Acupuncture influences multiple diseases by regulating gut microbiota

This comprehensive review examines how acupuncture influences multiple diseases through the regulation of gut microbiota, offering an innovative perspective on the therapeutic mechanisms of this ancient medical practice. The gut microbiota, which makes up approximately 80% of the total microbial population of the human body, plays a crucial role in maintaining the integrity of the intestinal mucosal barrier and the gut-brain axis. Imbalance of this microbiota (dysbiosis) is associated with the development of various conditions, ranging from gastrointestinal diseases to neuropsychiatric disorders. Acupuncture, recognized as a green therapy free of significant side effects, demonstrates a notable ability to modulate the composition and abundance of gut microbiota.

The authors analyzed evidence from animal and clinical studies, revealing that different acupuncture modalities, including manual acupuncture, electroacupuncture, and transcutaneous electrical stimulation, can effectively regulate the microbiota in various pathologic states. In gastrointestinal diseases, particularly ulcerative colitis, electroacupuncture at points such as Guanyuan (CV-4) and Zusanli (ST-36) promoted recovery of the colonic mucosa and significantly improved disease severity. Treatment increased beneficial bacteria such as Lactobacillus and Lachnospiraceae, while inhibiting pathogens such as Odoribacter and Streptococcus. Mechanistically, these changes correlated with modulation of regulatory T cells and Th17 cells, suggesting that acupuncture acts through the intestinal immune system.

In irritable bowel syndrome, electroacupuncture at ST-25 and ST-36 relieved visceral hypersensitivity, increased microbial diversity, and reduced the Firmicutes/Bacteroidetes ratio, a marker of dysbiosis. Notably, treatment also modulated the expression of corticotropin-releasing factor, a key mediator of the brain-gut axis. In mental disorders, particularly depression, acupuncture demonstrated antidepressant effects through microbiota regulation. Studies in chronic stress models showed that acupuncture at points such as Baihui (GV-20) increased the abundance of Lactobacillus while reducing Staphylococcus, correlating with improvement of depressive symptoms and restoration of serotonin levels and brain-derived neurotrophic factor.

For metabolic diseases, including obesity and type 2 diabetes, acupuncture proved effective in regulating microbiota related to energy metabolism. Treatment at points such as ST-36 and Daimai (GB-26) reduced the Firmicutes/Bacteroidetes ratio, increased short-chain fatty acid-producing bacteria, and improved insulin sensitivity through modulation of the IKKbeta/NF-kB-JNK-IRS-1-AKT pathway. In neurologic diseases such as Parkinson's and Alzheimer's, acupuncture demonstrated neuroprotective effects partially mediated by microbiota modulation. Treatment increased anti-inflammatory bacteria such as Butyricimonas and Bifidobacterium, while reducing pathogens associated with neuroinflammation.

These effects correlated with reduced microglial activation and improved blood-brain barrier function. The proposed mechanisms for the effects of acupuncture on the microbiota include vagal nerve modulation, activation of the cholinergic anti-inflammatory pathway, and direct regulation of the enteric nervous system. Stimulation of specific acupoints activates central neural networks that, through autonomic pathways, influence the intestinal environment and microbial composition. Identified limitations include the heterogeneity of acupuncture protocols used in the studies, variability in treatment duration and frequency, and the need for greater methodological standardization.

In addition, many studies are preclinical, requiring more randomized clinical trials for translational validation. The review highlights the growing importance of the microbiota-gut-brain axis in modern medicine and positions acupuncture as a promising intervention for therapeutic modulation of this pathway. The findings suggest that the pleiotropic effects of acupuncture across different organ systems may be partially explained by its ability to restore intestinal microbial homeostasis, offering a new mechanistic perspective on this ancient therapeutic practice.