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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.

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.

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.

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.

Dalian Hospital of Traditional Chinese Medicine researchers confirm that acupuncture combined with herbal medicine is effective for the treatment of insomnia in Parkinson’s disease patients. In a controlled clinical trial, a combination of scalp acupuncture and a modified version of the herbal formula Gui Pi Tang were tested. Using the Pittsburgh Sleep Quality Index (PSQI) as a quantitative measure, Parkinson’s disease patients demonstrated significant improvements in sleep. [1]

The PSQI scale rates subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleep medications, and daytime dysfunction. Higher numbers indicate worse overall quality of sleep. PSQI questionnaires completed before and after the treatment period showed a statistically significant improvement in sleep quality in the two Chinese medicine groups. Group one received acupuncture and herbal medicine and group two received only herbal medicine.

Participants in the acupuncture plus herbs group showed a greater improvement in sleep quality with PSQI scores reduced from a mean of 14.9 before treatment to 4.5 following treatment. Improvements in the herbal medicine monotherapy group were comparatively lower, reducing from a mean of 15.1 to 8.7 following treatment. The results indicate that although herbal medicine is effective, the addition of acupuncture to the treatment protocol significantly increases positive patient outcomes for Parkinson’s disease patients suffering from insomnia.

Insomnia is a common Parkinson’s disease complication, with between 70% and 95% of Parkinson’s sufferers affected. Symptoms such as tremors, stiffness, pain, and restless leg syndrome all make getting a good night’s sleep difficult. Also, common Parkinson’s disease medications (e.g., levodopa) have a stimulatory effect and can cause sleep problems if taken late in the evening.

A total of 50 patients with Parkinson’s disease were recruited for the study and were randomized to either the herb monotherapy group (n=25) or the acupuncture plus herbs group (n=25). The herb monotherapy group received a modified Gui Pi Tang formula, while the acupuncture plus herbs group received the identical modified Gui Pi Tang herbal formula plus scalp acupuncture points. Both groups were statistically similar in terms of demographics, with 13 males and 12 females in each group. The mean age of the herb monotherapy group was 69.7 years and the mean age of the acupuncture plus herbs group was 69.6 years.

Inclusion criteria for the study included tremors or mobility problems, stiffness of the limbs affecting the gait, and having undergone an MRI scan to rule out cerebral bleeding. According to Chinese medicine principles, the patients were diagnosed with a pattern of heart and spleen deficiency. This pattern is a combination of heart qi and blood deficiency with spleen qi deficiency. Common indications for the presence of this pattern are insomnia, forgetfulness, palpitations, dream disturbed sleep, poor appetite, and loose stools. The tongue is typically pale with a white coating and the pulse is deep and weak.

For heart and spleen deficiency, the treatment principle is to tonify the heart and spleen. The diagnostic inclusion parameter of heart and spleen deficiency matches the classical application of Gui Pi Tang within Traditional Chinese Medicine (TCM) for the treatment of this condition. In many clinical scenarios, Gui Pi Tang is used for patients that are light sleepers and wake frequently throughout the night. This is distinguished from other forms of sleep disorders. For example, if patients wake between 1–3 am and have stress, anxiety, tight jaws or grinding, and other manifestations of liver qi stagnation, an herbal formula such as Xiao Yao Wan or Dan Zhi Xiao Yao Wan are usually prescribed instead.

Exclusion criteria included reduced liver and kidney function, gastrointestinal bleeding, organ failure, abnormal cerebral function, stroke or cerebral bleeding, and psychological diseases. All of the participants were on various medications including antibiotics, blood pressure medications, or blood sugar regulatory drugs. All participants were prescribed oral levodopa (0.25mg, three times per day). The modified Gui Pi Tang formula consisted of the following herbs:

• Bai Zhu 15g
• Ren Shen 10g
• Dang Gui 15g
• Fu Ling 15g
• Yuan Zhi 10g
• Suan Zao Ren 15g
• Mu Xiang 10g
• Long Yan Rou 10g
• Da Zao 10g

These ingredients were decocted to 150ml of liquid to be taken orally twice per day. Each course lasted 15 days and a total of four courses were administered to both the herb monotherapy and the experimental groups. In addition to the modified Gui Pi Tang formula, the acupuncture plus herbs group also had scalp acupuncture treatments. The following points were selected for all participants:

• Baihui (GV20)
• Touwei (ST8)
• Sishencong (MHN1)
• Toulinqi (GB15)

The acupoints were stimulated manually using a reinforcing method and treatment was administered once per day. Each acupuncture course lasted 15 days (one treatment session per day) and a total of four courses were administered. The results demonstrate significant improvements from the herb monotherapy; however, the addition of acupuncture produces greater clinical results.

Related Research
Federal University of Pernambuco (Recife, Brazil) researchers had similar findings. In this study, 22 patients diagnosed with Parkinson’s disease by a neurologist were recruited and randomized to receive either acupuncture (n=11) or no intervention (n=11). Both groups included seven male and four female participants. The mean age in the acupuncture group was 65 years compared with 56 years in the control group. Despite this difference in age, both groups had similar clinical characteristics.

Inclusion criteria included a diagnosis of idiopathic Parkinson’s disease according to the UK Parkinson’s Disease Society Brain Bank criteria, stage I–III Parkinson’s disease according to the Hoehn-Yahr scale, and ages ranging between 35–80 years. Exclusion criteria included the presence of comorbid neurological diseases, cognitive impairment, or having undergone physiotherapy. All participants had been on a stable dose of Parkinson’s medications for at least 2 months prior to the study. The following acupuncture points were selected for the study on the basis of previous research:

• Taichong (LV3)
• Sanyinjiao (SP6)
• Hegu (LI4)
• Waiguan (TB5)
• Shenmen (HT7)
• Neiguan (PC6)
• Quchi (LI11)
• Fengchi (GB20)

Needles were retained for 30 minutes per session and treatments were administered weekly for a total of eight weeks. The results were analysed using the Parkinson’s Disease Sleep Scale (PDSS), a self-administered scale which comprises 15 items including overall quality of sleep, sleep onset and maintenance, nocturnal restlessness, nocturnal psychosis, nocturia (excessive waking for urination at night), nocturnal motor symptoms, sleep refreshment, and daytime dozing. There were no significant differences in PDSS scores between the groups prior to the study.

Following treatment, there was a significant improvement in PDSS scores in the acupuncture group in the domains of general sleep quality, nocturnal psychosis, and nocturnal motor symptoms. [2] There was a tendency towards improvement in sleep onset and maintenance, nocturnal agitation, nocturia, relaxing sleep, and daytime sleepiness, but these improvements were not as pronounced as the aforementioned improvements. The control group did not show significant improvements at the end of the study period. Based on the data, the researchers confirm that acupuncture improves sleep for patients with Parkinson’s disease.

References:
1. Li L. “Clinical Observation on Guipi Decoction Combined with Acupuncture and Moxibustion in the Treatment of Insomnia Patients with Parkinson” Guangming Journal of Chinese Medicine; July 2018. Vol 33.

2. De Amorim Aroxa, Fábio Henrique, Ihana Thaís Guerra de Oliveira Gondim, Elba Lúcia Wanderley Santos, Maria das Graças Wanderley de Sales, Amdore Guescel C. Asano, and Nadja Maria Jorge Asano. “Acupuncture as Adjuvant Therapy for Sleep Disorders in Parkinson’s Disease.” Journal of acupuncture and meridian studies 10, no. 1 (2017): 33-38.

Please join me next Friday, Aug. 17th for this informative lunch n’ learn. If you know of anyone who might benefit please share this post. This event is free but reservations are recommended as most of my events sell out. #cscla #cancersupportla

The first prescription medication extracted from the marijuana plant is poised to land on pharmacists’ shelves this fall. Epidiolex, made from purified cannabidiol, or CBD, a compound found in the cannabis plant, is approved for two rare types of epilepsy.

Its journey to market was driven forward by one family’s quest to find a treatment for their son’s epilepsy.

Scientific and public interest in CBD had been percolating for several years before the Food and Drug Administration finally approved Epidiolex in June. But CBD — which doesn’t cause the mind-altering high that comes from THC, the primary psychoactive component of marijuana — was hard to study, because of tight restrictions on using cannabis in research.

Sam Vogelstein’s family and his doctors found ways to work around those restrictions in their fight to control his seizures.

Sam’s seizures started in 2005 when he was four years old. It’s a moment his mother, Evelyn Nussenbaum, will never forget. The family was saying goodbye to a dinner guest when Sam’s face suddenly slackened and he fell forward at the waist.

“He did something that looked like a judo bow after a match,” says Nussenbaum.

Two months passed before Sam had another seizure, but then he started having them every week. Eventually he was suffering through 100 seizures a day.

“When they were bad, they were once every three minutes,” Nussenbaum says.

A roller-coaster ride

Sam was diagnosed with epilepsy with myoclonic-absences, which is characterized by an abrupt unresponsiveness and then sudden body jerks. The episodes were quick, but dangerous.

The electricity in Sam’s brain would misfire for about five to 20 seconds, enough time to fall down stairs, plunge face first into a dinner plate, or crack his head on a window.

“I don’t remember a lot of it really,” says Sam.

He does remember the barrage of medications his doctors put him on. Some helped briefly. Others triggered hallucinations, full body rashes and uncontrolled anger.

“Sam is a pretty gentle person, ” his mother says. “We put him on one medication and it made him angry, and he started punching kids. And it was like, ‘Oh my God, this is not my kid.’ “

More than 3.4 million Americans have epilepsy, according to the Centers for Disease Control and Prevention, but treating the disease is often a riddle doctors find difficult to solve.

Sam struggled to read, to write, to solve math problems and Nussenbaum watched her son fall further and further behind in school.

Life for Sam was like a bad cell phone connection: Every few moments the signal dropped out.

“It was scary,” Nussenbaum says. “I would often cry in my shower or I would drive up to the top of Grizzly Peak [in Berkeley] and sit in my car and scream.”

Pushing for access

In 2011, Nussenbaum came across an article in a British medical journal about a small seizure study on rats. The researchers successfully treated the rodents with CBD.

“I thought, ‘My son needs access to that,’ ” says Nussenbaum.

But, seven years ago, pure CBD was not easy to get. Many states have since legalized medical marijuana and CBD is widely available at dispensaries and on the internet, but it is still classified as a Schedule 1 drug by the U.S. Drug Enforcement Administration which means it’s illegal under federal law.

Then, Nussenbaum learned about a British pharmaceutical company – GW Pharmaceuticals — that was making a medicine derived from highly-concentrated CBD to treat multiple sclerosis patients. After months of phone calls and emails from Sam’s parents, the company agreed to let Sam try the drug, in the U.K., under a doctor’s supervision for two weeks. The family flew to London shortly after.

“After one day his seizures were down to 30,” says Nussenbaum. “After two days they were down to ten. After three days he had one seizure.”

Sam didn’t suffer any side effects.

Back in the U.S. Sam’s parents needed to find a way to keep getting the drug. They collaborated with Dr. Roberta Cilio, a neurologist at UC San Francisco. They petitioned the FDA to allow Sam to use the drug under a compassionate use program. Four months and hundreds of pages of documents later, the FDA allowed Sam to enroll in his own one-person trial at UCSF.

The DEA was a little more cautious. One day two agents knocked on Cilio’s office door. After hours of questioning, the two men requested she store the medication in a giant safe weighing close to 1,000 pounds.

According to GW Pharmaceuticals, Sam was the first patient in the world to receive Epidiolex.

An expanded trial and varying results

Inspired by Sam’s success, Cilio, and other clinicians, started trying Epidiolex on other patients. In 2015, she and several co-authors published a study in Lancet Neurology that included 214 patients with treatment-resistant epilepsy, all children and young adults.

For most patients the results were not as dramatic as they had been for Sam. Seizures dropped in 36.5 percent of patients, which is about the same success rate as other seizure medications, Cilio says.

And some patients experienced side effects like fatigue, diarrhea and convulsions. Cilio doesn’t know why CBD transforms some lives and other patients don’t respond at all.

“The studies that are out are mostly short term,” says Cilio. “We need to learn who the best responders are. Of course, we know this is not a miracle drug.”

There have been other trials of CBD oil for epilepsy, which have shown that the substance is helpful for a portion of patients. Several states have legalized CBD oil specifically for the treatment of intractable epilepsy or seizure disorders.

And as NPR has reported, CBD has gained popularity with consumers as a remedy for a variety of other ailments. But the products that are available over the counter or in medical cannabis dispensaries, aren’t regulated the way pharmaceutical drugs are, so the consistency and dose can vary widely.

The FDA’s decision to approve Epidiolex means that epilepsy patients will have access to a pharmaceutical-grade drug, which delivers a high-quality, consistent dose of CBD, says Robert Carson a pediatric neurologist at Vanderbilt University who treats patients with epilepsy.

Unanswered Questions

Epidiolex still has to get over one regulatory hurdle. The DEA needs to reclassify CBD so it is no longer considered a Schedule 1 substance. Drugs in this category are considered to have no medical use and a high potential for abuse. The FDA’s approval of Epidiolex means CBD no longer fits that category and the reclassification is expected some time in the fall.

Patients will need a prescription to get the drug. GW Pharmaceuticals has not released a price yet. And Sam’s mom, Evelyn Nussenbaum worries that some insurance companies might not cover it.

In the meantime, Sam still gets his drugs from the investigational pharmacy at UCSF. One day he hopes he’ll be prescribing the medication to patients like him.

“I want to be an epilepsy doctor,” Sam says.

First he’s working on his driving license. Dr. Cilio just cleared Sam to get behind the wheel. He’s 17 now and hasn’t had a seizure in more than two years.