Outrage over Acupuncture Evidence Attacks NIH

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Doctors from the University of Maryland School of Medicine, Baltimore and the University of Vermont College of Medicine, Burlington published a case vignette in the New England Journal of Medicine recommending acupuncture for the treatment of lower back pain. The article cites that patients with lower back pain account for over $90 billion in annual health care expenses in the US. The doctors conclude that acupuncture is an effective means for treating lower back pain based partly on a recent study of 6,359 patients published in Spine¹. For the lower back pain patient in the case study presented, 10-12 acupuncture treatments over an 8 week period are recommended.

The doctors cite physiological phenomena that measure the effects of acupuncture. Local anesthesia at needle insertion sites block the the analgesic effects of acupuncture showing that acupuncture is dependent upon neural innervation². Acupuncture has been proven to cause the release of endogenous opioids in brain-stem, subcortical, and limbic structures^3,4. Acupuncture has also been proven to induce the secretion of adrenocorticotropic hormone and cortisol from the pituitary gland thereby creating a systemic anti-inflammatory response⁵. Functional MRI studies in humans reveal that acupuncture stimulates limbic and basal forebrain areas involved in pain processing⁶. PET scan MRIs (positron-emission tomography) show that acupuncture increases opioid binding potential in the brain for several days⁷. Acupuncture has also been proven to mechanically stimulate connective tissues⁸, release adenosine at the site of needle stimulation⁹, and increase local blood blow¹⁰. The doctors then cite clinical trials showing the efficaciousness of acupuncture in the treatment of thousands of patients^10-15.

Despite this overwhelming evidence proving the mechanisms of action and efficaciousness of acupuncture, skeptics were outraged at the publication of an article supportive of acupuncture in the venerable New England Journal of Medicine. An article recently posted in the Forbes “science business” section stated that the article is “embarrassing” and that acupuncture “infiltrates” the University of Maryland Medical School. In the article, the author calls acupuncture “pseudoscience” and states that it is based on “magical thinking of non-existent life-force.” The skeptic author’s only proof of his theory is that one of the many studies cited in the article found that acupuncture was only 47.6% effective for the treatment of lower back pain and that sham acupuncture was 44.2% effective. Therefore, the author concludes that using “toothpicks” randomly on the human body will have the same pain relieving effects as acupuncture. What the author fails to mention in the Forbes attack article is that conventional western medicine therapy (a combination of drugs, physical therapy, and exercise) was only 27.4% effective in that very same study. Should we therefore abolish western medicine by MDs and call it pseudoscience? Acupuncturists have noted that the success of sham acupuncture noted in that particular study of 1,162 patients in Germany reveals that poorly placed acupuncture needles also derive benefit for the patient.

The author in the Forbes article does have an agenda, he calls for the elimination of the NCCAM (National Center for Complementary and Alternative Medicine), a division of the NIH (National Institutes of Health). He states that since acupuncture is poorly supported by research, the NCCAM should be abolished. The authors of the New England Journal of Medicine article contend that more research needs to be conducted on the efficacy of acupuncture based on existing and promising research. The authors suggest continuing acupuncture education and research as a means to better serve the public with quality medicine.


References
1. Yuan J, Purepong N, Kerr DP, Park J, Bradbury I, McDonough S. Effectiveness of acupuncture for low back pain: a systematic review. Spine 2008;33:E887-E900.
2. Wang SM, Kain ZN, White P. Acupuncture analgesia: I. The scientific ba- sis. Anesth Analg 2008;106:602-10.
3. Han JS. Acupuncture: neuropeptide release produced by electrical stimulation of different frequencies. Trends Neurosci 2003;26:17-22.
4. Pomeranz B. Scientific research into acupuncture for the relief of pain. J Altern Complement Med 1996;2:53-60.
5. Li A, Lao L, Wang Y, et al. Electroacupuncture activates corticotrophin-releasing hormone-containing neurons in the paraventricular nucleus of the hypothalamus to alleviate edema in a rat model of inflammation. BMC Complement Altern Med 2008;8:20.
6. Dhond RP, Kettner N, Napadow V. Neuroimaging acupuncture effects in the human brain. J Altern Complement Med 2007;13:603-16.
7. Harris RE, Zubieta JK, Scott DJ, Napa- dow V, Gracely RH, Clauw DJ. Traditional Chinese acupuncture and placebo (sham) acupuncture are differentiated by their effects on mu-opioid receptors (MORs). Neuroimage 2009;47:1077-85.
8. Langevin HM, Churchill DL, Wu J, et al. Evidence of connective tissue involvement in acupuncture. FASEB J 2002;16:872-4.
9. Goldman N, Chen M, Fujita T, et al. Adenosine A1 receptors mediate local anti-nociceptive effects of acupuncture. Nat Neurosci 2010 May 30 (Epub ahead of print).
10. Sandberg M, Lundeberg T, Lindberg LG, Gerdle B. Effects of acupuncture on skin and muscle blood flow in healthy subjects. Eur J Appl Physiol 2003;90:114-9.
11. Brinkhaus B, Witt CM, Jena S, et al. Acupuncture in patients with chronic low back pain: a randomized controlled trial. Arch Intern Med 2006;166:450-7.
12. Haake M, Muller HH, Schade-Brittinger C, et al. German Acupuncture Trials (GERAC) for chronic low back pain: randomized, multicenter, blinded, paralel-group trial with 3 groups. Arch Intern Med 2007;167:1892-8. [Erratum, Arch In- tern Med 2007;167:2072.]
13. Cherkin DC, Sherman KJ, Avins AL, et al. A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain. Arch In- tern Med 2009;169:858-66.
14. Thomas KJ, MacPherson H, Thorpe L, et al. Randomised controlled trial of a short course of traditional acupuncture compared with usual care for persistent non-specific low back pain. BMJ 2006; 333:623.
15. Witt CM, Jena S, Selim D, et al. Prag- matic randomized trial evaluating the clinical and economic effectiveness of acupuncture for chronic low back pain. Am J Epidemiol 2006;164:487-96.

Acupuncture proven to turn breech fetuses

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New research shows that acupuncture is an effective method for turning breech fetuses to the proper position for a healthy vaginal delivery. Five different randomized studies conducted by the Department of Fetal Medicine at Hautepierre Hospital in France demonstrate that needling acupuncture point UB67 (located on the 5th toe) is an effective means for turning a breech fetus. Another study published in Complementary Therapies in Medicine (which includes a lead researcher from the Harvard School of Public Health in Boston, Massachusetts) concludes that needling acupuncture point UB67 “reduces the number of breech presentations at term, thus, reducing the number of caesarean sections, and is cost effective compared to expectant management, including external cephalic version.” The latter study included stimulation with both acupuncture needles and moxibustion at acupoint UB67. Moxibustion is a technique used by acupuncturists to stimulate an acupoint with heat by burning a specially prepared mixture of the herb Ai Ye (mugwort) near the acupoint. The French study concludes that “acupuncture should be attempted in cases of breech presentation.”

The acupuncture treatment protocol for turning breech fetuses is over 1,000 years old. According to Traditional Chinese Medicine (TCM), acupuncture and moxibustion at point UB67 (also known as Zhiyin, “Reaching Yin”) is used to treat breech fetuses, occipital & vertex headaches and prolonged or difficult labor. Acupuncture point UB67 is most renown for its importance in turning breech fetuses. In China, pregnant women with a breech position fetus are often instructed how to warm acupuncture point UB67 with a moxibustion stick as a home measure. Often, using acupuncture is not necessitated since the moxibustion may achieve the proper clinical results of a well positioned fetus.

Weight-Cholesterol Loss From Pu-erh Tea

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New research shows that pu-erh tea causes healthy weight loss. The study conducted by the Yunnan Provincial Key Laboratory and the College of Food Science and Technology at the Yunnan Agricultural University notes that pu-erh significantly reduced total body weight, adipose pads, cholesterol, and triglycerides. The dangerous LDL cholesterol is lowered by pu-erh tea but the healthy HDL cholesterol is unaffected. The testing was performed on rats and the results showed clear evidence that the rats lost weight and recovered from hyperlipidemia. It is postulated that the fat reduction may be triggered by pu-erh’s ability to boost enzymes such as lipoprotein lipase, hepatic lipase, and hormone-sensitive lipase.

Pu-erh originates from a type of wild broad leaf tea plant from southwest China. Pu-erh tea (Camellia Sinensis) is typically aged and is classified by the year and region where it was produced. Older pu-erh tea is more valuable and fetches a much higher market price. Tea connoisseurs pay a high price for an old vintage. Pu-erh is often pressed into compacted cakes which allows for the proper maturing of the tea leaves although pu-erh is also available in loose leaf form.  Unaged pu-erh is often a green tea whereas aged pu-erh is categorized as a black tea. In China, black tea is referred to as red tea due to its red color in the cup when hot water is added. Most pu-erh originates from Yunnan province and the finest varieties come from mountains in the Xishuangbanna region. This region is famous for its tropical rainforests, wild animals, the beautiful costumes and customs of the Dai people, and its fine climate for growing pu-erh.

Research shows herbal benefit in Parkinson’s Disease

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New research shows that the herbal formula Yi Gan San exhibits neuroprotective effects and rescues dopaminergic neurons from toxicity. The Acupuncture & Meridian Science Research Center at Kyung Hee University conducted research showing that Yi Gan San is correctly used for the management of neurodegenerative disorders. Yi Gan San showed significant neuroprotection in an induced Parkinsonian mouse model. The study notes that “in the mouse Parkinson's disease model, treatment with Yi-Gan San also significantly improved motor functioning and prevented dopaminergic loss.” In another study, 'The Journal of Brain Disease' reported that Yi Gan San may be helpful in treating schizophrenia and many neuropsychological disorders because it has been shown to restore glutathione levels in the brain. In yet another study published in 'Progress in Neuro-Psychopharmacology and Biological Psychiatry', the Shimane School of Medicine concluded that Yi Gan San is a serotonin modulator and is a “safe and useful” formula for treating behavioural and psychological symptoms of dementia and borderline personality disorder. That study also shows a statistically significant improvement in tardive dyskinesia, psychosis, schizophrenia.

An Acupuncturist-Hebalist View

Yi Gan San (Restrain the Liver Powder) contains Dang Gui, Fu Ling, Bai Zhu, Gou Teng, Chuan Xiong, Chai Hu, and Gan Cao. This formula is often used for headaches, dizziness, anxiety, panic attacks, teeth grinding, chills & fever, seizures, palpitations, infantile epilepsy, disturbed dreams, insomnia, and spasms. Traditionally this formula quells rebellious Liver Qi and treats Liver Blood deficiency.

3 iPhone Apps for Acupuncture Education

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iFitness

iFitness is a first rate iPhone app. It features pictures, videos, and descriptions of exercises that are laid out in a very user-friendly format. iFitness covers weight lifting, isotonics, cardiovascular, and stretching exercises. Major categories include: abdominals, arms, back, chest, legs, shoulders, cardio, and stretches. The descriptions and visuals are very clear. It is easy to use correct form when following the iFitness advice. iFitness allows the user to setup their own routines and also customize and track workouts. It includes a weight monitor, BMI calculator, and a section for tracking body measurements. At HealthCMI, we give iFitness our highest rating. It is fully compatible with the new iOS 4.0 Apple operating system and will soon feature iPad updates. iFitness sells for $1.99 .

TCM Clinic Aid

In our last herbal iPhone app review, we gave a thumbs up to Ben Cao. We like its ergonomic interface and appreciate the accuracy of the individual herb and herbal formula information. Today, we are reviewing TCM Clinic Aid which sells for $5.99 . It offers three major categories to search: diagnosis, herbs, and acupuncture points. Regarding herbs, we much prefer the Ben Cao app. The TCM Clinic Aid interface is a bit clunky, searching is more difficult, and it lacks the easy-touch cross referencing of Ben Cao. However, TCM Clinic Aid’s acupuncture point descriptions offer nice pictures of the points for easy location. Although the ergonomics and layout have a long way to go, we like the accuracy of the information presented. The diagnostic section breaks down into internal organs, four levels, residual pathogenics, and six stages. It includes accurate theory information but we felt the layout could be improved significantly. Overall, we look forward to improvements in this iPhone App’s cross-referencing capabilities, layout, and ergonomics.

QLecture Acupuncture LITE

Qpuncture offers 14 different iPhone Apps. Today, we look at QLecture Acupuncture LITE. This is a basic review of the Lung channel from a videotaped lecture. At $0.99, it is an affordable review of the channel which may be helpful for acupuncture students looking to pass board examinations or perhaps acupuncturists interested in continuing education who are wishing to listen to a nice review. The instructor offers clear, accurate, and concise information on the Lung channel. The video and audio quality are acceptable but could be significantly better. Despite these low production qualities, the instructor’s excellence overcomes these technical setbacks to deliver a quality lecture. We really like the ability to tap on the name of a point and the lecture jumps to that section. There is also an option to “Play Lectures in One Section”. When selecting this option, the entire video plays from the starting point selected. Otherwise, it will only play the individual acupuncture point selected. This makes for a quality interface. We give the ergonomics a thumbs up. To get all 12 major channels plus the Du and Ren channels, you will need QLecture Acupuncture. This costs $99.00 and therefore warrants pause. We suggest giving the LITE version a try and deciding for yourself. Our official suggestion is that you can’t really lose at the 99 cent price point. In the future, we look forward to improvements in both video and audio quality to better enhance the lectures.