**4. Anti-inflammatory effects of acupuncture point injection with placental extract**

Acupuncture has been used in the treatment of several diseases for at least 5000 years in Asia. In the western society, acupuncture has become a central part of complementary medicine. An increasing number of patients, especially those suffering from chronic diseases, are seeking acupuncture treatment. The widespread application of acupuncture includes the treatment of infections, inflammatory diseases, autonomic dysfunction, psychological disorders, musculoskeletal diseases, and many other illnesses [25].

The neural activation by acupuncture was investigated by many researchers. With the stimulation of vision-related acupuncture points, visual cortices of the brain were found to be stimulated [26]. Liu et al. [27] and Li et al. [28] reported that the C-fiber rich afferents of the deep tibial nerve coincided with acupuncture points, implying rich distribution of nerve fibers/reflex complexes at acupuncture points. Abraham et al. [29] also proved that the acupuncture points contained a significantly higher number of transient receptor potential vallinoid type 1-positive Aδ- and C-fibers as compared with nonacupuncture points. Gao et al. [30] demonstrated that the enhancement of gastric motility induced by acupuncture point ST36 stimulation was mediated by N-methyl-D-aspartate receptors.

In acupuncture, the insertion of needle induces marked changes close to the needle in all different tissues that are penetrated. These peripheral events might improve tissue function through dilation in the skin due to axon reflexes [31]. Additional activation can be obtained through manipulation of the needle or electro-stimulation at different frequencies. Studies have shown that manual acupuncture (back-and-forth motion or up-and-down motion) or electrical stimulation in specific frequencies applied to acupuncture points can facilitate the release of specific neuropeptides in the central nervous system [32]. This activation is demonstrated to elicit profound physiological effects and even activate self-healing mechanisms [33]. Although the effect of manual acupuncture or electro-acupuncture is comparative to the effects of nonsteroidal anti-inflammatory drugs and opioid analgesics [34], maintenance of needles might be cumbersome, particularly in agitated animals. In order to overcome this disadvantage, other techniques might be used for stimulation of acupuncture points.

Acupuncture point injection (API) is a new acupuncture technique which combines acupuncture and medication. API is widely used to enhance and prolong the effect of stimulation of acupuncture points [35]. API with placental extract can be used to control pain syndromes due to anti-inflammatory effects from each member. Numerous uncontrolled trials, as well as a limited number of controlled trials, have been published after short-term or long-term use of acupuncture in the treatment of inflammatory diseases. The direct and indirect effects of acupuncture on regulation of inflammatory mediators such as neuropeptides, cytokines, and vasoactive substances have been assessed [36]. Even though there are some pitfalls such as relatively small number of patients and incompletely described methodological procedures, the results clearly show a beneficial effect of acupuncture in the reduction of symptomatic inflammatory response. As well, anti-inflammatory effects of placental extracts were fully evaluated. Porcine placental extract was shown to protect the contact hypersensitivity of skin by modulation of immunoglobulin E production [37]. Animal model studies showed that placental extracts reduced the concentration of free radicals, inflammatory cytokines interleukin-6 (IL-6), tumor necrosis factor (TNF), and interleukin-1 (IL-1) at the same time increasing the colony formation of progenitor cells in vitro [38]. Clinical trials of API with placental extracts showed anti-inflammatory effects in pain diseases. Injection of placental extract to acupuncture points ameliorated various inflammation-associated symptoms of complex regional pain syndrome [39, 40]. In osteoarthritic patients, API with placental extract improved daily working hours, reduced knee joint swelling, and abated pain [20].

one person to another and may have variations in the same person at different times. Various symptoms of pain syndromes are attributed from corresponding inflammatory profiles of discrete pain syndromes. The key to treat pain syndromes is inhibiting the production of inflammatory mediators at the same time regenerating injured or degenerative tissues. The term "regeneration" is used to describe the phenomena that allow an organism to reconstitute the structure damaged by injury and recover the functional homeostasis. A successful outcome is

Acupuncture has been used in the treatment of several diseases for at least 5000 years in Asia. In the western society, acupuncture has become a central part of complementary medicine. An increasing number of patients, especially those suffering from chronic diseases, are seeking acupuncture treatment. The widespread application of acupuncture includes the treatment of infections, inflammatory diseases, autonomic dysfunction, psychological disorders,

The neural activation by acupuncture was investigated by many researchers. With the stimulation of vision-related acupuncture points, visual cortices of the brain were found to be stimulated [26]. Liu et al. [27] and Li et al. [28] reported that the C-fiber rich afferents of the deep tibial nerve coincided with acupuncture points, implying rich distribution of nerve fibers/reflex complexes at acupuncture points. Abraham et al. [29] also proved that the acupuncture points contained a significantly higher number of transient receptor potential vallinoid type 1-positive Aδ- and C-fibers as compared with nonacupuncture points. Gao et al. [30] demonstrated that the enhancement of gastric motility induced by acupuncture point ST36 stimulation was medi-

In acupuncture, the insertion of needle induces marked changes close to the needle in all different tissues that are penetrated. These peripheral events might improve tissue function through dilation in the skin due to axon reflexes [31]. Additional activation can be obtained through manipulation of the needle or electro-stimulation at different frequencies. Studies have shown that manual acupuncture (back-and-forth motion or up-and-down motion) or electrical stimulation in specific frequencies applied to acupuncture points can facilitate the release of specific neuropeptides in the central nervous system [32]. This activation is demonstrated to elicit profound physiological effects and even activate self-healing mechanisms [33]. Although the effect of manual acupuncture or electro-acupuncture is comparative to the effects of nonsteroidal anti-inflammatory drugs and opioid analgesics [34], maintenance of needles might be cumbersome, particularly in agitated animals. In order to overcome this

disadvantage, other techniques might be used for stimulation of acupuncture points.

Acupuncture point injection (API) is a new acupuncture technique which combines acupuncture and medication. API is widely used to enhance and prolong the effect of stimulation of acupuncture points [35]. API with placental extract can be used to control pain syndromes

one that results in less inflammation, more regeneration, and thus less pain.

musculoskeletal diseases, and many other illnesses [25].

ated by N-methyl-D-aspartate receptors.

**placental extract**

116 Placenta

**4. Anti-inflammatory effects of acupuncture point injection with** 
