Clinical efficacy of the shallow puncture and more-twirling acupuncture method in migraine treatment and its effects on serum 5-HT and β-EP levels

1.Introduction

Migraine is a neurological disorder characterized by recurrent unilateral or bilateral attacks of moderate-to-severe headache that may be accompanied by nausea, fear of sound, and photophobia [1]. The incidence rate for migraine is 12% worldwide [2], and recurrence is common, which seriously affects physical and mental health of patients [3]. The World Health Organization (WHO) considers migraine the most disabling chronic disease [4]. Current medications for migraine are prone to drug resistance, addiction and toxic and side effects [5], whereas acupuncture shows efficacy with few adverse reactions in treating migraine [6] and thus has been listed as a recommended therapy by the WHO [7]. Based on the cutaneous region theory in Huangdi’s Internal Classics, the “shallow puncture and more-twirling” acupuncture method was developed by Doctor Chen Lei, a famous Chinese medicine expert in Zhejiang Province. This method is effective in treating migraine [8, 9], but the mechanism of action has not been elucidated. As a neurotransmitter and humoral transmitter, 5-HT is involved in important pathways for migraine in the central and peripheral areas. β-EP is an endogenous opioid peptide with potent analgesic effect, and the body’s decreased ability to release β-EP can lead to an increase in vasoactive substances, thereby upregulating sensitivity to pain.

This study is a single-center, evaluator-blinded, randomized controlled trial to observe the effects of the shallow puncture and more-twirling method on patients with migraine (as determined using the visual analog scale (VAS) score and comprehensive headache score) and to measure serum 5-hydroxytryptamine (5-HT) and beta-endorphin (β-EP) levels before and after treatment, so as to investigate the mechanism of action of the shallow puncture and more-twirling method in the treatment of migraine.

2.Materials and methods

3.Methods

4.Computer simulation and results

5.Conclusion

Migraine is classified as “headache” and “head wind” in traditional Chinese medicine. Headache can be divided into 2 types based on causative factors: external contraction and internal damage. “The top part is first attacked in individuals who are affected by wind pathogen,” and “only the wind can reach the high top.” Wind pathogen is considered the main causative factor for headache, regardless of external contraction or internal damage. The first to be affected by the invasion of wind pathogen is the cutaneous region and then from the exterior to the interior, passing through the meridians into the zang-fu organs. As described in Plain Questions – Cutaneous Region Theory, “if the skin is attacked by the pathogenic qi, the striae and interstices will open, and then, the pathogenic qi will enter the collateral vessels, followed by meridians and zang-fu organs”. Hence, the invasion path of pathogenic qi is from the cutaneous region to collateral vessels, meridians and zang-fu organs. The cutaneous region is the most superficial part of the meridian system and is the gateway of pathogenic qi in the body, contacting the body surface with the zang-fu organs, regulating the meridians, and opening and closing the striae and interstices. Therefore, relevant diseases can be treated via the function of the cutaneous region. The shallow puncture and more-twirling acupuncture method is an approach developed by Doctor Chen Lei, a famous Chinese medicine expert in Zhejiang Province, based on the cutaneous region theory. This method evolves from the traditional “skin needling method” and activates the meridian qi in the heaven of “heaven, human, and earth”, namely the superficial part of the transport points, creating an itchy or numb sensation on the skin, from local to peripheral positions and even to distal and diseased zang-fu organs, referred to as “qi reaching the lesion”. In addition, the shallow puncture method requires puncture of the skin first, the aim of which is to prevent the change in and block the entry and exit of the disease. After the retreating path of pathogenic qi is blocked, healthy qi is obtained, passing through the meridian system to activate the whole body meridian qi and intersect via multiple layers of pathways and to dispel the pathogenic qi. A significant wind-dispelling effect is then achieved. The more-twirling method enhances the regulatory effect of shallow puncture on the meridian points, activating blood and moving qi, so as to dispel wind pathogen by moving blood. The combination of these 2 methods can move blood to dispel wind and thus disperse pathogen, thus achieving an analgesic effect in treating migraine. Although the procedure seems simple, the needle should not be removed immediately once inserted. Moving and pushing qi occurs in the rapid twirling after the needle is inserted, thus unblocks meridians and harmonizes qi and the blood. For this reason, a fast and even twirl, the force applied by the needle tip and the maintenance of the needling sensation are crucial. Most doctors believe that the onset of migraine is related to wind, fire, phlegm, stasis and the deficiency of qi and blood, so traditional Chinese medicine treatment mostly adopts the method of dispelling wind, clearing fire, channeling and dissolving phlegm [11, 12]. Data analysis [13, 14] showed that the selection of migraine acupoints was mainly the Zushaoyang gallbladder meridian points, while Fengchi and Shuaigu were the main acupuncture point combinations. Studies [15] have shown that acupuncture points such as Sizhukong, Shuaigu, Fengchi can reduce intracranial blood flow velocity and improve the pain level of migraine patients.

In this study, patients with migraine were divided into two groups, and the effects of the two groups were compared by using the relevant scoring indicators. The results indicated that the VAS scores and comprehensive headache scores of patients in the acupuncture group markedly improved after treatment compared with before treatment and were superior to those in the control group, further demonstrating the definite clinical efficacy of the shallow puncture and more-twirling acupuncture method for the treatment of migraine. The results of the study are also consistent with relevant reports [16]. Compared with the gastrointestinal and other adverse effects that the drugs may cause, and combined with the research results, acupuncture for migraine has better clinical efficacy and lighter side effects which are more acceptable to patients.

Currently, there is no consensus on the pathogenesis of migraine, mainly involving the vascular theory, the cortical diffusion inhibition theory and the trigeminal vascular theory [17]. With in-depth research, the roles of 5-HT and β-EP in the pathogenesis of migraine have attracted increasing attention. 5-HT, which is a vital analgesic neurotransmitter and has some vascular activity, is principally distributed in the cerebral cortex and neuro synapses and has effects on nerves and blood vessels. During a migraine attack, the plasma level of 5-HT declines, whereas the level of 5-hydroxyindoleacetic acid (a metabolite of 5-HT) increases. Sumatriptan, amitriptyline and ergotamine are effective in treating migraine by directly or indirectly acting on 5-HT transmitters or receptors. β-EP, an important neurotransmitter of amino acids, is synthesized by the pituitary gland and is identified in the thalamus and pituitary gland. The dysfunction of human neurotransmitters caused by β-EP is reported to occur during migraine. In the case of a reduction in β-EP release, the ability to suppress the cytosolic activity of norepinephrine neurons is diminished, giving rise to the dysregulation of cervical vascular contraction and dilatation, with vascular changes consistent with those seen in patients with migraine in the early stage. Therefore, a growing number of studies have suggested that β-EP can relieve migraine [18].

According to a modern neurological study, the analgesic effect of acupuncture is mainly based on the effect of acupuncture on the nervous system and neurotransmitters [19]. In addition to an increase in the secretion of morphine-like substances in the brain, acupuncture can also facilitate the secretion of 5-HT and β-EP, resulting in the activation of the “midbrain limbic analgesic circuit” and, to a certain extent, control of the dorsal horn of the spinal cord, thus exerting an analgesic effect [20]. Moreover, acupuncture decreases the stimulation of 5-HT receptors on vascular smooth muscle [21], attenuates changes in cerebral vascular dilatation and contraction and relieves vasospasms, thus improving blood supply to the brain and relieving cerebral vasospasms. The results of this trial also indicated that serum 5-HT and β-EP levels in the acupuncture group were higher than those in the control group. As a result, the pain pathways were adjusted to increase the pain threshold and produce morphine-like analgesic effects. Nonetheless, further clinical studies and experiments are still needed to verify the exact mechanism of efficacy. Constrained by time and resources, inevitably there are certain limitations in e study, such as the lack of comparison of the efficacy between “shallow prick and multi-twist” acupuncture technique and ordinary acupuncture, no efficacy evaluation during the intervention process, limited follow-up after the intervention, and limited detection of upstream and downstream substances of relevant serum indicators, etc. We suggest that future research can improve from these areas.