Why Acupuncture and TENS are Different?

Why Acupuncture and TENS are Different?

The effects of transcutaneous electric nerve stimulation (TENS) and electroacupuncture (EA) on the cerebral cortex are largely unclear. The purpose of the present study was to investigate the effect of TENS and EA on the cerebral cortex by examining their effect on the median nerve-somatosensory evoked potentials (MN-SEPs). Twenty volunteers were studied. The cortical and cervical spinal potentials were recorded by median nerve stimulation at the left wrist. Sham TENS, 2 Hz TENS and 2 Hz EA were applied to both ST36 and ST37. MN-SEPs were recorded during sham TENS, 2 Hz TENS and 2 Hz EA, with at least 1 week interval for each subject. One-way analysis of variance was used to determine the differences in latency and amplitude of the MN-SEPs observed in the stimulation and post-stimulation periods compared with baseline. Scheffe's post hoc correction was employed to identify pairwise differences. No differences in mean latency were found between the stimulation procedures during the stimulation and post-stimulation periods. 2 Hz EA but not sham TENS or 2 Hz TENS caused higher mean amplitudes in N20 and N30 during the stimulation and post-stimulation periods. EA, but not TENS, induces changes in certain components of the signal.

Source: Kang YT, Liao YS, Hsieh CL. Different effects of transcutaneous electric nerve stimulation and electroacupuncture at ST36-ST37 on the cerebral cortex. Acupunct Med. 2014 Nov 28.

Systematic Reviews/Meta-Analysis on Acupuncture Trials

Systematic Reviews/Meta-Analysis on Acupuncture Trials

BACKGROUND:  The QUOROM and PRISMA statements were published in 1999 and 2009, respectively, to improve the consistency of reporting systematic reviews (SRs)/meta-analyses (MAs) of clinical trials. However, not all SRs/MAs adhere completely to these important standards. In particular, it is not clear how well SRs/MAs of acupuncture studies adhere to reporting standards and which reporting criteria are generally ignored in these analyses. OBJECTIVES:  To evaluate reporting quality in SRs/MAs of acupuncture studies. METHODS:  We performed a literature search for studies published prior to 2014 using the following public archives: PubMed, EMBASE, Web of Science, the Cochrane Database of Systematic Reviews (CDSR), the Chinese Biomedical Literature Database (CBM), the Traditional Chinese Medicine (TCM) database, the Chinese Journal Full-text Database (CJFD), the Chinese Scientific Journal Full-text Database (CSJD), and the Wanfang database. Data were extracted into pre-prepared Excel data-extraction forms. Reporting quality was assessed based on the PRISMA checklist (27 items). RESULTS:  Of 476 appropriate SRs/MAs identified in our search, 203, 227, and 46 were published in Chinese journals, international journals, and the Cochrane Database, respectively. In 476 SRs/MAs, only 3 reported the information completely. By contrast, approximately 4.93% (1/203), 8.81% (2/227) and 0.00% (0/46) SRs/Mas reported less than 10 items in Chinese journals, international journals and CDSR, respectively. In general, the least frequently reported items (reported≤50%) in SRs/MAs were "protocol and registration", "risk of bias across studies", and "additional analyses" in both methods and results sections. CONCLUSIONS:  SRs/MAs of acupuncture studies have not comprehensively reported information recommended in the PRISMA statement. Our study underscores that, in addition to focusing on careful study design and performance, attention should be paid to comprehensive reporting standards in SRs/MAs on acupuncture studies.

Source: Liu Y, Zhang R, Huang J, Zhao X, Liu D, Sun W, Mai Y, Zhang P, Wang Y, Cao H, Yang KH. Reporting Quality of Systematic Reviews/Meta-Analyses of Acupuncture. PLoS One. 2014 Nov 14;9(11):e113172.

Chinese Medicine Utilization in San Francisco

Chinese Medicine Utilization in San Francisco

To explore the utilization patterns and attitudes toward Chinese medicine (CM) among foreign-born Chinese residents of San Francisco. A cross-sectional survey using convenience sampling was conducted at 11 community organizations at San Francisco over a 2-month period. Among 244 participants using any healthcare services in the 2 years prior, 195 (80%) reported using CM. Over 90% of the CM users reported visiting conventional medical providers in the same period. Use of CM was significantly associated with recent immigration, origination from mainland China, lack of insurance, high school graduation, and marital status. Frequently used CM modalities included herbal prescriptions (52%) and over-the-counter herbal pills (44%). Half (48.2%) of the CM users reported using multiple CM modalities, and a third (35.9%) reported regular CM visits over the past 6 months. Of CM users, 36% reported informing physicians of their CM use. Of CM users that did not inform physicians of CM use, half (48.4%) indicated willingness to openly discuss the topic with their healthcare providers. CM utilization is common among foreign-born Chinese residents of San Francisco. Many use conventional treatments and CM concurrently, but few inform their physicians of CM use. Foreign-born Chinese patients may be better served if physicians better recognized and understood their medical needs, treatment preferences and practices.

Source:  Lam CN, Terp S, Lee MM. Use of Chinese medicine among foreign-born Chinese residents of San Francisco.  Chin J Integr Med. 2014 Nov 25.

Can Pulse Diagnosis Tells Pregnancy?

Can a pulse test confirm pregnancy? 

Chinese medicine says yes

BEIJING — "Stick out your tongue. Now give me your wrist."

That's how "Traditional Chinese Medicine (TCM)" practitioners begin to diagnose what ails you. It's often followed by a prescription of foul-tasting herbs, to be taken daily, along with exhortations to consume or avoid certain "hot" or "cold" foods.

But after more than 2,000 years of practice, the question remains: Is there scientific evidence that traditional Chinese medicine actually works? A doctor at one of Beijing's top hospitals is challenging these time-honored methods with a modern proposal: cash prizes for proof.

Dr. Ning Fanggang is offering 100,000 renminbi ($16,300) to anyone who resolves the common claim that traditional practitioners can tell if a woman is pregnant just by taking her pulse. "If (someone is) successful, I will never state that Traditional Chinese Medicine is a fake science," Ning promised. The 38-year-old is chief surgeon at Beijing Jishuitan Hospital, which specializes in burn victims, and is also one of the best-known doctors on Weibo, China's version of Twitter.

His challenge calls for readings of 80% accuracy, using the pulse method alone. Critics complain that isolating the wrist from the rest of the system undermines the validity of a diagnosis, and thus the challenge.

This is from USA Today.

Acupuncture Improves Immunity in Chemo Patients 

Chemotherapy is one of most significant therapeutic approaches to cancer. Immune system functional state is considered a major prognostic and predictive impact on the success of chemotherapy and it has an important role on patients' psychoemotional state and quality of life. In Chinese medicine, chemotherapy is understood as "toxic cold" that may induce a progressive hypofunctional state of immune system, thus compromising the fast recovery of immunity during chemotherapy. In this study, we performed a standardized acupuncture and moxibustion protocol to enhance immunity in cancer patients undergoing chemotherapy and to assess if the improvement of immunity status correlates with a better psychoemotional state and quality of life. 

Source: Pais I, Correia N, Pimentel I, Teles MJ, Neves E, Vasconcelos J, Guimarães J, Azevedo N, Moreira Pinto A, Machado J, Efferth T, Greten HJ. Effects of acupuncture on leucopenia, neutropenia, NK, and B cells in cancer patients: a randomized pilot study. Evid Based Complement Alternat Med. 2014;2014:217397

Acupuncture for Kidney Stone

Electro-acupuncture 
for Anaesthesia during Kidney Stone Procedure

Extracorporeal shock wave lithotripsy (ESWL) is the preferred option for urolithiasis treatment. However, intensities of pain may be induced and the sedative anesthetic or analgesics were usually needed. The aim of this study was to develop an improved acupuncture-assisted anesthesia approach in pain relief. We conducted a single-blind, randomized controlled study in China Medical University Hospital. Patients treated by ESWL due to upper urolithiasis were randomly divided into control group, sham-EA group, and 100 Hz EA group. The high frequency electroacupuncture (EA) was applied at the Weizhong acupoint (100 Hz EA group) for 20 minutes prior to the ESWL. In the sham-EA group, the same procedures were performed as those of 100 Hz EA group but no electric current was given to stimulate the acupoints. In the control group, no action was taken before operation. The information including the numbers and dosage of analgesic requirements, pain score, vital signs, and the satisfaction of procedure was collected. A total of 74 subjects were recruited and we found that the interval to the first request analgesic, the number/total dosage of additional analgesic, recovery time from anesthesia, and the satisfaction were all better in both the 100 Hz EA and the sham-EA group. The 100 Hz EA also showed better relief of painful sensations by delaying the onset of pain. The 100 Hz EA and the sham-EA can effectively relieve pain due to ESWL as well as reducing the dosage of opium analgesic used.

Source: Chen WT, Chang FC, Chen YH, Lin JG.An Evaluation of Electroacupuncture at the Weizhong Acupoint (BL-40) as a Means of Relieving Pain Induced by Extracorporeal Shock Wave Lithotripsy. Evid Based Complement Alternat Med. 2014;2014:592319).

A Reflection on De Qi

 Historical and Clinical Perspectives on De Qi: 

Exposing Limitations in the Scientific Study of De Qi.

by Birch S.

De qi is a concept most often associated with patient experiences during needling in acupuncture treatment. A review of the early historical literature on acupuncture shows that texts tended to describe de qi and its associated concept, qi zhi more in terms of practitioner-based phenomena and that this is something more in the realm of the experienced practitioner (i.e., it is skill based). Many modern authors in Asia and the West also describe the importance of practitioner-based experiences in the de qi of acupuncture, further implying that this may lie at the heart of the treatment effects of acupuncture. A review of scientific studies on de qi shows that qualitative studies have focused almost exclusively on patient-based aspects of de qi while quantitative studies have focused exclusively on them. There thus exists a gap in current research on the phenomenon of de qi that possibly reveals weakness in the wider study of acupuncture. It is important that precise qualitative studies of the practitioner-based aspects of de qi begin soon and as they become better understood, quantitative research also is initiated. This research will not only better inform clinical trials and physiologic research of acupuncture in general but could contribute significantly to rethinking of how to train practitioners.

To read more, click here.

Acupuncturists respond to controversial Australian study

Acupuncturists at World Federation of Acupuncture Societies-Houston Conference call for research conducted with rigorous science and rejection of unreliable studies

Houston TX, Nov 4, 2014. A controversial clinical study of acupuncture treatment on chronic knee pain by an Australia research group has been published in The Journal of the American Medical Association. The study concluded that "In patients older than 50 years with moderate or severe chronic knee pain, neither laser nor needle acupuncture conferred benefit over sham for pain or function. Our findings do not support acupuncture for these patients." (Oct 1, JAMA, Rana Hinman at el.: "Acupuncture for chronic knee pain: a randomized clinical trial"). These results immediately appeared on mainstream media such as Reuters News. During the interviews with reporters, the authors emphasized that acupuncture does not work on chronic knee pain. On November 2nd, the Australian study became a hot topic at a symposium organized by the World Federation of Acupuncture Societies and the Traditional Chinese Medicine American Alliance of Alumni (TCMAAA) in Houston, Texas. Preliminary analysis of this study by clinical experts and professional acupuncturists has yielded a number of unanswered questions. These questions tackle the aims of the study, evaluation methods, treatment protocol, and the interpretation of trial data. The report is not only inconsistent with case reports by acupuncturists and real world feedback from patients, but also contradicts several previously published peer reviewed studies. The findings of this report are inconclusive and should, at least, remain open to debate. Distribution of the inconclusive results to the media without greater scrutiny from the medical community was premature. The organizations of the symposium call for the conduct of more acupuncture research using rigorous scientific standards and the rejection of unreliable studies. When conducting future studies, medical researchers should select projects with the greatest clinical relevance, invite specialized acupuncturists to participate (all acupuncture treatments were performed by MD's with some acupuncture training), encourage multidisciplinary collaboration, respect traditional medical experience, and design studies with high scientific merits and relevant aims. The symposium has concluded that reliable evidences that can stand up to the rigors of scientific debate will ultimately yield the greatest benefit to both patients and medical professionals. Source: Symposium on Critical Issues of Acupuncture Trials Traditional Chinese Medicine American Alliance of Alumni (TCMAAA) World Federation of Acupuncture Societies Houston Conference, 2014

Source of the report is here.

Gui Lu Er Xian Jiao for Knee Osteoarthritis

Gui Lu Er Xian Jiao for Knee Osteoarthritis

Guilu Erxian Jiao (GEJ) is a widely used Chinese herbal remedy for knee osteoarthritis, but its clinical efficacy is unknown. We enrolled 42 elderly male patients with knee OA, including 21 patients who received the herbal drug GEJ as the case group and 21 patients who did not receive GEJ as the control group. The effects of 12 weeks of GEJ treatment on muscle strength of lower limbs were measured by a Biodex dynamometer, with disability evaluated on the Lequesne index and articular pain measured on the visual analog scale (VAS) between the two groups on the baseline and after treatment. There were significant increases in the levels of muscle strength of TQ/BW-ext-dominant and TQ/BW-flex-dominant between the two groups after treatment (P < 0.05). There were also significant increases in muscle strength of knee extensor muscles in the GEJ-treated group (n = 21) self-controlled before and after 12 weeks of treatment (all P < 0.01). There were significant decreases in articular pain (P < 0.01) and Lequesne index scores (P < 0.01) in the GEJ-treated group when compared to the non-GEJ-treated group.. Our results showed that GEJ is effective and is tolerated well in elderly men with knee OA. 

Source: Tsai CC, Chou YY, Chen YM, Tang YJ, Ho HC, Chen DY. Effect of the herbal drug guilu erxian jiao on muscle strength, articular pain, and disability in elderly men with knee osteoarthritis. Evid Based Complement Alternat Med. 2014;2014:297458.

SaAm Acupuncture Being Tested for Cancer Patients

SaAm Acupuncture Being Tested for Cancer Patients

To collect preliminary data on the effects of SaAm acupuncture with regard to the immunity in cancer patients. Ten cancer patients were analyzed for improvements in immunity. Acupuncture was applied at the 5 acupuncture points, Jingqu (LU 8), Zutonggu (BL 66), Yanggu (SI 5), Yangchi (TE 4), and Zhongwan (CV 12) for 2 weeks with 4 sessions. We assessed the effect of Korean Saam acupuncture on the immune system in cancer patients by measuring particular blood cell subsets, including CD3+, CD4+, CD8+, CD19+, and CD56+ cells, as well as total white blood cell count, absolute neutrophil count, and fatigue score. The measurement was performed before and after acupuncture and at a 2-week follow-up. There was a statistically significant increase in the number of CD3+ (P = 0.023) and CD8+ cells (P < 0.001) and T-cell subsets, as well as a decrease in the fatigue severity scale (FSS) score (P = 0.001) after Saam acupuncture using the 5 acupoints. Acupuncture may improve the immune system by increasing the counts of a few immune cells and relieve fatigue in cancer patients by decreasing FSS scores. Although this was a non-controlled study, it constitutes preliminary research investigating the potential effects of Saam acupuncture in increasing the counts of several immune cells in cancer patients. (Kim DJ, Park SH, Seo JC, Kim KS, Sohn KC, Shin IH, Ryoo HM. Efficacy of saam acupuncture treatment on improvement of immune cell numbers in cancer patients: a pilot study. J Tradit Chin Med. 2014 Oct;34(5):550-4.)

For an introduction to SAAM acupuncture, click here.

Study on the Four Properties of Chinese Herbs

Study on the Four Properties of Chinese Herbs

The purpose of this review is to summarize and reflect on the current status and problems of the research on the properties of Chinese medicinal herbs. Hot, warm, cold, and cool are the four properties/natures of Chinese medicinal herbs. They are defined based on the interaction between the herbs with human body. How to quantitatively assess the therapeutic effect of Chinese medicinal herbs based on the theoretical system of Traditional Chinese medicine (TCM) remains to be a challenge. Previous studies on the topic from several perspectives have been presented. Results and problems were discussed. New ideas based on the technology of biophoton radiation detection are proposed. With the development of biophoton detection technology, detection and characterization of human biophoton emission has led to its potential applications in TCM. The possibility of using the biophoton analysis system to study the interaction of Chinese medicinal herbs with human body and to quantitatively determine the effect of the Chinese medicinal herbal is entirely consistent with the holistic concept of TCM theory. The statistical entropy of electromagnetic radiations from the biological systems can characterize the four properties of Chinese medicinal herbs, and the spectrum can characterize the meridian tropism of it. Therefore, we hypothesize that by the use of biophoton analysis system, the four properties and meridian tropism of Chinese medicinal herbs can be quantitatively expressed.

Source: Fu J, Pang J, Zhao X, Han J. The Quantitative Ideas and Methods in Assessment of Four Properties of Chinese Medicinal Herbs. Cell Biochem Biophys. 2014 Nov 14.