Comparison & Integration
of Western and Eastern Medicine
Jing Liu, PhD, Lic.Ac
2011
A copy right is reserved for the materials in
the following presentation
Integrated Medicine
Western Medicine + TCM + Natural
Medicine ( Nutrition, diet, herbs, natural
therapies in the world)
11/10/10
Jing Liu
3
Natural Medicine
 从学科分类学的角度审视，一门学科不应是有地区属性的医学科学不
应分属于西、东方，应该统一于现代医学范畴内。中医药学应属于现
代医学的一个分支学科.
 从科学的定义上考虑，在中医药学最终能够被现代医学接受之前，将
中医纳入到自然医学体系。
 自然医学将逐步取代替代医学/中西医结合等名称而成为现代医学家族
的( 而非西方医学）中的一个重要学术分支。
 在自然医学的范畴中，国家的属性将被医学体系的自然性和科学性逐
渐取代，成为世界医学界都容易被接受的一门医学
Content
 Fatigue - Hormone Balance
 Inflammation
 Pain
 Comments on acupuncture clinical trails:
 Placebo, Specificity of acupoints
Cause of Fatigue
 Insomnia
Heart - kidney disharmony
 Hormone dysfunction
Kidney deficiency
 Gut inflammatory status
Spleen: Dampness / phlegm
Yin & Yang
Insomnia treatment
 WM
Sedative-Hypnotics or antipsychotics
Adverse reactions: drowsiness, weakness, pseudodepression in the morning
 EM
Encouraging Yang energy in the morning and nourishing
Ying in evening
Yang encouraging : Yin nourishing:
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Jing Liu
7
Yin & Yang Theory and Sleep
 A general principle in traditional Chinese Medicine (TCM)
practice
 Morning
Yang Time: adrenal, thyroid hormone awake and rise to peak energetic, active
 Evening and Night
Yin time: melatonin and serotonin dominant –calm and sound sleep
 Higher Yang in the morning, Deeper Yin control in
evening and night, better quality of sleep
11/10/10
Jing Liu
8
Sleep and Hormone Balance
Insomnia - Cortisol Dysfunction Syndrome
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Fatigue
Depression
Insomnia
Irritability/. Anxiety
Sweets craving
Poor concentration
Headache
Allergy
Elevated sympathetic nerve tone and decreased cortisol
 = Heart Kidney Disharmony 心肾不交 ?
Insomnia Treatment
Basic Formula (1)
Kidney strengthening
Mai Wei Di Huang Tang 麦味地黄
Add: Ginseng人参, Royal jelly蜂王浆,
Adrenal hormone promoting:
Shan Zhu Yu山茱萸, Shu Di Huang熟地黄
Estrogenic phytohormone:
Shan Yao山药(tocopherol, Coenzyme Q9, Cyloartenol,
1- feruloyl glycerol, hydro-Q9, chromene)
Insomnia Treatment
Basic Formula (2)
酸枣仁汤
 酸枣仁
 川芎 Anti-inflammatory
 茯苓 Reduce edema
 知母 Anti-sympathetic, Anti-inflammatory
 甘草 Anti-inflammatory, Detox
 Add:
hehuanhua合欢花， lianzixin莲子芯，baishao 白芍
Causes of Fatigue
 Heart: Insomnia
 Kidney: Hormone Dysfunction ( HPTA Axis)
 Spleen: Gastrointestinal Dysfunction
Fatigue and Hormone HPA Axis
 The current evidence supports the following factors of
HPTA axis dysfunction in patients related with chronic
fatigue syndrome (CFS):
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 Mild hypocortisolism
 Attenuated diurnal variation of cortisol
 Blunted HPTA axis responsiveness to body need.
 hypothyroid function
 Imbalanced sexual hormones
Adrenal Hormone Synthesis
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Adrenal Hormone Synthesis
Estrogen Family
Adrenal Dysfunction / Fatigue
 Adrenal glands are unable to keep pace with the
demands of perpetual stress.
 Stress signals > cortex > limbic system > sympathetic
nerve > adrenal gland > cortisol release/thyroid hormone
 The gland can't produce quite enough of the hormones
our mind-body need.
 Existing blood tests, aren't sensitive enough to detect the
decline in adrenal function: cortisol panel test
The Symptoms of Adrenal Fatigue
 Qi & Yin Deficiency
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Fatigue, mostly Midday Fatigue
Unexplained Weight loss
Reduced tolerance for stress
Insomnia
Anxiety
Craving for sweets and salty foods
Body hair loss
Body aches
Depression
 Low Cortisone Syndrome
 Above symptoms plus:
Increased susceptibility to infections
Allergies to things you were never allergic to before
Chemical sensitivities (Hyper Chemical Sensitivity)
Herbs for Adrenal Dysfunction
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Panax Ginseng 人参
Elwutherococcus 西伯利亚人参
Rhodiola 红景天
Yin Yang Huo 淫羊藿
Shan zhu yu 山茱萸
Ocimum sanctum ( holy basil） 圣罗勒
Withania 睡茄
Glycyrrhiza 甘草 (Hypotension)
Other herbs for Kidney Yin/Yang deficiency
Treatment of Adrenal Fatigue
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Progesterone cream
Iodine / tyrosine
Phosphorylated serine / He Shou Wu 何首乌
Pregnenolone / Cortisol
Melatonin at bed time
Hypothyroidism (1)
Qi & Yang Deficiency
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Fatigue
Shortness of breath with a shallow and slow respiratory pattern
Low basal body temperature, Cold intolerance
Thyroid-Related Depression
slow heart rate
Sluggish reflexes
Constipation
Poor muscle tone (muscle hypotonia)
Slow speech and a hoarse, breaking voice
Depression
Kidney deficiency
 Decreased libido
 Hair loss
 Lower renal function with decreased glomerular filtration rate
 Impaired memory
 Abnormal menstrual cycles
 Thin, brittle fingernails
Female infertility
Hypothyroidism (2)
Spleen deficiency
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Weight gain and water retention
Enlarged tongue
Yellowing of skin due to impaired conversion of beta-carotene to vitamin A
Impaired Puffy face, hands and feet (Non-specific Edema?)
Impaired cognitive function (brain fog)
Yin & Blood deficiency
 Dry, itchy skin
 Decreased sweating
 Others
 Elevated serum cholesterol
 Muscle cramps and joint pain
 Hyperprolactinemia and galactorrhea
Wilson's Temperature Syndrome
 Temperature lower than 98.60F
 Hypothyroidism symptoms with normal T3, T4
 Typically brought on by stress
 often exist with chronic fatigue syndrome,
fibromyalgia’
 Improved by treatment of T3 or herbs / supplements; not
respond to T4 treatment
Causes of Hypothyroid Syndrome
 Iodine deficiency
 Stress
 Hushimoto disease ( chronic lymphocytic thyroiditis), 25%
 lithium-based mood stabilizers, usually used to treat bipolar
disorder (previously known as manic depression)
 Congenital hypothyroidism is very rare accounting for approximately
0.2‰
Thyroid Hormone
 90% T3 (effects fast, short term)
 10% T4 (effects slow, long term)
 T3 is only form of thyroid hormone to supply
energy to heart from breaking down fat
 Over dose of T3 cause cardiac overloading
Conversion of T3 or RT3
Conversion of T4 to T3 Promoters (1)
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Kelp (iodine, Iron), selenium
Zinc, potassium, cupper
High protein diet
Vitamin A, E, C, B2, B3, B6, B12
Growth Hormone
Testosterone
Ashwaganda (India herb)
Inability to convert T4 to T3
 Excessive alcohol
 Low protein/fat diet
 Too much cruciferous vegetables
 Walnuts
Low T3 / High reverse T3 Promoters
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Stress - epinephrine / NE, cortisol
Free radicals
Aging
Fasting
Diabetes
Toxic metal exposure
Inflammation-elevated inflammatory factors: IL-6, TNFalpha, IFN-2
Iodine Deficiency
 88% America women are in iodine deficiency.
 Low iodine cause hyperestrogenic state and higher free estrogen level up
to 80 to 90%, normal is 40 to 60%.
 When Iodine is enriched, the estrogen receptor activity in the breast is
reduced.
 Iodine promote apoptosis and disrupt proliferation
 Low iodine cause fibrocystic breast; Effective therapy (82%) in treating
fibrocystic breast disease and prevent breast cancer
 TCM: Hai Zao, Kun Bu 海藻，昆布
Iodine Deficiency
Causes of Iodine Deficiency
 Diet in shortage of iodine
 Iodine Taken Up: Thyroid: 6mg; breasts: 5mg /day; other
tissues: 2mg/day
 Japanese women: 13.8mg daily, lowest in breast cancer
 Diet high in pasta/bread containing bromide (bind to
iodine receptor)
 Fluoride use (inhibiting iodine binding
 Vegan and vegetarian diet
Drugs for T3/T4 replacement
 T3: Liothyronine, Triiodothyronine
 T4: Levothyroxine (Synthroid)
Transfom to be T3, but take up to 8 weeks to reach the
required level of T3.
 Armour® a naturally derived from porcine thyroid glands.
(T3 liothyronine is 4x as potent as T4 levothyroxine; so
38 mcg T4and 9 mcg T3 per grain of thyroid.
Thyroid Hormone Replacement Failure
 After increase dosage still feel fatigue:
 Magnesium deficiency
 Adrenal deficiency
 Overdose
 Poor absorption from unhealthy gut
Side Effects of T3 Therapy
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Fluid pretension
Achiness
Jitteriness
Irritability
Dull headache
Increased heart rate
Can not be used for severe Adrenal or cardiac deficiency
Herbs for Thyroid Function
 Huang Qi黄芪
 Huang Qi Wu Wu Tang黄芪五物汤
 Or add: Xiao Chai Hu Tang小柴胡汤, in case of
autoimmune
 Prolonged hypothyroidism cause adrenal fatigue
 Adrenal: Ying Yang Huo 淫羊藿, Shan Zhu Yu山茱萸
 When the herbs not effective enough, add T3, to reduce
the dose of T3 and reduce the side effect of T3
Natural Supplements for Thyroid Function
 Guggul (Commiphora mukul)
increase iodine intake and thyroid hormone production, enhance
thyroid perocidase enzymes
 Seaweed (algae) :
Kelp (kun Bu)
bladder wrack
fucus vesiculosus (best antioxidant among seaweeds)
 Seaweed contain diiodothyoinine (DIT), which may promote thyroid
function
 Zinc, Selenium
 Blue Flag - potent detoxifier of thyroid
 Improvement usually occurs within 3 to 4 weeks
Hushimoto’s Disease
 Reduce autoimmune response and inflammation
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Xiao Chai Hu Tang 小柴胡汤
Curcumin
Boswellia
Lycopus virginicus（lycopus lucidus 泽兰)
 inhibit iodine metabolism, inhibits release of thyroxine from thyroid, binds
with TSH, decrease pulse and BP
 95% improvement rate, officially recognized in Germany as prescription
 Rosemary extract (迷 迭香100:1), reduce antibody
Hormone: Progesterone
 Produced mainly in ovary, little in adrenal gland;
Increase 100x during pregnancy
 Enhance: thyroid function, apoptosis, estrogen
sensitivity, brain cell growth in fetus
 Decrease: breast cell growth, breast cancer,
atherosclerosis,
 Decrease Brain degeneration, neuro-blastoma, MS; antidepression
 Burn fat for energy; hair growth;
 Progestins are NOT equal to progesterone
Herbs for Progesterone
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Juglans regia (England Walnut 核桃), progesterone detected
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Progesterone-like steroids in Dioscorea mexicana of yam family native
to Mexico, containing steroid diosgenin converting into progesterone.
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Diosgenin and progesterone found in other Dioscorea species.
Dioscorea pseudojaponica from Taiwan, containing saponins —converted
to diosgenin -> progesterone.
 Other Dioscorea species: Dioscorea villosa andDioscorea polygonoides.
 Dioscorea villosa contains 3.5% diosgenin.
 Dioscorea polygonoides contain 2.64%
 Dioscorea family: Shan Yao山药, Bi Xie, Chuan Shan Long穿山龙, Shan Ci
Gu山慈姑 I
 Sheng Ma 升麻
 Maca
 Fu Pen Zi 覆盆子
Hormons: Estradiol(E2)
Neuro-protective
Breast cancer promoting
Cell proliferation with alveoli formation
(hyperplasia) and even cyst formation
Effects of Estrogen Therapy
 Prevent osteoporosis
 Decrease LDL and increase HDL
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Increase blood pressure, triglyceride
Gallstone
Elevated liver enzyme
Increase carbohydrate craving
Decrease thyroid function by increasing binding thyroid
binding globulin
Estrogen Balance
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In the 1960s and 70s Dr. Henry Lemon concluded:
Estrogen Quotient
EQ=E3/E1+E2
EQ<1: high risk for breast cancer
EQ>1.5: low risk for breast cancer
Hormone: Estriol
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Anti-inflammation
Promote shift from T helper (Th) 1 to Th2
Reduce autoimmune disease
Prevent osteoporosis
Breast caner protection
Menopause improvement 92
Don't seem to increase risk of breast cancer
Estriol binds to estrogen receptors with much weaker
activity, competing stronger estradiol binding to
receptors - protective against breast cancer
Estrogen Dominance
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Fatigue
Hypothyroidism by decrease conversion of T4 to T3
Decreased sex drive
Depression / anxiety / Migraines / Insomnia
Memory loss or foggy thinking
Mood swings / Memory loss or foggy thinking
Weight gain secondary to insulin resistance / Fat gain
PMS / Menstrual disturbances--irregular and heavy bleeding.
Bone loss / Hair Loss
Breast cancer / Fibrocystic breasts / Uterine cancer / fibroids
Water retention, bloating.
Tendency of autoimmune disorder
Correction: Progesterone therapy
Estrogen Dominance
After menopause, Progesterone decreases by over
99% from its original youthful baseline levels; while
estrogen production only decreases by about 40%.
 New research show that almost all the uncomfortable
symptoms of PMS and of Menopause are actually
caused by low progesterone levels in the body.
Breast Cancer prevention
 Bio-identical Estrogen therapy
 E3:E2 = 4:1
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DIP
D Vitamin D deficiency
Iodine deficiency
P Progesterone deficiency
Hormone: Testosterone
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Testosterone
Improve insulin resistance, belly fat
Improve: sleep, vitality, libido/orgasm/arousal
Not necessary cause prostate cancer
Herbs：Yin Yang Huo淫羊藿, Rou Cong Rong肉苁蓉，
Lu Rong鹿茸, Ren Shen人参
Hormone: DHEA
the first anti-aging hormone
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Improve motivation, well being, memory, libido/orgasm
Anti-atherosclerosis
Antidiabetic
Anti-inflammatory
Antiosteoporotic
Anti-senility
Reduce fat
Protect thymus and immune function
 50mg daily anti-age without significant side effects
Fatigue
Fatigue and GI dysfunctiion / Candida
Symptoms of Candia (1)
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fatigue
concentration/focus memory problems
painful joints, muscle aches
unrefreshing sleep
white coated tongue
chronic sinusitis
Diarrhea or chronic constipation
headaches including migraines
visual blurring, sensitivity to light, eye pain
Depression, irritability, anxiety
sensitivity to heat/cold
alcohol intolerance
gluten intolerance
Symptoms of Candia (2)
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Irritable bowel
numbness/tingling in the face or extremities
dryness of mouth and eyes
menstrual problems (PMS/endometriosis)
recurrent yeast infections
skin rashes, dry/flaking skin
Eczema, dermatitis, acne
jock and rectal itching
chronic athlete's foot, toenail and fingernail fungus
ringing in the ears (tinnitus)
allergies
sensitivity to noise/sounds,foods,chemicals
feeling in a fog
muscle weakness
jerky-leg syndrome
low sex drive
Anti-Candida Herbs
 Cinammon
 Grapefruit seed extract
 Olive leaf extract
 Garlic extract
 Berbering, Goldenseal
 Oregano leaf extract
 Pau d’arco
 Zinc
 Coconut oil
 Candex (cellulase enzymes)
Introduction: Inflammation
 Normal inflammation is a necessary protective response
to harmful stimuli to the body.
 Prolonged or excessive inflammation is related
pathological status including infection, autoimmune
disorders, atherosclerosis, Alzheimer's, autism, arthritis
and even cancer
Inflammation Process
Eicosanoid Cyclooxygenase Pathway
Pathogen
IL-1, TNF-a, PDGF, IFNs, Tyrosine Kinase
chemokines
proliferation
inflammation
Adhesion
penetration
hypoxia, superoxide, NO, free radical
AA
COX2
cancer
inflammation
PGE2
Eicosanoid Synthesis
Prostaglandin/Inflammation Formation Pathway
Eicosanoid Synthesis
Prostaglandins and related compounds are collectively known as
eicosanoids. Most are produced from arachidonic acid (AA)
 Step one:
Release of AA from membrane phospholipids by phospholipase A2(PLA2).
 Step Two:
AA is metabolized by COX enzymes to be
prostaglandin E2 (PGE2),
or Thromboxin (TXA2)
or prostacyclin (PGI2),
 AA also metabolized by lipoxygenase or cytochrome P450 to be
 leukotrienes
Ecosanoid considered "local hormones." participating in intercellular
signaling,
Role of Ecosanoid
inflammation
fever
regulation of blood pressure
blood clotting
immune system modulation
control of reproductive processes & tissue
growth
regulation of sleep/wake cycle.
Ecosanoid Inhibitors
Corticosteroids are anti-inflammatory from preventing PL A2
expression, reducing AA release.
Stress – adrenal fatigue – cortisol exhaustion - inflammation
COX-2 is stimulated by growth factors, cytokines, and
endotoxins.
Attempts have been made to develop drugs that inhibit:
Phospholipase A2 / AA / COX
for treating inflammatory diseases
Inflammation
Inflammation exist in many diseases: cancer, autoimmune
disorders, infections, et al.
 WM
 COX-2 inhibitor (Vioxx, Celebrex)
 Adverse reactions: PGI2 inhibition – inner membrane of blood
vessel damage leading stomach ulcer, kidney failure, cardiac
attack
 EM
 Natural COX 2 inhibitor: Curcumin, turmeric姜黄, coptis黄连,
berberine, Paeonia Latiflora芍药, Boswellia乳香
 No obvious PG I 2 inhibition; Only benefit to heart
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COX-2
 COX-2 levels increase in inflammatory diseases such
as arthritis.
COX-2 expression is increased in some cancer cells.
Angiogenesis, essential to tumor growth, requires
COX-2.
Over expression of COX-2 leads to expression of VEGF
(vascular endothelial growth factor).
Regular use of NSAIDs has been shown to decrease
the risk of developing colorectal cancer.
Anti-inflammatory Therapy
Side effects & Limitations of Chemical Drugs
 Naproxen
 Naproxen, trade name Alevea, a nonsteroidal anti-inflammatory drugs (NSAID)
 ibprofen, indomethacin and ketoprofen.
 Common side effects
 Constipation; diarrhea; dizziness; drowsiness; gas; headache; heartburn; nausea;
stomach upset; stuffy nose.
 Severe side effects
 rash; hives; itching; swelling of the mouth, face, lips, or tongue; wheezing); bloody
stools; change in the amount of urine produced; chest tightness or pain; confusion;
dark urine; depression; fainting; fast or irregular heartbeat; fever, chills, or persistent
sore throat; loss of appetite; mental or mood changes; numbness of arm or leg; onesided weakness; pale stools; red, swollen, blistered, or peeling skin; ringing in ears;
seizures; severe headache or dizziness; stomach pain, nausea, vomiting or
bleeding; shortness of breath; weight gain; swelling of the hands, legs, or feet;
bruising or bleeding; joint or muscle pain; tiredness or weakness; vision or speech
changes; grounds; yellowing skin or eyes.
 This is not a complete list of all side effects that may occur.
COX Inhibitors
 Non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin
and derivatives of ibuprofen:
a. Inhibit COX to form prostaglandins involved inflammation, pain.
b. Inhibit blood clotting by blocking TXA2
c. block AA enters COX active site.
Most NSAIDs inhibit both COX I & COX II.
Selective COX-2 inhibitors have been developed, e.g., Celebrex and Vioxx.
 COX-2 inhibitors are less likely to cause gastric toxicity compared with
NSAIDs that block COX-1.
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Inflammation and Endothelial Dysfunction to
Microvascular Dysfunction
 Endothelial dysfunction is integral to the pathogenesis of
many disorders:
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Atherosclerosis
Autoimmune disorders
Inflammation
Infection
Trauma
Arterial Wall Anatomy
Endothelium of Blood Vessels
Vascular Endothelial Mediators
Thromboxane A2 - TXA2
Stimulates blood platelet aggregation, essential to role of
platelets in blood clotting.
 Aspirin inhibit TXA2 formation in blood platelets.
 This effect of aspirin is long-lived, 7 days, because
platelets lack a nucleus and do not make new
enzyme.
Leukotrienes
Leukotrienes produce inflammation in:
Blood vessel walls as part of the pathology of
atherosclerosis.
Bronchioles causing asthmatic constriction and asthma.
Anti-asthma medications include:
 Zyflo (zileuton): inhibitors of 5-Lipoxygenase
 Singulair (montelukast) & Accolate (zafirlukast):
block leukotriene-receptor interactions.
Natural COX-2 Inhibitors
 Huangqin黄芩 was found to have COX-2 inhibitory properties in
China, Spain, Korea, Canada and United States
 Ginger姜 is a strong anti-inflammatory herb. Studies indicate that
ginger is a safe COX- 2 and COX-1 modulator
 Scientists in the USA, Sweden, Taiwan and Germany have
confirmed that green tea is a high active COX-2 inhibitor.
 The chemical ingredients, salicylic acid and polyphenols, including
EGCG, in green tea are effective cancer antagonists.
Turmeric or curcuma longa
 The anti-COX-2 effect of turmeric was discovered by
Vanderbilt University researchers. Cornell University in
New York and the University of Leicester in England.
 The active anti-inflammation component curcumin is
about 50% as effective as cortisone.
 The purified form of 95% curcuminoids per dose is the
best anti-inflammatory effects.
 A number of publications have shown the anti-cancer
effects of turmeric in in vitro and in vivo.
Natural COX-2 Inhibitors
 Curcumin and capsaicin significantly lowered lysosomal
enzymes from macrophages in animals
 Macrophages from rats secreted less PG E2,
leukotrienes B4 and C4 and AA.
 Curcumin and capsaicin lowered eicosanoids and AA in
macrophage lipids.
 Curcumin and capsaicin can lower secretary functions of
macrophages in a beneficial manner.
Natural Anti-inflammation/COX-2 Agents
Drynaria fortunei
 Extracts of Drynaria fortunei (Gu Sui Bu): significant inhibition of
carrageenan-induced paw oedema and granuloma formation in rats,
almost comparable to that caused by indomethacin. Df significantly
attenuated formalin-induced pain and acetic acid-induced writhing
episodes in mice.
 Clinical trial: significant effects for arthritis pain, joint function and
osteoporosis without significant side effects
 CONCLUSION: potent anti-inflammatory agent for alleviating painful
inflammatory conditions of osteoarthritis.
 The herbal formula for arthritis: Gu Sui Bu, Fang Feng, Cuan Duan,
Zhi Mu, Jing Jie + Huang Qi Wu Wu Tang
Herbs with COX-2 Inhibitory Effects
 green tea, ginger, grape seed, Holy basil,
oregano, rosemary and willow bark
 Giardina C褐茸藻, Stylopine from chelidonium
majus白屈菜, Berbarine/Huanglian黄连, ginger,
ginsenoside人参皂甙 Rh1, grape seed葡萄,
Salvia miltiorrhiza 丹参, fevervew, scutellaria黄
芩, phellodendron amurense黄柏, carthamus
tinctorius红花, nettle leaf荨麻，willow bark柳树
皮
Anti COX Agents - Antioxidants
 The oxygen burst in the inflammatory status generate excessive
amount of reactive oxygen species (ROS) .
 Reactive neutrophil activity in the process is a principle source of
ROS.
 Inflammatory responses can be suppressed by the application of
ROS scavenger, superoxide dismutase (SOD) and antioxidants.
 Many antioxidants possess COX-2 inhibiting effects:
Polyphenol and catechin in green tea
Flavonoid and ursolic acid in many herbs
linoleic acid, melatonin, IFN-βin our bodies physiologically inhibitory
COX-2 effect
Omega-3: Role in Anti-inflammation
 ω-3, mainly DHA and EPA, can effectively inhibit COX
mediated AA metabolism and PGE2inflammation/cancer
 Plant ω-3 shows inhibitory effect on inflammation and
cancer
Acupuncture
Mechanism: Pain / Inflammation / immune
Pain
Inflammatory Immune
Cholinergic suppression:
Sensory nerves
Parasympathetic nerve endings
release acetylcholine (ACh),
suppress release
Hypothalamus
Anti-inflammatory
output via CNS
TNF-a, IL-1β in
brain
Neuroimmunology
modulation
Inflammation
Role of Arachidonic Acid
High arachidonic acid consumption
(Omega-6) is not advised for individuals
with a history of inflammatory disease, it
may counter the anti-inflammatory effects
of omega-3 fatty acid supplementation.
Inflammation
Omega-3 : Omega6
Inflammation
Omega-3 : Omega6
 Patients with autism had significantly higher
Omega 6 in RBC membranes compared to higher
Omega 3 in healthy people
 Significantly reduced levels of ARA /EPA ratio in RBC
polar lipids, when supplemented with EPA-rich fish oils
 By taken EPA supplements, significantly reduced PLA2
concentrations
Natural Anti-inflammation/COX-2 Agents
Curcuma longa L
 Positive effect on neurogenesis in hippocampus by
increasing
brain-derived neurotrophic factor(BDNF)
Improving stress, depression, a selective monoamine
oxidase inhibitor (MAOI)
Clinical trials: Alzheimer's disease.
Anti-inflammatary Supplements
Feverfew (菊蒿）
Holy basil (圣罗勒）
Nettle Leaf（荨麻）
Oregano
Rosemay（迷迭香）
Boswellia
Natural Anti-inflammation Agents:
Antioxidants
 The oxygen burst in the inflammatory status generate
excessive amount of reactive oxygen species (ROS) .
Reactive neutrophil activity in the process is a principle
source of ROS.
 Inflammatory responses can be suppressed by the
application of ROS scavenger, superoxide dismutase
(SOD) and antioxidants.
Natural Anti-inflammation Agents:
Antioxidants
 Many antioxidants possess COX-2 inhibiting effects.
 Phenol and flavonoid compounds in many herbs:
polyphenol and catechin in green tea, ginkgo biloba, soy,
etc.
 Some important antioxidants/anti-inflammation
chemicals produced in the body: Glutathione,, melatonin,
pyruvate, IFN-b, and SOD.
Natural Anti-inflammation Agents
from diet: Berries
 Berries
Blueberries, raspberries, strawberries: antiinflammatory
Blackberries and blueberries are especially
great.
Natural Anti-inflammation Agents
from diet: Omega-3
 -3, mainly DHA and EPA, can effectively inhibit
COX mediated AA metabolism and PGE-2
inducible inflammation/cancer.
 High -6 low -3 diet favor inflammation
 flax seed oil, walnut, pumpkin seed are rich in 3 but in shortage of DHA.
 Botanical -3 may anti-inflammation by inhibiting
-6 through competing delta desaturase 6.
Root of Inflammation
 Broad-spectrum antibiotics kill good bacteria in
gut, leading to leaky gut syndrome - large
molecules get through.

 London’s Royal Free Hospital studied 60 autistic
children: many more intestinal lesions than nonautistic children
 In fact, over 90% of autistic children had
chronically inflamed guts.
Root of Diseases - Inflammation
Root of Inflammation - GI microflara






Alzheimer, Autism
Chronic lung/bronchus infection
Arthrosclerosis
Sinus infection/allergy
Chronic Fatigue syndrome
Fibromyagia





Autoimmune disorders:
MS
Lupus
Colitis
Arthritis
Acupuncture
Pain
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90
Acupuncture for pain
Indication
 A wide range of pain conditions, such as postoperative pain, carpal
tunnel syndrome, fibromyalgia, headache, low-back pain, menstrual
cramps, myofascial pain, osteoarthritis, and tennis elbow.
 Doctors from three medical schools published on New England
Journal of Medicine
 Conclusion: acupuncture is an effective means for treating lower
back pain, based partly on a recent study of 6,359 patients
published
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91
Acupuncture Clinical Trail
Osteoarthritis
 20millions people with osteoarthritis
 No satisfied pharmaceutical drugs
 COX-2 inhibitor may cause heart, kidney stomach
damage
 Phase III radomized controlled clinical trail at Maryland
School of Medicine in 2006
 570 participants with moderate and severe pain
 Results: significantly improve knee pain and function
Acupuncture for pain
Significant, Mechanism
New branch of therapy in clinical medicine:
Trans-cutaneous Intervention therapy
 A lot of augments on the meridian theory
At least, most parts of acupuncture theory and practice can be
explained by the modern neurology or neurochemistry.
 CNS endorphin, serotonin, dopamine modulation, opioid receptor
stimulation
 Neural segmental analgesia (spinal cord)
 Local anti-inflammatory cytokine, microcirculation promotion
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Specificity of Acupuncture points
 Brain: Overlapped, relatively less specificity
 Spinal cord: neural segmentation distribution, relatively
specificity, with connection
 Local: chemicals, neuro-muscle-tendon effects, specific
Acupuncture
Evidences in neurochemistry
 In the mid 1970s, Mayer and his colleagues revealed
that acupuncture led to a significant increase in the
endogenous endorphin production and the effect of
acupuncture can be blocked by the opioid receptor
antagonist naloxone
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Acupuncture
Evidences in neurochemistry
 A large body of evidence indicates that acupuncture significantly
affects the production and release of neurotransmitters including
epinephrine, norepinephrine, dopamine, and 5-hydroxytryptamine
 Stress-induced increases in norepinephrine, dopamine, and
corticosterone were inhibited after EA,
 EA effects on the release of neurotransmitters are
likely to be mediated through endogenous opioids.
 EA at different frequencies (2, 10, or 100 Hz) elicited the analgesic
effects and such effects could be at least partially blocked by a
serotonin receptor antagonist
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Acupuncture
Neural segmental analgesia
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穴位特异性与神经阶段
内脏与体表相连：白交通支
Acupuncture
Pain management and muscle relaxation
 Acute pain
 Muscle spasm
 Chronic pain
 Muscle spasm - shortening - fibrosis -hardening
Trigger Point – neural-muscle cycle
 Pain signals from the muscles and joints cause changes
in the central nervous system (CNS) that in turn causes
changes in the nerves affecting muscles and joints
inducing perception of perpetuating pain. By needling
into specific sites, such as hypersensitive skin or tight
bands of muscle, this cycle is broken
Trigger Point – Muscle spasm
 Chronic inflammation and pain results in muscle spasms
and lead to changes in the muscle structure. Long
lasting muscle spasm causes accumulation of fibrotic
tissue inside the muscle (can be palpated as taut band)
with subsequent muscle shortening.
Trigger points - Location
 Taut bands of muscle and are especially tender to
palpate.
 The muscle tendon junction and tendon attachment to
bone provides a complete needling location for the tight
muscle and mechanical distraction of fibrotic tissue,
resulting in relaxation.
 The treatment will increases circulation to the area and
decreases pressure on joints.
Acupuncture for Pain
Neuro-muscular mechanism
Needling by blocking the excessive release of
acetylcholine from the peripheral nerve terminal at the
neuromuscular junction (where the nerve transmits
signals to the muscle); or muscle-tendon conjunction,
where golgi receptor located, inducing muscle
contraction inhibition, resulting in muscle relaxation
and pain releasing.
Negative feedback regulation of muscle
tension by Golgi tendon organs
Golgi Tendon Organ
“Golgi Points ?”
ST36
GB34, 37, Sp6
LI3, 10
BL25
Si5
Acupuncture
Back Pain- Piriformis Syndrome
Role of natural anti-inflammatory Agents in
Cancer Treatment
 WM
 Chemo or Radiation: limited effectiveness
 Side effects from cytotoxicity: immune, bone marrow,
digestion, wellbeing
 EM
 Supportive therapy: immune, bone marrow, digestion, gut
bacteria, detoxification (free radicals)
 Enhance and reduce resistance of chemo: anti-inflammation
 Cause of cancer treatment: inflammation/detox
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Cancer and COX-2
A number of clinical investigations showed
that high COX-2 activity was found in
patients with a variety of cancers:
Colorectal, gastric, breast, non-small cell
lung, ovarian, hepatocellular, pancreatic,
bladder, skin, and particularly, 80-90%
colon cancer
COX-2 Inhibitors for Chemo-resistance
 Chemotherapeutic drug resistance is an unresolved
challenge in clinical cancer treatment, particularly for the
metastasis carcinoma status.
 The inflammation and pro-inflammatory cytokines are
strong intrinsic factors for promoting multiple drug
resistance (MDR).
 Chemotherapy may induce the activities of COX-2 and
inflammation.
 COX-2 stimulates the P-Glycoprotein of the MDR, which
rejects the drug out of the cancer cells. COX-2 inhibitors,
celecoxib, aspirin, ibuprofen, and indomethacin may
enhance chemotherapy
Synergistic Effect of Herbs with Chemo?
 Multiple target model of cancer cell for Natural COX-2
Inhibitors
 Multiple Signal Transduction systems
(modulate the DNA/RNA and cell activities/growth,
developed from evolution, primary cell to human being )
Growth factors
Tyrosine Kinase
EGFR/HER2
IGFR
Pathway of Chemotherapy Resistance
Breast Cancer
Natural Anti-inflammatory Agents
Enhance Effects of Chemotherapy

Morphologic changes Fig 1. of MCF-7 cells treated with COPE and TAX
Are Antioxidants counteract with
Chemotherapy?
 Meith I. Block analyzed the results of antioxidants
applications, including glutathione, melatonin, vitamin A,
vitamin C, N-acetylcysteine, vitamin E, ellagic acid and
antioxidant mixture, from randomized and controlled
clinical trials in 845 articles.
 Conclusion: None of the trials reported evidence of
significant decreases in efficacy from taking antioxidant
supplements during chemotherapy.
Are Antioxidants counteract with
Chemotherapy?
 Instead, many of the studies suggested increased
survival times, increased tumor responses, and less
toxixity responses from taking antioxidants than
controls[1]
 [1] Block KI, etc.Impact of antioxidant supplementation on
chemotherapeutic toxicity: a systematic review of the evidence from
randomized controlled trials.
 Int J Cancer. 2008
Are Antioxidants counteract with
Chemotherapy?
 The natural supplements may be taken after the
chemotherapeutic agents are eliminated from plasma,
which could be from a few hours to a few days.
 The supplements should be stopped at least one day
before the next chemotherapy session.
 The information about the pharmacological dynamics of
the chemotherapeutic agents should be researched
before the natural supplements is administered.
Natural Medicine自然医学
Definition
 1、基于自然界整体观发展的医学理论体系，强调人体的生理、疾病与自然界
的紧密联系。
 2、强调人体内部整体间的相互关联。
 3、承认个体之间的差异性，因而诊治体现个性化差异。
 4、治疗手段，特别是药物，直接来源于自然界，强调其自然属性。
 5、治疗、预防与调养相结合的、符合人体生理特征的治疗方针。
 6、植根于悠久的民族、民间医学，具备丰富的临床实践经验。自然医学应融
合和吸收世界各国民族医学和自然疗法的精华，用现代医学的技术手段加以
证实和发展。
 7. 中医药学应以其悠久的历史，博大系统的理论、丰富的实践以及可信的疗
效，在自然医学的形成和发展中占有重要地位。
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118
End
Inflammation and Endothelial Dysfunction to
Microvascular Dysfunction
 Endothelial dysfunction is integral to the pathogenesis of
many disorders:





Atherosclerosis
Autoimmune disorders
Inflammation
Infection
Trauma
Vascular Endothelial Mediators
Nitric Oxide/L-Arginine-Herbs
Nitric Oxide (NO)
anti-inflammatory and anti-proliferative
effects
Endothelial function protection
Atherosclerosis protection
Nitric Oxide/L-Arginine-Herbs
 L-arginine
 Control blood pressure and improve heart
function
 Reducing cholesterol and plaque formation
 Promote anti-aging growth hormone
 Enhancing immune function and stop some
cancer cell growth
 Improving memory
 Improve erectile dysfunction
Nitric Oxide/L-Arginine-Herbs
Herb
Dang Gui
Bai Shao
Bai Jili
The signal molecule ·NO (nitric oxide) may
initiate prostaglandin synthesis by reacting
with superoxide anion (O2·-) to produce
peroxynitrite, which oxidizes the heme iron
enabling electron transfer from the active site
tyrosine.
Prostaglandin synthesis in response to some
inflammatory stimuli is diminished by
inhibitors of Nitric Oxide Synthase.
Autoimmune disorders
 WM
 Prednisone, immune suppressor, T-cell inhibitor
 Adverse reaction: mal-metabolism cortisone withdrawal syndrome,
immune dysfunction
 EM
 Immune enhancing and Immune suppression together: astraglus vs.
scutellaria, Bupleurum
 Stimulating adrenal –cortisone function for cortisone withdrawal
syndrome (NIH fund supported project)
 Gentle but effective T-cell or TNF inhibitor: Olivenol, Rapamycin,
Dichroa febrifuga黄常山，
Principle: TNF is a dual side blade sword
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132
Infection
 WM
 Limitations of antibiotics in Chronic infection: immune function,
beneficial bacteria damage, drug resistance
 Co-existing inflammation, congested microcirculation
 EM
 Detox - anti-pathogen
 De-congestion of circulation- open the microcirculation: antibiotic
availability, flushing out toxins
 Promoting Qi – enhancing immune function
 Strengthen “spleen system” – protect digestion and prebiotic
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133
Natural therapy for autoimmune disorder
David Fernandez (2010) discover: rapamycin can be an
effective treatment in human lupus, SLE. regulates
interferon-α and T cell and promote Th2 versus Th1
immune responses
suggest that the colitis, including crohn’s disease and
ulcerative colitis, can be well controlled by natural
therapy in many cases, and can be well integrated with
cortisone or immune suppressor
Probiotic + Enzymes + Herbs + Diet
Gastroesophageal reflux (GERD)
 WM




H2 blocker – Zantac
Proton pump inhibitor – Prilosec
Mucosal protectors – sucralfate
Motility drugs - empty stomach, Reglan.
 EM
 Mucosal protection: Gastric acid pseudo-overproduction, Deglycyrrhizinated
licorice (DGL)
Calming acid reflux and peptic ulcers by:
 Anti-inflammation and the pathogens
 Protect mucosal membrane by increasing the thick mucous production
 Free of the ingredients of increase fluid retention
 Anti-inflammation: Chamomile, slippery elm, coptis
 Motility promoting: Auklandia lappa
11/10/10 Digestive function promotion:
Jing Codonopsis
Liu, MD, PhD
135
穴位特异性 -安慰
 针灸穴位特异性的质疑一直与针灸是否为安慰治疗的争论
并存。对穴位的特异性的解释经常困扰临床研究的设计和
结论。
 穴位无特异性 = 安慰
 穴位部分特异 = 部分安慰
 穴位全部特异 = ？
安慰针对照原则
 目的：排除术者与病人的“期望” 和暗示效应
 要求：安慰刺激方式没有特定治疗作用
 方法：a.针刺或其他刺激方式选在没有特定治疗作用的部
位，sham？

b.受试者不能察觉安慰针与治疗针在外观和操作和
感觉上的差别
针刺部位选择的质疑
 采用非传统中医穴位作为疗效安慰对照，
 针刺穴位数目增加的历史。 “安慰穴位”可能是明日公
认的治疗穴位
 采用近经络刺激点作为经络论证或疗效对照
 不能排除经与络的连接。
 只适用于证明经络的特异程度，不适于疗效判定。
安慰针刺部位选择原则
 1，验证疗效：
 应符合如下全部条件：
 a. 非经络非传统穴位。
 b. 与治疗穴位保持一定距离，以回避“经与络”相关联的嫌疑
 c. 二组穴位非处于同一神经节段分布
 d. 二组穴位非同一解剖组织相关。例如，二穴不能位于同一肌肉上。
穴位的特异性与肌体组织结构相关。如肌肉、肌腱、骨膜，间质组织
。
安慰针刺部位选择原则
 2，验证传统针灸经络理论
 不同穴位或非穴位点：穴位特异性
 离开经络的针点：经络特异性
安慰方式质疑
 浅刺穴位点或非穴位点的方式作为安慰对照并不完全合理
.
 假针具欺骗性的可靠性值得怀疑：a. 钝针头压迫到表皮，
不能排除“假针“的治疗作用; b. 反复使用；c. 有针灸体
验或知识者， 尤其是从签署同意书时获知是受试者
 模拟皮表电刺激 ：没有任何刺激的感觉所引起的心理反
应
症结

 理想安慰方法：外观、感觉上与治疗组针灸没有区别，但
无特定疗效。即无暗示和期望效应。
 为何目前的安慰对照设计很难完全达到标准？针灸未被纳
入西方主流医学的障碍之一。
 问题的症结在于传统的安慰剂的概念和使用，不完全适用
于针灸？
药物：Placebo效应
 对临床疗效具有重要影响：与疼痛相关的治疗中Placebo
作用可达50%。焦虑明显影响Placebo效应。
 临床药物：单分子化学结构药物，有明确的特异受体或靶
点。其引起的生理或病理变化有明确的表现和体征。
 如果表述出与药物作用或毒副作用无关的反应，特别是心
理、精神方面的反应，也可能被认为安慰效应。
针刺 -介入疗法？
 针刺应与外科手术同属介入疗
法，在介入性治疗的临床研究
中不适于用安慰对照， 但这一
理由很难被西方医学界认同。
 主要原因：手术的危险性和伤
害程度要远甚于针刺？
合理对照的选择（1）
 2000年世界医学大会修订的《进行人体生物医学研究的伦
理道德原则》指明，测试一种新疗法时，应以当时最有效
的方法作对照，虽然并不排除使用安慰剂治疗对照，但仅
用于未有有效治疗方法对照时。
合理对照的选择（2）

Placebo或Sham针刺的结果不应是作为结论的绝对依据。此外，没
有Placebo 但有相应对照的研究论文也不应再被一概视为“不科学
、不可靠“的依据。

重视针灸临床方法学整体与细节上与国际化标准的接轨。除了对照
的差别
组设计外，随机原则的使用，样本量的考虑，受试者同意书的措辞
以及严格的管理执行体系。
1. 德国2005年在一份临床针灸方法学的研究报告中回顾总结了1000 例
头痛，腰痛的治疗，结论是针灸完全可以按照严格的标准来完成临
床实验研究
合理对照设计的建议
 最大限度的减少期望与暗示效应。为此，建立严格独立的随机分组，
诊断，治疗，资料收集，资料处理，统计处理系统。
 按照病因，病理详细针灸适应症，例如高血压，头痛，腰痛的病例选
择或结果分析
 用国际认可的标准量表，如疼痛，背功能量表
 组成基础，临床，统计，管理专家体系的针灸临床研究队伍，特别是
加强对安慰效应的基础研究如fMRI
穴位特异性
Hypothesis
 不同穴位刺激在大脑水平有相当的重叠反应，但强度不同
 穴位刺激 在脊髓阶段的反应有相应的特异性，但在一定
刺激强度下有各脊髓阶段之间的重叠
 穴位刺激， 特别是trigger 穴位的局部反应是相对特异的
 针刺通过三级反应共同完成效应机制
针刺特异性：
大脑效应：多系统、多靶点
 fMRI 研究的证据：针刺多个不同体表穴位后会在大脑神
经网络的躯体感觉区，边缘系统，扣带回前区，下丘脑，
海马回，大脑皮层前回，小脑蚓区 等不同神经元区域产
生广泛影响。
 边缘系统，扣带回前区，大脑皮层前回，小脑蚓区等对精
神、情绪、心理状态有控制，调节作用。
 针刺的反应过程有脑啡呔，单胺，多巴胺，5-羟色胺、等
神经介质的广泛参与。
针刺安慰效应
acupuncture placebo response
针刺的安慰效应(opioid placebo response) 主要集中在Posterior
midcingulate cortex, pMCC 的尾部。 这一区域对躯体疼痛有最高密
度的反应。
 吗啡的安慰效应(opioid placebo response) 主要集中在与内脏相关的
subgeneral anterior cingulated cortex 区域
 fMRI 的研究显示，placebo 麻醉效应区，主要是在导水管周围灰质（
PAG）, 扣带回前区啄部（rostroil ACC）, 岛区（insula）, 杏仁核，
下丘脑， 与针刺的作用靶点有重叠
 结果推测：Placebo效应可能是针刺的一个必然结果。
 针灸适用于心身（Mind-Body）疾病治疗的机制之一。
假设：激发启动效应
burst – firing mechanism
 “得气”刺激信号激发了神经介质参与的神经网络通路信号系统的调
整。其中包括了支配精神、情绪的神经元的整合。
 推论：与作用于神经、精神系统的化学药物仅作用于单一脑内受体不
同。针刺对大脑系统的作用是多方面的，不是单一的对某一受体的抑
制或增强，而是调整或重新整合式的，这一过程必然有控制情绪、精
神的神经元的被调整。
 举例：针灸可以减轻焦虑、紧张的状态，而情绪的紧张程度与痛觉感
受的程度相关。
 学说：针刺改变疼痛感受而不是疼痛本身
针刺安慰效应
 Placebo效应，也就是说Placebo可以通过心理暗示获得，
也可能通过物理、化学刺激获得，仅是效应强度和治疗可
能带来的副作用可能是不同的.
 针刺治疗的最常见适应症之一疼痛症与情绪状态有直接相
关。大脑前区在反应疼痛与情绪的过程中由扣带回区参与
了两者之间的整合.
情绪，精神心理的控制
3
针刺特异性的fMRI 证据 1

 (A) Both manual (MA) and electro-acupuncture (EA) but not tactile
control stimulation at ST-36 induce fMRI signal decrease in the
amygdala as evidence by fMRI signal time-courses during
stimulation blocks (gray).
 (B) The CTS patients demonstrated less hyperactivation and more
focused SI finger representation to innocuous stimulation of the 3rd
finger.
 (C) CTS patients demonstrated less separation of somatotopic
representations. After acupuncture treatment, the 2nd and 3rd finger
representations were more separated, approximating normal
somatotopy in HC
fMRI 证据: 穴位的特异性是相对的
 尚没有确立针刺的特异反应区
 针刺穴位与sham点似有不同的反应区
 不同穴位, 不同刺激方法引起的信号有相当的重叠
 针刺穴位较之钝针对边缘系统和边缘旁系统有更强烈的调整作用
 Insula cortex 可能是针刺的特异反应区，而针刺在Dosolateral PFC,
rostral ACC, 和 midbrain PAG 的反应可能与安慰期望程度有关
穴位特异性
Trigger point (扳机点）
 Trigger point 可以在传统穴位或非穴位位置上
 潜伏期：无疼痛。在病理刺激下转化（寒冷、疲劳、损伤
、肌肉紧张）
 被动期：可触摸到的疼痛
 活动期：清楚感觉的疼痛，穴位面积增大。最早多出现在
神经干、体表浅层、肌门，数目随疼痛迁延增多
穴位特异性
穴位的局部反应
改善（微）循环
调节免疫功能、减少炎症
缓解肌紧张
调节神经（眩晕、哮喘、呕吐）