Chinese medicine helps patients with muscular dystrophy

Duchenne muscular dystrophy (DMD) is a genetic disorder characterized by progressive muscle degeneration and weakness. Chinese medicine including acupuncture, herbs and Tuina holds potential to help alleviate symptoms and enhance muscle function of patients with DMD. A team of researchers combined a number of alternative therapies along with drug therapy to create a treatment regimen for DMD patients. During the study, the combined treatments resulted in a significant improvement in physical function and reduced inflammation in the patients’ bodies.

DMD was initially described by French neurologist Guillaume Benjamin Amand Duchenne in the 1860s. Research studies identified the chromosomal mutation responsible for DMD in 1986. This mutation leads to a lack of dystrophin protein in muscle cells thereby making them fragile. Onset is between ages 3 – 5 and boys are predominantly affected, and the carrier is the mother because the gene mutation is X-linked. 

The research team enrolled 60 paediatric DMD patients at the Neurology and Rehabilitation Department at Zhengzhou Children’s Hospital, in China for a two-year randomized controlled trial.Upon enrolment, patients were divided into combined treatment and drug-only groups. The combined treatment group received acupuncture, far infrared therapy, TCM tuina massage, herbal medicine, and drug therapy, while the drug-only group received drug therapy alone.

Following treatment, patients saw a total effective rate improvement of 20% in the combined treatment group, including reduced physical impairments and improvements in both walking and staircase climbing, compared to the drug-only group. Total effective improvement is calculated using full recovery, significant recovery, and effective as three parameters of improvement. The calculation led to a total effective rate improvement of 93.3% in the combined treatment group and 73.3% in the drug-only group.

In addition, the combined treatment group experienced significant improvements in enzymes and saw a reduction in serum inflammatory markers such as creatine phosphokinase (CPK), lactate dehydrogenase (LDH), and aspartate transaminase (AST). Enhanced enzyme profiles were indicative of lower inflammation in the combined treatment group when compared to the drug-only group.

The study showed that the combination of multiple types of CM with conventional drug treatment significantly improved physical impairment and reduced in inflammatory related muscle enzyme secretions. The further study with large size samples is warranted.

Reference

Meng, QP (2015). The clinical effects of combining acupuncture and physical therapy with drugs in treating children with Duchenne muscular dystrophy. Chinese Journal of Physical Medicine and Rehabilitation 2015; 37(6): 446-448.      http://wprim.whocc.org.cn/local/detail.jsp?channelid=75002&searchword=WPRIMID%3D884699

Scalp acupuncture reduced neurological deficits in a model of hemorrhagic stroke

Scalp acupuncture was shown to improve neurological deficits induced by intracerebral hemorrhage in a rat model. The study was recently published in the journal of Complementary Therapies in Medicine.

Scalp acupuncture is a modern acupuncture technique in which needles are penetrated the specific area of the scalp or lines on the scalp. Scalp acupuncture differs significantly from classic acupuncture in that it has its own theoretical basis and its acupoints are quite different from traditional acupoints. Scalp acupuncture has been effectively used to treat many neurological disorders including stroke. However, its mechanisms underlying its effectiveness were not well illustrated.

Recently Dr. H Liu and colleagues conducted a pre-clinical study to investigate the effect of scalp acupuncture on neurological dysfunction of intracerebral hemorrhage stroke rat model, and further the mechanism relating to the therapeutic effect. Rat model of intracerebral hemorrhage (ICH) received scalp acupuncture at acupoint DU20 through GB7 on the lesion side, for 30 mins, twice a day, from day one of surgery for consecutive 7 days. A group of intracerebral hemorrhage model not receiving scalp acupuncture and a group of sham surgery and a group of naïve were used as controls. Behavioural testing included a composite neurological scale, corner turn test, forelimb placing test, wire hang task and beam walking were conducted at days 3 and 7, followed by biochemical studies such as western blot analysis and histopathologic examination.

The data showed that at 3 days after intracerebral hemorrhage, there was no significant difference of behavioural tests between scalp acupuncture group and ICH and sham control groups compared to naïve control. However, at day 7 after surgery, there was a significant improvement of neurological deficits in scalp acupuncture treated group compared with ICH and sham control groups. Biochemical studies showed that brain content of tumour necrosis factor alpha and nuclear factor KappaB protein expression was markedly decreased in scalp acupuncture group compared with ICH and sham groups.  

The results demonstrated that improved behavioural effects by scalp acupuncture were associated with improvement in pathological features and decreased markers of inflammation in rat model of intracerebral hemorrhage.

Reference

H Liu et al., Scalp acupuncture attenuates neurological deficits in a rat model of hemorrhagic stroke. Complementary Therapies in Medicine 32 (2017) 85–90.    https://www.ncbi.nlm.nih.gov/pubmed/28619309

Acupuncture significantly improved renal function in patients with chronic kidney disease

Acupuncture treatment for 12 weeks significantly reduced the serum creatinine levels and increased the estimate glomerular filtration rate (eGFR) in patients with chronic kidney disease. Results of a preliminary clinical study were just published in the Journal of Complementary and Alternative Medicine.

Chronic kidney disease (CKD) is a progressive decline of kidney function over a period of months or years and is a recognized public health problem affecting up to 10% of global population. It is believed that the two main causes of CKD are diabetes and hypertension. Main symptoms that develop during CKD progression are proteinuria, peripheral edema, hypertension, anaemia, and fatigue. Although medication is able to control the progression of the disease, the adverse effects of long-term use of medication could cause more damage on kidney function. Complementary and alternative medicine such as acupuncture and Chinese herbal medicine are used to effectively treat CKD in China for a very long time.

Recently, a randomized and single-blinded controlled clinical study was conducted to assess the effect of acupuncture on renal function in patients with CKD. The subjects were randomly allocated to real acupuncture group (RA, n=30) and sham acupuncture (SA, n=29) groups. In RA group electro-acupuncture was performed on acupoints LI4, ST36 and KI3 to patients with CKD for 20 min per-session, once a week for 12 consecutive weeks. While in SA group, the acupuncture methods were identical to in the RA, acupuncture needle was applied to the subcutaneous layer at 1.5 cm lateral to the aforementioned acupoints, without electrical discharge. Renal function was monitored by measuring the levels of serum creatinine and estimated glomerular filtration rate (eGFR) at 3 months before acupuncture, immediately before the acupuncture treatment (baseline), at the end of 12-week treatment and at the 3-month follow-up.

The data showed that there was no difference of creatinine and eGFR at 3 months before acupuncture and baseline between RA and SA groups, however, there was significant decrease in creatinine and marked improvement in eGFR in RA group after 12-week acupuncture and 3-month follow-up compared with that of SA group.

The results of the study showed that acupuncture could improve renal function by reducing creatinine and improving eGFR in patients with CKD.

Reference:

JS Yu et al., Acupuncture on Renal Function in Patients with Chronic Kidney Disease: A Single-Blinded, Randomized, Preliminary Controlled Study. J Altern Complement Med. Volume 23, Number 8, 2017, pp. 624–631.   https://www.ncbi.nlm.nih.gov/pubmed/28422526

Recent development in acupuncture for carpal tunnel syndrome

Acupuncture has been used to treat patients with carpal tunnel syndrome (CTS) for improving symptoms such pain, numbness, preventing local muscle atrophy and regaining the function. Advantages of acupuncture over other treatments such as nonsteroidal anti-inflammatory drugs, local corticosteroid injection and surgical procedures have been gradually recognized. Here is the summary of recent reports of acupuncture treatments for CTS.

Recently Maeda et al., (2017) conducted a blinded; placebo controlled and randomized clinical study to assess changes in symptoms, neurophysiologic and brain neuronal activities between verum acupuncture and sham acupuncture treatments.

It was found that while both verum and sham acupuncture reduced CTS symptoms, verum was superior to sham in producing improvements in both peripheral and brain neurophysiological outcomes, i.e. median sensory nerve conduction latency and digits 2 and 3 cortical separation distance in the brain primary somatosensory cortex. Further, improvement in functional primary somatosensory cortical plasticity soon following acupuncture predicated the long-term symptom relief. Diffusion tensor imaging analysis of white matter microstructure found that acupuncture at local versus distal acupuncture sites may improve median nerve function at the wrist by mediating somatosensory neuroplasticity following therapy.

In another study, Ural and Öztürk explored the effect of acupuncture on cross-sectional area (CSA) of median nerve at the wrist in patients with CTS in a randomized clinical study. Visual analog scale (VAS), Duruoz Hand Index (DHI), Quick Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire scores, electrophysiologic measurements, and median nerve CSAs were measured before and after the treatment in both acupuncture and splinting only groups. Although VAS, DHI, Quick Disabilities of the Arm, DASH questionnaire scores, electrophysiologic measurements were improved in both groups, only acupuncture reduced CSAs, indicating anti-inflammatory effect by acupuncture.

Results from the studies indicate that acupuncture may improve CTS pathophysiology by both local and brain-based mechanisms involving somatosensory cortical neuroplasticity.

References:

Maeda Y et al., Rewiring the primary somatosensory cortex in carpal tunnel syndrome with acupuncture. Brain. 2017 Apr 1;140(4):914-927. doi: 10.1093/brain/awx015.   https://www.ncbi.nlm.nih.gov/pubmed/28334999
Ural FG & Öztürk GT, The Acupuncture Effect on Median Nerve Morphology in Patients with Carpal Tunnel Syndrome: An Ultrasonographic Study. Evidence-Based Complementary and Alternative Medicine, Volume 2017 (2017), Article ID 7420648, 5 pages.   https://www.hindawi.com/journals/ecam/2017/7420648/ 

Abdominal acupuncture is very effective in treating neck pain

Abdominal acupuncture was used to treat patients with neck pain. It was shown that abdominal acupuncture significantly improved the symptoms compared with sham acupuncture. The study was recently published in the journal of PLOS one.

Neck pain is a common medical condition, coming from a number of disorders and can involve any of tissues in the neck. For example, neck pain can come from the conditions directly affecting the muscles of the neck, e.g. fibromyalgia. Symptoms of neck pain can range from stiff neck, sharp stabling pain on one spot, tenderness or soreness on a general area, and pain that radiates down into the shoulders, arms or fingers; or radiates up into the head. Chronic neck pain is reported to severely affect people’s daily life and downgrade the quality of life. Conventional treatments such as pain relieves tablets is only temporary solution. The cause treatments for many cases are more complicated.

Abdominal acupuncture is a new form of acupuncture technique, based on traditional Chinese acupuncture meridian theory and developed by Dr. Zhiyun Bo in 1991. Since then it has been used to effectively treat various conditions including pain and neurological disorders.

Recently a randomized, double-blinded and sham controlled clinical trial of effect of abdominal acupuncture on chronic pain was conducted with 154 subjects, divided into abdominal acupuncture group (AAG, n=77) and sham acupuncture group (SAG, n=77). The patients in AAG received acupuncture on acupoints, CV12, CV4, bilateral KI17 and ST24 for 30 min each session, three times a week for two weeks. The primary outcome included mean improvement in neck pain disability scores evaluated by the Northwick Park Neck Pain Questionnaire (NPQ). Secondary outcomes included intensity of neck pain and health-related quality-of-life measures. The outcomes were monitored at baseline and at 2 and 6 weeks from baseline. Patients in the AAG received additional follow-up assessment at 14 weeks from baseline.

Results showed that patients in AAG showed significantly improvement in NPQ scores at both 2 and 6 weeks compared with those of SAG and the improvement was maintained at 14-week follow up. The secondary outcome measures in AAG were markedly improved compared with SAG.

The study showed that abdominal acupuncture is a very effective alternative treatment for people with neck pain.

Reference:

Ho LF, et al., Efficacy of abdominal acupuncture for neck pain: A randomized controlled trial. PLoS One. 2017 Jul 17;12(7):e0181360. doi: 10.1371/journal.pone.0181360.    https://www.ncbi.nlm.nih.gov/pubmed/28715459

True acupuncture is super to sham acupuncture in improving migraine

True acupuncture has been shown to be super to sham acupuncture in reducing migraine and in preventing future migraine attack. A study was recently published in JAMA Internal Medicine.

A large-size randomized acupuncture clinical study was conducted to investigate the long-term effects of true acupuncture compared with sham acupuncture in patients with migraine.

It was a 24-week randomized clinical trial (4 weeks of treatment followed by 20 weeks of follow-up). A total of 249 participants 18 to 65 years old with migraine without aura were randomly assigned to true acupuncture, sham acupuncture, or a waiting-list control group. Participants in the true acupuncture and sham acupuncture groups received treatment 5 days per week for 4 weeks for a total of 20 sessions. Four acupoints were used per treatment for 30 mins. All patients received acupuncture on 2 obligatory points, including GB20 and GB8. The 2 other points were chosen according to the syndrome differentiation of meridians in the headache region. The potential acupoints included SJ5, GB34, BL60, SI3, LI4, ST44, LR3, and GB40. The use of additional acupoints other than the prescribed ones was not allowed.

The primary outcome was the change in the frequency of migraine attacks from baseline to week 16. Secondary outcome measures included the migraine days, average headache severity, and medication intake every 4 weeks within 24 weeks.

Results showed that true acupuncture exhibited persistent, superior, and clinically relevant benefits for migraine prophylaxis, reducing the migraine frequency, number of days with migraine, and pain intensity to a greater degree than sham acupuncture or waiting list groups. Improvements in the emotional domain of quality of life were also found in true acupuncture group compared with controls.

The study showed that true acupuncture may be associated with long-term reduction in migraine recurrence compared with sham acupuncture or assigned to a waiting list among patients with migraine without aura.

Reference

L Zhao et al., The Long-term Effect of Acupuncture for Migraine Prophylaxis A Randomized Clinical Trial. JAMA Intern Med. 2017;177(4):508-515.   http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2603492

Electroacupuncture significantly improved urinary leakage in women with stress urinary incontinence

Electroacupuncture treatment has been shown to significantly improve urinary leakage in women with stress urinary incontinence (SUI), compared with sham acupuncture group, in a large size grouped clinical study which was recently published in the Journal of the American Medical Association.

SUI is the unintentional passing of urine when your bladder is under pressure e.g. when you cough, exercise or laugh. SUI occurs when the muscles that control your ability to hold urine get weak or don’t work. Weakened muscles such as bladder sphincter may be caused by childbirth, injury to the urethra area, some medicines or surgeries in the pelvic area or the prostate (in men). SUI is a common problem thought to affect millions of people and causes psychological burden, affects relationships, lowers physical productivity, and decreases quality of life in women. However, few effective therapies are available for treating SUI.

Acupuncture may be an effective treatment option for SUI as electroacupuncture has been found to decrease urine leakage. However, effects of acupuncture on SUI remain uncertain because of the small sample size, poor study design, and high risks of bias in previous clinical trials.

Very recently researchers in China conducted a multicenter, randomized clinical trial at 12 hospitals, enrolling 504 women with SUI to assess the effect of electroacupuncture on reducing urine leakage in women with SUI. Participants were randomly assigned (1:1) to receive 18 sessions (over 6 weeks) of electroacupuncture involving the lumbosacral region (acupoints BL33 and BL35, n = 252) or sham electroacupuncture (two sham acupoints, n = 252) with no skin penetration on sham acupoints. The primary outcome was change from baseline to week 6 in the amount of urine leakage, measured by the 1-hour pad test. Secondary outcomes included mean 72-hour urinary incontinence episodes measured by a 72-hour bladder diary (72-hour incontinence episodes).

Results showed that 482 out of 504 participants completed the study. At the end of 6-week treatment, the electroacupuncture group had significant decrease in mean urine leakage (−9.9 g) compared with baseline (18.4 g). In contrast, the sham electroacupuncture group had only minor decrease (-2.6 g) compared with baseline (19.1 g). The change in the mean 72-hour incontinence episodes from baseline was greater with electroacupuncture than sham electroacupuncture with between-group differences of 1.0 episode in weeks 1 to 6, 2.0 episodes in weeks 15 to 18, and 2.1 episodes in weeks 27 to 30. The incidence of treatment-related adverse events was 1.6% in the electroacupuncture group and 2.0% in the sham electroacupuncture group, and all events were classified as mild.

The study showed that among women with SUI, electroacupuncture treatment, compared with sham electroacupuncture, resulted in less urine leakage after 6 weeks. Authors suggested that further research is needed to understand long-term efficacy and the mechanism of action of this intervention.

Reference

Liu Z et al., Effect of Electroacupuncture on Urinary Leakage Among Women With Stress Urinary Incontinence A Randomized Clinical Trial. JAMA. 2017;317(24):2493-2501.    http://jamanetwork.com/journals/jama/article-abstract/2633916

Is sham acupuncture necessary in acupuncture clinical study?

Acupuncture is a therapy through physical stimulation by inserting a sharp, thin needle into the specific point on the body, with mechanical, electrical, or other physical manipulations, which stimulate nerve receptors both directly and indirectly through mechanical coupling via the connective tissue surrounding the needle. In general, the acupuncture stimulation, through the local reflex and central nervous system, induces endocrine, autonomic, and systemic behavioural responses. During past 20 years acupuncture studies have been extensively conducted worldwide, with a mean annual growth rate of 10.7%. It could be said that no other alternative medicines have been through such strict and detailed and scrutinized studies. Even though, the action mechanisms of acupuncture’s analgesic effect have been elucidated and the findings have been published on some top scientific journals.

There is a debate whether acupuncture clinical studies should be subjected to the standard drug therapy clinical trial, because acupuncture is not a medication. We know that efficacy of drug/medication can be assessed under ideal conditions of traditional randomized controlled, double-blinded, sham controlled trials. However, acupuncture is not a kind of medication therapy and is applied in routine circumstance. So the measurement of effectiveness such as comparative effectiveness research (CER), rather than efficacy used in standard drug therapy clinical trial, should be applied to acupuncture clinical studies. CER compares the benefits and harms of the best care options and produces evidence to support decision maker, which is a better option for public health. The real world evidence, more generalizable than the evidence produced by traditional randomized controlled trials, is better suited to inform real-world care decisions. With gradually understanding the nature of acupuncture, recently it was questioned whether it was necessary that sham control should be used in acupuncture clinical studies, because sham controlled study actually complicated result evidence base in some circumstance (Manheimer, 2011). Further, it has been suggested that assessment of the specific effect of acupuncture, by using sham acupuncture in an attempt to blind participants, could produce another limitation for clinical acupuncture trials by potentially attenuating the effects of ‘real’ acupuncture (Kim et al., 2017). Further discussion regarding study design and control interventions for acupuncture clinical trial is necessary.

Reference:

Manheimer E. Selecting a control for in vitro fertilization and acupuncture randomized controlled trials (RCTs): how sham controls may unnecessarily complicate the RCT evidence base. 2011, Fertil Steril. 95(8):2456-61.  https://www.ncbi.nlm.nih.gov/pubmed/21570069 

Kim TH. et al., What is lost in the acupuncture trial when using a sham intervention? Acupunct Med. 2017 Apr 29. pii: acupmed-2016-011333.   https://www.ncbi.nlm.nih.gov/pubmed/28456756

Acupuncture stimulation improved cognitive function in middle-aged people

Electro-acupuncture with low-frequency stimulation improved cognitive function in middle-aged women and men, reflected by the changes in P300 index. A report of pilot of randomized controlled clinical studies was published in journal of BMC Complementary and Alternative Medicine.

Aging is related to an increase in senile disorders such as Alzheimer’s disease. It has been recently reported that the number of patients with Alzheimer’s dementia is expected to reach 13.5 million by 2050 in the United States alone and will become a major problem worldwide over time. How to improve cognitive function is crucial to prevent senile-related conditions. The P300 is an important index that is used in clinical studies to evaluate reductions in memory and other cognitive functions and has been known to show decreased amplitude and delayed latency with aging. Acupuncture stimulation at some specific acupoints was reported to improve cognitive function and slow down the reduction of memory.

Recently Dr. KH Choi and colleagues conducted a pilot clinical study with randomised double-blinded controlled setting to evaluate the effect of low-frequency electro-acupuncture stimulation at BL62 and KI6 on cognitive function, using P300 index. Fifty-five healthy subjects in their 50s, including 26 males and 29 females were recruited and divided into real acupuncture (n=28) and sham acupuncture (n=27) groups. In real electro-acupuncture at an average of 24μA and 2 Hz stimulation at acupoints BL62 and KI6 lasted 30 mins each session, 12 sessions over one month. Brain activity of each subject was recorded by event related potentials (ERPs) of electroencephalogram before the first session and after the last session of acupuncture, then analysed using P300.

It was found that subjects in the real acupuncture group showed a tendency toward a decreasing P300 latency and increasing P300 amplitude after all 12 sessions of stimulation. In the women, the amplitude significantly increased at many perimeters, compared with sham group.

The authors suggested that the results of this study may serve as a foundation for the treatment of dementia and various brain disorders due to brain aging and impaired cognition. However, because the results of this study are limited to middle-aged women, further studies are necessary to determine the therapeutic effects in different age groups as well as in men and to discover the neurological mechanisms underlying the positive influence of low-frequency electrical stimulation on the brain.

Reference

KH Choi et al., Change in the P300 index–a pilot randomized controlled trial of low-frequency electrical stimulation of acupuncture points in middle-aged men and women. BMC Complementary and Alternative Medicine (2017) 17:246.    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5415720/

Synergistic effect of Chinese herbal medicine with l-dopa in treating Parkinson’s

Although conventional treatments such as l-dopa and many more markedly improved motor symptoms of Parkinson’s, long-term use is associated with severe adverse effects that could significantly impact on the quality of life of patients with Parkinson’s. Alternative therapies such as Chinese herbal medicine is proved to be as effective as conventional medicine but with markedly less side-effect.

Very recently Dr. Ahn S and colleagues investigated whether the modified Cheong-gan-tang (淸肝湯 CGT, KD5040) would have synergistic effects with l-dopa on motor function and reduce l-dopa-induced dyskinesia. Modified Cheong-gan-tang (淸肝湯, KD5040), consisting of Paeonia lactiflora Pall, Ligusticum chuanxiong Hort, Angelica gigas Nakai, Bupleurum falcatum Linne, Gardenia jasminoides Ellis, and Paeonia suffruticosa Andrews plus Eugenia caryophyllata Thunb and Pogostemon cablin Bentham was co-administered with l-dopa to the Parkinson’s mouse model.

It was shown that co-administration of CGT with low-dose l-dopa synergistically improved the motor function. In addition, it significantly reversed MPTP-induced lowering of substance P, improved enkephalin levels, both are neuropeptides involved in the motor regulation in the basal ganglia. Further, co-administration of both CGT and l-dopa ameliorated abnormal reduction in glutamate content in the motor cortex. Moreover, modified CGT significantly lowered abnormal involuntary movements and controlled l-dopa-induced abnormal levels of striatal FosB, pDARPP-32, pERK, and pCREB, which is the early gene expression pathway regulating occurrence of involuntary movement.

The findings of study suggested that modified CGT can be a possible candidate for adjunct therapy in treating motor dysfunction and dyskinesia in PD patients.

Reference

Ahn S et al., Effects of a combination treatment of KD5040 and L-dopa in a mouse model of Parkinson’s disease. BMC Complementary and Alternative Medicine (2017) 17:220.  https://www.ncbi.nlm.nih.gov/pubmed/28424060

Acupuncture significantly improved symptoms of narcolepsy – a case report

A patient (male, 45-year old) diagnosed with narcolepsy by the specialist about a year ago. Recently, he came to me for acupuncture treatment due to the worsen conditions. His narcolepsy was presented with poor interrupted night sleep and excessive daytime tiredness with at least 2 uncontrollable sleep attacks a day which lasted from a few seconds to a few minutes. His day time sleepiness has been for a couple of years. His cataplexy occurred when he was laughing or angry with someone and was presented as sudden head slump down or the jaw dropping for a few seconds and even fell down on the ground. The patient has had bad sleep for decades. He hasn’t taken any medication.

The patient was treated with manual acupuncture on many acupoints including BL62, KI6; GV20, EX-HN1, HT7, PC6, ST36, SP6, SP9 for 30 min twice a week for two weeks. After two sessions of acupuncture the patient had good sleep for a consecutive three-night and felt energetic. His daytime sleep attack reduced. After six-session treatment, the severity of cataplexy episode attack was markedly reduced. He could avoid fell down and held himself up when episode was occurring. When he was laughing, the anticipated episode didn’t happen. Then acupuncture was applied on above acupoints once a week. It was shown that the consecutive good sleep could last up to 4 or 5 nights after one session of acupuncture treatment. Daytime sleep attack was no longer an issue and cataplexy episode occurred in a minor level even with laughing or big mood swing during this time period. Now therapeutic effect of one session of acupuncture could last up to 6-7 days. The patient is very pleased.

Traditional Chinese medicine believes that ying-qi and wei-qi disharmony and imbalance of yin and yang may be the cause of narcolepsy. Ying-qi is running though Yin Qiao vessel and wei-qi is running though Yang Qiao vessel. Both Yin Qiao vessel and Yang Qiao vessel are believed to be part of body defence system, equalling to immune system in convention medicine. Modulation the activity of both vessels by stimulating corresponding acupoints on the vessels leads to rebalance body’s ying-qi and wei-qi and yin and yang. This may result in the improved immune system and rebalanced the levels of neurotransmitters or neuromodulators, in particular orexin (or hypocretin) in the brain leading to improvement of narcoleptic symptoms.

Acupuncture has been recommended as one of the favourable nonpharmacologic treatments for low back pain by American College of Physicians

Recently, acupuncture, an important part of traditional Chinese medicine, has been recommended as one of the favourable nonpharmacologic therapies for low back pain by American College of Physicians. Two reports published on journal of Ann Intern Med in February 2017 by Chou et al., 2017, and Qaseem et al., 2017 made the recommendation.

Lower back pain is one of the most common reasons for clinic visits in the United States. It is associated with increased healthcare costs as well as lost wages and decreased work productivity. Acute back pain generally lasts less than 4 weeks and usually resolves on its own. Subacute low back pain is defined as lasting 4 to 12 weeks, while chronic back pain lasts over 12 weeks. Up to 30% of patients report persistent low back pain up to 1 year after experiencing an acute episode. One in five report substantial limitations in activity, according to background information in the articles.

To develop the guideline, the ACP reviewed randomized controlled trials and systematic reviews of studies evaluating noninvasive, nondrug, and drug therapy for low back pain in adults. To be included, studies had to be published in English between January 2008 and November 2016. The authors identified earlier studies using the 2007 ACP/American Pain Society systematic reviews. The agency evaluated outcomes including reduction or elimination of back pain and number of back pain episodes, improvement in back-specific function, improvement in health-related quality of life, reduction in work disability, patient satisfaction, and adverse events. The guidelines and evidence reviews also underwent peer review and a public comment period.

Overall, the new guidelines emphasize conservative treatment. First-line therapy should incorporate nondrug therapies. New evidence supports acupuncture in acute low back pain alongside with massage, or spinal manipulation; and tai chi and acupuncture in chronic low back pain alongside exercise, multidisciplinary rehabilitation, yoga, motor control exercise, progressive relaxation. Nonsteroidal anti-inflammatories (NSAIDs) or muscle relaxants should be considered when nondrug therapy fails. The guidelines strongly discourage the use of opioids (which can be associated with addiction and accidental overdose).

Reference

Chou R, Deyo R, Friedly J, Skelly A, Hashimoto R, Weimer M, Fu R, Dana T, Kraegel P, Griffin J, Grusing S, Brodt ED. Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline. Ann Intern Med. 2017 Apr 4;166 (7):493-505.  https://www.ncbi.nlm.nih.gov/pubmed/28192793

Qaseem A, Wilt TJ, McLean RM, Forciea MA; Clinical Guidelines Committee of the American College of Physicians. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline from the American College of Physicians. Ann Intern Med. 2017 Apr 4;166 (7):514-530.   http://annals.org/aim/article/2603228/noninvasive-treatments-acute-subacute-chronic-low-back-pain-clinical-practice

Mechanism of electroacupuncture-induced tissue repair

Electroacupuncture (EA) stimulation at some immune acupoints such as L14, LI11, DU20, DU14, ST36 and LV3 in both humans and rats activated hypothalamus and enhanced sympathetic nervous system (SNY) function, leading to mobilization of mesenchyals stem cells (MSC). EA-induced mobilization of circulating MSC increased anti-inflammation products; markedly reduced pain sensitivity and enhanced tissue repair. The study was published in journal of Stem Cells recently.

Recently a collaboration of acupuncture study by many research groups in the United States investigated the mechanism responsible for the beneficial systemic effects and healing associated with acupuncture in both humans and models.

First, the fMRI studies in both humans and models found that EA stimulation at L14, LI11, DU20, DU14 acupoints increased functional connectivity between the anterior hypothalamus and the amygdala and mobilized MSC into the systemic circulation. MSC were characterized as adipocyte-derived MSC in human, whereas, MSC were considered more heterogeneous in models.

Then, Pharmacological disinhibition of model hypothalamus by administration of the GABAA receptor antagonist bicuculline enhanced SNS activation and similarly resulted in a release of MSC into the circulation.

Finally, in models with partial rupture of the Achilles tendon, EA stimulation reduced mechanical hyperalgesia, increased anti-inflammation products such as serum IL‐10 and enhanced tendon remodelling and tissue repair.

The study suggested that EA may serve as way of facilitating tissue repair following by supplying high level of circulating MSC into the circulation and could be used to treat acute or chronic conditions associated with inflammation.

 Reference

Salazar TE et al., Electroacupuncture Promotes CNS-Dependent Release of Mesenchymal Stem Cells. Stem Cells. 2017 Mar 16. doi: 10.1002/stem.2613.     https://www.ncbi.nlm.nih.gov/pubmed/28299842

Acupuncture improved the symptoms and quality of life in patients with lumbar spinal stenosis

Acupuncture treatment showed that it could relieve pain and improve quality of life in patients with lumbar spinal stenosis (LLS). The report was published in Journal of Acupuncture and Meridian Studies.

Lumbar spinal stenosis is a narrowing of the spinal canal in the lower back, known as lumbar area. This usually happens when bone or tissue-or both-grow in the opening of the spinal canal, caused commonly by spondylosis or degenerative arthritis. Neurogenic pain of LLS is normally exacerbated by walking, standing and/or maintaining certain postures and relieved with sitting or lying. Other symptoms of LLS include sensory loss and weakness of legs, reflecting involvement of spinal nerve roots within lumbar spinal canal. Although medication is effective in relieving symptoms temporarily and surgical procedures will improve the conditions in some cases, none of the treatments is curative.

Dr. MJ Hadianfard and colleagues in Iran conducted a clinical study to assess the effectiveness of acupuncture on patients with LLS. Twenty-four patients with LLS were recruited for the study and were given acupuncture on following acupoints: bilateral BL-23, BL-25, BL-26, BL-37, BL-40, BL-54, BL-57, LI-4, BL-60, DU-3, DU-4, and DU-20 for 30 minutes per session, three sessions a week and 10 sessions in total. The visual analogue scale (VAS) and Short Form-36 Health Survey (SF-36) were monitored for pain and quality of life before treatment, immediate after final treatment and 6-week follow-up. Patients did not receive other treatments during the course of acupuncture treatment.

It was shown that acupuncture treatment significantly improved pain and quality of life such as emotions, vitality, general health, bodily pain, and physical well-being not only immediate after final treatment and but maintained 6-week after treatment. There was no adverse effect reported.

The study demonstrated that acupuncture was able to relieve pain and improve the quality of life of patients with LLS.

Reference:

Hadianfard MJ et al., Effect of Acupuncture on Pain and Quality of Life in Patients with Lumbar Spinal Stenosis: A Case Series Study. J Acupunct Meridian Stud. 2016 Aug;9(4):178-82.    https://www.ncbi.nlm.nih.gov/pubmed/27555222

Dihuang Yinzi, a Chinese herbal formula improved amyotrophic lateral sclerosis – A case report of 12-year follow-up study

A woman patient with amyotrophic lateral sclerosis (ALS) was treated with Dihuang Yinzi, a Chinese herbal formula for 12-year still does not require permanent continuous ventilator and showed improvement in chocking on liquids and muscle twitching of limbs. The study was published in journal of Medicine.

A 41-year-old Chinese woman patient with complaints of weakened bilateral grip, slurred speech, stumbling, and muscle twitching for 3 years, and neurogenic injury in bilateral upper limbs and tongue shown by subsequent electromyography, was diagnosed with ALS. She was treated with Riluzole 100 mg daily for 10 months and stopped. Then, she was administered with Dihuang Yigzi (DHYZ) for the period of 12-year. During the 12 years, DHYZ was modified according to the changes in accompanied syndrome or symptoms. The patient survived with ALS up to now, and does not require permanent continuous ventilator support. The symptoms of choking on liquids were improved and the utility of 30 mL water swallow test was improved with grade 2. The symptoms of muscle twitching of limbs were also reduced. No obvious adverse effect was observed during 12-year treatment and follow-up. However, muscle strength worsened slowly.

Authors suggested that DHYZ can be a potential candidate for treating patients with ALS because it exerts multi-targeted neuroprotection and is a general safe herbal formula. Further rigorous randomized controlled trials are needed to confirm the results of the study.

Reference

Qiu H et al., Dihuang Yinzi, a Classical Chinese Herbal Prescription, for Amyotrophic Lateral Sclerosis: A 12-Year Follow-up Case Report. Medicine (Baltimore). 2016 Apr;95(14):e3324.
https://www.ncbi.nlm.nih.gov/pubmed/27057909

Acupuncture improved conditions of a patient with chronic schizophrenia and sleep disorders – a case report

This report described the use of acupuncture treatment for a patient with chronic schizophrenia and sleep disorder. It was published in journal of Case Reports in Psychiatry.

The 63-year-old woman suffered from long-term schizophrenia (length of illness: 16 years) and (subjective) sleep disorders. The patient received 12 weekly acupuncture treatments. A clinical diagnostic interview and psychological tests such as the Positive and Negative Syndrome Scale (PANSS), Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI) and many more were conducted before, immediately after and 3 months after the acupuncture treatment.

The patient experienced improved daily functioning and markedly improved cognitive functioning (working memory). In addition, the results showed that the overall score of the positive and negative symptoms did not change immediately; however, a decrease in symptoms occurred 3 months after acupuncture treatment. Moreover, the patient described an immediate improvement in sleep; this was confirmed by a daytime sleepiness questionnaire. The patient was not able to complete a (longer) test on sleep quality beforehand but did so after the treatment period. Finally, a delayed improvement in the depression scale was found.

This case study indicated that acupuncture may be beneficial treatment tool in patients with schizophrenia and sleep disorder.

Reference

Bosch P, et al., Acupuncture in the Treatment of a Female Patient Suffering from Chronic Schizophrenia and Sleep Disorders. Case Rep Psychiatry. 2016;2016:6745618.     https://www.ncbi.nlm.nih.gov/pubmed/28101392

Unanticipated ripple effect of acupuncture research

Since the report of acupuncture by James Restone in the United States in early 1970s, acupuncture as a modality has been significantly increased its popularity in the Western countries. Effectiveness of acupuncture for many conditions such as pain has been widely recognized. However, for acupuncture research the major impetus in the United States occurred in 1998, when the National Centre for Complementary and Alternative Medicine (now the National Centre for Complementary and Integrative Health) was established within the National Institutes of Health. Since then development of acupuncture research made good progress regarding to effectiveness of acupuncture and understanding of mechanisms of action of acupuncture.

Recently, Professor Hugh MacPherson and colleagues summarised some unexpected and broad-reaching discoveries that materialize when biomedicine and acupuncture encounter in the context of objective and systematic scientific exploration.

1.    Acupuncture stimulation increased release of endorphins leading to wider range of analgesia research.

2.    Increased interesting in connective tissue research in health and disease because insertion of acupuncture needle into connective tissue produce many local changes lead to mechanotransduction study.

3.    Toward better understanding of placebo effect. The use of the sham acupuncture needle as a unique placebo device has assisted researchers in identifying key components of treatment that may enhance the effect of placebo.

4.    Acupuncture-related devices that have beneficial effect on biomedicine, such as transcutaneous electrical nerve stimulation units for analgesia and acupressure bands for relief of nausea.

5.    Pragmatic clinical trials. Acupuncture research in pain helped the evolution of clinical research towards more pragmatic randomized controlled trials, as a part of comparative effectiveness research.

Those unexpected ripple effect of acupuncture research identified by authors not only are the clearest examples of this scientific cross-fertilization, but provide additional rationale for continued support of research evaluating acupuncture therapy.

Reference

MacPherson H, et al., Unanticipated Insights into Biomedicine from the Study of Acupuncture. J Altern Complement Med. 2016 Feb;22(2):101-7.    https://www.ncbi.nlm.nih.gov/pubmed/26745452