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Acupuncture, Acupuncture Blogs

Biochemical Changes and Acupuncture

Researchers have discovered that acupuncture causes a special biochemical reaction that reduces inflammation and muscle pain. The study, published in Molecular Neurobiology, investigated the effects of needling one acupuncture point on the leg. The research team measured a remarkable effect. 

Manual acupuncture stimulation downregulated M1 macrophages (pro-inflammatory cells) and upregulated M2 macrophages (anti-inflammatory cells). As a result, acupuncture reduced pain and swelling. This neurobiological acupuncture continuing education study solves a great mystery, how does acupuncture work? The secret is in the biochemistry. M2 macrophages are an important source of IL-10 (interleukin-10), an anti-inflammatory cytokine that plays an important role in immune responses. Cytokines are proteins released by cells that regulate reactions between cells. Manual acupuncture successfully downregulates M1 macrophages and upregulates M2 macrophages thereby promoting the release of greater IL-10 concentrations. As a result of IL-10 release, pain and inflammation significantly reduce.

This study measured responses in muscle tissues and confirmed that M1 to M2 macrophage phenotype switching is triggered by acupuncture stimulation. Acupuncture literally flips a switch wherein initial inflammatory responses are reduced and the secondary healing responses are promoted. M1 macrophage downregulation and M2 macrophage upregulation triggered by acupuncture was positively associated with reductions in muscle pain and inflammation.

The researchers tested the biochemical process by adding an IL-10 blocking agent in the laboratory experiment. When IL-10 was chemically blocked, acupuncture did not reduce pain and swelling. However, when no blocking agent was applied, acupuncture successfully reduced both pain and swelling. The M2 macrophage upregulation by manual acupuncture successfully created a greater source of IL-10. The researchers note, “These findings provide new evidence that MA (manual acupuncture) produces a phenotypic switch in macrophages and increases IL-10 concentrations in muscle to reduce pain and inflammation.” 

Macrophages are required by the body to resolve muscle injury. During injury, M1 macrophages are produced and release inflammatory biochemicals including pro-inflammatory cytokines. M2 macrophages have anti-inflammatory properties and promote the release of interleukin-10. An injury process features an initial inflammatory stage wherein M1 pro-inflammatory macrophages are upregulated. A secondary recovery phase wherein M2 anti-inflammatory macrophages are upregulated helps to promote healing and repair. Manual acupuncture successfully triggered the phenotype switch wherein the M1 macrophages were downregulated and M1 macrophages were upregulated thereby allowing increased IL-10, reductions in pain and decreased swelling.

 References
da Silva, Morgana D., Franciane Bobinski, Karina L. Sato, Sandra J. Kolker, Kathleen A. Sluka, and Adair RS Santos. “IL-10 Cytokine Released from M2 Macrophages Is Crucial for Analgesic and Anti-inflammatory Effects of Acupuncture in a Model of Inflammatory Muscle Pain.” Molecular Neurobiology (2014): 1-13.

Rafael Torres-Rosas, Ghassan Yehia, Geber Peña, Priya Mishra, Maria del Rocio Thompson-Bonilla, Mario Adán Moreno-Eutimio, Lourdes Andrea Arriaga-Pizano, Armando Isibasi, Luis Ulloa. Dopamine mediates vagal modulation of the immune system by electroacupuncture. Nature Medicine, 2014; DOI: 10.1038/nm.3479.

Wang, Ying, Rebekka Gehringer, Shaaban A. Mousa, Dagmar Hackel, Alexander Brack, and Heike L. Rittner. “CXCL10 Controls Inflammatory Pain via Opioid Peptide-Containing Macrophages in Electroacupuncture.” PloS one 9, no. 4 (2014): e94696.

Acupuncture, Acupuncture Blogs

Anti-inflammatory Acupuncture

Acupuncture reduces inflammation and researchers have discovered how it works. In a laboratory controlled scientific investigation, a key biological marker has been identified, quantified, and directly correlated with the application of acupuncture. Acupuncture successfully downregulates a proinflammatory biochemical (tumor necrosis factor alpha), which results in anti-inflammatory responses. In addition, the researchers have mapped the neural pathways by which acupuncture signaling stimulates anti-inflammatory effects.

Researchers in Korea have identified a mechanism by which acupuncture stimulation at the acupoint ST36 (Zusanli) has an anti-inflammatory effect. By downregulating tumor necrosis factor alpha (TNF-α), acupuncture relieves systemic inflammation. By testing the effects that a splenic neurectomy and vagotomy have on TNF-α levels in the spleen and the brain, Lim et al. found that the anti-inflammatory effects of ST36 (Zusanli) rely on the vagus nerve pathway. Both manual acupuncture stimulation (MAC) and electroacupuncture (EAC) induce c-Fos protein generation. However, only manual acupuncture stimulation has the effect of downregulating TNF-α; electroacupuncture has the opposite effect when applied to ST36.

Chronic inflammation is involved in a variety of disease processes. Inflammation is part of the body’s natural response to injuries, but if the condition persists it can lead to further damage. There are a number of factors related to chronic inflammation, including TNF-α. As an endogenous pyrogen, TNF-α is primarily involved in the regulation of immune cells. It is able to induce fever, inflammation, apoptosis, inhibit tumor growth, and inhibit virus replication. However, its dysregulation is implicated in the processes of a number of diseases including major depression, cancer, psoriasis, Alzheimer’s disease, and inflammatory bowel disease (IBD). The researchers in this study used lipopolysaccharide (LPS) to induce TNF-α production in lab mice. Next, they performed a real-time polymerase chain reaction (PCR) DNA analysis, which “showed that TNF-α mRNA was highly induced in the spleen following LPS administration and was downregulated by MAC.” 

The researchers also gave the mice either a splenic neurectomy or a vagotomy to discern which nerve pathway was responsible for transmitting the anti-inflammatory responses induced by the acupuncture treatments. They found that the TNF-α levels decreased with MAC but were re-elevated in mice with a splenic neurectomy and vagotomy, suggesting that “TNF-α induced in the spleen and the serum after LPS administration may be modulated by AS [acupuncture stimulation].” Another trial showed that CNQX (AMPA receptor blocker) and PPADS (selective purinergic antagonist) — which both inhibit the dorsal vagal complex (DVC) — also decreased splenic TNF-α, which implies the direct involvement of the vagus nerve in the modulation of TNF-α.

The vagus nerve is a cranial nerve best known for innervating the viscera. However, “growing bodies of evidence indicate that vagus nerve activity is important not only for homeostatic regulation of internal organs but also for the regulation of pathologic inflammatory reactions; thus, the vagus nerve acts as a bridge between the neural and immune systems. Notably, VNS can activate the a7 nicotinic acetylcholine receptor on the macrophages in the spleen.”

The cholinergic response, mediated by the vagus nerve, directly controls a proinflammatory response by way of the inflammatory reflex. Several inflammatory diseases are regulated by the ‘cholinergic anti-inflammatory reflex,’ including rheumatoid arthritis, diabetes, and obesity. Additionally, previous research finds that insulin resistance is caused by chronic inflammation resulting from immune and metabolic dysregulation; in addition, a decrease in vagus nerve activity is correlated with obesity. “Selective cholinergic activation within the efferent vagus nerve-mediated arm of the inflammatory reflex can suppress obesity-associated inflammation and reverse metabolic complications. These findings raise the intriguing possibility that dysregulation of vagus nerve-mediated signaling might contribute to the pathogenesis of obesity and its related comorbidities.”

Obesity has reached epidemic levels in many countries and is a precursor for many chronic diseases, including diabetes. Chronic inflammation is “a critical step in the pathogenesis of insulin resistance and type 2 diabetes mellitus. Cholinergic mechanisms within the inflammatory reflex have, in the past 2 years, been implicated in attenuating obesity-related inflammation and metabolic complications. This knowledge has led to the exploration of novel therapeutic approaches in the treatment of obesity-related disorders.”

 References

HD Lim et al., “Anti-Inflammatory Effects of Acupuncture Stimulation via the Vagus Nerve,” PloS one. 11, no. 3 (March 19, 2016), accessed February 3, 2017, pp 4-5. ncbi.nlm.nih.gov/pubmed/26991319

Valentin A. Pavlov and Kevin J. Tracey, The Vagus Nerve and the Inflammatory Reflex—linking Immunity and Metabolism, 8, no. 12, accessed February 3, 2017, ncbi.nlm.nih.gov/pmc/articles/PMC4082307/

Yun-Kyoung Yim et al., Electro-Acupuncture at Acupoint ST36 Reduces Inflammation and Regulates Immune Activity in Collagen-Induced Arthritic Mice, 4, no. 1 (August 18, 2006), accessed February 3, 2017, ncbi.nlm.nih.gov/pmc/articles/PMC1810363/

Lin, Lili, Nikola Skakavac, Xiaoyang Lin, Dong Lin, Mia C. Borlongan, Cesar V. Borlongan, and Chuanhai Cao. “Acupuncture-induced analgesia: the role of microglial inhibition.” Cell transplantation 25, no. 4 (2016): 621-628.

Zhang, Ruixin, Lixing Lao, Ke Ren, and Brian M. Berman. “Mechanisms of acupuncture–electroacupuncture on persistent pain.” The Journal of the American Society of Anesthesiologists 120, no. 2 (2014): 482-503.

Acupuncture, Acupuncture Blogs

Acupuncture Top 3 Treatments

Acupuncture news releases received a great deal of attention at HealthCMi this summer. The following are short excerpts taken from the HealthCMi summer top three list. The first in our top three is an article on the topic of acupuncture for the treatment of neck pain due to disc degeneration. 

Neck Pain
Acupuncture is effective for the treatment of cervical spondylosis, a painful disorder caused by intervertebral disc degeneration (due to wear and tear of the discs in the cervical spine). The acupuncture point GV14 (Dazhui) was found effective across multiple studies for the treatment of cervical spondylosis. Based on the data, this acupuncture point is recommended for patients with cervical spondylosis. Shao et al. tested the efficacy of acupuncture using the following acupuncture points:

  • GV14 (Dazhui)
  • SI3 (Houxi)
  • GV20 (Baihui)
  • GB20 (Fengchi)

Acupuncture at Dazhui was perpendicularly inserted and moxa was added. Deqi was elicited at the other acupoints combined with electroacupuncture. Fengchi was connected to Houxi on the afflicted side and Fengchi was connected to Baihui on the healthy side with electrodes. Acupuncture was applied once per day, 5 times per week, for a total of 2 weeks as one course of treatment. The results indicate that 24 out of 25 cases improved significantly for a total effective rate of 96%. [1]

The remainder of this article covered more research finding GV14 effective for the treatment of neck pain due to disc degeneration. The next article garnered a great deal of attention. The research item presented acupuncture for the treatment of fibromyalgia, using both subjective and objective instruments to determine the results.

 Fibromyalgia
Acupuncture is an effective treatment modality for patients with fibromyalgia. Researchers conclude that acupuncture improves two biochemical markers and subjective clinical outcomes for patients with fibromyalgia. Objective measures demonstrate that acupuncture increases serum serotonin levels and reduces Substance P levels. For subjective measurements, the researchers document enduring subjective improvements including less pain, fatigue, and anxiety. [2]

Fibromyalgia is a chronic condition with symptoms including pain, sleep problems, fatigue, and cognitive difficulties. Fibromyalgia frequently presents with depression and anxiety. The exact mechanism of the disease has not been fully identified within allopathic medicine, but it is posited that serotonin and Substance P play a significant role.

Serotonin is a neurotransmitter active with mood, sleep, sexual behavior, and pain regulation. Independent research confirms that fibromyalgia patients have lower serum serotonin levels than healthy individuals. Substance P is a neuropeptide involved in pain, depression, and neurogenic inflammation. [3] Excess Substance P levels may play a role in fibromyalgia pain perception.

The study measures levels of the biochemical markers along with several clinical changes, both before and after treatment with acupuncture. A total of 75 participants were recruited for the study. The patients were randomized into three groups; acupuncture, sham acupuncture, and simulated acupuncture. The following acupuncture points were administered in the study:

  • Hegu (LI4)
  • Quchi (LI11)
  • Shenmen (HT7)
  • Neiguan (PC6)
  • Qihai (CV6)
  • Taichong (LV3)
  • Zusanli (ST36)
  • Sanyinjiao (SP6)
  • Dazhui (GV14)
  • Jianzhongshu (SI15)

The article continues, demonstrating important aspects of acupuncture for the treatment of fibromyalgia. It is not unusual for patients to seek help with this condition from a licensed acupuncturist because it is non-nociceptive (i.e. the pain perception is not due to pain receptor activation). Often, medications cannot fully address the pain and fatigue levels and acupuncture has the ability to address both of these concerns.

The next research article finds acupuncture effective for the alleviation of pain during pregnancy. This is an important finding because the use of pain medications during pregnancy may be deleterious to the fetus. 

Pregnancy Pain
Acupuncture and cupping are both safe and effective for the treatment of lumbopelvic pain during pregnancy. A hospital-based study at a community clinic in New Zealand finds that acupuncture produces important positive patient outcomes, including significant reductions in lumbopelvic pain levels. [4] Lumbopelvic pain is located at the lower torso, lower back, and pelvic girdle. Acupuncture is an important treatment option because a variety of common prescription drugs and over-the-counter analgesics are contraindicated during pregnancy.

A total of 245 pregnant women attended the New Zealand clinic, 144 (56.5%) reported lumbopelvic pain as their primary or secondary complaint. A total of 63 women were excluded from the study because they either did not complete a baseline assessment or did not complete a post-treatment follow-up. Data from 81 pregnant women were included in the results. Forty-five women were nulliparous (55.5%) and the majority of women were in the third trimester of pregnancy (49.3%). A total of 31 were in their second trimester (38.2%) and 10 were in the first trimester (12.3%). Most participants were referred to the clinic by a midwife (72%).

 Treatment Approach
Acupuncture and cupping treatments were provided and points were selected on an individual basis and not all points were used on all of the women. The most commonly used points were Yanglingquan (GB34) and Zulinqi (GB41), which were used in over 50% of study participants. Ashi points on the lower back were used on 25–50% of participants, excluding needling of Ciliao (BL32) and Zhongliao (BL33). Ashi points surrounding Huantiao (GB30) and ashi points on, near, or between Qiuxu (GB40), Shenmai (BL62), and Taichong (LV3) were also used in 25–50% of participants. Ashi points between Neiting (ST44) and Lidui (ST45) and ashi points on, near, or between Chengshan (BL57), Feiyang (BL58), Yintang (MHN3), Baihui (GV20), Kunlun (BL60), Fengshi (GB31), and Waiguan (TB5) were used in fewer than 25% of participants. Cupping to the lower back was provided to over 50% of participants. This is an interesting selection given that cupping is ordinarily contraindicated on the abdomen and lower back during pregnancy.

Upon insertion of the needles, deqi was obtained manually and needles were retained for 20 minutes. Treatment was provided once per week, with each participant receiving a minimum of 3 treatments. The mean number of treatments was 3.85. Ear press needles were also offered to participants to be placed on foot acupoints. They were advised to retain these for 2–3 days and to remove them if they became uncomfortable.

 Results and Discussion
All women taking part in the study completed the Measure Yourself Medical Outcome Profile (MYMOP) questionnaires prior to and after acupuncture treatments. The MYMOP questionnaire allowed the participants to describe and rate symptoms on a scale of 0–6. They were allowed to give additional information on other symptoms, especially those related to functional impairment and well-being.

Of the 81 participants, 18 reported an improvement in symptoms of 1–1.99 points (22.2%), 30 reported an improvement of 2–2.99 points (37.0%), 15 reported an improvement of 3–3.99 points (18.5%), and 9 reported an improvement of 4 or more points (11.1%). A total of 72 participants (88.9%) reported clinically significant improvements following treatments with acupuncture and cupping. The data demonstrates that acupuncture and cupping are effective for the relief of pain during pregnancy.

There’s the summer top three popular research articles, we hope you liked them. If you have questions regarding these topics, contact a local licensed acupuncturist to learn more.

 References:
[1] Shao YX. Clinical study on treatment of vertebral artery type of cervical spondylosis with warm needling Dazhui [D]. Guangzhou: Guangzhou University of Traditional Chinese Medicine, 2008.

[2] Wolfe F. et al Serotonin levels, pain threshold, and fibromyalgia symptoms in the general population. The Journal of Rheumatology [01 Mar 1997, 24(3):555-559].

[3] Harrison S. Geppetti P. Substance P. The International Journal of Biochemistry & Cell Biology Volume 33, Issue 6, June 2001, Pages 555-576.

[4] Soliday E. Betts D. Treating Pain in Pregnancy with Acupuncture: Observational Study Results from a Free Clinic in New Zealand Journal of Acupuncture and Meridian Studies 2018;11(1):25e30.

Acupuncture, Acupuncture Blogs

Acupuncture Rivals Steroid Inhaler For COPD

Acupuncture is an effective treatment modality for patients with COPD (chronic obstructive pulmonary disease), an inflammatory lung disease. First Clinical Medicine College of Hubei University of Traditional Chinese Medicine researchers conducted a controlled clinical trial comparing acupuncture with the drug Seretide for improvements in lung function, clinical symptoms, and quality of life for patients with chronic obstructive pulmonary disease. Acupuncture produced results rivalling that of Seretide (a steroid plus beta-2-agonist inhaler). Spirometer measurements document that the lungs improve significantly from the drug and from acupuncture. Acupuncture monotherapy produced significant improvements in forced expiratory volume (FEV1), FEV1 to forced vital capacity ratio (FEV1/FVC), and peak expiratory flow (PEF). [1] 

The results of this study indicate that both the drug Seretide and acupuncture monotherapy treatments offer significant benefits for patients suffering from COPD. This includes improvements in lung function, reduction in clinical symptoms, and enhanced quality of life. Although acupuncture treatments resolve symptoms more slowly than Seretide, it has the advantage of being safe, with a low risk of adverse effects.

COPD is a severe and sometimes life-threatening disease. COPD is often caused by tobacco smoking, exposure to fumes, chronic bronchitis, and emphysema. Clinical symptoms include coughing, excessive sputum production (clear, white, yellow, or green), wheezing, chest tightness, and shortness of breath.

COPD symptoms often negatively impact the quality of life. Conventional treatments include inhaled drugs such as Seretide, which act to reduce inflammation and open the airways. However, long-term use of such medications may result in tolerance and serious adverse effects, including liver and kidney damage. The Hubei University of Traditional Chinese Medicine study aimed to identify whether or not acupuncture could offer an effective solution, improving the quality of life with an added benefit over drugs: a reduction in the risk of adverse effects. The results indicate that acupuncture is a potent treatment option that produces significant positive patient outcomes.

A total of 61 patients with stable COPD were recruited for the study. One dropped out due to being unable to complete the treatment period, and the remaining participants were randomly assigned to receive treatment with Seretide (n=30) or acupuncture (n=30). The Seretide group consisted of 13 male and 17 female participants, with a mean age of 65.25 years, and a mean duration of disease of 10.78 years. The acupuncture group consisted of 14 male and 16 female participants, with a mean age of 62.87, and a mean duration of disease of 10.34 years. There were no statistically significant differences between the two groups in terms of demographics at the onset of the investigation. Inclusion criteria for the study were the following: clinical diagnosis of stable COPD, age 45–75 years, duration of disease 4–25 years, and the ability to give informed consent.

 Seretide Group
Participants allocated to the Seretide group were prescribed Seretide inhalers containing the bronchodilator salmeterol (50mcg), and the corticosteroid fluticasone (250mcg). The dosage was one inhalation, twice per day, and the course of treatment was eight weeks.

 Acupuncture Group
Although COPD is a disease which primarily affects the lungs, according to Traditional Chinese Medicine (TCM) theory, it also has the potential to impact the kidneys and spleen. Disharmony of these three internal organs leads to insufficiency of yang qi, accumulation of dampness, phlegm stagnation, and obstruction of the lungs. On this basis, the following acupoints were selected for use on all acupuncture group patients:

  • Dingchuan (MBW1)
  • Feishu (BL13)
  • Zusanli (ST36)

Secondary acupoints were administered, based on diagnostic considerations:

  • Fengmen (BL12)
  • Lieque (LU7)
  • Gaohuang (BL43)
  • Danzhong (CV17)
  • Tiantu (CV22)
  • Fenglong (ST40
  • Pishu (BL20)
  • Shenshu (BL23)

Treatment was administered with patients in a seated position. Following standard disinfection, 0.35mm × 40mm filiform needles were inserted into the primary acupoints. Needles were inserted slowly and stimulated using a balanced reinforcing-reducing method to obtain deqi. Needles were retained for a total of 30 minutes.

Following removal of needles from the primary points, the patients were moved to a treatment couch and 2–3 of the secondary points were selected and needled according to the same procedure. Treatment was provided three times weekly, for a total of eight weeks. Any additional symptoms arising during the treatment period were treated with appropriate oral medications.

 Results
Outcomes for the study fell into three categories. Lung function was assessed with a spirometer, which was used to measure the 1 second forced expiratory volume (FEV1), FEV1 to forced vital capacity ratio (FEV1/FVC), and peak expiratory flow (PEF). Clinical symptoms were also assessed and quality of life was measured using the St George’s Respiratory Questionnaire (SGRQ).

FEV1 and FVC scores are an indicator of lung function and are expressed as a percentage of the expected score for a healthy person of equivalent age, weight, and height. Prior to treatment, both groups were statistically similar in terms of lung function. In the Seretide group, mean FEV1 was 44.73%, mean FEV1/FVC was 52.38%, and mean PEF was 54.57L/min. In the acupuncture group, mean FEV1 was 45.94%, mean FEV1/FVC was 51.28%, and mean PEF was 54.38L/min.

Following treatment, both groups showed improvements in mean FEV1 and FEV1/FVC scores, rising to 60.21% and 60.43% in the Seretide group, and 60.11% and 58.77% in the acupuncture group. Mean PEF scores also improved in the Seretide group, rising to 59.93L/min. This outcome measure was greater than in the acupuncture group, whose mean PEF score rose to 55.42L/min (p<0.05).

Clinical symptoms such as coughing, sputum production, and breathlessness were rated using a points system to assess severity, with symptoms rated on a scale of 0–3. Scores were then added together, with a higher total score indicating more severe symptoms. Mean baseline scores were 5.72 in the Seretide group and 5.55 in the acupuncture group.

At the four week assessment, improvements were significantly greater in the Seretide group, with scores falling to 4.55 compared with just 5.45 in the acupuncture group (p<0.05). However, after eight weeks there was no significant difference between the two groups, with symptom scores rated at 4.25 in the Seretide group and 4.43 in the acupuncture group (p>0.05).

Quality of life was measured using the SGRQ, a 50 item questionnaire used to assess symptom severity and impact on daily activities, on a scale of 0–100. Baseline scores were similar across the two groups, with a mean of 54.28 in the Seretide group, and 52.59 in the acupuncture group (p<0.05). At the end of the study, the mean score in the Seretide group fell to 45.52, compared with 38.64 in the acupuncture group, indicating greater improvements in the acupuncture group (p<0.05).

The results indicate that Seretide and acupuncture are effective therapies for the treatment of COPD. Seretide features a rapid effective action and acupuncture demonstrates lasting results. One advantage to acupuncture is improved long-term safety. Patients are advised to consult with a licensed acupuncturist to learn more about acupuncture as a treatment option for COPD.

 Reference:
1. Yang Junshu, Li Jia (2018) “Comparative Research on Effect of Acupuncture on Pulmonary Function and Life Quality of Patients with Chronic Obstructive Pulmonary Disease in Stable Phase” Journal of Hubei University of Chinese Medicine Vol 20 (4), pp. 30-33.

Acupuncture

Acupuncture Reduces Pain Levels

Acupuncture is effective for pain relief. Researchers from the University of South Florida (Tampa) and the Fujian University of Traditional Chinese Medicine (Fuzhou) document that acupuncture alleviates pain, in part, by regulation of microglial cells. These are non-neural cells that comprise part of the central nervous system structure. Scientists already knew that microglial cells act as macrophages at sites of damaged central nervous system tissue. The research team (Lin et al.) from the University of South Florida (Department of Neurosurgery and Brain Repair, Department of Pharmaceutical Sciences) along with researchers from the Fujian University of Traditional Chinese Medicine (College of Acupuncture) made the key findings.

The researchers cite evidence demonstrating that acupuncture inhibits “microglial and astrocytic proliferation coupled with improved functional recovery after SCI [spinal cord injury].” They add, “acupuncture exerts a remarkable analgesic effect on SCI by also inhibiting production of microglial cells through attenuation of p38MAPK and ERK activation.” The researchers note that their investigation summarizes “clinical evidence demonstrating that acupuncture is capable of producing analgesia in neuropathic pain by suppressing microglial activation.” Funding for the groundbreaking research was provided by the US Department of Defense, University of South Florida Neurosurgery and Brain Repair, and the James and Esther King Biomedical Research Foundation.

The researchers note that scientists find both microglia and astrocytes involved in inflammation and pain. In addition, the researchers cite evidence demonstrating that acupuncture has an inhibitory effect on microglial activation. The research team provides background to this information. Microglia are the primary immune system cells in the central nervous system. They secrete proinflammatory and neurotoxic mediators when activated. The release of these mediators creates a positive feedback loop that leads to increased reactive oxygen species (ROS) induced microglial activation and subsequent inflammatory responses. Since acupuncture inhibits ROS, the researchers note that their findings “provide the possibility that acupuncture can be used effectively as a nonpharmacological intervention for spinal cord injury (SCI)-induced chronic neuropathic pain in patients.” They add that acupuncture has an important benefit to the brain. Electroacupuncture alleviates oxidative damage to the hippocampus by “preventing microglial activation.”

Lin et al. cited specific acupuncture points shown to elicit specific microglial responses. Electroacupuncture at GB20 (Huantiao) and GB34 (Yanglingquan) “significantly suppressed CFA-induced nociceptive behavioral hypersensitivity and spinal microglial activation.” Freund’s Complete Adjuvant (CFA) is comprised of inactive mycobacteria, often used for stimulating cell mediated immunity responses in research. Moreover, when electroacupuncture was combined with a microglial inhibitor drug, the pain relieving effects of electroacupuncture were enhanced for cases of allodynia and hyperalgesia. The research team adds several other examples of microglial attenuation by acupuncture, including the ability of manual acupuncture to downregulate MAC-1 (macrophage-1 antigen), an indicator of microglial activation.

Lin et al. discussed other mechanisms shown to alleviate pain by modern research. They note that acupuncture stimulates the release of neurotransmitters, including opioids, in the central nervous system (2,3,4). The researchers add that this causes “potent analgesia, regulation of visceral functions, and immune modulation.” Lin et al. add that electroacupuncture enhances natural killer (NK) cell activity and beta-endorphin production via the hypothalamus.

The research team notes that numerous MRI (magnetic resonance imaging) studies find electroacupuncture effective for the activation of the hypothalamus. In one study cited by the team, researchers find “evidence suggesting that chronic pain patients respond to acupuncture differently than HC [healthy controls], through a coordinated limbic network including the hypothalamus and amygdala (Napadow et al.).”

Napadow et al. used fMRI data to compare true acupuncture with sham acupuncture for patients with carpal tunnel syndrome. The acupuncture point LI4 (Hegu) was tested. Both short-term and long-term responses were measured. True acupuncture at the real acupuncture point stimulated significantly “greater activation in the hypothalamus and deactivation in the amygdala” for patients with carpal tunnel syndrome. The research team was comprised of Massachusetts General Hospital (Charlestown), Spaulding Rehabilitation Hospital (Boston, Massachusetts), and Logan College of Chiropractic (Chesterfield, Missouri) researchers.

Lin et al. note that numerous studies find acupuncture effective for the relief of pain; however, the mechanisms of action were unknown. For example, University of Manchester (UK) researchers (Abuaisha et al.) note, “acupuncture is a safe and effective therapy for the long-term management of painful diabetic neuropathy, although its mechanism of action remains speculative.” Lin et al. add that researchers at the Toronto Rehabilitation Institute in the Lyndhurst Centre (Toronto, Ontario, Canada) also found acupuncture clinically effective but did not map the mechanisms of effective action. The Toronto Rehabilitation Institute researchers concluded, “This retrospective study suggests that the Lyndhurst Center Central Neuropathic Pain Acupuncture Protocol may be an effective treatment option for patients with SCI who are experiencing below-level central neuropathic pain.”

Lin et al. provided another important example of clinical results with a call for greater inquiry into the mechanisms of effective action. Researchers from the University of Maryland (Baltimore) conclude, “Electroacupuncture blocks pain by activating a variety of bioactive chemicals through peripheral, spinal, and supraspinal mechanisms. These include opioids, which desensitize peripheral nociceptors and reduce proinflammatory cytokines peripherally and in the spinal cord, and serotonin and norepinephrine, which decrease spinal N-methyl-d-aspartate receptor subunit GluN1 phosphorylation.” Given the results of their research, the University of Maryland team (Zhang et al.) adds, “Clarification of acupuncture/electroacupuncture mechanisms will open a variety of opportunities to combine acupuncture/electroacupuncture with medications to manage and control pain, which makes it all the more important to continue such research.” The University of Maryland study was published in the The Journal of the American Society of Anesthesiologists.

Lin et al. note that mechanisms of action have been explored in a variety of research. For example, Xiao et al. conclude that “P2X3 receptors in the lPAG [lateral midbrain periaqueductal gray] are involved in the supraspinal antinociception effect of EA [electroacupuncture] treatment.” Lin et al. note that the details of the research by Xiao et al. reveal that PAG (midbrain periaqueductal gray) is an important brain structure active in electroacupuncture pain regulation.

Lin et al. made significant findings. They note that acupuncture modulates homeostasis and alleviates pain. In addition, acupuncture activates areas of the central nervous system including the PAG and nucleus raphe magnus. In addition, acupuncture deactivates areas of the limbic system thereby regulating emotions correlated with pain.

 References
1. Lin, Lili, Nikola Skakavac, Xiaoyang Lin, Dong Lin, Mia C. Borlongan, Cesar V. Borlongan, and Chuanhai Cao. “Acupuncture-induced analgesia: the role of microglial inhibition.” Cell transplantation 25, no. 4 (2016): 621-628.

2. Han, J. S. Acupuncture neuropeptide release produced by electrical stimulation of different frequencies. Trends Neurosci. 26(1):17–22; 2003.

3. Mori, H.; Nishijo, K.; Kawamura, H.; Abo, T. Unique immunomodulation by electro-acupuncture in humans possibly via stimulation of the autonomic nervous system. Neurosci. Lett. 320(1–2):21–24; 2002.

4. Sato, A.; Schmidt, R. F. The modulation of visceral functions by somatic afferent activity. Jpn. J. Physiol. 37(1):1–17; 1987.

5. Napadow, V., N. Kettner, J. Liu, M. Li, K. K. Kwong, M. Vangel, N. Makris, J. Audette, and K. K. S. Hui. “Hypothalamus and amygdala response to acupuncture stimuli in carpal tunnel syndrome.” Pain 130, no. 3 (2007): 254-266.

6. Abuaisha, B. B., J. B. Costanzi, and A. J. M. Boulton. “Acupuncture for the treatment of chronic painful peripheral diabetic neuropathy: a long-term study.” Diabetes research and clinical practice 39, no. 2 (1998): 115-121.

7. Zhang, Ruixin, Lixing Lao, Ke Ren, and Brian M. Berman. “Mechanisms of acupuncture–electroacupuncture on persistent pain.” The Journal of the American Society of Anesthesiologists 120, no. 2 (2014): 482-503.

8. Xiao, Zhi, Shan Ou, Wen-Juan He, Yan-Dong Zhao, Xiao-Hong Liu, and Huai-Zhen Ruan. “Role of midbrain periaqueductal gray P2X3 receptors in electroacupuncture-mediated endogenous pain modulatory systems.” Brain research 1330 (2010): 31-44.

Acupuncture, Acupuncture Blogs

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.

Acupuncture, Acupuncture Blogs

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.