The analgesic efficacy of acupuncture has been widely recognized. However, the mechanism by which manual acupuncture-generated mechanical stimuli translate into biological signals remains unclear. This study employed a CFA-induced inflammatory pain rat model. Acupuncture intervention was then performed following standardized procedures. Enzyme-linked immunosorbent assay (ELISA) assessed inflammatory cytokines levels, while immunofluorescence and qRT-PCR screened the level of p38 and F-actin expression in the ST36 acupoint area of rats. Results indicated increased inflammatory factors, including IL-1β and TNFα, with reduced paw withdrawal mechanical threshold (PWMT) and paw withdrawal thermal latency (PWTL) in CFA rats compared to unmodeled rats. After acupuncture intervention, the heightened expression level of F-actin and p38 mRNA and the phosphorylation of p38 in the acupoint area was observed alongside decreased inflammatory factors in diseased ankle joints. The application of lifting and thrusting manipulations further enhanced the effect of acupuncture, in which the molecular expression level of muscle and connective tissue increased most significantly, indicating that these two tissues play a major role in the transformation of acupuncture stimulation. Moreover, antagonizing p38 expression hindered acupuncture efficacy, supporting the hypothesis that p38 MAPK-mediated F-actin transduces mechanical signals generated by acupuncture and related manipulation into biological signals.

Background: With the global recognition of Traditional Chinese Medicine (TCM), acupuncture has gained widespread acceptance. However, training and assessing procedural skills in acupuncture, particularly for international students, remain challenging. The Direct Observation of Procedural Skills (DOPS) is a clinical assessment tool that provides real-time feedback, offering a potential solution to enhance practical skill development. Objective: This study evaluates the effectiveness of DOPS in improving practical skills, clinical thinking, and overall teaching quality among international acupuncture students. Methods: The study was conducted at the School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine. A DOPS-based assessment scale was developed following the Technical Benchmark of Acupuncture and Moxibustion: Filiform Needle (2023). DOPS was applied through a three-stage process (preparation, operation, and feedback) to assess acupuncture preparation, needle insertion, manipulation, and disinfection. Feedback addressed deficiencies to enhance learning outcomes. Results: DOPS significantly improved international students’ practical skills, operational proficiency, and critical thinking. Teachers and students reported high satisfaction with the system, which also facilitated the integration of theory with practice. Students refined their clinical skills and excelled in national competitions. Conclusions: DOPS is an effective tool for acupuncture skills training, providing standardized, real-time feedback that enhances teaching quality and bridges gaps in clinical practice. Future advancements, such as virtual reality and artificial intelligence, could further optimize the system and advance international acupuncture education.