THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE

Volume 15, Number 11, 2009, pp. 1193–1200

ª Mary Ann Liebert, Inc.
DOI: 10.1089=acm.2008.0602

Effects of Scalp Acupuncture Versus Upper

and Lower Limb Acupuncture on Signal Activation
of Blood Oxygen Level Dependent (BOLD) fMRI
of the Brain and Somatosensory Cortex

Seong-Uk Park,1 Ae-Sook Shin,1 Geon-Ho Jahng,2

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Sang-Kwan Moon,3 and Jung-Mi Park, O.M.D., Ph.D.1

Abstract

Objective: The objective of this article is to investigate brain activity of scalp acupuncture (SA) as compared to
upper and lower limb acupuncture (ULLA) using functional magnetic resonance imaging (fMRI).
Subjects and methods: Ten (10) healthy right-handed female volunteers aged 20–35 were divided into 2 groups:
a SA group and an ULLA group. The SA group had needles inserted at the left Sishencong (HN1), GB18, GB9,
TH20, and the ULLA group at the right LI1, LI10, LV3, ST36 for 20 minutes, respectively. Both groups had tactile
stimulation in the order of the right LI1, LI10, LV3, ST36 before and after acupuncture for a block of 21 seconds
repeated 3 times. The blood oxygen level dependent (BOLD) fMRI was used to observe the brain and
somatosensory cortex signal activation.
Results: We compared the signal activation before and after acupuncture needling, and the images showed
signal activation after removing the acupuncture needles and the contralateral somatosensory association cortex,
the postcentral gyrus, and the parietal lobe were more activated in the SA group. The right occipital lobe, the
lingual gyrus, the visual association cortex, the right parahippocampal gyrus, the limbic lobe, the hippocampus,
the left anterior lobe, the culmen, and the cerebellum were activated in the ULLA group.
Conclusions: We concluded that there were different signal activations of BOLD fMRI before and after SA versus
ULLA, which can be thought to be caused by the sensitivity of acupoints and the different sensory receptors to
acupuncture needling.

Introduction between them. SA is used and has been reported to be clini-

cally effective based on the principle that neurons in the ce-

M ost meridians run either from scalp to extremities or

in the reverse direction, enabling treatment of diseases
through acupuncture of upper and lower limbs.1 On the other
hand, scalp acupuncture (SA) has combined the concept of the
cerebral cortex and its function with the principles of acu-
puncture, allowing treatment of diseases through needling of
points on the scalp. In SA, the Stimulation Area corresponds
with the cerebral cortex functions. It includes the Motor Area,
Sensory Area, Language Area, Balance Area, and the Re-
production Area.2 Many parts of the cerebral cortex connect to
these areas and play an important role in exchanging data
rebral cortex do not function directly on their own, but link to
each other either temporarily or permanently to maintain
connection.3–6 However, there is a need for fundamental re-
search on SA and for a method to verify how the cerebral
cortex functions; for this, functional magnetic resonance im-
aging (fMRI) is widely used.
Recently, fMRI has been used to image areas of the brain
activated by visual, motor, and sensory stimuli and to visu-
alize cognitive functions such as language and memory
(functional brain mapping).7–19 Thus, early diagnosis and
treatment of certain diseases through observation of brain

1
Department of Cardiovascular & Neurologic Disease (Stroke Center), East–West Neo Medical Center, College of Oriental Medicine,
Kyunghee University, Seoul, Korea.
2
Department of Radiology, East–West Neo Medical Center, School of Medicine, Kyunghee University, Seoul, Korea.
3
Department of Cardiovascular & Neurologic Disease (Stroke Center), Hospital of Oriental Medicine, Kyunghee Medical Center, College
of Oriental Medicine, Kyunghee University, Seoul, Korea.

1193
 1194
functions prior to the structural change occurs has become
possible.20–25
fMRI is also being utilized to verify the mechanisms and
the efficacy of acupuncture. There have been several studies
to observe which part of the brain is activated when a spe-
cific acupoint is stimulated,26–28 or after multiple acupoints
were stimulated,29,30 and to see whether different methods of
needling have different brain activations.31,32 These studies
used acupuncture to a limited extent on the upper and lower
limbs to see the effects of acupuncture on the brain.
However, this study observed the activation and deacti-
vation of the brain and investigated which part of the brain
performs specific functions of the high cerebral cortex when
tactile stimulation was done on upper and lower limbs using
fMRI. Furthermore, we observed the duration of the effects of
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acupuncture and compared blood oxygen level dependent
(BOLD) fMRI signal activations before and after acupuncture
in the SA and the upper and lower limb acupuncture (ULLA)
groups.
Materials and Methods
Subjects
Ten (10) healthy right-handed female volunteers aged
20–35 were recruited and consented to the study. None of the
participants were menstruating or pregnant. Volunteer can-
didates suffering from neurological, mental, or internal
problems; drug abuse; alcohol abuse; or those with a history
of cardiovascular or cerebrovascular diseases and on medi-
cations that could affect cerebral blood flow were excluded.
Caffeinated drinks such as coffee were restricted on the day
of the examination.
Materials
For acupuncture, disposable, stainless steel 0.25 mm!
40 mm (diameter!length) needles made by Dong-bang
Acupuncture & Moxibustion Company were used.
Methods
The 10 subjects were randomized into 2 groups: a SA
group and an ULLA group. After 30 minutes of rest, cotton
tips were used to stimulate the members of both groups 3
times on the right upper and lower limbs (LI1, LI10, LV3,
ST36) and the first fMRI was administered. After 5 minutes
of rest, the SA group was stimulated at the left Sishencong
(HN1), GB18, GB9, and the ULLA group was stimulated at
LI1, LI10 (located at the right upper limb), LV3, ST36 (located
at the right. lower limb) for 20 minutes. De qi was to be
achieved through needle manipulation when inserting the
acupuncture needles and 30 seconds before the needles were
pulled out. The ULLA group had needles inserted 1.5–2 cm
deep vertically while the SA group had them inserted ob-
liquely. After the needles were pulled out, cerebral perfusion
MRI and BOLD-based fMRI by blood oxidation were per-
formed in the same manner as the first time after a 21-second
block tactile stimulation was repeated 3 times. (To limit
variables while stimulation, it was done by the same person.
Tactile stimulation was performed twice per second consis-
tently and softly. Acupoints were needled until de qi was
achieved).
PARK ET AL.
Image acquisition
Preparations. A subject was positioned supine, with the
head in the standard head coil to adapt to the surroundings
after 30 minutes of rest. The head was fixed by a sponge and
during fMRI shooting the subject was not supposed to move
or open her eyes. The fMRI room was lit darkly and there
was no sound other than the sounds from the fMRI machine.
All images were acquired by a well-trained professional
operator at East-West Neo Medical Center, Kyunghee Uni-
versity.
fMRI imaging. 3.0 Tesla MRI (Philips, Acheiva, Best, The
Netherlands) was used. To maximize the effect of BOLD,
gradient-echo technique was used. With the echo planar
imaging technique, matrix size 64!64, field of view (FOV)
230!148!230-mm T2-weighted images (echo time [TE] ¼
30 ms, repetition time [TR] ¼ 3000 ms, flip angle ¼ 908) were
acquired. There were 30 slices, 5-mm width, the gap between
slices was 0 mm, the size of voxel was 3.43!3.43!5 mm, and
there were 42 volume images.
Anatomical MR acquisition. Additional 3D-T1-weighted
images (TE ¼ 5 ms, TR ¼ 9.335 ms, flip angle ¼ 88, FOV ¼
240!240!185 mm, 120 slices, slice width 1.0 mm) were ob-
tained to see the anatomical structure.
Data analyses
SPM 2 (Wellcome Department of Cognitive Neurology,
London, UK) was used for data analyses.
Motion correction. Motion of the head was calculated
by rotation and translation on X, Y, and Z coordinates and
realigned automatically using 3D motion correction.
Spatial normalization. fMRI images and anatomical MR
images have different resolutions, so there needs to be a pro-
cedure to compound on the common coordinates. First,
anatomical images were standardized using standard ana-
tomical space33 devised by Talairach and Tournoux. Anato-
mical images before normalization and fMRI images went
through coregistration, and anatomical images were nor-
malized in the same fashion as the anatomical images.34
Spatial smoothing. Gaussian filter was used to smooth
the checkered 64!64 plane resolution and 5 mm in width
data. The full width at half maximum was set to 9!9!12 mm
for multi-analysis.
Statistical analysis. 1. Individual statistical analysis.
Each normalized image was processed by general linear
model (GLM) taking hemodynamic response into consider-
ation. Among the GLM-processed BOLD signal, we chose
significantly activated areas to analyze.
We obtained a contrast map for activated areas of each ex-
perimental group. Through multiple comparison using NONE
p-value below 0.001 was considered significantly different.
2. Group statistical analysis
To compare the BOLD fMRI signal activation before and
after acupuncture, we used a contrast map of individual
patient and went through an analysis of variance test.
 EFFECTS OF BRAIN ACTIVITY IN SCALP AND LOWER LIMB ACUPUNCTURE 1195

1. Study design

10 Healthy, right-handed female volunteers aged 20–35 were randomized; scalp acupuncture (SA) Group:
5 upper and lower limb acupuncture (ULLA) Group: 5

30-minute rest

BOLD-based functional MRI, fMRI Tactile stimulation each point for 21 seconds repeated 3 times (R-S-R-S-R-S)
126 seconds, all 4 points (at LI1, LI10, LV3, ST36 about 9 minutes)
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After 5-minute rest, the SA group and the ULLA group had 4 acupoints stimulated, respectively.
20-minute needle retention, de qi, 30-sec de qi before pulling out the needles

SA: sishencong (HN1) GB18, GB9, TH20 (left side) ;

ULLA: LI1, LI10, LV3, ST36 (right side)

BOLD-based functional MRI, fMRI Tactile stimulation each point for 21 seconds repeated 3 times
(R-S-R-S-R-S) 126 seconds, all 4 points (at LI1, LI10, LV3, ST36 about 9 minutes)

Analysis of fMRI before and after acupuncture

R: Rest, S: stimulation

2. Procedure of tactile stimulation

S1 S2 S3

DS R1 R2 R3
12s 0s 21s 42s 63s 84s 105s 126s
Dummy scan was carried out during 12 seconds before the experiment. After 21 seconds of
rest, tactile stimulation with cotton tips at the acupoints was performed for 21 seconds. This
procedure (Rest-S1-Rest-S2-Rest-S3) was repeated 3 times (in the order of LI1, LI10, LV3,
ST36).
DS: dummy scan, R: rest, S: stimulation

P-value less than 0.001–0.05 was considered significantly claustrum, the frontal lobe, and the subgyral insula (BA 13,
different. 45, 47, p ¼ 0.01) (Fig. 1).

Results LV3. Tactile stimulation at the right LV3 activated the

Change of BOLD fMRI signal activation after tactile
stimulation (total 10 volunteers)
LI1. Tactile stimulation at the right LI1 activated the left
parietal lobe, the postcentral gyrus, the primary somatosen-
sory cortex (BA 1, 2, 3), and the primary motor cortex (BA 4)
( p ¼ 0.001) (Fig. 1).
LI10. Tactile stimulation at the right LI10 activated the
right frontal lobe, inferior frontal gyrus, the middle frontal
gyrus (BA 9, 44, 45, p ¼ 0.005) and the left sublobar, the
left parietal lobe, the inferior parietal lobule, the postcentral
gyrus, BA 2, 40 (primary somatosensory cortex, supramar-
ginal gyrus part of Wernicke’s area, p ¼ 0.001) (Fig. 1).
ST36. Tactile stimulation at the right ST36 activated the
left frontal lobe, the superior frontal, the middle frontal in-
ferior frontal gyrus, the subgyral (BA 8, 9, 10, 46), the inter-
hemispheric, the right cerebellum, the posterior lobe, the
pyramis, the tuber, the uvula, the inferior semilunar lobule,
the parietal lobe, the inferior parietal lobule, the sublobar, the
 1196
insula, the claustrum, the extranuclear, and BA 13, 40
( p ¼ 0.001) (Fig. 1).
Change of BOLD fMRI signal activation before
and after acupuncture in the SA group
(group statistical analysis, 5 subjects)
After SA, the right somatosensory association cortex
(BA 7), the postcentral gyrus, and the parietal lobe showed
more activation ( p ¼ 0.001) (Table 1).
Change of BOLD fMRI signal activation before
and after acupuncture in the ULLA group
(group statistical analysis, 5 subjects)
There was more signal activations before acupuncture
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in the left and right sublobar, the thalamus, the right
frontal lobe, the left inferior semilunar lobule and after acu-
puncture the left and right occipital lobe, the lingual gy-
rus, the visual association cortex (BA 18, 19), the right
parahippocampal gyrus, the limbic lobe, the hippocampus,
the left anterior lobe, the culmen, and the cerebellum
(Table 2).
Comparison between BOLD fMRI signal activation
of the SA group versus upper and lower limb group
(Group statistical analysis)
In the ULLA group, there was more activation on the left
side of the brain such as the left frontal lobe, the precentral
gyrus, the postcentral gyrus, the subcentral area, the parietal
lobe, and the right parietal lobe, the postcentral gyrus, and
the primary somatosensory cortex (BA 2). In the SA group,
particularly in the right (contralateral) pre–post central gyrus,
the frontal lobe, the parietal lobe, the primary somatosensory
cortex (BA 3), and the primary motor cortex showed
more activation compared to those of the ULLA group
(Table 3).
Discussion
With the instrumental development of MRI and its new
imaging techniques in the 1990s, it has become possible for us
to get functional information of the brain such as diffusion,
perfusion, MR spectroscopy, and functional brain mapping as
well as anatomical information.7 Images by fMRI, which is
capable of mapping brain functions, show a close correlation
with those obtained by positron emission tomography, and
are excellent in spatial resolution and do not require any ra-
dioisotope or contrast media with its repeated use, so fMRI is
being widely used.8–10 Healthy subjects have been part of the
studies that visualize images of activated brain areas invoked
by visual, motor, and sensory stimulation. Recently, cognitive
functions such as language and memory functions are also
being visualized by fMRI.11–17,35 Clinically in brain tumor
removal operations, fMRI is used to decide which part of the
tumor should be operated and to predict functional damages
after the surgery.19–22 It is also used to locate language dom-
inance in patients with epilepsy,18 to evaluate recovery from
strokes, and to explain reorganization of the brain.23–25
In the field of Korean traditional medicine, fMRI is mainly
used to investigate the mechanisms of acupuncture and to
verify its effect. There have been several studies to observe
which part of the brain is activated after a specific acupoint is
PARK ET AL.
needled,26–28 or after multiple acupoints were needled,29,30
and to see whether different methods of needling have dif-
ferent brain activations.29,30 However, there has been no
study so far involving scalp acupuncture with fMRI because
of technical problems. A previous study was done to see
whether the fMRI images were still valid after 30 minutes of
acupuncture, and was designed to investigate brain activity
after acupuncture needles were pulled out.36 Thus, we de-
signed this study accordingly to compare before and after
acupuncture needling when sensory tactile stimulation was
done throughout the session.
This fMRI study proves the theory that tactile stimulation
is received bilaterally in the brain but shows contralateral
dominance.37,38 Also, tactile stimulation is consistent with
high cerebral cortex functions and the specific acupoint ST36
showed diverse activations in the frontal lobe, the parietal
lobe, the cerebellum, the posterior lobe, as well as the inter-
hemispheric.
In a preliminary study where they used electroacupuncture,
manipulation time varied at the same frequency in each subject
to make sure de qi was achieved. After SA on the left side, we
could observe that the right parietal lobe, the postcentral gyrus,
and the somatosensory association cortex were activated (Ta-
ble 1). It mostly accords with the areas activated by tactile
stimulation, but the fact that the right parts of the brain were
more activated by acupuncture needling shows that acu-
puncture stimulates the contralateral side of the brain com-
pared to tactile stimulation. We could infer that tactile
stimulation sets off the left sides of the brain activations and SA
stimulates contralateral parts of the brain.
In the upper (LI1, LI10) and lower (LV3, ST36) limb acu-
puncture group, we could see both sides of sublobes, the
thalamus, right frontal lobe, and left inferior semilunar lob-
ule activated before acupuncture and both sides of the
occipital lobe, the lingual gyrus, the visual association cortex,
and the right parahippocampal gyrus, the hippocampus, the
limbic lobe, the left anterior lobe, the culmen, and the cere-
bellum activated (Table 2). To sum up, after ULLA activa-
tions in the left sublobe, the thalamus, and the frontal lobe
disappeared and the bilateral occipital lobe, the lingual gyrus,
the visual association cortex and the right parahippocampal
gyrus, the hippocampus, the limbic lobe, the left anterior
lobe, the culmen, and the cerebellum became more activated.
It indicates that after pulling out the needles, the activations
of the brain remain as in the SA group but in the ULLA
group it showed more signal activations in various regions
than the SA group or in case of tactile stimulation. Among
the 4 acupoints, ST36 showed the signal activations in the
occipital lobe, the visual association cortex, and the cerebel-
lum, suggesting that ST36 has the strongest effect. On the
other hand, the right parahippocampal gyrus, the hippo-
campus, and the limbic lobe were only activated because the
left sides were offset, showing dominance only on the right
sides. This is possibly explained as follows. Acupuncture at
ST36 sends signals to the multiple levels at the occipital lobe
and limbic systems.26 Although we instructed the subjects
not to open their eyes or move their eyeballs during the
study, there is a slight chance that they might have moved
their eyeballs toward the end of the session. The other acu-
points in the ULLA group activated the prefrontal cortex, the
insula, and the hippocampus, which possibly have a cogni-
tive function and memory as well.39,40
 EFFECTS OF BRAIN ACTIVITY IN SCALP AND LOWER LIMB ACUPUNCTURE
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FIG. 1. Brain areas with significantly increased cortical and brain activation during sensory tactile stimulation. HT, height
threshold; ET, extent threshold; BA, Brodmann area.
In comparing the SA and the ULLA groups, it may be
concluded that the ULLA group had more activated areas
doubled with tactile stimulation at the same acupoints,
whereas in the SA group the effect of the left acupoints on the
scalp and that of the right lower limb acupoints counterbal-
ances each other, or further research is needed to see whether
SA chiefly activated contralateral parts of the brain.
The sensory system of our body perceives and controls the
organs against surroundings consciously and unconsciously.
1197
The sensory system consists of the exteroceptive sensation,
the interoceptive sensation, and the proprioception sense.
The exteroceptive sensation perceives stimuli or change from
surroundings such as pain, temperature, position, and touch.
Thus, stimuli such as acupuncture and tactile stimulation are
perceived through receptors, which change mechanical,
chemical, and optical energy into electronic signals and the
generated action potential is transmitted to the central ner-
vous system via the special sensory route. Various outer
 1198
Table 1. Brain Areas with Significantly Increased
Signal Activation During Sensory Stimulation
Before and After Scalp Acupuncture
Brain regions
included Coordinates Peak
in cluster Side BA xyz Z-value
Pre>post None
Post>pre Parietal lobe, Right 30, #52, 70 3.30
postcentral gyrus
Parietal lobe, Right 7 26, #52, 72 3.39
postcentral gyrus
Parietal lobe, Right 7 34, #24, 62 3.90
superior parietal
lobule
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Height threshold: p ¼ 0.001 uncorrected.
BA, Brodmann area.
stimuli are perceived by respective sensory receptors or sen-
sory end organs and via peripheral nerves reaching the cen-
tral nervous system, the dorsal root ganglia, the spinal cord,
the brain stem, the thalamus, and the cortex.
Tactile stimulation on the upper and lower limb synapses
at the nucleus cuneatus and nucleus gracilis of the medulla,
respectively. Then the secondary afferents cross on the other
side of the brain via the internal arcuate fiber and synapse in
the thalamus (ventroposterolateral [VPL] nucleus) via the me-
dial lemniscus, which ascends all the way through the brain-
stem to the primary somatosensory cortex through the
posterior limb of the internal capsule.
SA travels through the trigeminothalmic pathway on the
fifth cranial nerve, and its first sensory neuron is in the
gasserian (semilunar) ganglion. The axon from here enters
the ipsilateral pons and travels down to C2 along the spinal
trigeminal tract and synapses with the second neuron, which
is the spinal trigeminal tract nucleus at various places. Then
it ascends to the other side of the brain to synapse with the
ventral posteromedial (VPM) nucleus in the thalamus and to
the parietal lobe through the posterior limb of the internal
capsule. This study shows the contralateral (right side) pa-
rietal lobe, and postcentral gyrus activated (Table 1).
In addition, the ULLA needling can be considered the
spinothalamic pathway of the anterolateral system. The
pathways that pain, temperature, and nondiscriminative
Table 2. Brain Areas with Significantly Increased Signal Activation During Sensory Stimulation
After Upper and Lower Limb Acupuncture (Height Threshold: p ¼ 0.001 Uncorrected)
Brain regions included in cluster
Pre > post Sublobar, thalamus
cerebellum, posterior lobe, inferior semilunar lobule
Sublobar, thalamus
Frontal lobe, inferior frontal gyrus,
Post > pre Occipital lobe, lingual gyrus,
Occipital lobe, middle occipital gyrus,
Limbic lobe, parahippocampal gyrus, hippocampus
Occipital lobe, lingual gyrus
Cerebellum, anterior lobe, culmen
Pre, before upper and lower limb acupuncture (ULLA); post, after ULLA; BA, Brodmann area.
PARK ET AL.
(light, crude) touch are transmitted by are called the ante-
rolateral system, and it has the direct and the indirect path-
way. The direct pathway, the (neo)spinothalamic pathway, is
clinically important because localized pain and temperature
are directly transmitted to the cerebral cortex from the spinal
cord through the thalamus. Pain, temperature, and non-
discriminative touch from the contralateral upper limb,
lower limb, and trunk are being passed on, and all the re-
ceptors have free nerve endings. This (neo)spinothalamic
pathway runs for 2 to 3 segments after the nociceptor (pain
receptor) signal enters the posterlateral fasciculus (Lissauer
tract) of the spinal cord through the Ad fiber. One segment
heading downward synapses with the interneuron and is
involved in the segmental spinal reflex. The other heading
upward synapses at the second neuron in the dorsal horn,
goes through the ventral white commissure, ascends to the
thalamus (VPL nucleus) through the contralateral white
matter. When the SA group and the upper and lower limb
group were compared, the latter was shown to follow this
route because the left frontal lobe, the precentral gyrus, the
postcentral gyrus, the subcentral area, the parietal lobe and
the right parietal lobe, the postcentral gyrus, and the pri-
mary somatosensory cortex including insula were activated
(Table 3).
When we compared results between before and after
acupuncture, the ULLA group showed activations in the
cerebellum, the occipital lobe, the visual association cortex,
the limbic lobe, the hippocampus, and the posterior lobe
(Table 2). This can be explained by the following two theo-
ries: that the subject could have moved her eyes or acu-
puncture has something to do with the spinocerebellar tract.
The unconscious proprioception is conveyed through the
dorsal and ventral spinocerebellar tract to the cerebellum
and engages in the unconscious control of posture and
movement. This comes from the neuron in the intermediate
gray matter of the spinal cord and has a fast conduction
speed through wide-diameter fibers. Information from the
lower limb is transmitted to both sides of the cerebellum. The
dorsal spinocerebellar tract and the cuneocerebellar tract
deliver the proprioception and the exteroceptive signal
generated in the muscle to the cerebellum and control the
feedback of fine motor control through the cortical and the
subcortical motor nucleus. Therefore, we could observe both
sides of the cerebellum activations after acupuncture nee-
dling, and further research is required.
Coordinates Peak
Side BA xyz Z-value
Left #2, #24, 8 3.53
Left #20, #84, #40 3.51
Right 4, 0, 6 3.11
Right 45 46, 24, 14 3.11
Right 18 32, #74, #6 3.45
Right 19 40, #78, 4 3.20
Right 22, #42, 6 3.17
Left 18 #22, #76, #2 3.50
Left #16, #38, #12 3.22
 EFFECTS OF BRAIN ACTIVITY IN SCALP AND LOWER LIMB ACUPUNCTURE 1199

Table 3. Brain Areas with Significantly Increased Cortical Activation During Sensory
Stimulation After Scalp Acupuncture Versus Upper and Lower Limb
Acupuncture (Height Threshold: p ¼ 0.0001 Uncorrected)

Coordinates Peak
Brain regions included in cluster Side BA xyz Z-value

Upper and lower limb > scalp Frontal lobe, precentral gyrus Left 43 #48, #6, 12 4.29
Parietal lobe, postcentral gyrus Left 43 #48, 10, 18 3.54
Insula Left 13 #42, 0, 8 3.30
Parietal lobe, postcentral gyrus Right 2 48, #24, 36 3.43
Scalp > upper and lower frontal lobe, precentral gyrus, Right 3, 4 38, #24, 60 3.69
limb acupuncture Parietal lobe, postcentral gyrus
Frontal lobe, precentral gyrus, Right 3, 4 34, #24, 62 3.56
postcentral gyrus

BA, Brodmann area.

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Conclusions Disclosure Statement

In conclusion, when the 4 acupoints were tactile stimu-
lated, it was received bilaterally in the brain but showed
dominance in the contralateral side of the brain. It is con-
sistent with the functions of high cerebral cortex. On tactile
stimulation at ST36, various locations such as the frontal
lobe, the parietal lobe, the posterior lobe, and the cerebellum
as well as the inter-hemispheric showed activations. In the
SA group it showed more activation after acupuncture to
prove the stimulation remains even after pulling out the
needles. The left SA activated the right side of the brain. The
left SA activated the right side of the brain, which can be
explained as signifying that the left side of the brain activa-
tion could have been offset by tactile stimulation or that
acupuncture activated the brain contralaterally. It also
showed brain activations after the needles were pulled out in
the ULLA group, and the typical contralateral activations
were different from those with tactile stimulation.
This study is different from the previous study, which
focused on the parts of the brain activated after a specific
acupoint was needled24–29,41 in that it had tactile stimulation
at the 4 acupoints before and after SA and ULLA, respec-
tively, and observed the effects of acupuncture after pulling
out the needles and the difference of brain signal activations
between the two groups. Thus, we excluded the data of each
acupoint’s brain activity in this article.
On a final note, the LI1 acupoint showed contralateral and
bilateral activations, particularly in the limbic lobe, and the
anterior cingulate to show that LI1 may have aroused emo-
tional stimulation caused by strong pain. In the upper and
lower limb group, LI10 and LV3 did not show signal acti-
vation after the needles were pulled out in the limbic lobe,
and the anterior cingulate where it controls fear and in-
stinct,40,42 thus showing a need for further research on a
specific acupoint involving in the pain control mechanisms
by suppressing the pain stimulus ascending to the brain
through the descending analgesia circuit.
Acknowledgments
We would like to thank Ja-Young Gwak and Yun-Kyung
Park for their time and efforts spent on this study. This
research was supported by the Kyunghee University Re-
search Fund in 2007 (KHU-20070622).
All of the authors declare that no competing financial
interests exist.
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Address correspondence to:
Jung-Mi Park, O.M.D., Ph.D.
Department of Cardiovascular & Neurologic Disease
(Stroke Center)
East–West Neo Medical Center of Kyunghee University
134-090, #149 Sangil-dong Gangdong-Gu
Seoul 134-090
Korea
E-mail: pajama@khu.ac.kr