The most obvious, and persistent, tradition of acupuncture is the idea of ‘correct’ acupuncture points for a particular condition. In a nicely performed RCT, Kim and colleagues used a consensus of ‘correct’ points for treating hot flushes and compared them with what they assumed were ‘incorrect’ points. In line with much of the evidence from other trials, they found no difference: hot flushes declined in both groups. Acupuncture's effect in this condition is a general effect on central nervous system mechanisms – by some (still unknown) combination of sensory nerve...]]>
In a recent prospective single blind controlled study on the effects of minimal acupuncture in infantile colic it was found that light needling (minimal acupuncture) at LI4 significantly reduced the rated crying intensity as compared with the control group. Pain-related behaviour, such as facial expression, was also significantly less pronounced in the light needling group as...]]>
Similarly, Traditional Chinese Medicine (TCM) diagnosis has proved less than perfect in the past. One fairly typical study found 47–80% reliability in a clinical trial.
To determine the effect of acupuncture in treating hot flushes in perimenopausal or postmenopausal women.
The study was a randomised single-blind sham-controlled clinical trial. Perimenopausal or postmenopausal women with moderate or severe hot flushes were randomised to receive real or sham acupuncture. Both groups underwent a 4-week run-in period before the treatment. The real acupuncture group received 11 acupuncture treatments for 7 weeks, and the control group underwent sham acupuncture on non-acupuncture points during the same period. Both groups were followed for 8 weeks after the end of treatment period. Changes from baseline in the hot flush scores at week 7, measured by multiplying the hot flush frequency and severity, were the primary outcome. Hot flush frequency, severity and menopause-related symptoms measured with the Menopause Rating Scale Questionnaire were regarded as secondary outcomes.
54 participants were randomised into the real acupuncture group (n=27) and the sham acupuncture group (n=27). The mean change in hot flush scores was –6.4±5.2 in the real acupuncture group and –5.6±9.2 in the sham group at week 7 from values at the start of the acupuncture treatment (10.0±8.1 vs 11.7±12.6), respectively (p=0.0810). No serious adverse events were observed during the whole study period.
Compared to sham acupuncture, acupuncture failed to show significantly different effects on the hot flush scores but showed partial benefits on the hot flush severity. Further consideration is needed to develop appropriate strategies for distinguishing non-specific effects from observed overall effectiveness of acupuncture for hot flushes. Whether acupuncture has point-specific effects for hot flushes should be also considered in designing future researches.
Although acupuncture sensation (also known as de qi) is a cornerstone of traditional acupuncture therapy, most research has accepted the traditional method of defining acupuncture sensation only through subjective patient reports rather than on any quantifiable physiological basis.
To preliminarily investigate the frequency of key sensations experienced while needling to specific, quantifiable tissue levels (TLs) guided by ultrasound (US) imaging.
Five participants received needling at two acupuncture points and two control points at four TLs. US scans were used to determine when each TL was reached. Each volunteer completed 32 sets of modified Southampton Needle Sensation Questionnaires. Part one of the study tested sensations experienced at each TL and part two compared the effect of oscillation alone versus oscillation + rotation.
In all volunteers, the frequency of pricking, sharp sensations was significantly greater in shallower TLs than deeper (p=0.007); the frequency of sensations described as deep, dull and heavy, as spreading, and as electric shocks was significantly greater in deeper TLs than shallower (p=0.002). Sensations experienced did not significantly differ between real and control points within each of three TLs (p>0.05) except TL 4 (p=0.006). The introduction of needle rotation significantly increased deep, dull, heavy sensations, but not pricking and sharp sensations; within each level, the spectrum of sensation experienced during both oscillation + rotation and oscillation alone did not significantly differ between acupuncture and control points.
The preliminary study indicates a strong connection between acupuncture sensation and both tissue depth and needle rotation. Furthermore, the new methodology has been proven feasible. A further study with an objective measurement is warranted.
Traditional Chinese medicine (TCM) offers various treatment modalities guided by TCM diagnoses. In the United States, acupuncture is a commonly employed TCM method for treating a variety of chronic illnesses. Three systematic reviews have been reported recently, reaching differing conclusions about the efficacy of acupuncture for the treatment of fibromyalgia (FM). Among the FM acupuncture studies considered in these reviews, none used TCM diagnosis as an inclusion/exclusion criterion or adjusted treatment based on TCM diagnosis. Overlooking TCM diagnosis may be a reason for such disparate results.
To obtain TCM diagnoses in a sample of women meeting 1990 American College of Rheumatology criteria for FM who were recruited for a yoga study and to investigate whether there is significant variability.
Two TCM practitioners conducted baseline TCM diagnostic examinations on 56 women with FM. A consensus diagnosis was reached based on standardised history, palpation and examination. Canonical discriminate analysis identified two baseline items which predicted TCM diagnosis.
School of Nursing, Oregon Health & Science University.
Women, ages 23–75, with FM recruited to a yoga intervention study
Three primary TCM diagnoses were found in the population: Qi and Blood Deficiency (46.4%, CI 33.0% to 60.36%), Qi and Blood Stagnation (26.8%, CI 15.8% to 40.3%), and Liver Qi Stagnation (19.6%, CI 10.2% to 32.4%).
It is likely that previous studies of FM were treating a heterogeneous study population where variable results might be expected. Future acupuncture studies should either control for TCM diagnosis or consider its usefulness as an inclusion/exclusion criterion.
To provide an in-depth analysis of seven well-reported studies that examined electrodermal activity (EDA) at acupuncture points with regard to three commonly held tenets of acupuncture: (1) EDA at pathology-related acupuncture points is distinguishable from non-pathology-related acupuncture points; (2) EDA at acupuncture points can assist in diagnosing and monitoring therapeutic progress; and (3) EDA at acupuncture points is able to identify substances that are either therapeutically beneficial or toxic to an individual.
Seven of 29 studies that scored >50% on their quality of reporting 54 essential technical and clinical details of EDA testing in human patients were identified from a previous literature review. Fourteen categories of data were extracted from these seven studies for further discussion.
Two studies compared EDA at pathology-related auricular acupuncture points to non-pathology-related sites. Two studies correlated EDA measurements at sites other than auricular acupuncture points with the presence of specific medical conditions. The final three studies assessed changes in EDA at acupuncture points on the fingers and toes when different substances were placed in the electrical circuit with the patient.
This review highlights the heterogeneity of approaches to EDA assessments and the discrepancies between common clinical practice and the scientific evidence to support that practice. It also provides pilot data that suggest EDA testing at auricular acupuncture points may distinguish pathology-related acupuncture points from non-pathology-related points; decreased skin conductance correlates with tiredness or low energy; and EDA testing at the Jing-Well acupuncture points, on the tips of the fingers and toes, may assist in monitoring effectiveness of acupuncture treatment. The evidence does not support the use of VEGA testing for allergic status.
Insulin resistance is frequently present in obesity and during the development of type 2 diabetes mellitus.
The purpose of the present study was to investigate the effect of electroacupuncture (EA) on high-fructose diet (HFD)-induced insulin resistance.
Male Wistar rats were fed HFD for 4 weeks and developed insulin resistance. Insulin sensitivity was assessed by clamp. The number of animals was seven, eight and seven in the control, HFD and HFD+EA groups, respectively. AMP-activated protein kinase (AMPK) and glucose transporter 4 (GLUT4) in skeletal muscle were measured by Western blotting analysis (n=7 in each group). EA stimulation was carried out 12 times over 4 weeks at an intensity of 1–3 mA and a frequency of 2/15 Hz in a conscious state without restraint.
There was no significant difference in mean body weight and fasting blood glucose concentration between groups at the end of the experiment. The mean glucose infusion rate during the clamp was significantly lower in the HFD group than in controls (p<0.05). There was no significant difference in expression of GLUT4 in skeletal muscle in the control and each group. Phosphorylated AMPKα (Thr172) in skeletal muscle showed a significant increase immediately after the final EA stimulation when compared with the control group (p<0.05).
Repeated application of EA is capable of improving diet-induced insulin resistance, probably through activation of AMPK signalling pathways in skeletal muscle. These results suggest that repeated application of EA may have beneficial effects on diet-induced insulin resistance.
Intravenous injection of lipopolysaccharide (LPS) stimulates macrophages to release proinflammatory cytokines and nitric oxide (NO). This results in hypotension, vascular hyporeactivity and multiple organ failure (eg, liver injury) in rats. In rats with endotoxin shock, electro-acupuncture (EA) of ‘Neiguan’ (PC6) retrieved blood pressure and reduced plasma concentrations of NO. The authors evaluated whether EA at PC6 could alleviate the development of liver injury and dysfunction in endotoxic rats.
A total of 28 male adult Wistar rats were included in this study. Rats received intravenous LPS (10 mg/kg for 4 h) or saline for 4 h followed by EA at PC6 acupuncture point.
Elevated biochemical parameters of liver injury and marked infiltration of neutrophils into liver tissues caused by LPS were significantly attenuated by EA. However, hypotension, tachycardia and raised production of plasma NO were not suppressed by EA at PC6 .
These results indicate that EA at PC6 should be further investigated as a possible adjuvant therapy for endotoxin-induced liver dysfunction. Its mechanism of action needs further investigation.
It is with very great sadness that the Society learnt of David Bowsher's death on 17 June 2011 at the age of 86. David, an honorary member of the Society (he was also a member of both the research committee and the international editorial board), made many important contributions to the British Medical Acupuncture Society (BMAS) by way of presenting talks, publishing papers and chapters on acupuncture, as well as on forms of stimulation-induced analgesia. He willingly and generously gave valuable advice, help, guidance, encouragement and inspiration to members and others. Those who were fortunate enough to hear him present a lecture or to have a discussion with him, quickly realised that he was someone with a multitude of exceptional gifts. He was a consultant neurologist, neuroanatomist and medical scientist who possessed that rare combination of a most erudite mind with an...]]>
Multicenter, randomised control trial (n=140) comparing traditional acupuncture with medication.
Adult patients diagnosed with migraine without aura who had previously not had prophylactic treatment were recruited from five hospital outpatient departments. They were randomised to two groups in equal numbers: (1) the treatment group had verum acupuncture plus placebo medication and (2) the control group had sham acupuncture plus flunarizine, a drug recommended as a first-line preventive treatment of migraine. The study period of 20 weeks included a baseline observation period of 4 weeks, a treatment period of 4 weeks, and follow-up period of 12 weeks.
Both verum and sham acupuncture groups had three treatment sessions lasting 30 min each week for 4 weeks which were conducted...]]>
Recent guidelines from NICE are encouraging the incorporation of acupuncture into pain management strategies within the NHS.
Ethical review by academic staff generated the opinions that the study raised no major ethical issues and that formal ethical approval was not needed. Ethical approval was, however, gained from the chairman of the Kensington and Chelsea Primary Care Trustand the doctors at the practice. I distributed the questionnaires to all patients attending the practice over five consecutive days. I expressed confidentiality verbally to...]]>
Herein we present additional clinical data supporting the idea that the effect of acupuncture is dependent on the...]]>
This was a pilot study...]]>
"Somewhere, something incredible is waiting to be known." Dr Carl Sagan, American astronomer, writer and scientist. 1934–1996
Planning and managing a research project can seem like a daunting undertaking, especially as we have little exposure to the techniques required for success during our professional training. It would be tempting to leave the research to those who find their career paths progressing into the world of laboratories and clinical trials. This seems a shame as there may be many of us who could provide interesting and important contributions, if we had a little help to start us off! With rising use of complementary and alternative treatments by the public, and little in the way of good clinical evidence to support, or indeed, fund it, it seems like a good time to encourage more professionals and practitioners to discover their ‘inner scientist’, and...]]>
The popular 1-day course with comprehensive presentations and demonstrations and a half-day practical session.
AS Super 4 Digital (illustrated) included with course fee
These courses follow a rolling programme of four days, focusing on practical needling of particular regions of the body. A selection of the four days will be covered over one year. The four days cover the core skills training for the Diploma of Medical Acupuncture (DipMedAc). Other self-directed study is...]]>
FOUNDATION COURSES last 4 days, spread either over two weekends or over a working week. While the historical aspects and traditional philosophy of acupuncture are discussed, the Foundation Course concentrates on a neurophysiological and evidence-based approach to the use of acupuncture as a technique following orthodox clinical diagnosis. Safe and effective needling are key features of this practical course, and the healthcare professionals attending should leave with the skills required to apply simple acupuncture techniques within their practice.
York: York District General Hospital.
Two weekends: 11–12 February and 10–11 March 2012.
Bristol: Southmead Hospital.
Two weekends: 18–19 February and 17–18 March 2012.
London WC1: 33 Queen Square.
Four weekdays: 2–5 April 2012.
Manchester: Wythenshawe Hospital.
Two weekends: 12–13 May and 16–17 June 2012.
Newcastle upon tyne: Freeman Hospital.
Two...]]>