BACKGROUND
acupuncture is an important part of traditional chinese medicine and has been used for the treatment and recovery of stroke patients.
recently, it has been proven to have a positive effect on post-stroke patients in multi-center studies involving large datasets of clinical observations and evidence-based literature analyses  <cit> .
however, the underlying mechanism of this relationship is still unclear.
there are numerous methods to study the mechanisms of treating stroke by acupuncture.
we focused on cerebral functional imaging because it enables observation of the real-time effects of acupoint needling and the reactions of functional brain regions in humans instead of in the animal brain.
cerebral functional imaging has been successfully combined with acupuncture researches.
needling at acupoints can activate particular cerebral areas under physiological conditions in both humans and monkeys  <cit> .
needling can also result in activation patterns that closely relate to areas involved with the treatment of depression, vascular dementia, rheumatoid arthritis, functional dyspepsia and parkinson’s disease  <cit> .
in addition, the response of the brain to needling at a single acupoint and needling at acupoints in different meridians or different regions has been studied  <cit>  and compared with true, sham and different manipulations of needling  <cit> .
studies based on cerebral functional imaging during acupuncture needling of stroke patients have been published previously.
acupuncture-related activation changes in certain cerebral functional areas of stroke patients have been observed.
he et al.
reported activations in the primary motor area, premotor area, primary sensory area, superior parietal lobe, superior temporal gyrus and insula of the opposite hemisphere as well as bilateral activation of the sensory areas and the affected areas when patients were asked to move their index finger while being needled at quchi  and shousanli  on the side affected by hemiparalysis  <cit> .
the study of he et al.
did not involve any control factors and was only an observation of needling.
the effect of the special acupuncture therapies commonly used to treat chronic stage stroke patients also has been studied.
wang f, et al.
observed a significant difference in the effect of needle retention and electro-acupuncture stimulation on the contralateral cerebral hemisphere cortex and thalamus, ipsilateral basal ganglion and bilateral cerebella: specifically, the change in cerebral blood flow induced by electro-acupuncture was greater than that induced by needle retention  <cit> .
schockert t, et al.
published that yamamoto new scalp acupuncture could affect certain cortical activations  <cit> .
zhang et al.
compared xingnao kaiqiao acupuncture with routine needling and found that the former had a stronger effect on the activation of cerebral functional regions  <cit> .
special therapies of acupuncture are worthy topics of study, but studies should ideally begin with the fundamental relationships between needling at one acupoint and the changes in brain functional areas.
the different effects of true and sham needling were investigated.
li et al.
reported that both electro-acupuncture and the touch of the needle tip on the skin in stroke patients and healthy volunteers resulted in the activation of the primary and secondary sensory centers, the motor center and cerebellum  <cit> .
however, the effects of needling stroke patients as well as the needle-tip-touching stimulation resulted in the strongest signals  <cit> .
jeun ss, et al.
observed that needling at gb <dig> could stimulate bilateral sensorimotor areas , whereas very few areas were activated when sham stimulation was given  <cit> .
schaechter et al.
found a significant positive correlation between changes in the function of the affected upper limb  and activation within a region of the ipsilesional motor cortex in patients treated with acupuncture relative to patients treated with sham acupuncture  <cit> .
the use of sham needling as the control factor strengthens the study, but it is not enough; needling on a sham point should also be included.
the effect of treating post-stroke aphasia patients with acupuncture and the relationship between acupuncture and cerebral functional regions were studied.
li et al.
and chau et al.
observed that language-deficit-implicated acupoint stimulation could selectively activate the brain on the lesion side in post-stroke aphasia patients  <cit> .
these studies highlighted the use of acupuncture in the study of post-stroke patients.
the above researches suggest that acupuncture can be applied to treat chronic stroke patients, and hence, in this study, we selected post-ischemic patients with the ischemic lesions limited to the left internal capsule, and the symptoms manifested as abnormal movements and sensations of the right limbs.
the published paper focused on some acupoints that are good for the recovery of stroke patients, including waiguan   <cit> .
te <dig>  can aid in the patient’s recovery of movement, sensation and speaking and treat dysfunctions of the eyes, ears and mental activities.
in this study, we targeted te <dig> on the right side of the patient and tried to analyze its action on regional cerebral functional areas.
the published studies described above have utilized pet, spect and fmri but not pet-ct. we used pet-ct as the examination method because it provides high spatial discrimination.
our observations included pure needling and a comparison between needling and sham needling, which provided stronger evidence for the underlying mechanisms.
in this experiment, we included a sham needle as well as a sham point, to clarify the distinction between the action of acupuncture and the selected acupoint.
the former studies focused on specialized acupuncture techniques or special groups of acupoints.
in this experiment, only one acupoint, te <dig>  and only one technique, twisting, were involved to simplify the experimental condition and illustrate the mechanism more easily.
previous research has focused on post-stroke patients with aphasia and found that acupuncture could affect the language-related cerebral regions.
the current experiment involves patients with left hemisphere ischemic damage accompanied by light aphasia in addition to typical hemiplagia.
the acupoint te <dig> can potentially help the recovery of language as well as address the abnormal motion and sensation of affected limbs.
thus, in this study, we execute needling at a single acupoint and compare the results with sham needling and needling at a sham point.
in this way, we tried to find the “special activated/deactivated cerebral functional regions” resulted from needling, target cerebral functional regions needling at te <dig> acting on, and then related these changed cerebral areas to the cerebral areas that involved in the recovery of stroke patients, in order to explain the mechanism of needling to help the recovery of hemiplegia.
the acupoint used in the experiment was te <dig>  a commonly used one in the treatment of stroke patients.
only one acupoint was adopted in this study, even if a group of acupoints were usually applied in the clinical practice of stroke treatment.
the basic mechanism study should be begin with a single point, and develop as “single point—two points grouping—more points grouping”.
in the mean time, it was convenient for us to process the “block stimulation” strictly.
RESULTS
all  <dig> patients finished the pet-ct scan under different states.
among them, a patient from group  <dig> who received needling at the sham point and another patient from group  <dig> who received sham needling at the sham point did not remain immobile during the scan, and the images were blurred due to large movements of the patient’s head.
the datasets were removed from the study, and the remaining  <dig> patients’ data were processed.
comparison between true and non-needling at te5
compared with non-needling, needling at te <dig> resulted in activation of ba <dig>  whereas sham needling at te <dig> and needling/sham needling at the sham point did not lead to any cerebral activation.
needling/sham needling at te <dig> and needling at the sham point did not deactivate any cerebral areas, but sham needling at the sham point led to a deactivation of ba <dig> .
comparison between true and sham needling at te5
compared with sham needling at te <dig>  needling at te <dig> activated ba <dig>   <dig> and  <dig> and did not deactivate any areas .
comparison between needling at te <dig> and at the sham point
compared with needling at the sham point, needling at te <dig> did not have any activating effect, but it did have a deactivating effect on ba <dig> .
discussion
as mentioned above, it is popular to treat chronic stage ischemic stroke patients with acupuncture in china  <cit> .
one of the commonly targeted acupoints for the treatment is te <dig>  according to the theory of meridians and acupoints, acupuncture at te <dig> has been shown to have curative effects on limbic paralysis and pain, dysfunction of the eye and ear, migraine, costal pain, fever and mental disorders, which indicates that it not only helps hemiplegia patients with motor recovery, but it also may ameliorate sensory dysfunction, post-stroke depression, dementia, aphasia, visual dysfunction, auditory dysfunction and sleeping disorders .
patients involved in this experiment received needling at te <dig>  to prove the relationship between needling at te <dig> and the activation/deactivation of cerebral functional regions, patients without any needling, with needling at a sham point and with sham needling at te <dig> were included as control groups.
the study showed that, compared with non-needling, sham needling at te <dig> and needling or sham needling at the sham point did not have any effect on the functional regions of the brain.
in contrast, needling at te <dig> resulted in activation of ba <dig>  a part of the limbic system, which indicates that needling at te <dig> in ischemic stroke patients could specifically act on the limbic system.
compared with non-needling, needling and sham needling at te <dig> and needling at the sham point did not have any deactivating effects on the brain.
one exception to this was observed in ba <dig>  which was deactivated when sham needling was done at the sham point.
ba <dig> is a motor center and takes part in the planning and execution of motor function.
according to clinical experience, needling at te <dig> can produce the strongest curative effect, followed by sham needling at te <dig>  then needling at the sham point, while sham needling at the sham point generally has the smallest effect.
our experiment proved that sham needling at the sham point, which produced the lightest curative effect, led to the deactivation of ba <dig> in ischemic stroke patients.
sham needling has been used as a control in some acupoint needling studies  <cit> .
the way it is implemented or manipulated can vary, and it is not a standard part of every study  <cit> .
compared to sham needling at te <dig>  needling at te <dig> was shown to activate ba <dig>   <dig> and  <dig>  but it did not lead to any deactivation, which indicates that there is a difference between true and sham needling.
ba <dig>   <dig> and  <dig> are located in the right hemisphere and participate in cortical association, vision processing and motor execution, respectively.
unlike sham needling, true needling acts specifically on functional areas related to vision and motor execution of the right hemisphere, the healthy side of the brain, and this may be related to the mechanism underlying the role of acupuncture in the recovery from left internal capsule ischemia.
there are different reports on the comparison between true and sham needling.
recently, a systematic review indicated that acupuncture may be no more effective than sham acupuncture in treating temporomandi-bular joint disorders  <cit> .
but a study on post-hemorrhoidopexy showed, acupuncture was better that both sham acupuncture and conventional analgesia group .
a fmri study found that acupuncture at sanyinjiao  was different from needling at the sham point based on the analysis of resting-state amplitude of low-frequency fluctuation in sleep deprivation volunteers .
according to tcm theory, sham needling also stimulated the “cutaneous region” of meridians , similar to transcutaneous stimulation, which may lead to a certain curative effect.
our group also made a comparison between true and sham needling at te <dig> in volunteers, and found the different activated areas were left ba <dig> and  <dig> and the cerebellum by the pet scan .
we found that acupoint needling effects manifested differently under the healthy or pathological conditions.
compared to sham needling, true needling at te <dig> in stroke patients mainly affect the healthy hemisphere and in this way to help the recovery of stroke.
compared to needling at the sham point, needling at te <dig> did not lead to activation, but it did lead to deactivation of ba <dig> and the right cerebellum.
ba <dig>  located in the both hemispheres, is involved in govern execution.
this experiment shows that needling at te <dig> is different from needling at the sham point.
needling at te <dig> caused deactivation of the cognitive execution center of the left brain  and deactivation of the right cerebellum, which is related to the planning and execution activity on the healthy side.
sham point, also called as non-acupoint, is regarded with no curative effect even if it may have a certain  curative effect because there is still some qi distributed to the border of the two meridians’ basins.
now it is used as a control involved in the acupucnture research.
recent studies showed the difference between needling at a true acupoint and a sham point.
stimulation at true acupoints elicited a greater response than that of non-acupoints in cardiovascular disease .
also the differences were found in the actions on the cerebral functional areas proved by brain imaging .
the sham point used in this study was located between two meridians but did not belong to any meridians.
the comparison showed that the difference between needling at the true and sham points concentrated to cognition of planning and execution activities.
te <dig> has the function of treating mental disorders , which was manifested in this experiment in the treatment of post stroke patients, compared with the sham point needling.
we have observed the specific action of needling at te <dig> on cerebral functional regions of ischemic stroke patients compared to non-needling, sham needling at te <dig> and needling at the sham point .
note: italics = deactivated areas.
our results indicate that needling at te <dig> activates brain areas that are involved in motor execution, vision and emotion and that are predominantly located in the healthy hemisphere.
there is also a trend indicating that needling of te <dig> on the right side in patients with left hemisphere ischemia could activate the areas of motor execution in the healthy hemisphere while simultaneously deactivating areas related to motor execution in the affected hemisphere.
in addition, needling at te <dig> led to the deactivation of the cerebellum on the healthy side and ba <dig> of the affected side of the brain.
deactivation, compared to the condition of baseline, the glucose metabolism is negative, which indicates a re-distribution of the attention resource .
ba  <dig> has close relationship with an organization of an execution.
cerebellum controls the movement, sensation and cognition .
compared to needling at the sham point, needling at the true acupoint could reduce the glucose metabolism of the cerebral area which controls the execution of affected hemisphere, in the mean time reduce the glucose metabolism of cerebellum of the healthy hemisphere.
it was inferred that needling at te <dig> resulting a re-distribution of glucose in order to help the recovery of stroke.
the results indicated that needling at te <dig> had a regulating action to the glucose metabolism of cerebral functional areas.
in order to help the recovery of stroke patients, needling at te <dig> increased the glucose metabolism of the healthy hemisphere and decrease it of the affected side, which meant that needling at te <dig> had a general regulation to the brain without focused on the affected local area.
CONCLUSIONS
we have attempted to explain the mechanism of treating chronic stage ischemic stroke patients with needling at te <dig> with observations relating needling at te <dig> with specific brain activations and deactivations.
we found that needling at te <dig> in stroke patients could activate motor execution- and vision-related cerebral regions in the healthy hemisphere and the limbic system of the affected hemisphere and also deactivate the motor execution-related cerebral region of the affected hemisphere and the cerebellum of the healthy hemisphere.
needling at te <dig> could improve the glucose metabolism of the healthy hemisphere while decreasing the glucose metabolism of the affected hemisphere, and this may be the mechanism underlying the role of acupuncture in the recovery of hemiplegia.

 acupuncture is an important part of traditional chinese medicine and has been used for the treatment and recovery of stroke patients. recently, it has been proven to have a positive effect on post-stroke patients in multi-center studies involving large datasets of clinical observations and evidence-based literature analyses. however, the underlying mechanism of this relationship is still unclear. there are numerous methods to study the mechanisms of treating stroke by acupuncture. we focused on cerebral functional imaging because it enables observation of the real-time effects of acupoint needling and the reactions of functional brain regions in humans instead of in the animal brain. cerebral functional imaging has been successfully combined with acupuncture researches. needling at acupoints can activate particular cerebral areas under physiological conditions in both humans and monkeys. needling can also result in activation patterns that closely relate to areas involved with the treatment of depression, vascular dementia, rheumatoid arthritis, functional dyspepsia and parkinson’s disease. in addition, the response of the brain to needling at a single acupoint and needling at acupoints in different meridians or different regions has been studied and compared with true, sham and different manipulations of needling. studies based on cerebral functional imaging during acupuncture needling of stroke patients have been published previously. acupuncture-related activation changes in certain cerebral functional areas of stroke patients have been observed. he et al. reported activations in the primary motor area, premotor area, primary sensory area, superior parietal lobe, superior temporal gyrus and insula of the opposite hemisphere as well as bilateral activation of the sensory areas and the affected areas when patients were asked to move their index finger while being needled at quchi and shousanli on the side affected by hemiparalysis. the study of he et al. did not involve any control factors and was only an observation of needling. the effect of the special acupuncture therapies commonly used to treat chronic stage stroke patients also has been studied. wang f, et al. observed a significant difference in the effect of needle retention and electro-acupuncture stimulation on the contralateral cerebral hemisphere cortex and thalamus, ipsilateral basal ganglion and bilateral cerebella: specifically, the change in cerebral blood flow induced by electro-acupuncture was greater than that induced by needle retention. schockert t, et al. published that yamamoto new scalp acupuncture could affect certain cortical activations. zhang et al. compared xingnao kaiqiao acupuncture with routine needling and found that the former had a stronger effect on the activation of cerebral functional regions. special therapies of acupuncture are worthy topics of study, but studies should ideally begin with the fundamental relationships between needling at one acupoint and the changes in brain functional areas. the different effects of true and sham needling were investigated. li et al. reported that both electro-acupuncture and the touch of the needle tip on the skin in stroke patients and healthy volunteers resulted in the activation of the primary and secondary sensory centers, the motor center and cerebellum. however, the effects of needling stroke patients as well as the needle-tip-touching stimulation resulted in the strongest signals. jeun ss, et al. observed that needling at gb could stimulate bilateral sensorimotor areas, whereas very few areas were activated when sham stimulation was given. schaechter et al. found a significant positive correlation between changes in the function of the affected upper limb and activation within a region of the ipsilesional motor cortex in patients treated with acupuncture relative to patients treated with sham acupuncture. the use of sham needling as the control factor strengthens the study, but it is not enough; needling on a sham point should also be included. the effect of treating post-stroke aphasia patients with acupuncture and the relationship between acupuncture and cerebral functional regions were studied. li et al. and chau et al. observed that language-deficit-implicated acupoint stimulation could selectively activate the brain on the lesion side in post-stroke aphasia patients. these studies highlighted the use of acupuncture in the study of post-stroke patients. the above researches suggest that acupuncture can be applied to treat chronic stroke patients, and hence, in this study, we selected post-ischemic patients with the ischemic lesions limited to the left internal capsule, and the symptoms manifested as abnormal movements and sensations of the right limbs. the published paper focused on some acupoints that are good for the recovery of stroke patients, including waiguan. te can aid in the patient’s recovery of movement, sensation and speaking and treat dysfunctions of the eyes, ears and mental activities. in this study, we targeted te on the right side of the patient and tried to analyze its action on regional cerebral functional areas. the published studies described above have utilized pet, spect and fmri but not pet-ct. we used pet-ct as the examination method because it provides high spatial discrimination. our observations included pure needling and a comparison between needling and sham needling, which provided stronger evidence for the underlying mechanisms. in this experiment, we included a sham needle as well as a sham point, to clarify the distinction between the action of acupuncture and the selected acupoint. the former studies focused on specialized acupuncture techniques or special groups of acupoints. in this experiment, only one acupoint, te and only one technique, twisting, were involved to simplify the experimental condition and illustrate the mechanism more easily. previous research has focused on post-stroke patients with aphasia and found that acupuncture could affect the language-related cerebral regions. the current experiment involves patients with left hemisphere ischemic damage accompanied by light aphasia in addition to typical hemiplagia. the acupoint te can potentially help the recovery of language as well as address the abnormal motion and sensation of affected limbs. thus, in this study, we execute needling at a single acupoint and compare the results with sham needling and needling at a sham point. in this way, we tried to find the “special activated/deactivated cerebral functional regions” resulted from needling, target cerebral functional regions needling at te acting on, and then related these changed cerebral areas to the cerebral areas that involved in the recovery of stroke patients, in order to explain the mechanism of needling to help the recovery of hemiplegia. the acupoint used in the experiment was te a commonly used one in the treatment of stroke patients. only one acupoint was adopted in this study, even if a group of acupoints were usually applied in the clinical practice of stroke treatment. the basic mechanism study should be begin with a single point, and develop as “single point—two points grouping—more points grouping”. in the mean time, it was convenient for us to process the “block stimulation” strictly.  all patients finished the pet-ct scan under different states. among them, a patient from group who received needling at the sham point and another patient from group who received sham needling at the sham point did not remain immobile during the scan, and the images were blurred due to large movements of the patient’s head. the datasets were removed from the study, and the remaining patients’ data were processed. comparison between true and non-needling at te5 compared with non-needling, needling at te resulted in activation of ba whereas sham needling at te and needling/sham needling at the sham point did not lead to any cerebral activation. needling/sham needling at te and needling at the sham point did not deactivate any cerebral areas, but sham needling at the sham point led to a deactivation of ba. comparison between true and sham needling at te5 compared with sham needling at te needling at te activated ba and and did not deactivate any areas. comparison between needling at te and at the sham point compared with needling at the sham point, needling at te did not have any activating effect, but it did have a deactivating effect on ba. discussion as mentioned above, it is popular to treat chronic stage ischemic stroke patients with acupuncture in china. one of the commonly targeted acupoints for the treatment is te according to the theory of meridians and acupoints, acupuncture at te has been shown to have curative effects on limbic paralysis and pain, dysfunction of the eye and ear, migraine, costal pain, fever and mental disorders, which indicates that it not only helps hemiplegia patients with motor recovery, but it also may ameliorate sensory dysfunction, post-stroke depression, dementia, aphasia, visual dysfunction, auditory dysfunction and sleeping disorders. patients involved in this experiment received needling at te to prove the relationship between needling at te and the activation/deactivation of cerebral functional regions, patients without any needling, with needling at a sham point and with sham needling at te were included as control groups. the study showed that, compared with non-needling, sham needling at te and needling or sham needling at the sham point did not have any effect on the functional regions of the brain. in contrast, needling at te resulted in activation of ba a part of the limbic system, which indicates that needling at te in ischemic stroke patients could specifically act on the limbic system. compared with non-needling, needling and sham needling at te and needling at the sham point did not have any deactivating effects on the brain. one exception to this was observed in ba which was deactivated when sham needling was done at the sham point. ba is a motor center and takes part in the planning and execution of motor function. according to clinical experience, needling at te can produce the strongest curative effect, followed by sham needling at te then needling at the sham point, while sham needling at the sham point generally has the smallest effect. our experiment proved that sham needling at the sham point, which produced the lightest curative effect, led to the deactivation of ba in ischemic stroke patients. sham needling has been used as a control in some acupoint needling studies. the way it is implemented or manipulated can vary, and it is not a standard part of every study. compared to sham needling at te needling at te was shown to activate ba and but it did not lead to any deactivation, which indicates that there is a difference between true and sham needling. ba and are located in the right hemisphere and participate in cortical association, vision processing and motor execution, respectively. unlike sham needling, true needling acts specifically on functional areas related to vision and motor execution of the right hemisphere, the healthy side of the brain, and this may be related to the mechanism underlying the role of acupuncture in the recovery from left internal capsule ischemia. there are different reports on the comparison between true and sham needling. recently, a systematic review indicated that acupuncture may be no more effective than sham acupuncture in treating temporomandi-bular joint disorders. but a study on post-hemorrhoidopexy showed, acupuncture was better that both sham acupuncture and conventional analgesia group. a fmri study found that acupuncture at sanyinjiao was different from needling at the sham point based on the analysis of resting-state amplitude of low-frequency fluctuation in sleep deprivation volunteers. according to tcm theory, sham needling also stimulated the “cutaneous region” of meridians, similar to transcutaneous stimulation, which may lead to a certain curative effect. our group also made a comparison between true and sham needling at te in volunteers, and found the different activated areas were left ba and and the cerebellum by the pet scan. we found that acupoint needling effects manifested differently under the healthy or pathological conditions. compared to sham needling, true needling at te in stroke patients mainly affect the healthy hemisphere and in this way to help the recovery of stroke. compared to needling at the sham point, needling at te did not lead to activation, but it did lead to deactivation of ba and the right cerebellum. ba located in the both hemispheres, is involved in govern execution. this experiment shows that needling at te is different from needling at the sham point. needling at te caused deactivation of the cognitive execution center of the left brain and deactivation of the right cerebellum, which is related to the planning and execution activity on the healthy side. sham point, also called as non-acupoint, is regarded with no curative effect even if it may have a certain curative effect because there is still some qi distributed to the border of the two meridians’ basins. now it is used as a control involved in the acupucnture research. recent studies showed the difference between needling at a true acupoint and a sham point. stimulation at true acupoints elicited a greater response than that of non-acupoints in cardiovascular disease. also the differences were found in the actions on the cerebral functional areas proved by brain imaging. the sham point used in this study was located between two meridians but did not belong to any meridians. the comparison showed that the difference between needling at the true and sham points concentrated to cognition of planning and execution activities. te has the function of treating mental disorders, which was manifested in this experiment in the treatment of post stroke patients, compared with the sham point needling. we have observed the specific action of needling at te on cerebral functional regions of ischemic stroke patients compared to non-needling, sham needling at te and needling at the sham point. note: italics = deactivated areas. our results indicate that needling at te activates brain areas that are involved in motor execution, vision and emotion and that are predominantly located in the healthy hemisphere. there is also a trend indicating that needling of te on the right side in patients with left hemisphere ischemia could activate the areas of motor execution in the healthy hemisphere while simultaneously deactivating areas related to motor execution in the affected hemisphere. in addition, needling at te led to the deactivation of the cerebellum on the healthy side and ba of the affected side of the brain. deactivation, compared to the condition of baseline, the glucose metabolism is negative, which indicates a re-distribution of the attention resource. ba has close relationship with an organization of an execution. cerebellum controls the movement, sensation and cognition. compared to needling at the sham point, needling at the true acupoint could reduce the glucose metabolism of the cerebral area which controls the execution of affected hemisphere, in the mean time reduce the glucose metabolism of cerebellum of the healthy hemisphere. it was inferred that needling at te resulting a re-distribution of glucose in order to help the recovery of stroke. the results indicated that needling at te had a regulating action to the glucose metabolism of cerebral functional areas. in order to help the recovery of stroke patients, needling at te increased the glucose metabolism of the healthy hemisphere and decrease it of the affected side, which meant that needling at te had a general regulation to the brain without focused on the affected local area.  we have attempted to explain the mechanism of treating chronic stage ischemic stroke patients with needling at te with observations relating needling at te with specific brain activations and deactivations. we found that needling at te in stroke patients could activate motor execution- and vision-related cerebral regions in the healthy hemisphere and the limbic system of the affected hemisphere and also deactivate the motor execution-related cerebral region of the affected hemisphere and the cerebellum of the healthy hemisphere. needling at te could improve the glucose metabolism of the healthy hemisphere while decreasing the glucose metabolism of the affected hemisphere, and this may be the mechanism underlying the role of acupuncture in the recovery of hemiplegia. 
needling at te had a regulating effect on cerebral functional areas shown by pet-ct, and this may relate to its impact on the recovery of post-stroke patients. forty-three ischemic stroke patients were randomly divided into groups: the waiguan needling group, the te sham needling group, the sham point needling group, the sham point sham needling group and the non-needling group. compared with the non-needling group, sham needling at te and needling/sham needling at the sham point did not activate cerebral areas. however, needling at te resulted in the activation of brodmann area needling/sham needling at te and needling at the sham point did not deactivate any cerebral areas, whereas sham needling at the sham point led to deactivation in ba compared with sham needling at te needling at te activated ba and and did not deactivate any areas. compared with needling at the sham point, needling at te had no associated activation but a deactivating effect on ba waiguan sham pointischemic strokeneedling/sham needlingpet-ct cerebral functional imagingcerebral activating/deactivating effect acupuncture has been applied to aid in the recovery of post-stroke patients, but its mechanism is unclear. this study aims to analyze the relationship between acupuncture and glucose metabolism in cerebral functional regions in post-stroke patients using fdg pet-ct techniques.
 acupuncture has been applied to aid in the recovery of post-stroke patients, but its mechanism is unclear. this study aims to analyze the relationship between acupuncture and glucose metabolism in cerebral functional regions in post-stroke patients using fdg pet-ct techniques. forty-three ischemic stroke patients were randomly divided into groups: the waiguan needling group, the te sham needling group, the sham point needling group, the sham point sham needling group and the non-needling group. cerebral functional images of all patients were then acquired using pet-ct scans and processed by spm software.  compared with the non-needling group, sham needling at te and needling/sham needling at the sham point did not activate cerebral areas. however, needling at te resulted in the activation of brodmann area needling/sham needling at te and needling at the sham point did not deactivate any cerebral areas, whereas sham needling at the sham point led to deactivation in ba compared with sham needling at te needling at te activated ba and and did not deactivate any areas. compared with needling at the sham point, needling at te had no associated activation but a deactivating effect on ba  needling at te had a regulating effect on cerebral functional areas shown by pet-ct, and this may relate to its impact on the recovery of post-stroke patients. waiguan sham pointischemic strokeneedling/sham needlingpet-ct cerebral functional imagingcerebral activating/deactivating effect 