A Korean study has demonstrated how Acupuncture can help patients with spinal cord injuries recover function.

In this article indexed by pubmed, two acupuncture points are shown to control the inflammation associated with traumatic spinal cord injury.  Inflammation is a good thing, but too much inflammation just bogs everything down.  In fact, that’s how steroids became wonder drugs – they mediate excessive inflammation.  Swelling then goes down, encouraging function.

Here’s the abstract:

Acupuncture-mediated inhibition of inflammation facilitates significant functional recovery after spinal cord injury.

Choi DC, Lee JY, Moon YJ, Kim SW, Oh TH, Yune TY.

Age-Related and Brain Diseases Research Center, Biology, School of Medicine, Kyung Hee University, Seoul 130-701, Korea; Neurodegeneration Control Research Center, Biology, School of Medicine, Kyung Hee University, Seoul 130-701, Korea.

Here, we first demonstrated the neuroprotective effect of acupuncture after SCI. Acupuncture applied at two specific acupoints, Shuigou (GV26) and Yanglingquan (GB34) significantly alleviated apoptotic cell death of neurons and oligodendrocytes, thereby leading to improved functional recovery after SCI. Acupuncture also inhibited caspase-3 activation and reduced the size of lesion cavity and extent of loss of axons. We also found that the activation of both p38 mitogen-activated protein kinase and resident microglia after injury are significantly attenuated by acupuncture. In addition, acupuncture significantly reduced the expression or activation of pro-nerve growth factor, proinflammatory factors such as tumor necrosis factor-alpha, interleukin-1beta, interleukin-6, nitric oxide synthase, cycloxygenase-2, and matrix metalloprotease-9 after SCI. Thus, our results suggest that the neuroprotection by acupuncture may be partly mediated via inhibition of inflammation and microglial activation after SCI and acupuncture can be used as a potential therapeutic tool for treating acute spinal injury in human. Copyright © 2010. Published by Elsevier Inc.

In addition to the mediation of inflammation, it appears that acupuncture also promotes constructive mechanisms.  The study actually mentions two points, GV 26 Shuigou and GB 34 Yanglingquan.  Let’s examine those two.

Renzhong or Shuigou is a well known resuscitation point in chinese medicine.  Normally it is known as a point to press to revive consciousness.  In addition, a list of it’s functions includes “benefitting the spine” which is the obvious mechanism here.  However, GV 26 is located at the very end of the GV channel.  This would imply that it would be best for treating the spine as a whole in general but the lumbar spine in particular.  This is because one maxim in meridian-style acupuncture is that points on one end can affect the meridian’s other end. I wonder if there is a significant difference in using GV 26 for cervical/thoracic spine injury as opposed to lumbar spine injury?

Pressing of GV 26 Renzhong from the movie Red Cliff Part 1

Gallbladder 34 is known as the influential point of the sinews and is indicated for neuromuscular problems in general.  In addition to strengthening the sinews and tendons, it also clears Damp Heat.  I believe that the terms “Heat” and “Fire” in Chinese medicine refer to the same thing westerners refer to as “inflammation”.  To be inflamed, if you think about it, means to be on fire, yes?  Dampness in Chinese can indicate heaviness – a consequence of inflammation, perhaps?

All in all I wish to know more details about this study: what was the method for stimulating the points? Was it light stimulation on the needle or heavy?  What were the animal models used in this study? etc etc

Again, more studies to look forward to.

… 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.”

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.

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.

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

I don’t normally just cut and paste blog entries here in my own blog, but this article is too good for me not to quote and is so self-explanatory that I can’t really comment on it further except to say, “yeah, that’s right.”  I’ll just highlight some goodies.

The Science of Traditional Chinese Medicine: How Does it Really Work? <http://www.cityweekend.com.cn/shanghai/articles/blogs-shanghai/cw-radar/the-science-of-traditional-chinese-medicine-how-does-it-all-really-work>  by Trista Baldwin, posted by Andrea Wong (yeah I’m a bit confused…) posted and accessed 11/19/2009

Relegated to the realm of alternative medicine in the West, TCM is often viewed as a system based more on ancient superstition than science. Trying to understand TCM from the viewpoint of 20th century science is akin to trying to decipher Old English without a modern translation. There is a methodical approach at work; it’s just difficult to understand.

Couched in the ancient language and philosophy of the time, with references to qi, the five elements and yin and yang, that approach is often misinterpreted as being overly philosophical. However, the applications are actually quite practical. Qi refers to a physiological process; yin and yang to balance. The five elements (wu xing) are in fact a system used to describe the interactions and relationships that connect the various systems in the body to each other and to the environment–the flow of energy or fluids, for example. These systems are further confused by the Western understanding of anatomy.

When a TCM doctor refers to the Lung, this is not the same as its anatomical counterpart. The Chinese organs are interrelated systems. “An organ has its own qi , and delivers that to another organic system which gets its energy from another system and so forth,” explains Doris Rathgeber, general manager of Body & Soul Medical Clinics. As such, “A cough might actually be related to a problem with the Kidney,” explains Dr. Shao Lei, head of the acupuncture department of Huashan Hospital Fudan University. “This is often hard for patients to understand.”

Western studies on TCM have focused particularly on the workings of acupuncture and herbology, although explanations are not easily forthcoming. Many of the world’s pharmaceuticals come from herbs, but “it’s still hard to measure why the combination of one herb with another herb works,” Rathgeber says. Herbal prescriptions alter according to changes in the patient’s constitution and environment, making herbal remedies harder to test in isolation.

The healing effects of acupuncture, though not fully explained, are strongly linked to the nervous system. Piercing the skin with a needle triggers the sensation of injury. The brain generates an immune response, stimulating the area and strengthening the immune system in one fell prick. “The nervous system is interconnected,” adds Shao. “One point affects another.”

Despite its strengths in preventative and palliative medicine, neither Shao nor Rathgeber believes TCM needs to be practiced in isolation. Acute conditions requiring antibiotics or other Western treatments should not be avoided if necessary. Neither doctor shies from using Western diagnostic tools such as X-rays, MRIs or lab tests to more clearly pin-point the exact cause of a perceived deficiency. “Western medicine is more concerned with exact measurements, whereas TCM focuses on the overall result,” says Shao.

“For me, it’s not important if TCM is proven scientifically,” states Rathgeber, “more that it’s proven to work for the patient.”

Okay, room for ONE comment.  For me, whether it works for my patients or not is most important, but it is also important to prove TCM scientifically.  By not doing so, we are discouraging more MDs from integrating TCM into conventional medicine and thus giving more benefit to patients.

Ear Acupuncture Chart (image courtesy http://www.acupunctureproducts.com

Afraid of having needles stuck in you?

The American Journal of Obstetrics and Gynecology noted that  “ear acupuncture” works better than sham acupuncture at “fake” points and control in relieving low back and pelvic pain.

Excerpts from the text (“Ear Acupuncture Curbs Back Pain in Pregnant Women” courtesy of Reuters Health), which again is “news” to some people who don’t know that this technique has been around for hundreds of years.

In a study, women who had pressure needles held in place with tape at three acupuncture points in their ears for one week, were more likely to experience significant reductions in lower back and pelvic pain than those who had the needles placed at three “sham” points or women in a control group who didn’t get real or fake acupuncture.

Some “skeptics” justify their position about acupuncture by citing studies claiming that fake acupuncture  – real needles inserted in non acupuncture points – work seemingly just as well as those inserted into real points.  They often claim this means points are useless.  They also forget that inserting needles is better than not inserting.

Actually this proves the meridian theory is real, since Qi flows through the meridians, thus putting needles along the meridians WILL have some effect, albeit not the ideal one.  So what did the researchers do here?

They randomly assigned 159 women in the 25th to 38th week of pregnancy to receive real acupuncture, acupuncture delivered to points that would theoretically not affect pain in the pelvic or lower back area, and a control group.

For ear acupuncture, the points are more specific and there are no “lines” connecting the dots.  Therefore, you have to use the points properly or have no effect at all, even if you put stimulation in other parts of the ear.

The results:

A 30 percent or greater reduction in pain was reported by 81 percent of women in the acupuncture group, 59 percent of women in the sham acupuncture group and 47 percent of women in the control group. The difference between the sham and control groups wasn’t statistically significant.

Thirty-seven percent of women in the acupuncture group were pain-free after a week of acupuncture, compared to 22 percent in the sham group and 9 percent of the control group. Improvements in function were significantly greater among women who had real acupuncture compared to those who got the fake version or received no treatment.

So, real acupuncture works better than fake or ordinary painkillers, etc…  Okay… maybe NOW the skeptics will believe us. (I wish.)

But the pain relief didn’t persist for some; a week after the end of acupuncture treatment, 68 percent of those who received the real thing still had a 30 percent or greater reduction in pain compared to the beginning of treatment, while 32 percent in the sham acupuncture group and 18 percent of the control group sustained this level of pain reduction. There was no significant difference among the groups in the percentage remaining free of pain two weeks into the study.

So one week of real acupuncture produced more lasting relief than fake acupuncture.  Imagine if we actually continued the treatment.

The original study: <http://www.ajog.org/article/S0002-9378(09)00424-4/fulltext>

Sources:

Reuters Health.  “Ear Acupuncture Curbs Back Pain in Pregnant Women” abcnews.go.com 16 October 2009.  17 October 2009 <http://abcnews.go.com/Health/WireStory?id=8847011&page=1>
Shu-Ming Wang, Peggy DeZinno, Eric C. Lin, Haiqun Lin, James J. Yue, Michael R. Berman, Ferne Braveman, Zeev N. Kain.  “Auricular acupuncture as a treatment for pregnant women who have low back and posterior pelvic pain: a pilot study” American Journal of Obstetrics & Gynecology September 2009 (Vol. 201, Issue 3, Pages 271.e1-271.e9) Online June 29, 2009.  17 October 2009 <http://www.ajog.org/article/S0002-9378(09)00424-4/fulltext>