MONITORING THE SUCCESS OF ACUPUNCTURE
IN TREATMENT OF REACTIVE AIRWAY DISEASE BY USE OF THE PEAK FLOW
By Capri-Mara Fillmore,
M.D., Bethesda, Maryland
One of the repeated criticisms of acupuncture
is the lack of objective measurable results. Sophisticated measurements
of results such as the PET scan are currently being studied. A
simple peak flow meter (cost: $15) is an inexpensive and easy
way to monitor the success of acupuncture treatment in treating
asthma or reactive airway disease. This meter measures the volume
of exhaled air at the point of maximum speed and forcefulness
of exhalation. This measuring device has boon recommended for
several years in the home management of asthma ( 1 ).
A review by Jobst (2) of acupuncture
in the treatment of pulmonary disease showed 10 of 16 studies
(double-blind, single-blind, and unblinded) had significant improvement
of "breathlessness" with acupuncture: 10 of 11 studies indicated
that medication could be reduced with acupuncture treatment.
A review by Helms discussed 16 controlled
studies (3); 9 studies concluded that acupuncture is more effective
than "sham" needling (4). Success was measured by reduction of
medicine, general well-being, and decrease in perception of dyspnea
or breathlessness. Pulmonary function tests were used to measure
succcss in one study: no measurable change over a period of several
months was found (4).
Acupuncture, Asthma, Reactive Airway
Disease, Peak Flow Meter CASE STUDY A 45-year-old Yang Ming earth
male presented for treatment with a five-day history of severe
cough and whitish-gray sputum. He stated that his symptoms were
worse than a usual cold. Coughing had made his diaphragm painful.
The patient's exam indicated bilateral pulmonary wheezes and ronchi
in all fields, oral temperature 101.8~F, chest X-ray normal. His
respiratory history was significant for occasional prolonged cough
with mild wheezing for a few weeks following common colds; no
smoking history. The patient's diagnosis was acute bronchitis
and infection-related reactive airway disease (or, infection-induced
He was treated bilaterally on his first
visit (April 13) with BL 10 (for acute cold symptoms): Kidney
Shu points (BL 23- -) connected with Ding Chuan points (++) for
20 minutes, at 8 hertz; and simultaneous cupping of BL 13 (Lung
Shu points) and the Hua Tuo points, with a single cup on each
side of the spine. This treatment was the patient's first experience
Auscultation immediately after the treatment
had only rare wheezes. The patient improved immediately. He was
given a prescription of clarithromycin, an albuterol inhaler,
and was told to return to thc clinic in two days.
Returning to the clinic, the man reported
that he felt well for 36 hours. However, he then reported feeling
fatigued, his cough returned (no longer productive), and his temperature
was 100.3"F. Auscultation of his lungs revealed bilateral wheezing.
KI 3 (- -) was connected to KI 7 (++) to strengthen the kidney
meridian. BL23 (- -) was connected to BL 13 (++); Dingchaun and
BL 10 were piqured. Cupping of BL 13 and Hua Tuo was done as a
second step. This time, a before-and-after peak flow measurement
was taken; they were 320dl and 420dl, respectively, with no wheezing
The patient returned to the clinic five
days later. He reported feeling well for 24 hours, but again displayed
increasing fatigue, though normal temperature. Bilateral wheezes
were evident on auscultation: peak flow had dropped to 410dl.
Both patient and physician became curious whether an albuterol
treatment did as well. Thus, two puffs of albuterol using a spacing
device was administrated. The patient reclined on his stomach
in a dimly lit room for 20 minutes (as was done during the acupuncture
treatment). A second peak flow reading showed 450dl with a mild
wheeze. He was then given another acupuncture treatment. LU I
was piqured instead of BL 10, since the dis- case was no longer
acute. Thc peak flow improved to 500dl. Lung sounds were clear.
The patient felt "well."
This individual was seen again seven
days later. He reported improvement. He had rare wheezes; peak
flow 500dl. Acupuncture treatment pictured LU 5 (- -) connected
to LU 7 (++), and LI 4 bilaterally (instead of KI 3,7, and LU
1 ). The physician chose a treatment reflecting the patient's
Yang Ming earth character. The illness was no longer acute. All
other points previously used were needled. After treatment, the
man no longer displayed wheezes or prolonged expiratory phase:
his peak flow was 600dl.
Several different methods are used for
the treatment of asthma or reactive airway disease with acupuncture.
However, many of the schools of acupuncture use the Dingchuan
point in the treatment of these diseases. This treatment is a
variation of the treatment taught by two sources, Helms (5) and
This case history appears to be one of
the few using an objective measuring instrument to compare the
acute effect of acupuncture treatment versus medication. Peak
flow was used for objective measurement of the success of treatment;
auscultation changes were also reported. The findings before and
after the treatments are listed in Table 1. The results were reproduced
at the time of each acupuncture treatment during this illness.
Peak flow measurements after treatment improved up to 25% higher
than before treatment. This improvement was greater than the improvement
expected or found with albuterol aerosol. However, since neither
patient nor physician was blinded, the placebo effect could be
argued. One might also argue that peak flow measurements could
be biased by greater effort after acupuncture treatment. The patient
appeared to be making his best effort with each peak flow test.
(Best of three measurements were used for each volume recorded
in Table 1.)
This study of acute changes in peak expiratory
flow does not give insight to the use of acupuncture in long term
treatment of reactive airway disease or asthma. Nonetheless, peak
flow measurement helped to confirm to both patient and physician
the immediate effectiveness of treatment of reactive airway disease
by acupuncture. Similar treatment was tried on several other patients
with similar success, but are not presented in this paper. The
peak flow meter is an inexpensive way to measure acupuncture effectiveness,
which may also be useful for clinical trials.
- National Institutes
of Health 1995, Global Initiative for Asthma: Global Strategy
for Asthma Management and Prevention. National Heart, Lung, and
Blood Institute/World Health Organization Worshop Report. N1H/NHLBI,
Publ No. 95-3659.
- Jobst KA. Acritical
analysis of acupuncture in pulmonary disease: efficacy and safety
of the acupuncture needle. J Altern Comple Med 1995; 1 ( 1 ):57-85.
- Hehns JM. Acupuncture
energetics: a clinical approach for physicians. Medical Acupuncture
Publishers, Berkeley, California 1995: 49.
- Jobst KA., et al.
Controlled trial of acupuncture for disabling breathlessness,
The Lancet 1986; 2:1416-1419.
- Helms JM. 1995 course
syllabus. Clinical pearls, acupuncture for physicians, 1994-5.
- Xinnong, C. Ed.
Chinese acupuncture and moxibustion. Foreign Languages Press,
1 · Type of treatment before and after auscultation and peak flow
wheeze, mild wheeze
Dr. Capri-Mara Fillmore is currently an Epidemiology and Biostatistics
Research Fellow at the National Cancer Institute, National Institutes
of Health, Bethesda, Maryland. She is doing a rotational year
at Johns Hopkins University Medical Center and School of Public
Health in Preventive Medicine. Dr. Fillmore has a Masters Degree
in Human Nutrition, and is board-certified in Family Medicine.
Fillmore, M.D. M.P.H., M.S.
Main St., Franklin, W. VA
10902 Kenilworth Ave. Garrett Park, MD
Phone: 301-962-0943 · Home: 301-402-3204 · Fax: 301-496-6829
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