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Acupuncture Found Effective for Postoperative Pain Relief

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Acupuncture Found Effective for Postoperative Pain Relief

 

Researchers conclude that acupuncture increases the effectiveness of epidural morphine analgesia for the relief of pain after intestinal cancer surgery. Guangdong Provincial Hospital of Traditional Chinese Medicine researchers combined scalp acupuncture with epidural morphine analgesia in a controlled clinical trial. Patients receiving both epidural morphine analgesia and scalp acupuncture in a combined pain management protocol after completion of intestinal cancer surgery showed significant improvements in visual analog scale (VAS) scores and Bruggman comfort scale (BCS) scores. The researchers documented another benefit of adding acupuncture to the pain management protocol. The addition of scalp acupuncture accelerated postoperative recovery of gastrointestinal functions.

The VAS and BCS scores demarcate significant improvements, measured at the 6 hour (T1), 12 hour (T2), 24 hour (T3), and 48 hour (T4) datapoints after completion of the operation. VAS is a measurement tool used to score the improvement of pain intensity. BCS is used to evaluate the postoperative comfort level. VAS scores at T1, T2, T3, and T4 in the patients of the acupuncture treatment group were all lower than those in the control group. The researchers note that “scalp acupuncture can serve as a preemptive analgesia technique and increase effectiveness of epidural morphine analgesia.” Pre-emptive analgesia is a treatment whereby a preoperative analgesic regimen is introduced to reduce noxious stimuli in the surgical process. BCS scores in the acupuncture group at T1, T2, T3, and T4 were all lower than those in the control group, indicating that scalp acupuncture is effective for postoperative discomfort relief.

The postoperative recovery of gastrointestinal functioning was recorded based on two parameters, the bowel recovery time and anal exhaust time. The average bowel sound recovery time of the acupuncture treatment group was 35.66 hours, while that of the control group was 58.44 hours. The acupuncture group outperformed the control group by 22.78 hours. The average anal exhaust time of the acupuncture treatment group was 49.34 hours, while that of the control group was 73.22 hours. The acupuncture group outperformed the control group by 23.88 hours. Both parameters demonstrate a significant difference after acupuncture treatment, indicating that scalp acupuncture facilitates the postoperative recovery of gastrointestinal functions.

Morphine is a common opioid analgesic in the postoperative period. While effective, the downside is that the medication may cause nausea, vomiting, constipation, lightheadedness, dizziness, drowsiness, increased sweating, and urinary retention. It may also cause respiratory depression and is contraindicated for patients with cardiopulmonary disease. [2] In addition, continued use or abuse of morphine can result in physical dependence and addiction. [3]

According to a published NIH (National Institutes of Health) Consensus Conference statement, acupuncture is recommended as a treatment for pain management. [4] In the Guangdong Provincial Hospital of Traditional Chinese Medicine study, acupuncture increases the effectiveness of epidural morphine analgesia by improving VAS and BCS scores and facilitates the postoperative recovery of gastrointestinal function. The finding is not an isolated occurrence. In a previous study, researchers (Chen et al.) note, “The addition of acupuncture therapy to epidural morphine analgesia in a clinical setting can reduce the total dosage of morphine and correspondingly eliminate the medication-induced side effect rate.” [5]

 

Design
Researchers (He et al.) from the Guangdong Provincial Hospital of Traditional Chinese Medicine implemented the following study design. A total of 60 patients that received intestinal cancer surgery under combined general/epidural anesthesia were treated and evaluated in this study. The patients received radical resection for colorectal cancer. They were randomly divided into an acupuncture treatment group and a control group, with 30 patients in each group. For the control group patients, combined general/epidural anesthesia was administered during the operation, while morphine was administered for patient-controlled epidural analgesia after the operation. The acupuncture treatment group received scalp acupuncture in addition to identical anesthesia treatments administered to the control group.

The statistical breakdown for each randomized group was as follows. The acupuncture treatment group was comprised of 16 males and 14 females. The average age in the treatment group was 57.65 (±6.67) years. The average weight in the treatment group was 54.63 (±6.58) kilograms. The control group was comprised of 13 males and 17 females. The average age in the control group was 58.07 (±7.02) years. The average weight in the treatment group was 55.32 (±6.50) kilograms. There were no significant statistical differences in gender, age, and weight relevant to patient outcome measures for patients admitted to the study.

 

Anesthesia Procedure
For both groups, patients received combined general/epidural anesthesia (CSEGA) during the operation. After the operation, patient-controlled epidural analgesia (PCEA) was also prescribed. Doses of morphine (3.5 mg) and 20 mL of 0.75% bupivacaine were diluted with 0.9% sodium chloride to make a 100 ml solution, which was injected into a patient-controlled analgesia (PCA) infusion pump. When the peritoneum was closed during the surgery, 1.5 mg of morphine and 2% lidocaine were diluted with 0.9% sodium chloride to make a 5 ml solution and was injected into the patients. Next, when the patients were fully awake after the surgery, a PCA pump was given to the patients daily (2 ml/h), for two continuous days.

 

Acupuncture Procedure
The treatment group patients received scalp acupuncture therapy 20 minutes before the operation. The scalp acupuncture lines used for the treatment group included the following:

  • Lateral line 3 of forehead
  • Lateral line 1 of vertex

Acupuncture treatment commenced with patients in a supine position. A disposable acupuncture needle was inserted obliquely into each scalp line. Once a deqi sensation was obtained, the needles were connected to an electroacupuncture device with a disperse-dense wave. The frequency was adjusted from a low level (2 Hz) to a high level (50 Hz). The intensity level was set to patient tolerance levels or until muscle contractions were observable. Once the electric stimulation began, the needles were retained until completion of the operation.

 

Results
The results indicate that scalp acupuncture combined with epidural morphine analgesia into an integrated treatment protocol is more effective than epidural morphine analgesia as a standalone therapy. The researchers conclude that scalp acupuncture is safe and effective for the relief of postoperative intestinal cancer pain.

 

Notes
[1] He BM, Li WS, Li WY. Effect of Previous Analgesia of Scalp Acupuncture on Postoperative Epidural Morphine Analgesia in the Patients of Intestinal Cancer [J]. Chinese Acupuncture and Moxibustion, 2007, 27 (5): 369-371.
[2] Branch of Anesthesiology of Chinese Medical Association. Expert’s Consensus on Adult Postoperative Pain Management [J]. Lin Chuang Ma Zui Xue Za Zhi (J Clin Anesthesiol, China), 2010, 26(3): 190 – 196.
[3] drugfreeworld.org/drugfacts/prescription/opioids-and-morphine-derivatives-effects.html
[4] NIH Consensus Conference. NIH Consensus Development Panel on ​Acupuncture [J]. JAMA, 1998, 280 (17); 1518 – 1524.
[5] Chen WT, Fu GQ, Shen WD. Progresses of Studies on Acupuncture Analgesia for Postoperative Reaction [J]. Acupuncture Research, 2013, 38 (1) :83 – 87.Ac

Source: HealthCMi

Acupuncture Ankylosing Spondylitis Relief Confirmed

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Acupuncture Ankylosing Spondylitis Relief Confirmed

Researchers conclude that acupuncture and herbal medicine provide relief for patients with ankylosing spondylitis (AS). Ankylosing spondylitis is a type of arthritis characterized by inflammation of the spine, joints, tendons, or ligaments. Long-term, AS can lead to ankylosis, which is stiffening and often immobility caused by fusion of bones. Ankylosing spondylitis is categorized in Traditional Chinese Medicine in several domains: lower back pain, kyphosis, spinal rigidity. In the advanced stages of the illness when bone fusion is present, it is categorized as zhu jie yang (bamboo spine).
Clinical trials at the Shaanxi Baoji Traditional Chinese Medicine Hospital determined that acupuncture and herbal medicine improve bone and muscle activity for AS patients with a three month course of treatment. The research determined that patients had significant reductions in pain levels and subsequent improvements in activities of daily living. [1]
Jilin General Hospital researchers also tested the efficacy of acupuncture and herbal medicine. Using a protocol of warm needle Huatuojiaji acupoints and Lei Wu Fang Chinese herbal medicine steam baths, patients improved significantly. [2]
Many patients experienced significant recuperation levels, with no pain or joint inflammation and restoration of normal joint functioning. Other patients had significant pain inflammation reductions. The ineffective rate was relatively low. Let’s look at the results.
Eighty AS patients were selected from Jilin General Hospital between January 2015 and January 2017. They were randomly divided into 2 groups, the observation group and the control group. Patients in the control group received treatment with sulfasalazine for 3 months. Sulfasalazine is derived from salicylic acid (found in aspirin) combined with sulfapyridine, an antibiotic. The drug reduces inflammation and is used for the treatment of Crohn’s disease, rheumatoid arthritis, and ankylosing spondylitis.
The treatment group received warm needle acupuncture and Chinese herbal medicine therapy. The primary acupoints were Huatuojiaji points applied to affected areas. Secondary acupuncture points were added to the following:
  • Dazhui GV14 (Hundred Taxations)
  • Ganshu BL18 (Liver Shu)
  • Dazhu BL11 (Great Shuttle)
  • Shenshu BL23 (Kidney Shu)
Patients were instructed to rest in a supine position for the treatment. After disinfection of the local skin areas, acupuncture needles were inserted toward the direction of the spine for all Huatuojiaji acupoints. Moxa was added to the needles, ignited, and supervised. Each acupuncture session was 30 minutes. Patients had one session per day for 20 consecutive days.
Treatment group patients also received Chinese herbal medicine soaking baths. The herbal medicine prescription was Lei Wu Fang, which consisted of the following ingredients:
  • Shenjincao (Common Clubmoss Herb), 20 grams
  • Qingfengteng (Sinomenii caulis), 20 grams
  • Dahuang (Rheum officinal), 15 grams
  • Tougucao (Tuberculate speranskia herb), 15 grams
  • Leigongteng (Tripterygium wilfordii), 15 grams
  • Fengfang (Nidus vespae), 15 grams
  • Buguzhi (Psoraleae fructus), 12 grams
  • Chuanwu (Monkshood), 10 grams
  • Caowu (Radix aconiti agrestis), 10 grams
  • Huajiao (Chinese prickly ash), 10 grams
  • Ruxiang (Baswellia carterii), 10 grams
  • Moyao (Commiphora myrrha), 10 grams
  • Mangxiao (Glauber’s salt), 10 grams
The ingredients were boiled with 3000–4000 ml of water. Patients then soaked in a steam bath containing the warm herbal decoction. The temperature of the tub was adjusted according to each patient’s condition. Each soaking treatment lasted for 30 minutes. Patients had one session per day for 20 consecutive days. Efficacy of the treatment was classified as follows:
  • Very effective: the patient did not experience any pain or other symptoms of joint inflammation after the treatment course. Joint functions were restored to normal and the patient was able to carry out daily tasks and work.
  • Effective: pain and other symptoms of joint inflammation were greatly reduced. Major joint functions were restored. Patient had limited capability in handling daily tasks and work. 
  • Ineffective: the patient did not improve significantly. [3]
Efficacy was also evaluated using the following measures:
  • The international AS evaluation criteria (AS score)
  • The patient’s overall evaluation index (PGA index)
  • The Bath Ankylosing Spondylitis Functional Index (BASFI) [4]
The total effective rate for the treatment group, combining both the very effective and effective rates was 95%. The total effective rate in the drug control group was 77.5%. The results demonstrate that a combination of acupuncture and herbal medicine is an effective approach to patient care for patients with ankylosing spondylitis.
Notes
1. Wang KJ, Zhao L, Zhang H. Clinical Observation of Warm Acupuncture and Chinese Herbal Fumigation to treating active Ankylosing Spondylitis [J] Modern Journal of Integrated Traditional Chinese and Western Medicine,2016,25(31):3434-3436.
2. Pu Quanjiang. Clinical Observation of Warm Acupuncture and Herbal Fumigation to treat Ankylosing Spondylitis [J] World Latest Medicine Information, 2018, 18 (5): 130.
3. Wang YL, Ren CJ. Therapeutic Effect of Warm Acupuncture and Acupoint Injection to treat Ankylosing Spondylitis [J] Modern Journal of Integrated Traditional Chinese and Western Medicine,2014,23(6):635-637.
4. Yuan GH. Clinical Observation of Tuina and Warm Acupuncture to treat Lumbar Intervertebral Disc Protrusion [J] Journal of Yichun University,2014,36(3):77-78. 
Source: HealthCMi

Acupuncture Found Effective for Chronic Fatigue Syndrome

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Acupuncture Found Effective for Chronic Fatigue Syndrome

 

Acupuncture is effective for the treatment of chronic fatigue syndrome (CFS). Researchers at the Beijing Chaoyang Fatou Community Health Service Center conducted a study comparing the effects of warm needling acupuncture, standard acupuncture, and sham acupuncture. [1] Based on the data, the researchers conclude that warm needling acupuncture is significantly more effective than using only standard acupuncture or sham acupuncture.

Three groups were compared. In one group, patients received sham acupuncture (a placebo control system used to simulate true acupuncture used in single-blinded and double-blinded trials). In the second group, patients received standard acupuncture as a means to control chronic fatigue syndrome. In the third group, standard acupuncture was combined with moxibustion therapy. The results demonstrate that sham acupuncture does not produce significant positive patient outcomes; however, standard acupuncture and warm needling acupuncture produce significant clinical results. The researchers note, “Acupuncture (and moxibustion) can be used as alternative and safe treatment protocols for chronic fatigue syndrome.”

 

About CFS
Chronic fatigue syndrome is defined as an illness characterized by severe disabling fatigue lasting for at least six months that is worsened by minimal physical or mental exertion. In the sphere of biomedicine, no definitive etiology has been identified. There are no key features or typical symptoms, but a sore throat, depression, and myalgia may all be present. [2]

The biomedical etiology of chronic fatigue syndrome (CFS) remains unclear. However, it has been suggested that psychological and social factors, viral loads, and immune system dysfunction may contribute to the condition. Previous studies find that CFS may be associated with a bias towards a Th2 type of response in Th1/Th2 immune balances. [3] Acupuncture’s ability to balance Th1 and Th2 may be one mechanism responsible for its effective action in the treatment of CFS.

Th1 (T helper 1) and Th2 (T helper 2) cells are types of T cells that play important roles in the adaptive immune system. Th1 cells secrete IL-2, interferon-gamma (IFN-γ), and tumor necrosis factor (TNF). Th2 cells produce IL-4, IL-5, IL-6, and IL-13. [4] In a Th2 immune response, IL-4 production by T cells is predominant over IFN-γ. Researchers Wang et al. note, “Acupuncturing at bilateral GV20 (Baihui), CV4 (Guanyuan), and ST36 (Zusanli) could elevate the serum IFN-γ concentration and the ratio of IFN-γ/IL-4 and regulate Th1/Th2 immune balance.” [5] This finding indicates that acupuncture may be of benefit to CFS patients with T cell imbalances.

 

Findings
The study involved 133 voluntary patients from the Beijing Chaoyang Fatou Community Health Service Center. All were diagnosed with CFS. Inclusion criteria were established based on the CDC (US Centers for Disease Control and Prevention) criteria for CFS and included the following:

  • Experienced unexplained persistent or relapsing chronic fatigue for more than six months, which is not substantially alleviated by rest, and results in substantial reduction in previous levels of occupational, educational, social, or personal activities. [6]

In addition, the aforementioned is concurrent with four or more of the following symptoms:

  • Substantial impairment in short-term memory or concentration
  • Sore throat
  • Tender lymph nodes
  • Muscle pain
  • Multi-joint pain without swelling or redness
  • Headaches of a new type, pattern, or severity
  • Unrefreshing sleep
  • Post-exertional malaise lasting more than 24 hours

 

Acupuncture
Patients were randomly divided into three groups: warm needling acupuncture group (n=44), acupuncture group (n=47), sham control group (n=42). For the warm needling acupuncture group, the average age of participants was 33.9 years. There were 20 males and 24 females. For the acupuncture group, the average age was 34.2 years (21 males and 26 females). For the sham control group, the average age of participants was 35.1 years (19 males and 23 females). The acupoints selected for the acupuncture and acupuncture plus moxibustion groups were the following:

  • GV20 (Baihui)
  • CV17 (Danzhong)
  • CV6 (Qihai)
  • CV4 (Guanyuan)
  • ST36 (Zusanli)
  • SP6 (Sanyinjiao)
  • LI4, LV3 (Siguan: Hegu plus Taichong)

For the sham acupuncture control group, body points selected were neither meridian acupoints nor special acupoints. They were located at the following areas:

  • 2 cm lateral to GV20
  • 2 cm lateral to CV17
  • 2 cm lateral to CV6
  • 2 cm lateral to CV4
  • 1.5 cm lateral to ST36
  • 1.5 cm lateral to SP6
  • 1 cm lateral to LI4, LV3

 

Chinese Medicine
The researchers provided a Chinese medicine theoretical basis for the protocols used in this acupuncture continuing education research. In Traditional Chinese Medicine, CFS falls in the scope of deficiency taxation (Xu Lao), wilting pattern (Wei Zheng), depression disease (Yu Bing), and hundred-union disease (Bai Hu Bing). CFS presentations are categorized into several differential diagnostic patterns including spleen qi deficiency, kidney jing-essence deficiency, spleen and kidney yang deficiency, liver depression, and qi stagnation. The treatment principle is to supplement deficiencies, support upright qi (Zheng Qi), and restore the liver’s function to control the smooth flow of qi.

Acupoints were selected to achieve the therapeutic actions guided by the treatment principles. Baihui is located on the Governing Vessel (Du Mai). Administering acupuncture at this acupoint lifts yang, boosts qi, and revives the spirit mind (shen). Danzhong, Qihai, and Guanyuan are located on the Conception Vessel (Ren Mai). Needling Danzhong restores the free flow of qi and supplements ancestral qi (Zong Qi). Acupuncture at the other two acupoints supports upright qi (Zheng Qi) and benefits the kidneys. Zusanli combined with Sanyinjiao is often used in modern clinical settings to strengthen the spleen and stomach and to benefit qi and blood. Siguan (a combination of bilateral Hegu and Taichong) was applied to restore the liver’s function to control the smooth flow of qi and activate qi and blood circulation.

For all three groups, each point was pierced with a disposable 0.25 mm × 40 mm needle (Huatuo brand), adhering to standard needling depths. For Baihui and Danzhong, the needles were inserted transverse-obliquely towards the direction of meridian energy flow. For the remaining acupoints, the needles were inserted perpendicularly. When a deqi sensation was obtained, Baihui, Qihai, Guanyuan, and Zusanli were manually stimulated with Bu (tonifying) manipulation techniques, while other acupoints were stimulated with the Ping Bu Ping Xie (attenuating and tonifying) manipulation techniques. Next, a needle retention time of 30 minutes was observed.

For the warm needling group, moxibustion was added to Baihui, Qihai, Guanyuan, and Zusanli. Medicinal moxa pieces of approximately 2 cm were attached to the needle handles and ignited. Thick paper heat shields were placed over the skin for protection. Moxa was left in place for 20 minutes per 30 minute needle retention time.

Acupuncture and moxibustion sessions were administered once per day. Each treatment course consisted of ten acupuncture treatments. All patients received two treatment courses in total. To evaluate the treatment effective rate, patients were scored before and after the treatments based on the Chalder Fatigue Scale as well as the Self-rating Satisfaction Scale. The Chalder Fatigue Scale is a measurement tool used for quantifying the severity of tiredness in CFS patients across multiple parameters (e.g., physical fatigue scores, mental fatigue scores, general fatigue scores).

After the treatment, the scores of the Chalder Fatigue Scale including physical fatigue scores, mental fatigue scores, and general fatigue scores were significantly decreased in the standard acupuncture and acupuncture warm needling groups, but not in the sham acupuncture group. The physical, mental, and general fatigue scores of the standard acupuncture and warm needling groups were significantly better than those of the sham acupuncture group, while the physical and general scores of the warm needling group were markedly better than those of the standard acupuncture group (P＜0.05). Interestingly, the CFS patients’ satisfactory rates of the standard acupuncture and acupuncture plus warm needling groups were 36.2% (17/47) and 72.7% (32/44) respectively—indicating that moxibustion was well-received by patients. All groups had no adverse effects resulting from treatment or other medical procedures in the protocols.

The results indicate that warm needling acupuncture or standard acupuncture is more effective than sham acupuncture. The study by Lu et al., mentioned in this report, demonstrates that acupuncture is safe and effective for the treatment of chronic fatigue syndrome. Important features of TCM protocols are that they produce a high total effective rate without any significant adverse effects.

 

Summary
Major causes of suffering include pain, paralysis, mental illness, nausea, immune system imbalances, and fatigue. CFS and other clinical scenarios involving severe fatigue are a significant source of suffering and may be as severe as any other form of illness or complication. One concern is that since there is no clearly defined etiology within hospital medicine for CFS, patients may be marginalized or receive incomplete care.

There are instances in which patients are given psychiatric medications without addressing the biophysical sources of CFS. This focus on treating only the symptom and not the root cause of CFS potentially leads to prolonged suffering. Given the results of the research data, acupuncture with moxibustion is a reasonable treatment option, referable by primary healthcare physicians.

 

Notes
[1] Lu C, Yang XJ, Hu J. Randomized Controlled Clinical Trials of Acupuncture and Moxibustion Treatment of Chronic Fatigue Syndrome Patients. Acupuncture Research, 2014, 39(4):313-317.
[2] Fukuda K, Straus SE, Hickie I, Sharpe MC, Dobbins JG, Komaroff A. The chronic fatigue syndrome. a comprehensive approach to its definition and study. Ann Intern Med. 1994;121:953 – 9. International Chronic Fatigue Syndrome Study Group.
[3] Skowera, A et al. “High Levels of Type 2 Cytokine-Producing Cells in Chronic Fatigue Syndrome.” Clinical and Experimental Immunology 135.2 (2004): 294–302.
[4] Choi, P, and H Reiser. “IL-4: Role in Disease and Regulation of Production.” Clinical and Experimental Immunology 113.3 (1998): 317–319.
[5] Wang XY, Liu CZ, Lei B. “Effect of Manual Acupuncture Stimulation of Baihui, Guanyuan, Zusanli on Serum IFN-γ and IL-4 Contents in Rats with Chronic Fatigue Syndrome.” Acupuncture Research 2014, 39 (05): 387 – 389.
[6] Fukuda K, Straus SE, Hickie I, Sharpe MC, Dobbins JG, Komaroff A. The Chronic Fatigue Syndrome: A Comprehensive Approach to its Definition and Study. Ann Intern Med. 1994 Dec 15;121(12):953-9.

Source: HealthCMi

Acupuncture and Herbs Proven Effective for PID Treatment

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Acupuncture And Herbs Proven Effective For Pelvic Inflammatory Disease Treatment

 

Researchers find acupuncture combined with herbal medicine effective for the treatment of chronic pelvic inflammatory disease. Guangzhou University of Traditional Chinese Medicine researchers investigated the effects of acupuncture and Chinese herbal medicine on patients with chronic pelvic inflammatory disease. [1] The combined therapy produced an 86.7% total effective rate. Acupuncture, as a standalone therapy (absent the use of herbal medicine), produced a 60.0% total effective rate.

Pelvic inflammatory disease (PID) is inflammation of the female pelvic organs or connective tissues. In the United States, pelvic inflammatory disease is estimated to affect about one million people annually. [2] Patients with pelvic inflammatory disease can experience fever, lower abdominal pain, leukorrhea, or painful intercourse. In some cases, PID may lead to irregular menstruation, ectopic pregnancies, or infertility. [3] PID may also result in depression or insomnia. [4]

The most common treatment of chronic PID involves antibiotic therapy. This is often a life-saving therapy for patients with acute PID. However, antibiotics may prove ineffective for chronic PID, especially for cases involving infected pelvic adhesions and connective tissue proliferations. Long-term use of antibiotics may lead to GI flora imbalances, gastrointestinal dysfunction, and drug intolerance. [5] Exploratory surgery may also produce limited results.

 

Traditional Chinese Medicine (TCM)
In Traditional Chinese Medicine, chronic pelvic inflammatory disease is in the scope of abdominal pain (Fu Tong), heat entering the blood chamber (Re Ru Xue Shi), abnormal vaginal discharge (Dai Xia Bing), concretions and conglomerations (Zheng Jia), or infertility (Bu Yun). According to TCM principles, pelvic inflammatory disease is caused by internal accumulation of dampness and heat combined with blood stasis. Treatment principles include invigorating blood circulation and transforming stasis, warming and dispelling cold-dampness, clearing heat and toxins, benefitting qi, or nourishing yin. Primary acupuncture points included in the treatment protocol included the following:

  • CV4 (Guanyuan)
  • CV3 (Zhongji)
  • SP6 (Sanyinjiao)
  • ST36 (Zusanli)

Additional acupoints were administered based on differential diagnostic patterns. For severe damp-heat patients, the following acupuncture points were added:

  • SP9 (Yinlingquan)
  • Ashi (Extra)

The researchers note that Traditional Chinese Medicine principles were used to make the acupoint selection for the study. Primary acupoints were selected for reinforcing purposes. Sanyinjiao is the crossing point of the liver, spleen, and kidney meridians. Needling this acupoint activates qi and blood, regulates the Chong (thoroughfare) and Ren (conception) vessels, fortifies the spleen to disinhibit dampness, and regulates the liver and kidneys.

Zhongji is located on the Ren vessel. Needling this acupoint regulates vessel qi of both the Chong and Ren vessels. Zusanli is the He-confluence point of the stomach meridian. Needling this acupoint supplements stomach qi so that the stomach and spleen can transform food into nutrients, qi, and blood to benefit the Chong and Ren vessels and the reproductive system. Secondary acupoints were used to clear excesses. Yinlingquan is the He-confluence point of the spleen meridian. Needling this acupoint clears damp-heat. Ashi points were needled to relieve pain and activate blood circulation.

Each acupuncture session lasted for 30 minutes. Patients received one acupuncture treatment per day for 30 consecutive days, except during menstruation. In total, two courses of treatment were applied.

Treatments began with patients in a supine position. Upon disinfection, acupuncture needles were inserted into each acupoint to a standard insertion depth. After achieving a deqi sensation, mild reinforcement and attenuation (Ping Bu Ping Xie) acupuncture techniques were applied to each needle. The needles were retained for the duration of the treatment session. The following herbal formula was decocted for all patients (Chai Shao Yi Yi Ren Tang):

  • Chai Hu 5 g
  • Dang Gui 10 g
  • Chuan Xiong 10 g
  • Chi Shao 10 g
  • Xiang Fu 10 g
  • Lu Lu Tong 10 g
  • Wang Bu Liu Xing 10 g
  • Yan Hu Suo 10 g
  • Fu Ling 10 g
  • Zao Jiao Ci 15 g
  • Che Qian Zi 15 g
  • Dan Shen 15 g
  • Pu Gong Ying 15 g
  • Yi Yi Ren 20 g
  • Dong Gua Ren 20 g
  • Gan Cao 5 g

The function of this herbal formula is to dispel damp-heat, activate blood circulation, and clear meridian obstructions. The decoction was made from new herbs each day, divided into two parts, and was administered in two servings (one in the morning and one at night). Throughout the treatment period, patients were instructed to avoid pregnancy and to stop using medications. The combined therapy of acupuncture and herbs achieved an 86.7% total effective rate.

In related news, Yang et al. achieved significant positive patient outcome rates in their investigation. Guangdong University of Traditional Chinese Medicine researchers achieved an 89.66% total effective rate for the treatment of chronic pelvic inflammatory disease with acupuncture plus moxibustion. [6] The primary acupuncture points employed in the investigation were based on two pre-selected prescriptions:

Prescription #1

  • CV6 (Qihai)
  • CV4 (Guanyuan)
  • CV3 (Zhongji)
  • EX-CA1 (Zigong)
  • ST36 (Zusanli)
  • SP6 (Sanyinjiao)
  • LV3 (Taichong)

Prescription #2

  • BL20 (Pishu)
  • BL23 (Shenshu)
  • BL25 (Dachangshu)
  • BL30 (Baihuanshu)
  • BL32 (Ciliao)

Only one prescription was applied each day; the two prescriptions were used alternately. Treatment commenced with patients in a supine position for prescription #1, and a prone position for prescription #2. 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. After elicitation of a deqi sensation, the needles were manipulated with a moderate reinforcing technique for 1–2 minutes.

Moxibustion was applied to Qihai, Guanyuan, Zhongji, Zigong, Shenshu, Dachangshu, Baihuanshu, and Ciliao. 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 two times per 30 minute needle retention time. One acupuncture and moxibustion session was applied every other day, three times per week, except during menstruation. The treatment was applied for a grand total of three menstrual cycles. An 89.66% total effective rate was achieved using acupuncture plus moxibustion.

 

Summary
Acupuncture and herbs are effective treatment modalities for the resolution of chronic PID. The aforementioned research produced significant positive patient outcome rates, indicating that consultation with a licensed acupuncturist regarding this condition is an important treatment option. At the Healthcare Medicine Institute (HealthCMi), we offer a variety of acupuncture continuing education courses online featuring the treatment of chronic PID. This includes online ebook and video courses for CEU and PDA credit. Licensed acupuncturists are encouraged to reference two sample courses provided in the following links:

Notes
[1] Wang JL. Clinical Observation on Chronic Pelvic Inflammatory Disease with Acupuncture plus Chinese Herbal Medicine [D]. Guangzhou University of Traditional Chinese Medicine, 2011.
[2] cdc.gov/stdtraining/self-study/pid/pid_epidemiology_self_study_from_cdc.html
[3] Mitchell, C; Prabhu, M (December 2013). Pelvic inflammatory disease: current concepts in pathogenesis, diagnosis and treatment [J]. Infectious disease clinics of North America. 27 (4): 793–809.
[4] Graziottin A, Skaper SD, Fusco M (2013) Inflammation and Chronic Pelvic Pain: A Biological Trigger for Depression in Women? [J]. Depress Anxiety 3:142.
[5] Fan LL, Yu WH, Liu XQ. A Meta-analysis on Effectiveness of Acupuncture and Moxibustion for Chronic Pelvic Inflammatory Disease [J]. Acupuncture Research, 2014, 39(2):156-163.
[6] Yang YL. Clinical Research in Treating Chronic Pelvic Inflammatory Disease by Moxibustion with Warming Needle [D]. Guangzhou University of Traditional Chinese Medicine, 2011.

Source: HealthCMi

 

Acupuncture and Drugs Found Equally Effective For Mild Depression

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Acupuncture and Drugs Found Equally Effective For Mild Depression

 

Guangdong Province Traditional Chinese Medicine Hospital researchers find acupuncture with moxibustion produces similar positive patient outcomes rates as the drug paroxetine for treatment of mild to moderate depression. In the study, true acupuncture produced similar results as paroxetine (a selective serotonin reuptake inhibitor, SSRI) and significantly outperformed a sham acupuncture control group. A total of 105 patients met the eligibility criteria and were randomly assigned to three study groups (acupuncture, paroxetine, control).

The acupuncture group received an integrated acupuncture program of standard acupuncture, moxibustion, and intradermal needling. The acupoints GV20 (Baihui), MHN3 (Yintang), GV26 (Shuigou), PC6 (Neiguan), LI4 (Hegu), and LV3 (Taichong) were selected. Following disinfection, LI4 and LV3 were needled first. Size 0.35 × 25mm filiform needles were selected and inserted perpendicularly to a depth of 10–12mm. GV20 and Yintang were then needled obliquely at a 15 degree angle to a depth of 10–12mm. Finally, GV26 and PC6 were needled perpendicularly to a depth of 10–12mm. All needles were then uniformly manipulated to obtain deqi. Needles were retained for 30 minutes with mild reinforcing–reducing manipulation (Ping Bu Ping Xie) applied every 10 minutes (a total three manual simulation applications).

In addition to the above points, Yin Qi Gui Yuan abdominal acupuncture was used. This method employs the points CV12 (Zhongwan), CV10 (Xiawan), CV6 (Qihai), and CV4 (Guanyuan). With the patient in a prone position, needles were inserted perpendicularly to a depth of 10–12mm, without manually stimulating the needles to obtain deqi. Needles were retained for 30 minutes.

Moxibustion was applied to the Sihua (four flowers) points: BL17 (Geshu), BL19 (Danshu). Moxa cones were sized at 0.2cm in height with a bottom diameter of 0.1cm (approximately the size of a sesame seed) with a burning time of 2–3 seconds. A cotton swab was used to apply a small amount of Dieda Wanhua oil to the moxa bonding point. The moxa was then applied and ignited. Once the patient felt a hot sensation, the operator quickly removed the moxa by hand. Two moxa cones were burned on each point.

Following disinfection, granular intradermal needles were inserted with tweezers to the points BL15 (Xinshu) and BL18 (Ganshu). Needles were inserted subcutaneously toward the spine to a depth of 5–8mm with the needle handle retained on the skin surface. The needles were secured with medical tape, using 0.5 × 0.5cm tape under the needle handle and 1.5 × 1.5cm tape on top. Needles were retained for 2–3 days until the next treatment. Treatment was administered twice per week, at intervals of 48 hours or more. Four weeks made up one course of treatment and two courses were administered, for a total of 16 treatments.

For patients in the drug group, paroxetine hydrochloride was orally administered with a starting dose of 20mg per day. After 2–3 weeks, the dosage was increased according to the each patient’s individual reactions. Dosage was increased by 10mg weekly to a maximum of 50mg per day over the course of eight weeks. The patients were treated for a total of eight weeks.

 

Results
The results were evaluated using the Hamilton Rating Scale for Depression (HAMD-17) to assess depressive symptoms, and Short Form 36 (SF-36) to assess overall quality of life. SF-36 rates eight different parameters: physical function (PF), physical limitations (RP), physical pain (BP), general health (GH), vitality (VT), social function (RE), mental health (MH). Assessments were carried out at four, eight, and twelve weeks following treatment.

 

Summary
The total effective rate of the three groups was compared. The integrated acupuncture and moxibustion group had an 84.3% total effective rate, the paroxetine group had an 86% total effective rate, and the sham acupuncture and moxibustion group had a 42% total effective rate. The difference between the integrated group and paroxetine group was not statistically significant (P>0.05) and both were better than the sham acupuncture placebo control (P<0.001).

There were fewer adverse effects in the true acupuncture integrated group, with one case of a hematoma and four of blistering due to moxibustion. In the paroxetine group there were four cases of palpitations, seven of dry mouth, two cases of loss of appetite, four of dizziness, two of constipation, and one patient cut his finger (possibly due to dizziness caused by the drug). Paroxetine and acupuncture produced similar positive patient outcome rates and acupuncture had a significantly lower adverse effect rate. [1]

The results indicate that acupuncture is a reasonable treatment option for patients with mild to moderate depression. To learn more, please contact local therapists or licensed acupuncturists to learn more about treatment options.

 

Related Research
In related research, acupuncture was found effective for alleviating insomnia and depression. [2] Ye et al. find acupuncture 90% effective for improving total sleep duration and sleep quality for patients with depression. Alleviation of insomnia directly correlated to improvements in the mental and physical health of the study participants. Acupuncture treatments lowered relapse rates and produced similar clinical results as antidepressant medication without any adverse effects.

Two groups were compared: group one received acupuncture and group two received oral mirtazapine pills (an antidepressant medication). Acupuncture achieved a 90% total effective rate and mirtazapine achieved a 92.5% total effective rate. Insomnia due to depression (termed depressive insomnia in Traditional Chinese Medicine), is characterized by difficulty falling asleep, dream disturbed sleep, general insomnia, and severe emotional fluctuations. Additional symptoms include major depression, loss of appetite, fatigue, chest tightness, manic states, hypochondriac region pain, and excessive pessimism.

Hamilton Depression Rating Scale (HAM-D) results measured significant improvements in both the acupuncture and drug therapy study groups. The acupuncture group demonstrated a 9.7% HAM-D score improvement within one month of treatment and by 36.2% within three months. The drug group demonstrated a HAM-D score improvement of 15.9% within one month and 32.5% within three months. The acupuncture group achieved a 90% total effective rate and the drug therapy group achieved a 92.5% total effective rate.

Regarding study design, the drug therapy group received 20mg doses of mirtazapine tablets orally at a rate of once per day, for three months. The acupuncture group received acupuncture treatments every other day. An exception was made for extreme cases of depressive insomnia—these patients received acupuncture at a rate of once per day. Treatments were applied over a three month period.

Acupuncture group patients received an acupuncture point prescription comprised of a set of primary acupuncture points for all patients and a set of secondary acupuncture points for specific differential diagnostic conditions. The primary acupoints were the following:

  • Shenmen (HT7)
  • Sanyinjiao (SP6)
  • Yintang (MHN3)

For patients with liver qi stagnation, Taichong (LV3) and Yanglingquan (GB34) were added. For patients with heart and spleen related disorders, Zusanli (ST36) and Jianshi (PC5) were added. Manual acupuncture stimulation was applied to elicit deqi followed by a 30 minute needle retention time. During the needle retention period, manual needle stimulation was applied every 10 minutes using lifting and thrusting techniques for sedation and tonification. The researchers conclude that acupuncture significantly improves sleep time and quality while also improving the overall mental and physical health of patients. Acupuncture did not cause any adverse effects and significantly reduced the relapse rate for depressive insomnia.

 

Notes
[1] Wu Guanghai, Fu Wenbin. “Clinical Study on Improving the Quality of Life of Patients with Mild to Moderate Depression by Acupuncture and Moxibustion” Guangzhou University of Chinese Medicine, R246.6. (2017).
[2] Ye GC & Yan H. (2014). Therapeutic Observation of Acupuncture for Depressive Insomnia. Shanghai Journal of Acupuncture and Moxibustion. 55(6).

Source: HealthCMi

 

Acupuncture Found Effective for Obesity Reduction

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Acupuncture Found Effective for Obesity Reduction

 

Researchers 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.

Source: HealthCMi

Acupuncture Benefits Digestion, Stops Burning Pain

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Acupuncture Benefits Digestion, Stops Burning Pain

 

Hunan University of Chinese Medicine researchers find acupuncture effective for the treatment of functional dyspepsia (indigestion). Results from the investigation demonstrate that acupuncture is effective for alleviating upper abdominal pain and burning, nausea, and belching. In a semi-protocolized clinical trial, two primary acupuncture points were proven effective for the treatment of functional dyspepsia (abdominal discomfort or pain with no known organic cause identifiable with endoscopy).

Electroacupuncture and manual acupuncture techniques were used to obtain treatment success. The total effective rates were 91.3% for upper abdominal pain, 90.62% for postprandial excess fullness, 95.45% for premature fullness, 93.33% for upper abdominal burning sensations, 87.5% for postprandial nausea, and 83.33% for belching. [1] This is significantly greater than scores in the sham acupuncture control group, which were never greater than 42.86% for any parameter.

Primary Acupuncture Points
For patients in the acupuncture treatment group, two acupoints were applied to all patients: Zusanli (ST36), PC6 (Neiguan). The researchers commented on the point selection. Zusanli was selected for its location on the stomach foot yangming channel and its ability to treat all fu-organs (gallbladder, large intestine, small intestine, bladder, stomach, sanjiao). They add that Zusanli promotes the health of the spleen and stomach, dredges the channel, and regulates gastric tone and motility. [2] They note that Zusanli has been proven effective for patients with gastric motility disorders in prior research. Zusanli regulates gastric electrical rhythms relating to electrogastrographic power and gastric emptying time, secretion of gastrin and motilin, gastrointestinal hormones, and gastric acid (a combination of hydrochloric acid, potassium chloride, and sodium chloride). [3] The researchers also comment that Neiguan is indicated for relieving pain and for promoting qi circulation and stomach health.

Additional points were added for specific diagnostic considerations. For patients with excess syndrome, Taichong (LV3) and Neiting (ST44) were added. For patients with deficiency syndrome, Gongsun (SP4) and Yinlingquan (SP9) were added. The researchers commented on the traditional use of these acupoints. Taichong is a yuan-source point on the liver channel and promotes health of the liver and stomach. Taichong promotes qi circulation and alleviates pain of the hypochondrium region. Taichong is also useful for treating emesis (vomiting) and abdominal bloating. Neiting is a ying-spring point on the stomach foot yangming channel. Both Taichong and Neiting are acupoints indicated for clearing heat from the liver and stomach channels.

Gongsun is located on the spleen foot-taiyin channel and promotes qi and blood circulation in the spleen and stomach channels. Gongsun regulates gastric acid secretion and prevents its excess. Yinlingquan is located on the spleen foot-taiyin channel and promotes qi circulation. Both Gongsun and Yinlingquan revitalize the stomach and spleen while activating qi circulation.

Acupuncture Procedure
Acupuncture points were applied unilaterally and sides were alternated every acupuncture session. Huatuo brand disposable acupuncture needles were used. All points were manually stimulated with a mild reinforcing and attenuating technique to achieve deqi.

Electroacupuncture was applied with a disperse-dense setting and the frequencies alternated between 2 Hz and 100 Hz at a 0.1–1.0 mA amplitude (based on patient tolerance levels) to all needles. Total needle retention time was 30 minutes per each acupuncture session. Acupuncture was applied daily for a total of five acupuncture treatments comprising one course of care followed by a two day break. Four courses of treatment were administered to each patient.

For the treatment of upper abdominal pain, the true acupuncture group outperformed the control group by 56.93%. For postprandial excess fullness, the acupuncture group outperformed the control group by 55.33%. For premature fullness, the acupuncture group outperformed the control group by 57.36%. For upper abdominal burning, the acupuncture group outperformed the control group by 64.76%. For postprandial nausea, the acupuncture group outperformed the sham acupuncture control group by 47.5%. For belching, the acupuncture group outperformed the control group by 40.47%.

 

Gongsun (SP4) and Neiguan (PC6)
In related research, investigators find acupuncture more effective than the drug mosapride for the treatment of abdominal pain and discomfort due to indigestion. Specifically, acupuncture outperformed mosapride for the treatment of functional dyspepsia. [4] The results were confirmed by electrogastrogram and other instruments. The acupoints used in the study were Gongsun (SP4) and PC6 (Neiguan), a classic eight extra channels confluent point combination.

The combination of Gongsun and Neiguan “significantly relieved clinical symptoms such as abdominal distention and discomfort after eating, early satiety, upper abdominal pain, and upper abdominal burning sensation.” The researchers note that “acupuncture outperformed drugs in regulating EGG dominant frequency as well as slow wave frequency.” They add, “compared with the drug group, the acupuncture group showed a significant difference in FDDQL scores.” [5]

Manual acupuncture and electroacupuncture were administered. Patients rested in a supine position. Upon disinfection, a 0.30 mm × 40 mm acupuncture needle was inserted into each point, to a maximum depth of 25–40 mm. A mild tonifying and attenuating manual acupuncture manipulation technique was applied to achieve a deqi sensation. Next, electroacupuncture was applied with a disperse dense wave of 2–100 Hz (0.1–1.0 mA). Intensity level was set to patient tolerance levels or until muscle contractions were observable. Electroacupuncture was applied once per day, 30 minutes per acupuncture session, for a total of 30 days. For the control group, patients received 5 mg of mosapride citrate tablets, 30 minutes before meals. Tablets were orally administered three times per day, for a total of 30 days.

Patients were evaluated before and after treatment. First, improvements were recorded using a clinical scoring system. Next, a functional digestive disorders quality of life questionnaire (FDDQL) was recorded for each partient. Third, an electrogastrogram (EGG) was utilized to measure the electrical activity of the stomach (including EGG dominant frequency and slow wave frequency). The results indicate that acupuncture is both safe and effective for the treatment of functional dyspepsia and acupuncture is more effective than mosapride. [6]

Notes
[1] Li DD, Yue ZH, Chao XL, Xie T, Hu GZ, Yang J. (2014). Evaluation of Long Term Effect of Electro Acupuncture on Patients with Functional Dyspepsia. Journal of Clinical Acupuncture and Moxibustion. 30 (2).
[2] Feng GX, Zhu Y, Jiang FD. (2004). The efficacy of conventional and auricular Acupuncture in treating Functional Dyspepsia (35 cases). Journal of Modern Chinese Medicine. 36(1): 48-49.
[3] Li YY. The effect of acupuncture on gastric acid secretion. (1991). Chinese Journal of Digestion. (6): 358.
[4] Hong Feng. Observations on the Efficacy of Electroacupuncture at Points Gongsun and Neiguan in Treating Functional Dyspepsia[J]. Shanghai Journal of Acupuncture and Moxibustion, 2016.
[5] Ibid.
[6] Ibid.

Source: HealthCMi

Acupuncture Improves Knee Meniscus Repair

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Acupuncture Improves Knee Meniscus Repair

 

Researchers conclude that acupuncture increases the effectiveness of rehabilitation exercises after knee meniscus repair surgery. [1] Patients receiving acupuncture in a controlled clinical trial had less quadriceps atrophy, limping, locking, pain, and swelling than patients receiving only rehabilitation exercises. Patients receiving acupuncture also had significantly better range of motion, stability, and the ability to walk, jump, and climb stairs.

Researchers from the Third Affiliated Hospital of Nantong University combined acupuncture with functional training exercises. Patients receiving both functional training exercises and acupuncture in a combined treatment protocol had superior patient outcomes compared with patients receiving only functional training exercises. The researchers conclude that the addition of acupuncture to a functional training regimen improves VAS scores, reduces the degree of quadriceps atrophy, increases range of motion (ROM) scores, and improves the Lysholm Knee Scoring Scale scores for patients after arthroscopic meniscus repair surgery.

Each knee has a pair of menisci, which are fibrocartilaginous pads located between the femur and tibia. Each meniscus plays a vital role in absorbing shock, relieving stress, and lubricating and stabilizing the knees. Meniscus tears are often caused either by an acute injury—such as a sudden twist or quick turn during sporting activities, or by chronic strains—such as cartilage degeneration in primary knee osteoarthritis. An individual with a torn meniscus may take a long time to recover, because the blood supply to the region is generally poor. In addition, a lack of proper management of meniscus tears leads to joint pain and instability, quadriceps atrophy, and secondary knee osteoarthritis, causing a negative impact on health and quality of life.

Arthroscopic meniscus surgery requires postoperative protection to allow healing. [2] While often effective, complications caused by this surgery include injuries to skin and nerves, blood clot formation, knee stiffness, and infections. [3] In Traditional Chinese Medicine, meniscus tears are often precipitated by deficiency of qi and blood, as well as poor qi and blood circulation. Acupuncture and moxibustion activate local blood circulation, transform stasis, drain dirty water buildup, and eliminate swelling. Importantly, postoperative application of acupuncture allows for faster recovery times with fewer complications.

 

Design
Researchers (Sun et al.) used the following study design. A total of 70 patients that received an arthroscopic meniscus repair surgery were treated and evaluated in this study. They were randomly divided into an acupuncture treatment group and a control group, with 37 and 33 patients in each group respectively. Both groups received arthroscopic meniscus repair surgery, followed by identical functional training exercises for the knee. The treatment group also received acupuncture and moxibustion.

The statistical breakdown for each randomized group was as follows. The control group was comprised of 17 males and 16 females. The average age in the control group was 52.17 (±9.84) years. The average weight in the treatment group was 72.72 (±12.05) kilograms. The treatment group was comprised of 17 males and 20 females. The average age in the treatment group was 54.67 (±10.94) years. The average weight in the treatment group was 73.56 (±11.95) kilograms. There were no significant statistical differences in gender, age, and weight relevant to patient outcome measures for patients initially admitted to the study. The patients fulfilling the criteria as stated below were selected for the study:

  • Age＞18
  • A history of knee injuries
  • Swelling, pain, clicking, locking, and tenderness of knee joints, with positive findings on McMurray, Apley, and Gravity tests
  • Diagnosed with meniscus tears under MRI and arthroscopic findings

 

Surgical Procedure
Under anesthesia, patients underwent an arthroscopic procedure to remove inflamed synovial tissue, repair the torn portion of the meniscus, and remove the damaged meniscal tissue. Within 24 hours after surgery, the surgical area was compressed with an elastic wrap. Within 48 hours after surgery, ice packs were used to relieve pain and inflammation.

 

Functional Training Exercises
Patients from both groups received functional training exercises. They involved the following sets of exercises:

  • The first set was conducted for 6 hours, 1 day after surgery. Patients performed isometric quadriceps, ankle flexion/extension, and toe flexion/extension exercises. The exercises were performed in sets of 10 repetitions, 20 – 30 sets per day.
  • The second set was conducted 1 – 2 days after surgery. First, patients performed straight leg raising (SLR). They were instructed to lift the leg up to the desired angle (30 degrees) above the plinth and hold the contraction during the lifting phase for 10 seconds. This exercise was performed in sets of 10 repetitions, 20 – 30 sets per day. Next, patients received passive knee flexion/extension exercises for 30 minutes on a continuous passive motion (CPM) machine. The exercises were performed twice per day.
  • The third set was conducted for 2 days, 1 month after surgery. Patients performed muscle strength training with a rolling walker.
  • The fourth set was conducted 1 – 2 months after surgery. Patients were trained with full weight bearing walking.

 

Acupuncture Procedure
Patients from the treatment group received acupuncture and moxibustion for 7 days, approximately 2 weeks after the surgery. A total of 4 – 8 acupuncture points were selected from a pre-selected set of acupuncture points:

  • SP9 (Yinlingquan)
  • SP10 (Xuehai)
  • ST34 (Liangqiu)
  • ST35 (Dubi)
  • EX-LE4 (Neixiyan)
  • EX-LE5 (Xiyan)
  • ST36 (Zusanli)
  • ST40 (Fenglong)

Upon disinfection, 0.35 mm × 40 mm or 0.35 mm × 50 mm acupuncture needles were inserted into the acupuncture points to a standard depth. After obtaining a deqi sensation, the needles were retained and moxibustion was applied to the same acupoints. Moxa cigar cuttings, each 2 cm long, were attached to each needle handle and ignited. Moxa was left in place to self-extinguish. A total of 3 moxa cigar cuttings were applied on each acupuncture point. One treatment session was administered daily.

 

Evaluations
Multiple subjective and objective instruments were used to measure patient outcomes at several data points: prior to the surgery (T1), and then 1 day (T2), 1 week (T3), 2 weeks (T4), and 4 weeks (T5) after completion of the surgery. First, the improvement of pain intensity was scored using the visual analog scale (VAS). Second, the muscle size was measured via MRI scans to assess the degree of quadriceps muscle atrophy. Third, knee joint range of motion (ROM) was recorded using a goniometer. Fourth, the general outcome of knee surgery was evaluated using the Lysholm Knee Scoring Scale, which measures the following:

  • limp
  • support, instability, locking
  • stair climbing, squatting
  • walking, running, jumping
  • pain and swelling

At T1, T2, and T3, there was no significant difference between the two groups in improving healing parameters. At T4 and T5, the acupuncture treatment group showed significantly greater improvement than the control group. VAS scores at T4 and T5 in the patients of the acupuncture treatment group were all lower than those in the control group (P<0.05). The degree of quadriceps atrophy at T4 and T5 in the treatment group were decreased significantly as compared with those in the control group (P<0.05). ROM scores were increased significantly compared with those in the control group (P<0.05) and the Lysholm Knee Scoring Scale scores at T4 and T5 in the treatment group increased significantly as compared with those in the control group (P<0.05).

 

Results
The results indicate that acupuncture combined with functional training into an integrated treatment protocol is more effective than functional training as a standalone therapy. Sun et al. conclude that acupuncture is safe and effective for speeding up knee joint recovery after arthroscopic meniscus repair surgery.

 

Notes
[1] Sun XX, Gao SN, Chen WY, Wang H, Gu YL. Effect of the Function Training Combined with Acupuncture Moxibustion in Rehabilitation Treatment of Meniscus Injury of Knee Joint [J]. Journal of Liaoning University of TCM, 2015(12):165-168.

[2] orthop.washington.edu

[3] Ardali G. A daily adjustable progressive resistance exercise protocol and functional training to increase quadriceps muscle strength and functional performance in an elderly homebound patient following a total knee arthroplasty[J]. Physiotherapy theory and practice, 2014, 30(4): 287-297.

Source: HealthCMi

Acupuncture Relief of Nasal Allergies Confirmed

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Acupuncture Relief Of Nasal Allergies Confirmed

 

Acupuncture soothes nasal allergy symptoms. Investigators at Beijing University of Traditional Chinese Medicine Affiliated Hospital conducted a meta-analysis of 30 independent clinical trials with a sample size of 2,602 allergic rhinitis patients. [1] The researchers (Tang et al.) conclude, “Acupuncture, either used alone or combined with other treatments such as moxibustion, herbal medicine, and western medicine, were proven to have both short and long-term clinical benefits to allergic rhinitis sufferers.” The following is a basic overview of common acupuncture points used for the treatment of allergic rhinitis across the multiple studies in the meta-analysis:

  • LI20 (Yingxiang
  • Yintang (extra)
  • LI4 (Hegu
  • ST36 (Zusanli)
  • EX-HN8 (Shangyingxiang, Bitong)

Allergic rhinitis (AR) is an inflammatory disorder of the nasal mucosa induced by allergen exposure that triggers IgE (immunoglobulin E) mediated inflammation. [2] In the USA, approximately 40–60 million people suffer from allergic rhinitis. [3] AR is clinically characterized by rhinorrhea (thin and primarily clear nasal discharge), sneezing, nasal itching, and nasal congestion. AR is also associated with decreased concentration and focus, irritability, sleep disturbances, and fatigue. This impacts the quality of life and reduces work productivity. In addition, there is a high risk of developing asthma for AR patients. [4] Common medications for the treatment of allergic rhinitis include intranasal corticosteroids, oral H1-antihistamines, and leukotriene receptor antagonists (LTRAs). While effective, these medications often produce adverse effects and may be contraindicated during pregnancy and for children, the elderly, and patients with specific medical conditions. [5]

The following are clinical details of the meta-analysis. A total of 27 out of 30 studies made extensive use of the Yingxiang point. This point is anatomically located on the nasolabial groove, at the midpoint of the lateral border of the ala nasi. This acupuncture point is located on the hand Yangming large intestine meridian. It is also the crossing point of the stomach and the large intestine meridians. Needling this point smooths the flow of qi in the meridians and clears obstructions from the nasal orifice.

This point is traditionally indicated for Bi Yuan (nasal congestion), Bi Qiu (sniveling nose), and Bi Niu (nosebleed). According to Traditional Chinese Medicine principles, the lungs and large intestine have an interior-exterior relationship (i.e., the lungs and large intestine are functionally interconnected). As a result, diseases of the lungs can be treated by needling acupuncture points on either the lung meridian or the large intestine meridian.

A total of 23 studies document use of the Yintang point. This acupoint is located between the two medial ends of the eyebrows in the glabella. Yintang plays a key role in “opening the orifices and regulating the spirit.” Needling this point promotes qi and blood circulation of the head and also stabilizes the mind and spirit. A total of 17 studies used the Hegu point. Hegu is the Yuan-source point of the hand Yangming large intestine meridian. Needling this point disperses obstructions in the Yangming meridian and regulates the lung qi.

A total of 14 studies used Zusanli. Zusanli is the He-confluence point of the foot Yangming stomach meridian, which starts at the side of the nose. The stomach meridian of foot yangming primary channel begins at the side of the nose at Yingxiang (LI20) and then ascends to the root of the nose where it intersects with Jingming (BL1). Zusanli activates local qi and blood circulation and removes local obstructions affecting the meridians. Needling this point also regulates the stomach, intestines, and lungs for purposes of strengthening the internal organs related to allergic rhinitis. A total of 11 studies used Shangyingxiang (also known as Bitong). Needling this point promotes local qi and blood circulation and relieves nasal congestion. This acupoint is located near the upper end of the nasolabial groove, at the junction of the maxilla and the nasal cavity.

The researchers conclude that acupuncture provides both long and short term relief as a standalone therapy, in combination with other Chinese medicine treatment modalities, and in combination with medications. Other independent sources indicate that acupuncture is effective for the alleviation of allergic rhinitis. The National Institutes of Health (NIH, USA) website covering the topic of seasonal allergies and complementary medicine states, “There are data from some randomized controlled trials that suggests that acupuncture may improve some symptoms of allergic rhinitis, as well as quality of life.” The NIH website notes that a clinical practice guideline issued by the American Academy of Otolaryngology states, “Clinicians may offer acupuncture, or refer to a clinician who can offer acupuncture, for patients with allergic rhinitis who are interested in nonpharmacologic therapy.” [7]

The NIH website references a meta-analysis with a sample size of 2,365 allergic rhinitis patients, “compared with a control group, the acupuncture treatment group had a significant reduction in nasal symptom scores, medication scores, and serum IgE, and an increase in quality of life scores.” [8,9] In addition, the NIH website notes that “there are high-quality randomized controlled trials that demonstrate efficacy for acupuncture in the treatment of both seasonal and perennial allergic rhinitis….” [10]

Scientific investigations confirm that acupuncture is a reasonable treatment option for patients with allergic rhinitis. To learn more, consult with your primary licensed acupuncturist or licensed acupuncturists in your area.

Notes
[1] Qu SH, Liu YX. Systematic Review and Meta-analysis of the Randomized Controlled Trial of Acupuncture for Allergic Rhinitis [J]. World Journal of Integrated Traditional and Western Medicine, 2016,11(07):900-906+948.

[2] Varshney J, Varshney H. Allergic Rhinitis: an Overview [J]. Indian J Otolaryngol Head Neck Surg. 2015 Jun; 67(2): 143–149.

[3] acaai.org/allergies/types/hay-fever-rhinitis

[4] Palma-Carlos AG1, Branco-Ferreira M, Palma-Carlos ML. Allergic rhinitis and asthma: more similarities than differences [J]. Allerg Immunol (Paris). 2001 Jun;33(6):237-41.

[5] ncbi.nlm.nih.gov/pubmedhealth/PMH0072670/

[6] Xia J, Peng D. Acupuncture Combined with Herbal Medicine for Treatment of Allergic Rhinitis and Its Effectiveness on Downregulating Ig E、TNF-α、IL-4 and IL-12 [J]. International Journal of Laboratory Medicine, 2018,39(03):374-377.

[7] nccih.nih.gov/health/providers/digest/allergies-science. documented 4-25-18.

[8] Ibid.

[9] Feng, Shaoyan, Miaomiao Han, Yunping Fan, Guangwei Yang, Zhenpeng Liao, Wei Liao, and Huabin Li. “Acupuncture for the treatment of allergic rhinitis: a systematic review and meta-analysis.” American journal of rhinology & allergy 29, no. 1 (2015): 57-62.

[10] Taw, Malcolm B., William D. Reddy, Folashade S. Omole, and Michael D. Seidman. “Acupuncture and allergic rhinitis.” Current opinion in otolaryngology & head and neck surgery 23, no. 3 (2015): 216-220. Authors: UCLA Center for East-West Medicine, UCLA (University of California, Los Angeles) Department of Medicine, David Geffen School of Medicine at UCLA bIntegrative Healthcare Policy Consortium, Pinecrest Wellness Center cDepartment of Family Medicine, Morehouse School of Medicine dDepartment of Otolaryngology – Head and Neck Surgery, Henry Ford Health System, Michigan.

Source: HealthCMi

Acupuncture Relieves Asthma Attacks

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Acupuncture Relieves Asthma Attacks

 

Researchers find acupuncture effective for relieving allergic asthma, a type of asthma triggered by allergens (e.g., dust mites, mold, pollen, foods). Symptoms include wheezing, difficulty breathing, itchy eyes, sinusitis, rhinitis, a general feeling of malaise, and sneezing. In a randomized controlled trial of 1,445 patients, acupuncture provided lasting relief for six months.

Acupuncture was provided for a maximum of 15 treatments over a three month period. Patients receiving acupuncture demonstrated significant relief from allergic asthma at all data points, including the six month post-treatment follow-up data point. Only manual acupuncture was administered. Laser acupuncture, electroacupuncture, and moxibustion were not permitted for the purposes of eliminating variables in the investigation. Healthcare costs for acupuncture treatment were covered by a cooperative agreement between insurance companies and the university researchers conducting the study.

Patients receiving acupuncture had marked reductions of allergic asthma during strenuous and moderate exercise, work and social activities, and during sleep. The overall quality of life scores for patients receiving acupuncture were significantly higher than patients in the control group receiving no acupuncture.

All patients were allowed usual care and acupuncture was an additional treatment modality for patients in the the acupuncture groups. The researchers note, “study results reveal that the use of acupuncture as adjunct to the routine care of allergic bronchial asthma was superior to routine care alone in improving both specific symptoms and general quality of life.” [1] Secondary outcome measures document that patients were satisfied with acupuncture treatment results.

The study allowed for real life clinical applications of acupuncture, except for the limitation to manual acupuncture. The acupuncture point prescriptions, including the number of acupoints used, were individualized for each patient. This differs from many research designs wherein a primary acupuncture point prescription is designated for all patients. Secondary acupuncture points are often allowed for specific medical considerations. In this study, the researchers allowed for complete customization of all acupuncture points based upon clinical presentations with no limitations to primary and secondary acupoint protocols.

The researchers note that after the three months of acupuncture treatments, patients had significant improvements in global quality of life scores and individual parameters such as symptoms, activities, emotions, physicality, and mental function. An important finding, the durability of acupuncture was confirmed by a six month follow-up. Despite not having any acupuncture for three months following the completion of the study’s treatment regimen, the six month data point measured improvements “comparable to the 3 months’ improvements.”

The researchers note, “In this pragmatic randomized trial, allergic asthma patients treated with acupuncture in addition to routine care showed clinically significant improvements in disease specific and general quality of life compared to patients who received routine care alone.” [2] The researchers indicate that the findings demonstrate that acupuncture is safe, effective, and is an appropriate referral recommendation. The researchers note, “This study provides further evidence for the safety of acupuncture as an intervention. This conclusion is consistent with findings in large, previously published surveys and trials.”

The researchers were from Charité – Universitätsmedizin Berlin, Universität Freiburg, and University of Zurich. They provided basic statistics on the prevalence of asthma. Incidence varies between countries, with a range of 4–32%. They add that corticosteroids are standard in usual care. They note that in China, “herbal medicine and acupuncture have traditionally been utilized in the treatment of lung disease, including asthma.” In addition, “A reasonable estimate is that about 30% of adults and 60% of children in the U.S. use some form of complementary and integrative medicine (CIM) therapy for their asthma.”

Research from Anyang General Hospital confirms the results of the aforementioned European research. [3] Acupuncture was determined safe and effective as an adjunct to usual care for the treatment of asthma. In the two week study, patients receiving only drug therapy were compared with patients receiving treatment with both drug therapy and acupuncture. The data indicates that acupuncture greatly improves treatment outcomes. [4]

The acupuncture treatment and drugs-only groups received drug therapy with beclometasone dipropionate and theophylline. Beclometasone dipropionate (a steroid) was provided in the form of an inhaler, 250 µg each dose, one time per day. Theophylline (a bronchodilator) was taken once per day in the from of 0.2 gram sustained-release tablets.

Acupuncture was applied twice per day if an acute asthma attack occurred and only once per day otherwise. Total treatment time for all patients was 14 days. The following acupuncture points were administered to patients in the acupuncture group:

  • Feishu (BL13)
  • Yuji (LU10)
  • Lieque (LU7)
  • Dingchuan (MBW1)
  • Dazhui (GV14)

The following secondary acupoints were applied, varying for each patient according to Traditional Chinese Medicine (TCM) differential diagnostics:

  • Ashi points
  • Neiguan (PC6)
  • Shanzhong (CV17)
  • Fengmen (BL12)

Yuji (LU10) was inserted first to an insertion depth of 0.5–1 cun. The needle was manipulated with strong attenuation techniques and was retained for 25 minutes. During retention, the needle was manipulated every five minutes. Feishu (BL13) and Dazhui (GV14) received standard insertion with equal reinforcement and attention techniques with lifting, thrusting, and rotating. Feishu (BL13) and Dazhui (GV14) were retained for 15 minutes, followed by cupping or warm needle acupuncture. For the remaining acupoints, the needles were manipulated with attenuation techniques (moderate to strong stimulation) and were then retained for 25 minutes. The results demonstrate that acupuncture provides significant relief from asthma when added to a usual care regimen.

In a separate investigation, an examination of Taiwan’s Bureau of National Health Insurance (BNHI) records yielded a sample size of 12,580 asthmatic children. Children with asthma receiving a combination of acupuncture, herbal medicine and drug therapy have superior patient outcomes, less visits to emergency rooms, and fewer hospitalizations than children receiving only drug therapy. In a 15 multi-hospital five year study, Traditional Chinese Medicine (acupuncture, herbal medicine, Chinese Tuina massage, herbal pastes) was combined with pharmaceutical drugs including inhaled bronchodilators and steroids in the study protocol.

The integrative medicine approach (TCM plus drug therapy) produced an astonishing result. Not a single child receiving integrative medicine during the study required an emergency room (ER) visit or hospitalization. The superior clinical outcomes and reduction of medical emergencies indicates that integrating TCM into conventional protocols benefits children with asthma. [5] The BNHI paid for all medical visits and examined the cost-effectiveness of combining TCM therapies with drug therapy. It was found that there is an additional upfront cost to provide TCM therapies but there is a savings on the backend in reduced emergency room visits and hospitalizations. [6]

Notes
[1] Brinkhaus, Benno, Stephanie Roll, Susanne Jena, Katja Icke, Daniela Adam, Sylvia Binting, Fabian Lotz, Stefan N. Willich, and Claudia M. Witt. “Acupuncture in patients with allergic asthma: a randomized pragmatic trial.” The Journal of Alternative and Complementary Medicine 23, no. 4 (2017): 268-277.
[2] Ibid.
[3] Wu JH. Effective observation on treating 68 cases of bronchial asthma by acupuncture plus medicine [J]. Clinical Journal of Chinese Medicine, 2016, 8(13): 109-111.
[4] Ibid.
[5] Hung, Yu-Chiang, I-Ling Hung, Mao-Feng Sun, Chih-Hsin Muo, Bei-Yu Wu, Ying-Jung Tseng, and Wen-Long Hu. “Integrated traditional Chinese medicine for childhood asthma in Taiwan: a Nationwide cohort study.” BMC complementary and alternative medicine 14, no. 1 (2014): 389.
[6] Ibid.

Source: HealthCMi

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