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Acupuncture and related interventions for the treatment of symptoms associated with carpal tunnel syndrome

Thank you to Cochrane library for this wonderful article and: Choi GH, Wieland LS, Lee H, Sim H, Lee MS, Shin BC. Acupuncture and related interventions for the treatment of symptoms associated with carpal tunnel syndrome. Cochrane Database of Systematic Reviews 2018, Issue 12. Art. No.: CD011215. DOI: 10.1002/14651858.CD011215.pub2.

Background:Carpal tunnel syndrome (CTS) is a compressive neuropathic disorder at the level of the wrist. Acupuncture and other methods that stimulate acupuncture points, such as electroacupuncture, auricular acupuncture, laser acupuncture, moxibustion, and acupressure, are used in treating CTS. Acupuncture has been recommended as a potentially useful treatment for CTS, but its effectiveness remains uncertain. We used Cochrane methodology to assess the evidence from randomised and quasi‐randomised trials of acupuncture for symptoms in people with CTS.

Objectives

To assess the benefits and harms of acupuncture and acupuncture‐related interventions compared to sham or active treatments for the management of pain and other symptoms of CTS in adults.

Search methods

On 13 November 2017, we searched the Cochrane Neuromuscular Specialised Register, CENTRAL, MEDLINE, Embase, AMED, CINAHL Plus, DARE, HTA, and NHS EED. In addition, we searched six Korean medical databases, and three Chinese medical databases from inception to 30 April 2018. We also searched clinical trials registries for ongoing trials.

Selection criteria

We included randomised and quasi‐randomised trials examining the effects of acupuncture and related interventions on the symptoms of CTS in adults. Eligible studies specified diagnostic criteria for CTS. We included outcomes measured at least three weeks after randomisation. The included studies compared acupuncture and related interventions to placebo/sham treatments, or to active interventions, such as steroid nerve blocks, oral steroid, splints, non‐steroidal anti‐inflammatory drugs (NSAIDs), surgery and physical therapy.

Data collection and analysis

The review authors followed standard Cochrane methods.

Main results

We included 12 studies with 869 participants. Ten studies reported the primary outcome of overall clinical improvement at short‐term follow‐up (3 months or less) after randomisation. Most studies could not be combined in a meta‐analysis due to heterogeneity, and all had an unclear or high overall risk of bias.

Seven studies provided information on adverse events. Non‐serious adverse events included skin bruising with electroacupuncture and local pain after needle insertion. No serious adverse events were reported.

One study (N = 41) comparing acupuncture to sham/placebo reported change on the Boston Carpal Tunnel Questionnaire (BCTQ) Symptom Severity Scale (SSS) at three months after treatment (mean difference (MD) ‐0.23, 95% confidence interval (CI) ‐0.79 to 0.33) and the BCTQ Functional Status Scale (FSS) (MD ‐0.03, 95% CI ‐0.69 to 0.63), with no clear difference between interventions; the evidence was of low certainty. The only dropout was due to painful acupuncture. Another study of acupuncture versus placebo/sham acupuncture (N = 111) provided no usable data.

Two studies assessed laser acupuncture versus sham laser acupuncture. One study (N = 60), which was at low risk of bias, provided low‐certainty evidence of a better Global Symptom Scale (GSS) score with active treatment at four weeks after treatment (MD 7.46, 95% CI 4.71 to 10.22; range of possible GSS scores is 0 to 50) and a higher response rate (risk ratio (RR) 1.59, 95% CI 1.14 to 2.22). No serious adverse events were reported in either group. The other study (N = 25) did not assess overall symptom improvement.

One trial (N = 77) of conventional acupuncture versus oral corticosteroids provided very low‐certainty evidence of greater improvement in GSS score (scale 0 to 50) at 13 months after treatment with acupuncture (MD 8.25, 95% CI 4.12 to 12.38) and a higher responder rate (RR 1.73, 95% CI 1.22 to 2.45). Change in GSS at two weeks or four weeks after treatment showed no clear difference between groups. Adverse events occurred in 18% of the oral corticosteroid group and 5% of the acupuncture group (RR 0.29, 95% CI 0.06 to 1.32). One study comparing electroacupuncture and oral corticosteroids reported a clinically insignificant difference in change in BCTQ score at four weeks after treatment (MD ‐0.30, 95% CI ‐0.71 to 0.10; N = 52).

Combined data from two studies comparing the responder rate with acupuncture versus vitamin B12, produced a RR of 1.16 (95% CI 0.99 to 1.36; N = 100, very low‐certainty evidence). No serious adverse events occurred in either group.

One study of conventional acupuncture versus ibuprofen in which all participants wore night splints found very low‐certainty evidence of a lower symptom score on the SSS of the BCTQ with acupuncture (MD ‐5.80, 95% CI ‐7.95 to ‐3.65; N = 50) at one month after treatment. Five people had adverse events with ibuprofen and none with acupuncture.

One study of electroacupuncture versus night splints found no clear difference between the groups on the SSS of the BCTQ (MD 0.14, 95% CI ‐0.15 to 0.43; N = 60; very low‐certainty evidence). Six people had adverse events with electroacupuncture and none with splints. One study of electroacupuncture plus night splints versus night splints alone presented no difference between the groups on the SSS of the BCTQ at 17 weeks (MD ‐0.16, 95% CI ‐0.36 to 0.04; N = 181, low‐certainty evidence). No serious adverse events occurred in either group.

One study comparing acupuncture plus NSAIDs and vitamins versus NSAIDs and vitamins alone showed no clear difference on the BCTQ SSS at four weeks (MD ‐0.20, 95% CI ‐0.86 to 0.46; very low‐certainty evidence). There was no reporting on adverse events.

Authors’ conclusions

Acupuncture and laser acupuncture may have little or no effect in the short term on symptoms of CTS in comparison with placebo or sham acupuncture. It is uncertain whether acupuncture and related interventions are more or less effective in relieving symptoms of CTS than corticosteroid nerve blocks, oral corticosteroids, vitamin B12, ibuprofen, splints, or when added to NSAIDs plus vitamins, as the certainty of any conclusions from the evidence is low or very low and most evidence is short term. The included studies covered diverse interventions, had diverse designs, limited ethnic diversity, and clinical heterogeneity. High‐quality randomised controlled trials (RCTs) are necessary to rigorously assess the effects of acupuncture and related interventions upon symptoms of CTS. Based on moderate to very‐low certainty evidence, acupuncture was associated with no serious adverse events, or reported discomfort, pain, local paraesthesia and temporary skin bruises, but not all studies provided adverse event data.

Plain language summary

Acupuncture and related treatments for symptoms of carpal tunnel syndrome

Review question

Do acupuncture and related treatments improve symptoms of carpal tunnel syndrome in adults?

Background

Carpal tunnel syndrome (CTS) is a condition that may cause pain, numbness, tingling and weakness in the hand. It develops when the median nerve, which stretches from the arm into the hand, is compressed as it passes through a structure called the carpal tunnel in the wrist. A person’s job could be a factor in developing CTS and it can be an additional problem in people with other diseases, such as inflammatory arthritis. CTS can be treated by hand exercises, splinting, pain medicines, and injections. Severe CTS may be treated with surgery. People with CTS sometimes choose acupuncture and related treatments to manage the symptoms of CTS. Acupuncture uses needles to puncture the skin and stimulate acupuncture points on the body. These acupuncture points lie along the meridian, which is thought of as a pathway of energy through the body. Acupuncture‐related treatments use different methods to stimulate the acupuncture points. For example, laser acupuncture uses lasers instead of needles.

Study characteristics

We found 12 studies, which analysed 869 people with CTS. There were 148 men and 579 women (1 study did not specify gender). Participant age ranged from 18 to 85 years. The number of people in each study was between 26 and 181. CTS symptoms had been present for months or years. The studies compared needle acupuncture or laser acupuncture to placebo/sham treatments or active treatments, such as corticosteroid nerve blocks, oral corticosteroids, ibuprofen, night splints, physical therapy, and vitamin B12.

Key results and certainty of the evidence

There may be little or no evidence for any difference between acupuncture or laser acupuncture and placebo or sham for symptoms of CTS. We cannot tell whether acupuncture and related interventions are more or less effective than other methods for the treatment of CTS symptoms. The studies we found were small and there may have been problems in how they were carried out. There was not much information on each comparison. The studies found some side effects from acupuncture, such as pain and bruising. None of the harms were serious. However, not all the studies provided information on side effects. We do not have enough good information from current studies to be sure about the effects of acupuncture and related treatments for CTS. We need larger and better‐quality studies to understand any effects of acupuncture and related interventions on symptoms of CTS.

This review is up‐to‐date to 13 November 2017 for English databases and 30 April 2018 for Chinese and Korean databases.

2018-12-12T10:42:19+00:00 December 12th, 2018|

Acupuncture MRI Results After Ischemic Stroke

Thank you to Health CMI for this informative article:

Acupuncture regulates brain regions for ischemic stroke patients. Southern Medical University researchers gathered MRI data in a controlled clinical trial consisting of both healthy subjects and patients suffering from ischemic stroke. In a controlled human clinical trial, Waiguan (TB5) applied unilaterally to the right arm produced significant MRI findings. True acupuncture caused important changes in brain functional connectivity.

The researchers determined that true acupuncture triggers significant negative activation in the default mode network (DMN) and other brain regions specific to the Traditional Chinese Medicine (TCM) indications of Waiguan. The DMN is a network of highly correlated brain regions, which is active under resting-state conditions. In addition, they found that ischemic stroke affects the brain’s overall response to acupuncture. The healthy control group and the ischemic stroke group had different negatively-activated brain regions in the DMN when receiving true acupuncture. [1]

 

Waiguan (TB5)
The earliest introduction of Waiguan was found in the Huangdi Neijing (The Yellow Emperor’s Classic of Medicine). Waiguan is the luo-connecting point of the hand shaoyang sanjiao meridian as well as one of the eight confluent points. It is the confluent point of the yang linking vessel. Needling Waiguan is indicated for the treatment of the following disorders: upper limb disorders (e.g., upper limb paralysis, pain, numbness, swelling and other motor and sensory dysfunction), head and sensory organ disorders (e.g., migraines, red and swollen eyes, tinnitus, deafness), fever and exogenous diseases (e.g., common cold, febrile illnesses). The researchers found that needling Waiguan raises negative activation in the somatic motor cortex, somatic sensory cortex, visual information processing cortex, and auditory information process cortex.

 

Results
In the normal control group, the brain regions deactivated by real acupuncture included the left superior parietal lobule, left inferior parietal lobule, left precuneus, left superior frontal gyrus, left precentral gyrus, left postcentral gyrus, left occipital lobe, right precentral gyrus, right postcentral gyrus, right precuneus, and right cuneus. The precentral gyrus and superior frontal gyrus are involved in somatic motor functions. The superior parietal lobule and postcentral gyrus are associated with somatic sensory functions. The occipital lobe interprets visual information. The aforementioned regions are specific to the indications of Waiguan. The inferior parietal lobule, occipital lobe, and precuneus are DMN related regions. On the other hand, the brain regions deactivated by sham acupuncture included the left precentral gyrus, left postcentral gyrus, and right superior frontal gyrus. The results indicate specific brain activation patterns associated with true acupuncture and sham acupuncture respectively.

In the ischemic stroke group, the brain regions deactivated by real acupuncture included the left medial frontal gyrus, left postcentral gyrus, left middle temporal gyrus, right postcentral gyrus, right precentral gyrus, and right medial frontal gyrus. The middle temporal gyrus is associated with interpreting auditory information. It is regarded as a Waiguan indication-specific region along with the precentral gyrus, postcentral gyrus, and middle temporal gyrus. The medial frontal gyrus is a part of DMN regions. By contrast, the brain regions deactivated by sham acupuncture included the left and right precuneus.

 

Design
The researchers (Zhang et al.) used the following study design. A total of 44 subjects participated in the study and were divided into two groups, with 24 and 20 subjects in each group respectively. The treatment group subjects were selected from the Nanfang Hospital and the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine. The treatment group patients were diagnosed with ischemic stroke. The control group subjects included healthy volunteers.

The statistical breakdown for each group was as follows. The treatment group was comprised of 10 males and 10 females. The mean age of the treatment group was 52.8 years. The mean weight was 50.3 kg. The mean height was 160.3 cm. The mean course of disease was 2.2 months. The control group was comprised of 12 males and 12 females. The mean age of the control group was 24.6±3.4 years. The mean weight was 51.4 kg. The mean height was 163.4 cm. There were no significant differences in terms of their gender, age, height, and weight. Both groups were scanned using fMRIs after receiving true or sham acupuncture intervention.

 

Real Acupuncture
True acupuncture and sham acupuncture were performed by the same acupuncturist with clinical and research experience. Both procedures employed the use of a tube-guided device that can be attached to the skin (Park Sham Tube, AcuPrime). The Park Sham Tube needle is a research device that mimics true acupuncture; however, the needle never penetrates the skin. Instead, the needle retracts into the handle when tapped, thereby visibly appearing as true acupuncture.

After disinfection of the acupoint site, a 0.30 × 40 mm disposable filiform needle was tapped into the acupoint of each patient with a high needle entry speed, reaching a depth of 10 (±2) mm. Upon a deqi sensation, the Ping Bu Ping Xie (attenuating and tonifying) manipulation technique was applied, with a twisting range of 180 degrees and frequency of 60 times/minute. The manipulation was not employed for the first 30 seconds, it was then initiated for the second 30 seconds, and then stopped again for the third 30 second interval. The whole process was repeated continuously for a total of 180 seconds. The device was placed on the skin until the treatment session was finished.

 

Sham Acupuncture Treatment Simulation
The sham acupuncture group use needles with a retractable, flattened needle point. The Ping Bu Ping Xie (attenuating and tonifying) manipulation was applied. For the first 30 seconds, the needle was slightly lifted to keep the needle point away from the skin; for the second 30 seconds, the needle was tapped into the tube to make the needle point slightly touch the skin, for the third 30 seconds, the needle was lifted again. The whole process was repeated continuously for a total of 180 seconds. The device was placed on the skin until the treatment session was finished.

 

Summary
According to the research, true acupuncture at Waiguan regulates DMN brain regions and raises negative activation in indication-specific regions, including the somatic motor cortex, somatic sensory cortex, visual information processing cortex, and auditory information process cortex. The process was verified by repeated applications across multiple subjects and was verified by MRIs. The results indicate that acupuncture produces point-specific effects on brain regions in ischemic stroke patients.

This type of research supports additional findings by other researchers. In another investigation, Yang et al. conclude that acupuncture has the ability to “promote the proliferation and differentiation of neural stem cells in the brain… accelerate angiogenesis and inhibit apoptosis…. prevent and treat neural injuries following cerebral ischemia.” [2] Yang et al. add that GV20 (Baihui) and GV26 (Shuigou) regulate cells which “increase the release of nerve growth factors (NGFs) to make nerve cells survive and axons grow, synthesize neurotransmitters, (and) metabolize toxic substances….” In addition, the researchers note that needling CV24 (Chengjiang), CV4 (Guanyuan), GV26, and GV20 “inhibit excessive proliferation of the hippocampal astrocytes and promote cellular differentiation.”

Yang et al. also note that acupuncture at GV20 and GV14 (Dazhui) affect the contents and expression of signal transducers and activators of transcription (STATs). STATs are active in the Janus kinase STAT pathway and transmit information from chemical signals outside the cell, through the cell membrane, and into gene promoters on the DNA inside the cell nucleus (causing DNA transcription and cellular activity). Yang et al. note that acupuncture’s influence on STATs indicates that it activates self-protection and reduction of “apoptosis of the nerve cells in and around the ischemic focus.” This indicates that acupuncture has a neuroprotective effect for stroke patients.

 

References
[1] Zhang GF, Huang Y, Tang CS, Lai XS, Chen JQ. Identification of Deactivated Brain Regions by Real and Non-penetrating Sham Acupuncture Stimulation on Waiguan: An fMRI Study in Normal Versus Pathological Conditions [J]. Chinese General Practice, 2017, 20(9):1098-1103.

[2] Zhou-xin Yang, Peng-dian Chen, Hai-bo Yu, Wen-shu Luo, Yong-Gang Wu, Min Pi, Jun-hua Peng, Yong-feng Liu, Shao-yun Zhang, Yan-hua Gou. Research advances in treatment of cerebral ischemic injury by acupuncture of conception and governor vessels to promote nerve regeneration. Journal of Chinese Integrative Medicine, 01-2012. vol. 10, 1. Shenzhen Traditional Chinese Medicine Hospital, Guangzhou University of Chinese Medicine.

 

2018-12-12T10:41:13+00:00 December 12th, 2018|

The Comforting Appeal of Herbs

Wonderful article from the NY Times By Ligaya Misha Nov. 21, 2018

 

  • ONCE, HERBS WERE weapons. Five thousand years ago, the Sumerians recorded, in cuneiform, lifesaving prescriptions of myrtle and thyme. The oldest surviving text of Chinese herbal pharmacology, extolling the benefits of ginseng, camphor and cannabis, was set down in the first century A.D. Around the same time, the Greek physician Dioscorides documented the properties of herbs he encountered as a surgeon with Nero’s imperial Roman army; Western doctors consulted his compendium, “De Materia Medica,” for the next 1,500 years. In Renaissance England, chamomile, hyssop, pennyroyal and tansy were strewn on   floors to ward off the plague; men and women wielded prophylactic posies of flowers and herbs like swords.

But with the triumphs of science and technology in the 19th century, herbs receded in significance. “These ancestral leaves, these immemorial attendants of man, these servants of his magic and healers of his pain,” as the American naturalist Henry Beston described them in 1935, became workhorses, steadfast and drained of alchemy. They came to be defined by that most prosaic of qualities: usefulness. Even in the kitchen, they were underlings, essential but largely confined to a supporting role. Any prettiness they possessed was incidental to their practical purpose and noted only in passing, en route to the boiling pot.

As the modern world has lost its luster, however, herbs are coming into ascendance once more, reasserting their curative powers and claiming a beauty of their own. A private herb garden has become a status symbol, as chefs flaunt seasonings that have fallen out of favor or are hard to find, like salad burnet, its bite as cleansing as a cucumber’s, or sculpit, which evokes a bashful tarragon. This goes beyond the now mainstream farm-to-table movement, which has roots in the counterculture of the 1960s, to what the Spanish chef Rodrigo de la Calle christened gastrobotánica: the restoration of forgotten plants to the realm of cooking. The British horticulturalist Jekka McVicar, who grows more than 650 varieties of herbs on her farm in South Gloucestershire, England, has been approached by British chefs seeking sweet woodruff, beloved in Germany as an infuser of Jell-O and beer, and baldmoney from the Scottish highlands, its flavor a sidestep from cumin. Farm.One, an underground hydroponic facility in downtown Manhattan, supplies avant-garde restaurants and pizzerias with rarities such as tiny, bright pluto basil and akatade, a Japanese water pepper that imparts a faintly anesthetic heat.

2018-11-27T13:22:17+00:00 November 27th, 2018|

Acupuncture for Anxiety

These are trying times indeed and can provoke anxiety. I can help you with
acupuncture and herbs. Please give me a call today!
310-444-6212. This article is from Psychology Today

Different approaches have beneficial effects.

Posted Oct 30, 2018

Animal and human studies suggest that the beneficial effects of acupuncture on health, including mental and emotional functioning, are related to different mechanisms of action, including changes in neurotransmitters involved in emotional regulation such as serotonin, modulation of the autonomic nervous system, and changes in immune function. Some researchers have argued that the placebo effect plays a significant role in clinical response to acupuncture; however, sham-controlled studies do not support this hypothesis.

Research findings support acupuncture as a treatment of anxiety.

Acupuncture and acupressure are widely used to treat anxiety in both Asia and Western countries. Extensive case reports from the Chinese medical literature suggest that different acupuncture protocols reduce the severity of generalized anxiety and panic attacks (Lake & Flaws 2001).

In a small double-blind sham-controlled study, 36 mildly depressed or anxious patients were randomized to either an acupuncture protocol traditionally used by Chinese medical practitioners to treat anxiety or to a sham acupuncture protocol (i.e. acupuncture points believed to have no beneficial effects). All patients received three treatments. Heart rate variability (HRV) and mean heart rate were measured at 5 and 15 minutes following treatment. Resting heart rate was significantly lower in the treatment group but not in the sham group, and changes in HRV measures suggested that acupuncture may have changed autonomic activity resulting in a reduction of overall anxiety. The significance of these findings is limited by the absence of measures of baseline anxiety before and after treatment.

In another double-blind study, 55 adults who had not been diagnosed with an anxiety disorder were randomized to either a sham acupuncture point or a bilateral auricular (involving points on the ears) acupuncture protocol called the “shenmen” point. That protocol is believed to be effective against anxiety. In all subjects, acupuncture needles remained in place for 48 hours. The “relaxation” group was significantly less anxious at 30 minutes, 24 hours, and 48 hours compared to the other two groups, however, there were no significant inter-group differences in blood pressure, heart rate, or electrodermal activity (Wang 2001).

Reviews report mainly positive findings.

An early narrative review of controlled studies, outcomes studies, and published case reports on acupuncture as a treatment of anxiety and depressed mood was published by the British Acupuncture Council. Sham-controlled studies yielded consistent improvements in anxiety using both regular (i.e. body) acupuncture and electro-acupuncture. The authors remarked that significant differences existed between protocols used in both regular and electro-acupuncture, suggesting that acupuncture may have general beneficial effects or possibly placebo effects. Although most controlled studies reviewed reported a general anxiety-reducing effect of acupuncture, the reviewers regarded these findings as inconclusive because of study design problems, including the absence of standardized symptom rating scales in most studies, limited follow-up, and poorly defined differences between protocols used in different studies.

A recently published systematic review (Amorim 2018) compared findings of studies on traditional (body) acupuncture, ear acupuncture (ariculotherapy), and electro-therapy in the treatment of anxiety. Some studies included in the review reported that acupuncture enhances response to prescription anti-anxiety medications and may also reduce medication side effects. The authors found good evidence that different styles of acupuncture reduce symptoms of anxiety in general, and recommended additional sham-controlled studies to help determine whether certain protocols are more beneficial than others.

For more information about complementary and alternative treatments of anxiety, read my e-book “Anxiety: The Integrative Mental Health Solution.”

Few mild adverse effects

Uncommon transient adverse effects associated with acupuncture include bruising, fatigue, and nausea. Very rare cases of pneumothorax (i.e. a potentially life-threatening condition caused when an acupuncture needle results in the collapse of a lung) have been reported.

References

“Anxiety: The Integrative Mental Health Solution” by James Lake MD http://theintegrativementalhealthsolution.com/anxiety-the-integrative-mental-health-soution.html

Acupuncture and electroacupuncture for anxiety disorders: A systematic review of the clinical research, Amorim et al. Comp Therapies Clin Practice, 2018 https://www.ncbi.nlm.nih.gov/pubmed/29705474

 

Animal and human studies suggest that the beneficial effects of acupuncture on health, including mental and emotional functioning, are related to different mechanisms of action, including changes in neurotransmitters involved in emotional regulation such as serotonin, modulation of the autonomic nervous system, and changes in immune function. Some researchers have argued that the placebo effect plays a significant role in clinical response to acupuncture; however, sham-controlled studies do not support this hypothesis.

Research findings support acupuncture as a treatment of anxiety.

Acupuncture and acupressure are widely used to treat anxiety in both Asia and Western countries. Extensive case reports from the Chinese medical literature suggest that different acupuncture protocols reduce the severity of generalized anxiety and panic attacks (Lake & Flaws 2001).

In a small double-blind sham-controlled study, 36 mildly depressed or anxious patients were randomized to either an acupuncture protocol traditionally used by Chinese medical practitioners to treat anxiety or to a sham acupuncture protocol (i.e. acupuncture points believed to have no beneficial effects). All patients received three treatments. Heart rate variability (HRV) and mean heart rate were measured at 5 and 15 minutes following treatment. Resting heart rate was significantly lower in the treatment group but not in the sham group, and changes in HRV measures suggested that acupuncture may have changed autonomic activity resulting in a reduction of overall anxiety. The significance of these findings is limited by the absence of measures of baseline anxiety before and after treatment.

In another double-blind study, 55 adults who had not been diagnosed with an anxiety disorder were randomized to either a sham acupuncture point or a bilateral auricular (involving points on the ears) acupuncture protocol called the “shenmen” point. That protocol is believed to be effective against anxiety. In all subjects, acupuncture needles remained in place for 48 hours. The “relaxation” group was significantly less anxious at 30 minutes, 24 hours, and 48 hours compared to the other two groups, however, there were no significant inter-group differences in blood pressure, heart rate, or electrodermal activity (Wang 2001).

Reviews report mainly positive findings.

An early narrative review of controlled studies, outcomes studies, and published case reports on acupuncture as a treatment of anxiety and depressed mood was published by the British Acupuncture Council. Sham-controlled studies yielded consistent improvements in anxiety using both regular (i.e. body) acupuncture and electro-acupuncture. The authors remarked that significant differences existed between protocols used in both regular and electro-acupuncture, suggesting that acupuncture may have general beneficial effects or possibly placebo effects. Although most controlled studies reviewed reported a general anxiety-reducing effect of acupuncture, the reviewers regarded these findings as inconclusive because of study design problems, including the absence of standardized symptom rating scales in most studies, limited follow-up, and poorly defined differences between protocols used in different studies.

A recently published systematic review (Amorim 2018) compared findings of studies on traditional (body) acupuncture, ear acupuncture (ariculotherapy), and electro-therapy in the treatment of anxiety. Some studies included in the review reported that acupuncture enhances response to prescription anti-anxiety medications and may also reduce medication side effects. The authors found good evidence that different styles of acupuncture reduce symptoms of anxiety in general, and recommended additional sham-controlled studies to help determine whether certain protocols are more beneficial than others.

2018-11-06T10:35:12+00:00 November 6th, 2018|

Acupuncture MRI Discovery For Sciatica Relief

Thank you to HealthCMI for this interesting article.

Acupuncture alleviates sciatica and MRIs reveal that acupuncture causes important pain relief related changes in brain functional connectivity. Affiliated Huashan Hospital of Fudan University researchers gathered objective and subjective data in a controlled clinical trial consisting of patients suffering from sciatica. Visual Analogue Scale (VAS) scores indicate that acupuncture produces significant decreases in both pain intensity levels and frequency of pain. Additionally, MRIs show that acupuncture restores pain-free connectivity related activity in the brain; acupuncture changed the functional state of the brain such that patients had greater resting states.

The researchers determined that acupuncture regulates the default mode network (DMN). In addition, the DMN regulation induced by acupuncture treatment correlates to significant reductions in pain for sciatica patients. The DMN is a complex of interconnected activated and deactivated brain regions and the DMN is at its peak activity level when the brain is at rest. Acupuncture facilitated key changes to the brain to allow for the resting state to return. The research indicates that sciatica-related pain disturbs the normal DMN pattern and that acupuncture restores the pattern.

Using functional magnetic resonance imaging (fMRI), the research team discovered that acupuncture “raises negative activation in the brain’s default mode network (DMN) of chronic sciatica patients, especially in the dorsal medial prefrontal cortex and anterior cingulate cortex.” [1] The cingulate cortex and the frontal cortex are known to be involved in pain-related subjective perception and cognition, memory, emotional responses, and attentional responses. [2]

Prior research confirms that decreased negative activation in the DMN is associated with increased pain. Another fMRI study compared chronic lower back pain patients with healthy volunteers. The results showed that patients with chronic lower back pain had significantly decreased negative activation in the default mode network (DMN) of the brain. [3] Negative activation is a form of functional connectivity found during the brain’s resting state. [4]

 

Symptoms
In the Affiliated Huashan Hospital of Fudan University sciatica research, Visual Analogue Scale (VAS) scores of the acupuncture treatment and control groups were compared before and after treatments. VAS was implemented as an instrument for assessing the intensity and frequency of pain. The scores in the acupuncture treatment group decreased from 5.6 ±1.3 before treatment to 1.2 ±0.8 after treatment. There was a statistically significant difference before and after treatment and the acupuncture group significantly outperformed the control group. The subjective data demonstrates that acupuncture reduces both pain intensity and frequency for patients with sciatica.

 

Brain Functional Connectivity
The researchers found that negative activation of the DMN in the healthy control group included the following regions: bilateral posterior cingulate, cuneus, precuneus, inferior parietal lobule, dorsal medial prefrontal cortex, and dorsal lateral prefrontal cortex. Prior to acupuncture, the treatment group showed decreased negative activation in the DMN regions as well, including the dorsal medial prefrontal cortex, dorsal lateral prefrontal cortex, anterior cingulate cortex, and precuneus. After acupuncture treatment, the negative activation in these regions increased. Acupuncture produced significant improvements towards the DMN activity found in the healthy control group; however, a slight decrease in negative activation in the precuneus of chronic sciatic patients persisted.

 

Design
The Fudan University researchers (Li et al.) used the following study design. A total of 20 subjects participated in the study and were divided into two groups, with 10 subjects in each group. The treatment group subjects were selected from the Department of Integrated Traditional and Western Medicine, the Affiliated Huashan Hospital of Fudan University. All were diagnosed with chronic sciatica. The control group subjects included only healthy volunteers. The following selection criteria were applied for the treatment group subjects:

  • Consistent with the diagnostic criteria of chronic sciatica: radiating pain in the sciatic nerve distribution area (i.e., buttocks, posterior thigh, posterior lateral lower leg, lateral dorsum of the foot).
  • Chronic lower extremity pain for more than 3 months.
  • No sedative or analgesic drugs were taken 24 hours before or during acupuncture treatment.
  • No acupuncture treatment within 0.5 years before the study.
  • The visual analogue scale (VAS) score was ≥5 points.
  • Informed consent was signed for each subject.

The following exclusion criteria were applied:

  • History of spinal fractures, tumors, and intervertebral disc surgery.
  • History of nervous and mental disorders.
  • Contraindications for MRI examination (i.e., claustrophobia).

The statistical breakdown for each group was as follows. The treatment group was comprised of 5 males and 5 females. The mean age of the treatment group was 39.5 ±6.0 years. The control group was comprised of 5 males and 5 females. The mean age of the control group was 37.7 ±5.1 years. Both groups were equivalent in all relevant demographics, setting the basis for a fair comparison of results. Only the treatment group received acupuncture treatment. Both groups were scanned twice using fMRIs, once before acupuncture and once after 10 sessions of acupuncture treatment.

 

Acupuncture Procedure
The primary acupoints selected for the treatment of chronic sciatica were the following:

  • BL40 (Weizhong)
  • GB30 (Huantiao)

Additional secondary acupoints were added based on symptom presentation. For lower back pain, the following acupoints were added:

  • BL23 (Shenshu)
  • BL25 (Dachangshu)

For pain radiating to the posterior lower leg, the following acupoint was added:

  • BL57 (Chengshan)

Manual acupuncture was applied prior to the application of electroacupuncture. After deqi was achieved at the acupoints, the acupuncture needles were connected to an electroacupuncture device (2 Hz,2–4 mA, 10 V). The needles were retained for 30 minutes starting from the initiation of electroacupuncture stimulation. One 30 minute electroacupuncture session was administered twice daily, 3 times weekly, for a grand total of 10 sessions for each participant. To learn more about acupuncture procedures to alleviate sciatica, visit the following online course:

Lower Back Pain and Sciatica >

 

Summary
Subjective clinical and objective MRI data indicates that acupuncture is effective for the treatment of chronic sciatica. According to the research, common protocols involve the application of acupoints Weizhong (BL40) and Huantiao (GB30) for this condition. Patients interested in learning more about acupuncture are recommended to contact a local licensed acupuncturist.

 

References:
[1] Li J, Dong JC, Le JJ, et al. Effects of acupuncture on default mode network images of chronic sciatica patients in the resting network state [J]. Chinese Journal of Integrated Traditional and Western Medicine, 2012, 32(12):1624-1627.
[2] Vogt BA, Derbyshire S, Jones AK. Pain processing in four regions of human cingulate cortex localized with co-registered PET and MR imaging [J]. Eur J Neurosci, 1996, 8 (7): 1461 – 1473.
[3] Baliki MN, Geha PY, Apkarian AV, et al. Beyond feeling: chronic pain hurts the brain, disrupting the default mode network dynamics[J]. J Neurosci, 2008, 28 (6) :1398 – 1403.
[4] Raichle ME, MacLeod AM, Snyder AZ, et al. A default mode of brain function[J]. Proc Natl Acad Sci USA, 2001, 98(2): 676 – 682.

2018-10-15T15:50:47+00:00 October 15th, 2018|

How CBD has become the USA’s coolest food and drink ingredient

(CNN) — The latest “it” ingredient to hit menus is CBD, short for cannabidiol, one of over 60 cannabinoids found in the cannabis sativa plant (more commonly known as marijuana).
Unlike THC, the most well-known cannabinoid, CBD has no psychoactive effects. So, while it won’t get you high, its reported therapeutic properties have driven CBD sales and popularity in the wellness industry.
While researchers are still trying to determine CBD’s effects, some studies suggest it can help treat inflammation, pain, anxiety and seizures.
The controversy around this superfood stems from inconsistent cannabis regulation at the federal and state level. Despite growing legalization, the DEA still considers cannabis — including CBD, unless sourced from industrial hemp — an illegal drug.
To date, the FDA hasn’t approved any CBD products apart from an epilepsy drug called Epidiolex. State laws vary and are changing all the time.
Take California, a state with legalized recreational cannabis and a famously vibrant cannabis cuisine scene: Just this summer, the California Department of Public Health stopped the sale of CBD additives in food and drink until it receives full FDA approval.
This left restaurants such as Gracias Madre and Superba Food + Bread scrambling to change their menus to accommodate the rule.
With the Golden State out of the culinary cannabis spotlight at the moment, it’s time to highlight some other less celebrated locations where you can find CBD-infused treats out in the wild.
From a sleek, wellness compound in Miami to a Portland dive bar known for late-night hot dogs, here are the coolest spots to find CBD on the menu (for now).

Adriaen Block, Queens, NY

Adriaen Block CBD Negroni

Adriaen Block’s CBD Negroni.
Lily Brown/Adriaen Block
This newly opened Queens cocktail bar and restaurant is a CBD mecca, showcasing the ingredient front and center.
For the uninitiated, the menu offers a word of advice: “CBD will not get you high, but you may experience a calming sensation.”
The infused drinks include the Stoney Negroni, Rolled Fashioned, and the Bakin’ & Eggs, which is made with Pineau des Charente, Lillet Blanc, blood orange bitters, egg white, and garnished with crisped bacon.
Teetotalers can get in on the action too, thanks to an equally thoughtful selection of CBD mocktails made with Seedlip, a swanky, non-alcoholic distilled spirit. Not thirsty? Also on offer are entrees with a side of AB CBD sauce or a pillowy blob of CBD-infused whipped cream to top off dessert.
Adriaen Block, 19-33 Ditmars Blvd, Astoria, NY 11105, +1 (718) 686-1391

Broomwagon, Lexington, KY

A community mecca for bike culture, this bicycle shop is also a beer garden and café serving up locally-sourced coffee, creative comfort food and ice-cold crafts and drafts.
Customers bringing in their bike for repairs can enjoy a snack by the mechanic’s work area while they wait, or check out the latest wheels and accessories. (New pannier bag, anyone?)
They’ll add a dose of CBD to any beverage for $2, or you can order a specialty drink like the Sage Advice Latte, with maple and sage-infused syrup, espresso, steamed milk and CBD.
Broomwagon Coffee + Bikes, 800 N. Limestone St., Lexington, KY 40505, +1 (859) 554-6938

Koku, Brooklyn, NY

kokus zen bowl cbd

This Kokus Zen bowl delivers on its name.
Courtesy Kokus
Think of the Zen Bowl as an ice cream sundae for the Goop set — dairy-free, probiotic-enriched coconut soft-serve heaped with colorful superfood toppings like antioxidant blueberries, nutritious black sesame granola and CBD cacao magic shell.
Available April through October at Brooklyn’s Smorgasburg on Saturdays in Williamsburg and Sundays in Prospect Park, it’s allergy-free and utterly Instagrammable.
You can also find the frozen treat at sporadic pop-ups (check their website for upcoming events), but stay tuned: A brick and mortar location is in the works for next year.
Koku, multiple locations

Donnie Vegas, Portland, OR

The coolest downtown Las Vegas dive bar is actually located in Northeast Portland, serving cocktails on tap and cheap, creative hot dogs like the Seoul Dog (kimchi, sambal aioli, scallion) and Tijuana Dog (cream cheese, pico de gallo, jalepeno) until 2:30 am.
They offer Jell-O shots and wine in a can, and a slushee with a hemp-derived twist — the Prickly Pear CBD Margaweeda, made with fresh lime juice, triple sec, silver tequila and prickly pear puree.
Donnie Vegas, 1203 NE Alberta St, Portland, OR 97211, +1 (503) 477-7244

Green Goddess Cafe, Stowe, VT

This homey café, a neighborhood go-to for fresh-pressed juices and tasty breakfast scrambles, was one the first in Vermont to put the wellness ingredient on the menu after “we experienced the benefits of CBD firsthand with our son, who has autism and a tumor disorder,” owner Athena Scheidet says.
One of their most popular specialty drinks is the Jamaican Me Shake, a CBD smoothie with tropical fruit, spinach, avocado, organic apple juice and whipped cream.
Green Goddess Cafe, 618 S Main St, Stowe, VT 05672, +1 (802) 253-5255

The James New York NoMad, New York City

James Nomad Hotel CBD Menu

The James NoMad brings CBD to R-n-R.
Courtesy The James Nomad
Travelers who want a break from Manhattan’s hectic pace don’t even need to leave their boutique hotel room for the latest way to unwind — CBD-infused room service from notable cannabis chef Annabel Drummer.
The in-room dining menu includes spicy meatballs, gorgonzola salad with walnuts and pear, and house tater tots. Or, you can pick a prepackaged CBD-infused treat like Chef For Higher Gummies, Grön Chocolate bars, and even Bark Avenue dog treats for stressed pets.
The James NoMad, 22 E 29th St, New York, NY 10016, +1 (212) 532-4100

VegeNation, Las Vegas

VegeNation CBD Whiskey Tea

Stay hydrated in Vegas with this whiskey CBD tea.
Courtesy Vege Nation
Downtown Las Vegas’s Fremont East area has become an artsy hub for plant-based eats and health-conscious cocktails — the antithesis of the Strip’s bottle service and Champagne-shower decadence.
Affordable global street food at VegeNation is locally grown and plant-based, and even the cocktails have a positive spin — particularly The Changemaker, a refreshing, infused whiskey tea made with local distilled liquor and tea from Bloomin’ Desert Herb Farm, a brew of rosemary, ginger, holy basil, red clover, nettle, peppermint, clove and raw CBD oil in purified water.
VegeNation, 616 Carson Ave #120, Las Vegas, NV 89101, +1 (702) 366-8515

Plant Miami, Miami

plant medicine miami

The secret ingredient in Plant Miami’s drink isn’t so secret.
Courtesy Plant Miami
Miami isn’t all neon lights, and pumping basslines. When the South Beach scene feels like it’s all too much, find your Zen at Sacred Space Miami.
The minimalist oasis in once-gritty Wynwood features a lush meditation garden, yoga and wellness classes, and Plant Miami, an organic, vegan farm-to-table restaurant.
The tropical Plant Medicine cocktail — with fresh pineapple, house coconut milk, dark rum, and a dose of CBD oil — is the perfect blend of Miami vibes and mindfulness.
Plant Miami, 105 Northeast 24th St, Miami, FL, 33137, +1 786 621 5006

River and Woods, Boulder

The comfort food at this historic cottage includes community-sourced dishes like Aunt Penny’s Mac & Cheese with mushrooms and onion-potato crunch and John’s Gnocchi Verde with spinach, Reggiano cream, and lemon zest.
There are family-friendly picnic tables in back, as well as an adult-centric Airstream that serves as an outdoor bar, where you can add a dose of CBD to cocktails like the Sloe Descent, with Luxardo amaretto, Spirit Works sloe gin, orange and pomegranate juice.
(They’re in the process of formulating a dedicated CBD-infused wellness cocktail, too.)
River and Woods, 2328 Pearl St, Boulder, CO 80302, (303) 993-6301

Coalition Brewing, Portland, OR

coalition brewing CBD beer

IPA + CBD = Coalition Brewing’s Two Flowers brew.
Courtesy Coalition Brewing
This brewery changed the game with Oregon’s first commercially produced CBD-infused beer, Two Flowers IPA, highlighting the kinship between cannabis and hops with an aromatic, grassy flavor.
The beer has become so popular that you can find it all over town at establishments like EastBurn Public House and Dot’s Café, though it’s worth a visit to the tasting room’s new patio where you can enjoy it in its original birthplace.
Coalition Brewing, 2705 SE Ankeny St, Portland, OR 97214, +1 (503) 894-8080

Zenbarn, Waterbury, VT 05676

ZenBarn CBD Burger

Yes, even your burger can help you chill.
Courtesy ZenBarn
You haven’t reached peak Vermont until you’ve visited this rustic barn-turned-restaurant’s periodic “Hemp and Hops” dinners, where five-course meals are infused with CBD and paired with local craft beers.
It’s a community-focused space, with a yoga studio upstairs and live music at night. (Be prepared to hear Grateful Dead covers.)
The daily menu offers CBD-spiked aioli for their burgers, including the vegetarian Zen Burger, a local black bean patty piled with cheddar, chipotle crema, avocado, lettuce, and crispy onion.
There’s also CBD honey vinaigrette for salad, a CBD brownie sundae with house-made CBD caramel, and clever CBD cocktails with names like Gin and Chronic, Le Verde and Up in Smoke.
Zenbarn, 179 Guptil Rd, Waterbury Center, VT 05677, +1 (802) 244-8134

Grön Cafe Portland, OR

Gron drinking chocolate CBD

Grön serves its CBD on the sweet side.
Courtesy Gron
If there was a Willy Wonka of cannabidiol, it would Christine Smith, founder of craft chocolate company GrönCBD.
The manufactory’s confections contain CBD extracted from a hemp alternative — evergreen tree bark combined with citrus peels.
The front of house is a drop-in cafe, where you can order CBD Drinking Chocolate served with whipped cream and a shortbread cookie, as well as infused chocolate lattes, steamers, iced chocolate drinks, chocolate-filled croissants, and truffles.
They’ll indulge your curiosity and your sweet tooth — visitors are encouraged to ask questions or sample the CBD caramel and chocolate sauces, chocolate bars, tinctures and body products.
2018-10-08T13:56:41+00:00 October 8th, 2018|

Why Chinese medicine is heading for clinics around the world

Thank you to David Cyranoski for a great article

Choi Seung-hoon thought he had an impossible assignment. On a grey autumn day in Beijing in 2004, he embarked on a marathon effort to get a couple of dozen representatives from Asian nations to boil down thousands of years of knowledge about traditional Chinese medicine into one tidy classification system.

Because practices vary greatly by region, the doctors spent endless hours in meetings that dragged over years, debating the correct location of acupuncture points and less commonly known concepts such as ‘triple energizer meridian’ syndrome. There were numerous skirmishes between China, Japan, South Korea and other countries as they vied to get their favoured version of traditional Chinese medicine (TCM) included in the catalogue. “Each country was concerned how many terms or contents of its own would be selected,” says Choi, then the adviser on traditional medicine for the Manila-based western Pacific office of the World Health Organization (WHO).

But over the next few years, they came to agree on a list of 3,106 terms and then adopted English translations — a key tool for expanding the reach of the practices.

And next year sees the crowning moment for Choi’s committee, when the WHO’s governing body, the World Health Assembly, adopts the 11th version of the organization’s global compendium — known as the International Statistical Classification of Diseases and Related Health Problems (ICD). For the first time, the ICD will include details about traditional medicines.

The global reach of the reference source is unparalleled. The document categorizes thousands of diseases and diagnoses and sets the medical agenda in more than 100 countries. It influences how physicians make diagnoses, how insurance companies determine coverage, how epidemiologists ground their research and how health officials interpret mortality statistics.

The work of Choi’s committee will be enshrined in Chapter 26, which will feature a classification system on traditional medicine. The impact is likely to be profound. Choi and others expect that the inclusion of TCM will speed up the already accelerating proliferation of the practices and eventually help them to become an integral part of global health care. “It will definitely change medicine around the world,” says Choi, now the board chair of the National Development Institute of Korean Medicine in Gyeongsan.

Whether this is a good thing depends on whom you talk to. For Chinese leaders, the timing could not be better. Over the past few years, the country has been aggressively promoting TCM on the international stage both for expanding its global influence and for a share of the estimated US$50-billion global market.

Medical-tourism hotspots in China are drawing tens of thousands of foreigners for TCM. Overseas, China has opened TCM centres in more than two dozen cities, including Barcelona, Budapest and Dubai in the past three years, and pumped up sales of traditional remedies. And the WHO has been avidly supporting traditional medicines, above all TCM, as a step towards its long-term goal of universal health care. According to the agency, traditional treatments are less costly and more accessible than Western medicine in some countries.

Many Western-trained physicians and biomedical scientists are deeply concerned, however. Critics view TCM practices as unscientific, unsupported by clinical trials, and sometimes dangerous: China’s drug regulator gets more than 230,000 reports of adverse effects from TCM each year.

With so many questions about TCM’s effectiveness and safety, some experts wonder why the WHO is increasing support for such practices. One of them is Donald Marcus, an immunologist and professor emeritus at Baylor College of Medicine in Houston, Texas, and a prominent TCM critic. In his opinion, “at some point, everyone will ask: why is the WHO letting people get sick?”

A traditional-medicine pharmacist stands behind a desk covered in dried product

A pharmacy in a traditional-medicine hospital in Beijing dispenses medications.Credit: David Gray/Reuters

Different approach

TCM is based on theories about qi, a vital energy, which is said to flow along channels called meridians and help the body to maintain health. In acupuncture, needles puncture the skin to tap into any of the hundreds of points on the meridians where the flow of qi can be redirected to restore health. Treatments, whether acupuncture or herbal remedies, are also said to work by rebalancing forces known as yin and yang.

Practitioners of TCM and Western-trained physicians have often eyed each other suspiciously. The Western convention is to seek well-defined, well-tested causes to explain a disease state. And it typically requires randomized, controlled clinical trials that provide statistical evidence that a drug works.

From the TCM perspective, this is too simplistic. Factors that determine health are specific to individuals. Drawing conclusions from large groups is difficult, if not impossible. And the remedies are often a mix of a dozen or more ingredients with mechanisms that cannot, they say, be reduced to a single factor.

There has, however, been something of a détente. Organizations steeped in the Western conventions, such as the US National Institutes of Health (NIH), have created units to research traditional medicines and practices. And TCM practitioners are increasingly looking for proof of efficacy in clinical trials. They often speak of the need to modernize and standardize TCM.

Chapter 26 is meant to be a standard reference that all practitioners can use to help diagnose disease and assess possible causes. For example, ‘wasting thirst syndrome’ is characterized by excessive hunger and increased urination and explained by “factors which deplete yin fluids in the lung, spleen or kidney systems and generate fire and heat in the body”. On the basis of those observations, physicians can work out how to treat them. The patient, who would probably be diagnosed as diabetic by a Western doctor, would probably be prescribed acupuncture, various tonics and moxibustion — in which practitioners burn herbs near the skin of the patient. Spinach tea, celery, soya beans and other ‘cooling’ foods would also be recommended.

TCM practitioners around the world are gearing up for Chapter 26, which is set to be implemented by WHO member states in 2022. “For the first time in history, ICD codes will include terminology such as Spleen Qi Deficiency or Liver Qi Stagnation,” reads a post on the website of Five Branches University, a TCM training and research institution based in San Jose, California, which worked with the WHO on a field trial of the diagnostic criteria in Chapter 26.

A patient is treated with heated cups at a traditional-medicine clinic in Shanghai.

A patient is treated with heated cups at a traditional-medicine clinic in south China’s Hainan Province.Credit: Xinhua/Avalon.red

Critics argue that there is no physiological evidence that qi or meridians exist, and scant evidence that TCM works. There have been just a handful of cases in which Chinese herbal treatments have proved effective in randomized controlled clinical trials. One notable product that has emerged from TCM is artemisinin. First isolated by Youyou Tu at the China Academy of Traditional Chinese Medicine in Beijing, the molecule is now a powerful treatment for malaria and won Tu the Nobel Prize in Physiology or Medicine in 2015.

But scientists have spent millions of dollars on randomized trials of other TCM medicines and therapies with little success. In one of the most comprehensive assessments, researchers at the University of Maryland school of medicine in Baltimore surveyed 70 systematic reviews measuring the effectiveness of traditional medicines, including acupuncture. None of those studies could reach a solid conclusion because the evidence was either too sparse or of poor quality1. The NIH’s National Center for Complementary and Integrative Health in Bethesda, Maryland, concludes that “for most conditions, there is not enough rigorous scientific evidence to know whether TCM methods work for the conditions for which they are used”.

In response to queries by Nature, the WHO said that its Traditional Medicine Strategy “provides guidance to Member States and other stakeholders for regulation and integration, of safe and quality assured traditional and complementary medicine products, practices, and practitioners”. It emphasized that the goal of the strategy “is to promote the safe and effective use of traditional medicine by regulating, researching and integrating traditional medicine products, practitioners and practice into health systems, where appropriate”.

China’s support of TCM started with former leader Mao Zedong, who reportedly didn’t believe in it but thought it a could reach under-served populations. Current Chinese President Xi Jinping has strongly supported TCM and, in 2016, the powerful state council developed a national strategy that promised universal access to the practices by 2020 and a booming industry by 2030. That strategy includes supporting TCM tourism, which steers large numbers of people to clinics in China. Every year, tens of thousands of mostly Russian tourists flock to Hainan off the southern coast seeking relief through TCM. The government has plans to build 15 TCM ‘model zones’ similar to the one in Hainan by 2020.

The country also has global ambitions. China’s Belt and Road trade initiative calls for creating 30 centres by 2020 to provide TCM medical services and education, and to spread its influence. By the end of 2017, 17 centres had sprung up in countries such as the United Arab Emirates, Hungary, Kazakhstan and Malaysia.

The ties are paying off. Sales of TCM herbal medicines and other related products exported to Belt and Road countries surged by 54% between 2016 and 2017, to a total of US$295 million.

Tight ties

The WHO’s support applies to all traditional medicines, but its relationship with Chinese medicine, and with China, has grown especially close, in particular during the tenure of Margaret Chan, who ran the organization from 2006 to 2017. In Beijing in November 2016, Chan gave an address full of praise for China’s advances in public health and its plans to spread traditional medicine. “What the country does well at home carries a distinctive prestige when exported elsewhere,” she said.

Xi Jinping talks with Margaret Chan

During a meeting in Beijing in 2016, China’s president Xi Jinping talks with Margaret Chan, then director-general of the World Health Organization.Credit: Xinhua/Photoshot

Chan has supported traditional medicines, and specifically TCM, and has worked closely with China to promote this vision. In 2014, the WHO released a ten-year strategy that aims to integrate traditional medicines into modern medical care to achieve universal health coverage. The document calls on member states to develop health-care facilities for traditional medicine, to ensure that insurance companies and reimbursement systems consider supporting traditional medicines and to promote education in the practices.

In the same year, Chan wrote an introduction to a supplement that ran in Science and was sponsored by the Beijing University of Chinese Medicine and Hong Kong Baptist University2. (Nature ran a similar paid-for supplement in 2011.) Chan wrote that traditional medicines are “often seen as more accessible, more affordable, and more acceptable to people and can therefore also represent a tool to help achieve universal health coverage”. In a 2016 speech in Singapore, Chan said that TCM has excelled at preventing or delaying heart disease because it “pioneered interventions like healthy and balanced diets, exercise, herbal remedies and ways to reduce everyday stress”.

But many Western physicians and scientists doubt that the herbal remedies and various other components of TCM or other traditional medicines have much to offer in their current use. They grant that TCM herbs might turn up useful molecules (many Western drugs are derived from plants, after all), but worry that TCM could replace proven drugs or be potentially dangerous.

Arthur Grollman, a cancer researcher at Stony Brook University in New York, has published work showing how aristolochic acid, an ingredient in many TCM remedies, can cause kidney failure and cancer3. He thinks that WHO documents should pay more attention to the risks of remedies that contain the chemical, which are still widely used.

For some scientists, the WHO’s embrace of TCM is perplexing. “I thought the WHO was committed to evidence-based medicine,” says Richard Peto, a statistician and epidemiologist at the University of Oxford, UK.

Many physicians and researchers also find the WHO’s declarations about traditional medicine hard to parse. Various WHO documents call for the integration of “traditional medicine, of proven quality, safety and efficacy”. But the agency does not say which traditional medicines and diagnostics are proven. Wu Linlin, a WHO representative in the Beijing office, told Nature that the “WHO does not endorse particular traditional and complementary medicine procedures or remedies”.

But that stands in sharp contrast to the WHO’s actions in other areas. The agency gives member countries specific advice on what vaccines and drugs to use and what foods to avoid. With traditional medicines, however, the specifics are mostly omitted. The WHO website carries some warnings and states that aristolochic acid is a carcinogen. But with the repeated emphasis on integrating traditional medicine, the message is clear, says Marcus. In his view, “the WHO is clearly saying these are safe and effective medicines”.

Nature tried to contact Chan multiple times through the WHO, but the agency says that she is not answering questions on matters related to the WHO.

Money matters

Despite the concern over the WHO’s decision to include TCM, even critics of the practices say that Chapter 26 could serve a constructive purpose. Peto says that Chapter 26 could help researchers to gather data on adverse reactions and what kinds of traditional treatments people are getting. “But if the aim is to endorse these things, it is inappropriate,” he says.

For those steeped in Western medicine, the continued spread of traditional treatments is worrisome. TCM practitioners increasingly talk of replacing proven Western medicines with traditional substitutes, where there is a cost advantage. Grollman thinks that ICD-11 is heading in that direction. Seventy per cent of money spent on health care globally is reimbursed or allocated on the basis of ICD information. Now TCM will be part of that system.

“The thing they want is to make it sound official and be recognized by the insurance companies. Because it’s relatively low cost, insurance companies will accept it,” says Grollman.

Many others agree that the WHO’s decision will help the spread of TCM. Inclusion in ICD-11 is “a powerful tool for [health-care] providers to say this is legitimate medicine” to insurers, says Ryan Abbott, a medical doctor who has also trained in TCM and is a faculty member at the University of California, Los Angeles, Center for East–West Medicine. The WHO’s action regarding TCM, he says, “is a mainstream acceptance that will have significant impact around the world”.

Nature 561, 448-450 (2018)

doi: 10.1038/d41586-018-06782-7

 

2018-10-02T13:08:53+00:00 October 2nd, 2018|

Acupuncture Prevents Heart Damage Confirmed

From Health CMI:

Acupuncture is effective for the prevention of acute myocardial ischemia (AMI), a condition causing damage to the heart from reduced cardiac blood flow and oxygen deprivation. Anhui University of Traditional Chinese Medicine researchers conclude that acupuncture applied to acupoints Shenmen (HT7) and Tongli (HT5) protects myocardial cells from ischemic injuries. In a laboratory experiment, the university researchers have proven that acupuncture prevents myocardial ischemia by regulating pro-inflammatory factors and hippocampal neurotransmitters. [1] The researchers note, “Electroacupuncture can protect myocardial cells in AMI rats, which may be associated to its effect in inhibiting the expression of serum creatine kinase (CK), hippocampal norepinephrine (NE), interleukin 6 (IL-6), interleukin-1β (IL-1β), and tumor necrosis factor- alpha (TNF-α).”

 

Biomarkers and Pathogenesis
AMI is an inflammatory process wherein IL-6, IL-1β, and TNF-α are the main biomarkers. IL-6 is a multifunctional cytokine that plays a major role in inflammatory responses. [2] IL-1β is produced by mononuclear phagocytes and can induce apoptosis with TNF-α. TNF-α is one of the cytokines that make up the acute inflammatory response system. [3] These proinflammatory cytokines activate the hypothalamic-pituitary-adrenal glandular (HPA) axis and stimulate sympathetic nerve activity in the autonomic nervous system, thereby aggravating myocardial injuries. [4]

Creatine kinase (CK) is an enzyme in heart, brain, skeletal muscle, and other tissues. Clinically, CK is used as a marker of damage in CK-rich tissue affected by myocardial ischemia. [5] The neurotransmitter norepinephrine (NE) is secreted in response to increased expression of proinflammatory cytokines. Excessive NE acts on the corticotropin-releasing hormone α1 (CRH-α1) receptors. Excess NE activates CRH neurons, overexcites sympathetic nerves, and causes heart dysfunction such as increased heart rates and high blood pressure. [6]

 

Research Gaps
The researchers conducting the investigation note, “Previous studies investigated that acupuncture can inhibit inflammatory responses in rats with myocardial ischemia by down-regulating the expression of proinflammatory cytokines such as IL-6, IL-1β and TNF-α. Some studies also found that acupuncture can regulate the activity of the nervous system and neurotransmitters in the hypothalamus and other related nerve nuclei, thereby improving acute myocardial ischemia.” They add, “However, whether the proinflammatory cytokines and hippocampal neurotransmitters interact together in the process of acupuncture against myocardial ischemia has not been reported before.” This study demonstrates that the IL-6, IL-1β, and TNF-α were positively correlated with the NE levels, and that acupuncture influences both proinflammatory cytokines and hippocampal neurotransmitters in AMI rats. This opens up directions for future research to build on this foundation of knowledge.

 

Acupuncture Treatment
The laboratory rats in this investigation were randomly divided into three groups, with 6 rats in each group. The first group received surgery to create an AMI model, in which the anterior descending branch (ADB) of the left coronary artery was occluded. The second group received sham AMI surgery, in which a surgical suture was simply threaded beneath the ADB without ligation. The third group was an AMI surgery model that received electroacupuncture (EA) on the bilateral heart meridian segment between the following two points:

  • Shenmen (HT7)
  • Tongli (HT5)

Upon selection of the aforementioned acupoints based on Chinese acupuncture principles, three 0.30 mm × 25 mm needles were evenly inserted into the Shenmen (HT7), Tongli (HT5), and the middle point between HT7 and HT5, with an interval of 2 mm. Next, the acupuncture needles were connected to an electroacupuncture device with an alternating frequency setting (1 mA, 2 Hz/15 Hz). The needles were retained for 30 minutes after initiating electroacupuncture. One 30-minute electroacupuncture session was conducted daily, for a total of 3 consecutive days.

 

Results
Before and after the surgery and acupuncture treatment, evaluations were performed. First, the electrocardiogram (ECG) readings of the neck-thoracic lead were recorded. Second, the contents of serum CK, hippocampal IL-6, IL-1β, and TNF-α were assayed. Third, the concentration of NE in the hippocampal CA1 area was detected.

Compared with the sham group, the ECG-ST height, serum CK, hippocampal NE, IL-6, IL-1β, and TNF-α contents of the CA1 region were significantly increased in the model group. After electroacupuncture intervention, the serum CK, hippocampal NE, IL-6, IL-1β, and TNF-α contents were significantly downregulated. The IL-6, IL-1β, TNF-α contents were positively correlated with the NE level.

 

Summary
The results of the investigation demonstrate that acupuncture is a laboratory proven treatment modality for the treatment of AMI. Researchers demonstrate that the IL-6, IL-1β, and TNF-α contents are positively correlated with NE levels in AMI rats, and that acupuncture alleviates AMI while simultaneously downregulating proinflammatory cytokines and neurotransmitters responsible for causing ischemic injury in AMI. Notably, these results are not isolated. Other researchers have demonstrated similar clinical outcomes in prior laboratory investigations.

 

University of California

Researchers from the University of California Los Angeles (UCLA) find acupuncture effective for protecting the heart. Electroacupuncture at PC6 (Neiguan) and P5 (Jianshi) in anesthetized rabbits with coronary artery occlusion resulted in a significant decrease in ventricular arrhythmias. Also, electroacupuncture decreased heart infarct size. [7] Essentially, acupuncture treatment protected heart tissue from cell death due to obstruction of normal blood and oxygen supply. The researchers proved that electroacupuncture causes a decrease in left ventricle dysfunction. A decrease in harmful ST segment elevation was recorded in response to needling PC6 and PC5. This is important because an ECG measuring a raised ST segment may indicate a myocardial infarction.

The results were published in the American Journal of Physiology Heart and Circulatory Physiology. Five groups were compared: non-treatment, electroacupuncture, sham (non-acupuncture point stimulation), and two additional experimental electroacupuncture groups. The experimental groups combined acupuncture with chemical blocking agents designed to block the regulation of the cardiac nervous system, opioid receptors, and PKC (Protein Kinase C) pathways.

PKC is a kinase enzyme that modifies proteins. PKC is active in signal transduction of extracellular stimuli, including hormones and growth factors. The researchers learned something very important by using PKC and other cardiac nervous system blocking agents. They discovered an important pathway involved in the therapeutic actions of electroacupuncture because electroacupuncture did not produce cardioprotective effects when the blocking agents were used.

Based on the evidence, the researchers conclude that electroacupuncture protects the heart by regulating the cardiac nervous system, opioid receptors, and PKC pathways. The group provided with electroacupuncture, without interference from blocking agents, demonstrated significant cardiac improvements. Every other group in the study did not show significant improvements. This evidence demonstrates clinically effective biochemical pathways active in electroacupuncture treatments.

 

References:
[1] Wang K. Wu SB, Cui S, Xiang SY, Wu X, Zhou MQ. Effect of Electroacupuncture on Hippocampal IL-6, IL-1β, TNF-α, Norepinephrine Levels in Acute Myocardial Ischemia Rats [J]. Acupuncture Research, 2018(6).
[2] Gwechenberger M, Mendozalh, Youkeray, et al. Cardiacmyocytes Produce Interleukin-6 In Culture and Inviable Border Zone of Re-Perfused Infarctions[J]. Circulation, 1999, 99(4): 546-551
[3] Chen BY, Li XQ, Chen XL. Clinical study on the relationship between tumor necrosis factor-α, IL-1β, IL-6 levels and congestive heart failure [J]. Journal of Clinical Internal Medicine, 2006, 23 (3): 184 – 185.
[4] Kangy M, Zhangzh, Xueb, et al. Inhibition of brain Proinflammatory cytokine synthesis reduces hypothalamic excitation in rats with ischemia-induced heart failure [J]. Am J Physiol Heart Circ Physiol, 2008, 295(1): 227-236.
[5] labtestsonline.org/tests/creatine-kinase-ck
[6] Zhao B, Ma L, Zhan LY et al. Role of inflammatory factor in SAFE pathway on brain injury in rats induced by myocardial ischemia reperfusion [J]. Hainan Med J, 2017, 28 (20): 3269-3271.
[7] Am J Physiol Heart Circ Physiol. 2012 May;302(9):H1818-25. Epub 2012 Feb 24.
Cardioprotection of electroacupuncture against myocardial ischemia-reperfusion injury by modulation of cardiac norepinephrine release. Zhou W, Ko Y, Benharash P, Yamakawa K, Patel S, Ajijola OA, Mahajan A. Department of Anesthesiology, UCLA – University of California, Los Angeles.

 

2018-09-10T12:27:31+00:00 September 10th, 2018|

Study shows benefits of eye-specific acupuncture in patients with glaucoma

Eye-specific acupuncture treatment had beneficial short-term effects on ocular blood flow in patients with primary open-angle glaucoma.

The study was conducted in 56 patients with primary open-angle glaucoma (POAG) treated with topical antiglaucoma medication. Patients were randomized into one eye-specific acupuncture treatment group and one eye-unspecific acupuncture treatment of 28 patients each.

Acupuncture treatment was performed with disposable stainless steel needles by an experienced, licensed acupuncturist. Measurements of OBF were taken with the Heidelberg retina flowmeter (HRF, Heidelberg Engineering), the dynamic vessel analyzer (DVA, Zeiss) and the OBF flowmeter (OBF Labs).

Analyzed with HRF, the patients showed no significant change in parapapillary retinal blood flow before and after acupuncture. DVA also did not reveal significant changes in retinal vessel diameters before and after the treatment in either group.

Data taken from the OBF flowmeter showed a decrease of mean OBF-IOP from 16.1 mm Hg to 15.3 mm Hg after the eye-specific treatment, an increase in mean pulse amplitude from 3.4 mm Hg to 3.7 mm Hg and a change in mean pulsatile OBF from 5.5 μL/min to 6.7 μL/min after the treatment.

In the eye-unspecific treatment group, mean OBF-IOP was 16.4 mm Hg before and 16.5 mm Hg after acupuncture. Mean pulse amplitude was 4.3 mm Hg before and 4.4 mm Hg after the treatment, and mean POBF changed insignificantly from 6.3 μL/min to 6.8 μL/min after the unspecific acupuncture.

“In our prospective randomized study, we were able to show that an eye-specific acupuncture treatment regimen affected ocular blood flow in patients with primary open-angle glaucoma in terms of a significant increase of pulsatile choroidal blood flow. However, retinal blood flow was not affected by acupuncture. Our short-term results may be indicative for a potential beneficial effect of acupuncture in glaucoma patients. However, further studies are certainly needed to confirm our preliminary results,” Naim Terai, MD, co-author of the study, told Healio.com/OSN. – by Michela Cimberle

 

Disclosure: The authors report no relevant financial disclosures.

2018-09-04T10:31:00+00:00 September 4th, 2018|

Acupuncture Carpal Tunnel Syndrome Relief Confirmed!

Researchers find acupuncture effective for the treatment of carpal tunnel syndrome (CTS), a local entrapment neuropathy affecting the wrist and hand that causes pain, numbness, and dysfunction. The research team documents acupuncture’s beneficial influence on the morphology of the median nerve and improvement of clinical symptoms.

According to researchers conducting the investigation, “while previous studies investigated the effect of acupuncture on clinical symptoms and electromyographic studies, to the best of our knowledge, its effect on median nerve morphology was not investigated before.” [1] This study demonstrates that acupuncture influences morphology of the median nerve, which opens up a host of possible future studies that may build upon this foundation of knowledge.

Median nerve compression in the carpal tunnel region of the wrist results in pain, numbness, and tingling in the fingers or hand, as well as possible weakness and atrophy of the hand muscles innervated by the median nerve. [2] More prevalent among women, it is correlated with overuse, diabetes mellitus, rheumatoid arthritis, hypothyroidism, and pregnancy. [3]

Diagnostically and prognostically, musculoskeletal ultrasound imaging has been growing in popularity for monitoring this condition because of its ease and cost effectiveness. Musculoskeletal ultrasound shows the cross-sectional area (CSA) in the wrist level of the median nerve and this study documents correlations between median nerve cross-sectional areas and electrophysiological changes within the CTS affected limb.

A total of 27 female patients (45 limbs) with CTS were diagnosed with electromyographic tests for the purposes of this investigation. The patients were similar in age, BMI (body mass index), duration of disease, and severity of CTS. Exclusionary criteria were the following: radicular pain, polyneuropathy, radial or ulnar nerve diseases, severe CTS, trauma history, prior hand surgery.

In patients with bilateral CTS, both extremities were included in the same group. All patients were informed about the study and provided consent. They were randomly divided into two groups (acupuncture and control). The mean duration of the disease was 18.3 months and 19.3 months respectively. Both groups used night wrist splints for CTS for 4 weeks, while only the acupuncture group received acupuncture treatments. The following nine acupoints were selected for the study:

  • Daling (PC7)
  • Ximen (PC4)
  • Neiguan (PC6)
  • Laogong (PC8)
  • Qingling (HT2)
  • Shenmen (HT7)
  • Shaofu (HT8)
  • Taiyuan (LU9)
  • Quchi (LI11)

The median nerve cross-sectional area was measured at the proximal carpal tunnel with musculoskeletal ultrasound, with the scaphoid and pisiform bones used as bony landmarks for the proximal tunnel where the cross section was measured. [4] Needles of size 0.25 × 25 mm were inserted into the points and were retained for 25 minutes per acupuncture session. Treatments were conducted two or three days per week for four weeks, totaling ten sessions.

 

Results
The median nerve cross-sectional area was measured by using musculoskeletal ultrasound on the patients while seated and positioned similarly (elbow at 90 degree flexion with the forearm in supination position). Cross-sectional areas of size 9 mm or greater had previously been determined as a possible diagnostic measure for CTS. [5]

Pain severity, hand function, and musculoskeletal ultrasound measurements were taken before and after treatments. The visual analog scale (VAS: 0–10 cm) measured pain severity. The Duruoz Hand Index (DHI) and Quick Disabilities of the Arm, Shoulder and Hand (DASH) scores were used to assess hand functions and disability. All electrophysiological tests were performed by using a Nihon Cohden Neuropack machine.

Compound muscle action potential (CMAP: normal >6.8 mV) measured the reaction of the abductor pollicis brevis muscle to stimulation at the wrist and elbow. Sensory nerve action potential (SNAP: normal >10 uV) measured the reaction of wrist stimulation to signals traveling in the opposite direction of normal signals in the nerve fiber (antidromic) of the second finger. Motor distal latency (normal <3.8 ms), sensory nerve conduction velocity (SNCV: normal >40.4 m/sec), and motor nerve conduction velocity (M-NCV: normal >49.4 m/sec) were also measured before and after treatment.

Acupuncture group positive outcomes proved significant. The median nerve cross-sectional area decreased from 11.6 to10.6 mm, motor distal latency decreased from 4.3 to 4.1 ms, and SNAP increased from 16.7 to17.6 uV. Also in the acupuncture group, VAS decreased from 9 to 4.8, CMAP increased from 12.9 to 14.8 mV, DHI decreased from 47 to 37, Quick DASH decreased from 67.2 to 56.8, S-NCV increased from 31 to 33.2 m/sec, and motor nerve velocity increased from 57.4 to 59 m/sec.

The improvement within the acupuncture group when comparing baseline values with the results highlights the success of acupuncture in decreasing clinical symptoms of CTS. It also highlights its ability to transform median nerve morphology such that acupuncture can reduce the cross-sectional area. The results within the control group were not as significant as the acupuncture group, highlighting the efficacy of acupuncture in treating neuropathic disorders compared with night splint monotherapy.

The researchers cited several investigations showing acupuncture’s positive influence on CTS. Recent studies have used magnetic resonance imaging to show how acupuncture may alter brain activity and the limbic system of CTS patients. [6,7,8] Acupuncture produces anti-inflammatory effects in the median nerve within the carpal tunnel, as well as effects that can be compared to ibuprofen, night splints, and oral or injected steroids. [9,10,11]

 

Summary
Acupuncture generates beneficial morphological changes in the median nerve of patients with carpal tunnel syndrome and reduces or eliminates symptoms. Based on the scientific evidence, acupuncture is a reasonable treatment option. Consult with a local licensed acupuncturist to learn more.

 

References:
1 Ural, Fatma Gülçin, and Gökhan Tuna Öztürk. “The acupuncture effect on median nerve morphology in patients with carpal tunnel syndrome: an ultrasonographic study.” Evidence-Based Complementary and Alternative Medicine 2017 (2017).

2. S. Tanaka, D. K. Wild, P. J. Seligman, V. Behrens, L. Cameron, and V. Putz-Anderson, “The US [musculoskeletal ultrasound] prevalence of self-reported carpal tunnel syndrome: 1988 national health interview survey data,”American Journal of Public Health, vol. 84, no. 11, pp. 1846– 1848, 1994.

3. R. J. Spinner, J. W. Bachman, and P. C. Amadio, “The many faces of carpal tunnel syndrome,” Mayo Clinic Proceedings, vol. 64, no. 7, pp. 829–836, 1989.

4. Ural, Fatma Gülçin, and Gökhan Tuna Öztürk. “The acupuncture effect on median nerve morphology in patients with carpal tunnel syndrome: an ultrasonographic study.” Evidence-Based Complementary and Alternative Medicine 2017 (2017).

5. J. T. Mhoon, V. C. Juel, and L. D. Hobson-Webb, “Median nerve ultrasound as a screening tool in carpal tunnel syndrome: correlation of cross-sectional area measures with electrodiagnostic abnormality,” Muscle and Nerve, vol. 46, no. 6, pp. 871–878, 2012.

6. A. U. Asghar, G. Green, M. F. Lythgoe, G. Lewith, and H. MacPherson, “Acupuncture needling sensation: the neural correlates of deqi using fMRI,” Brain Research, vol. 1315, pp. 111–118, 2010.

7. V. Napadow, J. Liu, M. Li et al., “Somatosensory cortical plasticity in carpal tunnel syndrome treated by acupuncture,” Human Brain Mapping, vol. 28, no. 3, pp. 159–171, 2007.

8. V. Napadow, N. Kettner, J. Liu et al., “Hypothalamus and amygdala response to acupuncture stimuli in carpal tunnel syndrome,” Pain, vol. 130, no. 3, pp. 254–266, 2007.

9. M. Hadianfard, E. Bazrafshan, H. Momeninejad, and N. Jahani, “Efficacies of acupuncture and anti-inflammatory treatment for carpal tunnel syndrome,” Journal of Acupuncture and Meridian Studies, vol. 8, no. 5, pp. 229–235, 2015.

10. Ho, Chien-Yi, Hsiu-Chen Lin, Yu-Chen Lee, Li-Wei Chou, Ta-Wei Kuo, Heng-Wei Chang, Yueh-Sheng Chen, and Sui-Foon Lo. “Clinical effectiveness of acupuncture for carpal tunnel syndrome.” The American journal of Chinese medicine 42, no. 02 (2014): 303-314.

11. Yang, Chun-Pai, Nai-Hwei Wang, Tsai-Chung Li, Ching-Liang Hsieh, Hen-Hong Chang, Kai-Lin Hwang, Wang-Sheng Ko, and Ming-Hong Chang. “A randomized clinical trial of acupuncture versus oral steroids for carpal tunnel syndrome: a long-term follow-up.” The Journal of Pain 12, no. 2 (2011): 272-279.

 

2018-08-30T15:50:05+00:00 August 30th, 2018|