Posted on Apr 22, 2019 From HealthCMi
Researchers conclude that acupuncture increases positive outcomes for cataract surgery patients that have comorbid glaucoma. Fenghua District People’s Hospital researchers determined that phacoemulsification (surgical removal of cataracts using an ultrasonic device) patients have better intraocular pressure, aqueous outflow (F value), pain relief, and visual acuity when receiving acupuncture and tuina massage. 
Wu et al. used the following study design. A total of 68 subjects participated in the study and were divided into two groups, with 34 subjects in each group. All subjects were selected from the department of ophthalmology at Fenghua District People’s Hospital. All were diagnosed with cataracts and glaucoma. The following selection criteria were applied for the treatment group subjects:
The statistical breakdown for each group was as follows. The treatment group was comprised of 17 males and 17 females. The mean age of the treatment group was 5 years. The control group was comprised of 16 males and 18 females. The mean age of the control group was 48 years. There were no significant statistical differences in gender, age, and LOCS II grades relevant to patient outcome measures for patients initially admitted to the study.
All patients received phacoemulsification. After the operation, the surgical sites were applied with tobramycin and dexamethasone eye drops. Tobramycin and dexamethasone is an antibiotic and steroid combination used to prevent eye infections. The TCM treatment group received acupuncture and tuina. The control group received phacoemulsification monotherapy and did not receive acupuncture and tuina treatment.
Acupuncture and tuina started three days before the operation. Tuina was administered by ophthalmologic nurses and acupuncture was administered by licensed acupuncturists. For tuina, patients were instructed to close their eyes and rested in a supine position. Taiyang (EX-HN5), Cuanzhu (BL2), Yuyao (EX-HN4), Sizhukong (TB23), Tongziliao (GB1), Qiuhou (EX-HN7), Chengqi (ST1), and acupoints around the orbits of the eyes were massaged. Each tuina massage session lasted for 10 minutes, twice per day, for a total of 60 days. The primary acupoints used for acupuncture treatments included the following:
Additional secondary acupoints were added based on symptom presentation. For liver and kidney deficiency, the following acupoints were added:
For spleen qi deficiency, the following acupoints were added:
For liver heat, the following acupoints were added:
Upon disinfection of the acupoint sites, a 0.25 mm × 40 mm filiform acupuncture needle was inserted into the acupoints, reaching a depth of 10–15 mm. After elicitation of a deqi sensation, the xie (attenuating) manipulation technique was applied for two minutes. A 30-minute needle retention time was observed for each session. Acupuncture and tuina was applied once every other day for for sixty days.
Multiple subjective and objective instruments were used to measure patient outcomes at several data points: prior to acupuncture (T1), and then 1 day (T2), 7 days (T3), 30 days (T4), and 60 days (T5) after completion of the treatment. First, the intraocular pressure (IOP) and visual acuity were measured. Second, pain severity was scored. Third, the aqueous outflow (F value) was recorded. Fourth, improvement of clinical symptoms (including lens opacities, blurred vision, distending pain, floaters, dry eyes) was calculated 60 days after the treatment.
Compared with before treatment, the IOP significantly decreased at T2, T3, T4, and T5 in the two groups, and the visual acuity significantly increased at T3, T4, and T5 in the two groups (p＜0.05). Compared with before treatment, the pain scores and F values at T3, T4, and T5 significantly reduced in the two groups (all p＜0.05).
IOP (intraocular pressure) at T2, T3, T4, and T5 in the TCM treatment group was lower than the surgery monotherapy control group (p＜0.05). Visual acuity at T3, T4, and T5 in the TCM treatment group was greater than the control group (p＜0.05). Pain scores and F values at T3, T4, and T5 in the TCM treatment group were lower than those in the control group (p＜0.05).
After 60 days of treatment, the number of patients that presented with general clinical symptoms in the TCM treatment group were significantly lower than in the control group (p＜0.05). The results indicate that acupuncture and tuina combined with phacoemulsification into an integrated treatment protocol is more effective than phacoemulsification monotherapy.
 Wu AM, Zhou XW, Mi LL, Cheng B, Cai X. Effects of acupuncture, tuina combined with phacoemulsification for cataract with glaucoma[J]. Chinese Acupuncture and Moxibustion, 2019,39(02):156-159.
Posted on Mar 31, 2019 From HealthCMi
Acupuncture mitigates adverse effects resulting from chemotherapy. Chongqing Tumor Institute (Oncology Department of Traditional Chinese Medicine) researchers conducted a controlled clinical trial consisting of rectal cancer patients receiving chemotherapy. Acupuncture significantly reduced the severity of hand-foot syndrome, a known side effect of chemotherapy characterized by redness, swelling, tingling, numbness, itching, and pain of the palms and soles.
Acupuncture achieved a 70% total effective rate with a 16.67% complete cure rate and a 53.33% markedly effective rate for rectal cancer patients receiving chemotherapy utilizing capecitabine as part of the treatment regimen.  A total of 60 patients with rectal cancer were recruited for the study and were randomly assigned to receive treatment with acupuncture (n=30) or vitamin B6 (n=30).
The acupuncture group was comprised of 13 male and 17 female patients, ages 45–80 years (mean age 62.29), with a disease duration of 9–20 months (mean duration 16.4 months). The vitamin B6 group was comprised of 16 male and 14 female patients, ages 51–73 years (mean age 61.25), with a disease duration of 10–19 months (mean duration 15.8 months). The severity of the participants’ symptoms were graded using two scales, the Common Toxicity Criteria of the National Cancer Institute of Canada (CTC) and the Karnofsky Performance Scale (KPS). The CTC grades symptoms using a scale of 1–4, with higher scores indicating increased severity. The KPS is on a scale of 0–100, with higher scores indicating an increased ability to perform daily activities and lower scores indicating increased levels of disability.
For inclusion in the study, participants were required to have a CTC score of >1 and a KPS score of ≥60. Further criteria limited participants to ages 18–80 years, with an anticipated survival period of at least three months. Informed consent and ethical approval were required for all participants. Exclusion criteria included pregnancy, lactation, serious heart, liver, kidney, or brain dysfunction, psychiatric disorders, inability to cooperate with the study requirements, and refusal of acupuncture treatment.
According to TCM (Traditional Chinese Medicine) principles, hand-foot syndrome is a type of bi syndrome involving obstruction of qi and blood circulation, deficiency of qi and blood, or dampness leading to a blockage of yang qi that is consequently unable to nourish the skin and muscles, thereby causing the symptoms of numbness and pain. Historically, the term “bi referred to the pathogenesis, or the symptoms as well as the name of the disease.”  Treatment principles were to tonify qi, promote blood circulation, promote yang qi, and remove stagnation. Patients allocated to the acupuncture group received treatment at the following acupoints:
For constitutionally weak patients, the following supplementary acupoints were added:
Treatment was administered with patients in a supine position. Following standard disinfection, 0.35 × 40 mm filiform needles were inserted into each acupoint. Baihui was needled obliquely toward the occiput to elicit a distending sensation in the local area. Hegu and Waiguan were needled obliquely towards the palm, to a depth of 0.2–0.3 cun. The needle sensations were transmitted towards the palms.
Zusanli was needled perpendicularly using a reinforcing-reducing method. The needle was first rotated clockwise to elicit deqi, with sensations transmitted along the medial edge of the tibia toward the thigh. The needle was then rotated counter-clockwise, while applying finger pressure to the upper part of the acupoint with the aim of transmitting needle sensations back toward the toes.
Ashi points were selected according to the most painful areas on the hands and feet. These were needled perpendicularly to a depth of 0.1–0.2 cun. After the arrival of deqi, the needles were manipulated with a rapid, low-amplitude lifting and thrusting techniques for two minutes to elicit a strong distending sensation. The supplementary points, if used, were stimulated using an even technique with rapid, low-amplitude lifting and thrusting to elicit needle sensations in the local area. All needles were retained for 30 minutes and treatments were administered daily for two weeks.
Participants allocated to the vitamin B6 group were treated with 300mg of oral vitamin B6, taken daily for a total of two weeks.
Outcome measures included changes in CTC and KPS scores, and the QLQ-C30 (Quality of Life Questionnaire Core), a 30-item functional scale covering the areas of PF (physical function), RF (role function), CF (cognitive function), EF (emotional function), and SF (social function). Patients whose CTC scores were downgraded to grade 1 after treatment, with a disappearance of symptoms and a KPS score of ≥ 90 were classified as cured. For patients whose CTC scores were downgraded to ≥ grade 1, with an improvement in symptoms, and a KPS score of 80–89, the treatments were classified as effective. For patients showing no obvious improvements and had KPS scores of < 80, the treatments were classified as ineffective.
Mean pre-treatment KPS scores were 67.23 in the acupuncture group and 68.07 in the vitamin B6 group. Following treatment, these scores rose to 84.23 and 77.84 respectively. Although both groups showed improvements, positive patient outcomes were significantly greater in the acupuncture group (p<0.05). In the acupuncture group, there were 5 cured, 16 effective, and 9 ineffective cases, yielding a total effective rate of 70.0%. In the vitamin B6 group, there were 4 cured, 7 effective, and 19 ineffective cases, yielding a total effective rate of 36.7%.
Mean pre-treatment QLQ-C30 scores in the acupuncture group were 40.72, 44.53, 34.35, 39.23, and 33.19 in the areas of PF, RF, EF, CF, and SF respectively. In the vitamin B6 group, the equivalent pre-treatment scores were 41.13, 40.87, 33.89, 40.75, and 32.07. Following treatment, these scores fell to 7.13, 18.77, 4.89, 6.32, and 10.16 in the acupuncture group and 16.72, 20.77, 11.76, 18.17, and 12.88 in the vitamin B6 group. Both groups showed improvements across all areas, but positive outcomes were greater in the acupuncture group, with improvements in PF, EF, and CF being of statistical significance (p<0.05).
The results of this study indicate that acupuncture is an effective treatment for hand-foot syndrome, with the ability to alleviate symptoms and improve overall quality of life. The results demonstrate that an integrative model of patient care utilizing acupuncture as a treatment modality produces significantly less adverse effects associated with chemotherapy.
1. Li Fangfei, Chen Hong, Li Guosen (2018) “Chemotherapy-induced hand-foot syndrome in rectal cancer treated with acupuncture” World Journal of Acupuncture-Moxibustion Vol.28 pp. 151-155.
2. Dai, J. H., Y. J. Shi, H. B. Yin, and H. Du. "The evolution of related names of Bi syndrome and the theory of etiology and pathogenesis." Zhonghua yi shi za zhi (Beijing, China: 1980) 39, no. 4 (2009): 214-217.
Posted on Feb 12, 2019 From HealthCMi
Acupuncture is effective for the treatment of autism spectrum disorder (ASD). In a double-blind randomized controlled trial, University of Hong Kong researchers reveal that electroacupuncture improves core functions in children with ASD, especially language comprehension and self-care ability. True acupuncture was compared with sham acupuncture and only true acupuncture provided significant clinical outcomes. Based on the evidence, University of Hong Kong researchers conclude that “acupuncture might be a useful adjunctive therapy in early interventional programs for children with ASD.” 
The research is among the first double-blind randomized clinical trials investigating the efficacy and safety of electroacupuncture for the treatment of ASD. Earlier trials primarily focused on tongue or manual scalp acupuncture. In this investigation, the University of Hong Kong researchers implemented acupuncture with electric stimulation. The research team chose electroacupuncture baed on the findings of Chen et al., whose research indicates that a short, intensive course of electroacupuncture potentially improves some specific features in children with ASD. 
University of Hong Kong researchers (Wong et al.) used the following study design. A total of 55 patients participated in the study and underwent post-treatment assessment. They were diagnosed and treated for ASD at the Duchess of Kent Children’s Hospital.
Subjects were divided into two arms. The treatment group received true electroacupuncture (EA), which was administered at acupoints based on a previous pilot study. The second arm was given sham electroacupuncture (SEA). Both groups received electric stimulation. Inclusion criteria were based on the following:
Exclusion criteria were applied. Patients having taken anti-epileptic drugs or having received acupuncture in the preceding six months did not participate in the study.
EA and SEA patients received three sessions of electroacupuncture treatments weekly on alternate days, for a total of 4 weeks. Each acupuncture treatment lasted 30 minutes and a total of 12 acupuncture sessions were provided. Participants received no sedation. Children were allowed to stay with their parents or caretakers throughout the acupuncture course of care. Patients receiving true acupuncture were needled at the following acupuncture points:
Treatment commenced with patients in either a supine or sitting position. After disinfection of the acupoint sites, a 0.30 mm × 40 mm disposable filiform needle was inserted into each acupoint to a standard depth. Once a deqi sensation was obtained, the needles were connected to an electroacupuncture device (model Hwato SDZ-II, Suzhou Medical Appliance Factory, China) with a disperse-dense wave. Once the electric stimulation began, the needles were retained for 30 minutes.
For the sham acupuncture group, the total number of needles, electroacupuncture settings, and duration of treatment time were identical to those of the true acupuncture group; however, sham acupuncture patients received needling at non-meridian sites that were 3–5 cm lateral to the selected acupoints for the true acupuncture group. Both groups received conventional intervention or educational programs for ASD. Two patients from the EA group also received neuroleptic drugs during the study.
The researchers provided the Traditional Chinese Medicine (TCM) basis for understanding ASD. ASD is categorized as “childhood disturbance.” The main treatment principle is to “awake, assist, and calm the mind, as well as enlighten the mentality and improve the developmental profile.” Primary acupoints were selected from scalp acupoints: Sishencong (EX-HN1), Yintang (EX-NH3). Auricular acupoints were added: Ear Naodian (AT3), Ear Shenmen (TF4).
The researchers selected secondary acupoints to complement the primary points. These points were located on the heart (Shenmen, HT7), pericardium (Neiguan, PC6), liver (Taichong, LV3), and spleen (Sanyinjiao, SP6) channels. The researchers note that “needling these acupoints can make the heart unobstructed, regulate the liver, correct derangements or imbalances, reinforce emotions, dredge stasis, invigorate the spleen and kidneys, and facilitate the source of vital function.”
Multiple instruments were used to measure patient outcomes. The researchers provided the reasons for adopting a comprehensive panel of assessment tools. They note, “Since ASD is a heterogeneous disorder with comorbidities, and there is a lack of a single assessment tool, it is difficult to test the efficacy of a particular therapy.” The researchers add that the measurement tools were chosen based on the researchers’ 25 years of experience with ASD interventions. In addition, assessment tools were applied by parents and professional assessors that were blind to the allocation of groupings. Parents were instructed on how to properly use the assessment tools.
The following outcome measures were provided by parents: Aberrant Behavioral Checklist (ABC), Ritvo-Freeman Real Life Scale (RFRLS), Pediatric Evaluation Disability Inventory (PEDI), Clinical Global Impression-Improvement (CGI-I), parental report. The following outcome measures were performed by assessors: Leiter International Performance Scale-Revised (Leiter-R), Functional Independence Measure for Children (WeeFIM), Reynell Developmental Language Scale (RDLS). The researchers note, “ABC and RFRLS were used to assess core autistic features, PEDI and WeeFIM examined functional abilities, RDLS assessed language, Leiter-R was used to study cognition, and CGI-I assessed global impression.”
Significant improvements were seen in the language comprehension domain of WeeFIM (p=0.02), self-care caregiver assistant domain of PEDI (p=0.028), and CGI-I (p=0.003) in the true EA group compared with the sham group. Based on the parental report, there were significant improvements in social initiation (p=0.01), receptive language (p=0.006), motor skills (p=0.034), coordination (p=0.07), and attention span (p=0.003) in the true EA group compared with the sham group.
Acupuncture compliance and side effects were recorded after treatment completion. In this study, acupuncture compliance was defined as “subjects were able to sit or lie on a couch to accept acupuncture, even if they cried or needed a gentle hand or head holding.” Good compliance meant that subjects were “able to accomplish this within the first three sessions, while poor compliance was defined as subjects “being unable to sit or lie on the couch for treatment for nine or more sessions.” The researchers note, “More than 70 percent of children with ASD adapted to acupuncture with good compliance, while only eight percent demonstrated poor acupuncture compliance.” As for side effects, “Only mild side effects of minor superficial bleeding or irritability during acupuncture were observed.” The researchers conclude, “A short, four-week (12 sessions) course of electroacupuncture is useful to improve core functions in children with ASD, especially for language comprehension and self-care ability.”
The researchers reference a report noting that “About 40% of ASD children have used complementary and alternative medicine, with acupuncture being the most common modality."  The results of the current investigation showed significant changes in favor of true acupuncture treatment, including improvements in language comprehension, self-care assistance, social initiation, receptive language, motor skills, coordination, and attention span. They add that most patients demonstrated good compliance with very limited side effects.
 Wong V, Chen W X, Liu W L. Randomized Controlled Trial of Electro-Acupuncture for Autism Spectrum Disorder [J]. Alternative Medicine Review, 2010, 15( 2) :136－146.
 Chen W X, Liu W L, Wong V. Electroacupuncture for children with autism spectrum disorder: pilot study of 2 cases [J]. The Journal of Alternative and Complementary Medicine， 2008, 14(8) :1057－1065.
 Wong VC. Use of complementary and alternative medicine (CAM) in autism spectrum disorder (ASD): comparison of Chinese and Western culture (Part A). J Autism Dev Disord 2009;39:454-463.
Posted on Jan 8, 2019 From HealthCMi
Acupuncture improves in vitro fertilization embryo transfer (IVF-ET) success rates. Qingdao University researchers conducted a controlled clinical trial and confirmed that acupuncture reduces failed embryo implantation rates using transvaginal ultrasonography. Findings include increases in good-quality embryo rates, endometrial receptivity, improvements in serological sex hormone levels, and the addition of acupuncture to standard ovulation stimulation drug therapy reduced the adverse effect rate of the drug therapy. 
Acupuncture’s increased endometrial receptivity, which is the ability of the endometrium to accept a blastocyst (the embryo on day 5 is called a blastocyst, which has approximately 70–100 cells) and allows it to adhere, penetrate, and morphologically change. Only a certain percentage of eggs mature, are fertilized, and transform into blastocysts.
In this study, transvaginal ultrasonography was utilized to examine endometrial morphology, thickness, and blood flow status for predicting endometrial receptivity. Endometrial morphology was measured by the percentage of type C endometrial patterns found. Type C patterns are predictive of higher pregnancy rates. Endometrial hemodynamic parameters used in the study included peak systolic blood velocity/end-diastolic blood velocity (S/D), resistive index (RI), and pulse index (PI); the lower the S/D, RI, and PI values, the greater the chance of pregnancy.
The number of the type C endometrial patterns in an acupuncture plus fertility medication treatment group was significantly higher than those in a fertility medication monotherapy control group. The endometrial hemodynamic parameters (S/D, RI, PI) were significantly lower in the acupuncture plus fertility medication treatment group than those in the drug monotherapy control group. The type C endometrium pattern appears as a multilayer structure with prominent outer and midline hypoechogenic lines and inner hypoechogenic regions. Gonen et al. find that the type C endometrial pattern indicates higher pregnancy rates per embryo transfer compared with type A or B endometrium patterns.  The Qingdao University researchers confirm that acupuncture increases the rate of type C patterns.
S/D, RI, and PI are used to predict pregnancy outcomes of IVF-ET. Researchers find that these parameters are negatively correlated with pregnancy outcomes. For example, Wang et al. note, “It has a better outcome for parameters with low endometrial blood flow (such as low PI, RI, S/D) of IVF-ET compared with those who had high blood flow parameters.”  The addition of acupuncture to fertility medication therapy significantly lowered these values.
Acupuncture increased good quality embryo rates and regulated pregnancy-related hormones. The rate of good quality embryos in the acupuncture treatment group was significantly higher than in the drug monotherapy control group. Good quality embryos met the following standards: embryo cells are uniform in size and regular in shape, the zona pellucida is intact, the cytoplasm is clear and contains no granules, cell fragment rates are between 0 and 5%. The levels of serum E2 and P on the day of hCG administration in the treatment group were higher than those in the control group. E2 and P are common serum biomarkers for predicting pregnancy outcomes in women undergoing IVF. Modern research confirms that high serum E2, P, and LH levels on the day of hCG administration lead to higher clinical pregnancy rates. 
Qingdao University researchers (Chen et al.) used the following study design. A total of 114 patients were treated and evaluated. All patients received IVF-ET. They were randomly divided into an acupuncture treatment group and a drug monotherapy control group, with 57 patients in each group. For the control group patients, the long gonadotropin-releasing hormone agonist (GnRH-a) protocol was administered. The long GnRH-a protocol is recognized as a gold standard for controlled ovarian hyperstimulation in IVF.  The treatment group received acupuncture and moxibustion in addition to the identical drug therapy administered to the control group.
The statistical breakdown for each randomized group was as follows. The average age in the treatment group was 31 years. The average duration of infertility in the treatment group was 3.71 years. The average age in the control group was 31 years. The average duration of infertility in the control group was 3.61 years. There were no significant statistical differences in relation to age, duration of infertility, IVF cycles, BMI, basal follicle-stimulating hormone levels, basal luteinizing hormone levels, and basal estradiol levels relevant to patient outcome measures for patients initially admitted to the study.
Both groups were administered the long GnRH-a protocol. While effective, the downside is that this protocol (along with other GnRH-a ovulation stimulation protocols) causes reduced endometrial receptivity in IVF-ET.  The long GnRH-a protocol includes the use of following drugs: triptorelin injection, follitropin beta injection, human chorionic gonadotropin (hCG) injection. Triptorelin is a gonadotropin-releasing hormone analogue that regulates the stimulation of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Follitropin beta is a man-made follicle-stimulating hormone that treats infertility. Human chorionic gonadotropin injection is a medication used for promoting ovulation and infertility treatment.
The long GnRH-a protocol started with administration of 0.05 mg triptorelin in mid-luteal phase of the cycle (on cycle-day 21), once per day, for a total of 14 days. Next, follitropin beta injection was administrated subcutaneously at 150–200 international units (IU) daily starting approximately on day 15 of the treatment, for a total of 4 days. The starting time of follitropin beta injection is based on hormone levels and ultrasonic scanning results. When follicular size reached more than or equal to 18 mm, muscular administration of 8000 IU hCG began. After 36 hours from the hCG injection, the mature oocytes were retrieved, followed by the administration of progesterone for luteal supplementation. Embryo transfer began on day 3 of oocyte retrieval, followed by another round of progesterone administration for luteal supplementation. In this protocol, transvaginal sonography (TVS) and hormonal levels including FSH, LH, estrogen, and progesterone were routinely monitored.
The primary acupoints selected for all acupuncture treatment patients were the following:
After disinfection of the acupoint sites, 0.25 × 25 mm disposable filiform needles were inserted perpendicularly into each acupoint, reaching a depth of 10–20 mm. Manual acupuncture stimulation techniques for obtaining deqi included lifting, thrusting, and rotating. Once a deqi sensation was obtained, the ping bu ping xie (attenuating and tonifying) manipulation technique was applied every 10 minutes during the 30-minute needle retention time.
When the needles were retained, a moxa box was placed on CV8 (Shenque). A moxa cigar in the box was ignited and left in place to self-extinguish. A total of 5–7 moxa cigars of medium length were used, lasting for 30–60 minutes. Treatments were applied once per day. Each treatment course began when ovulation promotion treatment started in the long GnRH-a protocol and lasted until embryo transfer. All treatment group patients received three treatment courses in total.
The researchers cite independent scientific research demonstrating that failed embryo implantation plays an important role in perpetuating infertility. For example, Norwitz et al. note that “Of the pregnancies that are lost, 75 percent represent a failure of implantation.” They determine that “Failed implantation is also a major limiting factor in assisted reproduction.” They explain, “Though high-quality embryos can often be transferred into the uterus, only a few embryos can successfully be implanted during the IVF-ET cycle.”  The results indicate that acupuncture combined with the long GnRH-a drug therapy into an integrated treatment protocol is more effective than long GnRH-a protocol monotherapy. Chen et al. conclude that acupuncture increases the success rate of IVF-ET.
This study was conducted to determine whether acupuncture can improve endometrial receptivity and benefit IVF-ET outcomes. The researchers note, “A better understanding of acupuncture mechanisms responsible for implantation may improve the ability to treat disorders related to these processes, including infertility.” They learned that the adverse effect rate was significantly mitigated in the acupuncture group versus the drug monotherapy group. Given the sophistication of the multi-drug fertility protocol, it is not surprising that the need for monitoring and treating adverse effects is of concern. The data indicates that acupuncture benefits positive patient outcomes rates while simultaneously mitigating adverse effects, indicating that acupuncture increases the safety and efficacy of long GnRH-a protocol fertility treatments.
 Chen Q, Hao CF. Impacts on pregnancy outcome treated with acupuncture and moxibustion in IVF-ET patients [J]. Chinese Acupuncture and Moxibustion, 2015,35(04):313-317.
 Gonen Y, Casper RF. Prediction of implantation by the sonographic appearance of the endometrium during controlled ovarian stimulation for in vitro fertilization (IVF) [J]. J In Vitro Ferti Embryo Transf, 1990, 7 (3): 146-152.
 Lina Wang, Jie Qiao, Rong Li, Xiumei Zhen, Zhaohui Liu. Role of endometrial blood flow assessment with color Doppler energy in predicting pregnancy outcome of IVF-ET cycles [J]. Reprod Biol Endocrinol. 2010; 8: 122.
 Wei M, Zhang XM, Gu FL, Lv F, Ji YR, Liu KF, She H, Hu R. The impact of LH, E2, and P level of HCG administration day on outcomes of in vitro fertilization in controlled ovarian hyperstimulation [J]. Clin Exp Obstet Gynecol. 2015;42(3):361-6.
 Grow D, Kawwass JF, Kulkarni AD, et al. GnRH agonist and GnRH antagonist protocols: comparison of outcomes among good-prognosis patients using national surveillance data. Reprod Biomed Online 2014; 29:299-304.
 Borm G, Mannaerts B. Treatment with the gonadotrophin-releasing hormone antagonist ganirelix in women undergoing ovarian stimulation with recombinant follicle stimulating hormone is effective, safe and convenient: results of a controlled, randomized, multicenter trial. The European Orgalutran Study Group[J]. Hum Reprod, 2000, 15(7):1490-1498.
 Norwitz ER, Schust DJ, Fisher SJ. Implantation and the survival of early pregnancy [J]. N Engl J Med, 2001, 345(19): 1400-1408. Posted on Oct 7, 2018 From HealthCMi
Posted on Dec 15, 2018 From HealthCMi
Acupuncture and herbs improve outcomes for premature ovarian failure patients. Chongqing Banan People's Hospital researchers conclude that the addition of Traditional Chinese Medicine (TCM) to hormone replacement therapy (HRT) protocols significantly improves outcomes. The hospital researchers confirm that a combination of acupuncture, moxibustion, herbal medicine, and HRT significantly alleviates premature ovarian failure symptoms, regulates hormone levels, and increases endometrial thickness. Based on the data, the researchers conclude that the combination of TCM therapies with HRT produces greater outcomes than HRT monotherapy.
The researchers based their conclusions on TCM efficacy index scores, changes in endometrial thickness, Kupperman Index scores (KI), and changes in levels of serum follicle stimulating hormone (FSH) , luteinizing hormone (LH), and estradiol (E2). A study group receiving TCM and HRT had a total effective rate of 91.7%, compared with 72.9% in the HRT monotherapy group. 
Ninety-six women were recruited to the study and were randomly assigned to receive either combined acupuncture, moxibustion, herbs, and HRT or HRT alone. The TCM group was comprised of 48 women, ages 26–38 (mean age 31). The mean age of menarche was 13 years and the mean duration of premature ovarian failure was 2.07 years. The HRT group was comprised of 48 women, ages 24–39 (mean age 31). The mean age of menarche was 14 years and the mean duration of premature ovarian failure was 2.24 years. There were no statistically significant differences between the two groups prior to treatments.
For inclusion in the study, the participants were required to be between the ages of 20–40 years, have experienced amenorrhea for at least four months, and show ovarian atrophy with no dominant follicle. Other inclusion criteria were FSH>40IU/L, LH>30IU/L, E2<73.4pmol/L, and endometrial thickness <6mm.
TCM diagnostic criteria included amenorrhea before the age of 40 years, prolonged or scanty menses, sore lumbar region and knees, vaginal dryness, palpitations, shortness of breath, five palms heat, irritability, dizziness, tinnitus, insomnia, poor memory, fatigue, a pale-dull tongue, and a sinking-fine pulse. At least three of the aforementioned criteria were required.
Women were excluded from the study that had received hormonal treatments or immune inhibitors within the previous three months, undergone ovarian surgery, had been exposed to environmental toxins, or had liver, kidney, cardiovascular, or other systemic diseases. Also excluded were patients with tumors, psychiatric disorders, multiple organ dysplasia, or drug allergies.
Hormone Replacement Therapy
The women assigned to both groups were treated with identical drug therapy to artificially stimulate menstruation. They were prescribed estradiol valerate (1mg) to be taken daily for 21 days, and progesterone (100mg) to be taken daily on days 12–21 of estradiol treatment. This drug protocol was designed to induce menstruation either on day five of treatment, or five days after withdrawal from medications. This cycle was repeated for three consecutive months.
Women assigned to the TCM group were treated with the aforementioned HRT protocol, plus acupuncture, moxibustion, and herbs. The selected acupoints were divided into two groups. The first group included:
Acupuncture was administered every Monday and Friday. The women rested in a supine position and single-use 0.25 × 25mm needles were inserted transversely at Baihui, Shenting, and Benshen to a depth of 5–15mm. At the remaining acupoints, 0.25 × 40mm needles were inserted perpendicularly to a depth of 5–30mm. After the arrival of deqi, needles were retained for 25 minutes. Following acupuncture treatment, moxibustion was administered by suspending a moxa tube above Guanyuan, Zigong (MCA18), and Qihai (CV6). The height and temperature were adjusted to an appropriate level, and the points were warmed for 20 minutes. The second group of acupoints included:
Acupuncture was administered at these points every Wednesday. The women rested in a prone position and single-use 0.25 × 40mm needles were inserted perpendicularly at Shenshu and Shiqizhuixia to a depth of 5 –30mm. Following this, 0.30 × 75mm needles were inserted at Ciliao to a depth of 50–60mm, penetrating through the sacral foramen towards the lower abdomen. After the arrival of deqi, needles were retained for 25 minutes. Moxibustion was administered at Shenshu, Pishu (BL20), and Ciliao. Twelve acupuncture treatments made up one course, and a total of three courses were administered. Women in the TCM group were also prescribed the following herbal formula:
For stomach and spleen deficiency, Chao Bai Zhu (10g) was added. For aversion to cold, Rou Gui (6g) was added. For liver depression, Yue Ji Hua (10g) was added. For insomnia with excessive dreaming, Yuan Zhi (10g) was added. For yin deficiency with deficiency heat, Nu Zhen Zi (10g) was added. The herbs were decocted and taken morning and evening for 21 consecutive days. After five days, the treatment was recommenced. A total of three courses were administered.
Outcomes and Discussion
Outcome measures included Kupperman Index scores (KI), rating a total of 12 items including physical and psychological symptoms on a scale of 0–3, with a higher score indicating more severe symptoms. Serum FSH, LH, E2, and endometrial thickness were also taken into account. In the HRT group, KI scores fell from a mean 16.86 to 10.65 following treatment. In the TCM group, KI scores fell from a mean 17.08 to 7.92.
In the HRT group, mean FSH and LH decreased from 72.71IU/L to 45.20IU/L and 56.34IU/L to 37.67IU/L respectively, and E2 increased from 48.76pmol/L to 88.28pmol/L. In the TCM group, mean FSH and LH decreased from 69.32IU/L to 36.96IU/L and 53.14IU/L to 28.76IU/L respectively, and E2 increased from 46.93pmol/L to 115.20pmol/L. The objective findings indicate that the TCM protocol provides significant outcome improvements.
In the HRT monotherapy group, endometrial thickness increased from a mean 5.24mm to 5.73mm following treatment. In the TCM group, endometrial thickness increased from a mean 5.43mm to 7.11mm. Outcome measures were significantly better for women in the TCM group across all parameters.
TCM efficacy index scores were calculated for both groups based on improvements in clinical symptoms and hormone levels. Women that experienced restored menstruation and improved hormone levels three months after the cessation of treatments were classified as cured, with an efficacy index of ≥90%. Women that experienced restored menstruation and improved hormone levels for one month after the cessation of treatment, the therapy was classified as highly effective, with an efficacy index of ≥70%. Women whose clinical symptoms were alleviated and had improved hormone levels but did not menstruate following cessation of treatment, the therapy was classified as effective, with an efficacy index of ≥30%. Women showing no improvement in symptoms or hormone levels and that did not menstruate following cessation of treatment, the therapy was classified as ineffective, with an efficacy index of <30%.
The cured, highly effective, and effective rates were added together to give the total effective rate. The total effective rate in the HRT group was 72.9%. The total effective rate in the TCM plus HRT group was significantly higher at 91.7%.
The safety of both therapies was taken into account. A total of three adverse effects were experienced in the HRT group, compared with one in the TCM group. There were no serious adverse effects, liver or kidney dysfunction in either group. The outcomes of this study suggest that combined HRT and TCM therapy is safe and effective in the treatment of premature ovarian failure, and performs significantly better than HRT monotherapy.
1. Wang Yu, Yu Hongmei (2018) “Therapeutic Observation of Acupuncture-moxibustion plus Chinese and Western Medications for Premature Ovarian Failure” Shanghai Journal of Acupuncture and Moxibustion. Vol.37 (9) pp.1042-1046. Posted on Oct 7, 2018 From HealthCMi
Posted on Nov 16, 2018 From HealthCMi
Acupuncture enhances weight loss and improves blood chemistry in patients with simple obesity. Researchers tested the efficacy of warm needle acupuncture by adding it to a weight loss dietary program. Patient outcomes improved significantly for patients receiving acupuncture plus dietary therapy when compared with patients receiving only dietary therapy.
Hospital researchers conclude that warm needle acupuncture successfully reduces body fat and adiposity, decreases serum triglycerides and total cholesterol, reduces harmful low-density lipoprotein (LDL) cholesterol, and raises beneficial high density lipoprotein (HDL) cholesterol levels when combined with a standardized weight loss diet program. The results demonstrate that the combined therapy is significantly more effective than dietary changes alone. 
Researchers at the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine (department of acupuncture and moxibustion) conducted a clinical trial consisting of sixty patients with simple obesity. They were randomized to receive either standardized dietary education plus warm needle acupuncture, or dietary education alone. The warm acupuncture group was comprised of 14 male and 16 female participants ages 19–45 years (mean age 30.3 years). They had obesity for a mean duration of 5.5 years and had a mean body mass index (BMI) of over 30, indicating clinical obesity. The control group was comprised of 13 male and 17 female participants ages 18–53 years (mean age 32.0 years). They had obesity for a mean duration of 6.0 years and had a mean BMI over 30. There were no statistically significant differences in gender, age, duration of disease, or BMI at the beginning of the study period.
For inclusion in the study, patients were required to be at least 18 years of age with a clinical diagnosis of simple obesity in line with both biomedical and traditional Chinese medicine (TCM) criteria. Patients with serious heart, liver, or kidney dysfunction, poor coagulation or bleeding disorders, and infectious diseases were excluded from the study, as were pregnant or lactating women and patients unable to comply with treatment due to dementia or psychological disorders. No other weight loss treatments were permitted for one month before commencement of the study.
The diagnosis of clinical obesity is generally determined using BMI as a measure. A BMI of 18.5–25 is considered healthy, and a BMI of 25–29.9 is considered overweight. A BMI over 30 is considered clinically obese. For patients in the latter group, secondary obesity due to endocrine, hypothalamic, or congenital disorders must be excluded in order to make a diagnosis of simple obesity.
From a TCM (Traditional Chinese Medicine) perspective, simple obesity is caused by the accumulation of excessive dampness and phlegm. Other possible symptoms of this diagnostic pattern include headaches, weakness of the four limbs, abdominal distension, loose stools, generalized heaviness and swelling, lack of thirst, and cough with expectoration. For this diagnosis, the tongue has a sticky, white coating and the pulse is taut, slippery, and soft.
The participants in both groups received standardized dietary education. They were instructed to reduce fat, sugar, and salt consumption, while increasing protein intake by eating more high protein foods such as eggs and yogurt and using protein supplementation if necessary. The patients in the warm needle acupuncture group also received treatment at the following acupoints:
The patients were treated while resting in a supine position using 0.30 × 40mm or 0.30 × 50mm disposable filiform needles. All acupoints were needled bilaterally and stimulated using a reducing technique. After the arrival of deqi, needles were retained for 30 minutes. Warm needle acupuncture was applied at the acupoints Hegu, Tianshu, Zhongwan, and Zusanli. These points were warmed by igniting a piece of moxa, approximately 2cm in length, attached to the needle handles. This process was repeated for each of the aforementioned points 2–3 times per treatment. Treatment was provided on alternate days for a total of eight weeks.
Outcomes and Discussion
At the end of the eight week study period, the two groups underwent assessment and comparison in the areas of BMI, body fat percentages, body adiposity index (BAI), serum triglycerides, total serum cholesterol, LDL cholesterol, and HDL cholesterol. In both groups, BMI, body fat percentages, and BAI decreased by the end of the eight week period, with the greatest decreases ocurring in the acupuncture group.
Patients with a body fat reduction of 26% for men and 30% for women, resulting in a BMI of 26–27 were classified as fully recovered. For patients with a 5% reduction in body fat and a reduction in BMI of over 4, the treatment was classified as highly effective. For patients with a 3–5% reduction in body fat and a reduction in BMI of 2–4, the treatment was classified as effective. For patients with a reduction in BMI of under 2, the treatment was classified as ineffective.
In the acupuncture group, one patient fully recovered and there were 16 cases of highly effective, 10 cases of effective, and 3 cases of ineffective treatment, yielding a total effective rate of 90%. In the dietary program monotherapy control group, no patients fully recovered. However, there were 11 cases of highly effective, 8 cases of effective, and 11 cases of ineffective treatment, yielding a total effective rate of 63.3%.
To assess triglycerides, total cholesterol, LDL cholesterol, and HDL cholesterol, fasting samples of venous blood were collected before and after the treatment period and underwent biochemical analysis. In both groups, triglycerides, total cholesterol, and LDL cholesterol levels reduced by the end of the study, and HDL cholesterol levels rose. These improvements were all greater in the warm needle acupuncture group, and the improvements in triglycerides and total cholesterol were statistically significant.
The results of this study indicate that warm needle acupuncture effectively enhances weight loss achieved by dietary adjustments. In addition, it improves serum triglyceride and total cholesterol levels, while decreasing harmful LDL cholesterol and increasing beneficial HDL cholesterol levels. The researchers note that these findings indicate that warm needle acupuncture may help reduce the risk of cardiovascular disease, heart attacks, and strokes in obese patients, as well as helping them to achieve a healthy BMI. To find out more, contact a licensed acupuncturist in your area.
1. Li Wei-qin, Jiang Wei, Liu Jian (2018) “Treatment of Simple Obesity Patients with Phlegm Dampness Stagnation Syndrome with warming Needle Moxibustion” Acupuncture Research Vol. 43 (8) pp. 522-525.
Posted on Oct 7, 2018 From HealthCMi
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Acupuncture and herbs alleviate cervical spondylosis, a disorder caused by disc degeneration in the neck that results in pain and range of motion impairment. Hubei University of Medicine Dongfeng Hospital researchers conclude that acupuncture combined with herbs successfully relieves pain and regulates excess sympathetic nervous system outflows for patients with cervical spondylosis.  Other improvements were also observed, including reductions in dizziness, palpitations, and neck dysfunction.
Common presentations of cervical spondylosis are neck and shoulder pain, numbness, hypersensitivity, and impaired fine motor function of the arms. However, cervical spondylosis is also a cause of symptoms relating to spinal cord compression or dysfunction. These symptoms include blurred vision, headaches, vertigo, tinnitus, nausea, palpitations, poor memory, and abdominal discomfort. 
It has also been suggested that increased sympathetic nervous system outflows due to compression of the cervical spinal cord region could put cervical spondylosis sufferers at an increased risk of cardiovascular events.  Blood viscosity is also a predictor of cardiovascular events, with increased viscosity increasing the risk of heart attacks and strokes. The study documents that the acupuncture and herbal medicine regimen reduces blood viscosity, which may produce important cardiovascular benefits.
The researchers conducted a randomized clinical trial using the scientific method. To provide a historical basis for the herbs and acupuncture points chosen for the study, the researchers presented Traditional Chinese Medicine (TCM) principles used for the selections. Cervical spondylosis is a disorder primarily belonging to the Du Mai (Governing Vessel) and Taiyang channels. Understood in anatomical terms, this correlates to the spine and paraspinal regions of the body.
TCM principles stipulate that an underlying deficiency of upright qi leaves cervical spondylosis patients vulnerable to pathogenic invasion by wind, cold, and dampness. This correlates to the conceptualisation that internal weakness facilitates greater vulnerability to wear and tear along with other stresses on the human body, including environmental influences. The result is pain in the back and neck region. Acupuncture is applied to improve local blood circulation, relax the musculature, relieve spasms, and reduce inflammation and swelling (especially in the region of nerve roots).
We’ll take a close look at the herbs and acupuncture points used to get the results. First, let’s delve into the outcomes. The subjective component of outcomes was determined using the visual analog scale (VAS) for pain and speed of resolution of other symptoms. Objective measurements include the quantification of blood viscosity.
VAS scores were rated by the patients in two study groups on a scale of 0–10, with 0 indicating a total absence of pain. By the end of the study period, both groups showed a significant reduction in pain (p<0.05). In the herbal medicine monotherapy group, mean VAS scores reduced from 6.91 pre-treatment to 2.86 by the end of the study. Reductions in the acupuncture plus herbs group were significantly greater, falling from 6.89 pre-treatment to just 1.22 by the end of the study (p<0.05).
Resolution of other symptoms such as dizziness, neck dysfunction, chest distress, and palpitations was also monitored closely. In the herbal medicine monotherapy group, dizziness took a mean 12.82 days to resolve, compared with just 7.89 days in the acupuncture plus herbs group. Neck dysfunction took a mean 13.79 days to resolve in the herbal medicine monotherapy group, compared with 9.41 days in the acupuncture plus herbs group. Chest distress and palpitations resolved in a mean 9.88 days in the herbal medicine monotherapy group, compared with 6.94 in the acupuncture plus herbs group. All symptoms resolved significantly and more quickly in the acupuncture plus herbs group (p<0.05). The results indicate that a combined treatment protocol is appropriate for optimal treatment of cervical spondylosis.
Resolution of pain and other symptoms were taken into account to give the total effective rates for both groups. In the herbal medicine monotherapy group, there were 24 cases of complete resolution, 20 cases of partial resolution, and 16 cases of unresolved symptoms, yielding a total effective rate of 73.33%. In the acupuncture plus herbs group, there were 40 cases of complete resolution, 16 cases of partial resolution, and 4 cases of unresolved symptoms, yielding a total effective rate of 93.33%.
Blood viscosity reduced significantly in both groups (p<0.05). Mean pre-treatment systolic blood viscosity measurements were 4.39 mPa.s (pascal-seconds) in the herbal medicine monotherapy group and 4.29 mPa.s in the acupuncture plus herbs group. Mean pre-treatment diastolic measurements were 9.26 mPa.s and 9.25 mPa.s respectively (p>0.05). Following treatment, measurements in the herbal medicine monotherapy group fell to 4.21 mPa.s systolic and 8.67 mPa.s diastolic blood viscosities. Reductions in the acupuncture plus herbs group were significantly greater, with mean systolic viscosity falling to 4.05 mPa.s and mean diastolic viscosity falling to 8.13 mPa.s (p<0.05).
A total of 120 participants aged 25–65 years were recruited for the study and were randomized to receive either an herbal decoction (n=60) or an herbal decoction plus acupuncture treatments (n=60). In the herbal medicine monotherapy group, the mean age was 50.22 years, mean duration of disease was 2.31 years, and mean body mass index (BMI) was 22.57. Of the 60 participants in this group, 13 suffered from hypertension, 10 from dyslipidemia, and 9 from diabetes. In the acupuncture plus herbs group, the mean age was 50.63 years, mean duration of disease was 2.25 years, and mean BMI was 22.10. Of the 60 participants in this group, 12 suffered from hypertension, 11 from dyslipidemia, and 10 from diabetes. There was no statistically significant difference in baseline characteristics between the two groups prior to the treatment regimen in the clinical trial (p>0.05).
Participants receiving concurrent treatment with other therapies, or that were unable to complete the study period, were excluded. Other exclusion criteria included patients with gastric bleeding or gastric ulcers, blood, liver, or kidney disease, psychological disorders, malignant tumors, and pregnant or lactating women.
The participants in both groups were prescribed an herbal decoction consisting of the following ingredients:
The herbs were boiled in water to produce 200–300 ml of liquid. Each decoction was taken once daily for a total of two months.
In addition to the above herbal decoction, participants in the acupuncture plus herbs group received treatment using the following acupoints:
The patients were asked to rest in a prone position. Following disinfection with iodine, 0.3 × 40 mm needles were inserted to a depth of approximately one cun. Huatuojiaji points level with the three intervertebral spaces above and below the affected vertebra were selected. Ashi points were applied to the local area.
All points were stimulated manually using a balanced reinforcing-reducing method. After obtaining deqi, a G6805-II electro-stimulator was connected and set to a frequency of 30 Hz. Electrical stimulation was applied for 30 minutes with the intensity adjusted according to each patient’s individual tolerance levels. Acupuncture was administered on alternating days for a total of two months.
The findings indicate that the prescribed herbal decoction combined with acupuncture successfully alleviates pain and other symptoms associated with cervical spondylosis, and is more effective than using an herbal decoction monotherapy. Furthermore, these therapies significantly reduce blood viscosity. The focus was to improve local circulation and promote faster healing based on the principle of invigorating the blood. These changes may also decrease the risk of heart attacks and strokes in patients with high blood viscosity. To learn more, contact a local licensed acupuncturist.
 Yi Jinke, Xu Yingle, Wang Wenke, Xu Penghui (2018) “Clinical effects of decoction combined acupuncture in treatment of sympathetic cervical spondylosis” Jilin Journal of Chinese Medicine Vol.38(8) pp. 966-968.
 Yuqing Sun, Aikeremujiang Muheremu, Wei Tian (2018) “Atypical symptoms is patients with cervical spondylosis; Comparison of the treatment effect of different surgical approaches” Medicine Vol. 97 (20) e.10731.
 Mohita Singh, indu Khurana, Zile Singh Kundu, Anup Aggarwal (2016) Link of sympathetic activity with cardiovascular risk in patients of cervical spondylosis” International Journal of Clinical and Experimental Physiology Vol.3 (1) pp.41-44.
Posted on Sep 11, 2018 From HealthCMi
Acupuncture is an effective treatment modality for the the alleviation of rheumatoid arthritis. Researchers conclude that acupuncture alone or in combination with additional treatment modalities alleviates rheumatoid arthritis, restores bodily functions, and improves quality of life.  In a meta-analysis, the researchers note that acupuncture exerts its effective actions through several biological mechanisms. The acupuncture research indicates that acupuncture produces anti-inflammatory, antioxidative, and immune system regulatory actions.
Three acupuncture points were common across the research reviewed in the China Medical University and Tri-Service General Hospital meta-analysis. The researchers note that ST36 (Zusanli) was the most commonly tested acupoint in patients with rheumatoid arthritis. GB34 (Yanglingquan) and LI4 (Hegu) were also commonly applied.
The results indicate that acupuncture applied to the aforementioned acupoints and others produces changes in specific inflammatory biomarkers. Acupuncture regulates the following: erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), interleukins, nuclear factor kappa B (NF-𝜅 B), and tumor necrosis factor alpha (TNF-𝛼). Another meta-analysis (Wang et al.), confirms that acupuncture regulates both ESR and CRP in rheumatoid arthritis (RA) patients.  In an important finding, researchers (Han et al.) conclude that acupuncture successfully downregulates “TNF-𝛼 and VEGF [vascular endothelial growth factor] in peripheral blood and joint synovia to improve the internal environment which is beneficial for RA.” 
In another study under review in the meta-analysis (Dong et al.), investigators used laboratory conditions to test the efficacy of electroacupuncture at acupoints ST36 (Zusanli) and BL60 (Kunlun). The researchers indicate that the “toll-like receptor (TLR) signaling pathway contributed to the development and progression of RA and acupuncture could reduce the expression of TLR4, thus leading to anti-inflammation.”  In addition, many other studies indicate that acupuncture improves quality of life.
The research team drew conclusions after a full review of each individual study in the meta-analysis. Based on the data, the researchers note, “acupuncture alone or combined with other treatment modalities is beneficial to the clinical conditions of RA without adverse effects reported and can improve function and quality of life and is worth trying.”  They add that additional well-designed randomized controlled trials are recommended to confirm these findings.
The conclusions were based on several parameters. The primary outcomes were determined by quantifying pain levels, morning stiffness, pain related disability, joint swelling characteristics and diameter, number of swollen joints, skin temperature, and arthritis index. Serum levels of inflammatory and anti-inflammatory biomarkers plus antioxidant levels were recorded for objective measurements. In addition, positron emission tomography (PET) scans were used to monitor changes in inflammation along with X-rays of the hands. Quality of life was assessed using the rheumatoid arthritis quality of life questionnaire (RAQoL), Pittsburgh sleep quality index, health assessment questionnaire (HAQ), and the short form-36 health survey. Overall, the meta-analysis reveals extensive use of subjective and objective instruments to verify the data and conclusions.
The majority of studies included in the meta-analysis were randomized controlled trials and several were double-blinded. The trials were human clinical trials and controlled laboratory experiments. Many acupuncture points were used in the clinical trials. As stated earlier, ST36, GB34, and LI4 were most commonly administered.
The researchers note that there is a difficulty in using only one acupuncture point prescription for all patients diagnosed with rheumatoid arthritis. According to Traditional Chinese Medicine (TCM) principles, rheumatoid arthritis may be divided into many diagnostic subcategories such as wind, cold, dampness, and heat. In addition, these categories are further differentiated according to syndrome presentation location and overall constitution of the patient. As a result, there is a need for heterogenous acupuncture point prescriptions. In TCM, no one set of acupoints for this biomedically defined condition is applicable to all patients. As a result, this makes study design a difficult proposition.
Despite these difficulties, the researchers conclude that acupuncture is effective for the alleviation of rheumatoid arthritis. Many of the findings mapped pathways of effective action. One interesting finding was that acupuncture enhances antioxidative effects by increasing serum superoxide dismutase (SOD) and catalase activities in rheumatoid arthritis patients. This indicates that acupuncture reduces oxidative stress and subsequent inflammation. Moreover, acupuncture “triggered release of endorphins” and regulated the immune system; levels of IgG, IgA, and IgM were successfully downregulated. 
Rheumatoid arthritis is an autoimmune disorder. Inflammation may occur in any location (including internal organs); however, the hands and knees are among the most common regions affected by the disorder. In joints, inflammation affects synovial membranes causing a fluid build-up and degradation. No singular blood test defines the diagnosis, although ESR, CRP, rheumatoid factor, and anti-cyclic citrullinated peptide antibodies are tests are helpful in making a determination. Ultrasound , MRI, and X-ray imaging are also important tools for confirming a diagnosis.
The meta-analysis results indicate that acupuncture benefits patients with rheumatoid arthritis. Acupuncture prevents or slows joint destruction, reduces pain levels, and increases mobility. However, acupuncture is not presented as a cure. Nonetheless, acupuncture is an important treatment option that may significantly improve quality of life. To learn more, contact a local licensed acupuncturists about treatment options.
 Chou, Pei-Chi, and Heng-Yi Chu. "Clinical Efficacy of Acupuncture on Rheumatoid Arthritis and Associated Mechanisms: A Systemic Review." Evidence-Based Complementary and Alternative Medicine 2018 (2018).
 C. Wang, P. de Pablo, X. Chen, C. Schmid, and T. McAlindon, “Acupuncture for pain relief in patients with rheumatoid arthri- tis: a systematic review.,” Arthritis & Rheumatology, vol. 59, no. 9, pp. 1249–1256, 2008.
 R. X. Han, J. Yang, T. S. Zhang, and W. D. Zhang, “Effect of fire-needle intervention on serum IL-1 and TNF-alpha levels of rheumatoid arthritis rats,” Zhen Ci Yan Jiu, vol. 37,no. 2, pp. 114–118, 2012.
 Z.-Q. Dong, J. Zhu, D.-Z. Lu, Q. Chen, and Y.-L. Xu, “Effect of Electroacupuncture in “Zusanli” and “Kunlun” Acupoints on TLR4 Signaling Pathway of Adjuvant Arthritis Rats,” American Journal ofTherapeutics, 2016.
 Chou, Pei-Chi, and Heng-Yi Chu. "Clinical Efficacy of Acupuncture on Rheumatoid Arthritis and Associated Mechanisms: A Systemic Review." Evidence-Based Complementary and Alternative Medicine 2018 (2018).
Posted on Aug 9, 2018 From HealthCMi
Acupuncture and cupping are safe and effective treatments for lumbopelvic pain during pregnancy. Researchers conducted an observational study at a hospital-based community antenatal clinic in New Zealand and determined that acupuncture produces significant positive patient outcomes, including reductions in lumbopelvic pain levels.  Lumbopelvic pain is in the lower torso, lower back, and pelvic girdle and is frequently experienced by pregnant women. Acupuncture provides an important alternative treatment option because many common prescription drugs and over-the-counter analgesics are not recommended during pregnancy.
During the study period, a total of 245 pregnant women attended the clinic, 144 (56.5%) of whom reported lumbopelvic pain as their primary or secondary complaint. Sixty-three women were excluded from the study as they either did not complete a baseline assessment or did not complete a post-treatment follow-up. Data from 81 women were included in the results. Of the women involved in the study, 45 were nulliparous (55.5%). The majority of women were in the third trimester of pregnancy (49.3%), 31 were in the second trimester (38.2%), and 10 were in the first trimester (12.3%). Most of the women were referred to the clinic by a midwife (72%).
Acupuncture and cupping treatments were provided according to the principles of traditional Chinese medicine (TCM). Points were selected on an individual basis and not all points were used on all of the women. The most commonly used points were Yanglingquan (GB34) and Zulinqi (GB41), which were used in over 50% of all women. Ashi points on the lower back were used in 25–50% of the women, excluding direct needling of Ciliao (BL32) and Zhongliao (BL33). Ashi points surrounding Huantiao (GB30) and ashi points on, near, or between Qiuxu (GB40), Shenmai (BL62), and Taichong (LV3) were also used in 25–50% of women. Ashi points between Neiting (ST44) and Lidui (ST45) and ashi points on, near, or between Chengshan (BL57), Feiyang (BL58), Yintang (MHN3), Baihui (GV20), Kunlun (BL60), Fengshi (GB31), and Waiguan (TB5) were used in fewer than 25% of women. Additionally, cupping therapy to the lower back was provided to over 50% of women in taking part in the study. This is an interesting selection given that cupping is ordinarily contraindicated on the abdomen and lower back during pregnancy.
Upon insertion of the needles, deqi was obtained manually and needles were retained for 20 minutes. Treatment was given once weekly, with each woman receiving a minimum of three treatments. The mean number of treatments was 3.85. Ear press needles were also offered to the women to place on the foot acupoints if desired. They were advised to retain these for 2–3 days and to remove them if they became uncomfortable or itchy.
Results and Discussion
All women taking part in the study completed the Measure Yourself Medical Outcome Profile (MYMOP) questionnaires prior to and after acupuncture treatments. The MYMOP questionnaire allowed the participants to describe their symptoms in their own words and to rate them using a scale of 0–6. They were also allowed to give additional information about other symptoms, especially those related to functional impairment and general well-being. Symptomatic changes were calculated by subtracting the post-treatment score from the pre-treatment score, and a reduction of one point or more was considered clinically significant.
Of the 81 women included in this study, 18 reported an improvement in symptoms of 1–1.99 points (22.2%), 30 reported an improvement of 2 –2.99 points (37.0%), 15 reported an improvement of 3 –3.99 points (18.5%), and 9 reported an improvement of 4 points or more (11.1%). A total of 72 women (88.9%) reported clinically significant improvements following treatments with acupuncture and cupping. The data demonstrates that acupuncture and cupping are effective treatment options.
In a prior study conducted at Yale-New Haven Hospital, researchers find auricular acupuncture effective for the treatment of pregnancy-related lower back and posterior pelvic pain.  A total of 152 pregnant women completed the study. They were randomized to receive auricular acupuncture, sham auricular acupuncture, or no treatment. All women were 25–38 weeks pregnant and had no prior experience with acupuncture.
Auricular press needles were administered at three points (kidney, analgesia, and Shenmen) and were secured with tape. These points were selected for their location close to the hip and lumbar spine areas on the auricular somatotopic map. The participants were instructed to keep these press needles in place continuously for one week without pressing or stimulating them in any way. If they experienced any redness or irritation, they were instructed to return to the clinic to have the needles inspected, adjusted, or removed if necessary.
Sham Auricular Acupuncture
The above procedure was also followed for the sham auricular acupuncture group, with the exception that three non-specific auricular points (shoulder, wrist, extra-auricular) were selected.
Pain and functional status were measured using a Visual Analogue Scale (VAS) with measurements taken at baseline, on day 7, and on day 14. On day 7, all participants reported improvements in pain, with the acupuncture group experiencing the greatest improvements compared to sham and control. In the acupuncture group, 81% of participants experienced significant improvements compared with 59% and 47% in the sham and control groups respectively. Additionally, 37% of women in the acupuncture group were pain-free at the 7-day mark, compared with 22% and 9% in the sham and control groups respectively. One limitation of the study design is that the data may indicate and active sham control, with the shoulder, wrist, and extra-auricular ear acupuncture points potentially providing clinically significant contributions to symptomatic relief.
At the 14 day follow-up, 68% of women in the acupuncture group reported significant improvements in pain levels, with 16% being entirely pain-free. In the sham group, 32% of women saw improvements in pain, with 9% being pain-free. In the control group, 18% had improvements, with 6% being pain-free. The results indicate that auricular acupuncture provides significant clinical benefits.
1. Department of Human Development, Washington State University Vancouver, Vancouver, Washington, USA.
2. National Institute of Complementary Medicine at University of Western Sydney, Sydney, Australia.
3. New Zealand School of Acupuncture and Traditional Chinese Medicine, Wellington, New Zealand.
4. Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut.
5. Department of Epidemiology and Public Health, Yale School of Medicine, New Haven, Connecticut.
6. Department of Orthopedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut.
7. Department of Obstetrics and Gynecology, Yale School of Medicine, New Haven, Connecticut.
8. Women's Education and Life Learning Center, Yale-New Haven Hospital, New Haven, Connecticut
9. Departments of Anesthesiology, Pediatrics, Psychiatry, and Human Behavior, University of California School of Medicine, Irvine, California.
1. Soliday E. Betts D. “Treating Pain in Pregnancy with Acupuncture: Observational Study Results from a Free Clinic in New Zealand” Journal of Acupuncture and Meridian Studies 2018;11(1):25e30.
2. Wang S.M. et al. “Auricular acupuncture as a treatment for pregnant women who have low back and posterior pelvic pain: a pilot study” American Journal of Obstetrics & Gynecology September 2009.
Posted on July 23, 2018 From HealthCMi
Acupuncture benefits patients suffering from hemiplegia (unilateral paralysis) after a stroke. Traditional Chinese Medicine Hospital of Baoji researchers compared daily exercise monotherapy with acupuncture plus daily exercises. Patient outcomes were consistently superior in the combined therapy group, demonstrating that the addition of acupuncture to the daily exercise treatment regimen improves clinical outcomes. The researchers conclude that acupuncture plus rehabilitation exercises improves motor function and cerebral blood flow, making it an effective intervention for post-stroke hemiplegia. 
Objective and subjective data were the basis for the conclusions. Blood flow changes in the brain were measured with a transcranial Doppler device, a specialized ultrasound unit utilized for measuring blood flow velocity through cerebral blood vessels. This was used to monitor the movement of blood in the anterior, middle, and posterior cerebral arteries. Both groups showed marked improvements in blood flow following treatment, but improvements in the combined therapy group were significantly greater (p<0.05). The measurements demonstrate that the addition of acupuncture to the treatment protocol enhances recuperation within the human brain.
Subjective clinical observations for both groups were made using the Neurological Deficit Scale and the Fugl-Meyer Assessment. The Neurological Deficit Scale (NDS) is designed to measure neurological function following a stroke. The Fugl-Meyer Assessment (FMA) is a scale specifically designed to measure post-stroke impairment based on categories including motor function, balance, sensation, and joint function. The results were divided into four categories:
Both groups showed improvements following treatment, but improvements in the combined therapy group were significantly greater (p<0.05). In the combined therapy group, 65.71% of patients fell within the cured category, compared with just 42.86% in the control group.
A total of 70 patients with hemiplegia were recruited and a definitive diagnosis of cerebrovascular accident (stroke) was confirmed by means of CT and MRI scans. Patients were randomly assigned to two groups. Both groups received standard physical rehabilitation exercises and one group received acupuncture. Acupuncture was performed on the side of the body affected by hemiplegia. Points on the upper limb included LI11 (Quchi), LI4 (Hegu), LI10 (Shousanli), and SI3 (Houxi). Points on the lower limb included ST36 (Zusanli), GB30 (Huantiao), SP6 (Sanyinjiao), and LV3 (Taichong). Filiform needles 40–75mm in length were used to needle the points and were manually manipulated to obtain deqi. The needles were retained for 20 minutes per acupuncture session. Treatment was administered once daily, with 10 treatments comprising one course. A total of 10 courses of treatment were administered consecutively.
Rehabilitation therapeutic exercises mainly consisted of daily exercises to strengthen the muscles of the trunk and limbs. These included passive or assisted stretches and exercises for patients that were confined to their beds or had limited mobility. Ambulatory patients were also encouraged to walk and climb stairs, aided by a walking stick if necessary. Exercises were administered for 30 minutes daily, with 10 days comprising one course. A total of 10 courses of exercises were administered consecutively.
Limitations of the study include a relatively small sample size and the lack of an acupuncture monotherapy arm. A strength of the study design is the use of both subjective and objective instruments to measure outcomes. Based on the data, acupuncture benefits patients with post-stroke hemiplegia and is a reasonable treatment option.
Chengdu University of Traditional Chinese Medicine
The aforementioned research is not isolated. Chengdu University of Traditional Chinese Medicine researchers conclude that acupuncture benefits brain activity in areas responsible for motor function, sensory perception, and emotions after an acute ischemic stroke.  Patients underwent fMRI scans before and after treatment to assess brain activity.
Brain activity was measured using regional homogeneity (ReHo) to show changes in activity in different areas of the brain. ReHo is a multimodal neuroimaging marker of the human connectome (a map of brain neural connections detailing neural interactions). The connectome is often described as the wiring map of the brain. The ReHo approach to functional magnetic resonance imaging (fMRI) methods used in this study measures brain connectomics, measuring the brain’s intrinsic dynamics. 
Two groups were compared using fMRIs. Group 1 received drug therapy. Group 2 received drug therapy plus acupuncture. Patients in the drug monotherapy group showed increased activity in the frontal lobe and parietal lobes. Patients in the acupuncture group showed increased activity in the frontal lobe, parietal lobe, middle temporal gyrus, cerebellum, and insula, which are areas responsible for motor function, sensory perception, and emotions.
Subjective instruments measured improved outcomes for patients receiving acupuncture. Results were based on three parameters: NDS, FMA, and the Modified Barthel index (MBI), a scale used to assess quality of daily life in stroke survivors. Both groups showed statistically significant (p<0.05) improvements in NDS, FMA, and MBI. However, improvement was greater in the acupuncture group in all three areas.
A total of 21 patients were selected and randomly assigned to receive either acupuncture plus conventional drug treatment (n=11) or conventional drug treatment alone (n=10). The two groups were demographically similar in terms of gender, sex, weight, and height. They also had similar disease characteristics including duration and severity of symptoms.
In the combined acupuncture and conventional medication group, treatments utilized the points GV20 (Baihui), GB20 (Fengchi), LI11 (Quchi), LI4 (Hegu), ST36 (Zusanli), GB34 (Yanglingquan), GB39 (Xuanzhong), and SP6 (Sanyinjiao). Needles were retained for 30 minutes and treatments were administered daily. Five treatments comprised one course and a total of four courses were administered, with a two day break between each one.
Both groups were treated with conventional medications including antiplatelet medication (aspirin, 100mg daily, for patients with abnormal platelet counts) and citicoline 500mg daily. Citicoline is a drug commonly used in the treatment of various neurological disorders, including stroke. Other symptomatic related treatments were also administered as needed.
The differences in brain activity demonstrated by the two groups in this study indicates that acupuncture increases brain activity following an ischemic stroke, significantly more so than conventional drug treatment alone. These findings indicate that acupuncture is a reasonable treatment option for stroke recovery and rehabilitation. To learn more, contact your local licensed acupuncturist for more information.
1. Hou Qiang, Li Jin-tao “Clinical value of acupuncture combined with rehabilitation therapy in patients with hemiplegia after cerebrovascular accident” Clinical Medical Research and Practice (2018) Issue 11.
2. Wu Ping et al. “Effect of acupuncture plus conventional treatment on brain activity in ischemic stroke patients: a regional homogeneity analysis” Journal of Traditional Chinese Medicine (2017) October 15; 37 (5).
3. Jiang, Lili, and Xi-Nian Zuo. "Regional homogeneity: a multimodal, multiscale neuroimaging marker of the human connectome." The Neuroscientist 22, no. 5 (2016): 486-505.
Posted on June 7, 2018 From HealthCMi
Acupuncture is effective for the treatment of chronic fatigue syndrome (CFS). Researchers at the Beijing Chaoyang Fatou Community Health Service Center conducted a study comparing the effects of warm needling acupuncture, standard acupuncture, and sham acupuncture.  Based on the data, the researchers conclude that warm needling acupuncture is significantly more effective than using only standard acupuncture or sham acupuncture.Three groups were compared. In one group, patients received sham acupuncture (a placebo control system used to simulate true acupuncture used in single-blinded and double-blinded trials). In the second group, patients received standard acupuncture as a means to control chronic fatigue syndrome. In the third group, standard acupuncture was combined with moxibustion therapy.
The results demonstrate that sham acupuncture does not produce significant positive patient outcomes; however, standard acupuncture and warm needling acupuncture produce significant clinical results. The researchers note, “Acupuncture (and moxibustion) can be used as alternative and safe treatment protocols for chronic fatigue syndrome.”About CFS
Chronic fatigue syndrome is defined as an illness characterized by severe disabling fatigue lasting for at least six months that is worsened by minimal physical or mental exertion. In the sphere of biomedicine, no definitive etiology has been identified. There are no key features or typical symptoms, but a sore throat, depression, and myalgia may all be present. The biomedical etiology of chronic fatigue syndrome (CFS) remains unclear.
However, it has been suggested that psychological and social factors, viral loads, and immune system dysfunction may contribute to the condition. Previous studies find that CFS may be associated with a bias towards a Th2 type of response in Th1/Th2 immune balances.  Acupuncture’s ability to balance Th1 and Th2 may be one mechanism responsible for its effective action in the treatment of CFS.Th1 (T helper 1) and Th2 (T helper 2) cells are types of T cells that play important roles in the adaptive immune system. Th1 cells secrete IL-2, interferon-gamma (IFN-γ), and tumor necrosis factor (TNF). Th2 cells produce IL-4, IL-5, IL-6, and IL-13.  In a Th2 immune response, IL-4 production by T cells is predominant over IFN-γ. Researchers Wang et al. note, “Acupuncturing at bilateral GV20 (Baihui), CV4 (Guanyuan), and ST36 (Zusanli) could elevate the serum IFN-γ concentration and the ratio of IFN-γ/IL-4 and regulate Th1/Th2 immune balance.”  This finding indicates that acupuncture may be of benefit to CFS patients with T cell imbalances.Findings The study involved 133 voluntary patients from the Beijing Chaoyang Fatou Community Health Service Center. All were diagnosed with CFS. Inclusion criteria were established based on the CDC (US Centers for Disease Control and Prevention) criteria for CFS and included the following:
In addition, the aforementioned is concurrent with four or more of the following symptoms:
Acupuncture Patients were randomly divided into three groups: warm needling acupuncture group (n=44), acupuncture group (n=47), sham control group (n=42). For the warm needling acupuncture group, the average age of participants was 33.9 years. There were 20 males and 24 females. For the acupuncture group, the average age was 34.2 years (21 males and 26 females). For the sham control group, the average age of participants was 35.1 years (19 males and 23 females). The acupoints selected for the acupuncture and acupuncture plus moxibustion groups were the following:
For the sham acupuncture control group, body points selected were neither meridian acupoints nor special acupoints. They were located at the following areas:
Chinese Medicine The researchers provided a Chinese medicine theoretical basis for the protocols used in this acupuncture continuing education research. In Traditional Chinese Medicine, CFS falls in the scope of deficiency taxation (Xu Lao), wilting pattern (Wei Zheng), depression disease (Yu Bing), and hundred-union disease (Bai Hu Bing). CFS presentations are categorized into several differential diagnostic patterns including spleen qi deficiency, kidney jing-essence deficiency, spleen and kidney yang deficiency, liver depression, and qi stagnation. The treatment principle is to supplement deficiencies, support upright qi (Zheng Qi), and restore the liver’s function to control the smooth flow of qi.Acupoints were selected to achieve the therapeutic actions guided by the treatment principles. Baihui is located on the Governing Vessel (Du Mai).
Administering acupuncture at this acupoint lifts yang, boosts qi, and revives the spirit mind (shen). Danzhong, Qihai, and Guanyuan are located on the Conception Vessel (Ren Mai). Needling Danzhong restores the free flow of qi and supplements ancestral qi (Zong Qi). Acupuncture at the other two acupoints supports upright qi (Zheng Qi) and benefits the kidneys. Zusanli combined with Sanyinjiao is often used in modern clinical settings to strengthen the spleen and stomach and to benefit qi and blood. Siguan (a combination of bilateral Hegu and Taichong) was applied to restore the liver’s function to control the smooth flow of qi and activate qi and blood circulation.For all three groups, each point was pierced with a disposable 0.25 mm × 40 mm needle (Huatuo brand), adhering to standard needling depths. For Baihui and Danzhong, the needles were inserted transverse-obliquely towards the direction of meridian energy flow.
For the remaining acupoints, the needles were inserted perpendicularly. When a deqi sensation was obtained, Baihui, Qihai, Guanyuan, and Zusanli were manually stimulated with Bu (tonifying) manipulation techniques, while other acupoints were stimulated with the Ping Bu Ping Xie (attenuating and tonifying) manipulation techniques.
Next, a needle retention time of 30 minutes was observed.For the warm needling group, moxibustion was added to Baihui, Qihai, Guanyuan, and Zusanli. Medicinal moxa pieces of approximately 2 cm were attached to the needle handles and ignited. Thick paper heat shields were placed over the skin for protection. Moxa was left in place for 20 minutes per 30 minute needle retention time.Acupuncture and moxibustion sessions were administered once per day. Each treatment course consisted of ten acupuncture treatments. All patients received two treatment courses in total.
To evaluate the treatment effective rate, patients were scored before and after the treatments based on the Chalder Fatigue Scale as well as the Self-rating Satisfaction Scale. The Chalder Fatigue Scale is a measurement tool used for quantifying the severity of tiredness in CFS patients across multiple parameters (e.g., physical fatigue scores, mental fatigue scores, general fatigue scores).After the treatment, the scores of the Chalder Fatigue Scale including physical fatigue scores, mental fatigue scores, and general fatigue scores were significantly decreased in the standard acupuncture and acupuncture warm needling groups, but not in the sham acupuncture group. The physical, mental, and general fatigue scores of the standard acupuncture and warm needling groups were significantly better than those of the sham acupuncture group, while the physical and general scores of the warm needling group were markedly better than those of the standard acupuncture group (P＜0.05). Interestingly, the CFS patients’ satisfactory rates of the standard acupuncture and acupuncture plus warm needling groups were 36.2% (17/47) and 72.7% (32/44) respectively—indicating that moxibustion was well-received by patients. All groups had no adverse effects resulting from treatment or other medical procedures in the protocols.
The results indicate that warm needling acupuncture or standard acupuncture is more effective than sham acupuncture. The study by Lu et al., mentioned in this report, demonstrates that acupuncture is safe and effective for the treatment of chronic fatigue syndrome. Important features of TCM protocols are that they produce a high total effective rate without any significant adverse effects.Summary Major causes of suffering include pain, paralysis, mental illness, nausea, immune system imbalances, and fatigue. CFS and other clinical scenarios involving severe fatigue are a significant source of suffering and may be as severe as any other form of illness or complication. One concern is that since there is no clearly defined etiology within hospital medicine for CFS, patients may be marginalized or receive incomplete care.There are instances in which patients are given psychiatric medications without addressing the biophysical sources of CFS. This focus on treating only the symptom and not the root cause of CFS potentially leads to prolonged suffering. Given the results of the research data, acupuncture with moxibustion is a reasonable treatment option, referable by primary healthcare physicians.
Notes  Lu C, Yang XJ, Hu J. Randomized Controlled Clinical Trials of Acupuncture and Moxibustion Treatment of Chronic Fatigue Syndrome Patients. Acupuncture Research, 2014, 39(4):313-317.  Fukuda K, Straus SE, Hickie I, Sharpe MC, Dobbins JG, Komaroff A. The chronic fatigue syndrome. a comprehensive approach to its definition and study. Ann Intern Med. 1994;121:953 – 9. International Chronic Fatigue Syndrome Study Group.  Skowera, A et al. “High Levels of Type 2 Cytokine-Producing Cells in Chronic Fatigue Syndrome.” Clinical and Experimental Immunology 135.2 (2004): 294–302.  Choi, P, and H Reiser. “IL-4: Role in Disease and Regulation of Production.” Clinical and Experimental Immunology 113.3 (1998): 317–319.  Wang XY, Liu CZ, Lei B. “Effect of Manual Acupuncture Stimulation of Baihui, Guanyuan, Zusanli on Serum IFN-γ and IL-4 Contents in Rats with Chronic Fatigue Syndrome.” Acupuncture Research 2014, 39 (05): 387 – 389.  Fukuda K, Straus SE, Hickie I, Sharpe MC, Dobbins JG, Komaroff A. The Chronic Fatigue Syndrome: A Comprehensive Approach to its Definition and Study. Ann Intern Med. 1994 Dec 15;121(12):953-9.
Posted on May 6, 2018 From HealthCMi
Hunan University of Chinese Medicine researchers find acupuncture effective for the treatment of functional dyspepsia (indigestion). Results from the investigation demonstrate that acupuncture is effective for alleviating upper abdominal pain and burning, nausea, and belching. In a semi-protocolized clinical trial, two primary acupuncture points were proven effective for the treatment of functional dyspepsia (abdominal discomfort or pain with no known organic cause identifiable with endoscopy).
Electroacupuncture and manual acupuncture techniques were used to obtain treatment success. The total effective rates were 91.3% for upper abdominal pain, 90.62% for postprandial excess fullness, 95.45% for premature fullness, 93.33% for upper abdominal burning sensations, 87.5% for postprandial nausea, and 83.33% for belching.  This is significantly greater than scores in the sham acupuncture control group, which were never greater than 42.86% for any parameter.
Primary Acupuncture Points For patients in the acupuncture treatment group, two acupoints were applied to all patients: Zusanli (ST36), PC6 (Neiguan). The researchers commented on the point selection. Zusanli was selected for its location on the stomach foot yangming channel and its ability to treat all fu-organs (gallbladder, large intestine, small intestine, bladder, stomach, sanjiao). They add that Zusanli promotes the health of the spleen and stomach, dredges the channel, and regulates gastric tone and motility.  They note that Zusanli has been proven effective for patients with gastric motility disorders in prior research. Zusanli regulates gastric electrical rhythms relating to electrogastrographic power and gastric emptying time, secretion of gastrin and motilin, gastrointestinal hormones, and gastric acid (a combination of hydrochloric acid, potassium chloride, and sodium chloride).  The researchers also comment that Neiguan is indicated for relieving pain and for promoting qi circulation and stomach health.
Additional points were added for specific diagnostic considerations. For patients with excess syndrome, Taichong (LV3) and Neiting (ST44) were added. For patients with deficiency syndrome, Gongsun (SP4) and Yinlingquan (SP9) were added. The researchers commented on the traditional use of these acupoints. Taichong is a yuan-source point on the liver channel and promotes health of the liver and stomach. Taichong promotes qi circulation and alleviates pain of the hypochondrium region. Taichong is also useful for treating emesis (vomiting) and abdominal bloating. Neiting is a ying-spring point on the stomach foot yangming channel. Both Taichong and Neiting are acupoints indicated for clearing heat from the liver and stomach channels.
Gongsun is located on the spleen foot-taiyin channel and promotes qi and blood circulation in the spleen and stomach channels. Gongsun regulates gastric acid secretion and prevents its excess. Yinlingquan is located on the spleen foot-taiyin channel and promotes qi circulation. Both Gongsun and Yinlingquan revitalize the stomach and spleen while activating qi circulation.
Acupuncture Procedure Acupuncture points were applied unilaterally and sides were alternated every acupuncture session. Huatuo brand disposable acupuncture needles were used. All points were manually stimulated with a mild reinforcing and attenuating technique to achieve deqi.
Electroacupuncture was applied with a disperse-dense setting and the frequencies alternated between 2 Hz and 100 Hz at a 0.1–1.0 mA amplitude (based on patient tolerance levels) to all needles. Total needle retention time was 30 minutes per each acupuncture session. Acupuncture was applied daily for a total of five acupuncture treatments comprising one course of care followed by a two day break. Four courses of treatment were administered to each patient.
For the treatment of upper abdominal pain, the true acupuncture group outperformed the control group by 56.93%. For postprandial excess fullness, the acupuncture group outperformed the control group by 55.33%. For premature fullness, the acupuncture group outperformed the control group by 57.36%. For upper abdominal burning, the acupuncture group outperformed the control group by 64.76%. For postprandial nausea, the acupuncture group outperformed the sham acupuncture control group by 47.5%. For belching, the acupuncture group outperformed the control group by 40.47%.
Gongsun (SP4) and Neiguan (PC6) In related research, investigators find acupuncture more effective than the drug mosapride for the treatment of abdominal pain and discomfort due to indigestion. Specifically, acupuncture outperformed mosapride for the treatment of functional dyspepsia.  The results were confirmed by electrogastrogram and other instruments. The acupoints used in the study were Gongsun (SP4) and PC6 (Neiguan), a classic eight extra channels confluent point combination.
The combination of Gongsun and Neiguan “significantly relieved clinical symptoms such as abdominal distention and discomfort after eating, early satiety, upper abdominal pain, and upper abdominal burning sensation.” The researchers note that “acupuncture outperformed drugs in regulating EGG dominant frequency as well as slow wave frequency.” They add, “compared with the drug group, the acupuncture group showed a significant difference in FDDQL scores.” 
Manual acupuncture and electroacupuncture were administered. Patients rested in a supine position. Upon disinfection, a 0.30 mm × 40 mm acupuncture needle was inserted into each point, to a maximum depth of 25–40 mm. A mild tonifying and attenuating manual acupuncture manipulation technique was applied to achieve a deqi sensation. Next, electroacupuncture was applied with a disperse dense wave of 2–100 Hz (0.1–1.0 mA). Intensity level was set to patient tolerance levels or until muscle contractions were observable.
Electroacupuncture was applied once per day, 30 minutes per acupuncture session, for a total of 30 days. For the control group, patients received 5 mg of mosapride citrate tablets, 30 minutes before meals. Tablets were orally administered three times per day, for a total of 30 days.
Patients were evaluated before and after treatment. First, improvements were recorded using a clinical scoring system. Next, a functional digestive disorders quality of life questionnaire (FDDQL) was recorded for each partient. Third, an electrogastrogram (EGG) was utilized to measure the electrical activity of the stomach (including EGG dominant frequency and slow wave frequency). The results indicate that acupuncture is both safe and effective for the treatment of functional dyspepsia and acupuncture is more effective than mosapride. 
Notes  Li DD, Yue ZH, Chao XL, Xie T, Hu GZ, Yang J. (2014). Evaluation of Long Term Effect of Electro Acupuncture on Patients with Functional Dyspepsia. Journal of Clinical Acupuncture and Moxibustion. 30 (2).  Feng GX, Zhu Y, Jiang FD. (2004). The efficacy of conventional and auricular Acupuncture in treating Functional Dyspepsia (35 cases). Journal of Modern Chinese Medicine. 36(1): 48-49.  Li YY. The effect of acupuncture on gastric acid secretion. (1991). Chinese Journal of Digestion. (6): 358.  Hong Feng. Observations on the Efficacy of Electroacupuncture at Points Gongsun and Neiguan in Treating Functional Dyspepsia[J]. Shanghai Journal of Acupuncture and Moxibustion, 2016.  Ibid.  Ibid.
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).  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.  It is a major cause of pain and disability and is also one of the most common musculoskeletal disorders.  In addition, the increased prevalence of the disease is proportional to increases in the obesity epidemic. 
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.  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.  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.  The disadvantage of micro-CT is that it doesn’t effectively image uncalcified soft tissue such as cartilage. 
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. 
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.  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.  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.  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  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.  arthritisresearchuk.org/  arthritisresearchuk.org/  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.  jia.org.uk/medication  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.  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.  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.  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.  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.  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.  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.
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 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.  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:
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.
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. 
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:
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:
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.
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.
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.
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. 
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. 
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.  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.  Let’s take a close look at the results.
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).
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.
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:
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.
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:
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.
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).
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.
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.
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:
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.
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.
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:
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:
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.
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.
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. 
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:
Secondary acupuncture points were added based on diagnostic considerations. For patients with heart and sleep deficiency, the following acupoints were added:
For heart deficiency related timidity, the following acupoints were added:
For liver qi depression transforming into fire, the following acupoints were added:
For phlegm heat, the following acupoints were added:
For patients with blood stasis, the following acupoints were added:
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.” 
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:
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.
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.”
 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.
 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.”
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.”
 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.”
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.”
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.
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.
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.
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