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Acupuncture Beats Drugs for Prostatitis

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Acupuncture Beats Drugs For Prostatitis

 

Acupuncture outperforms drugs for the treatment of chronic prostatitis. Researchers from the First Affiliated Hospital of Chongqing Medical University gathered objective and subjective data in a controlled clinical trial consisting of patients with chronic prostatitis. The acupuncture treatment group achieved a total effective rate of 87.5% and the drug control group achieved a total effective rate of 62.5%.

National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) scores indicate that acupuncture produces significant improvements in pain or discomfort intensity levels, urinary symptoms, and quality of life scores. Urethral sphincter electromyography uroflow rates show that acupuncture restores urethral sphincter and pelvic floor muscle function. The researchers conclude that acupuncture significantly outperforms drugs for the treatment of chronic prostatitis. [1]

 

Design
Researchers (Zhang et al.) used the following study design. A total of 48 patients were treated and evaluated in this study. All patients were diagnosed with chronic prostatitis. They were randomly divided into an acupuncture treatment group and a drug control group, with 24 patients in each group. Patients from the control group consumed one tablet each of sparfloxacin and Prostat tablets, twice a day, for a total of 4 weeks. Sparfloxacin is a fluoroquinolone antibiotic used for patients with bacterial infections. Prostat contains pollen extract EA-10 and P5 and is used in the treatment of benign prostatic hyperplasia and chronic prostatitis. The treatment group received electroacupuncture monotherapy. The diagnostic criteria included the following:

Symptoms (perineal and lumbosacral pain, abnormal urination) lasting for more than 3 months
Hard, tender, and normal sized/enlarged prostate found by the digital rectal exam
Positive or negative results for urine and prostatic secretion tests
NIH-CPSI scores ≥ 10

 

Acupuncture Points
Patients from the treatment group received acupuncture at the following primary acupoints:

  • CV4 (Guanyuan)
  • 
CV3 (Zhongji)
  • 
BL32 (Ciliao)
  • 
BL35 (Huiyang)

Additional secondary acupoints were added based on differential diagnostic considerations:

  • Qi and blood stagnation: LV3 (Taichong), SP10 (Xuehai), SP6 (Sanyinjiao)
  • Damp-heat pouring downward: LV3 (Taichong), ST40 (Fenglong), SP9 (Yinlingquan)

  • Fire excess due to yin deficiency: KI3 (Taixi), BL23 (Shenshu), SP6 (Sanyinjiao)

  • Kidney yang deficiency: BL23 (Shenshu), CV6 (Qihai), ST36 (Zusanli)

Upon disinfection of the acupoint sites, a 0.30 mm × 50 mm filiform acupuncture needle was inserted into each acupoint to a depth of 25-35 mm. Needles were rotated, lifted, and thrust rapidly after insertion to achieve a deqi sensation. For Guanyuan, Zhongji, Ciliao, and Huiyang, a deqi sensation radiating toward the perineum, penis, and testicles was noted by the researchers as producing better clinical outcomes. It is written in the Ling Shu (The Miraculous Pivot) that “A deqi sensation in the lesion area ensures the effectiveness of acupuncture.”

The acupuncture needles were attached to an electroacupuncture device. A continuous wave (1 Hz) was applied with an intensity level set to patient tolerance levels or until muscle contractions were observable. A 30 minute needle retention time was observed, timed from the initiation of electroacupuncture current. Electroacupuncture was applied once per day. Each treatment course consisted of 8 acupuncture treatments followed by a two-day break before the next course began. All patients received a total of 3 treatment courses.

 

Scoring
NIH-CPSI scores, changes in urethral sphincter electromyography determined uroflow rates, and total efficacy rates were measured before and after treatment. NIH-CPSI is a measurement instrument used to assess symptom severity in patients with chronic prostatitis. NIH-CPSI measures three different aspects including pain, urinary symptoms, and quality of life. Higher scores in NIH-CPSI assessment denote a more severe condition.

The urethral sphincter electromyography determined uroflow rate is a non-invasive test used to assess sphincter and pelvic floor muscle function, including measurements of maximum urine flow rates (Qmax), average urine flow rates (Qave), and TL value. TL value is a derived parameter from urethral sphincter EMG used to measure the degree of detrusor-sphincter synergia. [2] TL quantifies coordination of the detrusor and sphincter; “In normal humans, the bladder is supposed to empty by a synergistic contraction of the detrusor and relaxation of the sphincter during micturition.” [3] If both contract simultaneously, it is termed detrusor-sphincter dyssynergia. After completion of treatment, the efficacy rate for each patient was categorized into 1 of 3 tiers:

  • Recovery: Complete absence of symptoms. NIH-CPSI scoring reduction of at least 2/3.
  • Normal Qmax, Qave, and TL value.
  • 
Effective: Improvement of symptoms. NIH-CPSI scoring reduction of 1/3 to 2/3. Improvement of Qmax, Qave, and TL value.
  • 
Ineffective: No improvement of symptoms. NIH-CPSI scoring reduction of less than 1/3. No improvement of Qmax, Qave, and TL value.

 

Basis
The researchers provided a historical context for the acupuncture point selection administered during the investigation. Guanyuan and Zhongji are located on the Ren meridian. Needling Guanyuan reinforces the kidneys and strengthens yang energy. Guanyuan is indicated for seminal emission, impotence, inhibited urination, frequent urination, lower abdominal pain, and white turbidity of urine. According to the Qian Jin Yao Fang (A Thousand Gold Pieces Formulary), Zhongji is indicated for lower back pain, inhibited urination, impotence, premature ejaculation, and white turbidity of urine. Ciliao and Huiyang are located on the foot Taiyang bladder meridian. Ciliao is indicated for lower back pain, strangury (blockage or irritation of the bladder resulting in pain or urgent urination), and red urine. Needling Huiyang resolves dampness, clears heat, replenishes essence, and benefits the kidneys.

 

Summary
Subjective clinical and objective electromyography data indicate that acupuncture outperforms drugs for the treatment of chronic prostatitis. According to the research, common protocols involve the application of acupoints Guanyuan (CV4), Zhongji (CV3), Ciliao (BL32), and Huiyang (BL35) for this condition. Patients interested in learning more about acupuncture are recommended to contact a local licensed acupuncturist.

 

Prostatis vs. Benign Prostatic Hyperplasia (BPH)
Prostatitis is a term referring to prostate inflammation, usually caused by injury or infection. Bacterial infections in the blood (bacteremia) may cause prostatitis. Inflammation of the epididymis (epididymitis) may also cause prostatitis. The epididymis is a duct posterior to the testis that sperm passes through. Risk factors include catheterization, prostate biopsy, and pelvic trauma. Dysuria (painful or difficult urination), frequent urination, nocturia, urgent urination, hematuria (blood in the urine), painful ejaculation, and pain in the groin, penis, or testicles are all symptoms associated with prostatitis. Benign prostatic hyperplasia (BPH) is a different condition wherein the prostate becomes enlarged. It usually occurs as a result of aging. The aforementioned research applies to prostatitis.

 

References
[1] Zhang J, Liu CD, Ding Y, Tang QB. Clinical Observation on Therapeutic Effect of Electroacupuncture on Chronic Prostatitis and Detection of Urethral Sphincter EMG [J]. Chinese Acupuncture & Moxibustion, 2010,30(1):13-17.
[2] Qu CY, Xu DF, Wang CZ, Chen J, Yin L, Cui XA. Anal Sphincter Electromyogram for Dysfunction of Lower Urinary Tract and Pelvic Floor. 2017.
[3] Chang, Shyang, Shu-Ting Mao, Shih-Jen Hu, Wen-Ching Lin, and Chen-Li Cheng. “Studies of detrusor-sphincter synergia and dyssynergia during micturition in rats via fractional Brownian motion.” IEEE transactions on biomedical engineering 47, no. 8 (2000): 1066-1073.

Source: HealthCMi

Acupuncture Low Back Disc Protrusion CT Scan Results

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Acupuncture Low Back Disc Protrusion CT Scan Results

 

Acupuncture is effective for patients with lumbar disc protrusions. CT scans confirm that acupuncture reduces disc protrusion size and increases healthy space in the spinal canal. Along with relief from nerve compression, investigators conclude that acupuncture improves range of motion and reduces pain for patients with lumbar disc protrusions.

Researchers from the Nanyang Municipal Central Hospital tested two acupoint prescriptions. The results of the investigation demonstrate that both acupuncture point prescriptions that were tested are effective for alleviating lumbar disc protrusions, but one is more effective than the other. We will take a look at both. CT (computed tomography) scans confirm the results, including improvements across multiple parameters (i.e., anteroposterior diameter of the thecal sac, sagittal diameter of the spinal canal, nerve root compression ratio). [1]

Patients were evaluated before and after the treatment course. Both subjective and objective instruments were used to measure patient outcomes. The objective data was gathered using CT scans (also known as CAT scans), which are computer-processed X-ray images. The scans demonstrate that acupuncture reduces disc protrusions and alleviates nerve compression. CT images confirmed improvements in the thecal sac anteroposterior diameter and sagittal diameter of the spinal canal as well as the nerve root compression ratio.

Subjective data was gathered with two instruments. First, the Oswestry Disability Index (ODI) was used to measure functional disability of the lower back. Second, the Japanese Orthopedic Association Lower Back Pain Evaluation Questionnaire (JOABPEQ) was used as an outcome measure for patients with lumbar disc protrusions. Patients demonstrated improvements with both the ODI and JOABPEQ.

 

Symptoms
The following are results of the ODI and JOABPEQ for two separate groups receiving two different acupuncture treatment point prescriptions. The ODI score for the standard acupuncture control group averaged 23.35 before treatment and 8.34 after treatment. The ODI score for the acupuncture Yao San Zhen (lumbar three needles) treatment group averaged 23.12 before treatment and 5.28 after treatment.

The JOABPEQ score for the standard acupuncture control group was 6.22 before treatment and averaged 17.14 after treatment. The JOABPEQ score for the acupuncture Yao San Zhen (lumbar three needles) treatment group averaged 6.35 before treatment and 21.53 after treatment. The researchers conclude that the Yao San Zhen treatment group outperformed the standard acupuncture control group regarding the improvements of ODI and JOABPEQ scores.

 

CT Scans
The thecal sac (dural sac) is a sheath around the spinal cord (above L2) and cauda equina. It is composed of dura mater, which is a thick connective tissue membrane. The anteroposterior diameter of the thecal sac for the standard acupuncture control group decreased to an average of 35.72 mm after treatment, from a pre-treatment value of 56.44 mm. The anteroposterior diameter for the Yao San Zhen acupuncture treatment group averaged 56.35 mm before treatment and 26.14 mm after treatment. These measurements indicate a decrease in the size of the disc protrusions.

The sagittal diameter of the spinal canal for the standard acupuncture control group averaged 6.32 mm before treatment and 11.16 mm after treatment. The sagittal diameter for the Yao San Zhen acupuncture treatment group was 6.51 mm before treatment and 14.24 mm after treatment. This parameter is negatively associated with lumbar pain and the improvements are reflected by higher numbers. The Yao San Zhen style of acupuncture outperformed the standard acupuncture protocol.

The nerve root compression ratio for the standard acupuncture control group averaged 0.64 before treatment and 0.48 after treatment. The nerve root compression ratio for the treatment group averaged 0.67 before treatment and 0.32 after treatment. Both groups achieved significant improvements in CT measured parameters. Overall, the improvements were greater for the Yao San Zhen acupuncture treatment group.

 

Correlation Between ODI and CT
Correlation between ODI and CT parameters (anteroposterior thecal sac diameter, sagittal spinal canal diameter, nerve root compression ratio) for two groups were analyzed. The results showed that the anteroposterior diameter and nerve root compression ratio were positively correlated with ODI scores, while the sagittal diameter of was negatively correlated with ODI scores. The researchers concluded that, “In patients with lumbar disc protrusion, the more severe the nerve root compression, the narrower the sagittal diameter on the CT, and the larger the anteroposterior diameter of the thecal sac, the more serious the clinical symptoms.”

 

Design
A total of 78 patients participated in the study. They were diagnosed and treated for lumbar disc protrusions between January 2016 and January 2017. The following inclusion criteria were applied:

  • Meeting the diagnostic criteria for both western medicine and Traditional Chinese Medicine
  • Ages between 20–50 years
  • Pain in the lower back and lower extremities
  • Confirmed lumbar protrusions by CT or MRI
  • Positive straight leg raise (SLR) test

The following exclusion criteria were applied:

  • Comorbid tumors, lumbar vertebral spondylolisthesis, spinal stenosis, and spinal compression fractures
  • Severe and comorbid blood diseases and coagulation disorders
  • Pregnant or lactating
  • Neurological or mental diseases

Participants were randomly divided into two groups: Yao San Zhen treatment and standard acupuncture control, with 39 participants in each group. Both groups were equivalent in all relevant demographics. The treatment group was comprised of 26 males and 13 females. The average age of the Yao San Zhen treatment group was 39.21 years. The course of treatment of the Yao San Zhen treatment group was 3.53 months. The control group was comprised of 24 males and 15 females. The average age of the treatment group was 38.37 years. The course of treatment of the treatment group was 3.32 months.

 

Acupuncture Sessions
Patients from both groups received the following acupuncture points:

  • Huatuojiaji
  • GB30 (Huantiao) affected side
  • BL54 (Zhibian) affected side
  • Ashi points

Secondary acupuncture points were added bilaterally based on diagnostic considerations:

  • Lower back pain due to cold-dampness: BL39 (Weiyang), GV3 (Yaoyangguan)
  • Lower back pain due to damp-heat: GB34 (Yanglingquan), SP6 (Sanyinjiao)
  • Lower back pain due to blood stasis: SP10 (Xuehai), BL17 (Geshu)
  • Lower back pain due to kidney deficiency: KD3 (Taixi), GV4 (Mingmen)

Acupuncture treatments commenced with patients in a prone position. After disinfection of the acupoint sites, a 40 or 75 mm disposable filiform needle was inserted into each acupoint with a high needle entry speed, reaching a depth of 1–1.5 cun (with the exception of 2–3 cun for Huantiao). After achieving a deqi sensation, the needles were manipulated with the Ping Bu Ping Xie (attenuating and tonifying) technique.

The acupuncture needles were connected to an electroacupuncture device. A low frequency continuous wave (5–10 Hz) was applied with an intensity level set to patient tolerance levels or until muscle contractions were observable. The needles were retained for 30 minutes after the initiation of electric current.

For the treatment group patients, a special acupoint prescription called Yao San Zhen (lumbar three needles) of Jin’s three needling technique was added. This technique was established by Dr. Jin Rui, Ph.D. (chief professor supervisor of Guangzhou University of Traditional Chinese Medicine). The principle of the technique is to use three needle combinations to treat specific diseases. The Yao San Zhen prescription utilized the following acupoints:

  • BL23 (Shenshu)
  • BL25 (Dachangshu)
  • BL40 (Weizhong)

Needles were inserted into each acupoint with a high needle entry speed, reaching a maximum depth of 1–1.5 cun. Upon the arrival of a deqi sensation, the needles were manipulated with the Ping Bu Ping Xie (attenuating and tonifying) technique. A 30 minute needle retention time was observed. For both groups, treatments were applied every two days, 10 sessions as one treatment course, for a total of 8 weeks.

 

Summary
The clinical results demonstrate that acupuncture produces positive patient outcomes for the treatment of lumbar disc protrusions. Patients that received acupuncture saw improvements in ODI and JOABPEQ scores and parameters measured by CT (i.e., anteroposterior diameter of the thecal sac, sagittal diameter of the spinal canal, nerve root compression ratio). The data indicates that acupuncture is safe and effective for the treatment of lumbar disc protrusions.

 

Reference
[1] Fang F, Wei YX. Clinical observation on lumbar three needles in the treatment of lumbar disc protrusion and imaging changes [J]. World Chinese Medicine, 2018(5).

Source: HealthCMi

 

Acupuncture Fights Influenza

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Acupuncture Fights Influenza, Decreases Mortality Rate

 

Acupuncture is effective for the treatment of influenza. Two independent investigations confirm acupuncture’s efficacy for fighting influenza. One laboratory investigation tested acupuncture as a monotherapy and determined that acupuncture lowers mortality rates, increases serum interferon levels, and improves the phagocytosis of viruses. Another investigation finds acupuncture effective for enhancing the clinical efficaciousness of anti-viral drugs. Let’s start with the integrative investigation and we’ll look at the acupuncture monotherapy next.

Researchers from the Taizhou Municipal Hospital combined acupuncture with standard drug therapy. Patients receiving both oseltamivir and acupuncture in a combined treatment protocol had superior patient outcomes compared with patients receiving only oseltamivir. [1] In an independent laboratory experiment, the researchers proved that acupuncture exerts an antiviral effect by increasing the serum level of interferon (IFN) and improves phagocyte function in rats with influenza virus infections. [2]

The research team of Lang et al. compared a control group receiving only oseltamivir (an antiviral drug, also known by the brand-name Tamiflu) and a treatment group receiving both acupuncture and oseltamivir. The treatment group patients had significantly shorter recovery times for relieving fever, pharyngodynia (pharynx pain), and coughing. The researchers conclude that the addition of acupuncture to an oseltamivir treatment regimen increases the effective rate of oseltamivir for the treatment of influenza. Furthermore, the researchers conclude that acupuncture is both effective and safe; acupuncture did not produce any severe adverse effects.

 

Results
Following treatment, the average recovery time from fever was 63.80 hours in the drug monotherapy control group and 57.05 hours in the acupuncture plus drug treatment group. On average, acupuncture reduced fevers by 6.75 hours.

The average recovery time from pharyngodynia was 80.35 hours in the control group and 71.25 hours in the treatment group. Acupuncture improved the pharynx pain recovery time by 9.1 hours.

The average recovery time from coughing and other symptoms was 115.20 hours in the drug monotherapy control group and 104.70 hours in the acupuncture plus drug treatment group; acupuncture produced an improvement of 10.5 hours. The recovery time refers to the time it takes to completely relieve symptoms (including body temperature ≤37.4 degrees Celsius) for at least 24 hours from the start of treatment. The results showed that acupuncture significantly increases the total effective rate of oseltamivir and the combined therapy shortens the development course of H1N1 influenza.

 

Design
Researchers (Lang et al.) used the following study design. A total of 80 patients diagnosed with H1N1 influenza were treated and evaluated They were randomly divided into an acupuncture plus drug treatment group and a drug monotherapy control group, with 40 patients in each group. Inclusion criteria were established and included the following:

  • H1N1 influenza diagnosis
  • Body temperature ≥38 degrees Celsius
  • At least two indicative symptoms (e.g., sore throat, coughing)

The statistical breakdown for each randomized group entering the study was as follows. The control group was comprised of 22 males and 18 females. The average age in the control group was 22.55 years. The average course of disease in the control group was 21.73 hours. The body temperature in the control group was 38.59. The treatment group was comprised of 19 males and 21 females. The average age in the treatment group was 24.05 years. The average course of disease in the treatment group was 20.89 hours. The body temperature in the treatment group was 38.71. There were no significant statistical differences in gender, age, course of disease, and body temperature relevant to patient outcome measures for patients initially admitted to the study.

 

Treatment Procedure
Both groups were given identical drug therapy. A total of 75 mg of oseltamivir was administered twice daily, for a total of 5 days as one treatment course. Symptomatic treatment (antipyretic analgesics, antitussives, or expectorants) were also given if necessary.

The treatment group received acupuncture treatment. The following primary acupoints were selected bilaterally for the treatment group:

  • LI11 (Quchi)
  • TB5 (Waiguan)
  • LI4 (Hegu)
  • LU5 (Chize)

Additional secondary acupoints were added based on symptom presentation:

  • High fever: GV14 (Dazhui)
  • Severe cough: LU6 (Kongzui)
  • Sore throat: LU10 (Yuji), LU11 (Shaoshang)

After insertion, needles were manipulated with the attenuation (xie) technique for 2–3 times during a 10–15 minute needle retention time. For Yuji and Shaoshang (used for sore throat patients), the bleeding technique was applied instead of using the attenuation technique. The acupuncture treatment was administered daily, for a total of 5 days as one treatment course.

The Taizhou Municipal Hospital researchers determined that acupuncture improves outcomes for influenza patients taking oseltamivir. This includes reductions of fevers and symptomatic relief. Overall, the total recovery time improves when acupuncture is added to the drug therapy treatment regimen.

 

Nanjing University
In another investigation, Nanjing University of Traditional Chinese Medicine (TCM) researchers investigated the effect of acupuncture and moxibustion on rats infected with influenza virus. They found that both acupuncture and moxibustion decrease the mortality rate and increase the average survival time. In addition, they document that both TCM therapies significantly increase the serum level of IFN and improve phagocytosis of viruses.

Interferon (IFN) plays a major role in defective neutrophil recruitment and influenza virus killing. [3] The researchers conclude that both acupuncture and moxibustion are effective for the treatment of influenza. Notably, acupuncture produced superior outcomes over moxibustion therapy.

Three groups were compared. The first group received acupuncture. The second group received moxibustion. The third group was a control. For the acupuncture treatment group, a needle was inserted into one single point (Dazhui, GV14) and was manipulated with the twisting technique with a frequency of 30–50 times per minute. For the moxibustion treatment group, 10–15 mg of moxa cigar cuttings were applied upon the acupoint Guanyuan (CV4). A total of 4 cuttings were used in one treatment session. The above treatments were conducted daily, for 3 consecutive days in total. The control group received no treatment.

The mortality rate of the acupuncture treatment group was 63.5% and was 78.6% for the moxibustion group. The control group mortality rate was 96.4%. In addition, overall survival times improves in the acupuncture and moxibustion groups.

The serum IFN level of the acupuncture treatment group was 5.35 log IU/mL and that of the moxibustion treatment group was 4.22. The serum IFN level of both treatment groups was significantly higher that of the control group 2.63. The phagocytosis rate of virus infected cells for the acupuncture treatment group was 62.67% and was 50.58% for the moxibustion treatment group. Both were significantly higher than that of the control group, which was only 20.34%. Overall, acupuncture lower the mortality rate, increases serum interferon levels, and improves phagocytosis of viruses.

 

Summary
The aforementioned independent investigations indicate that acupuncture is an important treatment option for the treatment of influenza. Acupuncture improves the serum level of IFN and improves phagocytosis of viruses. Patients are encouraged to contact local licensed acupuncturists to consult about treatment options.

 

References
[1] Lang BX, Jin LQ, Liu SN, Liu XR. Clinical observation on the effect of acupuncture combined with conventional therapy on influenza H1N1 [J]. Chinese Archives of Traditional Chinese Medicine, 2011, 29(2):411-412.
[2] Chou YF, Cao YM, Wang JL, Yang ZM, Qiu ML. Protective effect of acupuncture on mice infected with influenza virus [J]. China Journal of Traditional Chinese Medicine and Pharmacy, 1990(2):16-18.
[3] Wenjing Li, Bruno Moltedo, Thomas M. Moran. Type I Interferon Induction during Influenza Virus Infection Increases Susceptibility to Secondary Streptococcus pneumoniae Infection by Negative Regulation of T Cells [J]. Journal of Virology, Oct 2012, 86 (22) 12304-12312.

Source: HealthCMi

Acupuncture Improves Eyesight For Diabetics

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Acupuncture Improves Eyesight For Diabetics

 

Acupuncture and herbs improve eyesight for patients with diabetic retinopathy. In a controlled clinical trial, Hubei Provincial Hospital of Traditional Chinese Medicine ophthalmology department researchers determined that herbal medicine monotherapy benefits vision. The addition of acupuncture to the treatment protocol significantly improved patient outcomes.

Diabetic retinopathy patients receiving acupuncture and herbal medicine demonstrated significant improvements in visual acuity. Also, patients demonstrated improvements in the health of the retina; there were reductions in ocular microaneurysms, hard exudate, cotton wool spots, retinal bleeding, edema, and leaking blood vessels. [1]

Before and after treatment, the data was verified with visual acuity tests (with the naked eye and correctional lenses). Additional tests confirm the data, including intraocular pressure and slit lamp exams. Testing of ocular blood flow, retinal thickness, and other parameters were tested with fluorescein angiography (FFA) and optical coherence tomography (OCT). OCT employs the use of light waves to take images of tissues that receive light. Glycated hemoglobin (HbA1c) and blood glucose levels were also taken into account.

The severity of diabetic retinopathy was assessed by the presence of various ocular clinical signs including: microaneurysms, hard exudate, cotton wool spots, retinal bleeding, edema, and the formation of new blood vessels. Patients showing improvement in four or more of these six areas were was classed as markedly effective. Patients showing improvement in two or more areas were classed as effective. Patients with no change were classified as ineffective. In the herb monotherapy group, 10 patients were markedly effective and 15 effective, producing a total effective rate of 71.4%. In the acupuncture plus herbs group, 15 patients were markedly effective and 15 were effective, producing a total effective rate of 83.3%. Visual acuity improved in both study groups: 58/70 in the herb monotherapy group and 61/72 eyes in the acupuncture plus herbs group.

 

Traditional Chinese Medicine
According to Traditional Chinese medicine (TCM) principles, diabetes mellitus is caused by qi and yin deficiency, stemming from liver and kidney deficiency syndrome. This leads to interior heat and dryness, bodily fluid and endogenous secretion insufficiency, and the formation of phlegm. These differential diagnostic imbalances result in blood stasis and reduced ocular blood flow. Primary treatment principles include supplementing qi, nourishing yin, and resolving blood stasis. On this basis, the participants in both groups were prescribed He Xue Ming Mu tablets, which contain the following ingredients:

  • Sheng Pu Huang
  • Sheng Di Huang
  • Huang Qin
  • Han Lian Cao
  • Dan Shen
  • Yu Jin
  • Chuan Xiong
  • Mu Dan Pi
  • Chi Shao
  • Ju Hua
  • Xia Ku Cao
  • Chong Wei Zi
  • Nu Zhen Zi
  • Jue Ming Zi
  • Che Qian Zi

A dose of five tablets (1.5g) was taken three times daily, swallowed with warm water after meals. Each course of treatment lasted 15 days and was separated by a three day interval. Follow-up appointments were administered two months into the treatment period and again after six months.

 

Acupuncture Treatment
In addition to He Xue Ming Mu tablets, participants in the acupuncture plus herbs group received acupuncture treatments. Treatment began with patients in a seated position and, following standard disinfection, 0.35mm × 40mm filiform needles were inserted at the following primary acupoints:

  • Fengchi (GB20)
  • Jingming (BL1)
  • Taiyang (MHN9)
  • Zanzhu (BL2)
  • Sizhukong (TB23)

Needles were inserted slowly and were manipulated using a balanced reinforcing-reducing technique, with a suitable degree of needle sensation directed towards the eyes. After obtaining deqi, needles were retained for 30 minutes. The patients were then moved to a treatment couch, and needles were inserted into the following secondary acupoints:

  • Guanyuan (CV4)
  • Sanyinjiao (SP6)
  • Ganshu (BL18)
  • Shenshu (BL23)

Needles were manipulated using a reinforcing method and were retained for 30 minutes. Treatments were administered every two days, with 30 days making up one course of care. A total of two courses were administered. The results indicate that herb monotherapy and acupuncture plus herbal medicine are both effective treatments for diabetic neuropathy.

 

Vision Loss
Diabetic retinopathy is the number one cause of vision loss. Diabetes affects more than 280 million people worldwide and about one third suffer from diabetic retinopathy. [2] Risk factors for diabetic retinopathy include hyperglycemia and hypertension. Diabetic retinopathy has been “ranked as the fifth most common cause of preventable blindness and fifth most common cause of moderate to severe visual impairment.” [3] The National Institutes of Health notes, “Diabetic retinopathy affects blood vessels in the light-sensitive tissue called the retina that lines the back of the eye. It is the most common cause of vision loss among people with diabetes and the leading cause of vision impairment and blindness among working-age adults.” [4]

All patients with diabetes are at risk. Early symptoms of diabetic retinopathy include a decrease in color vision, blurry vision, floaters or spots, dark areas in the visual field, and vision loss. Over time, the high blood sugar levels in diabetics may damage blood vessels in the retina (the eyeball rear layer containing light sensitive cells that send nerve impulses to the optic nerve). This causes fluid or blood leakage, which distorts vision. This may lead to scarring and retinal cell loss.

 

Outcomes
The outcomes of this study indicate that acupuncture combined with He Xue Ming Mu tablets improves visual acuity and slows the progression of diabetic retinopathy. To learn more, contact a local licensed acupuncturist.

The use of herbal medicine and acupuncture for the treatment of eye disorders has a long history in Traditional Chinese Medicine (TCM). One classic herbal formula used for the treatment of diabetic retinopathy and wet macular degeneration is Ning Xue Tang, containing the following ingredients:

  • Xian He Cao
  • Ce Bai Ye
  • Han Lian Cao
  • E Jiao
  • Sheng Di Huang
  • Bai Mao Gen
  • Zhi Zi Tan
  • Bai Shao
  • Bai Ji
  • Bai Lian

The clinical trial tested He Xue Ming Mu tablets, which shares Sheng Di Huang with Ning Xue Tang. Chi Shao is used in place of Bai Shao in Ning Xue Tang, focusing on invigorating and cooling blood over tonifying blood. Otherwise, this classic formula greatly varies from He Xue Ming Mu tablets. This, in part, is due to the fact that TCM has many individual herbs and herbal formulas that are designed for benefitting the eyes across multiple diagnostic patterns. Given the importance of eyesight, additional research is warranted to investigate the efficacy of acupuncture and herbal medicine for the treatment of vision disorders.

 

References:
1. Zhu Dan (2018) “Clinical Observation on Acupuncture Combined with He Xue Ming Mu Tablets in Treatment of Diabetic Retinopathy” Journal of Hubei University of Chinese Medicine Vol. 20 (4), pp. 87-89.
2. Lee, Ryan, Tien Y. Wong, and Charumathi Sabanayagam. “Epidemiology of diabetic retinopathy, diabetic macular edema and related vision loss.” Eye and vision 2, no. 1 (2015): 17.
3. Ibid.
4. nei.nih.gov/health/diabetic/retinopathy

Source: HealthCMi

Acupuncture Alleviates Neck Pain, Restores ROM

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Acupuncture Alleviates Neck Pain, Restores ROM

 

Acupuncture and herbs alleviate cervical spondylosis, a disorder caused by disc degeneration in the neck that results in pain and range of motion impairment. Hubei University of Medicine Dongfeng Hospital researchers conclude that acupuncture combined with herbs successfully relieves pain and regulates excess sympathetic nervous system outflows for patients with cervical spondylosis. [1] Other improvements were also observed, including reductions in dizziness, palpitations, and neck dysfunction.

Common presentations of cervical spondylosis are neck and shoulder pain, numbness, hypersensitivity, and impaired fine motor function of the arms. However, cervical spondylosis is also a cause of symptoms relating to spinal cord compression or dysfunction. These symptoms include blurred vision, headaches, vertigo, tinnitus, nausea, palpitations, poor memory, and abdominal discomfort. [2]

It has also been suggested that increased sympathetic nervous system outflows due to compression of the cervical spinal cord region could put cervical spondylosis sufferers at an increased risk of cardiovascular events. [3] Blood viscosity is also a predictor of cardiovascular events, with increased viscosity increasing the risk of heart attacks and strokes. The study documents that the acupuncture and herbal medicine regimen reduces blood viscosity, which may produce important cardiovascular benefits.

 

Chinese Medicine
The researchers conducted a randomized clinical trial using the scientific method. To provide a historical basis for the herbs and acupuncture points chosen for the study, the researchers presented Traditional Chinese Medicine (TCM) principles used for the selections. Cervical spondylosis is a disorder primarily belonging to the Du Mai (Governing Vessel) and Taiyang channels. Understood in anatomical terms, this correlates to the spine and paraspinal regions of the body.

TCM principles stipulate that an underlying deficiency of upright qi leaves cervical spondylosis patients vulnerable to pathogenic invasion by wind, cold, and dampness. This correlates to the conceptualisation that internal weakness facilitates greater vulnerability to wear and tear along with other stresses on the human body, including environmental influences. The result is pain in the back and neck region. Acupuncture is applied to improve local blood circulation, relax the musculature, relieve spasms, and reduce inflammation and swelling (especially in the region of nerve roots).

 

Results
We’ll take a close look at the herbs and acupuncture points used to get the results. First, let’s delve into the outcomes. The subjective component of outcomes was determined using the visual analog scale (VAS) for pain and speed of resolution of other symptoms. Objective measurements include the quantification of blood viscosity.

VAS scores were rated by the patients in two study groups on a scale of 0–10, with 0 indicating a total absence of pain. By the end of the study period, both groups showed a significant reduction in pain (p<0.05). In the herbal medicine monotherapy group, mean VAS scores reduced from 6.91 pre-treatment to 2.86 by the end of the study. Reductions in the acupuncture plus herbs group were significantly greater, falling from 6.89 pre-treatment to just 1.22 by the end of the study (p<0.05).

Resolution of other symptoms such as dizziness, neck dysfunction, chest distress, and palpitations was also monitored closely. In the herbal medicine monotherapy group, dizziness took a mean 12.82 days to resolve, compared with just 7.89 days in the acupuncture plus herbs group. Neck dysfunction took a mean 13.79 days to resolve in the herbal medicine monotherapy group, compared with 9.41 days in the acupuncture plus herbs group. Chest distress and palpitations resolved in a mean 9.88 days in the herbal medicine monotherapy group, compared with 6.94 in the acupuncture plus herbs group. All symptoms resolved significantly and more quickly in the acupuncture plus herbs group (p<0.05). The results indicate that a combined treatment protocol is appropriate for optimal treatment of cervical spondylosis.

Resolution of pain and other symptoms were taken into account to give the total effective rates for both groups. In the herbal medicine monotherapy group, there were 24 cases of complete resolution, 20 cases of partial resolution, and 16 cases of unresolved symptoms, yielding a total effective rate of 73.33%. In the acupuncture plus herbs group, there were 40 cases of complete resolution, 16 cases of partial resolution, and 4 cases of unresolved symptoms, yielding a total effective rate of 93.33%.

Blood viscosity reduced significantly in both groups (p<0.05). Mean pre-treatment systolic blood viscosity measurements were 4.39 mPa.s (pascal-seconds) in the herbal medicine monotherapy group and 4.29 mPa.s in the acupuncture plus herbs group. Mean pre-treatment diastolic measurements were 9.26 mPa.s and 9.25 mPa.s respectively (p>0.05). Following treatment, measurements in the herbal medicine monotherapy group fell to 4.21 mPa.s systolic and 8.67 mPa.s diastolic blood viscosities. Reductions in the acupuncture plus herbs group were significantly greater, with mean systolic viscosity falling to 4.05 mPa.s and mean diastolic viscosity falling to 8.13 mPa.s (p<0.05).

 

Participant Intake
A total of 120 participants aged 25–65 years were recruited for the study and were randomized to receive either an herbal decoction (n=60) or an herbal decoction plus acupuncture treatments (n=60). In the herbal medicine monotherapy group, the mean age was 50.22 years, mean duration of disease was 2.31 years, and mean body mass index (BMI) was 22.57. Of the 60 participants in this group, 13 suffered from hypertension, 10 from dyslipidemia, and 9 from diabetes. In the acupuncture plus herbs group, the mean age was 50.63 years, mean duration of disease was 2.25 years, and mean BMI was 22.10. Of the 60 participants in this group, 12 suffered from hypertension, 11 from dyslipidemia, and 10 from diabetes. There was no statistically significant difference in baseline characteristics between the two groups prior to the treatment regimen in the clinical trial (p>0.05).

Participants receiving concurrent treatment with other therapies, or that were unable to complete the study period, were excluded. Other exclusion criteria included patients with gastric bleeding or gastric ulcers, blood, liver, or kidney disease, psychological disorders, malignant tumors, and pregnant or lactating women.

 

Herbal Decoction
The participants in both groups were prescribed an herbal decoction consisting of the following ingredients:

  • Sheng Mu Li 30g
  • Zhen Zhu Mu 30g
  • Ge Gen 20g
  • Quan Xie 12g
  • Tian Ma 12g
  • Gou Teng 12g
  • Dan Shen 9g
  • Chuan Xiong 9g
  • Sang Ji Sheng 12g

The herbs were boiled in water to produce 200–300 ml of liquid. Each decoction was taken once daily for a total of two months.

 

Acupuncture Points
In addition to the above herbal decoction, participants in the acupuncture plus herbs group received treatment using the following acupoints:

  • Huatuojiaji (MBW35)
  • Ashi points
  • Hegu (LI4)
  • Shenmai (BL62)

The patients were asked to rest in a prone position. Following disinfection with iodine, 0.3 × 40 mm needles were inserted to a depth of approximately one cun. Huatuojiaji points level with the three intervertebral spaces above and below the affected vertebra were selected. Ashi points were applied to the local area.

All points were stimulated manually using a balanced reinforcing-reducing method. After obtaining deqi, a G6805-II electro-stimulator was connected and set to a frequency of 30 Hz. Electrical stimulation was applied for 30 minutes with the intensity adjusted according to each patient’s individual tolerance levels. Acupuncture was administered on alternating days for a total of two months.

 

Summary
The findings indicate that the prescribed herbal decoction combined with acupuncture successfully alleviates pain and other symptoms associated with cervical spondylosis, and is more effective than using an herbal decoction monotherapy. Furthermore, these therapies significantly reduce blood viscosity. The focus was to improve local circulation and promote faster healing based on the principle of invigorating the blood. These changes may also decrease the risk of heart attacks and strokes in patients with high blood viscosity. To learn more, contact a local licensed acupuncturist.

 

Notes
[1] Yi Jinke, Xu Yingle, Wang Wenke, Xu Penghui (2018) “Clinical effects of decoction combined acupuncture in treatment of sympathetic cervical spondylosis” Jilin Journal of Chinese Medicine Vol.38(8) pp. 966-968.
[2] Yuqing Sun, Aikeremujiang Muheremu, Wei Tian (2018) “Atypical symptoms is patients with cervical spondylosis; Comparison of the treatment effect of different surgical approaches” Medicine Vol. 97 (20) e.10731.
[3] Mohita Singh, indu Khurana, Zile Singh Kundu, Anup Aggarwal (2016) Link of sympathetic activity with cardiovascular risk in patients of cervical spondylosis” International Journal of Clinical and Experimental Physiology Vol.3 (1) pp.41-44.

Source: HealthCMi

Acupuncture For PCOS Infertility Produces Superior Outcomes

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Acupuncture For PCOS Infertility Produces Superior Outcomes

 

Acupuncture successfully regulates hormones and ovarian blood flow in women with polycystic ovary syndrome (PCOS) related infertility. Maternal and Child Healthcare Hospital of Hengfeng County researchers compared the efficaciousness of acupuncture and drug therapy. The addition of acupuncture to drug therapy produced superior patient outcomes over patients receiving only drug monotherapy. [1] The combined integrative medicine protocol using acupuncture produced improvements in the regulation of estradiol (E2), follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone (T), and prolactin (PRL) levels. Also, ultrasound imaging reveals that acupuncture improves ovarian blood circulation.

A total of 124 women diagnosed with infertility due to PCOS were recruited for the study and were randomly assigned to the control group or the acupuncture group. Participants in the control group were treated with conventional drug therapy. Participants in the acupuncture group received conventional drug therapy combined with acupuncture treatments.

 

Participant Intake
The drug monotherapy control group consisted of 62 women aged 21–36 years, with a mean age of 26.11 years. Participants weighed 53–84kg, with a mean weight of 74.06kg, and a mean body mass index (BMI) of 26.82. The duration of disease was 2–11 years, with a mean duration of 4.64 years.

The acupuncture group consisted of 62 participants aged 22–37 years, with a mean age 25.84 years. The participants weighed 55–82kg, with a mean weight of 72.43kg, and a mean BMI of 27.02. The duration of disease was 2–12 years, with a mean duration of 4.52 years. There was no statistically significant difference between the baseline characteristics of the two groups (p>0.05) prior to treatments in the investigation.

 

Drug Therapy
The participants in both groups were treated with pharmaceutical medications to regulate their menstrual cycles and promote ovulation. Oral ethinyl estradiol cyproterone (0.035mg) was prescribed to start on day two of the menstrual cycle, or day two of withdrawal bleeding in those women taking oral hormonal contraceptives. One dose was taken daily for 21 consecutive days, followed by a seven day break, during which time withdrawal bleeding would occur. The women were also prescribed oral clomifene (50mg). This was started on day 5 of the fourth menstrual cycle or fourth withdrawal bleed, and taken for five consecutive days. The total treatment length was six months.

 

Acupuncture Treatment
In addition to drug therapy, women in the acupuncture group also received acupuncture according to the principles of Traditional Chinese medicine (TCM). Eight acupoints were selected for the study with the following rationales:

  • Baihui (GV20) – raises yang and benefits qi
  • Tianshu (ST25) – raises clear yang qi and descends turbid fluids
  • Qihai (CV6) – supplements the kidneys, benefits essence and original qi
  • Guilai (ST29) – regulates blood flow and menstruation
  • Geshu (BL17) – tonifies qi and blood
  • Xinshu (BL15) – invigorates blood and calms shen
  • Shenshu (BL23) – tonifies the kidneys and nourishes essence
  • Pangguangshu (BL28) – regulates the lower burner, warms yang, and promotes the transformation of qi

 

Procedure
Participants were asked to empty their bladders and bowels prior to each treatment. Following standard disinfection, 0.25 × 40mm needles were inserted into the acupoints. Baihui was needled transversely, and after obtaining deqi, the needle was retained for 30 minutes.

The remaining points were needled perpendicularly, using a needle flicking insertion technique. After obtaining deqi, needles were manipulated with a reinforcing-reducing technique, using appropriate lifting, thrusting, and rotation. Needles were retained for 30 minutes. Treatment was administered daily for 21 consecutive days, with a seven day break allowing for menstruation before another course of care was initiated. Treatment was provided for a total of six months.

 

Outcomes
Outcomes for the study included quantifying levels of the hormones estradiol (E2), follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone (T), and prolactin (PRL). A 5ml sample of venous blood was taken during a fasting blood test carried out between days 2 and 5 of the participants’ menstrual cycles, both before and after all treatments. Mean pre-treatment E2 levels were 40.12ng/L in the control group and 39.50ng/L in the acupuncture group. Mean FSH levels were 7.03 and 7.08mIU/mL respectively, LH levels were 14.43 and 14.41mIU/mL respectively, T levels were 81.94 and 82.01ng/dL respectively, and PRL levels were 37.07 and 38.10mg/ml respectively. There was no statistically significant difference between the two groups’ baseline measurements (p>0.05) prior to treatments.

Following all treatments, mean E2 levels increased to 55.47ng/L in the drug control group and 57.76ng/L in the acupuncture group. Mean FSH decreased to 5.41 and 5.36mIU/mL respectively, LH decreased to 9.00 and 6.27mIU/mL respectively, T decreased to 62.16 and 51.84ng/dL respectively, and PRL decreased to 31.28 and 30.91mg/mL respectively. In both groups, mean E2 levels increased and mean FSH, LH, T, and PRL levels decreased significantly following treatment (p<0.05). Both LH and T levels reduced significantly more in the acupuncture group than in the drug control group (p<0.05).

Ovarian blood flow was also measured by way of vaginal ultrasound. This was administered on day 13–14 of the menstrual cycle, before ovulation occurred. Measurements were taken before and after the treatment period, and took into account: end diastolic velocity (EDV), peak systolic velocity (PSV), pulsatility index (PI), and resistive index (RI). Before treatment, mean EDV was 9.97cm/s in the drug control group and 10.00cm/s in the acupuncture group. Mean PSV measurements were 10.26 and 10.24cm/s respectively, PI measurements were 1.01 and 1.02 respectively, and RI measurements were 0.54 and 0.53 respectively (p>0.05).

Following treatment, mean EDV increased to 10.04cm/s in the drug control group and 15.51cm/s in the acupuncture group. Mean PSV decreased slightly to 10.20cm/s in the control group and increased slightly to 10.94cm/s in the acupuncture group. PI fell in both groups, to 0.98 and 0.87 respectively, and RI fell in both groups to 0.53 and 0.47 respectively. The improvements in EDV, PSV, and RI were significantly greater in the acupuncture group compared with the control (p<0.05).

The results indicate that acupuncture integrative care provides significant benefits for women with PCOS related infertility. These include improvements in the regulation of hormone levels and ovarian blood flow, which are significantly greater improvements than using only conventional drug monotherapy. The findings suggest that acupuncture has the potential to improve clinical outcomes for women with PCOS when combined with usual care. Contact your local licensed acupuncturist to find out more.

Reference:
Gu Yunxia, Li Jun, Zheng Pengying (2018) “Effect of Acupuncture Combined with Western Medicine on Hormone Level and Ovarian Blood Flow in Infertile Women with Polycystic Ovary Syndrome” Chinese Journal of Integrative Medicine Vol. 22 (25) pp. 3588-3590.

Source: HealthCMi

Acupuncture Alleviates Rheumatoid Arthritis Swelling and Pain

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Acupuncture Alleviates Rheumatoid Arthritis Swelling And Pain

 

Acupuncture is an effective treatment modality for the the alleviation of rheumatoid arthritis. Researchers conclude that acupuncture alone or in combination with additional treatment modalities alleviates rheumatoid arthritis, restores bodily functions, and improves quality of life. [1] In a meta-analysis, the researchers note that acupuncture exerts its effective actions through several biological mechanisms. The acupuncture research indicates that acupuncture produces anti-inflammatory, antioxidative, and immune system regulatory actions.

Three acupuncture points were common across the research reviewed in the China Medical University and Tri-Service General Hospital meta-analysis. The researchers note that ST36 (Zusanli) was the most commonly tested acupoint in patients with rheumatoid arthritis. GB34 (Yanglingquan) and LI4 (Hegu) were also commonly applied.

The results indicate that acupuncture applied to the aforementioned acupoints and others produces changes in specific inflammatory biomarkers. Acupuncture regulates the following: erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), interleukins, nuclear factor kappa B (NF-???? B), and tumor necrosis factor alpha (TNF-????). Another meta-analysis (Wang et al.), confirms that acupuncture regulates both ESR and CRP in rheumatoid arthritis (RA) patients. [2] In an important finding, researchers (Han et al.) conclude that acupuncture successfully downregulates “TNF-???? and VEGF [vascular endothelial growth factor] in peripheral blood and joint synovia to improve the internal environment which is beneficial for RA.” [3]

In another study under review in the meta-analysis (Dong et al.), investigators used laboratory conditions to test the efficacy of electroacupuncture at acupoints ST36 (Zusanli) and BL60 (Kunlun). The researchers indicate that the “toll-like receptor (TLR) signaling pathway contributed to the development and progression of RA and acupuncture could reduce the expression of TLR4, thus leading to anti-inflammation.” [4] In addition, many other studies indicate that acupuncture improves quality of life.

The research team drew conclusions after a full review of each individual study in the meta-analysis. Based on the data, the researchers note, “acupuncture alone or combined with other treatment modalities is beneficial to the clinical conditions of RA without adverse effects reported and can improve function and quality of life and is worth trying.” [5] They add that additional well-designed randomized controlled trials are recommended to confirm these findings.

The conclusions were based on several parameters. The primary outcomes were determined by quantifying pain levels, morning stiffness, pain related disability, joint swelling characteristics and diameter, number of swollen joints, skin temperature, and arthritis index. Serum levels of inflammatory and anti-inflammatory biomarkers plus antioxidant levels were recorded for objective measurements. In addition, positron emission tomography (PET) scans were used to monitor changes in inflammation along with X-rays of the hands. Quality of life was assessed using the rheumatoid arthritis quality of life questionnaire (RAQoL), Pittsburgh sleep quality index, health assessment questionnaire (HAQ), and the short form-36 health survey. Overall, the meta-analysis reveals extensive use of subjective and objective instruments to verify the data and conclusions.

The majority of studies included in the meta-analysis were randomized controlled trials and several were double-blinded. The trials were human clinical trials and controlled laboratory experiments. Many acupuncture points were used in the clinical trials. As stated earlier, ST36, GB34, and LI4 were most commonly administered.

The researchers note that there is a difficulty in using only one acupuncture point prescription for all patients diagnosed with rheumatoid arthritis. According to Traditional Chinese Medicine (TCM) principles, rheumatoid arthritis may be divided into many diagnostic subcategories such as wind, cold, dampness, and heat. In addition, these categories are further differentiated according to syndrome presentation location and overall constitution of the patient. As a result, there is a need for heterogenous acupuncture point prescriptions. In TCM, no one set of acupoints for this biomedically defined condition is applicable to all patients. As a result, this makes study design a difficult proposition.

Despite these difficulties, the researchers conclude that acupuncture is effective for the alleviation of rheumatoid arthritis. Many of the findings mapped pathways of effective action. One interesting finding was that acupuncture enhances antioxidative effects by increasing serum superoxide dismutase (SOD) and catalase activities in rheumatoid arthritis patients. This indicates that acupuncture reduces oxidative stress and subsequent inflammation. Moreover, acupuncture “triggered release of endorphins” and regulated the immune system; levels of IgG, IgA, and IgM were successfully downregulated. [6]

 

Summary
Rheumatoid arthritis is an autoimmune disorder. Inflammation may occur in any location (including internal organs); however, the hands and knees are among the most common regions affected by the disorder. In joints, inflammation affects synovial membranes causing a fluid build-up and degradation. No singular blood test defines the diagnosis, although ESR, CRP, rheumatoid factor, and anti-cyclic citrullinated peptide antibodies are tests are helpful in making a determination. Ultrasound , MRI, and X-ray imaging are also important tools for confirming a diagnosis.

The meta-analysis results indicate that acupuncture benefits patients with rheumatoid arthritis. Acupuncture prevents or slows joint destruction, reduces pain levels, and increases mobility. However, acupuncture is not presented as a cure. Nonetheless, acupuncture is an important treatment option that may significantly improve quality of life. To learn more, contact a local licensed acupuncturists about treatment options.

 

References:
[1] Chou, Pei-Chi, and Heng-Yi Chu. “Clinical Efficacy of Acupuncture on Rheumatoid Arthritis and Associated Mechanisms: A Systemic Review.” Evidence-Based Complementary and Alternative Medicine 2018 (2018).
[2] C. Wang, P. de Pablo, X. Chen, C. Schmid, and T. McAlindon, “Acupuncture for pain relief in patients with rheumatoid arthri- tis: a systematic review.,” Arthritis & Rheumatology, vol. 59, no. 9, pp. 1249–1256, 2008.
[3] R. X. Han, J. Yang, T. S. Zhang, and W. D. Zhang, “Effect of fire-needle intervention on serum IL-1 and TNF-alpha levels of rheumatoid arthritis rats,” Zhen Ci Yan Jiu, vol. 37,no. 2, pp. 114–118, 2012.
[4] Z.-Q. Dong, J. Zhu, D.-Z. Lu, Q. Chen, and Y.-L. Xu, “Effect of Electroacupuncture in “Zusanli” and “Kunlun” Acupoints on TLR4 Signaling Pathway of Adjuvant Arthritis Rats,” American Journal ofTherapeutics, 2016.
[5] Chou, Pei-Chi, and Heng-Yi Chu. “Clinical Efficacy of Acupuncture on Rheumatoid Arthritis and Associated Mechanisms: A Systemic Review.” Evidence-Based Complementary and Alternative Medicine 2018 (2018).
[6] Ibid.

Source: HealthCMi

Acupuncture Promotes Bone Fracture Recovery

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Acupuncture Promotes Bone Fracture Recovery

 

Acupuncture promotes the healing of bone fractures. Two independent investigations confirm that the addition of acupuncture to usual care protocols increases positive patient outcomes rates. Researchers find acupuncture effective for assisting in the restoration of mobility and reductions in both pain and inflammation.

The first investigation was conducted at The People’s Hospital of Hengfeng County. All patients had severe tibiofibular fractures (lower leg). All received surgical correction, requiring insertion of metal rods into the bone (internal fixation with intramedullary nails). The second investigation was conducted at The Traditional Chinese Medicine Hospital of Anyi County. All patients had supracondylar fractures of the humerus (upper arm near the elbow), a type of fracture common in children and teenagers. For both the arm and leg fractures, acupuncture significantly reduced swelling and pain. In addition, acupuncture resulted in improved functioning at the injured sites, with significant improvements in range of motion. [1], [2]

The first study was designed to investigate the effects of acupuncture on patients with tibiofibular fractures that underwent internal fixation procedures with interlocking, intramedullary nails. In this procedure, a long, metal rod is inserted into the bone and held in place with screws at either end. It is most commonly used in fractures of the long bones and prevents the bone from moving as it heals.

A total of 94 patients were recruited for the study and were randomized to either an acupuncture group or a control group. The acupuncture group consisted of 47 participants, aged 21–56 years (mean age 37.9 years). Of these patients, 25 had open fractures and 22 had closed fractures. The control group consisted of 47 participants, aged 22–58 years (mean age 38.1 years). All participants had the exact type, location, and direction of their fractures confirmed by X-ray imaging. Inclusion criteria for the study were the following: fracture type suitable for surgery, no obvious contraindications for surgery. Exclusion criteria were the following: pre-existing heart, liver, kidney, or cerebral disease.

The two groups were statistically similar in terms of baseline characteristics. Both groups were given internal fixation surgery with interlocking intramedullary nails. From the second postoperative day, they were prescribed functional rehabilitation exercises. Participants in the acupuncture group received acupuncture, while participants in the control group were treated with the herbal medicine Jie Gu Qi Li Pian (bone setting pills). The pills contain the following herbs: Ru Xiang, Mo Yao, Dang Gui, Di Bie Chong, Gu Sui Bu, Peng Sha, Long Xue Jie, Zi Ran Tong, and Da Huang. They are indicated for promoting circulation and preventing blood stasis. A 1.5g dose was given twice daily, for a total of 60 days.

 

Acupuncture Procedure
Acupuncture treatments were administered with patients resting on a treatment couch, with their affected leg in a raised position. The following acupoints were selected:

  • Baihui (GV20)
  • Shenshu (BL23)
  • Zusanli (ST36)
  • Neiguan (PC6)
  • Dazhu (BL11)
  • Geshu (BL17)

In addition, the following acupoints were only applied to the affected side:

  • Taichong (LV3)
  • Fenglong (ST40)
  • Xuehai (SP10)
  • Yanglingquan (GB34)
  • Ashi points

Needles were inserted into each acupoint and were stimulated with moderate strength. All points were stimulated using a reinforcing technique, with the exception of Fenglong (ST40), which was stimulated using a balanced reinforcing-reducing technique. All needles were retained for 30 minutes. Treatments were administered daily, with seven days making up one course of care. A total of two courses were provided, separated by a three day interval.

 

Outcomes
All participants were re-examined 60 days after surgery and their fractures were classified as healed, partially healed, or unhealed. Participants classified as healed showed no abnormal range of motion, no tenderness or longitudinal pain, and X-rays confirmed the complete healing of the fracture. Participants classified as partially healed showed no abnormal range of motion, some residual tenderness or longitudinal pain, and X-rays showed partial healing of the fracture. Participants classified as unhealed showed abnormal range of motion, residual tenderness or longitudinal pain, and X-rays confirmed that the fracture remained in poor condition. Swelling of the affected limb was also measured before and seven days after surgery by measuring the circumference of the leg. This compared with the healthy leg, and the degree of swelling was quantified as a percentage.

In the control group, 22 participants were classified as fully healed, 16 were partially healed, and 9 were unhealed. The total effective rate was 80.9%. In the acupuncture group, 32 participants were classified as fully healed, 13 were partially healed, and 2 were unhealed. The total effective rate was 95.7%. The results demonstrate that significantly greater improvements were experienced by participants in the acupuncture group. In addition, greater reductions of swelling were in the acupuncture group, falling from a mean 8.45% before surgery to 4.51% after seven days. This is compared with a reduction from a mean 8.52% to 7.02% in the control group. Based on the results, it was calculated that swelling subsided in 9.46 days for patients in the acupuncture group, compared with 14.93 days for the control group patients.

 

Humerus
The second study examined acupuncture treatments for supracondylar fractures of the humerus. A total of 64 patients were recruited for the study and were randomly assigned to the acupuncture group or the control group. The acupuncture group consisted of 32 participants, aged 6–14 years (mean age 8.17) and the control group consisted of 32 participants, aged 5–14 years (mean age 8.23). All participants were diagnosed with unilateral supracondylar fractures of the humerus. The fractures were due to a combination of traffic accidents, falls, or other injuries.

Inclusion criteria for the study were the following: diagnosis of a supracondylar fracture confirmed by X-rays, age 5–14 years, fractures with a Gartland classification of III (complete displacement), and fractures less than one week old. Exclusion criteria were the following: open fractures, nerve or blood vessel damage, and concurrent heart, liver, kidney or nervous system disease. The two groups were statistically similar in terms of baseline characteristics prior to the investigation.

Both groups were given standard treatments for fractures including surgery or manipulations to reposition the bones. Support with a splint or plaster cast was provided. Patients were prescribed Xue Sai Tong intravenous fluid, a preparation primarily made up of San Qi, an herb used to arrest bleeding and resolve blood stasis. This was administered daily for 14 days, with 0.2g given each time.

 

Acupuncture Procedure
The following acupoints were selected for the study:

  • Dazhu (BL11)
  • Geshu (BL17)
  • Shenshu (BL23)
  • Zusanli (ST36)
  • Ashi points

Following standard disinfection, 0.25 × 25mm single-use needles were used to needle the acupoints. After obtaining deqi, the needles were stimulated using moderate strength and were retained for 30 minutes. Treatment was administered daily for a total of 14 days.

 

Outcomes
Outcomes were assessed after 12 months using the Neer classification for humeral fractures. Patients received a score out of 100 divided into 35 points for pain, 30 for shoulder function, 25 for range of motion, and 10 for anatomical location. Participants in the acupuncture group scored consistently higher across all areas with a total score of 88.2, compared with 80.09 in the control group.

The efficacy of the treatment was also classified as either excellent, good, satisfactory, or unsatisfactory based on the participants’ clinical characteristics following the study. Those classified as excellent had normal range of motion in the elbow, those classified as good had their range of motion affected by 10 degrees or less, those classified as satisfactory had their range of motion affected by 10–20 degrees, and those classified as unsatisfactory had their range of motion affected by 20 degrees or more.

In the control group, 9 participants were classified as excellent, 16 as good, 5 as satisfactory, and 2 as unsatisfactory. In the acupuncture group, 18 participants were in the excellent category, 11 were classified as good, 2 as satisfactory, and just 1 as unsatisfactory. The excellent and good scores were added together to give the total effective rate, which was significantly higher in the acupuncture group at 90.62% compared with 78.13% in the control group.

The results of the aforementioned studies indicate that acupuncture significantly improves outcomes for patients with bone fractures. Acupuncture promotes a more complete healing of the bones, improves range of motion, and facilitates faster reductions in swelling and pain. To learn more, contact a local licensed acupuncturist.

 

References:
[1] Peng Zhen, Jiang Zelong, Teng Ning (2018) “Effect of Acupuncture on Rehabilitation of patients with Tibiofibular Fracture Undergoing Internal Fixation.” Chinese Journal of integrative Medicine Vol. 22 (26), pp. 3717-3718.
[2] Liu Guanglin, Fu Jingdong, Wang Yan (2018) “Clinical Role of Acupuncture Combined with Xuesaitong in the Treatment of Supracondylar Fracture of the Humerus.” Chinese Journal of integrative Medicine Vol. 22 (26), pp. 3719-3720.

Source: HealthCMi

 

Acupuncture Carpal Tunnel Relief Confirmed

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Acupuncture Carpal Tunnel Syndrome Relief Confirmed

 

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 to10.6 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.

Source: HealthCMi

Acupuncture Helps War Veterans Sleep Better

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Acupuncture Helps War Veterans Sleep Better

 

Emory University and Atlanta VA Medical Center researchers find acupuncture effective for the alleviation of sleep disorders for veterans with PTSD and brain injuries. The research team concludes that acupuncture produces significant improvements in both subjective and objective sleep parameters for veterans with mild traumatic brain injuries (mTBI), including veterans with PTSD (post-traumatic stress disorder). The team notes that “acupuncture provides meaningful relief for a particularly recalcitrant problem affecting large segments of the veteran population.” [1]

The randomized-controlled investigation featured a comparison of true acupuncture with sham acupuncture, including effective binding lasting the entirety of the clinical trial. True acupuncture produced a 2.7% improvement in sleep efficiency, measured by actigraphy. [2] True acupuncture was effective for both mTBI patients with or without PTSD. Sham acupuncture did not improve patients’ conditions; in fact, patients receiving sham acupuncture worsened by 5.3%.

True acupuncture produced significant clinical results as measured by Pittsburgh Sleep Quality Index (PSQI) scores and actigraphy. All patients received a total of ten acupuncture treatments. The clinical trial was administered at the Atlanta VAMC (US Department of Veterans Affairs Medical Center, Georgia). The study included a total of 60 veterans with a mean age of 40. The researchers conclude that acupuncture improves overall sleep for mTBI veterans with persistent sleep disturbances. [3]

Acupuncture has been shown to improve the condition of patients with other sleep disturbance etiologies. Researchers find back-shu (beishu) acupoints plus Shenmen (HT7) effective for the alleviation of menopausal insomnia. [4] Researchers from the Asian Sports Village Community Health Service Center (Beijing) and the Beijing Tibetan Hospital of China Tibetology Research Center (Beijing) conclude that acupuncture is more effective for the alleviation of menopausal insomnia than alprazolam (a benzodiazepine anti-anxiety drug).

PSQI scores and hormonal changes were measured, including levels of estradiol, follicle stimulating hormone, and luteinizing hormone. Patients in the acupuncture group received acupuncture once per day for five consecutive days followed by a two day break prior to the next round of care. The following acupuncture points were needled:

  • Feishu (BL13)
  • Xinshu (BL15)
  • Ganshu (BL18)
  • Pishu (BL20)
  • Shenshu (BL23)
  • Geshu (BL17)
  • Shenmen (HT7)

Three weeks of care comprised one course and three courses of care were administered. During the same period, the drug treatment group received oral alprazolam (0.4 mg–0.8 mg) prior to sleep. The results were evaluated 30 days after completion of all treatments. The total cohort size was 128 menopausal patients with a diagnosis of insomnia.

The total effective rate for the acupuncture group was 98.3% and the drug group had a 95.2% total effective rate. PSQI scores were better in the acupuncture group and hormone levels improved in both groups; however, the acupuncture group had significantly better hormone level improvements. Based on the data, acupuncture is more effective than alprazolam for the treatment of menopausal insomnia. [5] Two acupuncture continuing education courses at HealthCMi are relevant to the research presented above. The first course is on the topic of sleep improvement, click the following link to gain course access:

Acupuncture For Insomnia >

The second online course is on the topic of Traditional Chinese Medicine and menopause, click the following link to gain course access:

Menopause >

 

More Findings
Another important finding concerning acupuncture for the treatment of insomnia was produced by a research team comprised of University of Pennsylvania (Philadelphia), Memorial Sloan Kettering Cancer Center (New York), and Memorial University (Newfoundland and Labrador) researchers. This study was specifically designed to measure the effects of electroacupuncture on female breast cancer survivors with hot flashes and insomnia. The research team concludes that acupuncture significantly improves sleep duration and sleep latency (the length of time transitioning from wakefulness to sleep). [6] Moreover, the researchers discovered hot flashes and insomnia are bidirectional. Improvements in sleep produce reductions in hot flashes and vice versa.

The study included a drug control group. Acupuncture significantly outperformed gabapentin and venlafaxine. Acupuncture was significantly more effective than the drugs in improving sleep duration, latency, and efficiency, and was also more effective for reducing sleep disturbances and daytime dysfunction. Additionally, acupuncture did not produce the adverse effects that were caused by the drugs (dizziness, fatigue, ataxia, dry mouth, constipation, headaches). The clinical trial was supported, in part, by a grant from the US National Institutes of Health.

Patients received acupuncture 2 times per week for the first 2 weeks. Next, weekly acupuncture treatments were administered for an additional 6 weeks for a total of 10 acupuncture treatments over 8 weeks. Acupuncture point prescriptions were selected on an individual basis per differential diagnostics. Manual acupuncture techniques were applied to obtain deqi. Electroacupuncture (EA) was applied between 2 acupoints with a 2 Hz frequency setting. The specific points were not detailed in the report. Needles were retained for 30 minutes for each acupuncture treatment.

The researchers conclude that “EA produces comparable, if not better, improvements in sleep quality than GP [gabapentin], a currently recommended pharmacological intervention.” They add, “women receiving EA reported were able to fall asleep faster and spent more time in bed sleeping as opposed to lying awake in bed trying to sleep. Our results suggest that EA results in improved sleep in women with hot flashes and might be a viable treatment option in women who do not wish to take medication.” [7]

Insomnia affects approximately 30% of the adult population. [8] Given the results of the aforementioned research, acupuncture is a reasonable treatment option for the treatment of sleep disorders. Prospective patients are advised to consult with licensed acupuncturists to learn more.

 

References
[1] Huang, W., Johnson, T., Kutner, N., Halpin, S., Weiss, P., Griffiths, P. and Bliwise, D., 2018. Acupuncture for treatment of persistent disturbed sleep: A randomized clinical trial in veterans with mild traumatic brain injury and post-traumatic stress disorder. Annals of Physical and Rehabilitation Medicine, 61, p.e89.
[2] Ibid.
[3] Ibid.
[4] Li, O., and F. Wang. “Acupuncture at back-shu points of five zang, Geshu (BL 17) and Shenmen (HT 7) for the treatment of menopausal insomnia.” Zhongguo zhen jiu= Chinese acupuncture & moxibustion 38, no. 5 (2018): 4693.
[5] Ibid.
[6] Garland, Sheila N., Sharon X. Xie, Qing Li, Christina Seluzicki, Coby Basal, and Jun J. Mao. “Comparative effectiveness of electro-acupuncture versus gabapentin for sleep disturbances in breast cancer survivors with hot flashes: a randomized trial.” Menopause 24, no. 5 (2017): 517-523.
[7] Ibid.
[8] Roth, Thomas. “Insomnia: definition, prevalence, etiology, and consequences.” Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine 3, no. 5 Suppl (2007): S7.

Source: HealthCMi

 

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