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This study aims to explore the potential use of ultrasound in locating the second posterior sacral foramen acupuncture point, quantifying depth of insertion and describing surrounding anatomical structures. We performed acupuncture needle insertion on a study team member. There were four steps in our experiment. First, the acupuncturist located the acupuncture point by palpation. Second, we used an ultrasound machine to visualize the structures surrounding the location of the acupuncture point and measure the depth required for needle insertion. Third, the acupuncturist inserted the acupuncture needle into the acupuncture point at an angle of 30°. Fourth, we performed another ultrasound scan to ensure that the needle was in the desired location. Results suggested that ultrasound could be used to locate the acupuncture point and estimate the depth of needle insertion. The needle was inserted to a depth of 4.0 cm to reach the surface of the sacral foramen. Based on Pythagoras theorem, taking a needle insertion angle of 30° and a needle insertion depth of 4.0 cm, the estimated perpendicular depth is 1.8 cm. An ultrasound scan corroborated the depth of 1.85 cm. The use of an ultrasound-guided technique for needle insertion in acupuncture practice could help standardize the treatment. Clinicians and students would be able to visualize and measure the depth of the sacral foramen acupuncture point, to guide the depth of needle insertion. This methodological guide could also be used to create a standard treatment protocol for research. A similar mathematical guide could also be created for other acupuncture points in future.

Acupuncture has been found to relieve muscle stiffness effectively, especially after physical exercise.1 2 Previous studies have measured muscle stiffness pre- and post-acupuncture using a pressure scale1 or ‘muscle hardness meter’.2 Both of these methods estimate muscle stiffness based on the pressure required to compress muscle. Limitations of these devices include potential inaccuracy of measurement, as the distribution of muscle stiffness may be heterogeneous, as well as inability to visualise the muscle. Furthermore, changes in muscle stiffness during acupuncture needling cannot be evaluated. An ultrasound-based shear wave imaging technique has recently been developed to measure muscle stiffness.3 Benefits of using ultrasound include the ability to visualise the muscle under investigation and to quantify changes in muscle stiffness over time. Ultrasound as an imaging modality has many potential uses in acupuncture research and education,4 and can be successfully used to explore its physiological and physical effects.5 The aim of this study was to measure the effects of acupuncture needling on muscle stiffness using shear wave elastography. ### Acupuncture needle insertion We performed acupuncture needle insertion on two healthy volunteers (one male, one female) who were part of the study team. The acupuncture point used …

Quantification of needle movements during insertion and manipulation has been a challenge for acupuncturists.1 Needle manipulation includes lifting and thrusting of the needle and/or needle rotation after insertion. Such movements are critical for the elicitation of de qi and maximisation of treatment effectiveness. However, needle manipulation is highly individualised among acupuncturists, and this could have implications for treatment outcomes. Two studies have explored the displacement, rotation, torque and force exerted during needle manipulation using motion sensors (Acusensors).2 ,3 However, they did not include the speed of needle insertion and rotation. Our study aimed to analyse the trajectory of acupuncture needle motion from insertion to rotation manipulation to achieve de qi . We performed acupuncture needle insertion on a study team member. The team member signed an institutional informed consent form acknowledging that he knew the procedure involved during acupuncture, and understood the possible risks and complications. The acupuncture was performed by a certified acupuncturist with more than 20 years …

Ultrasound has been commonly used to guide clinical procedures in Western medicine, such as peripheral nerve blocks, biopsies, and fluid aspiration. Ultrasound is a useful tool because it is non-invasive, allows real-time visualisation of body images, and poses no risk to the human body, as it uses sound waves that are generally safe. In addition to guiding clinical procedures, ultrasound has been used to train medical students to perform clinical examinations.1 From a review of the literature, only one study has explored the use of ultrasound for acupuncture, and this focused on detecting soft-tissue displacement from movement of the needle.2 No study has explored the use of ultrasound in demonstrating the relationship between an acupuncture needle and the surrounding anatomical structures real-time in vivo. The aim of our study was to evaluate its feasibility and to discuss the implications for education and research. This study was conducted on a human cadaveric hand. Ultrasound scans were conducted using a Siemens Acuson P300 ultrasound system with a …

The standardized management of acupuncture-moxibustion in Singapore General Hospital is introduced. With gradual improvement of outpatient infrastructure, re-training of medical staff, strict disinfection of manipulation, periodical inspection of medical instruments, unified management of writing, saving and processing in medical records and public education of TCM knowledge, a standardized management system in accordance with modernized hospital is gradually established. As a result, efficiency and quality of clinical treatment is continuously increasing. From April of 1998 to December of 2012, a total of 74 654 times of treatment were performed, and treatment amount per day is gradually increased. The unusual condition of acupuncture is avoided. Periodical strict inspection of joint committee authenticated by domestic and overseas medical health organization is repeatedly passed and accepted. Additionally, three clinical researches funded by Singapore Health-care Company are still in progress in acupuncture-moxibustion department.

To observe the impacts of the different distances of moxibustion on local skin temperature and provide a safy distance of moxibustion.Three healthy adult volunteers were included. The pure moxa stick (without other herbs mixed together) was used. The moxa-stick moxibustion and the mild moxibustion (with moxa box) were applied to Zusanli (ST 36) on the right side and Guanyuan (CV 4) respectively. The distance from moxibustion to the local skin was 2 cm, 3 cm and 4 cm separately. The moxibustion time was limited by 3 cm stick burned out. The infrared thermography was adopted to record and store thermal images and made the systematic analysis. The same trial was repeated on the second day. The means of the skin temperature measured at each acupoint each time was taken as the results for the analysis.(1) Moxibustion with moxa box at Guanyuan (CV 4): at the distance of 4 cm, the local skin temperature at over 44 degrees C [(44.1 +/- 1.3)-(46.7 +/- 1.5) degrees C)] lasted 7 min; at the distance of 3 cm, the local skin temperature at over 44 degrees C [(44.1 +/- 1.3)-(49.3 +/- 2.0) degrees C] lasted about 10 min and that at over 49 degrees C [(49.0 +/- 2.1)-(49.3 +/- 2.0) degrees C)] lasted 2 min; at the distance of 2 cm, the observation could not be followed due to local burning pain. (2) Moxa-stick moxibustion at Zusanli (ST 36): at the distance of 4 cm, the skin temperature was ranged from (40.0 +/- 2.0) degrees C to (44.9 +/- 2.3) degrees C; at the distance of 3 cm, in 1 min of moxibustion, the skin temperature increased over 44 degrees C, sustaining in the range from (45.9 +/- 3.0) degrees C to (47.8 +/- 2.0) degrees C; at the distance of 2 cm, the observation could not be followed due to local burning pain.In moxibustion, the closer the moxa stick to the skin is, the higher the local skin temperature is. No matter with stick moxibustion or box moxibustion, the distance of moxa stick to the skin should be in the range from 3 to 4 cm.

The biotransformation, CYP reaction phenotyping, the impact of CYP inhibitors and enzyme kinetics of 3-cyanomethyl-4-methyl-DCK (CMDCK), a new anti-HIV preclinical candidate belonging to DCK analogs, were investigated in human intestinal microsomes and recombinant cytochrome P450 (CYP) enzymes. CMDCK (4 micromol L(-1)) was incubated with a panel of rCYP enzymes (CYP1A2, 2C9, 2C19, 2D6 and 3A4) in vitro. The remaining parent drug in incubates was quantitatively analyzed by a LC-MS method. CYP3A4 was identified as the principal CYP isoenzyme responsible for its metabolism in intestinal microsomes. The major metabolic pathway of CMDCK was oxidation and a number of oxidative metabolites were screened with LC-MS. The Km, Vmax, CLint and T1/2 of CMDCK obtained from human intestinal microsome were 45.6 micromol L(-1), 0.33 micromol L(-1) min(-1), 12.1 mL min(-1) kg(-1) and 25.7 min, respectively. Intestinal clearance of CMDCK was estimated from in vitro data to be 3.3 mL min(-1) kg(-1), and was almost equal to the intestinal blood flow rate (4.6 mL min(-1) kg(-1)). The selective CYP3A4 inhibitors, ketoconazole, troleandomycin and ritonavir demonstrated significant inhibitory effects on CMDCK intestinal metabolism, which suggested that co-administration of CMDCK with potent CYP3A inhibitors, such as ritonavir, might decrease its intestinal metabolic clearance and subsequently improve its bioavailability in body.

Objective To determine the effect of acupuncture on the phosphene threshold, by transcranial magnetic stimulation (TMS), and the clinical effect of acupuncture on headache frequency, duration and severity. Methods Twenty-one patients (16 women; mean age 46 years; range 23–61 years, 17 Chinese, 2 Malays, 2 Indians) underwent 10 acupuncture sessions scheduled twice a week for 5 weeks. The lowest TMS intensity to elicit phosphene perception is defined as the phosphene threshold. TMS was performed before the first and last sessions, and at 2 months’ follow-up. Results Acupuncture resulted in reduction of headache frequency, duration and severity over the course of treatment. However, this was not accompanied by a corresponding increase in the phosphene threshold over a similar time course. The baseline threshold before acupuncture treatment had no predictive value for outcome of treatment. Conclusions Although acupuncture was effective in treating migraine, the use of occipital cortex excitability as an adjunctive parameter to evaluate treatment response was not suitable. The relief of migraine with acupuncture may be related to separate neural pathways independent of occipital or visual processes in the human brain.