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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Acupuncture alleviates osteoporosis related pain and improves bone mineral density. First Affiliated Hospital of Chengdu Medical College researchers conducted a controlled clinical trial. The team measured bone mineral density and serum osteocalcin before and after the study, along with visual analog scale (VAS) measurements of pain levels. Based on the scientific evidence, the researchers conclude that acupuncture reduces pain levels and promotes increased bone density in patients with osteoporosis. [1]

Prior to getting into the results, let’s go over the bone formation biomarker and bone density indicator used in the investigation. Bone mineral density was measured with dual-energy x-ray absorptiometry (DEXA) scans. The biomarker of bone formation was osteocalcin. Osteocalcin is a hormone present in bone. Cells that build bone (osteoblasts) secrete this protein and osteocalcin is a common marker of bone formation.

Osteocalcin is active in mineralization and has a natural diurnal pattern; osteocalcin levels naturally peak in the morning and are lowest in the afternoon. Glucocorticoid medications and alcohol reduce osteocalcin levels. Approximately 1–2% of bone protein is comprised of osteocalcin and it comprises approximately 15% of noncollagenous protein in bone. Circulating osteocalcin is cleared via the kidneys. As a result, osteocalcin levels may have limited accuracy as a biomarker for bone formation in patients with kidney disease. Other variations occur post-menopause (higher levels) and during pregnancy (lower levels).

Acupuncture was compared with calcium supplementation. Both approaches to patient care produced positive patient outcomes; however, acupuncture outperformed calcium supplementation. In the acupuncture group, there were 77 cases that had very effective results, 5 cases of effective treatment, and 9 cases of ineffective treatment. This produced a total effective rate of 90.10%. Mean bone mineral density increased from -2.50SD to 0.83SD, mean serum osteocalcin increased from 3.5mg/L to 6.2mg/L, and mean VAS scores dropped from 4.50 to 2.70 following treatment. The drop in VAS scores indicates reduced pain levels.

Calcium supplements produced beneficial results. In the calcium supplementation group, there were 57 cases that had very effective results, 16 cases of effective treatment, and 18 cases of ineffective treatment. This produced a total effective rate of 80.22%. Mean bone mineral density increased from -2.80SD to 0.63SD following treatment, mean serum osteocalcin increased from 4.0mg/L to 5.2mg/L and mean VAS scores dropped from 4.23 to 3.41 following treatment.

The data indicates that both treatment modalities produce clinical results. A follow-up investigation combining the therapies into an integrated protocol is appropriate given the positive patient outcome rates. It is possible that combining calcium supplementation with acupuncture may produce additive or synergistic effects.

 Acupuncture and Moxibustion
Osteoporosis has been recognised by Traditional Chinese Medicine (TCM) since its mention in texts as early as the Huang Di Nei Jing and Sun Simiao’s Qian Jin Yao Fang. In these texts, it is referred to as bone wilting or bone desiccation disease. Osteoporosis is primarily attributed to deficiency of the kidneys, since the kidneys are related to marrow production within the TCM system. This reflects the important relationship of the kidneys and bones.

Spleen and Stomach deficiency may also play a role in the pathology of this disease since they are responsible for ensuring a plentiful supply of qi and blood, which is necessary to nourish the bones. In the five element system, the relationship of the kidneys and spleen in this process is that spleen-earth regulates kidney-water. Another important relationship relative to osteoporosis treatment is that kidney-water is the mother of liver-wood.

Acupuncture treatment was administered according to the TCM principles of supplementing the liver and kidneys and strengthening the spleen. Points were selected on the foot Shaoyin, foot Taiyang, foot Taiyin, and foot Yangming channels. Points on the Governing Vessel and Back-Shu points were also used. The main points selected for the study were:

• Baihui (GV20)
• Dazhu (BL11)
• Zusanli (ST 36)
• Ganshu (BL18)
• Shenshu (BL23)
• Pishu (BL20)
• Taixi (KD3)
• Sanyinjiao (SP6)
• Dazhui (GV14)
• Mingmen (GV4)
• Xuanzhong (GB39)
• Huatuojiaji (MBW35)
• Yaoyangguan (GV3)

Additional points used in the study included the following:

• Yongquan (KD1)
• Xuehai (SP10)
• Taibai (SP3)
• Weishu (BL21)
• Weizhong (BL40)
• Yanglingquan (GB34)
• Sanjiaoshu (BL22)
• Zhiyang (GV9)

First, a needle was inserted at Baihui, which was subsequently warmed with a moxa cigar for 15 minutes. Needles topped with a 1 cm piece of moxa were then inserted at Dazhu, Zusanli, Ganshu, Shenshu, and Pishu. The moxa was ignited after obtaining deqi using a lifting and thrusting reinforcing technique. All needles were retained for 30 minutes.

The remaining points were warmed for 30 minutes using only moxa. Treatment was administered once every two days, for a total of three consecutive months. Participants in the control group were prescribed calcium tablets (manufactured by Huishi Pharmaceuticals) to be taken orally, one tablet twice a day for a total of three consecutive months. Acupuncture group patients did not receive calcium supplementation.

 Results and Discussion
Results were obtained by measuring bone mineral density and serum osteocalcin before and after the study period. Bone pain scores were measured using a visual analog scale (VAS) from 0–10. A VAS score of 0 indicated no pain, a score of 1–3 indicated mild pain, a score of 4–6 indicated moderate pain interfering with sleep, and a score of 7–10 indicated severe pain.

Treatment was either rated as very effective (increased bone mineral density and resolution of clinical symptoms), effective (no further loss of bone mineral density and a reduction in clinical symptoms) or ineffective (bone mineral density and clinical symptoms unaffected or worse than pre-treatment levels). The total effective rate was calculated by adding together the number of participants with very effective and effective scores in each group.

Acupuncture produced a total effective rate of 90.10%. Mean bone mineral density and osteocalcin increases were greater in the acupuncture group than in the calcium supplementation group. VAS scores showed greater pain reduction in the acupuncture group than the calcium supplementation group.

 Design
A total of 182 participants were recruited for the study and were randomly assigned to receive warm needle acupuncture and moxibustion (n=91) or oral calcium supplementation (n=91). Outcome measures for the study included subjective bone pain (measured by the visual analog scale), serum osteocalcin, and bone mineral density. Bone mineral density was measured with dual-energy absorptiometry scans. The results of this scan were compared to the peak bone mineral density of a healthy young adult in order to determine a T score. T scores between +1 and -1 standard deviations (SD) indicate normal and healthy bone density. The participants recruited for this study had a bone mineral density T score lower than -2.0 SD or a 25% loss of bone mineral density, both of which are indicative of osteopenia or osteoporosis. All patients had exams confirming the presence of osteoporosis.

 Summary
The results indicate that acupuncture is helpful in restoration of bone density in patients with osteoporosis. Calcium supplementation also produced significant positive patient outcomes. We look forward to a three-arm study comparing and combining the therapies.

 Reference:
Wang Qiongfen, Jiang Yuan, Ai Haibo (2018) “Study on Prevention and Treatment of Primary Osteoporosis and Bone Loss by Supplementing Liver, Kidney, Spleen Warming Acupuncture and Moxibustion” Laboratory Medicine and Clinical Journal, 15 (14), pp.2046-2048.

Researchers find acupuncture effective for the treatment of coronary heart disease (CHD). Using Single Photon Emission Computed Tomography (SPECT) scans, researchers from the Department of Nuclear Medicine at Peking University Shenzhen Hospital document that acupuncture produces a 70.1% blood perfusion improvement in ischemic myocardium CHD patients, while sublingual administration of nitroglycerine produces a 77.4% improvement. [1] The SPECT scans indicate that acupuncture produces clinically significant results. 

Single Photon Emission Computed Tomography (SPECT) is a nuclear imaging test used to diagnose coronary artery disease and other heart problems. [2] It uses venous injection of radioactive materials to produce images of the heart. On the images, the areas where the heart’s blood circulation is healthy appear light. Areas with poor blood circulation are dark. The imaging results indicate that acupuncture benefits blood circulation to the heart.

CHD, also known as coronary artery disease, occurs when the coronary arteries are either damaged or diseased. CHD is typically due to plaque buildups within the coronary arteries and inflammation. This causes a lack of blood and oxygen supply to the myocardium (heart muscular tissue). Initially, the condition may be asymptomatic but angina, shortness of breath, or even a heart attack may ensue in later stages of the illness. It is imperative that the blood and oxygen supply is restored to the heart. Now, advanced imaging finds acupuncture a helpful tool in restoration of blood flow.

The researchers observe, “Many studies have proven that acupuncture is effective for the treatment of coronary heart disease (CHD) through increasing myocardial blood perfusion. However, the current studies are mainly based on clinical symptoms and laboratory tests. There is a lack of a direct, visible, and quantifiable method to measure acupuncture’s effectiveness for the treatment of CHD.” They add that “SPECT provides a new research method for the study of coronary heart disease. It is a non-invasive and effective tool for macroscopically observing blood perfusion and cell function in human organs.”

 Group Selection Process 
Inclusion criteria were as follows. All participants had a diagnosis of coronary heart disease, according to the Nomenclature and Criteria for Diagnosis of Ischemic Heart Disease established by the World Health Organization. In addition, all patients met the following inclusion criteria:

• Positive myocardial SPECT perfusion imaging results
• Between 36–68 years of age
• Signed consent form

Exclusion criteria were applied to assure that patients did not experience interference from other conditions. Patients with the following conditions did not participate in the clinical trial:

• Cardiac neurosis
• Menopausal syndrome
• Cervical spondylosis

 Design
The research team (Gao et al.) used the following study design. A total of 59 patients were treated and evaluated. All patients admitted to the study were diagnosed with coronary heart disease (CHD). They were randomly divided into an acupuncture group (n=32) and a nitroglycerine group (n=27).

The acupuncture group was comprised of 25 males and 8 females. The average age in the acupuncture group was 50.0 (±7.1) years. The average course of disease in the acupuncture group was 14.6 (±3.1) months. The nitroglycerine group was comprised of 21 males and 6 females. The average age in the nitroglycerine group was 58.1 (±11.9) years. The average course of disease in the acupuncture group was 12.5 (±4.2) months. There were no significant statistical differences in gender, age, and course of disease relevant to patient outcome measures for the patients when admitted to the study. Careful attention to inclusion criteria and randomness assured the validity of the results.

 Nitroglycerin and Acupuncture
For both groups, the myocardial perfusion imaging was performed 5 minutes after intravenous injection of 99mTc-methoxyisobutylisonitrile (99mTc-MIBI) during normal exercise (Bruce’s protocol) or drug (dipyridamole) load. After the myocardial perfusion imaging was completed, the nitroglycerine group patients received 1 mg of nitroglycerin sublingually. After 5 minutes, 99mTc-MIBI was intravenously injected. A second myocardial perfusion imaging scan was performed 5 minutes after injection.

After the myocardial perfusion imaging was completed, patients in the acupuncture group received electroacupuncture at bilateral Neiguan (PC6) and Xinshu (BL15) for 30 min, with the frequency alternating between 2 and 15 Hz. The current strength ranged from 9 to 18 mA. Next, 99mTc-MIBI was injected 15 minutes after needling. A second myocardial imaging scan was obtained 15 minutes after needling. Only experienced licensed acupuncturists were chosen to implement acupuncture treatment.

 Evaluations 
Patients were evaluated before and after the treatment course. The muscle and cavity of the left ventricle were divided into 9 segments for the regional analysis of myocardial perfusion. First, all patients underwent myocardial perfusion qualitative assessments, wherein the number of the heart’s light and dark areas were compared before and after acupuncture treatments.

Next, a quantitative comparison of myocardial perfusion imaging results before and after treatment were evaluated by measuring the radioactive uptake rate (RUR) increase of each myocardial segment. If RUR increased by more than 15% after treatment, myocardial perfusion improvement is labeled “obvious”; if less than 15%, the improvement is “not obvious”. Third, a quantitative comparison of RUR increased, specifically in ischemic myocardial segments in the two groups, was performed before and after treatment.

 Results
From a total of 288 myocardial segments from the 32 acupuncture group patients, there were 127 dark segments before treatment. After acupuncture treatment, 89 of the dark segments became light, indicating an improvement (70.1%, 89/127) in myocardial segment perfusion. From a total of 243 myocardial segments in the 27 nitroglycerin group patients, there were 93 dark segments before treatment. After nitroglycerin administration, 72 of the dark segments became light, indicating an improvement (77.4%, 72/93) in myocardial segment perfusion. Comparing the results of the above two groups, acupuncture produced statistically significant clinical outcomes.

The RUR of the acupuncture group before treatment was 33.1% (±7.5). After acupuncture treatment, RUR was increased to 47.1% (±11.9), showing “obvious” myocardial perfusion improvement. The RUR of the nitroglycerin group before treatment was 30.8% (±7.6). After nitroglycerin administration, RUR was increased to 49.0% (±12.2), showing “obvious” myocardial perfusion improvement. There was no statistically significant difference between the two groups after treatment (P>0.05).

The RUR in the 89 ischemic myocardial segments of the acupuncture group was significantly increased by 17.6% (±7.8). The RUR in the 72 ischemic myocardial segments of the nitroglycerin group was significantly increased by 20.3%(±9.9). There was no statistically significant difference between the two groups (P>0.05).

 Summary
The focus of this study was to scientifically verify acupuncture’s effectiveness for the treatment of CHD. SPECT imaging results indicate that acupuncture is effective for myocardial perfusion improvements in CHD patients. According to the research covered in this article, common protocols involve the application of acupoints Neiguan (PC6) and Xinshu (BL15). Patients interested in learning more about CHD treatment are recommended to contact local licensed acupuncturists.

 References:
[1] Gao Z, Hu S, Wang ZJ, Chen Q, Jia SW. Treating Coronary Heart Disease by Acupuncture at Neiguan (PC6) and Xinshu (BL15): An Efficacy Assessment by SPECT [J] Chinese Journal of Integrated Traditional and Western Medicine, 2013, 33(9):1196-1198.
[2] heart.org/en/health-topics/heart-attack/diagnosing-a-heart-attack/single-photon-emission-computed-tomography-spect

Acupuncture outperforms calcium supplementation for the treatment of postmenopausal osteoporosis. Researchers from Huazhong University of Science and Technology (Wuhan, Hubei province) conclude that acupuncture is effective for the alleviation of pain and the regulation of osteoporosis-related cytokines in postmenopausal osteoporosis patients. The study was approved and funded by Hubei Provincial Natural Science Foundation. The results were published in Chinese Acupuncture and Moxibustion. [1] 

Three groups were compared. The calcium group received calcium carbonate tablets. The electroacupuncture group received acupuncture combined with electrical stimulation. The warm needling group received acupuncture and moxibustion.

Compared with the calcium and electroacupuncture groups, the warm needling group significantly reduced the visual analog scale (VAS) pain scores for postmenopausal osteoporosis patients. In addition, the research team measured biochemical responses to supplements and acupuncture, making important findings. The warm needling group significantly increased the serum insulin-like growth factor 1 (IGF-1) level and decreased serum interleukin 6 (IL-6) and tumor necrosis factor α (TNF-α) levels. The researchers conclude that warm needle acupuncture produces greater positive patient outcomes when compared with calcium supplementation and electroacupuncture.

 Biomarkers and Mechanisms
Before getting into the results, let’s first take a look at the osteoporosis-related biomarkers and their clinical significance. The IGF-1 data demonstrates that acupuncture with moxibustion significantly increases IGF-1 and therefore contributes to improved skeletal health. Serum IGF-1 promotes the proliferation and accumulation of chondrocytes, synthesis of cartilage matrix, and activity of alkaline phosphatase from osteoblasts. These are important biomarkers in the maintenance of bone homeostasis, osteoblast differentiation, and cartilage formation. [2] In a previous study Xian et al. note, “Mice with osteoprogenitor cell knockout of the IGF-1 receptor had lower bone mass, a slower rate of dynamic bone formation and lower numbers of mature osteoblasts (but not osteoprogenitor cells) on bone surfaces than wild-type controls.” [3]

In many cases, IL-6 has the opposite function of IGF-1 and contributes to bone resorption. The study demonstrates that acupuncture downregulates IL-6 for patients with osteoporosis. IL-6 is a multifunctional cytokine formed by osteoblasts and monocytes. It contributes to bone resorption via stimulation of osteoclastogenesis. [4]

Acupuncture successfully downregulates TNF-α, which is a potent bone resorption inducer. It activates mature osteoclasts and inhibits their apoptosis by effecting osteoblasts. [5] In addition, TNF-α induces IL-6 release. [6] Overall, the biomarkers measured in the study indicate that acupuncture activates endogenous biochemical responses that counteract bone loss.

Osteoporosis is caused by an imbalance between osteoblast and osteoclast activity. In osteoporosis patients, the process of bone resorption induced by osteoclasts is faster than that of bone formation by osteoblasts, which results in bone loss. Osteoporosis is a common disease in postmenopausal women that seriously affects their quality of life. Research shows that there is a direct relationship between the lack of estrogen in postmenopausal women and the development of osteoporosis. In an independent study, Stuart et al conclude, “estrogens can modulate the production of cytokines, such as IL-1, TNF, and IL-6.” Their study finds that “estrogen inhibits the secretion of IL-1 and TNF-α.” [7]

 Design
Researchers (Cai et al.) used the following study design. A total of 90 patients were treated and evaluated. All patients were diagnosed with postmenopausal osteoporosis. They were randomly divided into a calcium group, an electroacupuncture group, and a warm needling group, with 30 patients in each group. Inclusion criteria were as follows:

• Ages 45–60 years
• Course of disease range: 6 months–5 years
• Bone density T value ≤ -2.5, measured by dual-energy X-ray absorptiometry (DEXA)

Patients with the following conditions were excluded from the clinical trial:

• Endocrine and metabolic diseases (e.g., hyperparathyroidism, Cushing’s syndrome, hyperthyroidism, hyperthyroidism, diabetes)
• Blood diseases (e.g., myeloma, leukemia)
• Severe gastrointestinal diseases
• Mental and nervous system disorders

The statistical breakdown for the randomized groups were as follows. The average age in the calcium group was 51 (±6) years. The average course of disease in the calcium group was 3.4 (±1.6) years. The average age in the electroacupuncture group was 50 (±6) years. The average course of disease in the electroacupuncture group was 3.5 (±1.7) years. The average age in the warm needling group was 51 (±6) years. The average course of disease in the warm needling group was 3.3 (±1.6) years. No significant statistical differences in age and course of disease relevant to patient outcome measures existed for patients entering the study.

 Treatment Procedure
In the calcium group, 600mg of calcium carbonate tablets were prescribed, to be ingested once a day for a total of 30 days. The electroacupuncture and warm needling groups received acupuncture treatments at the following acupoints bilaterally:

• Dazhu (BL11)
• Shenshu (BL23)
• Xuanzhong (GB39)

Upon disinfection, acupuncture needles were perpendicularly inserted into the acupoints, up to a 15–20 mm depth. The electroacupuncture group received 10 Hz of electric stimulation on the acupoints, while the warm needling group received moxibustion by attaching a 2 cm moxa cutting to each needle handle. The total needle retention time per treatment was 30 minutes. Acupuncture was administered once per day, for a total of 30 days.

 Evaluations and Results
The changes in the visual analogue scale (VAS), serum insulin-like growth factor1 (IGF-1), interleukin6 (IL-6), and tumor necrosis factor (TNF-α) were observed before and after treatments in the three groups. VAS scores were all reduced after treatment. The decrease in the warm needle acupuncture group was the most obvious (6.73 ± 0.24 before treatment vs. 4.43 ± 0.26 after treatment). Values after warm needle acupuncture treatment varied compared with patients in the electroacupuncture (5.13 ±0.31) and calcium groups (5.17 ±0.33). Serum IGF-1 levels improved after treatment in the warm needling acupuncture group (119.5 ng/mL before treatment vs. 156.5 ng/mL after treatment), which was more significant compared with the electroacupuncture (136.3 ng/mL) and calcium (127.7 ng/mL) groups’ post-treatment values.

 Summary
Clinical and laboratory results indicate that acupuncture is effective for the treatment of osteoporosis patients. Application of acupoints Dazhu (BL11), Shenshu (BL23), and Xuanzhong (GB39) are the acupoints used in investigation and are proven to produce subjective and objective results. Patients interested in learning more are recommended to contact a local licensed acupuncturist.

References:
[1] Cai GW, Li J, Xu XJ, et al. Clinical Research on Warm Acupuncture Therapy for Pain in Postmenopausal Osteoporosis [J]. Chinese Acupuncture and Moxibustion, 2014, 34(1):25-27.
[2] Carney EF. Bone: modulation of IGF-1 might prevent Osteoporosis [J]. Nat Rev Rheumatol, 2012, 8 (8): 440.
[3] Xian, L. et al. Matrix IGF-1 maintains bone mass by activation of mTOR in mesenchymal stem cells. Nat. Med. 2012 Jul;18(7):1095-101.
[4] Ara T, Declerck Y A. Interleukin-6 in Bone Metastasis and Cancer Progression[J]. Eur J Cancer, 2010, 46(7): 1223-1231.
[5] Yang N, Wang G, Hu C, et al. Tumor Necrosis Factors Suppresses the Mesenchymal Stem Cell Osteogenesis Promoter Mir-21 in Estrogen Deficiency-induced Osteoporosis [J]. J Bone Miner Res, 2013, 28(3): 559-573.
[6] Tanabe, K., Matsushima-Nishiwaki, R., Yamaguchi, S., Iida, H., Dohi, S., & Kozawa, O. (2010). Mechanisms of Tumor Necrosis Factor-Α-Induced Interleukin-6 Synthesis in Glioma Cells. Journal of Neuroinflammation, 7(1), 16.
[7] Ralston S H. Analysis of gene expression in human bone biopsies by polymerase chain reaction: evidence for enhanced cytokine expression in postmenopausal Osteoporosis [J]. J Bone Miner Res, 1994, 9(6): 883-890.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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