Observation of the immediate effect of ultrasound-guided acupuncture at Zusanli (ST36) point on Blood flow volume in lower limb arteries: a randomized controlled trial study protocol

Observation of the immediate effect of ultrasound-guided acupuncture at Zusanli (ST36) point on Blood flow volume in lower limb arteries: a randomized controlled trial study protocol | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Study protocol Observation of the immediate effect of ultrasound-guided acupuncture at Zusanli (ST36) point on Blood flow volume in lower limb arteries: a randomized controlled trial study protocol Jie Tu, Yongkang Sun, Shuet Ling Chung, jinling dai, Rong Zhang, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4362173/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The Zusanli(ST36) point, as one of the key health care points, has a wide range of indications and various effects. Given its effectiveness in regulating qi and blood flow, we investigated its direct impact on the arteries of the lower limbs. Earlier research indicates that the ST36 may enhance blood flow to the anterior tibial artery, yet there's a need to refine its research methodology and key findings. Consequently, our objective was to thoroughly investigate how the ST36 influences the blood flow dynamics in the arteries of the lower limbs. Methods This is a randomized, single-blind, and parallel controlled study. Participants will be evenly distributed in a 1:1 ratio between the interventional group (true acupuncture guided by ultrasound) and the control group (sham guided by ultrasound). Key metrics such as blood flow volume, peak systolic velocity, arterial diameter, and C-MASS evaluations will be documented and monitored pre and post-treatment. Ultimately, the analysis of the data was conducted utilizing the SPSS 25.0 software. Discussion Through this study, we aim to gain a deeper understanding of the hemodynamic effects of ultrasound-guided acupuncture at ST36, and hope to provide new treatment methods and scientific basis for lower limb arterial vascular lesions. Trial registration Chictr.org.cn Identifier: ChiCTR2400080275 Registered on 25 Jan 2024 Ultrasound guidance Zusanli(ST36) blood flow volum immediate effect lower limb arteries Figures Figure 1 Figure 2 Introduction Acupuncture, a primary therapeutic approach in China, has gained global recognition and application in the past few years [ 1 ] .A study report [ 2 ] reveals that 80% of nations have acknowledged their effectiveness. Within the U.S., acupuncture is licensed in 44 out of 50 states, with 3 to 6 million Americans getting acupuncture treatment annually. Owing to the potential adverse effects of overuse of drugs and the necessity for continuous treatment and recovery from complex chronic illnesses, there is a global search for a non-toxic, secure, and efficacious therapy. Consequently, acupuncture, known for its low side effects, enjoys global acceptance [ 3 ] . ST36 is an important acupoint widely used in traditional Chinese medicine, and its importance has been proved from ancient medical records to modern studies. Ancient Chinese medical records indicate that [ 4 ][ 5 ] ST36 has a wide range of indications, with functions such as tonifying the body’s righteousness and expel pathogenic, nourishing the internal organs and nourishing qi, regulating qi and blood, promoting meridians and activating collaterals, and clearing the internal organs and resolving phlegm. It is considered as an important acupoint for strengthening the body and promoting health [ 4 ][ 5 ] . Previous studies have shown [ 6 ][ 7 ] that acupuncture on ST36 in healthy people can significantly improve the blood perfusion of local skin; increase the mean blood flow velocity and beat index of bilateral posterior cerebral arteries to improve the cerebral blood flow supply. Therefore, ST36 is proved to improve blood circulation effectively. Aiming to understand the role of acupuncture in hemodynamic aspects, we have conducted this study to observe the immediate effect of lower limb artery blood flow velocity by acupuncture at ST36 guided by ultrasound device, so as to provide new treatment for the vascular lesions of lower limb arteries and scientific basis. Ultrasound-guided acupuncture therapy is an innovative means combining traditional Chinese medicine therapy with modern medical technology, providing a more accurate and safe operation mode for clinical practice. The ultrasound-guided technique can display the acupoints and the surrounding tissue structure in real time [ 8 ] , which enhances the deqi sensation of the subjects and the accuracy of the operator. This provides a unique opportunity for the investigators to more finely observe the effect of acupuncture on vascular blood flow velocity. With the gradual promotion of ultrasound guidance technology [ 9 ] , exploring the immediate effect of ST36 acupuncture on the blood flow velocity of lower limbs arteries not only helps to better understand the biological expression of traditional TCM theory, but also provides a more scientific basis for the clinical application of this treatment. Materials and methods Study design This study is a randomized, single-blind, parallel controlled study to investigate the effect of ultrasound-guided acupuncture on the immediate effect of lower limb arterial blood flow velocity in healthy subjects. Subjects who met the criteria and signed the informed consent were randomly divided into trial and control groups, and relevant data were recorded immediately before and after acupuncture. The flowchart of the study design is shown in Fig. 1 , and the evaluation time points are shown in Table 1 . This trial will strictly follow the Reporting Standards for Clinical Trials of Acupuncture [ 10 ] . Table 1 Schedule of enrollment, intervention, and assessment pour: "X" in this table represents the items that must be completed. Participants 3.1 Recruitment Strategies Participants in this study will be recruited from Shanghai Seventh People’s Hospital’s Outpatient Department, and the recruitment efforts are carried out via posters and various other mediums. Participants or their relatives will be engaged in verbal discussions with prior to inclusion. Individuals who fulfilled the specified requirements and planned to join the study were confirmed by a physician and they are required to provide their signatures on the informed consent form. 3.2 Inclusion Criteria (1) No medical confirmed disease; (2) Age: 20–40 years old (including 20 years old and 40 years old); (3) Did not take any drugs within one week before the test; (4) Willing to cooperate, high compliance, sign informed consent. 3.3 Exclusion Criteria (1) Patients with previous lower limb artery and venous vascular diseases; (2) Patients with previous abnormalities in the heart, liver, lung, kidney, brain and other important human organs; (3) Patients with previous mental illness and poor compliance; (4) Serious fear of acupuncture; (5) Pregnant or lactating women. 3.4 Elimination criteria (1) Those who are not found to meet the above inclusion criteria after enrollment; (2) Patients with poor compliance, ineffective explanation by the researchers, and who are unwilling to receive treatment according to the regulations; (3) During the experiment, the subjects have serious adverse reactions and special physiological changes, and should not continue to accept the test. Sample size The study was designed as a randomized, single-blind, parallel controlled trial with the significance level of α = 0.05, type II error (β) of 0.2, and test efficacy of 80%. The sample size was calculated according to similar study [ 11 ] , the ratio of test group to control group was 1:1, and 15% shedding rate was considered in each group. 66 patients will be randomly assigned to either the trial group or the control group. Ethics and Trial Registration The study protocol is in accordance with the Declaration of Helsinki and the Ethics Guidelines for Clinical Research. This study has been reviewed by the Clinical Research Ethics Committee (2024-7th-HIRB-006) of our hospital and is registered in the Chinese Clinical Trials Register (CCTR) (registration number: ChiCTR2400080275). All subjects will be informed of the study plan and potential risks and will sign a written informed consent before enrollment. They will be able to suspend or withdraw from the trial at any time during the course of the study. Randomization and Blinding Block randomization will be used in this experiment. Independent investigators who did not contact with the subjects will use SPSS25.0 to generate a random number table to divide the 66 eligible subjects in a 1:1 ratio between the experimental and control groups. The investigators will not participate in the randomization, the efficacy evaluator will be unaware of the study group protocol, and the data statistician will have no role in the design or implementation of the study. Interventions Interventional Group No direct sunlight is allowed in the laboratory. Patients are instructed to expose their lower limbs and lie on the hospital bed. The sonographer used a Doppler detector(PHILIPS,Netherlands,Affiniti 70W model) to measure the blood flow volume, peak systolic velocity and arterial diameter of the artery before needle puncture in the anterior tibial artery and dorsalis pedis artery before acupuncture. The ST36(Fig. 2 ) was located according to the World Health Organization standard Acupuncture acupoint positioning (Western Pacific Region). After routine disinfection of the site, the acupuncturist uses a 0.30x40mm stainless needle(Gushi Gongyuan Medical Devices Co.,Ltd.) with the help of a sonographer to acupuncture the deep fascia layer under ultrasound guidance. After 5 minutes, the sonographer detected the blood flow volume, peak systolic velocity and arterial diameter of the subjects again after acupuncture in anterior tibial artery and dorsalis pedis artery. Control Group Opt for a non-acupoint(Fig. 2 ) [ 12 ] , which is 3cm away from the ST36, and do not perform any manual treatment after needle insertion. The remaining environmental requirements and operating methods are the same as those of the interventional group. Outcome assessments Primary outcome Peak systolic velocity is the main index of this study and can be measured directly using the Doppler ultrasound diagnostic instrument. Measure and record before and after acupuncture. Secondary outcomes Secondary measures include blood flow volume, arterial diameter, and C-MASS volume meter. The maximum blood flow and arterial diameter can be measured directly by using Doppler diagnostic instrument, measure and record before and after acupuncture; C-MASS [ 13 ] is the acupuncture sensory scale of Massachusetts General Hospital, and the subjects will be assessed according to this scale after five minutes of acupuncture. Data management and quality control Considering that patients predominantly provide outpatient medical records in China, the “Study Case Report Form (CRF)” aims to fully safeguard the direct data from clinical trials. The CRF serves as the source document for participants in clinical trials and ought to be maintained within the hospital. Data collected throughout the study will be recorded in the study case report form, and any modification to the study protocol will be requested in advance and approved by the ethics committee of our hospital. A quality control team will be set up and the team members are responsible for regular or irregular monitoring visits and data verification of the research team. During the inspection, the study will be stopped if a protocol violation is found. All data will be stored in separate storage rooms to ensure data confidentiality and reliability. Access to the database will be limited by the investigators of this research team. The subject's information is not publicly available and shared without the subject's written permission. Statistical analyses All data in this study were analyzed and processed using SPSS25.0 software, and P < 0.05 was considered as statistically significant. If the measurement data meet the normal distribution, it is expressed as the mean ± standard deviation (‾x ± S). The correlation between the two groups was analyzed by independent sample t- test and paired t- test for intra-treatment; if the data does not meet normal distribution, the median and quartiles were expressed by the rank sum test, Median(Quartiles)[M (P25, P75)]. The counting data were expressed in terms of case or frequency, composition ratio and rate, and the cross-table χ 2 test was applied for the correlation analysis between the two groups. Rank sum test was used for rank data. Discussion This study is a randomized, single-blind, parallel controlled clinical trial, aiming to observe the immediate effect of acupuncture on lower limb arterial vessels in healthy subjects and to provide evidence for acupuncture treatment of vascular lesions in lower limb arteries. Therefore, this study established an interventional group and a control group to observe whether acupuncture at ST36 can cause changes in the hemodynamics of lower limb arterial blood vessels. According to the theory of acupuncture and moxibustion in traditional Chinese medicine, ST36, as the junction point of the Stomach Meridian of Foot Yangming. ST36 can promote the operation of blood, and thus nourish the lower limb blood vessels, and its effect is remarkable and extensive [ 14 , 15 ] . Therefore, acupuncture at ST36 can promote local blood circulation, and is expected to produce the effect of improving blood circulation. According to modern anatomy [ 16 , 17 ] , the anterior tibial artery runs between the tibialis anterior and the extensor digitorum longus, while the dorsalis pedis artery separates from the anterior tibial artery, and the squeezing of the two muscles will cause"arterial stop"caused by spasm of the tow muscles and patients with coldness on back of the foot, acupuncture the gap between the tibialis anterior and the extensor digitorum longus to stimulate myofacia, thus reduce muscle tension, reduce the extrusion of blood vessels, improve blood circulation. Earlier research [ 18 ] indicates that acupuncture enhances blood circulation in the anterior tibial artery and markedly boosts blood supply. This discovery reinforces the regulatory role of ST36 in blood flow. Additionally, decreased blood circulation in the lower extremities impacts the occurrence of arterial vascular disease in these limbs [ 19 ] . LEAD (Lower extremity arterial disease, LEAD), also known as lower extremity peripheral artery disease (lower limb peripheral artery disease, PAD), or lower extremity PAD, belongs to a large PAD family. This disease is a chronic obstruction characterized by reduced blood flow to the downward limb artery, leading to ischemia, which may accompany with thromboembolism [ 20 ] . The survey indicates that approximately 200 million individuals globally suffer from lower limb arterial vascular lesions (LEAD) [ 21 ] . This condition represents not just a localized form of systemic arterial lesions, but also forms part of peripheral arterial lesions. In clinical terms, the initial phases of LEAD typically exhibit no clear symptoms. Nonetheless, with the advancement of the illness, the patient might experience sporadic symptoms in the lower extremities and progressively suffer from pain at rest, culminating in gangrene at the extremity. Additional symptoms encompass undernourishment in the skin of the lower extremities, muscle wasting, dry skin, and reduced elasticity. From a clinical perspective, one can notice a reduction in skin temperature, pigmentation, and a diminished or non-existent acroartery pulse [ 22 ] . LEAD ranks as a frequent long-term complication associated with diabetes mellitus. Among LEAD patients, approximately 20–30% had diabetes in the study population, 25–90% of amputations were diabetes-related [ 23 ] . Findings from Professor Ji Linong's survey at Peking University People's Hospital revealed that 21.2% of diabetic patients in China suffer from LEAD [ 24 ] . Research conducted across multiple centers in China revealed a 19.5% occurrence of LEAD in diabetic patients aged over 50 [ 25 ] , in contrast to a single-center study which indicated a higher rate of 35.4% in diabetic patients over 60 years with LEAD [ 26 ] . Presently, LEAD's clinical treatments encompass endovascular therapy, pharmacotherapy, rehabilitation, surgical procedures, and cellular therapy [ 27 ] . While these therapies have demonstrated efficacy in enhancing LEAD patients' symptoms and outlook, the expense of their treatment remains irrefutable. Consequently, the use of acupuncture as a cost-effective and efficient substitute therapy offers us fresh alternatives. Acupuncture, now a favored substitute treatment in healthcare, offers not just reduced costs but also demonstrates promise in reducing LEAD symptoms and enhancing patient life quality. As a conventional Traditional Chinese Medicine treatment, acupuncture modifies qi and blood circulation in the body, aids in tissue repairment and recovery [ 28 ] , helps to relieve LEAD pain and muscle weakness [ 29 ] , and improves the blood circulation of patients, helps reduce the condition and improves the quality of life. It's important to recognize that acupuncture, although beneficial for certain LEAD patients, does not suit everyone, with its effectiveness differing based on personal variations. Consequently, in evaluating acupuncture as a potential treatment for LEAD, it's crucial for patients to thoroughly discuss and assess with doctors to confirm the suitability of the treatment for each specific case. Therefore, a more thorough investigation into Zusanli point's impact on the vascular dynamics of lower limb arteries will aid in uncovering acupuncture's role in enhancing blood flow. This study protocol thereby offers a more efficient acupuncture regimen and a scientific foundation for treating lower limb vascular disorders. Trial status Participants are currently being recruited for this study. Abbreviations ST36: Zusanli point; C-MASS: Chinese version of the Massachusetts General Hospital Acupuncture Sensation Scale; CRF: Study Case Report Form; LEAD: Lower extremity arterial disease; PAD: lower limb peripheral artery disease; TCM: Traditional Chinese Medicine. Declarations Funding This work is supported by the fund projects: 1. Pudong New District “Demonstration project of Inheritance, Innovation and Development in TCM supported by Central Government”- Shanghai Renowned Traditional Chinese Medicine Heritage Workshop Huangan Wu (Grant ID: YC-2023-0125) 2. National Project of Experimental Comprehensive Reformation of the Development of Traditional Chinese Medicine in Pudong New District - Advanced Inheritor of Traditional Chinese Medicine (Grant ID: PDZY-2023-0801) 3. Discipline construction project of Pudong New Area Health Commission “Characteristic Special diseases-postpartum urinary incontinence” (Grant ID: PWZzb2022-12) Competing Interests The authors declare that they have no competing interests. Authors’ contributions Conceptualization: Zhu Jin Data curation: Jinling Dai and Jie Tu Funding acquisition: Zhu Jin and Huan-Gan Wu Software: Shuetling Chung and Jie Tu Supervision: Zhu Jin, Yongkang Sun and Rong Zhang Writing----original draft: Jie Tu Writing----review and editing: Shuetling Chung All of the above authors adhere to the authorship guidelines of trials and have agreed to publish the article. All authors read and approved the final manuscript.These authors contributed equally. Acknowledgements The authors thank the staff and the subjects who participated in this trial. References Liu BC, Guo Y, Tian LX. Acupuncture – a national heritage of China to the world: international clinical research advances from the past decade. Acupunct Herb Med. 2021;1:65–73. von Schoen-Angerer T, Manchanda RK, Lloyd I, Wardle J, Szöke J, Benevides I, Martinez NSA, Tolo F, Nicolai T, Skaling-Klopstock C, Parker T, Suswardany DL, van Haselen R, Liu J. Traditional, complementary and integrative healthcare: global stakeholder perspective on WHO's current and future strategy. BMJ Glob Health. 2023 Dec 2;8(12):e013150. Lederer AK, Schmucker C, Kousoulas L, Fichtner-Feigl S, Huber R. Naturopathic Treatment and Complementary Medicine in Surgical Practice. Dtsch Arztebl Int. 2018 Dec 7;115(49):815-821. Li Mingjing, Zhang Jianqiang, Jiang Fan, et al. Visualization analysis of Zusanli(ST36) studies based on CiteSpace [J].Modernization of Traditional Chinese medicine- World Science and Technology . 2022,24(03):1240-1252. Ge Yunpeng, Ji Bo, Su-Hang, etc. Modern Research Progress of Moxibustion at Zusanli(ST36) Points [J]. Guiding Journal of Chinese Medicine and Pharmacy. 2019,25 (22): 95-99. Li Xiaomei, Li Yanqi, Zhou Dan, et al. Influence of Different Acupuncture Manipulations at Zusanli(ST36) on Skin Microcirculation Blood Perfusion in Healthy Subjects[J]. Acupuncture Research. 2013,38 (04): 297-300. Cheng Weiping, Zhao Jian, Niu Xiqian. Effect of Hemodynamics in PCA with the Acupuncture on the Left Zusanli(ST36) of Healthy Young People [J]. Journal of Clinical Acupuncture and Moxibustion. 2013,29 (09): 37-39. Liang YS, Chen LY, Cui YY, Du CX, Xu YX, Yin LH. Ultrasound-guided acupotomy for trigger finger: a systematic review and meta-analysis. J Orthop Surg Res. 2023 Sep 13;18(1):678. Romero-Morales C, Bravo-Aguilar M, Abuín-Porras V, Almazán-Polo J, Calvo-Lobo C, Martínez-Jiménez EM, López-López D, Navarro-Flores E. Current advances and novel research on minimal invasive techniques for musculoskeletal disorders. Dis Mon. 2021 Oct;67(10):101210. MacPherson H, Altman DG, Hammerschlag R, Youping L, Taixiang W, White A, Moher D; STRICTA Revision Group. Revised STandards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA): Extending the CONSORT statement. J Evid Based Med. 2010 Aug;3(3):140-55. Zeng Jin, Zhang Li, Wen Xiaoqiu, etc. Influence on Blood Flow Velocity of Anterior Tibial Artery and Posterior Tibial Artery by Acupuncturing at Xuehai Point [J]. Journal of Clinical Acupuncture and Moxibustion. 2016,32 (01): 38-40. Yang Xuguang, Li Ying, Tian Xiaoping and etc. Review on the non-acupuncture selection method of acupuncture and moxibustion research at home and abroad [J]. Journal of Traditional Chinese Medicine. 2009,50 (08): 748-750. Yu DT, Jones AY, Pang MY. Development and validation of the Chinese version of the Massachusetts General Hospital Acupuncture Sensation Scale: an exploratory and methodological study. Acupunct Med. 2012 Sep;30(3):214-21. Chen Xiaoli, Yue Zenghui, Liu Li, etc. Clinical Application and Study of Zusanli(ST36) Acupoint in the Past and Present [J]. Journal of Clinical Acupuncture and Moxibustion. 2016,32 (07): 80-83. Chen Jianyi, Tang Hongtu, Wang Hua, etc. Exploring and Discussing the Acupoint Zusanli [J]. Acta Chinese Medicine. 2020,35 (12): 2521-2524. Lou Xinfa, Yang Xindong, Jiang Songhe, etc. The angle and depth of Zusanli injection [J]. Acupuncture in China, 2006 (07): 483-486. Sun Qianhui, Guo Yuetong, Xu Chang, etc. About the national standard foot li positioning of my view [J]. Chinese acupuncture, 2021,41(12):1331-1332. Zhang Tong, Gong Weijun, Li Xuemei, etc. Hemodynamic Change of Anterior Tibial Artery during Acupuncture at Zusanli(ST36) [J]. Chinese Journal of Rehabilitation Theory and Practice. 2009,15 (07): 646-648. Belkin N, Damrauer SM. Peripheral Arterial Disease Genetics: Progress to Date and Challenges Ahead. Curr Cardiol Rep. 2017 Nov 1;19(12):131. Butnariu LI, Gorduza EV, Florea L, Țarcă E, Moisă ȘM, Tradafir LM, Cojocaru E, Luca AC, Stătescu L, Bădescu MC. The Genetic Architecture of the Etiology of Lower Extremity Peripheral Artery Disease: Current Knowledge and Future Challenges in the Era of Genomic Medicine. Int J Mol Sci. 2022 Sep 9;23(18):10481. Aboyans V, Ricco JB, Bartelink MEL, Björck M, Brodmann M, Cohnert T, Collet JP, Czerny M, De Carlo M, Debus S, Espinola-Klein C, Kahan T, Kownator S, Mazzolai L, Naylor AR, Roffi M, Röther J, Sprynger M, Tendera M, Tepe G, Venermo M, Vlachopoulos C, Desormais I, Document Reviewers, Widimsky P, Kolh P, Agewall S, Bueno H, Coca A, De Borst GJ, Delgado V, Dick F, Erol C, Ferrini M, Kakkos S, Katus HA, Knuuti J, Lindholt J, Mattle H, Pieniazek P, Piepoli MF, Scheinert D, Sievert H, Simpson I, Sulzenko J, Tamargo J, Tokgozoglu L, Torbicki A, Tsakountakis N, Tuñón J, Vega de Ceniga M, Windecker S, Zamorano JL. Editor's Choice - 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2018 Mar;55(3):305-368. Diabetes Branch of Chinese Medical Association, Infection Branch of Chinese Medical Association, Organization Repair and Regeneration Branch of Chinese Medical Association. Chinese Guidelines for the Prevention and Treatment of Diabetic Foot (2019 edition) [J]. Chinese Journal of Diabetes. 2019,11 (3): 161-189. Barnes JA, Eid MA, Creager MA, Goodney PP. Epidemiology and Risk of Amputation in Patients With Diabetes Mellitus and Peripheral Artery Disease. Arterioscler Thromb Vasc Biol. 2020 Aug;40(8):1808-1817. Zhang X, Ran X, Xu Z, Cheng Z, Shen F, Yu Y, Gao L, Chai S, Wang C, Liu J, Liu J, Sun Z, Zhao J, Ji L; China DIA-LEAD Study Investigators. Epidemiological characteristics of lower extremity arterial disease in Chinese diabetes patients at high risk: a prospective, multicenter, cross-sectional study. J Diabetes Complications. 2018 Feb;32(2):150-156. Guan Heng, Liu Zhimin, Li Guangwei, et al. Analysis of peripheral arterial obstructive disease related factors among diabetic population over 50 years [J]. National Medical Journal of China. 2007,87 (01): 23-27 Wang Aihong, Xu Zhangrong, Wang Yuzhen and so on. Investigation on the increaced lower extremity in the elderly diabetic patients with cardiovascular risk factors [J]. Geriatric and Health Care, 2005 (03): 147-149. Jiang X, Yuan Y, Ma Y, Zhong M, Du C, Boey J, Armstrong DG, Deng W, Duan X. Pain Management in People with Diabetes-Related Chronic Limb-Threatening Ischemia. J Diabetes Res. 2021 May 8;2021:6699292. Zhu W, Ye Y, Liu Y, Wang XR, Shi GX, Zhang S, Liu CZ. Mechanisms of Acupuncture Therapy for Cerebral Ischemia: an Evidence-Based Review of Clinical and Animal Studies on Cerebral Ischemia. J Neuroimmune Pharmacol. 2017 Dec;12(4):575-592. Zhang Xu, Yan Xin, Guan Ruijuan, etc. Analysis of Medication Rule of Traditional Chinese Medicine in the Treatment of Diabetic Peripheral Vascular Disease based on Data Mining [J]. Chinese Journal of Ethnomedicine and Ethnopharmacy. 2022,31 (15): 92-98. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4362173","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Study protocol","associatedPublications":[],"authors":[{"id":300754563,"identity":"8665a7b0-c9d0-4d15-ab46-209315fbbc7c","order_by":0,"name":"Jie Tu","email":"","orcid":"","institution":"Shanghai Seventh People’s Hospital of Shanghai University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Jie","middleName":"","lastName":"Tu","suffix":""},{"id":300754565,"identity":"be2b2a10-8d02-42d8-9338-e79a31792b50","order_by":1,"name":"Yongkang Sun","email":"","orcid":"","institution":"Shanghai Seventh People’s Hospital of Shanghai University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Yongkang","middleName":"","lastName":"Sun","suffix":""},{"id":300754567,"identity":"65b4c0f2-9981-4833-90b6-819201bdc835","order_by":2,"name":"Shuet Ling Chung","email":"","orcid":"","institution":"Shanghai Seventh People’s Hospital of Shanghai University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Shuet","middleName":"Ling","lastName":"Chung","suffix":""},{"id":300754568,"identity":"6d889698-26c7-41cf-841a-dd433e6c818a","order_by":3,"name":"jinling dai","email":"","orcid":"","institution":"Shanghai Seventh People’s Hospital of Shanghai University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"jinling","middleName":"","lastName":"dai","suffix":""},{"id":300754569,"identity":"91bcbcaf-325e-4c58-871a-c0ba13fd5a9a","order_by":4,"name":"Rong Zhang","email":"","orcid":"","institution":"Puxing Community Health Service Center, Pudong New Area, Shanghai, China","correspondingAuthor":false,"prefix":"","firstName":"Rong","middleName":"","lastName":"Zhang","suffix":""},{"id":300754570,"identity":"63368ba0-f634-447e-a482-d2350e4e1df8","order_by":5,"name":"Huan-Gan Wu","email":"","orcid":"","institution":"Shanghai Research Institute of Acupuncture and Meridian","correspondingAuthor":false,"prefix":"","firstName":"Huan-Gan","middleName":"","lastName":"Wu","suffix":""},{"id":300754572,"identity":"a620715e-ad62-4671-8cc8-397e7873a9a1","order_by":6,"name":"Zhu Jin","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAwklEQVRIiWNgGAWjYBACNmbm4z8SKiTk+NkbiNTCx86WIPHhjIWxZM8BIrXI8fMYSM5sqUjcMCOBaIcxGBjzNkgkbpB8vPEGQ41NNDFaEpJ5d0gYb5dOK7ZgOJaW20CElgOHec9IyO6cnWMmwdhwmBgtjI3NvG0SjBtuniFaCzMz48w2CcUNN3iI1sLGxvDhjAQwkIF+SSDGL/L9578xJFTUAaPy8MYbH2psCGtBBgYSCaQoh2ghVccoGAWjYBSMDAAA9406PNqinp8AAAAASUVORK5CYII=","orcid":"","institution":"Shanghai Seventh People’s Hospital of Shanghai University of Traditional Chinese Medicine","correspondingAuthor":true,"prefix":"","firstName":"Zhu","middleName":"","lastName":"Jin","suffix":""}],"badges":[],"createdAt":"2024-05-03 06:06:32","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4362173/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4362173/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":56478715,"identity":"295e3093-3f0e-4393-9d54-1426583baf90","added_by":"auto","created_at":"2024-05-14 17:52:56","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":106115,"visible":true,"origin":"","legend":"\u003cp\u003eTrial flowchart\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4362173/v1/c65f1ad43ca5710368e8cf3e.png"},{"id":56478716,"identity":"6da220c9-55c0-46fd-b2e2-e930268c4bbf","added_by":"auto","created_at":"2024-05-14 17:52:56","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":464858,"visible":true,"origin":"","legend":"\u003cp\u003eThe location of ST36 and non-acupoint. ST36 is the Zusanli acupoint; non-acupoint is the 3cm away from the ST36.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-4362173/v1/4330789844f0bbbb824942fc.png"},{"id":62478889,"identity":"9871d562-6a45-423f-9a84-6f5e47693d37","added_by":"auto","created_at":"2024-08-14 16:16:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1210127,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4362173/v1/856a9380-0672-4da0-a281-f27137e108d4.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Observation of the immediate effect of ultrasound-guided acupuncture at Zusanli (ST36) point on Blood flow volume in lower limb arteries: a randomized controlled trial study protocol","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAcupuncture, a primary therapeutic approach in China, has gained global recognition and application in the past few years\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e.A study report\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e reveals that 80% of nations have acknowledged their effectiveness. Within the U.S., acupuncture is licensed in 44 out of 50 states, with 3 to 6\u0026nbsp;million Americans getting acupuncture treatment annually. Owing to the potential adverse effects of overuse of drugs and the necessity for continuous treatment and recovery from complex chronic illnesses, there is a global search for a non-toxic, secure, and efficacious therapy. Consequently, acupuncture, known for its low side effects, enjoys global acceptance\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eST36 is an important acupoint widely used in traditional Chinese medicine, and its importance has been proved from ancient medical records to modern studies. Ancient Chinese medical records indicate that\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e][\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e ST36 has a wide range of indications, with functions such as tonifying the body\u0026rsquo;s righteousness and expel pathogenic, nourishing the internal organs and nourishing qi, regulating qi and blood, promoting meridians and activating collaterals, and clearing the internal organs and resolving phlegm. It is considered as an important acupoint for strengthening the body and promoting health\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e][\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. Previous studies have shown \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e][\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e that acupuncture on ST36 in healthy people can significantly improve the blood perfusion of local skin; increase the mean blood flow velocity and beat index of bilateral posterior cerebral arteries to improve the cerebral blood flow supply. Therefore, ST36 is proved to improve blood circulation effectively. Aiming to understand the role of acupuncture in hemodynamic aspects, we have conducted this study to observe the immediate effect of lower limb artery blood flow velocity by acupuncture at ST36 guided by ultrasound device, so as to provide new treatment for the vascular lesions of lower limb arteries and scientific basis.\u003c/p\u003e \u003cp\u003eUltrasound-guided acupuncture therapy is an innovative means combining traditional Chinese medicine therapy with modern medical technology, providing a more accurate and safe operation mode for clinical practice. The ultrasound-guided technique can display the acupoints and the surrounding tissue structure in real time\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e, which enhances the deqi sensation of the subjects and the accuracy of the operator. This provides a unique opportunity for the investigators to more finely observe the effect of acupuncture on vascular blood flow velocity. With the gradual promotion of ultrasound guidance technology\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e, exploring the immediate effect of ST36 acupuncture on the blood flow velocity of lower limbs arteries not only helps to better understand the biological expression of traditional TCM theory, but also provides a more scientific basis for the clinical application of this treatment.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003eStudy design\u003c/p\u003e\n\u003cp\u003eThis study is a randomized, single-blind, parallel controlled study to investigate the effect of ultrasound-guided acupuncture on the immediate effect of lower limb arterial blood flow velocity in healthy subjects. Subjects who met the criteria and signed the informed consent were randomly divided into trial and control groups, and relevant data were recorded immediately before and after acupuncture. The flowchart of the study design is shown in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e, and the evaluation time points are shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. This trial will strictly follow the Reporting Standards for Clinical Trials of Acupuncture\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e .\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e Schedule of enrollment, intervention, and assessment\u003c/p\u003e\n\u003cp\u003e\u003cimg 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\" width=\"651\" height=\"609\"\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003epour: \u0026quot;X\u0026quot; in this table represents the items that must be completed.\u003c/p\u003e\n\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003eParticipants\u003c/h2\u003e\n \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e\n \u003ch2\u003e3.1 Recruitment Strategies\u003c/h2\u003e\n \u003cp\u003eParticipants in this study will be recruited from Shanghai Seventh People\u0026rsquo;s Hospital\u0026rsquo;s Outpatient Department, and the recruitment efforts are carried out via posters and various other mediums. Participants or their relatives will be engaged in verbal discussions with prior to inclusion. Individuals who fulfilled the specified requirements and planned to join the study were confirmed by a physician and they are required to provide their signatures on the informed consent form.\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e\n \u003ch2\u003e3.2 Inclusion Criteria\u003c/h2\u003e\n \u003cp\u003e(1) No medical confirmed disease;\u003c/p\u003e\n \u003cp\u003e(2) Age: 20\u0026ndash;40 years old (including 20 years old and 40 years old);\u003c/p\u003e\n \u003cp\u003e(3) Did not take any drugs within one week before the test;\u003c/p\u003e\n \u003cp\u003e(4) Willing to cooperate, high compliance, sign informed consent.\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e\n \u003ch2\u003e3.3 Exclusion Criteria\u003c/h2\u003e\n \u003cp\u003e(1) Patients with previous lower limb artery and venous vascular diseases;\u003c/p\u003e\n \u003cp\u003e(2) Patients with previous abnormalities in the heart, liver, lung, kidney, brain and other important human organs;\u003c/p\u003e\n \u003cp\u003e(3) Patients with previous mental illness and poor compliance;\u003c/p\u003e\n \u003cp\u003e(4) Serious fear of acupuncture;\u003c/p\u003e\n \u003cp\u003e(5) Pregnant or lactating women.\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e\n \u003ch2\u003e3.4 Elimination criteria\u003c/h2\u003e\n \u003cp\u003e(1) Those who are not found to meet the above inclusion criteria after enrollment;\u003c/p\u003e\n \u003cp\u003e(2) Patients with poor compliance, ineffective explanation by the researchers, and who are unwilling to receive treatment according to the regulations;\u003c/p\u003e\n \u003cp\u003e(3) During the experiment, the subjects have serious adverse reactions and special physiological changes, and should not continue to accept the test.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eSample size\u003c/h2\u003e\n \u003cp\u003eThe study was designed as a randomized, single-blind, parallel controlled trial with the significance level of \u0026alpha;\u0026thinsp;=\u0026thinsp;0.05, type II error (\u0026beta;) of 0.2, and test efficacy of 80%. The sample size was calculated according to similar study\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e, the ratio of test group to control group was 1:1, and 15% shedding rate was considered in each group. 66 patients will be randomly assigned to either the trial group or the control group.\u003c/p\u003e\n \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e\n \u003ch2\u003eEthics and Trial Registration\u003c/h2\u003e\n \u003cp\u003eThe study protocol is in accordance with the Declaration of Helsinki and the Ethics Guidelines for Clinical Research. This study has been reviewed by the Clinical Research Ethics Committee (2024-7th-HIRB-006) of our hospital and is registered in the Chinese Clinical Trials Register (CCTR) (registration number: ChiCTR2400080275). All subjects will be informed of the study plan and potential risks and will sign a written informed consent before enrollment. They will be able to suspend or withdraw from the trial at any time during the course of the study.\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e\n \u003ch2\u003eRandomization and Blinding\u003c/h2\u003e\n \u003cp\u003eBlock randomization will be used in this experiment. Independent investigators who did not contact with the subjects will use SPSS25.0 to generate a random number table to divide the 66 eligible subjects in a 1:1 ratio between the experimental and control groups. The investigators will not participate in the randomization, the efficacy evaluator will be unaware of the study group protocol, and the data statistician will have no role in the design or implementation of the study.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003eInterventions\u003c/h2\u003e\n \u003cp\u003eInterventional Group\u003c/p\u003e\n \u003cp\u003eNo direct sunlight is allowed in the laboratory. Patients are instructed to expose their lower limbs and lie on the hospital bed. The sonographer used a Doppler detector(PHILIPS,Netherlands,Affiniti 70W model) to measure the blood flow volume, peak systolic velocity and arterial diameter of the artery before needle puncture in the anterior tibial artery and dorsalis pedis artery before acupuncture. The ST36(Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e) was located according to the World Health Organization standard Acupuncture acupoint positioning (Western Pacific Region). After routine disinfection of the site, the acupuncturist uses a 0.30x40mm stainless needle(Gushi Gongyuan Medical Devices Co.,Ltd.) with the help of a sonographer to acupuncture the deep fascia layer under ultrasound guidance. After 5 minutes, the sonographer detected the blood flow volume, peak systolic velocity and arterial diameter of the subjects again after acupuncture in anterior tibial artery and dorsalis pedis artery.\u003c/p\u003e\n \u003cp\u003eControl Group\u003c/p\u003e\n \u003cp\u003eOpt for a non-acupoint(Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e) \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e, which is 3cm away from the ST36, and do not perform any manual treatment after needle insertion. The remaining environmental requirements and operating methods are the same as those of the interventional group.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003ch2\u003eOutcome assessments\u003c/h2\u003e\n \u003cp\u003ePrimary outcome\u003c/p\u003e\n \u003cp\u003ePeak systolic velocity is the main index of this study and can be measured directly using the Doppler ultrasound diagnostic instrument. Measure and record before and after acupuncture.\u003c/p\u003e\n \u003cp\u003eSecondary outcomes\u003c/p\u003e\n \u003cp\u003eSecondary measures include blood flow volume, arterial diameter, and C-MASS volume meter. The maximum blood flow and arterial diameter can be measured directly by using Doppler diagnostic instrument, measure and record before and after acupuncture; C-MASS\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003eis the acupuncture sensory scale of Massachusetts General Hospital, and the subjects will be assessed according to this scale after five minutes of acupuncture.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003eData management and quality control\u003c/h2\u003e\n \u003cp\u003eConsidering that patients predominantly provide outpatient medical records in China, the \u0026ldquo;Study Case Report Form (CRF)\u0026rdquo; aims to fully safeguard the direct data from clinical trials. The CRF serves as the source document for participants in clinical trials and ought to be maintained within the hospital.\u003c/p\u003e\n \u003cp\u003eData collected throughout the study will be recorded in the study case report form, and any modification to the study protocol will be requested in advance and approved by the ethics committee of our hospital. A quality control team will be set up and the team members are responsible for regular or irregular monitoring visits and data verification of the research team. During the inspection, the study will be stopped if a protocol violation is found. All data will be stored in separate storage rooms to ensure data confidentiality and reliability. Access to the database will be limited by the investigators of this research team. The subject\u0026apos;s information is not publicly available and shared without the subject\u0026apos;s written permission.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n \u003ch2\u003eStatistical analyses\u003c/h2\u003e\n \u003cp\u003eAll data in this study were analyzed and processed using SPSS25.0 software, and \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered as statistically significant. If the measurement data meet the normal distribution, it is expressed as the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (\u0026oline;x\u0026thinsp;\u0026plusmn;\u0026thinsp;S). The correlation between the two groups was analyzed by independent sample \u003cem\u003et-\u003c/em\u003etest and paired \u003cem\u003et-\u003c/em\u003etest for intra-treatment; if the data does not meet normal distribution, the median and quartiles were expressed by the rank sum test, Median(Quartiles)[M (P25, P75)]. The counting data were expressed in terms of case or frequency, composition ratio and rate, and the cross-table \u0026chi;\u003csup\u003e2\u003c/sup\u003etest was applied for the correlation analysis between the two groups. Rank sum test was used for rank data.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study is a randomized, single-blind, parallel controlled clinical trial, aiming to observe the immediate effect of acupuncture on lower limb arterial vessels in healthy subjects and to provide evidence for acupuncture treatment of vascular lesions in lower limb arteries. Therefore, this study established an interventional group and a control group to observe whether acupuncture at ST36 can cause changes in the hemodynamics of lower limb arterial blood vessels.\u003c/p\u003e \u003cp\u003e According to the theory of acupuncture and moxibustion in traditional Chinese medicine, ST36, as the junction point of the Stomach Meridian of Foot Yangming. ST36 can promote the operation of blood, and thus nourish the lower limb blood vessels, and its effect is remarkable and extensive\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. Therefore, acupuncture at ST36 can promote local blood circulation, and is expected to produce the effect of improving blood circulation. According to modern anatomy \u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e, the anterior tibial artery runs between the tibialis anterior and the extensor digitorum longus, while the dorsalis pedis artery separates from the anterior tibial artery, and the squeezing of the two muscles will cause\"arterial stop\"caused by spasm of the tow muscles and patients with coldness on back of the foot, acupuncture the gap between the tibialis anterior and the extensor digitorum longus to stimulate myofacia, thus reduce muscle tension, reduce the extrusion of blood vessels, improve blood circulation. Earlier research\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e indicates that acupuncture enhances blood circulation in the anterior tibial artery and markedly boosts blood supply. This discovery reinforces the regulatory role of ST36 in blood flow. Additionally, decreased blood circulation in the lower extremities impacts the occurrence of arterial vascular disease in these limbs\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eLEAD (Lower extremity arterial disease, LEAD), also known as lower extremity peripheral artery disease (lower limb peripheral artery disease, PAD), or lower extremity PAD, belongs to a large PAD family. This disease is a chronic obstruction characterized by reduced blood flow to the downward limb artery, leading to ischemia, which may accompany with thromboembolism\u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. The survey indicates that approximately 200\u0026nbsp;million individuals globally suffer from lower limb arterial vascular lesions (LEAD)\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e. This condition represents not just a localized form of systemic arterial lesions, but also forms part of peripheral arterial lesions. In clinical terms, the initial phases of LEAD typically exhibit no clear symptoms. Nonetheless, with the advancement of the illness, the patient might experience sporadic symptoms in the lower extremities and progressively suffer from pain at rest, culminating in gangrene at the extremity. Additional symptoms encompass undernourishment in the skin of the lower extremities, muscle wasting, dry skin, and reduced elasticity. From a clinical perspective, one can notice a reduction in skin temperature, pigmentation, and a diminished or non-existent acroartery pulse\u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. LEAD ranks as a frequent long-term complication associated with diabetes mellitus. Among LEAD patients, approximately 20\u0026ndash;30% had diabetes in the study population, 25\u0026ndash;90% of amputations were diabetes-related\u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e. Findings from Professor Ji Linong's survey at Peking University People's Hospital revealed that 21.2% of diabetic patients in China suffer from LEAD\u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e. Research conducted across multiple centers in China revealed a 19.5% occurrence of LEAD in diabetic patients aged over 50 \u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e, in contrast to a single-center study which indicated a higher rate of 35.4% in diabetic patients over 60 years with LEAD\u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e. Presently, LEAD's clinical treatments encompass endovascular therapy, pharmacotherapy, rehabilitation, surgical procedures, and cellular therapy\u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e. While these therapies have demonstrated efficacy in enhancing LEAD patients' symptoms and outlook, the expense of their treatment remains irrefutable. Consequently, the use of acupuncture as a cost-effective and efficient substitute therapy offers us fresh alternatives. Acupuncture, now a favored substitute treatment in healthcare, offers not just reduced costs but also demonstrates promise in reducing LEAD symptoms and enhancing patient life quality. As a conventional Traditional Chinese Medicine treatment, acupuncture modifies qi and blood circulation in the body, aids in tissue repairment and recovery\u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e, helps to relieve LEAD pain and muscle weakness\u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e, and improves the blood circulation of patients, helps reduce the condition and improves the quality of life.\u003c/p\u003e \u003cp\u003eIt's important to recognize that acupuncture, although beneficial for certain LEAD patients, does not suit everyone, with its effectiveness differing based on personal variations. Consequently, in evaluating acupuncture as a potential treatment for LEAD, it's crucial for patients to thoroughly discuss and assess with doctors to confirm the suitability of the treatment for each specific case. Therefore, a more thorough investigation into Zusanli point's impact on the vascular dynamics of lower limb arteries will aid in uncovering acupuncture's role in enhancing blood flow. This study protocol thereby offers a more efficient acupuncture regimen and a scientific foundation for treating lower limb vascular disorders.\u003c/p\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eTrial status\u003c/h2\u003e \u003cp\u003eParticipants are currently being recruited for this study.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eST36: Zusanli point; C-MASS: Chinese version of the Massachusetts General Hospital Acupuncture Sensation Scale; CRF: Study Case Report Form; LEAD: Lower extremity arterial disease; PAD: lower limb peripheral artery disease; TCM: Traditional Chinese Medicine.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work is supported by the fund projects:\u003c/p\u003e\n\u003cp\u003e1. Pudong New District \u0026ldquo;Demonstration project of Inheritance, Innovation and Development in TCM supported by Central Government\u0026rdquo;- Shanghai Renowned Traditional Chinese Medicine Heritage Workshop Huangan Wu (Grant ID: YC-2023-0125)\u003c/p\u003e\n\u003cp\u003e2. National Project of Experimental Comprehensive Reformation of the Development of Traditional Chinese Medicine in Pudong New District - Advanced Inheritor of Traditional Chinese Medicine (Grant ID: PDZY-2023-0801)\u003c/p\u003e\n\u003cp\u003e3. Discipline construction project of Pudong New Area Health Commission \u0026ldquo;Characteristic Special diseases-postpartum urinary incontinence\u0026rdquo; (Grant ID: PWZzb2022-12)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization: Zhu Jin\u003c/p\u003e\n\u003cp\u003eData curation: Jinling Dai and Jie Tu\u003c/p\u003e\n\u003cp\u003eFunding acquisition: Zhu Jin and Huan-Gan Wu\u003c/p\u003e\n\u003cp\u003eSoftware: Shuetling Chung and Jie Tu\u003c/p\u003e\n\u003cp\u003eSupervision: Zhu Jin, Yongkang Sun and Rong Zhang\u003c/p\u003e\n\u003cp\u003eWriting----original draft: Jie Tu\u003c/p\u003e\n\u003cp\u003eWriting----review and editing: Shuetling Chung\u003c/p\u003e\n\u003cp\u003eAll of the above authors adhere to the authorship guidelines of trials and have agreed to publish the article. All authors read and approved the final manuscript.These authors contributed equally.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank the staff and the subjects who participated in this trial.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLiu BC, Guo Y, Tian LX. Acupuncture \u0026ndash; a national heritage of China to the world: international clinical research advances from the past decade. Acupunct Herb Med. 2021;1:65\u0026ndash;73.\u003c/li\u003e\n\u003cli\u003evon Schoen-Angerer T, Manchanda RK, Lloyd I, Wardle J, Sz\u0026ouml;ke J, Benevides I, Martinez NSA, Tolo F, Nicolai T, Skaling-Klopstock C, Parker T, Suswardany DL, van Haselen R, Liu J. Traditional, complementary and integrative healthcare: global stakeholder perspective on WHO\u0026apos;s current and future strategy. BMJ Glob Health. 2023 Dec 2;8(12):e013150. \u003c/li\u003e\n\u003cli\u003eLederer AK, Schmucker C, Kousoulas L, Fichtner-Feigl S, Huber R. Naturopathic Treatment and Complementary Medicine in Surgical Practice. Dtsch Arztebl Int. 2018 Dec 7;115(49):815-821.\u003c/li\u003e\n\u003cli\u003eLi Mingjing, Zhang Jianqiang, Jiang Fan, et al. Visualization analysis of Zusanli(ST36) studies based on CiteSpace [J].Modernization of Traditional Chinese medicine- World Science and Technology . 2022,24(03):1240-1252.\u003c/li\u003e\n\u003cli\u003eGe Yunpeng, Ji Bo, Su-Hang, etc. Modern Research Progress of Moxibustion at Zusanli(ST36) Points [J]. Guiding Journal of Chinese Medicine and Pharmacy. 2019,25 (22): 95-99.\u003c/li\u003e\n\u003cli\u003eLi Xiaomei, Li Yanqi, Zhou Dan, et al. Influence of Different Acupuncture Manipulations at Zusanli(ST36) on Skin Microcirculation Blood Perfusion in Healthy Subjects[J]. Acupuncture Research. 2013,38 (04): 297-300.\u003c/li\u003e\n\u003cli\u003eCheng Weiping, Zhao Jian, Niu Xiqian. Effect of Hemodynamics in PCA with the Acupuncture on the Left Zusanli(ST36) of Healthy Young People [J]. Journal of Clinical Acupuncture and Moxibustion. 2013,29 (09): 37-39.\u003c/li\u003e\n\u003cli\u003eLiang YS, Chen LY, Cui YY, Du CX, Xu YX, Yin LH. Ultrasound-guided acupotomy for trigger finger: a systematic review and meta-analysis. J Orthop Surg Res. 2023 Sep 13;18(1):678.\u003c/li\u003e\n\u003cli\u003eRomero-Morales C, Bravo-Aguilar M, Abu\u0026iacute;n-Porras V, Almaz\u0026aacute;n-Polo J, Calvo-Lobo C, Mart\u0026iacute;nez-Jim\u0026eacute;nez EM, L\u0026oacute;pez-L\u0026oacute;pez D, Navarro-Flores E. Current advances and novel research on minimal invasive techniques for musculoskeletal disorders. Dis Mon. 2021 Oct;67(10):101210. \u003c/li\u003e\n\u003cli\u003eMacPherson H, Altman DG, Hammerschlag R, Youping L, Taixiang W, White A, Moher D; STRICTA Revision Group. Revised STandards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA): Extending the CONSORT statement. J Evid Based Med. 2010 Aug;3(3):140-55. \u003c/li\u003e\n\u003cli\u003eZeng Jin, Zhang Li, Wen Xiaoqiu, etc. Influence on Blood Flow Velocity of Anterior Tibial Artery and Posterior Tibial Artery by Acupuncturing at Xuehai Point [J]. Journal of Clinical Acupuncture and Moxibustion. 2016,32 (01): 38-40.\u003c/li\u003e\n\u003cli\u003eYang Xuguang, Li Ying, Tian Xiaoping and etc. Review on the non-acupuncture selection method of acupuncture and moxibustion research at home and abroad [J]. Journal of Traditional Chinese Medicine. 2009,50 (08): 748-750.\u003c/li\u003e\n\u003cli\u003eYu DT, Jones AY, Pang MY. Development and validation of the Chinese version of the Massachusetts General Hospital Acupuncture Sensation Scale: an exploratory and methodological study. Acupunct Med. 2012 Sep;30(3):214-21. \u003c/li\u003e\n\u003cli\u003eChen Xiaoli, Yue Zenghui, Liu Li, etc. Clinical Application and Study of Zusanli(ST36) Acupoint in the Past and Present [J]. Journal of Clinical Acupuncture and Moxibustion. 2016,32 (07): 80-83.\u003c/li\u003e\n\u003cli\u003eChen Jianyi, Tang Hongtu, Wang Hua, etc. Exploring and Discussing the Acupoint Zusanli [J]. Acta Chinese Medicine. 2020,35 (12): 2521-2524.\u003c/li\u003e\n\u003cli\u003eLou Xinfa, Yang Xindong, Jiang Songhe, etc. The angle and depth of Zusanli injection [J]. Acupuncture in China, 2006 (07): 483-486.\u003c/li\u003e\n\u003cli\u003eSun Qianhui, Guo Yuetong, Xu Chang, etc. About the national standard foot li positioning of my view [J]. Chinese acupuncture, 2021,41(12):1331-1332.\u003c/li\u003e\n\u003cli\u003eZhang Tong, Gong Weijun, Li Xuemei, etc. Hemodynamic Change of Anterior Tibial Artery during Acupuncture at Zusanli(ST36) [J]. Chinese Journal of Rehabilitation Theory and Practice. 2009,15 (07): 646-648.\u003c/li\u003e\n\u003cli\u003eBelkin N, Damrauer SM. Peripheral Arterial Disease Genetics: Progress to Date and Challenges Ahead. Curr Cardiol Rep. 2017 Nov 1;19(12):131. \u003c/li\u003e\n\u003cli\u003eButnariu LI, Gorduza EV, Florea L, Țarcă E, Moisă ȘM, Tradafir LM, Cojocaru E, Luca AC, Stătescu L, Bădescu MC. The Genetic Architecture of the Etiology of Lower Extremity Peripheral Artery Disease: Current Knowledge and Future Challenges in the Era of Genomic Medicine. Int J Mol Sci. 2022 Sep 9;23(18):10481. \u003c/li\u003e\n\u003cli\u003eAboyans V, Ricco JB, Bartelink MEL, Bj\u0026ouml;rck M, Brodmann M, Cohnert T, Collet JP, Czerny M, De Carlo M, Debus S, Espinola-Klein C, Kahan T, Kownator S, Mazzolai L, Naylor AR, Roffi M, R\u0026ouml;ther J, Sprynger M, Tendera M, Tepe G, Venermo M, Vlachopoulos C, Desormais I, Document Reviewers, Widimsky P, Kolh P, Agewall S, Bueno H, Coca A, De Borst GJ, Delgado V, Dick F, Erol C, Ferrini M, Kakkos S, Katus HA, Knuuti J, Lindholt J, Mattle H, Pieniazek P, Piepoli MF, Scheinert D, Sievert H, Simpson I, Sulzenko J, Tamargo J, Tokgozoglu L, Torbicki A, Tsakountakis N, Tu\u0026ntilde;\u0026oacute;n J, Vega de Ceniga M, Windecker S, Zamorano JL. Editor\u0026apos;s Choice - 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2018 Mar;55(3):305-368.\u003c/li\u003e\n\u003cli\u003eDiabetes Branch of Chinese Medical Association, Infection Branch of Chinese Medical Association, Organization Repair and Regeneration Branch of Chinese Medical Association. Chinese Guidelines for the Prevention and Treatment of Diabetic Foot (2019 edition) [J]. Chinese Journal of Diabetes. 2019,11 (3): 161-189.\u003c/li\u003e\n\u003cli\u003eBarnes JA, Eid MA, Creager MA, Goodney PP. Epidemiology and Risk of Amputation in Patients With Diabetes Mellitus and Peripheral Artery Disease. Arterioscler Thromb Vasc Biol. 2020 Aug;40(8):1808-1817. \u003c/li\u003e\n\u003cli\u003eZhang X, Ran X, Xu Z, Cheng Z, Shen F, Yu Y, Gao L, Chai S, Wang C, Liu J, Liu J, Sun Z, Zhao J, Ji L; China DIA-LEAD Study Investigators. Epidemiological characteristics of lower extremity arterial disease in Chinese diabetes patients at high risk: a prospective, multicenter, cross-sectional study. J Diabetes Complications. 2018 Feb;32(2):150-156.\u003c/li\u003e\n\u003cli\u003eGuan Heng, Liu Zhimin, Li Guangwei, et al. Analysis of peripheral arterial obstructive disease related factors among diabetic population over 50 years [J]. National Medical Journal of China. 2007,87 (01): 23-27\u003c/li\u003e\n\u003cli\u003eWang Aihong, Xu Zhangrong, Wang Yuzhen and so on. Investigation on the increaced lower extremity in the elderly diabetic patients with cardiovascular risk factors [J]. Geriatric and Health Care, 2005 (03): 147-149.\u003c/li\u003e\n\u003cli\u003eJiang X, Yuan Y, Ma Y, Zhong M, Du C, Boey J, Armstrong DG, Deng W, Duan X. Pain Management in People with Diabetes-Related Chronic Limb-Threatening Ischemia. J Diabetes Res. 2021 May 8;2021:6699292. \u003c/li\u003e\n\u003cli\u003eZhu W, Ye Y, Liu Y, Wang XR, Shi GX, Zhang S, Liu CZ. Mechanisms of Acupuncture Therapy for Cerebral Ischemia: an Evidence-Based Review of Clinical and Animal Studies on Cerebral Ischemia. J Neuroimmune Pharmacol. 2017 Dec;12(4):575-592.\u003c/li\u003e\n\u003cli\u003eZhang Xu, Yan Xin, Guan Ruijuan, etc. Analysis of Medication Rule of Traditional Chinese Medicine in the Treatment of Diabetic Peripheral Vascular Disease based on Data Mining [J]. Chinese Journal of Ethnomedicine and Ethnopharmacy. 2022,31 (15): 92-98.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Ultrasound guidance, Zusanli(ST36), blood flow volum, immediate effect, lower limb arteries","lastPublishedDoi":"10.21203/rs.3.rs-4362173/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4362173/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe Zusanli(ST36) point, as one of the key health care points, has a wide range of indications and various effects. Given its effectiveness in regulating qi and blood flow, we investigated its direct impact on the arteries of the lower limbs. Earlier research indicates that the ST36 may enhance blood flow to the anterior tibial artery, yet there's a need to refine its research methodology and key findings. Consequently, our objective was to thoroughly investigate how the ST36 influences the blood flow dynamics in the arteries of the lower limbs.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis is a randomized, single-blind, and parallel controlled study. Participants will be evenly distributed in a 1:1 ratio between the interventional group (true acupuncture guided by ultrasound) and the control group (sham guided by ultrasound). Key metrics such as blood flow volume, peak systolic velocity, arterial diameter, and C-MASS evaluations will be documented and monitored pre and post-treatment. Ultimately, the analysis of the data was conducted utilizing the SPSS 25.0 software.\u003c/p\u003e\u003ch2\u003eDiscussion\u003c/h2\u003e \u003cp\u003eThrough this study, we aim to gain a deeper understanding of the hemodynamic effects of ultrasound-guided acupuncture at ST36, and hope to provide new treatment methods and scientific basis for lower limb arterial vascular lesions.\u003c/p\u003e\u003ch2\u003eTrial registration\u003c/h2\u003e \u003cp\u003eChictr.org.cn Identifier: ChiCTR2400080275 Registered on 25 Jan 2024\u003c/p\u003e","manuscriptTitle":"Observation of the immediate effect of ultrasound-guided acupuncture at Zusanli (ST36) point on Blood flow volume in lower limb arteries: a randomized controlled trial study protocol","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-14 17:52:46","doi":"10.21203/rs.3.rs-4362173/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8589659a-9f48-42d0-9a58-f0915199106d","owner":[],"postedDate":"May 14th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-08-14T16:08:30+00:00","versionOfRecord":[],"versionCreatedAt":"2024-05-14 17:52:46","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4362173","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4362173","identity":"rs-4362173","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}