Yoga is a therapeutic practice renowned for its multifaceted benefits across the body’s systems. Its positive impact spans the physical, mental and emotional realms, fostering harmony and well-being. Through a combination of postures, breathing techniques and meditation, yoga offers profound effects, enhancing flexibility, strength and balance while simultaneously promoting relaxation and reducing stress. This integrative approach not only cultivates physical resilience but also supports mental clarity, emotional balance and overall vitality, showcasing yoga as a comprehensive and impactful system for holistic health. The review delved into the multifaceted ways in which yoga exerts a positive influence on the body’s various systems. It highlights how yoga serves as a beneficial tool in addressing and counteracting the underlying factors associated with different diseases. By examining yoga’s effects on these systems and its potential in combating illness, the paper sheds light on the comprehensive therapeutic benefits that yoga offers.

Acupuncture, a therapeutic practice rooted in traditional Chinese medicine and integrated with modern neuroscience, achieves its effects by stimulating sensory nerves at specific anatomical points known as acupoints. This review systematically explores the therapeutic components of acupuncture, emphasizing the interplay between sensory nerve characteristics and neural signaling pathways. Key factors such as acupoint location, needling depth, stimulation intensity, retention time, and the induction of sensations (e.g., Deqi) are analyzed for their roles in neural activation and clinical outcomes. The review highlights how variations in spinal segment targeting, tissue-specific receptor activation, and stimulation modalities (e.g., manual acupuncture, electroacupuncture, moxibustion) influence therapeutic effects. Emerging evidence underscores the significance of ion channels, dermatomes, myotomes, and gene-specific pathways in mediating systemic effects. Additionally, the differential roles of mechanical, thermal and nociceptive stimuli and the temporal dynamics of sensory and immune responses are addressed. While insights from animal models have advanced our understanding, their translation to clinical practice requires further investigation. This comprehensive review identifies critical parameters for optimizing acupuncture therapy, advocating for individualized treatment strategies informed by neuroanatomical and neurophysiological principles, ultimately enhancing its precision and efficacy in modern medicine.

Background

Acupuncture is widely used in modulating brain excitability and motor function, as a form of complementary and alternative medicine. However, there is no existing meta-analysis evaluating the effectiveness and safety of acupuncture on corticospinal excitability (CSE), and the credibility of the evidence has yet to be quantified.

Objective

This study was designed to assess the efficacy and safety of electroacupuncture (EA) and manual acupuncture (MA) in enhancing brain excitability, specifically focusing on CSE as measured by transcranial magnetic stimulation (TMS).

Search strategy

This study followed a systematic approach, searching 9 databases up to August 2024 and examining grey literature, in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Inclusion criteria

Studies were included if they compared the clinical efficacy of EA or MA with sham acupuncture, no treatment or usual training.

Data extraction and analysis

Three investigators independently conducted literature screening, data extraction, and risk of bias assessment. The primary outcome focused on motor-evoked potentials as measured by TMS, with treatment effects quantified using mean differences or standardized mean differences between pre- and post-treatment. Subgroup analyses were conducted using mixed-effects models, while random-effects or fixed-effects models were used to estimate average treatment differences across studies.

Results

Based on 34 studies involving 1031 adults, acupuncture techniques significantly enhanced CSE. EA had a greater impact than MA, with effect sizes of 0.53 mV vs 0.43 mV (95% confidence interval [CI]: [0.30, 0.76], P < 0.00001 vs 95% CI: [0.28, 0.59], P < 0.00001). The 5 most frequently used acupoints were LI4 (Hegu, 32 times), ST36 (Zusanli, 10 times), LI11 (Quchi, 7 times), TE5 (Waiguan, 6 times), and GB34 (Yanglingquan, 5 times).

Conclusion

This systematic review indicates that both EA and MA could effectively and safely enhance CSE, bringing the corticospinal pathway closer to the threshold for firing, which may ultimately improve motor function. LI4, ST36, LI11, TE5 and GB34 are the most commonly used acupoints.

Background
Over 65 million people have long COVID. Evidence for using Chinese herbal medicine (CHM) to treat long COVID is growing. A systematic review of evidence for guiding clinical decision is warranted.
Objective
To examine the effects and safety of CHM in alleviating the severity of dyspnea, fatigue, exercise intolerance, depression, anxiety and insomnia in long COVID adults based on registered randomized clinical trials (RCT).
Search strategy
World Health Organization International Clinical Trials Registry Platform and Chinese Clinical Trial Registry were searched for registered trial protocols from database inception to February 10, 2023. English (PubMed, Embase, AMED and CINAHL) and Chinese databases (CNKI, Wanfang Data and CQVIP) were then searched to identify relevant publications from December 2019 through April 6, 2023.
Inclusion criteria
Registered RCTs that compared the effects of Chinese herbal medicines or Chinese herbal formulas against a control treatment (i.e., the placebo or usual care) in adults with persistent symptoms of long COVID. The primary outcome of dyspnea, and secondary outcomes of fatigue, exercise intolerance, depression, anxiety and insomnia were measured using validated tools at the end of the treatment.
Data extraction and analysis
Data were extracted, and eligible RCTs were evaluated using version 2 of the Cochrane risk-of-bias tool for randomized trials and Grading of Recommendations, Assessment, Development and Evaluations independently by two researchers. Effect sizes were estimated by random-effects modelling and mean difference (MD). Heterogeneity between trials was quantified by I2.
Results
Among the 38 registered clinical trials we identified, seven RCTs (1,519 patients) were included in the systematic review. One RCT had a low overall risk of bias. Compared to the control, CHM reduces dyspnea on the Borg Dyspnea Scale score (MD = –0.2, 95% confidence interval [CI] = –0.65 to 0.25) with moderate certainty, and reduces fatigue on the Borg Scale (MD = –0.48, 95% CI = –0.74 to –0.22) with low certainty. CHM clinically reduces depression on Hamilton Depression Rating Scale score (MD = –6.00, 95% CI = –7.56 to –4.44) and anxiety on Hamilton Anxiety Rating Scale score (MD = –6.10, 95% CI = –7.67 to –4.53), and reduces insomnia on the Insomnia Severity Index (MD = –4.86, 95% CI = –12.50 to 2.79) with moderate certainty. Meta-analysis of two RCTs (517 patients) showed that CHM clinically improves exercise intolerance by increasing 6-minute walking distance (MD = –15.92, 95% CI = –10.20 to 42.05) with substantial heterogeneity (I2 = 68%) and low certainty.
Conclusion
CHM is associated with a post-treatment clinical reduction in depression and anxiety in long COVID adults, compared to the control, but it does not have a strong treatment effect on dyspnea and insomnia. Effects of CHM on exercise intolerance and fatigue are uncertain, and the safety of using CHM remains questionable.

Progressive pulmonary fibrosis (PPF) is a progressive and lethal condition with few effective treatment options. Improvements in quality of life for patients with PPF remain limited even while receiving treatment with approved antifibrotic drugs. Traditional Chinese medicine (TCM) has the potential to improve cough, dyspnea and fatigue symptoms of patients with PPF. TCM treatments are typically diverse and individualized, requiring urgent development of efficient and precise design strategies to identify effective treatment options. We designed an innovative Bayesian adaptive two-stage trial, hoping to provide new ideas for the rapid evaluation of the effectiveness of TCM in PPF. An open-label, two-stage, adaptive Bayesian randomized controlled trial will be conducted in China. Based on Bayesian methods, the trial will employ response-adaptive randomization to allocate patients to study groups based on data collected over the course of the trial. The adaptive Bayesian trial design will employ a Bayesian hierarchical model with “stopping” and “continuation” criteria once a predetermined posterior probability of superiority or futility and a decision threshold are reached. The trial can be implemented more efficiently by sharing the master protocol and organizational management mechanisms of the sub-trial we have implemented. The primary patient-reported outcome is a change in the Leicester Cough Questionnaire score, reflecting an improvement in cough-specific quality of life. The adaptive Bayesian trial design may be a promising method to facilitate the rapid clinical evaluation of TCM effectiveness for PPF, and will provide an example for how to evaluate TCM effectiveness in rare and refractory diseases. However, due to the complexity of the trial implementation, sufficient simulation analysis by professional statistical analysts is required to construct a Bayesian response-adaptive randomization procedure for timely response. Moreover, detailed standard operating procedures need to be developed to ensure the feasibility of the trial implementation.

Background
There is a gap in understanding the effects of different acupoints and treatment methods (acupuncture and moxibustion) on microcirculatory changes in the lumbar region.
Objective
This study aimed to assess the thermal effects of acupuncture at Weizhong (BL40), with acupuncture at Chize (LU5) and moxibustion at both acupoints as control interventions.
Design, setting, participants and interventions
In this randomized controlled trial, 140 healthy participants were equally divided into four groups: acupuncture at BL40 (Acu-BL40), acupuncture at LU5 (Acu-LU5), moxibustion at BL40 (Mox-BL40) and moxibustion at LU5 (Mox-LU5). Participants underwent a 30-minute session of their assigned treatment. Infrared thermal imaging was used to collect temperature data on the areas of interest for analysis.
Main outcome measures
The primary measure was the change in average temperature of the observed area after the intervention. The secondary measures included periodic temperature changes every 5 min and the temperature changes of the Governor Vessel and Bladder Meridian in the observed area after the intervention.
Results
Significant interactions were observed between treatments and acupoints affecting temperature (P < 0.001). The Acu-BL40 group showed a notably higher increase in mean temperature after 30 min compared to the Acu-LU5 and Mox-BL40 groups, with increases of 0.29 (95% confidence interval [CI] = 0.17 to 0.41) and 0.24 (95% CI = 0.08 to 0.41) °C, respectively.
Conclusion
Acupuncture at BL40 acupoint can significantly increase the mean temperature in the observed area, highlighting the specific thermal effect of acupuncture compared to moxibustion in the lumbar area. This suggests a potential therapeutic benefit of acupuncture at BL40 for managing lumbar conditions.
Trial registration: ClinicalTrials.gov (NCT05665426).

Objective
Acupuncture has demonstrated efficacy as a treatment for fibromyalgia; however, predictors of short- and long-term analgesic response in this population are not well understood.
Methods
This manuscript describes a secondary analysis of a single-center, blinded, sham-controlled, randomized longitudinal acupuncture clinical trial in fibromyalgia. Baseline characterization included pressure pain threshold and pain interference, while residualized change in pain intensity from baseline to follow-up served as the primary outcome measure. Participants were randomized into groups that received verum (n = 36) or sham (n = 29) acupuncture treatment over a 12-week period (18 treatments) and were followed for 37 weeks from the initiation of treatment.
Results
Lower pressure pain thresholds at baseline were associated with greater analgesia only in the sham treatment group immediately following treatment, while those with higher pressure pain thresholds had greater analgesia with verum treatment (B = –13.43, P = 0.001). Additionally, greater perceived impact of pain at baseline was predictive of greater short-term analgesia irrespective of treatment. Pressure pain threshold was not found to be predictive of long-term differential treatment response (B= –1.71, P = 0.66). There was a significant difference in the relationship between perceived impact of pain at baseline and subsequent long-term analgesia between groups where those with greater perceived impact of pain displayed improved long-term analgesia for verum acupuncture compared to the sham group (B = –11.37, P = 0.004).
Conclusions
Our results support the use of a self-reported pain outcome in predicting long-term analgesia following acupuncture in fibromyalgia.

Objective

Comorbid pain and depression are common but remain difficult to treat. Electroacupuncture (EA) can effectively improve symptoms of depression and relieve pain, but its neural mechanism remains unclear. Therefore, we used resting-state functional magnetic resonance imaging (rs-fMRI) to detect cerebral changes after initiating a mouse pain model via constriction of the infraorbital nerve (CION) and then treating these animals with EA.

Methods

Forty male C57BL/6J mice were divided into 4 groups: control, CION model, EA, and sham acupuncture (without needle insertion). EA was performed on the acupoints Baihui (GV20) and Zusanli (ST36) for 20 min, once a day for 10 consecutive days. The mechanical withdrawal threshold was tested 3 days after the surgery and every 3 days after the intervention. The depressive behavior was evaluated with the tail suspension test, open-field test, elevated plus maze (EPM), sucrose preference test, and marble burying test. The rs-fMRI was used to detect the cerebral changes of the functional connectivity (FC) in the mice following EA treatment.

Results

Compared with the CION group, the mechanical withdrawal threshold increased in the EA group at the end of the intervention (P < 0.05); the immobility time in tail suspension test decreased (P < 0.05); and the times of the open arm entry and the open arm time in the EPM increased (both P < 0.001). There was no difference in the sucrose preference or marble burying tests (both P > 0.05). The fMRI results showed that EA treatment downregulated the amplitude of low-frequency fluctuations and regional homogeneity values, while these indicators were elevated in brain regions including the amygdala, hippocampus and cerebral cortex in the CION model for comorbid pain and depression. Selecting the amygdala as the seed region, we found that the FC was higher in the CION group than in the control group. Meanwhile, EA treatment was able to decrease the FC between the amygdala and other brain regions including the caudate putamen, thalamus, and parts of the cerebral cortex.

Conclusion

EA can downregulate the abnormal activation of neurons in the amygdala and improve its FC with other brain regions, thus exerting analgesic and antidepressant effects.

Objective
Treating peripheral nerve injury (PNI) presents a clinical challenge due to limited axon regeneration. Strychni Semen, a traditional Chinese medicine, is clinically used for numbness and hemiplegia. However, its role in promoting functional recovery after PNI and the related mechanisms have not yet been systematically studied.
Methods
A mouse model of sciatic nerve crush (SNC) injury was established and the mice received drug treatment via intragastric gavage, followed by behavioral assessments (adhesive removal test, hot-plate test and Von Frey test). Transcriptomic analyses were performed to examine gene expression in the dorsal root ganglia (DRGs) from the third to the sixth lumbar vertebrae, so as to identify the significantly differentially expressed genes. Immunofluorescence staining was used to assess the expression levels of superior cervical ganglia neural-specific 10 protein (SCG10). The ultra-trace protein detection technique was used to evaluate changes in gene expression levels.
Results
Strychni Semen and its active compounds (brucine and strychnine) improved functional recovery in mice following SNC injury. Transcriptomic data indicated that Strychni Semen and its active compounds initiated transcriptional reprogramming that impacted cellular morphology and extracellular matrix remodeling in DRGs after SNC, suggesting potential roles in promoting axon regeneration. Imaging data further confirmed that Strychni Semen and its active compounds facilitated axon regrowth in SNC-injured mice. By integrating protein–protein interaction predictions, ultra-trace protein detection, and molecular docking analysis, we identified myeloperoxidase as a potentially critical factor in the axon regenerative effects conferred by Strychni Semen and its active compounds.
Conclusion
Strychni Semen and its active compounds enhance sensory function by promoting axonal regeneration after PNI. These findings establish a foundation for the future applications of Strychni Semen and highlight novel therapeutic strategies and drug targets for axon regeneration.

Objective
The present study investigated the cytoprotective effects of a Pogonatherum paniceum extract prepared with 80% ethanol (PPE) using synchrotron radiation-based Fourier transform infrared (SR-FTIR) microspectroscopy and determined its phytochemical profile.
Methods
The volatile and polyphenolic compounds in PPE were characterized using gas chromatography–mass spectrometry and liquid chromatography–mass spectrometry, respectively. The antioxidant capacity of PPE was evaluated using chemical and cell-based assays. The SR-FTIR microspectroscopy was performed to evaluate the cytoprotective effect of PPE by identifying changes in macromolecule composition in tert-butyl hydroperoxide (tBuOOH)-induced oxidative damage in RAW264.7 cells.
Results
A total of 48 volatile compounds and 28 polyphenol components were found in PPE. PPE exhibited a high potential for antioxidant activity by scavenging the intracellular reactive oxygen species in tBuOOH-induced oxidative damage in RAW264.7 cells. PPE treatment also significantly protected RAW264.7 cells against tBuOOH-induced toxicity and restored cell viability. The SR-FTIR analysis revealed that tBuOOH increased the lipid and ester lipid content in RAW264.7 cells. The PPE exerted a cytoprotective effect by decreasing the levels of lipid and ester lipid compounds that had been elevated by tBuOOH in RAW264.7 cells. These findings indicate that PPE has cytoprotective potential due to its ability to inhibit endogenous reactive oxygen species.
Conclusion
This study extends the current knowledge on the phytochemistry of PPE and its antioxidant and cytoprotective effects. These findings support the use of SR-FTIR microspectroscopy to determine the cytoprotective effects of natural products. PPE extract may be a candidate compound for new therapeutics and nutraceuticals that target the prevention of oxidative stress-associated diseases.

Objective
Aloin, the main active component in Aloe vera (L.) Burm. f., has shown promising anti-tumor effects. This study investigated the impact of aloin in lung squamous cell carcinoma (LUSC) and explored its functional mechanism.
Methods
We analyzed the viability, migration, invasion, proliferation, and apoptosis of two LUSC cell lines after treatment with aloin. Target molecules of aloin and downstream target transcripts of nuclear receptor subfamily 3 group C member 2 (NR3C2) were predicted by bioinformatics. The biological functions of NR3C2 and metallothionein 1 M (MT1M) in the malignant properties of LUSC cells were determined. A co-culture system of LUSC cells with monocyte-derived macrophages was constructed. Mouse xenograft tumor models were generated to analyze the functions of aloin and NR3C2 in the tumorigenic activity of LUSC cells and macrophage polarization in vivo.
Results
Aloin suppressed malignant properties of LUSC cells in vitro. However, these effects were negated by the silencing of NR3C2. NR3C2 was found to activate MT1M transcription by binding to its promoter. Additional upregulation of MT1M suppressed the malignant behavior of LUSC cells augmented by NR3C2 silencing. Analysis of the M1 and M2 markers/cytokines in the macrophages or the culture supernatant revealed that aloin treatment or MT1M overexpression in LUSC cells enhanced M1 polarization while suppressing M2 polarization of macrophages, whereas NR3C2 silencing led to reverse trends. Consistent findings were reproduced in vivo.
Conclusion
This study demonstrated that aloin activates the NR3C2/MT1M axis to suppress the malignant behavior of LUSC cells and M2 macrophage polarization.