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literature
ABSTRACTS OF
CURRENT LITERATURE
Compiled by Russell J. Erickson, MD
1999 ACUPUNCTURE LITERATURE REVIEW
PART I - NEUROLOGY
1. Shi XM, Wang
S, Liu QZ, et al. Brain atrophy and ageing: research on the effect of
acupuncture on neuronal apoptosis in cortical tissue. Am J Acupuncture.
1998;26:51-254.
Senescence accelerated mice (SAM), whose neurons undergo early atrophy
with age-related learning and memory deterioration, were compared with
normal 3 mice. A previous study showed that acupuncture could increase
endurance and improve reaction time in SAM mice. A normal control group,
SAM control group, SAM group treated with PC(MH) 6, DU(GV) 26, and LR
3 points daily for 2 weeks, and a SAM nonacupuncture point group were
studied. Pretreatment SAM mice had significantly greater apoptotic (programmed
cell death) neurons than did regular mice (2.42 vs 0.85 n/mm2)
SAM mice treated with nonacupuncture point needling remained at 0.38
n/mm2; those treated with acupuncture
of the 3 points had 0.45 n/mm2 in the
cortex. This apoptotic process in humans is seen with Alzheimer's, Parkinson's,
and Huntington's diseases. The authors feel acupuncture works through
increasing activity of superoxide dismutase, decreased lipid oxidation,
and increased nitrous oxide levels in the brain. A previous study demonstrated
this acupuncture effect.
Comment: The authors present a concise, complex study that provides
backing for several articles from China claiming acupuncture at some
given points can help prevent senile deterioration as well as stroke-caused
dementia.
2. Luo H, Meng
F, Jia Y, ZhaoX. Clinical research on the therapeutic effect of the
electro-acupuncture treatment in patients with depression. Psychiatry
Clin Neurosci. 1998;52(suppl):S338-S340.
Two hundred forty-one patients with a diagnosis of depression were randomly
divided to receive electroacupuncture
and placebo or amitriptyline therapy. The acupuncture group did as well
as those given medication, with less anxiety and cognition disturbance.
Adverse effects were much less in the acupuncture group. Electroacupuncture
might work through norepinephrine metabolism changes.
3. Li Y, Zhuang
L, Zheng L, Yang W. Study on treatment of vascular dementia with acupuncture
and moxibustion principally. World J Acupuncture Moxibustion.
1999;9(2):6-11.
Patients were diagnosed using
DSM-III criteria, corrected for cultural background. Thirty-two
patients (mean age, 70 years) with symptoms for 3 months to 5 years
were divided to 16 treated with acupuncture and 16 with Chinese medicine.
GV 26, Sishencong, GV 24, GB 13 and 39, ST 36, and KI 3 alternated with
GV 20,14,4, and BL 18,23. Fu Yuan Tang herb was given once daily. The
control group received only the herbal concoction. Patients were treated
for 2 months. The acupuncture group went from 13.5 to 19.7 on the dementia
scale (<15 defines dementia state), and the herbal group rose from
14.3 to 17.9. Superoxide dismutase rose from 14.7 to 32 with acupuncture
(normal, 39.6 average), and rose from 16.5 to 26.7 with Chinese medicine.
Glutathione peroxidase (normal, 71.6) rose from 30.8 to 60.2 with acupuncture
and 34.4 to 50.1 with the herbs.
Comment: The study population is small and randomization and
term of followup not. given, but both psychological and biochemical
testing of compounds thought to be connected to senile deterioration
appear statistically valid (P<.05). A second article by this group
in this issue notes that thromboxane, a strong vasoconstrictor, dropped
from 461 to 355 (normal, 136) in these acupuncturetreated patients,
giving another plausible reason for
its result.
4. Wang Z, Xia D.
Clinical studies on the treatment of paraplegic patients' pain with
acupuncture. World J Acupuncture Moxibustion. 1999;9(2):17-20.
One hundred eighteen paraplegic
and quadriplegic patients were divided so pain levels were comparable
to treatment with World Health Organization - delineated analgesic medications,
electroacupuncture at DuMai (GV), body and scalp acupuncture, or both.
Scalp acupuncture was performed at sensory areas directed at the pain.
Body points included LR, KI, BL, GV, and CV. The combination of drugs
and acupuncture was best (62% marked effect), drugs alone least (20%
marked effect), and acupuncture alone better than analgesics at 44%.
5. Zhao X. Observation
on 291 cases of insomnia treated with electro-acupuncture. World
J Acupuncture Moxibustion. 1999;9(2):43-44.
Organic disorders were ruled
out in this group of patients aged 16 to 60 years. Points used included
Taiyang, PC 6, GV 20, ST 8, and Yintang. Ancillary points could be added
if other problems were present. Two hundred sixteen patients were cured
in an average of 15 treatments. The reasoning behind the point choice
is given.
6. Zhou F. Clinical
observation on acupuncture treatment of 100 cases of dysphagia caused
by cerebrovascular disease. World J Acupuncture Moxibustion.
1999;9(2):55-56.
In this study, pseudobulbar paralysis was present for 4 days to
4 years (average: 2 years, 3 months). Points TE (TH) 17 and GV 16 were
used. Of 100 patients, 87 had marked improvement with only occasional
choking in 2 to 4 treatments.
Comment: The author's claim of effectiveness is astounding; even
well beyond that at Tianjin, where a great many similar patients are
treated. The series needs to be repeated elsewhere.
7. Wu MT, Hsieh
JC, Xiong J, et al. Central nervous pathway for acupuncture stimulation:
localization of processing with functional MR imaging of the brain:
preliminary experience. Radiology. 1999;212:133-141.
Nine subjects had either acupuncture at ST 36 or LI 4 or superficial
control stimulations. Acupuncture at both points gave a deQi sensation
and bradycardia. The hypothalamus and nucleus accumbens were activated.
The rostral parts of the anterior cingulate cortex, amygdala, and hippocampus
were deactivated. Control stimulations did neither.
Comment: This is a third article to add to those of Alavi and
LaRiccia (SPECT scan) from 3 years ago and Hui's magnetic resonance
imaging (MRI) work of last year. All provide objective evidence of rapid
changes in brain metabolism following acupuncture.
8. Chen Y, Yang
M. Literature research on screening of the nucleus acupoints for treatment
of intellectual disturbances. J Tradit Chin Med. 1999; 19:83-88.
The authors review their findings derived from reading the Ming and
Qing Dynasty literature on acupuncture. They collected 29 "intelligence"
points directed toward treating intelligence loss, amnesia, low spiritual
Qi, insufficient heart Qi, and dementia. Some points are interesting
for unusual use today. HT 3 is indicated for insufficient HT Qi and
is common sense, but GB 30 for dementia might not be standard use, nor
BL 33. A table lists all the intelligence points recorded in 10 acupuncture
books. The frequency is given with which each point is mentioned in
the old texts for any diagnosis. Multipoint prescriptions for each diagnosis
are also supplied here. Basic, often-used points include GV(DU) 20,
11, HT 7, 5, 3, BL15, 43, LU 7, 3, ST 3 6, MH(PC) 6, 4, KI 1, 2 1, and
Sl 3.
9. Elgert G, Olmstead
L. The treatment of chronic inflammatory demyelinating polyradiculopathy
with acupuncture: a case study. Am J Acupuncture. 1999; 27:15-22.
Chronic relapsing Guillain-Barre syndrome, another term for demyleinating
polyradiculopathy, affects both motor and sensory nerves, with proximal
and distal weakness lasting 2 months or longer. The full diagnostic
spectrum is given. Steroid treatment, plasma exchange, and (lately)
intravenous y-globulin are all effective, but expensive or have multiple
adverse effects. The relapse rate is nearly 50%. A relapsing patient
was treated with acupuncture at SP 3, 6, ST 36, KI 3, Ren (CV) 6,12,
LI 4, 11, and GV 20, inserting from feet to head. Treatment was weekly,
then gradually once monthly for maintenance. She has done well for 2
years. The treatment rationale is discussed.
Comment: This is an article based on only 1 case, but 1 believe
it poses a rational use for acupuncture therapy and should be tried
further.
10. Walton-Hadlock
J. Primary Parkinson's disease: the use of Tuina and acupuncture in
accord with an evolving hypothesis of its cause from the perspective
of Chinese traditional medicine. Part 2. Am J Acupuncture. 1999;
27: 31-50.
I reviewed the first part of this series last year. In part 1, the
author found that patients with Parkinson's disease had prior foot and
ankle trauma, especially on the side most involved. By using forceless
Tuina to release the obstructed energy there, patients became responsive
to acupuncture therapy and improved. Qi in the ST channel is blocked
at ST 42, with obstruction and "rebellious" Qi backing up to affect
Yang Ming channels, arcing to GB region. Clinically, rigidity and tremors
result. When the trapped energy area is given a quick, gentle compression
and release, it might jerk or tremble up to a minute. Acupuncture should
be given only after this Tuina move. Then use up to 10 needles along
ST 42 to SP 3 to free channels bilaterally. A plan is then detailed
for extending needling to ST 36, then to LI points, to Yang Ming face
points, then crossing from leg Yang Ming on the first affected side
to arm LI points to restore balance. GB channel is then stimulated if
involved. The 3-stage forceless spontaneous response move is detailed,
lack of force is emphasized, and seeking pulsing Qi is discussed. This
is intricate and takes up 7 pages. A detailed case study, given step
by step, completes the presentation.
Comment: This pair of articles is actually very exciting. If
you deal at all with Parkinson's disease, request a copy (American Journal
of Acupuncture, PO Box 6 10, Capitola, CA 95010). A massage therapist
with good hands and empathy should be able to learn the Tuina moves
for your assistance if you are not hands-adept. The potential here is
great and fills a vast health care need. This study needs to be extended
in a randomized controlled trial that will be accepted
by the medical community.
11. Yang WO, Huang
YL, Da CD, Cheng JS. Electroacupuncture reduces rat's neuronal ischemic
injury and enhances the expression of basic fibroblast growth factor.
Acupunct Electrother Res. 1999; 24(l):1-10.
Basic fibroblast growth factor (BFGF) promotes neuron survival in
vitro and in vivo during ischemic insult. It is a potent mitogenic and
angiogenic polypeptide. Rats were allotted to sham operation, ischernia
of the middle cerebral artery, or ischernia plus 2 electroacupuncture
(EA) from GV(DU) 20 to 26. EA was given to I group during ischernia
and the other with reperfusion. The infarct volume was 40% of the hemisphere
with ischernia, reducing to 20% with EA during ischemia and a bit less
with EA during reperfusion. EA during reperfusion decreased the edema
response. BFGF was elevated in EAtreated rats, and is likely a factor
in EA protection in stroke. Surviving neurons in the frontoparietal
cortex were notable, with a level of 78 in sham (essentially normal
brain), 48 with ischernia, and 62 and 58 in the EA-protected rats. The
striaturn neuron levels were 105,27,47, and 45: nearly a doubling of
saved cells. BFGF mRNA has been shown in prior studies to be markedly
induced locally after ischernia with a further increase by EA treatment.
Comment: This is an important article I am adding to many on
stroke. It reinforces my belief that stroke patients should be treated
with acupuncture in the emergency department and therapy continued regularly
after that. Those with hemorrhagic stroke are in question, and most
Chinese authorities advise waiting 2 weeks, as acupuncture enhances
blood flow and diminishes advancing clotting. Its antiedema aspect,
if no increased bleeding occurred, would be good in any case.
12.Shi X, Zhang
C, Zhang H, et al. Clinical and experimental research on apoplectic
sequelae treated with "Xingnao Kaiqiao" (XNKQ) acupuncture method. World
J Acupuncture Moxibustion. 1999;9(l):3-7.
Thirty patients with hemiplegia
due to stroke for more than 3 months were treated with XNKQ acupuncture
(using PC(MH) 6, GV 26, SO 6, HT 1, LU 5, BL 40) and compared with 30
treated traditionally (Yang major points on LI, ST, GB, BL, and TH(TE)
meridians). Treatment was performed twice daily over a 2-month period.
In the XNKQ group, 27% were nearly cured and 20% experienced marked
effect, vs 7% and 13% of the traditional controls. Only
23% and 33%, respectively, had no effect. Plasma viscosity and high-density
lipoprotein cholesterol levels decreased in the XNKQ group only and
nail fold circulation increased.
Comment: The XNKQ approach
appears prominent in recent literature and the audiovisual I have regarding
the program is impressive. Someone outside China needs to evaluate it
and compare results. It requires at least nearly daily therapy for several
weeks, and would best be applied to group therapy for socioeconomic
reasons.
13.Shi X, Yang
Z, Zhang C. Clinical observation on acupuncture treatment of pseudobullbar
palsy: a report of 325 cases. J Tradit Chin Med. 1999;19:27-31.
(Also reported by Yang Z, et al, in Intern J Clin Acupuncture. 1999;10(3):299-302.)
Traditional Chinese Medicine etiologies are listed for this devastating
disorder. Eighty-nine percent of the authors' patients had 2 or more
strokes, 73% were male, and 74% were seen less than 60 days following
a stroke. All choked when eating, 128 had chronic cough, 153 received
nasal feeding, 185 were hoarse, 115 had lung infections, and all were
sluggish mentally. More than one third had motor aphasia. They were
treated with a variant of Xingnao Kaiqiao acupuncture, using GB 20,
SJ 17, or GB 12 aimed at the larynx, SP 6, PC(MH) 6, and GV(DU) 26.
The technique is described in the article. Treatment was daily for three
15-day courses. Sixty-nine percent were clinically cured, and 17% were
markedly better. The effect was improved if treatment was within 60
days of stroke.
Comment: The findings were very impressive, and our rehabilitation
units need to have a trial of this. If results were even half that of
the report, it would still be worthwhile.
14.Zhang S, Ye
X, Shan Q. Effects of acupuncture on the levels of endothelin, TXB,
and 6 -keto-PGF1 alpha in apoplexy patients. J Tradit Chin Med.
1999; 19:39-43.
Endothelin (ET) and prostacyclin (PGI2), metabolizing
to 6-keto-PGF1, are potent vasoconstrictors and thromboxane A2 (TXA2),
metabolizing to TXB2, is a vasodilator. Twenty
healthy subjects were compared with 20 poststroke and 20 stroke patients
treated with acupuncture with Yang meridian points. ET was 53 in healthy,
81 in poststroke, and 69 in acupuncture-treated stroke patients. TXB2
was 28,200, 52,000, and 24,700, respectively, while 6-keto-PGF1 was
37,300, 22,500, and 17,000. The vasodilatorconstrictor ratio was 0.76
in healthy subjects, 2.79 in patients after stroke, and 1.66 in patients
treated with acupuncture. Acupuncture with Yang points likely relieves
symptoms partially through vasodilation and increased blood flow.
15.Zang J. 80
cases of peripheral facial paralysis treated by acupuncture with vibrating
shallow insertion. J Tradit Chin Med. 1999; 19:44-47.
In Africa, 80 patients with facial paralysis, aged 10 months to
5 9 years, were treated with local and distal acupoints using quick
vibrating insertion as a stimulus. They were compared with 80 treated
with electroacupuncture. Three courses of 10 treatments were used. The
cure rate was roughly identical at 88%, with 6% to 8% improving markedly.
Comment: The point is that a quick, simpler, and gentler technique
works as well. Since the majority were seen less than 15 days after
occurrence, the end result is only a bit above nature's. Some, however,
had symptoms as long as 2 years.
16. Zhang X, Yuan
Y, Kuang P. Effects of electro-acupuncture on somatostatin and pancreatic
polypeptide in ischemic cerebrovascular diseases. J Tradit Chin Med.
1999;19:54-58.
Twenty-six patients without stroke
were evaluated as controls, and 33 stroke patients were treated with
dextran, nicotinic acid, aspirin, and dipyridamole in a comparative
study, with 31 treated with electroacupuncture and medications. Ll 12,
SJ 5, GB 30, and ST 36 were used. The outcomes of the 2 stroke groups
were nearly identical. Somatostatin levels increased with acupuncture
in plasma and spinal fluid in the patients who did well.
Comment: This article is novel since acupuncture did not enhance
cure over a questionable combination of medication. The choice of points
does not appear first rate, and therapy was given for only 2 weeks.
17Jiang Z-Y, Li
C-D, Li Y-K. Treatment of vascular dementia with acupuncture. Int
J Clin Acupuncture. 1999;10 (l):15-22.
Thirty patients, averaging 1
year following stroke, were treated with scalp acupuncture using 5 of
the WHO lines on the affected side, angling the needles to the galea.
Dense wave stimulation was given at 200 Hz. Treatment was 5 d/wk for
2 months. A comparative group of 30 persons after stroke (average, 13
months) with identical ages and symptoms was studied. Four rating scales
were used for objective data. Self-care ability, intellect, and memory
were elevated only in the acupuncture group (P<.00 1 except memory,
P<.05).
18. Jiang Z-Y,
Li C-D, Li Y-K. Sequelae of apoplexy (a mini-review). Int J Chin
Acupuncture. 1999;10(1):35-42.
A number of studies of stroke
therapy are reviewed. Studies show acupuncture treatment as markedly
effective in hemiplegia, dementia, speech, depression, pseudobulbar
palsy, pain in paralytic limbs, limb edema, and bowel and bladder disorders.
19. Zhang L-J.
Thirty one cases of vertigo treated by acupuncture based on the doctrine
of supplying water to nourish wood. Int J Chin Acupuncture. 1999;
10 (1):99-100.
Thirty-one patients, aged 45-65 years, with vertigo of I week to
2 years were treated with ST 36, LI 4, SP 6, LR 3, GV 20, and KI 1.
On average, a patient was treated for 29 days; 55% were cured and 32%
reported marked improvement.
Comment: A shotgun approach, using varied large metabolic points,
with no follow-up and excessive days of treatment. Mark Seem's approach
and others appear better with less time involved.
20. Li Y. Cervical
vertigo treated by acupuncture and acupoint injection: report of 75
cases. Shanghai J Acupuncture Moxibustion. 1998:16-18.
Seventy-five patients, aged 38 to 67 years, with vertigo symptoms
from 12 days to 5 years (average, 6 months) were treated using neck
Jiaji followed by injecting GB 20 with 0.3 mg of scopolamine and 100
mg of vitamin B6 half at each site. A control
group of 65 similar patients had Tuina, traction, and physical therapy.
Sixty percent of the acupuncture group recovered with no symptoms 1
month later, vs 45% of the control group, with 40% and 44% more able
to work with only occasional distress.
21. Zhou Y. Vertigo
treated by acupuncture: an analysis of 63 cases. Shanghai J Acupuncture
Moxibustion. 1998:19-21.
Here, GV 20, Yintang (Extra 2), PC(MH) 6, and ST 36 were needled with
adjuvant points depending on Traditional Chinese Medicine diagnosis,
for 7 to 12 sessions. Forty-one patients fully recovered and 18 improved.
Comment: Three approaches
to a problem: 1) a shotgun of "big" points, 2) more local, and 3) TCM
rationale, very individualistic and better results in less time. TCM
can be difficult for the Western-trained physician unless one can get
into a different thought process and work both sides of the brain simultaneously,
but it appears effective. There are many aspects to the art of acupuncture,
and comparing different approaches will be complex due to different
skill levels of practitioners coupled with differences in healer effectiveness.
22.Sui Y. Acupoint
injection treatment of insomnia. Shanghai J Acupuncture Moxibustion.
1998:28-29.
One hundred thirty-three patients
with insomnia, aged 19 to 61 years (insomnia duration, I month to 8
years), were treated by injecting sterile water in KI 9 and Sl 7. The
points were chosen as the Xi point of Yin-vyei controlling all Yin and
the Luo point of Sl with connection to the HT channel to ease anxiety.
Up to 3 courses of 10 treatments were given, with 46% cured and 2 1
% markedly improved.
23. Liu G, Zhang
Y, Liu A. Observation of the curative effect of acu-moxibustion plus
systematic desensitization on anxiety neurosis. Shanghai J Acupuncture
Moxibustion. 1998:68-70.
Three groups of 80 patients each were studied: I treated with acupuncture
at PC(MH) 6, ST 36, 25, LR 3, BL 23, DU(GV) 4, and LI 11; 1 by psychological,
relaxation, and biofeedback therapy; and 1 by acupuncture-moxibustion
using the listed points along with desensitization as in the second
group. One to 4 10-day courses were given. At the end of therapy, 21
acupuncture, 16 desensitization, and 42 combined therapy patients were
without symptoms; there was marked effect in 34, 36, and 23 patients,
respectively. A Iyear follow-up revealed continued normal status in
48% of the combined group, but less than half that in the other 2.
Comment: Moral to the story: adding a bit of acupuncture to your
psychological therapy might boost the long-term gain. I am convinced
after 20 years of needling people part-time to better their health that
the psyche obtains a healthy boost even when only normal healer encouragement
is given.
24.Wu Y-G, Yan
C-H. Effect of acupuncture on spinal cord evoked potential in experimental
spinal injury of rat. Int J Clin Acupuncture. 1999;10 (2):131-136.
Three millimeters of dura was exposed and a standard blow given the
spinal cords of 2 groups of 48 rats. The area was then covered and sutured.
One group had electroacupuncture between GV(DU) 4 (negative) and 14
(positive) at 30 minutes and 2 and 6 hours after injury, giving 1 Hz
continuous pulse current at 2 V. Normal spinal cord evoked potential
(SCEP) is 21.4 (average). Those of the control group were 21%, 39%,
and 71 % of that on days 7, 14, and 28 after injury. Acupuncture protection
increased SCEP to 30%, 54%, and 94% of normal. The differences were
significant (P<.05).
25.Wu Y-G, Yan
C-H, Sun S-T. Effect of acupuncture on spinal cord blood flow in experimental
spinal injury of rats. Int J Clin Acupuncture. 1999;10(2):137-140.
Two groups of 6 rats each were given spinal injury as noted in the prior
report. Spinal blood flow was determined by an H2 clearance method that
is described in the article. Immediately following injury, blood flow
was 89%, dropping to 76% at I hour and 50% after 4 hours. Flow returned
to 90% after 24 hours. The acupuncture-treated group decreased flow
in the same manner, but with a nadir of only 63% at 4 hours.
26.Wu Y-G, Yan
C-H. Effect of acupuncture on free radicals in experimental spinal cord
injury in rats. Int J Clin Acupuncture. 1999;10(2):141-144.
Sixty rats, divided into 2 groups, had spinal injury as in the prior
2 reports. Each group was subdivided into 5 for study of varied parameters.
The acupuncture was again 1 Hz between GV 14 and 4. Malic dealdehyde,
a major peroxidation product of lipids, was lower in the acupuncture
group from 2 hours to 7 days. Superoxide dismutase, a major anti-free
radical agent, was significantly higher.
Comment: These 3 articles demonstrate that acupuncture is definitely
good for spinal cord-injured rats. Unbelievers will note it proves nothing
in humans.
27.Ji X-P. Depression
(teaching rounds). Int J Clin Acupuncture. 1999; 10(2): 151-154.
A very complex case of an elderly German with depression, anxiety, and
chest oppression plus hypertension is presented. Diagnosis and treatment
from the TCM standpoint is discussed. Nourishing KI and LR (KI 3, LR
3, BL 23, 18) is described. RN(CV) 14, 17, HT 7, ST 36, SP 6, GV 20,
a few GB points, and LR 2 are also recommended. An interesting aspect
is morning depression being relieved in the afternoon. This is due to
Yin coming to an end, and Yang checking it toward noon. The author also
equates this in more modem terms with night melatonin secretion inhibiting
serotonin production, with the opposite during the day.
28. Yan S-M. Acupuncture
for Meniere's syndrome: short and long term observation of 189 cases.
Int J Clin Acupuncture. 1999;10(3):303-304.
One hundred eighty-nine patients, aged 20 to 75 years, with symptoms
of 1 month to more than 5 years, were treated at SP 6, KI 3, DU(GV)
20, GB 20,34, PC(MH) 6, HT 7, ST 40, and RN(CV) 4 for 2 courses of 15
days each. Results were compared with a similar group of 68 control
patients treated with Chinese herbs. There was complete response in
175 patients and partial in 12 of those treated with 1 course of acupuncture.
The control group had complete response in 41 % and partial in 12%.
After 1 year, 21 in the acupuncture group experienced recurrence, vs
29 in the control group.
Comment: A stated good result.
It is interesting and perplexing how often practitioners in China report
good results in a wide variety of conditions using a few recurrent "Helm's
big points."
PART II - PAIN
1.
Creamer P, Singh BB, Hochberg MC, Berman BM. Are psychosocial factors
related to response to acupuncture among patients with knee osteoarthritis?
Altern Ther. 1999;5:72-76.
Sixty-two patients with knee
osteoarthritis received acupuncture twice weekly for 8 weeks. A previous
report noted sustained improvement in pain level and function compared
with controls receiving standard care. One year after the study, 37
of the respondents could be contacted. Using accepted study vehicles,
depression, anxiety, fatigue, helplessness, pain, and quality of life
were evaluated. Those who had not responded had received less benefit
from acupuncture, with response at 8 weeks of treatment related to the
duration of pain and disability. Anxiety and fatigue were inversely
related to response, but no statistical significance was demonstrated.
By 12 weeks after therapy, this relationship was lost. No significant
relationship of psychosocial variables and response to acupuncture could
be found in this long-tenn follow-up study. Over time, more localized
media] knee pain alleviation was notably better than that of generalized
knee pain.
2. Gao SY, Zhao
DL, Me YG. A comparative study on the treatment of migraine headache
with combined distant and local acupuncture points versus conventional
drug therapy. Am J Acupuncture. 1999;27:27-30.
Sixty-four patients with migraine of I month to 15 years' duration were
randomly divided to acupuncture or drug (ergot plus caffeine during
headache and Chinese "Zhentianwan" twice daily between) therapy. All
patients had repeated episodes with premonitory signs and no evidence
of nonmigraine serious pathology. By TCM criteria, acupuncture was divided
into evilwind type (BL 60, Sl 7, GV 20, GB 20), liver type (LV 3 GB
43, Taiyang, GV 20), kidney type (KI 3, BL 23, GV 20, SS ST 36, Taiyang)
and stagnation type (GB 34, SP 10, Taiyang, GV 20, GB 8). One to 3 courses
of 10 treatments were given. Criteria for all 4 types were given. Twenty-four
of the 32 patients in the acupuncture group were cured, 12 after a single
course. The followup period was 1 year, and 11 in the control group
were cured.
Comment: The articles from China are beginning to contain 2 elements
not found a few years ago: randomization and longterm follow-up. Therapy
is more intensive than we provide in the United States. It might be
worth the cost of increased sessions to do a similar study here to see
if we could indeed duplicate long-term cessation of migraine.
3. Chen X. Observation
on the curative effect of 92 cases with lumbocrural pain treated by
the therapy of needle warming through moxibustion (Wen Zhen Jiti). World
J Acupuncture Moxibustion. 19995 9(2):1-16.
One hundred eighty-three patients with acute lumbar sprain, lumbar
muscle strain, lumbar disk prolapse, and vertebral canal stenosis were
randomly divided into a standard acupuncture group and 1 treated similarly
but with moxa heating added to the needles. Points from the lower bladder
and gallbladder meridians were used, adding JiaJi points for canal stenosis.
Daily treatment was given for 2 courses of 5 days each. For patients
with acute lumbar sprain, acupuncture with and without moxa was equally
effective. The muscle strain cases responded better with moxa (39 of
49 cured vs 7 of 49). Cases of prolapsed disk also responded more fully,
with 10 of 22 cured vs 6 of 21. Of 6 with canal stenosis in each group,
symptoms were totally relieved in 2 and 1, respectively, and 2 and I
improved. By TCM criteria, the heated needles were better at relieving
stagnation and channel obstruction.
Comment: More effort is required to heat the needles in offices
where moxa is permissable, and results might be better enough to enhance
the practitioner's reputation.
4. Ma J, Zhang S-X.
Cervical spondylosis. Int J Clin Acupuncture. 1999;10:143-145.
Recent advances in TCM treatment of headache, dizziness, and pain and
numbness of the neck, shoulders, and upper back is reviewed. The use
of local points, according to the 3 TCM categories of etiology, include
BL 10, 11, DU(GV) 14, GB 20, and 21 among others. SJ (TH) 3,5, Sl 11,
LI 11, 15, and ST 40 are prominent in distal points given. Warming needle
plus cupping, te chniques and points of moxibustion, point injection,
plucking, and auricular acupuncture are discussed.
5. An H. Herpes
zoster treated by acupuncture: clinical observation on 102 cases. Int
J Clin Acupuncture. 1999; 10: 215-218.
The TCM differential is Heat
in Yang Ming, Excess Fire in Shao Yang, Damp-heat in SP Meridian, and
Stagnation of LR Blood. The differentiation of types is discussed. Ten
treatments were given: DU(GV) 14, ST 36, and LI 11; SJ (TH) 6, LR 3,
and GB 40; SP 6 and 9; and LR I and RN(CV) 18 were needled, respectively,
for the 4 types. Nearly 100% resolution is reported, with 2 LR stagnation
and I Damp-heat SP failure. A control group of 60 treated with moxa
had a 72% resolution of symptoms.
6. Yin Z-F. Acupuncture
treatment of vascular headache: report of 42 cases. Int J Clin Acupuncture.
1999;10:277-278.
Headaches were present from I to 35 years in a group of 12 male and
30 female patients aged 14 to 58 years. The most painful Ashi on the
head, the ipsilateral GB 20 and SP 6, were used for treatment. Three
courses of 10 daily sessions were given: 52% were cured and 40% improved.
Comment: Good results were quoted, with excessive treatment by
our standard, and no follow-up period or control group. There are so
many approaches to headache treatment that it becomes more confusing
as one reads. From a few acceptable studies, information from clinicians,
and one's practice, it is evident that acupuncture can make a great
difference to many with recurrent headaches. Good studies are needed
of a few approaches compared with standard medical treatment. Once a
few approaches are widely accepted by the medical community, different
approaches can be compared.
7. Jiao H-B, Jiao
N-X. Acupuncture treatment of blood-stagnant headache: a clinical observation
of 100 cases. Int J Clin Acupuncture. 1999;10:279-280.
Recurrent or chronic headache following injury to the head was treated
with BL 17, LI 4, SP 6, 10, and Ashi points locally. A drop or 2 of
blood on needle withdrawal is advised. A course of 7 treatments was
given and 85 patients were cured. (It is uncertain if only I course
was used, which would not be usual in China.)
8. Zhang G-H, Duan
C-L. Primary trigeminal neuralgia treated by triple acupuncture at Zusanli:
observation of 37 cases. Int J Clin Acupuncture. 1999; 10:305-308.
The pain course was 2 weeks to 20 years in 14 men and 23 women,
aged 32 to 72 years. ST 36, LR 3, L14, and GB 20 were used, with BL
2, ST 7, or RN(CV) 24 depending on the nerve branch involved. The needling
technique is well discussed. In an average of 12 sessions, pain was
relieved for at least 3 months in 49%, and episodes were well reduced
in another 32%. The shortest cure was 5 sessions and the longest, 20.
Comment: This is a straightforward approach to a bad problem
with notably good results. Worth trying if your usual approach is not
working well.
9. Zheng S-X. Through
acupuncture to superficial points for primary of trigeminal neuralgia:
report of 31 cases. Int J Clin Acupuncture. 1999; 10: 309-312.
Eight patients, again of mixed sex and age, had symptoms for less than
I year, and 23 for longer. Points were on the affected side, except
LI 4 on the contralateral. In branch I pain, GB 14, Yuyao, SJ (TH) 23,
and LI 4 were used. For branch 11, ST 6,7, Sl 18, LI 20, and Hegu (LI
4) were needled. For branch 111, ST 4,6,7, RN(CV) 24, and Hegu were
used. Seventeen patients were cured without relapse in 6 months, and
8 were markedly better.
10.Yu P, Yang W-L,
Wang X-H, et al. Electro-acupuncture for severe herpes zoster: a clinical
observation. Int J Clin Acupuncture. 1999;10:317-320.
Thirty-one patients with symptoms failing medical treatment for
10 to 30 days were randomized to treatment and control groups. Huatojiaji
points at the level of the lesion and local Ashi were needled and current
applied at 3 Hz. DU (GV) 14 was pricked and cupped. Local Diprocaine
was given the control group, with piminodine or procaine along the peripheral
nerve to block pain. Each was treated daily for 2 courses of 5 days.
Thirteen acupuncture patients and 10 controls were without lesions or
pain after treatment. Lesions disappeared in an average of 4 days with
acupuncture and 6 with medication. Pain vanished after 6 and 14 days,
respectively.
Comment: The age range was 14 to 85 years. Lesions and pain might
be expected to disappear in the younger patients. A group older than
60 years, randomized to acupuncture and medication, would be of more
import.
11.Ma B-H. The
three points of shoulder for periarthritis. Int J Clin Acupuncture.
1999;10:321-324.
Frozen shoulder "originates from
deficient LR and KI, lack of Qi and blood." The author recommends LI
15, Jian I-one Cun anterior, and
Jian II-one Cun posterior, with LI 11. Cup the area 15 minutes after
needling, then "roll the arm" rapidly (I 20/min) with the healer's palm.
Finally, hold the wrist with both hands, lift the arm to 90o,
and forcibly shake it downward.
12.Kou S-L. Acupuncture
treatment of acute lumbar sprain: clinical observation of 100 cases.
Int J Clin Acupuncture. 1999; 10:329-330.
Patients (male to female ratio,
3: 1) were seen within 5 days of injury. With the patient standing,
Shanyao (2.5 cm below LI 11) is needled with large-amplitude movement
while the patient slowly moves the lumbar region. This was repeated
twice during 30 minutes with the needle in place. One treatment cured
46 and 41 felt notably better; 63 were cured after treatment 2.
13.Wu T. Comparison
of the curative effects on fibromyalgia syndrome between provocative
spot and traditional point puncture. Shanghai J Acupuncture Moxibustion.
1998:33-35.
"Acupuncture is one of few effective treatments for this disease which
has been generally applied by the medical circles of all the countries
in the world." Western treatment is by needling provocative spots (trigger
points). Thirty-two cases were treated this way and compared with 32
treated by TCM points, the most powerful on different meridians plus
Ashi, which varied with the TCM differential. Ten treatments were given,
with 2 cures and marked effectiveness in 14 of the provocative point
group and 4 cures and marked effectiveness in 18 of the TCM treated
group. Six-month follow-up demonstrated recurrence of symptoms in the
majority of the trigger-point treated group and in 7 patients in the
TCM group.
Comment: Fibromyalgia is hard.
The few cases I have treated with Seem-type needling of painful points,
or SQ nodules plus meridian therapy (often using Curious Meridians),
have taken 8 or more sessions to fully initiate relief and better sleep
patterns. I agree with the author that trigger-point or "provocative"
point needling alone is unlikely to do the job. Once symptoms are decreased,
periodic refreshing treatments, once monthly to quarterly, appear necessary
to maintain good health.
14. Cao W-Z, Wang
J-Q. A five step approach to acute lumbago. Int J Clin Acupuncture.
1999;10:23-26.
This is an introduction to the
approach and report of 150 cases. Patients had a short
course, acute onset, restricted mobility, and intense pain not relieved
by bed rest. The diagnosis was acute sprain in 50, disk protrusion in
4 1, vertebral tumors in 6, and other diagnosis in 53. First, GV 14
is needled toward GV 9 to drive sensation down to the lumbar region.
In cases of Cold and Wind, bring it back and thrust toward each GB 2
1. The needle is manipulated to Qi sensation and not left in. Second,
use reverse acupuncture-BL 2, adding BL 60 in some, or the corresponding
RN (CV) point in front of the painful area. Again, rapid insertion and
no needle retention. Third, Ashi are bled and cupped. Fourth, moxibustion
is used over the pain area. Fifth, replenish KI energy-BL 23, 6, 40
and KI 3. Add BL 10 if pain increases when bringing the head forward,
and LU 10 if cough aggravates. Forty-five of the 50 acute sprain patients
were cured (6-month follow-up), as were 36 of the 41 with a disk protrusion.
Of the 150 patients, 136 obtained some instant effect, and 8 were cured
with I treatment. Acute sprain required less than 10 treatments, the
other conditions required more. The authors emphasize that the immediate
relief of pain is noticeable to the patient even if cure takes longer.
15. Li B-S. Puncturing
Xuanzhong for 106 cases of non-purulent costal chondritis. Int J
Clin Acupuncture. 1999; 10: 77-78.
GB 39 was used to treat patients ranging in age from 19 to 60 years.
Forty-one had symptoms for less than I week, 38 from 2 to 4 weeks, and
the remainder for longer. The point is needled slightly upward and manipulated
until the sensation reaches the costal area. At this point, pain usually
stops. Either side can be used (both if pain is bilateral), alternating
sides if more than I session is required. Pain stopped in 39 patients
after I treatment and in another 59 after 2 to 3 treatments. There was
no recurrence on follow-up (length of time not stated).
Comment: Easy to do on a quick appointment, and preferable to
recommending cold or hot packs and giving assurance of eventual healing.
16. Zhou A. Clinical
observation on acupuncture treatment of 52 cases of stiff neck. World
J Acupuncture Moxibustion. 1999;9(l):51-53.
Patients were 10 to 58 years old, with stiffness and pain for I
to 3 days. LI 4 was needled for pain centered in Yang Ming, LR 6 for
ShaoYang, and SI 3 for Tai Yang. Forty-four patients were cured, 54%
with I treatment, and the rest improved. Up to 5 daily treatments were
given. Compared with a group of 30 treated with massage, acupuncture
gave better results. Only 40% were cured with the first session of massage.
Comment: One can compare this with Dr Colbert's demonstration
at the AAMA meeting in 1998, using pressure on the ipsilateral LR Ting
or midjoint of the large toe if needed, then neutral needle in LR 4.
Find the contralateral TH tender point (usually TH 5 or 8), and needle
it without stimulation. Have the patient slowly move the head and neck,
and the pain disappears.
17. Wen ZJ. Observation
on the curative effect of 92 cases with lumbocrural pain treated by
the therapy of needle warming through moxibustion. World J Acupuncture
Moxibustion. 1999;9:12-16.
Ninety-two patients with lumbar
and loin pain from lumbar sprain, disk prolapse, or canal stenosis were
treated by needling 4 to 6 BL or GB points, using burning moxa sticks
mounted twice on the handles. They were compared with 91 patients treated
with needling alone. Moxa addition definitely resulted in a greater
cure rate for muscle strain and disk protrusion. It "helps relieve stagnation
and obstruction of channels." Comment: If one's office tolerates moxa
smoke, heat the points; most patients like the sensation and it usually
appears beneficial.
18. Ernst E, White
AR. Contradictory systematic reviews: acupuncture for back pain. FACT.
1999;4(2):66-67. Commenting on: van Tulder MW, Cherkin DC, Berman B,
Lao L, Koes BW. The effectiveness of acupuncture in the treatment of
low back pain (Cochrane review).
Oxford, England: The Cochrane Library, Issue 1.
The original reporting group
searched MEDLINE, EMBASE, and Cochrane databases for randomized controlled
trials (RCTs) on this subject. Two independent reviewers extracted data
for a qualitative review because data were too heterogeneous to be grouped.
Eleven RCTs were included, but only 2 met more than 50% of the "high
quality" predetermined factors. There was "no evidence that acupuncture
was better than no treatment, and moderate evidence it was no better
than TENS or Trigger Point injection." They would not recommend it for
low back pain treatment. The commentary in FACT: "This SR is in overt
contradiction to an MA on the same question published by us 8 weeks
previously. Our conclusion was acupuncture was superior to various control
interventions." These reviewers used 4 criteria in a modified JADA method,
and Cochrane used 10. There were some other divergences in method. The
authors note that systematic reviews are not infallible, and weak RCT
articles are hard to combine and derive a satisfactory conclusion from.
Comment: This Cochrane report
was presented much too definitively for the data used, and will likely
prove detrimental to practicing physician and non-physician acupuncturists
who do indeed find that a good number of patients are grateful for the
pain relief. The Exeter group's approach is superior; though cautious,
they took the positive approach, stating acupuncture appeared of benefit
and called for better studies. I have reviewed a number of meta-analyses
and review papers. Most can be shredded logically, as they try to combine
papers with data not easily combined to achieve a sound end result.
Such analyses are much more likely to lead to a negative than positive
conclusion. They pose a danger to a growing neophyte field of endeavor
where much therapy is best individualized, and as Dr Greenwood has stated,
"put control in the hands of scientists rather than with physicians
and patients."
PART III - OBSTETRICS
& GYNECOLOGY
1. Ternov NK, Buchave
P, Svensson G, Akeson J. Acupuncture during childbirth reduces use of
conventional analgesia without major adverse effects: a retrospective
study. Am J Acupuncture. 1998;26:233-241.
Two parturient groups were studied in consecutive years. There were
1708 deliveries the first year with no acupuncture. The second year,
994 of 1609 patients had acupuncture during delivery. Four midwives
trained in acupuncture used at most 10 needles to points that included
GV 20, S1 3, PC 6, SP 6,9, LR 3, BL 60,57, ST 36, GB 34, and L1 4. Seven
percent of acupunc- 2 ture-treated women noted needle pain or accelerated
labor. There were more vacuum deliveries in the acupuncture group (6.6%
vs 3.4%) and more epidural analgesia (18% vs 9%), but the significance
is uncertain because the acupuncture group consisted of 47% primiparas
vs 25% not so treated. There were fewer emergency cesarean deliveries
and fewer infants referred to intensive care (P<.0 1). There was
less use of other types of analgesia. Seventy-eight percent of the women
would consider acupuncture again, and 58% were satisfied with pain relief
on a questionnaire.
Comment: This is a confusing study; so many factors were added
by a first-year study that appears irrelevant to the second year when
acupuncture and non-acupuncture groups 3. were compared. The 2 groups
were not randomized, and the difference in percentage of primiparas
makes it very difficult to compare the treated and untreated groups.
Furthermore, a number of "big points" in several meridians were used,
with the logic uncertain. A more carefully planned study is still needed,
although several studies indicate acupuncture might be helpful in pain
reduction, labor time, and aiding placenta disengagement.
2. Kvorning Ternov
N, Nilsson M, Lofberg L, Algotsson L, Akeson L. Acupuncture for pain
relief during childbirth. Acupunct Electrother Res. 1998; 23:19-26.
Reviewed in: FACT 1999; 4(2):65 (by A.R. White).
Ninety women wishing to receive
acupuncture were compared with 90 not so treated. Women were matched
for parity and acupuncture given after 3-cm dilation of the cervix.
Sixty percent of the acupuncture group did not receive standard analgesia
vs only 13% of the control group. The labor outcomes were the same in
both groups. All infants were healthy, and 94% of the women would receive
acupuncture again. Dr White notes
enough chance of bias to allow only an "acupuncture might be useful"
conclusion.
3. Zhou C-L. Acupuncture
for vomitus gravidarum. Int J Clin Acupuncture. 1999;10:335-336.
Thirty patients had not responded to prior Western or Chinese medication
and continued to vomit. Twenty-seven were gravida 1. PC (MH) 6, ST 36,
and SP 4 were needled once daily for I or 2 courses of 5 days. Nausea
and vomiting totally disappeared in 26 women after I course and 4 women
after 2 to 3. Neiguan (PC 6) and Zusanli (ST 36) are also helpful for
a smooth and uneventful pregnancy. Needling should be done in reduction
manipulation to avoid jeopardizing the pregnancy. SP 4 (Gongsun) is
manipulated in "moderate enhancement and moderate reduction" because
reduction alone might lead to rupture of the membranes.
Comment: Adding SP 4, given any chance of a premature delivery,
should not be done in the United States. I am hesitant still, following
Dr Helm's advice in the UCLA program, to needle a pregnant woman other
than in an urgent situation until acupuncture is more widely accepted
and its safety given full cognizance here.
PART IV - GASTROINTESTINAL
AND GENITOURINARY
1. Stellon A, Palmer
T. Acupuncture as an alternative to diazepam sedation for diagnostic
endoscopy. Acupuncture Med. 1999;17:2-4.
Two hundred six patients were
given pharyngeal xylocame spray, 95 chose sedation with intravenous
diazepam, 54 were given acupuncture, and 53 no other therapy as a control
group. Ll 4, PC (MH) 6, ST 9, and CV 23, 24 were needled, stimulated,
and left in situ during the procedure. Emotional and physical distress
was assessed using an ordinal scale. Distress and number of endoscopic
attempts were less in the sedated group. Emotional distress was less
in the acupuncture than control group, just above statistical significance;
there was no difference in physical distress. A total of 8.8% of sedated
patients required oxygen and respiratory attention v s 3.8 % of control
group and 0% of the acupuncture group. Some bias was introduced by providing
initial choice for sedation or none: more women chose sedation.
2. Zhang Z-Y, Yang
Y-H Acupuncture for rectal prolapse. Int J Clin Acupuncture.
1999;10:203-204.
Reasons why acupuncture is effective in treating rectal prolapse
are given. DU (GV) 1, 10 are the main points, with BL 57, ST 36, and
moxibustion at RN (CV) 4, 6. Treatment is given every 3 to 5 days.
Comment: A large number of treatments might be given, judging
from the 1 case presented. Dr Helms indicates GV (DU) 20 as an excellent
point for conditions in this region, and since it is deep organ pathology,
would Yang Kiao Mo be a choice?
3. Ma S. Observation
on the therapeutic effect of combined treatment of 60 cases of ulcerative
colitis with acupuncture and 5 moxibustion. World J Acupuncture Moxibustion.
1999;9(l): 24-26.
Sixty patients, following randomization,
were treated with acupuncture at points ST 25, 36, CV (RN) 4,12, LR
3, and abdomen Ashi and alternated with BL 23, 31, 32, 35. Disease duration
ranged from 6 months to 10 years in each group, with age ranging from
23 to 68 years. Treatment was daily for 30 days.
The 30 control patients were given sulfasalazine and metronidazole for
30 days. Seventy-seven percent of the acupuncture group and 57% of the
medication group had no symptoms and normal colonoscopy findings. There
was no recurrence at 6 months of follow-up.
4. Tian J. Acupuncture
treatment of 135 cases with hiccup. World J Acupuncture Moxibustion.
1999;9(l):54-55.
Treatment was given daily for
I to 3 days for patients with hiccups from I to 15 days. BL 13, 17,
and 21 with ST 44, 45, Ll I and 4 were needled, with the Ting points
bled 22 or 3 drops. One hundred thirty-one were cured; 95 after I treatment,
31 after 2. ATCM discussion is given.
5. Shen L, Zhang
C, Li Y. Treatment of hiccup by acupuncture in 30 cases of malignant
tumor patients after chemotherapies. World J Acupuncture Moxibustion.
1999;9(2):38-40.
Thirty patients with hiccup following
chemotherapy who did not respond to sedation and antispasmodic treatment
were needled at ST 36 and PC(MH) 6 for 15 to 20 minutes.
Hiccup disappeared after 1 treatment in 18 and after 2 to 4 in 10 patients.
6. Xu W. The observation
of the therapeutic effect on the patients with gastrelcoma by the treatment
of moxibustion. World J Acupuncture Moxibustion. 1999; 9(2):
51-52.
Thirty-four patients with gastric
ulcer (by symptom and gastroscopy) who had upper abdomen symptoms for
2 to 18 years were treated with moxa to ST 36, CV(RN) 12, and SP 4 twice
daily for 1 month. A compari son group of 30 was treated with cimetidine.
Sixtyeight percent were cured by moxibustion vs 31% with cimetidine
therapy. Follow-up period is not mentioned.
7. Ma J. Ear point
pressing in treatment of constipation: clinical observation of 123 cases.
Int J Clin Acupuncture. 1999, 10: 69-72.
Patients with chronic constipation were placed into TCM categories
of causation. Ear points Constipation, Rectum, Sympathetic and Spleen
were localized by ear point detector and vaccaria seeds applied every
other day 10 times. Fifty-nine patients were cured and 36 were able
to pass stool at least every other day without discomfort.
Comment: This approach appears, in conjunction with a reasonable
diet, less troublesome than chronic use of laxatives. It appears worth
trying, especially as an addition for patients being treating for other
problems.
8. Yang C, Yan H.
Observation of the efficacy of acupuncture and moxibustion in 62 cases
of chronic colitis. J Tradit Chin Med. 1999;19:111-114.
Sixty-two patients with symptoms
from 2 months to 10 years (average, 2.1 and 2.5 years in treated and
control groups) were randomly divided to acupuncture or medication therapy.
ST 25, 36, and RN (CV) 4 were needled daily, adding moxibustion to BL
23, KI 1, ST 36, and RN 4. The control group
received sulfasalazine. Twenty of 32 treated with acupuncture were cured
of symptoms and had colonoscopy findings revert to normal (1 year follow-up),
vs 10 of 30 in the medication group.
Comment: The number of 1 0-day courses
used is not given. This is 1 of many articles in recent years stating
acupuncture, provided intensely, is effective in ulcerative colitis.
9. Lu S-P, Zhong
J, Zhang S-Z. Acupuncture treatment of chronic prostatitis: a clinical
observation. Int J Clin Acupuncture. 1999;10:205-208.
Sixty-six patients aged 23 to 84 years, diagnosed as having chronic
prostatitis by a physician, with symptoms from 5 to 54 years, were treated
with points SP 6, 9, BL 17, 39, 66, ST 36, and RN(CV) 6. The TCM diagnostic
criteria are discussed, with damp heat, KI deficiency, and stagnant
Qi and blood types involved. Some point modifications are outlined.
Treatment is in repeated courses of 10 daily sessions with 5 day rests.
Twelve patients were cured and 32 were obviously improved.
Comment: A lesser rate of cure than is usual in articles from
China. THere is no longterm follow-up and criteria of cure are vague.
10. Xi Y, Xi Y.
Acupuncture treatment of 23 cases of acute urethral syndrome. Shanghai
J Acupuncture Moxibustion. 1998: 22-23.
Twenty-three patients with aseptic
frequency and dysuria were treated with 3 sessions of acupuncture using
Sishencong (Extra 6) and SP 6. Twenty-six others were treated with diazepam
(Valium) and oryzarol. Eighteen were cured with acupuncture and 5 improved,
versus 4 and 12, respectively, in the medication group. Using Sishencong,
a tranquilizing effect was obtained, and disease of the lower part was
treated by needling the upper part. SP 6 is a chief subsidiary point
for urinary disease, using its function
of meeting point of the 3 Yin channels.
11. Wu H. Acupuncture
plus Chinese medication for 49 cases of chronic prostatitis. Shanghai
J Acupuncture Moxibustion. 1998:24-25.
Forty-nine patients had symptoms
of perineal pain, frequency, dysuria, with prostatic swelling and tenderness
on digital examination for 7 months to 6 years. BL 23, RN (CV) 3, SP
6, and LR 3 were alternated with BL 28, 32, RN 2, 3, SP 6, and KI 3.
Oral herbs were added. Two to 3 courses of 10 days were given, with
cure in 45% and marked improvement in 33%. The TCM reasons for points
and herbs used are given.
12. Zhang H. Scalp
acupuncture plus body acupuncture for senile urinary incontinence. Int
J Clin Acupuncture. 1999; 10:101-104.
Seventy-six patients aged 46
to 78 (mean, 63) years had incontinence for I to 12 (average, 7.6) years.
Scalp foot-kinesthetic sensory and urogenital areas were needled, with
RN (CV) 3, ST 28, BL 23, 28, SP 6,9, and KI 3. Stimulation at 200 Hz
was given to scalp points. Treatment was 5 d/wk and I to 2 courses of
10 treatments were given. Thirty-eight patients were cured, and 20 reported
marked improvement.
13.Qian X. Clinical
application of Ciliao in acupuncture treatment. J Tradit Chin Med. 1999;19:1226-1228.
BL 32 is indicated for many types
of urinary and pelvic organ problems. Mr Qian presents 2 cases. The
point is conducive to adjusting the erection and ejaculation mechanisms
in impotency. It is helpful in dysmennorhea and pelvic inflammation,
with RN points. It is useful in prostate blockage and urination difficulty.
PART V - MISCELLANEOUS
1. Greenwood M.
Energetics and transformation: insights on the paradoxical opportunity
presented by chronic illness and pain-part II. Am J Acupuncture.
1998;26:271-276.
Dr Greenwood writes from the Victoria Pain Clinic, where acupuncture
and psychological therapy are intertwined for inpatients being treated
for chronic pain. Acupuncture, acupressure, hyperventilation, and active
therapeutic dialogue with spontaneous sounds, motions, and emotional
expression are combined in a "resistance free" approach. He explores
the existence of the void, both for the healer and the patient, which
carries one to the threshold of true healing as opposed to inhibiting
pain.
Comment: This is the second pail of an article reviewed last
year. Greenwood is integrating acupuncture with psychiatric approaches,
seeking to help people break through past traumas that play a role in
continued pain states.
2. Greenwood M.
Energetics and transformation-part III. Am J Acupuncture. 1999;27:51-56.
Illness makes us vulnerable;
it is important to retrieve power and a sense of control in the healing
process. Insistence on victimization can inhibit healing. By definition,
medicine has failed in chronic illness. The patient's belief in the
healing power of the therapist is a reflection of his/her sense of helplessness.
"Randomized double blind trials are
jewels of disempowerment purporting to test the efficacy of treatment
regimes delivered to a radically generalized or generic-human being."
Unusual results are ignored or written off as "anomalies." Individual
therapeutic relationships are dehumanized. Power, from patient to physician,
now is given the scientist. People find a physician on whom they rely,
and the physician acquires patients "to look after." However, most illness,
the author believes, results from years of imbalanced living and suppression
of warning signals. There is an epidemic of psychosomatic anxiety leading
to illness.
3. Sher L. Can acupuncture
points play a role in the response of the human Circadian clock to extraocular
light exposure? Am J Acupuncture. 1998;26: 277-280.
A recent study found that extraocular light exposure could shift
or reset the biological clock. Biological day and night are believed
to originate in the suprachiasmatic nucleus (SCN) portion of the hypothalamus,
which is connected to the pineal gland that produces melatonin mainly
in darkness. In a prior study, light was applied to the posterior knee
for 3 hours at night using fiberoptic pads. This reset the biological
clock and changed the wake-sleep cycle. This author believes the light
stimulates local acupoints and fits in with the ancient Midday-Midnight
Law of Chinese Medicine. Acupuncture has been used to counter jet lag
and for the treatment of sleep disturbances. The SCN is densely innervated
by serotonergic fibers and acupuncture has been shown to affect them.
Comment: The author proposes testing acupuncture, indicating
the new bent for laser therapy, as a therapy for circadian rhythm problems.
4. Eisenberg D.
Trends in alternative medicine use in the United States, 1990-1997JAMA.
1998;280:1569-1575. Commentary by: E. Ernst in FACT 1999;4(2): 60-61.
A random telephone survey repeated
in 1997 was compared with Dr Eisenberg's first in 1990. Herbal medicine
use had accelerated by 380% and complementary and alternative medicine
(CAM) use in general rose from 34% to 42%. Back pain, headache, depression,
and anxiety were the main entities leading people to the nonstandard
practices. A minority of users tell their physicians. Little has changed
in 7 years. Data suggest that the majority use CAM to stay healthy rather
than to treat disease. Acupuncture is still used by a small percentage
of people.
5. Wetzel MS, Eisenberg
DM, Kaptchuk T. Tracking and coordinating innovations in medical education.
JAMA. 1998;280: 784-787. Reviewed in: FACT 1999;4(2): 62-63.
One hundred seventeen medical
schools (94%) responded to a questionnaire and 64% offer CAM courses.
A total of 123 courses were reported, most often through the family
or internal medicine departments. Courses tend to be brief (likely introductory)
and involve a variety of topics. Reviewer A. Best notes that this article
will likely lead to more innovation by identifying courses and creative
teaching. "It appears that the presence of CAM medical education is
growing much faster than the intensity or quality."
6. Moss C. Five
Element acupuncture: treating body, mind, and spirit. Altern Ther.
1999;5(5):5-63.
Many current practitioners of Five-Element acupuncture, rooted in
Taoism, were trained by Worsley in England. Other medical and acupuncture
treatments do little to affect the spirit. The etiology of many disturbances
lies on this level of being. The first writings on Five Phases were
in the Nei Ching Su Wen, about 200 B.C. Here, Moss outlines the correspondences
for the Five Elements that involve the cycle of life. He details the
officials, functions, and laws with concise figures and tables. The
approach to interaction of body, mind, and spirit has a section. There
is discussion of assessing the individual as a whole, and treating in
Five Elements with a similar approach.
Comment: This is an excellent article that helps elucidate the
essence of this complex therapeutic art. Moss is one of, if not the,
leading proponent of Five-Element therapy among physicians in the United
States.
7. Ni Y, Yang J,
Wang J, Xu X. Treatment of epiphora due to insufficiency of lacrimal
passage by acupuncture at Jingming. J Tradit Chin Med. 1999;19:108-110.
Sixty-eight affected eyes in 42 patients were treated using acupuncture
at BL 1. Patient ages ranged from 31 to 63 years and they had symptoms
from 2 weeks to 3.5 years, with an average of 9 months. Lacrimal ducts
were patent by irrigation. Warmed needles were used and retained 10
to 25 minutes without stimulation. One to 2 courses of 5 daily treatments
were given. Twenty-eight eyes cleared up for the following 3 months,
and 35 improved. Twelve eyes were cured in 5 treatments.
Comment: This is likely another eye treatment that ophthalmologists
will neither believe nor try, but one of interest if other therapy
fails or is expensive or prolonged.
8. Sumauo H, Mateos
G. The use of acupuncture-like electrical stimulation for wound healing
of lesions unresponsive to conventional treatment. Am J Acupuncture.
1999;27:5-14.
Wounds in 34 patients had failed to heal with prior therapy and
were treated with 0.6 coulombs/cm2/d
through needles surrounding the periphery of the wound. An acupuncture
stimulator was used. Ten patients with second-degree burn wounds were
similarly treated, adding saline-soaked gauze over the surface. Alligator
clamps on the gauze were used in place of needles. Those with nonburn
wounds had a variety of compromising disorders including obesity, diabetes,
and ischernic disorders. The authors have studied rat wound healing
acceleration using electrical current therapy and found well-organized
skin healing with increased strength. The appearance of the healed wound
resembled that of unharmed skin. During treatment, pus if present was
cleaned off with saline, but antibiotic was not used. Ninety-three percent
of the patients achieved an excellent outcome. The average number of
treatments for grade 11 lesions was 10.6, but grade III required 4 1.
Since these patients had progressing sores that were unresponsive to
usual therapy, it was not felt necessary to randomize a control group
because of prior animal studies and literature backing. All wounds reacted
with an early clear increase in redness as the blood supply increased.
All patients were 100% cooperative, a result of improvement seen in
the first week even in the most severe wounds.
Comment: This study is good in many ways. First, it comes from
a veterinary school physiology department. Second, acupuncture is well
accepted in Mexico. It is easy for physicians to refer patients. There
is indication from many sources in many countries that electrical current
applied around wounds or broken bones or traumatized tendons hastens
healing and improves the end product. The authors caution that use of
negative or alternating current increases contracture. The appropriate
electrical dosage ranges from 0. 1 to 0.9 coulombs/cm2
for best result.
9. Van Benschoten
MM. Acupoint energetics of nutritional supplement intolerance: patient
self-prescribing may impair clinical progress. Am J Acupuncture.
1999;27:57-69.
Chronically ill patients often take multiple nutritional supplements.
This group finds that dairy and high-sugar foods often aid pathogens.
The high concentration of nutrients in pill form without the phytochemicals
from natural foods with antiviral, bacterial, and fungal effects also
can produce adverse symptoms. The author recommends using PC 6 and the
weak "O-ring" test to evaluate adverse response from each nutrient taken.
He supplies tables of common intolerances. Highdose multivitamins and
all glandular extraction products test consistently as gastrointestinal
irritants. Twenty case studies are presented.
Comment: O-ring theory is increasingly fascinating, as so many
praise its uses. Van Benschoten, perhaps, should be invited to an annual
AAMA conference for a talk on this topic.
10. Cocilovo A.
Colored light therapy: an overview of its history, theory, recent developments,
and clinical applications combined with acupuncture. Am J Acupuncture.
1999;27:85-94.
Recent European studies to evaluate Mandel's esogetic colorpuncture
therapy (ECT) are presented. Most have limitations in research design
or sample size.However, dramatic improvement is a general trend in the
studies, and they should be viewed at least as preliminary data showing
promise in therapy. Mandel uses colored light stimulation of acupuncture
points. The instruments used are described in detail. Kirlian photographs
provide before and after information directing therapy. The work is
based on Popp's biophoton emission work demonstrating an increase when
a cell's function leaves a state of balance. Studies on therapy effectiveness
in migraine, chronic insomnia in children, bronchitis, learning disorders,
attention-deficit disorder, and uterine fibroids are reviewed. Results
in all indicate potential effectiveness. Comment: This is a good
article for advocates of light and laser approaches. If they fulfill
the promise stated, children and the needle-shy will gain benefit. The
question is how stable and reproducible is the result from Kirlian photography?
11. Zhang Z-1,
Zhao S-h. Effects of middle Jiao-regulating acupuncture on NIDDM patients
with lipodystrophy. Int J Clin Acupuncture. 1999; 10: 113-118.
Fifty patients with type 2 diabetes
without ketoacidosis or other clinical
problems were divided into 2 comparable groups (P<.05). The acupuncture
group received dietary intervention but no medications during the first
month of SP-ST treatment using LI 4, 11, ST 36, SP 9, LR 3, and CV 1
(RN 12). During a second month, irrelevant points" (BL 60, L1 14, SJ
5, GB 34, 39), were used. The controls were given a hypoglycemic agent
and irrelevant points the first month and treatment the second. After
4 courses of 6 treatments the first month, total glucose level decreased
in the SP-ST acupuncture group (P<.01) more than did the glyburide
treated (P<.05). Total cholesterol levels declined more and high-density
lipoprotein was elevated by acupuncture treatment only.
Comment: Using "big points," the authors show positive biochemical
changes that confirm a prior study of 140 diabetic stroke patients.
Their findings are in line with other studies from China in the past
5 years. Since the US medical community tends to doubt findings from
China and we are unwilling to expend the time and financial
resources to duplicate the work, we likely will not know how much acupuncture
might positively change body metabolism, and for how long, in diabetes.
It would be exciting if we could better the diabetic state enough to
avoid long-term complications. Group therapy with these points could
be used to decrease the cost, even if periodic "boosters" were needed.
The overall longterm health care cost might well be lowered.
12.Zhang Q, Zhiu
L-X. Acupuncture for the beauty of breasts: report of 32 cases. Int
J Clin Acupuncture. 1999;10:119-123.
Points of SI, ST, SP, RN (CV), and GV (DU) channels connected with the
breast were treated 50 to 80 times on a daily routine. Breast size was
increased to normal in this group of adult females by "activating the
sensitivity of breast cells to female hormones."
13. Che J-I Zhang
Q. Acupuncture treatment of leukoderma (vitiligo) with discussion of
its mechanism. Int J Clin Acupuncture. 1999;10:125-129.
Eighteen patients were aged 13
to 60 years and had vitiligo of the face and/or neck for 3 months to
10 years. Two groups of Yang Ming, SP, GB, and GV (DU) points were alternated,
adding daily moxa over the affected area. After 3 courses of 12 daily
treatments, 1 patient was cured, 5 had more than 50% reduction, and
10 had partial decrease of vitiligo.
14.Wang Y-T. Needling
Yongquan for emergent cases. Int J Clin Acupuncture. 1999; 10:163-165.
Yongquan KI I is I of 9 points
for restoring Yang in case of collapse. It promotes resuscitation, restores
consciousness, clears heat, and stops convulsions. The author reports
4 case histories of severe hysteria, prolonged syncope, infantile convulsion,
and severe vertex headache with hypertension. All patients responded
nicely and immediately to acupuncture at this sensitive point.
15.Qi B, Wang S,
Xu L, Hu M. Lectures on acupuncture: scalp acupuncture. World J Acupuncture
Moxibustion. 1999;9:57-61.
This group of professors from the Tianjin College
of TCM advises on the locations, indications, and needling techniques
useful for scalp acupuncture. This center deals with a great number
of stroke patients as well as the usual variety of ailments and problems
brought to acupuncture clinics in China.
16. Zhou J, Li
Z, Jin P. A clinical study on acupuncture for prevention and treatment
of toxic side effects during radiotherapy and chemotherapy. J Tradit
Chin Med. 1999;19:16-21.
These authors review recent clinical studies from China on the use
of acupuncture and moxibustion to strengthen body responses to the adverse
effects of cancer therapy. For combating marrow inhibition, ST 36, SP
6, LI 4, 11, MH 6 (PC 6), BL 18, 20, and GV 14 (DU 14) are often used.
The authors list several studies demonstrating significant increases
in white blood cell response, usually within a few days. Moxibustion
alone caused elevations in several studies. Protection of the gastrointestinal
tract is another acupuncture function. Again, the above listed points
are often used, adding BL 20,21 (SP and ST back Shu points), and CV
12 (RN 12). Auricular points with vaccaria seed pressing can be added.
Nausea, vomiting, and diarrhea are significantly relieved. Immune functions
are also enhanced, with CD 3, 4, and 8 cell counts elevated.
Comment: This is a medical study that should perhaps be done
in the United States. Many articles from China and Japan indicate that
acupuncture causes a white blood cell increase following chemotherapy
and irradiation. Acupuncture of ST 36, MH 6, and SP 6 or 9 also halves
and shortens the white blood cell decrease seen after major surgery,
especially when morphine is used for analgesia. We should be looking
at this on behalf of patients at risk. We will likely prevent infections,
enhance recovery, and save a great deal of distress both for patients
and medical staff. With dedicated physicians, studies would be easy
to do and require little funding.
17. Chen H. Proper
comprehension of the connotation of acupuncture-moxibustion modernization:
main developments in acupuncture-moxibustion science in 1997. Shanghai
J Acupuncture Moxibustion. 1998:1-4.
Chen, of the Shanghai Research
Institute, notes 2850 articles were published in China in 1997 on acupuncture
and moxibustion. Some work was done noting relations between the channels
and viscera; some physical differences were found between meridians
and nonmeridian areas, and epithelial gap junctions were prominent in
meridian skin lines. Xin Yulung treated 16 10 cancer patients with a
direct current automated instrument attached to a needle penetrating
the tumor (guided by computed tomography or ultrasound to deep tumors).
The I -year survival was 87% and 5-year, 41 %. It is deemed worthy of
use for nonoperable situations. Acupuncture-assisted anesthesia use
has been increased. Han considered the effect of electroacupuncture
as equal to half a full dose of anesthetic. Research in laryngeal reconstruction
under acupuncture anesthesia won a TCM scientific advance prize, as
did a study on ST-SP meridian acupuncture effect on gastric motility
and pylorus pressure. A third study won for demonstrating the use of
RN (CV)3, 4, SP 6, and Zigonxue (Extra point 22) in treating sexual
dysfunction by moderating the pituitary-hypothalamic-ovarian axis. Efforts
should be made to direct acupuncture research according to guidelines
established by the West Pacific branch of the World Health Organization
so that research in China will be accepted throughout the world.
18. Chen J. Study
on algetic obesity treated by acupuncture. Shanghai J Acupuncture
Moxibustion. 1998:10-13.
Algetic obesity, or Dercum's
disease, is characterized by obesity with superficial painful subcutaneous
nodules, especially around the joints. Twenty menopausal (often prematurely)
female patients with this disorder in Tunisia were treated with electroacupuncture
surrounding the nodules plus auricular acupuncture. Recurrent 10-day
courses over 1 to 3 months were given, with significant reductions in
nodule size, patient weight, and levels of cholesterol and triglycerides.
19.Shen X. Acupuncture
treatment of hysteric aphonia: a report of 27 cases. J Tradit Chin
Med. 1998; 18:53-255.
Twenty-six female and 1 male
patient, 16 to 49 years. It was essential to convince patients there
was no organic etiology prior to acupuncture, and that they could be
cured by this treatment. LI 18 use was primary, with LU 8 and LR 2 (Qi
stagnation), or LU 9 and ST 36 (Qi deficiency), as adjuvant points.
Patients practiced counting out loud during needling. Full voice function
usually returned after 1 to 3 sessions. There was 1 failure.
20.Zheng Q Experience
in the point-selection for electro-acupuncture. J Tradit Chin Med.
1998;18:277-281.
The author, from the Institute
of Acupuncture and Moxibustion, Beijing, advises on selection of local,
distal, back-Shu, and front-Mu points for a variety of disorders.
AUTHOR INFORMATION
Dr Erickson is retired from private
practice in Berkeley, California. He is also retired from Kaiser-Permanente
Hospital in Richmond, California, where he was Senior Consultant and
former Chief of Pediatrics. Dr Erickson is Secretary of the Board of
the Medical Acupuncture Research Foundation (MARF).
Russell J. Erickson, MD
10 Ridge place
Pleasant Hill, CA 94523
Phone:925-229-0889 Fax: 925-228-4976
E-mail: Russpat@netvista.net
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