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How Acupuncture is Effective For Lumbar Disc Herniation

How Acupuncture is Effective For Lumbar Disc Herniation

by | Sep 6, 2016 | Back Pain

Acupuncture is Leading the Way in Pain Management

Researchers demonstrate excellent clinical results using acupuncture for the treatment of lumbar disc herniations.

Researchers find acupuncture safe and effective for the treatment of lumbar disc herniations across multiple independent clinical trials. A meta-analysis of investigations reveals that Jiaji acupoints yield significant positive patient outcomes when combined with manual and electroacupuncture techniques. Distal and abdominal acupuncture also demonstrated significant positive patient outcomes. This research review covers rare acupuncture points demonstrating clinical efficacy and details a powerful manual acupuncture technique proven effective for relief of lumbar disc herniation symptoms. We’ll start with primary research by Song et al. and then take a close look at a meta-analysis by Wang et al., including specific approaches to clinical care proven to deliver excellent results.

Researchers find both electroacupuncture and manual acupuncture effective for the treatment of lumbar disc herniations. Song et al. conducted a clinical trial at the Xixiang People’s Hospital in Guangdong, China. Electroacupuncture and manual acupuncture significantly reduced patients’ pain levels. Outstanding positive patient outcomes were recorded for the electroacupuncture treatment group. Patients with lumbar disc herniations receiving electroacupuncture had a 91.8% total treatment effective rate. Improvements included pain reductions, increases in range of motion, and improved straight leg lift testing. 

A sample size of 123 patients was randomly divided into two groups. In group one, 61 patients received electroacupuncture therapy. In group two, 62 patients received manual acupuncture. For the electroacupuncture patients, the Jiaji acupoints at the specific vertebra corresponding to the herniated lumbar disc, as well as on the two adjacent vertebrae, were selected as the primary acupoints and treated on both sides. Additional secondary acupoints were selected based on individual patient symptoms. For hip pain, the following acupoints were chosen:

Huantiao (GB30)
Chengfu (BL36)
For calf pain:

Weizhong (BL40)
Chengshan (BL57)
For lateral calf pain, the following acupoint were chosen:

Yanglingquan (GB34)
Zusanli (ST36)
Kunlun (BL60)
Xuanzhong (GB39)
Treatment commenced with the patient in a prone position. Upon disinfection, a 0.30 x 40 mm disposable needle was pierced perpendicularly into each acupoint until a deqi sensation was reported. Next, an electroacupuncture device was connected to the needles in the Jiaji acupoints. A continuous waveform was selected at an initial 0.8 Hz frequency. The intensity was then gradually increased until both sides of the lumbar muscle were twitching rhythmically at a tolerable rate for the patient. Subsequently, a 30 minute needle retention time was observed. One electroacupuncture session was conducted once per day for 20 consecutive days with a one day break after the 10th day. For the manual acupuncture patients, the following acupoints were selected according to the affected area:

Ganshu (BL18)
Shenshu (BL23)
Yaoyan (MBW24)
Huantiao (GB30)
Zhibian (BL54)
Chengfu (BL36)
Weizhong (BL40)
Weiyang (BL39)
Yanglingquan (GB34)
Feiyang (BL58)
Guangming (GB37)
Kunlun (BL60)
Tonggu (BL66)
Jinggu (BL64)
Houxi (SI3)
Treatment commenced with the patient in a prone position. Upon disinfection, a 0.30 x 40 mm disposable needle was pierced perpendicularly into each acupoint until a deqi sensation was felt. During the subsequent 30 minute needle retention time, the acupuncture needle was manipulated once every 10 minutes. One acupuncture session was conducted once per day for 20 consecutive days with a one day break after the 10th day. The total treatment efficacy was measured based on the TCM Treatment Efficacy Guidelines issued by the TCM Governing Board. Efficacy was categorized into 1 of 3 possible tiers:

Effective: Waist and leg pain ceased. Straightened leg lift of 70° and above. Normal waist and leg activity regained.
Improvement: Waist and leg pain relieved. Improvement in extent of waist movement.
Not effective: No improvement in symptoms.
The total treatment effective rate was measured as a percentage of patients who achieved at least the “improvement” tier. Electroacupuncture produced a 91.8% total treatment effective rate including pain reductions, increases in range of motion, and improved straight leg lift testing. Song et al. conclude that acupuncture is effective for the treatment of lumbar disc herniations.

The research team prefaced their study with background information. Lumbar disc herniation is a common disease among adults. Pain, numbness, or weakness arises due to damage or compression of the nerve root caused by herniation of the nucleus pulposus. This is the soft inner core of the vertebral disc that helps absorb compression and torsion. A herniation occurs when the soft material from the inner core escapes through the outer rings of the disc. This stubborn disease is usually characterized by an abrupt onset with a prolonged or repetitive course of symptomatic flare-ups. Main symptoms include leg and lumbar region pain, and also lower limb motor dysfunction. Lower limb paralysis is possible in severe cases.

Song et al. note that acupuncture is a relatively non-invasive treatment for disc herniations that dredges meridians, promotes qi circulation, eliminates blood stasis, and expels wind-dampness. Pain is thereby relieved when blood and qi circulation is restored. In modern terms, acupuncture stimulates parasympathetic tone and downregulates excess sympathetic nervous system activity. Resulting decreases in the inflammatory cascade of endogenous biochemicals results from the regulation of the autonomic nervous system.

Song et al. add that acupuncture regulates nerve activity, facilitates muscles relaxation, mitigates muscular spasms, dilates blood vessels, improves blood circulation, and also reduces both edema and inflammation. The Jiaji acupoints, located on the back beside the Du meridian, are used to treat diseases related to the corresponding affected nerve segments. Electroacupuncture utilizes electrical stimulation to facilitate the regeneration of damaged nerves by improving nerve cell metabolism and nerve cell enzyme activity. The basis of this is that electroacupuncture forms a localized, stable, and subtle electric current that boosts the electrophysiological properties of nerve cells (Sun, 1996).

In a related study, Wang et al. conducted a meta-analysis on the efficaciousness of acupuncture for the treatment of lumbar disc herniations. Without exception, the clinical investigations demonstrate that acupuncture is a safe and effective treatment modality for lumbar disc herniation patients. The following are examples of studies included in the meta-analysis.

Liu et al. investigated the efficacy of conventional acupuncture therapy. Conventional acupuncture treatment was administered by first identifying the vertebrae with lumbar disc herniations. Corresponding Du meridian acupoints and the two adjacent Jiaji acupoints were needled. The identified acupoints were treated with the Shao Shan Huo (Setting the Mountain on Fire) needling technique. Patients were treated for 10 consecutive days and achieved a 95% total treatment effective rate.

Shao Shan Huo is a powerful tonification needling technique in Traditional Chinese Medicine (TCM). Needles are inserted and stimulated to elicit the arrival of deqi for purposes of reinforcing qi. When applied properly, the patient feels a warm sensation at the needle region. In addition, the skin will be flush red as a result of enhanced micro-circulation of blood.

Initially, the needle is inserted slowly to superficial depth beneath the skin. During the procedure, lifting and thrusting is applied to three levels of depth beneath the skin, starting with the most superficial level at approximately a 0.5 cun depth. This is followed by lifting and thrusting at the middle level at approximately 1.0 cun and the deep level at approximately 1.5 cun. Depth varies according to patient size and acupoint location.

At each of the three depths of insertion, the needle motion combines quick and forceful thrusting with slow and gentle lifting for a total of nine times. Rotation may also be applied with the same techniques. After stimulation at all three levels is complete, the needle is lifted to the superficial level and the procedure is repeated, often three times, to ensure elicitation of a qi sensation producing heat and redness of the skin. The patient may also sweat in the region of the needle or throughout the body as a result of the heat sensation produced by this tonification method. Liu et al. achieved a 95% total treatment effective rate using the Setting the Mountain on Fire technique using the Du and Jiajia (Huatuojiaji) acupuncture points at correlated regions to lumbar disc herniations. Notably, acupuncture was applied for 10 consecutive days.

Deng and Cai’s investigation also examined application of the Jiaji acupoints for the treatment of lumbar disc herniations. In a different approach to needle stimulation, Deng and Cai applied electroacupuncture stimulation to the needles. They achieved significant levels of positive patient outcomes in their clinical trial. In their investigation, patients were treated every other day. Short-term results and a three month follow-up confirm significant clinical improvements.

He et al. had an entirely different approach to acupuncture therapy for the treatment of lumbar disc herniations. Their approach focused on abdominal acupuncture and anterior acupoints. The clinical investigation yielded significant positive patient outcomes. In their semi-protocolized investigation, a set of primary acupoints were applied plus secondary acupoints were added for specific diagnostic concerns. The primary acupoints for all patients were the following:

Shuifen (CV9)
Qihai (CV6)
Guanyuan (CV4)
Next, secondary acupoints were added based on diagnostic criteria. For acute lumbar disc herniations, the following acupoints were added:

Shuigou (GV26)
Yintang (MHN3)
For prolonged lumbar disc herniation, the following acupuncture point was added:

Qixue (KD13)
For generalized lumbago, the following acupoints were added:

Wailing (ST26)
Qixue (KD13)
Siman (KD14)
For sciatica occurring when sitting, the following acupuncture points were added:

Qipang
Wailing (ST26), affected side only
Xiafengshidian
Xiafengshixiadian
He et al. measured improvement rates after three weeks of acupuncture therapy. Patients achieved significant improvements. The researchers conclude that the protocol is effective for the treatment of lumbar disc herniation symptoms. He et al. used several acupoints termed ‘extra’ points including Xiafengshidian, Xiafengshixiadian, and Qipang. The acupoints demonstrate that the researchers focused on abdominal acupuncture as a means of treating lumbar concerns.

Xia Feng Shi Dian (Xia Feng Shi Dian, Lower Wind-Damp Point) is located 2.5 cun lateral to CV6 and is indicated for the treatment of knee disorders, including postoperative swelling and pain. Xiafengshixiadian (Xia Feng Shi Xia Dian, Below Wind-Damp Point) is located 3 cun lateral to CV5 and is used for leg, ankle, and foot disorders. Qipang (Qi Pang, Beside Qi) is located 0.5 cun lateral to CV6 and is indicated for lower back and leg pain, swelling, and weakness; including postoperative disorders.

The meta-analysis included the clinical research of Zhang et al. Manual acupuncture was applied to acupoints surrounding the afflicted area. All needles were directed towards the center of the afflicted region. Zhang et al. achieved a 97.5% total treatment effective rate.

Overall, the metal-analysis by Wang et al. documents that acupuncture is a safe and effective treatment modality for patients with lumbar disc herniations. Implementation of Jiaji acupoints was common across several studies. Other techniques including abdominal acupuncture and local Ashi acupoint acupuncture also demonstrated clinical effectiveness. Both electroacupuncture and specialized manual acupuncture demonstrated effectiveness as well. As a result of the findings, the researchers conclude that acupuncture is an important treatment option for patients with lumbar disc herniations.

 

References:
Song YJ, Yu MJ, Li L, Huang WX, Cai ZW, Su DP. (2013). Clinical Observation of Electro-acupuncture in Treatment of Lumbar Disc Herniation. Chinese Manipulation & Rehabilitation Medicne.

Sun ZR. Mechanism of acupuncture in the regeneration of surrounding damaged nerves. 1996(02).

Wang FM, Sun H, Zhang YM. (2014). Advance of Clinical Research in Intervention of Lumbar Disc Herniation（LDH） with Acupuncture Moxibustion. Journal of Clinical Acupuncture and Moxibustion.
30(3).

Deng W & Cai LH. (2011). Electroacupuncture on Jiaji acupoint in treating lumbar disc herniation. Journal of Clinical Acupuncture. (7).

He JX, Lin WR, Chen JQ, Huang Y, Wang SX, Lin HH & Chen HX. Abdominal acupuncture in treating lumbar disc herniation. Shanghai Journal of Acupuncture. 2012. (7).

Liu YZ, Sun XW & Zou W. (2012). Shao Shan Huo acupuncture technique on lumbar Jiaji acupoint in treating lumber disc herniation. Journal of Clinical Acupuncture. (6).

http://www.healthcmi.com/Acupuncture-Continuing-Education-News/1670-acupuncture-found-effective-for-lumbar-disc-herniations

Acupuncture Moves Stool, Relieves Constipation

by | Jun 20, 2016 | Acupuncture Nashville TN

Acupuncture Moves Stool, Relieves Constipation

Clinical trials demonstrate that acupuncture relieves chronic constipation and produces greater long-term patient outcomes than drugs.

Chengdu University of Traditional Chinese Medicine researchers find true acupuncture more effective than sham acupuncture for the relief of constipation. In another study by Yang et al., acupuncture combined with herbal medicine relieves constipation in the elderly and demonstrates superior patient outcomes to pharmaceutical medications. Acupuncture plus herbs produced a high total effective rate and very low relapse rate. Let’s take a look at the results of the investigations.

Zheng et al. (Chengdu University of Traditional Chinese Medicine) conclude that acupuncture is safe and effective for the treatment of functional constipation, often referred to as chronic idiopathic constipation (CIC). This type of constipation does not have a known anatomical or physiological etiology in biomedicine. CIC often involves infrequent defecation, hard stools, straining during bowel movements, and incomplete evacuation of stools. Secondary symptoms include stomach cramping, pain, and abdominal bloating or distention.

The study examines the efficaciousness of front mu (ST25) and back shu (BL25) acupoints of the large intestine meridian. This approach is consistent with Traditional Chinese Medicine (TCM) principles. The large intestine foot-yangming channel is often an integral aspect to treatments for constipation.

The researchers note that functional constipation is classified in the Da Bian Nan (difficulty in bowel movement) category in TCM. They cite prior research indicating that acupuncture effectively treats the root causes of constipation. As a result, acupuncture patients have lower relapse rates than patients having taken mosapride, a medication used to facilitate bowel movements. Although the drug is effective, the research indicates a relatively high relapse rate (54.2%) following discontinuation of the drug. The researchers add that acupuncture is effective without significant adverse effects whereas mosapride may cause loose stools, dizziness, headaches, insomnia, abdominal pain, and borborygmus. Mosapride is a serotonin 5HT₄-receptor agonist and serotonin 5HT₃-receptor antagonist that is a gastroprokinetic agent.

Acupuncture at the large intestine foot-yangming front mu and back shu points was compared with sham acupoint controls to ensure validity of the data. In a prior meta-analysis, acupuncture had a 72.8% total effective rate for the treatment of constipation. In this study, the classic front mu and back shu combination achieved an 82.56% total effective rate.

The active sham control group had a 67.65% total effective rate compared with the 82.56% total effective rate of the true acupuncture group. Notably, the sham points were located and needled 1 cm laterally to the true acupuncture point locations. This active sham control method may have contributed to clinical successes in the sham group. Nonetheless, the true acupuncture group significantly outperformed the sham control group. True acupuncture had better frequency of bowel movement scores, difficulty of bowel movement scores, and a higher total effective rate. The study involved 72 voluntary patients from the gastrointestinal department at Chengdu University of Traditional Chinese Medicine. Inclusion criteria were established and included the following:

Visited the hospital between October 2010 and December 2014

Met the Rome III diagnostic standard for functional constipation

Between 18 – 75 years old

Did not take any stomach or intestinal prokinetic medications within one week prior to the research starting date

Not participating in any other clinical research

Patients who had the following conditions were filtered out of the selection:

Constipation secondary due to biologically identified illness

Unable to describe symptoms due to ambiguous consciousness or psychosis

Progressive malignant tumors or other severe consumptive diseases

Prone to infection and bleeding

Severe primary and concomitant cardiovascular, liver, kidney, digestive or hematopoietic diseases

Pregnant or lactating

Participating in other clinical research

The patients were randomly divided into two groups of 36 patients each: true acupuncture treatment group, sham control group. The average age of participants was 44 years. There were 9 males and 27 females in the treatment group. There were 11 males and 25 females in the control group. The acupoints selected for the treatment group were the following:

Tianshu (ST25) – Large intestine front mu acupoint

Dachangshu (BL25) – Large intestine back shu acupoint

For the control group, body points selected were neither meridian acupoints nor special acupoints. They were located at the following areas:

 

1 cm to laterally to ST25

1 cm to laterally to to BL25

For both groups, each point was pierced with a disposable 0.3 mm X 50 mm needle (Huatuo brand, Suzhou Medical Equipment Ltd.), adhering to standard piercing depths. For each acupuncture point, the following protocol was observed. After regular disinfection, the needle was inserted into the point and manipulated with pulling, pushing or twisting techniques at a speed of 60 – 90 times per minute. The angle of twist was 90 – 180 degrees and the depth was 0.3 – 0.5 cm. Next, a needle retention time of 30 minutes was observed. Thereafter, the needle was removed and pressure was applied to the point with a dry cotton ball to prevent bleeding.

One 30 minute session was conducted per day. A full treatment cycle consisted of 5 consecutive days. The entire treatment course comprised 4 treatment cycles for a grand total of 20 acupuncture treatments. To evaluate the treatment effective rate, patients were scored before and after the treatments. The constipation signs and symptoms were evaluated for the following:

Frequency of bowel movement

Difficulty in bowel movement

Time taken to bowel movement

Comfort during bowel movement (strain, incomplete bowel movement, bloating, etc.)

Type of Feces

Treatment effective rates were categorized into 4 tiers:

Full recovery: No functional constipation symptoms and physical signs. Improvement rate score ≥90%

Significant improvement: Significant improvement in functional constipation symptoms and physical signs. Improvement rate score ≥70%

Improvement: Moderate improvement in functional constipation symptoms and physical signs. Improvement rate score ≥30%

Ineffective: Little improvement in functional constipation symptoms and physical signs. Improvement rate score <30%

The clinical results of the study by Zheng et al. demonstrate that acupuncture is an effective procedure for the treatment of functional constipation. Compared with prior investigations, the classic front mu and back shu acupoint combination of the large intestine meridian demonstrates excellent rates of positive patient outcomes. Let’s take a look at another study.

Yang et al. (Tianjin and Tongren, China) investigated the effects of acupuncture and traditional herbal medicine on constipation in the elderly. They determined that the combination of both TCM modalities is a more effective constipation in the elderly treatment protocol than a conventional pharmaceutical medication. However, the results were close. TCM yielded a 100% total effective rate and the gastroprokinetic agent cisapride had a 94.83% total effective rate.

In the elderly, constipation is a common complication secondary to other illnesses. Epidemiological studies demonstrate that 60% of the elderly suffer from constipation to varying degrees (Du et al.). The prevention and cure for constipation therefore has a high clinical value and significance. Biomedical etiologies often point to poor peristaltic movement in many cases of constipation in the elderly. This lengthens the stool retention duration and hardens stools due to excess absorption of water.

Constipation may cause acute and chronic stress in the elderly. For elderly patients, exertion during bowel movements may cause a change in coronary and cerebral vascular flow, potentially leading to more threatening conditions including angina, acute myocardial infarction, arrhythmias, high blood pressure, cerebral vascular damage, or death. A common treatment for constipation with medications often employs the purgation method, which is effective in the short-term. However, long-term purgation treatments may result in electrolyte imbalances or varying degrees of stomachaches and diarrhea.

In TCM, chronic constipation in the elderly is often due to a weak liver and kidneys, poor qi and bood circulation, and subsequent malnourishment of the large intestine. TCM also states that long-term consumption of bitter and chilled foods damage the spleen and stomach, slows qi and blood replenishment, and ultimately weakens peristaltic movements thereby affecting the ability to evacuate feces. Professor Han Jing Xuan from Tianjin University of TCM established a protocol using the Sanjiao acupuncture method and the traditional herbal decoction Huang Di San. These two therapeutic approaches have been extensively used in the clinical treatment of a wide range of elderly related diseases including constipation in the elderly.

The acupuncture protocol involves the needling of Zhongwan, Zusanli, and Xuehai to promote spleen and stomach health. Xuehai also promotes blood circulation and minimizes blood stasis. The Waiguan acupoint circulates and nourishes qi in the Sanjiao (triple burner). The study by Yang et al. followed the protocols established by Prof. Han Jing Xuan.

Using the established protocols, acupuncture plus herbs achieved a 100% total effective rate. Cisapride achieved a 94.83% total effective rate. Furthermore, the long-term improvement rate for the Sanjiao acupuncture and Huang Di San protocol was 88.33%. Cisapride had a 46.55% long-term improvement rate.

A total of 118 elderly constipation patients were randomly divided into two groups: treatment group, control group. The control group was given cisapride and the treatment group was given the Sanjiao acupuncture and Huang Di San protocol. Upon starting and throughout the treatment, both groups were given daily activity recommendations: maintain positive emotions, consume high-fiber foods, keep warm. For the Sanjiao acupuncture therapy, the selected primary acupoints were the following:

Shanzhong (CV17)

Zhongwan (CV12)

Qihai (CV6)

Zusanli (ST36)

Xuehai (SP10)

Waiguan (TB5)

After standard disinfection, a 0.25 mm disposable needle was swiftly inserted into each acupoint with a high entry speed. The Shanzhong acupoint was needled transverse-obliquely following the path of the Ren meridian for 0.5 – 1 inches. Other acupoints were pierced perpendicularly up to a depth of 0.5 – 1 inches. The Bu (rotate and push) manipulation technique was applied for Shanzhong, Zhongwan, Qihai, and Zusanli for 1 minute. The Xie (rotate and pull) technique was used on Xuehai for 1 minute. A needle retention time of 30 minutes was observed.

One 30 minute acupuncture session was conducted once per day. A full treatment cycle consisted of 10 days. The entire treatment course comprised 2 treatment cycles for a grand total of 20 days. The mandatory ingredients used in the Huang Di San herbal decoction were as follows:

Huang Jing (15 g)

Sheng Di Huang (15 g)

Sha Ren (15 g)

Pei Lan (15 g)

Shou Wu (15 g)

Dang Gui (15 g)

Additional herbs were added according to the nature of constipation. For patients with deficiency the following herbs were added:

Rou Cong Rong (12 g)

Bai Zhu (12 g)

Mai Dong (12 g)

Huang Qi (12 g)

Dang Shen (12 g)

Shan Yao (12 g)

For patients with primary deficiency with secondary excess (Ben Xu Biao Shi) differential diagnostic pattern differentiations, the following herbs were added:

Yu Li Ren (10 g)

Chuan Xiong (10 g)

Chi Shao (10 g)

Tao Ren (10 g)

Dan Zhu Ye (10 g)

The prescribed ingredients were brewed with water to make an herbal decoction. One brew was consumed orally per day in three separate doses throughout the day. One treatment cycle consisted of 10 days and the entire treatment course comprised 2 treatment cycles for a grand total of 20 days. Subjects in the control group took 10 mg of cisapride tablets, 3 times per day, before lunch, dinner, and sleeping. Treatment efficacy was categorized into 4 tiers:

Recovery: Bowel movement within 12 hours. No other symptoms. Scored 0 for interval between bowel movements

Significantly effective: Significant improvement in constipation. Bowel movement within 24 hours. Normal or slightly dry feces. No difficulty in bowel movement. Scored 1 – 9 for interval between bowel movements

Effective: Bowel movement within 72 hours. Moist feces. Slight difficulty in bowel movement. Scored 10 – 18 for interval between bowel movements

Ineffective: No changes in symptoms. Scored 19 – 20 for interval between bowel movements

The results indicate that acupuncture with herbs is more effective than the prescribed medication. Both studies mentioned in this report demonstrate that acupuncture is safe and effective for the treatment of constipation. Important features of TCM protocols is that they produce a high total effective rate, low relapse rate, and no significant adverse effects.

Contact Affinity Acupuncture for Nashville Acupuncture treatments and techniques.

References:

Ouyang, H. & Chen, J. Therapeutic roles of acupuncture in functional gastrointestinal disorders [J]. Alimentary pharmacology & therapeutics, 2004, 20(8): 831-841.

 

Zheng, H. B. & Chen,Y. (2015). A clinical randomized controlled trial of acupuncture at the combination of back shu point and front－mu point of large intestine meridian in the treatment of functional constipation. Practical Journal of Clinical Medicine. 4 (12).

 

Yang JX, Yu JC & Han JX. (2014). Clinical Study on Treatment of constipation in the elderly with Combination of Acupuncture and Chinese Medicine. World Science and Technology-Modernization of Traditional Chinese Medicine. 16(6).

 

Du WF, Yu L, Yan XK et al. (2012). Meta-analysis in acupuncture therapy in treating constipation. Journal of Chinese Acupuncture. 32(1): 92-96.

http://www.healthcmi.com/Acupuncture-Continuing-Education-News/1648-acupuncture-moves-stool-relieves-constipation

Acupuncture Helps Clear Acne

Acupuncture Helps Clear Acne

by | Jun 14, 2016 | Acupuncture Nashville TN

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:

Shenque (CV8)
Qihai (CV6)
Guanyuan (CV4)
Shenshu (BL23)
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.

Contact Affinity Acupuncture today for Nashville Acupuncture treatments and appointments!

References:
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.

http://www.healthcmi.com/Acupuncture-Continuing-Education-News/1645-acupuncture-and-moxibustion-clear-acne

Acupuncture relieves neck pain and improves range of motion.

by | Jun 8, 2016 | Acupuncture Nashville TN

Acupuncture relieves neck pain and improves range of motion. Chen et al. find acupuncture effective in alleviating cervical spondylosis, a painful disorder caused by intervertebral disc degeneration. Zeng et al. conclude that acupuncture alleviates cervical spondylosis and radiculopathy. The data demonstrates that acupuncture is more effective than NSAIDs (non-steroidal anti-inflammatory drugs). Zhou et al. find acupuncture effective for the alleviation of pain after surgery to the cervical spine. Li et al. conclude that acupuncture plus herbal medicine is effective for the relief of spasmodic torticollis, a disorder wherein the head becomes turned to one side, often due to painful muscle spasms. Liu et al. find acupuncture plus herbs effective for the relief of neck and shoulder pain. Neck points with sitting style technique are applied. 

Let’s take a look at each one of these discoveries. Chen et al. measured the effects of acupuncture on cervical spondylosis. Their findings indicate that a combination of auricular acupuncture with body style acupuncture is more effective than body style acupuncture as a standalone procedure.

Body style acupuncture combined with auricular acupuncture yielded the following results

70% recovered
26.67% significantly effective
3.33% ineffective
Body style only acupuncture yielded the following results

43.33% recovered
50% significantly effective
6.67% ineffective
Recovery was defined as: asymptomatic, muscular strength returned to normal, neck and limb function returned to normal, patient can return to normal work life and carry out more labor intensive activities. Significantly effective was defined as: mitigation of overall symptoms, neck and limb functional improvement, less pain of the neck, shoulder, and back.

Participants received acupuncture every other day for a total of ten sessions of care. Auricular acupuncture, also known as ear acupuncture, was applied to the intersecting region of the thoracic and cervical spine area on the outer ear. The needle was threaded subcutaneously through the cervical spine area. Needle retention time was thirty minutes and manual stimulation was applied 2 – 3 times during needle retention with 5 – 7 rotations each time.

Body style acupuncture was applied to acupoints including

Fengchi, GB20
Hegu, LI4
Jiaji (2 – 3 cervical points, affected side)
Mild reinforcing and reducing techniques were applied to elicit deqi. Needle retention time was thirty minutes, timed from the arrival of deqi. The researchers conclude that auricular acupuncture combined with body style acupuncture is highly effective in the treatment of cervical spondylosis. 

The findings are consistent with those of Zeng et al. whose research at the Guangzhou Dongsheng Hospital finds acupuncture plus herbs effective for the treatment of cervical spondylosis and related radiculopathy. The Traditional Chinese Medicine (TCM) group receiving both acupuncture and herbs had a 96.67% total effective rate. The control group received pharmaceutical medications and had an 83.33% total effective rate.

The control group received an NSAID (diclofenac) and mecobalamin (a form of B12). Diclofenac was administered in 75 mg doses, once per day. B12 was administered in 0.5 mg doses, three times per day. The drugs were administered for twenty days.

The primary acupuncture points used for the treatment group were

Fengchi, GB20
Bailao, M-HN-30
Jiaji (4 – 6 points)
Dazhui, DU14
Ashi
Tianzong, SI11
Supplementary acupoints were added based on diagnostic parameters. For yangming meridian pain or numbness, the following were added

Binao, LI14
Quchi, LI11
Shousanli, LI10
Hegu, LI4
For shaoyang meridian pain or numbness the following secondary acupoints were applied

Waiguan, SJ5
Zhongzhu, KD15
For pain or numbness of the taiyang meridian the researchers added Houxi (SI3). Manual stimulation was applied to acupoints until the arrival of deqi. Next, electroacupuncture was applied to 3 – 4 acupoints with a continuous wave. Intensity was set to tolerance levels. Additional manual techniques were applied to 1 – 2 spots of localized pain using the green dragon tail sweeping method. Needle retention time was thirty minutes per acupuncture session. A total of twenty acupuncture treatments were applied at a rate of once per day.

Herbal medicine was decocted in water and was administered orally once in the morning and also at night for twenty days. The formula included

Gui Zhi 15 g
Ge Gen 30 g
Bai Shao 15 g
Dan Shen 30 g
Yan Hu Suo 15 g
Fang Feng 10 g
Xu Duan 12 g
Dang Gui 10 g
Gan Cao 3 g
Additional herbs were added based on indications and differential diagnostics. For chills and aversion to wind combined with painful obstruction of the meridians, the following were added

Qiang Huo 12 g
Zhi Cao Wu 10 g
For dampness with heat and numbness, the following were added

Cang Zhu 15 g
Huang Bai 10 g
For blood stasis with painful blockage of the meridians, the following were added

Chuan Xiong 12 g
E Zhu 10 g
Acupuncture plus herbs yielded a 96.67% total effective rate and the medications yielded an 83.33% total effective rate. Acupuncture outperformed the medication group by 13.34%. The researchers conclude that acupuncture plus herbs is effective for the alleviation of cervical spondylosis and associated radiculopathy. Electroacupuncture applied to upper back and neck points is shown. 

Foshan Chinese Medicine Hospital researchers (Zhou et al.) looked at a very different type of neck pain. Their investigation examined the efficaciousness of electroacupuncture as a means to minimize pain after cervical spine surgery. Perioperative application of electroacupuncture to LI4 (Hegu) and PC6 (Neiguan) successfully reduced pain after surgery. In addition, patient controlled analgesia requests dropped sharply.

Several other clinical advantages to perioperative acupuncture were documented by the researchers. Electroacupuncture significantly reduced the dosage needs for remifentanil (synthetic opioid analgesic) and propofol (sedative). Acupuncture stabilized the heartbeat rate and the average arterial pressure. In addition, the time needed to regain consciousness after surgery was reduced by acupuncture. The time reduced from an average of 22.31 minutes for the medication only group to 7.01 minutes for the acupuncture plus medication group. Electroacupuncture significantly reduced the frequency of nausea, vomiting, and constipation after surgery.

LI4 and PC6 were needled perpendicularly and manual stimulation was applied to elicit the arrival of deqi. Continuous wave electroacupuncture was applied with a frequency increasing from 100 Hz to 1,000 Hz. The researchers concluded that electroacupuncture is effective in providing significant pain relief and minimizes complications due to surgery of the cervical spine.

Tianjin University of Traditional Chinese Medicine First Hospital (Li et al.) researchers document that acupuncture frees neck movement and stops pain. Their research also finds that combining Chinese herbal medicine with acupuncture increases the efficacy rate. A one year follow-up demonstrated that the acupuncture plus herbs protocol provides significant long-lasting clinical results.

Exclusion criteria were applied. For example, CT scans were used to ensure that participants did not have intracranial lesions. X-rays ruled out cervical spondylosis. Neurophysiological exams were used to determine inclusion criteria for spasmodic torticollis.

The treatment protocol featured strong acupuncture techniques. Bird-pecking-pulling (Que Zhuo Xie) manual acupuncture was applied to acupoint Shuigou (DU26) upwardly at 45˚. A pulling technique (Ti Cha Xie Fa) was applied with perpendicular insertion to Laogong (PC8) and Yongquan (KD1). Que Zhuo Xie was applied to Baihui (DU20) and Yintang was inserted to the bridge of the nose. Additional acupoints included

Tianzhu, BL10
Fengchi, GB20
Tianrong, SI17
Renying, ST9
Tianding, LI17
Ahshi
The herbal medicine decoction was based on the formula Zhen Gan Xi Huo Tang. The base formula consisted of

Sheng Long Gu 30 g
Zhen Zhu Mu 15 g
Jiang Can 10 g
Ci Shi 30 g
Additional herbs were added for specific conditions. For severe neck stiffness, the following were added

Bai Shao 45 g
Ge Gen 15 g
Gou Ji 15 g
For heat with phlegm, the following were added

Shi Chang Pu 15 g
Yuan Zhi 15 g
Zhu Ru 10 g
For participants with depression, the following herbs were added

Yu Jin 15 g
He Huan Pi 15 g
The herbs were decocted once per day and were administered in two doses, one in the morning and one at night. Outcomes measures included documentation of range of motion changes, shoulder lift, twitching, and tremors. The researchers concluded that acupuncture is effective for the treatment of spasmodic torticollis but acupuncture plus herbs is even more effective.

Liu et al. find acupuncture plus herbs effective for the relief of neck and shoulder dysfunction characterized by pain, numbness, inflammation, range of motion impingement, and hypodynamia (decrease in strength). The researchers commented that, statistically, white collar workers that spend a great deal of time sitting at a desk are particularly susceptible to this condition. In these cases, workers noted that their neck and shoulder tension and pain was partially alleviated by days off from work.

Acupuncture was applied to 2 – 4 points from a set of primary acupoints including

Taichong, LV3
Zulinqi, GB41
Xuanzhong, GB39
Fenchi, GB20
Jianjing, GB21
Zhongzhu, KD15
Manual needle stimulation was applied while patients actively and passively moved the neck and shoulder. Needle retention time was twenty minutes for this portion of the treatment session. Supplementary points were added for specific indications. For these points, electroacupuncture was applied. For posterior neck pain, Houxi (SI3) was added. For dampness, Fenglong (ST40) was added. For blood stasis, Xuehai (SP10) was added. An additional twenty minutes of needle retention time was added for the secondary electroacupuncture portion of the treatment session.

Herbal medicine was prescribed based on diagnostics. Patients with cold type pain were given Xiao Yao San. If neutral temperatures were determined, Si Ni San was prescribed. Dan Zhi Xiao Yao San was prescribed for patients with heat. For patients with deficiency, a combination of Xiao Yao San and Dang Gui Shao Yao San was prescribed. For cases of excess, Chai Hu Shu Gan San with Si Ni San was prescribed. Customization formulas based on differential diagnostics included the addition of herbs including Bai Shao, Gui Zhi, Huang Qi, Chai Hu, Fu Ling, and Ge Gen.

The researchers note that both the total recovery rate and the total effective rate was significant for participants receiving acupuncture plus herbs. All of the aforementioned studies indicate that acupuncture is an effective modality for the treatment of neck pain. The investigations demonstrate a variety of clinical scenarios and treatment protocols for the resolution of neck pain using acupuncture or acupuncture plus herbs.

References: 
Chen XP, Liang Q & Zhou SM. (2014). Controlled Clinical Studies on Treating Neck Cervical Spondylosis with Combination of Point-to-point Auricular Acupuncture along the Skin and Body Acupuncture. Clinical Journal of Chinese Medicine. 6(36).

Huang LC. (1991). Auricular Acupuncture: Diagnosis and Treatment. Beijing: Journal of Science & Technology.

Zeng R & Huang HF. (2015). Clinical observation on treating cervical spondylotic radiculopathy by floating-acupuncture, electro-acupuncture plus TCM medicine. Clinical Journal of Chinese Medicine. 7(29).

Zou XG. (2012). TCM, acupuncture, moxibustion, Tui Na and cervical traction in treating cervical spondylotic radiculopathy: 19 cases.China Modern Applied Medicine. 6(3): 42-43.

Zhou W, Chen YX & Ou JY. (2014). Electro Acupuncture on Hegu Point and Neiguan Point to Treat Acute Pain after Surgery on Anterior Cervical Spine. World Chinese Medicine. 9(4).

Li ZR. (2003). Acupuncture Experiments. Beijing: China TCM Publisher. 154.

Li, W. W. & Wu, L. Z. (2015). Clinical Observations on Combined Use of Acupuncture and Medicine for Treatment of Spasmodic Torticollis. Shanghai Journal of Acupuncture and Moxibustion. 34 (2).

Chen, Y., Qiao, K. & Jiang, W. X., et al. (2006). 146 cases of clinical study on EMG-guided botulinum toxin type A treatment of spasmodic torticollis [J]. Chinese Journal of Clinical Neurosciences. 14(2).

Liu YD. (2014). The treatment of neck-shoulder syndrome from liver and gallbladder theory by acupuncture plus TCM medicine. Clinical Journal of Chinese Medicine. 6 (16).

Shao SJ, Xie Q. (1999). Wei Jia Acupuncture Therapy. Shanghai University of TCM Publisher. 66.

http://www.healthcmi.com/Acupuncture-Continuing-Education-News/1585-acupuncture-alleviates-neck-pain-increases-motion

Acupuncture for Chronic Pain

Acupuncture for Chronic Pain

by | Apr 20, 2016 | Uncategorized

Chronic pain in the muscles and joints can make life miserable. Standard treatments like ice and heat, anti-inflammatory medications, physical therapy, and appropriate exercises can often ease the pain. But when they don’t, acupuncture is an option with a good track record that’s worth considering.

Over the years there has been substantial debate about whether acupuncture really works for chronic pain. Research from an international team of experts adds to the evidence that it does provide real relief from common forms of pain. The team pooled the results of 29 studies involving nearly 18,000 participants. Some had acupuncture, some had “sham” acupuncture, and some didn’t have acupuncture at all. Overall, acupuncture relieved pain by about 50%. The results were published in Archives of Internal Medicine.

The study isn’t the last word on the issue, but it is one of the best quality studies to date and has made an impression.

“I think the benefit of acupuncture is clear, and the complications and potential adverse effects of acupuncture are low compared with medication,” says Dr. Lucy Chen, a board-certified anesthesiologist, specialist in pain medicine, and practicing acupuncturist at Harvard-affiliated Massachusetts General Hospital.