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Abstracts
Of Current Literature
Compiled by Russell J. Erickson, MD
1999 and 2000 Acupuncture Literature Review
Part
I - obstetrics & gynecology
1. Stener-Victorin E, Waldenstrom U, Tagnfors U, Lundeberg T, Lindstedt
G, Janson PO. Effects of electro-acupuncture on anovulation in women
with polycystic ovary syndrome. Acta Obstet Gynecol Scand. 2000;79:180-188.
Reviewed in: FACT. 2000;5:192-193.
A non-randomized longitudinal study of 24 women aged 24 to 40 years
with polycystic ovary syndrome (PCOS) and oligorrhea or amenorrhea.
Ten to 14 acupuncture treatments were given using a fixed regimen with
body and lower limb points. The outcome was measured by basal body temperature
showing ovulation during treatment and the following 3 months. Nine
of the 24 patients showed a good effect, 7 of whom did not respond to
clomiphene stimulation. The women with positive outcomes had a less
androgenic hormonal profile. The reviewer notes that results need confirming
with a
randomized comparative study using ovarian ultrasound. The study description
is reproducible, population clearly defined, and discussion of PCOS
excellent. The androgenic profile denoted in the article might explain
prior varied acupuncture results for this condition. "Sometimes
a good case series can be more helpful than a poorly performed randomized
trial."
2. Tukmachi
E. Treatment of hot flushes in breast cancer patients with acupuncture.
Acupuncture Med. 2000;18:22-27.
An excellent symptom review is given in this article. Twenty-two consecutive
breast cancer patients unresponsive to other
therapies and referred by an oncologist for treatment of hot flushes
were treated with biweekly acupuncture for up to 7 weeks. Symptoms,
often severe, are caused by abrupt ovarian estrogen loss due to radiation
or chemotherapy. Hormone therapy is risky due to cancer. By TCM criteria,
symptoms are caused by LR Yin deficiency, and KI water exhaustion; HT
and SP dysfunction can be involved. BL 62, LR 14, KI 3, HT 7, and TE
6 are given as specific points; SP 6, LI 11, and ST 36 as homeostatic
points; and GV 20 and LI 4 as sedative points. The rationale is provided.
Between 6 and 10 points were needled each session for 6 to 14 sessions,
8 being maximum without a response. The number of hot flushes declined
from 13 per day and 10 per night to 1 or 2 each time period and remained
low on 3- to 5-week follow-up.
Comment: The author states that the study is uncontrolled, and
that therapy by acupuncture should be further investigated. However,
the results are spectacular and as previously stated, a carefully denoted
series of case studies can be as effective as a controlled study.
3. Cumins SM, Brunt AM. Does acupuncture influence the vasomotor
symptoms experienced by breast cancer patients taking tamoxifen? Acupuncture
Med. 2000;18:28.
This is an abstract of a paper presented in April 1998. Fifty patients
at a breast cancer clinic were surveyed. With tamoxifen therapy, 72%
had vasomotor symptoms. LI 4, LR 3, PC 6, ST 36, and SP 6 were needled
and symptom changes were noted by 3 outcome criteria using a 4-point
scale. Nineteen of 21 remaining in the study responded
satisfactorily.
4. Qi-cai W. Prohibition of acupuncture during menstruation. Int
J Clin Acupuncture. 2000;11:319-320.
Menstrual disorders can follow acupuncture treatment during menstruation.
Some points increase pelvic congestion and uterus contraction (such
as LI 4, SP 6, BL 31-34, GB 21) and are especially contraindicated.
LR 3, BL 60, and 67 can cause uterine contraction. A Shanghai Hospital
found that stimulation of ST 25 caused uterine bleeding in 80% of cancer
patients. Menstrual disorders caused by acupuncture can also be countered
with acupuncture, using RN 4, BL 17, SP 6, and ST 36. A number of adjunct
points for varied symptoms are given.
Part
II - neurology
1. Ren YE. Acupuncture in the treatment of hypertension and stroke.
Acupuncture Med. 2000;18:54-60.
This author reviews 13 hypertension and 14 stroke articles from English
and Chinese language publications retrieved from a database search (11
sites provided). These included 8 controlled studies. The author notes
that blinded studies for acupuncture are very difficult, patient preference
in a controlled study may be a factor in its success, and standardization
has its own weaknesses. Even the controlled and randomized studies had
many flaws. Only a few mentioned adverse effects. No evidence was found
from the controlled studies that acupuncture was better than sham acupuncture
or drug treatments. Case series acupuncture studies claimed effectiveness
in 6 of 7, but only 1 used statistical analysis. The author concludes
that acupuncture might be better than standard post-stroke therapy,
based on activities of daily living data. Further research is needed.
Comment: Here are 2 articles, 1 positive and the other guardedly
negative. We see a difference in belief based on a willingness to accept
some of the voluminous data coming from China and Japan; weak in Western
statistical approaches, but heavy in clinical material and case studies
with a very large "N." A good study is needed in the United
States and could easily be done, given the will and some financial backing.
If I am correct in believing acupuncture might reinstate a significant
portion of neurological loss, then we are doing many people and their
families a significant disservice by ignoring the Oriental experience
of many years. We are also wasting significant health care dollars.
2. Volf N. Somatosensory evoked potentials in the investigation of
auricular acupuncture points. Acupuncture Med. 2000; 18:2-9.
Somatosensory evoked potentials, discovered by Dawson in 1947, measure
middle cortical electrical response to stimulation of peripheral nerves.
Recordings were made on single points in 17 healthy, 4 post-stroke,
and 4 cholelithiasis patients. The experimental method is well detailed.
The somatosensory evoked potential for auricular wrist point (but not
for a nearby "sham" point) and that from the wrist median
nerve were similar. It is imperative to find the ear point exactly.
In post-stroke patients both the ear and wrist median nerve points were
altered dramatically. Direct stimulation of
the GB ear point and the T7 intercostal nerve provided similar somatosensory
evoked potential, but not a placebo ear
point. Both points were altered in patients with gallstones.
Comment: A clear-cut, objective approach to indicating that auricular
points might be real and related to their body parts. The author also
notes an interesting article (Cho ZH, Chung SC, Jone JP, et al. New
finding in the correlation between acupoints and corresponding brain
cortices using functional MRI. Proc Natl Acad Sci U S A. 1998;95:2670-2673).
That group found an activity correlation among points BL 60, 65, and
67, traditionally used for treating eye problems, and the occipital
brain area involved in vision.
3. Erickson RJ. Acupuncture therapy for stroke: approaches from the
acupuncture literature. Acupuncture Med. 2000; 18:48-53.
In China and Japan, acupuncture treatment for stroke is common and can
entail 20 to 60 sessions. It is given as soon after stroke as feasible,
waiting 2 weeks for hemorrhagic stroke since acupuncture has been shown
to dilate blood vessels, increase bloodflow, and decrease platelet aggregation.
A study from Scandinavia showed both clinical improvement and financial
savings when stroke patients were treated with acupuncture. Papers on
Xingnao Kaiqiao, a new technique from China, varied scalp acupuncture
approaches, and traditional body acupuncture approaches are summarized.
There are many in the literature demonstrating very favorable results
when acupuncture is added to post-stoke therapy. Body techniques include
primarily Yang meridian points, with some use of Yin, especially when
treatment has been greatly delayed, and a few papers emphasizing GV
and Jiaji points. Recent studies comparing Xingnao Kaiqiao with other
techniques purport to show the former as superior. Points used include
bilateral PC 6, GV 26, and on the affected side, SP 6, BL 40, HT 1,
LU 5, and sometimes LI 4 in that order, stimulated until the limb jerks
3 times. Some articles on basic science research providing data related
to the basis of acupuncture therapy success are reviewed.
4. Peng Y, Lingdi S, Shu-jing L. Treatment of decortical state of child
encephalitis with scalp acupuncture and the effects on EEG and BEAM.
J Tradit Chin Med. 2000;20:289-292.
Four patients with abnormal EEG (electroencephalogram) and BEAM (brain
electrical activity mapping) findings with decortical encephalitis were
needled in the scalp areas over locations of abnormal BEAM findings.
Continuous wave electrical stimulation was used, with high frequency
(150-200 Hz) where EEG waves were elevated and low frequency where decreased.
Daily 20-minute sessions were given. Two cases are described in detail
(possibly the authors' most successful?). Both stopped having convulsions
after the first session, and became conscious after 5 to 7. Their slow
recovery was fairly successful.
Part
III - pain
1. Zhu Y-W, Chen X-Y, Han H-S, Zhang Y. The influence of moxibustion
on immune function in the treatment of rheumatoid arthritis. Am J Acupuncture.
1991;19:315-318.
Eighty-two patients, aged 16 to 69, with arthritis (by American Rheumatism
Society standards) for 1 to 18 years (average, 6.3 years) were treated
with moxibustion applied over garlic mash and Myalbris-moschus powder.
This was applied from GV 14 to GV 2 with a snake trail of moxa burned
3 times. With this treatment the skin will be red and blistered. The
patient is advised to rest for 1 month. Hemoglobin increased in 65%
(to normal in 34%), the erythrocyte sedimentation rate decreased in
55% (to normal in 16%), IgG increased and IgM and IgA decreased remarkably,
and rheumatoid factor positivity went from 71% to 26%.
Comment: Perhaps a less vigorous approach is warranted in the
litigious and less masochistic West. The authors do not
say if patients were clinically improved, though one would think so.
If this is a 1-time treatment and the result so spectacular, the reasons
must be contemplated.
2. Shi J, Flemmig M, Stehr-Zirngibl S, Taeger K. Scherztherapie mit
Akupunktur bei chronischen Kopfschmerzen. Chin Med. 2000;15:14-25. Reviewed
in: FACT. 2000;5:191-192.
Needle acupuncture was compared with sham laser for chronic headache
treatment in a randomized, single-blind, sham-controlled trial with
34 patients resistant to prior treatments. Acupuncture points were varied
by TCM criteria for 10-12 sessions. A modified McGill Questionnaire
was used, as well as a numeric pain scale and a depression scale. The
pain rating was 7.1 of 10 at baseline, 3.1 after treatment, and 5.5
after 6 months of follow-up. The respective values were 6.6, 6.4, and
6.8 for the sham group. Improvement was shown for the McGill Questionnaire
and depression tests only in the acupuncture group. Medication use was
clearly lowered by acupuncture treatment. The reviewer notes a lack
of pain diary use, no statement of dropouts, questions the complete
lack of placebo response in the sham laser group, and suggests that
all researchers follow the CONSORT guidelines for publication of randomized
clinical trials.
3. Sternfeld M, Finkelstein Y, Eliraz A, Barzilai N, Hod I. Symptomatic
improvement and anatomical regression of arthritic hallux valgus deformity
(bunion) treated by acupuncture. Am J Acupuncture. 1992;20:9-12.
Seven female patients presented with severe pain and walking difficulty
due to bilateral hallux valgus; 6 had inflamed and infected skin. The
condition was present for 3 to 16 years and all were scheduled for surgery.
SP 4 and 5 were needled with 3 painful points above, lateral and medial
to the bunion where insertion went into periosteum of the bunion. This
is painful, so needles were not manipulated but left in for 30 minutes.
Seven to 16 weekly sessions were used. After a few sessions, result
was excellent to moderate in 4 patients. Three years following treatment,
results were excellent to good in 5, and moderate in 2 patients. Surgery
was cancelled for all.
Comment: A painful treatment with many sessions (the majority
had 16) required. However, surgery is not without pain and complications
and often does not relieve the entire situation, and is also expensive.
4. Schutz H, Bruhn HD, Kropp P, Niederberger U, Weinschutz T. Modulation
humoraler Parameter durch Laserakupunktur. Akupunktur Theorie Praxis.
2000;28:32-43. Reviewed in: FACT. 2000; 5:190-191.
A randomized, sham-controlled, double-blind trial involving 50 migraine
patients with 2 to 6 migraine attacks monthly for at least a year. Eight
laser acupuncture treatments were given weekly with 30 seconds of laser
to 6-10 points. No significant clinical or laboratory (serum noradrenaline,
adrenaline, and dopamine) outcomes were found between real and sham
acupuncture with laser. The reviewer notes lack of significant numbers,
short length of follow-up, insufficient description of patients, and
lack of power statistics.
5. Sheng-xu W, Xin-sheng L, Jin-xiong L. Electro-acupuncture of paravertebral
points in treating cervical spondylosis. Int J Clin Acupuncture. 2000;11:91-96.
Seventy patients with tingling pain in the neck, shoulder, and upper
arm with local neck tenderness were divided into a paravertebral group,
with needles above and below the involved segment at 15 Hz, and a traditionally
treated group using GB 21, SI 11, SJ 5 and 14, LI 11 and 4. BL 18 and
23 were also needled. A modified McGill Pain Questionnaire and a pain
visual analog scale indicated better results with the paravertebral
approach. Treatment with neck needling must be gentle because patients
faint easily.
Comment: Interesting, yet one has to be careful because personnel
from each acupuncture center in China perhaps seek a specialty approach
to boost their reputations, judging by reading of the literature.
Part
IV - disease
1. Gih M, Smith M. The development of acupuncture treatment for AIDS
in the USA. Am J Acupuncture. 1992;20:361-362.
In 1987, a report from New York Lincoln Hospital noted distinct improvement
in 200 AIDS patients treated with acupuncture after as little as 4 or
5 treatments. In Chicago, the AIDS Alternative Health Project was started
in 1986 and treats more than 80 patients per year, and the Northside
Project has treated more than 500 patients. In San Francisco, the Quan
Yn Acupuncture and Herbal Center has 6 acupuncturists who treat 125
AIDS patients per week. Clinicians here have pioneered an intensive
training program for acupuncture and maintain a list of certified graduates
throughout the United States. In Massachusetts, the Somerville Center
sees AIDS and HIV patients, as does the Austin, TX, HIV Wellness Center.
In Portland, OR, the Addiction Treatment Center sees AIDS patients,
as does the Kang Wen Clinic in Seattle, WA, and a center at the University
of Miami in Florida. Acupuncture appears to benefit the immune system
and relieve the mental and physical symptoms of AIDS.
2. Li-ping W, Yu-xin J. Diabetes [Teaching Rounds]. Int J Clin Acupuncture.
2000; 11:115-120.
Acupuncture can be effective in treating type 2 diabetes, especially
in early and mild cases. In Japan, a study denotes BL 18, 20, ST 25,
SP 8, LI 11, and GB 9 as points increasing pancreatic output. BL 13,
20, 21, 23, RN 4, SP 6, and ST 36 are used in China to abate symptoms
of diabetes and strengthen the pancreas. Treatment of peripheral neuropathy
is effective using Yang channel points. Urinary bladder malfunction
can be eased by needling BL 35, 29, and ST 28. Stimulation of LU 7 and
KI 6 also helps. One study noted acupuncture at the peak of insulin
secretion was much more effective. Organ-oriented ear points have also
shown effect in lessening diabetes sequelae.
3. Xiaolin Z, Lingling W. Acupuncture treatment of Parkinson's disease:
a report of 29 cases. J Tradit Chin Med. 2000; 20:265-267.
A report of cases with well-described symptoms treated every-other-day
for 3 months. Sishencong with electric stimulus was prominent, plus
strong GB, ST points (36, 40), TE 5, GV 20, and 2 Yin points, LR 3 and
SP 6. A rating system using 10 symptoms (poorly described) showed a
decrease in score from 13 to 9. Twenty-four control patients showed
no decrease but rather an increase in score from 14 to 17. Medication
requirements decreased from an average daily
dose of 329 mg to 227 mg, with no decrease in controls.
Comment: A poorly presented article, but I have had queries regarding
treating this condition. The reader now knows it is treated with acupuncture
in China but requires many sessions, and results seem helpful but not
outstanding.
4. Ji-ming L, Kui-lian L. Malaria treated with acupuncture. Int J
Clin Acupuncture. 2000;11:333-334.
Sixty-eight patients in various countries (48 from Tanzania) had acupuncture
treatment during the acute phase (symptoms (1 week). GV 14, 13, GB 20,
LI 4, PC 5, and 6 were stimulated. Twisting-reducing manipulation to
strong de Qi was used. The symptoms of 38 disappeared in 5 days or fewer
and 18 were better. Two cases are presented in which fever and chills
disappeared within minutes of acupuncture. The reasoning behind the
therapy is discussed.
Comment: Longer follow-up is not discussed, nor is possible transmissibility.
However, if on safari with needles and without appropriate medication,
or when confronted with a patient not rapidly responding, the approach
is reasonable to try.
5. Wen-jun L, Quan-ming Z, Shu-ming W. Ear acupuncture of epidemic
parotitis: analysis of 362 cases. Int J Clin Acupuncture. 2000;11:335-338.
Three hundred sixty-two patients with viral parotitis were divided into
192 treated with auricular acupuncture and 170 treated with Chinese
herbs. Ear points included Tragal tip, cheek, adrenal, ST or SP, GB,
with 2 or 3 punctured each treatment. Needles were stimulated every
30 minutes for 1 to 2 hours daily, alternating ears. After 2 days of
acupuncture, 119 patients were without symptoms vs 26 in the control
group. Fever and swelling decreased much more rapidly.
Comment: With mumps vaccine, we seldom see parotitis although
other viruses can affect the parotid gland, and stone or bacterial infection
must always be considered. Faced with such a patient, this would be
gratifying to try, and the patient would appreciate rapid cessation
of the discomfort.
Part
V - miscellaneous
1. Shima M. The future of oriental medicine in the West, part 1:
how we can benefit in training from the Japanese empirical schools.
Am J Acupuncture. 1992;20: 33-42.
TCM is actually a 20th-century derivative of ancient acupuncture and
herbal (especially the latter) treatment, organized in a "rather
incoherent manner with strong political biases." Acupuncture was
"herbalized" and performed with herbal diagnostic techniques.
TCM also is unnecessarily theoretical, sometimes to the point of dogmatic,
and is best practiced with an in-depth knowledge of classical Chinese
medical literature. Theories change with time but the underlying phenomena
remain. Classical Chinese medicine is a system of disease pattern recognition
that is its true strength. The medicine of the Sung-Chin-Yuan-Ming dynasties
was introduced to Japan around 1545 AD. The Japanese then went into
a self-imposed isolation for 200 years, allowing cultivation of their
own medical system. The Koho-ha school discarded many theories and derived
its own approaches from direct clinical observation. Todo Yoshimasu
developed "Fukushin" abdominal diagnosis. In 1681, by order
of Shogun Tsunayoshi, Waichi Sugiyama set up 45 acupuncture schools
for the blind practitioner, with tactile and palpational techniques
without emphasis on theory. Point location was by palpation as
experience noted points varied along the meridians and were not totally
stationary by anatomic location, even in one individual. The emphasis
is not on "the diagnosis," but on observing items such as
the abdominal patterns. There are built-in tests such as the O-ring,
Akabane, and Fukushin to allow correct balancing of meridians. Intuition
and sensitivity are developed and good patient rapport is important.
Kampo, the Japanese herbal medicine component, follows the classic system
of Shang Han Lun using symptom patterns to dictate herb use. Empiricism
is emphasized in all Japanese medicine. For acupuncture to thrive in
America, it must be clinically viable, cost-effective, and acceptable
and understandable to clinicians. Japanese systems of Kampo offer first
mastering 110 herbal formulas for common symptom complexes, and learning
painless skillful needling. De Qi is avoided. At least one testing method
such as Akabane, Fukushin, EAV, O-ring, or Vega is learned early by
the practitioner.
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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