Study of acupuncture using fMRI and Ultrasonic Imaging

Joie P. Jones
Department of Radiology Sciences
University of California Irvine
Ultrasonic Acupuncture and the Correlation Between Acupuncture Stimulation
and the Activation of Associated Brain Cortices Using Functional Magnetic
Resonance Imaging

The theory of acupuncture is difficult to reconcile with contemporary biomedical

concepts, because it is based on the premise that there are patterns of energy
flow (Qi) through the body that are essential for health. A disruption or blockage
of this flow is believed to be responsible for disease and ill-health. The
acupuncturist restores the flow of energy by stimulating specific acupuncture
points located just under the surface of the skin. The stimulation is accomplished
by inserting thin, metalic needles and manipulating them manually at the
acupoint. Since research studies have demonstrated biomedical correlates of
acupuncture effects the assumptions has been that the sensory stimuli and
microtrauma of needling must activate nerve pathways, release
neurotransmitters and hormones, trigger immune and circulatory responses and
even turn genes on or off.
Several laboratories have used medical imaging techinques such as functional
MRI and quantitative ultrasound methods to study acupuncture. Activation of
specific acupoints in the foot along a specific meridian elicits increases in cortical
blood flow in regions of the visual cortex, comparable in magnitute and brain
location to those obtained by stimulation of visual cortex by flalshes of light.
When the acupuncture needle is directed at a non-acupoint no effects are
observed. Similar relationship was confirmed between auditory-related acupoints
and the auditory cortex.
Replacing the acupuncture needle with a focused ultrasonic transducer working
at 5 MHz and higher, the acupoint was irradiated by ultrasonic pulses, at energy
levels considerably higher than those used in convensional ultrasonic imaging,
and a similar corresponding brain activity was recorded by fMRI. The stimulation
process is communicated to other acupoints on the same meridian at speeds of 5
to 10 cm/sec. Very sensitive individuals can sense the flow of energy. Optimal
results were obtained when the ultrasonic pulse was focused on the same
position as the tip of the acupuncture needle during conventional stimulation.
Focusing the pulse on the surface of the skin or in depth beyond the acupoint
produced no stimulation. No stimulations were oberved at intensities below
5W/cm2.
There are three different pathways the signal of stimulation gets to the brain.
One which is very fast, reaching the brain almost instanteniously <= 0.8 ms ,
two order of magnitude faster than any known process (consistent with the
concept of subtle energy field). A second pathway along the nerves takes 180 to
200 ms for the signal to fire in the brain. The third pathway is v. slow, it moves

along the meridians, taking 15 to 25 sec to get to the brain centers. So, via fMRI
we can see these three signals reaching the brain one after the other.
To image the acupoints conventional ultrasound imaging was unable to identify
any remarkable anatomical features. A 50 MHz A-mode system was used to
collect data in the vicinity of the acupoints. It has been discovered that the
acupoints are regions of enhanced acoustical attenuation and elasticity,
representing regions of ehanced electrical conductivity given the fact that
changes in electrical properties are almost always associated with changes in
acoustical properties. This finding is consistent with previous observations that
acupoints undergo changes in mechanical properties with needling and also that
the local mechanical properties along a meridian are different from surrounding
tissue. The acupoints can change shape as the acupoints twist around the
acupuncture needle, change size and even location over time. The mechanisms
of these chages are not known, but for example, changes in elasticity at an
acupoint could be produced by changes in the blood flow to the surrounding
capillary bed caused by a response from the sympathetic nerves or other local
factors.
This study and others have shown that all of the acupoints are located within the
connective tissue. This finding agrees with the observations of Langevin and
Yandow.
Quantitative ultrasound methods could potentially locate specific acupoints
which is estimated that even experienced acupuncturists miss-locate 50% of the
time, and at higher power levels provide the stimulation required. Using such
methods would greatly increase the accuracy of acupuncture, would insure that
the stimulation was done at the correct location with the correct amplitude for
the desired effect and would be a totally benign experience for the patient.
A variety of stimuli have proven effective in creating similar theraputic changes
via meridian pathways:

Electrical signals applied via superficial electrodes at specific

acupoints
Static pressure applied by hand
Low intensity energy laser beams