Acupuncture Research
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Research on acupuncture, collated and presented by acupuncturist Helen Smallwood at Shaftesbury Clinic, Bedford, UK
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Reporting Quality of Systematic Reviews/Meta-Analyses of Acupuncture

Reporting Quality of Systematic Reviews/Meta-Analyses of Acupuncture | Acupuncture Research |
PLOS ONE: an inclusive, peer-reviewed, open-access resource from the PUBLIC LIBRARY OF SCIENCE. Reports of well-performed scientific studies from all disciplines freely available to the whole world.


Reporting Quality of Systematic Reviews/Meta-Analyses of AcupunctureYali Liu,  Rui Zhang,  Jiao Huang,  Xu Zhao,  Danlu Liu,  Wanting Sun,  Yuefen Mai,  Peng Zhang,  Yajun Wang,  Hua Cao,  Ke hu Yang mail Published: November 14, 2014DOI: 10.1371/journal.pone.0113172ArticleAbout the AuthorsMetricsCommentsRelated ContentAbstractIntroductionMethodsResultsDiscussionSupporting InformationAcknowledgmentsAuthor ContributionsReferencesReader Comments (0)FiguresAbstractBackground

The QUOROM and PRISMA statements were published in 1999 and 2009, respectively, to improve the consistency of reporting systematic reviews (SRs)/meta-analyses (MAs) of clinical trials. However, not all SRs/MAs adhere completely to these important standards. In particular, it is not clear how well SRs/MAs of acupuncture studies adhere to reporting standards and which reporting criteria are generally ignored in these analyses.


To evaluate reporting quality in SRs/MAs of acupuncture studies.


We performed a literature search for studies published prior to 2014 using the following public archives: PubMed, EMBASE, Web of Science, the Cochrane Database of Systematic Reviews (CDSR), the Chinese Biomedical Literature Database (CBM), the Traditional Chinese Medicine (TCM) database, the Chinese Journal Full-text Database (CJFD), the Chinese Scientific Journal Full-text Database (CSJD), and the Wanfang database. Data were extracted into pre-prepared Excel data-extraction forms. Reporting quality was assessed based on the PRISMA checklist (27 items).


Of 476 appropriate SRs/MAs identified in our search, 203, 227, and 46 were published in Chinese journals, international journals, and the Cochrane Database, respectively. In 476 SRs/MAs, only 3 reported the information completely. By contrast, approximately 4.93% (1/203), 8.81% (2/227) and 0.00% (0/46) SRs/Mas reported less than 10 items in Chinese journals, international journals and CDSR, respectively. In general, the least frequently reported items (reported≤50%) in SRs/MAs were “protocol and registration”, “risk of bias across studies”, and “additional analyses” in both methods and results sections.


SRs/MAs of acupuncture studies have not comprehensively reported information recommended in the PRISMA statement. Our study underscores that, in addition to focusing on careful study design and performance, attention should be paid to comprehensive reporting standards in SRs/MAs on acupuncture studies.

Figures   12

Citation: Liu Y, Zhang R, Huang J, Zhao X, Liu D, et al. (2014) Reporting Quality of Systematic Reviews/Meta-Analyses of Acupuncture. PLoS ONE 9(11): e113172. doi:10.1371/journal.pone.0113172

Editor: Brett Thombs, McGill University, Canada

Received: November 5, 2013; Accepted: October 23, 2014; Published: November 14, 2014

Copyright: © 2014 Liu et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: Project supported by the National Natural Science Foundation of China (Grant No. 81373882) The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.


Systematic reviews (SRs) and meta-analyses (MAs) summarize large amounts of evidence and are a valuable tool for keeping clinicians up to date within their specialty [1], [2]. As with all research, however, the value of SRs/MAs depends on how the analyses are performed, the actual findings, and the clarity of reporting [3]. If key information is reported poorly, the potential usefulness of the SRs/MAs is diminished.

Since 1987, numerous researchers have recognized the need to evaluate the quality of these types of reviews. For example, in 1987 Sacks and colleagues [4] evaluated reporting in SRs/MAs and found that it was inadequate. The Consolidated Standards of Reporting Trials (CONSORT) Group subsequently developed the Quality of Reporting of Meta-Analyses (QUOROM) statement to address suboptimal MA reporting. Ten years later, an updated QUOROM statement—entitled Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement—was developed and published [3]. The PRISMA statement consists of a checklist of 27 study reporting items such as title, abstract, methods, results, discussion, and funding sources. The checklist is intended to guide authors of SRs/MAs to improve the consistency and quality of reporting.

Acupuncture, a traditional medicine technique, has been widely used in clinical practice for thousands of years in China and many western countries. The number of published SRs/MAs of acupuncture studies has increased considerably in recent years. As the transparency and completeness of SRs/MAs in many fields is still not optimal [5]–[8], we examined how well SR/MA reporting standards have been followed in the field of acupuncture and compared adherence to these standards in acupuncture SRs/MAs published in three different types of journals/databases.


The protocol for this study was written in Chinese and has not been published. The study was not a classical systematic review, but we tried to report it according to PRISMA Checklist [3](Text S1).

Inclusion/exclusion criteria

We included all SRs or MAs of acupuncture published in Chinese journals, international journals, and the Cochrane Database of Systematic Reviews (CDSR) prior to 2014. The experimental group of SRs/MAs of acupuncture studies was also compared with a control group of SRs/MAs of studies of other interventions, such as herbal medicine, massage and western medicine. Participants: human in any conditions, not animal; Intervention: acupuncture; Comparisons: sham acupuncture or other interventions, such as herbal medicine, massage, western medicine, etc; Outcomes: no limitations; Study design: SRs/MAs. We excluded SRs/MAs that focused primarily on traditional Chinese medicine (TCM) other than acupuncture (e.g., herbal medicine, massage).

Search strategy

We comprehensively and systematically searched the following literature archives for SRs/MAs published prior to 2014: CDSR, PubMed, EMBASE, Web of Science, Chinese Biomedical Literature Database (CBM), the TCM database, Chinese Journal Full-text Database (CJFD), Chinese Scientific Journal Full-text Database (CSJD), and the Wanfang database. Databases were searched three times: on March 24, 2011 for all entries submitted prior to March 2011, on June 12, 2012 for all entries submitted prior to January 2012 and on January 11, 2014 for all entries submitted prior to 2014. The search terms “acupuncture”, “needling”, “ear acupuncture”, “electroacupuncture”, “electro-acupuncture”, “acupuncture points”, “acupressure”, “moxibustion”, and “acupoint” were used with the terms “systematic review” or “meta-analysis”. The search strategy is presented in Checklist S1.


The titles and abstracts of the studies were independently screened by at least two reviewers (Jiao Huang, Xu Zhao, or Rui Zhang) based on inclusion and exclusion criteria, and the full text of potentially suitable articles was retrieved for further assessment (Text S2).

Data extraction and analysis

Data were extracted independently by at least two reviewers (Rui Zhang, Jiao Huang, Xu Zhao, or Danlu Liu) in accordance with the PRISMA checklist and the assessment checklist for SRs/MAs of acupuncture studies developed for this study. Inconsistencies were subsequently resolved by discussion between the two reviewers or final decisions were made by the third principal investigator (Yali Liu). Data input utilized a standardized form and was done by trained data extractors (Wanting Sun, Pen Zhang, and Hua Cao). The form consisted of a general characteristics section (title, first author, funding source, study design, disease(s) examined, diagnostic criteria, intervention, and outcome) and a 27-item PRISMA information section (including title, abstract, introduction, method, results, discussion, and funding). Each item was assessed as “yes” if it was described in the paper or “no” if it was not (Text S3). Data were summarized with descriptive statistical analysis. For continuous data, the means ± SD was provided and one-way ANOVA was used. Data that followed a normal distribution were compared using the LSD- t test. Dichotomous data were summarized with descriptive statistical analysis (frequency, percentage). Pearson's χ2 test and/or Fisher's exact test were used to assess differences in reporting among groups. P values less than 0.05 were considered significant. All statistical analyses were performed using Microsoft Excel (version 2007) and SPSS (version 13.0) software.


Our initial literature search identified 3993 potential SRs/MAs of acupuncture-related studies. After closer examination, 476 were chosen for inclusion in our analysis (Text S4). Of these, 203, 227, and 46 were published in Chinese journals, international journals, and CDSR, respectively. A flow chart of the literature search is shown in Figure 1.

 Download:PPTPowerPoint slidePNGlarger image (166KB)TIFForiginal image (299KB)

Figure 1. Flow chart of articles identified, included and excluded.

doi:10.1371/journal.pone.0113172.g001General characteristics

General characteristics of the SRs/MAs analyzed are summarized in Table 1. The earliest acupuncture SRs/MAs in Chinese journals and international journals were published in 2002 and 1989, respectively. The number of acupuncture SRs/MAs in Chinese and international journals increased sharply after 2005, whereas the majority of acupuncture SRs/MAs in CDSR were published between 2008 and 2013 (Figure 2).

 Download:PPTPowerPoint slidePNGlarger image (189KB)TIFForiginal image (551KB)

Figure 2. The number of included SRs MAs on acupuncture.

doi:10.1371/journal.pone.0113172.g002 Download:PPTPowerPoint slidePNGlarger image (82KB)TIFForiginal image (323KB)

Table 1. Characteristics of included studies.


Acupuncture SRs/MAs in Chinese journals were conducted entirely by Chinese authors, whereas those published in international journals tended to be multinational collaborations, with Chinese first authors being most prevalent (27.31%, 62/227). Chinese authors were also most prevalent first authors in CDSR studies (34.78%, 16/46). The percentage of published acupuncture SRs/MAs in Chinese journals, international journals, and the CDSR that reported at least one funding source was 54.19% (110/203), 50.66% (115/227), and 89.13% (41/46), respectively, and the maximum number of funding sources reported was 5, 3, and 7, respectively.

The majority of SRs/MAs (95.37%, 454/476) included at least one randomized controlled trial (RCT). Nervous system diseases, musculoskeletal system diseases, and mental illness were most frequently examined (23.11, 18.91 and 13.44%, respectively). Approximately 38% (180/476) of the SRs/MAs reported western diseases or TCM syndromes in their diagnostic criteria. All acupuncture SRs/MAs examined described the interventions in detail. 39.92% (190/476) and 19.54% (93/476) SRs/MAs included adverse events and quality-of-life in the outcome which were reported as primary and/or secondary outcomes.

PRISMA information reporting

Comparison of PRISMA reporting among the three types of journals/databases (Table 2)

 Download:PPTPowerPoint slidePNGlarger image (384KB)TIFForiginal image (996KB)

Table 2. Reporting of checklists for PRISMA statement.


Among 476 SRs/MAs, only 3 reported the information completely. By contrast, approximately 4.93% (1/203), 8.81% (2/227) and 0.00% (0/46) SRs/MAs reported less than 10 items on the checklist in Chinese journals, international journals, and CDSR, respectively. In general, the least frequently reported items (reported≤50%) in SRs/MAs were item 5 (“protocol and registration”), 15 and 22 (“risk of bias across studies”), and 16 and 23 (“additional analyses”). The remaining items on the checklist were adequately reported (i.e >90%), with the items listed in Table 2 being especially well reported.

Comparison of PRISMA reporting before and after release of the PRISMA statement (Table 3)

 Download:PPTPowerPoint slidePNGlarger image (397KB)TIFForiginal image (1.05MB)

Table 3. The comparison for Reporting of checklists for SRs/MAs on PRISMA statement.


We found no statistical difference (P>0.05) for item 2 (“structured summary”), 5 (“protocol and registration”), 6 (“eligibility criteria”), 8 (“search”), 10 (“data collection process”), 11 (“data items”), 12 (“risk of bias in individual studies”), 16 (“additional analyses”), 17 (“study selection”), 18 (“study characteristics”), 23 (“additional analysis”) and 27 (“funding”) between SRs/MAs published prior to release of the PRISMA statement and those published after its release. Unfortunately, the rate of reporting of two items (“objective” and “information sources”) had decreased in 2010–2013 compared with before 2010 (P<0.001).

Comparison of PRISMA reporting in Science Citation Index (SCI) and non-SCI journals (Table 3)

We found that PRISMA reporting in SRs/MAs in SCI journals was more complete overall than in non-SCI journals, especially for items 4 (“objective”), 5 (“protocol and registration”), 7 (“information sources”), 8 (“search”), 9 (“study selection”), 11 (“data items”), 23 (“additional analysis”), and 27 (“funding”) (P<0.001).


Over the last decade, numerous studies have assessed the quality of reporting in SRs/MAs by their compliance with assessment instruments such as the QUOROM and PRISMA statements [9]–[12]. These studies focused predominantly on SRs/MAs covering diagnostic research and critical care. Although some quality assessment studies have looked at acupuncture SRs/MAs [13]–[15], they have focused mainly on methodological diversity in database searching, risk of bias, and heterogeneity in search strategies among CDSR. Our study compared reporting quality and PRISMA compliance in acupuncture SRs/MAs between different journal types.

We found that the five PRISMA items, namely “Protocol and registration”, “Risk of bias across studies” (both in the methods and results), and “Additional analyses” (both in the methods andresults) in the methods and results, are not frequently reported, indicating that the overall quality of reporting in acupuncture SRs/MAs is far from adequate. Compared with SRs/MAs published in CDSR, those in Chinese and international journals were of inferior reporting quality. One possible explanation for the limited compliance may be that journals have failed to incorporate the PRISMA statement into their instructions to authors about submitting SRs/MAs[16]. We also found that SR/MA reporting was more complete in SCI journals than in non-SCI journals but that both require improvement in adherence to PRISMA standards.

Several studies have focused on the reporting quality of SRs/MAs covering the fields of TCM[17], [18], physical therapy [19], orthopaedics [20], and oral implantology [21] field, which showed that the reporting quality was indeed poor. Although differences exist between these results and those we repot here, the reporting of major items in the PRISMA statement was similar to what we found in our present study. Additional, Fleming PS et al. [22] found that the quality of reporting was considerably better in reviews published in CDSR (P<0.001) than in non-CDSR.

Both the QUOROM and PRISMA statements encourage the use of specific terms in the titles of SRs/MAs, which help to identify these studies. Because of the special title format requirements of the CDSR, however, SRs/MAs published in this database cannot conform to the QUOROM/PRISMA recommendation.

Unequivocal descriptions of the scientific background and rationale for using acupuncture in the treatment of both western diseases and TCM syndromes provide the reader with a better understanding of the research context and rationale of SRs/MAs. In this respect, SRs/MAs in the CDSR were more explicit in their descriptions than those in international or Chinese journals.

The importance of protocol consistency and registration of SRs/MAs to the transparency of reporting is underscored by the fact that they are considered key aspects of the “reporting guidelines for systematic review protocols” in the international prospective register of systematic reviews (PROSPERO) [23], [24]. We found that only SRs/MAs published in the CDSR provided protocol and registration details.

The PRISMA standards suggest that methodological details such as eligibility criteria, information sources, search strategies, study selection criteria, and data collection processes are necessary to judge the quality and accuracy of SRs/MAs. The majority of the SRs/MAs published in the CDSR adequately reported these items, whereas those published in Chinese and international journals did not. Eligibility criteria are an aspect of the PICOS criteria (participants, interventions, comparisons, outcomes, and study design) central to the PRISMA approach. We propose that it is equally important that search strategies be uniformly reported. Many international journals require information about search strategies in at least one database, and the flexibility of the CDSR layout allows reporting of search strategies for multiple databases. Chinese journals, however, rarely request search strategy information. There is also considerable need for more consistency in the databases obtain acupuncture studies. We propose that, AcuBriefs (, AcuBase (, Acudoc2 RCT (, and the TCM database are the most systematic and comprehensive sources for acupuncture information. Chinese RCTs make up the highest proportion of primary studies included in acupuncture SRs/MAs. If methods for sequence generation, allocation concealment, and study blindness are not adequately described, low-quality studies [25] may mislead reviewers.

We found that there is also considerable inconsistency in reporting of study selection criteria. For example, many primary studies on acupuncture report a random allocation design but are not specific enough for the reader to determine if they are actual RCTs. We propose that these uncertainties should be clarified by contacting the primary authors to determine the appropriateness of including the studies in the SRs/MAs. Because it has been suggested that only 6.8% of acupuncture efficacy studies published in Chinese journals are based on actual RCTs [25], we strongly propose that authors of SRs/MAs verify this information prior to inclusion of studies.

Acupuncture is considered an alternative or complementary treatment to western medical interventions such as drugs and surgery, and it can be considered a separate specialty. Thus, SRs/MAs on acupuncture require not only compliance with general PRISMA reporting standards but also accurate reporting of acupuncture information. As a result, it is necessary to develop an extension of the PRISMA statement for acupuncture.

There are several limitations to our study. First, our analyses were limited to acupuncture-specific SRs/MAs and therefore may not be applicable to SRs/MAs in other fields. Second, our assessment process was not blinded, and therefore the outcomes may be influenced by publication date and other factors. Third, our assessment criteria (yes or no) did not allow partial information to be used. Fourth, our study focused primarily on acupuncture rather than other TCM. We failed to distinguish acupuncture from herbal medicine massage, or western medicine because individual SRs/MAs we included in our analysis often contained several control groups rather than one group.

In summary, SRs/MAs of acupuncture studies have not comprehensively reported the information recommended in the PRISMA statement. Our study underscores that, in addition to focusing on careful study design and performance, attention should be paid to comprehensive reporting standards when publishing SRs/MAs of acupuncture studies.

Supporting InformationChecklist_S1.doc 1 / 5 figsharedownload

PRISMA Checklist.

Checklist S1.

PRISMA Checklist.



Text S1.

The English and Chinese databases search strategy.



Text S2.

Inclusion Exclusion Section.



Text S3.

Definitions of reporting items.



Text S4.

476 SRs/MAs of acupuncture.




We thank Yongteng Xu, Xianxia Yan, Shengping Yang, Xin Tian, Yannan Zhou,Yiming Lu, Qingshan Guo (Lanzhou University) for previous work that contributed to the development in this study. We thank BiomEditor for providing assistance with final revision of the manuscript.

Author Contributions

Conceived and designed the experiments: YLL KHY. Performed the experiments: RZ JH XZ DLL WTS PZ HC. Analyzed the data: YFM JH. Contributed reagents/materials/analysis tools: YJW. Wrote the paper: YLL RZ.

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Acupuncture in patients with osteoarthritis of the knee: a randomised trial : The Lancet

Acupuncture in patients with osteoarthritis of the knee: a randomised trial : The Lancet | Acupuncture Research |

The Lancet, Volume 366, Issue 9480, Pages 136 - 143, 9 July 2005<Previous Article|Next Article>doi:10.1016/S0140-6736(05)66871-7Cite or Link Using DOI Copyright © 2005 Elsevier Ltd All rights reserved.Acupuncture in patients with osteoarthritis of the knee: a randomised trialDr C Witt MD a , B Brinkhaus MD a, S Jena MSc a, K Linde MD c, A Streng PhD c, S Wagenpfeil PhD d, J Hummelsberger MD f,HU Walther MD b, D Melchart MD c e, Prof SN Willich MD aSummaryBackgroundAcupuncture is widely used by patients with chronic pain although there is little evidence of its effectiveness. We investigated the efficacy of acupuncture compared with minimal acupuncture and with no acupuncture in patients with osteoarthritis of the knee.MethodsPatients with chronic osteoarthritis of the knee (Kellgren grade ≤2) were randomly assigned to acupuncture (n=150), minimal acupuncture (superficial needling at non-acupuncture points; n=76), or a waiting list control (n=74). Specialised physicians, in 28 outpatient centres, administered acupuncture and minimal acupuncture in 12 sessions over 8 weeks. Patients completed standard questionnaires at baseline and after 8 weeks, 26 weeks, and 52 weeks. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index at the end of week 8 (adjusted for baseline score). All main analyses were by intention to treat.Results294 patients were enrolled from March 6, 2002, to January 17, 2003; eight patients were lost to follow-up after randomisation, but were included in the final analysis. The mean baseline-adjusted WOMAC index at week 8 was 26·9 (SE 1·4) in the acupuncture group, 35·8 (1·9) in the minimal acupuncture group, and 49·6 (2·0) in the waiting list group (treatment difference acupuncturevs minimal acupuncture −8·8, [95% CI −13·5 to −4·2], p=0·0002; acupuncture vs waiting list −22·7 [−27·5 to −17·9], p<0·0001). After 52 weeks the difference between the acupuncture and minimal acupuncture groups was no longer significant (p=0·08).InterpretationAfter 8 weeks of treatment, pain and joint function are improved more with acupuncture than with minimal acupuncture or no acupuncture in patients with osteoarthritis of the knee. However, this benefit decreases over time.

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Acupuncture article: EJOM Blood deficiency

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Acupuncture and moxibustion for stress-related disorders - "good for musculoskeletal symptoms" ... "effect on central, autonomic nervous, immune, metabolic, and endocrine systems to regulate the wh...

Acupuncture and moxibustion for stress-related disorders - "good for musculoskeletal symptoms" ... "effect on central, autonomic nervous, immune, metabolic, and endocrine systems to regulate the wh... | Acupuncture Research |

Acupuncture and moxibustion for stress-related disorders

Tetsuya Kondo and Masazumi Kawamoto

Additional article information


Acupuncture and moxibustion, which medical doctors are licensed by the government of Japan to perform, can improve the psychological relationship between doctors and patients, especially when it is disturbed by a “game”, a dysfunctional interpersonal interaction that is repeated unintentionally.


This advantage is due to the essential properties of acupuncture and moxibustion. Acupuncture and moxibustion are helpful in treating somatoform disorders, especially musculoskeletal symptoms. In Japan, a holistic acupuncture and moxibustion therapy called Sawada-style has been developed. This is based on fundamental meridian points that are considered to have effects on central, autonomic nervous, immune, metabolic, and endocrine systems to regulate the whole body balance. In addition, some of the fundamental points have effects on Qi, blood, and water patterns associated with major depression, generalized anxiety disorder, eating disorders, and somatoform disorders.


The fixed protocol of Sawada-style would be suitable for large-scale, randomized, controlled studies in the future. Recent systematic reviews indicate that electroacupuncture would be a useful addition to antidepressant therapy for some symptoms accompanying fibromyalgia. Acupuncture and moxibustion are also recommended for irritable bowel syndrome, instead of Western drug therapy.


Surprisingly, the dorsal prefrontal cerebral cortex, which is associated with a method of scalp acupuncture applied for gastrointestinal disorders, has been found to be activated in patients with irritable bowel syndrome. It is quite possible that regulation of this cortical area is related to the effect of scalp acupuncture. This acupuncture method can be effective not only for irritable bowel syndrome but also for other stress-related gastrointestinal disorders.


Keywords: Acupuncture, Moxibustion, Stress, Fibromyalgia, Functional gastrointestinal disorder, Irritable bowel syndrome, Autonomic nervous system, Hypothalamo-pituitary adrenal axis, Sawada-style holistic therapy

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DNA Staining Reveals the Existence of the Meridian Sub Systems

A previous article in Acupuncture Today referred
to an unpublished research article by Jiang et
al. (2004) that aimed to find the existence of
the meridians (D’Alberto 2005). Now, further research
in South Korea has revealed the existence of the
meridian subsystems using DNA-staining (Shin et al.
2005). The Shin et al. (2005) study in part, replicated
the original discovery made in 1963 by Bonghan Kim
in North Korea. The validity of Kim’s study has been
disputed since then, but several recent studies confirm
that he may have been correct (Cho et al. 2004, Lee et
al. 2004a, Lee et al. 2004b).
Bonghan Kim’s study involved the use of a secret
staining formula to isolate the meridians. This formula
was lost with Bonghan Kim’s death. Pierre de
Vernajoule replicated part of Bonghan Kim’s study in
humans during the mid 1980s as did Giovanardi,
Lonardo, and Abbati in 1992. Later in 2004 Lee BC
et al. developed an acridine orange fluorescence
method that isolated the subsystem ducts and allowed
them to be distinguished from fibrin threads. Until now,
the subsystem ducts were usually mistaken as being
coagulated fibrin threads during surgery. These ducts
were further isolated on the internal organs. Shin et al.
(2005) used a DNA-staining method (Feulgen reaction)
to differentiate these ducts from lymph vessels.
So why was the meridian subsystem duct network not
found until now? Shin et al. (2005) argue that these
structures are very small, cannot be easily detected
with the naked eye or with a low-magnification
surgical microscope, are semitransparent and are
commonly mistaken for lymph vessels. The difference
between these threadlike ducts and the lymph vessels is
that the threadlike ducts are found in bundles whereas
the lymph vessels are known to be singular tubes. The
threadlike ducts house granules which also contain
DNA, whereas lymph vessels do not. In addition, the
threadlike tissues can move freely as they are not fixed
to the surface of the internal organs. This is in contrast
to the lymph vessels, which cannot move freely as they
are fixed to the surface of the internal organs. Lastly,
the threadlike sub ducts contain 1µm sized granules
whereas lymph vessels carry 5 µm or larger
Many researchers of acupuncture believe that
acupuncture works via neurophysiological mechanisms,
involving segmental, intersegmental and supraspinal
reflexes, autonomic and neuro-humoral modulation
(Rogers 2005). However, Shin et al. (2005) state
another theory, in which the meridians are part of a
third circulatory system formed by interstitial
connective tissue, which links the surface of the body
with the internal organs and cells throughout the body.
Connective tissue consists largely of crystal collagen
fibres. Therefore, it may conduct electricity and create
piezo-electrical effects that alter the electrical
characteristics of the system. The liquid that flows
through the sub ducts contains 1-2 µm sized DNA
containing granules that correlates with therapeutic
effects to damaged internal organs.
The study by Shin et al. (2005) notes the similarities
between the granules in the Jingluo subsystems and
microcells used to study cancer and Down’s syndrome.
The granules and microcells are similar in size and
shape, and have intensively stained nuclei, both having
a thin outer membrane and one chromosome amount of
DNA inside. The internal organs generate the granules
found in the sub ducts by a natural in vivo process and
pass through the network of ducts, whereas a chemical
substance is used to generate the microcells in vitro.
Shin et al. (2005) also noted different threadlike
structures in different animal subjects. It is unclear
whether this is because of human error in detecting the
structures, or because of developmental irregularities in
the animals tested. If these differences relate to
differences in response to acupuncture, it may explain
why acupuncture is effective in some subjects and not
in others. Research is needed to examine this further.
This research is still in its early stages. At this time, it
is not detailed enough to confirm that the course of the
thread-like ducts on the surface of the body
corresponds exactly with the course of the meridians,
as described in classical and modern acupuncture texts.
Therefore, we must await confirmation from future
research that the complete Jingluo system, including
subsystems as well at the actual acupoints, can be
isolated and identified. Identification of the substance [...]

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Acupuncture enhances antidepressant effect of Seroxat - Phys.Org

Acupuncture enhances antidepressant effect of Seroxat - Phys.Org | Acupuncture Research |
Acupuncture enhances antidepressant effect of Seroxat
Acupuncture is more effective than oral antidepressants in improving depressive symptoms, and produces fewer side effects than tricyclic antidepressants.

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Dr. Max Gomez: Study Finds Acupuncture Can Relieve PMS - CBS Local

Dr. Max Gomez: Study Finds Acupuncture Can Relieve PMS - CBS Local | Acupuncture Research |
Dr. Max Gomez: Study Finds Acupuncture Can Relieve PMS
CBS Local
“So, patients will typically come in to see an acupuncturist if they've been on medication that's not working.

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Acupuncture Improves Appendicitis Recovery, New Study

Acupuncture Improves Appendicitis Recovery, New Study | Acupuncture Research |
Acupuncture improves recovery periods after appendectomy. New research finds intestinal function is sped up significantly.


on 01 May 2014.


Researchers conclude that combining acupuncture with conventional biomedical post-operative care improves patient outcomes for cases of appendicitis treated with surgical removal of the appendix. Acupuncture improved surgical recovery rates including a more rapid recovery of intestinal function. As a result, the research team concluded that acupuncture after an appendectomy is an effective modality for improving patient recoveries. 

Researchers from the Shanxi Hospital of Traditional Chinese Medicine (TCM) randomly divided 60 acute suppurative appendicitis cases equally into an acupuncture group and a control group. Suppurative appendicitis is a type of acute appendicitis with purulent exudate that is filled with bacteria and inflammation related fluids. This type of appendicitis is often severe, painful, late-stage and life threatening. The acupuncture group receiving the same care as the control group but with the addition of post-operative acupuncture treatments. The acupuncture group significantly outperformed the control group regarding the recovery of intestinal function. 

An appendectomy, surgical removal of the appendix, is often performed as an emergency procedure to prevent sepsis and morbidity. In the absence of access to surgical facilities, intravenous antibiotics are often used to prevent sepsis. Many cases treated with perioperatively with intravenous antibiotics resolve completely. Other cases require surgery. This is often performed laparoscopically, a minimally invasive surgical procedure when compared with an open operation.

The researchers investigated the effects of acupuncture on the recovery state of suppurative appendicitis patients who received laparoscopic appendectomies. Anesthesia combined with surgical trauma for the procedure requires a recovery period. A better and more rapid recovery period contributes to improved patient outcomes. After an appendectomy, the intestines are in a protective numb state due to the impact of the operation and anesthesia, causing the slowing down or even stopping of intestinal movement. Therefore, recovering the intestinal function as quickly as possible is critical in reducing the occurrence of intestinal adhesions and obstructions. 

The primary acupuncture points used in the study were Zhongwuan (CV12), Tianshu (ST25) and Shangjuxu (ST37). In Traditional Chinese Medicine (TCM) theory, these points have special functions. CV12 is the front Mu point of the stomach, the influential point for all yang organs, regulates stomach qi and transforms rebellious qi. As a result, this point is indicated for the treatment of stomach and intestinal disorders. ST25 is the front Mu point of the Large Intestine, regulates the function of the intestines, regulates qi and eliminates stagnation. It is often used for the treatment of abdominal disorders including obstructions, diarrhea, pain, distention and edema. ST25 is also widely used in the treatment of menstrual disorders. ST37 is the lower He Sea of the large intestine and is a Sea of Blood point. ST37 regulates the intestines and stomach, clears damp-heat and eliminates accumulations. It is widely used in the treatment of abdominal disorders.

After the appendectomy, the control group received routine biochemical medications while the treated group received acupuncture plus routine biochemical medications. Acupuncture was applied on the first day following operation. The primary acupoints were Zusanli (ST36), CV12, ST37 and ST25. Secondary acupoints were chosen according to differential diagnoses of individual patients: Taichong (LV3) for hyperactivity of Liver-yang, Fenglong (ST40) for damp-heat retention in the Spleen and Neiguan (PC6) for nausea and vomiting. Once the deqi sensation was achieved with manual acupuncture, electroacupuncture was applied using a continuous wave at 6-9V for 30 minutes. Acupuncture was applied once daily for three consecutive days.

After the treatment, the researchers used standard measurements to determine intestinal motility and restoration of function. Acupuncture significantly improved the recovery rates of the first flatulence, borborygmus and defecation. Based on these results, the researchers conclude that timely acupuncture after an appendectomy speeds up the recovery of intestinal function and thus the recovery of the patient.

Li, Pengfei, Junhua Ren, and Yonghong Dong. “Clinical observation of acupuncture on recovery of intestinal function after acute suppurative appendicitis.” Clinical Journal of Chinese Medicine 4 (2014): 59-60.

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Changes in Blood Fluidity Caused by Electroacupuncture Stimulation - Journal of Acupuncture and Meridian Studies

Changes in Blood Fluidity Caused by Electroacupuncture Stimulation - Journal of Acupuncture and Meridian Studies | Acupuncture Research |

In Oriental medicine, the state of blood stagnation is called “Oketsu,” meaning preceding state or symptomatic of sickness. Acupuncture stimulation is often used clinically for the treatment of “Oketsu.” The degree of “Oketsu” is indicated by tongue color and form, swelling, paroxysmal blushing, and dark circles under the eyes. The blood's fluidity is generally thought to be a blood stagnation factor. “Oketsu” is now considered as physiological blood flow and is studied from the perspective of the blood's fluidity and vascular resistance. In our preliminary research, acupuncture stimuli were very effective in treating conditions associated with a decrease in the fluidity of the blood, such as “Oketsu.” In this review, we discuss recent progress in acupuncture therapy and report mechanisms of its action; we then focus on our original findings on these topics. Furthermore, we propose new factors related to acupuncture stimuli, including the blood's fluidity, and report our investigations, using the restraint stress method, on the mechanisms underlying acupuncture stimuli.

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Study Suggests That Both Traditional and Simulated Acupuncture Relieve Pain but by Different Mechanisms | NCCAM

Study Suggests That Both Traditional and Simulated Acupuncture Relieve Pain but by Different Mechanisms | NCCAM | Acupuncture Research |


Although acupuncture has long been used to treat pain, the underlying cellular and molecular mechanisms are not fully understood.


Study Suggests That Both Traditional and Simulated Acupuncture Relieve Pain but by Different Mechanisms

Although acupuncture has long been used to treat pain, the underlying cellular and molecular mechanisms are not fully understood. The process appears to involve the brain’s ability to produce opioids (pain-reducing chemicals) that bind to neurons in distinct regions of the brain, and the ability of neurons to produce receptors for these endogenous opioids—specifically, μ-opioid receptors (MORs). Recent clinical trials have indicated that both traditional (actual) and simulated (sham/placebo) acupuncture decrease pain, but other studies have suggested that the neural mechanisms involved may be different.

To investigate these neural mechanisms, NCCAM-funded researchers at the University of Michigan randomly assigned 20 women diagnosed with fibromyalgia (a chronic pain condition) to receive either traditional acupuncture or simulated acupuncture treatments in 9 sessions over 4 weeks. (In traditional acupuncture, needles are inserted at specific points on the body. Simulated acupuncture mimics this procedure, but without piercing the skin or using specific points. Participants did not know which treatment they were receiving.) At the initial session and again at the ninth, the women had positron emission tomography scans to analyze MOR binding potential in the brain, and they completed a questionnaire to assess pain intensity.

Traditional acupuncture increased MOR binding potential, in both the short term (right after the first treatment) and the long term (after 4 weeks), in several regions of the brain that process pain. Simulated acupuncture generally resulted in slight reductions in MOR-binding potential. Both traditional and simulated acupuncture groups experienced similar, significant reductions in clinical pain. In the traditional acupuncture group, greater long-term increases in MOR-binding potential were associated with greater reductions in pain.

The researchers concluded that, in fibromyalgia patients, different mechanisms appear to be involved in the analgesic effects of traditional acupuncture and simulated acupuncture. By increasing MOR-binding potential, traditional acupuncture appears to help the brain use endogenous opioids more effectively. The slight reduction in MOR-binding potential suggests that simulated acupuncture increases the brain’s production of opioids. The researchers recommend additional studies to determine whether these differences are related to skin penetration of the acupuncture needles, point location, or both.

ReferencesHarris RE, Zubieta J-K, Scott DJ, et al. Traditional Chinese acupuncture and placebo (sham) acupuncture are differentiated by their effects on μ-opioid receptors (MORs). NeuroImage. 2009; 47(3):1077–1085.Additional ResourcesAcupuncture for Pain Publication Date: September 6, 2009

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Is there an "Acupuncture Molecule" ? Test show acupuncture affects your body on a molecular level: - the Classical Medicine Journal - Health, Medicine, And Breaking News on the Alternative Treatmen...

Is there an "Acupuncture Molecule" ? Test show acupuncture affects your body on a molecular level: - the Classical Medicine Journal - Health, Medicine, And Breaking News on the Alternative Treatmen... | Acupuncture Research |


 there an "Acupuncture Molecule" ? Test show acupuncture affects your body on a molecular level:FRIDAY, JANUARY 6, 2012 AT 10:17AM

 Researchers at Georgetown University Medical Center have found that acupuncture reduces the levels of a protein-like substance in rats linked to chronic stress.

 If replicated in humans, acupuncture could offer a therapy for stress, which is often difficult to treat. 

“It has long been thought that acupuncture can reduce stress, but this is the first study to show molecular proof of this benefit,” said the study’s lead author, Ladan Eshevari, Ph.D., an assistant professor. 
Eshkevari, a certified acupuncturist, conducted the study because many of the patients she treats with acupuncture reported a “better overall sense of well-being — and they often remarked that they felt less stress.” 
 While the World Health Organization states that acupuncture is useful as adjunct therapy in more than 50 disorders, including chronic stress, Eshevari said that no one has biological proof that it does so. 
She designed a study to test the effect of acupuncture on blood levels of neuropeptide Y (NPY), a peptide that is secreted by the sympathetic nervous system in humans. This system is involved in the “flight or fight” response to stress. 
 Rats are often used to research the biological determinants of stress because they mount a stress response when exposed to winter-like cold temperatures for an hour a day.

 Eshevari allowed the rats to become familiar with her, and encouraged them to rest by crawling into a small sock that exposed their legs. She conditioned them to become comfortable with the kind of stimulation used in electroacupuncture — an acupuncture needle that delivers a painless, small electrical charge. 
This form of acupuncture is a little more intense than manual acupuncture and is often used for pain management, she said, adding “I used electroacupuncture because I could make sure that every rat was getting the same treatment dose.”

 She then selected a single acupuncture spot to test: Zuslanli (ST 35 on the stomach meridian), which is said to help relieve a variety of conditions, including stress. That acupuncture point for rats — and humans — is on the leg below the knee.

 The study, published online in December in Experimental Biology and Medicine, utilized four groups of rats for a 14-day experiment: A control group that was not stressed and received no acupuncture; a group that was stressed for an hour a day and did not receive acupuncture; a group that was stressed and received “sham” acupuncture near the tail; and the experimental group that were stressed and received acupuncture to the Zuslanli spot on the leg.

 She found NPY levels in the experimental group came down almost to the level of the control group, while the rats that were stressed and not treated with Zuslanli acupuncture had high levels of the protein. 
In a second experiment, she stopped acupuncture in the experimental group but continued to stress the rats for an additional four days, and found NPY levels remained low. “We were surprised to find what looks to be a protective effect against stress,” she said.

 Source: Georgetown University Medical Center 2011/12/22/rat-study-shows- acupuncture-lowers-stress-molecule/32782.html

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Acupuncture Research: Examples of the State of the Science from Bench to Bedside

Acupuncture Research: Examples of the State of the Science from Bench to Bedside | Acupuncture Research |
Acupuncture Research: Examples of the State of the Science from Bench to Bedside
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Neurobiological Correlates of Acupuncture: Modern Science Explores Ancient Practice

Neurobiological Correlates of Acupuncture: Modern Science Explores Ancient Practice | Acupuncture Research |

Neurobiological Correlates of Acupuncture: Modern Science Explores Ancient Practice



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Journal of Chinese Medicine: Acupuncture reduces epidural use

Journal of Chinese Medicine: Acupuncture reduces epidural use | Acupuncture Research |

Acupuncture reduces epidural use  

A trial carried out in Sweden has found that women who received manual acupuncture (MA) or electro-acupuncture (EA) during labour used less epidural analgesia than women who received standard care. The longitudinal randomised controlled trial recruited 303 nulliparous women with normal pregnancies who were randomised to receive 40 minutes of either manual acupuncture (MA) or electro-acupuncture (EA), or standard care without acupuncture (SC). Subjective visual analogue pain scores did not differ between the three groups, however fewer women in the EA group used epidural analgesia (46%) compared with those in the MA group (61%) and SC group (70%). (Acupuncture with manual and electrical stimulation for labour pain: a longitudinal randomised controlled trial. BMC Complement Altern Med. 2014 Jun 9;14:187).

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The Roles of Acupuncture and Other Components of Integrative Medicine in Cataclysmic Natural Disasters and Military Conflicts

The Roles of Acupuncture and Other Components of Integrative Medicine in Cataclysmic Natural Disasters and Military Conflicts | Acupuncture Research |

The Roles of Acupuncture and Other Components of Integrative Medicine in Cataclysmic Natural Disasters and Military Conflicts

To cite this article:
Niemtzow Richard C., Marcucci Lisa, York Alexandra, Ives John A., Walter Joan, and Jonas Wayne B.. Medical Acupuncture. October 2014, 26(5): 255-263. doi:10.1089/acu.2014.1063.

Published in Volume: 26 Issue 5: October 16, 2014
Online Ahead of Print: September 24, 2014

Full Text HTML Full Text PDF (182.8 KB) Full Text PDF with Links (212 KB)Navigate ArticleTop of pageAuthor information <<ABSTRACTIntroductionPreparing for the Unexpec...A Systems Framework for R...Recent International and ...Examples of the Use of In...Acupuncture for Treating ...Other Integrative Medicin...Hormesis: Rapid Induction...ConclusionsDisclosure StatementReferencesAuthor informationRichard C. Niemtzow, MD, PhD, MPH,1 Lisa Marcucci, MD,2 Alexandra York, MS,3 John A. Ives, PhD,3 Joan Walter, JD, PA,3 and Wayne B. Jonas, MD31United States Air Force Acupuncture Center, Joint Base Andrews, MD.2InsideSurgery, LLC, Wayne, PA.3Samueli Institute, Alexandria, VA.

The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the United States Air Force Medical Corps, the Air Force at large, or the Department of Defense. The authors indicate that they do not have any conflicts of interests.

Address correspondence to:Richard C. Niemtzow, MD, PhD, MPHU.S. Air Force Acupuncture CenterJoint Base Andrews, Maryland 20762E-mail: n5evmd@gmail.comNavigate ArticleTop of pageAuthor informationABSTRACT <<IntroductionPreparing for the Unexpec...A Systems Framework for R...Recent International and ...Examples of the Use of In...Acupuncture for Treating ...Other Integrative Medicin...Hormesis: Rapid Induction...ConclusionsDisclosure StatementReferencesABSTRACT

Background: In the recent past, numerous natural disasters and wars have resulted in casualties on site that have been treated successfully by trained personnel using holistic medical techniques, including acupuncture, hypnosis, yoga, biofeedback and other techniques. Adaptations of several of these medical modalities may be taught to first responders.

Objective: This article provides a compilation of advice and techniques by practitioners of integrative medicine designed to aid first responders of cataclysmic natural disasters or military conflicts. Coverage includes simple, specific, integrative medicine modalities that have accessible techniques for most community-based responders.

Method: This overview describes techniques that have been found to be useful during natural disasters and armed conflicts, such as the Fukushima Daiichi earthquake and the battlefields of Iraq and Afghanistan. The more trained personnel who are able to respond in a crisis, the better the outcome will be for the wounded population.

Conclusions: Integrative medicine and traditional medicine techniques can be useful in times of natural cataclysmic disasters and military conflicts.

Navigate ArticleTop of pageAuthor informationABSTRACTIntroduction <<Preparing for the Unexpec...A Systems Framework for R...Recent International and ...Examples of the Use of In...Acupuncture for Treating ...Other Integrative Medicin...Hormesis: Rapid Induction...ConclusionsDisclosure StatementReferencesIntroduction

The purpose of this article is to explore the role that integrative medicine may play in a disaster and post-disaster environment, as well as in military conflicts. Integrative medicine will not take the place of classical Western medicine and life-saving surgery for resuscitation and stabilization; however, integrative medicine may mitigate significantly the psychologic and physical effects of stress and pain associated with natural disasters and military conflicts. For this reason, a discussion of the role of integrative medicine in these environments is warranted—especially some of the specific techniques and evidence that supports the use of integrative medicine.

The rescue, treatment, and evacuation of thousands of patients from a cataclysmic natural disaster or military conflict must be coordinated with a lead agency that is recognized and responsible for such an intervention. It cannot be anad hoc effort; rather it must be one that has been practiced repeatedly. Medical care must meet—at a minimum—the local health and international standards for disaster care.1

Mass casualty disasters place a severe strain not only on the victims but also on the people and resource personnel who have the extremely difficult task to rescue and care for hundreds to thousands of those victims. Their care often requires the enormous efforts of both local and international assistance. Any delays in the rescue of individuals or the provision of community resources and care will increase morbidity and mortality rates.1

Addressing the complex requirements involving the integration of many different communication systems and the difficulty of exchanging information among rescue agencies becomes a formidable technical challenge. This may be compounded by telecommunication-systems overload or failure and electrical-service disruption in the disaster areas.1

In addition, emergencies are characterized by a sudden need for an increase of information flow, an explosion in the topographical complexity of the information network, and a feeling of intense psychologic pressure among the participants involved in the early hours of the rescue. Unfortunately, many people and organizations who should be talking to each other do not do so until communication is urgently required because of an external emergency. Group members often find themselves confronted with unfamiliar procedures and with unknown partners in the crisis-management process. As a result, decisions may be made under conditions of low group trust and inadequate sharing of information.1

Established communication systems in most American communities consist of private services, state and federal agencies, and military and amateur radio operators. A disaster situation can disrupt routine hospital communication severely. Customary frequencies may be incompatible with military and emergency civilian frequencies or become overloaded and useless because of intense communication activity. In a cataclysmic disaster, local communication networks may be inadequate or unavailable to cope with the demands of the emergency. Disasters can stress health care systems to the breaking point and disrupt delivery of vital medical services.1 To the extent that care and relief can be allocated locally and rely less on these complicated systems, the less those relief components risk being slowed or entangled in those systems and the more timely and effectively care can be provided to the victims and affected communities.

Navigate ArticleTop of pageAuthor informationABSTRACTIntroductionPreparing for the Unexpec... <<A Systems Framework for R...Recent International and ...Examples of the Use of In...Acupuncture for Treating ...Other Integrative Medicin...Hormesis: Rapid Induction...ConclusionsDisclosure StatementReferencesPreparing for the Unexpected

Any area in the world that is prone to natural disasters should prepare for such an event. Even with regular disaster preparedness training and rehearsals, disaster medical workers may be hampered by the stress and fatigue caused by the actual disaster when it occurs, both of which may limit these rescuers' effectiveness as emergency providers. While a full discussion of critical logistic challenges, supplies, and specialized rescuers just for the initial first aid and rescue of the victims is beyond the scope of this article, it describes some approaches for allocating relief support to local communities as a possibility, using simple, integrative health care approaches that do not require extensive equipment, facilities, or supplies.

Navigate ArticleTop of pageAuthor informationABSTRACTIntroductionPreparing for the Unexpec...A Systems Framework for R... <<Recent International and ...Examples of the Use of In...Acupuncture for Treating ...Other Integrative Medicin...Hormesis: Rapid Induction...ConclusionsDisclosure StatementReferencesA Systems Framework for Responses to Catastrophic DisastersThe National Disaster Medical System

The National Disaster Medical System (NDMS) is a section of the United States Department of Health and Human Services, which is responsible for managing the federal government's medical response to major emergencies and disasters. The overall purpose of the NDMS is to supplement an integrated national medical response capability for assisting state and local authorities in dealing with the medical impacts of major peacetime disasters, and to provide support to the military and the Department of Veterans Affairs medical systems in caring for patients evacuated back to the U.S. from overseas armed conventional conflicts. The NDMS's federal partners include the Federal Emergency Management Agency, Department of Defense, and the Department of Veterans Affairs. The NDMS also interfaces with state and local Departments of Health, as well as with private hospitals.


NDMS has three major components:


(1) Emergency medical response by civilian medical teams, equipment, and supplies to a disaster area when local medical resources are overwhelmed


(2) Movement of ill and injured patients from a disaster area to unaffected areas


(3) Definitive care of patients in hospitals in areas unaffected by the disaster.


More than 8000 NDMS civilian volunteer medical individuals are organized into a number of types of medical teams, designed to accomplish an emergency medical response mission.

NDMS Teams

The NDMS is composed of several smaller teams, each of which focuses on a particular area of disaster relief. These include:


• Disaster Medical Assistance Team (DMAT)—provides medical care during a disaster or other incident


• National Medical Response Team—provides mass decontamination and medical care to victims of a release of weapons of mass destruction or a large-scale release of hazardous materials


• Disaster Mortuary Operational Response Team—provides victim identification and mortuary services during a disaster or other incident


• National Veterinary Response Team—provides assistance in assessing the need for veterinary services following major disasters or emergencies


• Federal Coordinating Centers—recruit hospitals and maintain local nonfederal hospital participation in the NDMS and coordinate exercise development and emergency plans


• National Pharmacy Response Team—assists with chemoprophylaxis or vaccination of large numbers of citizens in response to an emergency involving a disease outbreak


• International Medical Surgical Response Team—widely recognized as a specialized team, is trained and equipped to establish a fully capable field surgical facility anywhere in the world


• National Nurse Response Team—a specialty DMAT designed for a scenario requiring hundreds of nurses to assist in chemoprophylaxis, mass vaccination programs, or situations that overwhelm the nation's supply of nurses.


More than 1800 civilian hospitals in the United States are members of the NDMS. Their role is to provide ∼ 100,000 treatment beds to support NDMS operations in emergencies. When a civilian or military crisis requires the activation of the NDMS system, participating hospitals communicate information about their available bed space to a central control point. Patients can be distributed to a number of hospitals without overwhelming any one facility with casualties.2

The Red Cross provides significant aid to disaster victims from their volunteers and private donations. Their humanitarian efforts are unmatched worldwide not only during the rescue events but also in their post-rescue efforts to help stabilize wounded and demoralized victims by providing shelter and medicine. This organization serves as an important bridge for locating separated families and loved ones. The Red Cross is always present in the worst cataclysmic situations, bringing comfort and hope to victims.

Navigate ArticleTop of pageAuthor informationABSTRACTIntroductionPreparing for the Unexpec...A Systems Framework for R...Recent International and ... <<Examples of the Use of In...Acupuncture for Treating ...Other Integrative Medicin...Hormesis: Rapid Induction...ConclusionsDisclosure StatementReferencesRecent International and National Natural Cataclysmic Disasters.The 2011 Tōhoku Earthquake and Tsunami

The 2011 earthquake off the Pacific coast of Tōhoku (,Tōhoku-chihō Taiheiyō Oki Jishin), often referred to in Japan asHigashi nihon daishin-sai—also known as the 2011 Tohoku earthquake, the Great East Japan Earthquake, and the 3.11 Earthquake—was a magnitude 9.0 (Mw) undersea megathrust earthquake off the coast of Japan.3 The earthquake occurred at 14:46 JST (05:46 UTC) on Friday, March 11, 2011, with the epicenter ∼ 70 kilometers (43 miles) east of the Oshika Peninsula of Tōhoku and the hypocenter at an underwater depth of ∼ 32 km (20 miles). It was the most powerful known earthquake ever to hit Japan and one of the five most powerful earthquakes in the world since modern recordkeeping began in 1900. The earthquake triggered powerful tsunami waves that reached heights of up to 40.5 meters (133 feet) in Miyako in Tōhoku's [Iwate] Prefecture and which, in the Sendai area, traveled up to 10 km (6 miles) inland. The earthquake moved Honshu (the main island of Japan) 2.4 m (8 feet) east and shifted the Earth on its axis by estimates of between 10 cm (4 inches) and 25 cm (10 inches).

On September 12, 2011, a Japanese National Police Agency report confirmed 15,870 deaths, 6,114 injured, and 2,814 people missing across twenty prefectures. In addition, 129,225 buildings totally collapsed, 254,204 buildings “half collapsed,” and another 691,766 buildings were partially damaged. The earthquake and tsunami also caused extensive and severe structural damage in northeastern Japan, including heavy damage to roads and railways as well as fires in many areas, and a dam collapse. Japanese Prime Minister Naoto Kan said: “In the 65 years after the end of World War II, this is the toughest and the most difficult crisis for Japan.”3 Approximately 4.4 million households in northeastern Japan were left without electricity and 1.5 million were without water.

The tsunami caused a number of nuclear accidents, primarily the level 7 meltdowns at three reactors in the Fukushima Daiichi Nuclear Power Plant complex, and the associated evacuation zones, affecting hundreds of thousands of residents. Many electrical generators were taken down, and at least three nuclear reactors exploded as a result of hydrogen gas that had built up within their outer containment buildings after cooling-system failure. Residents within a 20-km (12 mile) radius of the Fukushima Daiichi Nuclear Power Plant and a 10-km (6.2 mile) radius of the Fukushima Daini Nuclear Power Plant were evacuated. In addition, the United States recommended that its citizens evacuate areas within up to 80 km (50 miles) of both plants.

Early estimates placed insured losses from the earthquake alone at US $14.5–$34.6 billion. The Bank of Japan offered ¥15 trillion (US $183 billion) to the banking system on March 14, 2013, in an effort to normalize market conditions. The World Bank's estimated economic cost was US $235 billion, making this earthquake the most expensive natural disaster in world history.3

The 2010 Haiti Earthquake

This catastrophic event was a magnitude 7.0 Mw earthquake, with an epicenter near the town of Léogâne, ∼ 25 km (16 miles) west of Port-au-Prince, Haiti's capital.4

By January 24, 2010, at least 52 aftershocks, measuring ≥4.5 Mw had been recorded. An estimated 3 million people (roughly 30% of the entire population) were affected by the quake; the Haitian government reported that an estimated 316,000 people had died, 300,000 had been injured, and 1,000,000 had been made homeless. The government of Haiti also estimated that 250,000 residences and 30,000 commercial buildings had collapsed or were severely damaged.

The earthquake caused major damage in Port-au-Prince, Jacmel, and other settlements in the region. Many notable landmark buildings were significantly damaged or destroyed, including the Presidential Palace, the National Assembly building, the Port-au-Prince Cathedral, and the main jail. Among the people killed were the Archbishop of Port-au-Prince, Joseph Serge Miot, and political [opposition] leader Micha Gaillard. The headquarters of the United Nations Stabilization Mission in Haiti, located in the capital, collapsed, killing many people, including the Mission's chief, Hédi Annabi.

Many countries responded to appeals for humanitarian aid, pledging funds; and dispatching rescue and medical teams, engineers, and support personnel. Communication systems; air, land, and sea transport facilities; hospitals; and electrical networks had been damaged by the earthquake, which hampered rescue and aid efforts. Confusion concerning who was in charge, air-traffic congestion, and problems with prioritization of flights complicated early relief work further. Port-au-Prince's morgues were overwhelmed with tens of thousands of bodies. These had to be buried in mass graves. As rescue efforts diminished, supplies, medical care, and sanitation became priorities. Delays in aid distribution led to angry appeals from aid workers and survivors, and looting and sporadic violence were observed. On January 22, 2010, the United Nations noted that the emergency phase of the relief operation was drawing to a close, and, on the following day, the Haitian government officially called off the search for survivors.4

Hurricane Sandy and the Moore, Oklhoma, Tornado

Two natural cataclysmic events in the United States were Hurricane Sandy, in several states, in late October 2012, and the more-recent tornado that struck Moore, OK, on May 20, 2013. Both of these natural disasters resulted in horrendous destruction and loss of life.5

Hurricane Sandy was responsible for 117 deaths in the United States (in New York State, New Jersey, Pennsylvania, West Virginia, Maryland, and elsewhere). In addition, 7.9 million businesses and households were without electricity and 9000 people in 13 states spent the night in 171 Red Cross Shelters. The damage produced billions of dollars worth of damage. In New Jersey alone, estimates were >$36.8 billion.6.

The Moore, OK, Tornado killed 24 people, created a 17-mile wound in the landscape, and left a trail of destruction that was>1 mile wide in some places. This was the most destructive tornado on the Fujita scale. The tornado pulverized buildings and homes; and photographs of the area look as if a nuclear bomb had flattened the town.7

Navigate ArticleTop of pageAuthor informationABSTRACTIntroductionPreparing for the Unexpec...A Systems Framework for R...Recent International and ...Examples of the Use of In... <<Acupuncture for Treating ...Other Integrative Medicin...Hormesis: Rapid Induction...ConclusionsDisclosure StatementReferencesExamples of the Use of Integrative Medicine During and After Natural Cataclysmic Disasters and Military ConflictsThe 2011 Japan Earthquake

Shin Takayama reported that, following the Great Japan earthquake that inflicted immense damage over a wide area of eastern Japan with the consequent tsunami (March 11, 2011), massage therapy and acupuncture were administered to 553 people at evacuation centers with a 92.3% satisfaction rate.8

Currently research on acupuncture utilization after a natural disaster or military conflict is mostly anecdotal. However, a study examined the use of electroacupuncture (EA) for post-traumatic stress disorder (PTSD) following an earthquake (the 2008 Japan Wenchaun earthquake). A total of 138 participants were randomly assigned to either EA or medication therapy. The researchers concluded that EA had better efficacy than medication therapy.9

Hurricane Katrina

Henri Roca III, MD—an assistant professor of medicine at Louisiana State University (LSU), in New Orleans, and chief of LSU's Integrative Medicine program—reported that the holistic approach, “is really the only way to work with people surviving [a] disaster.”10 Dr. Roca provided Katrina survivors with comprehensive holistic services, including acupuncture, guided imagery, biofeedback, massage, hypnotherapy, botanical medicine, and nutritional counseling.10

Acupuncturists Without Borders (AWB) organized hurricane relief efforts.11 Hurricane Katrina and its aftermath have elicited an unprecedented response from acupuncturists and supporters throughout the country. AWB is an organization mobilized to provide care and services for individuals affected by the storm and related tragedy. Community responses of this type were first mounted after the September 11, 2001, terrorist attack in New York and other cities on the East Coast.11 Using ear acupuncture and National Acupuncture Detoxification Association (NADA) approaches, treatment has been provided to thousands of individuals. The focus of treatment is on minimizing physical pain and psychologic distress related to disaster and/or tragedy.11

In response to Hurricane Katrina, AWB was able to mobilize ∼ 100 acupuncturists between 2005 and 2006 to treat victims who experienced psychologic stress caused by the hurricane.12 During a 3-month span (October–December 2005) acupuncturists delivered 2500 treatments in the hardest hit areas. The treatments were free and intended to provide relief from pain and sleeplessness and help mitigate stress during circumstances when medications and counseling were in short supply.

In addition, in 2006, AWB developed and launched the Military Stress Recovery Project (MSRP), which provides free acupuncture services to active-duty military, Veterans, and family members. The free treatments are offered weekly on a walk-in basis and were developed to help address the wounds and psychologic stress associated with current conflicts. As of 2010, AWB estimates that it has delivered more than 1000 treatments through the MSRP.12

Iraq and Afghanistan Military Conflicts

Sgt. Brandy Rose Lipscomb, a naturopathic student, ordered to active duty with her military reserve unit, found that she could bring many holistic techniques, including homeopathy, CranioSacral therapy, and guided imagery, to the (military) base. Some of the men (in this all-male group) she treated had been exposed to significant environmental toxins from trash dumps or the fires that inevitably follow heavy combat. “We were able to do detoxification protocols to help them clear the toxins,”10 she said. Sgt. Lipscomb found homeopathy to be an invaluable healing ally: “It really is an amazing modality. I treated soldiers with spider bites, chemical burns, mortar wounds. It is highly effective. I think homeopathy should be a basic part of American health care.”10

At Camp Leatherneck, which is a huge United States Marine Corps base in southern Afghanistan, physicians and other health care providers are using techniques, such as Battlefield Acupuncture (BFA) and Koffman's Acupuncture Cocktail, to help heal soldiers, particularly those who have pain and concussions from explosives.12 Although scientific studies may not have definitively proved acupuncture to be effective, Helm's Acupuncture Trauma Protocol is also being tried to heal the wounded warriors who have PTSD. The Navy, Army and Air Force have trained more than 100 physicians in medical acupuncture in formal acupuncture courses. In April 2013, $5.4 million was awarded to the Army, Navy, Air Force, and Veterans Administration (VA) to teach and evaluate BFA to health care providers in military and VA medical facilities. The Air Force has tried BFA to dampen the pain of wounded warriors who were being transported by air from Germany to Joint Base Andrews, MD.

Navigate ArticleTop of pageAuthor informationABSTRACTIntroductionPreparing for the Unexpec...A Systems Framework for R...Recent International and ...Examples of the Use of In...Acupuncture for Treating ... <<Other Integrative Medicin...Hormesis: Rapid Induction...ConclusionsDisclosure StatementReferencesAcupuncture for Treating Disaster VictimsBattlefield Acupuncture (BFA)

Immediately after the Haiti earthquake, when there was a paucity of pain medications; rescuers were successful in controlling pain by using BFA.13 Typically, gold Aiguilles Semi-Permanentes (ASP) needles (Sedatelac, Chemin des Muriers France, Irigny) can be retained in ear acupoints for up to 3–4 days or longer before being pushed out to the skin's surface by the previous flattened epidermis. Gold ASP needles are sequentially placed in the ear at very specific points—Cingulate Gyrus: Thalamus Point; Omega 2; Shen Men, and Point Zero bilaterally. There is an advanced technique that requires the acupuncturist to find the “dominant ear” and to use dissimilar metal ASP needles in either a linear formation or a clustering effect. Nevertheless, the majority of patients experience immediate pain reduction within seconds to minutes without side-effects. The remission period varies, depending on the pathology, but may be minutes, hours, days, or weeks. In post-earthquake Haiti, faced with short supply or nonavailability of appropriate needles to insert in the ear, health care personnel used their fingernails on the auricular points associated with the BFA technique to attenuate pain.

Most patients report a calming and significant reduction of pain within minutes. The rapid reduction of pain reduces the emotional stress of enduring acute and chronic pain. In a preliminary functional magnetic resonance imaging (fMRI) clinical pilot study conducted by Niemtzow (unpublished data) at the Neuroscience Research Institute (with Zhang-Hee Cho, PhD) in Incheon, Korea, normal subjects had pain produced in their left index fingers by immersion into hot water. A comparison of central nervous–system fMRI activity between subjects without and with needles in the BFA points was made. The study demonstrated that needles in the Cingulate Gyrus, Thalamus, Omega 2, Shen Men, and Point Zero points produced significant attenuation in the brain areas of the cingulate gyrus, thalamus, hypothalamus, and other areas. This attenuation correlated to a reduction of pain.

Although the results of another study were very preliminary, Litscher et al. demonstrated with infrared spectroscopy that oxygen levels in the brain may also be influenced by BFA.14 BFA may also have central nervous system, hyperbaric oxygen properties that may be useful in the healing of mild traumatic brain injuries.14

Because the needles are portable and the technique is rapid, efficient, taught easily, and almost without side-effects, the United States Armed Forces has taught this technique to hundreds of military physicians and special-operation forces. BFA has been used successfully in the Iraq and Afghanistan battlefield environment. It is also in widespread use in many parts of the world by health care providers. This technique may be used in land, sea, and air environments.

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Although more clinical studies are needed to document the benefits of programs that combine prānāyāma (yogic breathing) āsanas (yoga postures), and meditation, there is sufficient evidence to consider Sudarshan Kriya Yoga (SKY) to be a beneficial, low-risk, low-cost adjunct for treating stress, anxiety, PTSD, depression, stress-related medical illnesses, and substance abuse, as well as for addressing rehabilitation of criminal offenders. SKY has been used as a public health intervention to alleviate PTSD in survivors of mass disasters. Yoga techniques enhance well-being, mood, attention, mental focus, and stress tolerance. Proper training by a skilled teacher and a 30-minute practice every day will maximize the benefits. Health care providers play a crucial role in encouraging patients to maintain their yoga practices.15

Hypnosis in Mass Casualty Situations

Medical hypnosis may help in a mass casualty situation.

The three vital components of a successful hypnotic experience are (1) motivation, (2) belief, and (3) expectation.16In a trauma situation, motivation is usually not an issue, as people generally want to live, survive, and recover. The practitioner needs to foster belief and positive outcomes in patients by using techniques based on hypnotic phenomena. The effects listed below are normal human reactions that are intensified in the hypnotic situation. The effects that are most useful in a mass casualty situation would be:


• Amnesia—the ability to forget


• Dissociation—the ability to detach from the sensory environment around one to “go someplace else”


• Hypnoanalgesia—the ability to decrease pain sensations


• Hypnoanesthesia—the ability to remove pain sensations


• Negative hallucination—not seeing something that actually exists


• Positive hallucination—imagining something that does not really exist


• Time distortion—perceiving a different timeframe than that which actually exists


• Posthypnotic distortion—a suggestion offered during trance that affects perception or functioning at a later time.16


In medical hypnosis, there are two general strategies used to help create the above phenomena—psychodynamic and symptomatic16. For mass casualties in an acute situation, symptomatic technique—a technique used to just treat symptoms such as anxiety, pain, depression, fear, etc.—should be used.

Each individual hypnotic experience is comprised of the induction state, the trance stage, and the reversal stage. There is voluminous literature covering all three stages17. However, in a mass casualty situation, nonprofessional providers may be helping an experienced hypnotherapist, so the following concepts and strategies are important and appropriate for untrained practitioners to use:


Generally, a person who has a traumatic experience are in near trance and will very easily go into a hypnotic state. The provider can use varying words, tone, and inflections, depending on the situation to deepen the trancelike state into an actual trance.18 It is very important for the provider to mirror the patient. If the patient is agitated and screaming, the provider must have a louder, more-rapid rate of speech. If the patient is lying quietly and is motionless, the provider should speak in slow, soft tones. If the patient's name is known, it should be the first words said by the provider, as hearing one's name is very comforting and reassuring, and facilitates the therapeutic alliance greatly. Generally, one can tell that a trance is entered when the patient's eyelids start fluttering.16

In a mass casualty situation, a patient may be so injured or distraught that following simple instructions, such as clenching a fist, may be impossible to follow. Thus, the best induction technique to use would be the first one listed above (i.e., mirror the patient).


The trance stage occurs after induction is complete. A patient can be in a trance and yet seemingly be “wide awake” with the eyes open and conversing. However, more typically, a patient will close the eyes and become motionless.16

During trance the patient is given hypnotic suggestion to effect change in a symptom or physiologic or psychologic state—and this is where the amygdala is “talked to.” There are literally hundreds of symptoms or physiologic states that will respond to hypnotic suggestion. This includes parameters such as respiratory rate, oxygenation, heart rate, blood pressure, hemostasis, burn injury, and pain.19–22

In a mass casualty situation, there are many types of injuries with varying degrees of severity. As the providers may not be trained medical hypnotherapists, the best strategy would be a script that serves as a template that includes somewhat general suggestions.

The script should be short and simple so that the provider can recall it easily without notes. The best technique in this situation would be to provide a patient with more general, less-specific suggestions that a patient can then internalize and individualize to best suit his or her own emotional landscape. The overall theme of the suggestions is to foster the patient's belief and expectation that he or she will survive the casualty event and thrive afterward.


Generally, a patients who is helped to go into a trance should be given the opportunity by the provider to come out of the trance, but it is not unusual for patients to resist this. This is not deleterious and the provider should never force a patient to go into a reversal state. If the provider needs the patient to do something (i.e., run away from molten lava) and the patient is resisting reversal, then the command can be given as a hypnotic suggestion.

First responder implementation

One possible scenario for having the capability to provide medical hypnosis in a rapid, effective manner in a mass casualty situation would require some prior planning and training. Simple, short hypnosis scripts should be developed by medical hypnosis professionals. As medical hypnotherapy scripts are culturally and linguistically specific, every attempt should be made to have script authors who are familiar with the communities and populations in which the scripts would be deployed.23

First responders are then given training and rehearsal in delivering the scripts, which, if simple enough, would be likely to only require 8 hours of training. Responders could practice on each other to experience both providing medical hypnosis and going into and out of trance. The capability to provide this care is then placed into the treatment algorithm as decided on by the public health authorities.

Children are incredibly easy to hypnotize. Hypnosis should be considered as a very early intervention in the treatment of an injured child.24

Hypnosis is not effective in all patients and the reason for that is not well-known. It is likely that up to 10% of patients will not have much of a response even with experienced providers.25

Current author Marcucci had a patient who was hemorrhaging in an emergency room. The entire hypnotic session with induction, hypnotic suggestion, posthypnotic suggestion, and reversal, was accomplished with five sentences. The bleeding in the surgical field largely stopped ∼ 20 seconds after the instruction, and the patient survived the operation and was discharged later in satisfactory condition (personal communication with Lisa Marcucci, MD).

Navigate ArticleTop of pageAuthor informationABSTRACTIntroductionPreparing for the Unexpec...A Systems Framework for R...Recent International and ...Examples of the Use of In...Acupuncture for Treating ...Other Integrative Medicin...Hormesis: Rapid Induction... <<ConclusionsDisclosure StatementReferencesHormesis: Rapid Induction of Protective Tolerance to Treat or Protect Against Exposure to Toxins

Many victims of a catastrophic event may have been exposed to chemical and radioactive toxins.

After the attack of 9/11, toxins were released into the atmosphere by the destruction of the Twin Towers in New York City. Not only the general population at large was exposed, but the rescuers themselves were exposed to the toxins. Hormesis may be a possible consideration for future protection from such toxic exposures. The use of hormesis as a therapy or for protection would involve administering low, not toxic, doses of the primary agents to induce resistance or to accelerate cellular repair mechanisms. This process is called rapid induction of protective tolerance (RIPT).26

There are a number of examples whereby exposure to subtoxic doses of otherwise toxic compounds confers protection and treatment against higher toxic doses of the same or similar harmful compounds.27 RIPT occurs by inducing a stimulatory effect on cell repair, tolerance, and protective processes. One challenge in the study of this area is that significant clinical effects could arise from a coordinated whole organism response of inherent (self-derived) healing and defense processes that are complex to investigate. Thus, it is difficult to determine the dose and frequency of administration needed for each toxin. The clinical value of hormesis may be most evident if multiple, redundant mechanisms are induced.28,29

Many cellular protective mechanisms are distinct from immune stimulation, such as that produced by vaccines; yet immune mechanisms may enhance and extend a RIPT effect.30 If this proves to be true, it would allow rapid use of hormesis in a wide variety of situations, including terrorism; environmental disasters; drug toxicity, cancer; and emerging infections, such as influenza, severe acquired respiratory syndrome, (SARS) and Avian flu.

Terrorism and biowarfare protection

There is evidence that RIPT against biowarfare and terrorists agents may be feasible.31,32 In an early double-blinded, placebo controlled, multicenter clinical study, use of the biowarfare agent mustard gas demonstrated that low-dose mustard gas and similar blistering agents reduced damage caused by mustard in humans.33 Little research on the concept followed, however. Jonas et al. did a comprehensive, systematic review of the chemical, biologic, radiologic and nuclear (CBRN) literature for studies examining the stimulatory and protective effects of the top ten CBRN terrorist agents.34 Although the area is rarely investigated, most studies that specifically looked for stimulatory or protective effects, found them, including with the potent neurotoxins soman and sarin. Jonas and Dillner35investigated if low-dose preparations of infected tissue given to mice could induce protection against a higher infectious challenge by the same organism (F. tularensis). These preparations consistently increased mean survival time and decreased mortality from tularemia infection, a top biowarfare threat agent.

Environmental toxins and cancer

The RIPT approach may also help mitigate the effects of environmental toxins, such as arsenic, mercury, and cadmium. Linde et al.36 and Calabrese et al.37 conducted meta-analyses of the literature on the protective effects of environmental toxins of various types. Significant protective effects were demonstrated in repeated studies with arsenic and mercury, two of the most important environmental toxins worldwide. Low-dose arsenic and mercury enhanced toxin excretion up to 40% and reduced mortality to lethal doses by 19%.38 Similar work with cadmium was reported in studies.39 As with CBRN and brain-injury agents, the rapid induction of protective proteins appears to be an important mechanism. Van Wijk demonstrated that specific patterns of heat shock proteins predicted cross protection to a variety of environmental toxins.40

Gaddipati et al.39 and Delbancut et al.41 have shown in their respective laboratories that nontoxic, low-dose cadmium exposure rapidly stimulates the specific methallothienien production (a protective protein) and its mRNA signal, and that this effect can be maintained for weeks with no adverse effects on cell growth, replication, function or mortality. Subsequent exposure of the same cells to higher doses of cadmium showed delayed transformation into cancer, usually produced by cadmium. Thus, an apparent “window of protection” to specific agents can be turned on and off for weeks at a time without harm.

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The studies discussed in this article, and other studies and experiences, show that a number of integrative health care products and practices could provide valuable adjunctive approaches to the usual-care strategies used for natural disaster and combat zone relief. These approaches are usually inexpensive and nontoxic, are inherently low-risk, do not require complicated delivery methods, and can be pushed far forward in disaster relief effort even when other resources cannot be delivered. Such approaches may provide significant and rapid relief for victims of disasters and wars, as well as for their caregivers. These approaches should be investigated further and tested systematically in disaster and wartime environments. In addition, members of communities, such as Galveston TX, that experienced devastation after Hurricane Ike may find the use of various alternative medicine techniques helpful for building community resilience to future natural disasters.42


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Effects of Acupuncture on Leucopenia, Neutropenia, NK, and B Cells in Cancer Patients: A Randomized Pilot Study

Effects of Acupuncture on Leucopenia, Neutropenia, NK, and B Cells in Cancer Patients: A Randomized Pilot Study | Acupuncture Research |
Evidence-Based Complementary and Alternative Medicine (eCAM) is an international, peer-reviewed journal that seeks to understand the sources and to encourage rigorous research in this new, yet ancient world of complementary and alternative medicine.



Chemotherapy is one of most significant therapeutic approaches to cancer. Immune system functional state is considered a major prognostic and predictive impact on the success of chemotherapy and it has an important role on patients’ psychoemotional state and quality of life. In Chinese medicine, chemotherapy is understood as “toxic cold” that may induce a progressive hypofunctional state of immune system, thus compromising the fast recovery of immunity during chemotherapy. In this study, we performed a standardized acupuncture and moxibustion protocol to enhance immunity in cancer patients undergoing chemotherapy and to assess if the improvement of immunity status correlates with a better psychoemotional state and quality of life.

1. Introduction

Colorectal cancer (CRC) is one of the most common cancers and a major cause of death due to cancer worldwide. The functional state of the host immune system has a major prognostic and predictive impact on the fate of cancer patients treated with conventional or targeted chemotherapies [1].

According to the immunoediting theory [2], cancer cells and immune cells reciprocally modulate each other and the two possible outcomes are either the elimination or escape of tumour cells. NK cells are considered to represent a first line of defence against the metastatic spread of tumour cells. This idea is supported by the report of an association between the decreased activity or low numbers of circulating NK cells with progression of cancers and correlation between an absolute decrease in the activity of the NK cells and an absolute decrease in the lytic potential of these cells [3]. As effector members of the innate immunity, NK cells play a major role in anti-infection activity and tumour surveillance. NK cells can directly kill target cells to which they are capable of adhering within 1 to 4 hours without prior activation, priming or assistance by cytokines. NK cells have been recognized as major producers of cytokines in many physiological and pathological conditions, such as interferon  (IFN), tumour necrosis factor (TNF), and interleukin-10 (IL-10), as well as growth factors such as granulocyte macrophage colony-stimulating factor (GM-CSF), granulocyte colony-stimulating factor (G-CSF), and IL-3. NK cells also secrete several chemokines, which are vital for their colocalization with other hematopoietic cells such as dendritic cells (DC) in areas of inflammation.

Recent studies [4] provide the notion that tumour-induced alterations of activating NK cell receptor expression may hamper immune surveillance and promote tumour progression and reveal that NK cell activity is reduced in patients with metastatic CRC, pointing out to NK cells as a first line of defence against metastasis.


According to psychoneuroimmunology theory, psychological and emotional stress induces several alterations in diverse biological responses. The activation of the hypothalamic-pituitary-adrenal axis (HPA) and thesympathetic nervous system (SNS) may generate a change in the immune cell traffics and promotes inflammation via multiple neuroendocrine and immune pathways. Higher stress levels were associated with poorer immune responses (low NK cell activity) and the stress reduction with improvement of immune responses, in women with breast cancer [5].

Humoral and, especially, cellular immune functions have been reported as being boosted by acupuncture and moxibustion in cancer patients with significant increases in several T lymphocyte subsets. Immune system modulation has been noted also for various other conditions, such as asthma and autoimmune and inflammatory diseases [6, 7].

A review on the ascribed immunomodulation of acupuncture concludes that acupuncture treatment appears to be able to modulate immunosuppressed or immunoactivated conditions through different mechanisms, including macrophages, neutrophils, NK cells and lymphocytes stimulation, immunoglobulin production, and complement system activation [8]. In fact, two possible implicated mechanisms were previously reported: NK-related gene expression in the spleen [9] and the sympathetic nervous system [10]. Another study revealed that acupuncture enhances the NK cells activity and modulates the balance between Th1 and Th2 [11].

We aimed to evaluate the effect of acupuncture on the immune system (namely, on WBC, ANC, lymphocytes, and NK cells activity) on CRC patients and assess if the ascribed immunomodulatory effects of acupuncture have implications on patients’ psychoemotional state and quality of life.

2. Patients and Methods2.1. Selection of Patients

This study was approved by the Ethics Committee of S. João and Vila Nova de Gaia/Espinho Hospital Centers, Oporto, Portugal. Written informed consent was obtained from all patients before study enrollment. Patients were eligible for inclusion as follows: recently diagnosed or recurrent colorectal cancer, regardless of stage, receiving chemotherapy, no regular use of acupuncture within 120 days prior to enrollment, ability to give informed consent, and >18 years of age. Exclusion criteria were the following: (a) absolute neutrophil count (ANC) less than 500/L, (b) platelet count less than 25,000/L, (c) altered mental state, (d) clinically significant cardiac arrhythmias, and (e) other unstable medical conditions.

2.2. Study Design

All patients enrolled were evaluated at baseline. Patients were randomized into one of two groups: active acupuncture (AcuMoxa) or nonacupuncture (control group). All of the study patients were blinded to randomization assignments (Figure 1).

Figure 1: CONSORT flow of participants through the study.

Patients in the experimental group received 6 sessions of acupuncture, twice a week, beginning one week prior to cycle of chemotherapy and ending at the beginning of the following cycle of chemotherapy (Figure 2). At the end of the intervention, patients in the active arm continued their remaining chemotherapy cycles without any acupuncture treatment. Patients in the control arm were offered the active acupuncture protocol immediately after they completed the four weeks of blood sampling as a courtesy.

Figure 2: Study flow chart. Black solid dots: time points of outcome measurements. Open circle: first chemotherapy day. Black diamonds: the primary endpoints of the study. Dashed lines: the expected changes, during chemotherapy, of white blood cells (WBC) and absolute neutrophil counts (ANC). Short, blue down arrows: acupuncture treatments. CBC, complete blood counts; NK, NK cells and subsets.

Based on previous trials [12, 13], blood samples were collected at baseline (preintervention) 7 days before chemotherapy and then every 7 days during four weeks. Blood samples of both groups, experimental and control, were taken under the same conditions.

2.3. Acupuncture Protocol

All acupuncture treatments were performed at S. João and Vila Nova de Gaia/Espinho Hospital Centres, Porto, Portugal. The acupuncture treatments were administered only by one acupuncturist (the main researcher; master degree on TCM by the University of Porto). A standardized acupuncture protocol was developed based on the Heidelberg model of Chinese medicine (CM), in which CM is explained as a comprehensive model of system biology based on a technical understanding of the regulatory core termini of CM, such as Yin, Yang, the phases, and the Shan Hang Lung theory [14–17].

The experimental group (AcuMoxa): acupuncture points and their anatomical locations were as follows: lower extremity (LV3, ST36, SP3, and GB39) and upper extremity (LI4, PC5, TB5, and LU7), and disposable acupuncture needles with a size of 36 G, 0.20 × 25 mm (Tewa). The depth of needling was at approximately 10 mm. The de qi sensation was required [18]. Smokeless moxibustion treatment was used in the following points: SI6, TB5, ST32, and CV6; 2 minutes per point. Each session had a duration of 45 minutes.

2.4. Clinical and Laboratory Evaluation

Complete blood counts were collected at baseline and then once every 7 days at 3 time points during the study period (Figure 2). The timing for collecting blood samples was based on previous trials [12, 13].

Lymphocyte populations T, B, and NK were analysed by flow cytometry (Coulter, EPICS XL-MCL flow cytometer) with a combination of monoclonal antibodies anti-CD3-FITC/(CD56 + CD16)-PE (Immunotech).

Anxiety and depression scores as well as patients quality of life were assessed through Hospital anxiety and depression scale (HADS) and EORTC-QoL CR-29 questionnaires, respectively, in the beginning and at the end of the study for both groups.

2.5. Statistical Analysis

This study was designed to provide preliminary data about its feasibility and analysis to support a subsequent large-scale, fully powered study to evaluate the effects of acupuncture on NK cells in patients with CRC.

Differences between groups were assessed through Mann-Whitney  test. Intragroup analyses were assessed by Friedman test. In order to explore variables correlations, the Pearson correlation analyses was performed. Missing data were handled based on available data approach. SPSS for Windows was used for statistical computation. Results yielding a  value < 0.05, with alpha = 0.05 and C.I. level = 95, were considered statistically significant.

3. Results3.1. Baseline Sample Characterization

At baseline, patients in both groups shared similar demographic and clinical characteristics (Table 1). The majority of patients (88.9%) have a colon cancer, with Stage II (16.7%) and Stage III (55.6%); 66.7% of the patients were submitted to the FOLFOX and 16.7% to XELOX chemotherapy regimens.

Table 1: Baseline comparison between groups: sociodemographic and clinical characteristics; blood analyses and QOL-CR 29 and HADS scores.

Comparison of blood analyses at baseline showed no statistical differences among groups (Table 1).

A total of 18 (100%) patients completed the questionnaires of QOL-CR29 and HADS at the beginning and at the end of the study.

Comparison of QOL and anxiety and depression scores at baseline did not reveal any statistical differences among groups (Table 1); however the experimental group revealed high scores of depression.

3.2. Effect of Acupuncture on WBC and ANC

The effects of acupuncture treatment on WBC counts and ANC in study patients are shown in Figure 3. Comparison analyses between the two groups showed that AcuMoxa group had statistically significant higher values on WBC () as well as on ANC () at time point .

Figure 3: WBC and ANC. Comparison between groups.

Within group analyses showed that the changes in each group across time were significant: in the control group diminishing levels of WBC were seen (, , ); on AcuMoxa group (), there was an increasing level of these parameters overtime (, ; , , resp.) as well as the ANC ().

3.3. Effect of Acupuncture on Lymphocyte Populations

Although differences on total lymphocyte populations among control and experimental group were identified only after 6 sessions of AcuMoxa treatment (), higher values of B cells at time point  () and  () were seen in the AcuMoxa group. With respect to T cells, no statistical differences among groups were found (Figure 4).

Figure 4: Total lymphocytes and T and B cells. Comparison between groups.

Total lymphocytes as well as B and T cells intragroup analyses did not reveal differences across time.

3.4. Effect of Acupuncture on NK Cells

Comparison between groups showed significant higher values of NK cells on the AcuMoxa group from time point  until time point  (,  and , resp.) (Figure 5).

Figure 5: Total NK cells counts. Comparison between groups.

Within group analyses revealed significant increases on NK cells across time (, , ), while the control group showed a significant decrease of NK cells (, , ).

3.5. Effect of Acupuncture on Anxiety and Depression Levels

The comparison between the two groups did not reveal significant differences on anxiety (0.050) and depression levels (0.094) (Figure 6). However, when analyzing each group, it was shown that the experimental group had a significant decrease depression mean (), whereas in the control group the anxiety () and depression () levels increased significantly. In addition, exploratory analyses on a possible correlation between NK cells and depression and anxiety levels did not reveal any significant correlation, despite the observation of a decrease on anxiety and depression levels along with an increase of NK cells.

Figure 6: HADS scores. Differences among groups, at beginning () and at the end () of the study.3.6. Effect of Acupuncture on Patients QOL

With respect to the analyses of the different items of QOL questionnaires, no significant differences were identified between the control and experimental groups (Figure 7). However, data collected from QOL questionnaires showed a tendency of reduction of several symptoms such as gastrointestinal symptoms, urological symptoms, stoma-related symptoms, male sexual dysfunction, and chemotherapy side effects (Figure 5).

Figure 7: Symptoms related to QOL questionnaires. Differences among groups at the beginning () and at the end () of the study. CT, control group; AcuMoxa, experimental group.

Intragroup variability analyses showed a significant decrease of chemotherapy side effects (Figure 8) on the experimental group ().

Figure 8: Chemotherapy side effects. Intragroup analyses show significant decrease of chemotherapy side effects among AcuMoxa group.4. Discussion

The host immune system functional state has a major prognostic and predictive impact on the outcome of cancer patients treated with conventional or targeted chemotherapies [1].

Several authors revealed that acupuncture modulates NK cell number and function in diverse clinical situations such as in women with severe anxiety [19], in pain syndromes [20], and in healthy volunteers [21].

Studies regarding the effect of acupuncture and moxibustion on CRC patients are scarce. In fact, only two eastern studies have addressed modulation of NK cells activity in CRC patients [22, 23].

To the best of our knowledge, this research protocol is the first study on acupuncture for cancer patients conducted in the Portuguese National Health System and is the first controlled clinical trial on the West that addressed acupuncture and moxibustion NK cells modulation, its implications on psychoemotional state, and on the QOL of CRC patients.

Although our data must be carefully interpreted due to methodological limitations, some conclusions may be pointed out.

Firstly, we observed (1) a reduction on anxiety and depression and (2) consistent positive trends on the levels of WBC, ANC, and B and NK cells in the AcuMoxa group versus the control group. The increase on WBC and ANC resulted in approximately a 1.5x reduction in leukopenia and neutropenia rates. The acupuncture group showed a twofold increase in NK cells rate compared to the control group. These preliminary results indicate an immunomodulatory effect of acupuncture in CRC patients undergoing chemotherapy. Acupuncture stimulation may yield a myeloprotective effect as suggested by Lu et al. on a study on electroacupuncture plus TDP infrared lamp effect in gynaecologic malignancies. Despite the differences in the selection of acupoints and type of acupuncture, WBC and ANC levels were similar to those obtained by Lu et al.

Secondly, our preliminary results show that acupuncture benefits the emotional status by decreasing anxiety and depression levels. This effect may contribute to improvement on NK cells activity. As reported recently on a study on women with breast cancer [24], the emotional state influences NK cells numbers and activity.

Thirdly, with respect to quality of life, our study did not reveal significant differences between the two groups. However, we observed a tendency for decreasing certain symptoms on the AcuMoxa group, such as gastrointestinal and urological symptoms and chemotherapy side effects as well as the improvement of sexual function in men. This is probably due to the short period of treatment. In addition, intragroup analyses reveal a significant decrease of chemotherapy side effects on the AcuMoxa group indicating an overtime protective role of acupuncture for CRC patients during chemotherapy.

Fourthly, no acupuncture and moxibustion-related adverse events were observed. Globally, these preliminary results indicate that our AcuMoxa protocol is feasible and safe for CRC patients undergoing chemotherapy.

What may be the physiological explanation for the observed results of AcuMoxa stimulation?

It is generally accepted that acupuncture induces an increase on the release of -endorphin [5, 23] via the stimulation of the HPA axis. -Endorphins consequently influence immune cells by binding to opioid receptors on the surface of the cells, namely, on NK cells [25] promoting the expression of cytotoxic molecules and the production of IFN. In turn, IFN would further increase the expression of NK cells receptors and cytokine secretion by other immune cells, thereby amplifying anticancer immune functions.

The HPA axis and SNS are generally activated in cancer, resulting in high levels of catecholamine and glucocorticoids, which augments the sympathetic outflow and decreases NK activity in the periphery [25].

Therefore, we may hypothesize that acupuncture, by acting on the SNS and the HPA axis, may reduce the levels of catecholamines and consequently attenuate their suppressive effects on NK cells.

There are limitations in our preliminary study to be considered.(1)Although the patients were randomly allocated in each group, there is the possibility that results may have occurred by chance due to the small sample size. A larger study based on this protocol is required to precisely evaluate the effects of acupuncture on CRC patients during chemotherapy and to explore the relation of the cancer severity and different types of chemotherapy on the possible acupuncture immunomodulatory effect. Nevertheless, the small sample of patients allowed assessing the trial feasibility and preliminary data on efficacy.(2)Another limitation of our study was the heterogeneity on chemotherapy protocols which may have influenced the hypothesized AcuMoxa effects and results.(3)Finally, the short duration of the study did not allow obtaining more precise data regarding the impact of acupuncture on patients QOL and prognosis.

5. Conclusions

Our pilot study suggests that acupuncture and moxibustion may (1) stimulate anticancer immunity, (2) promote a myeloprotective effect, (3) improve the psychoemotional status and quality of life, and (4) minimize chemotherapy side effects.

This study protocol proved to be feasible and safe for CRC patients.

A larger and long-term acupuncture trial is needed to clarify acupuncture’s immunomodulatory effects in CRC. If this effect is ultimately established, then this treatment may serve as a possible complementary therapy for CRC treatment and possibly contribute to improving patients’ prognosis and quality of life.

Conflict of Interests

The authors declare that there is no conflict of interests regarding the publication of this paper.


The authors are grateful to all the nurse staff from the Departaments of Oncology of V.N.Gaia/Espinho and S. João Hospital Centers, Oporto, Portugal, for their contribution on collecting blood samples as well as to the administrative personnel involved in this project.


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Acupuncture's painkilling secret revealed: it's all in the twist action

Acupuncture's painkilling secret revealed: it's all in the twist action | Acupuncture Research |

Twist of a needle damages cells and triggers release of anti-inflammatory chemical adenosine, US scientists find

Ian Sample, science correspondentThe Guardian, Monday 31 May 2010Acupuncture 'meridians' match main nerve pathways, scientists believe. Photograph: Getty Images/Getty

Ever since Chinese doctors first poked their patients with sharp objects 4,000 years ago, and charged them for the pleasure, acupuncture has been shrouded in mystery.

Tradition has it that the procedure works by improving the flow of "qi" along invisible energy channels called meridians, but research published today points to a less mystical explanation for the painkilling claims of acupuncture.

The answer, according to a team of scientists in New York, follows an extraordinary study in which researchers gave regular acupuncture sessions to mice with sore paws.

After each half-hour session the mice felt less discomfort in their paws because the needles triggered the release of a natural painkiller, the researchers say. The needles caused tissue damage that stimulated cells to produce adenosine, an anti-inflammatory chemical, that was effective for up to an hour after the therapy was over.

Modern acupuncture involves inserting fine needles into the skin at specific points around the body. The needles are pushed in a few centimetres, and then heated, twisted or even electrified to produce their claimed medical effects.

Acupuncture has spread around the world since originating in China but conventional western medicine has remained steadfastly sceptical. Although there is now good evidence that acupuncture can relieve pain, many of the other health benefits acupuncturists claim are on shakier ground.

The latest research gives doctors a sound explanation of how sticking needles into the skin can alleviate, rather than exacerbate, pain. The discovery will challenge the view , widely held among scientists, that any benefits a patient feels after acupuncture are due purely to the placebo effect.

"The view that acupuncture has little benefit beyond the placebo effect has really hampered research into the technique," said Maiken Nedergaard, a neuroscientist at the University of Rochester medical centre in New York state, who led the study.

"Some people think any work in this area is junk research, but I think that's wrong. I was really surprised at the arrogance of some of my colleagues. We can benefit from what has been learned over many thousands of years," Nedergaard said.

"I believe we've found the main mechanism by which acupuncture relieves pain. Adenosine is a very potent anti-inflammatory compound and most chronic pain is caused by inflammation."

The scientists gave each mouse a sore paw by injecting it with an inflammatory chemical. Half of the mice lacked a gene that is needed to make adenosine receptors, which are found on major nerves.

The therapy session involved inserting a fine needle into an acupuncture point in the knee above each mouse's sore foot. In keeping with traditional practice, the needles were rotated periodically throughout the half-hour session.

To measure how effective the acupuncture was, the researchers recorded how quickly each mouse pulled its sore paw away from a small bristly brush. The more pain the mice were in, the faster they pulled away.

Writing in the journal, Nature Neuroscience, Nedergaard's team describe how acupuncture reduced pain by two-thirds in normal mice, but had no effect on the discomfort of mice that lacked the adenosine receptor gene. Without adenosine receptors, the mice were unable to respond to the adenosine released when cells were damaged by acupuncture needles.

Acupuncture had no effect in either group of mice if the needles were not rotated, suggesting that the tissues had to be physically damaged to release adenosine.

Nedergaard said that twisting the needles seems to cause enough damage to make cells release the painkilling chemical. This is then picked up by adenosine receptors on nearby nerves, which react by damping down pain. Further tests on the mice revealed that levels of adenosine surged 24-fold in the tissues around the acupuncture needles during and immediately after each session.

One of the longstanding mysteries surrounding acupuncture is why the technique only seems to alleviate pain if needles are inserted at specific points. Nedergaard believes that most of these acupuncture points are along major nerve tracks, and as such are parts of the body that have plenty of adenosine receptors.

In a final experiment, Nedergaard's team injected mice with a cancer drug that made it harder to remove adenosine from their tissues. The drug, called deoxycoformycin, boosted the effects of acupuncture dramatically, more than tripling how long the pain relief lasted.

"There is an attitude among some researchers that studying alternative medicine is unfashionable," said Nedergaard. "Because it has not been understood completely, many people have remained sceptical."

Although the study explains how acupuncture can alleviate pain, it sheds no light on the other health benefits that some practitioners believe the procedure can achieve.

Josephine Briggs, the director of the national centre for complementary and alternative medicine at the US National Institutes of Health, said: "It's clear that acupuncture may activate a number of different mechanisms … It's an interesting contribution to our growing understanding of the complex intervention which is acupuncture."

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Non-specific physiological background effects of acupuncture revealed by proteomic analysis in normal rats. [BMC Complement Altern Med. 2014] - PubMed - NCBI

Non-specific physiological background effects of acupuncture revealed by proteomic analysis in normal rats. [BMC Complement Altern Med. 2014] - PubMed - NCBI | Acupuncture Research |

The total effects of adequate real acupuncture treatment consist of pathologic-specific and non-specific physiological effects. The latter may be the fundamental component of the therapeutic effects of acupuncture. This study investigated the physiological background effect ofacupuncture in normal rats treated with acupuncture.


Manual acupuncture was performed on normal rats at experienced acupoints, GV14 (Dazhui), BL12 (Fengmen) and BL13 (Feishu), once every other day for two weeks. The proteomic profile of rat lung tissue was examined using 2-DE/MS-based proteomic techniques. Gene Ontology (GO) enrichment and the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway were analyzed for differentially expressed proteins using the WebGestalt toolkit.


In total, 25 differentially expressed protein spots were detected in the 2-DE gels. Among these spots, 24 corresponded to 20 unique proteins that were successfully identified using mass spectrometry. Subsequent GO and KEGG pathway analyses demonstrated that these altered proteins were mainly involved in biological processes, such as 'protein stabilization', 'glycolysis / gluconeogenesis' and 'response to stimulus'.


Our study indicated the non-specific background effects of acupuncture at acupoints GV14, BL12 and BL13 likely maintained internal homeostasis via regulation of the local stimulus response, energy metabolism, and biomolecule function balance, which may be important contributors to the therapeutic effects of acupuncture.

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Gold Acupuncture Needle MRI Pain Discovery - fMRI brain scan research shows it affects brain's pain perception

Gold Acupuncture Needle MRI Pain Discovery - fMRI brain scan research shows it affects brain's pain perception | Acupuncture Research |
Gold acupuncture needles are shown in MRI scientific data to reduce pain. This new discovery proves the effectiveness of acupuncture in modulating brain responses.


Gold Acupuncture Needle MRI Pain Discovery

on 03 January 2014.


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A new MRI study measured the pain relieving effects of gold acupuncture needles and revealed that acupuncture limits brain responses to pain. Researchers used blood oxygen level dependent fMRI (functional magnetic resonance imaging) on human volunteers receiving pain stimulation. Without acupuncture, fMRI imaging demonstrated widespread global responses to pain throughout the brain. With acupuncture, the researchers discovered acupuncture reduces responses to pain to very small, limited regions of the brain. This new fMRI brain mapping contributes to a greater understanding of the biological mechanisms involved in the analgesic effects of acupuncture.

The new scientific research was a result of a collaborative effort between the Zhejiang Sci-Tech University, Hangzhou; and the University of Traditional Chinese Medicine, Hangzhou. Participants showed brain responses to pain perception without acupuncture affecting nearly the entire brain including the “thalamus, hypothalamus, reticular formation of brain stem, limbic system, cerebral cortex and other parts.” The addition of acupuncture point LI4 (Hegu), located on the hand, limited the brain region responses to more specific, smaller and isolated areas of the brain: “precentral gyrus, the left of inferior corpus callosum, the right of thalamus, middle occipital gyrus, the right of cingulate gyrus, the left of caudate nucleus, fusiform gyrus, hippocampus, the left of superior temporal gyrus, middle temporal gyrus, supramarginal gyrus, angular gyrus, left of the superior parietal lobule and inferior parietal lobule.” The researchers used a Siemens 1.5T Megneton Sonata for MRI imaging. Acupuncture needles applied to LI4 were composed of 75% gold and were 40mm X .32mm.

The researchers also compared the analgesic affects of needle-free acupuncture point stimulation with an electrical device. Using TEAS (transcutaneous electric acupoint stimulation) at LI4, the researchers discovered two major findings. First, TEAS reduced brain responses to pain and produced an analgesic effect. Secondly, acupuncture needle stimulation of LI4 produced a greater reduction in brain responses to pain than non-needle TEAS. The researchers noted that manual acupuncture needle stimulation has wider and stronger effects on brain responses to pain than TEAS. The researchers concluded that acupuncture “is an effective means in pain relief.”

Gold Acupuncture Needles
The researchers chose gold needles for the study although acupuncture needles are often made from stainless steel, silver and other metals and alloys. Gold needles are associated with hypoallergenic properties. In Traditional Chinese Medicine, gold acupuncture needles are sometimes associated with Yang and tonifying properties. Modern research confirms that the impedance at electric terminal points is affected by the type of metal used in the manufacture of a needle. Historically, gold needles have been found in numerous archeological discoveries. The tomb of prince Liu Sheng (d. 113 BCE), unearthed in 1968, contained both gold and silver acupuncture needles. Liu Sheng was the son of Emperor Jing Di, ruler during the western Han Dynasty.

Scientific Equiptment
The researchers note that acupuncture was first used for surgical anesthesia in the 1950s. In an effort to understand the scientific phenomena of acupuncture analgesia, several modern techniques have successful measured the biochemical and electro-biochemical effects of acupuncture needle stimulation. The researchers note that this technology includes the electroencephalograph (EEG), magnetoencephalograph (MEG), positron emission tomography (PET) and fMRI. The researchers note that this most recent study and other studies have demonstrated objective scientific proof that acupuncture “is an effective means in pain relief.” This latest study demonstrated that TEAS is effective at acupuncture point LI4 but that its effects were mainly limited to the activation of the right side of the cerebral cortex whereas manual acupuncture at LI4 had a more global effect.

Yang, Jia-Min, Xiao-Yu Shen, Ling Zhang, Song-Xi Shen, Dan-Dan Qi, Shi-Peng Zhu, Li Luo et al. "The effect of acupuncture to SP6 on skin temperature changes of SP6 and SP10: An observation of Deqi‟."

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Acupuncture Heals Facial Paralysis - New Study - HealthCMI

Acupuncture Heals Facial Paralysis - New Study - HealthCMI | Acupuncture Research |
Acupuncture Heals Facial Paralysis - New Study
Acupuncture is widely used in the treatment for peripheral facial paralysis (FP).

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Acupuncture Lowers Hypertension - New Finding - HealthCMI

Acupuncture Lowers Hypertension - New Finding - HealthCMI | Acupuncture Research |
Acupuncture Lowers Hypertension - New Finding
Newly published research confirms that acupuncture reduces hypertension, high blood pressure.

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Acupuncture for Fibromyalgia and Chronic Fatigue Syndrome, including the research base

Acupuncture for Fibromyalgia and Chronic Fatigue Syndrome, including the research base | Acupuncture Research |

Acupuncture treatments for fibromyalgia(FMS) and chronic fatigue syndrome (CFS orME/CFS) are becoming much more common, either alone or as a complementary therapy.

Chinese acupuncture dates back thousands of years as traditional Chinese medicine (TCM) but only caught the attention of the American public in the 1970s. The National Institutes of Health formally recognized acupuncture as part of mainstream medicine in 1997, saying the procedure is safe and effective at treating a wide range of conditions, including fibromyalgia.


The Research

Multiple studies from both the East and the West suggest that acupuncture is effective for treating FMS. In the West, it hasn't been studied as much for ME/CFS, but many Chinese studies suggest it's effective for that condition. Meta analyses of acupuncture for both conditions conclude that it appears to be a beneficial treatment, but that further high-quality research is needed.

As acupuncture has moved more into the mainstream, many insurance companies have added it to their policies, and some doctor's offices and clinics have begun to offer it at their facilities. Make sure you know the details of your insurance policy before assuming it will cover acupuncture treatments.

How Does Acupuncture Work?

While multiple studies have shown that acupuncture does have the effects taught by TCM, researchers can't pinpoint exactly why it has the effects. Research suggests that it may produce complex changes in the brain and body, possibly by stimulating nerve fibers that then send signals to the brain and spinal cord to release certain hormones that block pain and makes you feel better. A study using images of the brain showed that acupuncture raises your pain threshold -- which is low in people with FMS and ME/CFS -- and therefore gives you long-term pain relief. One British experiment using magnetoencephalography (MEG) brain scans showed that acupuncture actually can deactivate part of your brain's pain matrix.



According to TCM, acupuncture works by correcting energy pathways through your body. This life-force energy is called qi or chi (pronounced "chee"). Qi flows through meridians in the body, each of which corresponds to an organ or group of organs. If you have too much, too little, or blocked qi, TCM teaches that it will create health problems.

If this is hard to understand, picture a stream. If something blocks the flow of water, pressure builds up behind the blockage and water can go spilling out over the banks. Too much water can lead to floods, while too little water can kill off plants and animals that live there. The purpose of acupuncture is to keep the stream flowing free and at desired amounts.

Benefits vs. Risks

When you consider treatment options for FMS and ME/CFS, or any health condition for that matter, it's important to weigh the potential benefits against the potential risks.

According to experts, both Eastern and Western, the potential benefits of acupuncture include:

Less painBetter sleepRelaxationPossible immune system boostBetter overall health

Research released in 2008 showed that after 20 acupuncture treatments, people with FMS had significant improvements in pain and quality of life that lasted for 3 months after treatment was stopped, with a gradual decline in those areas until all benefit was gone after 2 years.

Acupuncture can be much safer than other therapies, especially if you're combining several different treatments. Benefits as a complementary therapy include:

No negative interactions with other treatments, including drugsExtremely mild side effectsLow risk

Possible risks of acupuncture are extremely rare, especially with a licensed acupuncturist. Risks include:

Infection from non-sterile needlesOrgan puncture (very rare occurrence)NauseaDizziness & faintingBruising

Licensed practitioners in the United States are required to use sterile needles and dispose of them after each use, but this is not required in all parts of the world.

An Acupuncture Exam

When you go to an acupuncturist, he/she will likely take your pulse at several points along both wrists. Don't be surprised if you're asked to stick out your tongue; in TCM, the tongue's shape, color and coating are important diagnostic tools.

The needles only go in about a centimeter. After inserting them, the acupuncturist will twist or gently wiggle them to get them firmly into the proper point. You might get a muscle twitch or brief ache, or you might feel nothing at all. Once all the needles are in (the amount used varies), you'll stay in place and rest for anywhere from 15 minutes to an hour. You'll probably be extremely relaxed and could even fall asleep. Afterward, the acupuncturist will pluck out the needles, which doesn't hurt at all.

A few hours after your first treatment, you could feel some aches around your body. This is normal, and practitioners say it's a sign that the treatment is working. The aches don't typically last long, and over-the-counter pain relievers will help. It's common to sleep more deeply than usual that night, which is a definite bonus for anyone with FMS and ME/CFS.

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Neuroimaging Approaches to Deconstructing Acupuncture for Chronic Pain - includes fibromyalgia

Neuroimaging Approaches to Deconstructing Acupuncture for Chronic Pain - includes fibromyalgia | Acupuncture Research |

Neuroimaging Approaches to Deconstructing Acupuncture for Chronic Pain

This study is not yet open for participant recruitment.Verified February 2014 by University of MichiganSponsor:University of MichiganCollaborators:National Center for Complementary and Alternative Medicine (NCCAM)Massachusetts General HospitalInformation provided by (Responsible Party):Richard Harris, University of Identifier:NCT02064296First received: February 11, 2014Last updated: February 14, 2014Last verified: February 2014History of ChangesFull Text ViewTabular ViewNo Study Results PostedDisclaimerHow to Read a Study Record  Purpose

The aim of this study is to evaluate the impact of electro-acupuncture in pain processing on patients with fibromyalgia (FM). The investigators hypothesize that electro-acupuncture is effective for FM because it functions as a desensitization therapy, which when applied repeatedly over multiple treatment sessions, gradually habituates the nervous system to continuing pain and sensory signaling.

ConditionInterventionFibromyalgiaDevice: Needle acupuncture (Traditional Acupuncture)
Device: Laser acupuncture (Non-traditional Acupuncture)
Study Type:InterventionalStudy Design:Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Investigator, Outcomes Assessor)
Primary Purpose: DiagnosticOfficial Title:Neuroimaging Approaches to Deconstructing Acupuncture for Chronic Pain
Resource links provided by NLM:
MedlinePlus related topics: Acupuncture Acute Bronchitis Chronic Pain FibromyalgiaU.S. FDA Resources 
Further study details as provided by University of Michigan:
Primary Outcome Measures:Neurocircuitry underlying chronic pain [ Time Frame: At baseline ] [ Designated as safety issue: No ]Characterize the altered somatosensory-related neurocircuitry underlying chronic pain in FM.Change in brain connectivity and neurochemistry with acupuncture treatment [ Time Frame: 4 weeks ] [ Designated as safety issue: No ]Brain neurochemistry and connectivity will be assessed at baseline and following either electroacupuncture or laser acupuncture.
Secondary Outcome Measures:Predicting response to acupuncture [ Time Frame: 4 weeks ] [ Designated as safety issue: No ]Baseline neuroimaging outcomes of connectivity and neurochemistry will be used to predict subsequent response to electroacupuncture and laser acupuncture.
Estimated Enrollment:100Study Start Date:March 2014Estimated Study Completion Date:July 2019Estimated Primary Completion Date:October 2018 (Final data collection date for primary outcome measure)ArmsAssigned InterventionsNo Intervention: ControlsHealthy pain free controls will be recruited for comparison with fibromyalgia patients. Active Comparator: Non-Traditional Acupuncture40 fibromyalgia patients will be randomized to non-traditional laseracupuncture (Vita Laser 650, Lhasa OMS). They will receive 2 treatments per week for 4 weeks.Device: Laser acupuncture (Non-traditional Acupuncture)For non-traditional acupuncture, a laser acupuncture device will be positioned over all of the same acupoints used in EA. There will be no palpation prior to positioning these devices, and there will be no physical contact between device and skin.Active Comparator: Traditional Acupuncture40 fibromyalgia patients will be randomized to receive electro acupuncture (AS Super 4 digital needle stimulator, Harmony Medical Co) . They will receive 2 treatments per week for 4 weeks.Device: Needle acupuncture (Traditional Acupuncture)This group will receive needle acupuncture at 3 pairs of sites. The needles will be stimulated with low intensity, low frequency electric current using a constant-current electro-acupuncture device.
Detailed Description:

This study design has two components: 1) a cross sectional assessment of brain chemistry, connectivity and response to pain in healthy controls and age- and sex-matched fibromyalgia patients, and 2) a longitudinal assessment of the same outcomes in fibromyalgia patients randomized to either electro-acupuncture or laser acupuncture.

The investigators will evaluate 80 fibromyalgia patients who will receive acupuncture treatment twice a week for 4 weeks, for a total of 8 treatments. Baseline data from these patients will be compared to results from 20 pain-free controls.

Participants will undergo experimental pain assessments as well as brain neuroimaging.


Ages Eligible for Study:  18 Years to 65 YearsGenders Eligible for Study:  FemaleAccepts Healthy Volunteers:  YesCriteria

Inclusion Criteria for Fibromyalgia Participants

Met the American College of Rheumatology (1990) criteria for the diagnosis of FM [2] for at least one year.Continued presence of pain more than 50% of days.Pain greater than 4 on a 10cm Visual Analog Scale (VAS) for pain; 7-day recall; [Note: The VAS is widely used in clinical pain research and as such we chose to use it for inclusion criteria and for clinical pain assessment below. Within our group numerical ratings scales 0-100 are more commonly used in quantitative sensory assessment, and as such we chose to use NRS scales for evoked pain assessments below.]Willing to limit the introduction of any new medications or treatment modalities for control of FM symptoms during the study.Able to travel to the study site to receive acupuncture treatments up to two times weekly.Over 18 and under 65 years of age.Right-handed.Female.Capable of giving written informed consent.

Inclusion Criteria for Healthy Control Participants

Over 18 and under 65 years of age.Female.Right-handed.Pain less than 4 on a 10cm Visual Analog Scale (VAS) for pain; 7-day recallWilling to complete all study procedures.Capable of giving written informed consent.

Exclusion Criteria for Fibromyalgia Participants:

Acupuncture within last 6-months.Presence of a known coagulation abnormality, thrombocytopenia, or bleeding diathesis that may preclude the safe use of acupuncture.Presence of a concurrent autoimmune or inflammatory disease such as rheumatoid arthritis, systemic lupus erythematosus, inflammatory bowel disease, etc. that causes pain.Routine daily use of narcotic analgesics or history of substance abuse.Stimulant medications, such as those used to treat ADD/ADHD (e.g., amphetamine/ dextroamphetamine [Adderall®], methylphenidate, dextroamphetamine), or the fatigue associated with sleep apnea or shift work (e.g., modafinil), are excluded.Concurrent participation in other therapeutic trials.Pregnant or nursing.Severe psychiatric illnesses (current schizophrenia, major depression with suicidal ideation, substance abuse within two years).Contraindications to fcMRI, fMRI, or 1H-MRS methods. These may include but are not limited to: surgical clips, surgical staples, metal implants, and certain metallic dental material. [Note: a more formal description of contraindications for MRI is present in our DSM Plan].Any impairment, activity or situation that in the judgment of the Study Coordinator or Principal Investigator that would prevent satisfactory completion of the study protocol. This includes unreliable, or inconsistent pain scores as deemed by the principal investigator.

Exclusion Criteria for Healthy Control Participants:

Have met the American College of Rheumatology (1990) criteria for the diagnosis of FM.Presence of a concurrent autoimmune or inflammatory disease such as rheumatoid arthritis, systemic lupus erythematosus, inflammatory bowel disease, etc. that causes pain.Routine daily use of narcotic analgesics or history of substance abuse.Stimulant medications, such as those used to treat ADD/ADHD (e.g., amphetamine/ dextroamphetamine [Adderall®], methylphenidate, dextroamphetamine), or the fatigue associated with sleep apnea or shift work (e.g., modafinil), are excluded.Concurrent participation in other therapeutic trials.Pregnant or nursing.Severe psychiatric illnesses (current schizophrenia, major depression with suicidal ideation, substance abuse within two years).Contraindications to fcMRI, fMRI, or 1H-MRS methods. (see above section)Any impairment, activity or situation that in the judgment of the Study Coordinator or Principal Investigator that would prevent satisfactory completion of the study protocol.  Contacts and Locations
Please refer to this study by its identifier: NCT02064296

ContactsContact: U-M
LocationsUnited States, MichiganChronic Pain and Fatigue Research CenterNot yet recruitingAnn Arbor, Michigan, United States, 48106Contact: CPFRC    866-288-0046   Principal Investigator: Richard E Harris, PhD         Sub-Investigator: Steve E Harte, phD         Sub-Investigator: Bradly Foerster, MD         Sub-Investigator: Alex Tsodikov, PhD         Sub-Investigator: Daniel J Clauw, MD         Sponsors and CollaboratorsUniversity of MichiganNational Center for Complementary and Alternative Medicine (NCCAM)Massachusetts General HospitalInvestigatorsPrincipal Investigator:Richard E Harris, PhDUniversity of MichiganPrincipal Investigator:Viataly Napadow, PhDMassachusetts General Hospital  More Information
No publications provided 

Responsible Party:Richard Harris, Assistant Professor, University of Identifier:NCT02064296     History of ChangesOther Study ID Numbers:AcuAfference, R01AT007550Study First Received:February 11, 2014Last Updated:February 14, 2014Health Authority:United States: Institutional Review Board
Keywords provided by University of Michigan:Fibromyalgia Chronic Pain
Additional relevant MeSH terms:Fibromyalgia
Myofascial Pain Syndromes
Muscular Diseases
Musculoskeletal DiseasesRheumatic Diseases
Neuromuscular Diseases
Nervous System Diseases processed this record on March 05, 2014

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Acupuncture.Com - Research - Nocturnal Enuresis

Acupuncture.Com - Research - Nocturnal Enuresis | Acupuncture Research |

By Roje-Starcevic M.

[The treatment of nocturnal enuresis by acupuncture]

Neurologija, 1990, 39(3):179-84. 
(UI: 91148725) 
AT: UCLA siomed W1 NE265 
(PE title: Neurologija)

Abstract: The etiology of enuresis is not completely explained. It is assumed that it might be a psychosomatic disorder caused by psychological and urological predispositions combined with unfavorable environmental factors.

Thirty-seven patients of both sexes (mean age 8 years) were included in the acupuncture treatment. They had not shown any improvement after psychotherapy. During the observation period of 6 months (180 days) after the acupuncture treatment, the statistical decrease of enuresis was evident (2.9), thus confirming that acupuncture represents a new possibility of treatment of patients with enuresis.

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The acupuncture trials from Germany – What do they tell us about efficacy, effectiveness, cost-effectiveness and safety?

The acupuncture trials from Germany – What do they tell us about efficacy, effectiveness, cost-effectiveness and safety? | Acupuncture Research |
The acupuncture trials from Germany – What do they tell us about efficacy, effectiveness, cost-effectiveness and safety?
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