Acupuncture For The Treatment Of Adductor Spasmodic Dysphonia

Acupuncture For The Treatment Of Adductor Spasmodic Dysphonia
Steven Scheer, MD
Linda Lee, PhD

From http://www.medicalacupuncture.org/aama_marf/journal/vol14_3/article4.html

Vol. 14, #3

ABSTRACT
Background     Spasmodic dysphonia (SD), a rare neurologic spasm of the vocal folds, results in a chronic voice disorder that can affect patients’ quality of life. Current treatment, including surgery and botulinum toxin injections, produces inconsistent results.
Objective     To investigate the use of acupuncture in the treatment of SD.
Design, Setting, and Participants   Prospective case series of 10 individuals (n=9 women; mean age, 45 years) with adductor SD in a metropolitan Ohio area during 2001.
Intervention     Eight sessions (1 week apart) of acupuncture using the LU-LI distinct meridian; during sessions 2-8, electrical stimulation was applied. Auricular acupuncture to “larynx” points during sessions 4-8
Main Outcome Measures     Self-report of participants’ perception of sound and ease of voice production, as well as changes in vocal quality observed by speech/language pathologists and subjects’ associates.
Results     There was no value in the LU-LI treatment without electrical stimulation. Seven of the 10 participants reported vocal improve-
ment, and 2 others noted improvement during specific times of the investigation. Seven rated satisfaction as 3 or higher on a 5-point scale. Seven individuals reported that others noted vocal improvement.
Conclusions   Most participants reported improvement in vocal quality and speech production following acupuncture treatment. Further research of acupuncture for SD is needed.
KEY WORDS
Spasmodic Dysphonia, Voice Disorder, Acupuncture, Overadduction, Overabduction

INTRODUCTION
he neurologic condition known as spasmodic dysphonia (SD) or uncontrolled spasm of the vocal folds results in a chronic voice disorder.1,2 Believed to be related to the focal dystonias that include blepharospasm, torticollis, and writer’s cramp, SD is defined as an extreme overadduction or overabduction of the vocal folds that interferes with phonatory vibration.3-6 SD does not respond well to conventional voice therapy, behavior modification, or oral antispasmodic medication.5

While SD is rare (current estimates are 1 case in 20,000 persons), for many individuals, it is extremely disabling in life and work.5 The range of onset is from 3 to 85 years, with a mean around 38 years. It occurs more often in women (58%) than in men (42%).6 There are adductor, abductor, and mixed types of the condition, and some patients have symptoms of other focal dystonias as well.6 In the most common form, the adductor type, voice production is characterized by strain and effort, pitch or voice breaks, and there are occasional complete blocks in the ability to sustain the vibratory cycle.7-9 Because of the hyperadduction of the vocal folds and the amount of effort needed to phonate during spasms, many patients complain of physical fatigue, tension in the muscles surrounding the neck, and shortness of breath. Some persons with SD develop fear of speaking that may interfere with holding a job or even maintaining relationships. Use of the telephone is especially difficult for others. Initial thoughts on the possible psychiatric origin of SD have since been discounted.3,4 The presumed central nervous system site of the pathophysiologic disturbance is in the basal ganglia; exactly where is unclear, as is the case with other focal dystonias.10,11

Until recently, persons with this development were forced to resort to either surgical resection of the recurrent laryngeal nerve or the laryngeal muscles, or to the injection of botulinum toxin into one or, rarely, both vocal folds.2,12 Dedo and Izdebski2 established a surgical approach involving unilateral resection of the recurrent laryngeal nerve. While the initial success was reportedly high, subsequent reports suggested that the return of vocal cord dystonia and a worsened vocal quality were as high as 60% in the 3-year follow-up period.12

Another surgical approach, laryngoplasty, caused vocal cord relaxation but with a potential sacrificed loss of pitch and loudness.12 A newer procedure developed by Berke et al12  that prevents reinnervation of the vocal cord adductor muscles appears promising, but is still being investigated.

Use of botulinum toxin was approved by the US Food and Drug Administration (FDA) in 1989 for treatment of blepharospasm (eyelid spasm).7-9 The toxin blocks the release of acetylcholine at nerve terminals. If directed to localized areas of innervated muscle, botulinum toxin can be an effective local paralyzer of unneeded muscle action.

Shortly after its FDA approval for blepharospasm, botulinum toxin was used off-label for the treatment of SD.7 Following injection, the paretic muscle loses its spasm, but the vocal quality after treatment is quite variable: some patients have only a whisper for a number of weeks after injection while others have only a brief remission from the spasm and a return of the entirety of vocal problems within a few months.8,12,13

The procedure is expensive ($500-$750 per injection) and must be repeated every 2-12 months indefinitely.8,12,14 Each injection is followed by occasional difficulty in swallowing.8,12 Over time, botulinum toxin may lose its effectiveness, perhaps due to calcification of the injected muscle.14 Unofficial estimates of the frequency with which botulinum toxin injection is used for disabling SD are approximately 75% of patients with the condition.

A group of academic speech/language pathologists at the University of Cincinnati learned of a limited case study on the use of acupuncture for SD in 1997.15 The patient who underwent acupuncture therapy for SD improved on all measures of voice parameters even after a 6-month follow-up period. The exact nature of the acupuncture treatment was not identified in the report and an attempt to reach the investigative team was unsuccessful.

The first author participated as one of two physician acupuncturists in a pilot study of individuals with adductor SD in metropolitan Ohio. We intended to identify, using a few types of acupuncture treatments, whether a combination of methods could improve acoustic measures of voice and perception of vocal quality. We also hoped to determine which of a battery of measurement procedures best described the effects of treatment.

METHODS
Patient Selection
Ten individuals with adductor SD were investigated during 2001. The participants were drawn from the files of local speech/language pathologists or were recruited through an advertisement in the local SD newsletter. Participants ranged in age from 31 to 70 years (mean 45 years). Nine of the participants were women.

Five individuals had never received botulinum toxin injections, either because they were newly diagnosed or because they had rejected its use. Of the remaining 5 who had received botulinum toxin in the past, we excluded from consideration any persons who been treated within 12 months of the 1st acupuncture session. None of the 10 had undergone surgical treatment for SD. All eligible individuals gave informed consent to participate. The research proposal was reviewed and approved by the institutional review board of the University of Cincinnati.

Speech Evaluation
All clinical testing of speech variables was performed independently by 3 licensed speech/language pathologists from the University of Cincinnati or Miami University of Ohio. Main outcomes included measures of voice analysis (Kay Elemetrics Motor Speech Profile, CSL Model 4300B, Lincoln Park, NJ), and a self-report of participants’ perception of sound and ease of voice production (Voice Handicap Index16). Additional perceptual voice analysis was performed after participants were tape-recorded while reading a standard passage. After the treatments were completed, participants were asked a series of open-ended questions regarding their experience with the protocol, changes in vocal quality noticed by themselves, coworkers, or family members, and future plans regarding acupuncture. Participating physicians did not collect any data so as to minimize observation biases.

Acupuncture Treatment
 The acupuncture protocol (Table 1) was devised by two treating physicians, with input from Dr Joseph Helms and reference to primary texts.17,18 Each participant received 8 treatment sessions, spaced about 1 week apart. For each treatment, participants were placed on a padded plinth in the supine position. Music was played for added relaxation. Session 1 began with a brief description of the procedure to allay anxiety about acupuncture.

In each of the 8 sessions, the protocol required use of the LU-LI meridian17 (Figure 1) plus a focusing point at ST 9, electrically stimulated for all but the 1st session: LU 1 and LI 15 (crossed for negative black clip), LI 18 and ST 9 (crossed for positive red clip). Needles at ST 9
(Figure 1) were directed inward toward the middle of the thyroid cartilage lamina. Stainless steel Seirin 40- and 6-mm needles were used for the LU-LI meridian approaches. During sessions 2-8, a 3-channel electrical stimulator (OMS Medical Supplies Inc, Braintree, Mass) was used at either 80 Hz or 15 Hz. The needles were left in place for approximately 30 minutes. For body tonification points electrically stimulated during the 8th session, 2.5 Hz frequency was chosen. During sessions 2 through 8, attempts were twice made to turn up the intensity of electrical stimulation during each session to enhance the effect.

Ear acupuncture, used initially in session 4, featured double needling of both the French and Chinese “larynx point,” located respectively on the medial surface of the tragus and just posterior to the external auditory meatus on the cavum conchae19 (Figure 2). For ear acupuncture and for the needling of Ting points (LI 1 on the index finger tip, ST 45 on 2nd toe tip), 15-mm plastic-handled Seirin needles were used. Ear tacks 1.5 mm long were placed on the 2 larynx points of both ears for 5 days after session 6.

All participants received exactly the same acupuncture treatment protocol in sessions 1 through 3. Beginning with session 4, the acupuncturists allowed each patient to provide some input as to the efficacy of the previous 2 sessions. For sessions 4-8, the use of either 15 Hz or 80 Hz stimulation frequency was determined by the participants’ individual input as to which of treatments 2 or 3 provided the better week-long improvement. In sessions 7 and 8, participants could choose between use of Ting points (from session 6) or body tonification points (from session 5), again according to their self-perception of improvement.

Table 1. Acupuncture Protocol by Session Session Protocol 1 LU-LI distinct meridian, needles in dispersion, for 30 minutes 2 No. 1 plus electrical stimulation, 80 Hz for 30 minutes 3 No. 1 plus electrical stimulation, 15 Hz for 30 minutes 4 No. 2 or 3 plus double needling of both “larynx points” in each ear, 60 minutes 5 No. 2 or 3 plus body tonification points (LI 4, ST 36, SP 6, LV 3, MH 6) for 20 minutes 6 No. 2 or 3 plus double needling of LI and ST Ting points for 20 minutes; ear tacks placed on bilateral larynx points for 5 days 7 No. 2 or 3 plus choice of Ting or tonification points from sessions 5 or 6 8 No. 2 or 3 plus choice of Ting points or electrical stimulation of LI 4 and SP 6 at 2.5 Hz plus needles in other tonification points: ST 36, ST 43, PC 6, HT 3, LV 3

RESULTS
Participants showed significant improvement in some measures of vocal production and movement from outside to within normal range following treatment for many variables, even when statistically significant differences were not observed. Additionally, patients reported statistically significant improvements in their daily voice use on the Voice Handicap Index.

There was no value in use of the LU-LI Distinct Meridian treatment without electrical stimulation. Some participants were generally satisfied with the use of the Distinct Meridian; however, that was after at least 2 sessions that included electrical stimulation. Participants were equally likely to choose the 15-Hz or 80-Hz frequency setting for sessions 4-8.

Participants disliked the use of Ting points and did not feel they represented added value to the treatment; neither was there positive consensus about use of the body tonification points. Beginning with session 4, some individuals experienced reduction in vocal fold spasms with auricular stimulation at the French and Chinese “larynx” points. By the end of the study, the greatest improvements were noted when electrical stimulation was added to the Distinct Meridian treatment (session 2), and when the ear larynx points were stimulated (sessions 4 and 6). However, objective measures of voice production were more inconsistent in showing a positive response within 10 days after the protocol was completed.

Figure 1. Diagram of the Lung-Large Intestine Distinct Meridian Acupuncture Points Point 1 (LI 18) is located on the middle belly of the sternocleidomastoid muscle, lateral to point 2. Point 2 (ST 9, slightly displaced) is located at the anterior border of the sternocleidomastoid at the level of the thyroid cartilage. Point 3 (LI 15) is on the upper deltoid, just in front of the acromion. Point 4 (LU 1) is 2 in below the acromial end of the clavicle, in the depression. For electrical stimulation during sessions 2-8, needles at 3 and 4 were crossed and clipped by the negative pole stimulator (black); needles at 1 and 2 were crossed and clipped by the positive pole stimulator.

 

On a post-treatment questionnaire, 7 of 10 participants reported improvement in their voices, and 2 others noted improvement during specific times in the protocol. Seven of 10 individuals rated their satisfaction with treatment for voice quality as a 3 or higher on a 5-point scale. Six rated as 3 or higher their feelings about amount of voice change. Seven stated that family members and friends noticed improvement, and 3 of the 7 who were employed said coworkers noticed improvement.

DISCUSSION
With its significant life effects, persons with SD are frequently desperate to receive treatment for their voice disorder. 20,21 Surgery on the vocal mechanism that will yield consistently good outcomes for persons with SD is still being investigated.12 The usual treatment available in larger medical centers, and sought by patients who must sometimes travel long distances to receive it, is botulinum toxin injections repeated every 2-12 months.7-9,12,13 An available alternative to botulinum toxin injections or a treatment that would extend the period between injections would be well received.

Therefore, we were hopeful to find which of several types of acupuncture could benefit persons with SD. We were aware of only 1 other published account of the use of acupuncture for a single patient with SD.15 The points used and treatment protocol were not identified in that study.

Our decision to use the LU-LI meridian was based on its trajectory and territory of influence that incorporates the trachea,vocal cords, and larynx.17 Use of the focusing point at ST 9 (Figure 1)
is an obvious choice for all laryngeal disorders. Use of ear acupuncture seemed reasonable because muscle sites represented on the ventral surface of the ear will readily relax with stimulation. The larynx points on the ear were commonly quite tender to touch and to needling, as typically occurs in auriculotherapy, in which a pathologic body part can appear to be “hot” in its corresponding ear representation.19 One of our consulting experts recommended use of the Ting points, but a limited trial at session 6 was not well received by our participants for subsequent sessions. Ting points are generally more useful for surface-level problems.19

Figure 2. Ear Acupuncture Points C indicates Chinese “larynx” point inside tragus; F, French “larynx” point posterior to external auditory meatus.

We chose to use a standard protocol for each individual, allowing only a limited variation determined by participants’ input for the choice of frequency stimulation rate in the LU-LI meridian, and a variation on sessions 7 and 8 depending on the individual’s perception of better effects between sessions 5 and 6. Overall, each individual received generally the same treatment.

Individuals with previous botulinum toxin injections were allowed to participate because we believed that to have a sufficient sample size for our pilot study and for any future research on the use of acupuncture in SD, there was and will be a need to include individuals who have already had these injections.

Some participants reported week-to-week variation in the extent of improvement. The most dramatic and rapid laryngeal response to acupuncture was derived from bilateral needling of the larynx points on the inner surface of the tragus (Chinese larynx point), and the point 3 mm posterior to the external auditory meatus on the cavum conchae (French larynx point). One individual was speaking just as the ear larynx point was needled, and both he and the physician noted a dramatic change in vocal quality as the needle entered the point. The effect on that occasion lasted several days though the needle was removed after 60 minutes. Because of their awareness of the success of ear stimulation, some of our participants continued to use either a “pointer plus” 10-Hz ear point stimulator or a specially developed ear stimulator (provided by Dr Onje Erfan of Denver, Colo) that delivers electrical stimulation of several frequencies simultaneously. One month following the study, 5 of the individuals were self-stimulating the ear for their perceived improvements. At least 1 individual was still using ear stimulation bi-weekly 1 year later.

When asked to characterize their feelings about the effects of acupuncture in open-ended questions, a majority of study participants and frequently, their family members or coworkers, were positive. When asked to characterize the improvements, participants commonly described a reduction in the effort required to speak, and in perceived laryngeal tension while speaking. They commented that their voices, though still not normal, were more “functional” and could be “counted on.”

Future studies of the use of acupuncture for SD should consider scalp acupuncture and Koryo Hand acupuncture. There may be additional acupuncture programs derived from a Traditional Chinese Medicine (TCM) protocol that can be found through a Chinese literature search. A crossover design that uses different acupuncture methods would be beneficial, but a larger population will be needed to show significant differences. Finally, a trial that randomizes SD patients into either botulinum toxin injections or acupuncture treatment would be reasonable.

CONCLUSION
We undertook a pilot study to ascertain whether any of several standardized acupuncture treatments could ameliorate the vocal fold spasm and improve voice quality in persons with adductor SD. We found that a majority of our participants obtained subjective benefits in the ease of producing spontaneous speech through acupuncture treatment. The most useful approach included electrical stimulation with the LU-LI Distinct Meridian and auricular acupuncture on the larynx points. Further investigation of acupuncture for the treatment of adductor SD is warranted.

ACKNOWLEDGEMENTS
We sincerely thank Samantha Daughton, MA, Joseph Stemple, PhD, Barbara Weinrich, PhD, Tracy Miller-Seiler, MA, and Scott Goeller, MD, for their help in conducting this investigation. We also thank Susan Schmidt, PhD, and Aviva Scheer, PhD, for their editorial comments, and John Barrord, MD, for graphics work.

REFERENCES

1. Frontis E. Results of a National Survey. National Spasmodic Dysphonia Association, reported by the Center for Voice Disorders of Wake Forest University; June 6, 1992.
2. Dedo HH, Izdebski K. Intermediate results of 306 recurrent laryngeal nerve sections for spastic dysphonia. Laryngoscope. 1983;93:9-16.
3. Aronson AE, Hartman DE. Adductor spastic dysphonia as a sign of essential (voice) tremor. J Speech Hear Disord. 1981;46:52-58.
4. .Parnes SM, Lavorato AS, Myers EN. Study of spastic dysphonia using videofiberoptic laryngoscopy. Ann Otol Rhinol Laryngol. 1978;87:322-326.
5. Colton RH, Casper JK, Hirano M. Understanding Voice Problems: A Physiological Perspective for Diagnosis and Treatment. Baltimore, Md: Lippincott
   Williams & Wilkins; 1996.
6. Koufman JA, Blalock PD. Classification of laryngeal dystonias. Center for Voice Disorders of Wake Forest University Web site. Link: http://www.thevoicecenter.org/class_ld.html. Verified January 23, 2003.
7. Blitzer A, Brin MF, Fahn S, Lovelace RE. Localized injections of botulinum toxin for the treatment of focal laryngeal dystonia (spastic dysphonia). Laryngoscope. 1988;98:193-197.
8. Ludlow CL. Treatment of speech and voice disorders with botulinum toxin. JAMA. 1990;264:2671-2675.
9. Zwirner P, Murry T, Swenson M, Woodson GE. Acoustic changes in spasmodic dysphonia after botulinum toxin injection. J Voice. 1991;5:78-84.
10. Cannito MP. Neurobiological interpretation of spasmodic dysphonia.
    In: Vogel D, Cannito MP, eds. Treating Disordered Speech Motor Control.
    Austin, Tex: ProEd; 1990:275-317.
11. Schaefer SD, Finitzo-Geiber TJ, Freeman FJ. Brainstem conduction ab-
    normalities in spasmodic dysphonia. In: Bless DM, Abbs J, eds. Vocal Fold Physiology. San Diego, Calif: College-Hill Press; 1987:393-404.
12. Berke GS, Blackwell KE, Gerratt BR, Verneil A, Jackson KS, Sercarz JA.
    Selective laryngeal adductor denervation-reinnervation: a new surgical
    treatment for adductor spasmodic dysphonia. Ann Otol Rhinol Laryngol. 1999;108:227-231.
13. Ford CN, Bless DM, Patel NY. Botulinum toxin treatment of spasmodic
    dysphonia techniques: indications, efficacy. J Voice. 1992;6:370-376.
14. Lee RE, Tartell PB, Karmody CS, Hunter DD. Association of adhesive macromolecules with terminal sprouts at the neuromuscular junction after botulinum treatment. Otolaryngol Head Neck Surg. 1999;120:255-261.
15. Crevier-Buchman L, Laccourreye O, Papon JF, Nurit D, Brasnu D. Adductor spasmodic dysphonia: case reports with acoustic analysis following
    botulinum toxin injection and acupuncture. J Voice. 1997;11:232-237.
16. Jacobson BH, Johnson A, Gryswalski C, et al. The Voice Handicap Index (VHI): development and validation. Am J Speech Language Pathol. 1997;6:
    66-76.
17. Helms J. The distinct meridian subsystems. In: Acupuncture Energetics: A
    Clinical Approach for Physicians. Berkeley, Calif: Medical Acupuncture Publishers; 1995:189-214.
18. Unschuld PU. Introductory Readings in Ancient Chinese Medicine. Dordrecht, the Netherlands: Kluwer Academic Publishers; 1988:59-63, 69-70.
19. Oleson T. Auriculotherapy Manual: Chinese and Western Systems of Ear Acupuncture. Los Angeles, Calif: Health Care Alternative; 1990.
20. Lundy DS, Lu FL, Casiano RR, Xue JW. The effect of patient factors on response outcomes to Botox treatment of spasmodic dysphonia. J Voice. 1998;12:460-466.
21. Benninger MS, Ahuja AS, Gardner G, Grywalski C. Assessing outcomes
    for dysphonic patients. J Voice. 1998;12:540-550.

AUTHORS’ INFORMATION
Dr Steven Scheer’s specialties are Physical Medicine and Rehabilitation, Sleep Medicine, and Medical Acupuncture.

Steven Scheer, MD*
St Luke Hospitals
85 No Grand Ave
Fort Thomas, KY 41075

Linda Lee, PhD, is Professor and Graduate Program Director in the Department of Communication Sciences and Disorders at University of Cincinnati, Cincinnati, Ohio. She teaches and conducts research in the areas of voice disorders, craniofacial anomalies, and respiratory disorders.
Linda Lee, PhD
University of Cincinnati
Dept of Communication Sciences and Disorders
202 Goodman Ave
Cincinnati, OH 45267-0379
E-mail: Linda.lee@uc.edu

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BENIGN ESSENTIAL TREMOR RESOLVED WITH ACUPUNCTURE.(from Online)

BENIGN ESSENTIAL TREMOR RESOLVED WITH ACUPUNCTURE

 Cristina S. de la Torre, M.D.

 Medical Acupuncture. A Journal For Physicians By Physicians

Fall / Winter 1989 – Volume 1 / Number 1
“Aurum Nostrum Non Est Aurum Vulgi”

ABSTRACT– This article reviews the complete resolution of a case of benign essential tremor, in a patient treated with acupuncture, who previously had limited response to drug therapy. Three treatments were given over a three-week period. The patient’s tremor of the head and upper extremities resolved 100%, and she has remained asymptomatic to date (5 months after the last treatment).

     In April, 1989, a 38-year-old white female, presented with the chief complaint of intolerable shaking of her head for over one year. From 1987 until then, she was treated for a variety of routine conditions at the practice. She had been diagnosed as having benign essential tremor for many years. Her mother, also a patient of the practice, reported that the patient suffered tremor of the upper extremities since approximately age 2~3, being nicknamed “shaky bones” by her peers. The main medications were propanolol and diazepam, which only provided modest reduction in the intensity of the tremor.

Her condition had been extensively studied at several medical centers, where she was repeatedly told that “she had to learn to live with the tremor, hopefully obtaining some relief by taking prescribed medications”.

   The patient’s family history was significant for alcoholism in both parents, a disease which had also afflicted her. She became a heavy drinker between the ages of 21 and 25, and then again between 35 and 37. Other significant medical history included asthma in childhood, excision of an ovarian cyst in 1970, and a twin pregnancy delivery in 1982. The patient is married and owns a successful business.

    Marked tremor of the upper extremities (1,2,3), both postural and during voluntary activity, was observed since her first visit in 1987. Around February, 1988, the patient began to notice tremor of her head, which had not been present previously. In May, 1988, she was hospitalized for alcohol detoxification. Soon after discharge, she complained of worsening of her head tremor. She continued sober but increasingly tremulous u ntil April, 1989, when she returned, requesting acupuncture to help her with her head tremor, which by then had become intolerable.
The patient’s constitution was determined to be JUE YIN- Wood, on the East position, according to Dr. Yves Requena’s classification (4). Treatment was then organized following Dr. Maurice Mussat’s “Energy of Living Systems” theory (5,6), specifically the use of triangular equilibration.

   Her first treatment, on April 14, 1989, consisted of a JUE YIN triangular equilibration in evolution, using points along the JUE YIN (Lived Master of the Heart), ABSOLUTE YIN (Conception Vessel), and YANG MING (Large Intestine/Stomach).

   On her follow-up visit, one week later, she reported great improvement of her head tremor, and mentioned the onset of an unusual craving for sweets. She was then treated with a TAE YIN simple triangular equilibration, with points on TAE YIN (Spleen/ Lung), YANG MING and ABSOLUTE YANG (Governor Vessel).
On her third visit, on April 27, she reported further improvement of her head tremor, and an unexpected complete resolution of her upper extremities tremor. It was then decided to conclude her treatment series with a SHAO YANG simple triangular equilibration (Triple Heater/Gall Bladder), SHAO YIN (Kidney/Hear[), and ABSOLUTE YANG. She was instructed to return 3 weeks later for reassessment.

    She did not return until 2 months later, on June 27, when she reported complete resolution of both her upper extremities and head tremor. She was still taking di-azepam, 5 mg twice a day, but had stopped taking propanelei. She was advised to taper off the diazepam, and return for another series of acupuncture treatments, should symptoms recur.
She did not return until 3 months later, on September 28, when she brought in her mother for treatment. At the time, the patient reported no recurrence of her symptoms, being free of tremor for 5 months to date, and without taking any medications. A physical examination, including neurological evaluation, was normal.

DISCUSSION 

Tremors may be physiologic or a symptom of neurologic disease, such as tumors, trauma, infections, demyelinating disease, Parkinson’s disease, peripheral neuropathy, and essential tremor (7). Benign essential tremor (called familial or hereditary tremor when there is a positive family history) is thought to be inherited as a Mendelian autosomal dominant trait. No neuropathological lesion has been recognized in post mortem examinations, its neurochemistry is unknown, and its pathophysiology is obscure (8). It may appear at almost any time, often in early adult life, but it may begin in childhood (9}. It is characterized by coarse, rhythmic and symmetric tremor, persisting throughout the range of motion of voluntary activity, increasing in amplitude as the limb approaches an object (finger-to-nose test), or in handling or bringing food or liquid to the mouth.
The frequency of the tremor varies between 6 and 12 Hz, most commonly recording 6-8 Hz (10). The tremor amplitude diminishes with rest and the use of alcohol, and is exacerbated by emotional and physical stress. Tremor increases m amplitude with age, and may eventually interfere with fine movements.
Propanolol (in doses of 40-240 mg/day) and other beta-antagonists which pass the blood-brain barrier and therefore have central and peripheral actions, have been used with varying responses, but no definitive cure (11,12). More recently, primidone has been reported to be as effective as propanolol in treating this condition (13). Alcohol, although the most effective agent, is not recommended. Chronic alcoholism in patients with essential tremor is often a consequence of their attempts to control the symptoms by drinking (14).
The treatment of tremors with acupuncture has 1cng been documented in the classical Chinese medical texts, and continued to be reported in the European and American literature (15), as “problems related to Wind of External and Internal origin”.
For wider clinical applications, the therapeutic response of benign essential tremor to acupuncture needs to be studied in a significant sample of patients with this same condition. However, the complexity of medical acupuncture is such that treatment protocols may be inadequate to incorporate the necessary data into a useful diagnostic and therapeutic formulation (16). The patient’s own diagram of constitutional characteristics, past history, family history, and associated symptoms, eventually determine the most appropriate therapeutic intervention in each case.
With this individualized approach, other functional movement disorders may also be considered as potentially responsive to Medical Acupuncture. Concomitantly, further observations of the effect of acupuncture on tremors may lead to unexpected insights into intrinsic aspects of the motor system.

REFERENCES 

1. Critchley E. Clinical manifestations of essential tremor. J. Neurology and Neurosurgery- Psychiatry. 1972; 35: 365-75.

 2. Critchley M. Observations on essential (heredo-familial) tremor. Brain. 1949; 72: 113-39.

3. Marshall J. Observations on essential tremor. J. Neurology and Neurosurgery-Psychiatry. 1962; 25: 122-25.

4. Requena Y. Terrains and pathology in acupuncture. Vol I- Correlation with diathetic medicine. Paradigm Publications, Brookline, MA. 1986.

5. Mussat M. Energetique des Systemes Vivants. Medecine et Sciences Internationales, Paris. 1982. Transl. by J.M. Helms, 1983.

6. Mussat M. Cours d’Energetique des Systemes Vivants Appliquee a la Acupuncture. 1ere, 2eme, et 3eme Annee. Ecole Superieure d’Acupuncture Francaise. 1983.

 

7. Koller W., Lang A. et al. Psychogenic tremors. Neurology 1989; 39: 1094-99.

 8. Adams R.D., & Victor, M. Principles of neurology- 4th edition. McGraw-Hill Information Services Co., New York. 1989, chapter 5.

9. Young R.R. In: Diseases of the nervous system- clinical neurobiology. Edited by Ashbury A.K. et al. W.B. Saunders Co. 1986, Vol 1, chapter 32.

10. Weiner W.J. & Goetz C.G. Neurology for the non-neurologist. 2nd edition. J.B.Lippincott Co., Philadelphia. 1989.

11. Dupont E., Hansen H.J. et al. Treatment of benign essential tremor with propanolol. Acta NeuroL Scand. 1973; 49: 75-84.

12. Winkler G.F., & Young R.R. Efficacy of chronic propanolol therapy in action tremors of the familial, senile or essential varieties. New Eng. J. Med. 1974; 290: 984-88.

13. Findley L.I., Cieeves L. et al. Primidone in essential tremor of the hands and head: A double blind controlled clinical study. J. Neurology and Neurosurgery- Psychiatry. 1985; 48: 911-15.

14. Growdon J.H., Shahani B.T. et al. The effect of alcohol on essential tremor. Neurology. 1975; 25: 259-62.

15. Kaptchuk T.J. The webb that has no weaver- understanding Chinese medicine. Congdon & Weed, New York. 1983.

16. UCLA Extension. Medical Acupuncture for Physicians. Santa Monica, California. J.M. Helms, course chairman.

www.ChineseMedicineDoctor.us

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What is Acupuncture: from NIH-NCCAM’s view. Dr.Arthur Fan

From: National Institute of Health, National Center for Complementary and Alternative Medicine (NCCAM)

NCCAM Clearinghouse

Acupuncture is one of the oldest, most commonly used medical procedures in the world. Originating in China moe than 2,000 years ago, acupuncture became widely known in the United States in 1971 when New York Times reporter James Reston wrote about how doctors in Beijing, China, used needles to ease his abdominal pain after surgery. Research shows that acupuncture is beneficial in treating a variety of health conditions.

In the past two decades, acupuncture has grown in popularity in the United States. In 1993, the U.S. Food and Drug Administration (FDA) estimated that Americans made 9 to 12 million visits per year to acupuncture practitioners and spent as much as $500 million on acupuncture treatments.¹ In 1995, an estimated 10,000 nationally certified acupuncturists were practicing in the United States. By the year 2000, that number is expected to double. Currently, an estimated one-third of certified acupuncturists in the United States are medical doctors.2

The National Institutes of Health (NIH) has funded a variety of research projects on acupuncture that have been awarded by its National Center for Complementary and Alternative Medicine (NCCAM), National Institute on Alcohol Abuse and Alcoholism, National Institute of Dental Research, National Institute of Neurological Disorders and Stroke, and National Institute on Drug Abuse.

This information and resource package provides general information about acupuncture, summaries of NIH research findings on acupuncture, information for the health consumer, a list of additional information resources, and a glossary that defines terms italicized in the text. It also lists books, journals, organizations, and Internet resources to help you learn more about acupuncture and traditional Chinese medicine.

Acupuncture Theories

Traditional Chinese medicine theorizes that the more than 2,000 acupuncture points on the human body connect with 12 main and 8 secondary pathways, called meridians. Chinese medicine practitioners believe these meridians conduct energy, or qi, between the surface of the body and internal organs.

Qi regulates spiritual, emotional, mental, and physical balance. Qi is influenced by the opposing forces of yin and yang. According to traditional Chinese medicine when yin and yang are balanced they work together with the natural flow of qi to help the body achieve and maintain health. Acupuncture is believed to balance yin and yang, keep the normal flow of energy unblocked, and restore health to the body and mind.

Traditional Chinese medicine practices (including acupuncture, herbs, diet, massage, and meditative physical exercises) all are intended to improve the flow of qi.3

Western scientists have found meridians hard to identify because meridians do not directly correspond to nerve or blood circulation pathways. Some researchers believe that meridians are located throughout the body’s connective tissue;4 others do not believe that qi exists at all.5,6Such differences of opinion have made acupuncture a source of scientific controversy.

Preclinical Studies

Preclinical studies have documented acupuncture’s effects, but they have not been able to fully explain how acupuncture works within the framework of the Western system of medicine.7,8,9,10,11,12

Mechanisms of Action

Several processes have been proposed to explain acupuncture’s effects, primarily those on pain. Acupuncture points are believed to stimulate the central nervous system (the brain and spinal cord) to release chemicals into the muscles, spinal cord, and brain. These chemicals either change the experience of pain or release other chemicals, such as hormones, that influence the body’s self-regulating systems. The biochemical changes may stimulate the body’s natural healing abilities and promote physical and emotional well-being.13 There are three main mechanisms:

• Conduction of electromagnetic signals: Western scientists have found evidence that acupuncture points an strategic conductors of electromagnetic signals. Stimulating points along these pathways through acupuncture enables electromagnetic signals to be relayed at it greater rate than under normal conditions. These signals may start the flow of pain-killing biochemicals such as endorphins and of immune system cells to specific sites that are injured or vulnerable to disease.14,15
• Activation of opioid systems: research has found that several types of opioids may be released into the central nervous system during acupuncture treatment, thereby reducing pain.16
• Changes in brain chemistry sensation, and Involuntary body functions: studies have shown that acupuncture may alter brain chemistry by changing the release ofneurotransmitters and neurohormones in a good way. Acupuncture also has been documented to affect the parts of the central nervous system related to sensation and involuntary body functions, such as immune reactions and processes whereby a person’s blood pressure, blood flow, and body temperature are regulated.3,17,18

Conditions Appropriate for Acupuncture Therapy
Digestive Abdominal pain Constipation Diarrhea Hyperacidity Indigestion	Emotional Anxiety Depression Insomnia Nervousness Neurosis	Eye-Ear-Nose-Throat Cataracts Gingivitis Poor vision Tinnitis Toothache	Gynecological Infertility Menopausal symptoms Premenstrual syndrome
Miscellaneous Addiction control Athletic performance Blood pressure regulation Chronic fatigue Immune system tonification Stress reduction	Musculoskeletal Arthritis Back pain Muscle cramping Muscle pain/weakness Neck pain Sciatica	Neurological Headaches Migraines Neurogenic Bladder dysfunction Parkinson’s disease Postoperative pain Stroke	Respiratory Asthma Bronchitis Common cold Sinusitis Smoking cessation Tonsilitis
Source: World Health Organization United Nations. “Viewpoint on Acupuncture.” 19 19 (revised).23

Clinical Studies

According to an NIH consensus panel of scientists, researchers, and practitioners who convened in November 1997, clinical studies have shown that acupuncture is an effective treatment for nausea caused by surgical anesthesia and cancer as well as for dental pain experienced after surgery. The panel also found that acupuncture is useful by itself or combined with conventional therapies to treat addiction, headaches, menstrual cramps, tennis elbow,fibromyalgia, myofascial pain, osteoarthritis, lower back pain, carpal tunnel syndrome, and asthma; and to assist in stroke rehabilitation.19

Increasingly, acupuncture is complementing conventional therapies. For example, doctors may combine acupuncture and drugs to control surgery related pain in their patients.20 By providing both acupuncture and certain conventional anesthetic drugs, doctors have found it possible to achieve a state of complete pain relief for some patients.16 They also have found that using acupuncture lowers the need for conventional pain-killing drugs and thus reduces the risk of side effects for patients who take the drugs.21,22

Outside the United States, the World Health Organization (WHO), the health branch of the United Nations, lists more than 40 conditions for which acupuncture may be used.23 The table (above) lists these conditions.

Currently, one of the main reasons Americans seek acupuncture treatment is to relieve chronic pain, especially from conditions such as arthritis or lower back disorders.24,25 Some clinical studies show that acupuncture is effective in relieving both chronic (long-lasting) and acute or sudden pain,26 but other research indicates that it provides no relief from chronic pain.27Additional research is needed to provide definitive answers.

FDA’s Role

The FDA approved acupuncture needles for use by licensed practitioners in 1996. The FDA requires manufacturers of acupuncture needles to label them for single use only.28 Relatively few complications from the use of acupuncture have been reported to the FDA when one considers the millions of people treated each year and the number of acupuncture needles used. Still, complications have resulted from inadequate sterilization of needles and from improper delivery of treatments. When not delivered properly acupuncture can cause serious adverse effects, including infections and puncturing of organs.1

NCCAM-Sponsored Clinical Research

Originally founded in 1992 as the Office of Alternative Medicine (OAM), the NCCAM facilitates the research and evaluation of unconventional medical practices and disseminates this information to the public. The NCCAM established in 1998, supports 13 Centers, where researchers conduct studies on complementary and alternative medicine for specific health conditions and diseases. Scientists at several Centers are investigating acupuncture therapy.

Researchers at the NCCAM Center at the University of Maryland in Baltimore conducted arandomized controlled clinical trial and found that patients treated with acupuncture after dental surgery had less intense pain than patients who received a placebo.20 Other scientists at the Center found that older people with osteoarthritis experienced significantly more pain relief after using conventional drugs and acupuncture together than those using conventional therapy alone.29

Researchers at the Minneapolis Medical Research Foundation in Minnesota are studying the use of acupuncture to treat alcoholism and addiction to benzodiazepines, nicotine, and cocaine. Scientists at the Kessler Institute for Rehabilitation in New Jersey are studying acupuncture to treat a strokerelated swallowing disorder and the pain associated with spinal cord injuries.

The OAM, now the NCCAM, also funded several individual researchers in 1993 and 1994 to conduct preliminary studies on acupuncture. In one small randomized controlled clinical trial, more than half of the I I women with a major depressive episode who were treated with acupuncture improved significantly.30

In another controlled clinical trial, nearly half of the seven children with attention deficit hyperactivity disorder who underwent acupuncture treatment showed some improvement in their symptoms. Researchers concluded that acupuncture was a useful alternative to standard medication for some children with this condition.31

In a third small controlled study, eight pregnant women were given moxibustion to reduce the rate of breech births, in which tile fetus is positioned for birth feet-first instead of the normal position of head-first. Researchers found the treatment to be safe, but they were uncertain whether it was effective.32 Then, rescarchers reporting in the November 11, 1998, issue of theJournal of the American Medical Association conducted a larger randomized controlled clinical trial using moxibustion. They found that moxibustion applied to 130 pregnant women presenting breech significantly increased the number of normal head-first births.33

Acupuncture and You

The use of acupuncture, like many other complementary and alternative treatments, has produced a good deal of anecdotal evidence. Much of this evidence comes from people who report their own successful use of the treatment. If a treatment appears to be safe and patients report recovery from their illness or condition after using it, others may decide to use the treatment. However, scientific research may not substantiate the anecdotal reports.

Lifestyle, age, physiology, and other factors combine to make every person different. A treatment that works for one person in, y not work for another who has the very same condition. You, as a health care consumer (especially if you have a preexisting medical condition), should discuss acupuncture with your doctor. Do not rely on a diagnosis of disease by an acupuncturist who does not have substantial conventional medical training. If you have received a diagnosis from a doctor and have had little or no success using conventional medicine, you may wish to ask your doctor whether acupuncture might help.

Finding a Licensed Acupuncture Practitioner

Doctors are a good resource for referrals to acupuncturists. Increasingly, doctors are familiar with acupuncture and may know of a certified practitioner. In addition, more medical doctors, including neurologists, anesthesiologists, and specialists in physical medicine, are becoming trained in acupuncture, traditional Chinese medicine, and other alternative and complementary therapies. Friends and family members may be a source of referrals as well. In addition, national referral organizations provide the names of practitioners, although these organizations may be advocacy groups for the practitioners to whom they refer. See “Acupuncture Information Resources” for a list of these organizations.

Check a practitioner’s credentials.

A practitioner who is licensed and credentialed may provide better care than one who is not. About 30 states have established training standards for certification to practice acupuncture, but not all states require acupuncturists to obtain a license to practice. Although proper credentials do not ensure competency, they do indicate that the practitioner has met certain standards to treat patients with acupuncture.

The American Academy of Medical Acupuncture can give you a referral list of doctors who practice acupuncture. The National Acupuncture and Oriental Medicine Alliance lists thousands of acupuncturists on its Web site and provides the list to callers to their information and referral line. The Alliance requires documentation of state license or national board certification from its listed acupuncturists. The American Association of Oriental Medicine can tell you the state licensing status of acupuncture practitioners across the United States as well. To contact these and other organizations, see “Acupuncture Information Resources.”

Check treatment cost and insurance coverage.

Reflecting public demand, an estimated 70 to 80 percent of the nation’s insurers covered some acupuncture treatments in 1996. An acupuncturist may provide information about the number of treatments needed and how much each will cost. Generally, treatment may take place over a few days or several weeks. The cost per treatment typically ranges between $30 and $100 but it may be more. Physician acupuncturists may charge more than nonphysician practitioners.13

Check treatment procedures.

Find out about the treatment procedures that will be used and their likelihood of success. You also should make certain that the practitioner uses 1 new set of disposable needles in a sealed package every time. The FDA requires the use of sterile, nontoxic needles that bear a labeling statement restricting their use to qualified practitioners. The practitioner also should swat, the puncture site with alcohol or another before inserting the needle.

Some practitioners may use electroacupuncture; others may use moxibustion. These approaches are part of traditional Chinese medicine, and Western researchers are beginning to study whether they enhance acupuncture’s effects.

During your first office visit, the practitioner may ask you at length about your health condition, lifestyle, and behavior The practitioner will want to obtain a complete picture of your treatment needs and behaviors that may contribute to the condition. This holistic approach is typical of traditional Chinese medicine and many other alternative and complementary therapies. Let the acupuncturist, or any doctor for that matter, know about all treatments or medications you are taking and whether you have a pacemaker, are pregnant, or have breast or other implants. Acupuncture may be risky to your health if you fail to tell the practitioner about any of these matters.

The Sensation of Acupuncture

Acupuncture needles arc metallic, solid, and hair-thin, unlike the thicker, hollow hypodermic needles used in Western medicine to administer treatments or take blood samples. People experience acupuncture differently, but most feel minimal pain as the needles are inserted. Some people are energized by treatment, while others feel relaxed. 34 Some patients may fear acupuncture because they are afraid of needles. Improper needle placement, movement of the patient, or a defect in the needle can cause soreness and pain during treatment.35 This is why it is important to seek treatment only from a qualified acupuncture practitioner.

As important research advances continue to be made on acupuncture worldwide, practitioners and doctors increasingly will work together to give you the best care available.

For More Information

For more information about acupuncture research sponsored by different parts of NIH contact the respective Information Office or Clearinghouse. Call the NIH operator for assistance at 301-490-4000.

For more information about research on acupuncture, contact the NIH National Library of Medicine (NLM), which has published a bibliography of more than 2,000 citations to studies conducted on acupuncture. The bibliography is available on the Internet athttp://www.nlm.nih.gov/pubs/cbm/acupuncture.html or by writing the NLM, 8600 Rockville Pike, Bethesda. MD 20894. The NLM also has a toll-free telephone number: 1-888-346-3056.

For a database of research on complementary and alternative medicine, including acupuncture access the CAM Citation Index on the NCCAM Web site at http://altmed.od.nih.gov/nccam.

 

Glossary of Terms

Acupuncture – An ancient Chinese health that involves puncturing the skin with hair-thin needles at particular locations, called acupuncture points, oil the patient’s body. Acupuncture is believed to help reduce pa in or change a body function. Sometimes tile needles are twirled given a slight electric charge (see electroacupuncture) or warmed (see moxibustion).

Attention deficit hyperactivity disorder – A syndrome primarily found in children and teenagers that is characterized by excessive physical movement, impulsiveness, and lack of attention.

Clinical studies (also clinical trials, clinical outcomes studies, controlled trials, case series, comparative trials, or practice audit evidence) – Tests of a treatment’s effects in humans. Treatments undergo clinical studies only after they have shown promise in laboratory studies of animals. Clinical studies help researchers find out whether a treatment is safe and effective for people. They also tell scientists which treatments are more effective than others.

Electroacupuncture – A variation of traditional acupuncture treatment in which acupuncture or needle points are stimulated electronically.

Electromagnetic signals – The minute electrical impulses that transmit information through and between nerve calls. For example, electromagnetic signals convey information about pain and other sensations within the body’s nervous system.

Fibromyalgia – A complex chronic condition having multiple symptoms, including muscle pain, weakness, and stiffness, fatigue; metabolic disorders, allergies and headaches.

Holistic – Describes therapies based on facts about the “whole person,” including spiritual and mental aspects, not only the specific part of the body being treated. Holistic practitioners may advise changes in diet, physical activity, and other lifestyle factors to help treat a patient’s condition.

Merldians – A traditional Chinese medicine term for the 14 pathways throughout the body for the flow of qi, or vital energy, accessed through acupuncture points.

Moxibustion – The use of dried herbs in acupuncture. The herbs are placed on top of acupuncture needles and burned. This method is believed to be more effective at treating some health conditions than using acupuncture needles alone.

Neurohorinones – Chemical substances made by tissue in the body’s nervous system that can change the structure or function or direct the activity of an organ or organs.

Neurological – A term referring to the body’s nervous system, which starts, oversees, and controls all body functions.

Neurotransmitters – Biochemical substances that stimulate or inhibit nerve impulses in the brain that relay information about external stimuli and sensations, such as pain.

Opioids – Synthetic or naturally occurring chemicals in the brain that may reduce pain and induce sleep.

Placebo – An inactive substance given to a participant in a research study as part of a test of the effects of another substance or treatment. Scientists often compare the effects of active and inactive substances to learn more about how the active substance affects participants.

Preclinical studies – Tests performed after a treatment has been shown in laboratory studies to have a desirable effect. Preclinical studies provide information about a treatment’s harmful side effects and safety it different doses in animals.

Qi (pronounced “chee”) – The Chinese term for vital energy or life force.

Randomized controlled clinical trials – A type of clinical study that is designed to provide information about whether a treatment is safe and effective in humans. These trials generally use two groups of people, one group receives the treatment and the other does not. The participants being studied do not know which group receives the actual treatment.

Traditional Chinese medicine – An ancient system of medicine and health care that is based on the concept of balanced qi or vital energy that flows throughout the body. Components of traditional Chinese medicine include herbal and nutritional therapy restorative physical exercises, medication acupuncture, acupressure, and remedial massage.

Yang – The Chinese concept of positive energy and forces in the universe and human body Acupuncture is believed to remove yang imbalances and bring the body into to balance.

Yin – The Chinese concept of negative energy and forces in the universe and human body. Acupuncture is believed to remove yin imbalances and bring the body into balance.

References

• Lytle, C.D. An Overview of Acupuncture. 1993, Washington, DC: United States Department of Health and Human Services, Health Sciences Branch, Division of Life Sciences, Office of Science and Technology, Center for Devices and Radiological Health, Food and Drug Administration.
• Culliton, RD. “Current Utilization of Acupuncture by United States Patients.” National Institutes of Health Consensus Development Conference on Acupuncture, Program & Abstracts (Bethesda, MD, November 3-5,1997). Sponsors: Office of Alternative Medicine and Office of Medical Applications Research. Bethesda, MD: National Instittites of Health, 1997.
• Beinfield, H. and Korngold, E.L. Between Heaven and Earth: A Guide to Chinese Medicine. New York, NY: Ballantine Books, 1991.
• Brown, D. “Three Generations of Alternative Medicine: Behavioral Medicine, Integrated Medicine and Energy Medicine.” Boston University School of Medicine Alumni Report, Fall 1996.
• Senior, K. “Acupuncture: Can It Take the Pain Away?” Molecular Medicine Today. 1996. 2(4):150-3.
• Raso. J. Alternative Health Care: A Comprehensive Guide. Buffalo, NY Prometheus Books, 1994.
• Eskinazi, D. P. “National Institutes of Health Technology Assessment Workshop on Alternative Medicine Acupuncture.” Journal of Alternative and Complementaty Medicine. 1996. 2(1):1-253
• Tang, N.M., Dong, H.W., Wang, X. M., Tsui, Z.C., and Han, J.S. “Cholecystokinin Antisense RNA Increases the Analgesic Effect Induced by Electroacupuncture or Low Dose Morphine: Conversion of Low Responder Rats into High Responders.” Pain. 1997. 71(1)-.71-80.
• Cheng, X.D., Wu, G. C., He, Q. Z., and Cao, X. D. “Effect of Electroacuptuncture on the Activities ol Tyrosine Protein Kinasc in Subcellular Fractions of Activited T Lymphocytcs from the Traumatized Rao;.” Immunopharmacology. Forthcoming.
• Chen, L.B. and Li, S.X. “The Effects of Electrical Acupuncture of Neiguan in the PO2 of the Border Zone Between Ischemic and Non-Ischemic Myocardium in Dogs.” Journal of Traditional Chinese Medicine. 1983, 3(2):8 1-8.
• Lee, H.S. and Kim, J.Y. “Effects on Blood Pressure and Plasma Renin Activity in Two Kidney One Clip Goldblatt Hypertensive Rats.” American Journal of Chinese Medicine. 1994. 22(3-4):215-9.
• Okada, K_ Oshima, M., and 1 Kawakita, K. “Examination of the Afferentnt Fiber Responsible for the Suppression of Jaw-Open Reflex in Heat, Cold and Manual Acupuncture Stimulation in Anesthetized Rats.” Brain Research. 1996 740(1-2):201-7.
• National Institutes of Health. Frequently. Asked Questions About Acupuncture. Bethesda, MD: National Institutes of Health, 1997.
• Dale, R.A. “Demythologizing Acupuncture Part 1. The Scientific Mechanisms and the Clinical Uses.” Alternative & Complementary Therapies Journal. April 1997. 1(2)-.125-31.
• Takeshige, C. “Mechanism of Acupuncture Analgesia Based on Animal Experiments.”Scientific Bases of Acupuncture. Berlin, Germany: Springere-Verlag, 1989.
• Han, J.S. “Acupuncture Activates Endogenous Systems of Analgesia.” National Institutes of Health Consensus Development Conference on Acupuncture, Program & Abstracts (Bethesda, MD. November 3-5, 1997). Sponsors: Office of Alternative Medicine and Office of Medical Applications of Research. Bethesda, MD: National Institutes of Health, 1997.
• Wu, B., Zhou, R.X., and ZI M.S. “Effect of Acupuncture on Interleukin-2 Level and NK Cell Immunoactivity of Peripheral Blood of Malignant Tumor Patients.” Chung Kyo Chung Hsi I Chieh Ho Tsa Chich. 1994.14(9):537-9.
• Wit, B. “Effect Of Acupuncture on the Regulation of Cell-Mediated Immunity in Patients with Malignant Tumors.” Chen Tzu Yen Chiu. 1995, 20(3):67-71.
• National Instituties of Health Consensus Panel. Acupuncture National Institutes of Health Consensus Development Statement November 3-5, 1997). Sponsors: Office of Alternaive Medicine –ind Office of Medical Application., of Research Bethesda, MD: N ational Institutes of, Health, 1997.
• Lao, L., Bergman, S., Langenherg, P, Wong, R., and Berman, B. “Efficacy of Chinese Acupuncture on Postoperative Oral Surgery Pain,” Oral Surgery, Oral Medicine, Oral Pathology. 1995.79(4):423-8.
• Lewith, G.T. and Vincent, C. “On the Evaluation of the Clinical Effects of Acupuncture: A Problem Reassessed and a Framework for Future Research.” Journal of Alternative and Complementary Medicine. 1996. 2(1):79-90.
• TsibuIiak,VN., Alisov, A.P, and Shatrova,V.P. “Acupuncture Analgesia and Analgesic Transcutaneous Electroneurostimulation in the Early Postoperative Period,”Anesthesiology and Reanimatology 1995. 2:93-8,
• World Health Organization. Viewpoint on Acupuncture. Geneva, Switzerland: World Health Organization, 1979.
• Bullock, M.L., Pheley.A.M., Kiresuk.T.J., Lenz, S.K., and Culliton, PD. “Characteristies and Complaints of Patients Seeking Therapy at a Hospital-Based Alternative Medicine Clinic.” Journal of Alternative Medicine 1997-30):31-7.
• Diehl, D.L., Kaplan, G., Coulter, I., Glik, D.,and Hurwitz, E.L.” Use of Acupuncture by American Physicians.” Journal of Alternative and Complementary Medicine. 1997, 3(2):119-26.
• Levine, J.D., Gormley, J., and Fields, H.J., “Observatins on the Analgesic Effects of Needle Puncture (Acupuncture).” Pain. 1976.2(2):149-59.
• Ter Reit, G., Kleijnen, J., and Knipschild, P. “Acupuncture and Chronic Pain: A Criteria-Based Meta-Analysis.” Clinical Epidemiology 1990 43:1191-9.
• U.S. Food and Drug Administration. “Acupuncture Needles No Longer Investigational”FDA Consumer Magazine June 1996.30(5).
• Berman, B., Lao, L., Bergman, S., Langenberg, P, Wong, R., Loangenberg, P, and Hochberg, M. “Efficacy of Traditional Chinese Acupuncture in the Treatment of Osteoarthritis: A Pilot Study.” Osteoarthritis and Cartilage 1995. (3):139-42.
• Allen, J.J.B. “An Acupuncture Treatment Study for Unipolar Depression.” Psychological Science. 1998. 9:397-401.
• Sonenklar, N. Acupuncture and Attention Deficit Hyperactivity Disorder. National Institutes of Health, Office of Alternative Medicine Research Grant *R21 RR09463. 1993.
• Milligan, R. Breech Version by Acumoxa. National Instituties of Health, Office of Alternative Medicine Research Grant #R21 RR09327. 1993.
• Cardini, F. and Weixin, H. “Moxibustion for Correction of Breech Presentation: A Randomized Controlled Trial..” Journal of the American Medical Association. 1998. 280:1580-4
• American Academy of Medical Acupuncture “Doctor, What’s This Acupuncture All About? Brief Explanation for Patients.“Los Angeles. CA: American Academy of Medical Acupuncture, 1996.
• Lao, L. “Safety Issues in Acupuncture.” Journal of Alternative and Complementary Medicine. 1996, 2(1):27-9.
• 
  
• Go to NCCAM Resource List Go to NCCAM web site for more current information
• www.ChineseMedicineDoctor.US

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Is Traditional Chinese medicine Effective For Peripheral Neurology Pain?

Original article is at http://articlesprofessionals.com/health-fitness/is-traditional-chinese-medicine-effective-for-peripheral-neurology-pain September 11, 2011 | Author: Barbara Thomas

Leads to of Peripheral Neurophysiology

Peripheral neurophysiology is a typical issue that specifically is affected by diabetics, individuals present process radiation treatment, chemotherapy, and those with HIV. The most common regions impacted by neuropathy are the ft with the second becoming the fingers. Peripheral neuropathy signs might be diverse and can involve decreased sensation, elevated feeling, weak point of ankle or hand muscles, and signs and symptoms related to changes in the skin and nails.

Unfortunately, as the prevalence of diabetic issues increases, person suffering from diabetes neuropathy becomes more common. Statistics transcribe that 25% of person suffering from diabetes patients will experience neuropathic feet discomfort. And, because the incidence of diabetic issues is increasing, so is the incidence of neuropathy signs or symptoms.

Solution Choices

Of course, the most efficient implies of assisting to management diabetic issues connected path discomfort is working to manage all forms of diabetes itself. After signs and symptoms possess started, drugs like Lyrica and Neurontin are frequently recommended to assist management the neurological discomfort. For a lot of, the use of these medications are either ineffective or have facet effects which threshhold their use. In view of these the use of replenishable medicines similar to acupuncture is a far more prevalent.

Acupuncture Study

Once thinking about any solution hope it is fair to evaluate what the explore has to say regarding how effective the remedy is. For individuals suffering from peripheral neuropathy, there is great information regarding chinese medicine.

A 2007 examine entitled “Clinical commentary on bring about of acupuncture in healing diabetic peripheral neuropathy” concerned a overall of 60 participants. The study observed which individuals receiving chinese medicine had a statically higher remodeling in neurological signs and symptoms as well as enhanced nerve act for each sensory and engine nerve conduction when in contrast to the control organization team.

An additional examine carried out in Africa in 2006 located that for the 126 individual patients which received traditional chinese medicine for person suffering from diabetes peripheral neuropathy, 86% deemed the therapy as being efficient for lowering symptoms in their fingers and ft.

In a 2006 Canadian examine entitled “Traditional chinese medicine treatment for chemotherapy-induced peripheral neuropathy–a claim series” chinese medicine was utilized in five instances to decrease neuropathic pain in cancer patients. The chinese medicine treatment was considered effective in these instances where medication had failed.

And finally, in a Chinese language examine involving 90 participants, individuals receiving whole body or arm and ankle traditional chinese medicine has appreciably improved blood vessels glucose and lipids, decreased bloodstream viscosity, and enhanced features of peripheral nerve cells, therefore provoking therapeutic results for diabetic peripheral neuritis when in contrast to the control organization team. The examine additionally observed no significant difference in between the full body group and the ankle and arm remedy group.

Doing so sampling of the research in the use of acupuncture for the solution of peripheral neuropathy is really encouraging. Due to the nominal facet effects using chinese medicine in contrast to pharmaceutical remedy options, traditional chinese medicine should be regarded as as a reasonable treatment option for symptoms of neuropathy.

Is Chinese medicine Effective For Peripheral Neuropathy Pain? – Check Out peripheral neuropathy and neuralgia

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Multiple Sclerosis could be treated by Acupuncture. By Dr.Arthur Fan in Washington DC and Northern Virginia

Archive for the ‘Multiple Sclerosis’ Category

Don’t stop acupuncture when you just get your symptom free. By Dr.Arthur Fan, in Washington DC and Northern Virginia

Posted in Acid reflux, Allergy, Asthma, Carpal Tunnel Syndrome, Chinese medicine ABC,dementia, Dystonia or Chorea, Epilepsy, Facial Palsy, Fatigue, fertility, Gastro-intestinal issue, Guillain-Barre Syndrome, Headache, Hepatitis, Infertility, Interstitial Cystitis, Low Back Pain-Leg Pain, Motor Neuron Disease, Multiple Sclerosis, Neurological Issue,Neuropathy, OB / GYN, Parkinson Disease, Post Brain Injury, Psoriasis, Rheumatoid Arthritis, Seizure, Semantic dementia, Sensation Abnormal, Sinus Infection, Taste abnormal, Testerone deficiency, Tourett’s syndrome, tagged acupuncturist, washington DC, arthur yin fan, Arthur Fan, Virginia, Chinese Medicine, Acupuncture, Best Chinese medicine doctor, vienna, mclean, falls church, infertility, arlington, tysons corner, reston,herndon, Rockville, fairfax, 樊蓥, 针灸, 中医, 华盛顿, 维吉尼亚, Maryland, cervical dystonia, 马里兰, alexandria, stop acupuncture, symptom free on August 29, 2011 | Edit | Leave a Comment »

Here I post a doctor’s suggestion to his patient. I feel he is correct. “I was just thinking why you may not have taken advantage of your consultation. You’re probably like many others who suffer from back pain, headache, neck pain, soreness, or any type of physical ache or pain… the pain comes and goes and […]

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Acupuncture treats visual or eye problems, by Arthur Fan in the Greater Washington DC

Posted in Acupuncture in USA, Dr.Fan’s clinical world, eye disorders, Multiple Sclerosis,Uncategorized, tagged Acupuncture, acupuncturist, arlington, Arthur Fan, arthur yin fan,atrophy, Best Chinese medicine doctor, China, Chinese Medicine, circulation failure, 维吉尼亚, diarrhea, 针灸, fairfax, falls church, herndon, infant, Maryland, mclean, MS, Multiple Sclerosis, nanjing, northern virginia, optical nerve, reston, Rockville, Su Shangyi, vienna,Virginia, washington DC, 华盛顿, 樊蓥, 中医 on April 14, 2010 | Edit | 1 Comment »

During times like these I recall time spent with Dr. Su Shangyi, a TCM doctor (CMD) in Nanjing, China when I was an intern during 1985-1986. Dr. Su was passed away in the late 1990s. He was actually a very famous acupuncture doctor in 1950-1960s in China, when due to political reasons, he had to get “re-educated” […]

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Multiple Sclerosis Could Be Treated by Acupuncture, Chinese Medicine, by Dr. Arthur Fan 樊蓥

Posted in Multiple Sclerosis, tagged Acupuncture, acupuncturist, arlington, Arthur Fan,arthur yin fan, Chinese Medicine, 维吉尼亚, 针灸, fairfax, falls church, herndon, mclean, MS,Multiple Scleresis, northern virginia, reston, Rockville, tysons corner, vienna, Virginia,washington DC, 华盛顿, 多发性硬化, 樊蓥, 中医 on August 1, 2009 | Edit | Leave a Comment »

Recovered by Acupuncture and Chinese Herbology Patient Ms. J.J., 42 years old, initially saw Dr. Fan on August 6, 2005, because she had multiple sclerosis (MS) 3 years, with both legs, muscles stiffness, Tingling and Numbness one year; Long Thoracic Nerve Palsy 3 months. 1. Multiple Sclerosis (MS). J.J. was found of having MS 3 […]

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More articles related to neurology and acupuncture, Chinese Medicine posted by Dr.Arthur Fan

 

 

 

 

Dr.Fan posted many article before. Please visit:

http://arthuryinfan.wordpress.com/category/testimonies-or-records/neurological-issue/

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Acupuncture for migraine prophylaxis is very effective, according to a new clinical trial published in Pain. By Dr.Arthur Fan.

Efficacy of acupuncture for migraine prophylaxis: a single-blinded, double-dummy, randomized controlled trial.

Pain. 2011 Aug;152(8):1864-71. Epub 2011 May 26.

Wang LP, Zhang XZ, Guo J, Liu HL, Zhang Y, Liu CZ, Yi JH, Wang LP, Zhao JP, Li SS. 

Source

Acupuncture and Moxibustion Department, Beijing Traditional Chinese Medicine Hospital affiliated with Capital Medical University, Beijing, China. wlp5558@sina.com

Abstract

Insufficient clinical trial data were available to prove the efficacy of acupuncture for migraine prophylaxis. A multicenter, double-dummy, single-blinded, randomized controlled clinical trial was conducted at the outpatient departments of acupuncture at 5 hospitals in China to evaluate the effectiveness of acupuncture. A total of 140 patients with migraine without aura were recruited and assigned randomly to 2 different groups: the acupuncture group treated with verum acupuncture plus placebo and the control group treated with sham acupuncture plus flunarizine. Treated by acupuncture 3 times per week and drugs every night, patients from both groups were evaluated at week 0 (baseline), week 4, and week 16. The primary outcome was measured by the proportion of responders (defined as the proportion of patients with a reduction of migraine days by at least 50%). The secondary outcome measures included the number of migraine days, visual analogue scale (VAS, 0 to 10 cm) for pain, as well as the physical and mental component summary scores of the 36-item short-form health survey (SF-36). The patients in the acupuncture group had better responder rates and fewer migraine days compared with the control group (P<.05), whereas there were no significant differences between the 2 groups in VAS scores and SF-36 physical and mental component summary scores (P>.05). The results suggested that acupuncture was more effective than flunarizine in decreasing days of migraine attacks, whereas no significantly differences were found between acupuncture and flunarizine in reduction of pain intensity and improvement of the quality of life.

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Poking Around for Answers About Parkinson’s, Acupuncture

From http://www.michaeljfox.org/newsEvents_mjffInTheNews_moreMJFFNews_article.cfm?ID=507&headertitle=MJFF

By Sara Castellanos, Aurora Sentinel

For those suffering from Parkinson’s disease, most are willing to take a stab at anything to ease the endless days of being tired.

No doubt, the tremors, stiffness and slowness are par for the course. But it’s the general sense of fatigue that’s particularly debilitating.

“People with Parkinson’s disease still have fatigue even when their sleep problems are treated,” said Dr. Benzi Kluger, assistant professor of neurology and psychiatry at the University of Colorado Hospital.

The enervation is so overwhelming, that Kluger himself decided to take a stab at a non-traditional approach to reducing exhaustion. He’s leading a research study to determine whether alternative Eastern medicine, specifically acupuncture, can help alleviate the symptoms of severe fatigue in Parkinson’s patients. He secured $350,000 last year from the Michael J. Fox Foundation for Parkinson’s Research to fund the study, which commenced in November 2010. So far, about 20 Parkinson’s disease patients are participating in the study and Kluger hopes that number will increase to about 100 within two years.

In his study, Kluger is also trying to determine how much of acupuncture’s effects — if there are any — are due to the actual alternative medicine, and how much of its effects are due to placebo.

“It’s possible that both the acupuncture and placebo groups will show improvement,” he said. “Whether the acupuncture groups show greater improvement than the placebo groups is another question.”

For licensed acupuncturist Daisy Dong-Cedar, Kluger’s study is simply trying to prove what she already knows.

Dong-Cedar, who is the chief acupuncturist in the study, has been practicing the method for 26 years. She trained in China and joined the University of Colorado Hospital 10 years ago. In the past five years, the form of alternative medicine has grown more popular among doctors, she said.

“Physicians have started to integrate the medicine,” she said. “The public really demanded alternative medicine.” Acupuncture is covered for some conditions under certain insurance companies, but her clients usually pay out of pocket. The cost ranges from $25 to more than $100 per treatment, with the average treatment costing between $60 and $70 with a $100 initial consultation fee.

But the cost is often worth the results for people who are trying to quit smoking, trying to get pregnant, or trying to reduce pain in the lower back and neck, Dong-Cedar said.

“If you’re older and you have a lot of chronic conditions, the reaction to acupuncture is slower,” Dong-Cedar said. “If a person is young and healthy, and the condition is more acute, the result is much quicker, sometimes within one or two treatments.”

Kluger’s research is being conducted as a double-blind study. Also, the patients are blindfolded while they are receiving acupuncture treatment, and Kluger doesn’t know which patients are receiving acupuncture treatment and which patients are receiving placebo. Without divulging specifics about the study, Kluger said the acupuncturist places needles in acupuncture points on the patient’s face and back. For patients who are in the placebo group, the acupuncturist may place “fake” needles that don’t puncture the surface of the skin in spots that aren’t typical acupuncture spots.

Symptoms of severe fatigue are common in about half of the people diagnosed with Parkinson’s disease. The neuro-degenerative disease affects between 1 percent and 2 percent of people over the age of 65 and is second only to Alzheimer’s in neuro-degenerative illnesses, Kluger said. Those diagnosed with the disease will lose neurons in specific parts of the brain, affecting muscle movement and control. About half of those diagnosed with the disease have sought alternative treatments including acupuncture to help with their symptoms, but until now, there weren’t many evidence-based studies to determine whether acupuncture is, in fact, effective.

“Patients, particularly for symptoms like fatigue and pain, are going to other sources and they’re going to acupuncturists, herbalists and nutritionists,” Kluger said. “Their physicians don’t really have any good information to tell them about it. So that was really one of the major impetuses for doing this study.”

If Kluger finds that acupuncture can be used as an alternative form of medicine to alleviate the symptoms of severe fatigue, which plague nearly 50 percent of those with Parkinson’s disease, insurance companies might be more apt to cover the treatment, he said.

If the study reveals the effects of acupuncture are due mostly to placebo, that could be a major breakthrough as well.

“Placebo is enormously powerful, and really gives us evidence that people have so much capacity to heal but don’t know how to tap into it,” Kluger said.

It may be too soon to tell, but Parkinson’s patient Howard Ewy said he is noticing some results.

“I think it has helped me in that I can walk further and faster and I need fewer naps,” said Denver resident Ewy, 81, and a retired Navy aviator. He was diagnosed with the disease last year and until he decided to participate in Kluger’s study, he had never received acupuncture treatment before this. Ewy said he decided to participate in the study because he’s interested in learning more about all types of therapies available to alleviate the symptoms of his disease, from Western medicine to Eastern medicine.

www.ChineseMedicineDoctor.US

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Johns Hopkins University Hospital started to allow using herbal products in Neuro-Critical Care Unit

After Dr.Arthur Yin Fan saw the patient on May 10, 2009, due to patient’s urgent condition, the doctors in Neuro-Critical Care Unit agreed to start using the herbal medicine –Qing Kai Ling Keli, a revised herbal instant “tea” from the tradtional formula An Gong Niu Huang Wan for coma patient.

The starting date was on May 16, 2009.

The approval is based on Qing Kai Ling is a dietary product(in China, it is a OTC medication), not as the medication.

These doctors are very open mind, but the hospital rule is still very stiff.

See more at www.chinesemedicinedoctor.us

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