Bidirectional Regulatory Mechanism of Acupuncture in Treating Post-stroke Dysphagia Based on the Brain-Pharynx-Gut Axis

Abstract

Post-stroke dysphagia (PSD) is a common and debilitating complication of stroke that severely affects patient outcomes. Acupuncture has demonstrated clear therapeutic efficacy for PSD, yet its underlying mechanisms remain incompletely elucidated. This paper proposes the “Brain-Pharynx-Gut Axis” as an integrative theoretical framework to systematically articulate the bidirectional regulatory mechanisms of acupuncture in treating PSD. At the cerebral level, acupuncture reinstates the central drive for swallowing via three convergent routes: activation of the cortical-brainstem network, modulation of rhythmic generation within brainstem central pattern generator (CPG) nuclei, and suppression of neuroinflammation. At the pharyngeal level, acupuncture facilitates descending CPG commands to pharyngeal muscles, directly coordinates muscle contractions, and transmits pharyngeal afferent signals via the nucleus tractus solitarius (NTS) to the sensory cortex, establishing a closed loop of “peripheral stimulation → central activation → real-time feedback.” At the gastrointestinal level, acupuncture engages the vagus nerve to restore intestinal barrier integrity, remodel gut microbiota, and attenuate central neuroinflammation through the gut-brain axis, while also improving gastrointestinal motility to indirectly optimize the pharyngeal execution milieu. These three tiers operate synergistically to form a dynamic closed-loop system encompassing “descending drive – peripheral execution – ascending feedback – gastrointestinal synergy,” thereby providing a comprehensive theoretical reference for clinical optimization and mechanistic investigation of acupuncture in PSD.