‘Acupuncture [at Bai hui (DU20), Feng chi (GB20), Pi shu (BL20), Shen shu (BL23), San yin jiao (SP6) and Tai xi (KI3)] relieves the fatigue symptoms and the potential symptoms and improves the sleep quality in the patients of chronic fatigue syndrome. The effect mechanism is probably related to the decrease of the levels of IL-6 and INF-γ in serum.’ (1)

Acupuncture at Bai hui and Yin tang can help regulate the default mode network with sustained effects (5). 

Alzheimer’s Disease

EA (1mA, 2Hz) at Bai hui (DU20) and Shen shu, for 15 min, daily, 10 day as a course for a total of 4 courses, with an interval of 1 day, was shown to shorten the average maze escape latency, the number of platform crossing times was significantly increased, the average fluorescence intensity of NeuN and the number of NeuN-positive cells in hippocampus dentate gyrus region increased, the expression levels of Iba-1, TNF-α, IL-6 and IL-1β in hippocampus were decreased in Alzheimer’s disease rats and serious changes in morphology were somewhat reversed (6)

EA of Bai hui, Feng fu (DU16) and Shen shu can effectively improve the learning-memory ability in AD mice, which may be related to its function in inhibiting neuronal apoptosis in the hippocampus and down-regulating the expression levels of Aβ, Caspase 3 and Bax proteins in both hippocampus and cerebral cortex (7). 

Similarly researchers using Bai hui and Shen shu found that, with electroacupuncture, the, ‘can reduce inflammatory reaction and Aβ level, suppress activation of astrocytes and microglia, and up-regulate expression of AQP4 in the hippocampus tissue in APP/PS1 transgenic mice, which may contribute to its effect in improving recognition memory ability, suggesting a role of EA intervention in delaying the development of AD via promoting the drainage of Aβ by the glymphatic system in the brain.’ (8)

These points, plus Da zhui (DU14) also inhibit complement C1q-dependent microglial phagocytosis in the hippocampus, which was associated with improvements in memory and learning in age accelerated mice (9). 

Additionally, researchers found Shen shu and Bai hui was able to regulate hippocampal autophagy and removal of neurofibrillary tangles by suppressing PI3K/AKT/mTOR signaling pathway and thus improving memory and learning in Alzheimer’s disease rats (10). 

Bai hui and Shen shu, and for a stronger effect alongside metformin, ‘can improve cognitive ability and relieve senile plaques formation in cerebral cortex and hippocampus in Alzheimer’s disease (AD) mice, which may be associated with their functions in down-regulating the expression of βACE1 and up-regulating the expression of insulin-degrading enzyme.’ (11). 

EA at Bai hui, Feng fu and Shen shu can improve the learning-memory ability in AD mice, promote the proliferation and differentiation of endogenous neural stem cells towards neurons and inhibit the proliferation and differentiation of endogenous neural stem cells towards astrocytes in the hippocampus, which may be achieved by regulating Jagged1/Notch1 pathway (12).

EA, at Bai hui, Da zhui and Shen shu, can also improve myelination in Alzheimer’s disease rats which leads to improvements in the anxiety-like behavior and learning and memory ability of SAMP8 mice (13). 

EA at Bai hui and Si shen chong (EX-HN-1) reversed AD by suppressing neuroinflammation in the cortex and hippocampus. Part of the mechanisms could involve regulating Sphingosine-1-phosphate receptors and thus reducing the colocalized glial fibrillary acidic protein and ionized calcium-binding adaptor molecule-1 (14). 

Acupuncture at Bai hui, Shui gao/Ren zhong, and Yin tang can also help AD by ‘up-regulating SOD activity and GPX4 mRNA expression, and down-regulating MDA content and ptgs2 mRNA expression to reduce the lipid peroxidation in the process of ferroptosis [in the hippocampus].’ (15). 

EA at Bai hui, ‘attenuates cognitive deficits, modulates mitochondrial fusion and fission, and enhances autophagy via the PI3K/Akt pathway in a mouse AD model.’ (16)

The combination of human amnion-derived mesenchymal stem cells and acupuncture at Bai hui and Qu bin (GB7) provides a promising treatment for cerebral palsy, potentially alleviating brain damage through apoptosis regulation via normalized mRNA expression of Bax, Caspase 9, and Caspase 3. (17)

Acupuncture at 13 points of the Governor Vessel, Shen shu (BL23), Tai xi (KI3), Yang ling quan (GB34), Zu san li (ST36) and San yin jiao (SP6), Shen ting (DU24) Qian ding (DU21), Bai hui (DU20), and Si shen cong (Ex-HN 1) combined with rehabilitation therapy was better than that alone for children with cerebral palsy. The children in the acupuncture and rehabilitation group also showed more progress in cerebral development and lower levels of nerve damage (18)

Vascular dementia 

Acupuncture at Bai hui (DU20), Qian ding (DU21), Xin hui (DU22) and Shen ting (DU24) can upregulate the release of neurotransmitters such as acetylcholine (ACh), dopamine, and 5-hydroxytryptamine (5-HT) in hippocampus, improving the learning and memory functions of vascular dementia rats (19). 

EA of Bai hui (DU20), Feng fu (DU14) and BL23 can improve the recognition memory ability of mice with radiation-induced brain injury, which may be related to its effect in promoting the proliferation and differentiation of stem cells in the hippocampus (20). 

EA (6 times a week for a month) at Bai hui (DU20), Shen ting (DU24), Pi shu (BL20), Shen shu (BL23), Zu san li (ST36), San yin jiao (SP6), Fei shu (BL13), He gu (LI4) and Tai chong (LR3)  can improve the cognitive impairment of mice, as well as regulate body weight, blood glucose, and improve the cell morphology in the hippocampus, which may be related to its function in regulating the IRE1α-JNK pathway and related proteins (121)

‘EA at Bai hui, Da zhui and Shen shu can improve the learning and memory abilities of vascular dementia rats, alleviate the ultrastructural damage of neurons in hippocampal CA1 area, and repair the damaged neurons. The mechanism may be related to the reduction of reactive oxygen species level, LC3-Ⅱ/LC3-Ⅰ ratio, NLRP3 and Beclin1 protein expression, the decrease of neuronal autophagy, inhibition of activation of NLRP3 inflammasome and alleviation of central inflammatory response.’ (22)

Researchers looked into the mechanism behind acupuncture benefits for cognitive decline in vascular dementia, particularly at dopamine’s involvement in acupuncture benefits to neuroplasticity. They found that, ‘acupuncture remarkably reversed cognitive deficits in 2-vessel occlusion model (2VO) rats, and the acupuncture points Zusanli (ST36) and Baihui (DU20) were confirmed to be the most effective combination. Electrophysiological recording data showed that 2VO-induced impairments of long-term potentiation were prevented by acupuncture. In addition, acupuncture promoted the release of dopamine and its major metabolites in the hippocampus of 2VO rats. The immunofluorescence experiment showed that the decrease of D1R and D5R in hippocampal dentate gyrus region of 2VO rats was reversed by acupuncture. Furthermore, we found that the effects of acupuncture against 2VO-induced impairments in cognition and synaptic plasticity were abolished by SCH23390 [a D1 dopamine receptor antagonist]’ (23). 

Bai hui is also able to modulate BDNF expression in cognitive decline simulated mice (24). 

An interesting study on vascular dementia looked to add Bai hui, Shui gao (DU26) and Shen men (HT7), individually, or all together to a conventional 3 yang meridian points on the arms and legs. The researchers found that, ‘conventional acupoints plus DU20 could affect the inner temporal system, thalamencephalon system and prefrontal cortical system to improve memory and executive capacity of vascular dementia patients.’ Whereas, Shui gao mainly affected the prefrontal cortex and thus executive functions and Shen men would have similar but weaker effects to Bai hui, with a bit more benefit on memory. When combining all three plus conventional points it could, ‘effect rather roundly multiple aspects of the nervous system related to intellectual activities, to elevate the recognition and enhance the executive capacity.’ Again, we see when points are stacked together the effects are broader, to lead to better outcomes for patients (25).

EA at Yi feng (SJ17), Feng chi (GB20), Si shen cong (EX-HN1) and Bai hui (DU20) combined with Duxil, in patients with vascular dementia, was able to, ‘improve the patients’ social, daily living, and personality (emotional personality) abilities, reduced their serum homocysteine levels, increased the excitability of their cerebral cortexes, and improved the patients’ learning, memory and other recovery capabilities.’ (26)

Bai hui and Shen ting were also shown to regulate microvascular flow in VD rats. These effects may be down to ‘promoting angiogenesis, improving endothelial function and mitigating oxidative stress.’ This was shown in upregulating VEGF content and down-regulating the NO, iNOS and ET-1 contents (27).

Intracerebral haemorrhage (stroke)

A meta-analysis in Nature found that, ‘Baihui (DU20)-based scalp acupuncture could improve infarct volume and neurological function score and exert potential neuroprotective role in experimental ischemic stroke’ (28).

Acupuncture at Zu san li (ST36), Bai hui (DU20), Qian ding (DU21), Xin hui (DU22), Shen ting (DU24), Ge shu (BL17), Pi shu (BL20) and Shen shu (BL23) can increase the expression of proteins that maintain synaptic structures (PSD-95), enhance the levels of long term potentiation (important for neural plasticity, new connections and thus memory and learning), regulate the release of neurotransmitters/neuropeptides, enhance synaptic plasticity, and improve cognitive impairment after stroke. (29)

Acupuncture at Bai hui (DU20) and ST36 in rats after cerebral ischemia reperfusion injury can adjust the expression of heat shock protein 70 and TNF-α in the peripheral serum, which might be one of the mechanisms of acupuncture’s attenuation of cerebral ischemia reperfusion injury (30). 

Similarly EA of Bai hui and Zu san li was shown to improve neurological deficit and reduce cerebral infarct volume in CI rats, which may be associated with its functions in promoting angiogenesis in ischemic penumbra area and in up-regulating the activities of HIF/VEGF/Notch signaling pathway and related factors. (31)

Acupuncture from Bai hui to Qu bin (GB7) may be able to promote recovery of motor and sensory function, reduced the apoptotic cell percentage in the perihemorrhagic penumbra, and up-regulated Smo and Gli1 expression in post stroke rats. This may be via the sonic hedgehog pathway with is, surprisingly a real thing, a master pathway for adult neurogenesis, synaptic stability, myelination, and neurovascular health and links in with the BDNF–TrkB pathway, the PI3K–Akt–mTOR pathway and NF-κB signaling (32). 

This approach can also  improve neurological function and brain water content, and inhibit immunoreactivity and expression of Mincle, Syk, CARD9, and interkeukin-1β (33)

It also plays a role in nerve remodeling in stroke, possibly through promoting the expression of endogenous GDNF and early inhibiting the expression of VEGF (34)

And, modulates microglia polarization through miR- 34a-5p/Klf4 signaling (35).

Acupuncture at Bai hui penetrating Qu bin could also preserve blood brain barrier integrity and neurological function recovery after stroke by inhibiting RhoA/ROCK II/MLC 2 signaling pathway activation and regulating endothelial cell–related proteins (36).

These points also lead to increasing the expression of heme oxygenase-1 protein, reducing the volume of hematoma and the score of neurological deficit in rats with intracerebral hemorrhage, thus protecting the brain (37).

Acupuncture at Bai hui and Qu bin also, ‘effectively reduced hemorrhage and brain edema, elevated the expression levels of Nestin and basic fibroblast growth factor in the basal ganglia, and increased the number of Nestin- and glial cell line-derived neurotrophic factor-positive cells in the basal ganglia. Together, these findings suggest that acupuncture promotes functional recovery after cerebral hemorrhage by increasing the expression of neurotrophic factors’ (38). 

One of the key mechanisms for these points could be ‘reduc[ing] oxidative stress and neuronal apoptosis, at least in part, through the SIRT1/FOXO1 signaling pathway, improving neurological deficits and neuropathological damage after ICH’ (39)

Daily EA (4/20 Hz, 10 min/1 d) at Bai hui (DU20), Yin tang (EX-HN3), and Zu san li (ST36) for cerebral ischemia/reperfusion injury in rats can adjust the cell structure, further activate astrocytes, and increase the expression and phosphorylation of phosphoinositide 3-kinase/protein kinase B (PI3K/PKB or AKT) parts of the PI3K/ AKT signaling pathway (40).

EA (1-20Hz) at Bai hui and Shen ting (DU24) significantly relieves neurological deficits caused by cerebral ischemia/reperfusion injury, enhancing glucose uptake and metabolism in the injured cerebral hippocampus, which was likely mediated by the upregulation of glucose transporter genes GLUT1 and GLUT3 (4).

‘Electro-acupuncture at Bai hui and Shen ting can improve the learning-memory function in rats after cerebral ischemia-reperfusion, which may be associated with inhibition of P2X7 [purinoreceptor] to alleviate inflammation in hippocampus.’ (402)

A proteomic study showed that acupuncture at Bai hui, Da zhui and Ren zhong (DU26) can up and down regulate several protein pathways as well as key proteins in pathways related to restoration of brain tissue following ischemic injury, notably mitogen activated protein kinases, cell cycle, and apoptosis signaling pathways were particularly impacted and all more so than control (43). 

Acupuncture at Da zhui and Bai hui was shown to, ‘at 1 day postreperfusion, effectively downregulate astrocytic S100B expression to provide neuroprotection against delayed infarct expansion by modulating p38 MAP kinase-mediated NF-κB expression. These effects subsequently reduce oxidative/nitrative stress and inhibit the TNF-α/TRADD/FADD/cleaved caspase-8/cleaved caspase-3 apoptotic pathway in the ischemic cortical penumbra 7 days after reperfusion.’ (44)

‘Acupuncture and electroacupuncture [at Zu san li and Bai hui] significantly decreased infarct size and improved neurological function. Furthermore, target mRNA and protein levels and inflammatory cell infiltration were significantly reduced in groups [acupuncture and drug groups vs. control group]. However, MMP2/AQP levels and inflammatory cell infiltration were generally higher in groups A and EA than in group ED except MMP2 mRNA levels.’ (45).

‘Acupuncture can alleviate post-stroke spasticity effectively, which may be related to its effect in up-regulating the expressions of Na+/K+-ATPase and EAATs in the hippocampus. The anti-spastic effect of acupuncture at GB34+GV20 is superior to GB34 alone.’ (46)

Bai hui, Zu san li and Shui gao/Ren zhong reduce NF-κB pathway, NLRP3 inflammasome and pro-inflammatory cytokines in cerebral ischemic rats (47). 

Similarly, ‘Acupuncture [at Ya men (DU15), Feng fu (DU16), Bai hui (DU20), Shui gou (DU26), and He gu (LI4)] downregulates the expression of TLR4 and IKKα+IKKβ, inhibits the phosphorylation of IKKα/β and IκBα, reduces the nuclear expression of NF-κB p65, suppresses microglial M1 polarization, indirectly promotes M2 polarization, ameliorates neuronal damage after TBI, and promotes neural repair.’ (48)

Acupuncture at Bai hui can, ‘improve the neurological deficit signs of ICH mice, which maybe related to its function in regulating the mitochondrial function of brain tissue.’ The contents of GSH-Px and SOD were increased, while the content of MDA was decreased. A genomic analysis of this found that, ‘a total of 1097 differentially expressed genes were screened in the acupuncture group compared with the model group… 50 common differential genes were obtained after intersection with mitochondrial-related genes… of the screened differentially expressed genes revealed that the above differential genes were mainly enriched in the oxidative phosphorylation pathway.’ (49)

Acupuncture has also been shown to reduce cuproptosis, a newly discovered type of cell death related to excess copper binding to lipoylated proteins. Acupuncture at Bai hui, Da zhui and Shui dao/Ren zhong can reduce the volume of cerebral infarction and improve the symptoms of neurological deficit in CIRI rats, and its mechanism may be related to reducing the loss of FDX1 and LIAS proteins and inhibiting the surge of HSP70 protein, thus preventing cuproptosis in brain cells. (50)

EA at Bai hui and Shui gao/Ren zhong can also help reduce post stroke damage by, ‘inhibit[ing] the post-ischemic brain infiltration and activation of [natural killer] cells through STAT3 inhibition, significantly contributing to its therapeutic effects against brain ischemia.’ (51)

A proteomic analysis of rats with middle artery occlusion to cause cerebral ischemia reperfusion injury showed that acupuncture at Bai hui and Shen ting helped and that ‘the inter-synaptic regulatory proteins were the structural basis for the improvement of protein expression in MCAO rats by electroacupuncture.’ (52)

In a genomic study on EA at Bai hui and Zu san li for cerebral ischemia, researchers found , ‘18 significantly different genes related to atherosclerosis (AS), with their functions associated with lipid metabolism, thrombosis, monocytes and vascular smooth muscle cells. And, we detected 10 significantly different genes related to oxidative stress and apoptosis and 10 significantly different genes related to calcium overload and excitatory amino acids release. Also, we detected 19 significantly different genes related to blood-brain barrier (BBB) and 22 significantly different genes related to inflammatory response.’ (53)

EA at Zu san li and Bai hui also, ‘ exerts a neuroprotective effect, possibly via the regulation of the EPO-mediated JAK2/STAT3 cell pathway and downstream apoptotic pathways in a rat CIRI model.’ (54)

Xingnao Kaiqiao needling technique, primarily at Yin tang (EX-HN3), Shang xing (DU23), Bai hui (DU20), Si shen chong (EX-HN1), Feng chi (GB20), Tai chong (LR3) as well as hyperbaric oxygen can significantly improve the low-perfusion of bilate-ral semi-oval center and daily living ability in patients with delayed encephalopathy after carbon monoxide poisoning, more so than hyperbaric oxygen alone (55). 

Addiction

Acupuncture at Bai hui with moxibustion at Shen shu (BL23) can improve pathological changes in the synaptic ultrastructure of heroin re-addicted rats. This may be related to their effect in regulating the expression of synaptic skeleton proteins and genes – notably acupuncture up-regulated Arc protein and mRNA and the down-regulated MAP-2 and Tau (56)

Acupuncture at Bai hui and Da zhui (DU14) showed similar benefits, reversing pathological damage in the hippocampus and frontal lobe. This was achieved by reducing apoptosis by upregulating Bcl-2 expression and downregulating Bax expression (57).

Additionally, EA at Bai hui and Da zhui (DU14) alleviates cocaine-induced seizures and mortality in mice. The dopamine D3 receptor is involved, at least in part, in the anticonvulsant effects of EA in mice (58)

Acupuncture, primarily at Bai hui, Si shen chong (EX-HN-1) and Shen ting (DU24) may be able to help post Covid 19 patients with brain fog by improving memory, concentration and attention; restoring healthy function of the brain, liver, kidneys and spleen; and improving the patients’ physical condition and quality of life (59)

“Electroacupuncture at Baihui acupoint could effectively increase mRNA expression of molecules involved in NeuroD in the brains of newborn rats exposed to in utero fetal distress.’ (60)

Acupuncture at Bai hui and Yin tang might improve cognitive and behavioral abilities by increasing the expression of taurine transporter and taurine expression in the hippocampus and cerebellum (61).

Acupuncture at, ‘Baihui (DU20) and Fengchi (GB20) can regulate migraine by regulating inflammatory factors and HMOX1, AKT1, STAT3, P-ERK1/ERK2 and other changes in HIF-1 signaling pathway, signaling by interleukins and inflammatory response pathways.’ (62).

​​’Acupuncture intervention [at Bai hui and Da zhui] is effective in reducing the apoptosis of hippocampal neurons in convulsion rats, which may be related to its functions in down-regulating Caspase-12 expression and promoting influx of Ca2+ in the hippocampal neurons.’ (63)

Additionally ‘Acupuncture [at Bai hui and Da zhui] can significantly up-regulate the expression of MAP-2 and GAP-43 proteins in hippocampal neurons, which may play a positive role in improving synaptic plasticity and neuronal damage in convulsion rats.’ (64)

An interesting study comparing acupuncture with electroacupuncture, at Zu san li and Bai hui, found that, ‘’both acupuncture and electroacupuncture increase neurogenesis in the normal [rat hippocampus], but that electroacupuncture has greater effects on neuroblast plasticity than acupuncture in the dentate gyrus.’ (65)

Curiously acupuncture, at Xuan zhong (GB39), Bai hui (DU20), Shen men (HT7), Shen ting (DU24), and San yin jiao (SP6), also improves memory and learning in herpes simplex virus type-1 infected rats. ‘The functional mechanism of acupuncture may be through the p38 MAPK/CREB pathway.’ (66)

A review of acupuncture for epilepsy found that, ‘The main anti-epileptic pathways of the core acupoints were predicted by KEGG enrichment, including lipid and atherosclerosis, neurodegeneration, phosphatidylinositol-3-kinase/protein B kinase signaling pathway, mitogen-activated protein kinase signaling pathway, cyclic adenosine monophosphate signaling pathway, TNF signaling pathway, IL-17 signaling pathway, hypoxia-inducible factor-1 signaling pathway, apoptosis, etc., involving neuronal death, synaptic plasticity, oxidative stress, inflammation and other related biological process.’ The key points were Bai hui (DU20), He gu (LI4), Nei guan (PC6), Shui gou (DU26) and Tai chong (LR3) (67).

Acupuncture can also be beneficial for Parkinson’s Disease. Researchers found that 20 days of daily acupuncture at Bai hui, He gu (LI4) and Tai chong (LR3) led to, ‘significantly improved motor and cognitive function, reduced apoptosis, preserved dopaminergic neurons, increased tyrosine hydroxylase expression, and suppressed NLRP3 inflammasome activation.’ (68)

Daily acupuncture for 20 mins at Bai hui (DU20) Tian shu (ST25), Shang ju xu (ST37), Zu san li (ST36), and Tai chong (LR3) for two weeks can improve the general and emotional state, inflammatory response, and neuropeptide expression in rats with IBS-D, and alleviate the symptoms of IBS-D, which may be related to the regulation of neuropeptides and inflammatory factors levels, notably; interleukin-10, tumor necrosis factor-α, calcitonin gene-related peptide in the hypothalamus and colon tissue and corticotropin-releasing factor(CRF) in the hypothalamus and colon tissue (69). 

Electroacupuncture at Bai hui, Shen ting and Si shen chong can increase regional cerebral oxygenation (rSO2) levels in patients with diabetes (70)

‘Acupuncture [primarily at Baihui (GV20), Sishencong (EX-HN1), and bilateral Fengchi (GB20), Xuanzhong (GB39), Zusanli (ST36), Yanglao (SI6), Xinshu (BL15)] could improve cognitive dysfunction in patients with MCI, and its mechanism may be related to increasing the relative abundance of butyrate-producing bacteria such as Faecalibacterium, Clostridia, and Ruminococcaceae, maintaining the intestinal barrier, and inhibiting related inflammatory responses.’ (71)

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. (72)

The abnormal functional connectivity between the hypothalamus and whole brain regions may be one of the central pathological factors of premature ovarian insufficiency (POI). Acupuncture, at Bai hui (DU20), Zhong wan (REN12), Shen ting (DU24), Shen shu (BL23), Ci liao (BL32), can improve the ovarian function and clinical symptoms of patients with POI, which may be related to its effect in regulating the FC between the hypothalamus and multiple brain regions (73).

Acupuncture, alternating between the protocol of Bai hui (DU20), Shen ting (DU24), Guan yuan (REN4), Ben shen (GB13), Huang shu (KI16), Da he (KI12), Luan chao (Extra), Zu san li (ST36), San yin jiao (SP6), Tai xi (KI3), Tai chong (LR3) and the protocol of Shen shu (BL23) and Ci liao (BL32) benefitted patients with diinished ovarian reserve leading to evels of FSH, FSH/LH decreased, and the levels of estradiol (E2) and antral follicle count (AFC) increased and a 15% pregnancy rate (74). 

Acupuncture at Tai xi (KI3), Tai chong (LR3), Tai bai (SP3), San yin jiao (SP6), Shen shu (BL23), Gan shu (BL18), Pi shu (BL20), Guan yuan (REN4) is more effective than Bai hui (DU20), Guan yuan (REN4), Shen shu (BL23), Tai xi (KI3), San yin jiao (SP6) for perimenopausal symptoms across clinical scores as well as showing a stronger effect on regulating the hormones; estradiol, follicle stimulating hormone and luteinizing hormone (75)

‘Acupuncture [at Bai hui, Guan yuan (REN4) and Zu san li] and moxibustion may enhance the humoral immune response (diphtheria antitoxin titer) and cellular immune response (peripheral blood CD4+T/CD8+T cell ratio) by increasing the expression of the endogenous adjuvant HSP70 mRNA, suggesting that acupuncture may serve as a new vaccine adjuvant.’ (76)

Acupuncture, at Baihui (GU20), Shenshu (BL23), Ganshu (BL18), and Sanyinjiao, daily for 4 weeks, alleviates perimenopausal depression through dual regulation of sex hormone homeostasis (elevating serum estradiol while suppressing follicle stimulating hormone, luteinizing hormone, and gonadotropin-releasing hormone) and activation of the PI3K/AKT/mTOR pathway, suggesting a potential mechanism for its antidepressant effects in perimenopause (77).

EA at Bai hui, Shen men (HT7) and Tai chong (LR3) can help rats with chronic stress induced depression by ‘inhibit[ing] inflammatory response and oxidative stress, which may be related to its functions in activating Nrf2.’ (78)

Acupuncture at Bai hui and Yin tang have some similar effects, ‘[it] could inhibit the expression of NLRP3 inflammasome signal pathway in the pre-frontal cortex, and reduce the inflammation in the brain, which may mediate the anti-depressant effect of acupuncture.’ (79)

EA (2 Hz/100 Hz, 1 mA) at Bai hui (DU20), Shen ting (DU24) and Shen shu (BL23) for 20 min, daily for 21 days, can improve the motor activity in PTSD rats, which may be associated with its effect in increasing the binding ability of CREB to the synaptic key protein PSD95 to regulate the interaction between the synaptic plasticity and BDNF-TrkB signaling pathway of the amygdala and hippocampus. In simpler terms, EA at those points helps “rewire” the traumatized brain — it restores healthy communication between neurons in key emotional centers (amygdala, hippocampus) by boosting BDNF signaling and synaptic plasticity via CREB–PSD95 interactions. (80)

As above, EA at Bai hui and Da zhui (DU14) improves PTSD-like behaviors such as, social avoidance and anxiety-like behaviors. It also improves astrocyte activation, and lipocalin 2 expression. The researchers concluded that their findings, ‘indicate that lipocalin 2 expression in the brain may be an important biomarker for the development of PTSD-related symptoms.’ (81)

Acupuncture at Bai hui and Yin tang can help in eliminating PTSD-like behavior and that might be connected with reversing the pathological process of the inflammatory response mediated by the activation of microglia induced by single prolonged stress rats (82).

‘Acupuncture at San yin jiao (SP6) and Bai hui (DU20) can reduce the spontaneous activity and impulsivity, and improve learning and memory ability of ADHD model rats, which may be related to elevated contents of noradrenalin and 5-hydroxytrypamine in the pre-frontal cortex.’ (83)

Shallow needling at Bai hui alone can help patients with depression, to a similar level as oral paroxetine tablets. Comparatively, Bai hui is more effective in improving neurological function and cerebral perfusion, and the incidence of adverse reactions is lower (84).

‘EA at GV20 induced increased functional connectivity (FC) between the precuneus/posterior cingulate cortex (PC/PCC) and bilateral anterior cingulate cortex (ACC), and decreased FC between the PC/PCC and left middle prefrontal cortex, left angular gyrus and bilateral hippocampus/parahippocampus (HIPP/paraHIPP) in patients with major depressive disorder, which were the main brain regions showing significant differences between the patients and healthy subjects.’ (85)

Additionally, ‘compared to healthy subjects, MDD patients had aberrant intrinsic amygdala networks (AN) which mainly showed increased FC between amygdala and hippocampus, precuneus, precentral gyrus and angular gyrus, as well as decreased FC between amygdala and orbital frontal cortex (OFC). Moreover, our results indicated that EA at GV20 induced increased/decreased FC between amygdala and certain regions in MDD patients. In addition, the intrinsic amygdala FC within other certain brain regions in MDD patients were regulated by EA at GV20.’ (86).

Researchers also showed that, ‘​​acupuncture at Baihui (GV20) and Shenting (GV24) may alleviate depressive symptoms and reduce work- and life-related burdens and stress by regulating the CaMK signaling pathway.’ (87)

Acupuncture at Bai hui (DU20), Qian ding (DU21), Xin hui (DU22), and Shen ting (DU24), the lower 2/5 of the motor and sensory area of Jiao Shunfa, and sensory stimuli (sensitive area) on the opposite side of the face was used for patients with temporomandibular jaw disorder and was useful for pain relief, though not so for quality of life or sleep (88). 

‘Acupuncture protects postoperative cognitive function in older patients undergoing hip replacement, potentially reducing the incidence of POCD by upregulating miR-124 and miR-146a to inhibit neuroinflammation.’ Part of the benefit here would be controlling NF-κB–mediated neuroinflammation (89). 

It also attenuates central nervous system lesions, shortens post operative hospital stay and post operative delirium and improves post operative cognitive function as well as reducing neuron specific enolase and S-100β concentrations (90).

EA at DU20 demonstrates superior modulation of brain activity and enhanced antidepressant and analgesic effects compared to ST36 in rats with induced trigeminal neuralgia. The researchers also found that 2Hz modulation was superior to 100Hz (91). 

EA at Bai hui and Shui gao/Ren zhong thus triggering the trigeminal nerve can also open the blood brain barrier (BBB). ‘Brain NMDA receptors play a mediating role in promoting BBB permeability during EA of the trigeminal nerve, which may affect the expression of the [tight junction] protein occludin, and thus alter BBB permeability.’ (92) 

‘EA [at Bai hui and Shen shu (BL23)] can inhibit the over-expressions of IL-1β and α-SMA and increase the expression of IL-4 in aging renal tissue, which may contribute to its effects in delaying renal aging. Inhibiting the PI3K/Akt signaling may be one of the possible mechanisms of EA anti-renal fibrosis.’ (93)

Electroacupuncture at Xue hai (SP10) and Bai hui (DU20) significantly alleviated psoriasis by reducing skin lesions and epidermal thickness. This was likely achieved by reducing keratinocyte proliferation, CD3+, CD4+, and CD8+T cells infiltration. The mechanisms is, at least in part, mediated by inhibiting the expression levels of substance P and its receptor NK1R (94)

Acupuncture, 3 times a week for 10 session, at Bai hui (DU20) Shen shu (BL23), Tai xi (KI3), An mian (Extra) improves sleep in patients with perimenopausal insomnia; improving sleep quality, sleep latency, sleep duration, sleep efficiency, hypnotic, daytime dysfunction (95), this was corroborated in another stud2 (96).  

Electroacupuncture at Bai hui, Shen men and San yin jiao can regulate IL-1β, PGD2, melatonin, IL-10, IL-6, TNF-α, IFN-γ and cortisol in insomniac rats. As well as regulating the expression of TrkB, PI3K, Akt, P-TrkB, p-Akt, cAMP, CREB, and BDNF, apoptosis-related Bax, Bad and Caspase-3, and the monoamine neurotransmitters 5-HT, dopamine, norepinephrine and epinephrine, ‘taken together, these data illustrate the potential of DU20, HT7 and SP6 as a multitargeted therapy for insomnia in rats’ (97).

‘EA at the single acupoints Baihui (GV20), Shenmen (HT7), or Sanyinjiao (SP6) had an ameliorating effect on the spatial learning and memory deficits induced by insomnia. EA at combined acupoints exerted a synergistic effect on the improvements in spatial learning and memory impairment in rats with insomnia by upregulating the hippocampal PKA/CREB and BDNF/TrkB signaling, facilitating neurogenesis, and inhibiting neuronal apoptosis. These findings indicate that EA at combined acupoints [(Baihui (GV20), Shenmen (HT7), and Sanyinjiao (SP6)] achieves a more pronounced regulation of hippocampal neuroplasticity than EA at single acupoints, which may partly explain the underlying mechanisms by which EA at combined acupoints exerts a better ameliorative effect on the cognitive dysfunction caused by insomnia.’ (98)

‘EA [at Bai hui and Da zhui] can improve the learning and memory of sleep deprivation rats, which may be related to its function in regulating the expressions of synaptic related proteins PSD95 and MeCP2, and improving the synaptic structure.’ (99)

‘EA treatment at Bai hui has a protective effect on sleep-deprivation-induced depression-like behavior and cognitive impairment, which may be through regulating BDNF/TrkB protein expression.’ (100)

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