Prior to Conception: The Role of an Acupuncture Protocol in Improving Women's Reproductive Functioning Assessed by a Pilot Pragmatic Randomised Controlled Trial.Cochrane S1, Smith CA2, Possamai-Inesedy A3, Bensoussan A2.
The global average of couples with fertility problems is 9%. Assisted reproductive technologies are often inaccessible. Evidence points to acupuncture offering an opportunity to promote natural fertility. This study asked whether providing a multiphasic fertility acupuncture protocol to women with sub/infertility would increase their awareness of fertility and achieve normalisation of their menstrual cycle compared with a lifestyle control. In a pragmatic randomised controlled trial sub/infertile women were offered an intervention of acupuncture and lifestyle modification or lifestyle modification only. There was a statistically significant increase in fertility awareness in the acupuncture group (86.4%, 19) compared to 40% (n = 8) of the lifestyle only participants (Relative Risk (RR) 2.38, 95% confidence interval (CI) of 1.25, 4.50), with an adjusted p value of 0.011. Changes in menstrual regularity were not statistically significant. There was no statistical difference in the pregnancy rate with seven women (adjusted p = 0.992) achieving pregnancy during the course of the study intervention. Those receiving the acupuncture conceived within an average of 5.5 weeks compared to 10.67 weeks for the lifestyle only group (p = 0.422). The acupuncture protocol tested influenced women who received it compared to women who used lifestyle modification alone: their fertility awareness and wellbeing increased, and those who conceived did so in half the time.
In an Italian trial reported in the Journal of Clinical Oncology, Lesi et al found that the addition of acupuncture to enhanced self-care improved hot flashes, climacteric symptoms, and quality-of-life measures in women with breast cancer.
In the trial, 190 women were randomized to receive enhanced self-care with (n = 85) or without (n = 105) acupuncture. Both groups received a booklet with information about climacteric syndrome and its management to be followed for at least 12 weeks. The acupuncture group also received 10 traditional acupuncture treatment sessions involving predefined acupoints.
The primary outcome was hot flash score at the end of treatment at week 12; the score was calculated by multiplying the mean number of daily hot flashes during the week before assessment by mean daily severity (1 = mild, 2 = moderate, 3 = severe). Climacteric symptoms and quality of life were assessed by the Greene Climacteric and Menopause Quality of Life scales.
The acupuncture group had a significantly lower mean hot flash score at the end of treatment (11.3 vs 22.7,P < .001) and at 3-month (14.0 vs 21.9, P = .0028) and 6-month (12.6 vs 17.3, P = .001) post-treatment visits. Acupuncture was associated with fewer climacteric symptoms at 12 weeks (P < .001), 3 months (P = .0063), and 6 months (P < .001) and better quality-of-life outcomes at all time points in vasomotor, physical, and psychosocial domains (all P < .05). No differences were observed in the sexual domain.
The investigators concluded: “Acupuncture in association with enhanced self-care is an effective integrative intervention for managing hot flashes and improving quality of life in women with breast cancer.”
The study was supported by Osservatorio Medicine Non Convenzionali Regione Emilia Romagna.
Giorgia Razzini, PhD, of Civil Hospital, Carpi, is the corresponding author of the Journal of Clinical Oncologyarticle.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
The prevalence and appropriateness of acupuncture for addictions is well established. The US federal government’s Center for Substance Abuse Treatment (2007), the United Nations (2006), the State of New Mexico (Bigelow, 2008), as well as the US Department of Defense/Veteran’s Af- fairs (2010) have each published best practice guidelines that address the value of acupuncture for chemical dependency. Federal statistics (SAMHSA, 2000) show that over 500 addictions programs in the US use some form of acupuncture. A more recent estimate by Reuben et al. (2005) determined that at least 1500 addictions programs worldwide use some form of acupuncture for addictions. In Denmark, the NADA protocol is one of the most prevalent forms of Complementary and Alternative Medicine modalities used within rehabilitation programs (Skovgaard, la Cour, & Kristensen 2012). The evidence base for the adjunctive use of the NADA protocol for addictions continues to grow. Studies published in peer-reviewed journals support the adjunctive use of the NADA protocol for heroin, alcohol and cocaine addictions treatment (Bergdahl et al., 2012 Santasiero & Neussle, 2007, Russell, Sharp and Gilbertson 2000, Avants, Margolin, Holford, & Kosten, 2000, Shwartz, Saitz, Mulvey & Brannigan, 1999, Washburn, et al., 1993, Bullock, Culliton, Olander, 1989, Bullock, Ulmen, Culliton, & Olander, 1987,) as well as nicotine addictions (White, Rampes, Liu, Stead, & Campbell, 2011, Bier, Wilson, Studt, Shakleton, 2002, Stuyt & Meeker, 2006, He, Medbe, & Hostmark, 2001, He, Berg, & Hostmark, 1997). Recent studies by Chang, Sommers, & Hertz (2010), and Carter, Olshan-Perlmutter, Norton, & Smith (2011) demonstrate that the NADA protocol in addition to standard care is significantly better than standard addictions care alone. One observational study (Janssen, Demores & Whynot 2005) demonstrated the value of the NADA protocol for people with addictions problems within a harm reduction settings.
The use of ear acupuncture within behavioral health/psychiatric care has expanded in recent years, particularly within US and Indian military units (Niemtzow, 2011, Smith, 2012), European and US prisons and psychiatric hospitals (Smith, Carter, Landgren, & Stuyt, 2011). A national survey in Sweden found that the NADA protocol is widely used in public psychiatric programs (Lindell & Ek, 2010). An estimated 130 prisons in Europe offer the NADA protocol for inmates, with treatments provided by over 500 NADA-trained correctional staff (Smith et al., 2011). Acupuncture continues to be accepted within mainstream psychiatric treatment in the US. Yale Medical School has established a NADA training program for psychiatric residents (Bruce, 2011). The Department of Veteran’s Affairs (VA) and the Department of Defense Evidence Based Practice Guidelines (2010) assigns a “good quality” of evidence to support the use of acupuncture to treat post traumatic stress disorder (PTSD), including symptoms of pain, insomnia, depression and addictions issues. Standardized ear protocols are applied for trauma and pain by mainstream military medics in the US (Niemtzow, Litscher, Burns, & Helms, 2009, Niemtzow et al., 2008, Niemtzow, 2011, Belard & Pock, 2011, Helms et al., 2011). A number of studies support the adjunctive use of the NADA protocol for non-addictions programs within psychiatric hospital, mental health, and prison settings (Lemaire & Gonzalez, 2011, Payer, Ots, Marktl, Pfeifer, & Lehofer, 2007, Berman, Lundberg, Krook, & Gyllenhammar, 2004, Nixon, Cheng, & Cloutier, 2003, Berman & Lundberg 2002). Carter et al. (2011), though conducted within an addictions recovery setting, demonstrated how the NADA protocol alleviates a number of different common health symptoms. Additionally, several published qualitative reports (Cole & Yarberry, 2011, Yarberry, 2010), program evaluations (DARE 2011), acupuncture field reports (Dolan & Menolascino, 2010, Sommers & Porter, 2011) and news stories (Kocherga 2012, Scudder, 2012) demonstrate the value of the NADA protocol as a disaster relief/humanitarian aid intervention for first responders as well as populations affected by violence and trauma. Preliminary reports on the Military Stress Recovery Project’s numerous clinics around the US demonstrate that the NADA protocol can assist veterans with a variety of psychiatric symptoms (Duda Harris, 2012).
The NADA protocol has been used as an adjunctive care and self-help support modality for people with immune and blood disorders, including sickle cell disease, AIDS/HIV, and cancer. Programs using the NADA protocol have been established in the Sickle Cell Support Group of Atlanta, Quest Center for Integrative Health’s breast cancer and HIV programs in Portland, and the University of South Carolina Medical School. Two recent studies have demonstrated preliminary evidence for the use of the NADA protocol as part of cancer therapy (Valois, Young, Robinson, McCourt, & Maher, 2012, Harding, Harris, & Chadwich, 2008).
Ever since acupuncture’s introduction into the scientific community, there has been huge speculation about how the stimulation of acupuncture points affects the body. There is still no comprehensive theory to explain this phenomenon, but a study by Dr. Langevin and Mr. Yandow from the University of Vermont College of Medicine reveals that “the network of acupuncture points and meridians can be viewed as a representation of the network formed by interstitial connective tissue.”
I’ve highlighted the main points from their study entitled “Relationship of Acupuncture Points and Meridians to Connective Tissue Planes.”
Needle grasp is stronger on acupuncture points versus non-acupuncture points. If you have ever had an acupuncture needle inserted into your body, then you have felt the aching, tight pressure that acupuncturists call de qi, or “obtaining qi.” Simultaneously, the acupuncturist feels a tug of the needle, which is described in classical texts as “a fish biting on a fishing line.” The biomedical term for this is “needle grasp.”
So, what is the significance of the needle grasp? The Huang Di Nei Jing (HDNJ) (the fundamental doctrinal source of Chinese medicine) states, “acupuncture therapy does not take effect until the arrival of energy.” This means that acupuncture provides its affects when the patient and/or the acupuncturist feel the needle grasp, indicating that qi is being moved along the meridians in the body.
Therefore, if needle grasp is stronger on acupuncture points than on non-acupuncture points, there is a greater therapeutic effect (according to HDNJ). Dr. Langevin quantified the strength of needle grasp by measuring the force needed to pull a needle out of the skin. She took 60 healthy human subjects and needled 8 acupuncture points on one side of their bodies, and 8 control points (2 cm away from the real acupuncture points) on the other side. On average, pullout force was 18% stronger on acupuncture points than on control points!
This concludes that needle grasp is not limited to acupuncture points, but are definitely enhanced.
Acupuncture creates a mechanical stimulus that may cause long-term changes in the extracellular matrix surrounding the needle, which in turn causes change to cells that share the connective tissue matrix.Both in vivo and in vitro experiments show when a needle is inserted into connective tissue and slightly rotated, the connective tissue adheres and whorls around it. This allows manipulation of the needle to further pull and deform the connective tissue. This mechanical stimulation is called “needle-coupling,” and affects the connective tissue in 3 ways:
1. Mechanical signals are involved in cellular communication
2. Mechanical signals can be transduced into bioelectrical and/or biochemical signals.
3. Mechanical signals can cause changes in gene expression, protein synthesis, and extracellular matrix modification.
Thus, the mechanical stimulation that causes change in extracellular matrix may influence cell communication within the tissue, affecting immune, vascular, fibroblasts, and sensory afferent cells.
Most acupuncture points are located on intermuscular or intramuscular connective tissue, a network that is connected to organs, nerves, blood vessels, and lymphatics.Connective tissue envelopes and connects your entire body; from your arms and legs, to your torso, head and neck. It connects the muscles, bones and tendons, and even extends to more specialized tissue such as the periosteum, peritoneum, pleura and meninges. The fact that more than 80% of acupuncture points and 50% of meridian intersections of the arms are located on intermuscular or intramuscular connective tissue planes, shows that acupuncture points stimulation may permeate to organs, nerves, blood vessels and lymphatics. This explains why an acupuncture point on one part of the body can treat another part of the body.
Dr. Langevin summarizes her study with this simple chart explaining each TCM concept with its corresponding anatomical and/or physiological equivalent.
This article is part of a LEAPS project to promote research and educate health professionals in Traditional Chinese Medicine (TCM).
Reference Langevin, H. M. and Yandow, J. A. (2002), Relationship of acupuncture points and meridians to connective tissue planes. Anat. Rec., 269: 257–265. doi: 10.1002/ar.10185
Reposted from: https://medium.com/@saiju/how-acupuncture-points-correspond-to-sites-of-convergence-in-connective-tissue-1d99e01be22c#.enjnjyvsg
PC-6 (Pericardium-6) is an acupuncture point empirically known to treat nausea and vomiting, especially as a side-effect of pregnancy, chemotherapy and radiotherapy.
The Pericardium is connected to the chest, diaphragm and upper abdomen. This explains PC-6’s function for relieving nausea and vomiting, at least through TCM theory.
So how can PC-6 be explained physiologically outside of TCM theory?
Dr. Lijun Bai published a study in 2010 entitled “Neural Specificity of Acupuncture Stimulation at Pericardium 6: Evidence from an FMRI Study.” His team performed functional magnetic resonance imaging (fMRI) on the brain of 36 healthy subjects at three acupuncture points: PC-6, PC-7 (same channel and median innervation), and GB-37 (different channel, anti-emetic).
The results drew the following conclusions:
PC-6 stimulates areas of the brain involved in vestibular function, visceral sensation of the gastrointestinal tract, and the “fight-or-flight” response. This may explain its function on relieving nausea and vomiting.
GB-37 stimulates the visual processing center of the brain. It also produces opposite responses from PC-6 and PC-7, possibly corresponding to the yin / yang relationship between the Liver and Gallbladder.
This article is part of a LEAPS project to promote research and educate health professionals in Traditional Chinese Medicine (TCM).
Reference Bai, L., Yan, H., Li, L., Qin, W., Chen, P., Liu, P., . . . Tian, J. (2009). Neural specificity of acupuncture stimulation at pericardium 6: Evidence from an FMRI study. J. Magn. Reson. Imaging Journal of Magnetic Resonance Imaging, 71–77.
Reposted from: https://medium.com/@saiju