Neural mechanisms of acupuncture as revealed by fMRI studies

  • Tian He
    Affiliations
    Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, 23 Meishuguanhou Street, Dongcheng District, Beijing 100010, China
    Search for articles by this author
  • Wen Zhu
    Affiliations
    Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, 23 Meishuguanhou Street, Dongcheng District, Beijing 100010, China
    Search for articles by this author
  • Si-Qi Du
    Affiliations
    Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, 23 Meishuguanhou Street, Dongcheng District, Beijing 100010, China
    Search for articles by this author
  • Jing-Wen Yang
    Affiliations
    Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, 23 Meishuguanhou Street, Dongcheng District, Beijing 100010, China
    Search for articles by this author
  • Fang Li
    Affiliations
    Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, 23 Meishuguanhou Street, Dongcheng District, Beijing 100010, China
    Search for articles by this author
  • Bo-Feng Yang
    Affiliations
    Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, 23 Meishuguanhou Street, Dongcheng District, Beijing 100010, China
    Search for articles by this author
  • Guang-Xia Shi
    Affiliations
    Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, 23 Meishuguanhou Street, Dongcheng District, Beijing 100010, China
    Search for articles by this author
  • Cun-Zhi Liu
    Correspondence
    Corresponding author. Tel.:+86 10 52176905; fax:+86 10 52176813.
    Affiliations
    Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, 23 Meishuguanhou Street, Dongcheng District, Beijing 100010, China
    Search for articles by this author

      Highlights

      • Acupuncture could not only affect brain activity, but modulate connectivity of brain.
      • Acupuncture at diseases-related acupoints modulates diseases-related brain regions.
      • Acupuncture regulates brain network which are overlapped with pain-related areas.

      Abstract

      As an ancient therapeutic method, acupuncture has been used to treat many diseases as an adjunctive therapy. However, its clinical efficacy remains controversial and the neural mechanisms have not been well understood. Accumulating studies have revealed that fMRI has made it possible to study brain responses to acupuncture. This review aims to provide scientific evidence to support the notion and discuss how these findings contribute to the neural mechanisms of acupuncture.

      Keyword

      To read this article in full you will need to make a payment

      References

        • Asghar A.U.
        • Green G.
        • Lythgoe M.F.
        • Lewith G.
        • MacPherson H.
        Acupuncture needling sensation: the neural correlates of deqi using fMRI.
        Brain Res. 2010; 1315: 111-118
        • Assefi N.P.
        • Sherman K.J.
        • Jacobsen C.
        • Goldberg J.
        • Smith W.R.
        • Buchwald D.
        A randomized clinical trial of acupuncture compared with sham acupuncture in fibromyalgia.
        Ann. Intern. Med. 2005; 143: 10-19
        • Bai L.
        • Qin W.
        • Tian J.
        • Liu P.
        • Li L.
        • Chen P.
        • Dai J.
        • Craggs J.G.
        • von Deneen K.M.
        • Liu Y.
        Time-varied characteristics of acupuncture effects in fMRI studies.
        Hum. Brain Mapp. 2009; 30: 3445-3460
        • Bai L.
        • Qin W.
        • Tian J.
        • Dong M.
        • Pan X.
        • Chen P.
        • Dai J.
        • Yang W.
        • Liu Y.
        Acupuncture modulates spontaneous activities in the anticorrelated resting brain networks.
        Brain Res. 2009; 1279: 37-49
        • Bai L.
        • Tian J.
        • Zhong C.
        • Xue T.
        • You Y.
        • Liu Z.
        • Chen P.
        • Gong Q.
        • Ai L.
        • Qin W.
        • Dai J.
        • Liu Y.
        Acupuncture modulates temporal neural responses in wide brain networks:evidence from fMRI study.
        Mol. Pain. 2010; 6: 73
        • Bai L.
        • Yan H.
        • Li L.
        • Qin W.
        • Chen P.
        • Liu P.
        • Gong Q.
        • Liu Y.
        • Tian J.
        Neural specificity of acupuncture stimulation at pericardium 6: evidence from an FMRI study.
        J. Magn. Reson. Imaging. 2010; 31: 71-77
        • Beissner F.
        • Nöth U.
        • Schockert T.
        The problem of metal needles in acupuncture-fMRI studies.
        Evid. Based Complement. Alternat. Med. 2011; (808203)
        • Biella G.
        • Sotgiu M.L.
        • Pellegata G.
        • Paulesu E.
        • Castiglioni I.
        • Fazio F.
        Acupuncture produces central activations in pain regions.
        Neuroimage. 2001; 14: 60-66
        • Brinkhaus B.
        • Ortiz M.
        • Witt C.M.
        • Roll S.
        • Linde K.
        • Pfab F.
        • Niggemann B.
        • Hummelsberger J.
        • Treszl A.
        • Ring J.
        • Zuberbier T.
        • Wegscheider K.
        • Willich S.N.
        Acupuncture in patients with seasonal allergic rhinitis: a randomized trial.
        Ann. Intern. Med. 2013; 158: 225-234
        • Buckner R.L.
        • Sepulcre J.
        • Talukdar T.
        • Krienen F.M.
        • Liu H.
        • Hedden T.
        • AndrewsHanna J.R.
        • Sperling R.A.
        • Johnson K.A.
        Cortical hubs revealed by intrinsic functional connectivity: mapping, assessment of stability, and relation to Alzheimer's disease.
        J. Neurosci. 2009; 29: 1860-1873
        • Chae Y.
        • Lee H.
        • Kim H.
        • Sohn H.
        • Park J.H.
        • Park H.J.
        The neural substrates of verum acupuncture compared to non-penetrating placebo needle: an fMRI study.
        Neurosci. Lett. 2009; 450: 80-84
        • Chae Y.
        • Lee H.
        • Kim H.
        • Kim C.H.
        • Chang D.I.
        • Kim K.M.
        • Park H.J.
        Brain activity associated with acupuncture treatment in Parkinson's diseases.
        Mov. Disord. 2009; 24: 1794-1802
        • Chae Y.
        • Chang D.S.
        • Lee S.H.
        • Jung W.M.
        • Lee I.S.
        • Jackson S.
        • Kong J.
        • Lee H.
        • Park H.J.
        • Lee H.
        • Wallraven
        Inserting needle into the body: a meta-analysis of brain activity associated with acupuncture needle stimulation.
        J. Pain. 2013; 14: 215-222
        • Chen H.
        • Dai J.
        • Zhang X.
        • Wang K.
        • Huang S.
        • Cao Q.
        • Wang H.
        • Liang Y.
        • Shi C.
        • Li M.
        • Ha T.
        • Ai L.
        • Li S.
        • Ma J.
        • Wei W.
        • You Y.
        • Liu Z.
        • Tian J.
        • Bai L.
        Hypothalamus-related resting brain network underlying short-term acupuncture treatment in primary hypertension.
        Evid. Based Complement. Alternat. Med. 2013; (808971)
        • Chen S.
        • Bai L.
        • Xu M.
        • Wang F.
        • Yin L.
        • Peng X.
        • Chen X.
        • Shi X.
        Multivariate granger causality analysis of acupuncture effects in mild cognitive impairment patients: an FMRI study.
        Evid. Based Complement. Alternat. Med. 2013; (127271)
        • Chen J.
        • Wang J.
        • Huang Y.
        • Lai X.
        • Tang C.
        • Yang J.
        • Wu J.
        • Zeng T6.
        • Qu S.
        Modulatory effect of acupuncture at Waiguan (TE5) on the functional connectivity of the central nervous system of patients with ischemic stroke in the left basal ganglia.
        PLoS One. 2014; 9: e96777
        • Cho Z.H.
        • Chung S.C.
        • Jones J.P.
        • Park J.B.
        • Park H.J.
        • Lee H.J.
        • Wong E.K.
        • Min B.I.
        New findings of the correlation between acupoints and corresponding brain cortices using functional MRI.
        Proc. Natl. Acad. Sci. U. S. A. 1998; 95: 2670-2673
        • Cho Z.H.
        • Chung S.C.
        • Lee H.J.
        • Wong E.K.
        • Retraction Min B.I.
        New findings of the correlation between acupoints and corresponding brain cortices using functional MRI.
        Proc. Natl. Acad. Sci. U. S. A. 2006; 103: 10527
        • Cho S.Y.
        • Jahng G.H.
        • Park S.U.
        • Jung W.S.
        • Moon S.K.
        • Park J.M.
        fMRI study of effect on brain activity according to stimulation method at LI11, ST36: painful pressure and acupuncture stimulation of same acupoints.
        J. Altern. Complement. Med. 2010; 16: 489-495
        • Chu W.C.
        • Wu J.C.
        • Yew D.T.
        • Zhang L.
        • Shi L.
        • Yeung D.K.
        • Wang D.
        • Tong R.K.
        • Chan Y.
        • Lao L.
        • Leung P.C.
        • Berman B.M.
        • Sung J.J.
        Does acupuncture therapy alter activation of neural pathway for pain perception in irritable bowel syndrome?: a comparative study of true and sham acupuncture using functional magnetic resonance imaging.
        J. Neurogastroenterol Motil. 2012; 18: 305-316
        • Claunch J.D.
        • Chan S.T.
        • Nixon E.E.
        • Qiu W.Q.
        • Sporko T.
        • Dunn J.P.
        • Kwong K.K.
        • Hui K.K.
        Commonality and specificity of acupuncture action at three acupoints as evidenced by FMRI.
        Am. J. Chin. Med. 2012; 40: 695-712
        • Dai X.J.
        • Gong H.H.
        • Wang Y.X.
        • Zhou F.Q.
        • Min Y.J.
        • Zhao F.
        • Wang S.Y.
        • Liu B.X.
        • Xiao X.Z.
        Gender differences in brain regional homogeneity of healthy subjects after normal sleep and after sleep deprivation: a resting-state fMRI study.
        Sleep Med. 2012; 13: 720-727
        • Deng G.
        • Hou B.L.
        • Holodny A.I.
        • Cassileth B.R.
        Functional magnetic resonance imaging (fMRI) changes and saliva production associated with acupuncture at LI-2 acupuncture point: a randomized controlled study.
        BMC Complement. Altern. Med. 2008; 8: 37
        • Dhond R.P.
        • Yeh C.
        • Park K.
        • Kettner N.
        • Napadow V.
        Acupuncture modulates resting state connectivity in default and sensorimotor brain networks.
        Pain. 2008; 136: 407-418
        • Diener H.C.
        • Kronfeld K.
        • Boewing G.
        • Lungenhausen M.
        • Maier C.
        • Molsberger A.
        • Tegenthoff M.
        • Trampisch H.J.
        • Zenz M.
        • Meinert R.
        • GERAC Migraine Study Group
        Efficacy of acupuncture for the prophylaxis of migraine: a multicentre randomised controlled clinical trial.
        Lancet Neurol. 2006; 5: 310-316
        • Dong M.
        • Qin W.
        • Sun J.
        • Liu P.
        • Yuan K.
        • Liu J.
        • Zhou G.
        • von Deneen K.M.
        • Tian J.
        Tempo-spatial analysis of vision-related acupoint specificity in the occipital lobe using fMRI: an ICA study.
        Brain Res. 2012; 1436: 34-42
        • Ernst E.
        • Lee M.S.
        Acupuncture during stroke rehabilitation.
        Stroke. 2010; 41: e549
        • Fang J.
        • Jin Z.
        • Wang Y.
        • Li K.
        • Kong J.
        • Nixon E.E.
        • Zeng Y.
        • Ren Y.
        • Tong H.
        • Wang Y.
        • Wang P.
        • Hui K.K.
        The salient characteristics of the central effects of acupuncture needling: limbic–paralimbic–neocortical network modulation.
        Hum. Brain Mapp. 2009; 30: 1196-1206
        • Fang J.
        • Wang X.
        • Liu H.
        • Wang Y.
        • Zhou K.
        • Hong Y.
        • Liu J.
        • Wang L.
        • Xue C.
        • Song M.
        • Liu B.
        • Zhu B.
        The Limbic-Prefrontal Network Modulated by Electroacupuncture at CV4 and CV12.
        Evid. Based Complement. Alternat. Med. 2012; (515893)
        • Feng Y.
        • Bai L.
        • Zhang W.
        • Xue T.
        • Ren Y.
        • Zhong C.
        • Wang H.
        • You Y.
        • Liu Z.
        • Dai J.
        • Liu Y.
        • Tian J.
        Investigation of acupoint specificity by multivariate granger causality analysis from functional MRI data.
        J. Magn. Reson. Imaging. 2011; 34: 31-42
        • Feng Y.
        • Bai L.
        • Ren Y.
        • Wang H.
        • Liu Z.
        • Zhang W.
        • Tian J.
        Investigation of the large-scale functional brain networks modulated by acupuncture.
        Magn. Reson. Imaging. 2011; 29: 958-965
        • Feng Y.
        • Bai L.
        • Ren Y.
        • Chen S.
        • Wang H.
        • Zhang W.
        • Tian J.
        FMRI connectivity analysis of acupuncture effects on the whole brain network in mild cognitive impairmentpatients.
        Magn. Reson. Imaging. 2012; 30: 672-682
        • Gao L.
        • Zhang M.
        • Gong H.
        • Bai L.
        • Dai X.J.
        • Min Y.
        • Zhou F.
        Differential activation patterns of FMRI in sleep-deprived brain: restoring effects of acupuncture.
        Evid. Based Complement. Alternat. Med. 2014; (465760)
        • Gareus I.K.
        • Lacour M.
        • Schulte A.C.
        • Hennig J.
        Is there a BOLD response of the visual cortex on stimulation of the vision-related acupoint GB 37?.
        J. Magn. Reson. Imaging. 2002; 15: 227-232
        • He A.G.
        • Tan L.H.
        • Tang Y.
        • James G.A.
        • Wright P.
        • Eckert M.A.
        • Fox P.T.
        • Liu Y.
        Modulation of neural connectivity during tongue movement and reading.
        Hum. Brain Mapp. 2003; 18: 222-232
        • Ho T.J.
        • Duann J.R.
        • Chen C.M.
        • Chen J.H.
        • Shen W.C.
        • Lu T.W.
        • Liao J.R.
        • Lin J.G.
        Carryover effects alter FMRI statistical analysis in an acupuncture study.
        Am. J. Chin. Med. 2008; 36: 55-70
        • Hsieh C.W.
        • Wu J.H.
        • Hsieh C.H.
        • Wang Q.F.
        • Chen J.H.
        Different brain network activations induced by modulation and nonmodulation laser acupuncture.
        Evid. Based Complement. Alternat. Med. 2011; (pii: 951258)
        • Huang W.
        • Pach D.
        • Napadow V.
        • Park K.
        • Long X.
        • Neumann J.
        • Maeda Y.
        • Nierhaus T.
        • Liang F.
        • Witt C.M.
        Characterizing acupuncture stimuli using brain imaging with FMRI—a systematic review and meta-analysis of the literature.
        PLoS One. 2012; 7: e32960
        • Hui K.K.
        • Liu J.
        • Makris N.
        • Gollub R.L.
        • Chen A.J.
        • Moore C.I.
        • Kennedy D.N.
        • Rosen B.R.
        • Kwong K.K.
        Acupuncture modulates the limbic system and subcortical gray structures of the human brain: evidence from fMRI studies in normal subjects.
        Hum. Brain Mapp. 2000; 9: 13-25
        • Hui K.K.
        • Liu J.
        • Marina O.
        • Napadow V.
        • Haselgrove C.
        • Kwong K.K.
        • Kennedy D.N.
        • Makris N.
        The integrated response of the human cerebro-cerebellar and limbic systems to acupuncture stimulation at ST 36 as evidenced by fMRI.
        Neuroimage. 2005; 27: 479-496
        • Hui K.K.
        • Marina O.
        • Claunch J.D.
        • Nixon E.E.
        • Fang J.
        • Liu J.
        • Li M.
        • Napadow V.
        • Vangel M.
        • Makris N.
        • Chan S.T.
        • Kwong K.K.
        • Rosen B.R.
        Acupuncture mobilizes the brain's default mode and its anti-correlated network in healthy subjects.
        Brain Res. 2009; 1287: 84-103
        • Hui K.K.
        • Marina O.
        • Liu J.
        • Rosen B.R.
        • Kwong K.K.
        Acupuncture, the limbic system, and the anticorrelated networks of the brain.
        Auton. Neurosci. 2010; 157: 81-90
        • Jiang Y.
        • Hao Y.
        • Zhang Y.
        • Liu J.
        • Wang X.
        • Han J.
        • Fang J.
        • Zhang J.
        • Cui C.
        Thirty minute transcutaneous electric acupoint stimulation modulates resting state brain activities: a perfusionand and BOLD fMRI study.
        Brain Res. 2012; 1457: 13-25
        • Jiang Y.
        • Wang H.
        • Liu Z.
        • Dong Y.
        • Dong Y.
        • Xiang X.
        • Bai L.
        • Tian J.
        • Wu L.
        • Han J.
        • Cui C.
        Manipulation of and sustained effects on the human brain induced by different modalities of acupuncture: an fMRI study.
        PLoS One. 2013; 8: e66815
        • Jin L.M.
        • Qin C.J.
        • Lan L.
        • Sun J.B.
        • Zeng F.
        • Zhu Y.Q.
        • Yu S.G.
        • Yin H.Y.
        • Tang Y.
        Local anesthesia at ST36 to reveal responding brain areas to deqi.
        Evid. Based Complement. Alternat. Med. 2014; (987365)
        • Kang O.S.
        • Kim S.Y.
        • Jahng G.H.
        • Kim H.
        • Kim J.W.
        • Chung S.Y.
        • Kim J.W.
        • Yang S.I.
        • Park H.J.
        • Lee H.
        • Chae Y.
        Neural substrates of acupuncture in the modulation of cravings induced by smoking-related visual cues: an fMRI study.
        Psychopharmacology. 2013; 228: 119-127
        • Kaptchuk T.J.
        Acupuncture: theory, efficacy, and practice.
        Ann. Intern. Med. 2002; 136: 374-383
        • Kong J.
        • Kaptchuk T.J.
        • Polich G.
        • Kirsch I.
        • Vangel M.
        • Zyloney C.
        • Rosen B.
        • Gollub R.L.
        An fMRI study on the interaction and dissociation between expectation of pain relief and acupuncture treatment.
        Neuroimage. 2009; 47: 1066-1076
        • Kong J.
        • Kaptchuk T.J.
        • Polich G.
        • Kirsch I.
        • Vangel M.
        • Zyloney C.
        • Rosen B.
        • Gollub R.
        Expectancy and treatment interactions: a dissociation between acupuncture analgesia and expectancy evoked placebo analgesia.
        Neuroimage. 2009; 45: 940-949
        • Kong J.
        • Kaptchuk T.J.
        • Webb J.M.
        • Kong J.T.
        • Sasaki Y.
        • Polich G.R.
        • Vangel M.G.
        • Kwong K.
        • Rosen B.
        • Gollub R.L.
        Functional neuroanatomical investigation of vision-related acupuncture point specificity—a multisession fMRI study.
        Hum. Brain Mapp. 2009; 30: 38-46
        • Laufs H.
        Endogenous brain oscillations and related networks detected by surface EEG-combined fMRI.
        Hum. Brain Mapp. 2008; 29: 762-769
        • Li G.
        • Yang E.S.
        An fMRI study of acupuncture-induced brain activation of aphasia stroke patients.
        Complement. Ther. Med. 2011; 19
        • Li L.
        • Qin W.
        • Bai L.
        • Tian J.
        Exploring vision-related acupuncture point specificity with multivoxel pattern analysis.
        Magn. Reson. Imaging. 2010; 28: 380-387
        • Li C.
        • Yang J.
        • Sun J.
        • Xu C.
        • Zhu Y.
        • Lu Q.
        • Yuan A.
        • Zhu Y.
        • Li L.
        • Zhang W.
        • Liu J.
        • Huang J.
        • Chen D.
        • Wang L.
        • Qin W.
        • Tian J.
        Brain responses to acupuncture are probably dependent on the brain functional status.
        Evid. Based Complement. Alternat. Med. 2013; (175278)
        • Li C.
        • Yang J.
        • Park K.
        • Wu H.
        • Hu S.
        • Zhang W.
        • Bu J.
        • Xu C.
        • Qiu B.
        • Zhang X.
        Prolonged repeated acupuncture stimulation induces habituation effects in pain-related brain areas: an FMRI study.
        PLoS One. 2014; 9: e97502
        • Li Z.
        • Zeng F.
        • Yang Y.
        • Chen Y.
        • Zhang D.
        • Sun J.
        • Qin W.
        • Yang J.
        • Liang F.
        Different cerebral responses to puncturing at ST36 among patients with functional dyspepsia and healthy subjects.
        Forsch. Komplementmed. 2014; 21: 99-104
        • Liang P.
        • Wang Z.
        • Qian T.
        • Li K.
        Acupuncture stimulation of Taichong (Liv3) and Hegu (LI4) modulates the default mode network activity in Alzheimer's disease.
        Am. J. Alzheimers Dis. Other Demen. 2014; 29: 739-748
        • Linde K.
        • Streng A.
        • Jürgens S.
        • Hoppe A.
        • Brinkhaus B.
        • Witt C.
        • WagenpfeilS Pfaffenrath V.
        • Hammes M.G.
        • Weidenhammer W.
        • Willich S.N.
        • Melchart D.
        Acupuncture for patients with migraine: a randomized controlled trial.
        JAMA. 2005; 293: 2118-2125
        • Liu H.
        • Buckner R.L.
        • Talukdar T.
        • Tanaka N.
        • Madsen J.R.
        • Stufflebeam S.M.
        Task free presurgical mapping using functional magnetic resonance imaging intrinsic activity.
        J. Neurosurg. 2009; 111: 746-5
        • Liu P.
        • Zhang Y.
        • Zhou G.
        • Yuan K.
        • Qin W.
        • Zhuo L.
        • Liang J.
        • Chen P.
        • Dai J.
        • Liu Y.
        • Tian J.
        Partial correlation investigation on the default mode network involved in acupuncture: an fMRI study.
        Neurosci. Lett. 2009; 462: 183-187
        • Liu P.
        • Qin W.
        • Zhang Y.
        • Tian J.
        • Bai L.
        • Zhou G.
        • Liu J.
        • Chen P.
        • Dai J.
        • von Deneen K.M.
        • Liu Y.
        Combining spatial and temporal information to explore function-guide action of acupuncture using fMRI.
        J. Magn. Reson. Imaging. 2009; 30: 41-46
        • Liu J.
        • Qin W.
        • Guo Q.
        • Sun J.
        • Yuan K.
        • Liu P.
        • Zhang Y.
        • von Deneen K.M.
        • Liu Y.
        • Tian J.
        Distinct brain networks for time-varied characteristics of acupuncture.
        Neurosci. Lett. 2010; 468: 353-358
        • Liu P.
        • Zhou G.
        • Zhang Y.
        • Dong M.
        • Qin W.
        • Yuan K.
        • Sun J.
        • Liu J.
        • Liang J.
        • von Deneen K.M.
        • Liu Y.
        • Tian J.
        The hybrid GLM-ICA investigation on the neural mechanism of acupoint ST36: an fMRI study.
        Neurosci. Lett. 2010; 479: 267-271
        • Liu P.
        • Zhou G.
        • Yang X.
        • Liu J.
        • Sun J.
        • Dong M.
        • Yuan K.
        • Zhang Y.
        • Qin W.
        • Tian J.
        Power estimation predicts specific function action of acupuncture: an fMRI study.
        Magn. Reson. Imaging. 2011; 29: 1059-1064
        • Liu B.
        • Chen J.
        • Wang J.
        • Liu X.
        • Duan X.
        • Shang X.
        • Long Y.
        • Chen Z.
        • Li X.
        • Huang Y.
        • He Y.
        Altered small-world efficiency of brain functional networks in acupuncture at ST36: a functional MRI study.
        PLoS One. 2012; 7: 39342
        • Liu H.
        • Xu J.
        • Shan B.
        • Li Y.
        • Li L.
        • Xue J.
        • Nie B.
        Determining the precise cerebral response to acupuncture: an improved FMRI study.
        PLoS One. 2012; 7: e49154
        • Liu C.H.
        • Ma X.
        • Wu X.
        • Fan T.T.
        • Zhang Y.
        • Zhou F.C.
        • Li L.J.
        • Li F.
        • Tie C.L.
        • Li S.F.
        • Zhang D.
        • Zhou Z.
        • Dong J.
        • Wang Y.J.
        • Yao L.
        • Wang C.Y.
        Resting-state brain activity in major depressive disorder patients and their siblings.
        J. Affect. Disord. 2013; 149: 299-306
        • Liu H.
        • Xu J.Y.
        • Li L.
        • Shan B.C.
        • Nie B.B.
        • Xue J.Q.
        FMRI evidence of acupoints specificity in two adjacent acupoints.
        Evid. Based Complement. Alternat. Med. 2013; (932581)
        • MacPherson H.
        • Green G.
        • Nevado A.
        • Lythgoe M.F.
        • Lewith G.
        • Devlin R.
        • Haselfoot R.
        • Asghar A.U.
        Brain imaging of acupuncture: comparing superficial with deep needling.
        Neurosci. Lett. 2008; 434: 144-149
        • MacPherson H.
        • Richmond S.
        • Bland M.
        • Brealey S.
        • Gabe R.
        • Hopton A.
        • Keding A.
        • Lansdown H.
        • Perren S.
        • Sculpher M.
        • Spackman E.
        • Torgerson D.
        • Watt I.
        Acupuncture and counselling for depression in primary care: a randomised controlled trial.
        PLoS Med. 2013; 10: e1001518
        • Na B.J.
        • Jahng G.H.
        • Park S.U.
        • Jung W.S.
        • Moon S.K.
        • Park J.M.
        • Bae H.S.
        An fMRI study of neuronal specificity of an acupoint: electroacupuncture stimulation of Yanglingquan (GB34) and its sham point.
        Neurosci. Lett. 2009; 464: 1-5
        • Napadow V.
        • Makris N.
        • Liu J.
        • Kettner N.W.
        • Kwong K.K.
        • Hui K.K.
        Effects of electroacupuncture versus manual acupuncture on the human brain as measured by fMRI.
        Hum. Brain Mapp. 2005; 24: 193-205
        • Napadow V.
        • Liu J.
        • Li M.
        • Kettner N.
        • Ryan A.
        • Kwong K.K.
        • Hui K.K.
        • Audette J.F.
        Somatosensory cortical plasticity in carpal tunnel syndrome treated by acupuncture.
        Hum. Brain Mapp. 2007; 28: 159-171
        • Napadow V.
        • Dhond R.P.
        • Kim J.
        • LaCount L.
        • Vangel M.
        • Harris R.E.
        • Kettner N.
        • Park K.
        Brain encoding of acupuncture sensation—coupling on-line rating with fMRI.
        Neuroimage. 2009; 47: 1055-1065
        • Napadow V.
        • Dhond R.
        • Park K.
        • Kim J.
        • Makris N.
        • Kwong K.K.
        • Harris R.E.
        • Purdon P.L.
        • Kettner N.
        • Hui K.K.
        Time-variant fMRI activity in the brainstem and higher structures in response to acupuncture.
        Neuroimage. 2009; 47: 289-301
        • Napadow V.
        • Lee J.
        • Kim J.
        • Cina S.
        • Maeda Y.
        • Barbieri R.
        • Harris R.E.
        • Kettner N.
        • Park K.
        Brain correlates of phasic autonomic response to acupuncture stimulation: an event-related fMRI study.
        Hum. Brain Mapp. 2013; 34: 2592-2606
        • Napadow V.
        • Li A.
        • Loggia M.L.
        • Kim J.
        • Schalock P.C.
        • Lerner E.
        • Tran T.N.
        • Ring J.
        • Rosen B.R.
        • Kaptchuk T.J.
        • Pfab F.
        The brain circuitry mediating antipruritic effects of acupuncture.
        Cereb. Cortex. 2014; 24: 873-882
        • Peltier S.J.
        • Noll D.C.
        T2* dependence of low frequency functional connectivity.
        Neuroimage. 2002; 16: 985-992
        • Qin W.
        • Tian J.
        • Bai L.
        • Pan X.
        • Yang L.
        • Chen P.
        • Dai J.
        • Ai L.
        • Zhao B.
        • Gong Q.
        • Wang W.
        • von Deneen K.M.
        • Liu Y.
        FMRI connectivity analysis of acupuncture effects on an amygdala-associated brain network.
        Mol. Pain. 2008; 4: 55
        • Qin W.
        • Bai L.
        • Dai J.
        • Liu P.
        • Dong M.
        • Liu J.
        • Sun J.
        • Yuan K.
        • Chen P.
        • Zhao B.
        • Gong Q.
        • Tian J.
        • Liu Y.
        The temporal–spatial encoding of acupuncture effects in the brain.
        Mol. Pain. 2011; 7: 19
        • Qiu W.Q.
        • Claunch J.
        • Kong J.
        • Nixon E.E.
        • Fang J.
        • Li M.
        • Vangel M.
        • Hui K.K.
        The effects of acupuncture on the brain networks for emotion and cognition: an observation of gender differences.
        Brain Res. 2010; 1362: 56-67
        • Quah-Smith I.
        • Sachdev P.S.
        • Wen W.
        • Chen X.
        • Williams M.A.
        The brain effects of laser acupuncture in healthy individuals: an FMRI investigation.
        PLoS One. 2010; 5: 12619
        • Quah-Smith I.
        • Williams M.A.
        • Lundeberg T.
        • Suo C.
        • Sachdev P.
        Differential brain effects of laser and needle acupuncture at LR8 using functional MRI.
        Acupunct. Med. 2013; 31: 282-289
        • Quah-Smith I.
        • Suo C.
        • Williams M.A.
        • Sachdev P.S.
        The antidepressant effect of laser acupuncture: a comparison of the resting brain's default mode network in healthy and depressed subjects during functional magnetic resonance imaging.
        Med. Acupunct. 2013; 25: 124-133
        • Ren Y.
        • Bai L.
        • Feng Y.
        • Tian J.
        • Li K.
        Investigation of acupoint specificity by functional connectivity analysis based on graph theory.
        Neurosci. Lett. 2010; 482: 95-100
        • Romoli M.
        • Allais G.
        • Airola G.
        • Benedetto C.
        • Mana O.
        • Giacobbe M.
        • Pugliese A.M.
        • Battistella G.
        • Fornari E.
        Ear acupuncture and fMRI: a pilot study for assessing the specificity of auricular points.
        Neurol. Sci. 2014; 35: 189-193
        • Shukla S.
        • Torossian A.
        • Duann J.R.
        • Leung A.
        The analgesic effect of electroacupuncture on acute thermal pain perception—a central neural correlate study with fMRI.
        Mol. Pain. 2011; 7: 45
        • Sun J.
        • Qin W.
        • Dong M.
        • Yuan K.
        • Liu J.
        • Liu P.
        • Zhang Y.
        • von Deneen K.M.
        • Tian J.
        Evaluation of group homogeneity during acupuncture stimulation in fMRI studies.
        J. Magn. Reson. Imaging. 2010; 32: 298-305
        • Sun J.
        • Zhu Y.
        • Jin L.
        • Yang Y.
        • von Deneen K.M.
        • Qin W.
        • Gong Q.
        • Tian J.
        Partly separated activations in the spatial distribution between de-qi and sharp pain during acupuncture stimulation: an fMRI-based study.
        Evid. Based Complement. Alternat. Med. 2012; (934085)
        • Tian D.S.
        • Xiong J.
        • Pan Q.
        • Liu F.
        • Wang L.
        • Xu S.B.
        • Huang G.Y.
        • Wang W.
        De qi, a threshold of the stimulus intensity, elicits the specific response of acupoints and intrinsic change of human brain to acupuncture.
        Evid. Based Complement. Alternat. Med. 2014; (914878)
        • Tracey I.
        • Mantyh P.W.
        The cerebral signature for pain perception and its modulation.
        Neuron. 2007; 55: 377-392
        • Uchino K.
        Strong stimulation acupuncture with needle manipulation improved recovery in Bell palsy.
        Ann. Intern. Med. 2013; 159: JC8
        • Wager T.D.
        • Rilling J.K.
        • Smith E.E.
        • Sokolik A.
        • Casey K.L.
        • et al.
        Placebo-induced changes in FMRI in the anticipation and experience of pain.
        Science. 2004; 303: 1162-1167
        • Wang Z.
        • Nie B.
        • Li D.
        • Zhao Z.
        • Han Y.
        • Song H.
        • Xu J.
        • Shan B.
        • Lu J.
        • Li K.
        Effect of acupuncture in mild cognitive impairment and Alzheimer disease: a functional MRI study.
        PLoS One. 2012; 7: 42730
        • Wang X.
        • Chan S.T.
        • Fang J.
        • Nixon E.E.
        • Liu J.
        • Kwong K.K.
        • Rosen B.R.
        • Hui K.K.
        Neural encoding of acupuncture needling sensations: evidence from a FMRI study.
        Evid. Based Complement. Alternat. Med. 2013; (483105)
        • Wang Z.
        • Liang P.
        • Zhao Z.
        • Han Y.
        • Song H.
        • Xu J.
        • Lu J.
        • Li K.
        Acupuncture modulates resting state hippocampal functional connectivity in Alzheimer disease.
        PLoS One. 2014; 9: e91160
        • White P.
        • Lewith G.
        • Prescott P.
        • Conway J.
        Acupuncture versus placebo for the treatment of chronic mechanical neck pain: a randomized, controlled trial.
        Ann. Intern. Med. 2004; 141: 911-919
        • Witt C.M.
        • Reinhold T.
        • Jena S.
        • Brinkhaus B.
        • Willich S.N.
        Cost-effectiveness of acupuncture in women and men with allergic rhinitis: a randomized controlled study in usual care.
        Am. J. Epidemiol. 2009; 169: 562-571
        • Wu M.T.
        • Hsieh J.C.
        • Xiong J.
        • Yang C.F.
        • Pan H.B.
        • Chen Y.C.
        • Tsai G.
        • Rosen B.R.
        • Kwong K.K.
        Central nervous pathway for acupuncture stimulation: localization of processing with functional MR imaging of the brain—preliminary experience.
        Radiology. 1999; 212: 133-141
        • Wu M.T.
        • Sheen J.M.
        • Chuang K.H.
        • Yang P.
        • Chin S.L.
        • Tsai C.Y.
        • Chen C.J.
        • Liao J.R.
        • Lai P.H.
        • Chu K.A.
        • Pan H.B.
        • Yang C.F.
        Neuronal specificity of acupuncture response: a fMRI study with electroacupuncture.
        Neuroimage. 2002; 16: 1028-1037
        • Wu C.
        • Qu S.
        • Zhang J.
        • Chen J.
        • Zhang S.
        • Li Z.
        • Chen J.
        • Ouyang H.
        • Huang Y.
        • Tang C.
        Correlation between the effects of acupuncture at Taichong (LR3) and functional brain areas: a resting-state functional magnetic resonance imaging study using true versus sham acupuncture.
        Evid. Based Complement. Alternat. Med. 2014; (729091)
        • Xie Z.
        • Cui F.
        • Zou Y.
        • Bai L.
        Acupuncture enhances effective connectivity between cerebellum and primary sensorimotor cortex in patients with stable recovery stroke.
        Evid. Based Complement. Alternat. Med. 2014; (603909)
        • Xue T.
        • Bai L.
        • Chen S.
        • Zhong C.
        • Feng Y.
        • Wang H.
        • Liu Z.
        • You Y.
        • Cui F.
        • Ren Y.
        • Tian J.
        • Liu Y.
        Neural specificity of acupuncture stimulation from support vector machine classification analysis.
        Magn. Reson. Imaging. 2011; 29: 943-950
        • Yeo S.
        • Lim S.
        • Choe I.H.
        • Choi Y.G.
        • Chung K.C.
        • Jahng G.H.
        • Kim S.H.
        Acupuncture stimulation on GB34 activates neural responses associated with Parkinson's disease.
        CNS Neurosci. Ther. 2012; 18: 781-790
        • Yeo S.
        • Choe I.H.
        • van den Noort M.
        • Bosch P.
        • Jahng G.H.
        • Rosen B.
        • Kim S.H.
        • Lim S.
        Acupuncture on GB34 activates the precentral gyrus and prefrontal cortex in Parkinson's disease.
        BMC Complement. Altern. Med. 2014; 14: 336
        • Yeung W.F.
        • Chung K.F.
        • Tso K.C.
        • Zhang S.P.
        • Zhang Z.J.
        • Ho L.M.
        Electroacupuncture for residual insomnia associated with major depressive disorder: a randomized controlled trial.
        Sleep. 2011; 34: 807-815
        • You Y.
        • Bai L.
        • Dai R.
        • Cheng H.
        • Liu Z.
        • Wei W.
        • Tian J.
        Altered hub configurations within default mode network following acupuncture at ST36: a multimodal investigation combining fMRI and MEG.
        PLoS One. 2013; 8: 64509
        • Zhang Y.
        • Qin W.
        • Liu P.
        • Tian J.
        • Liang J.
        • von Deneen K.M.
        • Liu Y.
        An fMRI study of acupuncture using independent component analysis.
        Neurosci. Lett. 2009; 449: 6-9
        • Zhang Y.
        • Liang J.
        • Qin W.
        • Liu P.
        • von Deneen K.M.
        • Chen P.
        • Bai L.
        • Tian J.
        • Liu Y.
        Comparison of visual cortical activations induced by electro-acupuncture at vision and nonvision-related acupoints.
        Neurosci. Lett. 2009; 458: 6-10
        • Zhang G.
        • Yin H.
        • Zhou Y.L.
        • Han H.Y.
        • Wu Y.H.
        • Xing W.
        • Xu H.Z.
        • Zuo X.N.
        Capturing amplitude changes of low-frequency fluctuations in functional magnetic resonance imaging signal: a pilot acupuncture study on NeiGuan (PC6).
        J. Altern. Complement. Med. 2012; 18: 387-393
        • Zhang Y.
        • Glielmi C.B.
        • Jiang Y.
        • Wang J.
        • Wang X.
        • Fang J.
        • Cui C.
        • Han J.
        • Hu X.
        • Zhang J.
        Simultaneous CBF and BOLD mapping of high frequency acupuncture induced brain activity.
        Neurosci. Lett. 2012; 530: 12-17
        • Zhang Y.
        • Jiang Y.
        • Glielmi C.B.
        • Li L.
        • Hu X.
        • Wang X.
        • Han J.
        • Zhang J.
        • Cui C.
        • Fang J.
        Long-duration transcutaneous electric acupoint stimulation alters small-world brain functional networks.
        Magn. Reson. Imaging. 2013; 31: 1105-1111
        • Zhang Y.
        • Li K.
        • Ren Y.
        • Cui F.
        • Xie Shin J.Y.
        • Tan Z.
        • Tang L.
        • Bai L.
        • Zou Y.
        Acupuncture modulates the functional connectivity of the default mode network in stroke patients.
        Evid. Based Complement. Alternat. Med. 2014; (765413)
        • Zhong C.
        • Bai L.
        • Dai R.
        • Xue T.
        • Wang H.
        • Feng Y.
        • Liu Z.
        • You Y.
        • Chen S.
        • Tian J.
        Modulatory effects of acupuncture on resting-state networks: a functional MRI study combining independent component analysis and multivariate Granger causality analysis.
        J. Magn. Reson. Imaging. 2012; 35: 572-581
        • Zhou S.
        • Zeng F.
        • Liu J.
        • Zheng H.
        • Huang W.
        • Liu T.
        • Chen D.
        • Qin W.
        • Gong Q.
        • Tian J.
        • Li Y.
        Influence of acupuncture stimulation on cerebral network in functional diarrhea.
        Evid. Based Complement. Alternat. Med. 2013; (975769)
        • Zyloney C.E.
        • Jensen K.
        • Polich G.
        • Loiotile R.E.
        • Cheetham A.
        • LaViolette P.S.
        • Tu P.
        • Kaptchuk T.J.
        • Gollub R.L.
        • Kong J.
        Imaging the functional connectivity of the Periaqueductal Gray during genuine and sham electroacupuncture treatment.
        Mol. Pain. 2010; 6: 80