Acupuncture Continuing Education News
Acupuncture point LU11 (Shaoshang) has a confirmed anatomical composition. Researchers using fluorescence microscopy determined that the epidermal and underlying dermis layers of acupoint LU11 contain high densities of connexins, important intercellular communication structures. The researchers note that their findings support the principle that acupuncture points are “structurally defined entities.”
Connexons are comprised of connexins and are proteins that form gap junctions. A gap junction allows ions and molecules to pass between cells. When two adjacent cells align, a connexon in the membrane of one cell lines up with a connexon in the membrane of another cell. This creates an aqueous pathway for ions and molecules to transfer between the cells.
Connexins are the building blocks of gap junctions. There are six connexins that form a connexon and two connexons that form a gap junction. The researchers note that if the connexins found in LU11 form gap junctions or hemi-channels, they potentially contribute to rapid changes in electrical resistance in local tissues.
The researchers discovered an increase of connexin 26 and connexin 43 densities compared with controls. The increased densities extended to the stratum spinosum, stratum basale, subcutis, sweat glands, blood vessels, and fibrocytes. This research provides insight into the physical structure of acupuncture point LU11.
LU11 is located on the lateral aspect of the thumb at the junction of the lines intersecting from the radial border of the fingernail and the base of the fingernail. This acupoint is indicated for the treatment of loss of consciousness, sore throat, tonsillitis, and apoplectic delirium. According to Traditional Chinese Medicine (TCM) principles, LU11 functions to cool the lungs, benefit the pharynx, and revive patients after fainting.
In a related study, CT scans revealed anatomical structures related to acupuncture points ST36 (Zusanli) and ST37 (Shangjuxu). The researchers note that unique microvascular densities with bifurcations “can be clearly seen around thick blood vessels” at the acupoints. The acupuncture points showed both fine and thick high density blood vessel structures. Non-acupuncture points did not exhibit these characteristics.
Acupuncture speeds recovery from lumbar disc herniations. Researchers tested a protocol that increased the efficacy of electroacupuncture procedures for disc herniations by adding Chinese herbal medicine iontophoresis. They discovered that the combined therapy of electroacupuncture plus herbal iontophoresis enhances clinical efficacy with a significant synergistic effect.
Patients had greater pain relief and lumbar functional improvements with the combination therapy. The total effective rate of electroacupuncture only was 87.5%. The combined therapy approach had a total effective rate of 95.0%. McGill and Japanese Orthopedic Association assessments using a Visual Analogue Scale (VAS) were used to calculate improvements.
A lumbar intervertebral disc herniation is a rupture of the annulus fibrosus that causes extrusion of the nucleus pulposus from the center of the disc. This often causes low back pain, weakness, or numbness that may radiate to the legs and feet. The researchers confirmed disc herniations for participants with diagnostic tests including CT scans, MRIs, and a positive Lasegue’s or Bragard’s sign. Patients were also evaluated with X-rays and an assessment of range of motion restrictions and pain levels. A total of 80 patients from the rehabilitation center at the Second Hospital Affiliated to Heilongjiang University of Traditional Chinese Medicine (TCM) participated in the study.
The researchers used the following acupuncture points:
- Jiaji (Ex-B2, affected vertebral levels, bilateral)
- GB30 (Huantiao, affected side)
- GB34 (Yanglingquan, affected side for L4-5 herniations)
- BL40 (Weizhong, affected side for L5-S1 herniations)
Disposable, single-use, sterile filiform needles of 0.30 mm diameter and a 40-75 mm length were used. Jiaji points were needled with 50 mm needles to a depth of approximately 40 mm. Needles were angled slightly towards the spine. Manual acupuncture was subsequently applied with an even reinforcing-reducing technique. The researchers note that the optimal response is if the patient reported a sensation radiating downwardly towards the buttocks and leg on the affected side. Electroacupuncture was then applied to the Jiaji points of the affected vertebral level. A sparse-dense setting was used with a 2 - 100 Hz frequency. Intensity was set to patient comfortability levels.
Acupuncture improves knee recuperation after surgery. Researchers investigated the effects of acupuncture on patients that received arthroscopic meniscus surgical repair. The meniscus is fibrous cartilage that cushions impact and stabilizes the knee. Each knee has two menisci, one medial and one lateral. A torn meniscus may require surgical repair as is the case with patients in this study. Symptoms often include knee popping, swelling, stiffness, pain, difficulty straightening, or obstruction of movement.
In this randomized investigation, one group received acupuncture plus physical therapy and another group received only physical therapy. The researchers found that the group receiving acupuncture combined with physical therapy had significantly greater positive patient outcomes than the group that did not have acupuncture treatments.
The group receiving acupuncture demonstrated significantly greater improvements in knee joint energy, support torque, and swing torque. The measurements were taken on the acupuncture and non-acupuncture groups one month after treatment and at an additional assessment two months after treatment. Measurements were recorded using Lokomat gait assessment equipment, a highly advanced robotic functional therapy system. The state of the art Lokomat therapy system provided the research team with continuous feedback and precise therapy assessment.
Acupuncture alleviates itching. Researchers conducted a meta-analysis and found acupuncture effective for reducing itch intensity in itch related disorders. Acupuncture successfully reduced itching in cases of dermatological disorders and systemic diseases.
The researchers note that the antipruritic effects induced by acupuncture may correlate to acupuncture’s regulatory effects on brain signaling. The research team notes that acupuncture’s ability to reduce itching correlates with its ability to downregulate putamen responses. The data compared true acupuncture with antihistamine intake and placebo acupuncture. Only true acupuncture induced putamen brain responses correlating with itch reduction. The researchers note that electroacupuncture reduces itching when applied to affected or related dermatomes. They note that this may be due to electroacupuncture’s ability to regulate kappa-opioid receptor activity.
All studies reviewed in the meta-analysis were related to clinical trials. All trials were randomized with controls. No case reports or animal studies were admitted for review. The researchers note that medical scientists “should pay more attention to evaluate the efficacy of acupuncture on itch.” They also suggest additional randomized controlled trials comparing true acupuncture with placebo acupuncture and medications to verify the results. The researchers note, “In conclusion, our systematic review suggests that acupuncture is effective for ameliorating itch intensity in itch-related diseases.”
Acupuncture relieves depression. Research published in the Journal of Science and Healing finds acupuncture safe and effective as an adjunctive therapy for the treatment of depression. The researchers concluded that “acupuncture was an effective and safe therapy in treating major depressive disorders. Particularly, the qualities of sleep and life (involving emotions) in patients with depression and schizophrenia were found to be improved after acupuncture treatment.”
The research focused on the effects of manual acupuncture. Electroacupuncture, laser acupuncture, and acupressure were excluded from the meta-analysis. The researchers note that the primary goal of the investigation was to “evaluate the effects of acupuncture treatment for patients with depression or schizophrenia through a systematic review.” The secondary goal was to assess acupuncture’s working mechanisms.
The researchers cite acupuncture’s ability to benefit sleep as an underlying mechanism for its effective therapeutic actions. The researchers cited Bosch et al. whose methodologies included the Pittsburg Sleep Quality Index as a method of evaluation. Bosch et al. “found a significant improvement of sleep quality” from acupuncture treatments for patients with depression or schizophrenia. Additional research employing objective measures of sleep improvement, including actigraphs, demonstrated sleep improvements from acupuncture treatments in patients with schizophrenia or schizoaffective disorders. The improvements include reduced activity levels during sleep, less night awake time, ability to fall asleep faster, and less daytime sleepiness.
The researchers note that another mechanism by which acupuncture exerts its effective action is its ability to benefit emotions. Several key studies identified acupuncture’s ability to reduce anxiety and improve mood. The Beck Depression Inventory and the Hamilton Rating Scale were employed in the studies for purposes of evaluation. The researchers note, “A reduction of depressive symptoms was found after acupuncture therapy in patients with depression. Moreover, less anxiety and a better mood were found after acupuncture therapy in patients with schizophrenia.”
Acupuncture is safe and effective for the relief of migraine headaches. Researchers conducted a randomized-controlled investigation and determined that acupuncture reduces the frequency and intensity of migraines. The results were confirmed by comparing a real acupuncture study group with a sham acupuncture study group. The RMIT University and Royal Melbourne Hospital researchers conclude, “Acupuncture can be used as alternative and safe prophylaxis for frequent migraine. Our recommendation is that practitioners treat migraine sufferers twice per week for at least eight weeks.”
The research team made several important discoveries. They note that the total number of days with a migraine reduced for patients receiving real acupuncture. Real acupuncture improved quality of life scores and produced significant reductions in the need for migraine medication consumption. The researchers note “more participants in the RA (real acupuncture) group used less pain killers as relief medication than in the SA (sham acupuncture) group” at the end of the treatment regime. Sham acupuncture did not produce the significant positive patient outcomes as did real acupuncture. The relief from migraine frequency and intensity using real acupuncture was confirmed in a three month follow-up investigation. In addition, the real acupuncture group had significant improvements in pressure pain thresholds.
The total number of days with a migraine significantly reduced in the real acupuncture group over and above results in the sham acupuncture group. The researchers applied a further measure of clinical results in what they termed a “responder.” This is an individual whose clinical improvements were at least a 50% reduction in the total number of days with a migraine. Both at the end of the twenty week acupuncture treatment period and in a three month follow-up investigation, the real acupuncture group had an overwhelmingly significant number of responders when compared with the sham acupuncture group. Approximately 73% of real acupuncture patients had a 50% or greater reduction in the number of days with a migraine. The sham acupuncture group had an approximately 29% reduction. In addition, the real acupuncture group had a faster onset of pain relief from migraine attacks than the sham acupuncture group.
The researchers detailed issues concerning providing a valid sham control protocol for the study. They reported concern that some sham techniques involve needle penetration of the skin and, although the needles are not placed at acupuncture points, they activate spinal gate control system that stimulates pain reduction in spinal nerve segments by diffuse noxious inhibitory control. The research team used a hybrid technique of combining shallow insertion sham acupuncture needle stimulation on body acupoints while scalp sham acupuncture involved only non-insertion of needles. The researches comment that the “procedure seems to have been successful in this study.”
The researchers note, "The present trial showed that acupuncture was effective in reducing migraine days, as well as effecting a reduction of medication consumption and improvement in quality of life, when compared with sham acupuncture." They add that the “results demonstrated that manual acupuncture can be an effective and a safe prophylaxis for frequent migraine sufferers.” The positive patient outcomes were achieved using a semi-standardised treatment protocol.
Patients received a twenty week treatment period of acupuncture. Initially patients received acupuncture two times per week for four weeks followed by once per week for an additional four weeks. Next, acupuncture was administered once every two weeks for another four weeks. Finally, acupuncture was applied one time per month for two months. In total, patients received sixteen acupuncture treatments.
Acupuncture combined with plum blossom needling reduces cholesterol and triglyceride levels in obese patients with hyperlipidemia. Researchers discovered an additive effect when combining the two protocols. The total effective rate in the acupuncture combined with plum blossom needling group was higher than in a group receiving only acupuncture. Other clinically signifiant changes documented in the study were improvements in body mass index and body fat percentages.
Plum blossom needling, often referred to as seven star needling, refers to a group of needles attached to a wand. The flexible wand is manually manipulated to tap the needles to the surface of the skin. The researchers investigated the synergistic and additive effects of combining plum blossom needling with standard acupuncture protocols. One group received manual acupuncture and the other group received a combination of manual acupuncture plus plum blossom needling. Acupuncture was applied to acupoints including:
- Qimen (LV14)
- Taichong (LV3)
- Zhangmen (LV13)
- Taibai (SP3)
- Zusanli (ST36)
- Geshu (UB17)
- Ganshu (UB18)
- Pishu (UB20)
In the plum blossom group, the seven star needle was applied to the acupoints in addition to standard manual acupuncture. Acupuncture treatments were provided one time per two days for a period of three continuous months. The total effective rate in the acupuncture with plum blossom group was 96.2% and the acupuncture only group had a total effective rate of 84.6%. The researchers conclude that acupuncture combined with plum blossom needling is more effective than acupuncture as a standalone procedure for the treatment of hyperlipidemia (high cholesterol and triglycerides).
Several important changes to acupuncture laws and rules have recently been enacted. A 45th state in the USA has legalized acupuncture. Insurance billing requirements have changed and will see more changes before the year is out. In addition, the NCCAOM has changed acupuncture continuing education PDA (professional development activity) requirements.
North Dakota has recently passed its first law regulating acupuncture. The CEO of the NCCAOM (National Certification Commission for Acupuncture and Oriental Medicine) indicates that this will help attract quality licensed acupuncturists and raise the standards of care in North Dakota. Strong efforts to legalize acupuncture in North Dakota were led by members of the North Dakota Association of Acupuncture and Oriental Medicine.
The acupuncturist scope of practice defined by North Dakota law includes patient education, botanical medicine, qi gong, tai qi, dietetics, physical forces, manual acupuncture, electroacupuncture, and thermal stimulation of acupuncture needles. All needles must be sterile, disposable, filiform needles. All acupuncturists must have completed approved graduate level training.
The NCCAOM has made a few changes to acupuncture continuing education requirements. The California Acupuncture Board has one major change for acupuncture CEUs expected later in the year. For all NCCAOM diplomates re-certifying their diplomate status as of 2016, there are changes to the safety and ethics PDA requirements. Diplomates will need two safety and two ethics category PDAs instead of four safety and/or ethics PDAs. The Healthcare Medicine Institute offers both two hour safety and two hour ethics courses online for NCCAOM PDAs.
The NCCAOM will soon institute a CPR certification requirement. This is a shift from the CPR education requirement to the official certification process. The NCCAOM notes that in 2016, “CPR is required as a stand-alone requirement in addition to 60 PDA points.” Another subtle change is to the biomedicine category. Biomedicine, as it relates to clinical practice, is now part of the core medicine category. This lifts the limit on the number of biomedicine hours an acupuncturist can accrue for diplomate renewal as long as the hours are preapproved by the NCCAOM. All biomedicine hours at the Healthcare Medicine Institute are preapproved for core category PDAs. Also, the NCCAOM has reduced the number of tai chi (taiji) and qi gong hours that may be submitted for PDAs. The 10 PDA limit has been reduced to 4 PDA points.
The California Acupuncture Board will soon require California licensed acupuncturists to obtain continuing education CEUs in the category of ethics. The specifics of the new requirements will be posted on the California Acupuncture Board website once they have been finalized. A board representative states that this may occur in the fall. Once the ethics process has been finalized, the Healthcare Medicine Institute will offer courses meeting this acupuncture CEU requirement.
Last year saw a change in acupuncture insurance billing in California. The 97800 and 97801 acupuncture and electroacupuncture billing codes used for workers’ compensation cases have been retired. The CPT (current procedural technology) acupuncture workers’ compensation billing codes have been updated to the industry standard including: 97810, 97811, 97813, 97814. Another big change to affect all medical professionals is the retirement of the ICD-9 diagnosis codes in favor of ICD-10 codes. Enactment of the new diagnosis codes is planned for the fall. To learn more about billing, visit the Healthcare Medicine Institute insurance article or take the acupuncture continuing education insurance billing course.
Magnetic resonance imaging (MRI) reveals that acupuncture prevents and relieves migraines by restoring normal brain functions. MRI results demonstrate that acupuncture decreases the frequency and duration of migraine attacks by increasing functional connectivity in the brain’s frontal and temporal lobes. The researchers add that the MRI data reveals the “neural mechanisms of acupuncture treatment for migraine.”
Brain regions of the frontal and temporal lobes have “decreased functional connectivity” in migraine sufferers. The MRI results demonstrate that acupuncture restores functional connectivity in the affected regions. After a four week course of acupuncture treatment, migraine sufferers “showed significantly increased functional connectivity in the bilateral superior frontal gyrus, medial frontal gyrus, precuneus, inferior parietal lobule, posterior cingulate cortex, cingulate gyrus, superior temporal gyrus, middle temporal gyrus, and supramarginal gyrus as compared with before acupuncture treatment.” In addition, the researchers conclude that acupuncture decreases the frequency and duration of migraine attacks after a four week course of acupuncture therapy.
The researchers note that a large body of clinical research concludes that “acupuncture is able to alleviate headache degree and/or improve the quality of life and it is safe and at least as effective, if not more effective than prophylactic drug treatment.” The purpose of their investigation was to measure how acupuncture accomplishes pain relief. The researchers note, “The current results indicated that the neural mechanisms of acupuncture for migraine prophylaxis might be interpreted as that acupuncture treatment could increase the decreased resting-state functional connectivity in certain brain regions within the frontal and temporal lobe of MWoA (migraine without aura) patients.”
They add that studies show that the “frontoparietal network plays an important role in endogenous pain modulation.” As a result, the researchers posit “that acupuncture treatment could enhance the pain related modulatory effects of the frontoparietal network by increasing its functional connectivity in migraine patients.” They also note that the results indicate that acupuncture relieves pain by enhancing the “functional connectivity of the default mode network and other brain networks.”
Stanford University doctors conclude that acupuncture during surgery reduces pain. Research published in The Laryngoscope finds acupuncture effective for reducing pain and improving restoration of a normal diet postoperatively when acupuncture is applied during surgery. Doctors from the Stanford University School of Medicine conclude that acupuncture is “feasible, well tolerated, and results in improved pain and earlier return of diet postoperatively.”
The research was conducted by doctors from two Stanford University School of Medicine (Palo Alto, California) departments, the Department of Otolaryngology-Head and Neck Surgery and the Department of Anesthesia.
A randomized-controlled investigation of acupuncture’s benefits to pediatric tonsillectomy patients reveals that acupuncture patients “experienced significantly less pain at various postoperative time points as compared to the control cohort, and also that the onset of analgesia in the acupuncture cohort began by 36 hours postoperatively, whereas the control group did not reach significant analgesia until 84 hours postoperatively.”
Postoperative oral intake improved for patients receiving acupuncture during the tonsillectomy operation. The researchers note, “Oral intake was significantly more improved in the acupuncture group than the control group (P = 0.01).” They add that “the acupuncture group had significantly increased oral intake starting at 24 hours and lasting through all remaining time points examined, whereas the control group had significantly increased oral intake starting at 72 hours postoperatively.”
Acupuncture improves hearing for patients with hearing loss. Research published in the International Journal of Clinical and Experimental Medicine finds acupuncture effective for the treatment of nerve related deafness. This type of sensorineural deafness is hearing loss due to auditory nerve damage. The researchers, Jiang et al., conclude that acupuncture “can significantly improve the hearing of patients with nerve deafness, and the efficacy of acupuncture in combination with medication is superior to medication alone.”
Conventional medical treatments include cochlear implants, vasodilator medications, vitamin therapies, and steroids. In Traditional Chinese Medicine (TCM), both acupuncture and herbal medicines are used in the treatment of sensorineural hearing loss and deafness. The research finds acupuncture significantly more effective than medications. Acupuncture was also found more effective than than Er Long Zuo Ci Wan. This is a significant finding given that the herbal formula Er Long Zuo Ci Wan has been used in TCM for the treatment of hearing disorders for centuries and has also been found effective for the treatment of hearing related disorders in modern research.
Er Long Zuo Ci Wan contains the following herbal medicines:
- Magnetitum (Ci Shi)
- Radix Rehmanniae Preparata (Shu Di Huang)
- Fructus Corni Officinalis (Shan Zhu Yu)
- Cortex Moutan Radicis, Paeonia Suffruticosa (Mu Dan Pi)
- Rhizoma Dioscoreae Oppositae (Shan Yao)
- Sclerotium Poriae Cocos (Fu Ling)
- Rhizoma Alismatis Orientalis (Ze Xie)
- Radix Bupleuri Chinensis (Chai Hu)
Qiu et al. investigation the effects of Er Long Zuo Ci Wan and discovered that it reduces ototoxicity due to gentamicin consumption. Gentamicin is an antibiotic used in the treatment of gram-negative bacterial infections but has ototoxic and nephrotoxic properties. Qiu et al. also discovered that Er Long Zuo Ci Wan demonstrates protective effects on succinate dehydrogenase (SDH) in cochlear hair cells. Chen et al. note that hair cell loss correlates to hearing loss and SDH activity within cochlear hair cells and is a marker of cellular dysfunction and subsequent loss of auditory sensitivity. Together, these findings suggest that Er Long Zuo Ci Wan may have otoprotective properties. Additional research by Wang et al. suggests that Er Long Zuo Ci Wan may reduce chronic tinnitus.
MRI studies reveal the neurological mechanisms of acupuncture on human health. Research published in Autonomic Neuroscience demonstrates that stimulation of specific acupuncture points induces hemodynamic changes in specific brain networks. The researchers add that brain networks accessed by specific acupuncture points relate to specific medical disorders and suggest an “acupoint-brain-organ” pathway.
Functional magnetic resonance imaging (fMRI) studies reveal specific acupuncture point effects in the brain through blood-oxygen-level dependent (BOLD) measurements. In a meta-analysis of 82 fMRI studies, researchers found a large body of evidence supporting acupuncture point specificity. This applies to both manual acupuncture and electroacupuncture. True acupuncture point stimulation induced specific cortical effects whereas sham acupuncture did not. In addition, the researchers note that acupuncture point stimulation produces significantly “more positive and negative hemodynamic signal response(s) in brain regions compared with sensory stimulation used as a control condition.”
Many important findings were confirmed. Acupuncture exerted a stimulus that “could induce beneficial cortical plasticity in carpal tunnel syndrome patients.” It was also demonstrated that acupuncture relieved pain “by regulating the equilibrium of distributed pain-related central networks.”
The researchers note that a fundamental principle of Traditional Chinese Medicine (TCM) is that “specific acupoints have therapeutic effects on target organ systems remote from the needling site….” Recent fMRI investigations support this principle. The researchers note that “fMRI investigations regarding several acupoints have demonstrated that acupuncture stimulation at disorder-implicated acupoints modulates the activity of the disorder-related brain regions.”
In TCM, acupuncture point Neiguan (PC6) is indicated for the treatment of nausea and vomiting. The fMRI research supports this ancient principle. The researchers 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.”
Acupuncture reduces stress for women undergoing in vitro fertilization (IVF). Research in Fertility and Sterility, an American Society For Reproductive Medicine publication, measured the dose dependent effect of acupuncture on stress for women undergoing IVF. They discovered that elevated stress levels persist in women receiving only a single acupuncture treatment on the day of embryo transfer. However, stress reduced significantly for women receiving several acupuncture treatments prior to the day of embryo transfer.
The researchers note that “acupuncture appears to be a promising stress-lowering tool for women undergoing IVF.” The research suggests a dose dependent effect. The study compared women receiving a single acupuncture treatment on the day of embryo transfer with those receiving several acupuncture treatments over a period of time greater than one month. The researchers note that one acupuncture treatment was not clinically significant but that “when undergoing multiple acupuncture sessions, stress scores were significantly lower.” Citing research on the impact of lowering stress on fertility procedure positive patient outcomes, the researchers recommend additional studies on acupuncture’s effects on fertility outcomes.
A related study was published recently finding that in vitro fertilization (IVF) live birth success rates may increase with Traditional Chinese Medicine (TCM) therapies, including both acupuncture and herbal medicine. A meta-analysis of over 1,200 IVF patient records was examined. Application of TCM modalities was associated with a significant increase in the live birth rate. The live birth rate was increased for both fresh donor and non-donor IVF embryo transfers.
Combining acupuncture with a special Traditional Chinese Medicine (TCM) herbal formula relieves perimenopausal insomnia. Acupuncture, as a standalone treatment modality, is found effective for the treatment of perimenopausal related insomnia in a recent study. However, when a special herbal formula was added to the treatment regime, the total effective rate increased significantly. Researchers conclude that acupuncture combined with herbal medicine “is a simple and effective clinical intervention for the patients with perimenopausal insomnia….”
The researchers note that acupuncture combined with the herbal medicine formula Zi Shen Tiao Gan Tang (kidney reinforcing and liver regulating decoction) demonstrates the ability to “regulate endocrine functions” and nervous system functions. The researchers add that the acupuncture plus herbal medicine treatment protocol outlined in the study helps patients “avoid side effects from sedatives” through the use of this effective alternative to drugs. The following are the effective rates, acupuncture points, and herbs used to achieve positive patient outcomes for patients with perimenopausal insomnia.
The total effective rate for acupuncture combined with Zi Shen Tiao Gan Tang was 96.83%. Using the same acupuncture point prescription without the use of herbal medicine achieved a 74.60% total effective rate. The total effective rate was broken down into three categories: cure, remarkable effect, effect.
A cure was defined as sleep time restoration to normal or sleep time exceeding six hours of sound sleep with the patient being “full of energy” after waking. A remarkable effect was defined as pronounced sleep improvements with an increase of sleep time by three hours. Effect was defined by sleep time increasing to a greater length than prior to the study but less than a three hour improvement. Acupuncture plus herbal medicine achieved a cure rate of 34.92%, a remarkable effect rate of 31.75%, and an effect rate of 30.16%. Acupuncture without the addition of herbal medicine achieved a 26.98% cure rate, a remarkable effective rate of 25.39%, and an effect rate of approximately 22.22%.
Acupuncture reduces anxiety and pain for breast cancer patients that have had a mastectomy or breast reconstruction surgery. Researchers from the Mayo Clinic (Rochester, Minnesota) conclude that acupuncture “significantly improves symptoms of postoperative pain, anxiety, and tension, and demonstrates a trend toward improved postoperative relaxation.” They add that “acupuncture can be integrated into a busy postsurgical clinical practice” and “acupuncture may be an important intervention in the postoperative setting for breast cancer patients.”
The Mayo Clinic researchers note that there are “several important implications” from the study. The researchers tested the feasibility of incorporating acupuncture into a postoperative medical setting for mastectomy and breast reconstruction patients. The results suggest that acupuncture is feasible in this environment and note that acupuncture “can be successfully incorporated into a busy postoperative clinical setting….” The researchers note, “it appears that acupuncture can be incorporated into a postoperative inpatient setting without disrupting patient care or activities of care team members.”
All patients in the study noted that it was worthwhile and no patients indicated dissatisfaction. The researchers note that there was “a high degree of participant satisfaction in acupuncture.” The Mayo Clinic researchers add that satisfaction levels indicate “the value of acupuncture for surgical patients….” The researchers note that acupuncture improves the quality of life for patients citing that “acupuncture can have favorable effects on anxiety, tension and postoperative pain….” They add that the “study’s results suggest that acupuncture can be integrated successfully ino the postoperative care of breast surgery recipients.”
The study’s acupuncture point prescription was protocolized to a standardized set of acupuncture points. The prescription was based on the Traditional Chinese Medicine (TCM) principles of calming shen, tonifying qi and blood, and moving qi and blood. Acupuncture points included:
- DU20 (Baihui)
- Ex-HN3 (Yintang)
- LI4 (Hegu)
- LI11 (Quchi)
- PC6 (Neiguan)
- SP10 (Xuehai)
- SP6 (Sanyinjiao)
- ST36 (Zusanli)
- LV3 (Taichong)
- GB40 (Qiuxu)
The researchers selected the acupuncture points for their ability to address several indications including: headache, nausea, vomiting, GI pain, and musculoskeletal pain. The points were also chosen to induce a calming effect for the relief of anxiety. Acupuncture needles were Seirin J-type of two sizes: 0.16 x 15 mm, 0.20 x 30 mm. Needles were inserted and the de qi sensation was induced by manual acupuncture techniques. The acupuncture points were applied by a licensed acupuncturist (Minnesota Board of Medical Practice) with a masters degree level of training and who is certified by the National Certification Committee for Acupuncture and Oriental Medicine (NCCAOM).
Acupuncture significantly enhances peripheral blood flow. Photoplethysmography results published in Electron Devices and Solid-State Circuits demonstrates that acupuncture induces “significant elevation of peripheral blood flow.” The research team making this discovery notes that a prior investigation using single-channel photoplethysmography demonstrates that acupuncture enhances “local microvascular blood flow in tissue surrounding Zusanli after acupuncture at that site.” The new research takes the investigation another step further. Using multi-channel photoplethysmography, the researchers demonstrate that needling acupuncture point ST36 (Zusanli) induces “significant elevations in whole body peripheral blood flow and parasympathetic activities after acupuncture at Zusanli.”
The ancient principles of traditional Chinese medicine (TCM) posit acupuncture as a means to regulate qi and blood flow throughout the body through a transporting network of meridians and acupuncture points along those meridians. The researchers note that the study “reinforces the theory of traditional Chinese medicine….” The researchers measured acupuncture’s ability to induce “significant elevations in peripheral blood flow over the upper and lower limbs during and after acupuncture.” Based on the findings, the researchers conclude that “the results of this study support the theory of Chinese medicine that acupuncture at Zusanli augments systemic gastrointestinal and circulatory functions.”
The researchers provide background concerning the need for this investigation. In 1996, the World Health Organization (WHO) denoted that acupuncture is beneficial in the treatment of 64 conditions including those involving pain, psychiatric concerns, neurological disorders, digestive imbalances, respiratory disorders, dermatological conditions, and gynecological diseases. They add that in Taiwan, acupuncture is commonly used for the treatment of many conditions including “stroke, dementia, Parkinson’s disease, epilepsy, Bell’s palsy, carpal tunnel syndrome, and headache.” The study was designed to clarify the mechanisms by which acupuncture exerts its effective actions.
Research finds acupuncture combined with herbal medicine effective for the treatment of rheumatoid arthritis. Acupuncture combined with the herbal formula Dang Gui Si Ni Tang resulted in a total effective rate of 93.75%. The research demonstrates that acupuncture combined with the herbal formula has a “significant curative effect on rheumatoid arthritis….” While these findings are hopeful, the 93.75% total effective rate represents all clinically significant improvements and does not represent a cure rate.
Dang Gui Si Ni Tang, translated as Angelica Decoction for Frigid Extremities, is a Traditional Chinese Medicine herbal formula included in the Shang Han Lun (Treatise on Cold Damage Disorders), written in 220 CE. In the book, the herbal formulation is recommended for patients with a sensation of chilled hands and feet combined with a small and weak pulse, which is attributed to an external weakness of yang.
Dang Gui Si Ni Tang is categorized as an herbal formula that warms the channels and disperses cold. The formula warms the channels, expels the cold, nourishes the blood, and invigorates blood stasis. Dang Gui Si Ni Tang contains:
- Dang Gui (Radix Angelicae Sinensis)
- Gui Zhi (Ramulus Cinnamomi)
- Shao Yao (Radix Paeoniae)
- Xi Xin (Herba Asari)
- Zhi Gan Cao (Radix Glycyrrhizae Preparata)
- Mu Tong (Akebiae Caulis)
- Da Zao (Fructus Jujubae)
Another study investigated Dan Gui Si Ni Tang’s therapeutic effects for diabetics. Patients with diabetic foot ulcers due to blood stasis or kidney yang deficiency were randomized into an herbal group and a drug group. The randomized-controlled trial selected patients from the Maoming Hospital of Traditional Chinese Medicine at the Guangzhou University of Chinese Medicine. The treatment group received a modified version of Dang Gui Si Ni Tang and the control group received treatment with cilostazol, a quinolinone derivative used to relieve symptoms due to peripheral vascular disease.
Acupuncture successfully improves sleep quality and reduces both stress and depression in the elderly. Published in Neuroscience Letters, researchers made this determination based on a randomized, placebo-controlled study. The researchers note that “the rigorous methodology employed in this study ensured the reliability of the results concerning the improved sleep quality and relaxation effects involved with acupuncture during aging.”
Acupuncture significantly improved the Pittsburg sleep quality index (PSQI) scores, indicating substantial sleep quality improvements. In addition, beck depression inventory (BDI) and the perceived stress scale (PSS) measures demonstrated significant clinical improvements. True acupuncture demonstrated significant positive patient outcomes for improvements in sleep quality and reduction of both depression and stress. The researchers note, “No significant changes were observed in the placebo group.” The researchers add that the strict controls employed during the study “demonstrate the real effects of acupuncture.”
Acupuncture was applied to elderly patients in a hospital outpatient setting. Licensed acupuncturists applied the acupuncture needles while patients rested in a supine position on a stretcher. Acupuncture was applied at a rate of twice per week for a total of 25 minutes of needle retention time per treatment session. Each patient received a grand total of 10 acupuncture treatments. Sterile disposable acupuncture needles were applied to acupuncture points:
- SP6 (Sanyinjiao)
- LI4 (Hegu)
- ST36 (Zusanli)
- LV3 (Taichong)
- PC6 (Neiguan)
- Ex-NH3 (Yintang)
Manual needle stimulation was applied to the needles frequently during each acupuncture treatment session. For the placebo-controlled sham acupuncture group, acupuncture needles were applied to areas of the body not associated with classic acupuncture points as defined by Traditional Chinese Medicine (TCM). In addition, the placebo-controlled group’s needles were applied to a superficial depth without needle stimulation.
The acupuncture point prescription choice was similar to a prescription in a related study. The researchers note that Sun et al. used acupuncture points including ST36, SP6, PC6, and LV3 in an investigation of acupuncture’s effects on major depressive disorder (MDD). The researchers note that Sun et al. “found similar antidepressant effects of electroacupuncture (EA) as compared to fluoxetine-treated patients.” Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) antidepressant medication. It is also known by its trade names including Prozac and Sarafem.
The researchers add that electroacupuncture “had a faster onset of action, better response rate, and better improvement rate than fluoxetine, indicating that acupuncture can be a good intervention method for ameliorating psychological distress and depressive symptoms, thereby promoting relaxation and well-being.” Although there were similarities to Sun et al., the sleep researchers employed manual acupuncture stimulation whereas Sun et al. employed electroacupuncture. This contrast demonstrates that both electroacupuncture and manual acupuncture have therapeutic value in the treatment of depression.
Acupuncture reduces tooth socket bone loss due to periodontitis. Researchers conducting a laboratory experiment on the effects of periodontitis discovered that electroacupuncture decreases periodontal tissue destruction and also reduces pro-inflammatory mediators and a key pro-resorptive factor. Histomorphometry and microtomography confirm that electroacupuncture effectively reduces bone loss in the alveoli, the jawbone sockets containing the roots of teeth. The research was published in the Journal of Periodontology Online, an official publication of the American Academy of Periodontology.
The researchers identified key biochemical reductions in pro-inflammatory mediators. Application of electroacupuncture decreased expression of IL-1β, a pro-inflammatory cytokine, which is a cell-signaling protein used in intercellular communication. Zhe Liu et al. also measured reductions in IL-1β caused by the application of acupuncture. In an entirely different experiment on a different set of acupuncture points, GV20 and GB7, Zhe Liu et al. found that acupuncture reduces IL-1β in the brain tissue region of a hematoma after a stroke.
The periodontal experiment conducted by Lisboa et al. examined the effects of electroacupuncture on laboratory mice with ligature induced periodontitis. Acupuncture points LI4 (Hegu), LI11 (Quchi), ST36 (Zusanli) and ST44 (Neiting) were applied. The researchers identified another pro-inflammatory modulator that was downregulated by the application of acupuncture at these points. Expression of MMP-8 decreased. MMP-8 is a protein active in the breakdown of extracellular matrixes.
About the Acupuncture Points
All acupuncture points chosen for use in the periodontitis study were selected from either the large intestine hand-yangming or stomach leg-yangming channels. The stomach leg-yangming channel traverses several areas related to oral health. The primary stomach channel begins beside the nose near the ala nasi at LI20 and ascends to the root of the nose where it intersects with UB1. Next, the channel descends along the lateral side of the nose and enters the upper gums. Then, it joins acupuncture point DU26 and circles back around the corner of the mouth, meeting CV24 at the mentolabial groove. From there, it follows the angle of the jaw and runs upward in front of the ear. Another branch separates on the lower jaw and descends along the throat and enters the supraclavicular fossa.
In vitro fertilization (IVF) live birth success rates may increase with traditional Chinese medicine adjuvant care, including both acupuncture and herbal medicine. In this retrospective cohort study, researchers reviewed 1,231 IVF patient records and compared live birth outcomes for patients receiving IVF only and patients receiving IVF plus Chinese medicine.
Acupuncture was combined with Chinese medicine dietetics, lifestyle, and nutritional recommendations, and if appropriate, Chinese herbal medicine. The research team used the term whole-systems traditional Chinese medicine (WS - TCM) for the integrated protocol. WS -TCM was compared with two groups: women who underwent usual IVF care, women who elected to have two standardized acupuncture sessions on the day of IVF embryo transfer. WS - TCM was associated with a significant increase in live births compared with both groups.
The live birth rate was increased in both fresh donor and non-donor IVF embryo transfers. In the cycles using donor eggs (N=162), patients who elected WS - TCM care had an 85.7% live birth rate. A live birth rate of 62.5% occured in donor IVF patients receiving only usual IVF care and a 59.5% live birth rate occurred in women who elected day of embryo transfer acupuncture. For women who did IVF with their own eggs (N=1,069), the WS-TCM group's live birth rate was 61.3% compared with 48.2% in the usual IVF care group and 50.8% in acupuncture group.
All integrated Chinese medicine treatments were individualized to each patient. The researchers note that Chinese medicine focused on regulating the menstrual cycle in four phases for the treatment of reproductive concerns: menses, follicular, ovulation, luteal. During the menstrual cycle, treatment focused on regulating the menses and alleviating dysmenorrhea. The follicular phase focused on regulating reproductive hormones plus endometrial and follicular development. The ovulation phase focused on ovulation induction and the luteal phase involves regulating hormones.
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