Society of Fetal Medicine: Acupuncture Treats Depression

Acupuncture, Research | Posted by Philip
Feb 21 2010

Now before we wonder how fetuses in mommies get depression, let me clarify that what is mentioned here is depression of the mother-to-be.

Two New Studies Show Acupuncture Can Relieve Pain and Depression

The first study we have already mentioned (Scientists Find How Acupuncture Deactivates Pain (well, one of the ways) ) so let’s go to the second one:

Meanwhile, a study that was included in the 30th annual meeting of the Society for Maternal-Fetal Medicine in Chicago revealed that depression among pregnant women can be effectively treated with acupuncture.
I can’t get over a previous comment (see Some Guy: “No evidence for acupuncture”; Real World: “Lots of Evidence!“) where a commenter says that “the company that did the testing probably is in the work of acupuncture.  You think they’re gonna release anything that says anything EXCEPT “acupuncture works”?”  By that logic, then that whole society must be in the “work of acupuncture”.  It also means we should not take western medicine studies at their word because the company that did the testing is probably in the work of… selling western medicines.  Duh to the max.

Depression during pregnancy poses a tough dilemma for would-be mothers because anti-depression drugs can disrupt normal development of the fetus.
Nothing we don’t already know.
Experts at the acupuncture New York center suggest that the risk of miscarriage may increase upon intake of anti-depressants, especially Selective Serotonin Reuptake Inhibitors (SSRIs).
Mothers who take anti-depression medication during pregnancy are also prone to give birth prematurely to underweight and sickly infants.
“The results of our study show that the acupuncture protocol we tested could be a viable treatment option for depression during pregnancy,” Dr. Rosa Schyner, one of the authors of the study, said.
I wish the online text would specify what article it is…  (http://www.live-pr.com/en/two-new-studies-show-acupuncture-can-r1048405456.htm)
Previous studies providing scientific evidence validating the efficacy of acupuncture are plentiful.
Dr. Mike Cummings, Medical Director of the British Medical Acupuncture Society, pointed that decades of brain imaging data have already shown results like those of Dr. Asghar and Schyner’s studies.
*sarcasm alert* REALLY?!?!!? WOW, I didn’t KNOW THAT!!! (or as a blind, biased skeptic, I refuse to accept it)
He said that activity of primitive brain parts linked with pain and suffering decrease with acupuncture.
Dr. Cummings also said that acupuncture “appears to be particularly effective at treating pain and the suffering related to pain, but it may also have some effects on mood disorders, such as depression, through its general effects on the brain.”

Given that the qi sensations associated with REAL acupuncture are easily explained by stimulation of certain sensory fibers, and that all sensory stimuli pass through the hypothalamus, and that the hypothalamus is a collection of nuclei that affect everything from circadian rhythm to effecting the pituitary, I’m not surprised.

I still wish I could FIND the actual article and not just rely on the press release.  Google time.

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Another Biased Headline

News | Posted by Philip
Feb 09 2010

“Researcher Warns on Herbal Medicines”

(http://www.abc.net.au/news/stories/2010/02/08/2813236.htm)

Looking at the above headline, what thoughts enter your head?  Obviously it is an attempt to ingrain into the public mind that herbal medicines are dangerous per se.  Sadly, that’s not what the article says.

A forensic pathologist thinks some people’s embarrassment about taking herbal medicines can leave them vulnerable to taking a lethal cocktail of drugs.
Professor Roger Byard of Adelaide University has published a research paper on the dangers of herbal medicines when taken in large quantities, injected or combined with use of prescription drugs.
He has found it can lead to serious illnesses, worsen pre-existing conditions or cause death.
Professor Byard says people are often reluctant to tell their doctor they are taking herbal medicines for fear of ridicule, but it can be a fatal mistake.
Opening sentence: he’s not saying herbal medicines are bad, but that not telling your MD about your use of them can be.  That makes perfect sense because of drug-drug interaction.
“Although obviously a number of herbal substances are quite safe, you don’t know what’s in the package sometimes and there may be interactions, so it is important to talk to your doctor,” he said.
He says his research was sparked by the death of a young man who had injected a Chinese medicine chan su, which contains a toxin from toads.
“The materials that can be added include heavy metals, there’ve been cases of mercury poisoning and arsenic poisoning, lead poisoning, also sometimes the manufacturers will add western pharmaceutical agents, so they’ll add drugs that we manufacture to the herbal medicines to actually increase their effect,” he said.
Note it says that the young man “had injected” not “had been injected with”.  Could this be a case of self-medication?  If so, then he is right again: the message is that herbs can be safe, but some dangerous ones must be administered under the guidance of a qualified practitioner.  That’s something I’ve been saying for years.
Also, be careful of adulterated herbs or herbal products – hence the need for regulation by people who KNOW the herbs.
I generally tell my patients to never get over-the-counter chinese herbal preparations unless a) prescribed by a professional and b) from reliable factories.  If it just says “made in China” it’s probably fake.
Now back to the bias.  Again, the media is subtly manipulating thoughts via headline.  It could easily say “Scientist warns against dangers of abusing herbs.”  Instead, the title seems to imply that herbs are dangerous and that Professor Byard is warning against herbs in general.  In fact, the good Professor is warning against the same thing we do!
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Scientists Find How Acupuncture Deactivates Pain (well, one of the ways)

Acupuncture, Research | Posted by Philip
Feb 07 2010

… but are a bit lacking in their conclusion.  Let me explain.

Their headline is “Acupuncture ‘lessens pain in brain not body’, scientists discover”.

Acupuncture works by making the brain, rather than the body, no longer experience pain, according to new research.

by Andrew Hough (http://www.telegraph.co.uk/health/healthnews/7167362/Acupuncture-lessens-pain-in-brain-not-body-scientists-discover.html)

Scientists who scanned the brains of volunteers as they were given the Chinese therapy found it deactivated pathways that govern pain.
Complementary medicine expert Dr Hugh MacPherson, of the University of York, said: “These results provide objective scientific evidence that acupuncture has specific effects within the brain which hopefully will lead to a better understanding of how acupuncture works.”
A commenter earlier hinted that I am not being objective while citing evidence in this blog.  Fine.  I’m not objective.  I’m biased because I use acupuncture myself and can see the effects on patients firsthand.  I cannot help but acknowledge it works.  I myself am a “victim” of being “duped” as my headaches were gone for four years.  So don’t take my word for it.  Take the scientists’ word for it.  Oh wait, another commenter said that these studies that promote acupuncture are funded by companies that make money of it.  Let’s ignore the fact that most if not all western medicine studies on drugs are also funded by the drugs’ manufacturers.  I’m just saying let’s be consistent.  If we’re going to accuse acupuncture research of being biased because of who funds it, let’s distrust western medicine also!
Anyway, if I’m not being objective, let’s take Dr. MacPherson’s word for it.  Or are we to think that the University of York makes money by selling acupuncture needles?
The findings, published in Brain Research, suggest acupuncture has a significant effect on specific nerve structures.
Dr MacPherson and colleagues explained when a patient receives acupuncture treatment a sensation called deqi can be obtained. Scientific analysis showed this switches off areas within the brain that are associated with the processing of pain.
After reading this, I came to the realization that one reason that people do not understand that it is quite difficult to conduct double blind studies with acupuncture is the fact that they fail to see that acupuncture is more than just sticking needles into points.  The manipulation of the aforementioned needles is important, as they lead to the deqi sensation.  The feeling of deqi (“acquiring qi”) or “needling sensation” can be present upon inserting the needles alone (if done right), or through a bit of manipulation.  These manipulations are very dependent on the manual skill of the practitioner.  Hence, acupuncture should be treated as a PROCEDURE and not a pill.
G 06A 300x251 Scientists Find How Acupuncture Deactivates Pain (well, one of the ways)

Electroacupuncture is a supplement to enhance the "de qi"

You can insert the needles on the same points and not have the same effect if one acupuncturist just pricks the skin and the other manipulates them properly according to the specific needs of the patient.  For example I know that some patients are sensitive at LI 4 and only insertion is needed.  At the same time others may need a bit of stroking at the handle of the needle to obtain the deqi.  This knowledge comes from experience both with the points themselves in general and from knowing patients personally.
Dr MacPherson said: “We carried out two tests of acupuncture on our participants, one where the needles are inserted at a shallow depth which is the practise in Japan and the other where they went in much deeper which is the Chinese tradition.
“We found 10 out of the 17 experienced ‘deqi’ while the others didn’t, and this appeared to help in deactivating areas in the brain that are associated with pain.
“The Chinese have been using acupuncture for 2,000 years for wide ranging illnesses but we have only touched the surface at the moment.
“We believe it can help relieve a number of conditions, including depression which we have recruited 640 people for another study where half will receive acupuncture and the others counselling.”
Note the sequence of events: those who experienced “de qi” deactivated pain centers in the brain.  Those who did not… well.  I recall the words of the Yellow Emperor’s medical classic, and I paraphrase: for acupuncture to work, you need to obtain de qi.  Once de qi is obtained, there is no further need for manipulation.
needle Scientists Find How Acupuncture Deactivates Pain (well, one of the ways)

It's not enough to stick it in. The needles may have to be manipulated to obtain the qi sensation or "de qi"

As for that depression study, I am looking forward to it.  Then again the skeptics will just say that a sample size of 640 is too small.  Then 1000 will be too small… then 10,000… sigh.
Last summer acupuncture was recommended for the first time by the drugs watchdog NICE (National Institute for Health and Clinical Excellence) as a treatment option for NHS patients with lower back pain.
Guidelines now state that GPs should “consider offering a course of acupuncture comprising a maximum of ten sessions over a period of up to twelve weeks” for patients with this common condition.
Nice of NICE to say so.
Co researcher Dr Aziz Asghar, a neuroscientist at Hull York Medical School, added: “The results are fascinating. Whether such brain deactivations constitute a mechanism which underlies or contributes to the therapeutic effect of acupuncture is an intriguing possibility which requires further research.”
The team is currently researching if acupuncture has the ability to successfully treat irritable bowel syndrome and depression. Previous studies have indicated the holistic treatment works on knee pain and migraines.
Dr MacPherson and colleagues say their research could help to clear the way for acupuncture to be more broadly accepted as a treatment option on the NHS for a number of medical conditions.
But it’ll never be good enough for the “skeptics”.
Oh and my beef about the article title?  It shows the linear method of thinking.  The scientists found that acupuncture “defuses” pain sensations in the brain – so they conclude that that’s ALL it does.  Previous studies have shown acupuncture mediates pain in the spinal level and local level through various mechanisms (google the research of Bruce Pomeranz and Gabriel Stux).  It is multifactorial.
For reference, here is the abstract of the article (http://tinyurl.com/yb5p452)
Research Report
Acupuncture needling sensation: The neural correlates of deqi using fMRI
Aziz UR Asghara, b, Gary Greena, Mark F. Lythgoec, George Lewithd and Hugh MacPhersone, Corresponding Author Contact Information, E-mail The Corresponding Author
a York Neuroimaging Centre, University of York, Y10 5DG, UK
b Hull York Medical School and Department of Biological Sciences, University of Hull, Hull, HU6 7RX, UK
c RCS Unit of Biophysics, UCL Institute of Child Health, University College London, WC1N 3JH, UK
d Complementary Medicine Research Unit, University of Southampton, SO17 1BJ, UK
e Department of Health Sciences, University of York, YO10 5DD, UK
Accepted 7 December 2009.
Available online 16 December 2009.
Abstract
The needling sensation of deqi is considered by most acupuncturists to be an important component of acupuncture, yet neuroimaging research that investigates this needle sensation has been limited. In this study we have investigated the effect of deqi and acute pain needling sensations upon brain fMRI blood oxygen level-dependent (BOLD) signals. Seventeen right-handed participants who received acupuncture at the right LI-4 (Hegu) acupoint were imaged in a 3T MRI scanner. fMRI datasets were classified, on the basis of psychophysical participants’ reports of needling scores, into those that were associated with predominantly deqi sensations versus those with predominantly acute pain sensations. Brain areas showing changes in BOLD signal increases (activations) and decreases (deactivations) were identified. Differences were demonstrated in the pattern of activations and deactivations between groupings of scans associated with deqi versus pain sensations. For the deqi grouping, significant deactivations occurred, whereas significant activations did not. In contrast, the predominantly acute pain grouping was associated with a mixture of activations and deactivations. For the comparison between the predominately deqi sensation grouping and the acute pain sensation grouping (deqi > pain contrast), only negative Z value voxels resulted (mainly from deactivations in the deqi grouping and activations in the pain grouping) in the limbic/sub-cortical structures and the cerebellum regions of interest. Our results show the importance of collecting and accounting for needle sensation data in neuroimaging studies of acupuncture.
Keywords: Functional magnetic resonance imaging; Acupuncture; Needling sensation
Corresponding author. Senior Research Fellow, Department of Health Sciences, Area 3, Seebohm Rowntree Building, University of York, Heslington, York YO10 5DD, UK. Fax: +1904 321388.
Brain Research
Volume 1315, 22 February 2010, Pages 111-118
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The King of Medicinals

Acupuncture, Dietary Therapy, General, Herbal Medicine, News, Research | Posted by Philip
Feb 05 2010

Sun Simiao has been called the “yao wang” or king of medicinals.  He was a master of herbology, acupuncture, qigong and dietary therapy.  I’d believe it, because he lived to be a 100 years old.  Now I found an article about him speaking about medical ethics, sadly lacking today even in China.

Worth a read. (http://www.theepochtimes.com/n2/content/view/28988/)

Sun Simiao, Part 2

Sun Simiao’s Medical Ethics and Further Contributions to Medicine

by Shanxing

Sun Simiao expressed his belief that medicine is an art of kindness. In his book “Da Yi Jing Chen” (“Sincerity and Devotion of Great Doctors”), he wrote: “When a great doctor treats a patient, he must concentrate, calm down, and be free from desires and pursuits.
He needs to have a compassionate heart and devote himself to freeing patients from illness. If patients come for treatment, whether they are of high or low social status, rich or poor, elderly or young, beautiful or ugly, enemies or relatives, the Han race or other ethnic groups, intelligent or stupid, the doctor should treat them the same as if they were all the doctor’s dear ones. …”
He adopted a holistic approach to treating illnesses. He believed that through skillful nursing and caring for oneself, one could be free from illness. As long as “a good doctor treats the illness with prescriptions and acupuncture, the patient’s illness will be curable, and disasters on the earth will be avoided.” He stressed medical ethics and treated all patients equally. He said, “A human life is precious, and more valuable than one thousand liang of gold.”

Sun Simiao expressed his belief that medicine is an art of kindness. In his book “Da Yi Jing Chen” (“Sincerity and Devotion of Great Doctors”), he wrote: “When a great doctor treats a patient, he must concentrate, calm down, and be free from desires and pursuits.

Sunsimiao The King of Medicinals

Sun Si Miao, daoist, confucian, physician, healer.

He needs to have a compassionate heart and devote himself to freeing patients from illness. If patients come for treatment, whether they are of high or low social status, rich or poor, elderly or young, beautiful or ugly, enemies or relatives, the Han race or other ethnic groups, intelligent or stupid, the doctor should treat them the same as if they were all the doctor’s dear ones. …”
He adopted a holistic approach to treating illnesses. He believed that through skillful nursing and caring for oneself, one could be free from illness. As long as “a good doctor treats the illness with prescriptions and acupuncture, the patient’s illness will be curable, and disasters on the earth will be avoided.” He stressed medical ethics and treated all patients equally. He said, “A human life is precious, and more valuable than one thousand liang of gold.”

How different than today, where it seems life is seen as a statistic.

Sun Simiao also paid great attention to gynecology and pediatrics. He authored three volumes of “fu ren fang” (gynecology) and two volumes of “shao xiao ying ru fang” (pediatrics), which were placed inside of “Qian Jin Yao Fang.”

Definitely well rounded!

“Qian Jin Yao Fang” is the earliest encyclopedia of medical subjects in China. It covers a broad range of categories, from basic medical theories to different clinical subjects, and from theories and methodologies to prescription formulas and drugs. One part of the book covers classical material.

Another part details empirical formulas and prescriptions that were circulated among the populace. This book includes the strong points of different schools and is suitable for people of different educational backgrounds. It is still popular today. It is indeed an asset of traditional Chinese medicine.

By summarizing clinical experiences and prescription formulas from the era of Zhang Zhongjing, a famous doctor in the Han Dynasty, to that of Sun Simiao, the book demonstrated Sun Simiao’s profound medical knowledge and extraordinary medical skills.

Instead of ignoring and laughing at the past (I recall my earlier post criticizing a writer for basically treating past tradition like dirt), he takes it, corrects what is wrong and embellishes what is right.

Future generations have called “Qian Jin Fang”—the two books of “Qian Jin Yao Fang” and “Qian Jin Yi Fang”—the ancestor of prescription formulas.

Sun Simiao valued preserving health and actively practiced his values. Because he was good at the art of cultivating health, he lived to over 100 and still enjoyed good vision and hearing when he was old.

He combined ideas of the preservation of health from Confucianism, Taoism, and from India with those of traditional Chinese medicine. He proposed many practical and effective ways to cultivate good health, which even today, guide people’s daily lives.

Among them was proper diet… and this was in 600 AD or so!

For example: “One should keep a balanced mindset and not solely pursue recognition and self-interest. Be constrained in food intake, and do not eat or drink too much. Pay attention to the circulation of Qi and blood and do not be lazy and motionless. Live a regular daily life and do not violate the laws of the nature. …”

Emphasis: Do not violate the laws of nature? What does this mean?  It means eat food according to season, dress accordingly, sleep and rise at the proper time, and ensure adequate time for work and rest.  Sadly, not done then, not done now.

Sun Simiao was also the first to invent a urethral catheter. According to historical records, one of his patients could not pass urine. Seeing that the patient was in extreme pain, Sun thought, “It is already too late to treat him with medicine. If there was a way to insert a tube into his urethra, the urine could perhaps flow out naturally.”

He saw a neighbor’s child at play blowing on a green onion stem. The green onion stem was very thin, long, and soft. Sun decided to use such a tube and gave it a try. Having chosen a suitable green onion stem, he charred it gently, cut the sharp end off, and then carefully inserted it into the patient’s urethra.

He then blew into the tube once. As expected, the urine flowed out of the tube. The patient’s bloated abdomen gradually became smaller, and the patient’s illness was also cured.

Okay… I have sincere doubts about how an onion stem can be made into a foley cath… that must have been interesting.  No doubt though, that he had invented something similar to the modern foley catheter, since this was written before foley catheters were invented (obviously)

By cultivating morality and virtue and by being talented, Sun Simiao became a great figure, whom common people and medical professionals for several generations have greatly respected.

Hopefully this generation as well!

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Nothing Like The Real Thing

Acupuncture | Posted by Philip
Feb 03 2010

People sometimes ask me about my opinion regarding the use of cold lasers versus needles for acupuncture.  The first thing I say is that if it isn’t going to involve puncturing the skin, then it shouldn’t be called acu-PUNCTURE.  But we know what is meant by laser acupuncture.  It means using lasers to stimulate acupoints.

I’ve heard a lot of good things about it from my colleagues and patients who’ve tried it.  However, personally, I don’t think it works as well as the real thing.  Why is that?  Well just like in martial arts, you can have many different styles.  Some styles emphasize speed, some emphasize power.  In my acupuncture, my style is meridian style and it also relies a lot on the “needling sensation” or de qi.

This is something that’s hard to explain unless you’ve felt it.  Also, the sensation (if any) is not as pronounced in laser acupuncture.  I prefer the real thing.

This came to mind as I was reading this article:

Laser Acupuncture fails to Ease menopausal woes (http://www.reuters.com/article/idUSTRE61056H20100201)

NEW YORK (Reuters Health) – Women seeking relief of hot flashes and other bothersome symptoms of menopause might want to take a pass on laser acupuncture, based on a new study showing that it is largely ineffective in relieving menopausal symptoms.

Laser acupuncture uses a laser beam instead of the traditional acupuncture needles. The low-power laser beam is directed at the same points used in traditional acupuncture.

Here’s the first “red flag”.  The note that the points are the same as in traditional acupuncture.  Does this mean each patient is diagnosed individually and given a set of points that is tailored to their specific need at the time?  (That’s “traditional”) Or, do we mean a cookbook set of points to be used in any and all patients?

Studies on the ability of traditional acupuncture to cool hot flashes have been mixed and data regarding the effect of laser acupuncture on symptoms of menopause are lacking.

Given my first comment, I’m not surprised if the data is mixed.

To investigate, Dr. Paul A. Komesaroff, at Monash University Department of Medicine in Victoria, Australia and colleagues studied 40 otherwise healthy women 54 years old on average. The women were having about 40 to 50 daily and 20 or so nightly hot flashes a week and other symptoms of menopause, but were not using hormone replacement therapies.

Over 3 months, the women documented their menopause symptoms. During this time, 23 had laser-on and 17 had laser-off (sham) acupuncture to 10 specific body points every 14 days. Neither the women nor the laser operator knew the state of the laser during treatments.

Nice double blind, but I’m still not a fan of lasers except in Star Wars.

By the end of treatment, the women reported no adverse events and very similar symptom improvements, regardless of treatment group, the researchers report in the journal Menopause.

On average, the laser-on and laser-off groups, respectively, reported about 37 and 33 percent fewer daytime and about 30 and 39 percent fewer nighttime hot flashes.

Other menopause symptoms also declined, but detailed analyses of the women’s diaries showed no significant between-group differences in specific symptoms such as mood, energy level, bloating, or sex drive.

The investigators surmise that touching the laser probe to the skin, as occurred in both treatment arms, may explain the similar between-group responses.

Touching the probe to the skin… wouldn’t tui na or acupressure be better?

Based on the current study, Komesaroff and colleagues do not recommend laser acupuncture for relief of menopause symptoms. In this direct comparison of laser-on versus laser-off acupuncture, laser-on treatments were “ineffective in altering menopausal symptoms,” Komesaroff noted in an email to Reuters Health.

Neither would I.  Menopausal symptoms for me are a sign of yin deficiencies, and deficiencies are better treated with herbal formulas.  The logic is thus: if something is deficient, then something has to be added to make up for it.  Acupuncture can work, but not as efficiently as herbs for this.

The researchers suggest further studies of laser acupuncture in menopausal women focus on alternative acupuncture points.

SOURCE: Menopause, published online January 8, 2010

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