Flawed research slams acupuncture on labor induction

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The BJOG has published flawed acupuncture research claiming that acupuncture cannot induce labor. Perhaps one of the more difficult and lengthy treatments to perform, labor induction is typically over 70% effective with acupuncture. However, the proper protocols and procedures require a 3-6 hour acupuncture treatment in many cases. The study from Denmark published in BJOG merely used two 30 minute appointments. The study also failed to use the proper type of acupuncture needle. Choosing an ultra-thin needle for the study, the researchers failed to follow correct equipment procedures. The correct needle has a slightly thicker gauge. In addition, no report of standardizing the depth of needle insertion was reported. Moreover, the needles were applied by nurse midwives and not by skilled, licensed acupuncturists and electroacupuncture was not applied. Finally, points UB67, LI4, SP6, and GV20 were chosen by the researchers. However, standard procedure throughout China includes points UB31, UB32, LI4, SP6 and supplementary points SP6, GB21, Liv3, and UB60.

Studies conducted in China show a 72% effective rate for acupuncture labor induction using LI4 and SP6 with electroacupuncture. This method employs ipsilateral insertion on only one side of the body and electrical stimulation is applied for 6 to 8 hours at approximately 3 Hz at a mild, comfortable intensity level. This procedure is conducted on three consecutive days and is applied to alternate sides of the body each day. The study out of Denmark did not attempt to use electroacupuncture.

The researchers from Denmark from Herning Regional Hosptial and Aarhus University Hospital never had a chance to prove or disprove anything because their acupuncture procedure was flawed. A short excerpt from their published study reveals problems:

In the acupuncture group (AG), thin acupuncture Seirin B-type needles (Serin Corporation, Shizuoka, Japan) were used, whereas Park-Sham acupuncture needles were used in the control group (CG). In both groups, sticky tubes were used to conceal the type of needle used. The tube was fixed to the skin at the acupuncture point. The needle was then inserted into the tube. The real acupuncture needle penetrated the skin, while the sham needle had a blunt point so that the needle retracted into the needle handle and did not penetrate the skin.9,10 All the midwives were trained in acupuncture according to the guidelines described by Deadman et al.,8 and they were all regular practitioners of acupuncture, performing acupuncture treatments approximately five to six times a week.

This is an irresponsible study that fails to follow basic procedures. The problem may have arisen in trying to match the acupuncture procedure to the control group procedure. In order to have a double-blind randomized controlled study, neither the practitioner nor the patient may know whether or not acupuncture has been performed. Due to the complexity of this treatment, this is often not possible. For example, the raising and thrusting technique is necessary in many instances. During this procedure, the practitioner can and must visibly see the insertion depth of the needle varying. This technique was not employed in this study although it is standard procedure. Raising and thrusting is not a double-blind technique but rather requires careful visual monitoring by the practitioner. A better designed study might choose the LI4, SP6 electroacupuncture procedure. However, difficulties would emerge because the practitioner must ask the patient when she perceives mild electrical stimulation. Again, this breaks the double-blind aspect of the research. Overall, expect to see a lot of poor research on the effectiveness of acupuncture due to the limitations of double-blind research. Leaving out important acupuncture needle manipulation techniques is not standard procedure and will yield deficient outcomes.

Kombucha Tossed from Whole Foods on TTB Guidance

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Whole Foods and New Leaf markets have pulled Kombucha Tea from the shelves after the US Alcohol and Tobacco Tax Trade Bureau (TTB) issued guidance on Kombucha’s alcohol content levels. The TTD began investigating Kombucha Tea after receiving inquires from the states of Maine, Minnesota, Arizona, and Vermont. Kombucha is a fermented tea and is usually marketed as a non-alcoholic beverage. Non-alcoholic beverages may contain trace amounts of alcohol up to 0.5 percent by volume. The TTB notes that some Kombucha products have alcohol contents that substantially exceed 0.5 percent. The TTB has not determined the full scope of which brands exceed the legal limit for non-alcoholic beverages in its ongoing investigation.

All Kombucha products exceeding 0.5 percent must comply with the Federal Alcohol Administration Act (FAA Act). This act covers regulations for permitting, labeling, and advertising. All Kombucha teas exceeding 0.5 percent alcohol by volume must also comply with the Alcoholic Beverage Labeling Act which requires labeling the product as an alcoholic beverage and also requires a health warning on the label. In addition, the alcoholic beverage designation makes products subject to the Internal Revenue Code of 1986. This includes other labelling requirements and excise taxes. Under this code, beverages exceeding 0.5 percent alcohol by volume can be seized and forfeited unless compliant with the applicable taxes, permitting, and labeling requirements.

The TTB is advising producers and distributors of kombucha products to ensure that labeling laws for alcoholic beverages are followed. The TTB cites concerns for pregnant women, children, and individuals who must avoid alcohol for medical reasons. The TTB is in the process of testing samples of kombucha products in an effort to determine which brands are affected. Whole Foods is also working to determine which products are in compliance with federal regulations. Whole Foods operates over 290 stores in the US, Canada, and the UK.

Acupuncture Stops Pain & Treats Infertility

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A recent study published in Nature Neuroscience created a media buzz that hit many major news outlets. The study concludes that adenosine is released during acupuncture treatments. Adenosine is a neuromodulator with anti-nociceptive attributes. A nociceptor is a sensory receptor that responds to stimuli by conducting nerve signals to the spinal cord and brain. The process itself is referred to as nociception and commonly results in the perception of pain. Lead investigator Maikin Nedergaard, co-director of the Center for Translational Neuromedicine at the University of Rochester Medical Center in New York stated, “We have produced the first evidence that acupuncture releases a natural pain-relieving molecule into the body…. Adenosine is a key to reducing pain during acupuncture treatment.”

Adenosine and the Heart

Adenosine not only blocks pain transfer but also promotes sleep due to its role as an inhibitory neurotransmitter. Adenosine also functions to dilate the coronary arteries and relaxes the smooth muscle inside the artery walls. Adenosine is an antiarrhythmic agent and is responsible for helping individuals cardiovert from an abnormal heart rhythm to a normal heart rhythm. Interestingly, since caffeine’s chemical structure tends to bind to the same receptors are adenosine, the pharmacological effects of adenosine can be reduced from the intake of coffee, tea, and chocolate.

Fertility

The discovery of the adenosine release helps to understand the function of acupuncture in a western clinical model. However, numerous studies show that acupuncture stimulates the release of beta-endorphins which are also pain-killing chemicals. Generally, any major news of acupuncture mediating the pain response makes headlines. However, recently singer Celine Dion, age 42, notes that she used acupuncture to help get pregnant. This also created a media flurry.  Studies show that acupuncture patients have a lower miscarriage and ectopic pregnancy rate and a higher rate of live births than comparative non-acupuncture groups. In one randomized, double-blind study in Fertility and Sterility it was found that acupuncture improves implantation rates for in-vitro fertilization by 180% while discovering a significant reduction of gonadotrophins.

Research and Diabetes

There are many chemicals that are mediated by acupuncture treatments and what research on an individual chemical release fails to show is the natural homeostatic drive of an acupuncture treatment. Homeostasis, the tendency toward a relatively stable equilibrium in physiological processes, goes far in explaining why acupuncture is able to stimulate entire cascades of chemicals within the body to help stimulate optimal health.  For example, Life Science published research showing that the homeostasis model assessment (HOMA) index changed with acupuncture. HOMA is a method used to quantify insulin resistance and beta-cell function. The thrust of the study showed that acupuncture significantly improved glucose tolerance in rats with diabetes. In conclusion, studies support acupuncture’s effects on chemical pathways that help restore normal physiological processes. While researching the release of individual chemicals helps to understand acupuncture, it is only one part of understanding acupuncture’s ability to balance entire system of chemicals and neuropathways within the body. Continuing educational research into the methods of acupuncture's actions now begin to uncover a broader picture of its effects on bodily responses.

Acupuncture and Herbs iPhone Apps

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There are many iPhone apps for licensed acupuncturists. Today, let’s look at Ben Cao, Pocket TCM, and Points. The first two are Chinese herbal medicine iPhone apps and the last is an acupuncture app. These apps provide acupuncturists with educational opportunities for clinical cross referencing and acupuncture continuing education studies.

Ben Cao is an excellent herbal medicine iPhone app. Individual herbs can be looked up by pinyin, pharmaceutical name, English name, category, and channel. Formulas can be referenced by pinyin, English name, and category. There is also a ‘symptoms’ reference which allows users to research both individual herbs and formulas by indications. This is a handy and useful tool for licensed acupuncturists looking to refine or cross reference herbs and formulas. Yet another search reference tool is the ‘syndromes’ tool which allows users to look up herbs and formulas by the Chinese medicine differential diagnosis. In all cases, when one is viewing the infomation on an individual herb it is a simple tap to select any of the formulas that the herb appears in. Many aspects of the app are cross referenced so as important keywords appear in the description of an herb or formula, they can be tapped for further cross referencing. For example, if I look up the ‘syndrome’ of Empty Heat - all I need to do is tap on the topic. Next, a list of all of the herbs (properly categorized) appears and relevant formulas. The user can tap on any individual herb or formula to learn more. Let’s say the user chooses Qing Hao Bie Jia Tang. Now the user sees all of the data about this formula and can tap on any individual herb within the formula and many of the important ideas within the formula such as low grade fever, no sweating, Yin, and formulas that clear deficient heat. Overall, Ben Cao is an excellent resource. It is easy to use, fast, and fun.  It contains hundreds of herbs and formulas and sells for $29.99. Our only suggestion is to expand the program to contain thousands of herbs and formulas. We want to see it grow because it is already a great contribution to the practice of acupuncture and herbal medicine.

Points is a simple guide to looking up the locations and functional information on acupuncture points on the iPhone. When looking at a pictured diagram of an acupuncture channel, one is NOT able to select a point by tapping on its location. Rather, points are selected by a number wheel. This does make for some ergonomic issues and is non-intuitive. Overall, Points is fun but lacks the power and depth of something like Manual of Acupuncture on DVD for use on laptops. Other issues with Points is the use on non-standard language for indications and also we found minor errors. We’d like to see more from Points both in ergonomics and raw data. However, it is fun and costs $19.99. With some development and editing, Points may yet become a great program. In the meantime, Points may be more relevant to the layperson until these basic improvements are made. There are other acupuncture point programs for the iPhone which may better suit licensed acupuncturists.

The Pocket TCM iPhone app sorts herbal formulas by pinyin or English. It also has a search function to look-up a formula. It doesn’t do much more than this. There is no individual herb, function, diagnosis, or syndrome cross referencing. It’s just a plain ol’ list of formulas. However, the information is accurate and clear. We like the price point for this herbal formula iPhone app at $4.99. If you need more power, bump up to Ben Cao. The two make nice companions for a licensed acupuncturist with a busy schedule.

New Research- Ginseng Fights Rheumatoid Arthritis

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New research has discovered that several ginsenosides, biologically active compounds found in the herb ginseng, have strong anti-inflammatory effects. The research demonstrates that ginsenosides can reduce inflammation in septic shock, rheumatoid arthritis, and dermatitis including psoriasis. In the laboratory, researchers have applied this knowledge by creating a new ginsenoside called G-Rp1. This ginsenoside, made from the ginsenosides G-Rg5 and G-Rk1 found in ginseng root, exhibits an even stronger anti-inflammatory effect than naturally occuring ginsenosides. Further, all of the aforementioned ginsenosides have important immunosuppressive effects in fighting autoimmune diseases.

The immune system response defends the body from pathogens such as toxic materials, microorganisms, and viruses. Inflammation is the first step towards eliminating these pathogens created by the immune system response. One important chemical created by the immune system response is TNF-alpha.  It creates redness, pain, and swelling to help fight off invading pathogens. However, unregulated excess TNF-alpha in the bloodstream leads to excess inflammation, auto-immune disorders, rheumatoid arthritis, and psoriasis.

Excessive TNF-alpha causes damage to normal cells and stimulates the production of other inflammatory chemicals thereby creating an unhealthy and destructive cycle of inflammation. The research proves that G-Rp1, G-Rg5, and G-Rk1 have powerful therapeutic effects in fighting psoriasis, contact dermatitis, and rheumatoid arthritis. The research also suggests that G-Rb1 can be developed into a new drug to alleviate arthritis. Other ginsenosides also had anti-inflammatory effects including G-Rg3, G-Rf, and G-Rh2. Also, G-Rp1 showed a powerful ability to reduce edema in the joints. The researchers Jongsun Park and Jae Youl Cho note, “These results suggest that G-Rb1 can be regarded as the most potent medication currently available for the treatment of rheumatoid arthritis.”

An important note, do not take ginseng without first consulting your licensed acupuncturist to determine whether or not it is appropriate. There are many forms of ginseng, each of which apply in differing circumstances.