Acupuncture Effective for Fibromyalgia – Pain Modulators Improved For Months Following Treatments

Acupuncture has been shown both clinically and in plentiful research studies to be helpful for a range of pain conditions, psychological conditions as well as autoimmune conditions.  Fibromyalgia is quite commonly treated and generally does quite well in large part due to the systemic and broader nature of the effects of acupuncture on the body.  Fibromyalgia is more common than many may realize even though diagnosis can be difficult to pin down due to the range of symptoms.  Worldwide it is estimated at 3-6% of the population with about 10 million in the United States – 70% or more of cases showing up in women.

For a basic introduction to the Chinese Medicine view of fibromyalgia, I suggest “Understanding fibromyalgia from an acupuncture perspective” which I wrote a couple years ago.  Basically from a Chinese Medicine perspective we know it is a treatable condition and generally responds quite well.  From a research perspective, however, we don’t exactly know “how” it seems to help fibromyalgia and that is the focus of my article today.

To better understand the “how” a group of researchers from a variety of Turkish institutions, including researchers from the Departments of Physical Medicine and Rehabilitation at both the Istanbul Training and Research Hospital and within Ataturk University, conducted a study to look deeper.

Using an acupuncture treatment group, a sham acupuncture control group and another simulated acupuncture control group researchers looked at effectiveness of acupuncture for fibromyalgia via a variety of pain scales but also in modulation of serotonin and substance P.

Now most people know generally the term serotonin, probably more as a mood chemical, but it plays a large role in pain and inflammation management in the body.  Substance P, however, is less well known, certainly to the general public.  Substance P was originally discovered in the 1930’s and it is an important part of the body’s initial responses to threat including the experience of pain, inflammation for protection, and other mood changes.  It is often elevated, many times considerably so, in patients with fibromyalgia ( 1 ).

Researchers recruited 75 women with fibromyalgia and divided them into the treatment and two control groups.  They were offered treatment twice weekly for 4 weeks and were evaluated before and after these sessions.

The researchers found that serotonin levels were increased significantly in the acupuncture group and the Substance P levels were significantly decreased compared to the control groups.  In the acupuncture group all of the other pain scales and other markers were improved in addition to these very positive chemical changes.  In most cases researchers saw that these positive changes lasted upwards of 3 months following cessation of the acupuncture treatment.

The researchers concluded that “Acupuncture, rather than sham or placebo acupuncture, may lead to long-term improvements on clinical outcomes and pain neuromediator values. Changes in serum serotonin and SP levels may be a valuable explanation for acupuncture mechanisms in FM treatment.”

All things considered this is a very useful study giving us insight into the reactions of the body internally to acupuncture in fibromyalgia patients.  The findings here are, of course, not limited to fibromyalgia as many pain and destructive inflammatory responses related to many conditions have the same or similar chemical workings.

Acupuncture Effective for Chemo Fatigue – 10 Trials With 1327 Patients

Researchers from China recently conducted a meta-analysis of 10 randomized controlled clinical trials involving 1327 patients and concluded that “acupuncture is effective for CRF [chemotherapy related fatigue] management and should be recommended as a beneficial alternative therapy for CRF patients, particularly for breast cancer patients and those currently undergoing anti-cancer treatment.”

Besides fatigue, acupuncture has been shown in multiple studies to be effective for cancer and cancer treatment related pain.  While clinical experience is strong, one study, looked at how this might happen and found that acupuncture “activates 5-HT 1A receptors in the spinal cord and inhibits p-CaMKII” – which in laymens terms means simply that it activates processes in the body that block pain and inflammatory responses.

While the ranges of cancers and cancer treatments make it hard to talk about in general terms, Chinese Medicine generally sees cancer treatments challenging what we call the Qi, Blood and/or Yin of the body to varying degrees in each individual.

When your Qi is low, what we might call Spleen Qi Deficiency, you are fatigued and cold.

What we might call Spleen Blood Deficiency is a deeper version of Qi deficiency in many ways and is related to your “blood”, but is a much broader concept.  When your “blood” is low the symptoms of fatigue can be deeper and you may see changes in the hair and nails as well as dipping into or towards anemia.

When your yin is depleted, what we might call Kidney Yin Deficiency, you can feel hot, with nightsweats for example, possible anxious, or just simply tired and wired.

Rectifying these deficiencies is generally what is behind the Chinese Medicine approach in cancer care.  While they may seem like nebulous concepts they make sense within the mind of the practitioner and the theoretical framework allows for more systemic treatment which is required to truly help in situations like this.

One study, entitled “The Correlation of Traditional Chinese Medicine Deficiency Syndromes, Cancer Related Fatigue, and Quality of Life in Breast Cancer Patients” looked at trying to quantify the concept of qi deficiency with breast cancer patients.  Seeing if the more “qi deficient” they were from a TCM diagnostic approach if that meant a lower quality of life.

While these concepts are critical from a practitioners perspective they are often, unfortunately, part of what makes western medical professionals and patients alike turn their eyes away from Chinese Medicine – thinking it is mumbo jumbo.  People can be very critical, and somewhat understandably so, when they hear concepts such as Qi.  They are in reality meaningless outside of the full understanding of the theoretical framework of Chinese Medicine. This reaction and lack of attempts to dig deeper, however, is unfortunate based on the sheer amount of published clinical evidence for acupuncture with this range of conditions.  More particularly how important they are and how undesirable some of the western pharmaceutical approaches are.

Hopefully this article will help begin an exploration, or continue one, for people having difficulties through cancer treatments and the western health professionals trying to support them.  There is simply too much evidence to overlook and too little side effects to not recommend acupuncture for symptomatic treatment of cancer related fatigue, pain, and related issues.

 

Acupuncture Provides Neuroprotective Effects Against Vascular Dementia

Rates of vascular dementia double in the US every 5.3 years, Alzheimer’s rates double every 4.3 and they can co-exist later in life ( 1 ).  While Alzheimer’s and vascular dementia are different conditions they share many of the same contributing factors.  The primary factors appear to be poor diet as these conditions are linked with diabetes, high cholesterol, high blood pressure, which are essentially linked to an inflammatory diet and lifestyle.  For vascular dementia  looking for the beginnings of carotid intima-medial thicknes and arterial stiffness may offer early signs of damage that will over time lead to symptoms.  All of these, incidentally, are the same risk factors for stroke and dementia following a stroke appears to significantly lower life expectancy.

While this article is about a specific study showing neuroprotective effects of acupuncture, it is appropriate to point towards dietary advice due to how important that would be for an individual patient.  The recent text, The Alzheimer’s Solution: A Breakthrough Program to Prevent and Reverse the Symptoms of Cognitive Decline at Every Age, contains a very well laid out discussion of the importance of diet along with some very straightforward tips towards directing your diet away from inflammatory substances that contribute to dementia and other precursory lifestyle and diet related conditions.

Generally speaking we know that acupuncture provides a broad range of effects including systemically reducing inflammation and promoting circulation, among many others.  What we don’t know is how in technical terms it appears to be providing these benefits.  Many practitioners, and patients for that matter, may not even care so long as they get the results they are seeking.  But it is wise as practitioners, in my opinion, to better understand some of what is happening in scientific terms to help guide the design of treatments and better prognosis estimates.

The study I’m writing about today used a rat model of vascular dementia to figure out more of the underlying effects that acupuncture has in relation to vascular dementia and the causative factors of that condition.  The researchers were from the Beijing Hospital of Traditional Chinese Medicine and the Beijing University of Chinese Medicine.

Starting with previous studies that have shown acupuncture to have antioxidative and neuroprotective effects, the researchers were looking deeper at how these effects are accommodated by the body.  Using a range of scientific tests including the Morris water maze for the neuroprotective effects and detecting levels of DNA oxidation for the oxidative stress aspects, researchers wanted to see if acupuncture could mimic the effect of TXNIP inhibition.

TXNIP, or Thioredoxin interacting protein, is in laymens terms an on switch for the destructive processes present in vascular dementia as well as issues such as diabetic neuropathy, for example.  So when something can inhibit the release of TXNIP it will, in effect, limit the types of damage that are behind this range of issues.

In this study the researchers found that acupuncture was able to reverse a range of negative inflammatory and destructive markers including TXNIP.  They concluded that “the neuroprotective effects of acupuncture in VD are mediated through reducing expression of TXNIP-associated oxidative stress and inflammation”.

While in this rat model the vascular dementia was significant, the real place to start with these conditions is, ideally, long before they get strongly developed.  With dietary and lifestyle change, along with acupuncture, one may well be able to enjoy a sharper mind throughout life or at least into much later years.

Single Acupuncture Point Found To Suppress Methamphetamine Usage

Roughly 1.2 million people in the US have used methamphetamine in the last year. It is the second most commonly used drug in the world with roughly .4% of the worlds population having used it. It is an extremely complex health epidemic with strong dependency issues, cognitive impairments, a range of physical health affects infectious, cardiovascular and otherwise and, unfortunately, death.

Methamphetamine, while being the focus of the study we are discussing today, is only one of many strong substances that are destroying the lives of people around the world. The global addiction epidemic is a problem that crosses oceans, socioeconomic boundaries, ages and cultural backgrounds. Many people, upwards of roughly 80% in the US at least, start this destructive path by regularly prescribed pain medications. Reducing prescriptions, while a great idea for those not yet on that path, is not as easy for those who still have the same underlying issues that the pain medications did not resolve in many cases and now have a physical dependency on top of that.

There is a role for Chinese Medicine within this epidemic as it has been shown to be useful not just for a range of pain conditions (often the on ramp to the prescription drugs that lead to further problems), but for a range of psychological issues and physical addictions that continue this epidemic.

While the research I’ll be exploring today is about meth specifically, an article in forbes, “The Role Of Acupuncture In The Midst Of The Opioid Crisis” is a worthwhile read to explore the situation further. Further connections can be followed by keeping up with the “National Acupuncture Detoxification Website” (promoters of the NADA auricular acupuncture protocol).

Publishing in neuroscience letters a team comprised of researchers from China and Korea including those from the Daegu Haany University College of Korean Medicine conducted a study utilizing a single acupuncture point looking at its role in suppressing IV methamphetamine usage.

Utilizing a rat model with manual acupuncture at HT 7 and a control group utilizing LI 5 researchers were looking for whether or not acupuncture was helpful in reducing the self administration of meth and by using certain brain chemical antagonists how it was performing this function.

They concluded that “Acupuncture at HT7, but not at control acupoint LI5, reduced the self-administration behavior significantly. Also, the effects of acupuncture were blocked by the GABA receptor antagonists.” and ultimately they feel that the results “have shown that acupuncture at HT7 suppressed methamphetamine self-administration through GABA receptor system, suggesting that acupuncture at HT7 can be a useful therapy for the treatment of methamphetamine abuse.”

Now ultimately, as with most studies of this nature, it is unlikely that simple acupuncture at a single acupuncture point will be systemic enough to curve the entire opiate epidemic. Properly tailored acupuncture treatments will likely yield the most consistent results. But for those around the world with very limited (or no) access to health care (Western or Chinese) if this were to help with even 20% of the people worldwide the adoption of these methods would be important to say the least.

Acupuncture Helpful for Maternal Separation Anxiety

Maternal separation anxiety involves a mother experiencing emotions of worry, sadness and/or guilt during temporary separations from their child. No study has shown precise numbers but it seems to be a somewhat common phenomena, if not under diagnosed, which according to some studies is more likely in first time mothers. While a fairly extensive study didn’t find a correlation with maternal anxiety leading to separation anxiety in children, considered within the context of the psychological changes prevalent post-partum and other anxieties of child rearing any help in limiting anxiety from any cause is very likely a positive offering.

Acupuncture and Chinese Medicine more broadly is used for the entire range of psychiatric conditions including anxiety disorders, insomnia, depression and other more complicated conditions. There are any number of studies supporting the use of acupuncture and Chinese herbal medicine in the treatment of this range of conditions and postpartum depression issues fall well within this scope.

In very general Chinese Medicine terms the weaknesses that can arise from pregnancy, labor and delivery, and postpartum activities in both qi (your bodies energy) and blood (your blood and other facets of tissue nourishment) are often linked to psychiatric issues postpartum. Some of these deficiencies may have been prevalent before pregnancy and then only made more significant through the process, for others it may arise at anytime through the process. An example of some possibly underlying Chinese Medicine diagnoses for anxiety may be seen on our acupuncture for anxiety page. For more on how Chinese Medicine treats causal patterns and not symptoms/conditions – see “What Does Acupuncture Treat?“.

Treatment is centered around strengthening these deficiencies in Chinese Medicine terms, not in simply calming the person as a western psychiatric drug might be used for example. Due to the complexity of the diagnostic process in Chinese Medicine, the best outcomes will come by consulting with an acupuncturist in your local area to receive treatment tailored to your unique situation. What I am going to discuss today, however, is a fairly simple study using a single acupuncture point that changes some of the chemistry thought to be involved with maternal separation anxiety, thus relieving symptoms. This isn’t as much a recommendation to use this single point, although it can be used with acupressure, but to understand more of how it works in biochemical terms.

The point used in the study was HT 7. HT 7 is an important point in Chinese Medicine for what we term “calming the shen” and what in western terms would be for alleviating stress and anxiety. It is easily found with your palm facing up at the wrist crease on the pinky finger side just towards the inside of the tendon you feel there (flexor carpi ulnaris). Indications include strengthening deficiencies of the heart qi and blood, emotional issues particularly related to thinking, strong physical responses to emotional stimulation, etc.

In this study they utilized rat pups and divided them into 3 groups – a control, a HT 7 treatment group and then a group with a random acupuncture point – in this case UB 57 which is often used for hemorrhoids. They were treated for 7 days and various blood and biochemical samples were taken along with other stress related tests.

The researchers concluded that “acupuncture stimulation at HT 7 can alleviate the behavioral impairment and changes of the cytokines by MS, indicating that acupuncture can help to relieve MS-induced depression”.

In more biochemical terms the researchers found that compared with the other groups, those in the HT 7 treatment group had significantly lower levels of IL-1β and IL-6 (which when elevated indicate stress and anxiety), as well as reductions in GDNF (again, higher in stress responses) and lower overall cortisol levels.

While treatment is generally more directly tailored when applied by an acupuncturist, it is interesting to note that very simple approaches may also yield very productive results.

Need Focus and Impulse Control? – Practice Tai Chi

Without getting into an incredibly detailed discussion of your brain and nervous system, you have two modes of being; your sympathetic (“fight or flight”) mode and your parasympathetic (“rest and digest”) mode. Technically you need both, but many of our psychological and physical health issues come from over-activation of our sympathetic system – i.e. living in fight or flight. While that is bad enough, over time aspects of our brain will change to essentially facilitate operating in that undesirable mode making true emotional and physical wellness more difficult than just changing habits, diet or other aspects.

One of the principle reasons why people have a hard time changing their diet, lifestyle and emotional behaviors is that without the activation, growth, and development of certain parts of the brain the changes we wanted to do become a correction after we act (a response), rather than the consistent act of balance and choice without choosing (see “wu wei“) that we desire. In essence we want our initial, thoughtful intent to be what drives our behavior, not to always act by reacting to internal or external stimuli.

Put more simply, we want a brain to tell us we are calm and our reactions to be as they would be from a calm, thoughtful person, not to have to consistently tell ourselves that we “should” be calm after we behave poorly.

Much of this is laid out in detail in the text “Buddha’s Brain: The Practical Neuroscience of Happiness, Love, and Wisdom.” The text itself doesn’t have much to do with Buddhism, if anything really, but it discusses in practical terms the outcomes of some very extensive studies on a group of Tibetan meditation practitioners. Long story short, their brains facilitate the primary responses of calm, thoughtfulness and attention that we desire. And their brains do that because they are conditioned and developed, not unlike a muscle in our physical body, to perform that function. Essentially, if we live in fight or flight we focus poorly, we behave aggressively, we react – if we don’t, we don’t.

So how do we accomplish this?

Well there are any number of studies discussing the developmental changes that happen with the regular practice of meditation, and other internal arts such as yoga, tai chi, qigong and others. If you are not interested in the science, you can probably stop reading here and just start a basic meditation program or start taking tai chi, and over just a few months you will experience these positive changes.

For those who would like to better understand some of what is happening on a scientific level to better facilitate their mood and behavior researchers from the Massachusetts General Hospital and Harvard Medical School as well those from the Fujian University of Traditional Chinese Medicine among other institutions, recently conducted a brain imaging study to explore more deeply.

Researchers led participants through a 12 week program of tai chi and ba duan jin qigong exercise. Ba Duan Jin, also known as the “eight brocades” is a very common form of qi gong practice that has a few variations. We practice it regularly as part of our tai chi classes in my clinic in Chattanooga – there is a video of our version of it midway through a recorded live broadcast of our free weekly meditation, qi gong and tong ren class.

The participants were older adults and while the researchers were looking at all aspects of the brain scans, they were primarily interested in reducing memory deficiencies. They used various brain scans at the beginning and the end of the 12 week study and found that both Tai Chi and Qi Gong significantly increased grey matter volume (i.e. made them more active) in the following areas:

  • Insula – involved with perception, self-awareness, interpersonal communication, and cognitive/sensoral processcing.
  • Medial Temporal Lobe – important area for declarative memory (facts and events).
  • Putamen – involved in all aspects of physical movement.

There were no significant differences between a group that practiced only qi gong and a tai chi only group. Essentially the participants in such a short time experienced “improved mental control, recognition, touch and comprehension memory scores” – the researcher concluded that the results demonstrate the potential of tai chi and qi gong practice for preventing memory deficiencies in older adults.

While researchers here were looking at older adults and memory any exploration of those brain areas make it fairly clear that these benefits would be applicable to improvements in focus, impulse control, emotional control, and other related aspects in all ages. While your “fight or flight” system is telling you to just maintain the status quo and keep on doing what you are doing, now would be the time to start making changes – avoiding problems rather than managing them after the fact, that is “wu wei“.

Awakening a Child From a Vegetative State with Xing Nao Kai Qiao Acupuncture

Persistent vegetative states (or “unresponsive wakefulness syndrome”) arise following brain damage leaving the patients in a state of partial arousal. While potential outcomes will vary depending on the causal factors, after 3-6 months chances for a complete recovery are considered low and generally get lower as time progresses ( 1 ). For children under western medical care, one study, described potential outcomes as follows: “The long-term outcome for children discharged from the hospital in a persistent vegetative state was poor. Forty percent of the patients died and, at best, children showed only minimal awareness after an average of 4.5 yrs. Care costs were > $90,000/yr per patient.” ( 2 ).

Stroke recovery and the treatment of related neurological conditions are often treated by Chinese Medicine. A few years ago I wrote a brief review of a documentary entitled 9000 Needles. This documentary follows a Kentucky man’s struggle towards recovery following a brain stem stroke. After exhausting all western options and much of their insurance coverage and finances he heads to a famous Traditional Chinese Medicine hospital in China, the “First Teaching Hospital of Tianjin University“. Within their stroke center which utilizes the work of Dr. Shi Xuemin and his Xing Nao Kai Qiao (“activating the brain and opening the orifices”) treatment methods he exits a few months later walking nearly unaided and able to communicate fairly clearly.

Publishing in the frontiers in medicine journal a team using Dr. Shi’s system recently submitted a case report of the return of a 5 year old, 3 months into a persistent vegetative state, to a nearly completely recovered state after 50 days of treatment. The treatment was offered within the Xi’an Encephalopathy Hospital of Traditional Chinese Medicine in Xi’an, China.

The treatment offered was a combination therapy including Dr. Shi’s “Xing Nao Kai Qiao” acupuncture method, oral “An Gong Niu Huang Wan” Chinese herbal formula, and “Xing Nao Jing” herbal formula via IV drip. After the 50 day treatment the team reported that the child had “his health significantly improved and is nearly similar to that of a healthy child“. In this article, I’m going to explore the basics of their treatment – note, however, that I am only marginally familiar with the approaches of Dr. Shi and do not have a relationship with these particular researchers.

Dr. Shi’s “Xing Nao Kai Qiao”, “activate the brain and open the orifices”, method is drawn from his many years of clinical experience, particularly with stroke and other neurological conditions. The general points used are as follows. The primary points are always used and then some additional points would be used for each individual case.

  • Main Points:
  • PC 6 “inner pass” – influences the median nerve, used in TCM for a range of psychological issues, nausea, and opening and relaxing the chest.
  • SP 6 “three yin intersection” – influences the tibial nerve, used in TCM to tonify the yin and the blood for a range of psychological and menstrual conditions, clearing what we call “heat” in the blood.
  • GV 26 “water through” – with PC 6 forms a set of “command points” for the chest, heart and epigastrium areas, a very useful point for recovering from shock and/or fainting, as well as other psychological and neurological conditions such as epilepsy.
  • Secondary Points:
  • HT 1 “highest spring” – used for a range of shoulder and arm issues, but also tension in the chest and anxiety issues.
  • LU 5 “cubit marsh” – useful for a range of shoulder/arm/elbow issues, but of more relevance here for removing what we would call phlegm heat in Chinese Medicine.
  • UB 40 “bend middle” – another “command” point, this one for the lumbar region, but of more relevance here, used for clearing heat in cases of heatstroke and related issues.
  • Dysphasia Points:
  • GB 20 “wind pool” – an important point for dispelling “wind” in Chinese Medicine terms, symptoms such as vertigo, dizziness, numbness, etc., a “cva” in Chinese Medicine terms may be called a “wind stroke” alluding to the damage a strong “wind” can do.
  • GB 12 “completion bone” – another point for dispelling “wind” in the head,
    tinnitus, tremors, also some cases of insomnia and/or anxiety.
  • SI 17 “celestial countenance” – a “window of the sky” point, used to open the throat but also has a role in improving circulation to the brain.
  • Asphasia Points:
  • CV 23 “ridge spring” – commonly used in stroke patients to aid speech and swallowing.
  • Jinjin and Yuye “golden fluid and jade fluid” – a pair of “extra points” used for post stroke asphasia, but also other issues with the tongue and/or speech, or swelling of the tongue that restricts breathing.
  • Hand and Finger Paralysis:
  • LI 4 “union valley” – a commonly used point to release wind-heat or wind-cold in Chinese Medicine terms, strengthens immunity, used for many facial issues involving pain or mobility.
  • Bafeng and Sifeng “eight winds and four cracks” – “extra points” between the toes (bafeng) and the finger joints (sifeng) clinically noted for issues such as malaria and deep digestive issues, but used as strong local stimulators for stroke and other conditions.

Treatment is, if possible, offered twice daily for 10 days per course. Often 3-5 courses of treatment are required. The case report here, as an example, was 50 days of consecutive treatment.

Further exploration of Dr. Shi’s work can be started by reading “Shi Xuemin’s Comprehensive Textbook Of Acupuncture And Moxibustion, Volumes 1& 2“. Which is not a text exclusively related to stroke, but it provides a good framework and case studies from which a practitioner can begin to understand some of Dr. Shi’s methodology.

Now onto the Chinese herbal formula “An Gong Niu Huang” or “Calm the Palace Pill with Cattle Gallstone”. This formula is a strong herbal formula primarily used in patients who are unconscious and/or have had a stroke. The herbal ingredients are generally as follows:
Cattle Gallstone (Niu Huang), Rhinoceros Horn (Xi Jiao) * substituted with Water Buffalo Horn (Shui Niu Jiao), Navel Gland Secretions of Musk Deer (She Xiang), Coptis Rhizome (Huang Lian), Baical Skullcap Root, Scutellaria (Huang Qin), Cape Jasmine Fruit, Gardenia (Zhi Zi), Realgar (Xiong Huang), Borneol (Bing Pian), Tumeric Tuber (Yu Jin), Cinnabar (Zhu Sha), Pearl (Zhen Zhu).

This particular formula has been used for hundreds of years for a range of central nervous system issues and for resuscitation. A fairly lengthy clinical exploration of this formula, case studies and clinical applications may be read here.

The other formula that was given via IV, Xing Nao Jing, is used for stroke and other neurological conditions. A study exploring how it helps may be read here.

Exploring this case study is a useful enterprise for practitioners of Chinese Medicine as well as neurologists and other specialists from the western medical side. In many of these types of cases a combination approach of western and eastern medicine would in most cases be best. It is nice to see that type of integration happening in Chinese hospitals and perhaps with more studies of this nature that interest in integration will continue in western countries as well.