Acupuncture Study

[Lee Chiang Po]

How does one go about learning or training accupuncture? And how does one go about choosing an accupuncturist? What are their requirements in order to learn or train to be an accupuncturist? Surely there are checks and balances? Just say I wanted to become a licensed accupuncturist, how would I go about that? Not that I am wanting to do so, but it would give me some idea as to how serious a person has to be. These are serious questons and I hope you don't ignore me.

[sanjuro_ronin]

I had some done on my shoulder while rehabing it, it worked great.

[Xiao3 Meng4]

Assuming you want to practice ethically, the first thing to do is decide where you want to practice, and research the local laws which govern acupuncture. If there are no laws governing your area, take a quick look at any bills or acts that are currently in the government pipeline to see whether or not any laws are being drawn up. If you find nothing, then pick a school that is accredited by the NCCAOM. If the laws require licensing, then find a school or accredited teacher who is able to prepare you for the exams specific to your local licensing body.

In general, acupuncture programs in North America range from 1500 hours on the low end (much too little in my opinion) to 3000 hours on the high end (barely enough, really,) with varying mixes of theory, science and practice.

Licensed states and provinces require acupuncture curriculums to have a good chunk of Western Medical theory ranging from anatomy, physiology and pathology to neurology and myology. Curriculums will vary in their inclusion of modern scientific research on the effects and application of acupuncture.

The NCCAOM, which is the oldest licensing body for oriental medicine in North America, has had the experience of accommodating and testing the competence of practitioners from many different styles of acupuncture - 8 principle acupuncture, 5 element acupuncture, classical acupuncture and Japanese acupuncture. Other licensing bodies have not been around as long and unless they've taken all acupuncture styles into account, they may not be prepared to test the competency of certain styles and practitioners. It's therefore best to directly ask the licensing body which texts are used as source materials for the competencies and then use that information to help you pick a school.

As it stands now, acupuncture and Chinese medicine is still very diverse and stylistically ecclectic, with different licensing bodies favouring different acupuncture styles and methods. This needs to be addressed, and it is being addressed, albeit very very slowly. As time goes on, the various licensing bodies are evolving towards inter-compatibility. I hope this will encourage useful, valid science and will help remove more of the distortions being passed along in the schools today. It will be difficult, though, since people like to cling to ways and ideas and status.

[kfson]

How does one go about learning or training accupuncture? And how does one go about choosing an accupuncturist? What are their requirements in order to learn or train to be an accupuncturist? Surely there are checks and balances? Just say I wanted to become a licensed accupuncturist, how would I go about that? Not that I am wanting to do so, but it would give me some idea as to how serious a person has to be. These are serious questons and I hope you don't ignore me.

http://www.aoma.edu/
It's in Austin, Texas

[GeneChing]

Acupuncture fails to boost IVF success in study

NEW YORK | Tue Jul 13, 2010 5:15pm EDT

NEW YORK (Reuters Health) - While some studies have suggested that acupuncture might boost a woman's chances of becoming pregnant through in-vitro fertilization (IVF), new findings question whether there is a true benefit.

In a study of 160 women who underwent IVF at one infertility clinic, researchers found that those who were randomly assigned to have acupuncture right before and after their treatment were no more likely to become pregnant than those who had a "sham" version of acupuncture.

Of women in the acupuncture group, 45 percent were found to be pregnant five to six weeks after their IVF cycle. The rate was 53 percent among those who received the sham procedure.

Acupuncture has been used for more than 2,000 years in Chinese medicine to treat a wide variety of ailments. According to traditional medicine, specific acupuncture points on the skin are connected to internal pathways that conduct energy, or qi ("chee"), and stimulating these points with a fine needle promotes the healthy flow of qi.

IVF involves fertilizing a woman's eggs in a lab dish, then transferring the resulting embryos to her uterus.

Some past studies have found that acupuncture, performed around the time of the embryo transfer, may boost a woman's chances of becoming pregnant. But it was unclear whether that reflected a true effect of acupuncture or some "non-specific" effect of having an additional therapy.

So for the new study, Dr. Irene Moy and colleagues at Northwestern University in Chicago randomly assigned women undergoing IVF at their fertility clinic to one of two treatment groups. In one, women received two sessions of "true" acupuncture, delivered to points that are connected to fertility, according to traditional Chinese medicine; women in the other group received needle stimulation to body sites not used in acupuncture.

In both groups, the sessions were performed right before and after the embryo transfer.

In the end, Moy's team found, women who received the sham acupuncture had a higher pregnancy rate -- though the difference was not significant in statistical terms.

The findings are not the final word on acupuncture and IVF, however, according to Moy and her colleagues.

One possibility, they note, is that acupuncture needling, even performed at non-acupuncture sites, has some sort of effect on IVF pregnancy rates that is outside of the principles of traditional Chinese medicine. If that's the case, effects of the sham acupuncture used in this study might have masked any benefit of the traditional version.

The researchers say that future studies could compare true acupuncture with "placebo" needles that do not penetrate the skin.

They also note that the protocol used in this and other clinical trials -- acupuncture sessions only on the day of the embryo transfer -- may not be adequate. In real-world practice, acupuncturists treating women with fertility problems would typically perform several sessions over weeks or months.

I want to be a SHAM acupuncturist. How would you say 'sham' in Chinese?

[mawali]

Sham acupuncture working does not mean any quack can do acupuncture!
From the point of view of the specific trials that show this, it only means that neurological mechanisms through bi-directional/biochemical transformation that goes far beyond the 'diseased' location. This is not necessarilty a negative conclusion but there are those who can and will attempt to use it as such.

In clinical trials in North America, placebo controlled trials are the sine qua non of drug development! Active drug vs an inert control and depending on the class of drug(s) being tested, placebos come out ahead. Any astute individual who sees this should consider how placebo controls can be used for benefit instead of saying it show negative results and go on to the next drug product!

[CFT]

Acupuncture points to post-op comfort
by Andy Coghlan

http://www.newscientist.com/news/news.jsp?id=ns99996210

Acupuncture is a cheap and safe way of preventing people who have just had an operation from being sick or feeling nauseous. That is the conclusion of a review of 26 trials involving over 3000 patients.

Anna Lee of the Chinese University of Hong Kong and Mary Done of the New Children's Hospital in Sydney, Australia, focused on trials that studied the effects of "P6" treatment - stimulation of the "pericardium" (P6) acupuncture point on the wrist.

Patients receiving P6 acupuncture were 28 per cent less likely to feel nauseous and 29 per cent less likely to be sick than patients receiving sham treatments, such as insertion of the needle at the wrong place or pretended stimulation of P6.

They were also 24 per cent less likely to ask for anti-sickness drugs. Without treatment, post-operative nausea and vomiting is estimated to affect four out of five people who have had anaesthetics.

In head-to-head comparisons with routine anti-sickness drugs, acupuncture was equally good at preventing nausea and vomiting. The authors report that there were minimal side effects, and advocate P6 acupuncture as a safe and effective means of preventing post-operative sickness and nausea.

Journal reference: The Cochrane Database of Systematic Reviews 2004 (DOI: 10.1002/14651858.CD003281.pub2)

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Acupuncture Helps Knee Pain, Study Finds

2 hours, 54 minutes ago

WASHINGTON (Reuters) - Acupuncture can help boost the power of drugs in reducing the pain suffered by patients with arthritis in their knees, researchers report.

Patients who got three-months worth of regular acupuncture treatments along with their normal arthritis care reported less pain and better ability to move than patients who got a sham acupuncture treatment, the researchers said.

"These data show that traditional Chinese acupuncture provides clinically important relief of pain and improvement in function in patients with symptomatic knee osteoarthritis when added to background therapy," said Dr. Marc Hochberg, a rheumatologist at the University of Maryland School of Medicine who worked on the study.

Hochberg and colleagues studied 570 patients for their study, presented Sunday night to a meeting of the American College of Rheumatology in San Antonio, Texas.

The patients, with an average age of 65, got either traditional Chinese acupuncture involving needled, sham acupuncture with the needles tapped at certain points but not inserted, or basic care including anti-inflammatory drugs and analgesics.

The acupuncture patients got 23 treatments. Six months later the patients filled out a questionnaire called the WOMAC Osteoarthritis index. The sham acupuncture group reported a score of -2.92 for pain and -9.87 for movement, compared to -3.79 for pain and -12.42 for the group that got real acupuncture.

Osteoarthritis affects more than 17 million Americans over the age of 65 and in the knee is marked by a breakdown of cartilage.

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Acupuncture, Herbs Ease Hay Fever

1 hour, 38 minutes ago

By Alison McCook

NEW YORK (Reuters Health) - Regular sessions of acupuncture and daily doses of Chinese herbal medicine may help ease the burden of seasonal allergies, new research indicates.

A group of German investigators found that hay fever sufferers who received weekly acupuncture treatments and took three doses of a Chinese herbal formula per day showed fewer symptoms and were less likely to say their allergy was infringing on their daily activities than people who received a placebo treatment.

"There are additional options to conventional medicine," lead author Dr. Benno Brinkhaus of the Charite University Medical Center in Berlin told Reuters Health.

Brinkhaus suggested that people with seasonal allergies should consider acupuncture and herbs, but added that they should use it with caution, given that every treatment has side effects.

According to the report, published in the journal Allergy, the number of people with hay fever is growing in industrialized countries, affecting between 10 and 20 percent of the population.

Many of these patients are now opting for alternative medicine, including Chinese remedies, but few studies have rigorously examined their effects, Brinkhaus and colleagues note.

To investigate, the researchers asked 52 adults with moderate hay fever to try a combination of acupuncture and Chinese herbs or a placebo treatment. People given the placebo regimen had needles applied to non-acupuncture sites, and were given a non-specific Chinese herbal formula.

After 6 weeks, Brinkhaus and colleagues found that 85 percent of treated participants showed overall improvements in their hay fever, compared with only 40 percent of the comparison group.

More specifically, subjects who received the real treatment were more likely to report that their symptoms had decreased. They also tended to say their allergies were having less of an impact on their daily activities, such as sleep, everyday problems and general health.

People who got the genuine treatment were also twice as likely to experience a remission of their allergy, and had a bigger decrease in the number of drugs they took to relieve hay fever symptoms during the study period.

Patients given the real and sham treatment were equally likely to report side effects.

Brinkhaus noted that this study focused on people who already had symptoms, and acupuncture and herbs may be more effective when used before hay fever kicks in.

SOURCE: Allergy, September 2004.

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Acupuncture can improve chances of successful fertility treatment
By Maxine Frith Social Affairs Correspondent
21 October 2004


Acupuncture can improve a woman's chances of successful fertility treatment, research shows. Patients on needle therapy during IVF had higher rates of pregnancy and lower rates of miscarriage, the conference of the American Society for Reproductive Medicine in Philadelphia was told yesterday.

Doctors and scientists long sceptical about complementary therapies are increasingly convinced they can aid conventional medicine. Acupunct-ure and hypnosis are now available on the NHS.

Researchers from the Reproductive Medicine and Fertility Centre in Colorado Springs studied 114 women undergoing IVF. The transfer process can be uncomfortable and stressful, hampering the chances for a successful pregnancy.

Half of the women had acupuncture during the transfer, with needles in their ears and other areas; the other half had normal treatment without needles. Acupuncture is based on ancient Chinese theories about pressure points and how they affect health and well-being.

Only 36 per cent of the women on conventional treatment became pregnant, compared with 51 per cent of those who had acupuncture. Just 8 per cent of the acupuncture patients suffered a miscarriage, compared to 20 per cent of the other patients.

The therapy also reduced the risk of ectopic pregnancy, where the embryo develops in the fallopian tube rather than the womb. Live birth rates in the acupuncture women were 23 per cent higher for each IVF cycle.

Professor Edzard Ernst, professor of complementary med-icine at Exeter University said: "We are beginning to suspect acupuncture can have hormonal effects and it [could] influence fertility." He also said extra "tender, loving care" during treatment might have influenced results. He added: "These results deserve to be rigorously tested using placebo acupuncture to ensure the effect is real."
26 October 2004 08:00

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The Daily Camera

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URL: http://www.dailycamera.com/bdc/healt...223527,00.html

Joshua Lawton

Mary Saunders, a licensed acupuncturist at the Community Acupuncture Clinic in Boulder, performs a treatment on a patient as fellow practitioner Jennifer McLemore prepares for her patient Sasha Jacobs in the background.

Ancient medicine for the masses
New clinic offers low-cost acupuncture

By Lisa Marshall, Camera Staff Writer
October 4, 2004

In India, it is offered in drop-in, open-air clinics, where dozens of people are treated at once for little, if any, cost.

In China, it's available everywhere from urban hospitals to rural health centers where anyone, regardless of income, can afford as many sessions as they need. But in the United States, says Boulder acupuncturist Mary Saunders, the 2,000-year-old Chinese medicinal art she practices has taken an unfortunate turn as it has grown in acceptance and popularity: It has largely become a remedy for the rich, out of reach for the people who need it most.

"It has always been the medicine of the people. That is the nature of this medicine," says Saunders. "It is we, in this culture, that have turned it into this elitist, alternative thing. It is becoming so expensive that only people with lots of money or really good insurance can afford it."

Saunders aims to buck that national trend with the opening last month of the new Community Acupuncture Clinic, a Boulder facility that offers group acupuncture at a sharply reduced price. The clinic, nestled in the quiet basement of a restored Victorian house, features four cozy recliners, three massage tables and one straight-back chair in a peaceful space where as many as eight patients can be treated at once. As many as three licensed acupuncturists will be at the clinic at any given time.

Fees are based on a sliding scale — $30 to $60 for an initial visit and $15 to $45 for a follow-up. Private practitioners in the area charge anywhere from $55 to $85.

The clinic is modeled after a first-of-its-kind facility, Window of the Sky, which opened in Portland, Ore., two years ago with the aim of making regular acupuncture treatments available to low-income patients. That clinic now treats as many as 100 patients per week and has the capacity to see 15 at a time.

Window of the Sky founder Lisa Rohleder says she still makes a good living. "If you treat four people in an hour for $15, you still get $60, and they all get to come in," she says. "It's just not rewarding for me to get paid $85 a treatment but not be able to treat my neighbors."

After one visit to the Portland clinic, Saunders, a 20-year veteran of the trade and former director of the Southwest Acupuncture College in Boulder, spearheaded a community effort to get a clinic started here. She says almost every piece of furniture in the place was donated, and she was given a break on rent by Partners in Health, the complementary medicine practice that leased her the space.

She hopes to attract students and people of various economic and ethnic backgrounds who have yet to try acupuncture because of its cost. Saunders speaks fluent Spanish and has printed her fliers and delivered her answering machine message in both languages. She'd also like to see those who already get acupuncture but have a need for more frequent treatments able to get them.

"This is the way they do it in China. You want to make it so people can come often. Then they can get real results," she says. "It is not like you are getting lesser care because you are getting group treatment."

On a recent afternoon at the clinic, the quiet sounds of Native American flute echoed through the clinic as the smell of lavender essential oils and burning Moxa, a Chinese herb, wafted through the clinic.

At the massage table in one corner, Saunders gently removed a hair-thin, stainless steel acupuncture needle from the forehead of Veronique, a middle-aged woman who came to the clinic for help with chronic fatigue. Meanwhile, two other women and one man kicked back, eyes closed, acupuncture needles firmly in place, blankets covering them, in the lazy chairs across the room.

Meanwhile, Virginia Charnow, a 26-year-old who came to the clinic for help with hormonal problems, was making her next appointment.

"I felt like I got the same care here as what I received one-on-one at a private facility," said Charnow, who is unemployed right now. "For this cost, this is definitely doable."

Rohleder, of the Portland clinic, says she is thrilled to see another clinic following her lead, and she hopes to see the idea catch on nationally and filter into other forms of alternative medicine. Better access to such medicine, she believes, could translate to better preventive care and fewer costly visits to emergency rooms for the uninsured.

"Alternative medicine, the way it is taught, practiced, and put out in the community is not accessible to working-class people," Rohleder says. "This is really how it was meant to be. It is a radical social justice undertaking. We are trying to change the way medicine is being practiced in this country."

The Community Acupuncture Clinic will offer a free lecture on abdominal self-massage for women at 7 p.m. Oct. 12 at 2825 Marine St., Boulder. For more information on the clinic, call (303) 447-0443

Copyright 2004, The Daily Camera. All Rights Reserved.

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Acupuncture Helps Treat Knee
37 minutes ago

FRIDAY, Nov. 19 (HealthDayNews) -- Acupuncture, used as a complementary therapy to drugs, is a more effective treatment for knee osteoarthritis than medication alone, says a Spanish study in this week's issue of the British Medical Journal.

The study included 88 people with knee osteoarthritis who received either acupuncture and the anti-inflammatory drug diclofenac or dummy acupuncture and the drug. The patients were treated for 12 weeks and their levels of stiffness, pain and physical function were measured by the researchers.

Patients in the acupuncture group had a greater reduction of pain and stiffness and improved functioning and quality of life compared to the patients in the placebo group.

The study authors said future research should include longer observation periods after treatment to evaluate the duration of improvement offered by the combination of acupuncture and drug therapy.

Knee osteoarthritis affects nearly 10 percent of people over age 55, the researchers said.

More information

The American Medical Association has more about knee osteoarthritis.

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TCM holds promise in treating HIV/AIDS
Jia Hepeng
2004-11-23 06:05



When Lai Zuqin, a traditional Chinese medicine (TCM) doctor in Southwest China's Yunnan Province, tried in the late 1980s to develop a treatment for a strange syndrome which had a combination of symptoms - coughing, headaches, nausea, diarrhoea and hair-loss - he did not expect to become the inventor of China's first authorized anti-AIDS TCM: the Tang Herbal Tablet.

In the early 1990s, he knew the disease was called AIDS and that AIDS was fatal for all.

But to his astonishment, some of his AIDS patients were able to check the development of their illnesses after taking his medicine.

The discovery led Lai to give up all of his clinical work and focus on researching a new medicine based on his prescription.

He was joined by Qi Jieyuan, a Beijing-based pharmaceutical firm, in the medicine's research and development.

It took Lai and the company 10 years to obtain final approval from the State Food and Drug Administration in April 2004.

Like Lai, when TCM doctor teams of the Chinese Academy of TCM were sent to Tanzania to help treat local diseases in the early 1990s, they also thought of TCM.

The only difference is that Lai and the company developed the TCM into a tablet, while doctors from the Academy insisted on using various prescriptions of herbs.

More choices

"Chinese doctors, with little knowledge about AIDS at that time, found many of its symptoms could be treated with TCM. Later, they developed some effective prescriptions against AIDS," said Wei Jian'an, deputy director of the Centre of HIV/AIDS Treatment under the Academy.

Wei joined a Chinese TCM doctor team in Tanzania between 1999 and 2000, and chaired the research into using TCM when he returned to Beijing.

On October 30, a TCM prescription - CATCM-II - developed by Wei and his colleagues and based on their experience in Tanzania, was ranked as a major scientific innovation by the Ministry of Science and Technology.

Yet CATCM-II and the Tang Herbal Tablet are only a small part of nationwide efforts to treat HIV/AIDS with TCM.

In March, SH - another TCM theories-based herbal medicine invented by Chinese researchers in Kunming, Yunnan Province - was approved by Thai drug authorities as a new drug.

She Jing, vice-minister of health and the director of the State Administration of TCM, said at a news conference last month that another two were undergoing clinical trials.

They are TCM, called Ke'aite, literally "the drug that overcomes AIDS," and Qiankunning, produced by the Chengdu-based Enwei Pharmaceutical Co Ltd.

On October 31, Ke'aite reportedly passed the first stage of the trials and was approved by the Drug Administration to launch clinical trial II.

Director of the research centre at Enwei said Qiankunning was in the third phase of a clinical trial and may get the approval from drug authorities within one or two years.

Major advantages

"All the development illustrates that TCM has great potential to deal with HIV/AIDS," Wei said.

The disease is a new one to human beings as far as studies go, but its symptoms are not.

TCM theories are based on the analysis of the whole human body at the onset of the virus or bacteria attacks from the symptoms. The prescriptions are then developed to improve bodily functions to fight attacks and relieve symptoms.

Jin Lu, executive director of the Hong Kong-listed Golden Meditech Co Ltd, said that 200 AIDS patients were treated with TCM during the three clinical trial stages of the TCM, alongside another 200 in five hospitals in Beijing and Kunming.

Golden Meditech acquired Qi Jieyuan in June this year after the latter obtained new drug licence for its Tang Herbal Tablet.

All of the 200 AIDS patients taking the tablet during this trial are still alive, and most of their clinical symptoms have been reduced or even disappeared.

Ninety per cent of them improved their CD4 - a major index used to evaluate immunology against HIV/AIDS - with 51 per cent of them increasing their CD4 by more than 30 per cent.

Wei says one major advantage of using TCM to treat AIDS is its fewer side-effects, early treatment and lower cost.

The commonly used ****tail therapy - using a combination of different AIDS drugs and antibiotics - can control HIV and prolong life for AIDS sufferers.

But doctors say the therapy also has strong side-effects such as anorexia, insomnia and hair-loss.

"In certain cases, some AIDS patients give up the treatments because of these strong side-effects," Jin said.

The ****tail therapy has very strict standards on when to start treatment. If it is too early, the virus might develop strong drug-resistance.

It is often difficult for AIDS patients to know when they contracted the disease, so many of them lose the best chance to receive treatment at the right time. But TCM prescriptions can be used at any time during the disease's development, Jin told China Daily.

TCM researchers say the cost of using CATCM-II and the Tang Herbal Tablet is no more than 3,000 yuan (US$362.32) a year, and it could be lowered further when production costs are cut.

In contrast, using generic chemical medicines - such as Zidovudine, Stavudine, Didanosine and Zalcitabine - produced by Chinese drug makers for ****tail therapy - costs about 10,000 yuan per year (US$1,210), including the drugs and necessary medical checks.

For some poor countries which do not have the capability of producing generic chemical medicine against AIDS at a low cost, the expenditure is much higher.

Thailand's drug authorities are fully supportive of the development of SH in a bid to meet the urgency for inexpensive AIDS drugs, according to Luo Shide, the inventor of SH and a professor at the Kunming Institute of Botany under the Chinese Academy of Sciences.

Developing SH

Luo has been researching AIDS medicine based on the combination of TCM theories and modern chemical techniques since the late 1980s, after he returned to China from Germany.

His method is to first determine and purify the vital elements of herbal plants recorded by classic TCM books that treat poisons, and then to combine them into dozens of TCM prescriptions. In the end, some of these prescriptions proved effective in significantly reducing HIV levels.

Luo said his research has not been done at the molecular level, however. It is still difficult to make sure exactly what a single herbal plant's chemical content is, let alone a compound consisting of 20 plants.

He did not receive any government or company's financial support on his work for the first eight years.

"At that time, it was widely considered that HIV/AIDS was not a big problem for China. And anyway, no one believed TCM could be really used to treat HIV/AIDS," Luo said.

In 1998, Luo's research made some major progress and the achievement was posted in his institute's newspaper.

"A visiting Thai public health official found the report and immediately contacted me," Luo said.

The Thailand Government decided to finance Luo's research and offer the necessary equipment for clinical trials to take place.

In China, encouraged by TCM's potential to treat AIDS, China's health authorities have launched a programme to offer free TCM-based treatments to AIDS sufferers.

So far, the programme, chaired by Wei, covers 2,300 patients across five Chinese provinces. The number may double over next year.

The Ministry of Health estimates there were 840,000 HIV/AIDS patients in China in 2003. Experts warn that without effective control measures, the number of HIV carriers may exceed 10 million by 2010.

Challenges remain

Despite the promises, David Ho at New York-based Rockefeller University and the inventor of ****tail therapy, said there was no compelling evidence published in internationally recognized journals that TCM actually enhances immunity.

"I see no reason why TCM would not have some benefits for the immune system or for stopping the spread of HIV. But these claims must be supported by scientific studies. Too few of them have been done properly," Ho says.

Wei and Jin say they have not published their clinical reports in international journals, partly because it is difficult to explain TCM in Western scientific jargon.

They also say their medicines are so far better at improving immunity than directly stopping disease progression.

Luo said TCM may not be powerful enough to kill the virus because many vital elements may be lost during the traditional processing methods.

Luo said some purification work has been done in the United States to insure better purification of active ingredients of TCM. Jin said her company has been negotiating with the World Health Organization and another South Asian country to perform wider clinical research there.

"Based on our current very limited knowledge of TCM at the molecular level, it is impossible for TCM to pass the evaluation process of the US Food and Drug Administration and the European Union's drug authorities," Jin said.

There are still few regulations on using traditional Chinese medicine to treat HIV/AIDS. Any search on the Internet for TCM and AIDS will come up with dozens of websites claiming effective treatments. Even Ke'aite is sold online, yet this is still undergoing clinical trials.

Wei admitted there was little national standardization in using TCM to treat AIDS. "To solve the problem, there should be some official indices to evaluate the true effects of TCM," Wei says.


(China Daily 11/23/2004 page13)

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Acupuncture Increases Nocturnal Melatonin Secretion And Reduces Insomnia And Anxiety: a Preliminary Report: Part I.

Provided by The Journal of Neuropsychiatry and Clinical Neurosciences on 12/1/2004
by Spence, D Warren; Kayumov, Leonid; Chen, Adam; Lowe, Alan; Et al

Originally Published:20040101.

The incidence of insomnia is estimated to be 35% to 40% of the adult population. It currently affects more than 60 million Americans, and this figure is expected to grow to 100 million by the middle of the 21st century.1,2 The defining characteristic of insomnia in the context of anxiety is a pattern of multiple arousals from sleep. Anxious subjects have difficulty maintaining sleep, spend less time in deep sleep, and their sleep is more fragmented than that of normal subjects.3-5 Conversely, sleep deprivation may produce symptoms that fall within the total complex of anxiety.4 Although current opinion suggests that insomnia and anxiety are separate entities, their symptoms overlap considerably. Individuals with insomnia and individuals with anxiety have elevated psychosomatic profiles on psychological tests,6-8 maintain chronically high states of arousal, and rely on an "internalizing" style of conflict resolution (DSM-IV, 4th Edition).9 These commonalities have prompted speculation10 that a common thread underlies the conditions, although their exact relationship, namely whether insomnia is the product of or simply a correlate of anxiety, is still inconsistently viewed in current diagnostic systems (i.e., the ICD-IO, DSM-IV and ICSD [International Classification of Sleep Disorders]).11 It is nevertheless true that the dual diagnostic pattern of anxious insomnia is the most commonly seen problem in sleep disorder clinics today.12 The high rate of comorbidity between anxiety and insomnia, coupled with the high population incidence of insomnia, undoubtedly account for this phenomenon. Although we are unaware of any epidemiological studies on the incidence of anxiety which does not fulfill the criteria for a defined anxiety disorder, it is reasonable to infer that a large segment of the population may have "subsyndromal" anxiety, symptoms that are not associated with debilitating psychopathology, but which nevertheless produce a significant degree of mental discomfort.

Traditional treatment strategies for anxious insomnia have emphasized benzodiazepines. The useful anxiolytic effects of these agents have made them the most widely prescribed of all pharmaceuticals.13 The risks of benzodiazepines, however, are well documented and involve physical as well as psychological effects. These include their potential to promote dependence or acute toxicity in overdose.14,15 Other adverse effects include sedation, psyc****tor and cognitive impairment, memory loss, potentiation of other CNS depressants, and treatment-emergent depression.16 Acupuncture, which relies on the release of neurally active agents from endogenous stores, has been shown to have a superior side effect profile compared to some psychoactive drugs17,18 and may thus represent a means for addressing the concerns about benzodiazepine therapy.

Evidence supporting acupuncture's utility as a treatment for insomnia has come from a variety of sources, including the non-western scientific literature. Among these, investigations by Nan and Qingming,19 Jiarong,20 and Cangliang21 showed positive results. The shortcoming of these studies, however, is that their dependent measures have usually been inexact, relying mainly on subjective accounts of sleep experience or duration, and consequently, despite the consistency of their support for acupuncture, they are difficult to evaluate. Several European studies22-24 used polysomnography to measure acupuncture effects on sleep disorders, but all failed to monitor nocturnal neurochemical changes which would have strengthened their experimental design.

It is known that stress mediation is multifactorial and strongly influenced by GABAergic25 and dopaminergic neurotransmission.26-27 The neurohormone melatonin may also be involved in these effects. Melatonin is a CNS depressant with anxiolytic,28-29 mild hypnotic30 and anticonvulsant actions31 which may be related to its enhancements of GABAergic32-33 and striatal dopaminergic34-35 transmission. The effect of melatonin on mood and chronobiological functions has been established in a number of studies. The pattern of melatonin secretion over a 24-hour period is widely accepted as a measure of circadian activity in humans.36"37 This pattern is disrupted in insomnia. Compared to normal patients, those with insomnia have suppressed nocturnal outputs of melatonin38-39 and are more likely to have histories of depression.40 As noted above, the anxiolytic effects of melatonin have been recently established in rodent models.41-43 In humans, abnormalities in melatonin secretion have been confirmed in patients with bipolar I disorder.44 Taken together these findings support the inference that melatonin deficiency may play a key role in anxiety-associated insomnia.

Some evidence has also been provided that melatonin interacts with the opioid peptides.45-46 Melatonin is both utilized and synthesized following acute pain episodes in humans,47 the function of which may be to modulate fluctuations in opioid receptor expression and levels of beta-endorphin.48 The relationship of melatonin with the opioidergic system is complex and not completely understood, although there is evidence that it has mixed opioid receptor agonist-antagonist activity.49 In aggregate these findings lend support to the postulate of a "melatonin-opioid axis"48 possibly serving a variety of protectant functions.

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Part II:

Evidence of the endogenous opioid basis of acupuncture analgesia has been supported both in human50"51 and animal studies.52-53 These have shown that acupuncture analgesia treatment increases CSF levels of met-enkephalin, beta-endorphin, and dynorphin and can be reversed by the opiate receptor blocker naloxone. These findings are relevant to the present study inasmuch as the opioids not only mediate analgesia they also play a central role in subjectively experienced stress. In normal human subjects plasma beta endorphin levels are increased just before or after a stressful experience,54-55 and are associated with feelings of euphoria that is reported following, for example, bungee jumping.56 In depressed patients elevated plasma beta endorphin levels are positively correlated with severe stress and phobia,57 while anxious subjects show increases in beta endorphin immediately before and after cognitive and social Stressors.58 There is thus a reasonable basis for the inference that acupuncture modulates anxious responses and that these effects are mediated by the endogenous opioid system.

At the present time there have been only a few studies of acupuncture's effects on melatonin. In one of these however59 acupuncture was found to promote increases in melatonin in the pineal, the hippocampus, and in serum in rats.

The present study sought to use objective measures, including an analysis of 24-hour melatonin levels in urine, to evaluate acupuncture's effects on insomnia and anxiety. The hypotheses for this study were that a 5-week regimen of acupuncture would promote statistically significant improvements in polysomnographic markers of sleep quality, reduce anxiety (scores on the STAI), and enhance endogenous melatonin production in individuals scoring high on measures of anxiety and insomnia.

METHODS

Eighteen adult volunteers served as subjects in the study. To fulfill the inclusion criteria they had to report having symptoms of insomnia for at least two continuous years immediately prior to the study and to score above 50 (anxiety range) on the Zung Anxiety Self Rating Scale. The Zung is a validated self-administered rating scale60 employing a 20-item list of symptoms in a Likert scale response format. The selected subjects had symptoms of anxiety but did not fulfill DSM-IV criteria for any particular anxiety disorder (i.e., their condition was subsyndromal). Of the 18 subjects 11 were women and 7 were men. all subjects were between the ages of 18 and 55. Their mean age was 39.0 ± 9.6 years. One was of Chinese descent, two were black, and 15 were Caucasian. Prior to participation in the study all had heard of acupuncture and three reported having had acupuncture treatment in the past for conditions unrelated to their sleep problems. In no instance did any of the subjects have acupuncture treatment in the two years prior to participation in the study. The subjects were recruited through several sources, including newspaper advertising, posters placed on hospital bulletin boards, announcements made through the local chapter of an independent sleep-wake disorders patient support group, and occasional notices on a public service program of a local television station.

An initial screening interview was carried out by a psychiatrist or by an associate qualified in psychological interviewing. A preliminary diagnosis for inclusion in the study was made on the basis of the International Classification of Sleep Disorders. The subjects had to report having at least two symptoms of insomnia (fragmented sleep, frequent awakenings, early morning awakenings followed by an inability to fall back to sleep, feeling tired in the morning despite having spent a normal period of time in bed) for at least two years duration and that this experience was not related to an obvious environmental stressor. Potential participants with any concurrent medical, psychological, or psychiatric factors which might account for their sleep difficulties were excluded from the study. Other exclusion criteria were: a history of shift work within five years prior to the study, presence of other sleep disorders, age of less than 18 or greater than 55, a history of alcohol or drug abuse, current use of neurally active medications, or concurrently undergoing psychotherapy. The study protocol was approved by the Human Ethics Committee of the University of Toronto, and written informed consent was obtained from all participants after the procedures had been fully explained. all subjects were asked to sign a Committee-approved consent form confirming that they understood the goals, risks, and potential benefits of the study and their right to withdraw from the study at any time.

The study investigated the use of traditional (symptomatic) acupuncture without augmentation from herbs, pharmaceuticals or hormonal agents. Concentrations of a major melatonin metabolite 6-sulpha toxymelatonin (aMT6s) in urine were measured before and after the study (as described below). This was to evaluate changes in the neurohormone as released from endogenous sources (melatonin was not administered as an experimental treatment). For each subject the trial was conducted over a 7-week period during which the active phase of acupuncture therapy was 5 weeks (two sessions per week, 10 sessions in total). The acupuncture was administered by a master acupuncturist (AC) who was also the director of an acupuncture training program and clinic. The acupuncture needles were disposed of immediately after use and sterile technique was strictly observed. Each acupuncture session lasted approximately one hour. During the 1-week period preceding and following the active treatment phase, subjects were tested with polysomnography at an administratively convenient time in the Sleep Research Laboratory of the University Health Network, Toronto Western Hospital site. Figure 1 illustrates the design of the study.

Two consecutive overnight polysomnographic studies were performed at baseline (before treatment) and at the end of the 5 weeks of treatment with acupuncture. Polysomnographic results obtained on the first night during the before and after stages of the experiment were not included in the analysis to avoid a possible "first-night" effect.61 The sleep parameters included the sleep latency, sleep efficiency, the total sleep time, the arousal index, the percentage of REM sleep and REM latency, and the amount of time spent in stages 1 through 4. Additionally data were collected on the Alpha rating, an evaluative index of sleep quality62 which included an assessment of sleep fragmentation. For the baseline recordings, subjects chose their own retiring and wake up times as was consistent with their normal routine. just before retiring on the second night of polysomnographic testing subjects were also asked to fill out several paper and pencil tests of mood and cognitive efficiency. These included the Toronto Alexithymia Scale,63 a standard pre-sleep questionnaire; the Stanford Sleepiness Scale (SSS)64; and a seven-item Fatigue Scale. Additionally they were asked to fill out the State-Trait Anxiety Inventory65 to gauge the effect of acupuncture on anxiety. The Center for Epidemiological Studies Depression Scale (CES-D)66 was used to assess the presence of depressive symptoms.