Jia Zhou

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: Slow flow/no-reflow (SF-NR) complicates up to 44% of percutaneous coronary interventions (PCI) for acute myocardial infarction (AMI), worsening prognosis. Electroacupuncture (EA) may mitigate SF-NR, but clinical evidence is limited. Objective: This trial was designed to assess the feasibility and effectiveness of intraoperative EA in reducing SF-NR during PCI for AMI patients. Design, setting, and participants and interventions: This single-center, randomized, assessor-blinded pilot trial enrolled 60 eligible AMI patients undergoing PCI at Yueyang Hospital, China, from August 2023 to March 2024. Participants were randomized to receive PCI with electroacupuncture (EA) stimulating Neiguan (PC6) and Ximen (PC4) acupoints, or PCI alone (control group). Main outcomes and measures: The primary outcome was the incidence of SF-NR. Secondary outcomes included chest pain (Numerical Rating Scale, NRS), anxiety (Visual Analog Scale for Anxiety, VAS-A), and the occurrence of major adverse cardiac and cerebrovascular events (MACCE) within 30 days, cardiac biomarkers, inflammatory markers. Results: All 60 patients completed the trial (mean [SD] age, 63.2 [11.4] years; 86.7% male [52/60]). EA significantly reduced SF-NR incidence compared with control (6.7% [2/30] vs. 26.7% [8/30]; RR, 0.2; 95% CI, 0.0 to 0.4; P = .04). EA also significantly reduced median pain scores (0 h post-PCI: median difference, −2.5 [95% CI, −3.3 to −0.7]; 12 h post-PCI: median difference, −3.0 [95% CI, −3.5 to −1.9]; both P < .001), anxiety scores (0 h post-PCI: median difference, −2.0 [95% CI, −2.8 to −0.2]; 12 h post-PCI: median difference, −2.0 [95% CI, −3.3 to −1.1]; both P < .001). No significant differences were found in cardiac biomarkers or 30-day MACCE (16.7% [5/30] vs. 36.7% [11/30]; P = .09). However, EA was associated with inflammatory markers at 12 h (Leukocytes, P = .03; Neutrophils, P = .04; high-sensitivity C-reactive protein, P = .03). No adverse events were reported. Conclusions: Intraoperative EA during PCI was associated with reduced SF-NR and attenuated early inflammation. Improvements in patient-reported pain and anxiety were also observed, though the influence of non-specific effects cannot be ruled out. These preliminary findings demonstrate the feasibility of EA as a PCI adjunct and indicate a potential signal for efficacy, larger multicenter, sham-controlled trials larger multicenter, sham-controlled trials are needed. Clinical Trial Registration: https://www.chictr.org.cn/ , ChiCTR2300072265.

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.

To analyze the rules of clinical application of acupuncture in the prevention and treatment of perioperative neurocognitive disorder (PND) by using data mining method. Randomized controlled trials on acupuncture for preventing and treating PND from PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), VIP Database, and Wanfang Database were retrieved, with the retrieval time ranging from the establishment of each database to July 16, 2024. A relevant database was established to statistically analyze the application of acupuncture methods, selected acupoints, timing of acupuncture intervention, acupuncture stimulation parameters, and stimulation intensity. Additionally, association rules and cluster analysis of acupoints were carried out. A total of 69 articles were included, with 69 acupuncture prescriptions extracted, involving 40 acupoints. The top 5 acupoints in terms of usage frequency were Neiguan (PC6), Baihui (GV20), Zusanli (ST36), Hegu (LI4), and Sanyinjiao (SP6). The top 3 meridians by usage frequency were the Pericardium Meridian of Hand-Jueyin (49 times, 21.68%), Governor Vessel (44 times, 19.47%), and Stomach Meridian of Foot-Yangming (30 times, 13.27%). The top 3 specific acupoints in terms of usage frequency were the crossing acupoints (66 times, 29.20%), confluence points of the eight vessels (50 times, 22.12%), and luo-connecting acupoints (49 times, 21.68%). Regarding acupoints compatibility, the top 3 high-frequency acupoint pairs were PC6-ST36, PC6-GV20, and PC6-LI4. The high-frequency acupoints could be classified into 4 categories:Category 1 includes PC6, ST36, GV20, SP6, and LI4;Category 2 includes Shenmen (HT7) and Yintang (GV24⁺);Category 3 includes Benshen (GB13), Taichong (LR3), Sishencong (EX-HN1), and Shenting (GV24);Category 4 is Fengchi (GB20). The top 2 acupuncture treatment methods by usage frequency and times were transcutaneous electrical acupoint stimulation (TEAS) and electroacupuncture (EA). The intervention timing was mostly selected during and before surgery. For EA stimulation, sparse-dense waves were commonly used, with a frequency of 2 Hz/100 Hz, adjusted to the patient's tolerance. PC6, GV20, ST36, LI4 and SP6 are the core acupoints for the prevention and treatment of PND, and TEAS or EA is usually performed during or before the operation.

Acupuncture anesthesia is an innovative anesthesia technique which combines acupuncture therapy of traditional Chinese medicine with western anesthesia and surgery. Modern acupuncture anesthesia technology involves comprehensive preoperative evaluation and application, intraoperative assistance in anesthesia, and enhanced recovery after surgery, forming a set of perioperative management models with Chinese characteristics. In the present paper, we comprehensively summarized the application scenarios (including craniocerebral operations, neck surgery, cardiac and thoracic surgery, abdominal operation, obstetrical and gynecological operations, anorectal operation, and orthopedic operation) and values (such as analgesia, reduction in nausea and vomiting, accelerating recovery of gastrointestinal function, regulating immune function, etc.) of modern acupuncture anesthesia technology in the perioperative period, and also analyzed its advantages ［(1) fewer physiological interference to the patient, reducing operation-induced organ damage, and accelerating postoperative recovery； (2) no obvious adverse reactions and high safety； (3) significant social and economic benefits］, current challenges and opportunities of modern acupuncture anesthesia techniques. We think that it is urgent to formulate a set of consensus guidelines and reference for modern acupuncture anesthesia for each type of relevant operations based on evidence-based medicine, actively draw on, absorb and introduce the latest evidence-based concepts and research methodologies and technologies, strive to create new theories, new methods and new technologies, carry out standardized sustainable research, enrich and improve its own system and to expand its application scope through exchanges and mutual learning with cutting-edge technologies of modern medicine.