Category Archives: Acupuncture

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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.

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Acupuncture Plus Topical Herbs Facial Paralysis Recovery

Acupuncture combined with topical herbs is effective for the treatment of facial paralysis. Researchers from the Traditional Chinese Medicine department of People’s Hospital (Huairen, Shanxi) tested two acupuncture protocols. Using acupuncture as a monotherapy produced a 76.92% total effective rate. The addition of topical herbal medicine to the acupuncture point prescription increased the total effective rate to 97.44%. [1] The type of facial paralysis examined in the investigation is categorized as Bell’s palsy. 

Acupuncture monotherapy produced significant positive patient outcomes: 11 patients were cured, 13 had highly effective results, 6 achieved the effective tier of patient outcomes, 9 did not have significant outcomes. Adding topical herbal medicine paste to the identical acupuncture point prescription protocol produced superior patient outcomes. In the acupuncture and herbs group, 20 patients were classified as cured, 14 were classified as highly effective, 4 were classified as effective, and 1 was ineffective. [2]

A total of 78 patients suffering from facial paralysis were recruited for the study and were randomly assigned to receive either standard acupuncture or acupuncture plus herbs, applied directly to specific acupuncture points. Within the standard acupuncture group, there were 20 males and 19 females, with a mean age of 35.26 years. Their duration of disease ranged from 1–14 months, with a mean duration of 5.41 months. Within the acupuncture and herbs group, there were 21 males and 18 females, with a mean age of 36.15 years. The duration of disease ranged from 2–15 months, with a mean duration of 5.57 months. No statistically significant difference was found between the two groups prior to the clinical trial.

All of the participants received a clinical diagnosis of facial paralysis according to TCM and biomedical criteria, were aged 20–65 years, and gave voluntary, informed consent to participate in the study. Patients whose facial paralysis was due to physical trauma or tumors were excluded. Further exclusion criteria were either concurrent serious illness or known allergies to topical medications.

 Acupuncture Points
For all patients in the acupuncture monotherapy group, the following local points were selected:

  • Sibai (ST2)
  • Dicang (ST4)
  • Taiyang (MHN9)
  • Quanliao (SI18)
  • Xiaguan (ST7)
  • Yingxiang (LI20)
  • Jiache (ST6)
  • Yangbai (GB14)

Additional distal points and needle techniques varied according to each patient’s individual Traditional Chinese Medicine (TCM) diagnosis as follows:

 Wind-Heat
For patients with facial paralysis due to wind-heat, the following distal points were added (all points were needled using a reducing technique or electroacupuncture):

  • Hegu (LI4)
  • Quchi (LI11)
  • Dazhui (GV14)
  • Yuji (LU10)
  • Waiguan (TB5)

 Wind-Cold
For patients with facial paralysis due to wind-cold, the following distal points were added (all points were needled using a reducing technique with warm needle acupuncture):

  • Hegu (LI4)
  • Fengchi (GB20)
  • Lieque (LU7)

 Blood Stasis
For patients with facial paralysis due to blood stasis, the following distal points were added (all points were needled using a balanced reinforcing-reducing technique):

  • Ganshu (BL18)
  • Neiting (ST44)
  • Xuehai (SP10)
  • Geshu (BL17)

 Acupuncture and Herbs

All patients in the acupuncture plus herbs group received local and distal acupuncture treatment according to the same protocol as the acupuncture monotherapy group. In addition, topical herbs were applied directly to specific acupuncture points, according to each patient’s TCM diagnosis.

 Wind-Heat 
For patients with facial paralysis due to wind-heat, the following herbs were selected:

  • Lian Qiao 10g
  • Bo He 6g
  • Huang Lian 6gBing Pian 2g
  • Zhi Ma Qian 1g
  • She Xiang 0.2g

The herbs were ground to a powder and made into a paste using a small amount of ginger juice. The paste was then divided and formed into small cakes to be applied to the following acupoints:

  • Xiaguan (ST7)
  • Jiache (ST6)
  • Yifeng (TB17)
  • Wangu (GB12)

 Wind-Cold
For patients with facial paralysis due to wind-cold, the following herbs were selected:

  • Zhi Chuan Wu 10g
  • Fang Feng 10g
  • Rou Gui 10g
  • Bai Fu Zi 10g
  • Quan Xie 6g

The herbs were ground to a powder and made into a paste using a few drops of water. The paste was then divided and formed into cakes to be applied to the following acupoints:

  • Xiaguan (ST7)
  • Taiyang (MHN9)
  • Jiache (ST6)

 Blood Stasis
For patients with facial paralysis due to blood stasis, the following herbs were selected:

  • E Zhu 10g
  • Xiang Fu 10g
  • Ru Xiang 10g
  • Mo Yao 10g
  • San Leng 10g
  • Pao Shan Jia 10g
  • Hong Hua 6g

The herbs were ground to a powder and made into a paste using a small amount of alcohol. The paste was then divided and formed into cakes to be applied to the following acupoints:

  • Scalp motor area
  • Taiyang (MHN9)
  • Qianzheng (MHN16)
  • Local ashi points

 Outcomes and Discussion
Treatment outcomes were measured using the House-Brackmann scale for facial function (H-B). The H-B scale quantifies the degree of nerve damage and is helpful in determining a prognosis. This scale grades facial function on a scale of 1–6, with 1 indicating normal facial function and 6 indicating complete paralysis. Prior to treatment, there was no significant difference between the mean H-B scores of the acupuncture monotherapy and the acupuncture and herbs groups, at 3.89 and 3.92 respectively (p>0.05). Following treatment, the mean H-B scores of both groups fell significantly (p<0.05). However, the mean post-treatment score in the acupuncture and herbs group was significantly lower at 2.01 compared with 2.87 in the standard acupuncture group (p<0.05).

In addition, the participants were divided into four categories according to their H-B scores and overall improvement in clinical symptoms at the end of the study. The participants were classified as either cured (complete resolution of clinical symptoms, H-B score of 1), highly effective (face symmetrical when static, but with slight asymmetry on movement, H-B score of 2), effective (face symmetrical when static, but asymmetrical with movement, some facial spasms or twitching, H-B score of 3), or ineffective (no significant improvement of clinical symptoms). Acupuncture as a standalone treatment modality and the acupuncture plus topical herbal medicine protocol produced significant patient outcomes; however, the addition of herbal medicine produced superior patient outcomes.

 References:
1. Ji Shouquan (2018) “Clinical Observation on Acupuncture and Moxibustion Combined with Chinese Herbs Acupoint Application in the Treatment of Facial Paralysis” Guangming Journal of Chinese Medicine, Vol. 33 (14), pp. 2075-2077.
2. Ibid.

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Acupuncture Peptic Ulcer Relief Confirmed

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

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

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

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

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

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

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

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

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

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

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

  • BL17 (Geshu)
  • SP6 (Sanyinjiao)

For stomach yin deficiency, the following acupoints were added:

  • SP6 (Sanyinjiao)
  • KI3 (Taixi)

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

  • CV4 (Guanyuan)
  • CV6 (Qihai)

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

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

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

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

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

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Acupuncture Parkinson’s Insomnia Relief Confirmed

Dalian Hospital of Traditional Chinese Medicine researchers confirm that acupuncture combined with herbal medicine is effective for the treatment of insomnia in Parkinson’s disease patients. In a controlled clinical trial, a combination of scalp acupuncture and a modified version of the herbal formula Gui Pi Tang were tested. Using the Pittsburgh Sleep Quality Index (PSQI) as a quantitative measure, Parkinson’s disease patients demonstrated significant improvements in sleep. [1]

The PSQI scale rates subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleep medications, and daytime dysfunction. Higher numbers indicate worse overall quality of sleep. PSQI questionnaires completed before and after the treatment period showed a statistically significant improvement in sleep quality in the two Chinese medicine groups. Group one received acupuncture and herbal medicine and group two received only herbal medicine.

Participants in the acupuncture plus herbs group showed a greater improvement in sleep quality with PSQI scores reduced from a mean of 14.9 before treatment to 4.5 following treatment. Improvements in the herbal medicine monotherapy group were comparatively lower, reducing from a mean of 15.1 to 8.7 following treatment. The results indicate that although herbal medicine is effective, the addition of acupuncture to the treatment protocol significantly increases positive patient outcomes for Parkinson’s disease patients suffering from insomnia.

Insomnia is a common Parkinson’s disease complication, with between 70% and 95% of Parkinson’s sufferers affected. Symptoms such as tremors, stiffness, pain, and restless leg syndrome all make getting a good night’s sleep difficult. Also, common Parkinson’s disease medications (e.g., levodopa) have a stimulatory effect and can cause sleep problems if taken late in the evening.

A total of 50 patients with Parkinson’s disease were recruited for the study and were randomized to either the herb monotherapy group (n=25) or the acupuncture plus herbs group (n=25). The herb monotherapy group received a modified Gui Pi Tang formula, while the acupuncture plus herbs group received the identical modified Gui Pi Tang herbal formula plus scalp acupuncture points. Both groups were statistically similar in terms of demographics, with 13 males and 12 females in each group. The mean age of the herb monotherapy group was 69.7 years and the mean age of the acupuncture plus herbs group was 69.6 years.

Inclusion criteria for the study included tremors or mobility problems, stiffness of the limbs affecting the gait, and having undergone an MRI scan to rule out cerebral bleeding. According to Chinese medicine principles, the patients were diagnosed with a pattern of heart and spleen deficiency. This pattern is a combination of heart qi and blood deficiency with spleen qi deficiency. Common indications for the presence of this pattern are insomnia, forgetfulness, palpitations, dream disturbed sleep, poor appetite, and loose stools. The tongue is typically pale with a white coating and the pulse is deep and weak.

For heart and spleen deficiency, the treatment principle is to tonify the heart and spleen. The diagnostic inclusion parameter of heart and spleen deficiency matches the classical application of Gui Pi Tang within Traditional Chinese Medicine (TCM) for the treatment of this condition. In many clinical scenarios, Gui Pi Tang is used for patients that are light sleepers and wake frequently throughout the night. This is distinguished from other forms of sleep disorders. For example, if patients wake between 1–3 am and have stress, anxiety, tight jaws or grinding, and other manifestations of liver qi stagnation, an herbal formula such as Xiao Yao Wan or Dan Zhi Xiao Yao Wan are usually prescribed instead.

Exclusion criteria included reduced liver and kidney function, gastrointestinal bleeding, organ failure, abnormal cerebral function, stroke or cerebral bleeding, and psychological diseases. All of the participants were on various medications including antibiotics, blood pressure medications, or blood sugar regulatory drugs. All participants were prescribed oral levodopa (0.25mg, three times per day). The modified Gui Pi Tang formula consisted of the following herbs:

  • Bai Zhu 15g
  • Ren Shen 10g
  • Dang Gui 15g
  • Fu Ling 15g
  • Yuan Zhi 10g
  • Suan Zao Ren 15g
  • Mu Xiang 10g
  • Long Yan Rou 10g
  • Da Zao 10g

These ingredients were decocted to 150ml of liquid to be taken orally twice per day. Each course lasted 15 days and a total of four courses were administered to both the herb monotherapy and the experimental groups. In addition to the modified Gui Pi Tang formula, the acupuncture plus herbs group also had scalp acupuncture treatments. The following points were selected for all participants:

  • Baihui (GV20)
  • Touwei (ST8)
  • Sishencong (MHN1)
  • Toulinqi (GB15)

The acupoints were stimulated manually using a reinforcing method and treatment was administered once per day. Each acupuncture course lasted 15 days (one treatment session per day) and a total of four courses were administered. The results demonstrate significant improvements from the herb monotherapy; however, the addition of acupuncture produces greater clinical results.

 Related Research
Federal University of Pernambuco (Recife, Brazil) researchers had similar findings. In this study, 22 patients diagnosed with Parkinson’s disease by a neurologist were recruited and randomized to receive either acupuncture (n=11) or no intervention (n=11). Both groups included seven male and four female participants. The mean age in the acupuncture group was 65 years compared with 56 years in the control group. Despite this difference in age, both groups had similar clinical characteristics.

Inclusion criteria included a diagnosis of idiopathic Parkinson’s disease according to the UK Parkinson’s Disease Society Brain Bank criteria, stage I–III Parkinson’s disease according to the Hoehn-Yahr scale, and ages ranging between 35–80 years. Exclusion criteria included the presence of comorbid neurological diseases, cognitive impairment, or having undergone physiotherapy. All participants had been on a stable dose of Parkinson’s medications for at least 2 months prior to the study. The following acupuncture points were selected for the study on the basis of previous research:

  • Taichong (LV3)
  • Sanyinjiao (SP6)
  • Hegu (LI4)
  • Waiguan (TB5)
  • Shenmen (HT7)
  • Neiguan (PC6)
  • Quchi (LI11)
  • Fengchi (GB20)

Needles were retained for 30 minutes per session and treatments were administered weekly for a total of eight weeks. The results were analyzed using the Parkinson’s Disease Sleep Scale (PDSS), a self-administered scale which comprises 15 items including overall quality of sleep, sleep onset and maintenance, nocturnal restlessness, nocturnal psychosis, nocturia (excessive waking for urination at night), nocturnal motor symptoms, sleep refreshment, and daytime dozing. There were no significant differences in PDSS scores between the groups prior to the study.

Following treatment, there was a significant improvement in PDSS scores in the acupuncture group in the domains of general sleep quality, nocturnal psychosis, and nocturnal motor symptoms. [2] There was a tendency towards improvement in sleep onset and maintenance, nocturnal agitation, nocturia, relaxing sleep, and daytime sleepiness, but these improvements were not as pronounced as the aforementioned improvements. The control group did not show significant improvements at the end of the study period. Based on the data, the researchers confirm that acupuncture improves sleep for patients with Parkinson’s disease.

 References:
1. Li L. “Clinical Observation on Guipi Decoction Combined with Acupuncture and Moxibustion in the Treatment of Insomnia Patients with Parkinson” Guangming Journal of Chinese Medicine; July 2018. Vol 33.

2. De Amorim Aroxa, Fábio Henrique, Ihana Thaís Guerra de Oliveira Gondim, Elba Lúcia Wanderley Santos, Maria das Graças Wanderley de Sales, Amdore Guescel C. Asano, and Nadja Maria Jorge Asano. “Acupuncture as Adjuvant Therapy for Sleep Disorders in Parkinson’s Disease.” Journal of acupuncture and meridian studies 10, no. 1 (2017): 33-38.

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Acupuncture Migraine Relief Confirmed In Laboratory Investigation

Acupuncture alleviates migraine headaches. Many clinical trials compare MRI scans, biological markers, and subjective clinical outcomes in human trials. This investigation varies by using only biological markers to confirm the results in a laboratory investigation. Overall, this multi-arm investigation demonstrates that a limited acupuncture point prescription of local points is enhanced by the addition of distal acupoints. 

Researchers from Shandong University of Traditional Chinese Medicine found both a limited conventional acupuncture protocol and Shu Gan Tiao Shen acupuncture produce significant positive clinical outcomes for patients with migraines. Shu Gan Tiao Shen (translated as liver-soothing and spirit-calming) acupuncture is a method of acupuncture used by China’s renowned Traditional Chinese Medicine (TCM) doctor, Professor Shan Qiuhua. The primary acupoints in Shu Gan Jie Yu are: Baihui (GV20), Fengchi (GB20), Neiguan (PC6), and Taichong (LV3). [1] The researchers also explained the biological mechanisms stimulated by acupuncture. The study was funded by the National Natural Science Foundation of China.

 Biological Markers
Prior to getting into the results, let’s go over the biomarkers used in the study. Calcitonin gene-related peptide (CGRP) is an important marker of migraines. [2] It is released from the trigeminal neuro-microvascular system and triggers migraines by promoting sensitization of peripheral and central trigeminal neurons and glial cells, brain blood vessel vasodilation, and by enhancing release of substance P (SP) and 5-hydroxytryptamine (5-HT). [3] Receptor activity-modifying protein 1 (RAMP1) is essential for producing the receptor for CGRP.

A previous study demonstrates that elevation of RAMP1 can cause migraines by increasing neuronal CGRP receptor activity. [4] In addition, 5-hydroxytryptamin 1D Receptor (5-HT1DR) is a 5-hydroxytryptamine (5-HT) receptor. When interacting with 5-HT, 5-HT1DR mRNA relieves migraines by decreasing CGRP levels in the trigeminal ganglion and nucleus. Acupuncture was successful at increasing these levels, thereby facilitating migraine relief.

 Design
The randomized study involved 40 laboratory rats. Subjects were divided into four arms, with 10 subjects in each arm. The first arm is a blank control group, which didn’t receive any intervention. The other three arms were injected with nitroglycerin to induce a migraine model. After injection, the third arm received conventional acupuncture (CA), while the fourth arm received Shu Gan Tiao Shen acupuncture (SGTSA). The second arm was a migraine model group which received no treatment for the study duration.

 Results
Compared with the control group, the levels of RAMP1 protein and mRNA in the spinal trigeminal nucleus (STN) and mesencephalon were significantly increased (P<0.05), while those of 5-HT1DR protein and mRNA considerably decreased (P<0.05) in the model group. After acupuncture treatment, both increased levels of RAMP1 protein and mRNA and decreased levels of 5-HT1DR mRNA and protein were significantly reversed in the two acupuncture groups (P<0.05). In addition, Shu Gan Tiao Shen acupuncture provided significantly superior outcomes over conventional acupuncture in down-regulating RAMP1 mRNA and protein levels in the STN and mesencephalon (P<0.05) and in up-regulating 5-HT1DR mRNA and protein levels (P<0.05). The researchers conclude that, “Our data indicates that acupuncture provides positive outcomes for migraine treatment.” They add that Shu Gan Tiao Shen acupuncture produced a superior benefit over conventional acupuncture by down-regulating RAMP1 mRNA and protein levels and up-regulating 5-HT1DR mRNA and protein levels to a greater degree.

 Acupuncture Points
The following primary acupoints were selected for the CA group:

  • Baihui (GV20)
  • Fengchi (GB20, bilateral)

The following primary acupoints were selected for the SGTSA group:

  • Baihui (GV20)
  • Fengchi (GB20, bilateral)
  • Neiguan (PC6, bilateral)
  • Taichong (LV3, bilateral)

For the Baihui and Fengchi acupoints, the acupuncture needle was inserted obliquely, to a depth of 1–2 mm. For the Neiguan and Taichong acupoints, the acupuncture needle was inserted perpendicularly, to a depth of 1–2 mm. The needle retention time was 30 minutes. Acupoints were located according to Acupuncture Points of Experimental Animals issued by the China Association for Acupuncture and Moxibustion.

 TCM Theories
The modern laboratory findings of the study are consistent with ancient TCM acupuncture principles. Shu Gan Tiao Shen acupuncture employs the use of acupoints Baihui (GV20), Fengchi (GB20), Neiguan (PC6), and Taichong (LV3). Baihui is located on the very top of the head. Needling this local acupoint clears the mind, opens the orifices, and calms the spirit. This acupoint is indicated for headaches and migraines. Fengchi is a local point commonly used for migraines. Neiguan is the Luo-connecting point. Needling this acupoint frees the blood vessels, regulates heart-qi, and lifts the spirit. Taichong is the Yuan-source point of the liver meridian. This acupoint is indicated for migraines because needling it soothes the liver and promotes the free flow of qi and blood through the head. Clinically, Neiguan and Taichong are often used in combination to sooth the liver, relieve depression, regulate the heart, and calm the spirit.

The research confirms that acupuncture relieves migraines. The laboratory findings demonstrate that acupuncture regulates the balance of several biomarkers related to migraines; namely, CGRP, RAMP1, and 5-HT1DR. Shu Gan Tiao Shen acupuncture produces superior outcomes over the more limited conventional acupuncture protocol for migraine treatment.

 Migraine Relief
In related findings, researchers (Zhao et al.) conclude that acupuncture reduces migraine attack frequency, duration, and intensity. The researchers note, “True acupuncture [TA] exhibited persistent, superior, and clinically relevant benefits for migraine prophylaxis, reducing the migraine frequency, number of days with migraine, and pain intensity to a greater degree than SA [sham acupuncture] or WL [wait list].” Also, patients receiving true acupuncture demonstrated significant improvements in the “emotional domain of quality of life.” The research team concludes, “Acupuncture should be considered as one option for migraine prophylaxis in light of our findings.” [5]

The research team followed 249 subjects over a 24 week period and employed the use of manual acupuncture to elicit deqi and also used electroacupuncture. The researchers note that true acupuncture “was more efficacious for migraine prophylaxis than SA or no acupuncture, and the improvement induced by acupuncture persists for at least 24 weeks.” True acupuncture reduces the pain levels of migraine attacks while simultaneously reducing the duration of migraines. The researchers conclude, “Compared with SA [sham acupuncture] and WL [wait list] control groups, TA manifested persisting superiority and clinically relevant benefits for at least 24 weeks in migraine prophylaxis, including reducing the number of migraine frequency and days with migraine, as well as decreasing pain intensity.”

True acupuncture patients and sham acupuncture patients received 20 sessions of electroacupuncture treatments at a rate of once per day, for a total of 5 consecutive days. A two-day break followed each session prior to applying the next round of treatments. Each acupuncture treatment was 30 minutes long and the total span of acupuncture treatments lasted 4 weeks. Four acupoints were permitted during each acupuncture treatment. Two acupoints were applied to all patients in the real acupuncture group:

  • Fengchi (GB20)
  • Shuaigu (GB8)

Two additional acupuncture points were used based on diagnostics:

  • Hegu (LI4)
  • Neiting (ST44)
  • Taichong (LV3)
  • Qiuxu (GB40)
  • Waiguan (TB5)
  • Yanglingquan (GB34)
  • Kunlun (BL60)
  • Houxi (SI3)

Needles were 25–40 mm in length and were 32 gauge (0.25 mm). Left and right side acupuncture points were chosen by alternating sides, a practice common to prevent overstimulation in deficient patients. Deqi was stimulated with manual acupuncture at each point. Electroacupuncture was applied with an alternating frequency of 2/100 Hz. The frequency changed every 3 seconds. The intensity was set to tolerance levels and was limited to 0.1–1.0 mA. The researchers determined that acupuncture is an effective treatment modality, producing lasting and significant clinical outcomes.

 Population
Researchers from the Department of Neurology at the Albert Einstein College of Medicine (Bronx, New York) surveyed the USA and quantified the migraine prevalence. They conclude, “The number of migraineurs has increased from 23.6 million in 1989 to 27.9 million in 1999 commensurate with the growth of the population. Migraine is an important target for public health interventions because it is highly prevalent and disabling.” [6] Based on the aforementioned evidence and the widespread prevalence of migraine sufferers, acupuncture is a reasonable treatment option and access to care is essential to prevent widespread suffering. Patients seeking advice regarding acupuncture are advised to consult with local licensed acupuncturists.

 References:
[1] Wang MM, Yu XH, Di W, Cui HF, Wang CC, Han J, Yang DH. Manual Acupuncture Stimulation Regulates Expression of Receptor Activity-modifying Protein 1 and 5-HT 1D Receptor Proteins and Genes in Migraine Rats [J]. Acupuncture Research, 2018,43(07):440-444.
[2] Huang L, Cui YL, Chen YQ. Effect of Jiawei Sanchang Decoction on Behavioral Symptoms, Plasma NO, NOS, CGRP and Contents of NOS_1 and CGRP in Trigeminal Nerve Bone Nuclei in Rats with Nitroglycerin-induced Migraine [J]. Lishizhen Medicine and Materia Medica Research, 2016, 27 (12): 2890-2892.
[3] Levy D, Burstein R, Strassman A M. Calcitonin Gene-related Peptide Does Not Excite or Sensitize Meningeal Nociceptors: Implications for the Pathophysiology of Migraine [J]. Ann Neurol, 2005, 58(5): 698-705. 
[4] Zhongming Zhang, Christina S. Winborn, Blanca Marquez de Prado and Andrew F. Russo. Sensitization of Calcitonin Gene-Related Peptide Receptors by Receptor Activity-Modifying Protein-1 in the Trigeminal Ganglion [J]. Journal of Neuroscience 7 March 2007, 27 (10) 2693-2703.
[5] Zhao, Ling, Jiao Chen, Ying Li, Xin Sun, Xiaorong Chang, Hui Zheng, Biao Gong et al. “The long-term effect of acupuncture for migraine prophylaxis: a randomized clinical trial.” JAMA Internal Medicine (2017).
[6] Lipton, Richard B., Walter F. Stewart, Seymour Diamond, Merle L. Diamond, and Michael Reed. “Prevalence and burden of migraine in the United States: data from the American Migraine Study II.” Headache: The Journal of Head and Face Pain 41, no. 7 (2001): 646-657. Department of Neurology, Albert Einstein College of Medicine (Bronx, New York).

Acupuncture, Acupuncture Blogs

Acupuncture Knee Arthritis Treatments Found Effective

Guangzhou University of Traditional Chinese Medicine researchers find two different styles of acupuncture effective for the alleviation of knee osteoarthritis. Patients in the clinical trial had significant reductions in pain, stiffness, and joint immobility. The two styles tested were conventional acupuncture and four seas acupuncture. Results were very similar when comparing both groups. Four seas acupuncture produced a 96.7% total effective rate. Conventional acupuncture produced a 93.3% total effective rate. [1] 

Four seas acupuncture outperformed conventional acupuncture in one specific area. According to the participants’ self-rated scores, improvements and overall satisfaction were greatest in the four seas acupuncture group. Otherwise, the reductions in pain, stiffness, and joint mobility were similar across both acupuncture styles.

The results are intriguing given that the four seas style of acupuncture did not utilize standard local acupuncture points for the treatment of knee osteoarthritis (i.e., Xiyan, Xixia, Heding). The conventional acupuncture group received acupuncture needling at Xiyan, which is comprised of two acupoints: Neixiyan (MNLE16), Dubi (ST35). Neither group received needling at Xixia and Heding.

The four seas style of acupuncture focuses on promoting the free flow of qi and blood. In Traditional Chinese Medicine (TCM), the four seas are the sea of water and grain, sea of qi, sea of blood, and the sea of marrow. The four seas flow into the twelve main acupuncture channels and have a powerful effect on their related systems. When the four seas are functioning well, the human body is healthy. If they fall into dysfunction, disease occurs. Four seas acupuncture works on the basis set acupoint combinations to directly influence each one of the four seas, thus restoring a state of health.

The study’s inclusion criteria focus on patients with chronic, deficient knee osteoarthritis conditions. This, in part, explains the success of the four seas approach, given its focus on nourishing and sustaining the general health of the body. All participants admitted to the study had a type of knee osteoarthritis in the liver and kidney deficiency syndrome category. Diagnostic criteria for this syndrome include knee pain, aching of the lower back and knees, tenderness, swelling and reduced mobility of the affected joint, difficulty walking, and muscle atrophy. This was confirmed by tongue and pulse diagnosis, showing a tongue with red sides and a thin or thin-white coating, and a wiry, thin pulse.

All participants received a biomedical diagnosis of knee osteoarthritis, according to American College of Rheumatology guidelines. Diagnostic criteria included the following: frequent knee pain in the previous few months, bone proliferation at the edges of the knee joint, synovial fluid analysis showing typical markers for knee osteoarthritis, morning knee stiffness, knee crepitus upon movement, age 40 years or greater.

A total of 60 participants were randomly assigned to receive four seas acupuncture and moxibustion or conventional acupuncture and moxibustion. The four seas group consisted of 14 male and 16 female participants with a mean age of 54 years. The conventional acupuncture group consisted of 12 male and 18 female participants with a mean age of 52 years. The mean duration of disease for the two groups was 5.52 years and 5.74 years respectively. Exclusion criteria the following: serious cardiovascular, liver, or kidney disease, organ failure, malignant tumors, mental disorders, connective tissue disorders, bleeding disorders.

 Four Seas
In this group, acupuncture treatment was administered according to the four seas theory. The points selected for the study were:

  • Dazhu (BL11)
  • Zusanli (ST36)
  • Shangjuxu (ST37)
  • Xiajuxu (ST39)

Patients were placed in a seated position and the selected points were disinfected following standard procedure. Dazhu was needled using a 25mm filiform needle, inserted obliquely towards the spine to a depth of 0.8 cun. The remaining points were needled using 40mm filiform needles inserted to a depth of 1.2 cun. After obtaining deqi, the needles were retained for 20 minutes. After the needles were removed, moxibustion was administered using a moxa cigar suspended over each point until a sensation of heat was felt by the patient. Treatment was administered once daily, with five consecutive days of treatment making up one course. A total of four courses of treatment were administered.

 Conventional Acupuncture
In this group, the following points were selected according to TCM theory:

  • Neixiyan (MNLE16)
  • Dubi (ST35)
  • Xuehai (SP10)
  • Liangqiu (ST34)
  • Taichong (LV3)
  • Taixi (KD3)

Patients were treated in a seated position with their knees slightly bent. Following standard disinfection, 40mm filiform needles were inserted at Neixiyan and Dubi to a depth of 1–1.2 cun, taking care not to penetrate the joint capsule. This combination of points is also referred to as Xiyan. Xuehai and Liangqiu were needled to a depth of approximately 1.2 cun using 40mm needles. Taichong and Taixi were needled to a depth of 0.5–0.8 cun using 25mm needles. After obtaining deqi, needles were retained for 20 minutes, followed by suspended moxibustion as detailed above. Treatment was administered daily, with five consecutive days of treatment making up one course. A total of four courses of treatment were administered.

At the Healthcare Medicine Institute, many licensed acupuncturists have noted that patients are unable to comply with daily visits given issues with access to care, insurance coverage, and availability. Recommended are modified protocols to increase treatment intensity (e.g. electroacupuncture, added manual techniques) to facilitate patient recovery. To learn more, visit the acupuncture continuing education course: Acupuncture For Knee Pain >

 Results
The primary methods of assessment were the McGill pain Questionnaire (MPQ), Index of Severity for Osteoarthritis of the Knee (Lequesne MG), Lysholm Knee Scoring Scale (LKSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Japanese Orthopaedic Association Score for Osteoarthritic Knees (JOA). In addition, the participants self-assessed their improvement in symptom reporting and overall satisfaction with the treatment provided.

Both groups experienced significantly reduced MPQ and LKSS scores following treatment, with no significant difference between the two groups. Reductions were also seen in both groups’ Lequesne MG scores; notably, reductions in the four seas acupuncture group were significantly greater. WOMAC scores fell in both groups in the areas of pain, stiffness, and mobility, with total scores in the four seas acupuncture group being significantly lower. JOA scores improved for both groups; improvement was greater in the four seas group.

 Summary
The two aforementioned types of acupuncture are safe and effective for the treatment of knee osteoarthritis. To learn more, contact your local licensed acupuncturist and inquire about knee treatments.

 Reference:
Chen Yin-yao (2018) “Therapeutic observations of Four Seas Theory-based Acupuncture-moxibustion for Knee Osteoarthritis of Liver-kidney Deficiency Type” Shanghai Journal of Acupuncture and Moxibustion, vol. 37 (7), pp. 804-808.

Acupuncture, Acupuncture Blogs

Acupuncture Is Grounded In Science

The principles of acupuncture are firmly grounded in science, and you don’t need Chinese philosophy either to make it work, or to practice it, says a leading medically trained acupuncturist. Dr Adrian White, who is editor in chief of the scientific journal Acupuncture in Medicine, was speaking at the launch of the journal’s transfer to publication by BMJ Group after 27 years of publication with the British Medical Acupuncture Society (BMAS).

“One of the major problems facing medical acupuncture is the preconceived notions both the public and healthcare professionals have of it,” he said. “The perception is that acupuncture is still all about chi and meridians.”

This view has hindered its acceptance among healthcare professionals, and its wider use as a valid addition to pain control in conditions, ranging from nausea to arthritis, as well as after surgery, he contends.

“In the past it was easy for doctors and scientists to dismiss acupuncture as ‘highly implausible’ when its workings were couched in talk of chi and meridians. But it becomes very plausible when explained in terms of neurophysiology,” he explains.

Unfortunately, the scientific approach just isn’t as sexy,” he continues. “Many people, including practitioners and the public, have held on to the traditional explanations.”

And there’s plenty of scientific evidence, which has been building up for the past 30 years, to show that acupuncture stimulates the nerves in the brain and spinal cord, releasing feel good chemicals, such as opioids and serotonin. The research also shows that a needle placed outside of the traditional meridians will have an impact.

“Points don’t have any magical properties; they are simply convenient locations to needle,” he says.

Clinging to the traditional approach also stymied good quality research, because needling outside the meridians is often used as a comparator. “This misunderstanding has been a fundamental flaw in the design of many acupuncture studies,” comments Dr White.

Shrouding acupuncture in the mystery of Chinese philosophy has also prevented healthcare professionals from providing acupuncture themselves.

“[They] already know how to diagnose, and they already know a great deal about anatomy and physiology, so they can easily learn to practice acupuncture safely and effectively,” after a short foundation course, of the type provided by BMAS, he says.

“The aim of Acupuncture in Medicine is to build up the evidence base for acupuncture’s place in the modern health service,” says Dr White.

While it may not be a cure all, acupuncture does have a place, and is a relatively inexpensive approach to common conditions that can be difficult and often costly to treat, he says.