Acunpuncture needles out low back pain

Science Daily – Six months of acupuncture treatment appears to be more effective than conventional therapy in treating low back pain, according to a study in the Sept. 24 issue of Archives of Internal Medicine, one of the JAMA/Archives journals, although the study suggests that both sham acupuncture and traditional Chinese verum acupuncture appear to be effective in treating low back pain.

“Low back pain is a common, impairing and disabling condition, often long-term, with an estimated lifetime prevalence of 70 percent to 85 percent,” the authors write as background information in the article. “It is the second most common pain for which physician treatment is sought and a major reason for absenteeism and disability.” Acupuncture is increasingly used as an alternative therapy, but its value as a treatment for low back pain is still controversial.

Michael Haake, Ph.D., M.D., of the University of Regensburg, Bad Abbach, Germany, and colleagues conducted a randomized clinical trial involving 1,162 patients (average age 50) who had experienced chronic low back pain for an average of eight years.

Patients underwent ten 30-minute sessions (approximately two sessions per week) of verum acupuncture (387 patients), sham acupuncture (387 patients) or conventional therapy (388 patients). Verum acupunture consisted of needling fixed points and additional points to a depth of 5 millimeters to 40 millimeters based on traditional Chinese medicine, while sham acupuncture consisted of inserting needles superficially (1 millimeter to 3 millimeters) into the lower back avoiding all known verum points or meridians.

Conventional therapy consisted of a combination of medication, physical therapy and exercise. Five additional sessions were offered to those who had a partial response to treatment (10% to 50% pain reduction).

“A total of 13,475 treatment sessions were conducted (verum acupuncture, 4,821; sham acupuncture, 4,590; conventional therapy, 4,064),” the authors write. Patients receiving the additional five sessions were 232 (59.9%) in the verum group, 209 (54.3%) in the sham group and 192 (52.5%) in the conventional group.

Response rate was defined as a 33% improvement in pain or a 12 percent improvement in functional ability. “At six months, response rate was 47.6% in the verum acupuncture group, 44.2% in the sham acupuncture group and 27.4% in the conventional therapy group,” the authors note. “Differences among groups were as follows: verum vs. sham, 3.4%; verum vs. conventional therapy, 20.2%; and sham vs. conventional therapy, 16.8%.”

“The superiority of both forms of acupuncture suggests a common underlying mechanism that may act on pain generation, transmission of pain signals or processing of pain signals by the central nervous system and that is stronger than the action mechanism of conventional therapy,” the authors conclude. “Acupuncture gives physicians a promising and effective treatment option for chronic low back pain, with few adverse effects or contraindications. The improvements in all primary and secondary outcome measures were significant and lasted long after completion of treatment.”

Asthma gets help from injection-acupuncture

CM NEWS – Injection of a traditional Chinese medicine herbal extract into a widely used acupuncture point may have an anti-inflammatory and immune-regulatory effect on bronchial allergic asthma, according to a new South Korean study.

The herb used in the study was perilla seed (Perillae fructus; or 紫蘇, Zisu in Chinese; or Shiso in Japanese). Injection of the herbal extract into an acupuncture point (herbal acupuncture) is a therapeutic technique combining both acupuncture and herbal treatment.

The study was led by researchers at the Department of Acupuncture, College of Oriental Medicine, Daejeon University, South Korea.

In Chinese medicine, perilla has been shown to stimulate interferon activity and thus, the body’s immune system.

The Japanese often eat perilla with sashimi (sliced raw fish) or cut into thin strips in salads, spaghetti, and meat and fish dishes. It is also used as a flavourful herb in a variety of dishes, even as a pizza topping (initially it was used in place of basil).

Perilla seed has been used to treat respiratory diseases in Chinese medicine. According to TCM theory, perilla seeds enters the lung meridian, arrests coughing and wheezing with copious phlegm, and treats exhalation difficulties and stiffness in the chest. The leaves of perilla (Perilla frutescens) have shown a suppressive effect on type 1 allergies. However, perilla seed has not yet been investigated for use on allergic diseases.
Recent studies have shown that perilla seed polyphenols regulate allergic diseases due to 5-lipoxygenase inhibitory activity and suppression of histamine release from mast cells.

The functional compounds of perilla seed extract are flavonoid aglycons such as luteolin, apigenin, chrysoeriol, and resemarinic acid. It is known that the antioxidative activity and lipoxygenase inhibitory activity of flavonoid aglycons are stronger than that of corresponding glycosides.

Studies have shown that perilla seed extract inhibits the growth of cariogenic and periodontopathogenic microorganisms which in turn reduces plaque formation and acid production, helping to prevent dental carries.

Acupuncture and herbs are widely used to treat bronchial asthma – and according to TCM theory – by clearing the pathogenic factors and reinforcing the body’s resistance.

An important acupoint, zusanli (足三里), was investigated by the researchers in the current study. Zusanli is one of the most widely used acupuncture points, particularly for immune system regulation.

Zusanli is on the foot Yangming stomach meridian. This acupoint is known to strengthen the vital energy (qi). The ‘vital energy’ here means not only stomach qi, even though this acupoint belongs to the stomach meridian, but also the general qi in the whole body.

For this reason, zusanli is used to treat various diseases in different parts of the body or general symptoms in the whole body, including deficiency and weakness.

According to the book Chinese Acupuncture and Moxibustion, zusanli is listed to treat: gastric pain, vomiting, hiccup, abdominal distention, borborygmus, diarrhea, dysentery, constipation, mastitis, enteritis, aching of the knee joint and leg, beriberi, edema, cough, asthma, emaciation due to general deficiency, indigestion, apoplexy, hemiplegia, dizziness, insomnia, mania. (for a detailed explanation of zusanli, check here.)

Asthmatic mice were divided into 6 groups – both experimental and control. The experimental group was treated with perilla seed extract plus the acupuncture while the controlled ones received saline injection or just acupuncture. The treatments went on for 8 weeks.

According to the researchers:

Asthma is generally regarded as a T-cell mediated disease. Allergens cause the differentiation of naive T- cells into Th2 cells, which then secrete cytokines such as IL-4, IL-5 and IL-13 (3).

IL-4, which is pivotal in the pathogenesis of allergic disorders, acts on B cells to facilitate IgE production. Increased IgE production in response to common environmental antigens is the hallmark of atopic diseases such as bronchial asthma.

IL-4 also induces the rolling and adhesion of circulating eosinophils to endothelial cells. Therefore, inhibitors of the IL-4 signaling pathway have been suggested as therapeutic targets.

The results showed that perilla seed extracts + acupuncture at zusanli significantly decreased cytokins IL-4. It is inferred that the treatment may have an anti-allergic effect on allergic bronchial asthma by suppressing IL-4 secretion; and thus reduce eosinophil inflitration into the lungs by reducing the adhesion of circulating esoinophils to endothelial cells, the researchers wrote.

The researchers also found that even by applying acupuncture at zusanli ONLY may suppress asthma, though not as effective as the injection-acupuncture treatment. This result suggests that the mechanical stimulation of zusanli has a beneficial effect on bronchial allergic asthma.

“In summary, we hypothesize that PF-HA may be applicable to bronchial allergic asthma to reduce airway obstruction by inhibiting cellular infiltration and collagen accumulation in the lung, and to relieve airway hyper-responsiveness by reducing IL-4, IL-5, IL-13 and IgE,” the researchers conclude.

“Our data further suggest that PF-HA has a therapeutic effect on bronchial allergic asthma by regulating the immune system (suppressing excess Th2 activity and rebalancing Th1/Th2 in the immune system) and controlling eosinophilic inflammation in the airway. The anti-inflammatory effect of PF-HA may result from its immuno-regulatory effect on Th1 and Th2 activity.”

Electric acupuncture helps insomnia

CM NEWS – Using electric acupuncture to needle 4 “extraordinary” acupoints on the top of the head might have impressive effect on treating insomnia, a recent study indicates.

Researchers at the Shandong Provincial Hospital in China evaluated the clinical therapeutic effect of electric acupuncture at a set of 4 acupoints Sishencong (EX-HN 1, “Four Brightening Spirits”, 四神聰) on insomnia.

What is electric acupuncture? Electric acupuncture, the application of a pulsating electrical current to acupuncture needles as a means of stimulating the acupoints, was developed in China as an extension of hand manipulation of acupuncture needles around 1934.

The procedure for electric acupuncture is to insert the acupuncture needle as would normally be done, attain the qi reaction by hand manipulation, and then attach an electrode to the needle to provide continued stimulation. The benefits of using electrical stimulation are:

1. It substitutes for prolonged hand maneuvering. This helps assure that the patient gets the amount of stimulation needed, because the practitioner may otherwise pause due to fatigue. Electric acupuncture may also help reduce total treatment time by providing the continued stimulus. During electric acupuncture, the practitioner can attend to other patients.
2. It can produce a stronger stimulation, if desired, without causing tissue damage associated with twirling and lifting and thrusting the needle. Strong stimulation may be needed for difficult cases of neuralgia or paralysis.
3. It is easier to control the frequency of the stimulus and the amount of stimulus than with hand manipulation of the needles.

electric acupuncture penIn this study, 276 patients were randomly assigned to 2 groups, 138 in each group. The treatment group received electric acupuncture at Sishencong, and the control group with oral administration of Tianmeng Capsule (甜夢膠囊, or “Sweet Dream Capsule”, which is a all herb product for treating mild insomnia).

The treatment course for both groups was 3 weeks. The quality and related parameters of sleep before and after treatment were evaluated with a multi-channel sleep detector. The results showed that quality of sleep was improved in both groups after treatment.

What are Sishencong acupoints? Sishencong are the four points located one inch respectively lateral, anterior and posterior to Baihui (GV 20). Sishencong belongs to extraordinary acupoints (經外奇穴) located at the central crossing points of the vertex, the front and the back points are located on the track of Dumai (Du meridian, 督脈) and the left and right points are near the track of Bladder Meridian.

Literature shows that mild acupuncture stimulation of Sishencong has been used to treat tension insomnia.

Traditionally, Sishencong was used to treat headache, dizziness, insomnia, forgetfulness and other anxiety related conditions. In modern applications, Sishencong is related to treatments of vascular headaches, cerebrovascular diseases, hypertension, hyperactivity, vascular dementia etc.

However, the improvement in the electric acupuncture group was superior to that in the control group. The researchers suggest that needling Sishencong with electric acupuncture has obvious effect on insomnia.

Possible explanations

One study on the effect of needling Sishencong on mice shows that the acupuncture significantly increase nitric oxide synthase (NOS) activity and nitric oxide (NO) content in the brain. A growing body of evidence suggests that nitric oxide (NO) may play a role in the circadian and homeostatic processes of sleep regulation

In another study by a group of Taiwanese researchers revealed that the sensitivity of spontaneous barorecepor reflex was improved by acupuncture at Sishencong points.

What is baroreflex? In cardiovascular physiology, the baroreflex or baroreceptor reflex is one of the body’s homeostatic mechanisms for maintaining blood pressure. It provides a negative feedback loop in which an elevated blood pressure reflexively causes blood pressure to decrease; similarly, decreased blood pressure depresses the baroreflex, causing blood pressure to rise.

Sishencong acupuncture might be able to simultaneously enhance cardiac vagal activity and suppress cardiac and vascular sympathetic activities in humans. It also augments the sensitivity of baroreflex. The result can explain the therapeutic mechanism on tension insomnia by acupuncture at Sishencong points.

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