EA at Guan yuan and Zhong wan (REN12) can deactivate the limbic-prefrontal functional network. The local functional connectivity was significantly changed during EA stimulation, and the change persisted during the period after the stimulation. Although minor differences existed, both acupoints similarly modulated the limbic-prefrontal functional network, which overlapped with the functional circuits associated with emotional and cognitive regulation. Thus making them options for mental ill health conditions, including PTSD (2).

EA at Bai hui (DU20), Guan yuan (REN4), and Zu san li (ST36) significantly ameliorated Alzheimer’s Disease-like behaviors, cerebral blood flow reduction, microvascular deformation, damaged synaptic structure and reduced synaptic proteins. Additionally, EA, ‘downregulated the aberrantly elevated expression of PDGFRβ and CD31, enhanced the levels of tight junction proteins (Occludin, Claudin-5, and ZO-1) and glucose transporter 1 (GLUT1), and suppressed the expression of inflammatory proteins.’ Thus, ‘EA ameliorates AD-like phenotypes, potentially through preventing microangiopathy.’ (3)

Acupuncture and moxibustion at Zu san li, Guan yuan (REN4) and Nei guan (PC6) can effectively improve the symptoms (spontaneous activities, visceral hypersensitivity) of IBS-D rats. This may be due to its functions in regulating autonomic nervous activities, and down-regulating blood norepinepherine and calcitonin gene-related peptide contents and colonic 5-HT protein expression and immunoactivity, and the effects of the above acupoints are superior Zu san li, Tian shu (ST25) and Shang ju xu (ST37). (4)

EA Acupuncture at 6 differnet acupoints were compared for FD rats; Zu san li, Shang ju xu (ST37), Xia ju xu (ST39), Tian shu (ST25), Zhong wan (REN12) and Guan yuan (REN4). The researchers noted that, as others have, that abdominal points didn’t seem to increase gastric motility, but nor did they improve markers of inflammatory and mucosal injury. ST37 and ST39 could reduce the immunoreactivity of  eosinophil major basic protein and also ameliorated FD-tight junction protein in the expression of Claudin3 and ZO1, reducing inflammation and leaky gut. But only ST36 could regulate gut motility, the above markers and CD45 and occludin1, thus reducing immune cell infiltration and preventing gut membrane permeability, respectively (5).

Additionally, like [a] SIRT1 agonist, EA [at Zu san li, Zhong wan, Guan yuan and Feng long] suppressed body weight gain and insulin resistance levels in obese rats, but this was only partially blocked by the SIRT1 antagonist. EA could upregulate protein expression of hypothalamic SIRT1 and downregulate the acetylation level of FOXO1 in the hypothalamic arcuate nucleus (ARC), which decreased gene expression of neuropeptide Y and increased that of POMC. The agonist targeted the hypothalamic SIRT1gene, unlike EA, which targeted posttranscriptional regulation. (6)

Furthermore, EA at Zu san li, Tian shu, Guan yuan and Zhong wan, ‘was associated with a decrease in body weight, food intake, adipose tissue weight, and adipocyte size. At the same time, EA induced microglia to exhibit an M2 phenotype, representing reduced iNOS/TNF-α and increased Arg-1/IL-10/BDNF, which may be due to the promotion of TREM2 expression. EA also reduced microglia enrichment in the hypothalamic arcuate nucleus and declined TLR4 and IL-6, inhibiting microglia-mediated neuroinflammation. In addition, EA treatment promoted POMC expression, which may be associated with reduced food intake and weight loss in obese mice.’ (7)

EA, at Guan yuan (REN4), Zhong wan (REN12),  Zu san li (ST36), and Feng long (ST40), for 10 minutes 3 times a week, can effectively regulate intestinal Toll-like receptor 4 (TLR4), inhibit the interaction between TLR4 and NF-κB p65, and reduce the activity of NF-κB p65, which may be a potential mechanism of EA in reducing body weight and blood glucose in obese rats. Regulating this pathway can be beneficial for chronic inflammatory gut conditions, maintaining gut integrity and regulating the microbiome (8) 

Zu san li to Feng long and Zhong wan to Guan yuan as well as Tian shu EA is superior to abdominal EA in improving lipid metabolism in obesity rats, which may be related to its stronger effectiveness in down-regulating hepatic TLR4/NF-κB p65 signaling. (9)

Electroacupuncture at, Zu san li (ST36),  Zhong wan (REN12), Guan yuan (REN4) and “Fenglong”(ST40), was able to reverse the modeling induced increase of body mass, Lee’s index, contents of serum TNF-α, IL-6 and free fatty acid  (NEFA), expression levels of hypothalamic TNF-α, IL-6 and iNOS proteins, the immunoactivity level of Iba-1 and the content of Evans blue, and decrease of serum content and expression level of IL-10 in the hypothalamus. Thus ‘EA can treat obesity, improve body inflammation caused by obesity, and relieve central inflammation by repairing the blood-brain barrier.’ (10)

EA (10 or 30Hz, but not 2 or 100) at ST36, ST37, ST39 (Xia ju xu), or REN4 (Guan yuan) significantly inhibited local MPO activity, immune cells infiltration, and increased α-SMA, thus regulating inflammation in the intestinal musculature and was also able to improve post operative dysmotility (11). 

EA at Feng long (ST40) – Zu san li (ST36) and Zhongwan (REN12) – Guan yuan (REN4) can reduce the 24-hour food intake, body weight and serum insulin in the EA group were, while the glucose infusion rate was significantly increased. The Bacteroides abundance was increased, the pachytene abundance was decreased and the functional clustering of the above functional cog protein in the EA group was increased. It was also noted that intestinal flora, at the genus level, was riveted back to normal. Thus acupuncture can reduce appetite, regulate weight loss and may be related to its benefits on the intestinal microflora (12). 

In an interesting review for the parameters of acupuncture for ulcerative colitis showed that the core points should be Tian shu (ST25), Qi hai (RN6), Guan yuan (RN4), Shang ju xu (ST37), and Da chang shu (BL25) and on the basis of manual acupuncture, every other day for 10-30 minutes for 8 weeks was more effective than medication alone. Though combining manual acupuncture or electroacupuncture and medications led to the best outcomes. As well as being effective, acupuncture was shown to be safe, having fewer adverse effects than medication (13)

BiaoBen (branch and root acupuncture, in this case Feng long (ST40) Zu san li (ST36), (Zhong wan (REN12) Tian shu (ST25), Guan yuan (REN4)) EA is superior to abdominal EA, at the above points alone, in improving lipid metabolism in obese rats, which may be related to its stronger effectiveness in down-regulating hepatic TLR4/NF-κB p65 signaling. In other words, stacking local and distal points was more effective than just local (14).

EA at Zu san li, Feng long, Zhong wan and Guan yuan can reduce the body weight of  obese insulin resistance rats and improve insulin resistance, which may be related to down-regulating the hypothalamic TLR4/IκBα/NF-κB signaling pathway (15).

EA (2 Hz, 1 mA) at Zu san li (ST36), Feng long (ST40), Guan yuan (REN4) and Zhong wan (REN12), 10 minutes, 3 times a week, for a total of 8 weeks, can effectively promote the browning of WAT, which may be related to the activation of GLP-1 neurons in the nucleus of solitary tract, as well as the promotion of the phosphorylation of AMPK in the ventromedial nucleus of hypothalamus and up-regulation of UCP1 (16).

Both acupuncture and moxibustion at Zu san li and Guan yuan can improve ulcerative colitis in mice, which may be associated with its effects in down-regulating the expression of colonic STAT3 and HIF-1α proteins (17).

Another gene study tried to find out which genes are responsible for ageing in rats and whether acupuncture can slow down the aging process. The researchers found 4052 genes in rats, 3079 were expressed differently between the faster ageing rats and the controls. EA at Guan yuan (REN4), Zu san li and Bai hui (DU20) regulated 983 of those genes and was more similar to the control than the ageing group. (18)

Acupuncture at Zhong ji (REN3), Guan yuan (REN4), San yin jiao (SP6) and Tai chong (LR3) can help mice with poor ovarian reserve. Researchers noted improvements in estrous cycle disorder, estrous cycle, serum FSH and LH content, and apoptosis of ovarian granulosa cells, and expression levels of Bax and Caspase-3 mRNAs. And, may be related to its effects in regulating Yes associated protein ［YAP］ and transcriptional coactivator with PDZ binding motif ［TAZ］) in the Hippo signaling pathway (19).

Another study found EA at the Guanyuan (REN4) acupoint protected the granulosa cell by inhibiting cell apoptosis and promoting mitophagy, which was mediated by the Hippo-YAP/TAZ pathway (20)

Guan yuan (REN4), San yin jiao (SP6), Zi gong (EX-CA1) and Zhong ji (REN3) are the most commonly used points for uterine fibroids. They have close neurological connection with the uterus, can improve uterine microcirculation, boost uterine blood flow, and lower vascular resistance, regulate the HPO axis and thus sexual hormones, can reduce inflammation, and thus facilitate endometrial and uterine morphology repair (21)

Guanyuan (REN4), Sanyinjiao (SP6), Zigong (EX-CA1), Zusanli (ST36) and Zhongji (CV3) are the most commonly used points for PCOS and the mechanisms could be mediated via regulation of the estrogen receptor 1 (ESR1), proto-oncogene tyrosine-protein kinase Src (SRC), signal transducer and activator of transcription 3 (STAT3), peroxisome proliferator-activated receptor gamma (PPARG), and RAC-alpha serine/threonine-protein kinase (AKT1) and that the main pathways are the hypoxia-inducible factor 1 (HIF-1) signaling pathway, phosphatidylinositol 3-kinase-protein kinase B (PI3K-AKT) signaling pathway, and advanced glycation end products-receptor for advanced glycation end products (AGE-RAGE) signaling pathway. Thus acupuncture at the above points engages processes such as signal transduction, receptor complex formation, and cytokine activity (22).

Acupuncture plus IVF, at Zhong ji (REN3), Guan yuan (REN4), Zi gong (EX-CA1), San yin jiao (SP6), Tai xi (KI3), Xue hai (SP10), Zu san li (ST36), and Tai chong (LR3), significantly increased the number of retrieved mature oocytes in women aged more than 37 years and in those undergoing more than one controlled ovarian hyperstimulation cycle. The negative correlation between the number of retrieved mature oocytes and consecutive controlled ovarian hyperstimulation cycles was not observed in the Ac + IVF group irrespective of the maternal age. (23).

Acupuncture at Guan yuan (REN4), Zhong ji (REN3), San yinjiao (SP6) and Zi gong (CX-CA1) for 5 consecutive days can conspicuously downregulate the expressions of serum levels of testosterone and estradiol, improve the development of ovaries and uterus, promote ovulation, enhance endometrial receptivity, and advance blastocyte implantation in rats with polycystic ovary syndrome (24). 

Acupuncture at San yin jiao (SP6), Zu san li (ST36), Tai chong (LR3), Guan yuan (REN4), and Zhong ji (REN3) was able to help rats during the implantation period of pregnancy; significantly advancing glandular development and decreasing the serum estradiol levels and the glandular area and endometrial leukaemia-inhibitory factor and osteopontin expression were significantly higher vs medication (clomiphene citrate) and thus improved endometrial state and could improve pregnancy rates (25)

Acupuncture at Guan yuan (REN4), Zhong ji (REN3), Qi hai (REN6), San yin jiao (SP6) and Zi gong (EX-CA1) in rats with PCOS significantly decreases serum LH, FSH, testosterone and anti-Müllerian hormone levels and a significantly increases E2 levels. It was also shown to reduce granulosa cell autophagy and proliferation by decreasing the expression of LncMEG3, PI3K, AKT, mTOR, P62 and LC3II/I expression while increasing the expression of follicle stimulating hormone receptor (26, 27).

In a systematic review acupuncture, most commonly at Sanyinjiao (SP 6), Guanyuan (RN 4), Zigong, Zusanli (ST36), and Zhongji (RN 3), was shown to improve pregnancy outcomes, whilst regulating sex hormones, in patients with ovulatory disorder infertility. It was shown to be more effective than clomiphene citrate for improving pregnancy rate, endometrial thickness and reducing the miscarriage rate. Treatments were generally 3-7 times a week for two menstrual cycles (28). 

The core points for tubal infertility are Guan yuan (REN4), San yin jiao (SP6), Zi gong (EX-CA1), Zhong ji (REN3), Qi hai (REN6). Efficacy and safety needs more research, the researchers concluded (29).

Acupuncture at Shenshu (BL23), Guan yuan (REN4), Zhong wan (REN12) can improve the menstrual disorder in rats with ovarian hypofunction, which is closely related to its effects in improving antioxidant stress ability (notably increasing SOD levels) and regulating the expressions of apoptosis-related protein and mRNA of ovarian gra-nulosa cells (30).

Acupuncture at Zhong wan (REN12), Zhong ji (REN3), Qi hai (REN6), Shui fen (REN9), Guan yuan (REN4), Tian shu (ST25), Gui lai (ST29), Shou san li (LI10), Zu san li (ST36), Feng long (ST40), every other day for 4 weeks, with nutritional therapy, can help women with postpartum obesity issues. Reductions were observed in body weight, body mass index, percentage body weight, and waist to hip ratio (31)

The most commonly used points and basis for a point protocol for perimenopausal symptoms was San yin jiao, Shen Shu (BL23), Guan yuan (REN4), Bai hui (DU20), Shen men (HT7) (32). 

San yin jiao is among the most commonly used points for premature ovarian failure, the other points are Guanyuan (CV 4), Shenshu (BL 23), Zhongji (CV 3), Pishu (BL 20), Taixi (KI 3) and Ganshu (BL 18) and local extra points like Zi gong (33). 

Acupuncture at San yin jiao, Guan yuan, Zhong ji and Zi gong are the most commonly used points and the basis of a protocol for infertility (34). 

Acupuncture is beneficial for polycystic ovarian syndrome with San yin jiao (SP6) and Zu san li (ST36) or San yin jiao (SP6) and Guan yuan (REN4) being the most commonly used then additional points added depending on the TCM diagnosis (35). 

A group consensus and review for PCOS found Guan yuan to be a key point in a broader formula, and specifically, when regarding hyperandrogen issues, ovulation disorders, IVF, insulin resistance, obesity and sleep disorders. (36)

EA of REN4, SP6, ST36 and ST36+REN4+SP6 can reduce the number of follicles at the growth stage and regulate the expression levels of gonadotropins in PCOS rats. The effects of EA of REN4 and ST36 are evidently better than those of EA of SP6 in up-regulating serum FSH content and in down-regulating LH/FSH ratio, and serum anti-Mullerin hormone and inhibition B levels, and EA of SP6 is evidently superior to EA of REN4 down-regulating LH level, but without synergistic effect among the 3 acupoints. In other words you don’t get extra benefit for PCOS by stacking these points. That isn’t to say you shouldn’t stack them, but in doing so the effects aren’t stronger. This is because LH and FSH are governed by a single central GnRH oscillator with strong negative feedback. Once one point normalises the system, additional points cannot further “stack” the ratio — they hit a ceiling or interfere with timing rather than amplify the effect. (37).

A pretty massive systematic review and meta-analysis, with almost thirty thousand patients for acupuncture with IVF (when Guan yuan is a commonly used point) showed that acupuncture can enhance outcomes in a variety of ways, with many biomechanisms, though the outcomes do depend a lot on the patient. Overall, acupuncture improved clinical pregnancy rates and endometrial morphology. In some papers it increased the quality of the embryo and in some it increased the live birth rate, but on average it did not. Though there was issues comparing the studies as they collected different data and had differing methodologies. At best we can say acupuncture is safe and useful as an addition to IVF treatments, at least until we have more information (38). 

A group consensus and review of outcomes and approaches for acupuncture in IVF found Guan yuan to be a key point, especially, with a broader formula, for follicle growth, ovulation induction, endometrial receptivity, embryo transfer and emotional regulation during gestation (39)

EA can enhance the secretion of GnRH and LH in the diestrum and metaoestrus of the estrous cycle, which is realized by the hypothalamus-pituitary-gonad axis. The effect of EA on REN4 is better than that of PC6 (40).

‘NLRP3 inflammasome activation in primary dysmenorrhea (PMD) triggers pathological inflammation. San yin jiao (SP6) and Guan yuan (REN4) had specific effects on PDM. EA of SP6 and REN4 may treat PDM by inhibiting inflammation and protecting the morphological structure of the uterus.’ (41)

Acupuncture at ST36, REN4, and Yong quan (KI1), ‘repressed the progression of [non-alcoholic fatty liver disease] NAFLD by inhibiting inflammatory reactions, reducing oxidative stress, and promoting lipid metabolism of hepatocytes, suggesting that this approach might be an important complementary treatment for NAFLD.’ (42)

Acupuncture at Zu san li, Guan yuan and Yong quan suppresses lipid absorption by downregulating the expression of apolipoproteins in the small intestine in NAFLD mice. (43)

‘For patients with myelosuppression after chemotherapy, acupuncture significantly inhibited the decline in blood cell components (white blood cell count, platelet count, red blood cell count, and hemoglobin) except for neutrophils. As the central combination of acupuncture prescriptions for this population, ST36-SP6-RN6-SP10-RN4 presented promising prospects and deserved more exploration for clinical use.’ (44)

EA has clinical benefits in relieving septic inflammation, improving immune function, and attenuating related multi-organ injury through several mechanisms, such as activation of the cholinergic anti-inflammatory pathway (CAP), vagal-adrenal axis, inhibition of the nuclear factor Kappa-B (NF-κB) signaling pathway, signal transducers and activators of transcription (STAT) signaling pathway, and improvement of immune cell function. Zu san li (ST36), Tian shu (ST25), Shang ju xu (ST37) and Xiajuxu (ST39) was the second most used prescription in this review, after Zu san li and Guan yuan (45). 

Acupuncture, primarily at Zu san li (ST36), Yang ling quan (GB34), Nei guan (PC6), Guan yuan (REN4), can adjust immune function in sepsis patients thus improving outcomes. Changes were noted in increased CD3+, CD4+, CD8+, IgG, IgA, IgM, and CD4+ /CD8+ ratio (46)

Acupuncture at Baihui (DU20), Tan zhong (REN17), Qi hai (REN6), Guan yuan (REN4), Zu san li (ST36), He gu (LI4), Tai chong (LR3) and San yin jiao (SP 6) can benefit chronic fatigue syndrome patients improving physical and mental fatigue and total scores. However, warming needling at Bai hui (DU20), Qi hai (REN6), Guanyuan (REN4) and Zu san li (ST36) led to better outcomes on physical and total scores as well as patient satisfaction (47).

Guan yuan is a key point for COVID 19 prevention, and could more broadly strengthen the immune system to prevent infectious respiratory disease get in in the first place (48)

EA at Zu san li and Guan yuan (20 Hz/50 Hz, 1 mA) 20 mins, 6 times a week for 4 weeks can benefit arthritis by promoting the apoptosis of synoviocytes and the expressions of Fas and FasL proteins (49). 

EA at Guan yuan significantly improved osteoporotic morphological changes in the ovariectomized rats, increased serum alkaline phosphatase and osteocalcin/bone gla protein levels, enhanced the maximum and fracture loads, and increased bone mineral density. The mechanism is likely due to  the observed activation of the Wnt‑β‑catenin signaling pathway (50)

In a review for postmenopausal osteoporosis (POMP) researchers found that acupuncture improved bone mineral density and estrogen levels in animals with POMP. ST36, BL23, REN4, and SP6 are the core acupoints (51).

Electroacupuncture at San yin jiao and Guan yuan (REN4) was tested sensence accelerated mouse prone 8 to see if it benefited the hypothalamus-pituitary-ovary axis.  Estradiol levels were increased in San yin jiao and Guan yuan groups. In contrast, gonadotropin releasing hormone, luteinising hormone and follicle stimulating hormone levels were reduced. San yin jiao group was superior than Guan yuan group in increasing estradiol and declining gonadotropin releasing hormone levels. Spatial learning and memory were also improved but only by San yin jiao. This is important as the prevalence of Alzheimer’s disease is significantly higher in women due to dysregulation of the HPO axis, perhaps purely lower oestrogen levels. Acupuncture could be a safe and effective way to manage and mitigate this (52).

Acupuncture combined with integrated Chinese and Western medicine can improve proteinuria, renal function, and glucose and lipid metabolism in patients with DN. It also regulates fibrotic and reparative signals such as TGF-β1 and HGF, suggesting a potential role in delaying renal fibrosis. Core acupoints include ST36, SP6, and BL23, often used with REN12, REN3/REN4, SP10, ST40, and LI4. Best results are obtained when these therapies are combined, rather than used alone, likely due to broader regulatory benefits (53)

Neuropeptides or monoamine transmitters could be an important aspect of acupuncture effect, or the transmission of it. Researchers found by needling Guan yuan they found changes in the levels of epinephrine and 5-HT at Zhong wan. This effect was not seen by needling a point adjacent to Guan yuan and sampling a point adjacent to Zhong wan. Thus monoamines could be part of the transmission effect of acupuncture along the meridian. All the more curiously there was an unknown substance found whose concentration was significantly increased at Zhong wan after needling Guan yuan (54). 

Guan yuan is among the 5 most commonly used points for rehabilitation in patients with respiratory insufficiency, with Zu san li being the most commonly used point. Enhancing diaphragm function, improving hypoxia and carbon dioxide retention, and shortening MV time and regulating multiple pathways to achieve this (55). 

Zhong ji is a commonly used point for erectile dysfunction with other local and distal points. Guan yuan, however, is the most commonly used point. The mechanisms are likely to include HPA-T and endocrine regulation, local nerve and circulation improvements (56).

Another review showed that the mechanisms of acupuncture around premature ejaculation also are broadly active and include, ‘stimulating the frontal functional lobe, inhibiting spinal cord neural pathways, regulating serotonin levels, enhancing 5-hydroxytryptamine receptor IB excitability, reducing penile sensitivity, and modulating hormone levels.’ The most frequently used points were San yin jiao (SP6), Zhong ji (REN3), Tai chong (LR3), and Guan yuan (RNE4) (57).

Acupuncture has been used for millenia for erectile dysfunction. Research used datamining tools to discover the most commonly used acupoints and found, in order, Guan yuan (REN4), Shen shu (BL23), San yin jiao (SP6), Ming men (DU4), Zu san li (ST36), Zhong ji (REN3), Ci liao (BL32), Qi hai (REN6), Tai xi (KI3) and Tai chong (LR3) were the ten ten. San yin jiao, Qi hai and guan yuan were the highest confidence combination (58). 

Acupuncture at Guan yuan, as part of two different point combinations, can improve male fertility by increasing sperm motility and regulate seminal plasma acid phosphatase levels (59). 

A review of premature ejaculation, for which Guan yuan is a key point, found that acupuncture is safe. The evidence quality was not strong enough to compare effects vs medication (selective serotonin reuptake inhibitor), but there was enough evidence to show it was useful, more effective than sham and that best results where when medication and acupuncture was combined (60)

Acupuncture can effectively activate the electrical activity of hypothalamic sexual arousal stimulation-related excitatory neurons. The closer the acupoint to the genital organs, the stronger is the excitatory effect, with lower abdomen points, Zi gong (EX-CA1), Guan yuan (REN4), then lower limb points, Zu san li (ST36), being the strongest of the 8 acupoints observed (61)

A systematic review for benign prostatic hyperplasia in the elderly shows acupuncture is effective and the key points are Zhong ji (REN3), Guan yuan (REN4) and San yin jiao (SP6) (62). 

Further to this, another review found that a combination of three points, of  Zhong ji (REN3), Guan yuan (REN4), Ci liao (BL32), San yin jiao (SP6), and Yin ling quan (SP9) for a minimum of four sessions, though further sessions lead to further increase on quality of life and urinary symptoms, is effective for chronic prostatitis/chronic pelvic pain syndrome (CPPS). The researchers found that it significantly improved urinary symptoms, quality of life and pain and prostatitis index (National Institute of Health-Chronic Prostatitis Index). The index and pain were reduced more so than medication and the quality of life marginally so. (63)

EA at Zhong ji (REN3), Guan yuan (REN4) and Da he (KI12), could relieve pelvic pain and reduce prostatic inflammation in estradiol-induced chronic non-bacterial prostatitis rats. The researchers noted ‘restored the histomorphology of the prostate, reduced the inflammatory factor levels, inhibited NF-κB p65 nuclear translocation, and downregulated the expression levels of critical proteins.’ Notably toll-like receptor 4 (TLR4), myeloid differentiation factor 88 (MyD88), inhibitors of kappa‐B alpha (IκBα), and nuclear factor-kappa B (NF-κB). Therefore, the underlying mechanism may be related to the inhibition of the TLR4/NF-κB signaling pathway (64)

Acupuncture at Guan yuan (REN4), Zhong ji (REN3), Hui yang (BL35) and San yin jiao (SP6) may also benefit CPPS by promoting an anti-inflammatory analgesia effect by preventing the activation of P2X7R/NLRP3 signal pathway, inhibiting the release of inflammatory cytokines (65).

Similarly, EA at Guan yuan (REN4), Zhong ji (REN3), San yin jiao (SP6) and Hui yang (BL35) 20 times, with a frequency of 2/100Hz could help mediate inflammation and pain in CPPS by regulating the expression of related genes on PI3K-AKT/JAK-STAT signal pathway in spinal cord dorsal horn (L5-S2) (66).

The above points benefit can also be viewed through their beneficial regulatory effects on the modulation of cAMP-PKA-TRPV1/PLC-PKC-TRPV1 signaling pathway (67)

On top of these functions a review pointed to regulation of immune factors, improvement in endocrine function, morphology of the prostate, increases in cellular energy, reduced oxidative stress and inflammation, improved microcirculation, improved zinc levels as well as improving urinary measurements (68)

Curiously, researchers found that some of the benefit for CP/CPPS might be achieved by reducing the gray matter volume in the left middle cingulate gyrus (69)

EA at [Guan yuan] reduced the levels of 5-hydroxytryptamine receptor 3 (5-HT3R), calcitonin gene-related peptide (CGRP), Bradykinin, Hyaluronic acid, Kininogen 1 (KNG1), prostaglandin I2 (PGI2), transforming growth factor-β1 (TGF-β1), intercellular cell adhesion molecule-1 (ICAM-1) and TNF-α, and increased IL-2 levels. Furthermore, EA at REN4 inhibited sympathetic activity by decreasing tyrosine hydroxylase (TH) expression and restored the synaptic connections between the pelvic nerves of the dorsal commissural neuron (70)

Acupuncture at Guan yuan or Zhong ji is more effective than San yin jiao for neurogenic bladder post spinal cord injury. The benefits were noted on neurogenic detrusor overactivity (71).

Acupuncture at Guanyuan (CV4), Zhongji (CV3), and Sanyinjiao (SP6) combined with mirabegron was effective for OAB treatment. This treatment combination was superior to mirabegron alone without significant increases in adverse effects (72).

Acupuncture is a useful modality for overactive bladder. Treatments should be based on Guan yuan, Gong sun (SP4) and tai xi (KI3). ‘The treatment course of acupuncture should be no less than 4 weeks and maintain the frequency of acupuncture no less than once a week. The duration of each session should be no less than 20 minutes.’ (73)

Acupuncture is also a good and safe option for post-partum urinary retention and is much more effective than intramuscular injection of neostigmine. The most commonly used points are San yin jiao (SP6), Zhong ji (REN3), Zu san li (ST36), Guan yuan (REN4), Yin ling quan (SP9), San jiao (CO17), Shui dao (ST28), and Zhi yin (BL67) (74). 

EA is a good option for urinary incontinence, being safe and effective and the most commonly used points are Yin tang (EX-HN1), Shen shu (BL23), Zhong ji (RN3), Guan yuan (RN4), Ci liao (BL32), San yin jiao (SP6), Bai hui (DU20) and Qi hai (RN6). (75)

The immediate relief effect of electroacupuncture at REN4, REN3 on detrusor overactivity was greater than at SP6. Again showing local points are great (76).

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