Fu, Liang-Wu

Guo, Zhi-Ling

Su, Hou-Fen

Tjen-A-Looi, Stephanie C

English

eScholarship - University of California

UC IrvineUC Irvine Previously Published WorksTitleReply to “Letter to the Editor: Acupuncture is not a unique explanation for reflex excitatory cardiovascular responses”Permalinkhttps://escholarship.org/uc/item/54d8p5d8JournalAJP Regulatory Integrative and Comparative Physiology, 315(5)ISSN0363-6119AuthorsGuo, Zhi-LingFu, Liang-WuSu, Hou-Fenet al.Publication Date2018-11-01DOI10.1152/ajpregu.00237.2018 Peer reviewedeScholarship.org Powered by the California Digital LibraryUniversity of CaliforniaLETTER TO THE EDITORReply to “Letter to the Editor: Acupuncture is not a unique explanation forreflex excitatory cardiovascular responses”Zhi-Ling Guo, Liang-Wu Fu, Hou-Fen Su, and Stephanie C. Tjen-A-LooiDepartment of Medicine and Susan Samueli Integrative Health Institute, School of Medicine, University of California, Irvine,Irvine, CaliforniaSubmitted 27 July 2018; accepted in final form 6 August 2018REPLY: Dr. Wong was questioning if insertion and rotation of anacupuncture needle with a diameter of 0.20 mm at the acupointof the rat may damage adjacent vessels and cause local trauma,which may contribute to acupuncture’s action in the modula-tion of cardiovascular responses other than acupuncture-in-duced activation of afferent fibers in the median nerve. Wepoint out that acupuncture needles with diameters ranging0.16–0.30 mm are applied at the acupoints in small animals,including rats and mice, in many studies (8, 16). Tissuesaffected by the acupuncture needle commonly include skin,subcutaneous tissue, small blood vessels, and nerve endings(15). However, studies have demonstrated that the tissuesimpacted by the insertion of the acupuncture needle are verylimited, and the tissue damage during application of manualacupuncture is very minor (5, 7, 11). Also, in the current study,we have not noticed a hematoma in the area around theacupoint. The method used for manual acupuncture in ourstudy (at ~2 Hz for 5 min every 10 min during a 30-min period)has been reported in many other papers (1, 16). Importantly,we observed increased discharges of the afferent fiber in themedian nerve during manual acupuncture stimulation, whilethe afferent activity stopped after manual acupuncture (2).Thus, we believe that neural pathways involved in acupuncturestimulation mainly contribute to acupuncture’s action in theregulation of cardiovascular function. This assumption is sup-ported by numerous publications (6, 7, 9, 10, 14). In addition,as we have addressed in our paper, not only mechanicalstimulation, but also the chemical substances generated duringthe insertion and/or manipulation of the acupuncture needle,likely contribute to activation of sensory afferent nerves thatsend inputs to the central nervous system, leading to regulationof cardiovascular function (2).Dr. Wong was thinking that “the sham acupuncture shouldbe done with manual needle rotation on the adjacent nonacu-point skin.” We agree that this is one type of sham acupunc-ture. There are a variety of types of sham acupuncture, includ-ing needle location (e.g., use of nonacupoints or irrelevantacupoints), degree of needle insertion (e.g., no penetration ofdepths believed to be suboptimal), and needle stimulation (e.g.,no or suboptimal manual or electrical stimulation) (3, 4, 12,13). We and others have noted that each of these kinds of shamacupuncture has its limitations. In previous studies, we havedemonstrated that acupuncture at the P5–6 acupoints has thespecific action in modulating cardiovascular responses com-pared with the insertion of acupuncture needle without stimu-lation as well as to acupuncture applied to other acupoints ornonacupoints in the wrist (7, 10, 14, 16). Thus, in this study, wehave focused on investigating the specific effect of acupunctureat P5–6 compared with the sham control in which the acu-puncture needle was placed at the acupoint without eithermechanical rotation or electrical stimulation. We observed thatthe sham acupuncture did not activate somatic sensory affer-ents and inhibited sympathoexcitatory cardiovascular reflexes(2). Furthermore, the sham control used in our study is highlyrecommended by the United States and international acupunc-ture societies for the experimental study of acupuncture be-cause it can reduce a number of confounding factors comparedwith other types of controls (3).GRANTSThis work was supported by National Center for Complementary & Inte-grative Health Grant AT009347.DISCLOSURESNo conflicts of interest, financial or otherwise, are declared by the author.AUTHOR CONTRIBUTIONSZ.-L.G. drafted manuscript; Z.-L.G., L.-W.F., H.-F.S., and S.C.T.-A-L.edited and revised manuscript; Z.-L.G. approved final version of manuscript.REFERENCES1. Goldman N, Chen M, Fujita T, Xu Q, Peng W, Liu W, Jensen TK, PeiY, Wang F, Han X, Chen JF, Schnermann J, Takano T, Bekar L, TieuK, Nedergaard M. Adenosine A1 receptors mediate local anti-nocicep-tive effects of acupuncture. Nat Neurosci 13: 883–888, 2010. doi:10.1038/nn.2562.2. Guo ZL, Fu LW, Su HF, Tjen-A-Looi SC, Longhurst JC. Role ofTRPV1 in acupuncture modulation of reflex excitatory cardiovascularresponses. Am J Physiol Regul Integr Comp Physiol 314: R655–R666,2018. doi:10.1152/ajpregu.00405.2017.3. Langevin HM, Wayne PM, Macpherson H, Schnyer R, Milley RM,Napadow V, Lao L, Park J, Harris RE, Cohen M, Sherman KJ,Haramati A, Hammerschlag R. Paradoxes in acupuncture research:strategies for moving forward. Evid Based Complement Alternat Med2011: 180805, 2011. doi:10.1155/2011/180805.4. Langevin HM, Hammerschlag R, Lao L, Napadow V, Schnyer RN,Sherman KJ. Controversies in acupuncture research: selection of controlsand outcome measures in acupuncture clinical trials. J Altern ComplementMed 12: 943–953, 2006. doi:10.1089/acm.2006.12.943.5. Lao L. Safety issues in acupuncture. J Altern Complement Med 2: 27–31,1996. doi:10.1089/acm.1996.2.27.6. Li P, Pitsillides KF, Rendig SV, Pan H-L, Longhurst JC. Reversal ofreflex-induced myocardial ischemia by median nerve stimulation: a felinemodel of electroacupuncture. Circulation 97: 1186–1194, 1998. doi:10.1161/01.CIR.97.12.1186.Address for reprint requests and other correspondence: Z.-L. Guo, Dept. ofMedicine, C240 Medical Science 1, University of California, Irvine, CA92697-4075 (e-mail: zguo@uci.edu).Am J Physiol Regul Integr Comp Physiol 315: R984–R985, 2018;First published August 8, 2018; doi:10.1152/ajpregu.00237.2018.0363-6119/18 Copyright © 2018 the American Physiological Society http://www.ajpregu.orgR984Downloaded from journals.physiology.org/journal/ajpregu at Univ of California Irvine (128.200.223.175) on February 18, 2020.7. Li P, Tjen-A-Looi SC. Longhurst JC. Acupuncture’s role in cardiovas-cular homeostasis. In: Current Research in Acupuncture, edited by Xia Y,Dong G, Wu G-C. New York: Springer, 2013, p. 457–486.8. Lin D, Zhang J, Zhuang W, Yan X, Yang X, Lin S, Lin L. The effectof Electroacupuncture versus manual acupuncture through the expressionof TrkB/NF-B in the subgranular zone of the dentate gyrus of telomerase-deficient mice. Evid Based Complement Alternat Med 2018: 1013978,2018. doi:10.1155/2018/1013978.9. Longhurst JC. Defining meridians: a modern basis of understanding. JAcupunct Meridian Stud 3: 67–74, 2010. doi:10.1016/S2005-2901(10)60014-3.10. Longhurst JC, Tjen-A-Looi S. Acupuncture regulation of blood pres-sure: two decades of research. Int Rev Neurobiol 111: 257–271, 2013.doi:10.1016/B978-0-12-411545-3.00013-4.11. MacPherson H, Thomas K, Walters S, Fitter M. A prospective surveyof adverse events and treatment reactions following 34,000 consultationswith professional acupuncturists. Acupunct Med 19: 93–102, 2001. doi:10.1136/aim.19.2.93.12. MacPherson H, Nahin R, Paterson C, Cassidy CM, Lewith GT,Hammerschlag R. Developments in acupuncture research: big-pictureperspectives from the leading edge. J Altern Complement Med 14: 883–887, 2008. doi:10.1089/acm.2008.SAR-5.13. Mayer DJ. Acupuncture: an evidence-based review of the clinical litera-ture. Annu Rev Med 51: 49–63, 2000. doi:10.1146/annurev.med.51.1.49.14. Tjen-A-Looi SC, Li P, Longhurst JC. Medullary substrate and differ-ential cardiovascular responses during stimulation of specific acupoints.Am J Physiol Regul Integr Comp Physiol 287: R852–R862, 2004. doi:10.1152/ajpregu.00262.2004.15. Zhang ZJ, Wang XM, McAlonan GM. Neural acupuncture unit: a newconcept for interpreting effects and mechanisms of acupuncture. EvidBased Complement Alternat Med 2012: 429412, 2012. doi:10.1155/2012/429412.16. Zhou W, Fu L-W, Tjen-A-Looi SC, Li P, Longhurst JC. Afferentmechanisms underlying stimulation modality-related modulation of acu-puncture-related cardiovascular responses. J Appl Physiol (1985) 98:872–880, 2005. doi:10.1152/japplphysiol.01079.2004.R985AJP-Regul Integr Comp Physiol • doi:10.1152/ajpregu.00237.2018 • www.ajpregu.orgDownloaded from journals.physiology.org/journal/ajpregu at Univ of California Irvine (128.200.223.175) on February 18, 2020.

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