| The journal of the American Academy of Medical Acupuncture with acupuncture research articles, reviews, abstracts and case studies. | ||||||
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Medical
Acupuncture Spring
/ Summer 2000- Volume 12 / Number 1 |
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Abstracts
Of PART
I - miscellaneous
Channel sinews, Jing Jin, are also translated as muscle sinew channels or musculotendinous channels. These 12 channels are superficial, in contact with the outer environment, overlay the pathways of the 12 main meridians, and play a protective role. They do not connect with the organs, but do communicate with the Jing Well points. Their functions include binding the bones, joint movement, and muscle flexion. They carry defensive energy (Wei Qi). Symptoms relating to them, when full, include spasms, contractions, and edema, usually Yang, with redness, heat, and pain. Emptiness can be indicated by poor muscle tone, wasting, cold and pale surface, and dull, deep pain. Analysis of some ancient texts regarding channel sinews is given. TCM pathology includes wind and cold attack depriving muscles of warmth and nourishment with wandering pain, twitching, itching, tremors, and sweating. Cold regions are more likely with chronic disharmony. Qi and blood stagnation can lead to sudden sharp, cramping pain. The surface can be cold and pale, but can also generate heat and redness with time due to conflict of Wei Qi and cold pathogen. Wind-heat causes floppy muscles and atrophy and impotence when the genital region meridians are involved. A table lists symptoms of sinew channel invasions by wind, cold, heat, and dampness.
Case histories
are given illustrating possible outcomes of the distortions of functions
of given energies. KI Yin stores the genetic essence that produces the
brain "marrow." The relationship of the internal organs to
the sensory organs is more complex than presented in texts. Tinnitus,
as an example, can relate to LR, KI, or LU, depending on the sound involved.
KI Yin is always the foundation of functional integrity for all sensory
awareness and mediates learning, growth, and culture that our knowledge
of the past relies on. It relates to understanding of human limitations;
imbalance can involve megalomania. People with KI Yin balance are realistic
and rational, with a quest for the common good. KI Yin energy gives
life, but is needed for a productive transition to the hereafter. KI
Yang gives force to the "life-force"; it can be called Fire
of Ming Men. Without it, the body is sluggish, and motivation and willpower
are lacking. It is needed for involvement with the future, by allowing
collation of available information to approximate future trends. It
can be involved as a defense against future "insults," leading
to paranoia. KI Yang and LU maintain homeostasis of electrolytes in
the body. KI Yang also is involved in going beyond material essence
to Divine Awareness and intuitive wisdom, exercising creative intelligence
with HT energies. KI Qi goes into potential unconscious intelligence,
the realm of water. Healthy ego also lies in the KI Qi domain, as well
as awe, reverence, humility, universal values, acceptance, and faith.
Disharmonies and their psychological effects for these aspects of KI
energy are discussed at length. The BL is "Minister of Education,"
supervising the archives of memory; together with KI, Minister of Energy,
they give power, drive, and will.
Dr Hammer continues his discussion of KI, noting the inseparability of Yin and Yang and the KI as foundation of the Root of the body. This Root appears to be lost at younger and younger ages over the past 40 years due to stress, poor nourishment, pollution, and possibly, artificial birthing methods. He gives a fine discussion of the pulse, noting the right proximal deep position association with KI Yang and Yin at the deep left, but some aspect of both at either position. Feeble to absent pulses or changing intensity in all but the aged are associated with constitutional deficiency and a tight quality to postpartum etiologies. Patients with left pulse showing a constitutional deficiency can often be relieved of guilt by understanding they do not have the innate strength to do things they have been pushed at times to do. In acute pelvic disorders, these pulses will take on a flooding excess, slippery, or tight and rapid aspect. Relationship to the Triple Warmer or Burner is well discussed. TW integrates the 3 brain levels fundamental to mental equilibrium, and TW 3 is the controlling point for the sensory organs, especially eyes and ears. TW and KI must coincide to allow integration of all parts of the personality and the exterior world. TW-deficient persons are unbalanced with wide variations in performance, personal relations, and perceptions. Involvement of KI in Wei Qi and metabolism is covered, as well as the relation to endocrine, storage, sexual function, and hemopoiesis. Psychological problems related to KI energies are again discussed at length. Separation of KI Yang and Yin, the author believes, represents a most profound insult, and is associated with pernicious chronic disease, especially degenerative central nervous system and autoimmune disorders.
Mr Dale reviews
the development, systems, theory, clinical uses, and holograms of microacupuncture.
Every part of the body can function as an energetic reflection of the
body as a whole, both diagnostically and therapeutically. The Front
Mu points and back Shu are an early microsystem. Each of the 12 Mu-Shu
levels defines a torso reflex zone. The tongue and radial pulses function
classically as diagnostic microsystems. Anatomy, as well as Sheng and
Ke cycle 5-element phases, can be reflected in pulses. The ear microsystem
developed first by Nogier is discussed at length. A table outlines 42
microsystems and is accompanied by 13 pages of sketches of the holograms
involved in each system. Details of each system, from scalp, face, and
nose, to foot and hand, are discussed. Sometimes 2 or more holograms
can exist for 1 body part, as with Nogier's 3 phases and a Chinese system
for the ear. There is also the Fitzgerald-Ingham foot and hand system
contrasted with Yoo's Korean Koryo Chim hand approach that is very detailed
and exacting in use. A US and German tooth system coincide. A metacarpal
linear system (Zhang Ying-Qing) was proposed as embryo containing the
information of the whole organism. It is proposed that every long bone
of the body might contain this 12-point system.
Based on "a
critical review of 1,000 articles," the author concludes that blood
vessels and their associated sympathetic nerves, using the hypothalamus
as the highest center, form the material basis for the acupuncture energetic
channels. Acupuncture needling initiates a reaction involving the physiological
stress system. Yuan proposes a new classification of points: those of
cutaneous nerves, vascular nerves, mixed nerves, lymphatic vessel nerves,
pressure and pain sensitive points, and ordinary points without structural
features. Correlation of points with organs is best explained by peripheral
blood vessel sympathetic nerves with organ sympathetics. Reinforcement
and reduction approaches to needling should be restated in terms of
excitation and inhibition of nervous system response. Use can be made
of local reflexes, systemic activation of the sympathoadrenal system,
and activation of central endorphinergic and serotinergic systems. A
review of articles also indicates that combining acupuncture with moxibustion
is preferred due to the complexity of channels and points.
The author provides a concentrated overview and tables of Shu points, source points, connecting points, back Shu, Front Mu, cleft points, and Eight Influential Points, as well as Eight Confluence Points and Lower Confluence for the Six Fu Organs.
Appendicitis
can be nontypical in symptom and sign presentation. Lanwei pressing
(a point located 2 cun below ST 36) demonstrated local tenderness greater
on the right side when pressed with the thumb Diji point (SP 8) on the
right, and also tends to be more tender than the left; 200 cases were
correctly diagnosed by adding this technique.
Twenty cases
of acute and 10 of chronic appendicitis were treated with auricular
acupuncture using points Erjian, Lanwei, Shenmen, and adjunct points
SP, ST, and Sympathetic. Needles were retained 20-30 minutes twice daily,
needling each ear in turn. Erjian was bled 2-3 drops. Vaccaria seed
pressure could also be used in chronic cases. Seventeen of the 20 acute
and 5 of the 10 chronic cases resolved "rather satisfactory"
without surgery. Needling can have an antibacterial and inflammation-relieving
effect. Most patients find relief of symptoms after 3-5 sessions, with
good therapeutic effect after 10 days. Complications of surgery are
generally avoided. It is rare to see periappendiceal abscess when acupuncture
is used.
Twenty-nine
men and 7 women aged 19-77 years were referred by ophthalmologists.
Paralysis duration was 3 days to 6 months; 31 resulted from injury,
4 due to peripheral neuritis, and 1 by cerebrovascular accident. A number
of points around the eye were needled, coinciding with the involved
muscle position. In addition, big energetic points GB 20, LI 4, LR 3, ST 36, and SP 6 were used as adjuncts; 1-2 main eye
points and 2-3 adjunct were used for each daily session. Up to 3 courses
of 10 days each were used. Twenty-two of 36 were cured of all double
vision and had normal eye muscle use. Those seen within 5 days did much
better (17/20 cures). Only 2 of 9 seen 2-6 months after onset were cured.
Erjian, on the
tip of the ear helix when the auricle is folded, is bled 4-5 drops as
a treatment for hordeolum. Forty-three cases without abscess when seen
were cured, 36 after only 1 treatment, and 7 after 2. Twelve of 13 with
abscess drained and were healed after 1-2 sessions.
Point penetration
technique inserts a needle in 1 point to reach a second point. It was
often described in verse in early Chinese texts to be memorized by those
who could not read: "For deviation of the mouth and eye, on Dicang-Jiache
(ST 4-ST 6) rely." Moving from a Yang to a Yin point might induce
Yin energy for a chronic disease state. It increases the efficiency
of relaying Qi and dredging channels. It reduces the number of needles
used to save Wei Qi, and helps circumvent needle phobia. Go upstream
for disease reducing and downstream for Qi replenishing. Exterior-interior
points can be penetrated with the needle advanced until pushing up of
skin is seen, but not to penetration. Prescriptions for common conditions
are given (TE 5 to PC 6 for stiff neck or exogenous attack, or the opposite
direction for cardiac disorder or chest pain). Surrounding the perimeter
of a lesion with needles aimed centrally is a penetration device for
local problems such as shoulder pain, bruises, etc. Case histories are
given. The authors have used this approach to eliminate thecal wrist
cyst in 7 cases, avoiding surgery. A final caveat is given to avoid
large vessels in needle transition.
Some eye disorders involve the nervous system such as retinitis pigmentosa, Usher syndrome, and amblyopia. Enzyme disorders of the cytochrome oxidase system have been reported. An electroacupuncture therapy was designed to produce visual improvement through metabolic rebalance. No adverse reactions have been recorded, and a positive result has been achieved even in disorders previously thought irreversible. Dr Reinhold Voll of Berlin described the treatment in 1954, applying electrodes to the skin instead of using needles. The author favors auricular acupuncture adding body points. A long table is supplied of ear, body, and hand points that he uses. They are stimulated in an order with 5 seconds given each point during a 15-minute session, 4-5 days weekly for 3 weeks. The Pointmaster Plus (Reimers and Jansen GmbH, Berlin, Germany) with intermittent stimulation at 3.6 V, 10 mA, and 10 Hz was used. Improvement lasts 10-12 months; booster sessions are generally needed to maintain the effect. Forty-four case histories are given. Most of the patients at onset could be defined as legally blind. He also admits to failures but feels the number improving provides credence to the therapy.
Developing a
protocol allows researchers to focus systematically on every aspect
of a study. The attempt is made to avoid confounders, bias, and error.
A specific research question should be clearly defined. No guidelines
cover all circumstances but general principles should be applicable.
The title should express the question to be studied and give the essential
method. The introduction should detail the need for the research, provide
relevant literature items, and introduce the condition, its frequency,
and clinical or economic importance. A reasonable expectation that acupuncture
will help clients, but insufficient evidence that it definitely does,
allows use of a control group. Avoid baseless supposition. Efficacy
is the extent that acupuncture produces benefit under ideal conditions,
and effectiveness is a measure of its success in an average clinical
environment. The design can have various levels of blinding. Details
of recruitment and screening of subjects is important. A good definition
of the condition to be studied should be provided. Inclusion and exclusion
criteria must be set in advance, and a time schedule should be established.
Calculation of necessary sample size is too often neglected. P, the
statistical threshold for significance, is usually set at .05, and a,
the probability of missing an important difference (type II error),
is .20 or 80% power.
Evidence-based medicine relies on findings from clinical trials and their systematic review. A pyramid exists, working from top to bottom, with systematic reviews of randomized controlled trials (RCTs), controlled trials, and uncontrolled data (case reports). Many treatments in medicine have historically been deemed effective on the basis of uncontrolled data, only to be disproved later. The author pleads for randomization and controlled trials with independent validation. The Cochrane Collaboration, which is devoted to systematic reviews, including CAM, is discussed. The author notes data for acupuncture effect is conclusively positive for dental pain, low back pain, migraine, and nausea, and inconclusive in numerous others.
A stratified
sampling was done of Chinese medical journals prior to 1997 by 8 trained,
advanced medical students who sought RCTs. Ten times as many appeared
in the Chinese Journal of Integrated Traditional and Western Medicine
as in other journals, and the quality was higher. Randomized controlled
trials (2,938) were identified in 28 selected journals beginning in
the early 1980s. The number of such trials has doubled every 2 to 3
years. Journals of conventional medicine in China published a quarter
as many RCT trials of acupuncture as TCM journals (almost 10,000 RCTs
prior to 1997); 90% of trials involved herbal therapy. Problems included
poorly described randomizing process, lack of blinding, and small sample
sizes.
Dantian refers
to the center below the umbilicus where the mind concentrates in QiGong.
It is also a 3-point concept: lower as described, middle at the xiphoid,
and upper between the eyebrows. The lower was most important historically
as the center where life conception was stored. Moxibustion can be important
at the lower (Ren 8 to 3) for Qi deficiency (lassitude, trouble with
voice and breathing, pale tongue), prostration, blood, Jing, and marrow
deficiency, sudden HT Yang collapse, Middle Jiao disorders, SP Yang
deficiency, Chong and Ren deficiency, and lack of KI Yang.
Microwave resonance
therapy (MRT) is a novel medical treatment affecting the appropriate
acupuncture points by high-frequency microwaves (52-78 GHz). It is effective
for many disorders of all body systems. Extremely low-intensity and
energy microwaves are used with negligible energy loss down the acupuncture
channels. If the acupuncture system is disordered, the sensory response
is greater, as though a normal system is already at ground state. The
acupuncture system with microwave (MW) acts as an oscillatory holographic
Hopfield-like neural network. The Chinese Yin-Yang concept of acupuncture
pictures a network of energy-information systems and is echoed by Indian
traditional medicine of Swara Yoga; Qi is termed Prana, and 14 meridians
are Nadis. Gap junction investigations in cell membranes at acupuncture
points and channels act to transport small ions, messengers, and metabolites
between cells, and act as communication points as do clefts between
neurons. Normal intercellular separation of 20 nm lowers to 3.5. Ionic
acupuncture currents and their electromagnetic fields have ultra-low
frequency and MW components. The resonance ultra-low frequency stimulation
of acupuncture points at 4 Hz stimulates endorphins and at 200 Hz, serotonin
or norepinephrine. The efficiency of Ukrainian-Russian therapy gives
evidence for the MW involvement from approximately 30-300 GHz. The application
of MW to acupuncture points was elicited in the 1980s by Kiev scientists.
At present, more than 500,000 patients have been treated at 1500 centers.
Low energy, below the thermal body noise effect, is used.
Members of the largest Swiss health insurance group (N=670,000) were given orthodox medical care only, and a subgroup of 7,500 were given added CAM coverage at a 90% reimbursement level. Two years were studied. There was greater use of CAM modalities by the covered group, but no economically compensating decrease in conventional medical use was seen. No empirical support was demonstrated for the claim that CAM reduces health costs. The frequency of use of CAM by both groups, however, was much lower than expected (6.6% vs 4.8%). PART II - PAIN-related articles
Acupuncture is now used by about 5% of general practitioners in the UK health service, usually in a westernized method that hypothetically works on nerve endings. Needling is brief and success rates around 70% are common. Thirty-two patients with neck pain for between 24 hours and 3 months were consecutively recruited by 8 general practitioners; 25 had brief periosteal pecking in the cervical pillar area (as described by Mann in Reinventing Acupuncture), 5 with trapezius or occipital points added. In 4, named acupuncture points were needled, and in 1, a tender muscle; 100% of 9 with pain for fewer than 4 days, 67% with pain to 2 weeks, and 45% with pain for longer responded with 1 treatment. Up to 6 treatments were given to a few patients. Pain scores in 3 months showed only 3 of 32 no better, 4 slightly better, and 22 much better (the best score possible on the questionnaire used). The lack of control, the authors note, is a research problem. The ease and quickness of therapy is a plus.
Frozen shoulder
can result from trauma, disk degeneration, overuse, psychological factors,
and rare other causes. It usually occurs in persons older than 50 years.
Range of motion is restricted, usually above 50%, and there may be signs
of fibrositis in surrounding muscle and a diffuse tenderness in the
rotator cuff. Early diagnosis is important, as is a good physician-patient
relationship because patients may develop accompanying anxiety and depression.
Arthroscopic surgery might be indicated, and steroid injection is common
with the risk of tendon rupture. Acupuncture can be useful, but takes
several 30-minute sessions and should be considered ineffective if there
is no change in 6 sessions. Ashi or trigger points around the shoulder
should be carefully sought and needled superficially; ST 38 with strong
manipulation is useful. DeQi should be sought in the robust patient,
with less stimulus in the weak. Electroacupuncture at LI 11 and 15,
GB 21, and SI 9 at 5 Hz helps; GB 34 bilaterally for 2 minutes alone
often controls pain and releases stiffness. Auricular therapy at Shenmen,
shoulder, shoulder joint, clavicle, and adrenal points is helpful (illustrated
in the article). The patient should exercise faithfully with a slow
warm-up.
Migraine can
be divided into 7 types (provided in a table). Vascular factors include
unmyelinated C fibers from the trigeminal ganglion and upper cervical
roots to vessels of brain, meninges, and venous sinuses. They convey
noxious information to the brainstem subnucleus caudalis (medullary
dorsal horn). A neurogenic sterile inflammatory reaction might be at
fault. Activated afferents release calcitonin gene-related peptide,
substance P, and neurokinin A, dilating vessels and leaking fluid, and
protein locally. There is a unilateral cerebral blood flow decrease
initially followed by hyperperfusion, head and neck myofascial tension,
and tenderness between attacks, often with discrete tender focal points.
Emotional factors (limbic system overactivity) precipitate attacks in
up to 70%. Myofascial predominates in tension-type headaches. Increased
serotonin, especially in midbrain dorsal raphe nucleus, might relate
to headache and conversely, intravenous infusion of serotonin might
alleviate it, possibly by inhibiting output in the central brain. Sixty
percent of women with migraine have episodes near menstrual periods,
and estrogen withdrawal plays a role. Some foods trigger migraine (a
list is given). If emotional factors are strong, self-hypnosis can be
used frequently for relaxation. The use of medications as well as acupuncture
is discussed. Acupuncture (literature is discussed) involves gentle,
brief, superficial needling of neck, head, and shoulder Ashi points
with GB 20, 21, and distal LR 3 and LI 4. Other points are used in TCM
approaches. In tension headaches, pain referral points are pictured
in this article for head, forehead, sternocleidomastoid, temporalis,
and trapezius regions.
Patients aged
18 to older than 55 years had migraine symptoms for 6 months to 25 years.
The etiology was deemed vascular in 71, from sinus and nose in 17, and
12 due to trigeminal neuralgia. A point 4.5 cun lateral to midline and
parallel to the inferior border of the third thoracic vertebra was punctured
on the affected side. The needle was twirled 300 times/min. The puncture
was squeezed and cupped. After 1-3 treatments, 57 patients had no headaches
for 3 months; 26 were markedly improved.
The validity of the placebo was tested and found adequate; 19 acupuncture-treated and 20 placebo-treated patients were studied. Mean pain-free time was significantly longer with acupuncture (173 minutes) than with placebo (94 minutes). Pain medication consumption was reduced. Outcomes were not associated with psychological factors. PART III
This study from Sweden randomized 104 patients in 3 hospitals to deep acupuncture at 10 points with electroacupuncture at 2 Hz to the paretic side, superficial 4-point acupuncture, or no acupuncture. Treatment was twice weekly for 4 weeks. Assessments were made periodically by 2 blinded researchers. There were no significant differences between groups for neurological score, Barthel Index and Sunnaas daily living scales, or Nottingham Health Profile.
One hundred
eighteen patients admitted within 10-14 days after stroke were randomized
to electroacupuncture treatment on the affected side at GB, ST, LI,
TE, SP, and LR points, or no extra treatment control groups. Acupuncture
was given 30 min/d, 5 d/wk with electroacupuncture sufficient to contract
muscles. Limb spasticity and functional independence were measured by
a nurse practitioner on entry and discharge. Improvement in both was
superior for the acupuncture group.
Russell J. Erickson,
MD
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