Integrative Mechanism In Limbic System Of Combination Of Stomach Back-Shu Points And Front-Mu Point For Treating Of Functional Dyspepsia

Objective:To analyze the regional homogeneity from functional magnetic resonance imaging (fMRI), and explore the central mechanism of acupuncture for postprandial distress syndrome (PDS) of functional dyspepsia (FD) with stomach Back-Shu points (BL21), Frontal-Mu point (RN12), combination of Back-Shu (BL21) and Frontal-Mu (RN12) points, thus providing experimental evidence for the classic Shu-Mu combination.Methods:54patients who met the inclusion criteria were randomly divided into group A, B and C. Each group was administered puncturing in different points:Group A with stomach Back-Shu points (BL21), Group B with stomach Frontal-Mu point (RN12). Group C with the combination of stomach Back-Shu (BL21) and Frontal-Mu (RN12) points. Needling was done once a day and totally for20days. The Nepean dyspepsia index (NDI) and dyspepsia symptom score were used to evaluate the clinical efficacy; the self-rating depression scale (SDS), self-rating anxiety scale (SAS), Beck depression inventory (BDI) were used to evaluate the emotional state. Clinical evaluation and resting state BOLD-fMRI scans were performed on each group before and after treatment. The characteristics of regional homogeneity of brain in each group before and after treatment were investigated, and the correlation analysis between clinical effects and the change of regional homogeneity were detected to explore the central mechanism of combination of stomach Back-Shu and Frontal-Mu Points.Results:1. The results of the clinical efficacy evaluation of acupuncture for PDS with different acupoints are as follows:(1) The three groups are comparable with the same base line (P>0.05). (2) The Nepean dyspepsia symptom index (NDSI) and dyspepsia symptom score shows the score of PDS patients after acupuncture treatment are all significantly lower than those scores before the treatment (P<0.05); the Nepean dyspepsia life quality index (NDLQI) shows the score of PDS patients after acupuncture treatment are all significantly higher than that before the treatment (P<0.05); SAS, SDS, BDI indicates the emotional scores of PDS patients in the three groups after acupuncture treatment are significantly lower than those scores before the treatment (P<0.05); the result indicated no statistical differences in the three groups (P>0.05).2. The results of regional homogeneity of the brain in PDS patients after puncturing in different acupoints:(1) Group A:The regional homogeneity of brain regions was lowered:left insula (BA48). left parahippocampal gyrus (BA35), left middle cingulate cortex (BA23), right calcarine gyrus (BA19), left cerebellum posterior lobe, right cerebellum crus, et al. And the regional homogeneity of brain regions was increased:right hippocampal gyrus (BA30), bilateral parahippocampal gyrus (BA36), right amygdala (BA28), right insula (BA48), right calcarine gyrus (BA18), bilateral temporal pole (BA38), right cerebellum crus, et al.(2) Group B:The regional homogeneity of brain regions was lowered:bilateral middle cingulate cortex (BA23), left posterior cingulate cortex (BA23), left anterior cingulate cortex (BA32), bilateral hippocampus (BA20/37). left parahippocampal gyrus (BA37), right cerebellum crus, left cerebellum posterior lobe, et al. And the regional homogeneity of brain regions was increased:bilateral parahippocampal gyrus (BA28), right anterior cingulate cortex, right middle cingulate cortex (BA24), bilateral hippocampus (BA28), bilateral insula (BA48), bilateral amygdale (BA28/36), bilateral temporal pole (BA38), bilateral calcarine gyrus (BA17/19), left culmen of cerebellum, right cerebellum posterior lobe, et al.(3) Group C:The regional homogeneity of brain regions was lowered:bilateral posterior cingulate cortex (BA29), bilateral hippocampus (BA37), right parahippocampal gyrus (BA27), right insula (BA48), right temporal pole (BA38), bilateral cerebellum posterior lobe, et al. And the regional homogeneity of brain regions was increased:bilateral parahippocampal gyrus (BA20/27), bilateral calcarine gyrus (BA17), bilateral temporal pole (BA38/20), right vermis of cerebellum, left cerebellum posterior lobe, et al.3. Results of analysis on the correlation between regional homogeneity of the brain and clinical effects:(1) Group A:The change of regional homogeneity in right superior frontal gyrus was negatively correlated with NDSI score improvements; the change of regional homogeneity in left cerebellum was negatively correlated with NDSI score improvements.(2) Group B:The change of regional homogeneity in right superior frontal gyrus was positively correlated with NDSI score improvements; the change of regional homogeneity in right middle cingulate cortex, negatively correlated with NDSI score improvements; the change of regional homogeneity in left middle cingulate cortex, negatively correlated with NDSI score improvements; the change of regional homogeneity in left cerebellum, positively correlated with NDSI score improvements.(3) Group C:The change of regional homogeneity in right insula was negatively correlated with NDSI score improvements; the change of regional homogeneity of right cerebellum was in negative correlation tendency with NDSI score improvements.Conclusions:1. Puncturing on stomach Back-Shu points (BL21), stomach Frontal-Mu point (RN12). and the combination of the both respectively can affect brain functional activities of FD patients generally. Cerebellum and prefrontal cortex are the common regions for the above mentioned points to perform respondence.2. The combination of stomach Back-Shu and Frontal-Mu points tend to focus in affecting the brain functional activities of limbic system, compared to the separate stomach Back-Shu points (BL21) or Frontal-Mu point (RN12). 3. Adjustment in insula, which plays an important role in gastrointestinal regulation and FD pathological changes, probably is the major mechanism in the FD treatment by combination of stomach Shu-Mu points.