The Need for Relevant Acupuncture Research

A paper written for Graceland University 

by Sarah Piestrup EAMP, Dipl OM, RN

Some promising research is being conducted that sheds light on a few of the mechanisms behind the effects of acupuncture. These include adenosine, endomorphin-1, beta endorphin, encephalin, and serotonin release and fMRI changes (Cabyoglu, Ergene, & Tan, 2006; Fang, et al., 2004; Goldman, et al., 2010; Hui, et al., 2005). There is even theory that shows a plausible explanation for the physical existence of acupuncture channels just under the skin and between muscles (Silberstein, 2009). However, most research looking at acupuncture for allopathic diagnoses in humans is simply irrelevant.

Because acupuncture is based on an ancient Asian conceptual framework it is difficult to transfer meaning into modern allopathic scientific understanding. Studies that look at “Traditional Chinese Medicine for treatment of fibromyalgia” are as irrelevant as a study looking at “Allopathic medicine for heart fire.” With detailed study design it can be done, and scientific studies have shown some benefits of acupuncture as compared to placebo (Cao, Liu & Lewith, 2010). However, because fibromyalgia does not have one equivalent diagnosis in Traditional East Asian Medicine (TEAM), the meaning of this word is irrelevant to what points or modalities are chosen to treat an individual patient. In other words, the individual patient would normally be diagnosed with a TEAM diagnosis that would be different for different patients with the allopathic diagnosis of fibromyalgia, and different treatments would be rendered based on that individual TEAM diagnosis. There are many ways to treat this one allopathic diagnosis based on the person’s underlying constitution, their specific symptoms and how they all relate to their specific lifestyle. Indeed, there are many different styles in the TEAM system that could be used, making conducting a controlled study very difficult.

Some levels of control, like consistency of treatment details, such as specific point use, would render the study irrelevant because they would remove the theoretical basis and diagnosis of acupuncture when used with placebo needling which is sure to stimulate a nearby point. In this type of case we are left with a study that is comparing bad acupuncture to bad acupuncture. It would be just as irrelevant as an allopathic study on an acupuncture diagnosis that has no relevance to modern terminology and no allopathic diagnostic equivalent.

Volker Scheid helped shed some light on some of the deeper aspects of this problem (such as a lack of consistency within the acupuncture community in regards to terminology and diagnoses) with his papers and research that scientifically examines the system of Chinese medicine. He illustrates how the terms used to describe patterns such as menopause are westernized in modern acupuncture schools and textbooks. These oversimplify the medicine and ignore the meaning of the time-tested system (Scheid, 2008). He also had a hand in research looking critically at this problem with a review of the literature on the treatment of menopause with TEAM (Scheid, et al., 2010). This type of refinement is crucial for TEAM to be critically analyzed with any relevance. It is useless to study it without a clear understanding of the basic diagnosis and terminology that define a medicine.

TEAM is the longest continually practiced literate medicine used consistently worldwide with the first known evidence of acupuncture on Otzi the Iceman; a 5,300 year old mummy found in Austria who had tattoos of acupuncture points used today for lumbar lordosis of which his spine showed evidence. This long history must not be lost to modern confusion because TEAM is a far too important and valuable system of medicine to loose.



References

Cabyoglu, M. T., Ergene, N. & Tan, U. (2006). The mechanism of acupuncture and clinical applications. International Journal of Neuroscience, 116, 115-125.

Cao, H., Liu J., & Lewith, G. T. (2010). Traditional Chinese Medicine for treatment of fibromyalgia: A systematic review of randomized controlled trials. Journal of Alternative and Complimentary Medicine, 16(4), 397-409.

Fang, J. L., Krings, T., Weidemann, J., Meister, I. G. & Thron, A. (2004). Functional MRI in healthy subjects during acupuncture: different effects of needle rotation in real and false acupoints. Neuroradiology, 46(5), 359-62.

Goldman, N., Chen, M., Fujita, T., Xu, Q., Peng, W., Liu, W., ... Nedergaard, M. (2010). Adenosine A1 receptors mediate local anti-nociceptive effects of acupuncture. Nature Neuroscience, 13, 883-888. Retrieved from http://www.nature.com/neuro/journal/v13/n7/full/nn.2562.html

Hui, K. K., Liu, J., Marina, O., Napadow, V., Haselgrove, C., Kwong, K. K., Kennedy, D. N., & Makris, N. (2005). The integrated response of the human cerbro-cerebellar and limbic systems to acupuncture stimulation at ST 36 as evidenced by fMRI. Neuroimage, 27(3), 479-96.

Otzi the iceman. (2011). In Wikipedia. Retrieved from http://en.wikipedia.org/wiki/%C3%96tzi_the_Iceman

Scheid, V., Ward, T., Cha, W., Watanabe, K. & Liao, X. (2010). The treatment of menopausal symptoms by traditional East Asian medicines: Review and perspectives. Maturitas. doi: 10.1016/j.maturitas.2009.11.020

Silberstein, M. (2009). The cutaneous intrinsic visceral afferent nervous system: A new model for acupuncture analgesia. Journal of Theoretical Biology, 262(4), 637-642.

The Clinically Relevant Value of Meditation

A paper written for Graceland University
by Sarah Piestrup, RN, EAMP

Meditation is a cost effective and clinically proven tool that can benefit a myriad of health disorders. Aftanas and Golosheykin (2005) looked at electroencephalograms (EEGs) in a controlled environment to empirically show that meditators have more control over their reactions to stressful situations or “intensity of emotional arousal” (p. 894). According to the studies reviewed by Koopsen and Young (2009), meditation can provide physiological benefits such as a decrease in: oxygen consumption, blood lactate levels, cortisol levels, heart and respiratory rates, blood pressures, muscle tension, and pain and an increase in: skin resistance, alpha waves, and psychological benefits. These emotional and physiological effects have far reaching benefits to the health of a patient as well as the effectiveness of a health care provider if they too engage in conscious awareness.

Astin, Shapiro, Eisenberg, & Forys (2003) review a collection of cumulative clinical evidence that “lends strong support to the notion that medicine should indeed adopt a biopsychosocial rather than exclusively biologic-genetic model of health” (p. 141). They identify meta-analyses and randomized controlled trials that have shown mind-body medicine has effective benefits with: chronic low back pain, coronary artery disease, headache, insomnia, surgical procedure preparation, symptoms of cancer and its treatment, arthritis and urinary incontinence (Astin, et al., 2003). Grossman, Niemann, Schmidt, & Walach (2004) find that improvements in health are consistently seen in a variety of standardized mental health measures and measures of disability with mindfulness-based stress reduction. Other health parameters such as medical symptoms, sensory pain, physical impairment and functional quality of life estimates were also found to have benefits from mindfulness-based stress reduction (Grossman, et al., 2004).

Jung, et al. (2010) give us some clues about the background physiology of these positive effects. They looked at 67 subjects who regularly engaged in mind-body training vs. a control group of 57 healthy subjects and compared their plasma catecholamine (norepinephrine, epinephrine, and dopamine) levels as well as their positive and negative affect scores, and showed: lower stress, higher positive affect, and higher plasma dopamine levels in the meditation group.

A state of heart centered consciousness that can be achieved through meditation or even quick redirection of attention is contagious. A high state of “coherence” affects others in the room to also a achieve a high state of coherence (McCraty, Atkinson, Tomasino & Bradley, 2006). Coherence has been measured with reliable instruments and has shown health benefits in numerous studies over the past 20 years (McCraty, et al., 2006). Practitioners can have positive effects on their patients during a therapeutic encounter if they practice coherence (McCraty, et al., 2006). Nursing literature has examined similar phenomena under the term “presence” and researchers like Zyblock (2010) identify presence as having a sustained therapeutic effect. The Annals of Internal Medicine even has articles on healing skills for physicians that outline themes such as being open, listening, removing barriers and sharing authority (Churchill & Schenck, 2008).

Simple meditations can be easily taught by trained physicians and ancillary staff in a short amount of time and patients can be referred to a growing number of highly trained individuals who specialize in a variety of forms of mindful practices. With so many options and variations, all patients and providers should be able to find some form of mediation that works for them and implement them into daily practice.



References

Aftanas, L., Golosheykin, S. (2005). Impact of regular mediation practice on EEG activity at rest and during evoked negative emotions. International Journal of Neuroscience, 115: 893-909. doi: 10.1080/00207450590897969

Astin, J. A., Shapiro, S. L., Eisenberg, D. M. & Forys, K. L. (2003). Mind-body medicine: State of the science, implications for practice. Journal of the American Board of Family Practice, 16(2), 131-147.

Churchill, L. R. & Schenck, D. (2008). Healing skills for medical practice. Annals of Internal Medicine, 149, 720-724.

Grossman, P., Niemann, L., Schmidt, S., & Walach, H. (2004). Mindful-based stress reduction and health benefits: A meta-analysis. Journal of Psychosomic Research, 57, 35-43.

Jung, Y. H., Kang, D. H., Jang, J. H., Park, H. Y., Byun, M. S., Kwon, S. J., ... Kwon, J. S. (2010). The effects of mind-body training on stress reduction, positive affect, and plasma catecholamines. Neuroscience Letters, 479(2), 138-42.

Koopsen, C. & Young, C. (2009). Integrative health: A holistic approach for health professionals. Boston, MA: Jones and Bartlett Publishers.

McCraty, R., Atkinson, M., Tomasino, M. & Bradley, R. T. (2006). The coherent heart. Boulder Creek, CA: The Institute for HeartMath

Zyblock, D. M. (2010). Nursing presence in contemporary nursing practice. Nursing Forum, 45(2), 120-124.