < 0.05; ^** P < 0.01.

ICA, internal carotid arteries; VA; vertebral arteries; SE, standard error.

Comprehensive comparison of the influences on hemodynamic indices between the points of the Gallbladder meridian

The influences of various points of the Gallbladder meridian on hemodynamic indices were compared with one another by using the rates of the indices. There were remarkable changes among the total number of observation indices after stimulation was applied at some points of the Gallbladder meridian.

Table 5 shows that the largest number of indices had significant changes when stimulation was applied at the Fengchi (GB 20) point. Then, the hemodynamic indices were influenced by the Yangbai (GB 14), Muchuang (GB 16), and Yanglingquan (GB 34) points, in that order. Stimulation at the Qiuxu (GB 40) and the Linqi (GB 41) points did not cause any significant changes in every index.

Table 5.

Comprehensive Comparison of the Effects of Some Points of the Gallbladder Meridian

	ACA		MCA		PCA		ICA	VA
Points	C	R	C	R	C	R	Q	Q	Number of indices with marked change	Rate ^a (%)	Rank
Yangbai (GB 14)	↑	↓	↑	↓			↑		5	62.5	2
Muchuang (GB 16)	↑	↓							2	25.0	3
Fengchi (GB 20)	↑		↑		↑	↓	↑	↑	6	75.0	1
Yanglingquan (GB 34)						↓		↑	2	25.0	3
Qiuxu (GB 40)									0	0.0	4
Linqi (GB 41)									0	0.0	4

↑, increase; ↓, decrease.

Rate is a ratio of the number of indices with marked change to the total number of indices.

ACA, anterior cerebral arteries; MCA, middle cerebral arteries; PCA, posterior cerebral arteries, ICA, internal carotid arteries; VA; vertebral arteries; C, compliance; R, hemodynamic resistance; Q, blood flow quantity.

Comparison of the Values of the Hemodynamic Indices Before and After Acupuncture Stimulation at Points of the Bladder Meridian

Comparison of the values of compliance

Table 6 shows that compliance values of ACA, MCA, and PCA in the Meichong (BL 3) point group, MCA in the Tongtian (BL 7) point group, MCA and PCA in the Tianzhu (BL 10) point group, and PCA in the Jinggu (BL 64) point group increased significantly after stimulation than before stimulation. There were no remarkable changes in the Weizhong (BL 40) and Shenmai (BL 62) point groups.

Table 6.

Comparison of Compliances of Brain Arteries Before and After Acupuncture at Some Points of the Bladder Meridian ^a

			ACA		MCA		PCA
Points	Cases	Number of arteries	Before	After	Before	After	Before	After
Meichong (BL 3)	25	50	1.84 ± 0.16	2.20 ± 0.15^**	2.08 ± 0.19	2.65 ± 0.21^*	1.88 ± 0.12	2.10 ± 0.12^*
Tongtian (BL 7)	21	42	0.90 ± 0.12	1.01 ± 0.11	0.98 ± 0.10	1.28 ± 0.11^*	1.22 ± 0.08	1.30 ± 0.12
Tianzhu (BL 10)	21	42	1.31 ± 0.12	1.50 ± 0.13	1.47 ± 0.15	1.82 ± 0.18^*	1.48 ± 0.10	1.84 ± 0.11^*
Weizhong (BL 40)	16	32	1.64 ± 0.19	1.49 ± 0.17	1.61 ± 0.18	1.75 ± 0.18	1.56 ± 0.12	1.90 ± 0.23
Shenmai (BL 62)	20	40	1.27 ± 0.11	1.27 ± 0.11	1.30 ± 0.10	1.36 ± 0.11	2.74 ± 0.13	2.43 ± 0.14
Jinggu (BL 64)	20	40	0.98 ± 0.25	1.17 ± 0.19	1.19 ± 0.25	1.21 ± 0.20	1.40 ± 0.17	1.78 ± 0.28^*

Compared with the value before acupuncture: ^* P < 0.05; ^** P < 0.01.

ACA, anterior cerebral arteries; MCA, middle cerebral arteries; PCA, posterior cerebral arteries, SE, standard error.

Comparison of hemodynamic resistance

Table 7 shows that resistance values of ACA and MCA in the Meichong (BL 3) point group, and PCA in the Tianzhu (BL 10) point group decreased significantly after stimulation than before stimulation. However, the values of ACA and MCA in the Weizhong (BL 40) point group increased significantly, and there were no remarkable changes in the Tongtian (BL 7), Shenmai (BL 62), and Jinggu (BL 64) point groups.

Table 7.

Comparison of Hemodynamic Resistance of Brain Arteries Before and After Acupuncture at Some Points of the Bladder Meridian ^a

			ACA		MCA		PCA
Points	Cases	Number of arteries	Before	After	Before	After	Before	After
Meichong (BL 3)	25	50	0.69 ± 0.04	0.51 ± 0.04^**	0.68 ± 0.05	0.52 ± 0.04^**	0.61 ± 0.04	0.57 ± 0.08
Tongtian (BL 7)	21	42	1.30 ± 0.12	1.31 ± 0.11	1.36 ± 0.12	1.31 ± 0.11	0.91 ± 0.07	0.97 ± 0.07
Tianzhu (BL 10)	21	42	0.81 ± 0.08	0.72 ± 0.07	0.82 ± 0.09	0.71 ± 0.07	0.72 ± 0.06	0.55 ± 0.04^*
Weizhong (BL 40)	16	32	0.83 ± 0.11	1.06 ± 0.16^*	0.82 ± 0.10	1.06 ± 0.15^*	0.65 ± 0.04	0.71 ± 0.07
Shenmai (BL 62)	20	40	0.89 ± 0.06	0.79 ± 0.04	0.91 ± 0.06	0.77 ± 0.05	0.39 ± 0.02	0.43 ± 0.03
Jinggu (BL 64)	20	40	1.26 ± 0.17	1.09 ± 0.15	1.27 ± 0.17	1.07 ± 0.15	0.63 ± 0.05	0.61 ± 0.07

Compared with the value before acupuncture: ^* P < 0.05; ^** P < 0.01.

ACA, anterior cerebral arteries; MCA, middle cerebral arteries; PCA, posterior cerebral arteries, SE, standard error.

Comparison of blood flow quantity

Table 8 shows that the blood flow quantity values of ICA in the Meichong (BL 3) point group, VA in the Weizhong (BL 40) point group, and both ICA and VA in the Tianzhu (BL 10) Jinggu (BL 64) point groups increased significantly after stimulation than before stimulation.

Table 8.

Comparison of Blood Flow Quantity of Brain Arteries Before and After Acupuncture at Some Points of the Bladder Meridian ^a

			ICA		VA
Points	Cases	Number of arteries	Before	After	Before	After
Meichong (BL 3)	25	50	2.60 ± 0.18	3.09 ± 0.17^**	1.81 ± 0.12	1.96 ± 0.12
Tongtian (BL 7)	21	42	1.19 ± 0.09	1.21 ± 0.08	1.01 ± 0.08	1.02 ± 0.07
Tianzhu (BL 10)	21	42	1.89 ± 0.16	2.29 ± 0.20^**	1.40 ± 0.09	1.82 ± 0.14^**
Weizhong (BL 40)	16	32	1.97 ± 0.31	1.93 ± 0.26	1.39 ± 0.09	1.67 ± 0.17^*
Shenmai (BL 62)	20	40	1.49 ± 0.13	1.72 ± 0.14	2.19 ± 0.16	2.13 ± 0.12
Jinggu (BL 64)	20	40	1.22 ± 0.16	1.49 ± 0.15^*	1.37 ± 0.13	1.72 ± 0.17^*

Compared with the value before acupuncture: ^* P < 0.05; ^** P < 0.01.

ICA, internal carotid arteries; VA; vertebral arteries; SE, standard error.

Comprehensive comparison of the influences on hemodynamic indices between points of the Bladder meridian

The influences of various points of the Bladder meridian on homodynamic indices were compared with one another, by using the rates of the indices with remarkable changes among the total number of observation indices after stimulation was applied at some points of the Bladder meridian.

Table 9 shows that the largest number of indices had significant changes when stimulation was applied at the Meichong (BL 3) and Tianzhu (BL 10) points. Then, some hemodynamic indices had changes when stimulation was applied at the Jinggu (BL 64) and Weizhong (BL 40) points. Only one index had a change when stimulation was applied at the Tongtian (BL 7) point, and no change occurred when stimulation was applied at the Shenmai (BL 62) point.

Table 9.

Comprehensive Comparison of the Effects of Some Points of the Bladder Meridian

	ACA		MCA		PCA		ICA	VA
Points	C	R	C	R	C	R	Q	Q	Number of indices with marked change	Rate ^a (%)	Rank
Meichong (BL 3)	↑	↓	↑	↓	↑		↑		6	75	1
Tongtian (BL 7)			↑						1	12.5	4
Tianzhu (BL 10)			↑		↑	↓	↑	↑	5	62.5	2
Weizhong (BL 40)		↑		↑				↑	3	37.5	3
Shenmai (BL 62)									0	0	5
Jinggu (BL 64)					↑		↑	↑	3	37.5	3

↑, increase; ↓, decrease.

Rate is a ratio of the number of indices with marked change to the total number of indices.

Discussion

In recent years the combination of modern medical therapy and acupuncture has been applied actively in preventing and treating cerebrovascular diseases such as stroke and many points are used to make the acupuncture prescription based on various traditional medical theories, such as symptom differentiation by meridians and symptom differentiation by Zang and Fu organs.

However, acupuncture therapy for cerebrovascular diseases has not been conducted yet on the basis of scientific verification of the influences and mechanism of applying acupuncture at various points distributed across the body on physiologic functions and hemodynamics of the brain.

This study focused on the scientific principle that can make the acupuncture effect better by clarifying the functional property of acupuncture on brain hemodynamics when stimulation is applied at some points of the Gallbladder meridian and Bladder meridian and prescribing the most suitable acupoints for cerebrovascular diseases.

REG is a noninvasive CBF measurement that has the longest history, and REG's main principle is based on measuring the change in electrical resistance in a local brain tissue that occurs only when a tiny electrical current of high frequency flows the area so that it can reflect the blood repletion and condition of cerebral blood vessels (i.e., elasticity and tension).

Compliance of blood vessels is a comprehensive marker of elasticity of the walls of blood vessels, and hemodynamic resistance is a hydrodynamic one that acts on the blood flowing in an artery and is inversely proportional to the radius of artery if the length of the artery and the blood viscosity are fixed.

Blood flow quantity indicates the amount of blood flow that passes through a certain area of the circulatory system within a definite period. Blood flow quantity is definitely proportional to the pressure difference of an artery but is inversely proportional to hemodynamic resistance.

REG has been hardly used for a while since transcranial Doppler (TCD) imaging was introduced for evaluation of CBF.

However, the sensitivity of TCD measurements with the principle of measuring blood flow velocity is not so great, with such shortcomings as not being able to fully evaluate changes of elasticity and radius of a brain artery. Therefore, some scientists in this field have recently started to show interest again in REG, developing it further by combining modern mathematical theories and information technology. Thus is it possible to effectively evaluate the change of cerebral blood flow after acupuncture treatment.

This study investigated the effect of acupuncture stimulation at some points with the cerebrovascular diseases diagnosis system (CVD 3000), which was developed from REG in North Korea.

First the changes of compliances were observed in different brain arteries after acupuncture stimulation at points of the Gallbladder meridian. As a result, the compliance values of ACA and MCA in the Yangbai (GB 14) point group, the values of ACA in the Muchuang (GB 16) point group, and the values of ACA, MCA, and PCA in the Fengchi (GB 20) point group, after stimulation, increased significantly, compared with those values before stimulation. However, there were no remarkable changes in the Yanglingquan (GB 34), Qiuxu (GB 40), and Linqi (GB 41) point groups (Table 2). This indicates that the acupoints of the Gallbladder meridian on the head increase the elasticity of various brain arteries remarkably but the acupoints on the legs have no influence on this elasticity.

When changes of resistance according to brain arteries after stimulation was applied at points on the Gallbladder meridian were observed, the resistance values of ACA and MCA in the Yangbai (GB 14) point group, the values of ACA in the Muchuang (GB 16) point group, and the values of PCA in the Fengchi (GB 20) point group and the Yanglingquan (GB 34) point group decreased significantly after stimulation, in comparison to those values before stimulation. However, there were no remarkable changes in the Qiuxu (GB 40) and the Linqi (GB 41) point groups (Table 3).

This indicates that Yangbai (GB 14), Muchuang (GB 16), Fengchi (GB 20), and Yanglingquan (GB 34) decrease hemodynamic resistance by dilating various brain arteries. While Table 4 shows that the blood flow quantity value of ICA in the Yangbai (GB 14) point group, both values of ICA and VA in the Fengchi (GB 20) point group, and the value of VA in the Yanglingquan (GB 34) point group increased significantly after stimulation, compared with those values before stimulation. This might result from the change in compliance and resistance caused by acupuncture.

The influences of various points of the Gallbladder Meridian were compared comprehensively on hemodynamic indices (Table 5). As a result, the largest number of indices showed significant changes when stimulation was applied at Fengchi (GB 20), and then the hemodynamic indices were influenced, in order, by Yangbai (GB 14), Muchuang (GB 16), and Yanglingquan (GB 34). Stimulation at Qiuxu (GB 40) and Linqi (GB 41) did not cause any significant changes in every index.

This shows that among the points of the Gallbladder Meridian, the points on the head are more effective for hemodynamic indices than points on the legs. In addition, although there are points on the head, they have different effects on brain blood flow; that is, Yangbai (GB 14), located on the front side of the head, is more significantly effective for ACA and MCA, but Fengchi (GB 20), located on the back side of the head, is more significantly effective for PCA.

In the next stage of the study, the influences of acupuncture at different points of the Bladder Meridian on hemodynamic indices were investigated.

The influences of various points of the Bladder Meridian on hemodynamic indices were compared comprehensively (Table 9).

As a result, the largest number of indices showed significant changes in the Meichong (BL 3) and Tianzhu (BL 10) point groups, and some hemodynamic indices in the Jinggu (BL 64) and Weizhong (BL 40) point groups, only one index in the Tongtian (BL 7) group, and no change in the Shenmai (BL 62) group.

This result also shows that the points on head are more effective for hemodynamic indices than the points on the legs, and, among the points on the head, the Meichong (BL 3) point, located on the front side of the head, is more significantly effective for ACA and MCA, and the Tianzhu (BL 10) point, located on the back side of the head, is more effective for PCA.

Consequently, one can say that the systemic specificity of a meridian does exist in cerebral blood flow regulation performed by stimulation at the points of the Gallbladder and Bladder meridians (i.e., different points of a certain meridian have different functions).

Reviewing the experimental results on the influences of the points of the Gallbladder meridian and Bladder meridian on CBF, one can understand that the points on the front side of the head are more effective for ACA, MCA, and ICA, and the points on the back side of the head are more effective for PCA and VA, regardless of the corresponding meridian.

This indicates that the nearer a point is to the body surface projection region of a brain artery, the larger the regulatory effect will be on the artery.

The anterior part of the head is innervated with the trigeminal nerve and the posterior part of the head is innervated with branches of the superior cervical spinal nerve. Such nerve localizations of modern medicine may cause the difference between head points in regulating the brain arteries.

The mechanism for brain blood flow improved by the points on legs may be involved with many more complicated factors. Research on this should be continued.

Summarizing all these study results, it is suggested that in order to improve the efficacy of acupuncture therapy for cerebrovascular diseases, including poststroke, vertebrobasilar insufficiency, and chronic brain circulatory insufficiency, acupuncture should be conducted by prescribing the best effective points for the affected brain artery on the basis of hemodynamic examination results of patients with cerebrovascular diseases.

Conclusions

The influences of some points of the Gallbladder Meridian and Bladder Meridian on brain blood flow are different from each other:

(1) The effect of the points on the head on brain blood flow regulation is better than that of the points on the legs.

(2) The points on the anterior part of the head can improve blood flow more efficiently in ACA, MCA, and ICA, as well as the points on the posterior part of the head in PCA and VA.

Footnotes

Author Disclosure Statement

No competing financial interests exist.

CME Quiz Questions

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