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Abstracts
Of Current Literature
1999 and 2000 Acupuncture Literature Review
Compiled by Russell J. Erickson, MD
1.
Peng Y, Wei-lin Z, Lei L, Shu-jing L, Xiao-hua H, Yang S. Reinforcing
and reducing effects of scalp acupuncture studied using BEAM. Int J
Clin Acupuncture. 2000;11:179-186.
BEAM (brain electrical activity mapping) is described for 3 children
with viral encephalitis and decorticate status, both before and after
scalp electroacupuncture. High output and spikes were decreased within
10 minutes using high-intensity and high-frequency (200 Hz) input (reducing
manipulation). Stimulation over areas with low excitability brain waves
with low-intensity, low-frequency electrical input (100 Hz) quickly
resulted in elevating waves returning toward normal. The effect after
the 30-minute stimulation period is not recorded.
2. Qi-lun Y. The new map of ear points: a miniature of cerebral cortex.
Int J Clin Acupuncture. 2000;11:285-290.
In 1996, the author proposed a new map of the ear in the figure of the
cerebral cortex. When looking down at the ground, the ear presents a
view like the medial sagittal section of the brain. The auricle can
be divided into 5 lobes surrounding the auditory canal that represents
the brain aqueduct. Embryogenesis supports this hypothesis. The brain
is represented in the triangular fossa, with blood pressure, dizziness,
emotions, and insomnia areas. The line connecting helix crus and helix
2 corresponds to the central cerebral cortex sulcus with motor function
in the areas in front and sensory behind. Limbic representation, covering
visceral organs, is in the vagus-mediated cavum and cymba concha. Areas
designated for each of the organs are discussed. A third of points from
the old map are retained while the rest are new points or areas. The
veracity of point representation was examined “with 90% correlation”
in 110 patients. Good results have been obtained in ear pressing treatments.
Comment: I present this article to our auricular therapy experts
for evaluation and comment. Does it add anything new to Nogier 1, 2,
3 and the Chinese system?
3. Jian-wei Z, Fan Z, Ming X. Scalp acupuncture in treatment of stroke
[mini-review]. Int J Clin Acupuncture. 2000; 11:305-308.
One hundred twenty-six articles published in China from 1980-1996 were
reviewed, with scalp acupuncture only in 81 and a combination with body
and/or ear points in 45. A total of 14,427 patients were treated, 4,453
with cerebral hemorrhage. The most frequently used points were GV 20,
15, 16, GB 7, 18, Sishencong, and BL 7. Stimulation areas (Shung-Fa
or Shanghai) and international standardized scalp lines were also used
by many. Needles were manipulated by hand in 65% (rapid rotation in
nearly all, though the authors believe rapid-slow is superior) and electrically
in 35%. No significant difference was apparent in studies using stimulation
areas vs standard scalp lines. There appeared no significant difference
whether the healthy or diseased side was punctured, though some authorities
believe the healthy side gives a stronger effect. The effects increased
in proportion to the stimulation intensity. Early treatment is important.
The effect in ischemic stroke was notably better than in hemorrhagic.
Results were better with hematoma less than 40 mL or infarct area less
than 3 cm. Use of body or ear points with scalp produces superior results.
Many research articles show that acupuncture dilates cerebral vessels,
lowers blood viscosity, improves microcirculation, and enhances neuron
transmission.
1.
Hong-wu L, Jun-zheng L, Hong-yan C, Qing L, Jia-liang Z. Specific cardiotropic
effects of Neiguan. Int J Clin Acupuncture. 2000;11:107-110.
Ischemic ST-T wave changes were improved in 20 of 21 patients when PC
6 was intermittently manually stimulated for 30 minutes. No such changes
were seen when ST 36 was similarly stimulated. Plasma endothelialin
in 13 patients decreased with PC 6 stimulation (P<.001). This is
a potent 21-amino acid vasoconstrictor found by Yanagisana and colleagues
in Japan.
2. Lingping W, Xiai L, Haizhou M. Acupuncture treatment of 42 cases
of insufficient blood supply to the vertebrobasilar artery. J Tradit
Chin Med. 2000;20: 268-270.
Patients were aged 45 to 68 years, with 3 to 12 days of dizziness, visual
field defect or diplopia, weak extremities or ataxia, or cataplexy.
The diagnosis was reversible ischemic injury. “Rheoencephalograms”
were abnormally low. Points GB 20, BL 10, and GB 12 were stimulated
with rapid rotation for 3 minutes of every 10 for 30 minutes. Of 42
cases, “12 were cured and 10 much better” with normalizing
rheoencephalograms after 2 to 3 courses of 10 daily treatments.
Comment: Again, evidence of increased bloodflow following acupuncture.
If one has no other cost- and safe-effective means to help people with
this problem, acupuncture seems reasonable. The great number of papers
denoting bloodflow increase in human and animal studies is hard to ignore.
3.
Sternfield M, Lipskier E, Finkelstein Y, Eliraz A, Hod I. Triggerfinger
relieved by activation of distal Ahshi points in the area of the pericardium
and heart meridians: a pilot study. Am J Acupuncture. 1991;19:319-322.
Nine patients with trigger finger (traumatic tenosynovitis with impeded
movement), referred for surgery after other therapy failure, were treated
by needling Ahshi points along the affected finger to a 1-3 mm depth.
De Qi was achieved and the needles left in for 30 minutes twice weekly.
Seven of 9 reported being cured to having only moderate daytime pain
without functional disturbance. The number of treatments ranged from
4 to 8 with 2 exceptions. The follow-up period was 12 to 4 months.
1.
Wang RR, Tronnier V. Effect of acupuncture on pain management in patients
before and after lumbar disc protrusion surgery: a randomized control
study. Am J Chin Med. 2000;28: 25-33. Reviewed in: FACT. 2000;5:265-266.
True and placebo acupuncture at 6 to 9 points per treatment were compared
in a randomized group of 132 people with disk protrusion undergoing
a second lumbar surgery. Two to three 15-minute treatments were given
before and after surgery. Pain decreased by 28% extending to 54% within
6 hours with acupuncture before surgery and 31% extending to 63% after
surgery. The pain decrease with sham acupuncture was significantly less.
The reviewer notes lack of information about randomization method, dropouts,
qualification of the acupuncturist, and exact treatment. He therefore
rates the study of low quality.
Comment: Again, studies in all areas of medicine, Western as well as
complementary and alternative, have increasingly rigid demands. As demands
for rigid methodological rules increase, more expert research project
planning is required and unfortunately, more financing. The financing,
of course, is not as readily available for acupuncture as it is for
pharmaceutical therapies. Therefore, acupuncture research must be more
carefully thought out to circumvent the need for more money and rise
to the greater expectations imposed by the old paradigm medical approach.
Other references in FACT. 2000;5:311 include the following:
Mayer DJ. Acupuncture: an evidence-based review of the clinical literature.
Annu Rev Med. 2000;51:49-63.
Smith LA, Oldman AD, McQuay HJ, Moore RA. Teasing apart quality and
validity in systematic reviews: an example from acupuncture trials in
chronic neck and back pain. Pain. 2000;86:119-132.
Roschke J, Wolf C, Muller MJ, et al. The benefit from whole body acupuncture
in major depression. J Affect Disord. 2000;57:73-81.
2. Liguori A, Petti F, Bangrazi A, et al. Comparison of pharmacological
treatment versus acupuncture treatment for migraine without aura. J
Tradit Chin Med. 2000;20:231-240.
One hundred twenty patients with diagnosed migraine were randomized
to 2 equal groups treated at 4 public health centers. The control group
received several prophylactic medications plus sumatriptan for acute
attacks. The acupuncture group received no medications. A maximum of
3 courses of 10 acupuncture treatments were given biweekly, using ST
8, GB 5, 20, GV 14, and LU 7 with reducing method. Records of symptoms,
psychological status, days of work absence, and adverse effects were
kept monthly beginning 1 month prior to therapy and continuing for 1
year after therapy onset. Costs for acupuncture therapy, medical visits,
drugs, and social costs were tabulated. No adverse effects were seen
in the acupuncture group, but 47 of 60 patients reported such in the
drug therapy group. The cost of drug therapy was higher by 43%. Days
of work absence were 928 vs 937 in the first 6 months after treatment
onset and 192 vs 467 for the second 6 months. The social (work loss
and medical care) cost was 186 million Lit compared with 266.6 Lit for
drug therapy. If the acupuncture treatment for migraine was extended
to the entire national territory, the authors estimate a national savings
of 1,000 billion Lit (>$650 million US) per year for 800,000 patients.
Comment: We have to await the critical comments of our statistic-oriented
reviewers, but this appears an extensive and nicely done bit of research
with a good N follow-up, described technique, and data collection. There
are a number of acupuncture studies done on migraine therapy as well
as many for varied drug therapies. Many in both groups are of poor quality
when critically judged by research review experts. This study appears
better than average.
3. Yan-ning L, Ya-ping Y. Treatment of facial muscle spasms with
liver-soothing and kidney-tonifying approach. Int J Clin Acupuncture.
2000;11:253-256.
Thirty-two adults in the treatment group had painful facial spasms for
1 month to 10 years (average, 2.5 years). Thirty-one individuals in
the control group had spasms for 1.5 months to 9 years (average, 3 years).
GV 20, Sishencong, GB 15, 20, ST 2, 4, 6, LR 3, and KI 3, 7 were needled
with some adjuvant points based on TCM characteristics. One to 3 courses
of 10 days each were usually needed. The control group had carbamazepine
therapy. On 6-month follow-up, 8 vs 6 were cured and 22 vs 15 were markedly
better with occasional flare-ups with tension or undue fatigue.
1.
Dale RA. Acupuncture exercises for the sixth sense. Am J Acupuncture.
1992;20: 21-32.
The sixth sense is intuitive, spiritual, and right brain-derived. Intuition
regresses in “civilized” societies as the schooled left brain
processes become dominant. Right brain, diencephalon, and brain stem
are more involved with intuition and the spiritual, as well as the arts.
When the intuitive mode is dominant, brain waves go from beta (14-35
Hz) of left brain consciousness to alpha (7-14 Hz), theta, or delta.
The author believes health care also goes from maximal intuitive at
meditation, Qigong, and energetic therapies, to minimal with allopathy.
Right brain intuitive is “rehumanizing” and cannot be coercive.
It tends to be benign and holistic. Either left or right brain mode,
however, can be healthy or pathological. True health lies in integration
of both modalities. Five Phases methods are reviewed for enhancing intuition
use: Wood through the eye; Fire through movement; Earth through touch,
meditation, and fasting; Metal through breathing and electrostimulation;
and Water through sounds. Acupuncture exercises are then delineated.
HT 5 and 7 pressure can be useful. The “emotional line” of
10 points from vertex down about the ears (GV 20, GB 8, and 8 ear points),
can be pressed once daily for 8 times per point. Ten points of the “Circle
of Release” from GV 14 to Yintang and GV 26, CV 24, and 22 are
pressed once daily. “Unfortunately, it will require more than these
exercises for doctors, bureaucrats, and executives to lose their left
brain biases.”
Comment: Every small thing aids in broadening one’s outlook
and approach.
2.
Huang M-Z, Huo L-Q. The effect of acupuncture needle stimulation of
the phrenic nerve in resuscitation during respiratory arrest. Am J Acupuncture.
1992; 20:223-228.
Prior animal studies of phrenic nerve stimulation with electricity to
induce respiration are reviewed. The authors insert acupuncture needles
on either side of the neck at the superior margin of the thyroid cartilage
and medial margin of the sternocleidomastoid muscles. Needles are directed
posterior, lateral, and inferior at 30º to reach the surface of
the omohyoid. The needle tip must not be below the clavicle. They are
electrically connected at 16-26 Hz and 0.5-4.0 mA. Eighty-two comatose
patients without spontaneous respiration were treated. Respiration resumed
in all cases. Diagrams of the neck region involved are shown in lateral
and cross-sections. Four illustrative cases are presented: a near drowning,
chemical poisoning, arrest with encephalitis, and polio complication.
One must know the anatomy to avoid the carotid sinus and vagal nerve:
cadaver practice initially is recommended. The hands and arms must be
restrained.
Comment: This appears very promising for anesthesiologists, otolaryngologists,
and emergency physicians as a rapid way to restore respiration, with
the caution that one should be skillful.
3. Dale RA. The intersecting (Jiao Hui) points and channels of acupuncture.
Am J Acupuncture. 1992;20:129-136.
A table formulated from 13 sources is given denoting all the intersecting
points of the 12 regular and 8 Extra vessels. More than 1 of 4 acupoints
intersects 2 or more channels or meridians. The HT meridian has no intersections.
Only the CV and GV meridians of the 8 Extra channels have their own
points. These Extraordinary Vessels function as energetic reservoirs,
storing or releasing Qi to the 12 meridians. The Jiao Hui or 8 Confluent
points unite with or access the Extra vessels. Eight of the 12 Mu points
also intersect. There are 38 Yin vessel connecting points with 62 intersections
and 74 Yang channel points with 143 intersections. There are more lower
than upper connections. GB and Yang Wei have more intersecting points
than other channels.
4. Worsley JR. The future of oriental medicine in the West, part
iv: balance and health of body, mind and spirit. Am J Acupuncture. 1992;20:369-372.
The author calls for universal acceptance among acupuncture practitioners,
noting that all show compassion and concern for patients, but too many
become involved in fighting over the “only way to do it.”
It becomes like the madness of ostracizing people from different religions
when they do not believe exactly as we do. Arrogance is displayed if
we suggest our way is the only way; we should feel joy at seeing others
help the ill even if not using our specific approach. We need to be
healers and not politicians.
5. Darra JC, de Vernejoul P, Albarede P. Nuclear medicine and acupuncture:
a study on the migration of radioactive tracers after injection at acupoints.
Am J Acupuncture. 1992;20:245-256.
Technetium 99m was injected at control and acupoints (KI 7, LV 2) with
diffusion from the latter and a portion (<5%) migrating toward the
trunk at 30 cm after 51/2 minutes from the acupoint. Prior similar research
from 4 countries is discussed. The pathway does not follow lymphatics
and movement is slow. For KI 7, the flow was similar in control subjects,
but abnormal on the side of pathology for patients with unilateral kidney
disease, being reduced with cancer or degeneration and increased in
speed for inflammatory conditions. Unilateral laser stimulation of KI
2 increased the flow rate bilaterally. A 20-Hz electrical stimulation
varied the rate, but 48 Hz did not. A neurochemical response appeared
to be involved.
Comment: An interesting early study in the effort to prove the
presence of meridians that some consider limited due to the small fraction
of isotope migrating up the meridian pathway.
6. Coyle M, Aird M, Cobbin DM, Zazlawski C. The cun measurement system:
an investigation into its suitability in current practice. Acupuncture
Med. 2000; 18:10-14.
The cun measurement using the thumb as a standard unit was investigated
in Australian students. Cun ratio measurements for women were proportionally
higher than those for men. Ratio measurements for hand and leg were
consistently greater than the traditional. The system was reasonably
accurate for the arms. In clinical practice, a practitioner using the
directional method of point location would tend to overmeasure and pass
the point for the arms and undermeasure the points for the legs. Current
anthropomorphic data show substantial differences for body measurements
among US white, black, and Japanese males. There are also differences
between people of different countries. The cun system was designed for
a Chinese ethnic population of 2000 years ago. It is questionable if
it is still applicable.
7. Aird M, Coyle M, Cobbin DM, Zazlawski C. A study of the comparative
accuracy of two methods of locating acupuncture points. Acupuncture
Med. 2000;18:15-21.
Twenty fourth-year acupuncture students attempted to locate LI 10 and
ST 40 using a directional (a number of cuns from a body landmark) and
a proportional (subdividing the distance between landmarks) method.
All had passed 3 annual acupuncture point location examinations. Each
marked the acupuncture points on a volunteer’s limbs by each method.
The resulting points were recorded on transparent films for multiple
comparison. The accuracy along the limb Y axis by the 2 methods was
not similar, but the accuracy (or inaccuracy) was similar for the 2
methods. The range of differences in point finding was greater than
60 mm. Failure to adequately find acupuncture points might be diminishing
the effect of acupuncture. In research, inaccurate point finding leads
to a type II error (concluding no effectiveness). “The 12 channels
circulate deeply along the borders of the flesh” (Huang-fu Mi).
The position of points will vary between patients in relation to position
of muscle groups and the underlying tissues.
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