Acupuncture Test Anxiety Relief Confirmed

March 27 2019 HealthCMiacupuncture-head

Acupuncture alleviates test anxiety. Changchun University of Traditional Chinese Medicine researchers conducted a clinical trial consisting of undergraduate students with test anxiety, a type of performance anxiety. The results demonstrate that acupuncture reduces pre-examination anxiety and reduces sleep disturbances. [1]

HAMA (Hamilton Anxiety Rating Scale) and PSQI (Pittsburgh Sleep Quality Index) scores significantly improved for student receiving acupuncture. A total of 58 students were randomly divided into three groups. One group received traditional acupuncture, another received scalp acupuncture, and a third group received no treatment.

Inclusion criteria for the clinical trial were a HAMA score of ≥ 15 and a PSQI score of ≥ 7. The symptoms were required to be induced by pre-examination stress and not related to systemic illnesses such as fever, cough, surgery, pain, or any other external factor. Students that had taken psychotropic or anti-anxiety medications in the previous two weeks or had complications including cardiovascular, lung, liver, kidney, or hemopoietic disorders were excluded from the trial. Students were required to give informed consent to participate and were not permitted to receive any additional treatments during the clinical trial period. Students assigned to the traditional acupuncture group received treatments at the following acupoints:

  • Sishencong (MHN1)
  • Shenmen (HT7)
  • Sanyinjiao (SP6)

Treatment was administered with each patient in a seated or supine position and 0.25 × 25 mm or 0.25 × 40 mm needles were utilized. Needles were manipulated for five minutes using an even technique and were retained for a total of 30 minutes. Students assigned to the scalp acupuncture group received treatments at the following acupoints:

  • Upper Middle Line Occiput (MS12)
  • Middle Line Vertex (MS5)
  • Middle Line Forehead (MS1)

Treatment was administered with each patient in a seated or supine position. Needles were inserted rapidly at a 10 or 15-degree angle to the scalp, to a depth of 1–1.5 cm. Needles were manipulated for five minutes using an even technique and were retained for a total of 30 minutes. For both acupuncture groups, treatment commenced four weeks prior to an examination and was conducted daily with five treatments making up one course of care. A total of four courses were administered, separated by a two-day break each time.

Outcomes
Primary outcome measures included HAMA and PSQI scores plus total effective rates. The HAMA is a scale comprised of 14 parameters, each rated from 0–4, with higher scores indicating increases in anxiety. Mean pre-treatment HAMA scores were 25.67 in the control group, 25.0 in the traditional acupuncture group, and 25.2 in the scalp acupuncture group.

After one week, HAMA scores in all groups reduced slightly to 23.28, 22.4, and 22.4 respectively. After two weeks, HAMA scores in the non-treatment control group remained relatively stable at 24.22, while scores in the traditional and scalp acupuncture groups fell further to 17.5 and 18.5 respectively. After four weeks, HAMA scores in the control group were 21.22, while the traditional and scalp acupuncture groups fell to 6.95 and 5.8 respectively. One week post-treatment, respective HAMA scores for the three groups were 11.78, 5.80, and 4.55. The results indicate that acupuncture is effective for the treatment of test anxiety.

The PSQI rates sleep quality and duration over nine parameters, each rated on a scale of 0–3, with higher scores indicating increases in sleep disturbances. Mean pre-treatment PSQI scores were 15.78 in the control group, 15.75 in the traditional acupuncture group, and 15.95 in the scalp acupuncture group. After one week, PSQI scores in the non-treatment control group remained at 15.78, while scores in the traditional and scalp acupuncture groups reduced to 13.75 and 12.95 respectively.

After two weeks, PSQI scores in the control group rose slightly to 15.95, while scores in the traditional and scalp acupuncture groups continued to fall to 11.15 and 8.95 respectively. After four weeks, PSQI scores in the control group were 16.5, while the acupuncture groups fell further to 8.05 and 5.95 respectively. One week post-treatment, respective PSQI scores for the three groups were 9.78, 6.25, and 4.7. The results indicate that acupuncture successfully benefits sleep for test anxiety patients.

Total effective rates for the three groups were calculated based on total reductions in HAMA and PSQI scores. At the end of the study, students with reductions in HAMA scores of ≥ 75% and PSQI scores of 0–5 points were classified as cured. For students with < 75% reductions in HAMA scores and PSQI scores of 6–10, the treatment was classified as markedly effective. For students with < 50% reductions in HAMA scores and PSQI scores of 11–15, the treatment was classified as effective. For students with < 25% reductions in HAMA scores and PSQI scores of 16–20, the treatment was classified as ineffective. The cured, markedly effective, and effective cases were added together to give the total effective rates for each group.

Regarding anxiety symptoms, the non-treatment control group had 8 cured, 4 markedly effective, 3 effective, and 3 ineffective cases, yielding a total effective rate of 83.33%. The traditional acupuncture group had 18 cured, 2 markedly effective, no effective, and no ineffective cases, yielding a total effective rate of 100%. Similarly, the scalp acupuncture group had 16 cured, 2 markedly effective, 1 effective, and no ineffective cases, yielding a total effective rate of 100%.

Regarding sleep disorders, the control group had no cured, no markedly effective, 2 effective, and 16 ineffective cases, yielding a total effective rate of 11.11%. The traditional acupuncture group had 14 cured, 4 markedly effective, 1 effective, and 1 ineffective case, yielding a total effective rate of 95%. The scalp acupuncture group had 16 cured, 2 markedly effective, 1 effective, and 1 ineffective case, yielding a total effective rate of 95%. The results of this study indicate that both traditional and scalp acupuncture offer effective relief for students suffering from anxiety and sleep disturbances due to pre-examination stress.

Reference:
Guo-juan Dong, Di Cao, Yue Dong, Jing Zhang, Fu-chun Wang (2018). “Scalp acupuncture for sleep disorder induced by pre-examination anxiety in undergraduates,” World Journal of Acupuncture-Moxibustion, vol. 28, pp. 156-160.

Acupuncture Knee Arthritis Cartilage Repair Discovery

Acupuncture stimulates knee osteoarthritis cartilage repair by regulating proteins TGF-β1 and IGF-1. Beijing University of Traditional Chinese medicine researchers determined that acupuncture accelerates articular cartilage repair in the osteoarthritic knee by inhibiting the overexpression of TGF-β1 and IGF-1. With multiple objective laboratory instruments measuring outcomes, the investigation also reveal that acupuncture smooths the surface of knee cartilage while regulating cell proliferation and differentiation. [1] Under the results section of this article, you will be able to read more about this groundbreaking discovery.

Knee osteoarthritis (KOA) often presents with pain, limited mobility, and a reduction in quality of life. Pathologically, it is characterized by changes in the articular cartilage, the subchondral bone, the intra-articular space, ligaments, and the articular capsule region. The researchers designed a laboratory experiment to determine the biochemical mechanisms by which acupuncture exerts its therapeutic actions. The randomized study of 30 experimental rabbits was divided into three arms: a control group (n=10), a knee osteoarthritis model group (n=10), and an acupuncture treatment group (n=10). For the KOA model group and treatment group, a KOA model was made by immobilization of the rabbit knee. Only the treatment group received warm needle acupuncture treatments. The control group did not receive any medical procedures or treatment for the duration of the study.
Results
The hospital researchers conclude, “In comparison with the control group, the expression levels of both TGF-beta1 [transforming growth factor beta 1] and IGF1 [insulin-like growth factor 1] were up-regulated in the KOA model group and then down-regulated after the warm-needling treatment.” They add that both microscopic and macroscopic improvements in the knee joint were observed. After the treatment, “the surface of knee cartilage became smoother.” Additionally, “less abnormal cell proliferations and clusters were found in the warm-needling group compared to those of the model group.” The research team determined that “acupuncture can inhibit the overexpression of TGF-beta1 and IGF-1 in the knee cartilage of rabbits with KOA, having a solid effect in improving pathological changes of knee cartilage.”
Acupuncture 
Acupuncture treatment commenced one week after the KOA model was established. Acupuncture was applied once per day, for a total of four weeks. Needle retention time per acupuncture session was 20 minutes. Manual needle stimulation was applied to elicit a deqi response for each needle. Additionally, moxa cuttings were attached to each needle handle and ignited for 20 minutes to warm the needles. The acupoints used in the study were the following:
  • EX-LE4 (Neixiyan, medial Xiyan)
  • EX-LE5 (Waixiyan, lateral Xiyan)
  • SP10 (Xuehai)
  • GB34 (Yanglingquan)
The researchers note that Traditional Chinese Medicine (TCM) principles were used to make the acupoint selection for the study. This acupoint prescription is widely used on human patients. In Traditional Chinese Medicine, KOA is in the scope of Gu Bi (translated as bone impediment) and Xi Tong (translated as knee pain). The stagnation of external pernicious influences (e.g., wind, cold, damp, heat, phlegm) in the local meridians (acupuncture channels and collaterals) is a primary cause of KOA.
The TCM treatment principle is to invigorate local blood circulation and disperse stagnation. Neixiyan, Waixiyan, Xuehai, and Yanglingquan are located at the knee region. Needling these acupoints accelerates local blood circulation. According to the Huangdi Neijing (The Yellow Emperor’s Classic of Medicine), “the knee is the house of the tendons.” Yanglingquan (GB34) is the gathering point of the tendons. Needling this acupoint treats tendon issues, including those related to the knee joint. In this study, moxibustion was also applied as a part of warm needling therapy. Moxibustion warms the local area and supplements acupuncture to promote blood circulation and disperse stagnation.
Laboratory Detection
The researchers note, “KOA is caused by an imbalance between knee cartilage degradation and repair, the process of which is closely related to TGF-beta1 and IGF-1.” [1] This is supported by another research investigation, in which Stephen et al. concluded that “TGF-beta1 and IGF-1 plays an important role in cartilage homeostasis.” [2]
TGF-beta1 is a secreted protein involved in osteoblast formation and bone remodeling. There is a positive correlation between the concentration of TGF-beta1 and the degree of cartilage damage. Fahlgren et al. note that “high concentrations of TGF-beta1 in synovial lavage fluid seemed indicative for the later development of more severe OA changes in contrast to lower concentrations.” [3] Couchourel et al. document that “Elevated TGFβ1 levels in OA osteoblasts are responsible, in part, for the abnormal ratio of COL1A1 to COL1A2 and for the abnormal production of mature type I collagen. This abnormal COL1A1-to-COL1A2 ratio generates a matrix that blunts mineralization in OA osteoblasts.” [4] Homeostasis is the key. Tsai et al. find that “at proper levels, TGF-β1 could prevent OA from progression.” [5]
IGF-1 is a mitogen (substance that stimulates mitosis) that plays a role in regulating the proliferation, differentiation and apoptosis of chondrocytes. Lan et al. note that at the early stages of knee OA, normal increase in concentrations of IGF-1 activates bone growth and repair. [6] However, they also document that overexpression of IGF-1 leads to osteophyte formation and disease deterioration. In a related research, Wei et al. conclude, “TGF-1 regulates development and homeostasis of articular cartilage, and only TGF-1 at proper levels can accelerate cartilage repair and prevent OA’s progression.” [7]
Based on the findings, the Beijing University of Traditional Chinese Medicine research team concludes that “the relation between TGF-beta1 and IGF-1 levels and articular cartilage repair is a normal distribution.” They add, “the key of knee OA treatment is to reduce the overexpression of the two regulatory factors.” Their findings demonstrate that acupuncture stimulates a homeostatic response on expression of these factors.
Summary
Laboratory data indicates that acupuncture is effective for the treatment of KOA. According to the research covered in this article, common protocols involve the application of acupoints EX-LE4 (Neixiyan), EX-LE5 (Waixiyan), SP10 (Xuehai), and GB34 (Yanglingquan). Patients interested in learning more about treatment are recommended to contact local licensed acupuncturists.
Primary Research
[1] Gao L, Chen M, Yue P, Zhang R, Xin SC. Effect of Warm-needle Moxibustion on Expression of Transfer Growth Factor-beta1 and Insulin like Growth Factor 1 in Knee Cartilage of Rabbits with Knee Osteoarthritis [J]. Acupuncture Research, 2015,40(3):229-232.
Notes
[1] Gao L, Chen M, Yue P, Zhang R, Xin SC. Effect of Warm-needle Moxibustion on Expression of Transfer Growth Factor-beta1 and Insulin like Growth Factor 1 in Knee Cartilage of Rabbits with Knee Osteoarthritis [J]. Acupuncture Research, 2015,40(3):229-232.
[2] Trippel S B. Growth Factor Inhibition Potential Role in the Etiopathogenesis of Osteoarthritis [M]. Philadelphia: Lippincott Williams & Wilkins, 2004:47-52.
[3] Fahlgren A, Andersson B, Messner K. TGF-beta1 as a prognostic factor in the process of early osteoarthrosis in the rabbit knee. Osteoarthritis Cartilage. 2001; 9:195–202. doi: 10.1053/joca.2000.0376.
[4] Couchourel D, Aubry I, Delalandre A, et al. Altered Mineralization of Human Osteoarthritic Osteoblasts Is Attributable to Abnormal Type I Collagen Production. Arthritis and rheumatism. 2009;60(5):1438-1450. doi:10.1002/art.24489.
[5] Tsai S-H, Sheu M-T, Liang Y-C, Cheng H-T, Fang S-S, Chen C-H. TGF-β inhibits IL-1β-activated PAR-2 expression through multiple pathways in human primary synovial cells. Journal of Biomedical Science. 2009;16(1):97. doi:10.1186/1423-0127-16-97.
[6] Lan X, Liu XM, Ge BF et al. Observation of Serum IGF-1 Concentration of Primary Osteoarthritis in Guinea Pigs [J]. Orthopedic Journal of China, 2000, 7(7):667-668.
[7] Wei YX, Wei Z, Liu P et al. Experimental Study on the Repair of Articular Cartilage Defects and Prevention on Osteoarthritis by Intra-articular Injection of IGF-1, TGF-β1 [J]. Chinese Journal of Clinical Healthcare, 2010, 13(3):274-277.

From March 2018 Health CMi

Lumbar Spinal Stenosis

Background

Although the efficiency of conservative management for lumbar spinal stenosis (LSS) has been examined, different conservative management approaches have not been compared. We have performed the first comparative trial of three types of conservative management (medication with acetaminophen, exercise, and acupuncture) in Japanese patients with LSS.

Methods

Patients with L5 root radiculopathy associated with LSS who visited our hospital for surgical treatment were enrolled between December 2011 and January 2014. In this open-label study, patients were assigned to three treatment groups (medication, exercise, acupuncture) according to the visit time. The primary outcomes were Zurich claudication questionnaire (ZCQ) scores before and after 4 weeks of treatment. Least square mean analysis was used to assess the following dependent variables in the treatment groups: changes in symptom severity and physical function scores of the ZCQ and the ZCQ score of patient’s satisfaction after treatment.

Results

Thirty-eight, 40, and 41 patients were allocated to the medication, exercise, and acupuncture groups, respectively. No patient underwent surgical treatment during the study period. The symptom severity scores of the ZCQ improved significantly after treatment in the medication (p = 0.048), exercise (p = 0.003), and acupuncture (p = 0.04) groups. The physical function score improved significantly in the acupuncture group (p = 0.045) but not in the medication (p = 0.20) and exercise (p = 0.29) groups. The mean reduction in the ZCQ score for physical function was significantly greater for acupuncture than for exercise. The mean ZCQ score for treatment satisfaction was significantly greater for acupuncture than for medication.

Conclusions

Acupuncture was significantly more effective than physical exercise according to the physical function score of the ZCQ and than medication according to the satisfaction score. The present study provides new important information that will aid decision making in LSS treatment.

Citation: Oka, H., Matsudaira, K., Takano, Y., Kasuya, D., Niiya, M., Tonosu, J., … & Inanami, H. (2018). A comparative study of three conservative treatments in patients with lumbar spinal stenosis: lumbar spinal stenosis with acupuncture and physical therapy study (LAP study). BMC complementary and alternative medicine18(1), 19.

To download a copy, click here: s12906-018-2087-y

Fibromyalgia: New Research

Zhang, X. C., Chen, H., Xu, W. T., Song, Y. Y., Gu, Y. H., & Ni, G. X. (2019). Acupuncture therapy for fibromyalgia: a systematic review and meta-analysis of randomized controlled trials. Journal of Pain Research, 12, 527-542.  Purpose: Fibromyalgia (FM) can cause chronic widespread pain and seriously affect the quality of patient lives. Acupuncture therapy is widely used for pain management. However, the effect of acupuncture on FM is still uncertain. The aim of this review was to determine the effect and safety of acupuncture therapy on the pain intensity and quality of life in patients with FM.

Materials and methods: We searched PubMed, the Cochrane Library, Embase, the China National Knowledge Infrastructure, the Chinese Science and Technology Periodical Database, and the Chinese Biomedical Literature Database to collect randomized controlled trials (RCTs) of acupuncture for FM published before May 2018. A meta-analysis was performed according to the Cochrane systematic review method by using RevMan 5.3 software, and GRADE was used to evaluate the quality of the evidence.

Results: We identified 12 RCTs that compared acupuncture therapy to sham acupuncture or conventional medication. Meta-analysis showed that acupuncture was significantly better than sham acupuncture for relieving pain (MD =-1.04, 95% CI [-1.70, -0.38], P=0.002, I2=78%) and improving the quality of life (MD =-13.39, 95% CI [-21.69, -5.10], P=0.002, I2=82%), with low- to moderate-quality evidence in the short term. At follow-up in the long term, the effect of acupuncture was also superior to that of sham acupuncture. No serious adverse events were found during acupuncture.

Conclusion: Acupuncture therapy is an effective and safe treatment for patients with FM, and this treatment can be recommended for the management of FM.

Pelvic Pain & Acupuncture

talking-about-pelvic-painBACKGROUND: Endometriosis is a multifactorial, oestrogen-dependent, inflammatory, gynaecological condition that can result in long-lasting visceral pelvic pain and infertility. Acupuncture could be an effective treatment for endometriosis and may relieve pain. Our aim in the present study was to determine the effectiveness of acupuncture as a treatment for endometriosis-related pain.

METHODS:  In December 2016, six databases were searched for randomised controlled trials that determined the effectiveness of acupuncture in the treatment of endometriosis-related pain. Ultimately, 10 studies involving 589 patients were included. The main outcomes assessed were variation in pain level, variation in peripheral blood CA-125 level, and clinical effective rate. All analyses were performed using comprehensive meta-analysis statistical software.

RESULTS:  Of the 10 studies included, only one pilot study used a placebo control and assessed blinding; the rest used various controls (medications and herbs), which were impossible to blind. The sample sizes were small in all studies, ranging from 8 to 36 patients per arm. The mean difference (MD) in pain reduction (pre- minus post-interventional pain level-measured on a 0-10-point scale) between the acupuncture and control groups was 1.36 (95% confidence intervals [CI] = 1.01-1.72, P<0.0001). Acupuncture had a positive effect on peripheral blood CA-125 levels, as compared with the control groups (MD = 5.9, 95% CI = 1.56-10.25, P = 0.008). Similarly, the effect of acupuncture on clinical effective rate was positive, as compared with the control groups (odds ratio = 2.07; 95% CI = 1.24-3.44, P = 0.005).

CONCLUSIONS: Few randomised, blinded clinical trials have addressed the efficacy of acupuncture in treating endometriosis-related pain. Nonetheless, the current literature suggests that acupuncture reduces pain and serum CA-125
 levels, regardless of the control intervention used. To confirm these findings, additional, blinded studies with proper controls and adequate sample sizes are needed.
Citation: Xu, Y., Zhao, W., Li, T., Zhao, Y., Bu, H., & Song, S. (2017). Effects of acupuncture for the treatment of endometriosis-related pain: A systematic review and meta-analysis. PloS one, 12(10), e0186616.

Low Back Pain

50116042 - acupuncturist is treating the woman's backImpact of acupuncture treatment on the lumbar surgery rate for low back pain in Korea: A nationwide matched retrospective cohort study

Introduction

Low back pain (LBP) is a globally prevalent disorder with high social significance. Invasive surgical procedures are increasingly being used to treat LBP despite a lack of solid evidence supporting their long-term benefits. This nationwide retrospective cohort study investigated the association between acupuncture treatment and lumbar surgery rate in patients with LBP.

Methods

Using the National Health Insurance Service Sample Cohort Database for 2002–2013, we identified newly diagnosed LBP patients in Korea between 2004 and 2010 and divided them into an acupuncture group and control group according to whether or not they received acupuncture. Propensity scores based on age, sex, income, and Charlson Comorbidity Index were matched between the two study groups. The lumbar surgery rate in the two years following the first visit (control group) or the first acupuncture session (acupuncture group) was calculated. In addition to the overall analysis, stratified analyses were also conducted in different age, sex, and income strata. Sensitivity analyses were further performed using varying definitions of acupuncture treatment.

Results

After matching, 130,089 subjects were included in each study group. The lumbar surgery rate was significantly lower in the acupuncture group than in the control group (hazard ratio [HR] 0.633, 95% confidence interval [CI] 0.576–0.696). Decrease in HR was consistently observed in the acupuncture group for all age strata, except for patients in their 20s (HR 1.031, 95% CI 0.804–1.323). HR for lumbar surgery tended to be further reduced in the older age groups upon acupuncture treatment, with no apparent sex-related differences. Lowered HR in the acupuncture group was continuously observed across all income groups; the higher income group showed a tendency of greater decrease. Sensitivity analyses showed that the number of acupuncture sessions had no major impact on the likelihood of lumbar surgery, but also that more intensive acupuncture treatment was associated with further reduction in lumbar surgery rates.

Conclusion

The present results found that administration of acupuncture treatment is associated with lower lumbar surgery rates for LBP patients in Korea. Prospective studies are warranted in the future to further investigate the effect of acupuncture treatment on lumbar surgery incidence.

To download the full PDF study click here.

Citation: Koh, W., Kang, K., Lee, Y. J., Kim, M. R., Shin, J. S., Lee, J., … & Ha, I. H. (2018). Impact of acupuncture treatment on the lumbar surgery rate for low back pain in Korea: A nationwide matched retrospective cohort study. PloS one13(6), e0199042.

Acupuncture and Carpal Tunnel Syndrome

wristFrom HealthCMi Aug 2018

Researchers find acupuncture effective for the treatment of carpal tunnel syndrome (CTS), a local entrapment neuropathy affecting the wrist and hand that causes pain, numbness, and dysfunction. The research team documents acupuncture’s beneficial influence on the morphology of the median nerve and improvement of clinical symptoms.

According to researchers conducting the investigation, “while previous studies investigated the effect of acupuncture on clinical symptoms and electromyographic studies, to the best of our knowledge, its effect on median nerve morphology was not investigated before.” [1] This study demonstrates that acupuncture influences morphology of the median nerve, which opens up a host of possible future studies that may build upon this foundation of knowledge.

Median nerve compression in the carpal tunnel region of the wrist results in pain, numbness, and tingling in the fingers or hand, as well as possible weakness and atrophy of the hand muscles innervated by the median nerve. [2] More prevalent among women, it is correlated with overuse, diabetes mellitus, rheumatoid arthritis, hypothyroidism, and pregnancy. [3]

Diagnostically and prognostically, musculoskeletal ultrasound imaging has been growing in popularity for monitoring this condition because of its ease and cost effectiveness. Musculoskeletal ultrasound shows the cross-sectional area (CSA) in the wrist level of the median nerve and this study documents correlations between median nerve cross-sectional areas and electrophysiological changes within the CTS affected limb.

A total of 27 female patients (45 limbs) with CTS were diagnosed with electromyographic tests for the purposes of this investigation. The patients were similar in age, BMI (body mass index), duration of disease, and severity of CTS. Exclusionary criteria were the following: radicular pain, polyneuropathy, radial or ulnar nerve diseases, severe CTS, trauma history, prior hand surgery.

In patients with bilateral CTS, both extremities were included in the same group. All patients were informed about the study and provided consent. They were randomly divided into two groups (acupuncture and control). The mean duration of the disease was 18.3 months and 19.3 months respectively. Both groups used night wrist splints for CTS for 4 weeks, while only the acupuncture group received acupuncture treatments. The following nine acupoints were selected for the study:

  • Daling (PC7)
  • Ximen (PC4)
  • Neiguan (PC6)
  • Laogong (PC8)
  • Qingling (HT2)
  • Shenmen (HT7)
  • Shaofu (HT8)
  • Taiyuan (LU9)
  • Quchi (LI11)

The median nerve cross-sectional area was measured at the proximal carpal tunnel with musculoskeletal ultrasound, with the scaphoid and pisiform bones used as bony landmarks for the proximal tunnel where the cross section was measured. [4] Needles of size 0.25 × 25 mm were inserted into the points and were retained for 25 minutes per acupuncture session. Treatments were conducted two or three days per week for four weeks, totaling ten sessions.

Results
The median nerve cross-sectional area was measured by using musculoskeletal ultrasound on the patients while seated and positioned similarly (elbow at 90 degree flexion with the forearm in supination position). Cross-sectional areas of size 9 mm or greater had previously been determined as a possible diagnostic measure for CTS. [5]

Pain severity, hand function, and musculoskeletal ultrasound measurements were taken before and after treatments. The visual analog scale (VAS: 0–10 cm) measured pain severity. The Duruoz Hand Index (DHI) and Quick Disabilities of the Arm, Shoulder and Hand (DASH) scores were used to assess hand functions and disability. All electrophysiological tests were performed by using a Nihon Cohden Neuropack machine.

Compound muscle action potential (CMAP: normal >6.8 mV) measured the reaction of the abductor pollicis brevis muscle to stimulation at the wrist and elbow. Sensory nerve action potential (SNAP: normal >10 uV) measured the reaction of wrist stimulation to signals traveling in the opposite direction of normal signals in the nerve fiber (antidromic) of the second finger. Motor distal latency (normal <3.8 ms), sensory nerve conduction velocity (SNCV: normal >40.4 m/sec), and motor nerve conduction velocity (M-NCV: normal >49.4 m/sec) were also measured before and after treatment.

Acupuncture group positive outcomes proved significant. The median nerve cross-sectional area decreased from 11.6 to 10.6 mm, motor distal latency decreased from 4.3 to 4.1 ms, and SNAP increased from 16.7 to17.6 uV. Also in the acupuncture group, VAS decreased from 9 to 4.8, CMAP increased from 12.9 to 14.8 mV, DHI decreased from 47 to 37, Quick DASH decreased from 67.2 to 56.8, S-NCV increased from 31 to 33.2 m/sec, and motor nerve velocity increased from 57.4 to 59 m/sec.

The improvement within the acupuncture group when comparing baseline values with the results highlights the success of acupuncture in decreasing clinical symptoms of CTS. It also highlights its ability to transform median nerve morphology such that acupuncture can reduce the cross-sectional area. The results within the control group were not as significant as the acupuncture group, highlighting the efficacy of acupuncture in treating neuropathic disorders compared with night splint monotherapy.

The researchers cited several investigations showing acupuncture’s positive influence on CTS. Recent studies have used magnetic resonance imaging to show how acupuncture may alter brain activity and the limbic system of CTS patients. [6,7,8] Acupuncture produces anti-inflammatory effects in the median nerve within the carpal tunnel, as well as effects that can be compared to ibuprofen, night splints, and oral or injected steroids. [9,10,11]

Summary
Acupuncture generates beneficial morphological changes in the median nerve of patients with carpal tunnel syndrome and reduces or eliminates symptoms. Based on the scientific evidence, acupuncture is a reasonable treatment option. Consult with a local licensed acupuncturist to learn more.

References:
1 Ural, Fatma Gülçin, and Gökhan Tuna Öztürk. “The acupuncture effect on median nerve morphology in patients with carpal tunnel syndrome: an ultrasonographic study.” Evidence-Based Complementary and Alternative Medicine 2017 (2017).

2. S. Tanaka, D. K. Wild, P. J. Seligman, V. Behrens, L. Cameron, and V. Putz-Anderson, “The US [musculoskeletal ultrasound] prevalence of self-reported carpal tunnel syndrome: 1988 national health interview survey data,”American Journal of Public Health, vol. 84, no. 11, pp. 1846– 1848, 1994.

3. R. J. Spinner, J. W. Bachman, and P. C. Amadio, “The many faces of carpal tunnel syndrome,” Mayo Clinic Proceedings, vol. 64, no. 7, pp. 829–836, 1989.

4. Ural, Fatma Gülçin, and Gökhan Tuna Öztürk. “The acupuncture effect on median nerve morphology in patients with carpal tunnel syndrome: an ultrasonographic study.” Evidence-Based Complementary and Alternative Medicine 2017 (2017).

5. J. T. Mhoon, V. C. Juel, and L. D. Hobson-Webb, “Median nerve ultrasound as a screening tool in carpal tunnel syndrome: correlation of cross-sectional area measures with electrodiagnostic abnormality,” Muscle and Nerve, vol. 46, no. 6, pp. 871–878, 2012.

6. A. U. Asghar, G. Green, M. F. Lythgoe, G. Lewith, and H. MacPherson, “Acupuncture needling sensation: the neural correlates of deqi using fMRI,” Brain Research, vol. 1315, pp. 111–118, 2010.

7. V. Napadow, J. Liu, M. Li et al., “Somatosensory cortical plasticity in carpal tunnel syndrome treated by acupuncture,” Human Brain Mapping, vol. 28, no. 3, pp. 159–171, 2007.

8. V. Napadow, N. Kettner, J. Liu et al., “Hypothalamus and amygdala response to acupuncture stimuli in carpal tunnel syndrome,” Pain, vol. 130, no. 3, pp. 254–266, 2007.

9. M. Hadianfard, E. Bazrafshan, H. Momeninejad, and N. Jahani, “Efficacies of acupuncture and anti-inflammatory treatment for carpal tunnel syndrome,” Journal of Acupuncture and Meridian Studies, vol. 8, no. 5, pp. 229–235, 2015.

10. Ho, Chien-Yi, Hsiu-Chen Lin, Yu-Chen Lee, Li-Wei Chou, Ta-Wei Kuo, Heng-Wei Chang, Yueh-Sheng Chen, and Sui-Foon Lo. “Clinical effectiveness of acupuncture for carpal tunnel syndrome.” The American journal of Chinese medicine 42, no. 02 (2014): 303-314.

11. Yang, Chun-Pai, Nai-Hwei Wang, Tsai-Chung Li, Ching-Liang Hsieh, Hen-Hong Chang, Kai-Lin Hwang, Wang-Sheng Ko, and Ming-Hong Chang. “A randomized clinical trial of acupuncture versus oral steroids for carpal tunnel syndrome: a long-term follow-up.” The Journal of Pain 12, no. 2 (2011): 272-279.

Acupuncture Peptic Ulcer Relief

8/12/18 from HealthCMi

Acupuncture helps to heal peptic ulcers and prevents relapses. Researchers conclude that acupuncture increases the total effective rate of drug therapy for the treatment of peptic ulcers. Researchers from the Second Affiliated Hospital of Zhongnan University (Hunan, China) combined acupuncture with standard drug therapy. Patients receiving both drug therapy and acupuncture in a combined treatment protocol had superior patient outcomes compared with patients receiving only drug therapy. Furthermore, acupuncture increases the H. pylori-negative conversion rate and decreases the recurrence rate of drug therapy. [1] In a significant finding, acupuncture added to usual care reduces the relapse rate from 41.7% to 15.4%.

Two groups were compared. In one group, patients received bismuth subnitrate (known by the trade name Veytalo) tablets and amoxicillin as a means to control H. pylori infection. In the second group, bismuth subnitrate and amoxicillin were combined with acupuncture therapy. The drug control group achieve an 82.2% total effective rate. The acupuncture treatment group achieve a 95.6% total effective rate. In addition, the drug control group had a 71.1% H. pylori-negative conversion rate. The acupuncture treatment group had an 86.7% H. pylori-negative conversion rate (i.e., 86.7% of patients were no longer positive for the presence of Helicobacter pylori).

In a 12-month follow-up examination, patients receiving only drug therapy had a 41.7% recurrence rate of peptic ulcers. Patients receiving drug therapy plus acupuncture had a 15.4% recurrence rate. The researchers conclude that adding acupuncture to a bismuth subnitrate plus amoxicillin treatment regimen consolidates the treatment effects and prevents possible recurrence and necessitation for drug therapy.

Chinese Medicine Theory
Peptic ulcers are a common health problem that occur in the stomach (gastric ulcers) or the upper part of the small intestine, typically manifesting in duodenal ulcers. [2] In Traditional Chinese Medicine (TCM), peptic ulcers are in the scope of stomach duct pain (Wei Wan Tong), acid swallowing (Tun Suan), and blood ejection (Tu Xue). TCM principles specify that peptic ulcers are often due to dysfunction of the stomach, spleen, and liver. TCM principles also notate that spleen and stomach weakness is the underlying root cause of the disease. In the Incisive Light on the Source of Miscellaneous Disease (Za Bing Yuan Liu Xi Zhu), it is written that “Stomach disease is often due to pathogenic factors invading the stomach. When there is harmonious flow of abundant qi and blood, the stomach becomes so strong that pathogenic factors cannot affect it; if not, the stomach becomes so weak that pathogenic factors can easily affect it and cause stomach diseases.” The therapeutic treatment principles are to fortify the spleen, harmonize the stomach, and rectify qi to relieve pain.

Design
The researchers (Li et al.) used the following study design. A total of 90 human patients that were diagnosed with peptic ulcers were treated and evaluated in this study. Patients were randomly divided into an acupuncture therapy treatment group and a drug monotherapy control group, with 45 patients in each group. For the control group patients, bismuth subnitrate tablets and amoxicillin were administered. The combination of bismuth subnitrate with antibiotics has been used to treat Helicobacter pylori infections in clinical settings and was therefore chosen as the standard of usual care. The acupuncture therapy treatment group received acupuncture sessions in addition to the identical drug therapy administered to the drug control group.

Prior to beginning the study, both groups were comprised of equivalent demographic constituents. The acupuncture treatment group was comprised of 26 males and 19 females. The average age in the acupuncture group was 41.65 (±1.35) years. The average course of disease in the treatment group was 5.5 years. The drug control group was comprised of 28 males and 17 females. The average age in the drug control group was 40.18 (±0.35) years. The average total course of the disease in the drug control group was 5.8 years. For both groups, there were no significant differences in gender, age, and course of disease prior to beginning the investigation.

Drug and Acupuncture Treatment
For the drug control group, patients received 110 mg doses of bismuth subnitrate tablets and 250 mg of amoxicillin (orally administered, 4 times each day). Every 7 days of tablet consumption consisted of one treatment course. A total of 2 courses were administered. The acupuncture group received a combination of acupuncture and drug therapy. The needle retention time was 10 – 30 minutes. Acupuncture was administered once per day, 5 days per week, followed by a 2-day break. Each treatment course consisted of 2 weeks of acupuncture treatments. All patients received 2 treatment courses in total. A total of 2 – 3 primary acupoints were selected from the following list:

  • BL20 (Pishu)
  • BL21 (Weishu)
  • CV12 (Zhongwan)
  • ST36 (Zusanli)
  • PC6 (Neiguan)

Additional acupoints were selected on individual symptomatic presentations. The acupoint selection was based on the Traditional Chinese Medicine (TCM) theory of differential diagnosis by pattern differentiation. For disturbed qi dynamics, the following acupoints were added:

  • LV14 (Qimen)
  • LV2 (Xingjian)
  • BL18 (Ganshu)

For qi and blood stagnation, the following acupoints were added:

  • BL17 (Geshu)
  • SP6 (Sanyinjiao)

For stomach yin deficiency, the following acupoints were added:

  • SP6 (Sanyinjiao)
  • KI3 (Taixi)

For a cold and deficient stomach and spleen, the following acupoints were added:

  • CV4 (Guanyuan)
  • CV6 (Qihai)

Point Selection
Neiguan (PC6) is located 2 cun superior to the transverse crease of the wrist. This acupoint was selected because it is located on the pericardium meridian and is one of the confluent points of eight extra meridians, which makes it not only indicated for heart and chest diseases, but also spleen and stomach dysfunction. In Traditional Chinese Medicine (TCM), the heart (fire) is the mother of spleen (earth). Therefore, needling Neiguan is beneficial to the spleen. This is a basic five element implementation of the mother nourishes child principle; in this case, stimulating the pericardium meridian with the acupoint PC6 (Neiguan) supports the spleen and stomach.

Zusanli (ST36) is located below the knee. This acupoint is the He-Sea point of the stomach meridian. Zhongwan (CV12) is the Front-Mu point of the stomach meridian. Needling these two points regulates the spleen and stomach, tonifies qi and blood, and strengthens areas of weakness. Pishu (BL20) and Weishu (BL21) are the Back-Shu points of the spleen meridian and stomach meridians respectively. In TCM, Back-Shu points are the gathering places for the essence of their corresponding Zang-Fu organs. Needling Pishu and Weishu tonifies the spleen and stomach.

Modern research confirms that Zusanli and Zhongwan benefit gastrointestinal function. For example, researchers from the Hubei University of Traditional Chinese Medicine (Chen et al.) tested Zusanli in a controlled experiment and confirm that it is effective for benefiting the stomach. [3] In the experiment, rats had improved stomach acid levels and gastrointestinal motility. In an independent research, Luo et al note, “Needling Zusanli and Zhongwan has a bidirectional regulation on stomach acid levels and gastric pepsin levels.” They add that “Needling these points can stimulate the vagus nerve and inhibit acid secretion in people who develop gastric ulcers.” [4] Given the historical TCM indications and proven modern applications of Zusanli (ST36) and Zhongwan (CV12), Li et al. combined both acupoints into an acupuncture treatment protocol to determine their effects on peptic ulcers.

Results
The results indicate that acupuncture combined with conventional drug therapy into an integrated treatment protocol is more effective than bismuth subnitrate plus amoxicillin as a standalone therapy. Li et al. conclude that acupuncture is safe and effective for the alleviation of peptic ulcers.

Notes
[1] Li YM, Wu Q. Clinical Observation on 45 Cases of Peptic Ulcer Treated with Acupuncture [J]. Guiding Journal of Traditional Chinese Medicine and Pharmacy, 2008(06):84-85.
[2] kidshealth.org/en/parents/peptic-ulcers.html.
[3] Chen XH, Liu YX, Wang H. Comparative Study on the Effect of Acupuncture and Moxibustion “Zusanli and Guanyuan” on Immune Function of Rats with Yang Deficiency [J]. Chinese Acupuncture & Moxibustion, 1999, 18(9): 555.
[4] Luo YF. Analysis of the Saying which goes “Zusanli is indicated for stomach diseases” [J]. Chinese Acupuncture & Moxibustion, 1997, 16 (6): 38.

Obesity Reduction

SP6-ST36Researchers find acupuncture effective for the treatment of obesity. Results were obtained by implementing a protocolized body acupuncture point prescription without a diet or exercise program. [1] In a five week clinical trial, patients receiving acupuncture achieved a 2.9 kg mean weight loss and the decrease in mean BMI (body mass index) was 1.43. The laboratory findings, including serum levels of insulin, leptin, ghrelin, and cholecystokinin are consistent with the results. The controlled study documents that sham acupuncture does not produce significant positive patient outcomes, only true acupuncture achieves clinical results. Based on the evidence, the hospital researchers conclude that acupuncture treatment regulates weight for patients with obesity.

Obesity is an increasingly prevalent chronic condition that is associated with serious morbidity and mortality. [2] The risk of hypertension, heart disease, hypercholesterolemia, diabetes mellitus, cerebrovascular disease, gallbladder disease, and some types of cancer are higher for overweight (BMI>25) and obese (BMI>30) individuals. [3] Weight control treatments include diet therapy, behavioral treatment, pharmacotherapy, surgical procedures, and acupuncture. The downside to anti-obesity medications and surgery is the potential for iatrogenic illness. [4] In addition, a World Health Organization Report on acupuncture states that acupuncture demonstrates a therapeutic effect for the treatment of obesity. [5]

Laboratory data supports the conclusions of the researchers in this controlled clinical trial. After 5 weeks of acupuncture treatment, mean serum insulin and leptin levels decreased by 6.87 μIU/ml (43%) and 3.32 ng/ml (25%) respectively. No significant change was seen in these variables after sham treatment. Differences between the two study groups in these parameters were documented. The mean serum insulin and leptin levels in the acupuncture group were lower than in the sham acupuncture group by 8.27 μIU/ml and 6.17 ng/ml respectively. The true acupuncture group also demonstrated significant improvements in mean plasma ghrelin and CCK levels. The researchers note, “acupuncture treatment decreased insulin and leptin levels and induced weight loss, together with a decrease in BMI compared with sham acupuncture.”

Group Selection Process
The subject selection process was as follows. An acupuncture study was announced in a university hospital (Etlik Zubeyde Hanim Obstetrics and Gynecology Training and Research Hospital) for employees and people attending routine wellness examinations. Female obese volunteers who wanted to be involved in this study underwent the selection process and 40 of these with BMI>30 were accepted after routine medical examinations. Subjects selected for inclusion had normal physical examination findings and did not have hypertension, diabetes, nephropathy, heart failure, and were not receiving any medications.

The statistical breakdown for each randomized group was as follows. The mean age of participants was 34.6 ±6.3 years for the sham acupuncture group and 36.8 ±7.8 years for the acupuncture group. Pre-sham and pre-acupuncture groups showed no significant differences in weight, BMI, serum insulin and leptin levels. All participants successfully completed specified treatments without any dropouts or unintended outcomes.

True vs. Sham Acupuncture
The acupuncture group received traditional Chinese type general body acupuncture at the follow acupoints bilaterally:

  • LI4 (Hegu)
  • HT7 (Shenmen)
  • ST36 (Zusanli)
  • ST44 (Neiting)
  • SP6 (Sanyinjiao)

Treatment commenced with patients in a supine position. After disinfection of the acupoint sites, a disposable stainless steel needle (25 mm length, 0.25 mm diameter, Kingli brand) was inserted into each acupoint, reaching a depth of 5–10 mm. Twisting, lifting, and thrusting manual acupuncture techniques were applied to elicit deqi.

Patients in the other group were treated with sham acupuncture. The needles were not inserted but were applied under a tape at the same points. Both groups received two sessions per week for a total of 10 sessions. Duration of each session was 20 minutes. Both treatments were performed by a certified acupuncturist. All patients were asked not to follow dietary treatments, not to undergo heavy physical exercise, and not to take supplementary medications.

Auricular Points
Sun et al. conclude that acupuncture combined with auricular acupressure achieves an average weight loss of 5.04 kg after three months of treatment, The sample size was 110 obese female patients. [6] One study group received body acupuncture plus auricular acupressure (every 3–5 days for 3 months) and another received Capsulae Olei Oenothera Erythrosepalae, a weight control substance. Body weight of the acupuncture group reduced by an average 5.04 kg while that of the control group by an average of 2.08 kg. The differences between the two groups and between values of the same group before and after treatment were statistically significant. The primary body acupoints used in the study were the following:

  • ST25 (Tianshu)
  • SP6 (Sanyinjiao)
  • P6 (Neiguan)
  • ST40 (Fenglong)
  • ST36 (Zusanli)

Rapid needle insertion was performed. Twisting, lifting, and thrusting manual acupuncture techniques were applied to elicit deqi. After the arrival of deqi, the needle retention time was 15 minutes. The needling was administered every 3–5 days, 30 days as one course of treatment, for a total of three courses. For auricular acupressure, the researchers used the following ear acupoints:

  • Mouth
  • Esophagus
  • Stomach
  • Abdomen
  • Hunger
  • Shenmen
  • Lung
  • Endocrine

A grain of Vaccariae seed was affixed to each otoacupoint with a 5×5 mm piece of adhesive tape. The two auricles were used in alternation, and the patients were advised to apply digital pressure on the seed pellets three times daily at home, every 3 – 5 days, for a total of 3 months. The study was a single-blinded, randomized investigation comparing acupuncture and auricular acupressure with a weight control substance. The researchers conclude, “Acupuncture and auricular acupressure produced superior patient outcomes for obese patients including decreasing body weight, appetite, blood triple cholesterol (TC), and triglycerides (TG).”

Acupuncture demonstrates clinical efficacy for the treatment of obesity in two controlled investigations. Based on the data, additional research is warranted. Larger sample sizes will help to confirm these preliminary findings.

Common to both studies reviewed in this article are acupoints SP6 (Sanyinjiao) and ST36 (Zusanli). According to Traditional Chinese Medicine (TCM) principles, both acupoints are indicated for the treatment of digestion related disorders and stimulate the body’s transforming and transporting functions of the digestive system. In this respect, these acupoints are choices consistent with the goals of the research.

Notes
[1] Güçel F, Bahar B, Demirtas C, Mit S, Cevik C. Influence of acupuncture on leptin, ghrelin, insulin and cholecystokinin in obese women: a randomised, sham-controlled preliminary trial. Acupunct Med. 2012 Sep;30(3):203-7.
[2] Lehnert T, et al. Health burden and costs of obesity and overweight in Germany: an update. Eur J Health Econ. 2015;16(9):957–67.
[3] Carnethon MR. Diabetes mellitus in the absence of obesity: a risky condition. Circulation. 2014;130(24):2131–2.
[4] Ingrid Z, et al. The duodenal–jejunal bypass liner for the treatment of type 2 diabetes mellitus and/or obesity: a systematic review. Obes Surg. 2014; 24: 310–23.
[5] apps.who.int/iris/handle/10665/42414
[6] Sun Q, Xu Y. Simple obesity and obesity hyperlipemia treated with otoacupoint pellet pressure and body acupuncture. J Tradit Chin Med 1993;13:22–6.

Acupuncture Provides Parkinson’s Disease Relief

from HealthCMi 7/7/18park-image-one

Acupuncture is an effective treatment modality for the alleviation of Parkinson’s disease. Zhejiang University of Traditional Chinese Medicine (Hangzhou, China) researchers conducted a study comparing the effects of drug therapy as a standalone procedure with acupuncture plus drug therapy in an integrated treatment protocol. Based on the data, the researchers conclude that acupuncture plus antiparkinsonian drug therapy is significantly more effective than using only antiparkinsonian drug therapy. [1]

Two groups were compared. In one group, Parkinson’s disease patients received only levodopa-benserazide as a means to alleviate symptoms. In the second group, levodopa-benserazide was combined with acupuncture therapy. The acupuncture plus drug therapy group had a total effective rate of 89.4% after four courses of treatment, whereas the drug therapy only group had a 52.6% total effective rate for the management of Parkinson’s disease.

The results indicate that acupuncture is an important treatment option for patients receiving benderizine-levodopa for the purposes of Parkinson’s disease treatment. Levodopa-benserazide is a medication containing two ingredients: levodopa and benserazide. Levodopa is a precursor to dopamine, the latter of which is needed in the brain of Parkinson’s disease patients. Benserazide prevents the conversion of levodopa to dopamine prior to reaching the brain and reduces some of levodopa’s adverse effects. This combination is used to reduce symptoms for patients suffering from Parkinson’s disease.

Multiple subjective and objective instruments were used to measure patient outcomes before and after treatment. First, the Unified Parkinson’s Disease Rating Scale (UPDRS), which is the most widely used clinical rating scale for Parkinson’s disease, was used to record symptomatic improvement at several data points: before treatment, after two treatment courses, after four treatment courses. Second, the superoxide dismutase (SOD) activity and lipid peroxidation levels in plasma and red blood cells were recorded. Independent studies have proven that oxidative stress plays an important role in the degeneration of dopaminergic neurons in Parkinson’s disease (PD) patients, which is characterized by decreased SOD activity and increased lipid peroxidation. [2]

After four treatment courses, the scores in the acupuncture plus drug group were significantly improved (i.e., lower) than scores before treatment and for those in the drug control group (P<0.05). After four treatment courses, the SOD activity was significantly higher (i.e., improved) in the acupuncture plus drug group and were also better than scores in the drug control group (P<0.05). The lipid peroxidation levels in the acupuncture plus drug group were significantly lower (i.e., improved) than scores before treatment and were also better than scores in the drug control group.

Parkinson’s disease (PD) is the second most common progressive neurodegenerative disorder. [3] PD is characterized by both motor and non-motor symptoms, such as bradykinesia, resting tremors, and muscle rigidity (which occur due to dopamine deficiency). [4] Diagnostically, Parkinson’s disease is distinguished from essential tremors in that essential tremors are more prevalent with activity and Parkinson’s disease tremors worsen at rest. Levodopa (LD) remains the gold standard pharmacological treatment for PD. However, LD’s effectiveness may decrease overtime. In addition, it has side effects including motor response oscillations and dyskinesia. [5]

New treatment strategies that overcome these limitations are required. Acupuncture has been widely used as a complementary and alternative medicine to relieve the symptoms of PD in Asia, Europe, and in the United States. Previous studies have proven that acupuncture is effective for relieving the symptoms for patients with PD. With the help of acupuncture, both motor symptoms (gait disorder and balance) and non-motor symptoms (psychiatric disorders, sleep problems, gastrointestinal symptoms) can be relieved. In this study, the researchers note that “the use of acupuncture in an integrated treatment protocol can reduce the dosage of LD to eliminate its side effects.” [6]

Design

The Zhejiang University of Traditional Chinese Medicine researchers (Yang et al.) used the following study design. A total of 38 patients diagnosed with Parkinson’s disease were treated and evaluated in this study. They were randomly divided into an acupuncture plus drug treatment group and a drug control group, with 18 patients in each group. There were no significant statistical differences in age, gender, severity of disease, and course of disease relevant to patient outcome measures for patients initially admitted to the study (P>0.05).

Treatment Procedure

The control group received 62.5 – 500 mg of levodopa-benserazide (2 – 4 times per day). Dosage was dependent upon the severity of Parkinson’s disease. Patients in the control group were not treated with acupuncture. The treatment group received both scalp and body style acupuncture in addition to the identical drug treatment protocol administered to the control group. The acupoints used for scalp acupuncture included the following:

  • MS1 (middle line of forehead)
  • MS5 (middle line of vertex)
  • MS6 (anterior oblique line of vertex-temporal)

The acupoints used for body style acupuncture included the following:

  • LI4 (Gegu)
  • SI3 (Houxi)
  • LI5 (Yangxi)
  • SI6 (Yanglao)
  • LI11 (Quchi)
  • PC3 (Quze)
  • LU5 (Chize)
  • LV3 (Taichong)
  • ST41 (Jiexi)
  • KI3 (Taixi)
  • GB34 (Yanglingquan)
  • SP9 (Yinlingquan)
  • BL40 (Weizhong)
  • GB30 (Huantiao)

For scalp acupuncture, treatment commenced with patients in a supine position. A 0.25 mm × 40 mm disposable acupuncture needle was inserted transverse-obliquely into each acupoint, to a standard depth. Each needle was manipulated with the twirling method for three minutes. Once manual acupuncture achieved the arrival of deqi, electroacupuncture stimulation was added to the acupoints using a dense wave. The intensity level was set to patient tolerance levels. A 30 minute needle retention time was observed.

For body style acupuncture, needles were rapidly inserted perpendicularly and were manipulated with mild reinforcing and reducing (Ping Bu Ping Xie) manipulation methods. After achieving a deqi sensation, the needles were retained for 30 minutes. An acupuncture treatment was applied every two days. Each treatment course consisted of 10 acupuncture sessions, followed by a 7 day break before the next course of treatments. All patients received four treatment courses in total.

Results

The results indicate that acupuncture combined with levodopa-benserazide into an integrated treatment protocol is more effective than levodopa-benserazide as a standalone therapy. Based on the data, Yang et al. conclude that acupuncture is safe and effective for the treatment of Parkinson’s disease.

The Zhejiang University of Traditional Chinese Medicine clinical trial confirms additional research. University of Arizona surgery and neurology department doctors find acupuncture effective for the treatment of balance and gait disorders in Parkinson’s disease patients. Acupuncture produced significant clinical improvements in balance, gait speed, and stride length for Parkinson’s disease patients. The results of the sham controlled trial were published in Neurology, the journal of the American Academy of Neurology.

Each acupuncture session was 30 minutes in length. Patients received one acupuncture treatment per week for a total of three weeks. Patients receiving true acupuncture had a 31% improvement in balance, 10% improvement in gait speed, and 5% increase in stride length. Patients in the sham acupuncture control group did not demonstrate any improvements. The University of Arizona research team notes, “EA [electroacupuncture] is an effective therapy in improving certain aspects of balance and gait disorders in PD [Parkinson’s disease].” [7]

Notes

[1] Yang DH, Shi Y, Jia YM. Influence of acupuncture plus drug in the amelioration of symptoms and blood antioxidant system of patients with Parkinson’s disease. Chinese Journal of Clinical Rehabilitation, 2006 (19) :14 -16
[2] Dias V1, Junn E, Mouradian MM. The role of oxidative stress in Parkinson’s disease [J]. J Parkinsons Dis. 2013;3(4):461-91.
[3] I.H. Sturkenboom, M.J. Graff, G.F. Borm, et al., Effectiveness of occupational therapy in Parkinson’s disease: study protocol for a randomized controlled trial, Trials 14 (2013) 34.
[4] W. Poewe, K. Seppi, C.M. Tanner, et al., Parkinson disease, Nat. Rev. Dis. Prim. 3 (2017) 17013.
[5] Dias V1, Junn E, Mouradian MM. The role of oxidative stress in Parkinson’s disease [J]. J Parkinsons Dis. 2013;3(4):461-91.
[6] Yang DH, Shi Y, Jia YM. Influence of acupuncture plus drug in the amelioration of symptoms and blood antioxidant system of patients with Parkinson’s disease. Chinese Journal of Clinical Rehabilitation, 2006 (19) :14 -16.
[7] Lei, Hong, Nima Toosizadeh, Michael Schwenk, Scott Sherman, Stephen Karp, Saman Parvaneh, Esther Esternberg, and Bijan Najafi. “Objective Assessment of Electro-acupuncture Benefit for Improving Balance and Gait in Patients with Parkinson’s Disease (P3. 074).” Neurology 82, no. 10 Supplement (2014): P3-074.