Acupuncture Continuing Education

Acupuncture Prevents Chemotherapy Nausea and Vomiting

Acupuncture is effective for the prevention of nausea and vomiting caused by cisplatin based chemotherapy. Researchers at the Cangzhou Hospital of Integrated Traditional and Western Medicine (Hebei, China) conducted a study comparing the effects of drug therapy as a standalone procedure with acupuncture combined with drug therapy. Based on the data, the researchers conclude that acupuncture plus antiemetic drug therapy is significantly more effective than using only antiemetic drug therapy.

 

CV and ST channel acupoints 

 

Two groups were compared. In one group, chemotherapy patients received only tropisetron hydrochloride as a means to control nausea and vomiting. In the second group, tropisetron hydrochloride was combined with acupuncture therapy. The results indicate that acupuncture is an important treatment option for patients receiving cisplatin based chemotherapy for the purposes of preventing nausea and vomiting. 

 

Nausea
The acupuncture plus drug therapy group had a total effective rate of 93.3% by the second day of treatment, whereas the drug therapy only group had an 80.0% total effective rate for the prevention of nausea. By the fifth day, the acupuncture plus drug therapy group had a 90% total effective rate and the drug only group had a 63.3% total effective rate. On the sixth day of treatment, the acupuncture plus drug group had a 96.7% total effective rate and the drug only group had a 73.3% total effective rate for the prevention of nausea.

 

Emesis
The acupuncture plus drug therapy group had a total effective rate of 93.3% by the second day of treatment, whereas the drug therapy group had an 90.0% total effective rate for the prevention of vomiting. By the fifth day, the acupuncture plus drug therapy group had a 96.7% total effective rate and the drug only group had a 76.73% total effective rate. On the sixth day of treatment, the acupuncture plus drug group had a 96.7% total effective rate and the drug only group had a 93.3% total effective rate for the prevention of vomiting.

Both treatment groups received administration of tropisetron hydrochloride (5 mg, intravenous) while cisplatin based chemotherapy was provided daily for six days. The treatment group received the addition of acupuncture therapy to the following acupoints:

  • Zhongwan (CV12)
  • Xiawan (CV10)
  • Qihai (CV6)
  • Guanyuan (CV4)

Perpendicular insertion was applied at each point with the needle insertion depth set to 0.5 inches. Total needle retention time was 30 minutes per acupuncture session, daily. The combination therapy of drugs plus acupuncture demonstrated significant clinical improvements over the drugs only approach to care. In an interesting twist, one omission stands out in this investigation. Acupuncture point PC6 (Neiguan) was not used in the acupoint treatment protocol despite its inclusion in many studies investigating the antiemetic properties of acupuncture. Nonetheless, the researchers produced significant positive patient outcomes with their abdominal acupuncture approach to patient care.

Hyperemesis and nausea are common complications associated with chemotherapy. This is responsible for significant suffering and weakens the overall condition of patients. No solution has been proven 100% adequate, yet improvements in patient care include the development of pharmaceutical medications to address this concern. By broadening the horizon of care to include acupuncture therapy, this research demonstrates that immediate improvements in positive patient outcome rates are achievable.

In this study, the effects of tropisetron combined with acupuncture were investigated. Tropisetron is an antiemetic agent that is a serotonin receptor antagonist. It is effective for the relief of nausea and vomiting; however, side effects may include headaches, constipation, and dizziness. The results of this study indicate that the combination of acupuncture with tropisetron is safe and more effective using only tropisetron.

This study focused on the implementation of abdominal acupuncture. Additional studies indicate that acupoint PC6 (Neiguan) is also vital to the prevention and treatment of nausea and vomiting. According to Traditional Chinese Medicine (TCM) principles, PC6 is indicated for the treatment of nausea and vomiting. Existing fMRI research confirms this ancient principle. Researchers He et al. note, “Acupuncturing at Neiguan (PC6) could selectively evoke hemodynamic response of insula and cerebellar-hypothalamus in order to exert modulatory effects on vestibular functions, indicating the specific treatment effect on nausea and vomiting.” The research was published in the publication entitled Autonomic Neuroscience.

In related research, Cheong et al. find acupuncture effective for the alleviation of post-operative nausea and vomiting. In a meta-analysis of 30 randomized controlled trials, acupoint PC6 significantly reduced both nausea and vomiting. Only highly trained licensed acupuncturists were used to administer acupuncture in the study. The researchers note that acupuncture is both safe and effective.

Vomiting and nausea are categorized as a class of disorders known as rebellious qi within TCM. According to TCM principles, a healthy stomach has the qi to push energy downward. This is consistent with basic physiology wherein the stomach moves food downward. When the stomach is weakened, energetics reverse and pathologically rise upward. This includes nausea, vomiting, hiccups, and acid reflux. Together, this phenomena is termed rebellious qi. Xia-ping Shao determined that acupuncture is effective for the elimination of hiccups for patients with late stage cancer. Intractable hiccups due to diaphramatic muscle spasms is a concern for these patients, particularly because it may interfere with eating and sleep.

In a controlled investigation of 30 patients, 10 patients had excellent improvements, 18 patients demonstrated significant improvements, and 2 patients did not respond to acupuncture therapy. The total treatment effective rate was 93.33%. The acupoints used in the study by Xia-ping were the following:

  • P6 (Neiguan)
  • ST36 (Zusanli)
  • ST44 (Neiting)

Auricular acupuncture was added using Wang Bu Liu Xing at ear acupoints liver, stomach, heart, and subcortex. In addition, cupping was applied to acupoints CV17 (Danzhong) and CV12 (Zhongwan). The results demonstrate that this protocol is effective for controlling hiccups. We invite you to peruse more studies at the Healthcare Medicine Institute acupuncture continuing education news portal to learn more about acupuncture’s ability to benefit patients.


References
Xing JY, Li X, & Ren XM. (2013). Therapeutic observation of abdominal acupuncture in preventing nausea and vomiting caused by Cisplatin-based chemotherapy. Shanghai J Acu-mox. 32(12):1046-1048

Chert YY, Wang YJ, & Huang Y. (2012). Observation on therapeutic effects of abdominal acupuncture plus body acupuncture for moderate depression. JAcupunctTuinaSci. 10(1):14—17.

He, Tian, Wen Zhu, Si-Qi Du, Jing-Wen Yang, Fang Li, Bo-Feng Yang, Guang-Xia Shi, and Cun-Zhi Liu. "Neural mechanisms of acupuncture as revealed by fMRI studies." Autonomic Neuroscience (2015).

Cheong, Kah Bik, Ji-ping Zhang, Yong Huang, and Zhang-jin Zhang. "The Effectiveness of Acupuncture in Prevention and Treatment of Postoperative Nausea and Vomiting-A Systematic Review and Meta-Analysis." PLOS ONE 8, no. 12 (2013): e82474.

JOURNAL OF ACUPUNCTURE AND TUINA SCIENCE. Volume 10, Number 2 (2012), 117-119, DOI: 10.1007/s11726-012-0585-x. Electroacupuncture combined with auricular point sticking for hiccups in late-stage cancer. Xia-ping Shao.

Gottschling, S., T. K. Reindl, S. Meyer, J. Berrang, G. Henze, S. Graeber, M. F. Ong, and N. Graf. "Acupuncture to alleviate chemotherapy-induced nausea and vomiting in pediatric oncology–a randomized multicenter crossover pilot trial." Klinische Pädiatrie 220, no. 06 (2008): 365-370.

 

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