| |
|
|
ABSTRACTS
OF
CURRENT LITERATURE
Compiled
by Russell Erickson, M.D.,
Private Practical/Medical Acupuncture, Berkeley, California
1998
ACUPUNCTURE LITERATURE REVIEW
PART I - PAIN
1. Longworth,
W, McCarthy, P. Acupuncture treatment of lumbar disc disorders. Acup
in Med 16(l):18-32, 1998.
Low back disorders in the UK cost 480
pounds in 1994 to the NHS, with 70% of the cost attributed to 7% of
chronic sufferers. Time off work costs 5 billion pounds.
Operations for LBP involve 11,000 persons yearly.
The authors reviewed 37 acupuncture studies with 6,414 patients; primarily
unilateral sciatica. There were only 9 controlled studies, with 600
patients. A prior report found 15-20% of LBP patients suffer over one
year, and 70% will have 3 or more episodes. It takes longer to improve
with sciatica than with pain limited to the LB. Disc protrusion into
the central posterior ligament tends to resolve poorly. A prior review
including all LBP acupuncture studies showed 30% or less failed to respond
at all to needling. Pontinen (1979) reported 78% with pain under 6 months
were able to give up pain medication and 17% used less; 2 other studies
confirmed 33% or better reduced medication notably. In another study
of pain over 3 months, 83% improved, vs 3 1 % of untreated controls,
where 25% also worsened. A meta-analysis of controlled studies (in press)
concluded acupuncture yields statistically satisfactory results. There
is thought that acupuncture works less well with advanced bony abnorm
alities and better where spasm plays a prominent role. Acupuncture following
laminectomy with residual pain works better than in cases with fusion.
Response is slower with prior surgery of the LB. It must be remembered
that disc hermations resolve spontaneously in the majority over time
(with less resolution where there is only a bulge). Acupuncture hastens
pain, inflammation, and spasm resolution and might help re-enervation
via growth factor release. One controlled study showed acupuncture and
electrical stimulation groups had less post-laminectomy pain and much
more rapid recovery of motor and sensory deficits; results objectively
supported by EMG. Daily treatment seems better for neurologic recovery.
Recommendations are given for future research in this area.
Comment: A long article covering many
aspects of this common malady, worth obtaining for those working with
this disorder.
2. Chen, X,
Grzesiowska, M. Point penetration and deep puncture therapies for sciatica:
an observation on 108 cases. World J Acup Moxi 8(2): 17-19,1998.
The average duration of pain was 3.5 months;
108 patients were treated with buttocks and lumbar deep 3-needles at
BL 54, GB 30, Xinshe (midpoint posterior iliac spine and coccyx tip),
and L3-5 Huatojiaji. Many supplemental points were used, based on TCM
diagnosis. A control group of 90 with BL and GB points commonly used
was compared for effect. After 2 sessions of 10 treatments, 69% were
cured, and 34% in the control group.
Comment: The authors wish to prove their
approach superior to a routine TCM needling. Length of followup is not
given; nor is method of randomization, and improvement is subjective.
The emphasis is on going deep into the blocked areas.
3. Zhang,
Y. Clinical observation on acupuncture treatment of 120 cases of stiff
neck. World J Acup-Moxi 8(l):22-25,1998.
Symptoms were present I to 15 days; all acute
cases. GV 14 and 16, GB 20, TE (TH) 5, Sl 3, and CV 24 were utilized,
with lifting, thrusting, twirling, and cupping. Under age 50, 67% responded
in one session, and over 50, 41%. Shorter duration of symptoms, under
3 days, responded more quickly. All were cured by 3 to 7 sessions.
Comment: I like and prefer the miraculous
approach demonstrated by Agatha Colbert, MD, at the 1998 AAMA Symposium.
The ipsilateral LR I (Ting point) is pressed, and the neck moved; if
it doesn't loosen, press over the mid large toe joint. If either loosens
the neck spasm (or trapezius), needle LR 4, then look for Ashi points
along the contralateral TH arm line and needle the tender one. Neck
movement restoration is immediate for acute neck spasm - simpler, quicker,
worked for me, and for those few I have been able to aid since.
4. Hu, J.Acupuncture
treatment of migraine in Germany. J Tradit Chin Med 18 (2): 99-101,1998.
Factors which might influence headaches included
sleeping prone with the neck to the side (10-15% of patients), weather,
menstrual cycles, and psychic stress. Migraine was 2 weeks to 40 years
in duration, and 89 patients were treated by acupuncture. GB 8, 20,39,
BL 10, UB 17,18, 19, Taiyang, SJ (TH) 5, L1 4, LR 3 and Ashi points
were used. Ancillary KI, HT, MH, and SP points were used in some. Headaches
were treated, with 5 to 10 treatments following to prevent recurrence.
A quick cure was achieved in 62%, 17% did not finish a course, and 4%
failed to be helped.
Comment: The ubiquitous failure to provide
a prolonged followup seen in Chinese articles is again present. Would
concentration on GB, LR, and their Shu points have been as effective
without adding the distal strong points from other meridians?
5. Dang, W,
Yang, J. Clinical study on acupuncture treatment of stomach carcinoma
pain. J Tradit Chin Med 18(l):31-38,1998.
Forty eight intermediate and late gastric cancer
patients were randomly assigned to acupuncture, point-injection, and
Western medicine groups. The groups were comparable for cancer staging.
The Quantitative Pain Criteria of WHO was used. Yangming channel points
were basically used, with SP 6, 10, and 12, and P(MH) 6. Four to eight
points were used each session, alternating sides. Treatment was daily
for 2 weeks with 3 day breaks for 2 months. The injected group had 4
points injected with transfer factor twice weekly. Western analgesics
as needed were used for the control group, with 100% kept comfortably
free of pain. In the first 10 days, acupuncture had an immediate excellent
effect in 57, partial in 71, and little in 32 needlings, with less long-term
effect. Point injection was similar. In the last 10 days of treatment,
acupuncture had excellent effect in 77, partial in 7 1, and little in
only 12, with a similar longer-term effect. Plasma enkephalin increased
in the two needle treated groups, but not the medication group. Twelve
aspects of life quality increased more in the acupuncture groups than
that medicated. There were more medication related reactions in the
control group. Leukocyte counts and e-rosette formation did not drop
in the acupuncture groups as they did in the medication group. Activity
of copper-zinc dismutase did not fall so notably in the needle-treated
groups.
Comment: Acupuncture appeared to have
fair efficacy for pain and better immune status in these carcinoma patients,
and living status was better, though pain was better controlled with
drugs. The acupuncture treatment was intensive compared to usual use
in the medically expensive West. Suggest that some acupuncture could,
at least, be added on a weekly or biweekly basis with medication; this
would likely enhance life, help immunity, and likely lead to less medication
requirement.
6. Huang,
y, Fu, Z-H, Xia, D-B, Wu, RK. Introduction to floating acupuncture:
clinical study on the treatment of lateral epicondylitis. Amer J Acup.
26 (1):27-32,1998.
Floating acupuncture was devised by Dr. Zhonghua
Fu, based on wrist-ankle acupuncture. The tender Ashi point in each
zone must be found exactly, at or just distal to the epicondyle. A study
was done with 48 patients treated this way compared to 45 with routine
acupuncture. The patients had "tennis elbow" (lateral epicondylitis).
The Ashi was located, and a point distal to it by 5-8 cm., where a 5
cm needle is shallowly inserted and directed toward the Ashi point (if
2 points, do the same for both). The needle lies flat on the skin surface
if correctly placed. There is no manipulation and it is taped in place
for 1-2 days. For routine acupuncture, SJ (TH) 5, LI 11, and SI 9 were
used for electroacupuncture. Of the floating acupuncture group, 8 1
% had complete relief and 10% "marked" within 3 days after a single
treatment vs 22% and 3 3 % for the control.
Comment: The authors state they have
found, in contradistinction to another report, that retained needles
can elevate pain threshold in animals and humans. The reported relief
is short term (20 days followup), randomization appeared very thorough,
and the rate of relief after one treatment is impressive. How much medical-legal
distress would be caused by leaving a 5 cm needle subcutaneously for
one to two days in the USA?
7. Chen, X-S.
Comparative study on acupuncture needling methods for sciatica: routine
needling vs point to point penetration and deep acupuncture. ArnerJAcup37-42,1998.
Deep needles directed toward the pathologic
point, and needling from one point to another on an involved channel
seem to produce good results in chronic pain. Here, X-S Chen elucidates
more fully a ther~py also reported this year in World J Acup Moxi, 8(2).
Point to point for GB meridian pain was GB 31 to 30 and GB 34 to SP
6; for BL meridian, UB 36 to ST 31 and UB 57-40. Deep needles were placed
at UB 54, GB 30, and Xinshe (midway from coccyx tip to superior iliac
spine)-to 6 inches deep. Patients were followed 6 months and compared
to routine BL (UB) and GB meridian acupuncture. The percentage cured
was 68% vs 34, with 19 and 27% markedly improved. An extensive knowledge
of anatomy is important in such long needling!
Comment: A possibly more effective approach
to sciatic pain the author is fond enough to publish twice in one year,
but it is one that western acupuncturists might be hesitant to employ
due to needle length and extent of tissue penetration!
8. Ternov,
K, Nilsson, M, Lofberg, L, Algotsson, L, Akeson, J. Acupuncture for
pain relief in childbirth. Acup & ElectroTher Res. 23(l):19-26,1998.
Acupuncture analgesic effect was defined by
the need for other medical intervention in 90 women and compared with
90 control labors. Of the acupuncture group, 58% required no other pain
medication vs 14% of the control group. The groups were well randomized
for age, parity, labor duration, oxytocine use, and C-section rate.
Treatment was given by 5 midwives trained in acupuncture. Points used
included GV 20, LI 4 (stimulated every contraction until little pain
or 30 minutes), with BL 57, 60, S1 3, GB 34. ST 36, SP 6 or 9, and low
back and pelvic girdle Ashi added, with 6 to 8 needles added at various
of these points as needed. Nitrous oxide/oxygen was given in 28% of
the acupuncture labors vs 62% without, and meperidine was required in
1 vs 32%. Five of the acupuncture patients had epidural analgesia vs
12 controls. An article in the 1970s concluded acupuncture insufficient
for labor; in an era when completely painless delivery was sought (and
acupuncture often less adeptly applied in the West-reviewer). Here,
delivery time was not lessened by acupuncture, as reported in a Chinese
article. In future studies, a recurrent VAS pain scale should be used
as labor progresses.
Comment: Acupuncture, I believe, has
a definite role during labor, with need for less medication with its
possible effects on fetus and dulling of the mother. Nurse-midwives
would be a logical source, as they are there in increasing numbers of
deliveries, tend to spend more time and keep mothers more at ease than
obstetricians, with less need for medical intervention.
9. Lin, Z-t,
Ge, J-k, Ge, S-h.Acupuncture plus manual restitution in treating costal
chonritis: report of 139 cases. Inter J Clin Acup 9(l):79-82,1998.
Seventy cases were of less than a year
duration, and etiology was unknown in 85. The costal cartilages were
swollen with severe pressing and stabbing pain. PC (MH) 6 was needled
and the spine manipulated by the operator to reposition the spine and
rib connection. In 116 prior cases, acupuncture alone cured only 26;
with the addition of manipulation, 112 of 139 were cured.
Comment: I was unaware that restitution
of a rib-spine connection might realign the ribs and help cure costal
cartilage disorder. MH 6 use would seem most appropriate to relax the
patient for the procedure rather than a direct point for cure.
10. Cui,
Y-m, Qi, L-j. Treating frozen neck by puncturing Guangming on the healthy
side: report of 150 cases. Inter J Clin Acup 9(l):83-84,1998.
The authors treated 150 patients with neck
spasm with the contralateral GB 37 point, resolving symptoms in 72%
and improving all but 2 patients.
Comment: This, if confirmed, is as rapid
as using the LR Ting pressure, needling LR 4 and the opposite TH Ashi
point for wry neck.
PART
II- MISCELLANEOUS
1.
Zhang, Q, Zhu-L-x An inquiry into the nature of acupuncture and moxi-
bustion. Inter J ClinAcup 9(l):13-16, 1998.
The authors provide a chart of the results
of acupuncture treatment of 10,000 "difficult cases". Included are 1,400
cases of sexual dysfunction and 1,644 of infertility. They concentrate
on channel points most sensitive to palpation and rotate needles "to
go their own way to take the Golden Mean". As usual in China, they use
1to 3 courses of 10 treatments; no effect by 5 courses is failure. "Acupuncture
mobilizes the potential in the body which is disguised by manifest functions
in daily life; humans only use 10% of their functions". The sensitive
spots represent nodes in an information network; a new science should
be developed on this basis.
Comment: Only a few USA practitioners
like William Craig, M.D., can claim such patient numbers and we are
not set up to emulate the long treatment courses either financially
or by temprament.
2.
Liu, L-j. Li, J-f, Du, D, Han, C-y, Li,Y- g. Electroacupuncture treatment
of hyperplasia of mammary gland. Inter J ClinAcup 9(l):75-78.1998.
Women with painful breast nodules, with cancer
excluded, were divided into 3 groups with 30 treated by electroacupunc-
ture on days 6-8, 13-15, and 22-27 after menstruation, 28 with 2 courses
of 10 treatments, and 30 with herbs. Nodules and symptoms disappeared
in 24 of the first group, 20 with routine acupuncture, and 14 with herb
therapy. ST 15, CV(RN) 17, and LI 4 were primary points, with ancillary
dependent on TCM diagnosis. Periods normalized in those successfully
treated.
Comment: Several papers from China over
the past few years extol acupuncture for eliminating painful breast
nodules; would any of our ob-gyn comrades be brave enough to initiate
a drandomized study?
3.
OAM report. Alter Ther 4(3):22-23, 1998.
OAM's budget was increased from $ 12-$20
million this year, with a minimum $7 million for research. A study
of osteoarthritis will be financed, a multi-center trial methodological
pilot will be initiated, as well as field visits to CAM practitioner
offices to determine capability for research projects. A Fellow
will study the effects of acupuncture on alcoholism. A draft of
a 5-year strategic plan for OAM was presented to AMPAC members.
4.
Helms, J M. An overview of medical acupuncture. Alter Ther 4(3):35-45,
1998.
Dr. Helms briefly threads through history,
principal classical concepts, modem concepts, appropriate interactions
with patients, treatment design, therapies and outcomes and how
to evaluate results. He presents thoughts on disorders for which
acupuncture is most and least valuable. The article is completed
by paragraphs on training and quality assurance, reimbursement
and prospects for the future.
5.
Dossey, L The right man syndrome: skepticism and alternative medicine.
Alter Ther 4(3):12-19 & 108-113, 1998.
Dr. Dossey presents one of his erudite
(even rather astounding) commentaries; this one centering on truculent,
irascible skeptics and "anti-quackery" foes of complementary and
alternative (or "integrative" to be up to date) medicine. He discusses
various prominent groups trying to hold the old line against new
ideas and paradigms which are threatening as well as being deemed
anti-scientific. It is an article well worth while for those who
are CAM believers.
6.
MacPherson, H, Fitter, M. Factors that influence outcome: an evaluation
of change with acupuncture. Acup in Med 16(l):33-39,1998.
A multicenter study of outcomes in 58 patients
among 7 of an initial 10 practitioners provided data, raised research
awareness of practitioners, and increased assessment ability. The SF-36,
measuring 7 aspects of health and 2 other devices were used. Of patients,
59% had their condition over 2 years prior to acupuncture, and 45% had
musculoskeletal complaints. Outcomes indicate acupuncture was helpful,
even for drop-outs, who were also analyzed. The extent of help seemed
to taper after 7 treatments. Those with conditions less than 2 years
did better, declining from an ill-health level of about 5 to 2 vs 3.5
for those over 2 years. No strong conclusions can be drawn due to the
small number of patients.
Comment: The authors note that the study
was designed to be simple; some practitioners had great difficulty in
recruiting patients, others did well. The study indicates a positive
role for acupuncture in medical care, and directs one to hope more practitioners
would become involved in similar work to help give direction to the
increasing interest regarding acupuncture in the west.
7.
Jessel-Kenyon, J, Pfeiffer, L, Brenton, M. A statistical comparison
of repeatability in three commonly used bioelectronic devices: Kirlian
photography, the segmental electrogram, and the AMI of Motoyama. Acup
in Med 16(l):40-42,1998.
Kirlian photography, taken with high voltage
and high frequency mainly of hands, requires careful standardized con
ditions. Segmental electrograms measure skin impedance in 8 body segments,
before and after stimulation with a very small current (not physiologic).
The AMI was designed by Motoyama 20 years ago to diagnose organ deficiency
or excess, with application of a 10 millisecond 3 volts at the Ting
points of the meridians. All three are said to provide information regarding
bodily dysfunction. Here, 30 patients were tested with each apparatus
on 2 consecutive days under careful identical conditions for repeatability.
Only the AMI appeared consistent, indicating it could be a useful clinical
tool; the other two had too much variation.
Comment: There are many exotic, and
often expensive, test devices available. Studies of reliability, repeatability,
and clinical work with a large enough number of patients are often not
extant and are necessary before test acceptance and output of funds
by practitioners are indicated.
8.
Rosted, P. The use of acupuncture in dentistry: a systematic review.
Acup in ed.6(l):43-48,1998.
Only 15 papers of 74 published from 1966-1996
fulfilled the author's predefined criteria, and 48 papers were reviewed,
in 5 languages. Of the 15, 11 were favorable to acupuncture, and the
more criteria met, the higher the favorability. Four good papers on
temperomandibular joint dysfunction and facial pain demonstrated a role
for acupuncture in alleviation. More good studies are required.
9. Bareta, J C. Evidence
presented to consensus panel on acupuncture's efficacy. Alter Ther 4(l):22-30,1998.
Mr. Bareta summarizes the presentations
given at the NIH Consensus Panel on Acupuncture, November, 1997.
History and perspectives, current usage and licensing in the USA,
issues in research, safety, efficacy in various medical conditions,
and some physiological findings were discussed and are summarized
here for those not wishing to read the entire proceedings from
the NIH.
10. Resch, K-L. Acupuncture:
a systematic appraisal. Novartis foundation discussion meeting, London,
March 1998. FACT 3(2):76-77,1998.
The prior CIBA Foundation has changed
its name, and put on this discussion. Ted Kaptchuk reprised his
historical data. Jacqueline Filshie (UK) noted 86% of pain clinics
in the UK now use acupuncture and further noted drugs might be
the fourth leading cause of death. Mechanisms were discussed by
Adrian White (Exeter) and Thomas Lundberg (Sweden), and Edzard
Ernst (Exeter) advocated more research, and the group evidently
echoed this need. Hagen Rampes (UK) discussed side effects and
the relative safety of acupuncture.
11.
Marcus, SM. Assessing non-consent bias with parallel randomized
and non-randomized clinical trials. J Clin Epidemiol 50(7):823-828,1997.
FACT3(l):5-6, 1998.
Review and comments by Ted Kaptchuk.
Problems with randomized controlled trials include patients eligible
for trial withholding consent, skewing populations , and a parallel
set of studies, one randomized, and one based on parental preference
from those refusing RCT are presented showing differences. RCTs
often do not "show adherence effects" might distort effects of
active agents, and might change expectations.
Comment: Even random, controlled
tri als, the high alterplace of western medicine, can have problems,
even further confounding approaches to acupuncture research.
12.
Al-Sadi, M, Newman, B, Julious, SA. Acupuncture in the prevention of
postoperative nausea and vomiting. Anesthesia 52:658-661,1997. Review
and comments by White, AR, in FACT 3(l):7,1998.
An RCT, with patient and reviewer blinded,
covered 81 gynecological surgery patients given acupuncture to PC (MH)
6 under anesthesia but before morphine or surgery. Nausea and vomiting
dropped postoperatively from 54% with placebo plasters to 30% with therapy.
After discharge, the incidence was 44% vs 20%; both significant statistically.
Three control patients had to be readmitted, adding to cost. Dr. White
notes that the possibility of investigator bias was not totally excluded
as every 4.2 patients treated presented one case of gastric upset. Given
before the emetic stimulus, acupuncture appears to work even under anesthesia.
Comment: The NIH Consensus Panel in
1997 concluded that the areas of nausea and vomiting is one item where
there is no doubt as to the good effect of acupuncture, using the simple
PC (MH) 6 point.
13.
Frank, BL. Medical acupuncture enhances standard wilderness medical
care: a case from the inca trail, machu picchu, peru. Wilderness & Environ.
Med 8:161-163,1997.
A patient with an inflammed eye did not respond
to available potent eye drops, but was resolved immediately, and a vacation
saved, using GV 24.5 and GB 1 needling with a left hand point. Other
potential uses for acupuncture in the wilderness are discussed.
Comment: How to be a hero on a trek
carry acupuncture needles; little weight, sterile, and with many uses!
14.
Lu, DP, Lu, GP. Clinical comparison of anti-emetic effect between acupuncture
and acupressure for treatment of post-sedation nausea among dental patients.
Acup & ElectroTher Res. 23(l):66-67,1998.
Sedated dental patients were randomized to
Droperidol, acupuncture (PC (MH) 6, acupressure, and no treatment groups.
Pressure was applied to tingling, numbness, or electric shock occurrence.
Medication was most effective at 92%, but with side effects not uncommon.
Acupuncture relieved 73% greatly and 20% partially, and acupressure
relieved a bit less at 56% and 20%. Without treatment, 85% had notable
nausea and or vomiting. It is recommended Droperidol be used if acupuncture
or pre s sure fail.
15.Lukoff,
D, Edwards, D, Miller, M. The case study as a scientific method for
researching alternative therapies. Alter Ther 4(2):4052m 1998.
The authors are psychologists; they note that
patients rarely use a single treatment method, complicating the evaluation
of outcomes. Case study techniques can transform "anecdotal" into disciplined
inquiry, and can be especially useful in "alternative" therapy
with complex factors often involved. We have gone from overreliance
on theory in the medical Middle Ages to over-reliance on quantitative
group statistical designs today in the West. This misses educationally
important unusual cases. Quantitative research measures specific variables
and often misses in-depth information. Case studies research must have
a formal design, pose clear questions, develop hypotheses based on prior
research, and have data which can be inspected by third parties. Otherwise,
interpretations can be falsified and inferences attacked as unreliable.
Case studies can supply counter-examples defining limits or disproving
theories. Different types of case studies are defined in this article.
In case studies, observations and inferences must be based on more than
the examiner's impressions. Independent judges can read and check raw
data. Case studies do not distort behavior through experimentation;
they can offer better external validation than controlled experiments
in some situations. An observation from one case is a hypothesis; it
can be tested by reviewing a series of cases to achieve validity. If
a general principle is established, cases can be sought which define
or limit it. There is an implicit subjective nature to all research,
and case study must be rigorous to avoid biases (a consequence of pre-existing
bias or too little information).
Comment: This is an article important
to acupuncture, since so much of the "research" literature is based
on clinical case studies. These can be valid, if practitioners put prior
thought and good data collection based on set criteria into their work.
A great deal of material supporting and defining the uses of acupuncture
can come out of private practices - it requires inter I est, efficiency,
a bit of compulsive data collection and collation, with full consideration
of one's possible biases.
16.
Tekeoglu, 1, Adak, B, Ercan, M. Investigation into the possibilities
of using ear acupressure for increasing the pain threshold during athletic
training. Am J Acup 26(l):49-52, 1998.
In some countries, sports medicine is testing
varieties of acupuncture for analgesia and increasing performance. Toe
pressure sensitivity was tested before and after compression of ear
"toe" point in 30 athletes and compared in a placebo group of 30 where
light touch only was used. The "toe" point group raised the pain threshold
from 3.5 gm/mm squared to nearly 5, statistically significant, with
no elevation in the placebo group. It is suggested ear acupressure might
replace use of simple analgesics for temporary aches and pains of training.
Comment: For some reason, while the
placebo group was even up male and female, the acupressure group was
11 male to 19 female, bringing question to the randomizing process.
Pressure or electrical stimulation, however, seems reasonable prior
to medication for anyone's aches and pains, assuming athletes are not
driven past self-injury boundaries.
17.
Qi, B, Wang, S, Guan, Q, Hu, M. Fundamentals of acupuncture and moxibustion.
Lecture nine. Extra points. World J Acup Moxi 8(l):5459,1998.
This is a nice little summary of "extra" points
divided into areas of head and neck, points of the trunk, and points
of the four extremities. The authors provide Chinese names and international
number designations for each point, the location, and indications. There
are a goodly number this reviewer has never used, with common and uncommon
designations (Amnian, between GB 20 and TE (TH) 17, for insornma, disturbing
dreams, psychosis, palpitation, dizziness; Jiehexue-EX-B, 3.5 cun lateral
to GV 14, for tuberculosis).
18.
Li, H, Yu, Y, Dai, T. Clinical study on acupuncture treatment of side
reactions of radiotherapy and chemotherapy for malignant tumor. World
JAcup Moxi 8(2):8-12,1998.
Forty two patients with stage 11 and III cancers
were randomly divided to acupuncture and no acupuncture groups. Acupoints
ST 36, SP 6, LI 4, and LI 11 were selected for 3 courses of 6 daily
treatments. Each group had radiotherapy and/or chemotherapy, but none
within the prior 3 months, and none had hormones, immunotherapy, or
hemograrn affecting drugs during the study period. Acupuncture patients
had slight elevations in WBC and platelets vs depression in the nonacupuncture
group, with P>0.05 for the acupuncture platelet rise, but all factors
at P <0.05 otherwise. There was much less nausea, anorexia, G-I complaints,
dizziness, and insomnia in the acupuncture group. NK and IL-2 cells
increased "strikingly" (P<0.01) in the acupuncture group and decreased
in the non-treated group.
Comment: There are many articles from
China regarding treating cancer patients undergoing therapy with concommitant
acupuncture. Here, big points were used which could be done quickly,
without undressing, in any clinic setting. Chemotherapy nurses or technicians
could be taught this with safety, and a study of efficacy to confirm
these findings would be in order, as the potential benefit to these
poor individuals certainly outweighs any disadvantage I can foresee.
19.
Yinfang, T. Introducing the holographis-Jinluo system. World J Acup-Moxi.
8(2):29-31,1998.
The Jinluo system was formalized 2,000 years
ago in the NeiJin. All the holographic points are located on the Yang
side of hands and feet; properly stimulated, "de Qi" radiates along
the corresponding channel. KI, BL is noted graphically at the outer
fifth row, SJ (TH) proximal and above the toe and between and proximal
to the 4th and 5th fingers, LI along the proximal 2cd finger medially
and dorsally, and extraordinary channels at the mid-foot to posterior-lateral
ankle. The ankle points are stated to allow expulsion of pathogenic
Qi from these channels which have no specific points all their own.
No needling is needed, just pressure to the points.
Comment: This is a novel approach, like
Yamamoto's YNSA method, which also uses a very finite microsystern for
immediate effect. It will require exploration, and if the body will
respond to point pressures, could be a nice do-it-yourselfer.
PART
III - NERVOUS SYSTEM
1.
Duan, G, He, J, Zeng, Z, Tang, Q, Sun, S. Comparison of effects of acupuncture
on cerebral infarction in different parts. World J Acup-Moxi. 8(2):3-7,
1998.
Stable cerebral infarction patients were separated
into cerebral surface infarction and deep infarction on the basis of
symptoms and CT scans and randomized to acupuncture and control groups
(treated with usual care and drugs). There were 31 surface and 61 deep
infarctions, and patients were evaluated by a national Chinese Medical
Association clinical effects scale. The clinical injury score for all
92 patients dropped 12 points with acupuncture vs 6 points for controls
(22-23 baseline) with 11/16 markedly improved with acupunc ture in the
surface infarct group and 10/31 with deep infarction, vs 0 of 15 and
0 of 30 controls, respectively. Scalp acupuncture demonstrated definite
effectiveness, but less when the infarction is deep near the ventricles
and internal capsule. Acupuncture enhances cerebral blood flow and tissue
metabolism, but less abundant collateral circulation is available for
the region of deep infarcts. CT scans showed the superficial infarct
area reduced after I month of daily acupuncture, but the deep infarct
reduction was limited.
Comment: This is a well done study,
with patient acupuncture and control groups similar in extent of damage
and age, lacking data on the length of followup, with patients studied
clinically and by CT scan before and after a month of daily scalp acupuncture.
The authors reiterate findings from multiple papers from several countries
the past few years showing addition of acupuncture to therapy to be
very worthwhile for stroke patients, and the earlier applied, the better.
Agatha Colbert, MD, presented data at the 1997 AAMA Symposium showing
acupuncture influence diminishing as the area of infarct extends near
the ventricular wall region, which this larger study confirms. To obtain
maximum effect for acupuncture, it should be done daily, with short
rests, the first month. To be cost effective, the physical therapists
(as in Canada) or attending physiatrists need be involved. An acupuncturist
would have to be allied with treatment centers and able to treat 5 or
6 days weekly to be most effective.
2.
Hu, Y, Hu, D. Observation on therapeutic effects of acupuncture in 64
cases of auditory hallucination. World JAcup-Moxi. 8(2):13-16,1998.
Auditory hallucination is common in psychosis,
"and a main cause for harming others". Schizophrenic patients, 57 inpatient
and 7 out, with a disease course from 6 days to 27 years were needled
to 1-2 cun at bilateral Sl 19 for one hour daily for 20 days. The auditory
hallucinations disappeared in 50 after an average 5.2 treatments. The
course of disease did not seem related to therapeutic effect. The point
has tranquilizing and emotional stabilizing effects as well as influencing
the auditory system. Five of 14 non-responders stopped hallucinations
when more than 20 sessions were used.
Comment: This is rather remarkable if
confirmed elsewhere. Unfortunately, despite the simplicity of therapy
and lack of side effects, it will probably not be believed adequately
in western medicine circles to pass a local research committee and be
given a try. Again, the length and adequacy of follow-up is not noted;
a common problem in papers from China.
3.
Gao, S, Gao, Q. Can the addition of moxibustion during acupuncture therapy
improve recovery from bell's palsy?Amer JAcup 26(l):33-36,1998.
The ability of acupuncture to improve unilateral
facial palsy "is well accepted". Here, 60 cases were divided to acupuncture
with and without moxibustion. Facial and forehead points plus Ll 4 and
GB 20 were divided into 2 groups and alternated every other day on the
ipsilateral side (LI 4 and GB 20 bilateral). Treatment was daily 10
times, with two or three courses if needed. With moxa, 87% were cured
(more rapidly and with fewer treatments than with acupuncture alone)
vs 70% without, and all patients were better.
Comment: Again, we suffer from lack
of knowledge; how long had the palsy been present before therapy (the
majority in the early phase will self-heal) and how long was the follow-up?
Were the groups truly randomized?
4.
Wang, C, Du, S, Li, H, et al. 120 cases of psuedobulbar paralysis treated
by needling Lianquan and Chize. J. Tradit Chin Med 18(2):96-98,1998
Psudobulbar paralysis, with dyslalia and dysphagia
following stroke, was treated by needling LU 5 and CV (REN)23 in 120
patients and compared to 30 controls treated with medications. 76% of
the acupuncture group were able to eat and drink normally after up to
20 treatments, with 57% cured within 5 days! 40% of the control patients
had symptoms resolve.
Comment: Articles from the Orient claim
good results even in this devastating result of stroke, and the audiovisual
instruction tapes in my "Jhenziuology" set show some remarkable changes
after needling, though a variety of scalp and distal body points are
used, with GB 20 prominent.
5.
Yuan, X, Hao, X, Lai, Z, Zhao, H, Liu, W. Effects of acupuncture at
fengchi point (GB 20) on cerebral blood flow. J Tradit Chin Med 18(2):102-105,1998.
Transcranial Doppler was used to measure blood
flow in the vertebral and basilar arteries before and after needling
GB 20 in 97 patients. Needles were in 20 minutes, with strong stimulus
for patients with high blood flow initially and mild for low flow. Of
80 blood vessels with high flow, 62 decreased by over 5 cm/see and 14
by over 20; 5 had reversed response. Among 100 with low flow, 60 increased
flow over 5 cm/sec, with 4 over 20. Decreasing high flow was more effective,
but over 42% of those with low flow increased. The immediate therapeutic
effect on severe stenoses was rated poor. No significant flow changes
were seen in 15 normal controls.
6. Hesketh,T,
Zhu,WX. Health in china: traditional chinese medicine; one country,
two systems. BMJ 315 (7100):115-117,1997.
45 patients, average 40 days post stroke, were
randomized to controls (n=21) and acupuncture (n=24). Acupuncture was
3 to 4 times weekly for 6 weeks. Improvement was significantly greater
in the acupuncture group. Comment: More positive data in a Western journal.
7.
Kjendahl, A, Sallstrom, S, Osten, PE, Stanghelle, JK. A one year
followup study on the effects of acupuncture in the treatment
of stroke patients in the subacute stage: a randomized, controlled
study. Clin Rehab 11:192-200, 1997.
41 of 45 randomized patients (21 controls
and 20 acupuncture) were followed one year. The average entry
was 40 days post stroke. Both groups received rehabilitation therapy,
and one received 6 weeks of acupuncture given 3 to 4 times weekly.
Using a Motor Assessment Scale, Sunneas Index of Daily Living,
and Nottingham Health Profile, the improvement of the acupuncture
group was deemed significantly better.
8.
Meng, Q, Zhao,C, Liu, R. Clinical observation on 219 cases of arm numbness
treated by acupuncture at the experiential point biling. J Tradit Chin
Med 18(l):18-19, 1998.
The cause of arm numbness was CVA in 116, cervical
spondylopathy in 33, and peripheral neuritis in 70 persons. Biling is
located 1- 1.5 cun above the midpoint of the clavicle at the posterior
sternocleidomastoid muscle. Needle to 1-1.5 cun to achieve sensation
to the ipsilateral fingers. Cure is claimed in 78% for CVA(6 month followup),
54% for cervical spondylopathy, and 86% for peripheral neuropathy, and
occurred between I and 18 treatment sessions.
Comment: It appears this point centers
on arm numbness alone, and other therapy, acupuncture, physical therapy,
etc. was used for other symptomatology present with the 3 basic etiologic
causes.
9.
Chen, L. Clinical observations on 40 cases of Paralysis agitans treated
by acupuncture. J Tradit Chin Med 18(l): 23-26,1998.
Parkinson's disease or syndrome with tremor,
tetanic muscle tone, and decreased movement, is common, and "considered
liver and kidney deficiency with excess wind, phlegm stasis, and fire."
Points used were GB 12,20, BL 10, and DU (GV) 15. Ancillary points LI
4, 11, ST 40, P (MH) 6, HT 2, KI 3, SP 6 were added according to TCM
diagnosis. A grading system was established for symptoms, and acupuncture
was markedly effective (over 75% decrease in symptoms) in 25% and effective
in 40%. Patients were treated with 3 courses of 10 daily sessions. The
author notes others also use scalp acupuncture with tremor and chorea
areas plus motor area, but he prefers the "7 Acupoints of the Cranial
Base".
Comment: This is another treatment to
help those for whom too little help is available. It is difficult to
test in the west, because of the extensive number of treatments required.
The number of patients needed to be randomized and the length of follow-up
required for a good study would be believable by "western standards".
10.
Zhou, G, Jin, S-B Zhang, L-D. Acupuncture may allow reduced doses of
antipsychotics in treating schizophrenia. Amer J Acup 25: 25-31, 1997,
reported and commented on in FACT 3(l):9-10,1998 by White, AR, Univ
of Exeter.
A randomized, blind, controlled study on schizophrenia
according to Chinese Medical Association and DSM 111 criteria. 25 patients
received acupuncture and a 60% medication reduction, compared with 15
controls. Improvement in the two groups were statistically equal. Serum
beta-endorphins rose in the acupuncture group. AR White concludes that
defects in the study limit its impact.
Comment: Dr. White notes basic hypotheses
studied were not clearly defined prior to study, which appears a valid
criticism. His main point is that regression to the mean in a fluctuating
disorder could have been responsible for the results seen. This is a
common comment from academics and purists (who do have a definite role
in keeping us critical regarding research), but one 1 believe which
can be used to over criticize a great deal of all that is done in medicine.
11.
Tong, L, Li, Z-g, Ren, Y-x, Ynag, J, Meng, X-y, Ma, W-m, Ma, Z-q. Body
quick-needling plus scalp acupuncture in treating apoplexy and its sequelae.
Inter J ClinAcup 9(2):133140,1998.
Over 4 years, 130 hemiplegic stroke patients
were divided to a 100 acupuncture and a 30 control group. TCM diagnosis
was flaring LR Yang (36), Phlegm-Damp (37), and Qi-deficiency and Blood
Stasis (57). Scalp acupuncture needles were twirled twice in 30 minutes
at 200 RPM with the limbs exercised followed by body points LR 3, KI
1, ST 40, SP 10, BL 17 dependent on TCM diagnosis. Two to 4 courses
of 10 daily treatments were given. Treatment in the acute stage (to
2 weeks post stroke) cured 4 of 5, in the convalescent stage (2 weeks
to 6 months, 32 of 50, and sequelae stage 25 of 45. The "control" group,
treated by alternating scalp and body points, had less response.
Comment: I appear to beat this plea
to death, but all papers reporting stroke therapy by acupuncture give
the same picture - it helps and should be used. We in the USA should
at least be studying it, using knowledgeable practitioners with some
experience in achieving good results, with a wellplanned study which
would not be nit-picked and demeaned by those reticent to change from
our now inadequate approaches.
12.
Ji, X-p. Meniere's syndrome (a teaching round). Inter J Clin Acup. 9(2):
157-160,1998.
A discussion is given of the TCM approach to
treating and diagnosing Meniere's. The vertigo and aural scalp area
(a line 1.5 cm above the ear extending 2 cm anterior and 2 posterior),
S119, SJ 17, MH 6, ST 36, SP 6 and 9 were recommended after discussion,
used for the patient with cure.
Comment: Local and distal points based
on a TCM discussion not recommended for beginning physicians in acupuncture
until a broader Westernized basis is achieved; the TCM approach, based
on centuries of practice, works (though, I believe it slower than systems
taught by Dr. Helms), but boggles the Western mind. ST 40 would have
appeared better than ST 36, based on their diagnosis of stagnant phlegm.
13.
von Schweinitz, DG. Thermographic evidence for the effectiveness of
acupuncture in equine euromuscular disease. Acup in Med. 16(l):14-17,
1998.
Chronic pain and poor performance in horses
can be reflected in hypo or hyperthermic regions demonstrating change
in sympathetic tone when neuromuscular disease is a cause. It is often
associated with spinal disease not diagnosed to a specific etiology.
Horses can have neck or back pain, touch hypersensitivity and muscle
malfunction or wasting. Many veterinarians use acupuncture of tender
points in associated meridians. Skin temperature changes have been documented
by the author as high as 5 degrees Centigrade, within 3-4 hours of acupuncture
and persi sting to 5 days. These can extend to many weeks after 3 to
4 treatments. Thermography in man has correlated well with other studies
in back pain (references given). Scans for a representative case are
demonstrated, before and after acupuncture, emphasizing that treatment
restores blood flow homeostasis as neurologically induced pain diminishes.
The effectiveness of therapy in horses can be tested with thermography.
Comment: Placebo effect unlikely, and
regression to the mean probably is not a cause for healing in these
horses.
14.
Z-r, Sun, S-t. Scalp acupuncture in treatment of paraplegia due to stroke:
an investigation into the mechanism. Inter J Clin Acup. 9(l):1-6,1998.
64 control and 16 stroke patients were given
acupuncture to the motor cortex area of the scalp and motor evoked potentials
measured in the hand (extensor pollicis brevis). There is a latent period,
with MEP response to acupuncture of scalp in the opposite side muscle.
Acupuncture of scalp motor cortex area in normal and stroke patients
causes an action potential which descends to the innervated hand muscles.
In stroke patients with herniplegia and damage to the pyramidal tract,
the MEP occurs on the ipsilateral hand, indicating the healthy brain
side can induce response in the same side (the paralyzed hand side).
If acupuncture to the stroke scalp side does not work, the healthy side
should be used. If the pyramidal tract is largely intact, the MEP is
more latent and less strong after stimulus of the opposite damaged cortex
area, but does occur on the contralateral side.
Comment: More basic science evidence
of an objective sort indicating scalp acupuncture has measurable effects
with variations when used for stroke patients.
15.
Ziang, Z-y, Li, Y-k, Hu, K-m, Li, C-d, Wang, S-m, and Wu, J. Influence
of electric scalp acupuncture on blood apolipoprotein in patients of
stroke: A prospective, randomized trials on 183 patients. Inter J Clin
Acup 9(l):7-12,1998.
For 93 patients with herniplegic stroke 3 acupoints
on the ipsilateral anterior and posterior oblique vertex-temporal lines
were stimulated and results compared with 90 such patients treated with
body acupuncture to ipsilateral Yangming channels, with foot-Taiyang
and Shaoyang point supplements. Apolipoprotein Al (HDL cholesterol)
increased significantly in both groups and Apolipoprotein B100 (LDL)
decreased, but more significantly with scalp electroacupuncture. An
interesting variation is shown in graph form for varied TCM diagnoses
in stroke.
16.
Zhao,Y. Scalp acupuncture of heart-brain syndrome: an observation of
53 cases. Inter J Clin Acup 9(l):6972,1998.
Stroke can be followed by myocardial damage
and arrythmia, with a typical cerebrogenic ECG change. It accompanies
large are cerebral infarct or more focal thalamic damage. Patients had
acupuncture to scalp vasomotor and motor areas with rapid needle rotation
at 200 per minute. Here, ECG improvement was shown after 2 to 5-6 day
courses. Brady or tachycardia, ST segment elevation or depression, and
T wave abnonrialities decreased in a majority.
Comment: One would need a randomized
control here to test whether nature restores the electrical activity
of the heart toward normal over a 12 to 30 day period post-stroke. Without
this, one can't state that acupuncture has an influence.
17.
Chen, Y-h, Sui, Q-z. Contralateral puncture for facial paralysis: clinical
observation of 296 cases. Inter J Clin Acup 9(l):73-74,1998.
In this series, only 45 cases were of over
3 month duration and 189 within one month (well within natural recovery
period). Local and distal Yangming points on the opposite side were
needled. Point through point needling of the face was given. There was
a 70% cure and 16% more had excellent results.
Comment: Results were within that expected
from Mother Nature, or perhaps even lower. Without randomized control,
facial paralysis response is difficult to gauge in the first 3 months;
after 3 months, spontaneous cure is much less likely and one could logically
claim effectiveness.
AUTHOR
INFORMATION
Dr. Erickson is in private practice in acupuncture in Berkeley,
CA. He retired from Kaiser-Permanente Hospital in Richmond, CA,
where he was Senior Consultant and former Chief of Pediatrics.
He is Secretary of the Board of the Medical Acupuncture Research
Foundation.
Russell
J. Erickson, M.D.
2520 Milvia St.
Berkeley, CA 94702
Phone: 925-229-0889 - Fax: 925-228-4976 -
Email: Russpat@netvista.net
Back
to Top AAMA
Table
of Contents Journal
Index
|
|
|
|