Acupuncture and moxibustion are effective treatment modalities for acne sufferers. Zhang et al. conducted a clinical trial to determine the efficaciousness of acupuncture and moxibustion for the treatment of acne due to yin deficiency with internal heat. While both modalities produced positive patient outcomes, moxibustion was slightly more effective than acupuncture for the treatment of this particular class of acne.
In Traditional Chinese Medicine (TCM), acne due to yin deficiency with internal heat has a complex pathology. It is a result of many different types of bodily imbalances. Symptomatic presentations of this disorder appear as excess conditions involving toxins, damp-heat, etc… However, the root of the condition is yin deficiency leading to internal heat. As a result, this type of acne is often pernicious and insidious.
Zhang et al. comment that according to TCM principles, the treatment of acne due to yin deficiency with internal heat focuses on nourishing the root of deficiency and clearing excess heat. To bring a yin deficient bodily state to a yin and yang balanced state, effective medical treatments often follow these principles: facilitate the balance of yin and yang, promote circulation, improve internal organ health, release heat and toxins from the body.
In this study, acne patients who received acupuncture treatment had an 83.33% total treatment effective rate. Participants receiving moxibustion treatment had a 90% total treatment effective rate. In both groups, patients demonstrating significant improvements in acne did not experience a relapse of the condition in the four week window after completion of treatment.
A total of 66 patients with acne due to yin deficiency and internal heat participated in this study. They were randomly divided into two groups: acupuncture group, moxibustion group. Each group received only acupuncture or moxibustion therapy respectively. Due to external factors, 6 patients were eventually disqualified from the study, therefore, the final results were tabulated from a total of 60 patients. The acupoints selected for both moxibustion and acupuncture were identical:
Both groups underwent the same preparation procedures before starting their respective treatments. Firstly, the affected areas were disinfected. For each pustule, a disposable needle was used to gently pierce the pustule and release the pus. Disinfection was performed again after removal. Thereafter, each group underwent their respective treatments.
For the moxibustion group, edible grade salt was spread on the selected acupoints. Next, a slice of raw ginger (with a hole pierced in the center) was placed over the salt. Subsequently, 20 g of conical moxa was placed on top of the raw ginger slice and lit. Each acupoint was treated with a grand total of 60 g of moxa, 5 minutes per each 20 g dose. Throughout the treatment, consistent checks were made with the patients to ensure that they felt warmth at the acupoints, but not excessive heat. Moxibustion treatment was conducted twice per week, on Monday and Friday. One treatment cycle consisted of four consecutive weeks. The entire treatment course was comprised of three treatment cycles.
For the acupuncture group, a 0.30 x 25 mm disposable filiform needle was perpendicularly inserted (after disinfection) into each acupoint until a deqi effect was achieved. Standard insertion depths of the acupoints were followed with one exception, the Shenque (CV8) acupoint was pierced up to a 3–5 mm depth. Normally, this acupoint is contraindicated for needling. A total needle retention time of 30 minutes was observed. The acupuncturist applied the reinforcement manipulation technique every 10 minutes. Acupuncture treatments were conducted twice per week, on Monday and Friday. Identical to the moxibustion protocol, one treatment cycle consisted of four consecutive weeks. The entire treatment course was comprised of three treatment cycles.
The total treatment effective rate was assessed according to skin improvements and changes in yin deficiency patterns. Yin deficiency improvements were evaluated by changes in the clinical presentation of symptoms. Skin improvements were categorized into 4 tiers:
Recovery: >90% reduction in acne, or only pigmentation change observed
Significantly effective: 60%–89% reduction in acne
Effective: 30%–59% reduction in acne
Not effective: <30% reduction in acne, or condition worsened
Zhang et al. conclude that both acupuncture and moxibustion are effective in treating acne due to yin deficiency with internal heat. Moxibustion outperformed acupuncture in this clinical protocol. Based on the findings, further research is warranted.
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Zhang XP, Tong YN, Xue D, Li M, Fu JY. (2013). Clinical Research on “Yin-deficiency with internal heat” Acne Treatment Using Acupuncture and Moxibustion. World Science and Technology-Modernization of Traditional Chinese Medicine. 15(6).
Zhang XP, Li M, Xue D, et al. (2012). Acupuncture and Moxibustion in treating Yin deficiency diseases. Journal of Shanghai University of Traditional Chinese Medicine. 26(6):30-32.
Zhang SJ. (2008). Moxibustion in treating terminal illnesses. China Journal of Acupuncture and Moxibustion. 28(10):739–741.
New CT scan technology reveals acupuncture points. Click the following to read the story: Acupuncture Point Discovery.
Researchers have discovered how to measure and validate the existence of acupuncture points and their meridians. MRI studies and oxygen sensor studies come from some of the most prestigious universities in the world. Today, I want to start with remarkable research from investigators at one of the most prestigious universities in Korea.
Sungkyunkwan University (Seoul) was founded in 1398. Yes, over 600 years ago! It was recently acquired by the Samsung Group in 1996, which has helped preserve its legacy of excellence with substantial financial support. The university is a leader in many fields including nanotechnology and natural sciences, features a dual degree program with Ohio State University and has a collaborative program with the MIT (Massachusetts Institute of Technology) Sloan School of Management.
Two researchers from Sungkunkwan Univeristy worked with another researcher from the Department of Chemistry and Nano Science at Ewha Womans University on this ground breaking research. Notably, Ewha Womans University is considered one of the most prestigious schools in Korea and produced Korea’s first female doctor, lawyer, justice on the Constitutional Court and the first female prime minister of Korea.
Why all the fuss about researchers and the schools they hail from? In the many years I have worked in Chinese and Oriental Medicine, I have uniformly come across skepticism and resistance to valuable, peer reviewed research. I want to give a little background before going forward with something as important as this research. For some it seems, no research institute or study is sufficient so long as it says something positive about acupuncture and herbal medicine. Ethnocentrism abound, I wanted to stave off imperious pans decrying putative proofs and to assuage presumptive skepticism and concomitant guetapens. Perhaps establishing the authenticity and seriousness of the institutions from which the research emanates helps equanimity to mollify incredulity and for rapprochement to exist between the skeptic and modern scientists whose works demonstrate the existence of acupuncture points and their functions.
The research from Sungkyunkwan University and Ewha Woman University is entitled Heterogeneity of Skin Surface Oxygen Level of Wrist in Relation to Acupuncture Point. The study used an amperometric oxygen microsensor to detect partial oxygen pressure variations at different locations on the anterior aspect of the left wrist. The researchers concluded that partial oxygen pressure is significantly higher at acupuncture points.
Below are two images from the study measuring the increase of partial oxygen pressure combined with an overlay of the local acupuncture point locations. The images are representative of typical readings found in the study and remarkably map the Lung Hand Taiyin, Pericardium Hand Jueyin and Heart Shaoyin channels and their associated local points. Depicted are P7 and P6 clearly showing high oxygen pressure levels. The same is true for LU9, LU8, HT7, HT6, HT5 and HT4. Note that non-acupuncture point regions do not show higher oxygen pressure levels. These measurements are not needled points but are natural resting states of acupuncture points absent stimulation. This biomedical research gives us insight into the structural makeup of acupuncture points. This type of basic research is not isolated and numerous studies from multitudes of the top research centers and universities demonstrate specific properties and physiological actions of acupuncture points.
Wrist acupuncture points including the Peridcardium channel and Lung channel. (Seen Above)
The nexus of most research on the physical existence of acupuncture points and acupuncture meridians is hemodynamic, MRI, oxygen pressure, histological, physiological, clinical and electroconductivity research. Researchers at the University of California School of Medicine (Irvine, California) noted, “Recent evidence shows that stimulation of different points on the body causes distinct responses in hemodynamic, fMRI and central neural electrophysiological responses.” The investigators reviewed MRI results and noted that “stimulation of different sets of acupoints leads to disease-specific neuronal responses, even when acupoints are located within the same spinal segment.” This summarizes research in the vanguard of technical documentation on acupuncture.
University of California researchers Choi, Jiang and Longhurst note of acupuncture, “hemodynamic, functional magnetic resonance imaging and neurophysiological studies evaluating the responses to stimulation of multiple points on the body surface have shown that point-specific actions are present.” Naturally, they are running into the difficulty of AhShi points and their specific actions. Perhaps they will discover new effective actions for AhShi points as a result of basic research. Other research shows point specificity in brain physiology and reflects the overall direction of scientific investigation in the field of acupuncture.
The Journal of Magnetic Resonance Imaging featured research on the neurophysiological effects of acupuncture points using MRI imaging noting that acupoint GB40 stimulation enhanced “connectivity between the superior temporal gyrus (STG) and anterior insula.” The investigators concluded, “The current study demonstrates that acupuncture at different acupoints could exert different modulatory effects on RSNs. Our findings may help to understand the neurophysiological mechanisms underlying acupuncture specificity.” Here, the researchers have validated acupuncture point specificity and suggest a possible physiological model of understanding acupuncture points.
HRV (Heart Rate Variability) is a measure of cardiovascular health. One study notes that, “HRV changes significantly during auricular acupuncture….” This research also notes that, “HRV total increases during auricular acupuncture….” Another related study from the International Society for Autonomic Neuroscience notes that acupuncture “causes the modulation of cardiac autonomic function.” These are but two examples of investigations citing specific medicinal actions of specific acupuncture points and is in no way exhaustive of the vast body of research demonstrating acupuncture point specificity for the treatment of hypertension, atrial fibrillation and other cardiovascular disorders. Investigators from the University of California (Los Angeles and Irvine) “have shown that electroacupuncture stimulation activates neurons” in specific brain regions thereby reducing hypertension.
Dr. Berman, M.D. served as a lead researcher in a University of Maryland School of Medicine investigation published in the prestigious Annals of Internal Medicine. The research concludes that, “Acupuncture seems to provide improvement in function and pain relief as an adjunctive therapy for osteoarthritis of the knee when compared with credible sham acupuncture and education control groups.” What is interesting in this clinical trial is that it was an early study showing that sham acupuncture was not as effective as verum acupuncture. The study sought to isolate and address the placebo effect and found that it is not responsible for the medical benefits associated with acupuncture therapy. There are many papers showing the specific medical benefits of acupuncture on internal organs, tissues and towards the resolution of specific ailments. I thought I would highlight this investigation given its historical value.
Einstein’s Theory of Relativity initially did not catch on and was ridiculed before acceptance. The same is true for much of medicine both old and new. People’s presuppositions often circumvent equanimity and receptiveness to new insights. Backing up a bit, one might have thought that a basic neurologic test for the Babinski Sign was pure fiction. It may have seemed logical and self-evident that rubbing someone’s foot and looking for dorsiflexion of the great toe and fanning of the other toes could not possibly indicate brain or spinal cord damage. Yet, the great French neurologist of Polish origin, Babinski, discovered that this plantar reflex identifies central nervous system damage, which is now an accepted medical reality by medical doctors and is an effective diagnostic tool for central nervous system damage.
Acupuncturists and herbalists have faced acrimonious traducements and caluminiations towards substantiated supportive research. Often there is a predilection towards rejecting the efficacy of Chinese and Oriental Medicine that trumps the realities of hard evidence and smacks of ethnocentrism. The Flat Earth Society felt the same way about the infidels suggesting that the earth is round. Galileo had his fair share of troubles too. It cannot be underestimated how high the stakes really are for patient care and beneficial patient outcomes. At risk is non-integration of cost-effective medicine that roots out the source of suffering by healing illness. A time honored traditional clinical medicine history combined with supportive modern research data suggests that acupuncture is an effective modality of therapeutic care. Acupuncture seems impossible? Recall the words of Mark Twain, “Fiction is obliged to stick to possibilities. Truth isn’t.”
It may appear to some that it is self-evident and logical that acupuncture points exist only as part of some sort of chimerical hermeneutic system. However, extensive research has already been conducted at major universities worldwide demonstrating not only that acupuncture points and meridians exist but also how they physiologically function. There is a resistance to an enormous body of research. Cloaked in veil of mature skepticism and realism, naysayers grasp at piecemeal attack pieces to fight off what has already been measured, documented and peer reviewed both in individual studies and large scale meta-analyses. I suggest an era of open-mindedness towards the modern research documenting the efficacy of Chinese and Oriental medicine, acupuncture and herbal medicine.
 Minyoung Hong, Sarah S. Park, Yejin Ha, et al., “Heterogeneity of Skin Surface Oxygen Level of Wrist in Relation to Acupuncture Point,” Evidence-Based Complementary and Alternative Medicine, vol. 2012, Article ID 106762, 7 pages, 2012. doi:10.1155/2012/10a6762.
 Point specificity in acupuncture. Chin Med. 2012 Feb 28;7:4. doi: 10.1186/1749-8546-7-4. Choi EM, Jiang F, Longhurst JC.
 Susan Samueli Center for Integrative Medicine, Department of Medicine, School of Medicine, University of California, Irvine CA 92697-4075, USA.
 Point specificity in acupuncture. Chin Med. 2012 Feb 28;7:4. doi: 10.1186/1749-8546-7-4. Choi EM, Jiang F, Longhurst JC.
 Zhong, C., Bai, L., Dai, R., Xue, T., Wang, H., Feng, Y., Liu, Z., You, Y., Chen, S. and Tian, J. (2011), Modulatory effects of acupuncture on resting-state networks: A functional MRI study combining independent component analysis and multivariate granger causality analysis. Journal of Magnetic Resonance Imaging.
 Evidence-Based Complementary and Alternative Medicine. Volume 2012 (2012), Article ID 817378, 7 pages. doi:10.1155/2012/817378. Sino-European Transcontinental Basic and Clinical High-Tech Acupuncture Studies—Part 1: Auricular Acupuncture Increases Heart Rate Variability in Anesthetized Rats. Xin-Yan Gao, Kun Liu, Bing Zhu and Gerhard Litscher.
 Kurono Y, Minagawa M, Ishigami T, Yamada A, Kakamu T, Hayano J. Auton Neurosci. Acupuncture to Danzhong but not to Zhongting increases the cardiac vagal component of heart rate variability. 2011 Apr 26;161(1-2):116-20. Epub 2011 Jan 7.
 Evidence-Based Complementary and Alternative Medicine. Volume 2012 (2012), Article ID 878673, 9 pages. doi:10.1155/2012/878673. Neuroendocrine Mechanisms of Acupuncture in the Treatment of Hypertension. Wei Zhou and John C. Longhurst. Department of Anesthesiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA. Department of Medicine, University of California Irvine, Irvine, CA.
 Ann Intern Med, Berman, Lixing, Lagenberg, Lee, Gilpin, Hochberg. 2004; 141:901-910.
The following is an OpEd recently submitted by Affinity Acupuncture to The Tennessean and other local press.
Affinity Acupuncture would like to commend the state Attorneys General for ruling that Intramuscular Manual Therapy (“IMT”), also known as Trigger-Point Dry Needling, does not fall within the scope of practice of physical therapy as defined by the Occupational and Physical Therapy Act, Tenn. Code Ann. §§ 63-13-101 to -318.
While this topic has not received much media attention, it is very important to state licensed acupuncturists.
Acupuncture and Trigger-Point Dry Needling, often referred to as Dry Needling, have many similarities. In fact, the ruling states that “while there are no doubt distinctions to be drawn between the two, dry needling’s obvious similarity to acupuncture cannot be ignored, and physical therapists may not perform acupuncture, which is a branch of medicine.” A 2008 Mayo Clinic study found a 93.3% anatomic correspondence with classic acupuncture points. The World Health Organization (WHO) lists Trigger Points as a subset of the catalog of acupuncture points. Our office considers dry needling to be a form of acupuncture.
Acupuncture is considered a branch of medicine. While it is growing in popularity, acupuncture is still a fairly controversial practice in the US. Most Americans are more comfortable with conventional Western techniques, or even Eastern techniques performed by Western practitioners. For this reason, some opt for dry needling from Physical Therapists or Doctors of Chiropractic Medicine. The reason this concerns acupuncturists does not reflect their confidence in Chiropractors or Occupational or Physical Therapists. Acupuncture, Chiropractic, and Occupational and Physical Therapy are all effective Complimentary and Alternative Medicines (CAM). They can have tremendous positive impact on the body with or without the compliment of Western medicine. Our office often refers individuals to Physical and Occupational Therapists, as well as Chiropractors, when we believe they can benefit from the services that are clearly outlined in their scopes of practice.
With a well-trained practitioner of Acupuncture, Physical Therapy, or Chiropractic, the methods used are generally regarded as safe. The concern of Occupational and Physical Therapists, and even Chiropractors, performing Dry Needling lies in the level of training specific to the application of applying needles to the body. There is currently no uniform requirement for education of Dry Needling technique, which is disconcerting. It is not included in entry-level education for Physical Therapists, but additional training is available.
There are two main programs for training, neither of which require more than 104 hours of study for individuals who have not had previous training on the insertion of a surgical needle into the human body. The state of Tennessee requires that Licensed Acupuncturists (L.Ac.) complete a minimum of 1490 hours of training in Acupuncture, 660 hours of which are clinical hours supervised by a Licensed Acupuncturist. Acupuncturists are also required to complete Clean Needle exams through the Council of Colleges of Acupuncture and Oriental Medicine. This is significantly more training than Physical Therapists and Chiropractors receive; many states only require 200-300 hours of approved training for licensed MDs.
It is in the best interest of the public that training meets certain standards. Without uniform levels of competency and safety, there are serious risks involved. If the required hours of training for Occupational and Physical Therapists, Chiropractors, and even MDs are not increased, the hours required for acupuncturists should be reduced so that everyone performing the techniques is educated on the same level.
Once again, Physical Therapy and Chiropractic work are highly regarded by our office. That being said, we do applaud the recent opinion by the state Attorneys General, that Dry Needling is similar enough to a branch of medicine, acupuncture, that cannot be performed by Physical Therapists.