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TCM, Acupuncture and Eastern Medicine

The Effect of Acupressure on Cardiac Rhythm and Heart Rate Among Patients With Atrial Fibrillation: The Relationship Between Heart Rate and Fatigue
Ozlem Ceyhan, RN, PhD;  Ali Dogan, PhD;  Ferhan Elmali, PhD;  Sultan Tasci, PhD, RN
Objectives • Atrial fibrillation (AF) is the most common arrhythmia among rhythm disturbances causing symptoms such as dyspnea, palpitation, and fatigue. Various methods are used for control and treatment of the disease. This randomized controlled study was conducted to determine the effect of acupressure applied to patients with AF on their cardiac rhythm and heart rate, as well as relationship between heart rate and fatigue. Design • The study was conducted with 60 individuals (30 in the intervention group and 30 in the placebo group) who met the inclusion criteria of the study in cardiology service. The data in the study were collected using a questionnaire, patient observation form, and brief fatigue inventory. In the study, ethics committee approval, institutional permission, and written informed consent from individuals were obtained. Interventions • In addition to standard medical treatments, the individuals in the intervention group were applied with acupressure on their acupuncture points (PC-6, HT-7, CV-17), which were specified by using a specially developed acupressure device, twice per day (minimum 2 and maximum 4 sessions). The individuals in the placebo group were attached to the acupressure device in addition to their standard medical treatments, but the pressure was not applied. All the patients were connected to holter, their pulse and blood pressure were monitored and followed up by being before, during, and after the acupressure. The value of P < .05 was accepted as significant in comparisons. Results • After the acupressure administration, heart rate and systolic/diastolic blood pressures of the individuals in the intervention group decreased (P < .05), whereas only diastolic blood pressure of the individuals in the placebo group decreased at the first administration (P < .05), and the decrease in systolic blood pressure and heart rate was not significant (P < .05). In all patients in sample group, rhythm was not sinus and acupressure did not have a different effect on fatigue. Conclusion • As a result of the study, it was determined that the acupressure decreased heart rate in patients with AF, it was effective in decreasing systolic and diastolic blood pressure at repeated administrations, and this decrease was not effective in reducing fatigue. According to these results, it could be recommended to perform the repeated acupressure administration along with pharmacological treatment for reducing heart rate and blood pressure in AF.
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Acupuncture for Primary Dysmenorrhea: A Meta-analysis of Randomized Controlled Trials
Bing-Yan Cao, PhD;  Yu-Pei Chen, MD;  Tong Liu, PhD;  Yuan-Yuan Peng, MD;  Jia-Ni Yu, PhD;  Li Zhang, PhD
Context • Primary dysmenorrhea (PD) is one of the most common complaints among young women. Acupuncture has been widely applied as a therapeutic modality in China and abroad for PD; however, the evidence for its benefits is still not convincing. Objective • The study intended to conduct a systematic review of randomized, controlled trials (RCTs) to evaluate the evidence regarding the use of acupuncture in treating PD. Design • The research team retrieved reports for RCTs published in 7 databases from their inception to March 2016, with no language restrictions: PubMed, Medline, Embase, the Cochrane Central Register of Controlled Trials, the Chinese National Knowledge Infrastructure database, the Chinese Biomedical database, and the Wanfang database. Setting • The study was conducted at the Beijing University of Traditional Chinese Medicine (Beijing, China). Participants • Participants in the reviewed studies were women aged 14 to 49 y who had received a diagnosis of PD in the absence of any visible pelvic pathology. Interventions • The types of acupuncture included traditional acupuncture, electroacupuncture, ear acupuncture, scalp acupuncture, superficial acupuncture, electrosuperficial acupuncture, wrist-ankle acupuncture, and abdominal acupuncture. Outcome Measures • The primary outcome was pain relief measured using a visual analogue scale (VAS), a verbal rating scale (VRS), or a numerical rating scale (NRS). The secondary outcomes included (1) overall improvement as measured by the short-form McGill pain questionnaire or symptom scale based on the Clinical Study Guideline for New Developed Chinese Medicine, (2) menstrual distress as measured by the Menstrual Distress Questionnaire, (3) quality of life as measured by a validated scale (eg, the short-form 36), and (4) adverse effects. Results • Twenty-three trials enrolling a total of 2770 patients were included in the review. Overall, most trials were of poor quality. Among the trials, only 6 were evaluated as having a low risk of bias, 3 of which indicated that acupuncture was statistically more effective than sham acupuncture—mean difference (MD), -3.51; 95% confidence interval (CI), -5.27 to -1.75; P < .0001; I², 0%—or no treatment—MD, -21.95; 95% CI, -25.45 to -18.45; P < .00001; I², 0%—on the VAS (0 to 100 mm). Acupuncture also showed superiority to the control arms on the VRS, the NRS, and the McGill pain questionnaire, but those findings had been influenced by methodological flaws. Conclusions • The available evidence suggests that acupuncture may be effective for PD and justifies future high-quality studies.
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Influence of Huang Lian Jie Du Decoction on Quorum Sensing System of Pseudomonas aeruginosa
Ping Wang, PhD;  Fei Xia, PhD;  Lihua Ye, MD;  Mingwei Zhang, RPh
Context • Pseudomonas aeruginosa (P aeruginosa) is an opportunistic and nosocomial, Gram-negative pathogen that is characteristic of quorum sensing (QS) modulation. QS inhibition (QSI) is considered to be a new approach to antimicrobial treatment that may reduce issues of antibiotic resistance. Traditional Chinese herbs have been recognized as a source of QSI. Objective • This study was intended to investigate whether the Huang Lian Jie Du decoction (HLJJD) possesses the ability to produce anti-QS activity. Design • P aeruginosa PAO1 was cultivated in the presence and absence of HLJDD or of the aqueous extracts of each of its 4 constituent herbs: Rhizoma coptidis (RC), Radix scutellariae (RS), Cortex phellodendri (CP), and Fructus gardeniae jasminoidis (FGJ). The minimum inhibitory concentrations (MICs) were found for the HLJDD or its 4 constituents through testing each for evidence of antibacterial activity at 3.13, 6.25, 2.5, 25, 50, 100, 200, and 400 mg/mL. Outcome Measures • QS-dependent virulence factors were analyzed at subminimum MICs (sub-MICs) for the HLJDD and its constituent herbs. The mRNA of the QS genes was also assessed by a quantitative real-time polymerase chain reaction. Results • The HLJDD exhibited the lowest MIC of 100 mg/mL, compared with MICs of 200 mg/mL for the RC and RS, 400 mg/mL for the CP, and more than 400 mg/mL for the FGJ. At the sub-MIC of 50 mg/mL for HLJDD, the results showed a significant reduction in pyocyanin pigment, elastolytic activity, proteolytic activity, biofilm formation, and bacterial motilities in the PAO1, without inhibiting the bacterial growth. The mRNA level of the P aeruginosa elastase gene (lasB) was also significantly reduced. The mRNA analysis also showed an increasing tendency for overexpressed QS genes when observed at sub-MICs. That inhibitory tendency was also observed in the sub-MICs of the constituent herbs in different degrees. Conclusions • The HLJDD showed the synergism of its 4 constituents against the growth of P aeruginosa and the QS-dependent virulence factors. Its anti-QS activity may interrupt the QS domination of the virulence factors of P aeruginosa downstream, leading to the overexpressed QS genes.
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Comparison Between Acupuncture and Biofeedback as Adjunctive Treatments for Primary Insomnia Disorder
Hsien-Te Huang, MS, MD;  Shang-Lun Lin, MD;  Chi-Hung Lin, MS, MD;  Dong-Sheng Tzeng, MD, PhD
Context • Insomnia affects from 5% to 35% of the general population worldwide. Primary insomnia disorder is the most frequently diagnosed, sleep-related disorder. Pharmacological treatments remain the most widely used treatments for insomnia. Nonpharmacological treatments for primary insomnia disorder have been found to be effective. Objective • This study intended to determine the appropriateness of acupuncture and biofeedback as adjuncts to medication for primary insomnia disorder. Design • The research team designed a randomized, controlled study. Setting • The study took place in a psychosomatic clinic at a regional general hospital in southern Taiwan. Participants • Participants were patients at the clinic with primary insomnia disorder who had never received prior hypnotic medication or alternative treatments. Intervention • All participants received 10 mg of zolpidem. The participants were divided into 3 groups: (1) acupuncture adjunctive to zolpidem (AAZ) group—18 patients received 1 acupuncture session weekly; (2) biofeedback adjunctive to zolpidem (BAZ) group—17 patients received 1 biofeedback session weekly; and (3) control (OZ) group—14 patients received only zolpidem. Patients visited the clinic 1 ×/wk for 4 wk, at baseline and on days 7, 14, and 21 of the intervention. Outcome Measures • The Pittsburgh Sleep Quality Index (PSQI) was used to measure outcomes. Treatment success was defined as a final PSQI score of =5. The generalized estimating equation (GEE) was used for statistical analysis. Results • Using analysis of variance, the reduction in the PSQI scores were (1) 3.72 for the AAZ group, (2) 2.00 for the BAZ group, and (3) 2.29 for the OZ group (P = .28). The GEE analysis indicated no differences in the therapeutic effects among the 3 groups: P = .37 for the AAZ group vs the OZ group and P = .07 for the BAZ group vs the OZ group, when the PSQI of the OZ group was set to 0. The AAZ group had a significantly higher score than the OZ group for the sleep duration domain (B = 3.01, P < .001), whereas the BAZ group had a significantly higher score than the OZ group on the sleep disturbance domain (B = 6.78, P < .001). Higher scores indicate more difficulty in a domain. Conclusions • The change in the PSQI score and the success rate were better in the acupuncture group. The heterogeneity in primary insomnia disorder might mean that different therapeutic compositions are needed.
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Wrist-ankle Acupuncture Increases Pain Thresholds in Healthy Adults
Hai-jin Bi, BM;  Hong-yun Chen, MM;  Yu-yu He, BM;  Guo-cheng Wu, BM;  Shuang Zhou, MD;  Qing-hui Zhou, MD
Context • Wrist-ankle acupuncture (WAA) has been used to relieve both chronic and acute pain in China. Some research has shown that WAA can increase the pain thresholds in pain patients, but the ability of WAA to affect the pain thresholds in healthy adults is unknown. Objective • The study intended to assess the influence of WAA on the pain thresholds of healthy adults. Design • This is an observational study. Setting • This study was conducted in the School of Traditional Chinese Medicine at the Second Military Medical University (Shanghai, China). Participants • Participants were 50 healthy university students aged 19–23 y. Intervention • In the theory of WAA, each side of the body and each limb are longitudinally divided into 6 regions, with 1 needling point defined for each region at the wrist or ankle. The theory indicates that needling a point should relieve pain in a point’s corresponding region. For the study, a needle was inserted and retained for 30 min in the Upper 2 point of the left wrist of each participant. Outcome Measures • The pressure pain threshold was measured by a handheld algometer at a position in the left Upper 2 region corresponding to the site of the needling and at positions in the right Upper 2 region as well as the left and right Upper 3 regions not corresponding to the site of the needling. The measurements were taken at 40 min before needling, 5 min after needling, 30 min after needling when the needles were removed, and 70 min after needling. Results • The immediate influence of the WAA on the pain threshold was not significant at 5 min after needling (P > .05). However, at 30 min after needling when the needles were removed, the increases in the pain thresholds were statistically significant when compared to those at 40 min before needling, which were the measurements at baseline (P = .01). At 70 min after needling, the pain thresholds remained higher than those at 40 min before needling (P < .05). From 40 min before needling to 70 min after needling, the pain thresholds in the different positions showed a continuous increase. Conclusions • The WAA had an analgesic effect on pressure-induced pain not only in the corresponding but also in the noncorresponding regions of the needling point in healthy adults. The immediate analgesic effect of the WAA at 5 min after needling was not obvious, but the effects at 30 min and 70 min after needling were statistically significant.
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Acupuncture is Effective for Chronic Knee Pain: A Reanalysis of the Australian Acupuncture Trial
Arthur Yin Fan, MD, PhD, LAc;  Sherman Gu, BMed, AdvDipMyother, MAppSc;  Yong Ming Li, MD, PhD;  Kehua Zhou, MD, DPT, PT, LAc
Context • In the October 2014 issue of the Journal of the American Medical Association (JAMA), Hinman et al published the results of an Australian clinical trial on acupuncture in a paper entitled “Acupuncture for Chronic Knee Pain: A Randomized Clinical Trial” (JAMA report), in which they concluded that neither acupuncture nor laser acupuncture had any greater effects than sham laser acupuncture for pain or function for patients aged 50 y and older with moderate-to-severe knee pain. That study has been criticized extensively by international scholars for its validity because serious methodological flaws existed throughout the study’s design, implementation, and conclusions. Objective • The current study intended to re-examine the prior study’s conclusions about the efficacy of acupuncture for chronic knee pain. Design • The current research team performed a reanalysis of relevant data from the JAMA report. Intervention • The original study included 4 groups: (1) an acupuncture group, which received needle acupuncture, inferred by the current authors to have been set up to be a positive control in the original study; (2) a laser acupuncture group, which received laser acupuncture; (3) a sham laser acupuncture group, which received sham laser acupuncture and acted as the negative controls for the laser acupuncture intervention; and (4) a control group, which received conventional care but no acupuncture or laser treatments. The study lasted 12 wk. Outcome Measures • The measures included evaluations in the following areas: (1) poststudy modifications—an evaluation of the consistency of the JAMA report with the study’s intentions as identified for a grant that was originally approved and funded by the Australian National Health and Medical Research Council (NHMRC) in 2009, as indicated in the study’s trial registration, and as compared with the published protocols and to the study’s originally stated objectives; (2) high heterogeneity—an assessment of the heterogeneity among the 4 groups for the overall outcome related to pain; (3) ineffectiveness of laser acupuncture—an analysis of laser acupuncture’s efficacy for chronic knee pain as stated in the JAMA report, using effect size (ES); (4) effectiveness of acupuncture—a reanalysis of acupuncture’s efficacy for chronic knee pain in comparison with the original analysis in the JAMA report, using ES; and (5) acupuncture after data adjustment—a new analysis of acupuncture’s efficacy for chronic knee pain using data from the original study that was discussed in the JAMA report, using ES, with an estimation after data adjustment and elimination of the dilution effect of the Zelen design. Results • Contrary to a general impression that acupuncture was the focus, laser acupuncture was the primary intervention tested in the actual study, “Laser Acupuncture in Patients With Chronic Knee Pain: A Randomized, Placebo Controlled Trial.” The study discussed in the JAMA report was neither a truly randomized, controlled trial (RCT) for acupuncture nor was it an appropriately designed, randomized study in general. High heterogeneity was found among its groups in the evaluation of overall pain in patients. Both the ES of 0.60 that had been set by Hinman et al for the minimal clinically important difference (MCID) and the resulting interpretation of results in the JAMA report were not appropriate. Using the original study’s criteria of efficacy, the reanalysis has confirmed that the laser acupuncture was not effective, whereas the acupuncture was found to be moderately effective for chronic knee pain (P < .05) for both overall pain and function at 12 wk, with an ES of 0.58, or after the adjustment of the data, with an ES of 0.67. Conclusions • The JAMA study was neither a conventional RCT nor an appropriately randomized trial, and its results are probably invalid. The ES of 0.60 for the MCID that was used in the JAMA study and the resulting explanation were not appropriate. Even with an ES of 0.60 for the MCID, acupuncture remained effective after data adjustment. Consequently, compared with conventional care, acupuncture treatment was found to be moderately effective for chronic knee pain in patients aged 50 y and older. (Altern Ther Health Med. 2016;22(3):32-36.)
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