Neurobiological foundations of acupuncture: The relevance and future prospect based on neuroimaging evidence

Acupuncture is currently gaining popularity as an important modality of alternative and complementary medicine in the western world. Modern neuroimaging techniques such as functional magnetic resonance imaging, positron emission tomography, and magnetoencephalography open a window into the neurobiological foundations of acupuncture. In this review, we have summarized evidence derived from neuroimaging studies and tried to elucidate both neurophysiological correlates and key experimental factors involving acupuncture. Converging evidence focusing on acute effects of acupuncture has revealed significant modulatory activities at widespread cerebrocerebellar brain regions. Given the delayed effect of acupuncture, block-designed analysis may produce bias, and acupuncture shared a common feature that identified voxels that coded the temporal dimension for which multiple levels of their dynamic activities in concert cause the processing of acupuncture. Expectation in acupuncture treatment has a physiological effect on the brain network, which may be heterogeneous from acupuncture mechanism. "Deqi" response, bearing clinical relevance and association with distinct nerve fibers, has the specific neurophysiology foundation reflected by neural responses to acupuncture stimuli. The type of sham treatment chosen is dependent on the research question asked and the type of acupuncture treatment to be tested. Due to the complexities of the therapeutic mechanisms of acupuncture, using multiple controls is an optimal choice.