Hong Cai

Abstract：In recent years, the application of ultrasound medicine in conjunction with traditional Chinese medicine diagnosis and treatment techniques has become increasingly widespread in clinical practice. Under ultrasound guidance, some traditional Chinese medicine diagnostic and treatment techniques have transitioned from “blind procedures” to “visualization,” making invasive procedures in traditional Chinese medicine more precise, safer, and more effective. This can provide clinical evidence for the effectiveness and safety of traditional Chinese medicine diagnostic and treatment techniques.

Key words: Ultrasound guidance; visualization; traditional Chinese medicine; acupuncture; surgical techniques

Editor’s Note: The “needle knife” mentioned here is an acupotomy needle, which is a heavier gauge of the needle with a sharpened edge at the tip. They are employed to cut or disrupt tissue at deep locations. While their use is widespread in China, in the US they are generally not in our scope of practice.

Traditional Chinese medicine diagnostic and treatment techniques are based on solid knowledge of traditional Chinese medicine theory and extensive clinical experience, to diagnose and treat diseases without relying on any modern medical facilities or equipment. However, due to differences in the mindset and accumulated experience of practitioners, there can be significant variations in diagnostic and treatment methods for the same disease, making it challenging to establish a unified understanding and treatment standard. In recent years, the application of ultrasound medicine in conjunction with traditional Chinese medicine diagnosis and treatment techniques has become increasingly widespread in clinical practice. Under ultrasound guidance, some traditional Chinese medicine diagnostic and treatment techniques have transitioned from “blind procedures” to “visualization.” This transformation not only reduces the risks associated with “blind procedures” but also significantly enhances clinical efficacy. As a result, it has gained favor among healthcare professionals.

Clinical research on the application of ultrasound guidance to the nervous system

Li Yunan^［1］and colleagues conducted a study on 14 patients with allergic rhinitis who received treatment involving ultrasound-guided bilateral sphenopalatine ganglion acupuncture. This study evaluated the clinical efficacy, rhinitis symptom scores, and Visual Analog Scale (VAS) scores before treatment, immediately after treatment, and 6 months post-treatment. The results showed that ultrasound-guided acupuncture of the bilateral sphenopalatine ganglion had stable short-term and long-term effects on allergic rhinitis. It also maximally avoided adverse reactions such as facial hematoma and persistent pain caused by blind needling.

Lin Bing^［2］et al randomly divided 46 stroke patients into an ultrasound treatment control group and an ultrasound combined with an acupuncture group. They assessed patients’ neurological function using the National Institutes of Health Stroke Scale (NIHSS) before and after treatment. The results showed that the observation group had a better improvement in neurological function compared to the control group. Jin Haipeng^［3］and colleagues divided 120 post-stroke dysphagia patients into an observation group, control group 1, and control group 2, each with 40 patients. The observation group received electro-acupuncture treatment of the tongue muscle group under ultrasound guidance. Control group 1 received conventional acupuncture treatment at specific acupoints (e.g., Lianquan, Wangu, Fengchi), while control group 2 received tongue muscle group electro-acupuncture based on anatomical positioning. The experimental conclusion indicated that ultrasound-guided electric acupuncture of the tongue muscle group could improve the swallowing function of post-stroke dysphagia patients by increasing the movement of the tongue-throat complex. Its effect and safety are better than conventional acupuncture and conventional suprahyoid muscle group electroacupuncture. Liao Yue^［4］and colleagues divided 60 patients with post-stroke limb spasticity into a control group and an observation group, each with 30 patients. The control group received treatment with a small needle knife, while the observation group received treatment with a small needle knife combined with shockwave therapy under ultrasound guidance. The study results showed that the combination of small needle knife therapy and shockwave therapy under ultrasound guidance was more effective in treating post-stroke limb spasticity compared to the control group. It had a positive effect on muscle tone and motor function in these patients.

Clinical Research on the Application of Ultrasound Guidance

in the Musculoskeletal System

Trunk Diseases

1.Neck Diseases

Liu Hong^［5］and colleagues divided 200 patients with cervical spondylosis into a treatment group and a control group, with 100 patients in each group. The treatment group received ultrasound-guided acupuncture treatment with a needle knife, while the control group received traditional acupuncture treatment with a needle knife. The experimental results showed that ultrasound-guided. needle knife treatment significantly improved the neck function of patients with cervical spondylosis, reduced pain, and was more effective than traditional acupuncture therapy. Huang Bingxiang^［6］divided 80 patients with nerve root cervical spondylosis into a needling group and a blade needle group, with 40 patients in each group. 〖JP2〗They then observed the clinical effects of ultrasound-guided blade needle decompression of cervical transverse processes for treating nerve root cervical spondylosis. The experimental conclusion 〖JP3〗indicated that ultrasound-guided blade needle decompression for treating nerve root cervical spondylosis was superior to fine needle acupuncture in relieving the patient’s symptoms, improving cervical mobility, and achieving clinical efficacy. Zhong Zhinian^［7］divided 60 patients with vertebral artery-type cervical spondylosis into a treatment group and a control group, with 30 patients in each group. The treatment group underwent ultrasound-guided needle knife stimulation of the stellate ganglion, while the control group received stellate ganglion blockade treatment. The experimental results showed that ultrasound-guided needle knife stimulation of the stellate ganglion for treating vertebral artery-type cervical spondylosis was safe and effective in improving clinical symptoms and function, as well as increasing vertebral-basilar artery blood flow velocity. The incidence of hematoma and symptoms at the needle insertion site was significantly lower than in the control group.

2. Lumbar Diseases

Wang Yongqi^［8］et al. studied the clinical efficacy of ultrasound-guided acupuncture of myofascial trigger points for the treatment of lumbar and hip myofascial pain syndrome. The experimental results showed that ultrasound-guided acupuncture of myofascial trigger points effectively improved the local tissue elasticity and altered the local deformation capability in patients with lumbar and hip myofascial pain syndrome, resulting in good treatment outcomes. Lin Xiuhua^［9］divided 60 patients with lumbar disc herniation into a control group and a treatment group, with 30 patients in each group. The control group received conventional needle knife treatment under ultrasound guidance, while the treatment group added the release of the ligamentum flavum on the affected side of the herniated segment. The experimental results showed that ultrasound-guided needle knife release of the ligamentum flavum had better outcomes in the treatment of lumbar disc herniation. Liu Xin^［10］and colleagues observed the effect of ultrasound-guided acupuncture at the Weizhong point on the side of lumbar pain in patients with acute lumbar sprain. The depth of ultrasound-guided acupuncture needed to reach the location near the deep fascia of the tibial nerve, followed by twisting and lifting techniques to achieve a therapeutic effect, which was significant. Liu Pengqun^［11］divided 60 patients with third lumbar transverse process syndrome into an ultrasound group and a control group, with 30 patients in each group. The ultrasound group received acupuncture treatment with ultrasound guidance, while the control group received acupuncture treatment using an empirical trigger point technique. The experimental results showed that ultrasound-guided acupuncture treatment for the third lumbar transverse process syndrome was more effective in improving patients’ pain symptoms and lumbar spine mobility, compared to the control group. Yang Dan^［12］observed the efficacy of ultrasound-guided needle knife treatment for chronic nonspecific low back pain. The study results indicated that ultrasound-guided needle knife treatment was more effective for chronic nonspecific low back pain compared to traditional needle knife treatment. There are also experimental studies suggesting that ultrasound-guided silver needle treatment can effectively relieve pain symptoms, improve lumbar function, and enhance the quality of life in patients with failed back surgery syndrome, with better outcomes than nerve blockade^［13-14］.

Limb Diseases

1. Upper Limb Diseases

Zhou Bin^［15］studied the efficacy of ultrasound-guided precise positioning for the treatment of subacromial impingement syndrome, targeting the coracoid process point, greater tuberosity of the humerus point, anterior medial acromion point, and lower edge of the acromion point. The conclusion pointed out that ultrasound-guided needle knife treatment with precise positioning was superior to the group without ultrasound guidance in relieving shoulder pain, improving shoulder joint mobility, and ensuring safety. Zhang Shulan^［16］and colleagues conducted a study on the treatment of shoulder periarthritis by ultrasound-guided positioning of shoulder joint lesions (effusion, proliferation, calcification, and contracture adhesions). The conclusion indicated that the ultrasound-guided positioning group had better outcomes in the treatment of shoulder periarthritis compared to the traditional needle knife group. Qiao Ruoyu^［17］treated 34 patients with long head of biceps tendonitis through ultrasound-guided positioning of their lesions and local needle knife release. The research results showed that ultrasound-guided needle knife release for the treatment of long head of biceps tendonitis had better effect, significantly improving shoulder pain and functional mobility in patients. Zhang Xu^［18］divided 60 tennis elbow patients into a control group and a treatment group, with 30 patients in each group. The treatment group received blade needle acupuncture combined with blockade treatment under musculoskeletal ultrasound guidance, while the control group received only blockade treatment under musculoskeletal ultrasound guidance. The results showed that musculoskeletal ultrasound-guided bladed acupuncture combined with closure had better short-term and long-term effects in the treatment of tennis elbow. Feng Yan et al.^［19］divided 60 patients with carpal tunnel syndrome into a study group and a control group, with 30 patients in each group. The study group received modified needle knife treatment with injection of lidocaine+triamcinolone+Vit12 suspension solution under ultrasound-guided fine needle puncture, while the control group received traditional needle knife treatment with the same injection. The research results showed that the ultrasound-guided modified needle knife treatment in the study group had an excellent effect on carpal tunnel syndrome compared to the control group. Fan Tianbing et al. ^［20］used ultrasound guidance to accurately locate the stenotic and thickened tendon sheath of the flexor tendon and used acupotomy to treat stenosing tenosynovitis. The conclusion showed that ultrasound-guided acupuncture release was more effective than conventional acupuncture in the treatment of flexor tendon stenosing tenosynovitis. Knife release is more effective and safer.

2. Lower Limb Diseases

Li Luning et al.^［21］divided 60 patients with knee osteoarthritis into an ultrasound-guided needle knife group and an acupuncture group, with 30 patients in each group. The experimental results indicated that ultrasound-guided needle knife treatment for knee osteoarthritis had better clinical outcomes than the acupuncture group. Xu Peifu et al.^［22］used ultrasound to determine the anatomical shape of the iliotibial band in patients with iliotibial band syndrome, found tender points at the lower edge of tensor fascia lata and the lateral femoral condyle, and performed small acupotomy treatment under ultrasound guidance. The research results showed that ultrasound-guided acupotomy has good clinical efficacy in the treatment of iliotibial band syndrome.

Ma Muti Amuding^［23］divided 60 patients with plantar fasciitis or plantar heel pain into a treatment group and a control group, with 30 patients in each group. In the treatment group, patients underwent soft tissue blockade under musculoskeletal ultrasound guidance, followed by blade needle release treatment. The control group received only soft tissue blockade under musculoskeletal ultrasound guidance. The experimental results showed that musculoskeletal ultrasound-guided blade needle release combined with blockade treatment had better short-term and long-term outcomes for plantar heel pain compared to the control group.

Zhao Shanxu et al.^［24］conducted an observational study on the effectiveness of traditional Chinese medicine steaming and washing combined with ultrasound-guided needle knife release for plantar fasciitis. The experimental conclusion indicated that traditional Chinese medicine steaming and washing combined with ultrasound-guided needle knife release treatment for plantar fasciitis was more effective than either ultrasound-guided needle knife release treatment alone or traditional Chinese medicine steaming and washing treatment.

Clinical Research on the Application of Ultrasound Guidance in Other Systems

Chen Yingqi et al^［25］divided 72 healthy subjects into an observation group and a control group, with 36 subjects in each group. They studied the gastric antral motility by assessing the depth of acupuncture at the Zusanli acupoint under ultrasound guidance and whether qi was obtained during acupuncture. The research results showed that acupuncture at the Zusanli acupoint with qi obtained under ultrasound guidance could to some extent change gastric antral motility.

Lang Yi^［26］divided 120 insomnia patients into an acupuncture group, an ultrasound-guided stellate ganglion block group, and a combination therapy group, with 40 patients in each group. The research results showed that the acupuncture group and the ultrasound-guided stellate ganglion block group had similar treatment effects on insomnia, which are both lower than the stellate ganglion block combined with acupuncture treatment group.

Chu Kaiyun^［27］and colleagues assessed and monitored the affected limbs before and after He’s fire needling therapy for lower limb varicose veins using ultrasound technology, providing clinical evidence for the safety and effectiveness of He’s fire needling.

Wang Yushuang et al.^［28］used ultrasound follow-up to observe the changes in breast hyperplasia tissue and hyperplastic nodules during the treatment of breast hyperplasia with traditional Chinese medicine, and then used it to evaluate the efficacy of traditional Chinese medicine on breast hyperplasia, which improved the accuracy of the treatment effect.

Reflection:

With the ongoing improvement of medical technology, while ultrasound and TCM diagnosis and treatment technology are from two different medical systems, they can be integrated in the clinical process to good effect. Some TCM diagnostic and therapeutic techniques have evolved from empirical treatments in the past towards ultrasound-guided visualization. From the content of the research mentioned above, it is clear that TCM diagnostic and therapeutic techniques guided by ultrasound visualization mainly focus on techniques involving needle-knife treatment and regular acupuncture points. There is relatively little literature on other modalities such as silver needles, blade needles, fire needles, Chinese herbal medicine, etc. This is also from a certain point of view, in that, to an extent, it illustrates clinical medicine’s need for precision and safety for invasive operations of TCM diagnosis and treatment. Ultrasound can provide refined cross-section anatomy, allowing the practitioner to avoid blood vessels, nerves and other organs and tissues, and reach specific tissues with assurance, making TCM diagnosis and treatment more effective.

At the same time, ultrasound-guided TCM diagnostic and therapeutic techniques are mainly used to treat various pain conditions. This relies on the clear visualization of the anatomical structures in the corresponding areas during treatment under ultrasound guidance, facilitating the transformation of traditional TCM “blind procedures” into minimally invasive procedures. Ultrasound technology, as an important monitoring tool, also allows for a more intuitive and scientific demonstration of the effectiveness of TCM diagnostic and therapeutic techniques, avoiding claims of pseudoscience by some scholars. Therefore, the combination of TCM diagnostic and therapeutic techniques guided by ultrasound visualization represents both an opportunity and a challenge in the development of traditional Chinese medicine. The combination of the two will move forward through continuous exploration and will definitely bring new vitality to traditional medicine.

Author information:

Hong Cai, Doctor of Yubei District People’s Hospital of Chongqing

References

［1］Li Yunnan, Ou Yuyang, Lan Yangjing, et al. Preliminary efficacy observation of ultrasound-guided acupuncture of the sphenopalatine ganglion in the treatment of allergic rhinitis ［J］. Journal of China-Japan Friendship Hospital, 2023, 37(01): 25-28 + 2.

［2］Lin Bing, Gao Shangzhong, Ren Li. Clinical effect of ultrasound combined with acupuncture in the treatment of cerebral infarction and its impact on related indicators ［J］. Clinical Medical Research and Practice, 2020, 5(17): 126-127.

［3］Jin Haipeng, Wang Yong, Ye Qingjing, et al. Ultrasound-guided electroacupuncture of the suprahyoid muscles for the treatment of post-stroke pharyngeal dysphagia: a randomized controlled trial ［J］. Chinese Acupuncture, 2022, 42(03):251-256.

［4］Liao Yue, Liu Jisheng, Lan Caihong, etc. The effect of small acupotomy therapy combined with ultrasound-guided shock wave in the treatment of limb spasm after stroke and its impact on patients’ muscle tone and motor function ［J］. Chinese Contemporary Medicine, 2023, 30( 04):149-152.

［5］Liu Hong, Zhang Zesheng, Zhang Liangzhi, et al. Clinical effect of ultrasonic visual acupotomy technology in the treatment of cervical spondylosis ［J］. China Medical Herald, 2021, 18(15): 180-183+196.

［6］Huang Bingxiang. Observation on the clinical efficacy of ultrasonic-guided blade needle release of posterior cervical transverse process nodules in the treatment of radicular cervical spondylosis ［D］. Heilongjiang University of Traditional Chinese Medicine, 2023.

［7］Zhong Zhinian. Observation on the clinical efficacy of ultrasonic-guided acupuncture stimulation of the stellate ganglion in the treatment of vertebral artery-type cervical spondylosis ［D］. Beijing University of Chinese Medicine, 2015.

［8］Wang Yongqi, Xu Lei, Sun Qing, et al. Clinical study on ultrasound-guided acupuncture in the treatment of waist and hip myofascial pain syndrome ［J］. Chinese Journal of Orthopedics and Traumatology of Traditional Chinese Medicine, 2022, 30(03): 26-29 .

［9］Lin Xiuhua, Liu Cunbin, Geng Kai, et al. Clinical effect of ultrasonic-guided acupuncture release of ligamentum flavum in the treatment of lumbar disc herniation ［J］. China Medical Herald, 2022, 19(09): 157-160.

［10］Liu Xin, Sun Luyuan, Li Shanshan, et al. Clinical study on ultrasound-guided acupuncture at Weizhong point in the treatment of acute lumbar sprain ［J］. Chinese Journal of Traditional Chinese Medicine Emergencies, 2023, 32(05): 796-800.

［11］Liu Pengqun, Zhu Liguo, Chen Xin, et al. Clinical observation on the treatment of third lumbar transverse process syndrome with beryllium acupuncture under ultrasound guidance ［J］. Beijing Chinese Medicine, 2023, 42(06): 607-610.

［12］Yang Dan. Clinical observation of acupotomy under ultrasound guidance in the treatment of chronic non-specific low back pain ［D］. Chengdu Institute of Physical Education, 2023.

［13］Li Zhipeng, He Yuezhen, Gong Wenkui, et al. Effect of ultrasound-guided silver needles in the treatment of failure syndrome after lumbar spine surgery ［J］. Guangdong Medicine, 2017, 38(06): 872-874.

［14］Wang Zhigang, Peng Cheng. Effect of ultrasound-guided silver acupuncture in the treatment of failure syndrome after lumbar spine surgery ［J］. Famous Doctors, 2021(17):52-53.

［15］Zhou Bin. Observation on the clinical efficacy of ultrasonic-guided needle-knife precise positioning in the treatment of subacromial impingement syndrome ［D］. Fujian University of Traditional Chinese Medicine, 2020.

［16］Zhang Shulan, Bai Yu, Liu Yibing, et al. Observation on the efficacy of acupotomy in the treatment of frozen shoulder under ultrasonic positioning ［J］. Journal of Hubei Institute of Science and Technology (Medical Edition), 2020, 34(06): 483-486.

［17］Qiao Ruoyu. Clinical study on the treatment of long head of biceps tendonitis with ultrasonic positioning acupotomy ［D］. Beijing University of Chinese Medicine, 2019.

［18］Zhang Xu. Observation on the clinical efficacy of blade acupuncture combined with closure in the treatment of tennis elbow under musculoskeletal ultrasound guidance ［D］. Xinjiang Medical University, 2021.

［19］Feng Yan, Qin Xin, Xing Ruilin, et al. Application effect of modified small needle puncture under ultrasound in the treatment of carpal tunnel syndrome ［J］. Imaging Science and Photochemistry, 2022, 40(05): 1051-1055.

［20］Fan Tianbing, Wang Cheng. Research and analysis on the efficacy of ultrasound combined with small needle knife release in the treatment of flexor tendon stenosing tenosynovitis ［J］. Zhejiang Trauma Surgery, 2021, 26(05): 871-872.

［21］Li Luning, Hu Guoqiang, Gao Chengchao, et al. Clinical effect of acupotomy under ultrasound guidance in the treatment of knee osteoarthritis ［J］. China Medical Herald, 2018, 15(33): 138-141.

［22］Xu Peifu, Zhao Lina, Ren Shujun, et al. 60 cases of iliotibial band syndrome treated with small acupuncture under ultrasound guidance ［J］. Chinese Journal of Orthopedics and Traumatology of Traditional Chinese Medicine, 2022, 30(10): 57-60.

［23］Mamut Amudin. Analysis of the clinical efficacy of blade acupuncture combined with sealing in the treatment of heel pain under musculoskeletal ultrasound guidance ［D］. Xinjiang Medical University, 2021.

［24］Zhao Shanxu, Zhu Junchen. Observation on the efficacy of traditional Chinese medicine fumigation combined with ultrasound-guided acupuncture release in the treatment of plantar fasciitis ［J］. Journal of Shanxi University of Traditional Chinese Medicine, 2023, 24(02): 172-175+179.

［25］Chen Yingqi, Bian Bo, Zhao Yuanyuan, et al. Effect of acupuncture at Zusanli point on gastric antral contraction function under ultrasound guidance: a randomized controlled study ［J］. World Science and Technology-Modernization of Traditional Chinese Medicine, 2021, 23(05) :1463 -1469.

［26］Lang Yi. Clinical study on ultrasound-guided stellate ganglion block combined with acupuncture in the treatment of insomnia［D］. Southwest Medical University, 2019.

［27］Chu Kaiyun, Bao Chaohui, Liu Xuemei. Application of ultrasound in the treatment of varicose veins of lower limbs with He’s fire acupuncture ［J］. World Journal of Integrated Traditional Chinese and Western Medicine, 2018, 13(08): 1119-1122.

［28］Wang Yushuang, Wang Li. Evaluation of the efficacy of ultrasound in the treatment of breast hyperplasia with traditional Chinese medicine ［J］. Inner Mongolia Traditional Chinese Medicine, 2013, 32(25):7.