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Neuroradiology |
1 From the Department of Radiology, Kaohsiung Veterans General Hospital, 386 Ta-chung 1st Rd, Kaohsiung 813, Taiwan (M.T.W., C.F.Y., H.B.P.); the NMR Center, Massachusetts General Hospital, Charlestown (M.T.W., J.X., Y.C.I.C., B.R.R., K.K.K.); the School of Medicine (M.T.W., J.C.H., C.F.Y., H.B.P., Y.C.I.C., G.T.) and Institute of Neuroscience, School of Life Science (J.C.H.), National Yang-Ming University, Taipei, Taiwan ; the Laboratory of Functional Brain Imaging, Taipei Veterans General Hospital, Taiwan (M.T.W., J.C.H.); the Department of Radiology, National Defense Medical College, Taipei, Taiwan (C.F.Y.); and the Laboratory of Molecular and Developmental Neuroscience, Massachusetts General Hospital, Boston, (G.T.). From the 1996 RSNA scientific assembly. Received July 20, 1998; revision requested August 26; revision received October 5; accepted January 20, 1999. M.T.W. supported in part by National Science Council (Taiwan) grant NSC 87-2314-B-075B-002 and National Health Research Institute (Department of Health, Taiwan) grant NHRI DOH88-HR-824. Address reprint requests to M.T.W. (e-mail: mtwu@isca.vghks.gov.tw).
PURPOSE: To characterize the central nervous system (CNS) pathway for acupuncture stimulation in the human brain by using functional magnetic resonance (MR) imaging.
MATERIALS AND METHODS: Functional MR imaging of the whole brain was performed in two groups of nine healthy subjects during four stimulation paradigms: real acupuncture at acupoints ST.36 (on the leg) and LI.4 (on the hand) and control stimulations (minimal acupuncture and superficial pricking on the leg). Stimulations were performed in semirandomized, balanced order nested within two experiments. Psychophysical responses (pain, De-Qi effect [characteristic acupuncture effect of needle-manipulation sensation], anxiety, and unpleasantness) and autonomic responses were assessed. Talairach coordinates–transformed imaging data were averaged for a group analysis.
RESULTS: Acupuncture at LI.4 and ST.36 resulted in significantly higher scores for De-Qi and in substantial bradycardia. Acupuncture at both acupoints resulted in activation of the hypothalamus and nucleus accumbens and deactivation of the rostral part of the anterior cingulate cortex, amygdala formation, and hippocampal complex; control stimulations did not result in such activations and deactivations.
CONCLUSION: Functional MR imaging can demonstrate the CNS pathway for acupuncture stimulation. Acupuncture at ST.36 and LI.4 activates structures of descending antinociceptive pathway and deactivates multiple limbic areas subserving pain association. These findings may shed light on the CNS mechanism of acupuncture analgesia and form a basis for future investigations of endogenous pain modulation circuits in the human brain.
Index terms: Acupuncture, 40.1299 • Anesthesia, 10.459 • Brain, function, 10.99 • Brain, MR, 10.121412, 10.121413, 10.121419 • Magnetic resonance (MR), functional imaging, 10.121419
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