[Acupuncture and biological resilience]

This paper systematically elaborates the theories of stress, biological resilience and hormesis. Mild low-dose stress induces organismic overcompensation via preconditioning, activates nuclear factor erythroid 2-related factor 2 (Nrf2)-mediated antioxidant, autophagy, DNA repair and other pathways, and presents an inverted U-shaped biphasic dose-response relationship. Preconditioning is categorized into local and remote types, which exerts long-term protective effects on systemic organs via metabolic reprogramming as well as neuro-humoral and immune pathways, with 2 distinct protective time windows (early and delayed). Numerous clinical trials have validated that remote ischemic preconditioning improves the prognosis of organ transplantation, stroke, hypertension and other diseases, yet its clinical application is limited by the requirement to predict injuries in advance. It proposes that somatic stimulation therapies including acupuncture, scraping and cupping act as mild stress-like interventions that fully conform to the six core characteristics of hormesis. By regulating oxidative stress, inflammatory response, mitochondrial function and DNA repair pathways, these therapies elevate systemic biological resilience, consistent with the evolutionary law that "mild stress confers benefits" and the traditional Chinese medicine health-preserving philosophy of tempering vitality through hardship as recorded in ancient texts. Acupuncture can be applied to perioperative care, chronic disorders, neurological diseases and full-life-cycle health management. Nevertheless, current research on acupuncture modulating resilience-related pathways remains insufficient, and in-depth exploration of its underlying basic mechanisms and clinical translation is still warranted.