IMPORTANT INFORMATION

DR. AJIT D. MISTRY

IMPORTANT INFORMATION

In reality, the first two actions can also be attributed to the regulation of physiological functions. The therapeutic effects of acupuncture are thus brought about through its regulatory actions on various systems, so that it can be regarded as a nonspecific therapy with a broad spectrum of indications, particularly helpful in functional disorders. Although it is often used as a symptomatic treatment (for pain, for instance), in many cases it actually acts on one of the pathogenic links of a disease.

Although different acupuncture points and manipulations may have an effect through different actions, the most important factor that influences the direction of action is the condition of the patient. Numerous examples reveal that the regulatory action of acupuncture is bi-directional. Acupuncture lowers the blood pressure in patients with hypertension and elevates it in patients with hypotension; increases gastric secretion in patients with hypoacidity, and decreases it in patients with hyperacidity; and normalizes intestinal motility under x-ray observation in patients with either spastic colitis or intestinal hypotonia (11). Therefore, acupuncture itself seldom makes the condition worse.

Since its therapeutic actions are achieved by mobilization of the organisms own potential, acupuncture does not produce adverse effects, as do many drug therapies. For example, when release of hydrocortisone plays an important role in the production of a therapeutic effect, the doses of this substance released by acupuncture is small and finely regulated, thereby avoiding the side effects of hydrocortisone chemotherapy.

REVIEW OF CLINICAL TRIAL REPORTS

Acupuncture and pain

The effectiveness of acupuncture analgesia has already been established in controlled clinical studies. As mentioned previously, acupuncture analgesia works better than a placebo for most kinds of pain, and its effective rate in the treatment of chronic pain is comparable with that of morphine. In addition, numerous laboratory studies have provided further evidence of the efficacy of acupuncture’s analgesic action as well as an explanation of the mechanism involved .In fact, the excellent analgesic effects of acupuncture have stimulated research on pain.

Because of the side-effects of long-term drug therapy for pain and the risk of dependence, acupuncture analgesia can be regarded as the method of choice for treating many chronically painful conditions.

The analgesic effect of acupuncture has also been reported for the relief of eye pain due to subconjunctival injection, local pain after extubation in children, and pain in thromboangitis obliterans.

Acupuncture and head and face

The use of acupuncture for treating chronic pain of the head and face has been studied extensively.

For tension headache, migraine other kinds of headache due to a variety of causes, acupuncture has performed favorably in trials comparing it with standard therapy, sham acupuncture, or mock transcutaneous electrical never stimulation .The result suggest that acupuncture could play a significant role in treating such conditions.

Chronic facial pain, including craniomandibular disorders of muscular origin, also responds well to acupuncture treatments.

Locomotor system

Chronically painful conditions of the locomotor system accompanied by restricted movements of the joints are often treated with acupuncture if surgical intervention is not necessary. Acupuncture not only alleviates pain, it also reduces muscle spasm, thereby increasing mobility. Joint damage often results from muscle malfunction, and many patients complain of arthralgia before any changes are demonstrable by x ray .In these cases, acupuncture may bring about a permanent cure. Controlled studies on common disease and conditions in this category have been reported by authors, with favorable result for acupuncture treatments compared with standard therapy, delayed treatment controls, control needling, mock TENS, or other sham acupuncture techniques.

The conditions concerned includes

• Cervical spondylitis or neck pain due to other cases ,
• Periarthritis of the shoulder
• Fibromyalgia
• Fascitis
• Epicondylitis (tennis elbow),
• Low back pain,
• Sciatica,
• Osteoarthritis with knee pain,
• Radicular and pseudoradicular pain syndromes.

Acupuncture is an effective and judicious adjunct to conventional care for patients with osteoarthritis of the knee.

Acupuncture is beneficial in the treatment of rheumatoid arthritis. While acupuncture may not improve the damage that has been done to the joints, successful pain relief has been verified in the majority of controlled studies .The action of acupuncture on inflammation and the dysfunctional immune system are also beneficial.

Gout

In a randomized controlled trial, the acupuncture group showed greater improvement then the allopurinol group.

In addition, a similar reduction of uric acid levels in the blood and urine of both groups was noted.

Biliary and renal colic

Biliary and renal colic are two conditions for which acupuncture can be used not only as an analgesic but also as an antispasmodic.

Traumatic or postoperative pain

For traumas such as sprains, acupuncture is not only useful for relieving pain without the risk of drug dependence, but may also hasten recovery by improving local circulation.

Acupuncture analgesia to relieve postoperative pain is well recognized and has been confirmed in controlled studies.

Acupuncture and Dentistry

There are reports of randomized controlled trials on the analgesic effect of acupuncture for postoperative pain from various dental procedures,including tooth extraction ,pulp devitalisation and acute apical periodontitis .

Infections

Acupuncture has been reported to be effective for treating acute bacilliary dysentery

Its effect is comparable with that of conventional medicines such as furazolidone.

Neurological disorders

In the neurological field, headache, migraines and neuralgia are the common painful conditions treated with acupuncture. Strokes and their sequelae are another major indication for acupuncture. Early treatment of paresis after stroke has proved highly effective. In randomized controlled studies, acupuncture treatment of hemiplegia due to cerebral infarction gave better results then conventional medication and physiotherapy. In one study, patients with ischaemic cerebraovascular disease treated with acupuncture were compared with patients treated with conventional drugs. Nerve function, as evaluated by electroencephalographic map and somatosensory evoked potential, showed a much more marked improvement in the patients treated with acupuncture.

Comparative studies have shown acupuncture treatments to be as effective for treating hemiplegia due to cerebral haemorrhage as for that due to cerebral infarction. Since early treatment with physiotherapy is unsatisfactory, it is advisable to use acupuncture as the primary treatment. Even in hemiplegia of long duration, remarkable improvements can often be achieved. Hemiplegia due to other causes, such as brain surgery, can also be improved by acupuncture.

For example, good effects for Bell’s palsy have been reported in randomized controlled trials. Facial spasm is another peripheral nervous disorder for which acupuncture treatment may be indicated. Acupuncture is significantly better than traditional body acupuncture.

Coma is serious condition that can hardly be cured by acupuncture alone, but in a comparative study of two groups of patients with similar levels of coma, a significantly greater number of patients in the acupuncture group had a 50% or greater neurological recovery than those in the control group. This suggests that it is reasonable to incorporate acupuncture along with other therapeutic and supportive measures in the treatment of the comatose patient.

Insomnia can also be treated successfully with acupuncture in randomized control trials; both auricular acupressure and auricular acupuncture had a hypnotic effect.

Respiratory disorders

Acupuncture is often used in treating respiratory disorders. Allergic rhinitis is one of the major indications.In controlled studies it has been shown that acupuncture is more effective then antihistamine drugs in the treatment of allergic rhinitis.Acupuncture’s lack of side effects is a distinct advantage in treating this condition.

Although there are conflicting results from controlled trials in treating bronchial asthma with acupuncture, the majority of the reports suggest that acupuncture is effective and that the effect is related to the points used. While bronchial asthma is not cured by acupuncture, it may be substantially relieved, at least for short periods of time. The success rates quoted in the literature are 60-70%. Acupuncture has a limited role in treating acute asthmatic attacks since it is a weak bronchodilator, but it may serve as a prophylactic measure over the long term. Controlled trials have shown that acupuncture brings about modest improvement in objective parameters, with significant subjective improvement. Prospective randomized single-blind studies of the effects of real and sham acupuncture on exercise-induced and metacholine-induced asthma revealed that real acupuncture provided better protection than did sham acupuncture, but it failed to modulate the bronchial hyperreactivity to histamine. Corticosteroid-dependent bronchial asthma may respond better to acupuncture treatment than other types: the required dosage of corticosteroids gradually decreases during the first weeks of acupuncture treatment. Acupuncture may also provide symptomatic improvement in the late stages of bronchial asthma, where there are complications of disabling breathlessness due to impaired lung function.

Digestive disorders

Acupuncture provides satisfactory relief of epigastric pain significantly better then injections of anisodamine or morphine plus atropine as shown in randomized controlled trials .For gastrointestinal spasm, acupuncture is also superior to injection of atropine and for gastrokinetic disturbances, the effectiveness of acupuncture is comparable with that conventional medicine domperidone.

Another common symptom of digestive is nausea and vomiting. This can be due to disordered function of the stomach, but it is more often a symptom or sign of generalized disorders. Morning sickness, postoperative vomiting, and nausea and vomiting related to chemotherapy are frequently encountered clinically. In all these conditions acupuncture at point neiguan (PC6) seems to have a specific antiemetic effect.

Irritable colon syndrome and chronic ulcerative colitis are often difficult to treat with conventional medication. For these diseases, acupuncture may serve as a complementary or alternative therapeutic measure.

Acupuncture shows good analgesic and antispasmodic effects on the biliary tract and, as indicated preciously, can be recommended for treatment of biliary colic .It also has a cholagogic action, which has been demonstrated in experimental studies .In the treatment of biliary colic due to gall stones, acupuncture is not only effective for relieving the colicky pain but is also useful for expelling the stones. Satisfactory results were reported when electric acupucnture was used in combination with oral administration of Magnesium Sulfate.Acupuncture is also worth trying for chronic cholesystitis, even if there is acute exacerbation.

Blood disorders

Among various blood disorders, leucopenia is the most suitable for acupuncture treatment.

In controlled studies, acupuncture has been shown to be more effective then batilol and/or cystine phenylacetate in the treatment of leucopenia due to chemotherapy or benzene intoxication.

Urogenital disorders

Urinary retention due to functional disorders, with no organic obstruction is often treated with acupuncture. For postpartum or postoperative urinary retention, successful micturition usually occurs immediately after one session of needling. A randomized controlled trial on traumatic retention of urine, a condition more complicated than postpartum or postoperative retention. In this trial, the efficacy of acupuncture was remarkably superior to that of intramuscular injection of neostigmine bromide.

Acupuncture is not only useful for relieving renal colic, but also for expelling urinary stones (if they are not too large), because it dilates the ureter. Satisfactory results have been obtained in comparisons with conventional medication, but it is better to use acupuncture as a complementary measure in conjunction with medication or lithotrips.

Acupuncture may also be helpful to patients with chronic prostatitis.

In women, it has been shown that acupuncture can lower urethral pressure and relieve urethral syndrome. Acupuncture has also been successfully used as a prophylaxis against recurrent lower urinary tract infections.

Gynecological and obstetric disorders

Primary dysmenorrhoes, a painful condition, is one of the major indications for acupuncture in the field of gynecological disorders .The beneficial effect of acupuncture on this condition has been repeatedly reported in controlled trials.Acupuncture relieves pain and also regulates the motility of the uterus to facilitate menstrual discharge and further alleviate the pain.

Premenstrual syndrome is characterized by cyclical mood changes and is a common condition in women of fertile age. Acupuncture seems to be helpful to patients with this syndrome. In a controlled study, the majority of the patients receiving acupuncture gained relief from symptoms and no recurrence in the six-month follow-up.

Acupuncture is also worth trying in the treatment of female infertility due to inflammatory obstruction of the fallopian tubes, where it seems to be superior to conventional therapy with intrauterine injection of gentamicin, chymotrypsin and dexamethasone.

Acupuncture stimulates milk secretion after childbirth and can be used to treat deficient lactation due to mental liability or depression. It has been observed that acupuncture elevates the blood prolactin level in women with deficient milk secretion after childbirth; in the majority of cases, lactation starts as the blood prolactin level increases. The clinical use of acupuncture to promote lactation has also been demonstrated in a randomized controlled study.

Cardiovascular disorders

Acupuncture is suitable for treating primary hypotension and early essential hypertension. It has been reported that the influence of acupuncture on hypertension might be related to its regulatory effect on the level of serum nitrogen monoxide. For primary hypotension, acupuncture seems to be more effective than general tonics. For mild and moderate essential hypertension, the hypotensive effect of acupuncture is much more potent than that of placebos and is comparable with that of certain conventional hypotensive agents. In addition, acupuncture is often effective for relieving subjective symptoms, and it has no side effects.

Encouraging results have been reported for a number of controlled studies on the treatment of heart disease with acupuncture, particularly in psychosomatic heart disorders, such as cardiac neurosis. In coronary heart disease, acupuncture has been shown by various authors to be effective in relieving angina pectoris. Its beneficial influence has been demonstrated during coronary arteriography.Cardiological, neurophysiological and psychological observations, made in mutually independent studies, indicated that acupuncture improved the working capacity of the heart in patients with angina pectoris and activated autoregulatory cardiovascular mechanisms in healthy persons. In controlled studies, acupuncture has provided significantly greater improvement in symptoms and cardiac work capacity than either placebo or conventional medication, such as glyceryenl trinitrate. Dilation of the coronary artery during acupuncture has been shown to be comparable with that observed during intracatheter injection of isosorbide. In addition, acupuncture has a beneficial effect on the left ventricular function of patients with coronary heart disease, and is also more effective than nifedipine and isosorbide dinitrate. Neiguan (PC6) is the point most commonly used for treating cardiac disorders. The beneficial effect of acupuncture at this point has been demonstrated by serial equilibrium radionuclide angiography. Acupuncture also produces haemorrheological improvement.

In order to avoid unexpected accidents, however, special attention should be paid to the treatment of heart disease. Acupuncturists must be able to differentiate between angina pectoris and acute myocardial infarction.

Psychiatric disorders and mental disturbances

Acupuncture is being increasingly used in psychiatric disorders. The effect of acupuncture on depression (including depressive neurosis and depression following stroke) has been documented repeatedly in controlled studies. Acupuncture is comparable with amitriptyline in the treatment of depression but has fewer side-effects. In addition, acupuncture has been found to be more effective in depressive patients with decreased excretion of 3-methyl-4 hydroxy-phenylglycol (the principal metabolite of the central neurotransmitter norepinephrine), while amitriptyline is more effective for those with inhibition in the dexamethasone suppression test. This suggests that these two therapies work through different mechanisms. There have also been reports that,in controlled trials of schizophrenia treatment, acupuncture might have a better effect than chlorpromazine.

Acupuncture (auricular acupressure) is much more effective than psychotherapy in the treatment of competition stress syndrome,and is worth further study.

The possible use of auricular acupuncture as a treatment for opium dependence was first noted in 1973.

The most convincing results are from randomized controlled trials of passive abstinence, with no suggestion or motivation to stop smoking. The patients were told they would receive acupuncture for other purposes, and they were not asked to stop smoking. A comparison of the effects of auricular acupuncture and body acupuncture was made: 70% of the auricular-acupuncture patients and 11% of those receiving body acupuncture either abstained totally from smoking or reduced the amount of consumption by half. In addition, 72% of the auricular-acupuncture patients experienced disgust at the taste of tobacco.

Acupuncture has also been reported to be useful for treating alcohol recidivism. In placebo-controlled trials (with acupuncture at nonspecific points as the control), the patients in the treatment group expressed less need for alcohol than did the control patients. Patients in the treatment group also had fewer drinking episodes and admissions to a detoxification center. It is interesting to note that in an experimental study on healthy volunteers, acupuncture diminished clinical alcohol intoxication by increasing the alcohol level in expired air and decreasing blood alcohol levels.

Disorders of the sense organs

A recent randomized controlled clinical trial on sudden-onset deafness in adults favored acupuncture treatment.

Acupuncture might be useful in the treatment of Meniere disease for relieving symptoms and also for reducing the frequency of attacks. It seems to be more effective than conventional drug therapy (betahistine, nicotinic acid and vitamin B6).

In some countries, many skin diseases are customarily treated with acupuncture, but very few controlled studies have been published. In a randomized controlled clinical trial on chloasma acupuncture had a significantly better effect then vitamins C and E.

Acupuncture is known to have an antipruritic effect. This has been shown experimentally in volunteers, suggesting that acupuncture could be used in clinical conditions associated with pruritus. Acupuncture with dermal needles (7 star or plum blossom needles) as traditionally being used in the treatment of neurodermatitis, but confirmation of its effect in a controlled clinical trial was only recently reported.

For the treatment of acne vulgaris, acupuncture, particularly ear acupunture, is worth recommending if the reported therapeutic effects can be further proved.

Cancers

Acupuncture has uses in cancer treatments. One is to relieve cancer pain, and the other is to control the adverse reactions to radiotherapy and chemotherapy. For cancer pain, it has been reported that acupuncture provided an immediate analgesic effect similar to that of codeine and pethidine, with a more marked effect after use for 2 months .The effect was comparable with that achieved using the analgesic steps recommended by WHO .For radiotherapy and chemotherapy, acupuncture can greatly lessen the adverse reactions in the digestive and nervous systems, as well as providing protection against damage to haematopoiesis.

Other reports

Obesity and hyperlipaemia are becoming increasingly important medical issues .If acupuncture could help in reducing body weight and blood lipids, its clinical use could be greatly expanded.

Acupuncture may be of benefit to patients with non-insulin dependent diabetes mellitus.

Its efficacy has been shown to be superior to that of placebo and comparable with that of tolbutamide.

Anisodamine is effective in treating excessive salivation induced by drugs (usually anti psychotics), but acupuncture seems to be more effective.

There are also reports on the treatment Sjogren syndrome (sicca syndrome), Raynaud syndrome, Stein-Leventhal syndrome (polycystic ovary syndrome), and Tietze syndrome (costochondritis), which indicate beneficial effects from acupuncture treatment.

That is one of the Chinese

medicine’s  strongest  strengths  —  significant  reduction  of  pain

without the prolonged use of drugs.

Chinese medicine greatly enhances  the  effect  of  other  therapies,  and  reduces

Un wanted side effects from various drugs. Facial Rejuvenation Acupuncture may erase as many as five to fifteen years from the face, with results apparent after just a few treatments. Fine lines may be entirely eliminated and deeper wrinkles diminished. Bags under the eyes can be reduced, jowls firmed, puffiness eliminated, droopy eyelids lifted and double chins minimized. Other likely results include: moisturizing of the skin with increased local circulation of blood and lymph to the face; increased collagen production, muscle tone, and dermal contraction; tightening of the pores; brightening of the eyes; improving of hormonal balance to help acne; reduction of stress evident in the face – bringing out the innate Beauty and Radiance of an individual.

Many sources indicate that acupuncture has been used for almost 5,000 years to treat a wide range of conditions. Having proven itself with literally billions of people, Acupuncture has survived the test of time. The use of Acupuncture in Cosmetology-especially in preventing and reducing wrinkles-has already attracted great attention in Japan, Hong Kong, and Sweden. The effectiveness of Acupuncture is due to its direct manipulation of the body’s energy system-balancing, removing blockages or adding emery when necessary. A 1996 report in the International Journal of Clinical Acupuncture reported that among 300 cases treated with Facial Acupuncture, 90% had marked effects with one course of treatment. The effects included: the skin becoming delicate and fair, improvement of the elasticity of facial muscles and leveling of wrinkles, a ruddier complexion, and overall rejuvenation-not confined to the face.