Photoacoustic Acupuncture Imaging Advancement

Photoacoustic tomography of the brain during acupuncture reveals cerebral responses to acupuncture needle stimulation. Researchers have developed new photoacoustic imaging techniques for use during acupuncture that employ short laser pulses to generate ultrasonic waves in living tissues. The techniques generate high ultrasonic resolution images with sharp contrast. The images show structural and functional images of cerebral responses to acupuncture.

Researchers using photoacoustic imaging measured brain blood circulation changes when applying acupuncture at acupoint KD1 (Yongquan). KD1 is located on the sole of the foot between the second and third metatarsal bones in a depression formed with then foot is plantar flexed. According to Traditional Chinese Medicine (TCM) principles, KD1 benefits the sensory organs, calms the spirit and helps the qi to descend. It is indicated for use in reviving consciousness, controlling seizures including epilepsy, and for the treatment of shock, vertex headaches, blurry vision, foot disorders, coughing with blood and insomnia.

The researchers developed photoacoustic imaging techniques to augment MRI (magnetic resonance imaging) and PET (positron emission tomography) imaging of responses to acupuncture. The researchers note that MRI imaging excels in recording oxygen level changes in the blood but is expensive and has low spatial and temporal resolution. They note that PET scans excel in recording glucose metabolism and blood flow but patients must be injected with tracer isotopes prior to imaging. The researchers add that near infrared spectroscopy has helped scientists to understand the mechanisms of acupuncture on the body.

The photoacoustic imaging reveals cerebral hemodynamic changes induced by manual acupuncture needle stimulation. Significant changes in blood flow were measurable between the middles cerebral artery and branch vessel. The research documents that needle stimulation induced significant brain cortex responses and increased blood flow. The researchers note that one of the most important aspects of the photoacoustic imaging techniques is that it measures cerebral hemodynamic changes non-invasively.


References:
Li, Tingting, Xueliang Xu, Bingzhang Chen, Jian Rong, and Huabei Jiang. "Photoacoustic imaging of acupuncture effect in small animals." Biomedical Optics Express 6, no. 2 (2015): 433-442.

J. S. Han and L. Terenius, “Neurochemical basis of acupuncture analgesia,” Annu. Rev. Pharmacol. Toxicol.22(1), 193–220 (1982).

K. K. Hui, V. Napadow, J. Liu, M. Li, O. Marina, E. E. Nixon, J. D. Claunch, L. LaCount, T. Sporko, and K. K. Kwong, “Monitoring acupuncture effects on human brain by FMRI,” J. Vis. Exp.8(38), 1190–1197 (2010).

- See more at: http://www.healthcmi.com/Acupuncture-Continuing-Education-News/1421-photoacoustic-acupuncture-imaging-advancement#sthash.Tp2Xt2k0.dpuf

Acupuncture Warms And Alleviates Neck Pain

Acupuncture is highly effective in reducing neck pain and restoring range of motion. A study comparing two manual acupuncture techniques finds one technique has a very high total effective rate and recovery rate. A second technique examined in the study, although effective, had lower scores. A computer monitoring thermographic changes within the neck measured significantly higher neck temperatures induced by the superior acupuncture technique. The researchers link the ability of this acupuncture technique to reduce pain with its ability to warm the neck.

The setting the mountain on fire (Shao Shan Huo) needle manipulation technique produced a complete recovery rate of 68.3% and a total effective rate of 98.3%. The even reinforcing-reducing technique produced a 28.3% complete recovery rate and an 81.7% total effective rate. Complete recovery from neck pain was determined by the following criteria: no remaining symptoms, complete improvement of positive signs, normal neck range of motion. The total effective rate was calculated by adding the following groups: complete recovery, significant improvements, and slight improvements.

Needles were applied to local acupuncture points of the neck known as Huatuojiaji acupoints. The Huatuojiaji points were needled lateral to the cervical vertebrae from C4 to C7. In classical Chinese medicine texts, Huatuojiaji points begin below C7 at T1, however, modern day licensed acupuncturists often use Huatuojiaji points located 0.5 to 1 cun lateral to the cervical vertebrae. Needle retention time for both acupuncture technique groups was 20 minutes following manual needle manipulation techniques. All needles were 0.30 mm x 40 mm. All patients were treated one time per day with ten treatments comprising one course of care. The results were tabulated after two courses of treatment.

The setting the mountain on fire technique demonstrated significantly superior objective and subjective clinical outcomes. The researchers note that this technique was first described in the Jin Zhen Fu (Ode to the Gold Needle), a Traditional Chinese Medicine (TCM) classic text written during the Ming Dynasty. They add that modern studies confirm that the setting the mountain on fire technique increases blood circulation to the limbs and induces “dilation of capillaries.”

This study compared two standard acupuncture techniques used for the treatment of cervical radiculopathy. This condition was the inclusion requirement for participation in the study. All participants had cervical radiculopathy characterized by neck pain that radiates to the upper limbs, decreased sensation in the irritated nerve pathway, muscular atrophy, and decreased muscle strength. Objective measurements for cervical radiculopathy included the following inclusion criteria: positive Spurling sign, positive brachial plexus tension test, X-rays showing vertebral bone hyperplasia, joint hyperplasia, intervertebral space narrowing, decreased intervertebral foramen size, CT or MRI scan demonstrating “vertebral outgrowth and nerve root canal stenosis.” An additional inclusion criterion was the Traditional Chinese Medicine diagnosis of “neck pain due to wind-cold obstructing the meridians.”

A total of 120 patients met the criteria for inclusion and were randomly divided into the setting the mountain on fire and even reinforcing-reducing acupuncture groups. Both groups demonstrated high levels of efficacy but the complete recovery rate of the setting the mountain on fire group was significantly superior at 68.3% versus the even reinforcing-reducing group at 28.3%.

For centuries, patients have reported a warm sensation induced by use of the setting the mountain on fire acupuncture technique. This study demonstrates that this is a physiologic effect and is not limited to a psychological event. Thermograms measuring changes in infrared levels demonstrate a clear rise in temperature induced by the setting the mountain on fire technique. This is consistent with the Traditional Chinese Medicine principle that this technique warms and unblocks the channels, dissipates cold, and alleviates pain.


References:
Sun, Yi-jun, Yao-chi Wu, Jun-feng Zhang, Yan Li, and Ying Wang. "Therapeutic efficacy observation on ‘setting fire on the mountain’ manipulation by Lu Shou-yan for cervical radiculopathy." Journal of Acupuncture and Tuina Science 12, no. 6 (2014): 331-334.

Ming Dynasty. Xu Feng. Zhen Jiu Da Quan (Great Compendium of Acupuncture and Moxibustion). Beijing: People’s Medical Publishing House, 1958: 62-63.

Yang F, Xie W, Yang YK. Research advance and reflections on needling technique of ‘setting fire on the mountain’. Zhenjiu Linchuang Zazhi, 2008, 24(6): 57-58.

Gu JQ. Therapeutic observation on supreme deep-needling at cervical Jiaji (EX-B 2) points for cervical spondylosis of neck type. Shanghai Zhenjiu Zazhi, 2013, 32(5): 382-383.

Sun YJ, Wu YC, Zhang JF, Zhang P, Tang ZY. Effects of electroacupuncture on muscle state and electrophysiological change in rabbits with lumbar nerve root compression. Chin J Integr Med, 2013, 19(6): 446-452.

- See more at: http://www.healthcmi.com/Acupuncture-Continuing-Education-News/1404-acupuncture-warms-and-alleviates-neck-pain#sthash.QpCXI5Q7.dpuf

Acupuncture Point Sensitivity Linked to Menstrual Pain

Tenderness at acupuncture point SP6 (Sanyinjiao) is linked to incidences of menstrual cramping with pain. Tenderness at this lower leg acupuncture point has been associated with dysmenorrhea in Traditional Chinese Medicine (TCM) for over a thousand years. Now, researchers have completed a randomized study to test the scientific basis for this phenomenon. The researchers discovered a significant “tenderness at Sanyinjiao (SP6) exists in women undergoing primary dysmenorrhea.”



The term dysmenorrhea refers to painful cramps occurring before or during the menstrual period. The symptoms of dysmenorrhea include abdominal pain and pressure, hip and lower back pain, and inner thigh pain. Primary dysmenorrhea is a type of recurring menstrual cramps not caused by other diseases.

The use of SP6 in acupuncture is highly defined and established. Indications for the use of acupoint SP6 in TCM are abdominal pain and distention, dysmenorrhea, irregular menstruation, uterine bleeding, leukorrhea, uterine prolapse, infertility, delayed labor, nocturnal emissions, enuresis, dysuria, lower limb disorders, vertigo from deficiency and insomnia. TCM theory states that SP6 benefits the spleen and kidneys, transforms dampness, and spreads the liver qi. SP6, roughly translated as three yin junction, is also the meeting point of the three lower yin meridians.

Research supports using SP6 for the treatment of dysmenorrhea. Shi, et. al., measured significant pain relief induced by needling acupuncture point SP6 for patients with primary dysmenorrhea. Blood samples were taken of participants during the study. It was shown that although acupuncture decreased menstrual pain, the beneficial effects were not related to changes in plasma levels of prostaglandins. The researchers conclude that the analgesic effects of SP6 are not mediated by prostaglandin variations in the bloodstream.

Another study of 66 patients finds acupuncture, combined with cupping and moxibustion, effective for the relief of menstrual pain. The patients had significant relief of menstrual pain within 2 - 6 acupuncture treatments. This study employed the use of SP6 and other acupuncture points: CV4 (Guanyuan), SP10 (Xuehai), K3 (Taixi), SP8 (Diji).

Licensed acupuncturists often combine acupuncture with herbal medicine for the treatment of gynecological conditions. Research backs up this time honored approach to patient care. A high quality study finds acupuncture and Chinese herbal medicine effective for the relief of endometriosis related pain. The total effective rate for auricular acupuncture was over 90%. The total effective rate for Chinese herbal medicine was 60%. A closer look reveals that the effective rate for mild to moderate dysmenorrhea due to endometriosis for both auricular acupuncture and Chinese herbal medicine is similar. However, auricular acupuncture showed greater efficacy for the relief of severe dysmenorrhea due to endometriosis. The randomized, blinded controlled trial was of high quality and a laparoscopy was required to confirm the diagnosis of endometriosis.

Zhou, et. al., find acupuncture combined with moxibustion and herbs is more effective for reducing menstrual pain and cramping than ibuprofen. The results were published based on research of a randomized investigation of patients with primary dysmenorrhea. Data points were taken at three, six and nine months after the beginning of treatment. The long-term positive clinical outcomes for patients having received acupuncture, moxibustion and herbal medicine was significantly superior to patients having taken ibuprofen.

Research conducted at the Affiliated Hospital of Hubei College of Medicine and Pharmacy involved a trial of 90 patients with primary dysmenorrhea. The patients were randomly divided into two study groups. Group 1 received acupuncture, herbal hot compresses and moxibustion. Group 2 received oral administration of ibuprofen at 300 mg per dose, three times daily. The treatment lasted for three menstrual cycles.

During the course of treatment, dietary restrictions were applied to both group 1 and group 2. Patients were advised to avoid eating raw, cold, pungent or very spicy foods. Patients were advised to increase their consumption of fresh vegetables and fruits. In addition, patients were advised to avoid prolonged exposure to cold temperatures on the lower abdomen. The total effective rate observed in the acupuncture group was much higher than that of the ibuprofen group.

The hot compresses were applied to the umbilical region and local regions of pain on the lower abdomen. The herbal medicines in the compresses were Dan Shen 10g, Yan Hu Suo 10g and Yi Mu Cao 30g. The herbs were decocted for one hour and strained. A 10 cm x 15 cm flannel cloth was soaked in the decoction, removed and squeezed to remove excess fluid. The cloth was applied to the patient. One hot compress treatment lasted for fifteen minutes.

Customization of acupuncture points was applied according to TCM differential diagnostics. Primary acupuncture points used in the study were:

Sanyinjiao (SP6)
Zusanli (ST36)
Guanyuan (CV4)
Qihai (CV6)

In cases of excess, the following were added:
Taichong (LR3)
Diji (SP8)

For cases of deficiency, the following acupuncture points were added:
Xuehai (SP10)
Geshu (BL17)

Reinforcing and reducing acupuncture needle manipulation techniques were applied until a deqi sensation was achieved. Moxa was applied to needles. The needles were withdrawn after the use of 3 - 5 cones of moxa. The approximate treatment time was 30 minutes. Acupuncture, moxibustion and hot compresses were applied once daily for a period of six days. The treatment started one week before the menstrual period began and ended by the first day of the menstrual cycle. The treatment resumed before the next menstrual period. One course of treatment comprised one menstrual period and the entire treatment lasted for three courses. The acupuncture group significantly outperformed the ibuprofen group at three, six and nine months after the beginning of treatment. The results indicate that acupuncture combined with moxibustion and herbal compresses is safe and effective for the treatment of primary dysmenorrhea.

A different approach to using acupuncture points includes injecting vitamins. Researchers at the University of California (UCSF, San Francisco) injected vitamin K1 into acupuncture point SP6. They discovered that the acupuncture point injections of vitamin K alleviate dysmenorrhea. The women participating in the study experienced less menstrual pain and a shorter duration of menstrual symptoms.

A survey of the participants finds 94% “agreeable to receiving injection therapy” and 77% would receive monthly injections if the treatment were made available. The researchers note, “This finding is consistent with outcomes from the Obstetrics and Gynecology Hospital in Shanghai, China, where the protocol was developed.”

A closely related investigation at the UCSF Clinical Research Center (San Francisco, California) tested plasma concentrations of vitamin K1 (phylloquinone) in patients with primary dysmenorrhea. Samples were collected 1 - 2 days after acupuncture point injections of vitamin K1 into acupoint SP6. A direct correlation between higher vitamin K1 levels and reduced menstrual pain and cramping was observed. The researchers note this indicates that further research into the role of vitamin K deficiency in inflammation and pain is warranted.

There is a historical precedent for the research and use of vitamin K in the USA. Routine injections of vitamin K1 are given to infants to prevent hemorrhage, taking advantage of vitamin K1’s anticoagulant properties. The researchers note, “Vitamin K is typically studied in the context of blood clotting and bone health although recent emerging research suggests that vitamin K may have other roles, including reproductive health.” The researchers note that prior studies show a relationship between vitamin K deficiency and menstrual disorders. Additional research demonstrates relaxation of uterine muscle spasms after administration of vitamin K. The researchers add, “Vitamin K therapy may decrease the length of prolonged menstrual flow as a result of its action on prothrombin, a vitamin K-dependent coagulation protein produced in the liver.”

The researchers describe a correlation between Traditional Chinese Medicine (TCM) theory and the current research. They note that the liver is an important organ in the regulation of menstruation and is involved in the movement of qi and blood. They add that acupuncture point SP6 is commonly used in the treatment of menstrual conditions by licensed acupuncturists “because it is a crossing point of the liver, spleen, and kidney channels, which are important in creating, storing, and moving blood.”


References:
Zhang, C. N., X. K. Huang, Y. Luo, J. Jiang, L. Wan, and L. Wang. "Reflection of dysmenorrhea in acupoint sanyinjiao (SP 6) region." Zhen ci yan jiu= Acupuncture research/[Zhongguo yi xue ke xue yuan Yi xue qing bao yan jiu suo bian ji] 39, no. 5 (2014): 401.

Shi, Guang-Xia MSc, Liu, Cun-Zhi PhD; Zhu, Jiang BSc; Guan, Li-Ping MSc; Wang, De-Jin MSc; Wu, Meng-Meng MSc. Effects of Acupuncture at Sanyinjiao (SP6) on Prostaglandin Levels in Primary Dysmenorrhea Patients. Clinical Journal of Pain: March/April 2011 - Volume 27 - Issue 3 - p 258–261.

Huang, Tao, Bin Han, Lu Wang, Ingrid Gaischek, and Gerhard Litscher. "Warming Needle Eases Severe Pain During Menses: A Case and Thermographic Measurement." Medical Acupuncture 25, no. 3 (2013): 227-231.

World Journal of Acupuncture - Moxibustion. Volume 22, Issue 2, 30 June 2012, Pages 68–70. Acupuncture and moxibustion combined with cupping for primary dysmenorrhea in 66 cases. Ming-gao LI, De-chen LI, Shu-ren LI.

Zhu, Xiaoshu, Kindreth D. Hamilton, and Ewan D. McNicol. "Acupuncture for pain in endometriosis." Sao Paulo Medical Journal 131, no. 6 (2013): 439-439.

Wayne PM, Kerr CE, Schnyer RN, et al. Japanese-style acupuncture for endometriosis-related pelvic pain in adolescents and young women: results of a randomized sham-controlled trial. J Pediatr Adolesc Gynecol 2008;21:247-257.

Zhou, Juan. “Acupuncture and Moxibustion plus Herbal Hot Compress for Primary Dysmenorrhea.” Journal of Clinical Acupuncture and Moxibustion 60.2 (2014): 11-13.

Chao, Maria T., M. L. Callens, C. M. Wade, P. D. Abercrombie, and D. Gomolak. "An innovative acupuncture treatment for primary dysmenorrhea: a randomized, crossover pilot study." Alternative therapies in health and medicine 20, no. 1 (2014): 49-56.

Chao, Maria T., Christine M. Wade, and Sarah L. Booth. "Increase in Plasma Phylloquinone Concentrations Following Acupoint Injection for the Treatment of Primary Dysmenorrhea." Journal of Acupuncture and Meridian Studies (2014). Author Affiliations:
Osher Center for Integrative Medicine, University of California, San Francisco, California.
Institute for East-West Medicine, New York, NY.
Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts.

- See more at: http://www.healthcmi.com/Acupuncture-Continuing-Education-News/1414-acupuncture-point-sensitivity-linked-to-menstrual-pain#sthash.nJcWmjcX.dpuf