Clinical Evidence of Brain Effect Difference between True Point and False Point: A Meta-analysis Based FMRI

Special Article – Acupuncture and Rehabilitation

Phys Med Rehabil Int. 2021; 8(4): 1190.

Clinical Evidence of Brain Effect Difference between True Point and False Point: A Meta-analysis Based FMRI

Chen C¹*, Chen Z², Liu A², Zhang Q¹, Huang W¹, Lu L¹, Mo Y¹ and Zheng S¹

1Affiliated Hospital of Traditional Chinese Medicine, Guangzhou Medical University, Guangzhou, Guangdong 510130, China

2Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong 518055, China

*Corresponding author: Chuyun Chen, Affiliated Hospital of Traditional Chinese Medicine, Guangzhou Medical University, Guangzhou, Guangdong 510130, China

Received: September 08, 2021; Accepted: October 06, 2021; Published: October 13, 2021


Imaging studies after acupuncture at acupoints and sham acupoints have shown significant changes in the function of specific parts of the brain, but these findings are not consistent. In this meta-analysis, we examined different studies to determine whether there are differences in brain function changes in the brain imaging findings of acupuncture at real and sham points. Pubmed, Embase, Cochrane, CNKI, VIP and Wanfang databases were used to search for acupuncture brain imaging literatures published by May 2020. Study selection, quality assessment and data extraction were carried out by two independent researchers. The whole brain function data of acupuncture points were analyzed by sdM-PSI. Thirteen studies met the inclusion criteria, including 266 subjects enrolled at acupoints including Taichong, Xingjian, Neiting, Guangming, Neiguan, Baihui, Fengchi, Sanyinjiao, Zusanli, Wai Guan, Feng Long, Zhongdu, Xiangu, 214 true acupoints, 186 false acupoints. Our analysis revealed that the brain region positively activated by acupuncture was Right fusiform gyrus, BA 30, Right inferior gyrus, Stationarity BA 48, and Right superior Temporal gyrus, BA 42. These findings suggest that the limbic system is the common difference in brain function after acupuncturing at different true and false acupoints.

Conclusion: The functional changes of limbic system are the brain regions that distinguish true and false acupoints.

Keywords: Acupoints; Brain; Acupuncture


Traditional acupuncture and moxibustion science believes that La acupoint is a special place on the body surface where qi from viscera and meridians is injected, which is not only the reaction point of diseases, but also the operation site of acupuncture and moxibustion. La acupoint exerts effects on the body far away through meridians. This theory has been applied in the treatment of diseases for more than 2500 years. The effect of acupoints may be related to the distribution characteristics of local vascular nerve bundles, the circulation distribution of fascia and some muscles, tendons and ligaments, or the composition characteristics of these tissues at acupoints [1-3]. Studies have proved that there may be differences or changes in temperature and skin resistance between acupoints and non-acupoints under physiological or pathological conditions, stimulated or non-stimulated conditions, and biomolecules released after stimulation may be different due to the different amount of stimulation [4-9]. At the same time, the central nervous system plays an important role in the effect of acupoints [10-17]. It has been found in acupuncture analgesia studies that acupuncture induces signals in the afferent nerve, thus regulating spinal cord signal transmission and pain sensation in the brain. Moreover, acupuncture activates some brain regions, which contribute to the decline of inhibition and inactivation of several marginal regions, thus contributing to the regulation of pain emotions [18-21]. Acupuncture at a certain point can specifically activate the corresponding brain regions, and these brain regions are closely related to the efficacy of the point, indicating that acupuncture points have a relatively specific response to blood oxygen dependent level signals in the brain region. Acupuncture at a certain point can specifically activate the corresponding brain regions, and these brain regions are closely related to the efficacy of the point [22-23]. With the development of Functional Magnetic Resonance Imaging (fMRI) technology, the brain region specificity of acupoint effect has been confirmed. Some studies have proved that there are differences in brain regions activated by functional magnetic resonance imaging between acupuncture at wax points and non-wax points, indicating that there are differences in brain effects between acupuncture points and non-wax points. Then, whether there are similarities in brain functional changes after acupuncture at different true and false points can be demonstrated by brain imaging, so as to distinguish the true and false points from the brain functional changes. In this study, seed-based D-mapping with subject image arrangement (SDM-PSI) was used to conduct standard random effect meta-analysis to investigate the changes in brain activity between true and false acupuncture points in published controlled trials [24].

Data and Methods

Data retrieval

We systematically searched databases pubmed, embase and Cochrane, China National Knowledge Network (CNKI), VIP, Wanfang for literatures published from the earliest available up until May 2020. We used the following key words: acupuncture OR needling OR acupoints and MRI OR fMRI OR magnetic resonance OR Brain MRI. We included all articles of fMRI studies to investigate the effects of acupuncture on human brains with at least one group that received needle based acupuncture.

Literature screening

Inclusion criteria: (1) Trials on healthy volunteers as well as patients diagnosed with certain diseases with no limitations on gender and origin; (2) People aged between 18-65 years old; (3) Trials on hand acupuncture; (4) Sham acupoints were set as controls; (5) fMRI studies based on BOLD signals were used as the outcome indicators with the MNI coordinates (x, y, z) and T-value/F-value provided; (6) At least 10 subjects were included.

Exclusion criteria: we excluded all citations that fit the following criteria (1) Reviews, systematic reviews, scientific reports, and republished researches; (2) Trials without whole brain functional imaging analysis; (3) MNI or Talairach coordinates were not available; (4) Statistics of coordinates such as T-value/F-value were not available; (5) Only the comparative analysis was performed before and after acupuncture treatments in each group; (6) Statistical analyses were carried out using software packages except SPM,

Data extraction

Extraction of basic information includes information of research object (gender, age, number of cases, physiological or pathological state), acupuncture program (acupoint, acupuncture method, manipulation) and data processing software.

Extraction of brain functional imaging data includes MNI or Talairach spatial coordinate values (statistics corresponding to x, Y and Z coordinate points (z or T values), and text files are created. According to the requirements of SDM-PSI software, all statistics of Z values are converted to T values by SDM online tools.

Statistical methods

In this study, sdM-PSI 6.21 software (https://www. Sdmproject. com) was used for voxel based meta-analysis. The statistical analysis threshold was P<0.005, Z>1, clustering degree N10, and PV 0.05 after calibration.

Quality assessment

Study selection and data extraction and summarization were independently performed in a standardized manner by two investigators (Yuxiao Mo and Shuidiao Zheng); any disagreements were resolved by a third investigator (Chuyun Chen). This meta_ analysis has been registered with the PROSPERO International Prospective Register of Systematic Reviews of the University of York (PROSPERO registration no. CRD42021187391).


A total of 3309 articles were found through database search, of which 1393 duplicated publications (42.1 percent) were deleted and 1903 articles (57, 5 percent) were excluded because they did not meet the inclusion criteria. Thirteen articles (0.4%) were included in the meta-analysis (Figure 1 and Table 1). A total of 209 healthy subjects were included in the 13 trials, including 41 myopia patients and 16 ischemic stroke patients. The characteristics of these RCTS are summarized in Table 1. The acupoints involved are Taichong, Xingjian, Neitingj Guangming, Neiguan, Baihui, Fengchi, Sanyinjiao, Zusanli. Waiguan, Fenglong, Zhongdu. Xiangu, 214 acupoints 186 Pseudo acupoints. Eleven studies (84.6 percent) were conducted in China, one (7.7 percent) in the United States, and one (7.7 percent) in Germany.