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.

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).

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.

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.

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.