Of Current Literature
1999 and 2000 Acupuncture Literature Review
Compiled by Russell J. Erickson, MD
Part I -
1. Wei G-W, Huang Y-L, Wu G-C, Cao X-D. Regulation of glial cell
line-derived neurotrophic factor expression by electroacupuncture after
transient focal cerebral ischemia. Acupunct Electrother Res. 2000;25:81-90.
Glial cell-derived neurotrophic factor (GDNF) specifically aids dopaminergic
neurons and has been shown to reduce the infarct volume in rat brain
by inhibiting nitric oxide production and protecting striatal neurons
from released excitatory amino acids. Rats that had middle cerebral
artery occlusion for 2 hours were compared with sham-operated rats.
Electroacupuncture was applied between GV 20 and GV 26 with dense-sparse
electrostimulation at 20 and 4 Hz, starting 10 minutes after middle
cerebral artery occlusion for 1 hour. Reverse transcriptase polymerase
chain reaction and immunohistochemistry were used to study GDNF. Levels
of GDNF and its mRNA increased greatly for 2 hours in peri-infarct tissue,
then declined dramatically at 12 and 24 hours. Acupuncture did not change
the peak of GDNF, but elevated the levels of GDNF and its mRNA at 12
hours post-perfusion. Acupuncture appears to increase GDNF expression
after ischemia and this might be one of its protective mechanisms.
Comment: One more bit of evidence that it might be prudent to perform
acupuncture as quickly as possible after a non-hemorrhagic stroke.
2. Peng Y, Lingdi S, Shu-jing L. Treatment of decortical state of
child encephalitis with scalp acupuncture and the effects on EEG and
BEAM. J Tradit Chin Med. 2000;20:289-292.
Four patients with abnormal EEG (electroencephalogram) and BEAM (brain
electrical activity mapping) findings with decortical encephalitis were
needled in the scalp areas over locations of abnormal BEAM findings.
Continuous wave electrical stimulation was used, with high frequency
(150-200 Hz) where EEG waves were elevated
and low frequency where decreased. Daily 20-minute sessions were given.
Two cases are described in detail (possibly the authors' most successful?).
Both stopped having convulsions after the 1st session, and became conscious
after 5 to 7. Their slow recovery was fairly successful.
1. Mu-sheng W. Vascular headache treated by acupuncture. Int J Clin
Acupuncture was compared with TCM in 96 cases of headache and a higher
cure rate was found. PC 6 and LI 4 with GB 20 and Ah Shi points is a
very effective combination, with adjunct points determined by TCM criteria.
2. Ezzo J, Berman B, Hadhazy VA, Jaddad AR, Lao L, Singh BB. Is acupuncture
effective for the treatment of chronic pain? a systematic review. Pain.
2000; 86:217-225. Reviewed in: FACT. 2000; 5:263-264.
English-language reports are reviewed of randomized trials of acupuncture
for chronic pain in patients with symptoms lasting longer than 3 months.
There were 2 independent reviewers "using a validated instrument."
Results were positive in 21 studies, neutral in 27, and negative in
Trials were construed as low quality in general. High quality tended
to use sham acupuncture as a control and the risk of false-negative
error is high. This group believed that there is limited evidence that
acupuncture is effective for chronic pain. The reviewer notes that sham-controlled
studies since 1990 favor sham over true point use. The better the quality
of study, the more likely negative.
Comment: A true riddle exists. Acupuncture practitioners around
the world see, on a daily basis, patients obtain relief from chronic
and acute pain. Yet, results of RCTs (randomized controlled trials)
tend to negate what is seen in clinical practice. Why? Does putting
patients in the role of a study subject interfere with Qi transmission
from the practitioner? Does it set them into a position where the acupuncture
is suspect and cannot assist their own body's natural ability to heal?
(I believe both this ability and Qi interaction play a major role in
the healing.) Is there a current disparity in the approach of research
groups and the clinician? Does statistical analysis group too many patients
together, not allowing one to distinguish the 70% or so said to be helped
from the 30% who do not respond? Combining the 2 groups might take statistics
below the magic 5% probability threshold and refute benefit in academic
eyes. Perhaps we need to look at both RCTs and good series of case studies,
as has been suggested elsewhere.
4. Chang-yong D. High-frequency manipulation at Ashi points in the
treatment of soft tissue injuries. Int J Clin Acupuncture. 2000;11:227-228.
Two hundred six patients with acute injury (sprain) of varied joints
(limbs, lumbar, neck) pointed to the most tender local spot that was
then needled with thrusting and twisting 200 times per minute. The patient
moved the joint to reproduce pain until the pain lessened or disappeared.
A session was a maximum of 20 minutes even if pain remained. Pain disappeared
in 1 to 5 daily treatments in 63 of 76 patients with muscle spasm but
in only 50 of 130 patients with non-infectious inflammation. This technique
is especially effective for neck and lumbar spasm.
Comment: Interesting but painful therapy; requires a control group taking
analgesics to define acupuncture effect vs the natural course.
1. Xin L, Li R. Twenty-five cases of intractable cutaneous pruritus
treated by auricular acupuncture. J Tradit Chin Med. 2000;20:287-288.
Fifty patients with eczema, neurodermatitis, prurigo nodularis, and
lichen planus were divided and half treated at ear points Lung, Shen
men, Feng Xi, adrenal, and LI. Electrostimulation (Hz not given) was
given for 30 minutes twice per week for 5 sessions. Eleven treated were
cured and 11 were rated more than 60% improved. The control group (receiving
several medications, even oral prednisone) had 3 cured and 9 improved.
Comment: This would need repeating, preferably in the U.S. It could
provide a good clinical study for a practitioner with enough dermatology
patients in the practice. Length of follow-up is not stated in this
article and would be an important item, as well as denoting true randomization
procedure and aiming for a high enough N to ensure significant power
is reached. Diagnosis and follow-up evaluation would be best done by
a second physician with good dermatology skills.
Part V -
1. Bjorkstrom G, Hellstrom AL, Andersson S. Electro-acupuncture in
the treatment of children with monosymptomatic nocturnal enuresis. Scand
J Urol Nephrol. 2000;34:21-26. Reviewed in: FACT. 2000;5:261.
25 children and adolescents (20 male) had alternating SP 6, BL 20, LR
3, CV 3 and KI 3, SP 9, ST 44, and CV 3 needling for 20 sessions. Three
sessions featured manual stimulation, then 2 and 15 Hz electroacupuncture.
Dry nights increased from an average of 2.3 per week to 5.0 by the 6-month
follow-up. Eleven had more than 50% dry nights at 6 months. Older patients
responded better than those younger than 8 years.
Comment: I noted that most of the children coped easily with acupuncture.
Whether the response was due to acupuncture, intense attention, or dislike
of anticipation of further therapy is unknown. Having extensive experience
with bedwetters in a pediatric practice, I believe there are equally
effective and less-costly approaches. Acupuncture, I believe, can help
bladder control, but this study does not prove it.
1. Shu-fa L. Treatment of optic atrophy by needling Xinmeng. Int
J Clin Acupuncture. 2000;11:247-252.
19 eyes in 12 patients were affected, 68% following infection. There
was peripheral atrophy and some had large scotomata. Xinmin I, 0.5 cun
anterosuperior to SJ 17 at the center of the posterior ear lobe skin
fold, and Xinming II, 1 cun above and 0.5 cun aside the tip of the brow,
were needled. Needle angles and manipulation are detailed. Treatment
was once daily for 4 to 6 courses of 10 sessions separated by 5-day
rests. Six eyes returned to normal vision with blood vessels and optic
papilla color restored. Eight eyes improved vision 10-fold with eyeground
and visual field improvement.
Comment: I include this article of poor quality as so many come into
the literature from China regarding improvement of visual abnormalities
featuring techniques Western ophthalmologists generally will not consider
feasible. It is intriguing to think there might be approaches which
we do not consider that would return some lost vision.
1. Bensoussan A. Contemporary acupuncture research: the difficulty
of research across scientific paradigms. Am J Acupuncture. 1991;19:357-366.
In the Chinese model, any symptom can only be interpreted subjectively
in relation to many elements. Any observation in the patient can hold
several meanings depending on other observations. For instance, an article
states that needling LI 4 and TW 4 caused vasodilation and PC 6, vasoconstriction.
Repeating the work might produce different results as dilation or constriction
might depend on the state of the patient's health, time of needling,
and how the needle was applied and stimulated. In traditional acupuncture,
there is no standard treatment for any disease; all must be altered
to fit the patient's needs. The maximum effect is not likely when a
single protocol is set for all patients in a trial. Making research
even harder, many excellent acupuncture practitioners are not interested
in research and many researchers are not fully trained and capable in
2. Sancier K, Hu B-K. Medical applications of Qigong and emitted
Qi on humans, animals, cell cultures and plants: review of selected
scientific research. Am J Acupuncture. 1991;19:367-378.
Qigong involves self-activation, relaxation, breathing exercises, meditation,
visualization, body postures and movements, and self-applied massage.
External Qi is emitted by a master with the object of affecting another
person or thing. Ten studies are reviewed here, demonstrating that Qi-gong
positively affected hypertension, decreased symptoms in those with cancer,
decreased the incidence of stroke, increased superoxide dismutase enzyme,
can change electroencephalographic waves with more alpha, decreased
rat tumors with external Qi applied by a master, and cell growth could
be inhibited by "destroying mind" and increased by a "peaceful
mind" master's approach. Lung cancer cell growths were inhibited
by external Qigong applied by a master with increased cell apoptosis.
Proliferation of T lymphocytes in culture was elevated by as much as
30% by external Qigong from 4 masters. Rice seed germination went from
a level of 30 to 41 to 56 in 5 Qigong stimulation trials. There is literature
supporting the effectiveness of Qigong.
Dr Russell Erickson is retired from private practice in Berkeley, California.
He is also retired from Kaiser-Permanente Hospital in Richmond, California
where he was Senior Consultant and former Chief of Pediatrics. Dr Erickson
is Secretary of the Board of the Medical Acupuncture Research Foundation
Russell J. Erickson, MD
10 Ridge Place
Pleasant Hill, CA 94523
Phone: 925-229-0889 o Fax: 925-228-4976