Research on the Mechanism and Application of Acupuncture Therapy for Asthma: A Review

Figures & data

Table 1 Information Associated with Key Acupoints

No.	Criticality	Standard Name*	Acupoints	Meridian	Location**	Application Principles^▲
1	Main acupoints	BL13	Feishu	Bladder meridian	On the upper back region, at the same level as the inferior border of the spinous process of the third thoracic vertebra (T3), 1.5 B-cun lateral to the posterior median line	Asthma; cough
2		LU1	Zhongfu	Lung meridian	On the anterior thoracic region, at the same level as the first intercostal space, lateral to the infraclavicular fossa, 6 B-cun lateral to the anterior median line	Asthma; cough
3		CV22	Tiantu	Conception vessel	In the anterior region of the neck, in the center of the suprasternal fossa, on the anterior median line	Asthma; cough
4		CV17	Danzhong	Conception vessel	In the anterior thoracic region, at the same level as the fourth intercostal space, on the anterior median line	Asthma; cough; oppression in the chest
5		LU6	Kongzui	Lung meridian	On the anterolateral aspect of the forearm, on the line connecting LU5 with LU9, 7 B-cun superior to the palmar wrist crease	Asthma; cough
6		EX-B1	Dingchuan	Extra points	In the back region, at the same level as the inferior border of the spinous process of the seventh cervical vertebra (C7), 0.5 B-cun lateral to the posterior median line	Asthma; cough
7		ST40	Fenglong	Stomach meridian	On the anterolateral aspect of the leg, lateral border of the tibialis anterior muscle, 8 B-cun superior to the prominence of the lateral malleolus	Asthma; cough; phlegm
8	Auxiliary acupoints	BL12	Fengmen	Bladder meridian	In the upper back region, at the same level as the inferior border of the spinous process of the second thoracic vertebra (T2), 1.5 B-cun lateral to the posterior median line	Cough; fever; pulmonary heat
9		BL11	Dazhu	Bladder meridian	In the upper back region, at the same level as the inferior border of the spinous process of the first thoracic vertebra (T1), 1.5 B-cun lateral to the posterior median line	Cough; fever
10		GV14	Dazhui	Governor vessel	In the posterior region of the neck, in the depression inferior to the spinous process of the seventh cervical vertebra (C7), on the posterior median line	Cough; asthma; heat symptom complex
11		LI11	Quchi	Large intestine meridian	On the lateral aspect of the elbow, at the midpoint of the line connecting LU5 with the lateral epicondyle of the humerus	Obstruction syndrome
12		SP3	Taibai	Spleen meridian	On the medial aspect of the foot, in the depression proximal to the first metatarsophalangeal joint, at the border between the red and white flesh	Splenic asthenia
13		BL20	Pishu	Bladder meridian	In the upper back region, at the same level as the inferior border of the spinous process of the 11th thoracic vertebra (T11), 1.5 B-cun lateral to the posterior median line	Edema; abdominal distension; diarrhea
14		ST36	Zusanli	Stomach meridian	On the anterior aspect of the leg, on the line connecting ST35 with ST41, 3 B-cun inferior to ST35	Asthma; cough; edema; yang deficiency syndrome
15		BL23	Shenshu	Bladder meridian	In the lumbar region, at the same level as the inferior border of the spinous process of the second lumbar vertebra (L2), 1.5 B-cun lateral to the posterior median line	Asthma; dysuria; edema
16		CV4	Guanyuan	Conception vessel	On the lower abdomen, 3 B-cun inferior to the center of the umbilicus, on the anterior median line	Yang deficiency (impotence, dysuria, diarrhea, etc.)
17		KI3	Taixi	Kidney meridian	On the posteromedial aspect of the ankle, in the depression between the prominence of the medial malleolus and the calcaneal tendon	Cough; asthma; deficiency of both qi and yin
18		BL15	Xinshu	Bladder meridian	In the upper back region, at the same level as the inferior border of the spinous process of the fifth thoracic vertebra (T5), 1.5 B-cun lateral to the posterior median line	Cough; cardiodynia
19		CV6	Qihai	Conception vessel	On the lower abdomen, 1.5 B-cun inferior to the center of the umbilicus, on the anterior median line	Yang deficiency (impotence, dysuria, diarrhea, etc.)
20		PC6	Neiguan	Pericardium meridian	On the anterior aspect of the forearm, between the tendons of the palmaris longus and the flexor carpi radialis muscles, 2 B-cun proximal to the palmar wrist crease	Cardiodynia; vomit
21		HT6	Yinxi	Heart meridian	On the anteromedial aspect of the forearm, radial to the flexor carpi ulnaris tendon, 0.5 B-cun proximal to the palmar wrist crease	Asthma; yin deficiency syndrome
22		KI7	Fuliu	Kidney meridian	On the posteromedial aspect of the leg, anterior to the calcaneal tendon, 2 B-cun superior to the prominence of the medial malleolus	Edema; deficiency of kidney yin
23		SP6	Sanyinjiao	Spleen meridian	On the tibial aspect of the leg, posterior to the medial border of the tibia, 3 B-cun superior to the prominence of the medial malleolus	Deficiency syndrome
24		LU7	Lieque	Lung meridian	On the radial aspect of the forearm, between the tendons of the abductor pollicis longus and the extensor pollicis brevis muscles, in the groove for the abductor pollicis longus tendon, 1.5 B-cun superior to the palmar wrist crease	Cough; asthma
25		LI4	Hegu	Large intestine meridian	On the dorsum of the hand, radial to the midpoint of the second metacarpal bone	Pain induced by heat symptom complex
26		LU10	Yuji	Lung meridian	On the palm, radial to the midpoint of the first metacarpal bone, at the border between the red and white flesh	Cough; asthma; fever
27		LU5	Chize	Lung meridian	On the anterior aspect of the elbow, at the cubital crease, in the depression lateral to the biceps brachii tendon	Cough; asthma
28		BL17	Geshu	Bladder meridian	In the upper back region, at the same level as the inferior border of the spinous process of the seventh thoracic vertebra (T7), 1.5 B-cun lateral to the posterior median line	Cough; asthma
29		LU9	Taiyuan	Lung meridian	On the anterolateral aspect of the wrist, between the radial styloid process and the scaphoid bone, in the depression ulnar to the abductor pollicis longus tendon	Asthenia of both lung and kidney; asthma

Notes: *Standard name, also known as WHO standard acupuncture point, collected from the book “WHO standard acupuncture point locations in the western pacific region”. **Locations, collected from the book “WHO standard acupuncture point locations in the western pacific region”. ^▲Application principles, collected from old Chinese medical books and clinical reports.

Table 2 Formula and Mechanism of Acupuncture Therapy for Asthma in the Last 10 Years

NO	Reference	Model	Acupoints	Acupuncture Parameters	Mechanism	Effects
1	Yu, 2023^Citation74	Rat	GV14; BL12; BL13	Once every other day	Reduce p-p38MAPK	Inhibit proliferation of ASMC
2	Tang, 2023^Citation75	Mouse	GV14, BL12, BL13	Once a day for 3 days	Reduce IL-4, IL-13, MDA, oxidized GSH, and the non-heme Fe^2+ level; downregulate the expression of ACSL4-15-LO1	Alleviate RL; relieve erastin-induced exacerbation of lung inflammation and lipid peroxidation in ferroptosis
3	Tang, 2022^Citation76	Rat	BL13; EX-B1; CV17	Catgut-embedding once	Reduce p38MAPK, ICAM-1, and IL-4	Inflammatory cells are absent from blood vessels; eosinophils are decreasing
4	Teng, 2021^Citation77	Mouse	GV14; BL12; BL13	Catgut-embedding once	Decrease IL-4, IL-13, and IgE in the BALF^#; downregulate the expression of p-NF-κB p65 and IFN-γ increase	The percentage of RL increases slower; the percentage of Cdyn decreases slower; the proliferation of ILC2s, leukocytes, eosinophils, lymphocytes, and neutrophils is inhibited
5	Yang, 2021^Citation78	Human	EX-B1; BL13; ST36; CV17	Catgut-embedding semimonthly	Decrease IgA and IgE in the serum	PEF, FEV1, MEF25%, MEF50%, MEF75%, and MEF25%–75% are higher than in the control group
6	Wang, 2022^Citation79	Human	LU9; LU7; LU5	Three times per week for 4 weeks	N/A	The scores of FEV1, PEF, Asthma control test, and Asthma Quality of Life Questionnaire increase
7	Zhao, 2021^Citation51	Mouse	GV14; BL13; ST36	Every other day for 13 days	Downregulate the expression of proteins and mRNAs related to autophagy (ATG5, Beclin-1, p62, and LC3B) and endoplasmic reticulum stress (p-PERK, p-IRE-1, Grp78, and ATF6); increase in IFN-γ and decrease in IL-4, IL-17, and TGF-β in the BALF, lung tissue, and serum	Inflammatory cells decrease; suppressed level of autophagy and endoplasmic reticulum stress; balance of Th1/Th2 and Treg/Th17; RL decrease
8	Qiao, 2021^Citation80	Mouse	BL13; LU1	Once daily for 2 weeks	Reduce IgE and IL-4 and increase IFN-γ; upregulate the expression of PI3K, Foxp3, and ROR gammat	Suppress inflammatory responses
9	Zheng, 2021^Citation81	Rat	GV14; BL12; BL13	Once a day for 7 days	Downregulate the expression of Bcl-2 and upregulate the expression of Fas	Reduce eosinophils and enhance apoptosis of eosinophils
10	Tang, 2021^Citation45	Mouse	GV14; BL12; BL13	Retained for 20 min	Reduce IgE, CCL5, CCL11, and IL-17A in BALF and IL-4, IL-5, and IL-13 in serum; downregulate the expression of SLC3A2 and ATP1A3; enhance the level of SOD and GSH, and lower the level of MDA	Relieve RL and enhance Cdyn; decrease the inflammatory score, PAS+ epithelial cells, and eosinophils
11	Hu, 2020^Citation46	Rat	GV14; BL12; BL13	Once a day for 7 days	Downregulate the expression of CCL1, CCR8, and STAT6	Reduce inflammatory responses
12	Cheng, 2021^Citation82	Human	LU9; LU7; LU5; HT3; HT6; HT7	Retained for 30 min	N/A	FEV1, PEF, The Self-rating Anxiety Scale, and Self-rating Depression Scale are improved
13	Yu, 2020^Citation83	Human	LU9; LU7; LU5; HT3; HT6; HT7	Three times a week	N/A	Improve the Asthma Control Test (ACT), the peak expiratory flow rate (PEFR), and forced expiratory volume in 1 s (FEV1)
14	He, 2021^Citation84	Rat	GV14; BL12; BL13	Once a day for 7 times	Downregulate the expression of FIZZ1, NOTCH1, and α-SMA	Inhibit the differentiation of fibroblasts, reduce the proliferation of smooth muscle
15	Cui, 2021^Citation43	Mouse	GV14; BL12; BL13	Every other day for 2 weeks	Reduce IL-5, IL-9, IL-13, IL-25, IL-33, and soluble IL-33 receptor (sST2)	Relieve RL and enhance Cdyn; decrease the inflammatory score, PAS+ epithelial cells, and eosinophils; inhibit the proliferation of ILC2s
16	Zhou, 2020^Citation85	Rat	GV14; BL12; BL13	Every other day for 13 days	Upregulate the expression of MT-2, Akt1, and CaMK2β; induced phosphorylation of 14 proteins is upregulated, while that of 37 proteins is downregulated	Relieve RL
17	Hua, 2020^Citation50	Rat	GV14; ST36; BL13	Retained for 20 min	Downregulate IL-5 and GATA-3 and upregulate IFN-γ and T-bet	Balance Th1/Th2; suppress inflammation responses
18	Chen, 2020^Citation86	Rat	GV14; BL12; BL13	30 min a day on every other day	Increase cAMP/cGMP and substance P; downregulate vasoactive intestinal peptide, neurokinin A, and neurokinin B	Alleviate neurogenic inflammation and hyperresponsiveness of the airway
19	S. Elsheikh, 2019^Citation87	Human	LU5; LU7; LU9; SP6; ST36; BL13; BL23; CV17; GV14	N/A	N/A	Relieve RL
20	Dong, 2019^Citation52	Mouse	GV14; BL12; BL13	Every other day for 4 weeks	Upregulate T-bet, FOXP3+, and IL-10, and reduce IL-5, IL-13, IL-17A, and RAR-related orphan receptor gamma t (RORγt)	Upregulate the cell numbers of CD4+ interferon gamma (IFN-γ)+, CD4+ Foxp3+, and CD4+ IL-17A+; balance CD4+ T cell subtypes
21	Nurwati, 2019^Citation88	Mouse	BL13; ST36	Three times a week for 6 weeks	N/A	Reduce neutrophils, eosinophils, and goblet cells; reduce thickness of the bronchioles
22	Liu, 2018^Citation89	Mouse	GV14; BL13; ST36	Once a day for three days	Reduce TGF-β1 in BALF and downregulate the expression of Smads, type-I, and α-SMA	Relieve RL
23	Dong, 2018^Citation90	Mouse	GV14; BL12; BL13	Every other day for 2 weeks	Reduce TNF-α, IL-1β, and IL-33; increase sST2	Relieve RL and enhance Cdyn; reduce the inflammatory responses, PAS+ epithelial cells, and CD4 +IL-17A+ (Th17) cells;
24	Han, 2018^Citation91	Human	LU6; EX-B1; BL13; LU10	Retained for 20 min	Reduce NGF and MMP-9	Upregulate Th1/Th17; relieve FEV1, PEF, FEV1/FEV
25	Chen, 2017^Citation92	Rat	BL13; BL23	Retained for 30 min, once daily for 14 days	Reduce IL-1β and IgE	Reduce CD8+ T cells; relieve inflammatory responses
26	Yang, 2017^Citation93,Citation94	Rat	GV14; BL13; BL12	Once every two days, for seven times	Downregulate the expression of Akt and p-Akt	Relieve inflammatory responses
27	Xu, 2017^Citation95	Rat	GV14; BL13; BL12	Acupuncture for 15 min or 30 min	N/A	Inhibit ACh-induced contractile responses of airway smooth muscle cells (ASMCs)
28	Yang, 2017^Citation96	Rat	GV14; BL13; BL12	Retained for 20 min, once other day	Downregulate the expression of PI3K	Relieve RL and Cdyn
29	A. Dabbous, 2017^Citation19	Human	CV17; LU5; LU7; LU9; ST36; SP6; GV14; BL13; BL23; LI4	Laser acupuncture for 2 min per point; three sessions per week	N/A	Relieve FEV1 and FVC
30	Wei, 2017^Citation97	Mouse	GV14; BL13; BL12	Every other day for 4 weeks	Reduce TNF-α, IL-1β, IL-5, and eotaxin; increase CORT and ACTH	Relieve RL and inflammatory cells, enhance Cdyn
31	Wang, 2016^Citation98	Rat	GV14; BL13; BL12	Retained for 20 min	Increase CORT	Relieve RL and eosinophils
32	Yu, 2016^Citation99,Citation100	Rat	GV14; BL13; BL12	Once other day for 14 days	Reduce TGF-β, c-fos; downregulate p-p38MAPK	Reduce leukocytes and eosinophils; relieve RL
33	Dong, 2015^Citation73	Mouse	GV14, BL12, BL13, BL23	Three times a week for 6 weeks	Reduce IL-17A, IL-4, and IL-5 in BALF and serum; increase IFN-γ and IL-10	Relieve RL and enhance Cdyn; lower inflammatory score
34	Wei, 2015^Citation53	Mouse	GV14; BL13; BL12	Every other day for 4 weeks	Reduce IL-17A, IL-17F, IL-22, and IgE; suppress the expression of IL-17R, RORγt, p65, and NF-κB kinase-α (IKKα)	Relieve RL and enhance Cdyn; reduce leukocytes, eosinophils, neutrophils, and CD4+IL-17A+ cell numbers, and increase CD4+Foxp3+ cell numbers in BALF
35	Ke, 2015^Citation101	Human	BL13; CV17; LI4; GV14; ST40; LU1; LU6	Once a day for three days	Reduce C-RP, Ig E, IL-1, IL-6, and TNF-α in the serum	Relieve the syndrome of asthma
36	Li, 2014^Citation102	Rat	GV14; BL13; BL12	Once a day for 10 days	Reduce TGF-β in the lung	Decrease the thickness of the airway wall and smooth muscle
37	Tang, 2014^Citation103	Mouse	GV14; BL13; BL12; EX-B1; BL23; BL20	Once a day for 7 days	Reduce thymic stromal lymphopoietin (TSLP) and GATA; increase T-bet	Decrease the thickness of the airway wall and smooth muscle
38	Ngai, 2013/ 2011^Citation104,Citation105	Human	BL13/LU7; LU9	N/A	N/A	Decrease the skin impedance and heart rate variability (LF/HF)/increase the skin impedance at LU7 and LU9
39	Fu, 2014/ 2013; Zhu, 2013; Tan, 2012^Citation10,Citation106–108	Human	LU1, LU5, LU7; LI11, LI4, ST25; LU5, LU7, LI4, ST25	Every other day, three times a week for 12 weeks	N/A	Improve PEF, FEV1, MEF25%, MEF50%, and MEF75%
40	Wang, 2014^Citation109	Rat	GV14; BL13; BL12	Once every two days, for seven times	Reduce p38MAPK	Reduce eosinophils
41	Yang, 2013^Citation71	Human	GV14; BL13; BL12	Once every other day for 5 weeks	Reduce secretory IgA (sIgA) and total IgA in the saliva and IgE in the serum	Reduce CD3+, CD4+, CD8+, IL-2R+ T lymphocytes, and eosinophils
42	Cui/ Yang 2013^Citation110,Citation111	Rat	GV14; BL13; BL12	Once a day for 7 days	Reduce pan-Ras and c-fos/ reduce c-fos and p38MAPK	Relieve the syndrome of asthma
43	Yin, 2010/ 2009^Citation112,Citation113	Rat	GV14; BL13; BL12	Five consecutive days	Reduce Dusp1, S100A9, and MT-2	Relieve the syndrome of asthma
44	Chen, 2012^Citation114	Rat	BL13, BL23, CV17; BL23; BL13, CV17	Catgut-embedding once	N/A	Relieve inflammatory responses
45	Wang, 2012^Citation115	Rat	GV14; BL13; BL12	Once two days for seven times	Reduce Cav3.3	Relieve inflammatory responses
46	E.R. Carneiro, 2010^Citation116	Rat	GV14, BL13, EX-B1, LU1, CV17, ST36, SP6	Every other day for 2 weeks	Increase IL-1, IFN-γ, and IL-4; reduce NO, IL-10, and LTB4	Balance Thl/Th2
47	Yan, 2010^Citation117	Rat	GV14; BL13; BL12	Once two days for seven times	Increase surfactant protein-A in BALF	Relieve the syndrome of asthma

Abbreviations: ^#BALF, bronchoalveolar lavage fluid; RL, airway resistance; Cdyn, lung dynamic compliance.

Figure 1 The mechanisms of acupuncture therapy in treating asthma.

Figure 2 Common acupuncture points and their locations.

Figure 3 Inflammation and cell recognition in asthma.

Figure 4 Intracellular mechanism involved in asthma.

Figure 5 Ligand–receptor chemical signaling pathway involved in asthma.

Figure 6 Data analysis of the collected data from literature.

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