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Fertil Steril. 2012 Mar;97(3):599-611. Epub 2012 Jan 11.

Effects of acupuncture on pregnancy rates in women undergoing in vitro fertilization: a systematic review and meta-analysis.

Source

Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China.

Abstract

OBJECTIVE:

To evaluate the effect of acupuncture on in vitro fertilization (IVF) outcomes.

DESIGN:

Systematic review and meta-analysis.

PATIENT(S):

Women undergoing IVF in randomized controlled trials (RCTs) who were evaluated for the effects ofacupuncture on IVF outcomes.

SETTING:

Not applicable.

INTERVENTION(S):

The intervention groups used manual, electrical, and laser acupuncture techniques. The control groups consisted of no, sham, and placebo acupuncture.

MAIN OUTCOME MEASURE(S):

The major outcomes were clinical pregnancy rate (CPR) and live birth rate (LBR). Heterogeneity of the therapeutic effect was evaluated with a forest plot analysis. Publication bias was assessed by a funnel plot analysis.

RESULT(S):

Twenty-four trials (a total of 5,807 participants) were included in this review. There were no significant publication biases for most of the comparisons among these studies. The pooled CPR (23 studies) from all of the acupuncture groups was significantly greater than that from all of the control groups, whereas the LBR (6 studies) was not significantly different between the two groups. The results were different when the type of control was examined in a sensitivity analysis. The CPR and LBR differences between the acupuncture and control groups were more obvious when the studies using the Streitberger control were ignored. Similarly, if the underlying effects of the Streitberger control were excluded, the LBR results tended to be significant when the acupuncture was performed around the time of oocyte aspiration or controlled ovarian hyperstimulation.

CONCLUSION(S):

Acupuncture improves CPR and LBR among women undergoing IVF based on the results of studies that do not include the Streitberger control. The Streitberger control may not be an inactive control. More positive effects from using acupuncture in IVF can be expected if an appropriate control and more reasonable acupuncture programs are used.

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Acupuncture Today, April, 2012, Vol. 13, Issue 04      http://www.acupuncturetoday.com/mpacms/at/article.php?id=32551

Real Acupuncture or Real World Acupuncture? Deciphering Acupuncture Studies in the News .  By Matthew Bauer, LAc

Recent studies have concluded that acupuncture is no more effective than various forms of sham or placebo acupuncture, and these conclusions have been reported in the media and used by skeptics to discredit acupuncture.

The Oriental medical (OM) community’s response to these reports has been ineffective, perhaps counterproductive. These studies, and the resulting media coverage, can serve was a wake-up call to the OM community, alerting us that we need to be more proactive in our public education efforts and rethink some long-held beliefs regarding the efficacy of traditional theories.

In the News 

In the last few years, several studies sought to measure the effectiveness of acupuncture in treating common conditions.1,2,3 The findings of these studies were widely reported within the media.4,5,6 The good news for the Oriental medicine (OM) profession is that these studies found that acupuncture was not only effective, but often more effective than conventional therapies. The bad news is that these studies also found that traditional acupuncture techniques – based on the point/channel theories taught inOMschools – were no more effective than what is termed “sham” or “placebo” acupuncture.

The most recent of these studies, published in the May 11, 2009 issue of the Archives of Internal Medicine and sometimes referred to as the “Seattle” study, built on other recent studies and is a good example of current acupuncture research. One of the conclusions this study’s authors reached is particularly striking:

“Collectively, these recent trials provide strong and consistent evidence that real acupuncture needling using the Chinese Meridian system is not more effective for chronic low back pain than various purported forms of sham acupuncture.”

As someone who has treated thousands of people with chronic low back pain using the Chinese meridian system, my first reaction to this statement was to feel the researchers were mistaken. But, I also respect scientific research and feel it would be a great mistake for those of us in the OM profession to criticize these studies just because they tell us something we don’t want to hear, without looking critically at both the studies and our own beliefs.

Real Vs. Real World 

The only evidence these studies actually provide is that so-called “real” acupuncture is not more effective than sham acupuncture in a controlled, clinical trial environment. I believe this detail is of critical importance. But, before I explain why this detail is of such importance, I want to critique the response to these studies from within the OM profession.

Up to this point, the sparse response from theOMfield to these studies has been limited to pointing out that there are many acupuncture points including hundreds of extra points, so “sham” acupuncture is still hitting acupuncture points. Regarding studies that use “placebo” techniques in which acupuncture is simulated with the skin unbroken, some acupuncturists have pointed to tapping techniques, common in Japanese acupuncture, that never pierce the skin. While there is some merit to these arguments, they ignore the greater problem with these studies and make theOMprofession sound to the public like we are grasping at straws and making excuses. If researchers can’t help but hit useful points no matter how hard they try to avoid them, why should anyone bother seeking treatment from people trained in the complex traditional theories that stress diagnosing qi imbalances to identify the best point prescriptions?

The primary problem with these studies is not that researchers inadvertently performed real acupuncture when they attempted to do sham or placebo acupuncture, but that the real acupuncture seriously underperformed. Most of these studies show the real acupuncture groups to be somewhere in the 45-60% effective range. Only 45-60%? If I was only getting 45-60% positive effect for my patients, I would never have been able to build my practice and support my family for the last 23 years. Ask any clinically successful acupuncturist, and they will tell you for common pain problems like low back pain, the average range of effectiveness is somewhere between 75-85%.

Obviously, something about the design of these studies does not capture what happens in the real world when using acupuncture to treat these conditions. Unfortunately, we don’t have enough studies that reflect what happens in the real world because most of the money for research has gone to the “controlled” studies using sham and placebo controls, and the type of patient contact that happens in real world treatment is not allowed. None of these recent studies allowed the acupuncturist who did the needling to consult with the patient and choose points and techniques.

In most of these studies, a set of points were prescribed and used repeatedly regardless of the patient’s progress, or lack thereof. TheSeattlestudy was the only study that attempted to mimic actual practice by having a diagnostic acupuncturist see one group of patients before each treatment. This diagnostician chose the points to be used based on traditional diagnostic rationale, but then these points were passed along to the treating acupuncturist who did the actual needling.

Qi Interaction

Will it affect the outcome if the acupuncturist who inserts the needles is not allowed to interact with the patient and choose what points and techniques to use? It shouldn’t matter, if acupuncture only stimulates specific nerve endings, causing mechanical neuro-chemical responses within the body. But, if acupuncture actually works by manipulating qi, as its founders and supporters have claimed for more than 2,000 years, then there is very good reason to believe that the qi dynamic between the acupuncturist and the patient is an important factor that must be considered.

The first day I interned in the private practice of my school’s clinic director, he asked me to take charge of treating a very difficult case. When I balked and said I thought I was too inexperienced to manage such a difficult case, my teacher told me that my sincere enthusiasm created a positive qi that helped to offset my lack of experience. Over the years, I have come to believe the acupuncturist’s qi can be as important as the points themselves. Points do matter, but the effect these points elicit is influenced by the qi of the one stimulating them. Like yin and yang, there is a combination of both factors at play: different points have different tendencies regarding how they influence a patient’s qi dynamics, but that tendency is influenced by the qi of the person manipulating the points. Because this fact is rarely discussed in acupuncture circles, researchers have not taken this into account in their studies.

Skeptics have long contended that acupuncture only works if the patient believes in it (ignoring the effects of veterinary acupuncture or animal studies), but it may be more important that acupuncturists believe in what they are doing. The best practitioners with the highest success rates put everything they have into every treatment – into every needle or patient contact. We choose points and techniques because we believe they are very best for our patients, and that belief influences the effects of the points. Any acupuncturist who puts needles in a patient not believing it to be the very best they can do is inserting those needles with less than optimal qi.

Unlike administering drugs or performing surgery, which manipulates the body in a more mechanical fashion, influencing qi dynamics is more dependant on subtle factors, including the qi of the one doing the manipulating. This may sound like what skeptics call “woo-woo” – irrational, new age mysticism — but it is a key part of acupuncture’s traditional foundation and deserves consideration. Before jumping to conclusions about traditional concepts, we should encourage studies using acupuncture in a way that reflects what takes place in the real world. Let’s study what happens to patients when treated in actual clinic conditions with no blinding or controls, in which the acupuncturist does whatever their years of training and experience leads them to believe is the best they can do for each patient. Don’t limit them in their techniques and communication with the patient, because such limits are not imposed in real world practice. And don’t refer to acupuncture being done under research constrained controls as “real” acupuncture, because it does not resemble the manner in which acupuncture is done in actual practice.

These studies point to sobering realities theOMprofession needs to face. We cannot ignore the fact that in study after study in which researchers stimulated points in a manner that seemed incompatible with traditional Chinese medicine protocols, a respectable percentage of test subjects experienced significant improvement. So while it may be fact that the best trained and most experienced acupuncturists will obtain 75-85% effectiveness rates for their patients, it may also be a fact that poking some needles virtually anywhere will get 40%-50%, sometimes even 60% effectiveness. (See sidebar.) If that is the case, then the value of comprehensive traditional training and years of experience may be in getting that extra 20-30% of successful outcomes.

I am not surprised that poking needles anywhere can help a decent percentage of pain-related cases because I believe any acupuncture stimulates the body to produce anti-trauma chemistry such as pain modifiers and anti-inflammatory compounds. That is why I was never strongly opposed to other health care professionals being able to legally do some acupuncture. I have long felt that rather than fighting to prevent other health care professionals from having the right to perform acupuncture, theOMprofession should be trying to educate these other professions that the more comprehensive training allows for that additional 20-30% effectiveness. In a spirit of mutual respect, we could encourage other health care professionals to refer their more difficult cases to us. This suggestion may not be welcomed by some, but theOMprofession must be open to evolve with the times.

Regardless of how we approach the issue of other health care professionals using acupuncture in their practices, the recent studies and media reporting of their findings should make one thing very clear: The OM profession needs to be much more proactive both in encouraging research that better reflects real-world acupuncture and in educating the public and media about OM and the OM profession. TheOMprofession has never mounted a comprehensive, multi-year, public education campaign. We have never seen fit to make such a campaign a priority. This must change. We cannot continue to leave the manner in whichOMis perceived by the public and portrayed within the media to outside forces. For too many years, our profession has acted as if all we have to do is raise education standards and do the good work of helping people and the rest would take care of itself. The conclusions of these studies and the media reports that followed should be making it clear that this is not the case.

Conclusion

If it were true that getting successful results does not depend on where one puts the needles, then every first-year acupuncture intern would get the same results as their most experienced teachers, which is not the case. While it seems to be true that having positive qi can make up for lack of experience, almost any acupuncturist will tell you that they get better results with experience. After training and licensure, acupuncturists typically spend the next several years of their careers learning more techniques and theories to add to their arsenal. Why do we do this? Because we learn that sometimes your Plan A or Plan B does not get results, so you better have a Plan C, D, and E as back-up if you want to get the highest degree of success. If it did not matter where you put the needles, no one would bother to keep learning additional techniques and the robust continuing education offerings out there would cease to exist.

We OM professionals, who work our tails off helping our patients, know how valuable our services are and we know that points do matter. We are buoyed by the gratitude of our patients, even as they tell us how they wished they had known aboutOMsooner and wonder why more people don’t take advantage of this safe healing resource. We don’t have to manipulate the facts to educate the public, media, and policymakers about what we have to offer, but we do have to guard against allowing the facts to be manipulated against us. There are acupuncture researchers who have a greater grasp of the subtle dynamics of clinical acupuncture, including the Society for Acupuncture Research, and the OM profession should do more to familiarize ourselves with their work and to encourage that the real-world effects of OM is given its just due.

References

  1. Haake M, Mueller HH, Schade-Brittinger C, et al. German acupuncture trials (GERAC) for chronic low back pain. Arch Intern Med. 2007;167(17):1892-1898.
  2. Cherkin D, Sherman K, Avins A, et al. A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain. Arch Intern Med. 2009;169(9):858-866.
  3. Moffet HH. Sham acupuncture may be as efficacious as true acupuncture: A systematic review of clinical trials. J Altern Complement Med. 2009;15(3):213-6.
  4. Bankhead C. Acupuncture tops conventional therapy for low-back pain. MedPage Today, 2007. www.medpagetoday.com/PrimaryCare/AlternativeMedicine/6770. Accessed October 11, 2009.
  5. Doheny K. Acupuncture may ease chronic back pain. WebMD Health News, 2009.www.webmd.com/back-pain/news/20090511/acupuncture-may-ease-chronic-back-pain. Accessed October 11, 2009.
  6. Park A. Acupuncture for bad backs: Even sham therapy works. Time.Com, 2009.www.time.com/time/health/article/0,8599,1897636,00.html. Accessed October 11, 2009.
  7. Amaro J. Is most of acupuncture research a “sham?” Acupuncture Today. August 2009;10(8).www.acupuncturetoday.com/mpacms/at/article.php?id=32013. Accessed October 11, 2009.

About the Studies 

The two main trials referenced in this article are the German Acupuncture Trails (GERAC) for chronic low back pain and that carried out in both the Center for Health Studies,Seattle,Wash.and the Division of Research, Northern California Kaiser Permanente,Oakland,Calif.that is sometimes called the “Seattle Study.”

In the German trails, 1,162 patients were randomized into groups receiving “real” acupuncture, “sham” acupuncture, or conventional therapy. Participants underwent 10 30-minute sessions usually at 2 treatments a week for 5 weeks. An additional five treatments were offered to those who had partial response to treatment. The “real” acupuncture groups were needled at points traditionally believed to be beneficial for lower back pain while the sham acupuncture involved superficial needling at non-traditional points. At 6 months, positive response rate was 47.6% in the real acupuncture group, 44.2% in the sham acupuncture group, and 27.4% in the conventional therapy group.

In theSeattlestudy, 638 adults with uncomplicated low back pain of 3-12 months duration were randomized into four groups: individualized acupuncture, standardized acupuncture, simulated acupuncture, and conventional care. In the individualized acupuncture groups, a “diagnostic acupuncturist” considered the patient’s progress and prescribed points according to traditional theory. The prescribed points were then needled by the treating acupuncturist. The standardized group employed a set of points traditionally considered helpful in treating low back pain that were used throughout the treatment series. The simulated group had the same points as used in the standardized group but toothpicks were used to simulate the feeling of acupuncture. The treatments were done using back points so subjects could not see the needles. Treatments in the first three groups were done by experienced acupuncturists and consisted of two treatments a week for three weeks then once a week for four weeks.

At eight weeks, mean dysfunction scores for the first three groups were 4.5, 4.5, and 4.4 points compared to 2.1 points for conventional care. Symptoms improved by 1.6 to 1.9 points in the first three groups and 0.7 in the conventional care group.

While I emphasize the need to distinguish what both of these studies refer to as “real” acupuncture from that which is practiced in the real world of clinical acupuncture settings, the Seattle Study did make note that its design had limitations, including restricting treatment to a single component of TCM (needling), pre-specification of the number and duration of treatment, and limited communication between the patient and acupuncturist. While I applaud this study’s authors for mentioning these limitations, the conclusions they reached regarding the “strong and consistent evidence” that real acupuncture is not more effective than sham acupuncture indicate they did not consider these limitations too significant.


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Dear colleagues & Friends,

A Spring seminar will be hold by Virginia Institute of Traditional Chinese Medicine (VITCM) on April 1, 2012, Sunday. Hope everyone will arrange time to attend, and share your knowledge and experience.

Topics: The Western Diagnosis, TCM Treatments and Research Updates of Common Skin Diseases; Yellow Emperor’s Classics of Internal Medicine.

Location:Potomac Community Center, 11315 Falls Road,Potomac, Maryland 20854;Tel: 240-777-6960.

Skin problems, which affect more than 10 million Americans, can be one of the most frustrating and stubborn group of symptoms to successfully treat. Many pharmaceutical solutions offer quick relief but do not provide a lasting solution, and come with risks such as toxic build-up in the body and weakening of other organ systems. Therefore, more and more people are choosing alternative solutions such as Chinese Medicine, which can be safer and which intends to address the root cause of the symptom instead of covering it up each time it appears. In fact, dermatology is a recognized specialty in traditional Chinese Medicine. Treatments for skin disorders have been described as early as 1100-221 BC in China.  Acupuncture and Chinese herbs offer a natural solution to improving skin conditions with its sophisticated system, both external and internal administration. There are hundreds of herbal formulas available for skin disorders such as herpes, eczema, and psoriasis.

Fee: $208. (Mail check before March 15, 2012, discount rate at $188).

Contact Person: Dr. Arthur Fan,Tel:(703)499-4428, e-mail: ChineseMedicineInstitute@gmail.com. Address: VITCM,8214 Old Courthouse Rd,Vienna, VA 22182.

Lecture Details (included in lecture and discussion):

8:00AM-9:30AM: Tai Chi and Medical Applications. By Drs. Eugene Zhang, Arthur Fan (Outside, in Parking lot; if rain or snow, cancel). 

9:30AM-1:30PM: Western Diagnosis & TCM Management for Common Skin Diseases. By Dr. Yongming Li (this special lecture outline is available in the Blog part)

1:30 PM- 3:00PM:  TCM and Skin Disorder: An Update on Clinical Research. By Dr. Lixing Lao.

3:00PM-5:30PM: Yellow Emperor’s Classics of Internal Medicine: Four Seasons, Five Organs, Yin Yang and Related Experiments. By Dr. Quansheng Lu

Instructors

Dr.Lixing Lao,  CMD, PhD, LAc, Professor of Family Medicine, Director of Traditional Chinese Medicine Research, Center for Integrative Medicine,University of Maryland School of Medicine, Baltimore,MD.

Dr. Lao graduated from Shanghai University of TCM (MD in Chinese medicine) and completed his PhD in physiology at the University of Maryland at Baltimore. He has practiced acupuncture and Chinese medicine for more than 20 years, and has been awarded numerous grants from the NIH and the U.S. Department of Defense to conduct research on acupuncture and alternative medicine. He presents frequently at national and international conferences, including the seminal 1997 NIH Consensus Development Conference on Acupuncture and the White House Commission on Complementary and Alternative Medicine Policy. He was board cochair of the Society for Acupuncture Research, chief editor of American Acupuncturist, the official journal of American Association of Acupuncture and Oriental Medicine.

Dr.Lao was one of funders and professor of former Maryland Institute of Traditional Chinese Medicine (MITCM), which was a well-known school in TCM education during 1990s to 2000s. Currently, he is the honor president and main lecturer of VITCM.

Dr. Eugene Zhang, CMD, PhD, LAc. has been practicing acupuncture for over 15 years, and is a graduate of famous oriental medical school in the world: the Beijing University of TCM.

In China, Eugene Zhang was a Medical Doctor (MD in Chinese Medicine); here in  US he is one of the top Licensed Acupuncturists inVirginia,Maryland and Washington DC. area. He was a well-respected professor and Clinical Supervisor for the prestigious Maryland Institute of Traditional Chinese Medicine (MITCM). Because of his years of experience, he serves as a consultant for the council of Colleges of Acupuncture and Oriental Medicine (CCAOM).

Dr. Zhang is also a senior Taiji (Tai Chi) and Qigong Instructor, both in the United Statesand in China. He has written a detailed book, “The Ultimate Exercise for Mind and Body” that explains the benefits of Qigong and shows pictorially the different body postures.

Dr. Yongming Li, MD, PhD, LAc (in New York and New Jersey). Our guest speaker.

Dr.Li is a leading doctor in both Chinese medicine and Western medicine. He graduated from Liao-ning college of TCM in 1983, and got PhD, MD in USA.

He is a well-known doctor in dermatology, doctor and scholar in the field of acupuncture and Oriental medicine with more 20 years’ clinical experience. Currently, he also serves as a NIH grant reviewer. He was the president of American Traditional Chinese Medicine Society, which has more than 700 members in New York area.

He has published many academic papers and books,included in “Acupuncture Journey to America”, a new published book in acupuncture history.

Dr. Quansheng Lu, CMD, PhD, L. Ac. Dr.Lu is a licensed acupuncturist in Maryland. He graduated from Henan University of TCM in China and subsequently worked as a resident and attending physician of TCM at a general hospital in China for 8 years. During this period, thousands of patients recovered under his treatment.  Given his outstanding contribution in TCM, Dr. Lu was awarded the Outstanding Doctor Award from the Local government. Dr. Lu pursued his master degree in TCM at Beijing University of TCM.

He continued to expand his education and later received a  PhD in cardiology in Chinese and western integrated medicine  at the China Academy of Chinese medical science. He focused on exploring hypertension molecular mechanisms and looked for new anti-hypertensive natural herbs. His supervisor is Professor Keji Chen; president of The Chinese Association of Integrated Medicine, and academician of the Chinese Academy of Sciences. Dr. Lu was a postdoctoral fellow at Georgetown University Medical Center and Children’s National Medical Center.

Dr. Arthur Yin Fan (Fan Ying),PhD, CMD, LAc, a leading specialist in Acupuncture and Chinese herbology, has more than two decades of clinical experience in both Traditional Chinese Medicine (TCM) and Western medicine. In China, he was awarded an M.D. degree in TCM and a Ph.D. in Chinese internal medicine from famous Nanjing University of TCM. He completed additional one year’s training in the Western medicine diagnosis and treatment of neurological disorders as well as a six-year medical residency combining TCM and Western internal medicine. He was a medical doctor in both TCM and coventional medicine when he worked in a University hospital in China. He was the funder of  Nanjing Stroke Center which is now a China national key center in Stroke rescuing and rehabilitation.

An evaluator of medical science research grant applications for many countries, Dr. Fan is currently a consultant for the Complementary and Alternative Medicine program at the University of Maryland medical school. He has also conducted CAM research for the Georgetown University medical school’s programs in nutrition and herbology.

Dr. Fan holds the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) certificate in Oriental Medicine, which comprises Acupuncture, Chinese Herbology and Asian Bodywork. Dr.Fan was awarded the third place prize in Taiji-quan (Tai Chi) in China first national health-sport congress (1985,Shenyang,China). Dr.Fan is the funder of VITCM.

Ron Elkayam, MSTCM, graduated from the Academy of Chinese Culture and Health Sciences in Oakland,California in 2004 where he studied acupuncture and Chinese medicine. While still in school studying Chinese Medicine,  Ron studied with Robert Levine, L.Ac., in Berkeley, where he furthered his understanding of acupuncture, herbal formulas, diagnosis, and pulse taking. Inspired to take his learning to a new level, he moved to Taiwan in 2005 to learn Mandarin as a way of deepening his studies in Chinese medicine.Over the course of almost five years, Ron studied Mandarin in universities in Taipei, Shanghai, and Beijing, received advanced Mandarin language certification, and worked in hospitals (Guanganmen,Tonren hospitals) as interns, where he was able to communicate with doctors and patients in their native language and gain useful clinical experience.

Ron has a background in mind-body disciplines and has a 2nd kyu (brown belt) in aikido. He has also studied qigong (Wild Goose style), taiji (Wu and Chen styles), and Kripalu yoga. He also believes in the importance of diet and exercise in helping patients reach optimum health and happiness.

In late 2010, Ron finally returned to theU.S.to bring his clinical experience to American patients.  He has NCCAOM certification in acupuncture and herbal medicine, in addition to being licensed inVirginia,California, and Rhode Island. Ron is originally from Baltimore,MD.At present time, he works part-time to assist VITCM’s daily work.

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“Incredible, my daughter could sleep well and did not have hives again after first-time drinking of the herbal tea you prescribed. Just very slight in the second and the third day’s night. In one word, she has significant improvement, and will get cured.” the patient’s mom said in an e-mail to Dr.Arthur Fan.

This kid has hives several months, esp. during the night- time. Patient had a lot of hives all over the body, affecting her sleeping. Every interesting, the hives disappeared in morning automatically. During the day-time, patient had hives very occasionally.

 “难以置信,您开的药吃的第一夜我女儿就安睡,没有起荨麻疹。第二天下午有一些,但白天好办,玩儿一会儿引开注意力就没事了。第二夜有一点儿。第三夜好好的,一夜无话。总之明显好转,痊愈在即。

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Acupuncture and Chinese herbal medicine is very effective in Guillain-Barre Syndrome’s recovery in some cases.

Here we have a case record in video, I hope patients with Guillain-Barre Syndrome don’t get frustrated, use acupuncture or/and Chinese herbal medicine as early as possible, in most of cases, very good.http://www.youtube.com/watch?v=6Ngu5WrPDcE&feature=youtu.be

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One patient asked Dr.Fan: “Do you think acupuncture could stop my vaginal bleeding during my early stage of pregnancy? ”

My reply is: “Yes. In most of the cases, acupuncture does  help the patients to stop mild vaginal bleeding during their early stage of the pregnancy.”

We had at least 8 successful cases since 2007.

Stopping the vaginal bleeding means stabilizing the condition which may induce the miscarriage.

One patient.Ms.T.M. came today, she had brown color-like bleeding in her vaginal discharge 4 days during her pregnancy week 6.  After one time acupuncture, the brown color disappeared.

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“Opening Through” the menstruation Tong Jing 通经

from http://chinesemedicinetopics.wordpress.com/2010/05/11/%E2%80%9Copening-through%E2%80%9D-the-menstruation-tong-jing-%E9%80%9A%E7%BB%8F/

May 11, 2010 by sharon weizenbaum

I’ve been away in Taiwan for the last month and have unfortunately neglected this blog while I was away!  I hope I didn’t lose your attention!  If you are interested in our travels in Taiwan you can click here for the little blog of our trip.   Well I’m back and have some interesting material to post that I hope you’ll enjoy!  I am going to do a series now, relying heavily on the work of Dr. Xia Guisheng.  I’ll start here with a brief introduction to Dr. Xia and and follow this with a discussion of learning some of the subtleties in treatment and the term that I am translating as “opening through”.  I’ll follow this with some entries that include the writings of Dr. Xia together with some of my own clinical experience utilizing his insights.

Dr. Xia is the director of the Gynecology Department at the Affiliated Hospital in Nanjing and professor of Gynecology at the Nanjing University of Tradition Chinese Medicine.  Bringing  over 50 years of experience and insight to his writings, he is not only a highly effective practitioner, he is also a clear teacher/writer.  His material is written in a way that guides the student/practitioner through the necessary steps to gain understanding.

 

He has pioneered the articulation of the theories that direct us to work with the ebb and flow or Yin and Yang in relation to the menstrual cycle.  He applies this understanding to all areas of gynecology in great detail.  It is no surprise, after reading his books, to discover that he has become know as a manifestation of Guan Yin, the Chinese goddess who come to the aide of women and children.  Though he is perhaps best known in the West for his work with modifying formulas according the the timing of the menstrual cycle, Dr. Xia pays such close attention to the details of patho-physiology in combination with the function of formulas and the individual herbs within them that his books are really a treasure trove of useful gems.  In this particular series, I will be paying attention to his work with blood stasis and the idea of “opening through” in relation to women’s physiology, patho-physiology and menstruation.  These ideas have many implications in the treatment of women including but going beyond the treatment of dysmenorrhea and infertility.

Most entry level Chinese herbalists have a very limited idea of gynecological blood stasis, it’s diagnosis and treatment.  This becomes very apparent as the practitioner works with women in the clinic and finds that so much of what was learned in school simply doesn’t work or works in a way that is far from ideal.  Poor clinical results can be frustrating but they can also push us to learn more and can help our diagnosis and treatments become more nuanced. For me, less than excellent results have pushed me to research many topics, including the topic of “opening through” in relation to gynecology.  This topic also brings up the concept of a more nuanced use of individual herbs.  In relation to blood stasis – many of my own students don’t come in with much more of an understanding of blood stasis herbs other than that they all move the blood and that they should therefore not be used when there is heavy bleeding or during pregnancy.  And yet, through experience we learn that sometimes we must strongly move the blood in order to stop heavy bleeding and that sometimes moving the blood can help prevent a miscarriage.  We also learn that all blood vitalizing herbs are not equal to each other nor the same as each other.  They range from strong to weak and from cold to hot.  Some are especially good at stopping pain, others are especially good improving the quality of the blood itself.  Here is a bit of a preliminary list just some of the various functions of some individual blood vitalizing herbs:

Stopping pain

Softening hardness

Cracking stasis

Warming the blood

Regulating the Qi within the blood

Stopping bleeding

Harmonizing the blood

Nourishing the blood

Supplement the Kidneys

Descend the Heart blood to the uterus

Cool the blood

Relieve constipation

Open up the chest and breast area

And finally blood vitalizing herbs that function to “open through” the menstruation…..

I first noticed that there was something going on with this idea of “opening through” when I was working beside my teacher Dr. Sheng Yufeng, in Hang Zhou, PRC.  I was constantly trying to figure out why she would use particular herbs in particular situations.  I noticed that there were times she would give a formula for blood stasis and include herbs like Huai Niu Xi or Chuan Niu Xi along with herbs such as Su Mu, Chong Wei Zi and Shan Zha.  I wanted to know when and why she used these herbs.  It was not until I found the writings of Dr. Xia Guicheng that these ideas were fulling articulated for me.  Since studying these writings, the diagnosis and appropriate treatment methods for of some patients in my clinic has become clearer and the treatment results improved.

So, what is this “opening through”?  I am translating the character 通, tong1. as “opening through”.  The Eastland Press glossary translates this as “unblocks, promotes, pervades”.  Wiseman and Ye’s Practical Dictionary of Chinese Medicine, Second Edition translates this term variously as “free, open, restore flow, unstop and connecting.  Thinking of this as “opening through” just what gets opened through?  This term is used when the Luo vessels, the channels, the Qi, the lactation, the bowels, the nasal passages, the blood vessels, the urination, the Ren vessel and finally, the menstruation are blocked. What I want to point out in relation to all of these functions is that what is being “freed” or “opened” or “connected” all relates to structures in the body that are tubular.  This is why the idea of “opening through” is useful.  It gives us the image, not only of blockage, but of a tube that is blocked up and needs to be opened.  Though the term “unblocking” may suffice, it does not convey the image of a tube that should be open end to end the way that “opening through” does.  I have to admit “opening through” is a rather bulky term though, but at least for now, I’d like to use it to effectively illustrate the physiology, patho-physiology, treatment principles and function of herbs.

A bit more about the character tong1 通. It is made up of two parts. The first is this: 甬 yong3 which carries the meaning of path or corridor.  The second is 辶 chou4, which carries the meaning of walking or going.  So altogether we have the meaning of movement through a corridor or path.   When we take the 甬 yong3 corridor or path part of the character and combine it with the disease radical getting 痛 tong4, meaning pain.  In other words, when the corridor is pathologically effected, there is pain.  The characters 通 and 痛 are the one’s that are in the famous saying 通则不痛,不通则痛,  or when there is opening through there is no pain and when there is no opening through there is pain.

So what is this tube that is related to “opening through” the menstruation?  This tube is related both to the Ren Vessel and to the Bao Tai, which connects the upper body, especially the Heart and chest, to the uterus.  This tube can get blocked up and when it does, it needs to get opened through from end to end.  Various symptoms can arise when this tube gets blocked up including amenorrhea, scanty menstruation, lack of free flow of menstruation, painful menstruation, heavy menstruation and infertility.  Upper Jiao symptoms can involve the breasts, the head, the emotions or even cause bleeding in the upper warmer as the menstrual blood fails to descend.  The blockage can effect the middle Jiao as well.  Recently I successfully treated a woman with Achalasia, which involved difficulty swallowing and esophageal spasming that was worse premenstrually, integrating the method of opening through the menstruation.  In general, when the menstruation is not open through, a failure of the downward movement of the Qi mechanism can lead to a whole variety of upward rebelling symptomatology in addition to the lower warmer issues.

Before moving on to the entries that include the Dr. Xia’s writings on this topic, I want to include a bit about how he organizes his discussions in his book, Gynecology Formluas and Herbs from Clinical Experience and Study in Fifteen Chapters. In this text, Dr. Xia has a whole chapter devoted to the idea of “opening through”.  He divides this chapter into 8 parts, each part being represented by one of his “opening through” experiential formulas.  He begins with a basic formula Jia Yu Tong Yu Jian (modified Opening Through Stasis decoction) which is based on Zhang Jingyue’s formula Tong Yu Jian (Opening Through Stasis decoction). He uses this formula as a jumping off place for the deeper, more detailed discussion of the topic.  The formulas that follow morph off of the original idea in the variety of ways that Dr. Xia sees most often in his clinical work.  By carefully going through each chapter, the practitioner learns, not only about these particular formulas but so much more.  We learn how to modify a formula to suit a variety of clinical realities but more importantly, we learn about women’s physiology and patho-physiology in great depth.  Finally, we learn about the individual herbs and their nuanced and careful use.  It is like looking at an issue through a variety of lenses until we feel we have quite a complete understanding.  I’ve not previously seen texts organized in this manner and have found it to be an excellent way to transmit his valuable information.

So, stay tuned!  Dr. Xia’s writings will soon be posted here!

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Last year, I tried to call and e-mail my former patients, who had treatments in our office  due to various infertility conditions, to see exact how many cases of pregnant (and rate) after our treatments of acupuncture, or/and Chinese herbology. I wanted to do a statistical work and give our patients a real data.  However, I found this task seems very difficult -I got frustrated, because some people don’t like to  discuss their personal stuff over the phone or in e-mail.

This week, a patient saw me for her low back pain. She told me she saw me because she feels comfortable with me and my acupuncture. She said she got a pair of twin boys after my one acupuncture treatment 5 years ago–this is really a good news, but I spend 5 years to get it!

There have been over 55 pregnancy success cases after our treatments since January, 2007.  Actually, there may be some more didn’t report to me. I hope I could get the news in time.

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The best way to choose a TCM doctor is to ask questions.

First ask friends whether they have a herbalist, and if so, would they recommend him/her? Using Chinese medicine practitioner’s website is usually the best way to get detail information about TCM doctor and his / her personality, as well as practice.

There are also many online registries of Chinese medicine practitioners, such as NCCAOM— the national board for acupuncture and Chinese medicine in USA,  which handles national examinations and issues certificates which are required for licensing in most of States to practice of acupuncture, Chinese herbal medicine, tuina – Chinese therapeutic massage in the USA. Currently, there are over 10,000 professionally qualified TCM practitioners registered with NCCAOM ,which provides Chinese medicine practitioners contact information by state.

You should ask the provider some questions to decide how helpful the TCM doctor is.

For example:

*Does this TCM doctor assure you that the body heals itself and that the Chinese medicine give opportunity to heal?

*Does this TCM doctor make you feel that you can trust him or her?

*Can this TCM doctor answer your questions to your satisfaction?

*Does this TCM doctor teach you why you might be ill in the first place?

*Does this TCM doctor listen to you or understand you ( Some Chinese may be  poor in spoken English)?

*Do you feel uncomfortable with your TCM doctor?

Remember–lack of trust can hinder the healing.

Remember–any healthcare professional, that offers a quick fix to all problems, is not offering healthcare. There are no magic bullets or miracle cures. Take care!

And if a provider’s fee schedule is very low (based on your common sense ), you should question the quality of his / her practice.

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Acupuncture For The Treatment Of Adductor Spasmodic Dysphonia
Steven Scheer, MD; Linda Lee, PhD

From http://www.medicalacupuncture.org/aama_marf/journal/vol14_3/article4.html

Vol. 14, #3

ABSTRACT
Background
     Spasmodic dysphonia (SD), a rare neurologic spasm of the vocal folds, results in a chronic voice disorder that can affect patients’ quality of life. Current treatment, including surgery and botulinum toxin injections, produces inconsistent results.
Objective     To investigate the use of acupuncture in the treatment of SD.
Design, Setting, and Participants   Prospective case series of 10 individuals (n=9 women; mean age, 45 years) with adductor SD in a metropolitan Ohio area during 2001.
Intervention     Eight sessions (1 week apart) of acupuncture using the LU-LI distinct meridian; during sessions 2-8, electrical stimulation was applied. Auricular acupuncture to “larynx” points during sessions 4-8
Main Outcome Measures     Self-report of participants’ perception of sound and ease of voice production, as well as changes in vocal quality observed by speech/language pathologists and subjects’ associates.
Results     There was no value in the LU-LI treatment without electrical stimulation. Seven of the 10 participants reported vocal improve-
ment, and 2 others noted improvement during specific times of the investigation. Seven rated satisfaction as 3 or higher on a 5-point scale. Seven individuals reported that others noted vocal improvement.
Conclusions   Most participants reported improvement in vocal quality and speech production following acupuncture treatment. Further research of acupuncture for SD is needed.
KEY WORDS
Spasmodic Dysphonia, Voice Disorder, Acupuncture, Overadduction, Overabduction

INTRODUCTION
he neurologic condition known as spasmodic dysphonia (SD) or uncontrolled spasm of the vocal folds results in a chronic voice disorder.1,2 Believed to be related to the focal dystonias that include blepharospasm, torticollis, and writer’s cramp, SD is defined as an extreme overadduction or overabduction of the vocal folds that interferes with phonatory vibration.3-6 SD does not respond well to conventional voice therapy, behavior modification, or oral antispasmodic medication.5

While SD is rare (current estimates are 1 case in 20,000 persons), for many individuals, it is extremely disabling in life and work.5 The range of onset is from 3 to 85 years, with a mean around 38 years. It occurs more often in women (58%) than in men (42%).6 There are adductor, abductor, and mixed types of the condition, and some patients have symptoms of other focal dystonias as well.6 In the most common form, the adductor type, voice production is characterized by strain and effort, pitch or voice breaks, and there are occasional complete blocks in the ability to sustain the vibratory cycle.7-9 Because of the hyperadduction of the vocal folds and the amount of effort needed to phonate during spasms, many patients complain of physical fatigue, tension in the muscles surrounding the neck, and shortness of breath. Some persons with SD develop fear of speaking that may interfere with holding a job or even maintaining relationships. Use of the telephone is especially difficult for others. Initial thoughts on the possible psychiatric origin of SD have since been discounted.3,4 The presumed central nervous system site of the pathophysiologic disturbance is in the basal ganglia; exactly where is unclear, as is the case with other focal dystonias.10,11

Until recently, persons with this development were forced to resort to either surgical resection of the recurrent laryngeal nerve or the laryngeal muscles, or to the injection of botulinum toxin into one or, rarely, both vocal folds.2,12 Dedo and Izdebski2 established a surgical approach involving unilateral resection of the recurrent laryngeal nerve. While the initial success was reportedly high, subsequent reports suggested that the return of vocal cord dystonia and a worsened vocal quality were as high as 60% in the 3-year follow-up period.12

Another surgical approach, laryngoplasty, caused vocal cord relaxation but with a potential sacrificed loss of pitch and loudness.12 A newer procedure developed by Berke et al12  that prevents reinnervation of the vocal cord adductor muscles appears promising, but is still being investigated.

Use of botulinum toxin was approved by the US Food and Drug Administration (FDA) in 1989 for treatment of blepharospasm (eyelid spasm).7-9 The toxin blocks the release of acetylcholine at nerve terminals. If directed to localized areas of innervated muscle, botulinum toxin can be an effective local paralyzer of unneeded muscle action.

Shortly after its FDA approval for blepharospasm, botulinum toxin was used off-label for the treatment of SD.7 Following injection, the paretic muscle loses its spasm, but the vocal quality after treatment is quite variable: some patients have only a whisper for a number of weeks after injection while others have only a brief remission from the spasm and a return of the entirety of vocal problems within a few months.8,12,13

The procedure is expensive ($500-$750 per injection) and must be repeated every 2-12 months indefinitely.8,12,14 Each injection is followed by occasional difficulty in swallowing.8,12 Over time, botulinum toxin may lose its effectiveness, perhaps due to calcification of the injected muscle.14 Unofficial estimates of the frequency with which botulinum toxin injection is used for disabling SD are approximately 75% of patients with the condition.

A group of academic speech/language pathologists at the University of Cincinnati learned of a limited case study on the use of acupuncture for SD in 1997.15 The patient who underwent acupuncture therapy for SD improved on all measures of voice parameters even after a 6-month follow-up period. The exact nature of the acupuncture treatment was not identified in the report and an attempt to reach the investigative team was unsuccessful.

The first author participated as one of two physician acupuncturists in a pilot study of individuals with adductor SD in metropolitan Ohio. We intended to identify, using a few types of acupuncture treatments, whether a combination of methods could improve acoustic measures of voice and perception of vocal quality. We also hoped to determine which of a battery of measurement procedures best described the effects of treatment.

METHODS
Patient Selection
Ten individuals with adductor SD were investigated during 2001. The participants were drawn from the files of local speech/language pathologists or were recruited through an advertisement in the local SD newsletter. Participants ranged in age from 31 to 70 years (mean 45 years). Nine of the participants were women.

Five individuals had never received botulinum toxin injections, either because they were newly diagnosed or because they had rejected its use. Of the remaining 5 who had received botulinum toxin in the past, we excluded from consideration any persons who been treated within 12 months of the 1st acupuncture session. None of the 10 had undergone surgical treatment for SD. All eligible individuals gave informed consent to participate. The research proposal was reviewed and approved by the institutional review board of the University of Cincinnati.

Speech Evaluation
All clinical testing of speech variables was performed independently by 3 licensed speech/language pathologists from the University of Cincinnati or Miami University of Ohio. Main outcomes included measures of voice analysis (Kay Elemetrics Motor Speech Profile, CSL Model 4300B, Lincoln Park, NJ), and a self-report of participants’ perception of sound and ease of voice production (Voice Handicap Index16). Additional perceptual voice analysis was performed after participants were tape-recorded while reading a standard passage. After the treatments were completed, participants were asked a series of open-ended questions regarding their experience with the protocol, changes in vocal quality noticed by themselves, coworkers, or family members, and future plans regarding acupuncture. Participating physicians did not collect any data so as to minimize observation biases.

Acupuncture Treatment
 The acupuncture protocol (Table 1) was devised by two treating physicians, with input from Dr Joseph Helms and reference to primary texts.17,18 Each participant received 8 treatment sessions, spaced about 1 week apart. For each treatment, participants were placed on a padded plinth in the supine position. Music was played for added relaxation. Session 1 began with a brief description of the procedure to allay anxiety about acupuncture.

In each of the 8 sessions, the protocol required use of the LU-LI meridian17 (Figure 1) plus a focusing point at ST 9, electrically stimulated for all but the 1st session: LU 1 and LI 15 (crossed for negative black clip), LI 18 and ST 9 (crossed for positive red clip). Needles at ST 9
(Figure 1) were directed inward toward the middle of the thyroid cartilage lamina. Stainless steel Seirin 40- and 6-mm needles were used for the LU-LI meridian approaches. During sessions 2-8, a 3-channel electrical stimulator (OMS Medical Supplies Inc, Braintree, Mass) was used at either 80 Hz or 15 Hz. The needles were left in place for approximately 30 minutes. For body tonification points electrically stimulated during the 8th session, 2.5 Hz frequency was chosen. During sessions 2 through 8, attempts were twice made to turn up the intensity of electrical stimulation during each session to enhance the effect.

Ear acupuncture, used initially in session 4, featured double needling of both the French and Chinese “larynx point,” located respectively on the medial surface of the tragus and just posterior to the external auditory meatus on the cavum conchae19 (Figure 2). For ear acupuncture and for the needling of Ting points (LI 1 on the index finger tip, ST 45 on 2nd toe tip), 15-mm plastic-handled Seirin needles were used. Ear tacks 1.5 mm long were placed on the 2 larynx points of both ears for 5 days after session 6.

All participants received exactly the same acupuncture treatment protocol in sessions 1 through 3. Beginning with session 4, the acupuncturists allowed each patient to provide some input as to the efficacy of the previous 2 sessions. For sessions 4-8, the use of either 15 Hz or 80 Hz stimulation frequency was determined by the participants’ individual input as to which of treatments 2 or 3 provided the better week-long improvement. In sessions 7 and 8, participants could choose between use of Ting points (from session 6) or body tonification points (from session 5), again according to their self-perception of improvement.

 Table 1. Acupuncture Protocol by Session

Session

Protocol

1

LU-LI distinct meridian, needles in dispersion, for 30 minutes

2

No. 1 plus electrical stimulation, 80 Hz for 30 minutes

3

No. 1 plus electrical stimulation, 15 Hz for 30 minutes

4

No. 2 or 3 plus double needling of both “larynx points” in each ear, 60 minutes

5

No. 2 or 3 plus body tonification points (LI 4, ST 36, SP 6, LV 3, MH 6) for 20 minutes

6

No. 2 or 3 plus double needling of LI and ST Ting points for 20 minutes; ear tacks placed on bilateral larynx points for 5 days

7

No. 2 or 3 plus choice of Ting or tonification points from sessions 5 or 6

8

No. 2 or 3 plus choice of Ting points or electrical stimulation of LI 4 and SP 6 at 2.5 Hz plus needles in other tonification points: ST 36, ST 43, PC 6, HT 3, LV 3

RESULTS
Participants showed significant improvement in some measures of vocal production and movement from outside to within normal range following treatment for many variables, even when statistically significant differences were not observed. Additionally, patients reported statistically significant improvements in their daily voice use on the Voice Handicap Index.

There was no value in use of the LU-LI Distinct Meridian treatment without electrical stimulation. Some participants were generally satisfied with the use of the Distinct Meridian; however, that was after at least 2 sessions that included electrical stimulation. Participants were equally likely to choose the 15-Hz or 80-Hz frequency setting for sessions 4-8.

Participants disliked the use of Ting points and did not feel they represented added value to the treatment; neither was there positive consensus about use of the body tonification points. Beginning with session 4, some individuals experienced reduction in vocal fold spasms with auricular stimulation at the French and Chinese “larynx” points. By the end of the study, the greatest improvements were noted when electrical stimulation was added to the Distinct Meridian treatment (session 2), and when the ear larynx points were stimulated (sessions 4 and 6). However, objective measures of voice production were more inconsistent in showing a positive response within 10 days after the protocol was completed.

Figure 1. Diagram of the Lung-Large Intestine Distinct Meridian Acupuncture Points
Point 1 (LI 18) is located on the middle belly of the sternocleidomastoid muscle, lateral to point 2. Point 2 (ST 9, slightly displaced) is located at the anterior border of the sternocleidomastoid at the level of the thyroid cartilage. Point 3 (LI 15) is on the upper deltoid, just in front of the acromion. Point 4 (LU 1) is 2 in below the acromial end of the clavicle, in the depression. For electrical stimulation during sessions 2-8, needles at 3 and 4 were crossed and clipped by the negative pole stimulator (black); needles at 1 and 2 were crossed and clipped by the positive pole stimulator.

 

On a post-treatment questionnaire, 7 of 10 participants reported improvement in their voices, and 2 others noted improvement during specific times in the protocol. Seven of 10 individuals rated their satisfaction with treatment for voice quality as a 3 or higher on a 5-point scale. Six rated as 3 or higher their feelings about amount of voice change. Seven stated that family members and friends noticed improvement, and 3 of the 7 who were employed said coworkers noticed improvement.

DISCUSSION
With its significant life effects, persons with SD are frequently desperate to receive treatment for their voice disorder. 20,21 Surgery on the vocal mechanism that will yield consistently good outcomes for persons with SD is still being investigated.12 The usual treatment available in larger medical centers, and sought by patients who must sometimes travel long distances to receive it, is botulinum toxin injections repeated every 2-12 months.7-9,12,13 An available alternative to botulinum toxin injections or a treatment that would extend the period between injections would be well received.

Therefore, we were hopeful to find which of several types of acupuncture could benefit persons with SD. We were aware of only 1 other published account of the use of acupuncture for a single patient with SD.15 The points used and treatment protocol were not identified in that study.

Our decision to use the LU-LI meridian was based on its trajectory and territory of influence that incorporates the trachea,vocal cords, and larynx.17 Use of the focusing point at ST 9 (Figure 1)
is an obvious choice for all laryngeal disorders. Use of ear acupuncture seemed reasonable because muscle sites represented on the ventral surface of the ear will readily relax with stimulation. The larynx points on the ear were commonly quite tender to touch and to needling, as typically occurs in auriculotherapy, in which a pathologic body part can appear to be “hot” in its corresponding ear representation.19 One of our consulting experts recommended use of the Ting points, but a limited trial at session 6 was not well received by our participants for subsequent sessions. Ting points are generally more useful for surface-level problems.19

Figure 2. Ear Acupuncture Points
C indicates Chinese “larynx” point inside tragus; F, French “larynx” point posterior to external auditory meatus.

We chose to use a standard protocol for each individual, allowing only a limited variation determined by participants’ input for the choice of frequency stimulation rate in the LU-LI meridian, and a variation on sessions 7 and 8 depending on the individual’s perception of better effects between sessions 5 and 6. Overall, each individual received generally the same treatment.

Individuals with previous botulinum toxin injections were allowed to participate because we believed that to have a sufficient sample size for our pilot study and for any future research on the use of acupuncture in SD, there was and will be a need to include individuals who have already had these injections.

Some participants reported week-to-week variation in the extent of improvement. The most dramatic and rapid laryngeal response to acupuncture was derived from bilateral needling of the larynx points on the inner surface of the tragus (Chinese larynx point), and the point 3 mm posterior to the external auditory meatus on the cavum conchae (French larynx point). One individual was speaking just as the ear larynx point was needled, and both he and the physician noted a dramatic change in vocal quality as the needle entered the point. The effect on that occasion lasted several days though the needle was removed after 60 minutes. Because of their awareness of the success of ear stimulation, some of our participants continued to use either a “pointer plus” 10-Hz ear point stimulator or a specially developed ear stimulator (provided by Dr Onje Erfan of Denver, Colo) that delivers electrical stimulation of several frequencies simultaneously. One month following the study, 5 of the individuals were self-stimulating the ear for their perceived improvements. At least 1 individual was still using ear stimulation bi-weekly 1 year later.

When asked to characterize their feelings about the effects of acupuncture in open-ended questions, a majority of study participants and frequently, their family members or coworkers, were positive. When asked to characterize the improvements, participants commonly described a reduction in the effort required to speak, and in perceived laryngeal tension while speaking. They commented that their voices, though still not normal, were more “functional” and could be “counted on.”

Future studies of the use of acupuncture for SD should consider scalp acupuncture and Koryo Hand acupuncture. There may be additional acupuncture programs derived from a Traditional Chinese Medicine (TCM) protocol that can be found through a Chinese literature search. A crossover design that uses different acupuncture methods would be beneficial, but a larger population will be needed to show significant differences. Finally, a trial that randomizes SD patients into either botulinum toxin injections or acupuncture treatment would be reasonable.

CONCLUSION
We undertook a pilot study to ascertain whether any of several standardized acupuncture treatments could ameliorate the vocal fold spasm and improve voice quality in persons with adductor SD. We found that a majority of our participants obtained subjective benefits in the ease of producing spontaneous speech through acupuncture treatment. The most useful approach included electrical stimulation with the LU-LI Distinct Meridian and auricular acupuncture on the larynx points. Further investigation of acupuncture for the treatment of adductor SD is warranted.

ACKNOWLEDGEMENTS
We sincerely thank Samantha Daughton, MA, Joseph Stemple, PhD, Barbara Weinrich, PhD, Tracy Miller-Seiler, MA, and Scott Goeller, MD, for their help in conducting this investigation. We also thank Susan Schmidt, PhD, and Aviva Scheer, PhD, for their editorial comments, and John Barrord, MD, for graphics work.

REFERENCES

  1. Frontis E. Results of a National Survey. National Spasmodic Dysphonia Association, reported by the Center for Voice Disorders of Wake Forest University; June 6, 1992.
  2. Dedo HH, Izdebski K. Intermediate results of 306 recurrent laryngeal nerve sections for spastic dysphonia. Laryngoscope. 1983;93:9-16.
  3. Aronson AE, Hartman DE. Adductor spastic dysphonia as a sign of essential (voice) tremor. J Speech Hear Disord. 1981;46:52-58.
  4. .Parnes SM, Lavorato AS, Myers EN. Study of spastic dysphonia using videofiberoptic laryngoscopy. Ann Otol Rhinol Laryngol. 1978;87:322-326.
  5. Colton RH, Casper JK, Hirano M. Understanding Voice Problems: A Physiological Perspective for Diagnosis and Treatment. Baltimore, Md: Lippincott
    Williams & Wilkins; 1996.
  6. Koufman JA, Blalock PD. Classification of laryngeal dystonias. Center for Voice Disorders of Wake Forest University Web site. Link: http://www.thevoicecenter.org/class_ld.html. Verified January 23, 2003.
  7. Blitzer A, Brin MF, Fahn S, Lovelace RE. Localized injections of botulinum toxin for the treatment of focal laryngeal dystonia (spastic dysphonia). Laryngoscope. 1988;98:193-197.
  8. Ludlow CL. Treatment of speech and voice disorders with botulinum toxin. JAMA. 1990;264:2671-2675.
  9. Zwirner P, Murry T, Swenson M, Woodson GE. Acoustic changes in spasmodic dysphonia after botulinum toxin injection. J Voice. 1991;5:78-84.
  10. Cannito MP. Neurobiological interpretation of spasmodic dysphonia.
    In: Vogel D, Cannito MP, eds. Treating Disordered Speech Motor Control.
    Austin, Tex: ProEd; 1990:275-317.
  11. Schaefer SD, Finitzo-Geiber TJ, Freeman FJ. Brainstem conduction ab-
    normalities in spasmodic dysphonia. In: Bless DM, Abbs J, eds. Vocal Fold Physiology. San Diego, Calif: College-Hill Press; 1987:393-404.
  12. Berke GS, Blackwell KE, Gerratt BR, Verneil A, Jackson KS, Sercarz JA.
    Selective laryngeal adductor denervation-reinnervation: a new surgical
    treatment for adductor spasmodic dysphonia. Ann Otol Rhinol Laryngol. 1999;108:227-231.
  13. Ford CN, Bless DM, Patel NY. Botulinum toxin treatment of spasmodic
    dysphonia techniques: indications, efficacy. J Voice. 1992;6:370-376.
  14. Lee RE, Tartell PB, Karmody CS, Hunter DD. Association of adhesive macromolecules with terminal sprouts at the neuromuscular junction after botulinum treatment. Otolaryngol Head Neck Surg. 1999;120:255-261.
  15. Crevier-Buchman L, Laccourreye O, Papon JF, Nurit D, Brasnu D. Adductor spasmodic dysphonia: case reports with acoustic analysis following
    botulinum toxin injection and acupuncture. J Voice. 1997;11:232-237.
  16. Jacobson BH, Johnson A, Gryswalski C, et al. The Voice Handicap Index (VHI): development and validation. Am J Speech Language Pathol. 1997;6:
    66-76.
  17. Helms J. The distinct meridian subsystems. In: Acupuncture Energetics: A
    Clinical Approach for Physicians. Berkeley, Calif: Medical Acupuncture Publishers; 1995:189-214.
  18. Unschuld PU. Introductory Readings in Ancient Chinese Medicine. Dordrecht, the Netherlands: Kluwer Academic Publishers; 1988:59-63, 69-70.
  19. Oleson T. Auriculotherapy Manual: Chinese and Western Systems of Ear Acupuncture. Los Angeles, Calif: Health Care Alternative; 1990.
  20. Lundy DS, Lu FL, Casiano RR, Xue JW. The effect of patient factors on response outcomes to Botox treatment of spasmodic dysphonia. J Voice. 1998;12:460-466.
  21. Benninger MS, Ahuja AS, Gardner G, Grywalski C. Assessing outcomes
    for dysphonic patients. J Voice. 1998;12:540-550.

AUTHORS’ INFORMATION
Dr Steven Scheer’s specialties are Physical Medicine and Rehabilitation, Sleep Medicine, and Medical Acupuncture.

Steven Scheer, MD*
St Luke Hospitals
85 No Grand Ave
Fort Thomas, KY 41075

Linda Lee, PhD, is Professor and Graduate Program Director in the Department of Communication Sciences and Disorders at University of Cincinnati, Cincinnati, Ohio. She teaches and conducts research in the areas of voice disorders, craniofacial anomalies, and respiratory disorders.
Linda Lee, PhD
University of Cincinnati
Dept of Communication Sciences and Disorders
202 Goodman Ave
Cincinnati, OH 45267-0379
E-mail: Linda.lee@uc.edu

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Many patients choose anti-hypertension medications when diagnosed with hypertension. Many medical professionals also suggest patients with hypertension use such medications as soon as possible, and as long as possible. The reason being to prevent heart, brain and kidney complications caused by long-term and/or very high hypertension.

However, it would benefit patients with the stage one hypertension to seek non-medication treatment first.  At stage one, hypertension is more related to the imbalance of a patients’ autonomic nervous system; the high activity of sympathic nerve and low activity of vagus nerve. This imbalance can be corrected by one or more of the following: resting, meditation(such as Tai ji, Qigong or meditation-like yoga), acupuncture, or Chinese herbology. A lower sodium diet will also help to some extent.

Recently, there are have been few patients with hypertension who came to see me. One patient had hypertension for about four months prior the her visit due to high stress. Her father was very ill and passed away. She flew to his hospital prior to his death and stayed there to take care of him for many days. She did not get enough sleep and her BP was consistently 140-160/90-110mmHg.   When she came to me, her BP was 150/85mmHg. I gave her an acupuncture treatment, and after half hour’s treatment, her BP lowered to 126/86mmHg. I gave her an herbal pill, Jia Wei Xiao Yao Wan to use at home for one week. Today, she saw me again and reported that her BP was very stable-about 124/86mmHg(we confirmed this data). I treated her with acupuncture once again, and she admitted to feeling very relaxed.

Another patient who already has had stage two hypertension for a few years came to my office recently. She has been using acupuncture and herbs, and her blood pressure has also returned to normal.

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BENIGN ESSENTIAL TREMOR RESOLVED WITH ACUPUNCTURE

 

Cristina S. de la Torre, M.D.

 

 Medical Acupuncture. A Journal For Physicians By Physicians

Fall / Winter 1989 – Volume 1 / Number 1
“Aurum Nostrum Non Est Aurum Vulgi”

 

ABSTRACT– This article reviews the complete resolution of a case of benign essential tremor, in a patient treated with acupuncture, who previously had limited response to drug therapy. Three treatments were given over a three-week period. The patient’s tremor of the head and upper extremities resolved 100%, and she has remained asymptomatic to date (5 months after the last treatment).

 

     In April, 1989, a 38-year-old white female, presented with the chief complaint of intolerable shaking of her head for over one year. From 1987 until then, she was treated for a variety of routine conditions at the practice. She had been diagnosed as having benign essential tremor for many years. Her mother, also a patient of the practice, reported that the patient suffered tremor of the upper extremities since approximately age 2~3, being nicknamed “shaky bones” by her peers. The main medications were propanolol and diazepam, which only provided modest reduction in the intensity of the tremor.
Her condition had been extensively studied at several medical centers, where she was repeatedly told that “she had to learn to live with the tremor, hopefully obtaining some relief by taking prescribed medications”.
The patient’s family history was significant for alcoholism in both parents, a disease which had also afflicted her. She became a heavy drinker between the ages of 21 and 25, and then again between 35 and 37. Other significant medical history included asthma in childhood, excision of an ovarian cyst in 1970, and a twin pregnancy delivery in 1982. The patient is married and owns a successful business.
Marked tremor of the upper extremities (1,2,3), both postural and during voluntary activity, was observed since her first visit in 1987. Around February, 1988, the patient began to notice tremor of her head, which had not been present previously. In May, 1988, she was hospitalized for alcohol detoxification. Soon after discharge, she complained of worsening of her head tremor. She continued sober but increasingly tremulous u ntil April, 1989, when she returned, requesting acupuncture to help her with her head tremor, which by then had become intolerable.
The patient’s constitution was determined to be JUE YIN- Wood, on the East position, according to Dr. Yves Requena’s classification (4). Treatment was then organized following Dr. Maurice Mussat’s “Energy of Living Systems” theory (5,6), specifically the use of triangular equilibration.
Her first treatment, on April 14, 1989, consisted of a JUE YIN triangular equilibration in evolution, using points along the JUE YIN (Lived Master of the Heart), ABSOLUTE YIN (Conception Vessel), and YANG MING (Large Intestine/Stomach).
On her follow-up visit, one week later, she reported great improvement of her head tremor, and mentioned the onset of an unusual craving for sweets. She was then treated with a TAE YIN simple triangular equilibration, with points on TAE YIN (Spleen/ Lung), YANG MING and ABSOLUTE YANG (Governor Vessel).
On her third visit, on April 27, she reported further improvement of her head tremor, and an unexpected complete resolution of her upper extremities tremor. It was then decided to conclude her treatment series with a SHAO YANG simple triangular equilibration (Triple Heater/Gall Bladder), SHAO YIN (Kidney/Hear[), and ABSOLUTE YANG. She was instructed to return 3 weeks later for reassessment.
She did not return until 2 months later, on June 27, when she reported complete resolution of both her upper extremities and head tremor. She was still taking di-azepam, 5 mg twice a day, but had stopped taking propanelei. She was advised to taper off the diazepam, and return for another series of acupuncture treatments, should symptoms recur.
She did not return until 3 months later, on September 28, when she brought in her mother for treatment. At the time, the patient reported no recurrence of her symptoms, being free of tremor for 5 months to date, and without taking any medications. A physical examination, including neurological evaluation, was normal.

 

DISCUSSION 
Tremors may be physiologic or a symptom of neurologic disease, such as tumors, trauma, infections, demyelinating disease, Parkinson’s disease, peripheral neuropathy, and essential tremor (7). Benign essential tremor (called familial or hereditary tremor when there is a positive family history) is thought to be inherited as a Mendelian autosomal dominant trait. No neuropathological lesion has been recognized in post mortem examinations, its neurochemistry is unknown, and its pathophysiology is obscure (8). It may appear at almost any time, often in early adult life, but it may begin in childhood (9}. It is characterized by coarse, rhythmic and symmetric tremor, persisting throughout the range of motion of voluntary activity, increasing in amplitude as the limb approaches an object (finger-to-nose test), or in handling or bringing food or liquid to the mouth.
The frequency of the tremor varies between 6 and 12 Hz, most commonly recording 6-8 Hz (10). The tremor amplitude diminishes with rest and the use of alcohol, and is exacerbated by emotional and physical stress. Tremor increases m amplitude with age, and may eventually interfere with fine movements.
Propanolol (in doses of 40-240 mg/day) and other beta-antagonists which pass the blood-brain barrier and therefore have central and peripheral actions, have been used with varying responses, but no definitive cure (11,12). More recently, primidone has been reported to be as effective as propanolol in treating this condition (13). Alcohol, although the most effective agent, is not recommended. Chronic alcoholism in patients with essential tremor is often a consequence of their attempts to control the symptoms by drinking (14).
The treatment of tremors with acupuncture has 1cng been documented in the classical Chinese medical texts, and continued to be reported in the European and American literature (15), as “problems related to Wind of External and Internal origin”.
For wider clinical applications, the therapeutic response of benign essential tremor to acupuncture needs to be studied in a significant sample of patients with this same condition. However, the complexity of medical acupuncture is such that treatment protocols may be inadequate to incorporate the necessary data into a useful diagnostic and therapeutic formulation (16). The patient’s own diagram of constitutional characteristics, past history, family history, and associated symptoms, eventually determine the most appropriate therapeutic intervention in each case.
With this individualized approach, other functional movement disorders may also be considered as potentially responsive to Medical Acupuncture. Concomitantly, further observations of the effect of acupuncture on tremors may lead to unexpected insights into intrinsic aspects of the motor system.

 

REFERENCES 
1. Critchley E. Clinical manifestations of essential tremor. J. Neurology and Neurosurgery- Psychiatry. 1972; 35: 365-75.

 

2. Critchley M. Observations on essential (heredo-familial) tremor. Brain. 1949; 72: 113-39.

 

3. Marshall J. Observations on essential tremor. J. Neurology and Neurosurgery-Psychiatry. 1962; 25: 122-25.

 

4. Requena Y. Terrains and pathology in acupuncture. Vol I- Correlation with diathetic medicine. Paradigm Publications, Brookline, MA. 1986.

 

5. Mussat M. Energetique des Systemes Vivants. Medecine et Sciences Internationales, Paris. 1982. Transl. by J.M. Helms, 1983.

 

6. Mussat M. Cours d’Energetique des Systemes Vivants Appliquee a la Acupuncture. 1ere, 2eme, et 3eme Annee. Ecole Superieure d’Acupuncture Francaise. 1983.

 

7. Koller W., Lang A. et al. Psychogenic tremors. Neurology 1989; 39: 1094-99.

 

8. Adams R.D., & Victor, M. Principles of neurology- 4th edition. McGraw-Hill Information Services Co., New York. 1989, chapter 5.

 

9. Young R.R. In: Diseases of the nervous system- clinical neurobiology. Edited by Ashbury A.K. et al. W.B. Saunders Co. 1986, Vol 1, chapter 32.

 

10. Weiner W.J. & Goetz C.G. Neurology for the non-neurologist. 2nd edition. J.B.Lippincott Co., Philadelphia. 1989.

 

11. Dupont E., Hansen H.J. et al. Treatment of benign essential tremor with propanolol. Acta NeuroL Scand. 1973; 49: 75-84.

 

12. Winkler G.F., & Young R.R. Efficacy of chronic propanolol therapy in action tremors of the familial, senile or essential varieties. New Eng. J. Med. 1974; 290: 984-88.

 

13. Findley L.I., Cieeves L. et al. Primidone in essential tremor of the hands and head: A double blind controlled clinical study. J. Neurology and Neurosurgery- Psychiatry. 1985; 48: 911-15.

 

14. Growdon J.H., Shahani B.T. et al. The effect of alcohol on essential tremor. Neurology. 1975; 25: 259-62.

 

15. Kaptchuk T.J. The webb that has no weaver- understanding Chinese medicine. Congdon & Weed, New York. 1983.

 

16. UCLA Extension. Medical Acupuncture for Physicians. Santa Monica, California. J.M. Helms, course chairman.

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The acute effects of acupuncture upon autonomic balance in healthy Subjects.

Source

Department of Rehabilitation Medicine, College of Physicians and Surgeons of Columbia University, New York, NY 10027, USA.

Abstract

Restoration of the sympathovagal (S/V) balance, involving a lowering of sympathetic and/or an augmentation of vagal modulation or a combination of both is associated with improvements in cardiovascular morbidity and mortality. To determine whether acupuncture exerts a favorable influence upon resting blood pressure and sympathovagal balance, a single-blind cross-over investigation was used to study the acute effects of acupuncture on S/V balance in normal healthy subjects. The ANOVA revealed a significant lowering of the sympathovagal balance (LF:HF) during rest for the acupuncture treatment from pre (4 +/- 2 nu) to post (2.2 +/- 1.8 nu)(p < 0.05). No such change was seen during sham treatment. The ANOVA revealed significant differences in systolic blood pressures during rest (114 +/- 4 vs. 108 +/- 3 mmHg) for the acupuncture treatment (p < 0.05). No significance was found during the sham treatment. The ANOVA failed to reveal any significant improvements in sympathovagal balance during the sustained isometric contraction. The clinical significance of these findings appears to suggest that acupuncture treatment might be beneficial in lowering blood pressure at rest. Furthermore, the lowering of the blood pressure might be in part due to a lowering of the sympathovagal balance. These findings are of importance since acupuncture treatments are non-pharmacological and have no known detrimental side-effects. This investigation employed healthy volunteers, yet acupuncture has been found to have more potent effects in animal models of hypertension and or in the presence of an autonomic imbalance.

PMID:20821816 [PubMed – indexed for MEDLINE]

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Clin Exp Hypertens. 2010;32(7):423-5. Epub 2010 Sep 9.

Cupping for hypertension: a systematic review.

http://www.ncbi.nlm.nih.gov/pubmed/20828224

Lee MS, Choi TY, Shin BC, Kim JI, Nam SS. Source Division of Standard Research, Korea Institute of Oriental Medicine, Daejeon, South Korea. drmslee@gmail.com

Abstract

The objective of this review is to assess the clinical evidence for or against cupping as a treatment for hypertension. We searched the literature using 15 databases from their inception to 30 June 2009, without language restrictions. We included all clinical trials (CTs) of cupping to treat hypertension in human patients. Risk of bias was assessed using the Cochrane criteria. Two CTs met all inclusion criteria. One RCT (randomized CT) assessed the effectiveness of dry cupping on changes in cerebral vascular function compared with drug therapy. Their results suggested significant effect in favor of cupping on vascular compliance and degree of vascular filling. One uncontrolled observational study (UOS) tested wet cupping for acute hypertension and found that a one-time treatment reduced blood pressure. In conclusion, the evidence is not significantly convincing to suggest cupping is effective for treating hypertension. Further research is required to investigate whether it generates any specific effects for that condition.

Dr.Arthur Fan’s view:

Cupping is an effective, safe and easy way to treat the hypertension, esp. for the satge one.  However, due to limited information, many people could not know this is an effective way to treat people’s hypertension. Investing for its scientific study is a little bit charllenge, because this study will not give the industry any benefit (for drug study may have a big “money return”.)

Patients could use cupping by themselve in home, once a day for two weeks, and take BP everyday, then could see how effective it is!

The mechanism of cupping, is adjusting the “Qi flow” (adjusting autonomic nervous system), activating the blood circulation(at least the microcirculation), then BP automatically back to normal.

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