Recent News

Acupuncture Beats Drug For Knee Arthritis Relief

Posted on April 11, 2018 From HealthCM  

 

Acupuncture combined with moxibustion is more effective for the treatment of knee osteoarthritis than meloxicam (a nonsteroidal anti-inflammatory drug). Researchers from Shanghai University of Traditional Chinese Medicine quantified the curative effect of warm needle acupuncture using micro-CT (computed tomography). [1] In the study, acupuncture combined with moxibustion successfully improves the condition of the osteoarthritic knee bone structure. In addition, knee cartilage scores document that acupuncture with moxibustion reduces inflammation and accelerates knee cartilage repair. 


Knee osteoarthritis is characterized by degeneration of articular cartilage, intra-articular inflammation with synovitis, and remodeling of periarticular and sub-chondral bone. [2] It is a major cause of pain and disability and is also one of the most common musculoskeletal disorders. [3] In addition, the increased prevalence of the disease is proportional to increases in the obesity epidemic. [4]


Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most commonly used drugs for the treatment of knee osteoarthritis (KOA). While effective for pain management, the downside is that NSAIDs can lead to heartburn, indigestion, stomach ulcers, hypogonadism, and skin rashes. [5] In China, warm needle acupuncture is widely used for treating KOA. In this study, the researchers note that “In the early stages of KOA, warm needle acupuncture not only relieves pain, but also accelerates bone tissue repair.” The researchers conclude that “Warm needle acupuncture is safe and effective for the treatment of KOA.”


In this randomized study, 40 experimental rats were divided into 4 groups: a control group (n=10), a KOA model group (n=10), a medication group (n=10), and a warm needle acupuncture group (n=10). With the exception of the control group, the other three groups underwent surgery to create a KOA model. The medication group received intragastric administration of meloxicam, once per day, for 20 consecutive days. Meloxicam is an NSAID used to treat pain and inflammation caused by osteoarthritis. The warm needle acupuncture group was treated with acupuncture and moxibustion at bilateral Xiyan (ST35 Dubi and Neixiyan), once per day, for 20 consecutive days. The KOA model group did not receive any treatment.


Micro-CT Imaging
High-resolution micro–computed tomography (micro-CT) imaging has been established as the gold standard for assessing the morphology of calcified tissue. [6] Micro-CT has many advantages, including providing direct visualization of the whole joint as well as quantification of parameters such as articular cartilage volume and surface area. [7] The disadvantage of micro-CT is that it doesn’t effectively image uncalcified soft tissue such as cartilage. [8]


In this study, the researchers used the imaging technology to quantify the two dimensional and three dimensional changes of the knee bone. After validating the rat KOA model using established technology, Zhang et al. scanned the knee joints in situ and analyzed the samples in two different ways. First, the researchers observed the samples in 2-D views for morphological changes. In this first phase, the Region of Interest (ROI) involves the tibial intercondylar eminence, femoro-patellar joint space, and the lateral aspect of the patella. In medical imaging, ROI is a selected area of the whole image identified for a particular purpose. Second, they reconstructed the knee joint in 3-D views. In the second phase, ROI includes the femoral condyle and tibial plateau.


After 2-D scanning of the knee joint, the control group showed a smooth intercondylar eminence, normal joint space, and a healthy lateral aspect of the patella. The KOA model group displayed an edgy intercondylar eminence, narrowed joint space, and thickened lateral aspect of the patella. For the medication group, the imaging results were like that of the KOA model group. For the warm needle acupuncture group, the imaging results were closer to that of the control group. After comparing different groups, the researchers concluded that warm needle acupuncture outperformed meloxicam for knee bone repair.


In a 3-D presentation, the control group displayed a smooth joint surface and no bone loss. The KOA model group showed obvious bone loss. The reconstruction results of the medication group were closer to that of the KOA model group. For the warm needle acupuncture group, the results were closer to that of the control group, indicating that warm needle acupuncture provides a significant bone healing effect.


Macroscopic Grading of Cartilage Changes
The cartilage area of the femoral condyle and tibial plateau was measured and graded based on a 0 – 4 scaling assessment: 0 = surface appears normal, 1 = minimal fibrillation or a slight yellowish discoloration of the surface, 2 = erosion extending into superficial or middle layers, 3 = erosion extending into the deep layers, 4 = erosion extending to the subchondral hone. [9]


For scoring of cartilage changes, the KOA model group, medication group, and acupuncture group were more impacted than the control group (P<0.01). However, the medication group and the acupuncture group were less impacted than the KOA model group (P<0.05). Importantly, the acupuncture group was significantly less impacted than the medication group (P<0.05). The researchers concluded that warm needle acupuncture has a superior effect for knee cartilage repair when compared with meloxicam. 


Acupuncture Procedure
The acupoint pair used in this study is Xiyan. Treatment commenced with the knee at a 45 degree angle. Upon disinfection, needles were inserted to a depth of 5 mm. Once a deqi sensation was obtained, the needles were retained and moxibustion was applied.

Moxa cigar cuttings were attached to each needle handle and kept 2 – 3 cm above the skin. It is noted that moxa is best ignited from the bottom to ensure an optimal warming effect and then left in place to self-extinguish. [10] A total of two moxa cigar cuttings were used during the treatment session.


Traditional Chinese Medicine
The researchers cited the ancient historical roots behind the protocol used in the study. In TCM (Traditional Chinese Medicine), KOA is in the scope of Gu Bi (translated as bone impediment). According to the
Huangdi Neijing (Yellow Emperor’s Classic of Medicine), Gu Bi is caused by the congestion of wind, cold, and dampness. The root cause of the disease is liver and kidney deficiency. The treatment principle is to tonify the liver and kidneys, and to alleviate the congestion of the exogenous pathological factors.


Warm needle acupuncture is a combination of acupuncture and moxibustion. This needling technique invigorates blood circulation, transforms stasis, warms the meridians, and relieves pain. Previous studies demonstrate that warm needle acupuncture is beneficial to patients for the treatment of KOA. [11] In the Jing Yue Quan Shu (Jing-Yue's Complete Compendium), it is written that “Impediments are worsened by cold, but relieved by heat.” In the Qian Jin Yao Fang (A Thousand Gold Pieces Formulary), a special moxibustion technique called Zhong Zhi (translated as heavy moxibustion) is mentioned. This technique requires the use of large amounts of moxa cigar cuttings during one single treatment session and provides a significant curative action. In this study, two moxa cigar cuttings were used on the laboratory animals. The researchers note that “the effectiveness equals using 28 moxa cigars on human patients, which is an example of Zhong Zhi.”


The research team cited previous research to explain the anti-inflammatory actions of acupuncture. [12] They note that warm needle acupuncture influences the expression of transforming growth factor beta 1 (TGF-β1), osteoprotegerin (OPG, osteoclastogenesis inhibitory factor), basic fibroblast growth factor (bFGF), and insulin-like growth factor 1 (IGF-1). Healthy regulation of these protein levels plays an important role in promoting cartilage repair and chondrocyte proliferation.


The researchers conclude that acupuncture with moxibustion is effective for the alleviation of KOA. In addition, warm needle acupuncture outperforms meloxicam. Patients interested in learning more are encouraged to contact local licensed acupuncturists.

Notes
[1] Zhang Y, Mi Y, Gang J, Wang H. Effects of Warm Needling Moxibustion on Knee Cartilage and Morphology in Rats with Knee Osteoarthritis [J]. Chinese Acupuncture and Moxibustion, 2016 Feb;36(2):175-9.
[2] arthritisresearchuk.org/
[3] arthritisresearchuk.org/
[4] Li Q, Duan WP, Cao XM, et al. Case-control Study on the Relationship Between Body Mass Index and Lower Limb Alignment of Patients with Knee Osteoarthritis [J]. China Journal of Orthopaedics and Traumatology, 2011, 24(11):911-914.
[5] jia.org.uk/medication
[6] Bouxsein ML, Boyd SK, Christiansen BA, Guldberg RE, Jepsen KJ, Muller R. Guidelines for assessment of bone microstructure in rodents using micro-computed tomography. J Bone Miner Res 2010; 25:1468–86.
[7] Ruan MZ1, Dawson B, Jiang MM, Gannon F, Heggeness M, Lee BH. Quantitative imaging of murine osteoarthritic cartilage by phase-contrast micro-computed tomography [J]. Arthritis Rheum. 2013 Feb;65(2):388-96. doi: 10.1002/art.37766.
[8] Ruan MZ1, Dawson B, Jiang MM, Gannon F, Heggeness M, Lee BH. Quantitative imaging of murine osteoarthritic cartilage by phase-contrast micro-computed tomography [J]. Arthritis Rheum. 2013 Feb;65(2):388-96. doi: 10.1002/art.37766.
[9] Pelletier JP, Jovanovic D, Fernandes JC, Manning P, Connor JR, Currie MG, Di Battista JA, Martel-Pelletier J. Reduced progression of experimental osteoarthritis in vivo by selective inhibition of inducible nitric oxide synthase [J]. Arthritis Rheum. 1998 Jul;41(7):1275-86.
[10] Zhou HJ. Effect of Moxa-stick Ignition Locations on Temperature of Needle Body and Surrounding Environment During Warm Needling [J]. Chinese Acupuncture and Moxibustion, 2014, 34(7):675-677.
[11] Xiong GP, Huang Q, Dong YF, Chen P, Luo T. The Effectiveness of Bone Acupuncture Combined with Moxibustion for the Treatment of Osteoarthritis: 30 Cases [J]. Chinese Acupuncture and Moxibustion, 2011, 31(6):551-552.
[12] Chen YD, Qiu HP, Jin XQ, et al. Laboratory Study on Influence of Warm Acupuncture -Moxibustion on Matrix Metalloproteinase and Histomorphology of the Rabbit Experimental Knee Osteoarthritis Model [J]. Chinese Archives of Traditional Chinese Medicine, 2011(5):1060-1062.

Acupuncture Facial Recovery For Bell’s Palsy

Posted on March 14 ,2018 From HealthCM  


Researchers find acupuncture effective for the treatment of Bell’s Palsy—a type of facial paralysis. In one independent investigation, electroacupuncture produced optimal results. In another investigation, warm needle acupuncture combined with vitamin and drug injections produced excellent results. Let’s take a look at the results after a brief introduction. 


In an online acupuncture continuing education course at HealthCMi it is noted, “Bell’s Palsy is an acute facial paralysis caused by inflammation of the seventh cranial nerve (facial nerve). … A key feature of Bell’s Palsy is its sudden onset. Bell’s Palsy also causes unilateral impairment of motor function. … With Bell’s Palsy, swelling of the facial nerve and subsequent facial paralysis primarily occur via either an infectious or vascular mechanism.” The online course covers diagnostics, acupuncture treatment principles, and outcomes. 


The following are the two independent investigations mentioned above: 

Guangxi University
Guangxi University of Traditional Chinese Medicine researchers (Wu et al.) tested electroacupuncture and manual acupuncture for the treatment of Bell’s Palsy. Electroacupuncture produced a 92% total effective rate and manual acupuncture produced a 76% total effective rate. [1] Patient outcomes measured significant improvements in facial function and symmetry.


A total of 100 patients participated in the study. Identical sets of acupoints were applied to the electroacupuncture and manual acupuncture groups. Treatment was conducted once per day. The entire course of treatment was 2 treatment cycles, wherein one treatment cycle consisted of ten consecutive treatment days. The following acupoints were treated:

  • Yangbai (GB14) — afflicted side
  • Xiaguan (ST7) — afflicted side
  • Dicang (ST4) threaded to Jiache (ST6) — afflicted side
  • Quanliao (SI18) — afflicted side
  • Waiguan (TB5) — healthy side
  • Hegu (LI4) — healthy side
  • Zusanli (ST36) — bilateral
  • Sanyinjiao (SP6) — bilateral

Size 0.30 mm x 50 mm filiform acupuncture needles were used for treatment. Upon achieving deqi after insertion, the needle was manipulated with reinforcement and attenuation (Ping Bu Ping Xie). At this point, the needles were retained for 30 minutes for the manual acupuncture group. For the electroacupuncture treatment group, the needles were first connected to an electroacupuncture device (continuous wave), then retained for 30 minutes.


Liaoning University
Affiliated Hospital of Liaoning University of Traditional Chinese Medicine researchers find acupuncture an effective complementary medicine for the treatment of Bell’s Palsy. The total recovery rate for one arm of the study receiving medications plus acupuncture was 87.23% and the total effective rate was 97.87%. For the other arm of the study receiving only medications, the total recovery rate was 32.61% and the total effective rate was 80.43%. Acupuncture produced significant improvements in effective rates. [2]


The medications used for both groups were IV injections of dexamethasone over a five day period plus vitamin B1 and B12 intramuscular injections. Patients were instructed to start physiotherapy as early as possible and to practice facial movements like whistling, grinning, closing eyes, raising the forehead, frowning, etc. Patients were instructed to practice these exercises multiple times per day for approximately 10 minutes each time. They were also instructed to massage the facial muscles regularly.


The group receiving acupuncture had the same medications and instructions plus the application of the following acupoints in two treatment cycles, wherein one treatment cycle was comprised of 10 consecutive treatments followed by a one day break:

  • Dicang (ST4)
  • Jiache (ST6)
  • Hegu (LI4)
  • Yangbai (GB14)
  • Sibai (ST2)

Moxa sticks were held 1-2 cm from the needled acupoints. Then, the pecking (Quezhuojiu) moxibustion technique was used to manipulate the stick, while moving it in small clockwise circles, for approximately 1 minute. During this process, burnt ashes were continuously removed from the stick to reveal the red fire. Moxibustion was paused when if patient felt stinging or when the treated skin was flush or very perceived as hot. This entire moxibustion process was repeated 7 times for each acupoint. After moxibustion, eye region acupuncture was applied to the following zones on the afflicted side:

  • Shangjiao area
  • Fei area
  • Pi area

Acupuncture was administered with the patients’ eyes closed. While inserting the needle, one hand was used to pull the skin taut and the other used for insertion. The needle was inserted swiftly to a 2-3 mm depth. The insertion direction was adjusted until deqi was achieved. The needle was then retained for 15 minutes without any manipulation. During needle removal, care was taken to press the needled region for 3-5 minutes with a cotton swab to prevent bruising. The results indicate that this protocol produces a very high positive patient outcome rate in combination with usual care.

Results


The results indicate that acupuncture, as a standalone therapy, and that acupuncture combined with usual care are both effective treatment protocols. Patients interested in learning more are advised to contact local licensed acupuncturists regarding treatment options.


References
1. Wu CG, Jia RL, Li DH, Liu JY. Acupuncture combined with electroacupuncture in the treatment of acute peripheral facial paralysis for 50 cases [J]. Guangming Journal of Chinese Medicine, 2017, 32(2): 240-241.

2. Ju QB, Wang PQ. Clinical observation of eye acupuncture combined with Leihuo moxibustion in treating acute peripheral facial palsy [J]. Liaoning Journal of Traditional Chinese Medicine, 2017, 44(5): 1067-1069.


Acupuncture Beats Drugs For Insomnia Relief

Posted on FEBRUARY 10 ,2018  From HealthCM 


Researchers find acupuncture more effective than drugs for the treatment of insomnia. Zhejiang Chinese Medical University researchers conducted a controlled clinical trial and determined that acupuncture is more effective for the treatment of insomnia than a powerful nonbenzodiazepine hypnotic drug, zopiclone. Although zopiclone is not legal for use in the USA, a drug with an identical molecular formula and sequence of bonded atoms is available by prescription in the USA, that stereoisomer is eszopiclone (brand name Lunesta). Acupuncture outperformed zopiclone with a 92.9% total effective rate. Zopiclone had a 67.9% total effective rate. [1] 


A separate study conducted by Yuexiu District Second Hospital of Traditional Chinese Medicine researchers finds acupuncture more effective than a benzodiazepine, estazolam. The drug is a triazolobenzodiazepine hypnotic agent taken for sleep disorders. Acupuncture achieved a total effective rate of 92.5% and estazolam achieved a 67.5% total effective rate. [2]


In another investigation, Hangzhou Hospital of Traditional Chinese Medicine researchers determined that auriculotherapy (also known as ear acupuncture or auriculoacupuncture) is an effective acupuncture microsystem for the treatment of insomnia. [3] The researchers concluded that the application of press tack needles on ear acupoints is an effective treatment modality for insomnia patients. In addition, researchers from Beijing Tongzhou Maternal and Child Health Care Hospital Children's Health Care Center conclude that a combination of body style acupuncture and auriculotherapy is effective for the treatment of insomnia. [4] Let’s take a close look at the results.

 

Design
A total of 54 patients were selected between March 2016 and July 2017. They were randomly divided into an acupuncture treatment group and an estazolam control group. The treatment group included 10 males and 17 females with an average age of 53 ±18 years (range 22–75 years of age). The group suffered from insomnia for an average duration of 65.55 ±59.65 months (range 2–240 months). The control group included 12 males and 15 females with an average age of 50 ±12 years (range 25–71 years of age). The group suffered from insomnia for an average duration of 73.80 ±69.17) months (range 5–264 months). Statistical analysis of the profiles and case histories of patients in both groups (age, gender, duration of insomnia) showed no significant difference (P>0.05).


Diagnostic Criteria
Patients were diagnosed based on the standards listed in
China Classification and Diagnostic Criteria for Mental Disorders. Symptoms of insomnia include difficulty falling and staying asleep, waking up during the night, waking up too early, having trouble going back to sleep, daytime sleepiness, fatigue, drowsiness, etc. For this classification of insomnia, it occurs at least 3 times a week over a period of more than 1 month, and sleep deprivation reduces capability of attention and concentration leading to disruption of normal work or social activities.

Sleep disorders caused by physical illness or mental disorders do not meet the criteria and patients with this type of secondary insomnia are excluded from the study. In addition, pregnant or lactating patients were excluded from the study.


Acupuncture Treatment
Patients in the treatment group underwent a combination of conventional body style acupuncture and auriculotherapy. For body style acupuncture, routine disinfection of the local skin was applied followed by the application of acupuncture needles (disposable 0.25 mm × 25–50 mm ). The following acupoints were applied:

  • Baihui GV20 (Hundred Meetings)
  • Xinshu BL15 (Heart Shu)
  • Neiguan PC6 (Inner Pass)
  • Shenmen HT7 (Spirit Gate)
  • Zusanli ST36 (Leg Three Miles)

Acupuncture Techniques
For the Baihui GV20 acupoint, the needle was inserted obliquely, forming a 30° angle with the skin surface, with a depth of insertion ranging from 5–25 mm. For Xinshu BL15, the needle formed a 45° angle with the skin surface towards the spine, with a depth of 15–20 mm. Needles were inserted perpendicularly at the remaining acupoints. The twisting and reinforcing method was used at Baihui GV20, Neiguan PC6, and Shenmen HT7. Needles were then left in position for 30 minutes and manipulated every 10 minutes. Treatment was administered three times a week (Monday, Wednesday, Friday) over a course of 4 weeks for a total of 12 acupuncture treatment sessions.


Auriculotherapy
Auricular acupuncture was administered with 0.20 × 0.8 mm Hwato brand sterile disposable press needles (Suzhou Medical Products Co., Ltd.) after routine disinfection of the outer ear. The ear acupuncture point were as follows:

  • Shenmen HT7 (Spirit Gate)
  • Jiaogan AH6a (Sympathetic)
  • Xin (Heart)
  • Nao (Brain)
  • Neifenmi (Endocrine)

Press needles were inserted at the auricular acupoints and adhesive tape was applied to keep them in place. Press needles were then left in place for 24 hours after each session. Patients were instructed to press on the specific points 3 times a day for 2 minutes each, until soreness and tingling sensations were experienced. Treatment was administered three times a week (Tuesday, Thursday, Saturday) over the course of 4 weeks for a total of 12 acupuncture treatment sessions.


Drug Control
Patients in the control group were given estazolam tablets (Beijing Yimin Pharmaceutical Co., Ltd., 1 mg/tablet). One to two tablets were administered orally, thirty minutes before bedtime, on a daily basis, over a period of four weeks.


Observation and Analysis
The Pittsburgh Sleep Quality Index (PSQI) was used to assess the efficacy of the treatment using seven components: subjective sleep quality, sleep latency (i.e., how long it takes to fall asleep), sleep duration, habitual sleep efficiency (i.e., the percentage of time in bed that one is asleep), sleep disturbances, use of sleeping medications, and daytime dysfunction. Each component was weighted on a 0–3 interval scale. The global PSQI score was then calculated by adding the seven component scores, providing an overall score ranging from 0–21, where lower scores denote a healthier sleep quality. Pre and post-treatment PSQI scores were taken for comparison between the two groups. Statistical analysis was performed using the SPSS 11.0 statistical software. Comparison using paired sample t–test data from pre and post–treatment scores, as well as independent sample t–test data, showed that the difference was statistically significant (P<0.05).


Results
There was significant difference in the post-treatment PSQI scores between the two groups (P<0.01). There were also significant differences in sleep quality, use of sleeping medications, and sleep duration between the two groups (P<0. 01), while no significant differences were found for sleep latency, sleep efficiency, sleep disturbances, and daytime dysfunction (P>0.05).


As for the pre-treatment PSQI scores, no significant differences were found between the two groups (P> 0.05). However, the rate of reduction in post-treatment PSQI scores of the acupuncture treatment group (P<0.01) as well as that of each evaluating component were statistically significant (P <0.01, P <0.05). The rate of reduction in post-treatment vs. pre-treatment PSQI scores of the drug control group (P<0.05), as well as that of sleep quality, sleep latency, sleep duration factors were statistically significant (P<0.01, P<0. 05). The increment rate of the sleep medication factor was also found to be statistically significant in post vs. pre-treatment scores. The other factors, namely sleep efficiency, sleep disorders, and daytime dysfunction showed no significant difference (P>0.05).


According to Traditional Chinese Medicine (TCM), insomnia is termed Bu Mei or Bu De Wo (sleeplessness). The researchers determined that acupuncture provided significant clinical advantages over estazolam for the treatment of insomnia in their investigation. They conclude that acupuncture offers a holistic approach towards the improvement of sleep quality and sleep duration and is an effective alternative for the clinical treatment of insomnia.


 References
1. Shao, Yue. Clinical study on acupuncture for primary insomnia. [J] Journal of Acupuncture and Tuina Science 15, no. 6 (2017): 410–414.

2. Lai, DJ. Clinical Study of Traditional Chinese Medicine and Acupuncture vs Estazolam in the Treatment of Insomnia. Journal of Taishan Medical College, 2018, 02: 216–217.

3. Liang XM. Clinical Observations on the Therapeutic Effect of Auriculotherapy on Primary Insomnia in Elderly Patients [J] Shanghai Journal of Acupuncture and Moxibustion, 2017,36(6):719–722.

4. Li J, Fan S, Wang CY, Wei J, Huo Y, Si JT. Clinical Observation on Acupuncture and Auriculotherapy in Treating Insomnia [J] Journal of Basic Chinese Medicine, 2017, 23 (12): 1748–1749.

Acupuncture Migraine Relief Found Effective

Posted on JANUARY 17, 2018 From HealthCM


Researchers find acupuncture effective for the prevention and alleviation of migraine attacks. Migraines are the source of intense pain, lasting for hours or days. Chronic migraine sufferers may experience nausea, vomiting, and hypersensitivities—making them prone to anxiety and depression. Research conducted at the 254th Hospital of the Chinese People's Liberation Army demonstrates that electroacupuncture therapy in the projection zone and conventional acupuncture are both effective protocols for the elimination of migraine attacks.


A total of 120 migraine patients, between ages 18–70, were randomly divided into four groups: 


Projection zone group
Patients were treated with electroacupuncture by licensed acupuncturists in the projection zone area—from Yuzhen (BL9) to Tianshu (ST25)—using 0.30 mm × 50 mm Hwato brand acupuncture needles (Suzhou Medical Supplies Co., Ltd.). Four equidistant needles were applied along the BL9 to ST25 line, until patients experienced deqi sensations (e.g., soreness, numbness, heaviness). A Han's Acupoint Nerve Stimulator (HANS) with a 2/100 Hz alternating frequency at 8–20 mA was applied to BL9–ST25. The 30 minute treatment was administered once per day, over the course of 10 consecutive days. 


Conventional acupuncture group
Acupuncture therapy was applied to the following acupoints and were manipulated to achieve a deqi response:

  • Taiyang (MHN9)
  • Lougu (SP7)
  • Xuanlu (GB5)
  • Touwei (ST8)
  • Fengchi (GB20)
  • Waiguan (TB5)
  • Taichong (LV3)
  • Zulinqi (GB41)

Next, electroacupuncture with the HANS device using identical electroacupuncture settings as the projection zone group was applied (8-20 mA, 2/100 Hz, 30 minutes). Daily treatment was similarly administered over 10 consecutive days.


Non-acupoint group
Patients were treated over 10 days with four equidistant needles applied 2 inches away from the Yuzhen (BL9)/Tianzhu (BL10) line, until deqi sensations were induced. This was also followed by the use of the HANS device with the same electroacupuncture settings (8-20 mA, 2/100 Hz, 30 minutes) as the projection zone group.


Drug group
Diclofenac sodium enteric-coated tablets were administered orally, twice per day, 50 mg per dose, over the course of 10 days. Diclofenac sodium is a nonsteroidal anti-inflammatory drug (NSAID).

Exclusion criteria were established. Patients with the following conditions were not admitted to the study:

  • blood disease
  • heart disease
  • liver disease
  • kidney damage
  • brain trauma
  • brain tumor
  • epilepsy
  • high blood pressure
  • mental illness
  • infectious diseases

Pregnant or lactating women were excluded from the study. In addition, patients taking migraine medications or with basilar migraines were excluded. Scores were taken before and after treatment for the comparison and analysis of the therapeutic effects. The study evaluated the therapeutic effects of the four groups using the following four types of rating methods:

  • Visual Analogue Scale (VAS) scores: a value based on the scale of pain
  • TCM syndrome scores: a value based on the frequency, intensity, duration, and associated symptoms of headaches
  • Self-rating anxiety scale scores (SAS)
  • Self-rating depression scale scores (SDS)

Results
The total effective rate of the therapy in the projection zone group (93.33%) was higher than that of the conventional acupuncture group (86.67%), drug group (70.00%), and non-acupoint group (63.33%), with statistical significance (P=0.004). Pre-treatment VAS scores and TCM syndrome scores in all four groups improved significantly (P<0.05) after treatment. Post-treatment VAS scores in the projection zone acupuncture group were significantly better than the other three groups, and their TCM syndrome scores were also significantly better than the drug group and non-acupoint group (P<0.05). SDS scores in all four groups also improved significantly, with statistical significance (P<0.05). Post-treatment SAS and SDS scores in the projection zone group were significantly better than the other three groups (P<0.05).


The researchers conclude that acupuncture successfully alleviates migraines and reduces associated anxiety and depression. Electroacupuncture in the projection zone outperformed all other groups in the investigation.


References
Xiao L, Wang Y, Wang S, Wang LX, Cui Q, Zhang C, Yao LH, Shao JY, Xing J. Clinical Study on electroacupuncture Treatment of Migraine in Surface Projection Zone of the Pyramid Decussation [J]Chinese Journal of Information on TCM, 2018 (01).

Xiao L, Cui Q, Zhang QJ et. al, Study on the Therapeutic Effect of electroacupuncture on 60 Cases of Migraine [J]. People's Liberation Army Medical Journal 2013,25(7): 61-64.

Zhao L, Chen J, Li Y et. al, The Long-term Effect of Acupuncture for Migraine Prophylaxis [J]JAMA Intern Med. 2017;177(4):508-515.

Zhao JP, Wang RH, National TCM Professional Qualification Examination Outline "Chinese Acupuncture Major” (Intermediate) [M]. Beijing: China TCM Publishing House, 2015:752,903-904.

Zhou WJ, Sun QL Hemiplegia rehabilitation assessment manual [M]Beijing: People's Medical Publishing House, 2006:66-67,69.

Acupuncture Outperforms Drug For Insomnia Relief

Posted on December 27, 2017 From HealthCM 


Acupuncture is effective for insomnia relief. Research published by Zhejiang Chinese Medical University finds acupuncture more effective than a powerful sleep drug for improving sleep duration, quality, latency, efficiency, and daytime functioning. Acupuncture achieved a 92.9% total effective rate and the drug zopiclone achieved a 67.9% total effective rate. [1] 


Zopiclone is a central nervous system depressant used for helping patients fall asleep and maintaining sleep throughout the night. The Zhejiang Chinese Medical University research indicates that acupuncture is more effective than zopiclone for improving these sleep parameters. Zopiclone is limited to short-term use because patients develop tolerance or dependence, risking the possibility of addiction. Although a nonbenzodiazepine hypnotic agent used as a sedative, zopiclone enhances GABA (gamma-aminobutyric acid) via benzodiazepine receptors. Consequently, withdrawal symptoms are similar to those of benzodiazepines. The research indicates that acupuncture is an effective alternative without the adverse effects associated with drug intake.


Acupuncture improved sleep latency for patients in the study. This is the time to transition from wakefulness to sleep. Acupuncture also improves sleep efficiency. This is the percentage of total time spent sleeping at night while in bed. In Traditional Chinese Medicine (TCM), these parameters are paramount to an accurate differential diagnosis. Imbalances preventing falling asleep and imbalances causing patients to wake have differing causes within TCM. As a result, acupuncture and herbal medicine modifications are based on how easily patients fall asleep, how often they wake, and what times of day they wake.


A total of 112 patients with primary insomnia were randomized into an acupuncture group and a zopiclone group. For the drug group, zopiclone was administered in 7.5 mg doses, once per day, for 30 days. All patients receiving acupuncture had the following acupoints inserted with 0.25 mm diameter, 40 mm length filiform acupuncture needles:

  • Baihui (GV20)
  • Sishencong (EX-HN 1)
  • Anmian (extra, midpoint of Fengchi (GB20) and Yiming)

Secondary acupuncture points were added based on diagnostic considerations. For patients with heart and sleep deficiency, the following acupoints were added:

  • Shenmen (HT7)
  • Taibai (SP3)
  • Zhizheng (SI7)
  • Fenglong (ST40)

For heart deficiency related timidity, the following acupoints were added:

  • Shenmen (HT7)
  • Zhizheng (SI7)
  • Qiuxu (GB40)
  • Guangming (GB37)

For liver qi depression transforming into fire, the following acupoints were added:

  • Taichong (LV3)
  • Yangfu (GB 38)

For phlegm heat, the following acupoints were added:

  • Fenglong (ST 40)
  • Neiting (ST 44)
  • Quchi (LI 11)

For patients with blood stasis, the following acupoints were added:

  • Xuehai (SP10)
  • Geshu (BL17)

Standards of manual acupuncture needle manipulation were maintained according to accepted TCM principles. An even reinforcing and reducing technique (ping bu ping xie) was applied to the three primary acupuncture points administered to all patients. Reinforcing or reducing techniques were applied to the secondary acupoints based on differential diagnostic considerations. One course of treatment was comprised of one acupuncture treatment per day for 10 days. A one day break between each course was observed. Patients received three courses of care. Needles were retained during each acupuncture session for 30 minutes.


Acupuncture, achieving a 92.9% total effective rate, significantly outperformed the medication, which achieved a 67.9% total effective rate. A closer look at the numbers reveals important findings. In the acupuncture group, 10 patients completely recovered, whereas there were only 3 complete recoveries in the drug group. On the other end of the spectrum, only 4 acupuncture patients did not improve, whereas 18 drug patients did not improve.


In the middle range of improvements, patients receiving acupuncture had more significant improvements across a wider array of parameters. Patients receiving drug therapy had improvements limited to sleep quality, latency, and duration. Acupuncture caused improvements across these parameters plus daytime functioning, sleep efficiency, and reduction of sleep disturbances.


The research presents historical insight into TCM theoretical principles. Insomnia is classified as Bu Mei or Bu De Wo (sleeplessness). The research indicates that “Scholars in history made rich discussion on physiology and pathogenesis of insomnia, mostly based on the theory of imbalance between yin and yang, in which it holds that change of yin and yang within human body determines the sleep and awake cycle, and it is an inevitable phenomenon of yin yang alternation.” [2,3] They add that the “brain is the house of the original spirit,” which is linked to mental states. As a result, regulation of yin, yang, and spirit (shen) is indicated for patients with insomnia.


In a detailed analysis of each acupoint, the research presents the reasons for each point selection. GV20 was chosen because yang gathers at this point; it is a crossing point of the hand and foot yang channels with the Governing Vessel. GV20 is designated as the sea of yang channels; it regulates the qi and blood of all yang channels. As a results, the research notes that the “pathological state of yang failing to enter yin can be corrected.” The research also notes that GV20 is effective for “relieving fright and calming spirit.” [4]


Sishencong shares similar therapeutic properties on the two acupoints of the four point combination that are located on the Governing Vessel. In addition, the lateral points are within 0.5 cun of the Bladder Channel, which connects with the kidneys and also enters the brain. As a result, the research indicates that the lateral points of the Sishencong combination refresh the brain and tonify essence. The acupoint Anmian, translated as peaceful sleep, was noted for its ability to improve sleep by regulating excitatory responses in the brain and for improving micro-circulation.


The research was conducted at the Hospital of Integrated Traditional Chinese and Western Medicine (Zhejiang Chinese Medical University). Based on the data, acupuncture is more effective than zopiclone for the treatment of insomnia. An additional benefit is that acupuncture is non-addictive whereas the drug presents tolerance and dependence risks. To learn more, visit the acupuncture continuing education course on the treatment of insomnia at HealthCMi:


Notes:
1. Shao, Yue. "Clinical study on acupuncture for primary insomnia." Journal of Acupuncture and Tuina Science 15, no. 6 (2017): 410-414.


2. Xu F, Feng ZT, Wang ZN. Heart-spleen deficiency insomnia treated by five notes syndrome differentiation cooperate Guipi Anmei decoction. Jilin Zhongyiyao, 2014, 34(6): 582-585.


3. Xue DX, Zhang ZJ. Discussion of the syndromes and treatment of insomnia in Shang Han Lun (Treatise on Cold Damage Diseases). Xin Zhongyi, 2014, 46(8): 232-234.


4. Shao, Yue. "Clinical study on acupuncture for primary insomnia." Journal of Acupuncture and Tuina Science 15, no. 6 (2017): 410-414.

Acupuncture Immune System Discovery

Posted on November 17, 2017 From HealthCM


Researchers conclude that acupuncture benefits the immune system. In a controlled laboratory experiment, Hubei University of Chinese Medicine researchers discovered that electroacupuncture stimulation of acupuncture point ST36 (Zusanli) “enhanced the level of immune cytokines and splenic CD4+ T cells through TRPV channels.”


[1] In addition, the researchers document that electroacupuncture applied to ST36 enhances serum interferon-γ (IFN-γ) levels, interleukin (IL)-2, and IL-17. Results were confirmed using immunohistochemical analysis. The research measured the effects of electroacupuncture and precisely identified that electroacupuncture at ST36 enhances cytokines, which are proteins secreted by cells that have a specific effect on the interactions and communications between cells. 


[2] The researchers discovered that electroacupuncture enhancement of cytokines and helper T cells (CD4+ T cells) is through TRPV (transient receptor potential vanilloid) channels. TRPV channels are cellular sensors for a broad variety of physical and chemical stimuli involved in the formation of visual and auditory sensations, touch, olfactory perception, taste, temperature, and algesia. TRPV involvement in cell signaling triggers host cell responses to “benign or harmful environmental changes.” 


[3]The findings are significant because CD4+ T cells are of paramount importance in human immune systems. These cells are referred to as helper T cells and are active in the immune system’s defense against microbes, including viruses. CD4+ T cells have the ability to differentiate into many different types of cell subsets in the body’s effort to activate immune system cells, immunoregulation, and cytotoxic defense mechanisms.


The research reveals the role of electroacupuncture (2–15 Hz) in the enhancement of CD4+ T cells through TRPV channels, indicating an important pathway of acupuncture’s effective action. The researchers add, “These results proved that the rise in the intracellular Ca2+ induced by electroacupuncture at the ST36 acupoint was responsible for the differentiation, proliferation and activation of splenic CD4+ T cells.”


The researchers conclude, “the present study has demonstrated that electroacupuncture at the ST36 acupoint was able to regulate the production of immune cytokines (IFN-γ , IL-2 and IL-17) and the differentiation and activation of splenic T cells, which was mediated by the regulation of extracellular and intracellular Ca2+ concentrations.” 


The investigation was made possible by cooperation between three Hubei University of Chinese Medicine departments: Department of Biochemistry, Department of Anatomy, Department of Pathogenic Biology.The use of ST36 for the treatment of diseases in Traditional Chinese Medicine (TCM), according to the researchers, “has a long history of use as a supplementary therapy.” 


[4] The research supports the efficaciousness of traditional ST36 applications and maps the pathways and effective actions of needling ST36 when stimulated with an electroacupuncture device. This sheds light on the fundamental scientific question, how does acupuncture work? The researchers document that acupuncture achieves therapeutic results by Ca2+ signaling “in the context of T cell activation and differentiation.” 


[5]The research team notes that the investigation was prompted by results from prior investigations finding acupuncture effective in the treatment of stress induced immunodeficiency. [6,7] They add that the impetus for the investigation was also supported by prior research finding electroacupuncture stimulation of ST36 effective in activating the immune system and benefitting patients receiving anti-cancer therapy. 


[8–10] They added that an increased understanding of the “curative mechanisms of electroacupuncture” will help to expand the uses of the procedure on a greater scale.The researchers used modern techniques to measure the effects of electroacupuncture. Flow cytometry was used to measure the Ca2+ concentration of spleen cells. Immunofluorescence was integral to the immunohistochemical analysis. Ultrasonication was required for homogenates and an “ELISA assay was used to assess the IFN-γ, IL-2 and IL-17 levels in the serum and extracts from the ST36 acupoint area.” 


[11]The research is a quintessential laboratory investigation serving to more greatly understand ancient Traditional Chinese Medicine (TCM) in modern terms; specifically, the role of acupuncture point ST36 in reference to immune system enhancement. Traditionally, ST36 is known for its ability to tonify qi, nourish blood and yin, activate the channels, benefit source qi, and alleviate pain. The investigation updates this understanding with specific, quantifiable, and repeatable biochemical changes elicited by electroacupuncture stimulation of ST36.ST36 has long been an important acupuncture point in TCM. 


In approximately 440 CE, imperial medical officer Qin Cheng-zu stated that “all diseases can be treated” with the application of ST36. During the Han Dynasty (206 BCE–220 CE), the Chinese physician Hua Tuo applied ST36 for the treatment of the five taxations: excessive use of the eyes injuring the blood, excessive lying down injuring the qi, excessive sitting injuring the flesh, excessive standing injuring the bones, excessive walking injuring the sinews. These are but two historical examples for the uses of ST36. Now, with the advent of the Hubei University of Chinese Medicine research, we can add that ST36 enhances the immune system, stimulates production of helper T cells, and promotes cytokines. 


Notes:
1. Chen, Longyun, Anli Xu, Nina Yin, Min Zhao, Zhigang Wang, Tao Chen, Yisheng Gao, and Zebin Chen. "Enhancement of immune cytokines and splenic CD4+ T cells by electroacupuncture at ST36 acupoint of SD rats." PloS one 12, no. 4 (2017): e0175568.


2. Zhang, Jun-Ming, and Jianxiong An. "Cytokines, inflammation and pain." International anesthesiology clinics 45, no. 2 (2007): 27.


3. Zheng, Jie. "Molecular mechanism of TRP channels." Comprehensive Physiology (2013).


4. Chen, Longyun, Anli Xu, Nina Yin, Min Zhao, Zhigang Wang, Tao Chen, Yisheng Gao, and Zebin Chen. "Enhancement of immune cytokines and splenic CD4+ T cells by electroacupuncture at ST36 acupoint of SD rats." PloS one 12, no. 4 (2017): e0175568.


5. Ibid.


6. Vickers AJ, Cronin AM, Maschino AC, Lewith G, MacPherson H, Foster NE, et al. Acupuncture for chronic pain: individual patient data meta-analysis. Arch Intern Med. 2012; 172(19):1444–53.


7. Richardson PH, Vincent CA. Acupuncture for the treatment of pain: a review of evaluative research. Pain. 1986; 24(1):15–40. PMID: 2937004.


8. Wu B, Zhou RX, Zhou MS. [Effect of acupuncture on interleukin-2 level and NK cell immunoactivity of peripheral blood of malignant tumor patients]. Zhongguo Zhong Xi Yi Jie He Za Zhi. 1994; 14(9):537–9.


9. Rogers PA, Schoen AM, Limehouse J. Acupuncture for immune-mediated disorders. Literature review and clinical applications. Probl Vet Med. 1992; 4(1):162–93.


10. Wu B, Zhou RX, Zhou MS. [Effect of acupuncture on immunomodulation in patients with malignant tumors]. Zhongguo Zhong Xi Yi Jie He Za Zhi. 1996; 16(3):139–41.


11. Chen, Longyun, Anli Xu, Nina Yin, Min Zhao, Zhigang Wang, Tao Chen, Yisheng Gao, and Zebin Chen. "Enhancement of immune cytokines and splenic CD4+ T cells by electroacupuncture at ST36 acupoint of SD rats." PloS one 12, no. 4, pg. 13 (2017): e0175568.


12. Han JS. Acupuncture: neuropeptide release produced by electrical stimulation of different frequencies. Trends Neuroscience. 2003; 26(1):17–22.  

Acupuncture And Herbs Regulate Cardiac Arrhythmias

Posted on October 30, 2017 From HealthCM 

Hunan Hengyang Traditional Chinese Medicine Hospital researchers find acupuncture combined with herbal medicine more effective than calcium channel blockers and beta-blockers for the treatment of cardiac arrhythmias. Results were confirmed by ECG (electrocardiogram). Patients receiving only pharmaceutical medications in one group and acupuncture plus herbs in another group were compared in a four week clinical trial. Twenty-four hour ECG tests confirm that acupuncture plus herbs produces superior patient medical outcomes. 


Traditional Chinese Medicine (TCM) scoring was used in addition to ECGs to confirm clinical efficacy. The TCM scoring system evaluated for key symptoms including heart palpitations, chest discomfort, shortness of breath, fatigue, and limb weakness. According to a four point scale (the more severe the symptom, the higher the score), patients were evaluated for improvements. Acupuncture plus herbs outscored drug therapy for the regulation of arrhythmias. Based on the results of ECGs and TCM scoring, the treatment efficacy for each patient was categorized into 1 of 4 tiers as detailed:

  • Clinical recovery: Complete recovery of symptoms, no abnormalities detected in ECG.
  • Significantly effective: Symptoms mostly remedied or under control, ECG showed significant reduction in arrhythmia frequency.
  • Effective: ECG showed ≥50% reduction in arrhythmia frequency, with a ≥50% reduction in duration for each abnormality.
  • Not effective: No significant reduction of arrhythmias, or worsening of condition.

Based on the data, the acupuncture plus herbs group had a 95.3% total effective rate, outscoring the drug therapy group by 15.3%. The drug group scored 80%. Both approaches to patient care were significantly effective. However, one advantage to acupuncture plus herbal medicine is a dramatically lower adverse effect rate. 


Another advantage applies to patients that may be taking medications for secondary conditions. For these patients, arrhythmia medications pose contraindication issues with their medication regimen.Looking at the data, the acupuncture plus herbs group and the drug group had similar TCM scores prior to the clinical trial. The acupuncture plus herbs treatment group had a score of 11.5 ± 2.3 and the control group had an 11.8 ± 2.4 score. Essentially, there were equivalent patient samples at the initiation of the investigation. After treatment, the scores varied enormously. 


The acupuncture plus herbs group had a 3.8 ± 1.4 score and the drug group had a 6.2 ± 2.1 score. The acupuncture plus herbs group outperformed drugs by 2.4 TCM score points. Keeping in mind that lower numbers reflect improvements in heart palpitations, chest discomfort, shortness of breath, fatigue, and limb weakness results, the quality of life improved more greatly for the acupuncture plus herbs group than the drug group. 


The ECG results tell an important story. There is a bias in commonly accepted conventional wisdom that drugs are more potent and effective than holistic therapies such as acupuncture and herbal medicine. The ECG numbers indicate that acupuncture plus herbs is significantly more effective for the regulation of arrhythmias than medications, bucking the myth that drugs are somehow a more bona fide and successful treatment option. 


The ECG results demonstrate that acupuncture plus herbs is a responsible rout for arrhythmia treatment protocols. The drug group and the acupuncture plus herbs group started with similar ECG mean 24-hour arrhythmia frequency scores prior to the investigation (1405.4 arrhythmias in 24 hours and 1378.4 respectively). After the four week treatment program, the ECG results for the acupuncture group were 328.4. The drug group also improved, albeit with a lower positive patient outcome: 451.5.The study design was straightforward. 


A total of 90 patients from Hunan Hengyang Traditional Chinese Medicine Hospital were treated and evaluated in the study. The patients were diagnosed with arrhythmias between January 2013 and December 2013. They were randomly divided into the acupuncture plus herbs and drug groups, with 45 patients in each group. All patients had confirmed diagnoses of cardiac arrhythmias. Patient were excluded from the clinical trial if they had the following conditions: severe internal medicine diseases, mental illness, tachycardia due to blood loss, fever, and hyperthyroidism. Pregnant and nursing women were also excluded from the study. The primary acupoints selected for the acupuncture plus herbs treatment group were the following:

  • Shenmen (HT7)
  • Neiguan (PC6)
  • Shanzhong (CV17)
  • Guanyuan (CV4)
  • Zusanli (ST36)
  • Qihai (CV6)

Secondary acupoints were selected based on TCM differential diagnostics. For qi deficiency in the heart and gallbladder, the following acupoints were added:

  • Xinshu (BL15)
  • Danshu (BL19)

For weakness of heart and spleen qi and blood, the following acupoints were added:

  • Xinshu (BL15)
  • Pishu (BL20)

For yin deficiency with heat excess, the following acupoints were added:

  • Shenshu (BL23)
  • Taixi (KD3)

One standard acupuncture session was conducted daily. After 6 consecutive days of treatment, a break day was observed. For TCM herbal treatment, a decoction was brewed and administered based on the Xiaoyaosan herbal formula, for oral ingestion. All decoctions contained the following herbs:

  • Chai Hu (15 g)
  • Dang Gui (10 g)
  • Bai Shao (15 g)
  • Bai Zhu (10 g)
  • Fu Ling (10 g)
  • Bo He (5 g)
  • Zhi Gan Cao (15 g)
  • Sheng Di Huang(30 g)
  • He Huan Pi (10 g)
  • Yuan Zhi (10 g)
  • Sheng Jiang (10 g)
  • Da Zao (10 g)

For patients experiencing headaches, the following herbs were added:

  • Chuan Xiong (10 g)
  • Huang Qin (10 g)

For irritability, the following herbs were added:

  • Mu Dan Pi (10 g)
  • Zhi Zi (10 g)

For belching and sour taste, the following herbs were added:

  • Chuan Lian Zi (10 g)
  • Yan Hu Suo (10 g)

The decoction was consumed when warm, once in the morning and once at night. For the drug therapy groups, standard protocols were observed for calcium channel blocker and beta-blocker administration. The TCM score and ECG results indicate that acupuncture plus herbs is an effective treatment option, outscoring two types of drugs.Early documentation of arrhythmias into the canons of TCM exists in the Huangdi Neijing Suwen-Ju Tong Lun; the principle of unblocking liver qi stagnation to soothe the heart was introduced. 


Many scholars date the work to approximately 200 BCE, between the late Warring States period and the emergence of the Han dynasty. The Hunan Hengyang Traditional Chinese Medicine Hospital researchers tested the liver qi stagnation principle with the scientific method using the herbal formula Xiao Yao San (used to regulate liver qi) and acupuncture. The results support the ancient principle that freeing the liver qi benefits the heart.In related research, Changchun Traditional Chinese Medicine Hospital researchers document that acupuncture plus herbs outperforms medications for the treatment of premature ventricular contractions (PVCs). 


A total of 72 patients from Changchun TCM Hospital were treated and evaluated in the study. The patients were aged between 19 – 85, with a PVC history between 1 – 20 years. Patients were randomly divided into an acupuncture plus herbs treatment group and a drug control group, with 36 patients in each group. The treatment group was given acupuncture, an herbal medicine decoction, and an intravenous injection of TCM herbs. The control group received conventional medication. The primary acupoints selected for the treatment group were the following:

  • Shenmen (HT7)
  • Neiguan (PC6)
  • Xinshu (BL15)
  • Jueyinshu (BL14)

For qi deficiency, the following secondary acupoints were added:

  • Pishu (BL20)
  • Zusanli (ST36)
  • Qihai (CV6)

With the patients resting in a supine position, acupuncture was administered by manipulating each needle with the Ping Bu Ping Xie (tonify/attenuate) technique after insertion, until a deqi sensation was perceived. Thereafter, a 20 – 30 minute needle retention time was observed. One acupuncture session was conducted daily. The following auricular acupoints were selected for ear acupuncture:

  • Xuexin
  • Jiaogan
  • Shenmen
  • Pizhixia
  • Gan
  • Neifenmi
  • Sanjiao
  • Shen

A total of 3 – 4 auricular acupoints were pierced with moderate force during one ear acupuncture session. Needles were retained for 30 – 40 minutes. During needle retention, each needle was rotated rapidly 3 – 4 times. One ear acupuncture session was conducted daily. For TCM herbal treatment, different brews and ready-made formulas were administered to each patient, based on differential diagnostics. For deficiency of qi and yin, a modified Shengmaisan decoction and Wenxinkeli pills were administered. The decoction was comprised of the following herbs:

  • Shengshaishen
  • Maimendong
  • Wuweizi
  • Huangjing
  • Baihe
  • Tianmendong
  • Yuanzhi
  • Shichangpu
  • Longchi
  • Zhigancao

For weak heart and spleen qi and blood, a modified Guipitang decoction and ready-made Guipiwan pills were administered. The decoction was comprised of the following herbs:

  • Dangshen
  • Huangqi
  • Danggui
  • Longyanrou
  • Baizhu
  • Fushen
  • Yuanzhi
  • Fuxiaomai
  • Zhigancao

For deficiency of yin and yang, a modified Zhigancao decoction was administered, comprised of the following herbs:

  • Zhigancao
  • Xiyangshen
  • Maidong
  • Wuweizi
  • Guizhi
  • Danggui
  • Huangqi
  • Yuanhu
  • Gansong
  • Chaozaoren

For stasis of phlegm and blood, a modified combination decoction of Erchentang and Taohongsiwutang was administered:

  • Chenpi
  • Banxia
  • Fuling
  • Taoren
  • Honghua
  • Shengdi
  • Chuanxiong
  • Danggui
  • Chishao
  • Gualou

For stasis of blood and qi, a modified Xuefuzhuyutang decoction was administered:

  • Chaihu
  • Danggui
  • Shengdi
  • Niuxi
  • Jiegeng
  • Shaoyao
  • Taoren
  • Honghua
  • Chuanxiong
  • Danshen

For heart fire caused by hot phlegm, a modified Huanglianwendantang decoction was administered:

  • Huanglian
  • Banxia
  • Chenpi
  • Fuling
  • Zhishi
  • Yuanzhi
  • Shichangpu
  • Quangualou
  • Dannanxing

The following intravenous infusions were administered according to differential diagnostics:

  • Shenfu IV infusion
  • Shengmai IV infusion
  • Chuanxiong IV infusion
  • Fufangdanshen IV infusion
  • Honghua IV infusion

For the control group, betaloc tablets (23.75 mg) were administered twice per day. Metoprolol is an active ingredient in betaloc, a beta-blocker. Other medications were prescribed according to individual diagnostics, including antianginal and anticoagulant drugs.For both groups, the entire treatment course was 4 weeks. Patients were evaluated pre-treatment and post-treatment. The treatment efficacy for each patient was categorized into 1 of 4 tiers as detailed:

  • Significantly effective: Significant improvement in clinical symptoms. ≥70% reduction in TCM symptom score. Complete absence or occasional occurrence of PVC.
  • Effective: Improvement in clinical symptoms. ≥30% reduction in TCM symptom score. ≥60% reduction in PVC occurrence.
  • Not effective: No significant improvement, or worsening of clinical symptoms. <30% reduction in TCM symptom score. <60% reduction in PVC occurrence.

The total treatment effective rate of acupuncture and herbal TCM treatment was 94.5% and drug therapy produced an 86.1% total treatment effective rate. The results indicate that acupuncture plus herbs is effective for the treatment of PVCs. 


References:
Wei B. TCM Treatment of Arrhythmia 96 Clinical Cases[J]. Guangming TCM,2011,26(3): 565-566.


Zheng XY. TCM New Medicine Clinical Research Guidelines (Pilot)[M]. Beijing China Medical Technology Publishing House,2002.68.


Wang WN, Ding BY. TCM Treatment of Arrhythmia Clinical Research Advancement [J]. Yatai Traditional Medicine,2009,5(9):159-160.


Tan YJ. Modified Zhigancao Formula Treatment Efficacy for Heart Palpitations 58 cases [J]. China Medicine Guide,2010,8(5):77-78.


Yang NN, Zhou SH. Warm Acupuncture Treatment of Heart Palpitations Belonging to Deficiency of Heart-yang 40 Cases [J].Jiangxi TCM,2013,44(5):47-48


Zhou QW. Acupuncture in Treating PVC [J]. Xiaxi TCM,2003,24(2):11.


Yang ZM. Study of Acupuncture and Moxibustion Methods [M]. Shanghai: Shanghai Scientific Technology Publishing House, 1996.  

UC Irvine – Acupuncture Reduces Hypertension Confirmed

Posted on September 26, 2017 From HealthCMI 

University of California School of Medicine researchers have proven that acupuncture lowers blood pressure in subjects with hypertension. [1] The depth and breadth of the research extends across multiple university controlled studies. 


The investigations also reveal how acupuncture works; the biological mechanisms stimulated by acupuncture are no longer a mystery. The University of California School of Medicine, Irvine, researchers determined several key items. Acupuncture produces long-lasting lowering of blood pressure in subjects with hypertension. Acupuncture regulates sympathetic nervous system responses resulting in lower blood pressure in cardiovascular related centers of the brain and “specific neurotransmitter systems.” 


[2] In addition, their cross-over double blinded research identifies specific acupuncture points and procedures that are especially effective for lowering blood pressure.The researchers note that electroacupuncture is effective “at two sets of standardized acupoints known to provide input to brain stem regions that regulate sympathetic outflow lowers blood pressure….” [3] They highlight three key points. First, electroacupuncture that is administered once per week in 30 minute acupuncture sessions over a period of 8 weeks is effective for lowering blood pressure in patients with hypertension. [4] Second, results are observed by the second week of acupuncture therapy and last for 4–6 weeks if no follow-up treatment is administered after completion of the 8 weeks of acupuncture therapy. [5] Third, monthly acupuncture maintenance treatments maintain the healthy low blood pressure for at least 6 months. 


[6]The University of California School of Medicine researchers find electroacupuncture a mediator of the autonomic nervous system. Plasma norepinephrine and renin-aldosterone measurements indicate that electroacupuncture lowers blood pressure by downregulating sympathetic nervous system outflows.


 [7] This mechanism resulted in a lowering of both systolic and diastolic blood pressure in subjects with hypertension. Furthermore, the researchers successfully differentiated acupuncture points that were effective from those that were not. 


Acupuncture Points
Electroacupuncture applied to PC5 (Jianshi)–PC6 (Neiguan) and ST36 (Zusanli)–ST37 (Shangjuxu) was found effective for lowering blood pressure. Electroacupuncture applied to LI6 (Pianli)–LI7 (Wenliu) and GB37 (Guangming)–GB39 (Xuanzhong, Juegu) was ineffective. Using 24/7 ambulatory blood pressure monitoring equipment, electroacupuncture applied to PC5–PC6 and ST36–ST37 was effective for reducing peak and average systolic and diastolic blood pressure. [8] The results were published in the
Journal of Intensive and Critical Care. Point Specificity


A closer look reveals extensive prior research by University of California School of Medicine researchers. One investigation demonstrates that electroacupuncture applied to PC5–PC6 produces “point-specific effects on cardiovascular reflex responses.” [9] The researchers add that sympathetic cardiovascular rostral ventral lateral medulla neurons that respond to both visceral (reflex) and electroacupuncture nerve stimulation “manifest graded responses during stimulation of specific acupoints.” 


[10]The researchers conclude that electroacupuncture "demonstrates a range of cardiovascular responses" and the levels of "visceral reflex pressor responses are influenced by the anatomic location of somatic nerves beneath the acupoints." [11] They identified specific responses; "deep nerves exerting strong influence and superficial cutaneous nerves demonstrating little or no attenuation of cardiovascular reflex responses." 


[12] The acupuncture continuing education results were published in the American Journal of Physiology – Regulatory, Integrative and Comparative Physiology.Another investigation by the University of California researchers was published in Autonomic Neuroscience. The research identifies specific regions of the brain regulated by acupuncture. Based on the findings, they conclude that electroacupuncture “suppresses elevated blood pressure (BP) by activating the arcuate nucleus, ventrolateral periaqueductal gray (vlPAG), and inhibiting cardiovascular sympathetic neurons in the rostral ventrolateral medulla.” 


[13] The research documents that “a reciprocal excitatory glutamatergic neural circuit between the arcuate and vlPAG contributes to long-lasting EA [electroacupuncture] cardiovascular inhibition.” [14] Glutamatergic biochemicals regulate the excitatory amino acid system throughout the body and brain. Endocannabinoids and Serotonin


In another investigation, the researchers mapped the effects of electroacupuncture on endocannabinoids and the cardiovascular system. The researchers determined that a “long-loop pathway, involving the hypothalamic arcuate nucleus (ARC), ventrolateral periaqueductal gray (vlPAG), and the rostral ventrolateral medulla (rVLM), is essential in electroacupuncture (EA) attenuation of sympathoexcitatory cardiovascular reflex responses.” 


[15] They note that electroacupuncture “releases endocannabinoids and activates presynaptic CB1 receptors to inhibit GABA release in the vlPAG. Reduction of GABA release disinhibits vlPAG cells, which, in turn, modulate the activity of rVLM neurons to attenuate the sympathoexcitatory reflex responses.” 


[16]University of California researchers completed another study mapping the effects of electroacupuncture on serotonin. They determined that electroacupuncture applied to PC5–PC6 “activate serotonin (5-HT)-containing neurons in the nucleus raphe pallidus (NRP).” [17] They note that “activation of the NRP, through a mechanism involving serotonergic neurons and 5-HT (1A) receptors in the rVLM during somatic stimulation with EA [electroacupuncture], attenuates sympathoexcitatory cardiovascular reflexes."


[18] In another study, the researchers document additional pathways. They conclude that the arcuate nucleus is required for prolonged suppression of reflex cardiovascular excitatory responses by electroacupuncture. [19] In the rostral ventrolateral medulla, opioids and GABA (γ-aminobutyric acid) are active in long-term electroacupuncture inhibition of sympathoexcitatory cardiovascular responses. [20] High and Low Frequency Electroacupuncture


In another investigation, the researchers discovered that manual acupuncture and electroacupuncture produce similar results at PC5 and PC6. The researchers conclude that “there is little difference between low-frequency EA [electroacupuncture] and MA [manual acupuncture] at P 5–6. Furthermore, simultaneous stimulation using two acupoints that independently exert strong effects did not lead to an additive or a facilitative interaction.” 


[21] Low frequency acupuncture proved more effective than higher frequencies. Two Hz electroacupuncture “activated more somatic afferents than” 10 or 20 Hz electroacupuncture. [22] The researchers add that the “similarity of the responses to EA and MA and the lack of cardiovascular response to high-frequency EA appear to be largely a function of somatic afferent responses.” 


[23]The above-mentioned studies are only a fraction of the published research on acupuncture and its mediation of cardiovascular and cortical activity. Important is that there is both clinical and laboratory research that is blinded, randomized, and sham controlled. The findings determine efficacy rates for specific acupuncture points for specific conditions and the biological mechanisms responsible for positive patient outcomes. 


The University of California School of Medicine, Irvine, (UCI) researchers provide us with great insight into the active mechanisms involved in acupuncture treatments. Susan and Henry Samueli College of Health Sciences The quality and level of research produced at UCI brings exacting rigor to the scientific investigation of acupuncture.


In related news, the College of Health Sciences at UCI received a $200 million gift for the purposes of exploring and supporting interdisciplinary integrative health. This is one of the largest donations ever granted to a public university.The integrative health center, devoted to teaching and patient care, is named after its donors: The Susan and Henry Samueli College of Health Sciences. The goal of the center is to promote health, based on scientific evidence. This includes redefining the practitioner-patient relationship and a holistic approach to lifestyle, preventative measures, and healthcare disciplines. 


This complements the efforts of the existing Susan Samueli Integrative Health Institute, which focuses on research, education, service, and community.At the Healthcare Medicine Institute, we support and promote appropriate medicine, defined as medicine that is both safe and effective. The Susan and Henry Samueli College of Health Sciences and the Susan Samueli Integrative Health Institute adhere to this principle by identifying and supporting treatment options based on positive patient outcome rates. 


Fundamental to implementation of healthcare is the identification of optimal approaches to individual and community based medicine. We look forward to additional clinical and laboratory research that ultimately yields healthier outcomes.What we are seeing is a fundamental shift in awareness. 


Modern research now widens treatment options to those once considered outside the norm of scientific medicine. Acupuncture now gains acceptance, along with many other forms of holistic medicine, as scientific investigations map mechanisms of action and document rates of effectiveness. This understanding ultimately contributes to the humanitarian relief of suffering. 


Notes
1. Tjen-A-Looi, Stephanie C. "Reduction of Blood Pressure by Electro Acupuncture in Mild to Moderate Hypertensive Patients: Randomized Controlled Trial." Journal of Intensive and Critical Care 3, no. 1 (2017): 2, pg.1.
2. Ibid.
3. Ibid.
4. Ibid.
5. Ibid.
6. Ibid.
7. Ibid, 2.
8. Ibid, 1.
9. Tjen-A-Looi SC, Li P, Longhurst JC (2004) Medullary substrate and differential cardiovascular responses during stimulation of specific acupoints. Am J Physiol Regul Integr Comp Physiol 287: R852-R862.
10. Ibid.
11. Ibid.
12. Ibid.
13. Li P, Tjen-A-Looi SC, Guo ZL, Longhurst JC (2010) An arcuateventrolateral periaqueductal gray reciprocal circuit participates in electro acupuncture cardiovascular inhibition. Auton Neurosci 158: 13-23.
14. Ibid.
15. Tjen-A-Looi SC, Li P, Longhurst JC (2009) Processing cardiovascular information in the vlPAG during electroacupuncture in rats: roles of endocannabinoids and GABA. J Appl Physiol 106: 1793-1799.
16. Ibid.
17. Moazzami A, Tjen-A-Looi SC, Guo ZL, Longhurst JC (2010) Serotonergic projection from nucleus raphe pallidus to rostral ventrolateral medulla modulates cardiovascular reflex responses during acupuncture. J Appl Physiol 108: 1336-1346.
18. Ibid.
19. Tjen-A-Looi SC, Li P, Longhurst JC (2007) Role of medullary GABA, opioids and nociceptin in prolonged inhibition of cardiovascular sympathoexcitatory reflexes during electro acupuncture in cats. Am J Physiol Heart Circ Physiol 293: H3627-H3635.
20. Ibid.
21. Zhou W, Fu LW, Tjen-A-Looi SC, Li P, Longhurst JC (2005) Afferent mechanisms underlying stimulation modality-related modulation of acupuncture-related cardiovascular responses. J Appl Physiol 98: 872-880.
22. Ibid.
23. Ibid. 

Acupuncture Plus Herbs Beats Acid Reflux Drug

Posted on August  6, 2017 From HealthCMI

Acupuncture plus herbal medicine outperforms omeprazole (Prilosec, Zegerid) for the treatment of acid reflux. Often referred to as gastroesophageal reflux disease, GERD, or reflux esophagitis, acid reflux occurs when stomach acid reverses direction and enters the esophagus, causing inflammation, heartburn (burning pain), regurgitation of acid into the throat or mouth, nausea, or bloating. Acupuncture plus herbs was more effective than drug therapy in both the short and long-term. In addition, acupuncture plus herbal medicine had a lower relapse rate. 

 

In research conducted at the Hebei Provincial Hospital of Traditional Chinese Medicine, acupuncture plus herbs produced an 89.7% total effective rate, using only herbal medicine produced an 82.1% total effective rate, and drug therapy using omeprazole (a proton pump inhibitor) produced an 82.8% total effective rate. The results were measured with gastroscopy (esophagogastroduodenoscopy) and Reflux Disease Questionnaire (RDQ) scoring at the completion of all medical treatments. 

Another set of measurements were made in a 6 month follow-up for all patients in the study. The results indicate that acupuncture plus herbs has a lower relapse rate than drug therapy. Acupuncture plus herbs had a 21.7% relapse rate, using only herbs produced a 35.0% relapse rate, and omeprazole drug therapy had a 45.5% relapse rate. The data indicates that acupuncture and herbal medicine have significantly longer lasting results than drug therapy for the treatment of acid reflux.

 

Chinese Medicine Theory

The results are attributable, according to Traditional Chinese Medicine (TCM) theory, to the basic principles involved in the acupuncture point prescription and herbal formula selection. Both selections treat the root cause of the disorder and the symptom. A basic approach to TCM therapy, a percentage of each therapy focuses on symptomatic relief and another percentage treats the underlying root cause of the disease. In this research review, we will take a look at the acupuncture point selection and herbal medicine prescription responsible for obtaining the high positive patient outcome rates. TCM principles specify that reflux esophagitis is often due to dysfunction of the stomach, liver, and spleen. TCM principles also notate that emotional swings or dietary irregularities weaken the liver’s ability to govern the free coursing of qi, impairs the spleen’s ability to transport and transform water and grain, and damages the stomach’s ability to maintain the balance of upward and downward bearing qi. Water and grain (i.e., food) in the stomach fail to be transformed into essence and instead turn into toxic masses. If the downward flow of qi in the stomach is disturbed, it pathologically ascends. As a result, the stomach contents backflow into the esophagus. Reflux esophagitis in TCM focuses on transforming turbidity, harmonizing the stomach, and restoring the downward bearing of stomach qi to prevent counterflow. This focus restores normal functioning of the lower esophageal sphincter (LES), enhances gastric motility, and improves gastric emptying. 

 

Dietary Instructions

All three groups (i.e., acupuncture plus herbs, herbs only, drugs only) received treatment for 8 consecutive weeks. All groups received identical instructions prior to beginning the clinical trial. Patients were advised to adhere to a bland diet and to avoid spicy, rich, and high-fat foods. They were asked not to lie down right after eating and not to eat 2–3 hours before bedtime. Patients were also advised to raise the height of their pillows by 10–20 cm. Objective and subjective assessments were made after completion of therapy and in a 6 month follow-up examination.  

Patient Breakdown

A total of 86 patients with reflux esophagitis were treated and evaluated in this study. The patients were diagnosed with reflux esophagitis between January 2014 and June 2015. They were randomly divided into an acupuncture plus herbs group, an herbal medicine group, and a drug group with 29, 28, and 29 patients in each group respectively. The acupuncture plus herbs and herbs only group received identical herbal medicines (Huazhuo Jiedu Jiangni Tang). For the drug group patients, two 20 mg omeprazole sustained release capsules were given to the patients daily, one after breakfast and one after dinner. The statistical breakdown for each randomized group was as follows. The average age in the acupuncture plus herb group was 25 (±3) years. The average course of disease in the acupuncture plus herb group was 3.6 (±1.5) years. The average age in the herb group was 22 (±3) years. The average course of disease in the herb group was 3.6 (±1.6) years. The average age in the drug group was 23 (±3) years. The average course of disease in the drug group was 3.6 (±1.5) years. There were no significant statistical differences in terms of age, gender, and course of disease relevant to patient outcome measures. 

 

Acupuncture Sessions


Peer review by Healthcare Medicine Institute licensed acupuncturists finds the acupuncture treatment protocol selected by the researchers consistent with standard TCM primary acupuncture point prescriptions. No use of proprietary or off channel acupuncture points were added to the acupuncture point prescription. The main difference between the acupuncture points received by all patients in the study versus those received by patients in a standard acupuncture clinical session is that the acupoint prescription was identical for all patients and not based on differential diagnostic considerations. 

 

Acupuncture treatments commenced with patients in a lateral position on the right side. After disinfection of the acupoint sites, a 0.35 mm x 50 mm disposable filiform needle was inserted into each acupoint with a high needle entry speed. For Ganshu and Danshu, the needles were inserted perpendicular-obliquely towards the direction of the spine, up to a depth of 15 mm. For Neiguan, Zusanli, Zhongwan, and Taichong, the needles were inserted perpendicularly, to a depth of 10–30 mm. For all acupoints, a deqi sensation was obtained and the needles were manually stimulated with the Ping Bu Ping Xie (attenuating and tonifying) manipulation techniques every 10 minutes during the 30 minute needle retention times. Acupuncture sessions were administered once per day.

Acupuncture point Zusanli was selected to promote spleen and stomach health and to benefit the functioning of the lower esophageal sphincter (LES), enhance the frequency of gastric motility, and improve gastric emptying. Zhongwan was chosen to accelerate qi and blood circulation and to promote the transformation of turbidity. Zhongwan enhances fluid and blood flow at the fundus of the stomach, inhibits acid secretion, and benefits gastric mucosa. Taichong, Ganshu, and Danshu regulate the liver and bladder and relieve stomach distention and qi counterflow. Neiguan regulates qi flow and alleviates vomiting.


The researchers note that the ingredients help the body to transform turbidity, remove toxicity, and promote the downward movement of qi and prevent counterflow rebellious qi. The herbal formula was decocted and brewed once per day. Patients consumed 300 ml of the decoction, twice per day, 2 hours after breakfast and dinner. After treatment completion for patients in all three study groups, the treatment efficacy for each patient was categorized into 1 of 4 tiers: 

  • Recovery: Absence of symptoms. 
  • Significantly effective: Significant absence of symptoms. 
  • Effective: Symptoms showed improvement.
  • Not effective: Symptoms showed no visible improvement.  

Patients were evaluated before and after the treatment course. Both subjective and objective instruments were used to measure patient outcomes. All patients took the Reflux Disease Questionnaire (RDQ) before and after their treatments. RDQ is an instrument that measures treatment responses for reflux esophagitis patients. Next, gastroscopy was conducted and the condition of the esophageal mucosa was scored according to the Consensus on the Treatment of Gastroesophageal Reflux Disease in China with Both Traditional Chinese Medicine and Western Medicine (2010). All three groups demonstrated significant improvements in RDQ scores and gastroscopy examination scores. Compared with the herbs group and the drug group, the acupuncture plus herbs group produced better RDQ scores. Statistical analyses of outcomes demonstrates that the acupuncture plus herbs group had the greatest rate of positive patient outcomes. The researchers conducted follow-up examinations 6 months after treatment completion. They found that the recurrence rate of reflux esophagitis in the acupuncture plus herbs group was 21.7%. The recurrence rate of reflux esophagitis in the herbs treatment group was 35.0%. The recurrence rate of reflux esophagitis in the drug group was 45.5%. The results indicate that acupuncture with herbs is more effective than herbs as a standalone therapy or administration of the proton pump inhibitor drug. The study mentioned in this report demonstrates that acupuncture is safe and effective for the treatment of reflux esophagitis. Important features of TCM protocols is that they produce a high total effective rate, low relapse rate, and no significant adverse effects.   


Reference:Zhang W, Li BL, Sun JH, Wang ZK, Zhang NN, Shi F, Pei L. Therapeutic Effects of The Integrated Acupuncture and Chinese Herbal Medicine on Reflux Esophagitis [J]. Chinese Acupuncture and Moxibustion, 2017, Vol37, No.7.