Ke Wang

Acupuncture anesthesia (AA) is widely recognized as a notable achievement within the realm of integrative medicine; however, its advancement remains limited despite increasing scientific interest and expanding clinical research. This article reevaluates the contemporary challenges faced by AA from an epistemic standpoint, positing that these challenges stem not primarily from a lack of efficacy but from an inherent structural tension between evidence-based evaluation and cross-cultural medical reasoning. By drawing upon medical history, the philosophy of medicine, and studies in traditional Chinese medicine (TCM), we illustrate that methodological incompatibilities within current evidence hierarchies, alongside divergent cognitive frameworks, collectively influence the scientific assessment, clinical application, and international discourse surrounding AA. Instead of perceiving these tensions as irreconcilable conflicts between traditional and modern medicine, we propose that they represent differences in the organization, interpretation, and legitimization of medical knowledge across distinct epistemic traditions. Building on this analysis, the paper delineates three complementary pathways: the development of evidence architectures that align with the systemic logic of TCM, the enhancement of interdisciplinary education and collaborative clinical practice, and the reconstruction of international communication through value-oriented dialogue. Collectively, these strategies are designed not to integrate AA into conventional biomedical paradigms, but rather to establish more inclusive evaluative frameworks that can accommodate diverse forms of medical knowledge. Consequently, the experience of AA serves as a broader model for reconciling evidence, cultural identity, and epistemic pluralism within the context of the modernization and globalization of traditional medicine.

Background: Perioperative neurocognitive disorder (PND) is a common complication following major surgery under general anesthesia, particularly among elderly patients, and adversely impacts postoperative recovery and quality of life. Although electroacupuncture (EA) has shown potential in preventing PND, conclusive evidence remains lacking. This study aimed to evaluate the effectiveness and safety of perioperative EA intervention for preventing PND in elderly patients undergoing general anesthesia surgery. Methods: We systematically searched eight electronic databases [PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), Chongqing VIP Chinese Science and Technology Periodical Database (CQVIP), Wan Fang Database, and China Biology Medicine disc (CBM)] and three clinical trial registries from inception to March 16, 2025. Eligible studies were randomized controlled trials (RCTs) investigating perioperative EA for PND prevention in patients aged ≥ 60 years receiving general anesthesia. Control interventions included sham EA, standard care, or no intervention. Primary outcome was PND incidence. Secondary outcomes included neuropsychological assessment scores [Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA)], inflammatory biomarkers [serum interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) levels], neurological damage markers [serum neuron-specific enolase (NSE), S100 calcium-binding protein β (S100β) levels], and safety outcomes (incidence of adverse events). Two reviewers independently performed blind screening, data extraction, and risk-of-bias assessment using the Cochrane RoB 2 tool. Meta-analyses were conducted using RevMan 5.4, with random-effects or fixed-effect models applied based on heterogeneity ( I ² statistics). The certainty of evidence was evaluated with the GRADE. Results: Twenty-six RCTs ( n = 2,309) were included. Compared to the control groups, perioperative EA significantly reduced the incidence of PND (RR = 0.47, 95% CI: 0.42 to 0.54, p < 0.00001; I ² = 0%; moderate to low certainty), improved MMSE scores (MD = 1.92, 95% CI: 1.59 to 2.26, p < 0.00001; I ² = 96%; low to very low certainty), lowered serum IL-6 (SMD = −1.09, 95% CI: −1.73 to −0.44, p = 0.0010; I ² = 88%; very low certainty), IL-1β (SMD = −2.85, 95% CI: −5.32 to −0.39, p = 0.02; I ² = 99%; very low certainty), TNF-α (SMD = −2.64, 95% CI: −4.16 to −1.12, p = 0.0007; I ² = 98%; low certainty), and S100β (SMD = −1.56, 95% CI: −2.77 to −0.35, p = 0.01; I ² = 97%; low certainty) levels, and reduced adverse events (RR = 0.52, 95% CI: 0.37 to 0.72, p < 0.0001; I ² = 0%; moderate certainty). MoCA scores and serum NSE levels could not be meta-analyzed due to insufficient data. Conclusion: Perioperative EA intervention demonstrates significant clinical benefits in elderly patients undergoing general anesthesia surgery, effectively reducing PND incidence, improving cognitive function, attenuating neuroinflammation, and reducing neurological injury with a favorable safety profile. However, current evidence is constrained by methodological limitations, including potential selection bias and insufficient blinding in the included studies. Future rigorously designed multicenter RCTs with standardized EA featuring standardized EA protocols and long-term cognitive monitoring are needed to confirm its neuroprotective effects. Systematic review registration: https://www.crd.york.ac.uk/prospero/ , identifier CRD420251035172.

Objective: This study investigated whether electroacupuncture (EA) at Neiguan (PC6) acupoint alleviates adverse myocardial remodeling in post–myocardial infarction (MI) heart failure (HF) by activating the vagus nerve–mediated cholinergic pathway and its downstream α7nAChR‐Akt‐HIF‐1α‐VEGF signaling cascade. Methods: Male Sprague Dawley (SD) rats were randomized into sham, MI model, and EA groups ( n = 6 per group). MI was induced by ligation of the left anterior descending coronary artery. EA was applied at PC6 for 14 days starting 1 week after MI induction. Cardiac function and structure were evaluated using echocardiography and histological examination. The expression levels of choline acetyltransferase (ChAT), α7‐nicotinic acetylcholine receptor (α7nAChR), phosphorylated Akt ( p ‐Akt), hypoxia‐inducible factor‐1α (HIF‐1α), and vascular endothelial growth factor (VEGF) were analyzed by real‐time quantitative PCR, Western blotting, and immunohistochemistry. Results: EA intervention significantly attenuated pathological myocardial remodeling and improved cardiac function. Compared with the model group, EA treatment markedly enhanced cardiac function, increased contractility, reduced ventricular dilation, restored autonomic balance, and alleviated myocardial necrosis and fibrosis. Molecular studies revealed that EA treatment increased the expression of ChAT and α7nAChR, elevated p ‐Akt levels, and upregulated the expression of HIF‐1α and VEGF. These findings suggest the activation of the vagus nerve–cholinergic signaling pathway and its downstream prosurvival and pro‐angiogenic pathways. Conclusions: EA attenuated maladaptive ventricular remodeling and improved cardiac performance. These effects were associated with modulation of autonomic function and engagement of the α7nAChR/Akt/HIF‐1α/VEGF signaling axis, supporting a potential neuro‐immune‐angiogenic mechanism underlying EA‐mediated myocardial repair during the subacute post‐MI phase.

Background: Perioperative neurocognitive disorder (PND) is a prevalent complication among older patients undergoing general anesthesia, imposing significant burdens on individuals, health care systems, and society. While electroacupuncture shows promise for PND prevention, current evidence remains inconclusive. Objective: This study aims to critically evaluate the effectiveness and safety of perioperative electroacupuncture for PND prevention in older patients undergoing surgery under general anesthesia. Methods: A comprehensive literature search will be conducted in 8 electronic databases (PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Chongqing VIP Chinese Science and Technology Periodical Database, Wan Fang Database, and China Biomedical Literature Database) and 3 clinical trial registries from inception to March 16, 2025. The search strategy aims to identify all relevant randomized controlled trials evaluating perioperative electroacupuncture for PND prevention in older patients (aged ≥60 years) undergoing general anesthesia. The primary outcome will be the incidence of PND. Secondary outcomes will include (1) neuropsychological assessment scores (Mini-Mental State Examination and Montreal Cognitive Assessment), (2) serum inflammatory biomarker levels (interleukin-1β, interleukin-6, and tumor necrosis factor-α), (3) serum neurological damage marker levels (neuron-specific enolase and S100 calcium-binding protein β), and (4) safety outcomes (incidence of adverse events). Two independent reviewers will perform study selection, data extraction, and methodological quality assessment using the revised Cochrane risk of bias tool for randomized trials. All statistical analyses will be conducted in RevMan 5.4 using suitable meta-analysis models based on heterogeneity testing. The certainty of evidence will be evaluated using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results: The study selection process will be presented through a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram, detailing the number of records identified, screened, and included. Characteristics of eligible studies will be summarized in evidence tables, including study designs and populations, intervention protocols, and outcome measures. The results will be visualized through a risk of bias graph, forest plots displaying pooled effect estimates with 95% CIs, and funnel plots for publication bias evaluation (when ≥10 studies are available). This protocol is currently in the active phase. The literature search has been completed as of April 2025, with an updated search planned until December 31, 2025. Data extraction is scheduled to commence on January 15, 2026, followed by data analysis starting February 1, 2026. Results are expected to be submitted for publication in March 2026. Conclusions: The effectiveness and safety of perioperative electroacupuncture for PND prevention in older patients undergoing general anesthesia remain uncertain. This systematic review will provide an evidence-based evaluation of perioperative electroacupuncture’s effectiveness in preventing PND, offer practical recommendations for optimizing surgical care for older adults, and identify knowledge gaps to inform future research.

This study aimed to evaluate the effects of electroacupuncture (EA) on cancer-induced bone pain (CIBP) and investigate its interaction with the STING/IFN-I pathway. A CIBP model was established in female rats. EA was administered for six consecutive days at bilateral L3–L5 Jia Ji points (EX-B2). EA-induced antinociception was evaluated through mechanical, thermal, and cold sensitivity assessments. EA significantly increased the paw withdrawal threshold (PWT) and paw withdrawal latency (PWL) in rats with CIBP ( p < 0.01). In the spinal cord of CIBP model rats, western blot analysis demonstrated that the application of EA upregulated the expression of STING, IRF3, and IFNAR ( p < 0.05). The ELISA results indicated that EA significantly increased the expression of IFN-α ( p < 0.005) and IFN-β ( p < 0.01) and reduced the expression of TNF-α and IL-1β ( p < 0.05). Immunofluorescence analysis revealed that STING was predominantly localized in microglia, with a minimal presence in neuronal cells. Furthermore, intrathecal administration of the STING antagonist C-176 attenuated the analgesic effects of EA in CIBP ( p < 0.05). Both EA and STING agonist were effective in alleviating pain in rats with CIBP, possibly through the activation of the STING/IFN-I pathway. Notably, EA treatment reduced pro-inflammatory cytokines and increased anti-inflammatory cytokines. In contrast, while the STING agonist exhibited analgesic effects, it was associated with elevated levels of pro-inflammatory cytokines. These finding underscore the therapeutic potential of EA in the management of CIBP.

Background: Patients undergoing video-assisted thoracoscopic surgery (VATS) often experience preoperative anxiety, which can significantly impact the surgical process and postoperative recovery. However, the efficacy of Transcutaneous Electrical Acupoint Stimulation (TEAS) in managing preoperative anxiety in VATS patients is unknown.Methods: A total of 82 patients scheduled for thoracoscopic surgery were randomly divided into TEAS group (n = 41) and sham TEAS (STEAS) group (n = 41). The TEAS/STEAS intervention began 3 days before the thoracoscopic surgery, with one session lasting 30 min per day for three consecutive days. The primary outcome measure will be the change in Generalized Anxiety Disorder Scale scores between the day before surgery and the baseline. Secondary outcome include intraoperative anesthetic consumption, time to postoperative chest tube removal, postoperative analgesic consumption and pain scores, length of postoperative hospital stay, serum concentrations of 5-hydroxytryptamine (5-HT), norepinephrine (NE), and gamma-aminobutyric acid (GABA).Results: On the third intervention day, anxiety levels in the TEAS group were significantly lower than in the STEAS group (p < 0.01). TEAS patients required less intraoperative sufentanil, remifentanil, and dexamethasone (p < 0.01). Chest tube removal time and hospital stay were shorter in the TEAS group (p < 0.01). Postoperative meperidine consumption and VAS pain scores were lower in the TEAS group (p < 0.01). Serum 5-HT levels were lower in the TEAS group on day three (p < 0.01), while NE levels remained lower from day three of intervention to postoperative day three (p < 0.05). GABA levels were higher in the TEAS group (p < 0.01).Conclusion: TEAS effectively reduces preoperative anxiety, decreases intraoperative anesthetic and anti-inflammatory drug use, shortens postoperative chest tube removal time and hospitalization, and alleviates postoperative pain. These results indicate that TEAS, as an adjunctive therapy, has valuable potential in improving surgical outcomes and postoperative experience for patients with pulmonary nodules.Clinical trial registration: https://clinicaltrials.gov, NCT04887090.

Background: Neuropathic pain (NP) is a prevalent chronic condition frequently accompanied by adverse emotional states. Previous research has demonstrated the clinical efficacy of electroacupuncture (EA) in mitigating neuropathic pain and its associated mood disorders. Recent studies have underscored a correlation between gut microbiota and both NP and negative emotional states. Nevertheless, the relationship between the modulation of gut microbiota by EA and the amelioration of NP remains inadequately understood. Methods: Mice were randomly assigned to one of the three groups: the Control (Con) group, the EA group, and the Chronic Constrictive Injury (CCI) group (n = 12 each). Starting from the 8th day post-CCI induction, the EA group underwent EA treatment once every two days, for a total of 20 sessions. To investigate the impact of gut microbiota on CCI mice, we employed a variety of methods, including various behavioral tests and 16S ribosomal DNA (rDNA) sequencing. Results: The results indicated that EA significantly ameliorated mechanical allodynia and emotional dysfunction induced by CCI in mice. Analysis through 16S rDNA sequencing revealed that the gut microbiota of NP model mice exhibited a marked increase in diversity. However, EA could partially reverse changes in the diversity of gut microbiota. The abundance of Alloprevotella, A2, Roseburia, Muribaculum, Ruminiclostridium, and Rikenella was increased, and the abundance levels of Bacteroides were decreased at the genus level in CCI mice. Following EA treatment, the relative abundance of Alistipes, A2, Roseburia, and Rikenella was decreased, whereas the relative abundance of Alloprevotella and Parabacteroides was increased in EA group when compared with the CCI group. Conclusion: These findings suggested that EA exerted a significant therapeutic effect on NP, potentially through modulation of the gut microbiota.

Introduction The incidence of postoperative gastrointestinal dysfunction (POGD) is notably high among patients following colorectal cancer surgery, highlighting the urgency for the prompt development of efficacious preventive and therapeutic approaches. Electroacupuncture (EA) represents an intervention modality that holds promise for the management of POGD. However, the existing empirical evidence substantiating its efficacy remains scarce. The aim of this study is to evaluate the efficacy and safety of EA as a treatment for POGD in patients undergoing colorectal cancer surgery. Methods This study is a multicenter, parallel-group, randomized controlled trial, named as CORRECT. CORRECT trial will recruit 300 participants diagnosed with colorectal cancer and about to undergo radical surgery across four sub-centers. The participants will be randomly assigned to one of three groups: the EA group, sham-electroacupuncture group, or control group, with a randomization ratio of 2:2:1. All groups will follow a standardized Enhanced Recovery After Surgery (ERAS) protocol. The EA group will receive EA at acupoints LI4, SJ6, ST36, and ST37, while the SA group will undergo sham-electroacupuncture. The treatments will be administered twice daily from the day of surgery until the fourth day after the operation. The primary endpoint is the time to first flatus, while secondary endpoints encompass time to first defecation, bowel sound emergence, initial water intake, duration of postoperative hospitalization, nausea and vomiting, pain levels, and blinded evaluations. Additional outcomes include medication usage and complication rates, et al. Discussion The CORRECT trial aims to provide high-quality evidence for the role of EA in the treatment of POGD following colorectal cancer surgery. It will contribute data towards the integration of acupuncture into ERAS protocols. Insights from the trial could help in tailoring treatment plans based on individual patient responses to EA, optimizing care on a case-by-case basis. Trial registration Clinical Trial Registry registration was approved by the ClinicalTrials.gov committee on November 2023 with the ClinicalTrials.gov Identifier: NCT06128785. URL: https://clinicaltrials.gov/study/NCT06128785?tab=history&a=1#study-details-card.