Acupuncture is over 2500 years old and practiced in most countries throughout the world. In the past three decades, there have been extensive studies on acupuncture and great efforts have been undertaken to conduct controlled clinical trials, including the use of "sham" acupuncture or "placebo" acupuncture controls. During the past decade, there has been a growing convergence between the most advanced research knowledge from physiology, biochemistry and pharmacology, and knowledge obtained by research in the field of acupuncture; that is to say, a convergence of modern international science with traditional Chinese medicine.
Findings from basic medical research that acupuncture stimulation causes release of endorphins, serotonin, enkephalins, and γ-amino-butyric acid (GABA; a major inhibitory neurotransmitter of the brain), norepinephrine, and dopamine helped to explain the acupuncture effect on a biomedical and pharmacological basis that was acceptable to the Western medical establishment. Numerous articles are being published on the efficacy of acupuncture for many types of diseases.
In the Americas and Europe there is significantly increased familiarity with acupuncture and thousands of patients have sought acupuncture treatment to relieve pain and stress-related syndromes, to enhance the immune system, to reduce insomnia, to improve athletic performance, to address neurological conditions, as well as for cardiac and poststroke therapy. From the viewpoint of modern medicine, the principle action of acupuncture is to regulate the function of the human body and to increase its resistance by enhancing the immune system and the antiphlogistic, analgesic, antispastic, antishock and antiparalytic abilities of the body.
Acupuncture now occupies a unique place in modern medicine. Research on acupuncture has taken place in many universities and research institutions around the world, increasing our understanding of how the human body works. These articles only review a fraction of the research that has been conducted on acupuncture.
• A 2010 study of the GABA modulating effects at the Daegu Haany University in South Korea in 2010 followed up on similar study in 2006 (Zhao et al) and found that acupuncture stimulation at a single point (HT7) effectively modulated GABA neuron excitability and dopamine release.
• A 2012 study at the Henan College of Chinese Medicine Zhengzhou, China, found that stimulation at the acupuncture points HT7, UB62 and K6, Shenman, Shenmai, and Zhaohai, potentiated GABA expression and the expression of GABA receptors in the hypothalamus, significantly better than stimulation at P6, ST36 and SP6.
• A clinical study in 2010, at the Catholic University of Korea, Department of Integrative Medicine, found that a 2 Hz 2mA electrical stimulation for just 10 minutes at a single acupuncture point, ST36, ameliorated physiological dysfunctions in anxiety triggered by restraint stress, such as cortisone spikes and immunoreactive expression affecting neurotransmitters, as well as decreasing anxiety-related behavioral responses.
• A 1999 article on acupuncture and the limbic system outlines some of the early scientific observations after fMRI studies revealed how directly acupuncture stimulation affected the limbic system, and how science explains these effects.
• A study in 2003 in Seoul, South Korea, at Kyung Hee University, found that acupuncture stimulation significantly modulated the hippocampus and neuropeptide Y, restoring functional activities. The hippocampus and neuropeptide Y have been observed to have decreased activity in patients with stress disorders, causing physical symptoms.
• A follow-up study in South Korea to the one mentioned above found that neuropeptide Y is involved in the regulation of various physiological functions related to anxiety, and that specific acupuncture stimulations signficantly modulated the expression of both neuropeptide Y (NPY) in the amygdala, as well as the expression of NPY-immunoreactive cells. The researchers found that this may be one way that the acupuncture stimulation reduced anxiety-related symptoms in study animals following traumatic stress.
• A 2008 study at Kyung Hee University then found that acupuncture stimulation also modulated corticotropin-releasing factor (CRF), as well as neuropeptide Y, in the limbic system, to improve physical manifestations of anxiety induced by chemical stimulation.
• A 2012 study at the Henan College of Medicine, Zhengzhou, China, found that acupuncture stimulation at P6, ST36, HT7, SP6, K6 and UB62 increased both the expression of GABA type A receptors in the hypothalamus of laboratory animals, as well as the up-regulation of GABA at the receptors. Stimulation at points UB62 to K6 and HT7 were shown to be significantly more effective in this regard, providing information that acupuncturists can use to achieve better results with waking insomnia and anxiety.
• A 2014 study in China showed that electroacupuncture stimulation at the points ST36 and GB34 downregulated expression of CRF type 2 receptors and upregulated expression of CRF type 1 receptors in the amygdala of laboratory animals. This not only achieved pain relief, but also had positive effects on the animal affect, or mood. This same imbalance of corticotropin releasing factor (CRF) receptor types is seen in chronic use of benzodiazepines, showing that this treatment could potentially aid in benzo withdrawal over time.
• A 2010 study at Shanghai Medical College of Fudan University, in China, also found that electroacupuncture to ST36 and SP6 improved the measurable disorder in the hypothalamus-pituitary-adrenal axis (HPA) of laboratory animals with induced traumatic stress, and normalized the balance of CRF receptor types and UCN 1 expression (urocortin). Since these imbalances are found to be at the heart of the pathology of benzodiazepine withdrawal and rebound syndromes, such study shows the potential of electroacupuncture in the holistc treatment regimen.
• A 2015 study in China showed that acupuncture stimulation at the points DU20 and PC6 every other day for 28 days significantly reduced inflammatory and oxidant stress in the hippocampus of laboratory animals, reducing depression. Such studies demonstrate the potential for acupuncture stimulation to help restore these key areas of mood control in the brain, integrated with a more holistic protocol.
• A 2015 human clinical study with functional MRI in China found that electroacupuncture stimulation at the points DU20 and DU24, along with acupuncture at Sishencong and GB20, performed 3 times a week for 12 weeks, significantly restored connectivity between the hippocampus and parietal lobe in patients with PTSD, and inhibiting excess activity between the hippocampus, parahippocampal gyrus, and amygdala, relieving symptoms.
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Acupuncture Physiology –
Biochemical and Neural Mechanisms
Bossy J (1979) Neural mechanisms in acupuncture analgesia. Minerva Med 70: 1705–1715.
The summary of the nervous levels implicated in analgesia in general helps one to understand that the acupuncture analgesia is not simply a psychological or sociological matter as some said when it first appeared. Its mechanisms are the same as the ones existing in other antalgic therapeutics whether nervous or humoral. Not everything has been explained in the action of acupuncture but acupuncture opens new ways to us in the practical field of controlling pain as well as in the theoretical field of pain, the major problem of all the medicines.
Chan W, Weissensteiner R, Rausch W et al (1998) Comparison of substance P concentration in acupuncture points in different tissues in dogs. Am J Chin Med26: 13–18.
Histologically, acupuncture points show neuronal innervation. One hundred seventy-seven tissue samples of acupuncture points and control points from 4 dogs were collected. Concentrations of substance P, a neurotransmitter, in the skin, muscle and subcutis of acupuncture points and control points were measured by means of enzyme immunoassay. The determined tissue concentrations of substance P (mean ± SEM) in a acupuncture points and control points were 1.81 ± 0.13 and 1.51 ± 0.1 ng/g in the muscle, 3.33 ± 0.29 and 2.63 ± 0.28 ng/g in the skin and 1.59 ± 0.22 and 1.32 ± 0.16 ng/g in the subcutis, respectively. The results indicate that there is a difference in the neurochemical profile between acupuncture points and control points.
Chapman C, Benedetti C, Colpitts Y, Gerlach R (1983) Naloxone fails to reverse pain thresholds elevated by acupuncture: acupuncture analgesia reconsidered. Pain 16: 13–31.
We were unable to demonstrate the reversal of dental acupunctural analgesia following the injection of 0.4 mg naloxone using evoked potential methodology. Since our findings differed from those of Mayer, Price and Rafii who used pain threshold methods, we attempted to replicate their study. Subjects who demonstrated acupunctural analgesia during electrical stimulation of the LI-4 point on the hands received either 1.2 mg naloxone or normal saline under double blind conditions. Pain thresholds elevated by acupuncture failed to reverse when naloxone was given. Review of experimental design issues, other related human subjects research, and animal studies on acupunctural analgesia provided little convincing evidence that endorphins play a significant role in acupunctural analgesia. Because endorphins can be released in response to a Stressor, endorphin presence sometimes correlates with acupunctural treatment in animal studies and some human studies, especially those involving pain patients. The primary analgesia elicited by acupunctural stimulation seems to involve other mechanisms.
Cho ZH, Wong G (1998) New findings of the correlation between acupoints and corresponding brain cortices using functional MRI. Proc Natl Acad Sci 95: 2670–2673.
A preliminary study of the correlation between acupuncture points (acupoints) for the treatment of eye disorders suggested by ancient Oriental literature and the corresponding brain localization for vision described by Western medicine was performed by using functional MRI (fMRI). The vision-related acupoint (VA1) is located in the lateral aspect of the foot, and when acupuncture stimulation is performed there, activation of occipital lobes is seen by fMRI. Stimulation of the eye by directly using light results in similar activation in the occipital lobes by fMRI. The experiment was conducted by using conventional checkerboard 8-Hz light-flash stimulation of the eye and observation of the time-course data. This was followed by stimulation of the VA1 by using the same time-course paradigm as visual light stimulation. Results obtained with 12 volunteers yielded very clean data and very close correlations between visual and acupuncture stimulation. We have also stimulated nonacupoints 2 to 5 cm away from the vision-related acupoints on the foot as a control, and activation in the occipital lobes was not observed. The results obtained demonstrate the correlation between activation of specific areas of brain cortices and corresponding acupoint stimulation predicted by ancient acupuncture literature.
Clement-Jones V, Mc Loughlin L, Tomlin, S, Besser G, Rees L, Wen H (1980) Increased beta-endorphin but not met-enkephalin levels in human cerebrospinal fluid after acupuncture for recurrent pain. Lancet iii: 946–948.
Low-frequency electroacupuncture effectively alleviated recurrent pain in 10 patients. Basal levels of β-endorphin and met-enkephalin in the lumbar cerebrospinal fluid (CSF) of these patients were not different from those in pain-free control subjects. After electroacupuncture in the patients with pain CSF β-endorphin levels rose significantly in all subjects, but met-enkephalin levels were unchanged. These results suggest that the analgesia observed after electroacupuncture in patients with recurrent pain may be mediated by the release into the CSF of the endogenous opiate, β-endorphin.
Clement-Jones V, McLaughlin L, Lowry P, Besser G, Rees L,
Ernst M, Lee M (1987) Influence of naloxone on electro-acupuncture analgesia using an experimental pain test. Acupunct Electrotherap Res 12: 5–22.
The purpose of this study was to examine in man the analgesic effect of non-segmental electroacupuncture (EA) limited to a single point (Hoku hand point) and the influence of naloxone using an original modified electrical dental pain test. Results in the literature are still contradictory as to the degree and specificity of acupuncture analgesia and its opioid nature. Acupuncture techniques as well as experimental pain models are factors accounting for the discrepancies in the results. For this reason, we designed an experimental pain test characterized by a high degree of specificity, validity and reliability. We chose optimal conditions for eliciting specific acupuncture effect ,i.e. non-segmental, low frequency and painful intensity range. A cross-over repeated measure experimental design was used. Five normal trained subjects participated in 65 sessions under four conditions (control, EA, EA+naloxone, EA+placebo). Changes in experimental dental pain thresholds served as indices of analgesia. The results indicated a 27% pain threshold increase after 30 minutes of EA stimulation (p<.0001), with no differential effect between pain detection (mild pain sensation) and pain discomfort (strong pain sensation). This increase was partially blocked by the double blind injection of 0.8mg naloxone IM (p<.005). The experiment was designed in such a way as to prevent the occurence of a stress analgesic effect. The endogeneous opioid system was shown to be partially involved in acupuncture analgesia. Other mechanisms of action are discussed in view of the literature findings.
Ho, W. K. K., H. K. Wong, and H. L. Wen. The influence of electroacupuncture on naloxone-induced morphine withdrawal—III The effect of cyclic-AMP. Neuropharmacology 18, no. 11 (1979): 865-869.
The role of cyclic-AMP in the treatment of morphine addiction by electroacupuncture was studied in rats and mice. During addiction there was a significant drop of plasma cyclic-AMP level. On the other hand, when animals were going through withdrawal, a dramatic rise of plasma cyclic-AMP was observed. Electroacupuncture was effective in suppressing withdrawal behaviour but whether this was associated with a concomitant reduction of plasma cyclic-AMP level is uncertain. Pre-administration of a phosphodiesterase inhibitor subcutaneously or dibutyl-cyclic-AMP intracerebrally into addicted animals completely antagonized the effect of electroacupuncture. In view of the possibility that the effect of acupuncture may be mediated by the secretion of β-endorphin, these results suggest that cyclic-AMP may somehow be involved.
Ho W, Wen H, Lam S, Li A (1978) The influence of electroacupuncture on naloxone induced morphine withdrawal in mice: elevation of brain opiate-like activity. Eur J Pharmacol 49: 197–199.
Hsieh C (1998) Modulation of cerebral cortex in acupuncture stimulation: a study using sympathetic skin response and somatosensory evoked potentials. Am J Chin Med 26: 1–11.
Although acupuncture has been widely used for treating disorders, its therapeutic mechanism remains unclear. In order to study the physiological mechanism of acupuncture stimulation, both palm recordings of sympathetic skin response (SSR) were evoked by electrical stimulation of the right median nerve on 13 normal adult volunteers. Median nerve evoked short-latency somatosensory evoked potential (SEPs) recordings were taken at least one week after SSR recording. The latencies and amplitudes were calculated. N13 component was obtained from Cv7, and N20 and P25 were from somatosensory cortex. The control did not receive acupuncture stimulation. Acupuncture needles were inserted into both Zusanli (St-36) acupoints as follows: 1) manual acupuncture (MA): using fingers to twist the acupuncture needle until so-called Der-Qi was obtained, 2) 2 Hz eletroacupuncture (EA): 2 Hz square-wave electrical pulse were applied between the Zusanli needle and the Shangjuxu (St-37) needle bilaterally. Our results indicated that the mean latencies of SSR were largest during 2 Hz EA followed by MA stimulation, whereas the period of control exhibited the shortest mean latencies. In contrast, the mean amplitudes of SSR were smallest during the period of 2Hz EA, followed by the period of MA, and the period of control exhibited the largest mean amplitudes of SSR. The latencies of N13, N20 and P25 remained unchanged, but the amplitudes of P25 were largest during the period of 2Hz EA, followed by the period of MA; the period of control exhibited the smallest mean amplitudes of SEPs. The results suggest that acupuncture stimulation of both Zusanli acupoints inhibited SSR, which implies that the cerebral cortex contributed at least in part to this inhibition. The stimulation effect of 2Hz EA is stronger than MA.
Kashiba H, Ueda Y (1991) Acupuncture to the skin induces release of substance P and calcitonin gene-related peptide from peripheral terminals of primary sensory neurons in the rat. Am J Chin Med 19: 189–197.
We immunohistochemically examined the short term effects of electron-acupuncture (E-acupuncture) to the skin on substance P (SP)- and calcitonin gene-related peptide (CGRP) containing primary sensory neurons in the rat. Immunoreactivity to SP and CGRP in these neurons at the treatment site decreased after 30 min of E-acupuncture. These results suggest that E-acupuncture induces release of SP and CGRP from peripheral terminals of primary sensory neurons.
Lee T (1977) Thalamic neuron theory: a hypothesis concerning pain and acupuncture. Med Hypoth 3: 113–121.
A new theory is proposed to explain various pain phenomena hitherto unexplainable. It is hypothesized that neurons in the thalamic region are responsible for the generation of most pain, particularly in chronic pain states. It is also hypothesized that the thalamic neurons are organized according to a master scheme representing a homunculus in the fetal position. Various painful conditions and the treatments of them including the trigger points phenomena, neurosurgical techniques, acupuncture and acupuncture anesthesia can be explained on this basis.
Lee T (1994) Thalamic neuron theory: theoretical basis for the role played by the central nervous system (CNS) in the causes and cures of all disease. Med Hypoth 43: 285–302.
The Thalamic Neuron Theory (TNT) postulates that the central nervous system (CNS) is involved in all disease processes, as the CNS not only processes incoming physical and chemical information from the periphery, it also sends out physiological commands to the periphery in order to maintain homeostasis for the entire body. Inherent in its capacity to learn and adapt (i.e. to habituate) is the CNS' ability to learn to be sick (pathological habituation) by looking in certain deranged central neural circuitries, leading to chronic disease states. These pathologically habituated states can be reversed by dehabituation through manipulation or modulation of the abnormal neural circuits by physical means (physical neuromodulation) like acupuncture, or chemical means (chemoneuromodulation) such as Chinese medicine, homeopathy or other modern medical techniques in a repetitious manner to mimic the habituation process. Chemoneuromodulation can also be achieved by delivery of minute amounts of pharmacological agents to specific sites in the periphery such as the acupuncture loci. It is hypothesized that humoral and neurotrophic factors and cytokines could be highly effective neuromodulating agents. TNT assumes the blue print for embryological development is embodied in the phylogenetically ancient part of the brain. This primordial master plan, organized in the form of a homunculus, possibley encased in a small nucleus, retains control over the subsequently evolved parts of the brain so that the entire CNS functions like a composite homunculus which controls the physiological functions of the entire body. TNT further postulates that the master homunculus takes the shape of a curled-up embryo with its large head buried close to its pelvic region, with its large feet and hands crossed over to the contralateral sides. Neuronal clusters along a neuronal chain in the homunculus represent acupuncture points in the periphery. The neuronal chain itself represents a meridian and Chi is nothing more than the phenomenon of neurotransmissions. Certain new theoretical concepts such as the principles of Adynamic Stat and Bilaterality are also presented. Many difficult to explain clinical observations in modern medicine, Chinese herbal medicine, acupuncture and homeopathy can now be adequately explained using TNT. Based on this model, new therapeutic techniques can be launched to combat a whole host of intractable diseases.
Pomeranz B, Chiu, D (1976) Naloxone blockade of acupuncture analgesia: endorphin implicated. Life Sci 19: 1757.
Electroacupuncture in awake mice produced analgesia to noxious heat stimuli causing a 54% increase in latency to squeak. Subcutaneous naloxone completely abolished this acupuncture analgesia implicating endorphin. Naloxone injections in control mice caused a 17% hyperalgesia suggesting that “normal” mice also release endorphin. These results imply that endorphin is released at a low basal rate in “normal” mice, and at a much higher rate during acupuncture.
Takeshige C, Sato T, Mera T, Hisamit T, Fang J (1992) Descending pain inhibitory system involved in acupuncture analgesia. Brain Res Bull 29: 617–634.
The descending pain inhibitory system (DPIS) associated with acupuncture analgesia (AA), caused by low frequency stimulation of an acupuncture point, was identified by the results of lesion and stimulation procedures previously determined to differentiate the afferent and efferent paths in rats. The DPIS starts in the posterior arcuate nucleus and descends to the hypothalamic ventromedian nucleus (HVM) from whence it divides into two pathways: one path, the serotonin mediated path, descends through the ventral periaqueductal central gray (V-PAG) and then to the raphe magnus (RM). The other, the noradrenaline mediated path, descends through the reticuloparagigantocellular nucleus (NRPG) and part of the reticulogigantocellular nucleus (NRGC). The afferent and efferent paths are both present in the RM and NRGC, and were separately identified by means of the analgesia (SPA) produced by stimulation of the separate regions in AA responders and nonresponders, because SPA of these regions in nonresponders produced only efferent pathway mediated analgesia.
Wen HL (1979) Acupuncture in heroin addicts: changes in met-enkephalin and beta-endorphin in blood and cerebrospinal fluid. Lancet ii: 380–382.
In heroin addicts showing features of heroin withdrawal basal β-endorphin levels were elevated in both blood and cerebrospinal fluid (CSF) and did not change during electroacupuncture, although this therapy suppressed the clinical features of withdrawal. Met-enkephalin levels were not elevated in blood or CSF before treatment. However, successful electroacupuncture was associated with a rise in CSF met-enkephalin levels in all patients studied, although concentrations in blood did not alter.
Acupuncture on Opiate and Alcohol Addiction
Brewington V, Smith M, Lipton D (1994) Acupuncture as a detoxification treatment: an analysis of controlled research. J Substance Abuse Treatment 11: 289–307.
The research literature on the use of acupuncture as a substance abuse treatment is reviewed. In recent years numerous descriptive reports have been published concerning the efficacy of acupuncture in alleviating withdrawal symptoms with substance abusers attempting abstinence. While a limited number of experimental design studies have been conducted in this area, results from controlled studies generally support that acupuncture can be effective in assisting active drug and alcohol users become abstinent. Controlled, experimental research on acupuncture and related techniques used as substance abuse treatments are reviewed. An overview regarding acupuncture and related procedures used as substance abuse treatments is first provided. Animal and human studies on acupuncture's usefulness in alleviating opiate withdrawal symptoms are presented, followed by studies concerning other substance abuse problems (i.e., alcohol, tobacco and cocaine). Possible physiological mechanisms related to acupuncture's effects are reviewed.
Bullock M, Culliton P, Olander R (1989) Controlled trial of acupuncture for severe recidivist alcoholism. Lancet i: 1435–1439.
In a placebo-controlled study, 80 severe recidivist alcoholics received acupuncture either at points specific for the treatment of substance abuse (treatment group) or at nonspecific points (control group). 21 of 40 patients in the treatment group completed the programme compared with 1 of 40 controls. Significant treatment effects persisted at the end of the six-month follow-up: by comparison with treatment patients more control patients expressed a moderate to strong need for alcohol, and had more than twice the number of both drinking episodes and admissions to a detoxification centre.
Smith, M. O., and I. Khan. An acupuncture programme for the treatment of drug-addicted persons. Bull Narc 40, no. 1 (1988): 35-41.
Over the past 13 years, Lincoln Hospital, New York City, has used acupuncture as the primary method of treatment for drug-addicted persons. The programme receives, on a daily out-patient basis, 200 drug-addicted persons for detoxification. Acupuncture relieves withdrawal symptoms, prevents the craving for drugs and increases the rate of participation of patients in long-term treatment programmes. The best results have been obtained by treating patients in an open-group setting, using acupuncture points in the external ear with needles without electrical stimulation. The same points are used at each visit, regardless of the type of drug to which the person is addicted. This method is also used for the treatment of persons suffering from stress. The National Acupuncture Detoxification Association (NADA) has conducted successful training programmes for physicians and related staff in using the technique and philosophy of traditional Chinese acupuncture. These training programmes usually include courses in counselling skills, ethical responsibilities and sterilization procedures that are appropriate to local conditions. NADA has begun to operate a pilot programme to treat approximately 1,000 drug abusers and people who are under a high level of stress, which may lead them to the abuse of drugs. It is assumed that acupuncture, in conjunction with other drug-demand reduction programmes, can make a significant impact on the illicit demand for drugs by reaching this entire range of patients.
Wen HL, Ho WK, Wong HK et al (1978) Reduction of adrenocorticotropic hormone (ACTH) and cortisol in drug addicts treated by acupuncture and electrical stimulation (AES). Compar Med East West 7: 237–240.
Forty-two heroin addicts and 31 normal persons were examined for the effect of acupuncture and electrical stimulation (AES) on plasma ACTH, cortisol and cyclic-AMP levels. Both ACTH and cortisol levels were reduced significantly in the addicts after treatment whereas no such significant reduction was observed in the normals. Plasma cyclic-AMP level was not affected in either group. Taken together, results from the present study suggest that the mechanism of AES in the treatment of addiction may have a neuroendocrinological basis. This hypothesis is particularly attractive in view of the isolation of opiate-like peptides from the brain.
Wen H, Ho K, Ling N, Ma L, Choa G (1979) The influence of electro-acupuncture on naloxone-induced morphine withdrawal. II. Elevation of immunoassayable beta-endorphin activity in the brain but not the blood. Am J Chin Med 7: 237–240.
The effect of electro-acupuncture in the treatment of naloxone precipitated morphine withdrawal in mice was studied. Thirty minutes of acupuncture was enough to suppress withdrawal behaviors by more than 60%. Concomitant to the decrease of withdrawal behavior, there was a significant increase of brain beta-endorphin level in the acupunctured animals. Plasma beta-endorphin level of the treated and untreated group was not significantly different.
Wen HL (1977) Fast detoxification of drug abuse by acupuncture and electrical stimulation (AES) in combination with naloxone. Mod Med Asia 13: 13–17.
Detoxification can be accomplished more rapidly by first "flushing" the opiates from the receptor sites. Naloxone, a short antagonist displaces opiates from the receptor sites and such displacement precipitates an abstinence syndrome. Recently, a method of using acupuncture and electrical stimulation (AES) in combination with naloxone for fast detoxification was reported. This technique was applied to 50 cases of heroin addicts. Forty-one were detoxified. There were nine failures. Of the 41 cases, 18 patients were sent to rehabilitation centres and did not experience abstinence symptoms. Six were sent out of Hong Kong where heroin is not available, and two others did not go to a rehabilitation centre but still abstained. The other 15 were presumed to be on the drug. It is advocated that AES increases endorphin and relieves abstinence syndrome, but also at the same time inhibits the autonomic nervous system, mainly the parasympathetic nervous system. The technique does not stop the craving, therefore after detoxification, the patients should be sent for psycho-social rehabilitation, or alternatively be put on long acting antagonist.
Yang M, Kwok S (1986) Evaluation of the treatment of morphine addiction by acupuncture, Chinese herbs, and opioid peptides. Am J Chin Med 14: 46–50.
Experimental studies on the effects of acupuncture, combined Chinese herbs, and opioid peptides on morphine withdrawal symptoms were carried out in 119 addicted rats. Electroacupuncture was found to be the most effective method as it reduced the morphine withdrawal scores to -85%. The combined herbs, Qiang Huo, Gou Teng, Chuan Xion, Fu Zi and Yan Hu Suo suppressed the withdrawal scores of – 68%. The opioid peptides, endorphin, enkephalin, and dynorphin, produced marked sedative effect and alleviated the withdrawal symptoms, reducing the scores from -28% to -74%. It is suggested that acupuncture and herbs, being non-opiate and having less side effect, might be used as alternative supplementary treatment on morphine addiction.
Acupuncture Treatment for Anxiety and Depression
Manber, Rachel, Rosa N. Schnyer, John JB Allen, A. John Rush, and Christine M. Blasey. Acupuncture: a promising treatment for depression during pregnancy. Journal of affective disorders 83, no. 1 (2004): 89-95.
Few medically acceptable treatments for depression during pregnancy are available. The aim of this randomized controlled pilot study was to determine whether acupuncture holds promise as a treatment for depression during pregnancy. Sixty-one pregnant women with major depressive disorder and a 17-item Hamilton Rating Scale for Depression (HRSD17) score ≥14 were randomly assigned to one of three treatments, delivered over 8 weeks: an active acupuncture (SPEC, N=20), an active control acupuncture (NSPEC, N=21), and massage (MSSG, N=20). Acupuncture treatments were standardized, but individually tailored, and were provided in a double-blind fashion. Responders to acute phase treatment (HRSD17 score<14 and ≥50% reduction from baseline) continued the treatment they were initially randomized to until 10 weeks postpartum. Response rates at the end of the acute phase were statistically significantly higher for SPEC (69%) than for MSSG (32%), with an intermediate NSPEC response rate (47%). The SPEC group also exhibited a significantly higher average rate of reduction in BDI scores from baseline to the end of the first month of treatment than the MSSG group. Responders to the acute phase of all treatments combined had significantly lower depression scores at 10 weeks postpartum than nonresponders. Generalizability is limited by the small sample and its relative homogeneity. Acupuncture holds promise for the treatment of depression during pregnancy.
Wang, Shu-Ming, and Zeev N. Kain. Auricular acupuncture: a potential treatment for anxiety. Anesthesia & Analgesia 92, no. 2 (2001): 548-553. Acupuncture can be an effective treatment for chronic anxiety disorders. The purpose of this study was to assess the effectiveness of acupuncture in reducing anxiety in a volunteer population. If found effective, this modality could be introduced as a treatment of anxiety before surgery. Adult volunteers (n = 55), were randomized to three treatment groups: a) Shenmen group—bilateral auricular acupuncture at the “shenmen” point; b) Relaxation group—bilateral auricular acupuncture at a “relaxation” point; and c) Sham group—bilateral auricular acupuncture at a “sham” point. Press-acupuncture needles were inserted at the respective auricular areas for 48 h. State anxiety, blood pressure, heart rate, and electrodermal activity were assessed at 30 min, 24 h, and 48 h after insertion. Analyzing anxiety levels using repeated-measures analysis of variance has demonstrated a significant difference [F (2,51) =8.8, P = 0.001] between the three treatment groups. Post hoc analysis demonstrated that patients in the Relaxation group were significantly less anxious at 30 min (P = 0.007) and 24 h (P = 0.035) as compared with patients in both the Shenmen group and the Sham group, and less anxious at 48 h (P = 0.042) as compared with patients in Shenmen group. Repeated-measures analysis of variance performed for electrodermal activity, blood pressure, and heart rate demonstrated no group differences (P = ns). We conclude that auricular acupuncture at the “relaxation” point can decrease the anxiety level in a population of healthy volunteers.
Acupuncture for Angina Pectoris
Liu, Yuan, Hao-yu Meng, Mohammad Reeaze Khurwolah, Jia-bao Liu, Heng Tang, Nan Aa, and Zhi-jian Yang. Acupuncture therapy for the treatment of stable angina pectoris: An updated meta-analysis of randomized controlled trials. Complementary therapies in clinical practice (2018).
Seven databases were searched ranging from 1959 to February 2018. Quantitative analysis of randomized controlled trials (RCTs) was performed by RevMan 5.3 software and STATA 12.0 program, and Cochrane criteria for risk-of-bias was used to assess the methodological quality of the trials. Results: A total of 12 RCTs involving 974 patients were enrolled in this study. The pooled results showed that both acupuncture group (RR: 0.35, P < 0.00001; RR: 0.49, P < 0.00001) and acupuncture plus medicine group (RR: 0.26, P < 0.00001; RR: 0.52, P = 0.03) were associated with a higher percentage of improved anginal symptoms as well as electrocardiographic (ECG) results compared to medicine group. The acupuncture plus medicine group also had a lower intake rate of nitroglycerin than medicine group (Non-event RR: 0.79, P = 0.03). However, there was no significant difference in the reduction or discontinuation of nitroglycerin intake between acupuncture group and medicine group. No acupuncture-related adverse effects were observed or reported in the included trials. Conclusion: Acupuncture therapy may improve anginal symptoms and ECG results in patients with stable angina pectoris, and can serve as an adjunctive treatment for this condition.
Acupuncture for Asthma
Jiang, Chunxiang, Lanlan Jiang, and Qingwu Qin. Conventional Treatments plus Acupuncture for Asthma in Adults and Adolescent: A Systematic Review and Meta-Analysis. Evidence-Based Complementary and Alternative Medicine 2019 (2019).
Objectives. The efficacy of conventional treatments plus acupuncture for asthma in adult and adolescent is uncertain. Literature reports are conflicting; therefore, the aim of this study was to determine the efficacy of conventional treatments plus acupuncture versus conventional treatments alone using a meta-analysis of all published randomized clinical trials (RCTs). Methods. Two reviewers independently performed a comprehensive literature search from multiple electronic sources (1990–2018), including PubMed, EMBASE, the Cochrane Library, Web of Science, China National Knowledge Infrastructure, and WanFang databases. RCTs in which adult and adolescent patients with asthma (age ≥12 years) were divided into conventional treatments plus acupuncture and conventional treatments alone were included. Results. Nine studies were included. The results showed that conventional treatments plus acupuncture as a complementary therapy could improve the symptom response rate (OR = 7.87, 95% CI = [4.13, 14.99], p < 0.00001) and significantly decrease interleukin-6 (IL-6) levels (MD = -11.42; 95% CI = [-15.28, -7.56], p < 0.00001). However, indices of pulmonary function, including the forced expiratory volume in one second (FEV1) (MD = 0.22, 95% CI = [-0.11, 0.56], p = 0.19) and FEV1/forced vital capacity (FVC) (MD = 8.62, 95% CI = [-0.35, 17.59], p = 0.06), failed to be improved with conventional treatments plus acupuncture. Conclusion. Conventional treatments plus acupuncture are associated with significant benefits for adult and adolescent patients with asthma. Therefore, we suggest the use of conventional treatments plus acupuncture for asthma patients.
Acupuncture for Chronic Constipation
Zhu, Lingping, Yunhui Ma, and Xiaoyan Deng. Comparison of acupuncture and other drugs for chronic constipation: A network meta-analysis. PloS one 13, no. 4 (2018): e0196128.
The objective of this study was to compare the efficacy and side effects of acupuncture, sham acupuncture and drugs in the treatment of chronic constipation. Randomized controlled trials (RCTs) assessing the effects of acupuncture and drugs for chronic constipation were comprehensively retrieved from electronic databases (such as PubMed, Cochrane Library, Embase, CNKI, Wanfang Database, VIP Database and CBM) up to December 2017. Additional references were obtained from review articles. With quality evaluations and data extraction, a network meta-analysis (NMA) was performed using a random-effects model under a frequentist framework. A total of 40 studies (n = 11032) were included: 39 were high-quality studies and 1 was a low-quality study. NMA showed that (1) acupuncture improved the symptoms of chronic constipation more effectively than drugs; (2) the ranking of treatments in terms of efficacy in diarrhoea-predominant irritable bowel syndrome was acupuncture, polyethylene glycol, lactulose, linaclotide, lubiprostone, bisacodyl, prucalopride, sham acupuncture, tegaserod, and placebo; (3) the ranking of side effects were as follows: lactulose, lubiprostone, bisacodyl, polyethylene glycol, prucalopride, linaclotide, placebo and tegaserod; and (4) the most commonly used acupuncture point for chronic constipation was ST25. Acupuncture is more effective than drugs in improving chronic constipation and has the least side effects. In the future, large-scale randomized controlled trials are needed to prove this. Sham acupuncture may have curative effects that are greater than the placebo effect.
Acupuncture Treatment for Perimenopausal and Menopausal Symptoms
Befus, Deanna, Remy R. Coeytaux, Karen M. Goldstein, Jennifer R. McDuffie, Megan Shepherd-Banigan, Adam P. Goode, Andrzej Kosinski et al. Management of menopause symptoms with acupuncture: An umbrella systematic review and meta-analysis. The Journal of Alternative and Complementary Medicine 24, no. 4 (2018): 314-323.
Vasomotor symptoms (VMSs) are the most common symptoms reported during menopause. Although hormone therapy is effective for reducing VMSs, its use is restricted in some women. Many women with VMSs thus seek nonhormonal, nonpharmacologic treatment options such as acupuncture. An umbrella systematic review (SR) was conducted, supplemented by a search of published randomized controlled trials (RCTs), that assessed the effectiveness of acupuncture for VMSs, health-related quality of life (HRQOL), and adverse effects of treatment in perimenopausal or postmenopausal women. Meta-analyses were conducted using a random-effects model when data were sufficient. Three SRs and four new RCTs were identified that met eligibility criteria. Meta-analyses of this study revealed statistically significant standardized mean differences (SMDs) associated with acupuncture compared with no acupuncture at reducing VMS frequency (SMD −0.66, 95% confidence interval [CI] −1.06 to −0.26, I2 = 61.7%, 5 trials) and VMS severity (SMD −0.49, 95% CI −0.85 to −0.13, I2 = 18.1%, 4 trials) and improving HRQOL outcomes (SMD −0.93, 95% CI −1.20 to −0.67, I2 = 0.0%, 3 trials). SMDs were smaller or not statistically significant when acupuncture was compared with sham acupuncture. Evidence from RCTs supports the use of acupuncture as an adjunctive or stand-alone treatment for reducing VMSs and improving HRQOL outcomes, with the caveat that observed clinical benefit associated with acupuncture may be due, in part, or in whole to nonspecific effects. The safety of acupuncture in the treatment of VMSs has not been rigorously examined, but there is no clear signal for a significant potential for harm.
Feng, Jialei, Wei Wang, Yuan Zhong, Chonghui Xing, and Taipin Guo. Acupuncture for perimenopausal depressive disorder: A systematic review and meta-analysis protocol. Medicine 98, no. 7 (2019): e14574.
Perimenopausal depressive disorder (PDD) is a disease that plagues many perimenopausal women. There is an urgent need for a safe way to treat the disease. With few side effects, acupuncture treatment for PDD has been gradually accepted. However, at present, the evidence is insufficient and relevant studies are not in-depth enough. The purpose of this study is to explore the efficacy and safety of acupuncture for PDD. All randomized controlled trials articles on acupuncture treatment of PDD will be searched in databases such as MEDLINE, EBASE, Cochrane Library, Springer, World Health Organization International Clinical Trials Registry Platform, China National Knowledge Infrastructure, Wan Fang, Chinese Biomedical Literature Database, Chinese Scientific Journal Database and so on. Non-RCT articles will be screened and key information will be extracted. The primary outcome is the Hamilton depression scale. Second outcomes are the Hamilton anxiety scale, Quality of life scale, changes of symptoms in traditional Chinese medicine and hormone levels. This systematic review will provide the highest level of evidence and provide an evaluation of the efficacy and safety of acupuncture for PDD. This study provides evidence for evaluating the efficacy and safety of acupuncture in the treatment of PDD.
Acupuncture Treatment for Chronic Pain and Neuropathy
Abuaisha, B. B., J. B. Costanzi, and A. J. M. Boulton. Acupuncture for the treatment of chronic painful peripheral diabetic neuropathy: a long-term study. Diabetes research and clinical practice 39, no. 2 (1998): 115-121.
Forty-six diabetic patients with chronic painful peripheral neuropathy were treated with acupuncture analgesia to determine its efficacy and long-term effectiveness. Twenty-nine (63%) patients were already on standard medical treatment for painful neuropathy. Patients initially received up to six courses of classical acupuncture analgesia over a period of 10 weeks, using traditional Chinese Medicineacupuncture points. Forty-four patients completed the study with 34 (77%) showing significant improvement in their primary and/or secondary symptoms (P<0.01). These patients were followed up for a period of 18–52 weeks with 67% were able to stop or reduce their medications significantly. During the follow-up period only eight (24%) patients required further acupuncture treatment. Although 34 (77%) patients noted significant improvement in their symptoms, only seven (21%) noted that their symptoms cleared completely. All the patients but one finished the full course of acupuncture treatment without reported or observed side effects. There were no significant changes either in the peripheral neurological examination scores, VPT or in HbA1c during the course of treatment. These data suggest that acupuncture is a safe and effective therapy for the long-term management of painful diabetic neuropathy, although its mechanism of action remains speculative.
Hawks, Matthew, and Stephen Cook. Is acupuncture effective for treating diabetic neuropathy? Evidence-Based Practice 21, no. 5 (2018): E1-E2.
Acupuncture appears to improve diabetic peripheral neuropathy symptoms better than B vitamins or no treatment and to improve symptoms of diabetic gastroparesis better than gastroprokinetic agents. Electroacupuncture improves symptoms of diabetic gastroparesis better than sham procedure, but the difference is likely not clinically significant. Acupuncture may be considered for symptom management in patients with diabetic gastroparesis.
Johansson, Anders, Bengt Wenneberg, Curt Wagersten, and Torgny Haraldson. Acupuncture in treatment of facial muscular pain. Acta Odontologica Scandinavica 49, no. 3 (1991): 153-158.
Forty-five individuals with long-standing facial pain or headache of muscular origin were randomly allocated into three groups. The first group was treated with acupuncture, the second group received an occlusal splint, and the third group served as controls. Both acupuncture and occlusal splint therapy significantly reduced subjective symptoms and clinical signs from the stomatognathic system. No differences between these two groups were found with regard to treatment effects. It is concluded that acupuncture is an alternative method to conventional stomatognathic treatment for individuals with craniomandibular disorders of muscular origin.
Pan, Hong, Rongjiang Jin, Mengxiao Li, Zhihong Liu, Qing Xie, and Pu Wang. The Effectiveness of Acupuncture for Osteoporosis: A Systematic Review and Meta-Analysis. The American journal of Chinese medicine 46, no. 03 (2018): 489-513.
To summarize the existing evidence and evaluate the efficacy of acupuncture as a clinical treatment for osteoporosis. Six English and four Chinese databases were searched from their inception to April 2017. Randomized controlled trials were included, in which warm acupuncture, needling or electroacupuncture were compared with sole Western medicine with osteoporosis. All the data were assessed and extracted by two authors independently. The bias risk assessment recommended by the Cochrane Collaboration’s tool was used to assess the quality of the selected studies. This meta-analysis was conducted by using RevMan 5.3. Pooled analyses were calculated by standardized mean difference (SMD) and 95% confidence interval (CI). Heterogeneity was assessed by I2 test. Thirty-five studies involving 3014 patients were located. Meta-analysis showed that warm acupuncture could increase the bone mineral density of lumar (SMD == 0.93, 95% CI == 0.65, 1.21, P<P<0.00001) and femur (MD==0.11, 95% CI==0.05, 0.16, P==0.0002), the level of serum calcium (MD==0.18, 95% CI==0.13, 0.24, P<P<0.00001) and estradiol (SMD==0.65, 95% CI==0.32, 0.98, P==0.0001), relieve pain (MD==–1.64, 95% CI==–2.69, –0.59, P==0.002), decrease the level of serum alkaline phosphatase (MD==–7.8, 95% CI==–14.17, –0.84, P== 0.03) compared with sole Western medicine. Electroacupuncture could relieve pain (MD== –1.32, 95% CI==–2.15, –0.48, P==0.002), increase the level of serum calcium (MD==–0.12, 95% CI == –0.16,-0.09, P<P<0.00001) and decrease the level of serum alkaline phosphatase (MD == –3.63, 95% CI == –6.60, –0.66, P== 0.02) compared with sole Western medicine. Needling could relieve pain (MD == –2.27, 95% CI == –3.11, –1.43, P<P<0.00001) compared with sole Western medicine. This present systematic review indicated that acupuncture could be an effective therapy for treating osteoporosis. Warm acupuncture seemed to more effective than electroacupuncture and needling for osteoporosis in comparison to sole Western medicine.
Vickers, Andrew J., Emily A. Vertosick, George Lewith, Hugh MacPherson, Nadine E. Foster, Karen J. Sherman, Dominik Irnich, Claudia M. Witt, Klaus Linde, and Acupuncture Trialists' Collaboration. Acupuncture for chronic pain: update of an individual patient data meta-analysis. The Journal of Pain 19, no. 5 (2018): 455-474.
Acupuncture is effective for the treatment of chronic musculoskeletal, headache, and osteoarthritis pain. Treatment effects of acupuncture persist over time and cannot be explained solely in terms of placebo effects. Referral for a course of acupuncture treatment is a reasonable option for a patient with chronic pain.
Acupuncture Treatment for Obesity and Hyperlipema
Kim, S‐Y., I‐S. Shin, and Y‐J. Park. Effect of acupuncture and intervention types on weight loss: a systematic review and meta‐analysis. Obesity reviews 19, no. 11 (2018): 1585-1596.
This systematic review and meta‐analysis involving 32 intervention arms and 2,219 patients suggests that the effect of acupuncture on obesity may be maximized when auricular and manual acupuncture, pharmacopuncture or catgut embedding treatments is combined with lifestyle modification. Acupuncture treatment alone may be not effective on weight loss. Unlike herbal medicine and lifestyle modification, acupuncture treatment may be more effective in patients with overweight than in patients with obesity. Further studies are required to overcome the limitations of small number of RCTs, short‐term effect and low methodological quality.
Sun Q, Xu Y (1993) Simple obesity and obesity hyperlipema treated with otoacupoint pressure and body acupuncture. J Trad Chin Med 13: 22–26.
161 cases of simple obesity with or without hyperlipemia were treated by pellet pressure on auricular acupoints plus body acupuncture for 3 months in a single-blind experiment. Patients on Capsulae Olei Oenothera Erythrosepalae were taken as positive controls. Body weight, circumference of chest, abdomen, arms and legs, the appetite, sleep, bowel movement, blood TC, TG and HDL-C were recorded for comparison. The results indicated that treatment in the auricular and body acupoint group was superior to treatment in the control group. In the acupoint group body weight dropped by an average of 5.04 kg in 84.55% of the patients, who also showed decreased appetite, blood TC and TG.
Acupuncture Point Location - Verification with Electrical Impedance Testing
Hyvarinen J, Karlsson M (1977) Low skin resistance skin points that may coincide with acupuncture loci. Med Biol 55: 88–94.
Electrical resistance of skin was studied with the aid of a specially designed meter that compared the resistance per surface area of small skin points with that of the surrounding skin. In a systematic study of the hands, face and ears in five subjects low-resistance skin points were repeatedly found in characteristic loci, comparable in different individuals and symmetric about the body midline. The low-resistance skin points had diameters of 1.5 +/- 0.5 mm and their borders were abrupt. On the dry skin resistance values were around 10 kilo-ohms at the center of the points but around 3 mega-ohms in the surrounding skin. Voltages could also be recorded at these points, but they proved to be result of electrode polarization reflected at these points because of their low electrical resistance. The distribution of the low points in the hands, face and ears resembled that of classical acupuncture points.
Langevin, Helene M., and Jason A. Yandow. Relationship of acupuncture points and meridians to connective tissue planes. The Anatomical Record: An Official Publication of the American Association of Anatomists 269, no. 6 (2002): 257-265.
Acupuncture meridians traditionally are believed to constitute channels connecting the surface of the body to internal organs. We hypothesize that the network of acupuncture points and meridians can be viewed as a representation of the network formed by interstitial connective tissue. This hypothesis is supported by ultrasound images showing connective tissue cleavage planes at acupuncture points in normal human subjects. To test this hypothesis, we mapped acupuncture points in serial gross anatomical sections through the human arm. We found an 80% correspondence between the sites of acupuncture points and the location of intermuscular or intramuscular connective tissue planes in postmortem tissue sections. We propose that the anatomical relationship of acupuncture points and meridians to connective tissue planes is relevant to acupuncture's mechanism of action and suggests a potentially important integrative role for interstitial connective tissue. Anat Rec (New Anat) 269:257–265, 2002. © 2002 Wiley‐Liss, Inc.
Reichmanis M, Marino A, Becker R (1975) Electrical correlates of acupuncture. IEEE Trans Bio-Med Engin 22: 533–535. Employing a Wheatstone bridge, skin conductance was measured over those putative acupuncture points on the large intestine and pericardium meridians lying between the metacarpophalangeal joints and the elbow. Results were compared to those from anatomically similar locations devoid of acupuncture points. At most acupuncture points on most subjects, there were greater electrical conductance maxima than at control sites.
Reichmanis M, Marino A, Becker R (1976) D.C. skin conductive variation at acupuncture loci. Am J Chin Med 4: 69–72. Skin conductance was measured in 10 subjects with a DC Wheatstone bridge in 10 areas purportedly containing acupuncture loci on the Triple Burner (TB) and Lung (Lu) meridians. When the results were compared to those from anatomically similar locations devoid of acupuncture loci, local conductance variation was found to be significantly different (p<0.05) in most acupuncture locus locations.
Soh, K. S. (2004). Bonghan duct and acupuncture meridian as optical channel of biophoton. Journal of the Korean Physical Society, 45(1), 1196-1198.
A biophoton in connection with inter-cellular communication is introduced, with its important source DNA. The Bonghan duct as anatomical structure of acupuncture meridians is considered with its ﬂowing contents, DNA-granules. A hypothesis of an optical channel of coherent biophotons is proposed as a new communication and control network of photons, which is the physiological function of Bonghan ducts. This can explain scientiﬁcally the therapeutic effects of acupuncture.
Xianglong H, Baohua W, Xiaoqing H, Jinsen X (1992) Computerized plotting of low skin impedance points. J Trad Chin Med 12: 277–282.
The distribution of low skin impedance points (LSIP) was studied on 68 subjects with a computer system designed for the measurement of skin impedance. The results demonstrated that LSIPs were basically distributed along the 14 channels, the overwhelming majority located right on or within 5 mm bilaterally to their courses. LSIPs were found in the area between every two channels only in a few cases. Moreover, there was no marked natural fluctuation of skin impedance in the human body and the distribution of LSIPs was considerably stable, which could be plotted on any day in the experiment. It is clear that such particular distribution of LSIPs along channels was really a biological phenomenon, not an experimental error. However, the distribution of low skin impedance was not an uninterrupted solid line but a series of LSIPs basically along the channel course. The method used in this work was accurate, reliable and repeatable which has upgraded the measurement of LSIPs to a new level. Under certain conditions, skin impedance can be used as an objective index in channel research.