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).

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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.

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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.

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New CT Scans Reveal Acupuncture Points

CT scans reveal anatomical structures of acupuncture points. 

A CT (computerized tomography) scan is a series of X-rays used to create cross-sectional images. In this study published in the Journal of Electron Spectroscopy and Related Phenomena, researchers used in-line phase contrast CT imaging with synchrotron radiation on both non-acupuncture points and acupuncture points. The CT scans revealed clear distinctions between the non-acupuncture point and acupuncture point anatomical structures.

Acupuncture points have a higher density of micro-vessels and contain a large amount of involuted microvascular structures. The non-acupuncture points did not exhibit these properties.

The researchers note that the state-of-the-art CT imaging techniques used in this study allow for improved three-dimensional (3D) imaging of a large field of view without artifacts. This greatly improves imaging of soft tissue and allowed the researchers to make this important discovery.

The acupuncture points ST36 (Zusanli) and ST37 (Shangjuxu) were shown to have very distinct structural differences than surrounding areas. At the acupuncture points, microvascular densities with bifurcations “can be clearly seen around thick blood vessels” but non-acupuncture point areas showed few thick blood vessels and none showed fine, high density structures. The acupuncture points contained fine structures with more large blood vessels that are several dozen micrometers in size plus beds of high density vascularization of vessels 15-50 micrometers in size. This structure was not found in non-acupuncture point areas.

The researchers note that the size of an acupuncture point “can be estimated by the diameter of microvascular aggregations….” They also commented that other research has found unique structures of acupuncture points and acupuncture meridians using MRI (magnetic resonance imaging), infrared imaging, LCD thermal photography, ultrasound and other CT imaging methods. The researchers commented that many studies using these technological approaches have already shown that acupuncture points exist. They note that “the high brightness, wide spectrum, high collimation, polarization and pulsed structure of synchrotron radiation” facilitated their discovery. They concluded, “Our results demonstrated again the existence of acupoints, and also show that the acupoints are special points in mammals.”

In another interesting study, researchers used an amperometric oxygen microsensor to detect partial oxygen pressure variations at different locations on the anterior aspect of the wrist. The researchers concluded that partial oxygen pressure is significantly higher at acupuncture points. Below are images from the study measuring the increase of partial oxygen pressure combined with an overlay of the local acupuncture point locations. The images map the Lung, Pericardium and Heart channels and their associated local points. Acupuncture points P7 and P6 clearly show high oxygen pressure levels as do the other acupuncture points in the region.

These measurements are not needled points but are natural resting states of acupuncture points absent stimulation. A truly unique finding, acupuncture points exhibit special oxygen characteristics. Acupuncture points and acupuncture channels are scientifically measurable phenomena in repeated experiments.

References:
Chenglin, Liu, Wang Xiaohu, Xu Hua, Liu Fang, Dang Ruishan, Zhang Dongming, Zhang Xinyi, Xie Honglan, and Xiao Tiqiao. "X-ray phase-contrast CT imaging of the acupoints based on synchrotron radiation." Journal of Electron Spectroscopy and Related Phenomena (2013).
Author Affiliations:
1. Liu Chenglin, Wang Xiaohua, Xu Hua; Physics Department of Yancheng Teachers’ College, Yancheng, China.
2. Liu Fang, Dang Ruishan; Anatomy Department of Second Military Medical University, Shanghai, China.
3. Zhang Dongming, Zhang Xinyi; Synchrotron Radiation Research Center of Fudan University, Shanghai, China.
4. Xie Honglan, Xiao Tiqiao; Shanghai Synchrotron Radiation Facility of Shanghai Institute of Applied Physics, Shanghai, China.

Minyoung Hong, Sarah S. Park, Yejin Ha, et al., “Heterogeneity of Skin Surface Oxygen Level of Wrist in Relation to Acupuncture Point,” Evidence-Based Complementary and Alternative Medicine, vol. 2012, Article ID 106762, 7 pages, 2012. doi:10.1155/2012/10a6762.

Yan X H, Zhang X Y, et al. Do acupuncture points exist? [J]. Physics in Medicine and Biology, 54 (2009):N143–N150.

Zhang Y, Yan X H, Liu C L, et al. Photoluminescence of acupuncture points “Waiqiu” in human superficial fascia [J]. J Lumin. 2006, 119-120:96-99.

Julia J. Tsuei, Scientific Evidence in Support of Acupuncture and Meridian Theory: I. Introduction. IEEE Engineering in Medicine and Biology Magazine. 1996, 15(3):58-63.

Li Lei, Yau To, Yau Chuen-heung. What Is the Origin of Acupoint. J. Acupunct. Tuina. Sci. 2012, 10 (2):125-127.

Song X J, Zhang D. Study on the manifestation of facial infrared thermography induced by acupuncturing Guangming (GB 37) and Hegu (LI 4) [J]. Chinese Acupuncture & Moxibustion. 2010, 30(1):51-54.

Liu P, Zhou G Y, Zhang Y, et al. The hybrid GLM‒ ICA investigation on the neural mechanism of acupoint ST36: An fMRI study [J]. Neuroscience Letters, 2010, 479: 267-271.

Fei L, Cheng H S, et al. The experimental exploration and the research prospects about the material basis and the functional characteristics of the meridian [J]. Chinese Science Bulletin, 1998, 439(6):658-672.

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Obésités graves et acupuncture

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• Dr Ahmed Hamid Brahimi
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Résumé : 

Introduction : Les obésités graves se définissent par un IMC > 35. En MTC, l'obésité est décrite sous le terme de feipang. Ce dernier désigne un surpoids du corps dû à l'accumulation de graisse qui correspond à des mucosités. Les obésités graves ne sont pas nécessairement la conséquence du ‘trop manger/peu bouger' mais résultent de déséquilibres énergétiques plus profonds. Et l'acupuncture semble tout à fait indiquée dans la correction de ces déséquilibres.

Méthodes : Afin de déterminer l'apport de l'acupuncture associée à la diététique dans le traitement des obésités graves, une étude a été réalisée de Janvier 2000 à Décembre 2009. 

Résultats : L'analyse portant sur 1486 patients souffrant d'obésité grave et soumis à un protocole de traitement acupunctural standardisé a bien mis en évidence le rôle positif de l'acupuncture par comparaison à d'autres études où cette dernière n'était pas utilisée. L'acupuncture permet une perte de poids significativement plus importante tout en apportant plus de confort au patient. En plus de son rôle régulateur du métabolisme, elle réduit la faim et calme le stress. 

Conclusions : Ces premiers résultats, bien que très encourageants, nécessitent d'être validés par d'autres études similaires. L'acupuncture constitue une voie de recherche à ne pas négliger et une alternative qu'on aurait tort d'ignorer.

Effectiveness of Stimulation of Acupoint KI 1 by Artemisia vulgaris (Moxa) for the Treatment of Essential Hypertension: A Systematic Review of Randomized Controlled Trials

Xiaochen Yang, Xingjiang Xiong, [...], and Jie Wang

Abstract

Objective. A systematic review of randomized controlled trials has been performed to assess the effectiveness of stimulation of acupoint KI 1 by Artemisia vulgaris (the Japanese name is moxa) to lower blood pressure compared to antihypertensive drugs.Methods and Findings. Articles published from 1980 to August 2013 in databases of CENTRAL, Pubmed, CBM, CNKI, VIP, and online clinical trial registry websites were searched. Studies included were randomized controlled trials (RCTs); moxibustion-type intervention on KI 1 compared with antihypertensive drugs; meta-analysis showed superior effects of moxibustion plus antihypertensive drugs on systolic blood pressure (WMD: −4.91 [−7.54, −2.28]; P = 0.0003) but no superior effects on diastolic blood pressure (WMD: −6.38 [−17.17, 4.41]; P = 0.25). 

Conclusions. Our systematic review of the current literature shows a beneficial effect of using moxibustion interventions on KI 1 to lower blood pressure compared to antihypertensive drugs. However, the results are influenced by the existing differences in design of the current trials.

Treating vascular mild cognitive impairment by acupuncture: a systematic review of randomized controlled trials

Zhongguo Zhong Xi Yi Jie He Za Zhi. 2013 Dec;33(12):1626-30.

Zhou L1, Zhang YL2, Cao HJ3, Hu H1.

Abstract

OBJECTIVE:

To systematically evaluate the effect and safety of acupuncture in the treatment of vascular mild cognitive impairment (VMCI).

METHODS:

Recruited were China National Knowledge Infrastructure Database (CNKI) (1979-2012), Chinese Science and Technology Periodical Database (VIP) (1989-2012), Chinese Biomedical Database (CBM), Wanfang degree and conference papers database (1985-2012), PubMed Database (1966-2012), and The Cochrane Library (Issue 1, 2012). The search date ended in February 2012. Randomized controlled trials (RCTs) by taking acupuncture as the main treatment for VMCI (nonvascular dementia) were collected. Results were measured using at least one internationally recognized evaluation cognitive scale. Two analysts selected the data independently. The assessment of methodological quality was based on the Cochrane Handbook and the data were analyzed by using RevMan 5.1.0 Software. The mean difference (MD) or risk ratio (RR) were taken and graphed with 95% confidence interval (CI).

RESULTS:

Recruited 12 RCTs included a total of 691 cases meeting the inclusion criteria (all of the methodological quality was of B level). Acupuncture combined other therapies was involved in 9 RCTs, with effect compared with that of other therapies. Results of meta-analysis showed, compared with the cognitive function training alone, electroacupuncture (MD 1.59, 95% CI 0.69-2.48, P = 0.0005, 3 studies) or body acupuncture (MD 3.26, 95% CI 1.69-4.83, P < 0.01, 1 study) combined with the cognitive function training could significantly increase the mini-mental state examination (MMSE) score of patients. In comparison to Western medicine, acupuncture could elevate ADAS-Cog score (MD 2.16, 95% CI 1.36-2.95, P < 0.01, 3 studies). In all the studies, adverse event had not been reported.

CONCLUSIONS:

Acupuncture in combination with other therapies could significantly improve cognitive functions. Acupuncture itself appeared to have better therapeutic effects than Western medicine alone.

Comparison the effect of lateral wedge insole and acupuncture in medial compartment knee osteoarthritis: A randomized controlled trial

Knee. 2013 Dec 27. pii: S0968-0160(13)00249-4. doi: 10.1016/j.knee.2013.12.002.

Ashraf A1, Zarei F2, Hadianfard MJ3, Kazemi B3, Mohammadi S3, Naseri M4, Nasseri A2, Khodadadi M5, Sayadi M6.

Abstract

BACKGROUND:

There is lack of well-designed trials evaluating structural benefits of non-pharmacologic therapies in knee osteoarthritis (OA). In this parallel-group randomized controlled trial, we aim to compare the possible advantages of lateral wedge insole and acupuncture in patients with medial knee OA.

METHOD:

Patients with grade two or three of medial knee OA were randomly allocated to group one who received an in shoe lateral wedge and group two who underwent acupuncture. We assessed patients' pain, function and knee joint cartilage thickness before and after intervention. Paired t-test and independent samples t-test were used for in group and between group analyses. (Level of evidence: 2.) 

RESULTS: Twenty patients in each group were recruited in the study. Pain significantly decreased after therapy in both groups one and two (paired t test, P<0.001, 95% CI: 1.62-3.25 and 1.58-3.20 respectively). Function improved in each group (paired t test, P=0.001, 95% CI of 0.94-2.38 in group one and 0.97-2.43 in group two). A non-clinically statistically significant difference regarding the femoral and tibial cartilage thickness was obtained in both groups one (P=0.005, CI: -0.43-0.82 and P=0.037, CI: -0.44-0.80 respectively) and two (P=0.025, CI: -0.45-0.79 and P=0.035, CI: -0.29-0.96 respectively). Between groups analysis showed no significant difference regarding abovementioned measures.

CONCLUSION:

Both lateral wedge insole and acupuncture can be effective in the treatment of medial knee osteoarthritis without any superiority of one over the other. 

Copyright © 2013 Elsevier B.V. All rights reserved.

KEYWORDS:

Acupuncture, Knee osteoarthritis, Lateral wedge insole, Magnetic resonance imaging

Efficacy observation of carpal tunnel syndrome treated with electroacupuncture

Zhongguo Zhen Jiu. 2013 Aug;33(8):700-2.

Xia Q, Liu XW, Wang XL, Tao Y.

Author information

Abstract

OBJECTIVE:

To explore the impacts of electroacupuncture on median nerve conduction velocity and morphology in patients of carpal tunnel syndrome (CTS) and evaluate the efficacy of electroacupuncture on CTS.

METHODS:

Thirty cases of CTS were treated with electroacupuncture at Quchi (LI 11), Yangchi (TE 4), Shousanli (LI 10), Neiguan (PC 6) and Hegu (LI 4) on the affected side, combined with semiconductor laser irradiation at Shenmen (HT 7) and Yangxi (LI 5) on the affected side. The improvements in the symptoms and changes in nerve conduction velocity and ultrasound morphology were observed before and after treatment.

RESULT:

The clinical total effective rate was 96.7% (29/30). The median nerve conduction velocity was accelerated apparently and the amplitude was increased after treatment as compared with those before treatment, indicating the statistically significant difference (all P<0.001). The distal motor latency was shortened apparently (P<0.001) and the motor amplitude had no apparent change (P>0.05). The proximal median nerve swelling was relieved apparently after treatment (P<0.05) and the effective rate was 36.7% (11/30). There was no apparent difference in the ratio of the vertical and horizontal diameters of carpal tunnel after treatment as compared with that before treatment (P>0.05).

CONCLUSION:

Electroacupuncture presents the positive repair function to the median nerve in the patients of CTS. It can effectively alleviate inflammatory reaction and relieve ischemia and swelling of nerve fibers. And it cannot induce the changes in morphology in a short term.

Acupuncture effectiveness as a complementary therapy in functional dyspepsia patients

Arq Gastroenterol. 2013 Jul-Sep;50(3):202-7. doi: 10.1590/S0004-28032013000200036.

Lima FA, Ferreira LE, Pace FH.

Abstract

Context: Functional dyspepsia represents a frequent gastrointestinal disorder in clinical practice. According to the Roma III criteria, functional dyspepsia can be classified into two types as the predominant sympton: epigastric pain and postprandial discomfort. Even though the pathophysiology is still uncertain, the functional dyspepsia seems to be related to multiple mechanisms, among them visceral hypersensitivity, changes in the gastroduodenal motility and gastric accommodation and psychological factors. 

Objective: Evaluate the effectiveness of acupuncture as a complementary to conventional treatment in functional dyspepsia patients. 

Methods: Randomized clinical trial in which were enrolled patients with functional dyspepsia patients in according with Rome III criteria. One group was submitted to drug therapy and specific acupuncture (GI) and the other to drug therapy and non-specific acupuncture (GII). The gastrointestinal symptoms, presence of psychiatric disorders and quality of life were evaluated, at the end and three months after treatment. 

Results: After 4 weeks of treatment there was improvement of gastrointestinal symptoms in Group I (55 ± 12 vs 29 ± 8.8; P = 0.001) and Group II (50.5 ± 10.2 vs 46 ± 10.5; P = 0.001). Quality of life was significantly better in Group I than group II (93.4 ± 7.3 vs 102.4 ± 5.1; P = 0.001). Anxiety (93.3% vs 0%; P = 0.001) and depression (46.7% vs 0%; P = 0.004) were significantly lower in Group I than group II. When comparing the two groups after 4 weeks of treatment, gastrointestinal symptoms (29 ± 8.8 vs 46 ± 10.5; P<0.001) and quality of life (102.4 ± 5.1 vs 96 ± 6.1; P = 0.021) were significantly better in Group I than group II. Three months after the treatment, gastrointestinal symptoms remained better only in Group I, when compared to the pre-treatment values (38 ± 11.3 vs 55 ± 12; P = 0.001). 

Conclusion: In patients with functional dyspepsia the complementary acupuncture treatment is superior to conventional treatment. Further studies with more patients are needed to confirm these findings.

Combined treatment with acupuncture reduces effective dose and alleviates adverse effect of l-dopa by normalizing Parkinson's disease-induced neurochemical imbalance

Brain Res. 2013 Dec 7. pii: S0006-8993(13)01524-2. doi: 10.1016/j.brainres. 2013.11.28

Kim SN1, Doo AR2, Park JY2, Choo HJ3, Shim I2, Park JJ4, Chae Y1, Lee B5, Lee H1, Park HJ6

Abstract

This study first showed the behavioural benefits of novel combination therapy of l-dopa with acupuncture on Parkinson's disease, and its underlying mechanisms within basal ganglia. The previous study reported that acupuncture may improve the motor function of a Parkinson's disease (PD) mouse model by increasing the dopamine efflux and turnover ratio of dopamine. Hence, we hypothesised that combining l-dopa with acupuncture would have a behavioural benefit for those with PD. We performed unilateral injections of 6-OHDA into the striatum of C57Bl/6 mice to model hemi-Parkinsonian attributes. To test motor function and dyskinetic anomalies, we examined cylinder behaviour and abnormal involuntary movement (AIM), respectively. 

We found that (1) a 50% reduced dose of l-dopa (7.5mg/kg) combined with acupuncture showed an improvement in motor function that was comparable to mice given the standard dose of l-dopa treatment (15mg/kg) only, and that (2) the combination treatment (l-dopa +acupuncture) was significantly superior in reducing AIM scores when equivalent doses of l-dopa were used. The combination treatment also significantly reduces the abnormal increase of GABA contents in the substantia nigra compared to the standard l-dopa treatment. Furthermore, abnormal expression of FosB, the immediate early gene of l-dopa induced dyskinesia (LID), was mitigated in the striatum by the combination treatment. 

All of these results indicate that acupuncture enhances the benefits of l-dopa on motor function with reduced dose of l-dopa and alleviating LID by normalising neurochemical imbalance within the basal ganglia.

© 2013 Published by Elsevier B.V.

Thread-moxa in Zhuang folk medicine combined with acupuncture and external application drugs on AIDS patients with herpes zoster: a clinical observation

Zhongguo Zhong Xi Yi Jie He Za Zhi. 2013 Aug;33(8):1050-3.

Liu ZW, Mo JH, Pang J, Deng X.

Abstract

OBJECTIVE:

To observe the efficacy of thread-moxa in Zhuang folk medicine (TM) combined with acupuncture and external application drugs for AIDS patients with herpes zoster (AHZ).

METHODS:

A randomized, controlled clinical trial was conducted in 60 patients with AHZ. They were randomly assigned to the treatment group (treated with TM combined with acupuncture and Jingwanhong Scald Ointment) and the control group (treated with Famciclovir Tablet, nimesulide dispersible tablet, vitamin B1, ribavirin ointment). The treatment course was 14 days for both groups.The clinical efficacy, significant efficiency visual analog scale score (VAS), sleep quality score (QS), the postherpetic neuralgia rate in 1 year after treatment were observed.

RESULTS:

The markedly effective rate was significantly higher in the treatment group than in the control group (86.7% vs. 53.3%, P < 0.01). There was no statistical difference in the total effective rate between the two groups (96.7% vs. 80.0%, P > 0.05). The post-treatment VAS, QS, the time for pain disappearance, skin repair, crusting, and 1-year postherpetic neuralgia incidence rate were significantly lower in the treatment group than in the control group (P < 0. 05, P < 0.01).

CONCLUSIONS:

TM combined with acupuncture and Jingwanhong Scald Ointment was effective for treating AHZ patients. It relieved pain quickly, shortened their course of disease, and improved their quality of sleep.

Ganglion cyst of the foot treated with electroacupuncture: A case report

J Can Chiropr Assoc. 2013 Dec;57(4):310-315.

Woitzik E, Kissel J.

Source

Division of Graduate Studies, Sports Sciences, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Canada M2H 3J1.

Abstract

in English, French

Complete Text (PDF)

OBJECTIVE:

To present the clinical management of a ganglion cyst presenting on the dorsolateral aspect of the foot.

CLINICAL FEATURES:

A 45-year-old female cyclist complaining of ganglion cyst following training period.

INTERVENTION AND OUTCOME:

Patient was treated with high-frequency electroacupuncture in four consecutive sessions over four weeks, and reported resolution of the cyst following therapeutic intervention.

CONCLUSIONS:

Ganglion cysts of the foot are relatively rare connective tissue tumours with variable treatment approaches. Electroacupuncture may be a novel and non-invasive conservative approach for the treatment of ganglion cysts. Further evaluation of the efficacy of such treatment is warranted.

Patients with anorexia nervosa receiving acupuncture or acupressure; their view of the therapeutic encounter

Complement Ther Med. 2013 Dec;21(6):675-81. doi: 10.1016/j.ctim.2013.08.015. Epub 2013 Aug 31.

Fogarty S, Smith CA, Touyz S, Madden S, Buckett G, Hay P.

Source

Centre for Complementary Medicine Research, University of Western Sydney, Australia. Electronic address: s.fogarty@uws.edu.au.

Abstract

BACKGROUND:

Anorexia nervosa is a serious illness with significant morbidity. The evidence base for existing psychological and pharmacological interventions to manage anorexia nervosa is not strong, and use of new adjunctive therapies that improve the effectiveness of existing treatments, and lead to improved mental health outcomes for this patient group is highly desirable. This study investigates the views of patients with anorexia nervosa receiving an acupuncture or acupressure intervention.

METHOD:

A randomised controlled trial was conducted in Sydney, Australia. Twenty-six inpatients with a diagnosis of anorexia nervosa were randomised to a six week intervention of acupuncture or acupressure with light massage. Treatment was administered twice weekly for three weeks, then weekly for three weeks. A post treatment questionnaire was administered to explore participant views, of the study consultation. Questions examined important aspects of the clinical encounter including the, patient's perception of the practitioners' relational empathy (CARE), treatment perceptions and the, therapeutic relationship.

RESULTS:

Participants in both groups scored highly on the CARE scale assessing empathy and the, therapeutic relationship. There was no difference in the mean CARE scores for the acupuncture group (50 (SD 0.0)) and the acupressure group (49.5 (SD 0.8)). Participants highly valued the therapeutic, encounter and in particular the characteristics of empathy, positive regard, acceptance, non, judgemental responses and trust. Having someone to talk to, being less stressed/relaxed and contact, with the study staff were also perceived to be important.

CONCLUSION:

Study participants perceive the therapeutic relationship and empathy as important qualities of the acupuncture or acupressure intervention as an adjunct therapy for the treatment of anorexia nervosa.

Electroacupuncture treatment for pancreatic cancer pain: A randomized controlled trial

Pancreatology. 2013 Nov-Dec;13(6):594-7. doi: 10.1016/j.pan.2013.10.007. Epub 2013 Oct 23.

Chen H, Liu TY, Kuai L, Zhu J, Wu CJ, Liu LM.

Source

Department of Integrative Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.

Abstract

BACKGROUND:

Pancreatic cancer is often accompanied by severe abdominal or back pain. It's the first study to evaluate the analgesic effect of electroacupuncture on pancreatic cancer pain. A randomized controlled trial compared electroacupuncture with control acupuncture using the placebo needle.

METHODS:

Sixty patients with pancreatic cancer pain were randomly assigned to the electroacupuncture group (n = 30) and the placebo control group (n = 30). Patients were treated on Jiaji (Ex-B2) points T8-T12 bilaterally for 30 min once a day for 3 days. Pain intensity was assessed with numerical rated scales (NRS) before the treatment (Baseline), after 3 treatments, and 2 days follow-up.

RESULTS:

Baseline characteristics were similar in the two groups. After 3 treatment, pain intensity on NRS decreased compared with Baseline (-1.67, 95% confidence interval [CI] -1.46 to -1.87) in the electroacupuncture group; there was little change (-0.13, 95% CI 0.08 to -0.35) in control group; the difference between two groups was statistically significant (P < 0.001). Follow-up also found a significant reduction in pain intensity in the electroacupuncture group compared with the control group (P < 0.001).

CONCLUSIONS:

Electroacupuncture was an effective treatment for relieving pancreatic cancer pain.

Treatment of Multiple Sclerosis With Chinese Scalp Acupuncture

Glob Adv Health Med. 2013 Jan;2(1):8-13.

Hao JJ, Cheng W, Liu M, Li H, Lü X, Sun Z.

Source

National Certification Commission for Acupuncture and Oriental Medicine, Santa Fe, New Mexico, United States.

Abstract

Chinese scalp acupuncture is a contemporary acupuncture technique with just 40 years of history. It integrates traditional Chinese needling methods with Western medical knowledge of the cerebral cortex and has been proven to be a very effective technique for treating multiple sclerosis (MS) and other central nervous system disorders. 

A 65-year-old male patient who had had MS for 20 years was treated with Chinese scalp acupuncture. The motor area, sensory area, foot motor and sensory area, balance area, hearing and dizziness area, and tremor area were stimulated once a week for 10 weeks, then once a month for six sessions. After the 16 treatments, the patient showed remarkable improvements. He was able to stand and walk without any problems. The numbness and tingling in his limbs did not bother him anymore. He had more energy and had not experienced incontinence of urine or dizziness after the first treatment. He was able to return to work full time. At this writing, the patient has been in remission for 26 months. 

This case demonstrates that Chinese scalp acupuncture can be a very effective treatment for patients with MS. Chinese scalp acupuncture holds the potential to expand treatment options for MS in both conventional and complementary or integrative therapies. It can not only relieve symptoms, increase the patient's quality of life, and slow and reverse the progression of physical disability but also reduce the number of relapses and help patients with multiple sclerosis to remain in remission.

Treating coronary heart disease by acupuncture at neiguan (PC6) and xinahu (BL15): an efficacy assessment by SPECT

Zhongguo Zhong Xi Yi Jie He Za Zhi. 2013 Sep;33(9):1196-8.

Gao Z, Hu S, Wang ZJ, Chen Q, Jia SW.

Source

Department of Nuclear Medicine, Peking University Shenzhen Hospital, Guangdong 518036, China.

Abstract

OBJECTIVE:

To evaluate the clinical efficacy of acupuncture combined single photon emission computed tomography (SPECT) in treating coronary heart disease (CHD) and its effect on the myocardial ischemia/perfusion and the recovery of heart functions.

METHODS:

Totally fifty-nine patients with confirmed CHD were randomly assigned to two groups, the acupuncture group (32 cases) and the nitroglycerine group (27 cases). Patients in the acupuncture group were electro-acupunctured at bilateral Neiguan (PC6) and Xinshu (BL15) for 30 min with the frequency of 2/15 Hz and the current strength 9 - 18 mA after myocardial imaging induced by routine exercises or drug load. 99mTc-MIBI 370 MBq was injected 15 min after needling. The myocardial perfusion imaging was performed immediately after needling. 99mTc-MIBI740 MBq was injected to those in the nitroglycerine group during routine exercises or drug load. The myocardial perfusion imaging was performed 5 min after injection. Patients were asked to sublingual administration of nitroglycerine 1 mg after the myocardial perfusion imaging was completed. 99mTc-MIBI 370 MBq was intravenously injected 5 min later, and myocardial perfusion imaging was performed 5 min after injection.

RESULTS:

There was statistical difference in changes of radioactive uptake between before and after treatment in the two groups (P < 0.05, P < 0.01). Both acupuncture and buccal administration of nitroglycerine could increase the blood perfusion of ischemic myocardium. But there was no statistical difference in the improvement of ischemic myocardial cells (t = 1.57, P > 0.05).

CONCLUSION:

Using SPECT could clearly display therapeutic effects of acupuncture on CHD, thus providing a new visible research method for CHD studies.