Dose nonmechanical and nonpsychological therapeutic qi exist in acupuncture?

According to traditional Chinese medicine the effectiveness of acupuncture resides in qi, a term or concept that has no equivalent in western culture. The de qi sensation is characterized as grasp and controlled at acupoints and along meridians and is to unblock the blocked point along meridian and rebalance the qi within the body. This therapeutic qi is supposed to be independent of mechanical and psychological factors. However the modern needle stimulation, which requires no participation of practioner, is to activate the body by different stimulating modes, leading to physical changes.

Recently researchers in Switzerland performed a randomized, controlled, single-blinded, two-phase crossover study to investigate whether the hypothetical therapeutic qi can be sensed by test participants when mechanical and psychological influence are ruled out or controlled. The researchers used two novel devices; one allows the insertion of acupuncture needle without touching it and the other holds the needle in place and prevents the transmission of movement from the needle handle to the tip.

The study was designed two phases: the first is intervention treatment with needle inserted into acupoint PC6, then practioner held the end of needle between their thumb and index fingers without rotating and thrusting the needle. The second phase is control treatment in which the end of needle is untouched.  

Thirty volunteers were recruited for the study. They experienced both interventions due to a crossover design and had to decide which phase was and which phase was without touch and stimulation. Participants were asked to record their subjective sensations on a questionnaire.

It was found that 79% of test participants believed that they had received stimulation when it had actually been preformed, and 93% sensed the difference between treatment and control phases. The study showed that participants were able to sense the transmission of therapeutic qi in the absence of mechanical and psychological influence.

The authors suggest that experimental setup in the study can be used to make physiological measurement of therapeutic qi accessible.   

Reference:

RJ Hochstrasser et al., Perception of Therapeutic Qi, a Nonmechanical, Nonpsychological Factor in Acupuncture That Originates from the Therapist. J Acupunct Meridian Stud 2015;8(4):203e208.    http://www.sciencedirect.com/science/article/pii/S2005290114002325

Acupuncture enhanced anaesthetic effect of inferior alveolar nerve block in patients with irreversible pulpitis

Preoperative acupuncture stimulation at LI4 acupoint significantly improved analgesic of inferior alveolar nerve block for the teeth with symptomatic irreversible pulpitis. The study was reported in the Journal of Endodontics.

Pain control is one of the most challenges during an endodontic surgery for dentists especially in mandibular posterior teeth with irreversible pulpitis. To anaesthetize the mandibular posterior teeth, inferior alveolar nerve block is usually applied. However the procedure does not always provide satisfactory anaesthesia for patients with irreversible pulpitis.

The Dr NM Majd and colleagues in Iran performed a randomized triple-blind clinical trial to assess the effect of preoperative acupuncture on the success rate of inferior alveolar nerve block for teeth with symptomatic irreversible pulpitis. Forty patients with irreversible pulpitis were randomly divided into two acupuncture and control groups. In acupuncture group patients were given acupuncture at LI4 acupoint for 15 min, and then inferior alveolar nerve block was administered. In control group patients were given sham acupuncture, with a mimicking acupuncture procedure without inserting needle into LI4 acupoint and then given inferior alveolar nerve block injection.

It was found that the success rate of inferior alveolar nerve block was 60% in acupuncture group compared with only 20% in control group. Further patients in acupuncture group reported no side effect up to 48 hours after the procedures.

Authors suggest that preoperative acupuncture treatment significantly increased effectiveness of inferior alveolar nerve block for mandibular teeth with irreversible pulpitis.

Reference:

NM Majd et al., The Effect of Acupuncture on the Success of Inferior Alveolar Nerve Block for Teeth with Symptomatic Irreversible Pulpitis: A Triple-blind Randomized Clinical Trial. J Endod. 2015 Jun 16. pii: S0099-2399(15)00447-1.   http://www.ncbi.nlm.nih.gov/pubmed/26092771

Acupuncture significantly improved acute low back pain

Acupuncture helped pain relief significantly in patient with acute low back pain and analgesic effect of acupuncture lasted up to 3 days after a treatment. A clinical study of efficacy of acupuncture on low back pain in the emergency department was reported in journal of Evidence-Based Complementary and Alternative Medicine.

Low back pain is one of the most common complaints from patients in the emergency department. Although there are many pain relief medications available and some are quite temporarily effective many associated side effects make them not suitable for many patients. Acupuncture has been used to treat both acute and chronic pain in China since the beginning use of acupuncture.

Recently a group of scientists and physicians led by Dr. LC Lo in Taiwan, China carried out a clinical study to assess the efficacy and safety of acupuncture treatment to acute low back pain in emergency department. Recruited patients with acute low back pain were divided into verum acupuncture group (n=45) and sham acupuncture group (n=14). Due to most patients were unable to maintain a face-down posture during treatment acupoints were selected at the limbs according to traditional Chinese meridian system. Within verum group patients were given acupuncture at LI4, LI10, ST36, GB34 and LR3 acupoints for 15 min. The control group were received sham acupuncture by pasting seed-patches next to the acupoints used in verum group. Outcome evaluations include the visual analogue scale and heart rate variability and adverse events. The visual analogue scale was graded from 0 points (no pain) to 10 points (the worst possible pain) and was measured 3 times, before, after treatment and 3-day follow-up.

Data from study showed that verum acupuncture significantly reduced low back pain soon after treatment and the therapeutic effect of acupuncture maintained 3 days after acupuncture compared with sham acupuncture. There were no obvious alternations in heart rate variability and no adverse effect was reported.

The authors suggested that acupuncture produced an immediate pain relief in patients with low back pain in emergency department. Acupuncture could be a very viable alternative for pain management for those patients.

Reference

LC Lo et al., Efficacy and Safety of Acupuncture for Acute Low Back Pain in Emergency Department: A Pilot Cohort Study. Evidence-Based Complementary and Alternative Medicine. Volume 2015, Article ID 179731,8 pages.    http://www.hindawi.com/journals/ecam/2015/179731/

Acupuncture treatment improved phonotraumatic vocal fold injury

Acupuncture stimulation at voice-related acupoint significantly improved vocal function and healing of vocal folds lesion in patients with dysphonia. Data from a clinical study was recently reported in the Journal of Voice.

Dysphonia is a common condition and occurs around 6% of the population and even higher in specific group such as teacher. Dysphonia is caused by the vocal nodules, polyps and chronic laryngitis. Conventional approaches include behavioural voice therapy and surgery. The former requires extended period of treatment and the later is invasiveness which are not a viable option for many patients. It is reported that around 10-20% of patients with dysphonia did not respond to those treatment regime at all. Acupuncture has been used to treat dysphonia in China for a long time.

Recently a group of multi-national researchers led by Dr. EML Yiu in Hong Kong, China  carried out a randomized control clinical study to assess the efficacy of acupuncture treatment on dysphonia. One-hundred thirty-two patients with dysphonia were divided into genuine acupuncture group (n=40), sham acupuncture group (n=44) and control group (n=39). In genuine group acupoints including Hegu, Leique, Renying, Zhaohai on two sides and Lianquan were stimulated for 30 mins, twice a week for 6 weeks. In sham group, blunted needles were touched on skin of those acupoints mentioned in genuine group. Patients in control group did not receive any treatment. Outcome measures included vocal function test, changes in vocal folds pathologies and quality of life questionnaire.

At the end of treatment it was found that there was a significant improvement in vocal function and quality of life in patients of both genuine and sham treatment groups compared with control group. However, significant improvement in vocal folds pathologies was only found in genuine acupuncture group not in sham acupuncture group. There was no side effect reported.

Authors suggested that acupuncture treatment produced a significant improvement in vocal function and healing of vocal folds injury and could be a very effective alternative treatment for patients with dysphonia.

Reference:

EML Yiu et al., Is Acupuncture Efficacious for Treating Phonotraumatic Vocal Pathologies? A Randomized Control Trial.  J Voice. 2015 Aug 19. pii: S0892-1997(15)00152-6. doi: 10.1016/j.jvoice.2015.07.004.  http://www.jvoice.org/article/S0892-1997(15)00152-6/abstract

What are the most frequently used acupoints for vascular dementia treatment?

Acupuncture has been used to treat vascular dementia in China for a very long time. However therapeutic effect of acupuncture on the vascular dementia is inconsistent in part, due to the different selection of acupoints used in the treatment. So finding the acupoints with better efficacy remains challenging.

Recently a group of scientists and clinicians led by Professor FR Liang in China carried out a study to find out the most frequently appeared acupoints in treatment of vascular dementia. The data was published in journal of Evidence-Based Complementary and Alternative Medicine.

Professor Liang and colleagues employed a technique called data mining that is an analytic process designed to explore a large amount of data in search of consistent patterns between variables, and then to validate the findings by applying the detected patterns to a new subset of data, ultimately predicts the more effective acupoints.

Two-hundred and thirty-eight acupuncture prescriptions for vascular dementia were analysed by data mining technique. It was found that Baihui (GV20), Sishencong (EX-HN 1), Fengchi (GB 20), Shuigou (GV 26), and Shenting (GV 24) emerged as the most frequently in the analysis and were potential acupoints for vascular dementia treatment.

Many studies reported that needling Baihui (GV20) improved calculation ability and short-term memory and corrected the changes in personality of patients with vascular dementia. Needling Shuigou (GV26) improved naming ability and short-term memory. A SPECT study showed that stimulation at Baihui (GV20) activated the inner temporal system, thalaencephalon system and prefrontal cortical system, while needling Shuigou (GV26) activated prefrontal cortical system.

Authors suggest that Baihui (GV 20), Sishencong (EX-HN 1), Fengchi (GB 20), Shuigou (GV 26), and Shenting (GV 24), emerging higher frequencies in the analysis, may have better therapeutic effects on vascular dementia.

Reference:

S Feng et al., Discovery of Acupoints and Combinations with Potential to Treat Vascular Dementia: A Data Mining Analysis. Evidence-Based Complementary and Alternative Medicine Volume 2015, Article ID 310591, 12 pages.   http://www.hindawi.com/journals/ecam/2015/310591/

What the role does acupuncture play in perioperative medicine?

Perioperative medicine evolved from clinical anaesthesia and is about the medical care of patients starting from the time of contemplation of surgery through the operative period to full recovery, but not counting the operation or procedure itself. Perioperative medicine is a large and constantly developing area encompassing involvement in many different clinical areas.

The use of acupuncture in perioperative medicine dated back to 31/08/1958 when a tonsillectomy was completed under acupuncture without using any other anaesthetics in Shanghai, China. From that time acupuncture has been used in surgery to enhance the effect of anaesthetic medicine and promote recovery after operation. Recently Dr. Xiong and colleagues in China provided an update on the benefits of acupuncture in perioperative medicine in a review article published in the British Journal of Anaesthesia.

It is well known that acupuncture stimulation at some specific acupoints exerts analgesic effect which has been used to reduce the consumption of anaesthetics and analgesics, such as opioids. This is importance because higher doses of drugs are generally associated with high risk of morbidity, longer duration of recovery and higher cost.

Use of acupuncture reduces many anaesthetic-related adverse effects such as nausea, vomiting, haemodynamic instability and intubation-related complication. Many studies showed that acupuncture therapy can rebalance haemostasis and alleviate stress response by modulating sympathetic nerve function.

Acupuncture enhances post-operative analgesia. Many studies reported that acupuncture prolonged anaesthetic effect and significantly reduced the use of pain killers following surgery. Further acupuncture exerts organ-protective effect after surgery. Acupuncture exerts modulatory effect on heart, increasing cardiac output, stroke volume, and decreasing total peripheral resistance and central venous pressure. Acupuncture improves postoperative pulmonary function, and protects brain against brain oedema, and increases blood circulation to other important organs such as liver and kidney.

The authors suggest that better selection of acupoint, advanced techniques used to stimulate acupoints and good timing of acupoint stimulation will maximise the benefits of acupuncture in perioperative medicine.

Reference:

Lu et al., Perioperative acupuncture modulation: more than anaesthesia. British Journal of Anaesthesia115 (2): 183–93 (2015).    http://bja.oxfordjournals.org/content/115/2/183.short

How does acupuncture relieve primary sciatica?

It has been know that acupuncture helps relieve pain in patients with sciatica. However how acupuncture exerts its action is not well understood. Recently a clinical study reported that arginine vasopressin, a hormone secreted in the particular areas of brain, played an important role in electroacupuncture analgesia. The study has been published in journal of Neuropetides.

Primary sciatica, also called piriformis syndromes, is a neuromuscular disorder that occurs when the sciatic nerve is compressed or otherwise irritated by the piriformis muscle. Primary sciatica usually starts with pain, tingling or numbness in the buttocks. Pain can be severe and extend down the length of sciatic nerve; and can be triggered by climbing, sitting for long periods of time or by applying firm pressure directly over piriformis muscle. However, most cases of sciatica are not due to piriformis syndrome. So many tests including MRI may be required to rule out other causes of sciatic nerve compression such as a herniated disc. Conventional approaches for primary sciatica include physiotherapy and anti-inflammatory medication which only provides temporary solution.

Recently Dr. XY Zhao and colleagues in China performed a clinical study to investigate the role of arginine vasopressin in the analgesic of acupuncture in patients with primary sciatica. Patients were divided into acupuncture group (n-45) and sham group (n=32). Patients in acupuncture group were given electroacupuncture at ST36 acupoint for 60 min while patients in sham group were given acupuncture at non-specific acupoint. Cerebrospinal fluid and serum were collected before, 30 min, 60 min and 120 min after acupuncture to detect the changes in arginine vasopressin levels. It was found that acupuncture stimulation at ST36 significantly increased the arginine vasopressin concentration in the cerebrospinal fluid but not in the serum. The increase in cerebrospinal arginine vasopressin level corresponded the pain relief level.

Arginine vasopressin in brain is reported to participate modulation of analgesia through its action to enhance the secretion of the endogenous opiate peptide such as beta-endorphin and dynorphin which are involved in pain modulation.

This study provides more evidence of central action of acupuncture analgesic effect.

Reference:

XY Zhao et al., The role of arginine vasopressin in electroacupuncture treatment of primary sciatica in human. Neuropeptides. 2015 Aug;52:61-5. doi: 10.1016 /j.npep.2015.06.002.   http://www.ncbi.nlm.nih.gov/pubmed/26142756