Functional Connectivity Network Involved In Acupuncture Along Meridians Based On FMRI Study

Objective:To analyse the functional connectivities and explore the central mechanisms of healthy subjects and migraineurs with acupuncture along meridians, which can provides new evidence for the theory of selecting acupoints according to the channel.Methods:1. Collected and arranged the ancient and modern literatures for migraine with acupuncture, and then analyzed the law of selecting meridians, acupoints and acupoints compatibility in migraine treatment by using'Data Mining System for Acupuncture V1.0'.2.20 healthy subjects who matched the inclusion criteria were randomly divided into Shaoyang Group(Group A) and Jueyin Group (Group B).Observed the brain functional network caused by real-time acupuncture under NRER experimental procedure.3.48 migraineurs who matched the inclusion criteria were randomly divided into 4 groups: Shaoyang Group (Group A), Jueyin Group (Group B) and Yangming Group (Group C) non-acupoints group (Group D). Each patients received acupuncture once per day and totally for 16 times. Clinical evaluation and resting state fMIR scans were performed on each group before and after treatment. The characteristics of functional connectivity in each group after treatment were investigated, and the correlation analysis between clinical effects and the change of functional connectivity were detected.Results:1. The principle of acupuncture treatment with migraine:mainly selected acupoints along Shaoyang Meridians, and combined with distal-proximal points.2. The rostral Anterior Cingulate Cortex (rACC) was found in both groups during stimulating period under physiological conditions (P<0.001 uncorrected), and then the rACC was chosen as the seed region for the functional connectivity analysis for resting period. The results showed that several shared brain regions were involved in both groups A and B, such as the insula, amydala and hypothalamus. On the other hand, significant differences were located at the Posterior Cingulate Cortex (PCC) as revealed by a two sample t-test (P<0.05, corrected).3. The results of functional connectivity after regulating by acupuncture along meridians:1)The clinical efficacy of acupuncture at acupoints along meridians:①Group A reduced comprehensive score significantly after treatment(P<0.01), and significantly improved MSQ score in three dimensions(P<0.05).②Group B significantly reduced comprehensive score after treatment(P<0.01), and significantly improved MSQ score in emotion dimension(P<0.05).③Group C significantly reduced comprehensive score after treatment(P<0.01), and significantly improved MSQ score in functional limitation dimension(P<0.05).④Group D significantly reduced SAS score and SDS score after treatment, and significantly improved MSQ score in functional limitation dimension and functional disorder dimension(P<0.05).⑤Group A and Group B were statistically different from Group D in the improvement of comprehensive score(P<0.05).2) VBM analysis showed that the gray matter density of right insula (coordinates:X=38, Y=12, Z=-6) in migraine patients decreased compared with healthy subjects, and it negatively correlated with the disease courses (r=-0.3229, P=0.0347).3) The resting state functional connectivity with right insula of migraine patient were quite different after acupuncture treatment. After acupuncture treatment, the functional connectivity with right insula of Group A was similar to healthy subjects', particularly manifested in right insula with thalamus and ACC compared with other groups.4) The results of correlation analysis:The change of functional connectivity in right insula-DLPFC was negatively correlated with comprehensive score improvements in Group A(r=-0.7453,P=0.0134). The change of functional connectivity in right insula-thalamus was positively correlated with comprehensive score improvements in Group B(r=0.6546,P=0.04). The change of functional connectivity in right insula-temporal pole was negatively correlated with SAS score improvements in Group C(r=0.7509,P=0.0123). The change of functional connectivity in right insula-MPFC was positively correlated with SAS score improvements in Group D(r=0.7548,P=0.0116).Conclusions:1.The principle of acupuncture treatment with migraine:mainly selected acupoints along Shaoyang Meridians, and combined with distal-proximal points.2.Under physiological conditions, the similarities and differences in functional connectivity caused by puncturing acupoints along meridians reflected the integration of acupoints functions which oriented by meridian functions.3. The right insula is the key position reflecting the abnormalities of migraine without aura. Migraine without aura is a progressive disease, and is founded that the density of grey matter markedly decreased while the course of disease extends.4. Cerebral limbic system is involved in the right insula functional connectivity network when treating patients with migraine along channels. As compared with non-acupoints, the right insula-thalamus functional network is influenced specifically by treating Shaoyang meridian group. Moreover, as compared with Jueyin meridian group and Yangming meridian group, the right insula-ACC functional network is mainly affected by the treatment along Shaoyang meridian.5. Selective modulation for the pain pathway guided by acupuncture along meridians might be the central mechanism for treating patients with migraine along meridians. The central mechanism of treating Shaoyang, Jueyin and Yangming meridians might be connected with interactive, synergetic and indirect regulation for the medial or the lateral pain pathway. However, the effects of non-acupoints might be achieved through regulating medial pain pathway indirectly.