Acupuncture and the brain

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Acupuncture and the brain
Hugh MacPherson

• Foundation for Traditional Chinese Medicine, York
• Department of Health Sciences

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What is acupuncture?

• Insertion of fine needles
• At acupuncture points
• With a deqi sensation

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What about the evidence?

• Are there biological markers that correlate with
  acupuncture?
• Is there an experiment that we could do to show
  an acupuncture effect?

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Aim of experiment

• To explore changes in the brain using fMRI when
  needling the acupuncture point Hegu (LI-4)
• comparing superficial deep needling
• exploring deqi

Acupuncture point (LI-4)
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Block design used for both superficial and deep
needling
needle stimulation
needle stimulation
needle insertion
needle withdrawal
0
2
4
6
8
10
12
14
16
minutes
Timing used in block design as per Hui et al 2000
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Scanning and fMRI analysis

• Seventeen volunteers, naïve to acupuncture
• 3 Tesla GE MRI scanner
• Activations
• Deactivations

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Model fit
activations
deactivations
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Similar Activations on Needle Stimulation
Superficial Needling (n17)
Deep Needling (n17)
Z score 5.6 Cluster size 62
Z score 6.8 Cluster size 141
Cerebellum
Cerebellum
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More Deactivation than Activation
Superficial Needling (n17)
Deep Needling (n17)
Z score 7.5 Cluster size 4209
Z score 7.6 Cluster size 1469
Left hemisphere deactivations Precuneus
(BA39) Cingulate gyrus
Left hemisphere deactivations Occipital lobe
(BA19) Precuneus (BA39) Cerebellum
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Deactivation on Deep Needling
Activation on Deep Needling
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Needle sensation what is deqi?

• Literally deqi is the obtaining of qi
• Often described as a dull ache
• Most acupuncturists
• Aim to elicit deqi on needling
• Associate deqi with a therapeutic effect

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Activations when not Deqi
Deqi (n10)
Not Deqi (n7)
Z score Cluster size
Z score 7.9 Cluster size 633
NO ACTIVATIONS
Cerebellum Brainstem (midbrain) Temporal Lobe
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Deactivations with Deqi
Deqi (n10)
Not Deqi (n7)
Z score 6.0 Cluster size 129
Z score 9.6 Cluster size 1014
Occipital lobe Inferior occipital gyrus Cuneus
Middle temporal gyrus Limbic lobe anterior
cingulate
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Is this a placebo response?

• Participants were acupuncture naïve
• Participants were blind to the depth of needling
• Superficial and deep needling were delivered in
  randomised order
• The placebo effects associated with expectation
  and belief were the same in both groups

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Implications for research

• Main finding depth of needling and deqi
  sensation have specific impact on brain
• What is the meaning of the deactivations that
  predominate?
• How important are these findings in terms of
  therapeutic effects?

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Acknowledgements

• Aziz Asghar
• Hull York Medical School, University of Hull
  University of York
• Gary Green Angel Nevado
• York Neuroimaging Centre, University of York
• George Lewith,
• Complementary Medicine Research Unit,
• University of Southampton
• Mark Lythgoe Robyn Haselfoot
• Institute of Child Health, University College
  London