Responses of Autonomic Nervous System and Gastrointestinal Function to Acupuncture at Abdominal Anterior Cutaneous Nerve : A Pilot Study

Seohyun Park; Hojun Kim; Dongho Keum; Park, Seohyun; Kim, Hojun; Keum, Dongho

doi:10.13048/jkm.19009

JKM > Volume 40(1); 2019 > Article

Park, Kim, and Keum: Responses of Autonomic Nervous System and Gastrointestinal Function to Acupuncture at Abdominal Anterior Cutaneous Nerve : A Pilot Study

Original Article

The Journal of Korean Medicine 2019; 40(1): 99-113.

DOI: https://doi.org/10.13048/jkm.19009

Responses of Autonomic Nervous System and Gastrointestinal Function to Acupuncture at Abdominal Anterior Cutaneous Nerve : A Pilot Study

Seohyun Park

, Hojun Kim, Dongho Keum

Department of Rehabilitation Medicine of Korean Medicine, College of Korean Medicine, Dongguk University

Correspondence to: 금동호 (Dongho Keum), 경기도 성남시 분당구 불정로 268 동국대학교분당한방병원 한방재활의학과, Tel: +82-31-710-3728, FAX: +82-31-710-3780, E-mail: keumdh660@naver.com

Received February 24, 2019 Revised March 15, 2019 Accepted March 15, 2019

Abstract

Objectives

This study is designed to identify the responses of autonomic nervous system and gastrointestinal function which are induced by acupuncture at abdominal anterior cutaneous nerve.

Methods

This study is one group before and after pilot study. Subjects were treated once, after having been fasting six hours. They had before tests, labeling points for acupuncture, acupuncture, and after tests in order. The points of acupuncture were motor points of rectus abdominis where the abdominal anterior cutaneous nerve came to the skin from abdominal wall. Before and after tests were consisted of three things: Digital Infrared Thermographic Imaging(D.I.T.I.), Heart Rate Variability(HRV), and Recording of bowel sounds.

Results

There were significant differences on the skin temperature of upper body and the frequency of bowel sounds(p<0.001, p<0.001). The HRV parameters and volume of bowel sounds had no significant differences(p>0.05, p>0.05).

Conclusion

Even though no significant differences in HRV parameters, the significant differences of skin temperature of upper body and frequency of bowel sounds could mean acupuncture at abdominal anterior cutaneous nerve could affect the autonomic nervous system and gastrointestinal function. However, this study had no group to compare with. Future randomized project should address this issue.

Keywords: Abdominal anterior cutaneous nerve, Acupuncture, Autonomic nervous system, Gastrointestinal function

Fig. 1

Digital Infrared Thermographic Imaging

Fig. 2

Electrostethoscope

Fig. 3

Point for attaching electrostethoscope

Fig. 4

Analyzing bowel sounds

(a) Visualized bowel sounds and noise

(b) Transformed bowel sounds for analyzing

Fig. 5

Electric probe

Fig. 6

Abdominal Anterior Cutaneous Nerve15)

(a) Nerves of anterior abdominal wall

(b) Thoracoabdominal nerves

Fig. 7

Points for acupuncture.

Fig. 8

Skin temperature changes of anterior and posterior side of upper body

(a) Skin temperature changes of anterior side of upper body

(b) Skin temperature changes of posterior side of upper body

Fig. 9

Changes of Heart Rate Variability

(a) Changes of MHRT

(b) Changes of RMS-SD

(d) Changes of HR

(e) Changes of LF/HF ratio

Fig. 10

Changes of bowel sounds’ volume and frequency

(a) Changes of volume of bowel sounds

(b) Changes of frequency of bowel sounds

Table 1

General Characteristics of the Subjects

Group		Total
n		30
Age		27±3.10
Gender	Male n(%)	7(23.0)
Gender	Female n(%)	23(77.0)

Values are mean ± S.D.

Table 2

Skin Temperature Changes of Anterior and Posterior Side of Upper Body

	Anterior Part (°C)	Posterior Part (°C)
Before	31.63 ± 1.17	32.05 ± 1.10
After	32.58 ± 0.90	33.82 ± 0.68
P-value	< 0.001	< 0.001

Values are mean ± S.D.

P-values were calculated by Paired T-test

Table 3

Changes of Heart Rate Variability

	Before	After	P-value
MHRT*	64.42 ± 8.93	63.11 ± 8.41	0.221
RMS-SD†	40.67 ± 19.85	40.44 ± 17.37	0.929
LF‡	1417.35 ± 2047.81	1698.06 ± 4261.04	0.877
HF§	1121.82 ± 1533.49	947.97 ± 1468.19	0.558
LF/HF ratio	1.31 ± 1.11	1.35 ± 0.81	0.344

Values are mean ± S.D.

* MHRT : Mean Heart rate,

† RMS-SD : Root Mean Square of the Successive Differences

‡ LF : Low Frequency Density,

§ HF : High Frequency Density

P-values of MHRT and RMS-SD was calculated by Paired T-test

P-values of LF, HF and LF/HF ratio was calculated by Wilcoxon signed rank test

Table 4

Volume and Frequency of Bowel Sound

	Volume (dB)	Frequency (Hz)
Before	−13.61 ± 2.48	165.32 ± 36.80
After	−13.87 ± 1.59	200.38 ± 31.21
P-value	0.611	< 0.001

Values are mean ± S.D.

P-values were calculated by Paired T-test

참고문헌

1. Drossman, DA. Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Features and Rome IV. Gastroenterology, (2016). 150(6), 1262-79.

2. Li, YQ, Zhu, B, Rong, PJ, Ben, H, & Li, YH. Neural mechanism of acupuncture-modulated gastric motility. World J gastroenterology, (2007). 13(5), 709-16.

3. Phillips, RJ, & Powley, TL. Innervation of the gastrointestinal tract: patterns of aging. Autonomic neuroscience : basic & clinical, (2007). 136(1–2), 1-19.

4. Kim, BJ, Hong, JW, Hwang, MW, & Chae, H. Systemic analysis for research strategy establishment of gatrointestinal disease with Oriental medicine in Korea. Korean J Oriental physiology&pathology, (2009). 23(6), 1273-81.

5. Kim, BY, Seo, BN, Park, JE, Yang, CS, Kim, IT, & Lym, JW, et al. A systematic review of acupuncture-moxibution treatment for functional dyspepsia. Korean J acupuncture, (2017). 34(1), 8-36.

6. Kim, YS, & Yoon, SH. Combination Effects of Zusanli (ST36) Electroacupuncture and Manual Acupuncture of other Acupoints on Gastric Vagal Nerve Activity and Pyloric Valve Function in Patients with Functional Dyspepsia. J Korean medicine, (2008). 29(3), 621-8.

7. Ma, TT, Yu, SY, Li, Y, Liang, FR, Tian, XP, & Zheng, H, et al. Randomised clinical trial: an assessment of acupuncture on specific meridian or specific acupoint vs. sham acupuncture for treating functional dyspepsia. Aliment Pharmacol Ther, (2012). 35(5), 552-61.

8. Noguchi, E, Ohsawa, H, Tanaka, H, Ikeda, H, & Aikawa, Y. Electro-acupuncture stimulation effects on duodenal motility in anesthetized rats. Jpn J Physiol, (2003). 53(1), 1-7.

9. Sato, A, Sato, Y, Suzuki, A, & Uchida, S. Neural mechanisms of the reflex inhibition and excitation of gastric motility elicited by acupuncture-like stimulation in anesthetized rats. Neurosci Res, (1993). 18(1), 53-62.

10. Sato A, Sato Y, Uchida S, editors. Reflex modulation of visceral functions by acupuncture-like stimulation in anesthetized rats. J international congress series, (2002). 1238, 111-23.

11. Yang, M, Li, X, Liu, S, Li, Z, Xue, M, & Gao, D, et al. Meta-analysis of acupuncture for relieving non-organic dyspeptic symptoms suggestive of diabetic gastroparesis. BMC complement Alternative Med, (2013). 13(1), 311.

12. Jee, SR, Jung, HK, Min, BH, Choi, KD, Rhee, PL, & Kang, YW, et al. Guidelines for the treatment of functional dyspepsia. Korean J gastroenterol, (2011). 57(2), 67-81.

13. Cramer G, Darby S. Basic and Clinical Anatomy of the Spine, Spinal Cord, and ANS. 2nd ed. YangJY. Seoul. Koon Ja;(2005). p. 452-4. p. 481-90. p. 512-8.

14. Mol, FM, Lataster, A, Scheltinga, M, & Roumen, R. Anatomy of abdominal anterior cutaneous intercostal nerves with respect to the pathophysiology of anterior cutaneous nerve entrapment syndrome (ACNES): A case study. Translational research in anatomy, (2017). 8, 6-10.

15. Netter FH. Atlas of Human Anatomy. 4th ed. New York. Elsevier Health Sciences;(2017). p. 164p. 167p. 180p. 192p. 257-8.

16. Ching, SS, & Tan, YK. Spectral analysis of bowel sounds in intestinal obstruction using an electronic stethoscope. World J gastroenterology, (2012). 18(33), 4585-92.

17. Srinivasan, R, & Greenbaum, DS. Chronic abdominal wall pain: a frequently overlooked problem. Practical approach to diagnosis and management. Am J gastroenterology, (2002). 97(4), 824-30.

18. Sung JW. Pain’s Principle and Insight. Soeul. Koon Ja;(2016). p. 219-54.

19. Ombregt L. A system of orthopaedic medicine. 3rd ed. LeeJCLymHSJungJWJungJHJungJP. Seoul. Han Mi;(2015). p. 379-87.

20. Hwang, EM, Wang, GH, Bae, JI, & Keum, DH. The effect of dry cupping treatment applied to Back-shu points on the autonomic nervous system through HRV. J Korean medicine of rehabilitation, (2013). 23(1), 51-64.

21. Park, JK, Huh, KC, Shin, CM, Lee, H, Yoon, YH, & Song, KH, et al. Current issues in functional dyspepsia. Korean J Gastroenterol, (2014). 64(3), 133-41.

22. Yoon, SH. Postprandial epigastric fullness and pyloric valve disturbance in patients with functional dyspepsia-Analysis of bowel sounds and electrogastrography. Korean J Orient Int, (2007). 28(4), 769-78.

23. Yoshino, H, Abe, Y, Yoshino, T, & Ohsato, K. Clinical application of spectral analysis of bowel sounds in intestinal obstruction. Dis Colon Rectum, (1990). 33(9), 753-7.

24. Gobbo, M, Maffiuletti, NA, Orizio, C, & Minetto, MA. Muscle motor point identification is essential for optimizing neuromuscular electrical stimulation use. J Neuroeng Rehabil, (2014). 11(1), 17.

25. Park, JW, & Keum, DH. Comparison Study about Surface Mapping of Motor Points in Biceps Brachii Muscle Using Surface EMG and Electric Probe. J of Korean medicine of rehabilitation, (2018). 28(1), 85-96.

26. Applegate, WV. Abdominal cutaneous nerve entrapment syndrome (ACNES): a commonly overlooked cause of abdominal pain. Sergery, (2002). 6(3), 20.

27. Clarke, S, & Kanakarajan, S. Abdominal cutaneous nerve entrapment syndrome. Continuing education in anaesthesia, Critical Care, Pain, (2014). 15(2), 60-3.

28. Scott F, Jane B, James PR. Bonica’s management of pain. Illinois. Lippincott Williams&Wilkins;(2010). p. 24-33.

29. Filshie J, White A. Medical acupuncture: a Western scientific approach. 2nd ed.New York. Elsevier Health Sciences;(2016). p. 86-8. p. 368-74.

30. Lara, FP, Berges, AF, Quesada, JQ, Ramiro, JM, Toledo, RB, & Muñoz, HO. Thoracic disk herniation, a not infrequent cause of chronic abdominal pain. Int Surg, (2012). 97(1), 27-33.

31. Lyons, M, Windgassen, E, Kinney, C, Johnson, D, Birch, B, & Boucher, O. Thoracic meningioma masquerading as chronic abdominal pain. Turk Neurosurg, (2012). 22(3), 365-7.

32. Treadwell, EL, Cunningham, PR, Kowalski, HM, & Weaver, MD. Thoracolumbar compression fractures presenting with an acute ileus. J Natl Med Assoc, (1990). 82(9), 669-72.

33. Kimura, K, Masuda, K, & Wakayama, I. Changes in skin blood flow and skin sympathetic nerve activity in response to manual acupuncture stimulation in humans. Am J Chin Med, (2006). 34(2), 189-96.

34. Liao, TJ, Urata, S, & Nishikawa, H. Transient decrease in skin resistance response and level at the deh-chi stage caused by manual acupuncture. Tohoku J Exp Med, (1998). 186(1), 19-25.

35. Takahashi, T. Mechanism of acupuncture on neuromodulation in the gut--a review. Neuromodulation, (2011). 14(1), 8-12. discussion.

36. Sim, WB, Kim, JH, Kim, JS, Song, JS, Kim, KS, & Sohn, IC. Effects of Zusanli (ST36) Acupuncture on Abdominal Thermography of Health Subject. Korean J Meridian Acupunct, (2003). 20(1), 1-20.

37. Lund, I, & Lundeberg, T. Mechanisms of acupuncture. J Acupuncture and related therapies, (2016). 4(4), 26-30.

38. Tjen, ALSC, Fu, LW, Zhou, W, Syuu, Z, & Longhurst, JC. Role of unmyelinated fibers in electroacupuncture cardiovascular responses. Auton Neurosci, (2005). 118(1–2), 43-50.

39. Li, QQ, Shi, GX, Xu, Q, Wang, J, Liu, CZ, & Wang, LP. Acupuncture effect and central autonomic regulation. Evid Based Complement Alternat Medicine, (2013). 2013(1), 267959.

40. Pomeranz, B, Macaulay, RJ, Caudill, MA, Kutz, I, Adam, D, & Gordon, D, et al. Assessment of autonomic function in humans by heart rate spectral analysis. Am J Physiol, (1985). 248(1 Pt 2), H151-3.

41. Uchida, C, Waki, H, Minakawa, Y, Tamai, H, Hisajima, T, & Imai, K. Evaluation of Autonomic Nervous System Function Using Heart Rate Variability Analysis During Transient Heart Rate Reduction Caused by Acupuncture. Med Acupunct, (2018). 30(2), 89-95.

42. Kim, SY, Han, CW, Park, SH, Kwon, JN, Lee, I, & Hong, JW, et al. Correlation Study between Electrogastrography and Heart Rate Variability in Dyspeptic Patients. Korean J Physiology and pathology, (2012). 26(4), 532-8.

43. Paulson, KL, & Shay, BL. Sympathetic nervous system responses to acupuncture and non-penetrating sham acupuncture in experimental forearm pain: a single-blind randomised descriptive study. Med, (2013). 31(2), 178-84.

44. Shu, Q, Wang, H, Litscher, D, Wu, S, Chen, L, & Gaischek, I, et al. Acupuncture and Moxibustion have Different Effects on Fatigue by Regulating the Autonomic Nervous System: A Pilot Controlled Clinical Trial. Sci Rep, (2016). 42(4), 37846.

45. Uchida, S, Kagitani, F, & Hotta, H. Neural mechanisms of reflex inhibition of heart rate elicited by acupuncture-like stimulation in anesthetized rats. Auton Neurosci, (2010). 157(1–2), 18-23.

46. Baid, H. A critical review of auscultating bowel sounds. Br J Nurs, (2009). 18(18), 1125-9.

47. Jeong, YS, Park, H, Choi, EJ, Kim, YG, & Lee, SI. Fasting and postprandial analysis of bowel sounds and plasma 5-hydroxytryptamine level. Korean J gastroenterol, (2004). 44(3), 142-6.

48. Ranta, R, Louis-Dorr, V, Heinrich, C, Wolf, D, & Guillemin, F. Principal component analysis and interpretation of bowel sounds. Conf Proc IEEE Eng Med Biol Soc, (2004). 1, 227-30.

49. Zaborski, D, Halczak, M, Grzesiak, W, & Modrzejewski, A. Recording and Analysis of Bowel Sounds. Euroasian J hepatogastroenterol, (2015). 5(2), 67-73.

50. Craine, BL, Silpa, M, & O’Toole, CJ. Computerized auscultation applied to irritable bowel syndrome. Dig Dis Sci, (1999). 44(9), 1887-92.

51. Yoon, SH. Postprandial epigastric fullness and pyloric valve disturbance in patients with functional dyspepsia; analysis of bowel sounds and electrogastrography. Korean J Orient Int, (2007). 28(4), 769-78.

52. Hong, IA, & Yoon, SH. A Study of Gastrointestinal Parasympathetic Nerve Activity and Pyloric Valve Function, and Clinical Characteristerics in Patients with Functional Dyspepsia-Analysis of Bowel Sound. Korean J Orient Int, (2008). 29(3), 666-74.

53. Politzer, JP, Devroede, G, Vasseur, C, Gerard, J, & Thibault, R. The genesis of bowel sounds: influence of viscus and gastrointestinal content. Gastroenterol, (1976). 71(2), 282-5.

54. Hur, WY, Yoon, SH, Park, YS, Jung, YJ, Kim, YS, & Hong, IA, et al. Change of gastric motility assesed with electrogastrography and phonoenterography after traditional Korean medical treatment in 2 patients with functional dyspepsia. Korean J Orient Int, (2008). 88-101.

55. Haker, E, Egekvist, H, & Bjerring, P. Effect of sensory stimulation (acupuncture) on sympathetic and parasympathetic activities in healthy subjects. J Auton Nerv Syst, (2000). 79(1), 52-9.

56. Sugiyama, Y, Xue, YX, & Mano, T. Transient increase in human muscle sympathetic nerve activity during manual acupuncture. Jpn J Physiol, (1995). 45(2), 337-45.

57. Ahn YG. Principles of Meridians and Acupoints. Seoul. Seong Bo;(2006). p. 137-9.

58. Leung, L. Neurophysiological basis of acupuncture-induced analgesia--an updated review. J Acupunct Meridian Stud, (2012). 5(6), 261-70.

59. Ygge, J. On the organization of the thoracic spinal ganglion and nerve in the rat. Exp Brain Res, (1984). 55(3), 395-401.