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Abstracts
of
Current Literature
Compiled by Russell J. Erickson, MD
1999 Acupuncture Literature Review
Part
I - VETERINARY
1. Xie HS, Wang Q-L. Application of acupuncture in the treatment
of race horses. Am J Acupuncture. 1991;19:59-62.
Case studies are presented from horses treated
in Japan. All had failed usual therapies. An 800-kg gelding, presenting
with severe muscle atrophy and a lame shoulder following a fall 11 months
before treatment, was needled 5 cm deep at 2 points described and received
electroacupuncture at 30-40 Hz, followed by "pneumo-acupuncture"
filling the subcutaneous tissues of the shoulder with air via a point
over the spine of the scapula. The effect was dramatic after 1 treatment
and he appeared normal after 12 days. A 12-year-old mare was lame with
a carpal joint injury. Three points (described) were given laser acupuncture,
followed by injection of procaine in 1 point. The horse recovered and
won a second place in jumping 3 days later. A 12-year-old gelding had
a forelimb flexor tendon swollen 4 times larger than normal with lameness.
Alcohol flame was applied carefully over the tendon for 40 minutes (described).
Symptoms gradually decreased from the 5th day after treatment, resolving
19 days later. Bleeding acupuncture to 2 points was used for another
animal with a swollen leg with good effect. Veterinary acupuncture anesthesia
has been used for more than 40 types of operations in animals. The authors
used 2 sets of points (described) to anesthetize a horse for abdominal
surgery via electroacupuncture at 200-300 Hz. A 16-minute induction
was followed by painless surgery except for initial skin incision. Pulse
and heart rate remained normal and the horse ate after surgery.
Part
II - GASTROINTESTINAL / GENITOURINARY
1. Teppone M. Therapeutic effect of EHF-puncture on gastric polyps:
clinical analysis of eleven cases. Am J Acupuncture. 1991;19:11-16.
Extremely high frequency (low power level, non-thermal
electromagnetic waves) treatment was used. Eleven patients, 44 to 63
years, with polyps for 6 months to 4 years (diagnosed with gastroscopic
evidence) were treated. Seven had single polyps, and 4 had 3 or more
polyps, the largest being 2.5 cm. SP 3 and ST 40 were treated, with
SP 4 later in some, and SP 2 and BL 40 tonified in all. An electromagnetic
radiation generator set in the range of 53-78 GHz was used (power not
>0.1 mW). Reinforcement was a 2-5 minute course, until the first
sensation. Points reduced were treated 20-25 minutes until sensation
had disappeared. Treatment was once weekly for 1 to 4 months. Four had
polyps disappear and all but 1 reduced in size from 1/3 to 1/2.
Comment: Included to remind us that Eastern
Europe and Russia are doing much energetic work with different devices.
Part
III - PAIN
1. Lindall S. Is acupuncture for pain relief in general practice
cost-effective? Acupuncture Med. 1999;17:97-100.
Sixty-five patients with pain, mainly musculoskeletal,
were offered acupuncture. Most had little relief from usual medical
therapies and sought orthopedic referral, which was denoted as granted
should acupuncture fail. Trigger-point acupuncture was used, with some
distal points (usually LI 4/LR 3). A visual analog scale of 0-10 (10
being normal) was used, and 7 or more set as a positive result of therapy.
The average response rating was 7.6. A table is given of savings, comparing
acupuncture cost with cost of referral to specialty care, plus 1 averted
knee surgery. The acupuncture cost of $10,943compared with an estimated
$26,783 in referral costs saved money. There were 46 successful therapies
and 14 failures. The author adds a cautionary word, as patients were
highly selected. Only those he believed from past experience might benefit
were offered this option. Acupuncture was a cost addition for the 14
who did not respond to acupuncture and went on to referral.
2. Ip VUY. The use of acupuncture for pain relief in a Chinese hospital
clinic. Acupuncture Med. 1999;17: 101-109.
The author took a 6-week medical school teaching
elective in Tianjin. The TCM hospital there has been awarded national
prizes for its good results and expertise; it has trained students from
40 countries. Therapy "is based on holistic patterns, causal relationships,
non-linear logic, non-reductionist views, and empirical evidence."
The author studied outcomes using a visual analog scale from 0-5 for
45 patients with pain in various areas. Pain level fell from an average
of 2.5 to 1. Most patients were of middle to upper class socioeconomic
status, as acupuncture expense cannot be afforded by those with lower
incomes. Patients might have been biased by emotional need to experience
acupuncture positively. A sterility problem was noted in a country with
a high level of hepatitis B. Disposable needles were not used, and needles
were cleaned simply by soaking in alcohol for 4 hours. Local people
seek the TCM treatment for chronic illnesses, believing that standard
(Westernized) medicine does not seek the root of the problem.
Comment: A folksy article, more a picture
of life in a TCM hospital clinic than objective data regarding results
of therapy.
3. Li Y, Peng C. Treatment of 86 cases of facial spasm by acupuncture
and pressure on otopoints. J Tradit Chin Med. 2000;20:33-35.
Eighty-six patients were put in a combined group;
38 had acupuncture only, and 40 had only pressure on otopoints. The
groups were similar in age, sex, and disease condition. Muscle tics
had developed to include all muscle groups on one side of the face.
Local facial points involving the tic areas of the ST, TE, SI, and LI
meridians, plus Yintang were used. Three treatment courses of 10 days
separated by 5-day rests were given, 20 minutes daily with stimulation
to tolerance. Otopoints included Shenmen, KI, GB, LR, brain, cheek,
eye, and mouth, alternating sides with vaccaria seed pressure. Thirty-eight
percent of the combination group was cured, with no relapse for 1 year,
16% of the acupuncture group, and 5% of the otopoint-only group had
the same outcome.
Twenty-six
percent, 39%, and 45%, respectively, were improved. Routine treatment
with anticonvulsants or block often showed relapses in a short time,
unlike the treatment with acupuncture.
Comment: Results are important, but again,
to emulate Chinese data, we will have to develop ways to involve group
efficiency, enabling more treatments at less cost. Three tables are
given; therapeutic results, comparison of total effective rates, and
comparison of cure rates do not match well in this article.
4. Watkin H. Segmental dysfunction. Acupuncture Med. 1999;17:118-123.
Segmental dysfunction is impaired or altered
function of skeletal, arthrodial, and myofascial structures related
to the level, with vascular, neurological, and lymphatic components.
A problem in the function of a spinal segment can cause symptoms without
obvious physical pathology. Physical and/or emotional stress as well
as visceral disease can produce a reaction at the dysfunctional segment
more easily than at normal ones. Segmental acupuncture is well accepted
by some experts and is detailed in the text Medical Acupuncture, A Western
Scientific Approach. Pain could be caused by dysfunction of an innervating
segment (as heel pain could result from L5-S1 dysfunction). Such etiology
should be sought, especially where no evidence of local pathology can
be detected. Detecting the correct segment necessitates keen palpatory
skill. Tenderness, asymmetry, range of joint motion, and tissue texture
abnormality must be sought. Sympathetic activity can be mapped. These
modes of approach are discussed. The root cause can be trauma or even
microtraumas. Faulty movement patterns or even visceral disease can
increase the ultimate effect. Secondary segmental dysfunction can occur,
just as secondary trigger points result from primary ones. Animal experiments
show that dorsal root damage produces a sustained discharge only when
there is pre-existing minor chronic injury. Local released acetylcholine
causes muscle spasm in the area sensitized to the compound. This occurs
in a segmental pattern. Other life factors can alter pain perception.
"Convergence-facilitation" is discussed. Noxious input leads
to substance P and calcitonin gene-related peptide, activating N-methyl
D-aspartate in the dorsal horn, inducing potentiation where a stimulus
response can rise to 20 times normal. Abnormal discharge can subside
in the spine but remain in the thalamus (phantom pain). Long-term segmental
dysfunction can thus become a response to a central nervous system pattern.
Two illustrative cases are presented. The author ends by stating this
is a rich field for research.
Part
IV - OBSTETRICS
1. Rempp C, Bigler
A. Pregnancy and acupuncture from conception to postpartum. Am J Acupuncture.
1991;19: 305-314.
Experience in France with more than 1000 patients
and 800 deliveries is reported. Caution: do not do anything that might
trigger a powerful downward energy movement or disrupt Qi balance to
threaten the pregnancy. Acupuncture can help the pregnancy by restoring
or maintaining energy balance and is less threatening than drug therapies.
Weakness and Qi or blood deficiency are responsible for most delivery
problems. Seek KI, SP-ST weakness or LR Qi stagnation problems and history
(symptoms are given for each). KI 9 is always prescribed for pregnant
women as it is said to block adverse hereditary patterns. Needle it
at the end of the 1st and 2nd trimesters. The article describes approaches
for morning sickness, edema, sciatica, abdominal pain, low back pain,
risk of premature delivery, breech presentation, delivery, postpartum
pain, urinary retention, lactation deficiency, and postpartum depression.
Comment: This appears a very useful compendium
for obstetrician/gynecologists and delivering family practitioner members,
based on the vast experience of 2 physicians from France.
Part
V - PEDIATRIC
1. Filipowicz WA. The application of modern acupuncture techniques
and methods on children with cerebral palsy. Am J Acupuncture. 1991;19:5-10.
(Poland)
Sixty-five children from 40 days to 7 years
of age with cerebral palsy (CP) were treated with needle and laser acupuncture
over a 5-year period. Those with metabolic disorders were excluded.
Fifty-seven percent had spastic problems, 24% were dyskinetic, and 8%
hypotonic, with the rest mixed. Acupressure massage was briefly used
daily. Up to age 2 years and for uncooperative patients, laser was used.
For other children, a combination of laser and needling was given. Head
acupuncture alternated with body treatment. Major (Helm's "big
points") were used varying with the condition; KI 1 with laser
appeared to calm most children. Initial treatment was for 4 months,
10-15 days and a 5-day break, then once to twice weekly with breaks
over a 5-year period. Ninety-four percent showed considerable improvement.
Contracted tendons appeared to respond quickly to laser acupuncture.
Treatment in younger children early in the course gave better resolution
of muscle spasms.
Comment: A randomized controlled study
is needed, especially when contemplating such a long and expensive treatment.
Prior studies from China and Eastern Europe have also indicated notable
benefit for children with CP.
Part
VI - DERMATOLOGY
1. Rosted P. A protocol for successful treatment of chronic skin
diseases. Am J Acupuncture. 1992;20:321-326.
The author waits 3-6 months before assessing
the long-term result of therapy for skin conditions due to common fluctuations.
Skin conditions always have an element of stress, so LR 3 and GV 20
points with Sishencong are used for the first 2 treatments. Then LU
7 and LI 4 are added (unless the first 2 treatments alone give marked
effect). When the psoriasis, eczema, etc., improves (usually after 4
treatments), treatment is reduced to LR 3, LU 7, and LI 4. If there
is no improvement, ear LU and Adrenal points are added. If then it does
not improve or flares, all points continue to be used once weekly to
10 treatments. Reinforcing treatments are used after improvement, tapering
to once monthly for a total of 4-8 months. Laser is used only in children.
Four cases are illustrated: psoriasis, pruritus, acne, and eczema.
Part
VII - NEUROLOGY
1. Cantera B, Mendoza C, Hernandez I, Loynaz C, Alvarez O. EEG study
on acupuncture treatment preceding induced epileptic seizures. Am J
Acupuncture. 1992;20:43-46. (Cuba)
Over 8 years, the authors adapted classic points
for treating epilepsy. Here, a study of 30 rats: a control, LI 4 treatment,
and GV 20 were instituted after electrode implantation to enable induced
seizures. There was a significant decrease in electroencephalographic
spikes in both acupuncture groups, and time elapsed from stimulation
to discharge was longer.
2. Yamamoto T, Ishiko N. The effect of scalp acupuncture on the weight-lifting
capacity of the healthy and paralyzed lower limb. Am J Acupuncture.
1992;20 47-54.
The Yamamoto New Scalp Acupuncture system consists
of 23 scalp points divided into 7 kinetic, 4 sensory, and 12 internal
organ points. The use of D point was found more effective for lower
limb paralysis than traditional Chinese motor scalp points. In this
study, ankle movement against a weight was measured before, during,
and 10 minutes after needling point D (frontal area at the anterior
hairline in a line with the canthal eye fold and ear top). There was
an immediate increase in load lifting ability in 54% of patients. The
effect was less marked as elapsed time from the stroke increased.
Part
VIII - MISCELLANEOUS
1. Lu DP, Lu GP. Clinical management of needle-phobia patients requiring
acupuncture therapy. Acupunct Electrother Res. 1999;24:189-201.
Synergy exists between hypnosis and acupuncture.
Fear of needles in patients who could otherwise benefit from acupuncture
can cause avoidance, syncope, needle adherence due to muscle spasm and
movement, and stress with epinephrine release, possibly preventing a
good result. Fourteen needle-phobic patients had sessions of acupuncture
alone and hypnosis alone, followed by combined therapy. Needles could
be inserted during trance without reaction or awareness. Hypnotized
patients with or without needling were much more relaxed. The most pain
relief occurred with combined therapy where healing suggestion was given,
followed by combined therapy without such suggestion. The disadvantage
of this therapy is the time involved and need for personnel trained
in hypnotherapy.
2. Dong Q, Dong X, Xian M, Zhang S, Xianlong Zheng X. Antipyretic
action of moxibustion and its relation with acupoint receptors. World
J Acupuncture Moxibustion. 2000;10:31-35.
In this study, rabbits were randomly divided
into 4 groups: saline control, endotoxin, endotoxin plus 40º moxibustion,
and endotoxin plus 47º moxibustion. Moxibustion was by controlled
projector light heat, applied to GV 14 and 20. There was a febrile response
to endotoxin that tapered over 4-5 hours. The response was notably less
in the 47º moxibustion group, but not in the 40º group. The
authors surmise that warm receptors are activated at 40º and do
not provide an antifebrile response, while polymodal receptors activated
at 47º do.
Comment: This study might have added
moxa. Some acupuncturists feel strongly that moxa has benefits beyond
the heat process alone. If the authors are correct, even moxa should
be administered carefully but to the point of local irritation from
overheating for best effect in the unresponsive hyperpyrexic state.
3. Fan Y, Yang Z. Acupuncture treatment of side effects of chemotherapy.
Int J Clin Acupuncture. 2000;11:23-26.
Four articles are cited that added acupuncture
for patients receiving chemotherapy. All demonstrated a smaller decrease
in white blood cells, hemoglobin, and platelets. The effect was enhanced
in 1 study in which acupuncture was given daily for 5 days prior to
chemotherapy. One group found that low CD4/CD8 cell levels in patients
with cancer could be elevated by acupuncture therapy. A significant
increase in natural killer cell activity occurred in another study.
Values of cortisol, estradiol, and testosterone were elevated by acupuncture
treatment. Moxibustion to RN 4, 8, and ST 36 suppressed gastrointestinal
reactions to chemotherapy. Moxibustion to GV 14, back Shu points, ST
36, and SP 6 have demonstrated elevation of hematology factors in several
studies. One study demonstrated that auricular acupuncture relieved
gastrointestinal distress better than medication. The authors asserted
that chemotherapy tends to harm resistance and lower immunity. It is
important to add acupuncture and moxibustion to counteract this.
Comment: A brief review of articles from
China otherwise not likely read. Dr Gayle O'Duffy wrote an exacting
and superb article on her experience with acupuncture and chemotherapy,
relating specific point use with individual chemotherapy drug combinations
(N Z J Acupuncture. 1998;16-25).
4. Wu Z, Wang H. Sjogren's syndrome treated by regulating Sanjiao.
Int J Clin Acupuncture. 2000;11:39-42.
Sjogren's syndrome, with dry mouth, eyes, and
other organs, is a chronic autoimmune disease. Traditional Chinese Medicine
(TCM) links it to deficiency of body fluid and exhaustion of Yin and
blood. Detail of the symptoms, diagnosis, and TCM factors is given.
Sanjiao is the water passage point, and points along this meridian are
selected along with LU and local points. If there are signs of heat,
GV 14, LI 4, and LU 11 are added. For dry mouth and nose, RN 12, ST,
and SP points are added. If the lower Jiao is involved (bladder, genitals),
KI, BL, ST, and LI points become important. The authors "have had
good fortune" treating with acupuncture, and a typical case is
presented.
5. Zhao M, Liu Z, Su J. The time-effect relationship of central action
in acupuncture treatment for weight reduction. J Tradit Chin Med. 2000;
20:26-29.
In this study, rats were raised consuming high-fat
food, and those with body weight more than 20% above normal were chosen
as the obese model. They were divided into an acupuncture group (n =
6) and control group (n=7). A third group (n=8) received a normal grain
diet and was not obese. Electroacupuncture at ST 36 and 44 was given
for 12 days, alternating sides. The treated group dropped from 480 to
449 g, and the control went from 480 to 492 g. The normal controls went
from 401 to 421 g. The satiety center in the ventromedial hypothalamus
nucleus was studied by microelectrode. Discharge frequencies were about
12 Hz/s for non-obese controls, 23 Hz/s for the acupuncture group, and
5 Hz/s for obese controls. The study concluded that acupuncture can
increase the excitability of the satiety center in the brain.
Comment: The number of subjects used
is small, though differences appear significant. The possibility of
weight loss due to handling and needle trauma is not excluded by the
study design. A fourth group with equal handling and needling in non-acupuncture
spots is needed.
6. Tang JL, Zhan S-Y, Ernst E. Review of randomized controlled trials
of traditional Chinese medicine. BMJ. 1999; 319:160-161. Reviewed by
T.J. Kaptchuk in: FACT. 2000;5:26-27.
A sampling of 28 of 100 Chinese journals up
to 1996 revealed 2,938 randomized controlled trials (RCTs) reported.
This led to an estimate of 7,500 RCTs in TCM journals with a quarter
as many in conventional journals. Many methodological problems were
found. Often, RCTs compared treatment with other TCM treatments that
had not been evaluated objectively. Small sample sizes and other problems
were common. The quality of Chinese medicine trials must be improved
if research is to be done in Asia and deemed credible in the West. About
90% of studies investigated herbal therapies.
7. Lao L, Bergman S, Hamilton GR, Langenberg P, Berman B. Evaluation
of acupuncture for pain control after oral surgery: a placebo-controlled
trial. Arch Otolaryngol Head Neck Surg. 1999;125:567-572. Reviewed by
A.R. White in: FACT. 2000;5:17-18.
Acupuncture was given ipsilaterally for dental
extraction. A sham approach was given by tapping a plastic tube on a
bony area, tapping a needle to skin, and stimulating with a dental probe
near the needle. Validity of placebo and psychological factors were
assessed. Pain was less in the acupuncture group (P<.01). The sham
appeared valid. Eighty percent still registered moderate pain within
3 hours with acupuncture, and 70% required analgesics within 5 hours.
Acupuncture was more effective given prior to pain onset.
8. Ruedy J, Kaufman
DM, MacLeod H, Alternative and complementary medicine in Canadian medical
schools: a survey. CMAJ. 1999;160:816-817. Reviewed by A. Best in: FACT.
2000;5: 13-14.
Thirteen medical schools (81%) now offer complementary
and alternative medicine (CAM) education. Faculty and student interest
is high (>80%). Curricula content includes acupuncture in 77%. Only
2 schools provided specific instruction in CAM techniques.
9. Chen J, Chen M, Zhao B, Wang Y. Effects of acupuncture on the
immunological functions in hepatitis B virus carriers. J Tradit Chin
Med. 1999;19: 268-272.
Thirty control patients receiving B and C vitamins
with inosine, 30 receiving manual acupuncture at ST 36, and 30 receiving
electroacupuncture at 4 Hz at ST 36 were compared. All were treated
for 60 days. Hepatitis B surface antigen levels decreased from an average
of 40 to 30 ng/mL with manual acupuncture, and 39 to 21 ng/mL with electroacupuncture.
There was no decrease in untreated controls. IgG and C3 were elevated
by acupuncture treatment. A number of other parameters were studied
with lesser changes shown. Acupuncture appeared to enhance humoral immunity.
10. Guan Z. Tongue acupuncture part 1. Int J Clin Acupuncture. 2000;11:31-36.
"The tongue is the body opening of the
heart as well as the outer sign of the spleen." It has connections
with the whole body and can be needled to treat systemic diseases. A
purplish tongue indicates LR and GB problems; yellowish, SP and ST;
reddish, HT and SI; whitish, LU and LI; and blackish, KI and BL. Fissures
and ulcers indicate excess heat in HT or SI, curling terminal LR exhaustion,
stiffness and swelling excess heat in SP and ST, protrusion and tenseness
involvement of KI. LU difficulties can show minimal tongue signs. A
figure illustrates dorsal and ventral acupuncture points of the tongue.
Comment: More on therapy in the next
issue. This is an article aimed at those interested in more exotic or
ancillary therapy, or perhaps with specialties in otolaryngology or
dentistry.
11. Dong Q, Yang Z, Liu N, Chou Y. Clinical application of model
CLRH: an auricular point detector. World J Acupuncture Moxibustion.
1999;9:8-12.
This detector comes from the Nanjing Xiaosong
Institute of Medical Instruments. Statistics are given. Touching the
ear, a baseline is set at "Shangergen" point. Pressure must
then be consistent. Positive points found were compared with diagnoses
with a 77% correlation. Acupuncture done by the prior point-finding
method and compared with this point finder obtained a positive response
in 41 of 50 patients for the CLRH approach vs 11 controls. The instrument
is small, "simple, economical, and convenient."
Comment: An article advertisement, of possible interest to those specializing
in auricular therapy.
REVIEWED
BY
Dr Russell 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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