Acupuncture Found Effective For IBS-D

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from HealthCMi 2/26/18

Investigators find acupuncture effective for the treatment of IBS (irritable bowel syndrome). In a controlled study, Yiwu Central Hospital researchers conclude that acupuncture has a 90.7% total effective rate for IBS-D patients. Perhaps more importantly, acupuncture produces a 34.9% complete recovery rate. The total recovery rate accounts for all patients showing significant improvements and the complete recovery rate is a quantitative measure of all patients cured of IBS-D by acupuncture therapy.

Results were determined from both subjective and objective data. Subjectives were based on improvements in bowel movement frequency, shape, texture, and consistency. Subjectives also included measures of abdominal discomfort, anxiety, and sleep improvements. Objective data was based on changes of 5-hydroxytryptamine (5-HT), neuropeptide Y (NPY) and calcitonin gene-related peptide (CGRP) serum expression using automated ELISA analysers. The 90.7% total effective rate and the 34.9% complete recovery rate were calculated based on the the subjective and objective data.

About IBS
In this article, we are going to take a close look at the acupuncture points that achieved the results. First, let’s review a little about IBS before getting into the details. Irritable bowel syndrome (IBS) is a disorder affecting the digestive system. It is characterized by recurring abdominal pain and discomfort associated with alterations in the frequency of bowel movements or consistency of stool. At present, the occurrence of IBS is related to the patient’s history of gastroenterological viral infections, psychological factors, age, gender, occupation, history of medications, intestinal microflora balance, metabolic disorders of brain-intestinal axis, and other factors.

Based on the main pathological manifestations, IBS can be classified into four subtypes: IBS-D (diarrhea-predominant), IBS-C (constipation-predominant), IBS-M (mixed), and unspecified IBS (IBS-U). According to Traditional Chinese Medicine (TCM) principles, diarrhea-predominant IBS (IBS-D) belongs to the “diarrhea” (xie xie) and “abdominal pain” (fu tong) categories. The main causes of IBS are stagnation of liver qi, deficiency of the spleen and kidneys, and the invasion of cold and heat pernicious influences. [1] These result in gastrointestinal imbalances. TCM principles note that IBS is easily exacerbated by changes in the diet.

Design
Yiwu Central Hospital researchers conducted a two-arm study of 86 IBS-D patients between January 2016 and December 2016. [2] Patients were randomly divided into control group and an observation group, with 43 cases in each group. Patients were identified using the Rome III Diagnostic Criteria for Irritable Bowel Syndrome (IBS) as well as the TCM standards related to liver qi-stagnation and spleen-deficiency (gān yù pí xū) in the “Consensus on the Diagnosis and Treatment of Irritable Bowel Syndrome.” [3–4]

Patients in the control group were given the following herbal medicines over a 30-day period. The first medication was Spleen and Bowel-Reinforcing Pills (bǔ pí yì cháng wán), manufactured by China Resources Pharmaceutical Group Ltd. It was administered in 6-gram doses that were orally administered 3 times per day, after meals. In addition, patients were given herbal medicine in the form of Xiao Yao Wan (Hubei Wushi Pharmaceuticals) in 6-gram doses. The herbal pills were orally administered twice per day, after breakfast and after dinner.

Acupuncture Treatment
Patients in the observation group received acupuncture therapy in addition to the same herbal medicines administered to the control group. With patients in the supine position, needles were inserted swiftly to a depth of 20 mm. Twisting and reinforcing-reducing techniques were applied to achieve a deqi sensation of soreness, distention, numbness, or a radiating sensation towards the abdomen. Needles were then left in place for 30 minutes. The following are the acupoints used for all observation group patients:

  • Yintang MHN3 (Hall of Impression)
  • Baihui GV20 (Hundred Meetings)
  • Shangjuxu ST37 (Upper Great Void)
  • Tianshu ST25 (Heaven’s Pivot)
  • Sanyinjiao SP6 (Three Yin Intersection)
  • Zusanli ST36 (Leg Three Miles)
  • Taichong LV3 (Great Rushing)

Twenty minutes of moxibustion therapy was also applied to the following acupoints:

  • Shenque CV8 (Spirit Gateway)
  • Tianshu ST25 (Heaven’s Pivot)

Patients experiencing severe diarrhea and cold syndromes received ginger moxibustion (ge jiang jiu) at Shenque CV8. Treatment was administered 5 times per week, over the course of 30 days.

Chinese Medicine
The above acupoints are key for benefitting the liver and spleen. The combined use of these acupoints is able to sooth the liver and strengthen the spleen (shu gan jian pi), firm the intestines and stop diarrhea (gu chang zhi xie), and promote the harmonious rise and fall of spleen and stomach qi. As IBS sufferers are prone to emotional disorders, acupuncture therapy at Yintang (MHN3) and Baihui (GV20) was added for a tranquilizing effect.

Efficacy of Treatment
Clinical efficacy was evaluated and compared after one course of treatment by assessing indicators such as main symptoms, psychological status, and sleep quality. Expressions of 5-hydroxytryptamine (5-HT), neuropeptide Y (NPY) and calcitonin gene-related peptide (CGRP) in serum samples were measured and compared before and after the intervention.

Main symptoms were scored based on the “Guiding Principles of Clinical Research on New TCM Drugs,” with each symptom given a score between 0 and 3. [5] The main symptoms included the following:

  • Abdominal discomfort (0: no discomfort, 1: mild discomfort, 2: moderate pain, 3: severe pain)
  • Stool frequency (0: 1 to 2 times/day, 1: 2 to 5 times/day, 2: 5 to 10 times/day, 3: ≥ 10 times/day)
  • Shape, texture and consistency of stool (0: normal, 1: soft stool, 2: mushy stool, 3: watery stool)
  • Presence of mucus in the stool and feeling of incomplete relief after bowel movement (0: never, 1: rarely, 2: frequently, 3: every time)

Psychological status of the patients was assessed using the Self-Rating Anxiety Scale (SAS) and the Self-Rating Depression Scale (SDS):

  • SAS: Patients who scored 50–59 points had mild levels of anxiety, 60–69 points had moderate levels of anxiety, and ≥70 points had extreme levels of anxiety.
  • SDS: Patients who scored 53–62 points had mild levels of depression, 63–72 points had moderate levels of depression, and >72 points had extreme levels of depression.

Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI), and was scored on a range of 0 to 21 points, with higher scores depicting better sleep quality. Serum levels of 5-HT, NPY, and CGRP were analyzed (5 mL of fasting peripheral venous blood was obtained from each patient 1 day before the start of treatment and one day after the entire course of treatment). Blood samples were centrifuged at 3000 r/min for five minutes to obtain the serum for analysis.

Efficacy standards were based on earlier research conducted by Affiliated Hospital of Shandong University of Traditional Chinese Medicine: [6]

  • Treatment cured IBS: Absence of abdominal discomfort and related symptoms. Bowel movement appears normal and patients pass stool no more than 2 times daily.
  • Treatment was highly effective: Significant improvement of various symptoms and reduction in stool frequency. Shape, texture and consistency of stool appear normal.
  • Treatment was fairly effective: Alleviation of abdominal discomfort, reduction in stool frequency and improvement in shape, texture and consistency of stool.
  • Treatment was ineffective: No improvement or worsening of the main symptoms.

Results
The recovery rate was 34.9% and the total effective rate was 90.7% in the observation group, versus 18.6% and 79.1% in the control group, and the total clinical efficacy of the observation group was significantly better than that of the control group (P<0.05). Both groups displayed significant improvements in the main symptoms after the intervention (P<0.05), with main symptoms scores of the observation group significantly better than those of the control group (P<0.05).

Both groups’ SAS, SDS, and PSQI scores improved after treatment (P<0.05) and the post-treatment SAS, SDS, and PSQI scores of the observation group were better than those of the control group (P<0.05). Only 5-HT levels were downregulated in the control group after the treatment (P<0.05). Levels of 5-HT, NPY and CGRP were downregulated in the observation group after the treatment (P<0.05). All three indicators were lower in the observation group than those in the control group after the intervention (P<0.05).

The results indicate that acupuncture is an effective treatment modality for patients with IBS-D. Patients interested in acupuncture for the treatment of IBS are encouraged to consult with local licensed acupuncturists to learn more about treatment options.

References
1. Liu ZH, Qi AZ,Li ZR et al. Pathological analysis of Irritable Bowel Syndrome in Chinese Medicine [J] Shaanzi Journal of TCM,2005,26(9):974–975.

2. Li GY. Clinical Observation of Acupuncture-moxibustion in Treating Irritable Bowel Syndrome [J] Shanghai Journal of Acupuncture and Moxibustion, 2018, 37(2):187–191.

3. Drossman DA. The functional gastrointestinal disorders and the Rome Ⅲ process[J]. Gastroenterology, 2006,130 (5):1377-1390.

4. Chinese Society of Traditional Chinese Medicine Branch of the Spleen and Stomach. Consensus on Diagnosis and Treatment of Irritable Bowel Syndrome [J] China Journal of Traditional Chinese Medicine and Pharmacy, 2010,25(7):1062-1063.

5. Zheng XY. Guiding Principles of Clinical Research on New TCM Drugs (Trial) [S].Beijing: China Medical Science and Technology Publishing House,2002:139-143.

6. Kong SP,Wang WQ,Xiao N,et al. Clinical Study on Diarrhea-Predominant Irritable Bowel Syndrome Treated by Acupuncture and Ginger Moxibustion [J]. Shanghai Journal of Acupuncture and Moxibustion,2014,33(10):895-898.

Acupuncture Enhances Fertility Treatment, Lowers Adverse Effects

from HealthCMi 1/8/18

CV4-GuanyuanAcupuncture boosts the efficaciousness of fertility treatments. Three independent studies confirm that acupuncture increases positive patient outcome rates. Two studies find acupuncture effective for increasing the the efficacy of clomifene for the treatment of infertility due to ovulatory dysfunction. Another study finds acupuncture effective for reducing the adverse effects caused by bromocriptine treatments for hyperprolactinemia related infertility. The study also confirms that acupuncture balances hormone levels.

Ovulatory Dysfunction
Ovulatory dysfunction accounts for approximately 25–30% of female infertility. The root of ovulatory dysfunction is related to disorders of the hypothalamic–pituitary–gonadal axis (HPG axis) because it is closely related to the uterine and ovarian roles in menstruation cycles. The hypothalamus secretes gonadotropin-releasing hormone (GnRH). GnRH stimulates the anterior pituitary to produce two important hormones essential for folliculogenesis and ovulation: luteinizing hormone (LH) and follicle-stimulating hormone (FSH). As a result, dysfunction of the HPG axis may lead to problems in proper follicle development, maturation, and rupture.

Treatment for this type of infertility includes ovulation inducing drugs, surgical intervention, and assisted reproductive technology (ART) including artificial insemination, in-vitro fertilization, etc. Clomifene is often a prescribed drug for ovulation induction, and while it has a high efficacy rate, it also has common adverse effects. It may deleteriously affect cervical mucus or decrease the amount produced. Vaginal dryness due to thicker cervical mucus is a common adverse effect, which impedes sperm transport and is ultimately counterproductive to the drug’s other properties that promote fertility. Anti-estrogenic actions of clomifene reduce uterine vascularization, eventually lowering endometrial receptivity. Therefore, though clomifene helps patients to ovulate, it may not be entirely conducive to the goal of conceiving. It is therefore beneficial to use other treatments with fertility boosting value to complement clomifene ovulation induction.

Hyperprolactinemia
Hyperprolactinemia (HPL) is characterized by elevated serum prolactin. The occurrence of HPL in females with reproductive disorders falls between 9% and 17%. Infertility from HPL arises from the inhibitory effect of prolactin on GnRH secretion. Some HPL patients, despite having elevated serum prolactin, do not show signs of pituitary or central nervous system diseases, nor any other identifiable causes of increased prolactin secretion. In these cases, we term this condition idiopathic hyperprolactinemia (IH).

Bromocriptine is a medication option for IH treatment because it normalizes serum prolactin levels. However, the drug comes with a downside. According to research, approximately 12% of IH patients choose to discontinue bromocriptine intake due to adverse effects such as dizziness, nausea, hallucinations, and uncontrollable movements. It is important for treatments to be tolerable. An effective treatment cannot realize its full potential if patients are unable to comply with treatment regimens. The research reveals that acupuncture is well-suited as a complementary therapy to prevent or attenuate bromocriptine adverse effects.

TCM
According to Traditional Chinese Medicine (TCM) principles, hyperprolactinemia is a condition arising from spleen and kidney deficiency, liver qi stagnation, excess dampness, and imbalances in the Chong and Ren channels. Acupoints Qihai (CV6), Guanyuan (CV4), and Zusanli (ST36) are included in primary acupuncture point protocols because they are useful for nourishing the female reproductive system and correcting the aforementioned constitutional imbalances. Qihai and Guanyuan are particularly useful for correcting Ren channel related deficiencies and Zusanli is administered to tonify qi and promote blood circulation. Together, these acupuncture points fortify yuan qi.

Ovulatory Dysfunction Study #1
The first study was conducted by researchers Zhong Weihua and Chen Qiuping. Their research finds that acupuncture effectively raises hormone levels and benefits endometrial thickness among ovulatory dysfunction patients taking pharmaceutical drugs. The 2-month clinical trial compared two patient groups, both receiving clomifene and one receiving acupuncture additionally. The results demonstrate that acupuncture creates a more fertile environment for successful conception.

Two indicators were used to evaluate clinical efficacy: hormone levels and endometrial thickness. Before and after treatment, 3 mL of peripheral blood was taken from each patient. Estrogen (E2), FSH, and LH levels were measured via enzyme-linked immunosorbent assay (ELISA). Sonography was used to measure endometrial thickness. In addition to ELISA and sonography, the overall treatment efficacy was also surveyed. With reference to “Guidelines for the Clinical Study of New Drugs of Traditional Chinese Medicine,” the treatment efficacy for each patient was categorized into 1 of 3 tiers:

  • Clinical recovery: Successful conception.
  • Effective: Ovulation detected via ultrasound. Basal body temperature (BBT) showed bi-directional trend. Periodical change detected via exfoliative vaginal cytology. No successful conception.
  • Not effective: No ovulation detected after treatment for 3 menstrual cycles.

The clomifene plus acupuncture group achieved a treatment effective rate of 92.11%. The group receiving only clomifene had a 68.42% rate. The treatment effective rate for each group was derived using the following formula:

  • [Clinical recovery + Effective] / [Total number of patients in group] * 100%

The data demonstrates that patients receiving acupuncture in addition to clomiphene have significantly higher positive patient outcome rates. The group receiving acupuncture and clomiphene had a boost in hormone levels:

  • E2 (ng/L) was 317.34 ±24.83 before treatment and 418.34 ±27.56 after treatment. For the group receiving only clomifene, E2 was 319.83 ±24.46 before and 367.45 ±25.34 after.
  • Interesting numbers for FSH (IU/L) were documented. The acupuncture plus clomiphene group was 7.98 ±1.54 before and 23.42 ±2.75 after. The clomiphene only group was 8.04 ±1.50 before and 15.78 ±1.93 after.
  • LH (IU/L) for the clomiphene plus acupuncture group was 13.47 ±1.46 before and 54.84 ±4.50 after. The group receiving only clomifene was 13.42 ±1.50 before and 29.75 ±2.04 after.

The post-treatment levels for clomifene plus acupuncture were all markedly higher than that of standalone clomifene. The difference in post-treatment results indicates that acupuncture promotes the production of E2, FSH, and LH, making the uterine environment more conducive for healthy folliculogenesis and ovulation.

Endometrial thickness results document a similar trend. Before treatment, the mean endometrial thickness for both groups were equivalent, at 6.34 ±0.48 mm for clomifene plus acupuncture and 6.39 ±0.45 mm for clomifene only. After treatment, the results increased to 8.12 ±0.32 mm for clomifene plus acupuncture and 7.31 ±0.37 mm for clomifene only. Both treatments were effective when compared to pre-treatment results, but clomifene plus acupuncture produced greater endometrial thickness than clomifene. The results demonstrate that acupuncture is valuable in maintaining healthy folliculogenesis, ovulation, and endometrial receptivity, which are essential aspects of successful conception.

The study was set up as a comparative clinical trial as described henceforth. A total of 76 patients with ovulatory dysfunction infertility participated in the study. They were diagnosed between September 2014 and September 2016. The following selection criteria were applied in choosing trial participants:

  • Fulfilled diagnostic criteria based on “Male and Female Infertility,” by Luo Lilan (1998).
  • 18 – 40 years of age and aiming to conceive.
  • Male partner had healthy reproductive function.
  • Signed informed consent.

The following exclusion criteria were applied:

  • Congenital anomalies in reproductive organs.
  • Ovulatory dysfunction due to sexual physiological defects.
  • Uterine leiomyomas (fibroids) or endometriosis.
  • Recently took steroids.
  • Premature ovarian failure.
  • Severe liver, cardiac, renal, or hematopoietic diseases.

Patients were randomly divided into two groups of 38: treatment and control. Both groups were comprised of equivalent demographics. The treatment group ranged between 23 – 37 years of age, (mean age 30.84 ±1.64), duration of infertility 2 – 12 years (mean duration 7.30 ±1.27 years). The control group ranged between 22 – 39 years (mean age 31.02 ±1.56 years), duration of infertility 2 – 13 years (mean duration 7.23 ±1.31 years). Both groups received drug treatment with clomifene. In addition, the treatment group received acupuncture. Treatment was administered for 2 menstrual cycles. The following primary acupoints were treated for the treatment group:

  • Guanyuan (CV4)
  • Sanyinjiao (SP6)
  • Zhongji (CV3)
  • Zigong (extra)
  • Zusanli (ST36)
  • Taichong (LV3)
  • Taixi (KD3)

Stainless steel filiform acupuncture needles were used to administer acupuncture. For abdominal acupoints, the needles were diagonally inserted facing downwards. After achieving deqi, needles were retained for 30 minutes. Moxibustion was applied to Shenque (CV8) and Sanyinjiao (SP6). Treatment commenced from the 5th day of menstruation, at a rate of once per day. For drug treatment, clomifene was orally administered starting from the 5th day of menstruation. The prescribed dosage was 50 mg each time, once per day, for 5 consecutive days. The addition of acupuncture to clomiphene treatments increased the total effective rate by 23.69%.

Henan Zhengzhou Huashan Hospital
The second study was conducted by Sheng et al. from Henan Zhengzhou Huashan Hospital. The team finds that acupuncture increases the conception rate in patients with ovulatory dysfunction. The 5-month clinical trial compared two patient groups, both groups receiving ovulation induction treatment with drugs and one group receiving additional acupuncture treatment. The results show that acupuncture increases fertility rates.

Ovulation and conception rates were used to evaluate clinical efficacy. The rates represented the percentage of patients in each group that successfully achieved ovulation and conception. Ovulation was monitored by ultrasonography. Starting from the 9th day of menstruation, ovarian development was observed via ultrasound and LH tests. Ovulation was confirmed upon detection of ≥18 mm follicles, follicle rupture, and a ≥20 mIU/mL increase in LH levels. The definitive standards for conception were:

  • 50 consecutive days without menstruation.
  • Subsequent detection of gestational sac via ultrasound.
  • Subsequent positive human chorionic gonadotropin (hCG) urine test.
  • Subsequent detection of fetal heartbeat.

The data shows that the drugs and acupuncture group achieved an ovulation rate of 67.8% and a conception rate of 52.5%. The drugs only group achieved an ovulation rate of 51.9% and a conception rate of 30.4%. Though the ovulation rate did not differ significantly between both patient groups, the conception rate was much higher for the drugs plus acupuncture group. The data shows that acupuncture effectively creates a healthier internal environment and increases the chances of conception.

The study was set up as a comparative clinical trial as detailed hereafter. A total of 138 patients from the infertility division of Henan Zhengzhou Huashan Hospital, diagnosed with ovulatory dysfunction infertility, participated in the study. The diagnostic criteria for patients were in accordance with “TCM New Medicine Clinical Research Guidelines: 1st Edition” and “Integrative Medicine Diagnosis and Treatment Guidelines for Endometriosis, Gestational Hypertension and Female Infertility,” listed below:

  • Menstrual cycle >35 days or <21 days.
  • Continuous ultrasonography throughout ≥1 menstrual cycle showing slow follicle growth, absence of dominant follicles, premature follicle shrinkage or termination, no follicle rupture, and abnormally thin endometrium.

For the diagnosed patients, the following selection criteria were applied in choosing trial participants:

  • No follicle ruptures.
  • No severe complications.
  • No response after 2 – 3 cycles of clomifene treatment.

The selected patients were randomly divided into 2 groups: treatment and control. Both groups had equivalent demographics. The treatment group with 59 patients were aged between 20 – 38 years (mean age 25.00 ±2.37 years), duration of infertility was 2 – 4.5 years (mean duration of fertility 3.00 ±1.37 years). The control group with 79 patients were aged between 19 – 37 years (mean age 25.00 ±2.07 years), duration of infertility was 2 – 4 years (mean duration of fertility 3.00 ±1.09 years).

Both groups received ovulation induction treatment with the pharmaceutical drugs clomifene, menotropins, and hCG (human chorionic gonadotropin). In addition, the treatment group received acupuncture. Both groups received treatment for 3–5 months. All patients were monitored by ultrasound and were advised to have intercourse during ovulation. The following primary acupoints were used:

  • Zhongji (CV3)
  • Guanyuan (CV4)
  • Zigong
  • Zusanli (ST36)
  • Neiguan (PC6)
  • Sanyinjiao (SP6)

Treatment consisted of conventional acupuncture, electroacupuncture, and indirect moxibustion. Hwato brand acupuncture needles (Suzhou Medical Appliances Factory Co., Ltd.) were used. An SDZ-II model electroacupuncture device (Suzhou Medical Appliances Factory Co., Ltd.) was used for electroacupuncture. 10 mm x 200 mm moxa cigars (Nanyang Wolong Hanyi Moxa Factory Co., Ltd.) and single-vent bamboo moxa boxes (Guangzhou Shangguan Beauty Supplies Factory Co., Ltd.) were used for indirect moxibustion.

Conventional acupuncture was applied to Zhongji, Guanyuan, Zusanli, and Neiguan. Electroacupuncture was administered to Zigong and Sanyinjiao. Both acupoints were stimulated until deqi was achieved. Next, the electroacupuncture device was connected to the needles and set to a low continuous frequency (2 Hz) for 30 – 45 minutes. Shenque (CV8) was treated with indirect moxibustion. A lit moxa cigar was inserted, lit side down, into a moxa box. After ensuring that the temperature was warm but not too hot, the moxa box was placed over Shenque and left for 30 – 45 minutes. One treatment cycle was administered per menstrual cycle. A treatment cycle started on the 9th day of menstruation and was comprised of 7 – 10 consecutive treatment days, one session per day.

For both groups, the following protocol was observed for ovulation induction treatment with pharmaceutical drugs. Starting from the 3rd day of menstruation, clomifene citrate capsules (GKH Pharmaceutical Ltd.) were given orally. The prescribed dosage was 50 mg each time, twice per day, for 5 consecutive days. Starting from the 5th day of menstruation, injectable menotropins (Ningbo Renjian Pharmaceutical Group Co., Ltd.) was administered via intramuscular injection. The prescribed dosage was 75 U each time, once per day, for 7 consecutive days. In the event that no ovulation was detected after treatment with 75 U for 2 menstrual cycles, the dosage was increased to 150 U each time. Starting from the 9th day of menstruation, when sonography showed ≥18 mm average follicle diameter, one shot of hCG (Ningbo Renjian Pharmaceutical Group Co., Ltd.) was administered via intramuscular injection. The prescribed dosage was 5000 – 10000 U.

Drugs plus acupuncture achieved an ovulation rate of 67.8% and a conception rate of 52.5%. Drugs without acupuncture achieved an ovulation rate of 51.9% and a conception rate of 30.4%. The data indicates that acupuncture optimizes positive patient outcome rates.

Mawangdui Hospital
The third study was conducted by Hu et al. from Mawangdui Hospital of Hunan. The research finds that adding acupuncture reduces infertility drug adverse effects and improves hormone level regulation in women with idiopathic hyperprolactinemia (IH) infertility. Patients receiving only bromocriptine were compared with patients receiving both bromocriptine and acupuncture in this 1-year clinical trial. The results highlighted the importance of acupuncture in supporting bromocriptine treatment by reducing adverse effects and balancing hormones.

Referring to the guidelines by the Obstetrics and Gynecology Committee of the World Federation of Chinese Medicine Societies, the study evaluated treatment efficacy by considering hormone normalization time, adverse effects, and conception rates. Before and throughout treatment, hormone levels of prolactin, E2, progesterone (P4), and FSH were measured. The time taken for hormone levels to adjust to normal levels was recorded. The number of patients that did or did not experience adverse effects was also recorded. Finally, the conception rate was recorded. The conception rate for each group was defined as the percentage of patients that successfully conceived within 6 months after the start of treatment.

Similar results were recorded for the acupuncture plus bromocriptine and bromocriptine only groups for some parameters. Both groups took 2 – 3 menstrual cycles for prolactin levels to be normalized. For the bromocriptine group, the longest normalization time was 3 menstrual cycles and the shortest normalization time was 2 menstrual cycles. For the bromocriptine with acupuncture group, the normalization time was 2 menstrual cycles for all. The conception rates varied, acupuncture plus bromocriptine had a 43.3% conception rate and standalone bromocriptine produced a 20.0% rate.

The bromocriptine group had 19 patients who experienced adverse effects during treatment while the bromocriptine with acupuncture group had 7 patients that experienced adverse effects during treatment. The data shows that acupuncture effectively alleviates the adverse effects caused by bromocriptine intake. Considering that many patients discontinue bromocriptine due to adverse effects, acupuncture may be helpful to improve long-term compliance.

The time for hormones E2, P4, and FSH to reach normal levels differed (P < 0.05) between both groups. For the bromocriptine group, the longest normalization time was 6 menstrual cycles and the shortest normalization time was 3 menstrual cycles. For the bromocriptine with acupuncture group, the longest normalization time was 4 menstrual cycles and the shortest normalization time was 2 menstrual cycles. Here, the study shows that acupuncture is advantageous in creating hormonal balance.

The study was designed as a comparative clinical trial as detailed hereafter. A total of 60 IH patients from the gynecological division of Mawangdui Hospital (Hunan) participated in the trial. All 60 patients were recorded in the final results since none were disqualified for failure to complete treatment, failure to follow treatment protocols, adverse effects, or severe complications. The diagnostic criteria for patients were in accordance with the 7th edition of “Gynecology,” by People Health Publishing House and “TCM Gynecology,” listed below:

  • Normal sex life.
  • No conception for ≥ 2 years without contraception.
  • Irregular periods, galactorrhea, amenorrhea or pre-menstrual mastalgia.
  • Easily agitated, weakness and soreness in waist/knees, constant thirst, red tongue with thin coating, thin and taut pulse.
  • Serum prolactin concentration 40 ng/mL.

For the diagnosed patients, the following selection criteria were applied in choosing trial participants:

  • 26 – 33 years of age.
  • Male partner with healthy sperm quality.
  • The following exclusion criteria were applied:
  • Pregnant or lactating.
  • Taking medication which influences serum prolactin.
  • Pituitary tumors.
  • Hyperthyroidism, hypothyroidism, or kidney dysfunction.
  • Congenital reproductive anomalies.

Patients were randomly separated into 2 groups of 30: treatment and control. Both groups were equivalent in age, duration of illness, serum prolactin levels, and other hormone levels (E2, P4, FSH). The treatment group had a mean age of 28.77 ±1.74 years, mean duration of illness 4 years, and 24 patients with abnormal hormone levels. The control group had a mean age of 28.47 ±1.72 years, mean duration of illness 4 years, and 20 patients with abnormal hormone levels. Both groups received drug treatment and the treatment group received acupuncture treatment. The treatment period was 1 year. Patients also complied with a 1-year long follow-up after treatment ended. The following primary acupoints were applied to the acupuncture treatment group:

  • Qihai (CV6)
  • Guanyuan (CV4)
  • Zusanli (ST36)
  • Sanyinjiao (SP6)
  • Taichong (LV3)
  • Taixi (KD3)
  • Ligou (LV5)

Hwato brand 0.30 x 40 mm acupuncture needles were used. Qihai, Guanyuan, Taixi, and Zusanli were applied with reinforcing needle manipulation techniques. Taichong and Ligou were applied with attenuating techniques. Needles were retained for 30 minutes. One treatment cycle was conducted per one menstrual cycle. A treatment cycle started on the 8th day of menstruation and was comprised of 10 consecutive treatment days, one session per day.

For drug treatment, bromocriptine was administered. Patients were initially prescribed 1.25 mg each time, twice per day, after meals. After the first 7 days, the prescribed dosage was increased to 2.5 mg each time, twice per day, after meals. BBT (basal body temperature) was monitored throughout treatment. If there was no bidirectional trend in BBT after 3 months of treatment, clomifene was prescribed, in ovulation induction dosages. The data indicates that acupuncture reduces infertility drug adverse effect rates and improves hormone level regulation in women with idiopathic hyperprolactinemia (IH) related infertility.

Summary
Acupuncture is a proven complementary therapy for women receiving drug therapy for the treatment of infertility. Acupuncture increases positive patient outcome rates and reduces the adverse effects caused by medications. Patients interested in learning more about acupuncture and herbal medicine for the treatment of infertility are advised to consult with local licensed acupuncturists.

References
Zhong WH, Chen QP. Curative Efficacy of Feizhen Acupuncture Combined with Ovulation. Stimulants in Treatment of Anovulatory Infertility and its effects on Sex Hormone and Endometrium [J]. Hebei Medicine, 2017, 23(10): 1715-1718.

Zhou X, Fu CH, Huang JZ, et al. Progress of TCM research on ovulatory dysfunction infertility [J]. Henan TCM, 2014, 34(06): 1154-1156.

Zheng XY. Guidelines for the Clinical Study of New Drugs of Traditional Chinese Medicine [M]. Beijing: China Medical Science Press, 2002. 23.

Li JX, Zhou B. Clinical research on acupuncture with Bushenhuoxuetang Decoction in treating ovulatory dysfunction infertility [J]. TCM Journal, 2016, 31(08): 1156-1159.

Sheng YH, Liu HZ, Jiang CY, et al. Observation of clinical efficacy of acupuncture with medication in treating ovulatory dysfunction infertility 59 cases [J]. Hebei TCM, 2015(8): 1216-1217.

Ministry of Health of the People’s Republic of China, TCM New Medicine Clinical Research Guidelines: 1st Edition [S]. Beijing, 1993: 276.

Wang M, Yu J, Qian ZQ. Integrative Medicine Diagnosis and Treatment Guidelines for Endometriosis, Gestational Hypertension and Female Infertility (Revised in the 3rd Academic Conference by the Obstetrics & Gynecology Committee of the Chinese Association of Integrative Medicine) [J]. Integrative Medicine Journal, 1991, 11(6): 376-379.

Feng YJ, Shen K. Obstetrics & Gynecology [M]. 2nd edition. Beijing: People’s Medical Publishing House, 2010: 256-261.

Yang JR, Ma YY, Liu YL, et al. Case-control study of acupuncture in treating infertility of endocrine origin [J]. China Acupuncture, 2005, 25(5): 299-300.

Zheng SL, Song FJ, Ma DZ. Clinical efficacy assessment of acupuncture in treating ovulatory dysfunction infertility [J]. Clinical Acupuncture Journal, 2007, 23(1): 9-10.

Huang LC. Clinical observation of TCM with acupuncture in treating ovulatory dysfunction infertility 25 cases [J]. New TCM, 2011, 43(8): 113-114.

Hu J, Yan XL, Wang ZX. Acupuncture and Bromocriptine in the Treatment of Special HPL in Infertile Women [J]. Acupuncture Clinical Journal, 2014, 30(7): 7-9.

Liu Shu J, Zhang ZB. A brief TCM analysis of idiopathic hyperprolactinemia [J]. Hebei TCM, 2013, 35(8): 1157-1158.

 

Acupuncture Reduces Hypertension Confirmed

University of California School of Medicine researchers have proven that acupuncture lowers blood pressure in subjects with hypertension. [1] The depth and breadth of the research extends across multiple university controlled studies. The investigations also reveal how acupuncture works; the biological mechanisms stimulated by acupuncture are no longer a mystery.

The University of California School of Medicine, Irvine, researchers determined several key items. Acupuncture produces long-lasting lowering of blood pressure in subjects with hypertension. Acupuncture regulates sympathetic nervous system responses resulting in lower blood pressure in cardiovascular related centers of the brain and “specific neurotransmitter systems.” [2] In addition, their cross-over double blinded research identifies specific acupuncture points and procedures that are especially effective for lowering blood pressure.

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

The University of California School of Medicine researchers find electroacupuncture a mediator of the autonomic nervous system. Plasma norepinephrine and renin-aldosterone measurements indicate that electroacupuncture lowers blood pressure by downregulating sympathetic nervous system outflows. [7] This mechanism resulted in a lowering of both systolic and diastolic blood pressure in subjects with hypertension. Furthermore, the researchers successfully differentiated acupuncture points that were effective from those that were not.

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

Point Specificity
A closer look reveals extensive prior research by University of California School of Medicine researchers. One investigation demonstrates that electroacupuncture applied to PC5–PC6 produces “point-specific effects on cardiovascular reflex responses.” [9] The researchers add that sympathetic cardiovascular rostral ventral lateral medulla neurons that respond to both visceral (reflex) and electroacupuncture nerve stimulation “manifest graded responses during stimulation of specific acupoints.” [10]

The researchers conclude that electroacupuncture “demonstrates a range of cardiovascular responses” and the levels of “visceral reflex pressor responses are influenced by the anatomic location of somatic nerves beneath the acupoints.” [11] They identified specific responses; “deep nerves exerting strong influence and superficial cutaneous nerves demonstrating little or no attenuation of cardiovascular reflex responses.” [12] The acupuncture continuing education results were published in the American Journal of Physiology – Regulatory, Integrative and Comparative Physiology.

Another investigation by the University of California researchers was published in Autonomic Neuroscience. The research identifies specific regions of the brain regulated by acupuncture. Based on the findings, they conclude that electroacupuncture “suppresses elevated blood pressure (BP) by activating the arcuate nucleus, ventrolateral periaqueductal gray (vlPAG), and inhibiting cardiovascular sympathetic neurons in the rostral ventrolateral medulla.” [13] The research documents that “a reciprocal excitatory glutamatergic neural circuit between the arcuate and vlPAG contributes to long-lasting EA [electroacupuncture] cardiovascular inhibition.” [14] Glutamatergic biochemicals regulate the excitatory amino acid system throughout the body and brain.

Endocannabinoids and Serotonin
In another investigation, the researchers mapped the effects of electroacupuncture on endocannabinoids and the cardiovascular system. The researchers determined that a “long-loop pathway, involving the hypothalamic arcuate nucleus (ARC), ventrolateral periaqueductal gray (vlPAG), and the rostral ventrolateral medulla (rVLM), is essential in electroacupuncture (EA) attenuation of sympathoexcitatory cardiovascular reflex responses.” [15] They note that electroacupuncture “releases endocannabinoids and activates presynaptic CB1 receptors to inhibit GABA release in the vlPAG. Reduction of GABA release disinhibits vlPAG cells, which, in turn, modulate the activity of rVLM neurons to attenuate the sympathoexcitatory reflex responses.” [16]

University of California researchers completed another study mapping the effects of electroacupuncture on serotonin. They determined that electroacupuncture applied to PC5–PC6 “activate serotonin (5-HT)-containing neurons in the nucleus raphe pallidus (NRP).” [17] They note that “activation of the NRP, through a mechanism involving serotonergic neurons and 5-HT (1A) receptors in the rVLM during somatic stimulation with EA [electroacupuncture], attenuates sympathoexcitatory cardiovascular reflexes.” [18] In another study, the researchers document additional pathways. They conclude that the arcuate nucleus is required for prolonged suppression of reflex cardiovascular excitatory responses by electroacupuncture. [19] In the rostral ventrolateral medulla, opioids and GABA (γ-aminobutyric acid) are active in long-term electroacupuncture inhibition of sympathoexcitatory cardiovascular responses. [20]

High and Low Frequency Electroacupuncture
In another investigation, the researchers discovered that manual acupuncture and electroacupuncture produce similar results at PC5 and PC6. The researchers conclude that “there is little difference between low-frequency EA [electroacupuncture] and MA [manual acupuncture] at P 5–6. Furthermore, simultaneous stimulation using two acupoints that independently exert strong effects did not lead to an additive or a facilitative interaction.” [21] Low frequency acupuncture proved more effective than higher frequencies. Two Hz electroacupuncture “activated more somatic afferents than” 10 or 20 Hz electroacupuncture. [22] The researchers add that the “similarity of the responses to EA and MA and the lack of cardiovascular response to high-frequency EA appear to be largely a function of somatic afferent responses.” [23]

The above-mentioned studies are only a fraction of the published research on acupuncture and its mediation of cardiovascular and cortical activity. Important is that there is both clinical and laboratory research that is blinded, randomized, and sham controlled. The findings determine efficacy rates for specific acupuncture points for specific conditions and the biological mechanisms responsible for positive patient outcomes. The University of California School of Medicine, Irvine, (UCI) researchers provide us with great insight into the active mechanisms involved in acupuncture treatments.

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

Acupuncture for … Multiple Myeloma

Excerpt from Cure Today by Katie Kosko 9/27/17
“Researchers from Memorial Sloan Kettering Cancer Center (MSK) in New York City and MD Anderson Cancer Center in Houston, examined if acupuncture could help manage symptom burden of hematopoietic stem cell transplantation (HCT) in patients with multiple myeloma.

HCT used in combination with high-dose chemotherapy can offer patients a chance for durable remission. However, patients who undergo this can experience fatigue, disturbed sleep, lack of appetite, nausea, drowsiness and physical weakness…

Combining non-drug therapy with drug therapy for better symptom management is the future direction of cancer supportive care,” he said [Gary E. Deng, M.D., Ph.D., medical director, Integrative Medicine Service at MSK].

In the trial, patients underwent high-dose melphalan – a prescription chemotherapy drug used as a conditioning treatment prior to HCT – followed by autologous HCT, which is when the cells used in the transplant are the patient’s own.

Among the 60 patients participating, some received true acupuncture, while others received sham acupuncture, a research technique that removes the non-specific effects of acupuncture. This happened once a day for five days, starting the day after chemotherapy.Patients and clinical evaluators did not know which patients were assigned to either group.”
“Results: Among 60 participants, symptoms that are significantly reduced by true acupuncture more than sham acupuncture at 15 days include the following: nausea, lack of appetite, and drowsiness (p = 0.042, 0.025, and 0.010, respectively). Patients receiving sham acupuncture were more likely to increase use of pain medication post-transplantation (odds ratio 5.31, p = 0.017). “

Deng plans to take this research further. He hopes to get funding to support a larger study, which would allow him to examine acupuncture to alleviate symptom burden of HCT with a bigger patient population.

“This is the first study that suggests acupuncture being a non-drug therapy that reduces symptoms and use of pain medications in bone marrow transplant patients,” said Deng. “If confirmed in a larger study, we would have one more therapy that helps those patients through the course of transplantation.”

 
Citation:
Deng, G., Giralt, S., Chung, D. J., Landau, H., Siman, J., Coleton, M., … & Cassileth, B. (2017). Acupuncture for reduction of symptom burden in multiple myeloma patients undergoing autologous hematopoietic stem cell transplantation: a randomized sham-controlled trial. Supportive Care in Cancer, 1-9.

Acupuncture Painful Menstruation Relief Finding

from HealthCMi 9/6/17

Over half of all women experience primary dysmenorrhea, and many consider their menstrual pain inevitable. However, the prevalence of pain implies neither normalcy nor necessity. In the occident, acupuncture has recently gained popularity for women’s reproductive health conditions, especially infertility. Nevertheless, believing that pain an inevitable consequence of being born a woman, many do not seek acupuncture to treat their dysmenorrhea; in some cases, it is only after seeking out acupuncture for other conditions that women are educated in its potential to treat their menstrual pain. In Traditional Chinese Medicine (TCM), dysmenorrhea (including menstrual pain and other pre-menstrual symptoms) is considered a disorder just as worthy of treatment as any disease. Researchers at The National Institute of Complementary Medicine at Western Sydney University in Australia conducted a study to compare the efficacy of manual acupuncture and electro-acupuncture, at two timing intervals, for the treatment of primary dysmenorrhea. The researchers found that, in all cases, acupuncture leads to a significant reduction in the intensity and duration of menstrual pain after three months of treatment, and the results were sustained one year after trial entry. [1] This study, along with others in the same vein, will hopefully be encouraging for those women who suffer each month from dysmenorrhea.

 

Menstrual Cycle Chart

 

Primary dysmenorrhea is menstrual pain that has no identified organic cause; women with endometriosis, or other biomedically defined uterine conditions, may have menstrual pain, but that pain is considered secondary dysmenorrhea since the etiology is known. Primary dysmenorrhea is most common in young women under the age of 25. The characteristic symptoms are cramps — colicky spasms of pain in the suprapubic area — occurring within 8–72 hours of menstruation, and the pain usually peaks with the increase in menstrual flow during the first few days of a woman’s menstrual cycle. “In addition to painful cramps, many women with primary dysmenorrhea experience other menstrual-related symptoms, including back and thigh pain, headaches, diarrhoea, nausea and vomiting.” [2] Iacovides et al. note that “the prevalence of primary dysmenorrhea is highly underestimated, yet difficult to determine, because few affected women seek medical treatment, despite the substantial distress experienced, as many consider the pain to be a normal part of the menstrual cycle rather than a disorder…. Prevalence estimates vary between 45 and 95% of menstruating women, with very severe primary dysmenorrhea estimated to affect 10–25% of women of reproductive age. As such, dysmenorrhea appears to be the most common gynecological disorder in women irrespective of nationality and age. [3]

Amongst women, dysmenorrhea is the most common cause of absenteeism from school and work, and it may also lead to “a reduction in academic performance, reduced participation in sport and social activities and an overall significant decrease in women’s quality of life. Despite the significant negative impact and disruption to daily living that primary dysmenorrhea has on women most do not seek medical treatment. When women do present to their doctor with primary dysmenorrhea, the most commonly prescribed treatments are non-steroidal anti-inflammatories (NSAIDs) and the combined oral contraceptive (COC) pill.” [4] While these treatments help some women, they are ineffective or unpalatable for others. “Lack of satisfaction in standard treatment leads to an increase in self-care, with women commonly using complementary therapies to deal with their menstrual pain in addition to, or instead of, pharmaceutical pain relief, due to a lack of perceived effectiveness or a dislike of using analgesic medication” [5] Alternative therapies such as acupuncture are gaining traction as women find practitioners that take their conditions seriously and offer tangible relief without medication.

In Traditional Chinese Medicine (TCM), dysmenorrhea refers to recurrent abdominal or lumbosacral pain experienced before, during, or after menstruation. According to TCM theory, there are three primary etiologies, each manifesting according to its root cause: liver qi stagnation, cold accumulation, and qi and blood deficiency. [6] Liver qi stagnation causes distending pain in the lower abdomen, which may refer to the waist and back; when qi stagnation leads to blood stasis, there may be spells of sharp, stabbing pain, which is relieved by the passing of small clots of menstrual blood. Stagnated liver qi can also cause the irritability and emotional issues associated with PMS. Similarly, cold accumulation will slow and coagulate the blood, causing blood stasis; this pattern causes the sharp, stabbing pain associated with blood stasis, as well as the cramping or contracting of the uterine muscles due to cold accumulation. Alternatively, deficient qi and blood fail to nourish the uterus, leading to dull, aching pain that may occur during or after menstruation. Both the excess cold and qi and blood deficiency patterns can be alleviated by warmth, and thus moxibustion — the burning of mugwort on or near the body at acupoints or around the area of pain — is indicated for both of these etiologies. [7] According to Hsu et al., “the syndrome of cold coagulation and blood stasis is mostly seen,” [8] though, considering how few women seek out treatment for dysmenorrhea, it is possible that this pattern is more common clinically because of the extreme pain and cramping associated with this pattern, as compared to the relatively mild — or manageable — pain associated with the patterns.

According to scientific studies, dysmenorrhea is linked to an increase in both the tension and contraction frequency of the uterine muscles, as well as a discord in the rhythm of shrinkage; the uterine muscles contract and do not relax fully between contractions. These abnormalities cause a disorder in uterine micro-circulation that leads to ischemia and hypoxia. [9] Tests conducted on lab rats by Hsu et al. find, “dysmenorrhea of the cold coagulation syndrome presents a high intensity of uterine tension and high contraction of the microvascular diameter, the uterine microcirculation, and tension have negative correlation. The uterine microvascular and capillary contraction decreases the uterine microvascular blood flow and increases uterine contraction wave number. This furthermore explains that dysmenorrhea could cause uterine muscle spasm, increase contraction, and produce microcirculation disorder. Accordingly, it proves that uterine contraction and uterus microcirculation are closely related to dysmenorrhea environment.” [10]

The prevailing theory is that the changes in uterine micro-circulation and contractility associated with dysmenorrhea are related to the disordered production of endometrial prostaglandins (PGs), endogenous hormone-like lipid compounds. During the luteal phase, women have increased levels of PGs. However, women with dysmenorrhea have notably higher levels of circulating PGs than eumenorrheic women, especially during the first 48 hours of their menses, when their symptoms peak. Furthermore, “the severity of menstrual pain and associated symptoms of dysmenorrhea are directly proportional to the amount of PGs released,” [11] confirming that altered PG levels are the likely cause of pain. In another study, Zahradnik et al. studied the menstrual blood collected from both eumenorrheic and dysmenorrheic women and found that dysmenorrheic women had a concentration of prostaglandin F2α (PGF2α) that was 2.5 times higher than eumenorrheic women, though their levels of prostaglandin E2 (PGE2) were identical. [12] Hsu et al. attributed dysmenorrheic pain to this increase in the ratio between PGF2 and PGE2: “while PGE2 may result in either myometrial contraction or relaxation, PGF2a always causes potent vasoconstriction of uterine blood vessels, and myometrial contractions.” [13] As vasoconstriction causes a decrease in blood flow, myometrial contractions increase the need for oxygenated blood; the prevalence of these two factors together lead to hypoxia. Doppler ultrasonography, used to investigate uterine blood flow, has similarly shown, “that the strong and abnormal uterine contractions in women with dysmenorrhea during menstruation are associated with reduced uterine blood flow and resultant myometrial ischemia, and hence pain.” [14] PGs also have a range of biological effects on a wide variety of physiological and pathological activities — including pain, inflammation, body temperature, and sleep regulation [15] — so disproportionate production may be related to some of the secondary effects of dysmenorrhea as well.

There are a variety of theories regarding the mechanisms by which TCM therapies can relieve pain from dysmenorrhea. Armour et al. suggest there are “plausible mechanisms of action for acupuncture to improve primary dysmenorrhea, including endogenous opioid release, reduction of inflammation, alterations in uterine blood flow and changes in prostaglandin levels.” [16] In a study conducted by Yang et al. to investigate the efficacy of moxibustion at the acupoints CV4 (Guanyuan), CV8 (Shenque), and SP6 (Sanyinjiao), the researchers found that pain levels decreased over the three month trial, and that the therapeutic effect of moxibustion was sustained in the three months after the trial ended. Through blood tests, the researchers also found that moxibustion decreased levels of both PGF2 and PGE2, which allows for increased blood flow and decreased contractility of the uterus. [17] Heat is also well understood to regulate menstrual pain — “an abdominal heat wrap was found to be as effective as ibuprofen, and more effective than acetaminophen in relieving dysmenorrheic pain” [18] — and thus it is not surprising that heat from moxa, especially directly over the abdomen, would be similarly effective for inducing vessel dilation and increasing blood flow to decrease pain. [19] The acupoint SP6 (Sanyinjiao) may be distal, but it is effective for the treatment of dysmenorrhea, “likely due to the fact that SP6 is segmental to the uterus… This segmental activation at the level of sacral spinal nerve 2 (S2) may lead to reflex sympathetic inhibition of the uterus resulting in increased uterine blood flow.” [20]

In the exploratory study conducted by Armour et al., the researchers used a 2×2 factorial design “to test the individual and combined effects of changing 1) treatment timing, and 2) mode of stimulation. This study used a pragmatic clinical trial design with some qualifications, including the use of a manualised acupuncture protocol designed to reduce the amount of variation between practitioners.” [21] Each patient was given acupuncture by one of two modalities: manual acupuncture (MA) or electro-acupuncture (EA). Manual acupuncture is the insertion of fine needles at specific points on the body which, in this trial, were stimulated again 10–15 minutes after insertion; [22] electro-acupuncture uses the same points but adds electrical stimulation to the points. In this case, an ITO ES-160 electro-acupuncture machine with a 2Hz / 100Hz square wave pulse of 200ms for 20 minutes was employed. [23]

DeQi was obtained at all acupoints at the beginning of the treatment. “DeQi (the arrival of Qi) is the sensation generated by the insertion and/or manipulation of an acupuncture needle in an acupuncture point,” and TCM practitioners consider this important an important variable in the efficacy of a treatment. [23a] For the patient, DeQi feels like soreness, pressure, or heaviness at the site of insertion; for the practitioner, it is an indication that the qi has begun to flow at the acupoint, accessing the unique energy of the point to heal.

Treatment timing was tested by separating the participants into high and low frequency test groups. “All women in the study were scheduled to receive 12 treatments over the course of three menstrual cycles. Women in the high frequency (HF) group received three treatments in the seven days prior to the estimated day one of the menstrual cycle. Women in the low frequency (LF) group received three treatments in the time between menses, approximately every seven to ten days’ dependent on cycle length.” [24] The 2×2 factorial design lead to a total of 4 test groups: LF-MA, HF-MA, LF-EA, and HF-EA.

Treatment was based on the eight principles of TCM, as well as Zang Fu (visceral organ) diagnosis. “Once a TCM diagnosis had been ascertained, the practitioners had the flexibility with their point selection to address the diagnosed pattern of disharmony as per the treatment handbook.” [25] Up to two concurrent patterns of disharmony were supported by this trial, distinguished into primary (root) and secondary (branch) patterns. [26] No more than 7 unique acupoints were chosen for each patient, according to the diagnosis, and all points were needled bilaterally, with the exception of those for which unilateral insertion is indicated, such as opening the extraordinary vessels. [27] “Each pattern also has moxibustion as a compulsory, optional or forbidden component of the treatment. Indirect moxa was administered via smokeless moxa stick for 5–10 minutes on one of the selected acupuncture points. Each patient was given a diet and lifestyle advice sheet during their first treatment session. These were grounded in TCM theory.” [28]

The primary outcome of this study was the decrease in peak menstrual pain one year after trial entry. [29] All groups showed a significant reduction in peak pain and duration of pain over time, and neither the mode nor frequency of treatment showed a stronger effect by the one-year follow-up. However, manual acupuncture provided more immediate pain reduction. “The proportion of responders with clinically significant pain reduction of 30% in their peak pain was highest in the HF-MA group across all three days (55%, 60% and 61% of women respectively) and over a third of women in this group had a 70% reduction in their peak pain. Almost three-quarters (72%) of the women in the HF-MA group had a clinically significant 30% reduction in their average pain, with 69% of the LF-MA group, 61% of the LF-EA group and the 47% of the HF-EA group achieving this reduction. Almost 60% of the LF-MA group and 55% of the HF-MA group had a 50% reduction in average pain from baseline to one-month follow-up. The electro-acupuncture groups had lower scores, with 42% and 33% of the HF-EA and LF-EA groups achieving a 50% reduction.” [30]

The researchers also compared health related quality of life (HRQoL), supplementary analgesic use, and secondary symptoms. HRQoL measures subjective physical and mental well-being, by collecting participant data on factors including body pain, vitality, social function, and mental health. Decreased nonsteroidal anti-inflammatory drug (NSAID) use, measured in mean doses per day, [31] is thought to be another way of measuring pain relief, since patients will only take medications once their pain meets their personal threshold. Secondary symptoms may vary between women, but common symptoms include mood changes, bloating, and breast tenderness. [32] The results indicate that high frequency and manual treatments show better results for these factors. “Health related quality of life increased significantly in six domains in groups having high frequency of treatment compared to two domains in low frequency groups. Manual acupuncture groups required less analgesic medication than electro-acupuncture groups.” [33] More specifically, manual acupuncture provides the same — or greater — pain relief, while simultaneously decreasing the analgesic medication required. [34] Of all groups, HF-MA had the best results for the reduction of secondary menstrual symptoms compared: [35] “after the course of acupuncture treatment, participants had less problems with work or daily activities as a result of their physical health, less pain and subsequent limitations due to pain, more energy, and less interference from physical and emotional problems in social activities, all of which are commonly experienced by women with primary dysmenorrhea.” [36] The use of moxa for indicated conditions, which was found by Yang et al. to regulate PGF2 and PGE2 levels, [37] may have also contributed to the lasting effects of the course of treatment.

While this study did not include a control group that did not receive acupuncture treatment, a previous study conducted by Armour “that included a no-treatment or wait-list control group showed that the acupuncture intervention appeared to provide an immediate analgesic effect, irrespective of the dose delivered,” [38] and that treatment before the onset of menses produced greater pain reductions than treatment during menstruation. [39] Other studies focus on point selection and technique. Zhao et al. found that SP6 (Sanyinjiao) is the most commonly used acupoint to treat dysmenorrhea, inducing significant analgesic effects, and that achieving DeQi, “improves the immediate analgesic effect of acupuncture at SP6 in patients with primary dysmenorrhea,” [40] especially for those patients with the specific TCM diagnosis of cold and dampness stagnation. [41] Hsu et al. found similar results in rats, showing that acupuncture at SP6 with DeQi significantly increased microvascular uterine blood velocity as compared with the model control group that received the same treatment without DeQi. [42]

Self-care advice may also play an important role in TCM treatment. Both practitioners and their patients have expressed that acupuncture treatment is “more than needles,” [43] and women interviewed about their experience with acupuncture for the treatment of dysmenorrhea felt that, “TCM self-care advice was related to positive outcomes for their dysmenorrhea and increased their feelings of control over their menstrual symptoms.” [44] Women responded well to the advice regarding diet and lifestyle choices and, “discussed how the context in which these explanations and advice were delivered, in a nonjudgmental and supportive environment, was different to their previous experiences with general practitioners and how this relationship with their acupuncture practitioners impacted their ability to understand their menstrual cycle better and implement the self-care advice given.” [45] Additionally, TCM practitioners tend to spend more time talking — and most importantly, listening — to their patients, allowing practitioners to better understand the life-world of the client and provide explanations and self-care advice that was appropriate and achievable for the individual, [46] whereas patients often report that they do not get sufficient explanations for their condition from orthodox medical consultations. [47] Furthermore, “empathy from practitioners has been shown to increase enablement and is linked to positive treatment outcomes through the improvement of self-efficacy. Improved self-efficacy is also linked to increased optimism of future improvements.” [48] The women interviewed overwhelmingly confirmed that the explanations about menstrual physiology, as well as the advice on self-care, increased their self-efficacy. [49]

The most important result of this study, and others like it, is that menstrual pain is not inevitable. Many women may feel that medications — either NSAIDs or oral contraceptives — are their only option for treating their monthly symptoms, but acupuncture has been shown to be equally effective, and its effects last long after the course of treatment. Additionally, TCM practitioners provide individualized advice that helps women take an active role in caring for themselves. Acupuncture can provide a safe and effective alternative to medications. This study shows that the abdominal pain and emotional symptoms of primary dysmenorrhea can be addressed with TCM, and it will hopefully empower women to address their menstrual pain holistically and efficiently.

Notes:
1 Armour, Mike, Hannah G. Dahlen, Xiaoshu Zhu, Cindy Farquhar, and Caroline A. Smith. “The role of treatment timing and mode of stimulation in the treatment of primary dysmenorrhea with acupuncture: An exploratory randomised controlled trial.” Plos One 12, no. 7 (2017). pg 2.

2 Armour et al, The role of treatment timing and mode of stimulation, pg 2.

3 Iacovides, Stella, Ingrid Avidon, and Fiona C. Baker. “What we know about primary dysmenorrhea today: a critical review.” Human Reproduction Update vol 21, no 6, (2015). Pg 764.

4 Armour et al, The role of treatment timing and mode of stimulation, pg 2.

5 Armour et al, The role of treatment timing and mode of stimulation, pg 2.

6 Cheng, Xinnong, ed. Chinese Acupuncture and Moxibustion. Beijing: Foreign Languages Pr, 2012. Pgs475-477.

7 Chinese Acupuncture and Moxibustion, pgs 475-477.

8 Hsu, Wing-Sze, Xiao-Yu Shen, Jia-Min Yang, Li Luo, Ling Zhang, Dan-Dan Qi, Song-Xi Shen, Shi-Peng Zhu, Ya-Fang Zhao, Xiao-Xuan Ren, Meng-Wei Guo, Xiao-Hong Li, Bo Ji, Lu-Fen Zhang, and Jiang Zhu. “Effects of Acupuncture Applied to Sanyinjiao with Different Stimuli on Uterine Contraction and Microcirculation in Rats with Dysmenorrhea of Cold Coagulation Syndrome.” Evidence-Based Complementary and Alternative Medicine 2014 (2014): 6.

9 Hsu et al., Effects of Acupuncture Applied to Sanyinjiao, pg 6.

10 Hsu et al., Effects of Acupuncture Applied to Sanyinjiao, pg 7.

11 Iacovides, et al., What we know about primary dysmenorrhea today, pgs 765-6.

12 Zahradnik, H. P., and M. Breckwoldt. “Contribution to the pathogenesis of dysmenorrhea.” Archives of Gynecology 236, no. 2 (1984): 99-108.

13 Iacovides, et al., What we know about primary dysmenorrhea today, pg 766.

14 Iacovides, et al., What we know about primary dysmenorrhea today, pg 766.

15 Iacovides, et al., What we know about primary dysmenorrhea today, pg 764-5.

16 Armour et al., The role of treatment timing and mode of stimulation, pg 2.

17 Yang, M., Chen, X., Bo, L., Lao, L., Chen, J., Yu, S., . . . Liang, F. (n.d.). Moxibustion for pain relief in patients with primary dysmenorrhea: A randomized controlled trial.

18 Iacovides, et al., What we know about primary dysmenorrhea today, pg 772.

19 Yang et al., Moxibustion for Pain Relief, pg 12.

20 Armour, M., & Smith, C. A. (2016). Treating primary dysmenorrhoea with acupuncture: a narrative review of the relationship between acupuncture ‘dose’ and menstrual pain outcomes. Acupuncture in Medicine, 34(6), pg 422.

21 Armour et al., The role of treatment timing and mode of stimulation, pg 3.

22 Armour et al., The role of treatment timing and mode of stimulation, pg 4.

23 Armour et al., The role of treatment timing and mode of stimulation, pg 4.

23a Xing-Yue Yang, Guang-Xia Shi, Qian-Qian Li, Zhen-Hua Zhang, Qian Xu, and Cun-Zhi Liu, “Characterization of Deqi Sensation and Acupuncture Effect,” Evidence-Based Complementary and Alternative Medicine, vol. 2013, Article ID 319734, 7 pages, 2013.

24 Armour et al., The role of treatment timing and mode of stimulation, pg 4.

25 Armour et al., The role of treatment timing and mode of stimulation, pg 4.

26 Armour et al., The role of treatment timing and mode of stimulation, pg 4-5.

27 Armour et al, The role of treatment timing and mode of stimulation, pg 5.

28 Armour et al., The role of treatment timing and mode of stimulation, pg 6.

29 Armour et al., The role of treatment timing and mode of stimulation, pg 1.

30 Armour et al., The role of treatment timing and mode of stimulation, pg 12.

31 Armour et al, The role of treatment timing and mode of stimulation, pg 9.

32 Armour et al., The role of treatment timing and mode of stimulation, pg 14.

33 Armour et al, The role of treatment timing and mode of stimulation, pg 1.

34 Armour et al., The role of treatment timing and mode of stimulation, pg 15.

35 Armour et al., The role of treatment timing and mode of stimulation, pg 1.

36 Armour et al., The role of treatment timing and mode of stimulation, pg 14.

37 Yang et al., Moxibustion for Pain Relief, pg 1

38 Armour & Smith, Treating Primary Dysmenorrhea with Acupuncture, pg 422.

39 Armour & Smith, Treating Primary Dysmenorrhea with Acupuncture, pg 416.

40 Zhao, M., Zhang, P., Li, J., Wang, L., Zhou, W., Wang, Y., . . . Zhu, J. (2017). Influence of de qi on the immediate analgesic effect of SP6 acupuncture in patients with primary dysmenorrhoea and cold and dampness stagnation: a multicentre randomised controlled trial. Acupuncture in Medicine. pg 5.

41 Zhao et al., Influence of De Qi on the immediate analgesic effect of SP6, pg 2.

42 Hsu et al., Effects of Acupuncture Applied to Sanyinjiao, pgs 4-5.

43 Armour, M., Dahlen, H. G., & Smith, C. A. (2016). More Than Needles: The Importance of Explanations and Self-Care Advice in Treating Primary Dysmenorrhea with Acupuncture. Evidence-Based Complementary and Alternative Medicine, 2016, pg 5.

44 Armour, Dahlen & Smith, More Than Needles, pg 1.

45 Armour, Dahlen & Smith, More Than Needles, pg 5.

46 Armour, Dahlen & Smith, More Than Needles, pg 7.

47 Armour, Dahlen & Smith, More Than Needles, pg 8.

48 Armour, Dahlen & Smith, More Than Needles, pg 7.

49 Armour, Dahlen & Smith, More Than Needles, pg 5.

Acupuncture Beats Drug For Endometriosis Relief

ST25acupuncturefrom HealthCMi 7/11/17

Researchers find acupuncture more effective than hormone drug therapy for the treatment of endometriosis. Acupuncture relieves menstrual pain due to endometriosis, reduces the size of pelvic masses, lowers CA125 levels, and reduces the recurrence rate of endometriosis. CA125 a is biomarker for several types of cancer and benign conditions including endometriosis and menstrual disorders.

Researchers at Tongji University hospital compared acupuncture with standard drug therapy. Patients receiving acupuncture achieved a 92.0% total effective rate. Patients receiving mifepristone achieved a 52.0% total effective rate. Mifepristone, also known by its trademarked name RU-486, is a synthetic steroid that inhibits progesterone action and is used for the treatment endometriosis and also for inducing abortions. Notably, low doses of “mifepristone inhibits endometrial proliferation (Narvekar et al.).”

Acupuncture reduced pain levels more significantly than the medication. Relapse rates were less in the acupuncture group than the drug group. One year follow-up examinations determined that the recurrence rate for the group receiving drug therapy was 36%. By comparison, the group receiving acupuncture had an endometriosis recurrence rate of 20%. Pelvic mass sizes and proliferation lessened more significantly in the acupuncture treatment group than in the drug group. The findings were detected and verified with B-scan ultrasonography.

Inclusion criteria for this study included Traditional Chinese Medicinal (TCM) differential diagnostic pattern differentiation of blood stasis. In TCM, endometriosis is related to the dysfunction of the liver, spleen, and kidneys. In addition, coldness may lead to obstruction of meridians and blood stasis in the uterine region. This impedes qi and blood circulation in the uterus, leading to menstrual pain due to a lack of delivery of vital energy and nutrients to uterine tissues. Endometriosis treatment in TCM focuses on promoting blood circulation, transforming and dissolving blood stasis, and regulating the functions of the liver, spleen, and kidneys.

For the mifepristone group, patients received 12.5 mg of mifepristone tablets daily. Tablets were orally administered once per day for 6 consecutive months. Patients in the acupuncture treatment group were treated with the following acupoints: CV6 (Qihai), CV4 (Guanyuan), CV3 (Zhongji), Zigong (Extra), SP10 (Xuehai), SP6 (Sanyinjiao), LV2 (Xingjian), LV3 (Taichong)

Treatment commenced with patients in a supine position. After disinfection of the acupoint sites, a 0.30 mm × 40 mm disposable filiform needle was inserted into each acupoint with a high needle entry speed. Xuehai, Sanyinjiao, Xingjian, and Taichong were perpendicularly needled to achieve a deqi sensation. Qihai, Guanyuan, Zhongji, and Zigong acupoints were obliquely (in a downward direction, 45°) needled to a standard depth. Needles were rotated, lifted, and thrust rapidly after insertion to achieve a deqi sensation in the pelvic region. Subsequently, the needles were retained and moxibustion was applied to acupoints (Qihai, Guanyuan, Zhongji, Zigong). Moxa cigar cuttings, each 2 cm long, were attached to each needle handle and ignited. Moxa was left in place to self-extinguish. Moxibustion was applied three times per 30 minute needle retention time. One acupuncture and moxibustion session was applied every other day, except during menstruation. The treatment was applied for a grand total of 6 months.

The treatment effective rate for all patients in the study was evaluated based on the VAS rating scale and categorized into 1 of 3 tiers:

  • Significantly effective: Rating reduction of at least 50%. Significant improvement of menstrual pain.
  • Effective: Rating reduction of at least 25%. Improvement of menstrual pain.
  • Ineffective: Rating reduction of less than 25%. No improvement of menstrual pain.

All patients underwent Visual Analogue Scale (VAS) assessments before and after their treatments. VAS is an instrument that measures pain intensity levels experienced by patients. B-scan ultrasonography was conducted to calculate the size of pelvic masses. A CA125 test was also conducted to measure the amount of CA125 (cancer antigen 125) in the blood. CA125 is used clinically in the diagnosis and management of endometriosis.

Prior research (Chang et al.) documents that patients with endometriosis have higher levels of CA125 than women without endometriosis. Chang et al. note that the value of CA125 reflects the invasiveness of endometrial tissue beyond a normal locus. Additionally, the Tongji University researchers cite investigations demonstrating that the value of CA125 is related to the severity of dysmenorrhea (menstrual cramping and pain).

Compared with the drug group, the acupuncture treatment group displayed a significant improvement in VAS scores. Patients in the acupuncture treatment group had smaller pelvic masses caused by endometriosis and had lower levels of CA125. There is a statistically significant difference between the two groups. The researchers also conducted a follow-up survey after treatment completion. They found that the recurrence incident rate of endometriosis in the treatment group was 20%. The recurrence incident rate of endometriosis in the control treatment group was 36%.

The research demonstrates that acupuncture is a safe and effective treatment for the alleviation endometriosis. Subjective and objective data supports the conclusions of the researchers in the controlled clinical trial. Based on the data, acupuncture is found effective for the treatment of endometriosis and lowers relapse rates.

The study design was as follows. The study involved the selection of 50 patients at the acupuncture and gynecology departments at the affiliated Tongji hospital of Tongji University. All patients were diagnosed with endometriosis between January 2010 and December 2015. They were randomly divided into an acupuncture treatment group and a drug control group, with 25 patients in each group. The treatment group underwent Traditional Chinese Medicine (TCM) acupuncture therapy and the control group received mifepristone tablets.

The statistical breakdown for each randomized group was as follows. The average age in the acupuncture treatment group was 36 (±3) years. The average course of disease in the acupuncture treatment group was 2.49 (±2.11) years. The average age in the drug control group was 34 (±4) years. The average course of disease in the drug control group was 2.87 (±1.89) years. For both groups, there were no significant differences in terms of their gender, age, and course of disease prior to the beginning of the study.

The primary acupoints selected for the treatment of endometriosis were the following: Qihai, Guanyuan, Zhongji, Zigong, Xuehai, Sanyinjiao. The researchers provided the TCM basis for the acupuncture point selection. Qihai is located on the Ren meridian. Needling Qihai regulates source qi and blood circulation. Guanyuan is a meeting point of the Chong meridian and the Ren meridian. Needling Guanyuan regulates both the Chong and Ren meridians, promotes qi and blood circulation, and relieves menstrual pain. Zhongji is a meeting point of the three foot yin meridians and the Ren meridian. Needling this point is indicated for benefiting qi and blood circulation and relieving menstrual pain. In a clinical setting, Qihai, Guanyuan, and Zhongji are used as a combination for relieving menstrual pain. Zigong is an extra acupoint and is traditionally indicated for lower abdominal pain due to obstruction of qi and blood. Xuehai is an acupoint on the foot Taiyin spleen meridian. Needling this acupoint regulates qi and blood circulation. Sanyinjiao is a meeting point of the three foot yin meridians. Needling this point fortifies the liver, spleen, and kidneys, which is also helpful for regulating qi and blood circulation and relieving menstrual pain.

The focus of this study was to scientifically verify that traditionally indicated acupoints for the treatment of endometriosis are effective. Objective examinations and subjective data confirm that the TCM treatment protocol is both safe and effective for the treatment of endometriosis. Less pain, smaller masses, and improved CA125 levels were documented. Moreover, acupuncture outperformed one type of drug therapy.

References
Shen Q, Lu J. Clinical Observation of Acupuncture-moxibustion for Endometriosis [J]. Shanghai Journal of Acupuncture and Moxibustion, 2017, 36 (6).

Narvekar, Nitish, Sharon Cameron, Hilary OD Critchley, Suiqing Lin, Linan Cheng, and David T. Baird. “Low-dose mifepristone inhibits endometrial proliferation and up-regulates androgen receptor.” The Journal of Clinical Endocrinology & Metabolism 89, no. 5 (2004): 2491-2497.

Acupuncture Helps Hemiplegia (one-sided paralysis)

Acupuncture helps hemiplegia cases…

By Dr Raman Kapur  |   Published: 17th June 2017 in The New Indian Express

Around 53 Hemiplegic [one-sided paralysis] patients—36 male and 17 female—between 12 and 80 years were treated with Acupuncture in Shanghai Medical University. Among the 53, 38 were cases of cerebral infraction and 15 of cerebral hemorrhage. The clinical manifestations were hemiplegia contralateral to the brain lesion, sometimes accompanied by aphasia. Acupuncture treatment was begun after restoring consciousness. All patients underwent CT scans of the head as well as lumbar puncture.

Occlusion of cerebral arteries leads to ischemia of the brain tissue, causing encephalomalacia and cerebral necrosis which are manifested as low density in CT scans.  Hemorrhages caused by ruptured intracranial blood vessels appear as high density shadows with distinct margins.  CT scans showed the location and scope of lesions, which were either single or multiple, located bilaterally or unilaterally. Superficial lesions are localised at the cortical surface and the deep lesions involve the internal capsule, thalamus, nuclei of basal ganglia, peri-ventricular white mater and brain stem.

The shadows correlate to the extent of thrombosis or homerrhage, and can be estimated by CT scans.  Large lesion refers to lesions over 3 cm in length, small lesion to those less than 2 cm, and moderate lesion to those in between. The 10 cases found in CT scans to have multiple lesions were all of the ischemic type. The severity of hemiplegia was classified according to the muscle strengths at six joints, the shoulder, elbow, wrist, hip, knee and ankle, as slight, moderate or severe cases. The muscle strength of mild cases was grade four and above, of severe cases, grade two or less, and moderate cases between two and four.

The use of acupuncture was to dredge the channels and collaterals and regulate Qi and Blood in order to promote recovery of the hemiplegic limbs. Electro acupuncture, using relatively strong electric stimulation, was applied for 30 minutes once daily, six days per week for a total of  four weeks and acupuncture was given on specific acupuncture points.
The effect of acupuncture treatment on hemiplegia was classified into three groups according to the increase in muscle strength.

Increase in muscle strength of more than two grades, increase in muscle strength of 1-2 grades and increase in muscle strength of less than one grade. Of the 53 cases, 13 were markedly effective, 31 cases were effective, and nine cases were ineffective. The total effective rate was 83 per cent, and markedly effective rate was 24.5 per cent.

Acupuncture treatment was started within three months of the onset of disease. The total effective rate for patients who started acupuncture therapy within three weeks of the onset of disease was considerably higher than patient who began treatment after three weeks.

Acupuncture therapy was ineffective for patients with conditions such as pneumonia, diabetes, renal failure or lowered immune resistance.The prognosis for patient complicated with other diseases was not favourable.
The author is Head of the Department of Acupuncture, Sir Ganga Ram Hospital, New Delhi

Acupuncture Found Effective For Lumbar Disc Herniations

Researchers demonstrate excellent clinical results using acupuncture for the treatment of lumbar disc herniations from HealthCMi August 16, 2016

Researchers find acupuncture safe and effective for the treatment of lumbar disc herniations across multiple independent clinical trials. A meta-analysis of investigations reveals that Jiaji acupoints yield significant positive patient outcomes when combined with manual and electroacupuncture techniques. Distal and abdominal acupuncture also demonstrated significant positive patient outcomes. This research review covers rare acupuncture points demonstrating clinical efficacy and details a powerful manual acupuncture technique proven effective for relief of lumbar disc herniation symptoms. We’ll start with primary research by Song et al. and then take a close look at a meta-analysis by Wang et al., including specific approaches to clinical care proven to deliver excellent results.

Researchers find both electroacupuncture and manual acupuncture effective for the treatment of lumbar disc herniations. Song et al. conducted a clinical trial at the Xixiang People’s Hospital in Guangdong, China. Electroacupuncture and manual acupuncture significantly reduced patients’ pain levels. Outstanding positive patient outcomes were recorded for the electroacupuncture treatment group. Patients with lumbar disc herniations receiving electroacupuncture had a 91.8% total treatment effective rate. Improvements included pain reductions, increases in range of motion, and improved straight leg lift testing.

A sample size of 123 patients was randomly divided into two groups. In group one, 61 patients received electroacupuncture therapy. In group two, 62 patients received manual acupuncture. For the electroacupuncture patients, the Jiaji acupoints at the specific vertebra corresponding to the herniated lumbar disc, as well as on the two adjacent vertebrae, were selected as the primary acupoints and treated on both sides. Additional secondary acupoints were selected based on individual patient symptoms. For hip pain, the following acupoints were chosen: Huantiao (GB30) and Chengfu (BL36).

For calf pain: Weizhong (BL40) and Chengshan (BL57).

For lateral calf pain, the following acupoint were chosen: Yanglingquan (GB34), Zusanli (ST36), Kunlun (BL60), and Xuanzhong (GB39).

Treatment commenced with the patient in a prone position. Upon disinfection, a 0.30 x 40 mm disposable needle was pierced perpendicularly into each acupoint until a deqi sensation was reported. Next, an electroacupuncture device was connected to the needles in the Jiaji acupoints. A continuous waveform was selected at an initial 0.8 Hz frequency. The intensity was then gradually increased until both sides of the lumbar muscle were twitching rhythmically at a tolerable rate for the patient. Subsequently, a 30 minute needle retention time was observed. One electroacupuncture session was conducted once per day for 20 consecutive days with a one day break after the 10th day. For the manual acupuncture patients, the following acupoints were selected according to the affected area:

  • Ganshu (BL18)
  • Shenshu (BL23)
  • Yaoyan (MBW24)
  • Huantiao (GB30)
  • Zhibian (BL54)
  • Chengfu (BL36)
  • Weizhong (BL40)
  • Weiyang (BL39)
  • Yanglingquan (GB34)
  • Feiyang (BL58)
  • Guangming (GB37)
  • Kunlun (BL60)
  • Tonggu (BL66)
  • Jinggu (BL64)
  • Houxi (SI3)

Treatment commenced with the patient in a prone position. Upon disinfection, a 0.30 x 40 mm disposable needle was pierced perpendicularly into each acupoint until a deqi sensation was felt. During the subsequent 30 minute needle retention time, the acupuncture needle was manipulated once every 10 minutes. One acupuncture session was conducted once per day for 20 consecutive days with a one day break after the 10th day. The total treatment efficacy was measured based on the TCM Treatment Efficacy Guidelines issued by the TCM Governing Board. Efficacy was categorized into 1 of 3 possible tiers:

  • Effective: Waist and leg pain ceased. Straightened leg lift of 70° and above. Normal waist and leg activity regained.
  • Improvement: Waist and leg pain relieved. Improvement in extent of waist movement.
  • Not effective: No improvement in symptoms.

The total treatment effective rate was measured as a percentage of patients who achieved at least the “improvement” tier. Electroacupuncture produced a 91.8% total treatment effective rate including pain reductions, increases in range of motion, and improved straight leg lift testing. Song et al. conclude that acupuncture is effective for the treatment of lumbar disc herniations.

The research team prefaced their study with background information. Lumbar disc herniation is a common disease among adults. Pain, numbness, or weakness arises due to damage or compression of the nerve root caused by herniation of the nucleus pulposus. This is the soft inner core of the vertebral disc that helps absorb compression and torsion. A herniation occurs when the soft material from the inner core escapes through the outer rings of the disc. This stubborn disease is usually characterized by an abrupt onset with a prolonged or repetitive course of symptomatic flare-ups. Main symptoms include leg and lumbar region pain, and also lower limb motor dysfunction. Lower limb paralysis is possible in severe cases.

Song et al. note that acupuncture is a relatively non-invasive treatment for disc herniations that dredges meridians, promotes qi circulation, eliminates blood stasis, and expels wind-dampness. Pain is thereby relieved when blood and qi circulation is restored. In modern terms, acupuncture stimulates parasympathetic tone and downregulates excess sympathetic nervous system activity. Resulting decreases in the inflammatory cascade of endogenous biochemicals results from the regulation of the autonomic nervous system.

Song et al. add that acupuncture regulates nerve activity, facilitates muscles relaxation, mitigates muscular spasms, dilates blood vessels, improves blood circulation, and also reduces both edema and inflammation. The Jiaji acupoints, located on the back beside the Du meridian, are used to treat diseases related to the corresponding affected nerve segments. Electroacupuncture utilizes electrical stimulation to facilitate the regeneration of damaged nerves by improving nerve cell metabolism and nerve cell enzyme activity. The basis of this is that electroacupuncture forms a localized, stable, and subtle electric current that boosts the electrophysiological properties of nerve cells (Sun, 1996).

In a related study, Wang et al. conducted a meta-analysis on the efficaciousness of acupuncture for the treatment of lumbar disc herniations. Without exception, the clinical investigations demonstrate that acupuncture is a safe and effective treatment modality for lumbar disc herniation patients. The following are examples of studies included in the meta-analysis.

Liu et al. investigated the efficacy of conventional acupuncture therapy. Conventional acupuncture treatment was administered by first identifying the vertebrae with lumbar disc herniations. Corresponding Du meridian acupoints and the two adjacent Jiaji acupoints were needled. The identified acupoints were treated with the Shao Shan Huo (Setting the Mountain on Fire) needling technique. Patients were treated for 10 consecutive days and achieved a 95% total treatment effective rate.

Shao Shan Huo is a powerful tonification needling technique in Traditional Chinese Medicine (TCM). Needles are inserted and stimulated to elicit the arrival of deqi for purposes of reinforcing qi. When applied properly, the patient feels a warm sensation at the needle region. In addition, the skin will be flush red as a result of enhanced micro-circulation of blood.

Initially, the needle is inserted slowly to superficial depth beneath the skin. During the procedure, lifting and thrusting is applied to three levels of depth beneath the skin, starting with the most superficial level at approximately a 0.5 cun depth. This is followed by lifting and thrusting at the middle level at approximately 1.0 cun and the deep level at approximately 1.5 cun. Depth varies according to patient size and acupoint location.

At each of the three depths of insertion, the needle motion combines quick and forceful thrusting with slow and gentle lifting for a total of nine times. Rotation may also be applied with the same techniques. After stimulation at all three levels is complete, the needle is lifted to the superficial level and the procedure is repeated, often three times, to ensure elicitation of a qi sensation producing heat and redness of the skin. The patient may also sweat in the region of the needle or throughout the body as a result of the heat sensation produced by this tonification method. Liu et al. achieved a 95% total treatment effective rate using the Setting the Mountain on Fire technique using the Du and Jiajia (Huatuojiaji) acupuncture points at correlated regions to lumbar disc herniations. Notably, acupuncture was applied for 10 consecutive days.

Deng and Cai’s investigation also examined application of the Jiaji acupoints for the treatment of lumbar disc herniations. In a different approach to needle stimulation, Deng and Cai applied electroacupuncture stimulation to the needles. They achieved significant levels of positive patient outcomes in their clinical trial. In their investigation, patients were treated every other day. Short-term results and a three month follow-up confirm significant clinical improvements.

He et al. had an entirely different approach to acupuncture therapy for the treatment of lumbar disc herniations. Their approach focused on abdominal acupuncture and anterior acupoints. The clinical investigation yielded significant positive patient outcomes. In their semi-protocolized investigation, a set of primary acupoints were applied plus secondary acupoints were added for specific diagnostic concerns. The primary acupoints for all patients were the following:

  • Shuifen (CV9)
  • Qihai (CV6)
  • Guanyuan (CV4)

Next, secondary acupoints were added based on diagnostic criteria. For acute lumbar disc herniations, the following acupoints were added:

  • Shuigou (GV26)
  • Yintang (MHN3)

For prolonged lumbar disc herniation, the following acupuncture point was added: Qixue (KD13)

For generalized lumbago, the following acupoints were added:

  • Wailing (ST26)
  • Qixue (KD13)
  • Siman (KD14)

For sciatica occurring when sitting, the following acupuncture points were added:

  • Qipang
  • Wailing (ST26), affected side only
  • Xiafengshidian
  • Xiafengshixiadian

He et al. measured improvement rates after three weeks of acupuncture therapy. Patients achieved significant improvements. The researchers conclude that the protocol is effective for the treatment of lumbar disc herniation symptoms. He et al. used several acupoints termed ‘extra’ points including Xiafengshidian, Xiafengshixiadian, and Qipang. The acupoints demonstrate that the researchers focused on abdominal acupuncture as a means of treating lumbar concerns.

Xia Feng Shi Dian (Xia Feng Shi Dian, Lower Wind-Damp Point) is located 2.5 cun lateral to CV6 and is indicated for the treatment of knee disorders, including postoperative swelling and pain. Xiafengshixiadian (Xia Feng Shi Xia Dian, Below Wind-Damp Point) is located 3 cun lateral to CV5 and is used for leg, ankle, and foot disorders. Qipang (Qi Pang, Beside Qi) is located 0.5 cun lateral to CV6 and is indicated for lower back and leg pain, swelling, and weakness; including postoperative disorders.

The meta-analysis included the clinical research of Zhang et al. Manual acupuncture was applied to acupoints surrounding the afflicted area. All needles were directed towards the center of the afflicted region. Zhang et al. achieved a 97.5% total treatment effective rate.

Overall, the metal-analysis by Wang et al. documents that acupuncture is a safe and effective treatment modality for patients with lumbar disc herniations. Implementation of Jiaji acupoints was common across several studies. Other techniques including abdominal acupuncture and local Ashi acupoint acupuncture also demonstrated clinical effectiveness. Both electroacupuncture and specialized manual acupuncture demonstrated effectiveness as well. As a result of the findings, the researchers conclude that acupuncture is an important treatment option for patients with lumbar disc herniations.

 References:

Song YJ, Yu MJ, Li L, Huang WX, Cai ZW, Su DP. (2013). Clinical Observation of Electro-acupuncture in Treatment of Lumbar Disc Herniation. Chinese Manipulation & Rehabilitation Medicne.

Sun ZR. Mechanism of acupuncture in the regeneration of surrounding damaged nerves. 1996(02).

Wang FM, Sun H, Zhang YM. (2014). Advance of Clinical Research in Intervention of Lumbar Disc Herniation(LDH) with Acupuncture Moxibustion. Journal of Clinical Acupuncture and Moxibustion.
30(3).

Deng W & Cai LH. (2011). Electroacupuncture on Jiaji acupoint in treating lumbar disc herniation. Journal of Clinical Acupuncture. (7).

He JX, Lin WR, Chen JQ, Huang Y, Wang SX, Lin HH & Chen HX. Abdominal acupuncture in treating lumbar disc herniation. Shanghai Journal of Acupuncture. 2012. (7).

Liu YZ, Sun XW & Zou W. (2012). Shao Shan Huo acupuncture technique on lumbar Jiaji acupoint in treating lumber disc herniation. Journal of Clinical Acupuncture. (6).

 

 

Acupuncture Found Effective For Cervical Spine Disorders

Long needle acupuncture, electroacupuncture and Xiaoxingnao acupuncture show positive treatment outcomes for both cervical spondylosis and cervical spondylotic radiculopathy. 

Two recent research studies find acupuncture a highly effective and flexible method for the treatment of cervical spondylosis and cervical spondylotic radiculopathy (neck spinal and soft tissue degeneration causing nerve impingement and subsequent pain or numbness).

One study from Xindu District Hospital of Traditional Chinese Medicine found long needle acupuncture to be highly effective for the treatment of cervical spondylotic radiculopathy. Another from Tianjin University of TCM determined that electroacupuncture treatment in combination with Xiaoxingnao acupuncture produces significant patient outcomes.

In the first study, researchers Xie et al. (Xindu District Hospital of Traditional Chinese Medicine) conducted a scientific investigation of long needle acupuncture compared with conventional acupuncture for the treatment of cervical spondylotic radiculopathy. The results demonstrate that long needle acupuncture produces superior patient outcomes. Let’s take a look at the advanced procedures that produced the results. Please keep in mind that the following procedures are only appropriate for licensed acupuncturists trained in these expert techniques and procedures.

Cervical spondylotic radiculopathy is a common disease that usually affects patients between the ages of 25 and 65 years old. It is mainly caused by bone hyperplasia and hypertrophy of the intervertebral discs, vertebral joints and facet joints. Consequently, the corresponding spinal nerve roots and other nerve roots are compressed or damaged. The main symptoms of this condition include neck, shoulder, back, upper limb, and finger pain, numbness, radiculopathy, or limb and finger weakness (Yang et al., 2012).

Long needle acupuncture accelerates qi and blood circulation in the meridians and also facilitates communication between the yin and yang meridians or between multiple acupoints. For this reason, it is appropriate for the treatment of cervical spondylotic radiculopathy. The study found that long needle acupuncture demonstrates a higher efficacy rate than conventional acupuncture for the treatment of this condition.

A total of 126 patients with cervical spondylotic radiculopathy were selected for the study. They were divided into two groups: treatment group (64 patients), control group (62 patients). The treatment group underwent long needle acupuncture whereas the control group underwent conventional acupuncture treatment. Identical primary acupoints were selected for both therapies: neck Jiaji acupoints and traditional Hua Tuo Jiaji acupoints. These acupoints run in two parallel lines on either side of the spinal column and the Governing Vessel meridian, 0.5–1 cun lateral to the spinous process of each vertebrae. They function to stimulate the nerve segment corresponding to their specific locations.

For the long needle acupuncture treatment, a 3 inch acupuncture needle was held with both hands and inserted into each acupoint. For the neck Jiaji acupoints, the long needle was pointed downwards and inserted towards the seventh cervical vertebra. Upon insertion, either the Ping Bu Ping Xie (gently reinforcing and reducing) or the Xie (reducing) needle manipulation technique was applied. Needle techniques were selected depending upon the individual patient’s clinical symptoms. One acupuncture session was conducted daily for 20 days in total, in two cycles of 10 consecutive days, with a 1 to 2-day break between each cycle.

For conventional acupuncture, a 1.5 inch filiform needle was inserted into each acupoint, angled toward the midline. Upon insertion, either the Ping Bu Ping Xie or the Xie needle manipulation technique was applied, depending upon the individual patient’s clinical symptoms. One acupuncture session was conducted daily for 20 days in total, in two cycles of 10 consecutive days, with a 1 to 2 day break between each cycle. The patients receiving long needle acupuncture achieved a 95.3% total treatment effective rate, while those who received conventional acupuncture achieved an 80.6% rate. The results of this study indicate that long needle acupuncture is highly effective in treating cervical spondylotic radiculopathy, showing greater improvements in symptoms than conventional acupuncture.

In the second study, researchers Gong and Xue (Tianjin University of TCM) found that Xiaoxingnao acupuncture (a specialized acupuncture technique which effectively dredges meridians, improves blood circulation and refreshes the mind) combined with electroacupuncture on the cervical Jiaji acupoints is effective for the treatment of Vertebral artery cervical spondylosis. Vertebral artery cervical spondylosis arises from arterial oppression or damage from mechanical and dynamic factors. This leads to stenosis, which eventually decreases blood supply to the vertebral basilar artery. The main symptoms of vertebral artery cervical spondylosis include: neck and shoulder pain, dizziness, headache, cataplexy, optical conditions (e.g., fogged vision, dark spots, transient amaurosis, temporary vision defects, degenerated vision, ambiopia, visual hallucinations, blindness). In addition, bulbar paralysis and other neurological symptoms may be observed including slurred speech, dysphagia, pharyngeal reflex, choking due to backflow while drinking water, palatoplegia, voice hoarseness or facial paralysis.

The study involved a total of 60 patients with vertebral artery cervical spondylosis. They were divided into two equal groups of 30: the treatment group and the control group. Patients in the treatment group were treated with a combination of Xiaoxingnao acupuncture therapy with electroacupuncture. The control group patients received pharmaceutical medications. The clinical results of this study demonstrate that combining electroacupuncture and Xiaoxingnao acupuncture yields significantly better treatment outcomes than medications. Primary acupoints selected for the treatment group’s therapy were the following:

  • Fengchi (GB20)
  • Fengfu (GV16)
  • Tianzhu (BL10)
  • Wangu (SI4)
  • Dazhui (GV14)
  • Cervical Jiaji acupoints

Fengchi, Fengfu and Tianzhu acupoints were selected for their ability to reduce muscule spasms, regulate autonomic nerve functions, dilate blood vessels and improve blood supply to the brain. Wangu was selected for the treatment of headaches and neck pain. Dazhui was selected to facilitate blood flow. Finally, the cervical Jiaji acupoints were selected as local points to dredge the affected meridians (Deng et al., 2008). For the Fengchi, Fengfu, Tianzhu and Wangu acupoints, the needles were inserted 1.5 – 2 inches deep, toward the Adam’s apple. Acupoints were manipulated by rotating in small turns at a high frequency. For the Dazhui acupoint, multiple needles were inserted in various directions: upward, downward, to the left, to the right and perpendicularly (until the patient felt a sensation radiating toward the shoulder).

The cervical Jiaji acupoints were inserted perpendicularly to a depth of 1.5 – 2 inches. An electroacupuncture device was connected to the needles at the cervical Jiaji acupoints, set at 2 – 10 Hz with disperse-dense waves. Additional secondary acupoints were selected on an individual symptomatic basis as follows:

For phlegm and dampness retention:

  • Fenglong (ST40)
  • Yanglingquan (GB34)

For phlegm and blood stasis:

  • Hegu (LI4)
  • Sanyinjiao (SP6)
  • Geshu (BL17)
  • Zhongwan (CV12)
  • Fenglong (ST40)
  • Zusanli (ST36)

For accumulation of dampness and heat:

  • Danshu (BL19)
  • Yanglingquan (GB34)
  • Neiguan (PC6)
  • Shenmen (HT7)
  • Fenglong (ST40)

For blood deficiency:

  • Geshu (BL17)
  • Xuehai (SP10)
  • Zusanli (ST36)
  • Sanyinjiao (SP6)
  • Qihai (CV6)

For all secondary acupoints, the Ping Bu Ping Xie needle manipulation technique was applied. After needle insertion and manipulation, a needle retention time of 20 minutes was observed. One 20 minute acupuncture session was conducted daily for 2 consecutive weeks.

Patients taking medications received intravenous infusions including mannitol and safflower extract injections in addition to medications to promote blood circulation, nourish nerves, and energize the body. The medications were administered once daily for 2 consecutive weeks. The results of this study showed that patients who underwent combined Xiaoxingnao acupuncture and electroacupuncture achieved an excellent total treatment effective rate of 93.3%, while those who received conventional medications plus infusions achieved a 76.7% total treatment effective rate.

The two aforementioned clinical studies demonstrate that different types of acupuncture have varying efficacy rates for the treatment of cervical spondylosis and cervical spondylotic radiculopathy. Electroacupuncture and Xiaoxingnao acupuncture were more effective than medications. Long needle acupuncture produced greater positive patient outcomes than conventional acupuncture. This reflects the dynamic nature of acupuncture and its flexibility for the treatment of these common conditions.

References:
Xie XY, Qing S, Liao JK, Xiao Y, Liu JQ. (2013). Clinical Efficacy of Long Needle Penetration Acupuncture on Cervical Spondylotic Radiculopathy: A Clinical Observation of 64 Cases. Guiding Journal of Traditional Chinese Medicine and Pharmacology. 7(7).

Yang JX, Yu JC, Zhang JP et al. (2012). Triple Jiao acupuncture in treating cervical spondylotic radiculopathy. Chinese General Practice. 15(25): 2963-2965.

Gong XL, Xue YY. (2014). Clinical Observation of Xiaoxingnao acupuncture Combined with Electroacupuncture at Cervical Jiaji Points in Treatment of Vertebral Artery Type of Cervical Spondylosis.
Journal of Hubei University of Chinese Medicine. 16(5).

Deng LX, Wu XP, Huang W, Wu QK & Jiang GD. (2008). Electroacupuncture in treating vertebral artery type of cervical spondylosis. Journal of Hubei College of Traditional Chinese Medicine. 1.

Palliative care of cancer: overview of systematic reviews

Effectiveness of acupuncture and related therapies for palliative care of cancer: overview of systematic reviews

Objective

Acupuncture and related therapies such as moxibustion and transcutaneous electrical nerve stimulation are frequently used in the management of cancer-related symptoms. Their effectiveness and safety of acupuncture and related therapies are discussed controversial. The authors aim was to provide an overview to summarise the evidence on acupuncture for palliative care of cancer.

Methods

A systematic review of 23 systematic reviews was conducted. The systematic review synthesised the results from clinical trials of patients with any type of cancer. The methodological quality of the 23 systematic reviews was assessed using the Methodological Quality of Systematic Reviews Instrument.

Results

The methodological quality of the 23 systematic reviews was regarded satisfactory. Evidence was found for acupuncture for the management of cancer-related fatigue, chemotherapy-induced nausea and vomiting and leucopenia in patients with cancer.

For the treatment of cancer-related pain, hot flashes and hiccups, and improving patients’ quality of life there are conflicting results. There is currently insufficient evidence to support or refute the potential of acupuncture and related therapies in the management of xerostomia, dyspnea and lymphedema and in the improvement of psychological well-being. No serious adverse effects were reported in any study.

Conclusion

The results of the study suggest that there is evidence for the use of acupuncture for the management of cancer-related fatigue, chemotherapy-induced nausea and vomiting and leucopenia in patients with cancer. As acupuncture appears to be relatively safe, it could be considered as a complementary form of palliative care for cancer patients.

To Read Full Publication: Palliative_Cancer

Citation
Wu, X., Chung, V. C., Hui, E. P., Ziea, E. T., Ng, B. F., Ho, R. S., … & Wu, J. C. (2015). Effectiveness of acupuncture and related therapies for palliative care of cancer: overview of systematic reviews. Scientific reports, 5, 16776.
https://doi.org/10.1016/S0415-6412(17)30048-6