Acupuncture, the Limbic System, and

the Default Mode Network of the Brain

Tara Sporko and Phoebe Chan
HUI LAB
MGH/MIT/HMS Athinoula A Martinos Center for
Biomedical Imaging
MGH/MIT/HMS Athinoula A Martinos Center for
Biomedical Imaging
THEMEN Nr . 2, Mai 2008
MGH/MIT/HMS Athinoula A Martinos Center for
Biomedical Imaging
History of Acupuncture?
(http://www.drmanik.com/chap1.htm)
MGH/MIT/HMS Athinoula A Martinos Center for
Biomedical Imaging
1996-1997 2007 2005 1998-2000 2009
present
Central effects of
acupuncture (ST36) on the
cerebellum and limbic
system
Concerted signal decrease
with deqi vs signal increase
in pain
Characterized deqi
response in
acupuncture
Acupuncture (LI4)
modulates limbic
system and subcortical
gray structures
Significant differences
between acupuncture
stimulation and sensory
stimulation
FIRST abstract published
using fMRI to image brain
response to acupuncture
Acupuncture (LI4)
produces widespread
effects on human brain
Signal decreases in some
structures
Three acupoints (LI4, ST36, LV3)
Virtual identity of deactivations in
LPNN to DMN
Functional connectivity of task-
negative LPNN and task-positive
SMN
Hui et al. 2000
Hui et al. 2007
Hui et al. 2009a, b Hui et al. 2005 Hui et al. 1996,1998
Correlation of BOLD signals with sensations
Commonality and specificity of the three
pain-relief acupoints
Modulation of brain connections in limbic
system during acupuncture (ST36)
Effects of acupuncture at four cardiac-related
acupoints on brain activity
Effects of acupuncture on brain activity of
patients with psychological disorders
Innovations Timeline
NCCAM CERC Center dedicated as the Kathleen Hui Center of Excellence
Hui KKS, Liu J, Wu MT, Kwong KK.
Functional mapping of the human
brain during acupuncture with
magnetic resonance imaging.
Proceedings of the 4th World
Conference on Acupuncture 1996; 71.
Hui KKS, Liu J, Kwong KK.
Functional mapping of the human
brain during acupuncture with
magnetic resonance imaging
somatosensory cortex activation.
World J Acupuncture-Moxibustion
1997;7(3):44-49.
1996-1997 2007 2005 1998-2000 2009
present
Central effects of
acupuncture (ST36) on the
cerebellum and limbic
system
Concerted signal decrease
with deqi vs signal increase
in pain
Characterized deqi
response in
acupuncture
Acupuncture (LI4)
modulates limbic
system and subcortical
gray structures
Significant differences
between acupuncture
stimulation and sensory
stimulation
FIRST abstract published
using fMRI to image brain
response to acupuncture
Acupuncture (LI4)
produces widespread
effects on human brain
Signal decreases in some
structures
Three acupoints (LI4, ST36, LV3)
Virtual identity of deactivations in
LPNN to DMN
Functional connectivity of task-
negative LPNN and task-positive
SMN
Hui et al. 2000
Hui et al. 2007
Hui et al. 2009a, b Hui et al. 2005 Hui et al. 1996,1998
Correlation of BOLD signals with sensations
Commonality and specificity of the three
pain-relief acupoints
Modulation of brain connections in limbic
system during acupuncture (ST36)
Effects of acupuncture at four cardiac-related
acupoints on brain activity
Effects of acupuncture on brain activity of
patients with psychological disorders
Innovations Timeline
NCCAM CERC Center dedicated as the Kathleen Hui Center of Excellence
MGH/MIT/HMS Athinoula A Martinos Center for
Biomedical Imaging
Collaborators
Outside MGH
Norman Kettner Wendy Qiu Yanping Sun
Center for Morphometric Analysis
David Kennedy Nikos Makris Mark Vangel
Athinoula A. Martinos Center for Biomedical Imaging
Randy Buckner Gregory Cavanagh Iris Chen
J oshua D. Claunch J iliang Fang Randy Gollub
J ian Kong Kenneth K. Kwong Ming Li
Fa-hsuan Lin J ing Liu Ovidiu Marina
Vitaly Napadow Erika E. Nixon Bruce Rosen
MGH/MIT/HMS Athinoula A Martinos Center for
Biomedical Imaging
Acupuncture, the Limbic System, and
the Default Mode Network of the Brain
1. Acupuncture experiment protocol
2. Acupuncture (with deqi) evokes:
deactivation of a limbic-paralimbic-neocortical network
(LPNN) (match with default mode network)
deactivation of amygdala and hypothalamus
activation of somatosensory network (match with anti-
correlated task-positive network)
3. Commonality and specificity of brain responses
to different acupoints
4. Connectivity of the LPNN, amygdala and
hypothalamus
MGH/MIT/HMS Athinoula A Martinos Center for
Biomedical Imaging

MGH/MIT/HMS Athinoula A Martinos Center for

Biomedical Imaging
Acupuncture Stimulation Paradigm
Time (minutes)
0 2 10 9 7 4
M1 M2 R1 R2 R3
needle in needle out
Scan starts Scan stops
DEQI SENSATIONS
Aching Soreness Pressure Heaviness Fullness
Warm Cool Numbness Tingling Dull Pain
SHARP PAIN
Tactile Stimulation
Acupuncture Stimulation
MGH/MIT/HMS Athinoula A Martinos Center for
Biomedical Imaging
Signal Decreases in the Limbic Brain (LI4)
(Hui et al., 2000)
BOLD signal BOLD signal
BOLD signal
MGH/MIT/HMS Athinoula A Martinos Center for
Biomedical Imaging
1
2
11
10
7
4
5
3
12
8
9
6
N = 11
1. Frontal pole
2. Ventromedial prefrontal cortex
3. Pregenual cingulate
4. Subgenual cingulate
5. Subgenual Brodmannarea 25
6. Septal nuclei
7. Hypothalamus
8. Posterior cingulate
9. Precuneus
10. Substantianigra
11. Reticular formation
12. Cerebellar vermis
Brain Responses to Acupuncture Deqi
(ST36)
(Hui et al., 2005)
MGH/MIT/HMS Athinoula A Martinos Center for
Biomedical Imaging
Sharp Pain Deqi
R
R
L
L
1
2
3
4
1
5
6
7
8 8
10
8
9
Brain Responses to Acupuncture Deqi vs.
Sharp Pain (ST36)
(Hui et al., 2010)
MGH/MIT/HMS Athinoula A Martinos Center for
Biomedical Imaging
Acupuncture Modulates Limbic System
(ST36)
Acupuncture Deqi Acupuncture Deqi+Pain Sensory
(Hui et al., 2005)
MGH/MIT/HMS Athinoula A Martinos Center for
Biomedical Imaging
VI
VI VI VIIIA
X = X = X =
N=11 N=4 N=5
Acupuncture Modulates Cerebellum
(ST36)
(Hui et al., 2005)
MGH/MIT/HMS Athinoula A Martinos Center for
Biomedical Imaging
Needling
Sensation
Predominant
Signal Change
Deqi
Pain
Deqi + Pain
Decrease
Increase
Correlation between fMRI Response and
Needling Sensations
MGH/MIT/HMS Athinoula A Martinos Center for
Biomedical Imaging
Acupuncture Modulates Limbic System
and Cerebellum (LI4, ST36, LV3)
(Hui et al., 2009)
MGH/MIT/HMS Athinoula A Martinos Center for
Biomedical Imaging
Brain Responses to Acupuncture Deqi vs.
Sharp Pain (LI4, ST36, LV3)
(Hui et al., 2009)
MGH/MIT/HMS Athinoula A Martinos Center for
Biomedical Imaging
0
20
40
60
80
100
P
e
r
c
e
n
t





+
/
-
S
E
Acupunct ure, N=286 Sensory, N=88
* p<.05, ** p<.0001
**
*
**
**
**
**
**
*
Sensations at Acupoints LI4, ST36 and LV3
MGH/MIT/HMS Athinoula A Martinos Center for
Biomedical Imaging
Virtually Identical Patterns of
Limbic-paralimbic Neocortical Network (LPNN)
and Default mode Network (DMN)
Deactivations during acupuncture at LI4, ST36 and LV3
(Hui et al., 2009)
(3D map of DMN from Buckner et al., 2008)
DMN
LPNN
MGH/MIT/HMS Athinoula A Martinos Center for
Biomedical Imaging
Acupuncture
Correlations in LPNN
Correlation with BA31
Correlation with Hypothalamus
Acupuncture
Tactile
Tactile
Functional Anti-correlated Brain Networks
Involved in Acupuncture Action
(Hui et al., 2009)
Activated regions (Warm colors)
Deactivated regions (Cool colors)
MGH/MIT/HMS Athinoula A Martinos Center for
Biomedical Imaging
Summary of Major Findings
Acupuncture evokes extensive deactivation of the LPNN
and more limited activation of the SMN and paralimbic
structures. The general brain response is associated with
acupuncture sensations (deqi).
LI4shows the most extensive deactivation response,
consistent with its high clinical potency.
The LPNN shows highly correlated activity among
different regions, overlapping with DMN.
The amygdala and hypothalamus normally not part of
DMN in the literature are deactivated frequently in
acupuncture. Their involvement is a unique feature of
acupuncture action.
MGH/MIT/HMS Athinoula A Martinos Center for
Biomedical Imaging
Summary of Major Findings (Cont)
The posterior cingulate and precuneus shows strongest
functional connectivity with the rest of the brain may also
be the hub of acupuncture deactivation network. This is
further demonstrated in the effective connectivity study.
Acupuncture stimulation modulates the interactions
among the cortical and subcortical brain regions in LPNN
and DMN.
MGH/MIT/HMS Athinoula A Martinos Center for
Biomedical Imaging
Acupuncture may mobilize the intrinsic functionally anti-correlated
systems to maintain a balance of brain functions and mediate its
diverse modulatoryand analgesic effects.
An analogy between the functionally anti-correlated systems of the
brain and the opposing forces of yin and yang in TCM, although
speculative, may be worth considering.
MGH/MIT/HMS Athinoula A Martinos Center for
Biomedical Imaging
Kathleen KS Hui, MD Ming Li, lic. acupuncturist
In commemoration of Kathleen Huis life work and
contributions to science and medicine
MGH/MIT/HMS Athinoula A Martinos Center for
Biomedical Imaging
Acknowledgements
Administrative colleagues
Carol Barnstead
Linda Butler
Deedee Correia
Karen Dervin
Maureen Kelly
Stacey Ladieu
Monica Langone
Mary Roy
J anice White
Technical & Computing
colleagues
David Covin
Mary Foley
Chris J ohnson
Sam Mehl
Larry White
Paul Raines