title: Effect of acupuncture 'dose' on modulation of the default mode network of the brain.
abstract: OBJECTIVE
  Recent functional MRI (fMRI) studies show that brain activity, including the default mode network (DMN), can be modulated by acupuncture. Conventional means to enhance the neurophysiological 'dose' of acupuncture, including an increased number of needles and manual needle manipulation, are expected to enhance its physiological effects. The aim of this study was to compare the effects of both methods on brain activity.
  
  
  METHODS
  58 healthy volunteers were randomly assigned into four groups that received single needle acupuncture (SNA, n=15) or transcutaneous electrical nerve stimulation (TENS, n=13) as active controls, or enhanced acupuncture by way of three needle acupuncture (TNA, n=17) or SNA plus manual stimulation (SNA+MS, n=13). Treatment-associated sensations were evaluated using a visual analogue scale. Central responses were recorded before, during, and after treatment at LI4 on the left hand using resting state fMRI.
  
  
  RESULTS
  TNA and SNA+MS induced DMN-insula activity and extensive DMN activity compared to SNA, despite comparable levels of de qi sensation. The TNA and SNA+MS groups exhibited a delayed and enhanced modulation of the DMN, which was not observed followed SNA and TENS. Furthermore, TNA increased precuneus activity and increased the DMN-related activity of the cuneus and left insula, while SNA+MS increased activity in the right insula.
  
  
  CONCLUSIONS
  The results showed that conventional methods to enhance the acupuncture dose induce different DMN modulatory effects. TNA induces the most extensive DMN modulation, compared with other methods. Conventional methods of enhancing the acupuncture dose could potentially be applied as a means of modulating brain activity.
authors.affiliation: Institute of Traditional Medicine, school of medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Yii-Jeng
authors.initials: YJ
authors.lastname: Lin
authors.affiliation: Institute of Traditional Medicine, school of medicine, National Yang-Ming University, Taipei, Taiwan.|Center for Traditional Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Yen-Ying
authors.initials: YY
authors.lastname: Kung
authors.affiliation: Institute of Neuroscience, school of medicine, National Yang-Ming University, Taipei, Taiwan.|Laboratory of Integrated Brain Research, Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Wen-Jui
authors.initials: WJ
authors.lastname: Kuo
authors.affiliation: Laboratory of Integrated Brain Research, Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan.|Institute of Brain Science, School of Medicine, National Yang-Ming, University, Taipei, Taiwan.
authors.forename: David M
authors.initials: DM
authors.lastname: Niddam
authors.affiliation: Laboratory of Integrated Brain Research, Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Chih-Che
authors.initials: CC
authors.lastname: Chou
authors.affiliation: Laboratory of Integrated Brain Research, Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Chou-Ming
authors.initials: CM
authors.lastname: Cheng
authors.affiliation: Laboratory of Integrated Brain Research, Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan.|Institute of Brain Science, School of Medicine, National Yang-Ming, University, Taipei, Taiwan.
authors.forename: Tzu-Chen
authors.initials: TC
authors.lastname: Yeh
authors.affiliation: Laboratory of Integrated Brain Research, Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan.|Institute of Brain Science, School of Medicine, National Yang-Ming, University, Taipei, Taiwan.
authors.forename: Jen-Chuen
authors.initials: JC
authors.lastname: Hsieh
authors.affiliation: Institute of Traditional Medicine, school of medicine, National Yang-Ming University, Taipei, Taiwan.|Division of General Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Jen-Hwey
authors.initials: JH
authors.lastname: Chiu
mesh_terms: D015670:Acupuncture Therapy / Q000295:instrumentation / Q000379:methods*; D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging / Q000502:physiology; D001931:Brain Mapping / Q000379:methods; D005260:Female; D006225:Hand / Q000000981:diagnostic imaging / Q000502:physiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009339:Needles; D009415:Nerve Net / Q000502:physiology*; D012146:Rest / Q000502:physiology; D012677:Sensation / Q000502:physiology*; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods; D064232:Visual Analog Scale
keywords: ACUPUNCTURE; NEUROLOGY