Introduction: Cerebrospinal fluid (CSF) circulates in the subarachnoid space around the brain and spinal cord, and in the ventricles of the brain. It serves as a buffer to protect the brain from physical and immunological damage. Since important actions such as removing soluble waste from the brain occur as the CSF circulates, various diseases including cognitive disorders can occur if CSF circulation is impaired. Therefore, it is very important to find anatomical treatment points that improve CSF circulation. Methods: We summarized various clinical symptoms and related diseases caused by CSF circulation failure and reviewed anatomical structures that could affect CSF circulation. Based on the reviewed data, we proposed several treatment points that can contribute to the improvement of CSF circulation. Results: Symptoms and diseases caused by decreased CSF circulation include headaches, sleep disorders, and Alzheimer's disease. In particular, Alzheimer's disease was also related to cerebral blood flow, which was also closely related to CSF circulation. The anatomical structure associated with CSF circulation was dura mater, deep cervical lymph nodes, meningeal lymphatic vessels, and emissary vein. The structures connected to the dura mater were also important, such as the myodural bridge (MDB) directly connected to the dura mater and the soft tissues such as the suboccipital muscles and ligaments connected to the dura mater via MDB. Conclusion:We propose several treatment points based on anatomical structures that may affect CSF circulation. It is the soft tissues of the suboccipital site including MDB, submucosal tissue of the nasal cavity, stylomastoid foramen, and emissary vein.
Objective Shoulder pain is a common complaint in outpatient clinics and can result in an inability to work or perform household activities, leading to significant socioeconomic burden. Acupotomy, as one kind acupuncture that has flat knife-shaped tip, has been widely used for treating shoulder pain. However, despite the widespread use of acupotomy in primary medical institutions, large sample size clinical trials have not sufficiently been performed. In this respect, this multi-center retrospective study aimed to investigate the effectiveness and safety of acupotomy in reducing shoulder pain and disability using data from multi-center primary care clinics. Methods This study was conducted in 25 Korean medicine clinics affiliated with the Korean Medical Society of Acupotomology, Republic of Korea, from August 2021 to December 2021. The medical records of patients who visited the clinics complaining of shoulder pain were gathered, and among them were those of patients who underwent acupotomy treatment and those who received acupuncture combined therapy. The Numeric Rating Scale (NRS), SPADI (Shoulder Pain and Disability Index), Range of Motion (ROM) and adverse event were evaluated at each visit. A linear mixed-effects models and paired t -test were used to identify the effectiveness of the treatment. Results Overall analysis showed that the NRS score of patients decreased from 4.95 ± 1.97 before treatment to 3.78 ± 2.03 after treatment (n = 332, difference in NRS score, 1.17; 95% CI: 0.96–1.38, t = 10.89 p < 0.001). SPADI score decreased from 19.05 ± 20.44 at baseline before treatment to 12.12 ± 17.26 after the last visit, which was statistically significant (n = 332, mean difference in SPADI score, 6.93; 95% CI: 4.71–9.15, t = 6.150, p < 0.001). No serious adverse event was reported in both groups. Conclusion This study showed the effectiveness of acupotomy therapy for shoulder pain, and as the treatment sessions increased, the effect of pain reduction and shoulder function improvement were also increased.
Background: Acupuncture treatment on back-shu points (BSPs) has received attention owing its ability to control the function of visceral organs. We aimed to conduct a systematic review to provide detailed information on the effectiveness and safety of BL18, BL20, and BL22 on the digestive system in terms of soft tissue and anatomical structure and assist in the appropriate application.Methods: Medline, Cochrane Library, EMBASE, OASIS, RISS, and CNKI were searched from their inception to July 2021. This systematic review included randomized controlled trials, controlled clinical trials, case series, and case reports that addressed anatomical structures or needling methods of BL18, BL20, and BL22.Results: In total, 115 articles were included from the 7 electronic databases. One hundred eight articles described the depth and method. A total of 96 articles described depth, 86 articles described the angle, and 74 articles described both. Seventynine articles described the target muscles and anatomical structure. Acupuncture on BSP is effective in gastrointestinal diseases because of compression of the spinal nerve, sympathetic nerve hyperactivity, and connection of the diaphragm. By reviewing each study's acupuncture method and target muscles, we analyzed the angle and depth of the needle that effectively leads to therapeutic response.Conclusions: This study provides guidance on applying needles in terms of anatomical structures to yield therapeutic responses. However, few studies have assessed how to effectively stimulate BSP to trigger digestive effects and their mechanisms. Additional studies on the relationship between BSP and the digestive system are needed to use these acupoints for digestive diseases.Abbreviations: BSP = back-shu point, CRH = corticotropin-releasing hormone, JP = Jiaji point, MALS = median arcuate ligament syndrome, WBS = Wu-Zhang back-shu point.
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