Full title: Prediction of gastric ulcers based on the change in electrical resistance of acupuncture points using fuzzy logic decision-making.

Many theories of reflexology use ancient concepts which do not coincide with the modern medical terminology of anatomy, physiology and biophysics. This substantially reduces the trust of physicians in reflexology methods. During this research, several mathematical models for the interaction of the internal and biological active points of meridian structures have been proposed. The analysis of these models allows the specification of a list of gastric diseases for which reflex diagnostics and reflex therapy methods are most effective and also allows increasing the effectiveness of these procedures. It is shown that good results for the prediction and early diagnosis of diseases from the reaction energy of biologically active points (acupuncture points) are obtained using fuzzy logic decision making.

Comput Methods Biomech Biomed Engin. 2012 Jan 31. Al-Kasasbeh R, Korenevskiy N, Alshamasin M, Ionescou F, Smith A. a Faculty of Engineering Technology, Al-Balqa Applied University , Amman , Jordan.

Aim: The aim of this review is to examine the evidence for acupuncture's effectiveness as a depression intervention. Unlike other reviews, which consider methodological concerns relevant to all experimental evaluations, this review focuses on the scope of studies, and uses a PICO (patients, intervention, comparison, and outcome) structure to determine what can potentially be learned from primary studies that have already been screened for methodological quality by reviewers. Discussion: The review identified a number of study limitations. (i) Patients: majority of trial reports have not described a rationale for the selection of patients or inclusion/exclusion criteria. Prognostic indicators were not reported and there were also concerns about the generalizability of study populations. (ii) Intervention: most trials investigate poorly rationalized standardized acupuncture protocols thus quality of care may be an issue and generalizability to routine clinical practice is a main concern. In trials using other methods generalizability is also poor. (iii) Comparisons: concerns were raised about using therapeutically inappropriate acupuncture. (iv) Outcomes: short-term focus and the narrow range of outcomes explored. According to more recent systematic review evidence it is probable the shortcomings identified in the PICO review have not been addressed by subsequent research. The concept of model validity, proposed by other researchers, is discussed, and suggestions put forward about complex intervention evaluation methods, which may be better suited to evaluating acupuncture care. Conclusion: Uncertainty remains about the value of acupuncture care, as it is routinely practiced in the West, and this uncertainty has not been resolved by trials to date. Existing evaluations may however be useful for guiding decisions about the value of specific techniques for patients with depression.

CNS Neurosci Ther. 2011 Oct;17(5):398-410. doi: 10.1111/j.1755-5949.2010.00159.x. Schroer S, Adamson J. Health Sciences Department, ARRC Building, University of York, Heslington, York YO10 5DD, UK.

PURPOSE: Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation and by both systemic and airway inflammation. In COPD, acupuncture has been shown to improve quality-of-life scores and decrease breathlessness; similar findings have also been reported after pulmonary rehabilitation (PR). The hypothesis of this study was that acupuncture in conjunction with pulmonary rehabilitation would improve COPD outcome measures compared to pulmonary rehabilitation alone. METHODS:: The design was a randomized prospective study; all subjects had COPD. There were 19 controls, 25 who underwent PR, and 16 who had both acupuncture and PR. The primary outcome measure was a change in measures of systemic inflammation at the end of PR and at 3 month followup. Lung function, including maximum inspiratory pressure (PiMax), quality-of-life scores, functional capacity including steps taken, dyspnea scores, and exercise capacity, were secondary endpoints. RESULTS: After PR, both groups had significantly improved quality-of-life scores, reduced dyspnea scores, improved exercise capacity, and PiMax, but no change in measures of systemic inflammation compared with the controls. There were no differences in most of the outcome measures between the 2 treatment groups except that subjects who had both acupuncture and PR remained less breathless for a longer period. CONCLUSION: The addition of acupuncture to PR did not add significant benefit in most of the outcomes measured.

J Cardiopulm Rehabil Prev. 2011 Oct 5. Deering BM, Fullen B, Egan C, McCormack N, Kelly E, Pender M, Costello RW. Departments of Respiratory Medicine, Beaumont Hospital and the associated Education and Research Centre (Mss Deering, Egan, and McCormack and Drs Kelly and Costello), and School of Public Health, Physiotherapy, and Population Science,University College of Dublin (Mss Fullen and Pender), Dublin, Ireland.

Data sourcesMedline, PubMed, The Cochrane Library 2010, CINAHL, Embase, seven Korean Medical Databases and a Chinese Medical Database (China Academic Journal, www.cnki.co.kr).Study selectionParallel or cross-over RCTs that assessed the efficacy of acupuncture regardless of blinding, language and type of reporting published in English, Chinese and Korean were included. Dissertations and abstracts were included provided they contained sufficient detail. Complex interventions in which acupuncture was not a sole treatment and studies with no reported clinical data were excluded.Data extraction and synthesisAll RCTs were obtained and read in full by two independent reviewers and data extracted according to pre-defined criteria. Quality was assessed using the Cochrane risk of bias criteria. Meta-analysis was conducted using random effect models if excessive statistical heterogeneity did not exist. Additional subgroup analysis or sensitivity analysis additionally was conducted to explore heterogeneity. Publication bias was assessed by funnel plot using the Cochrane software.ResultsSeven RCTs (including 141 patients) met our inclusion criteria. Six studies comparatively tested needle acupuncture against penetrating sham acupuncture, non-penetrating sham acupuncture or sham laser acupuncture, whilst the remaining study tested laser acupuncture against sham laser acupuncture. Five studies were considered to be at low risk of bias. Outcomes were reported for pain intensity, facial pain, muscle tenderness and mouth opening.Conclusions: This systematic review produced limited evidence that acupuncture is more effective than sham acupuncture in alleviating pain and masseter muscle tenderness in TMD. Further rigorous studies are, however, required to establish beyond doubt whether acupuncture has therapeutic value for this indication.

Evid Based Dent. 2011;12(3):89. doi: 10.1038/sj.ebd.6400816. Türp JC. Clinic for Reconstructive Dentistry and Temporomandibular Disorders, Dental School, University of Basel, Switzerland.

Full Title: Synthesis of fuzzy logic for prediction and medical diagnostics by energy characteristics of acupuncture points.

A great number of reflexologies use ancient concepts that do not coincide with modern medical terminology of anatomy, physiology, and biophysics, substantially reducing the trust of today's physicians in this direction of their profession. Recently, several mathematical models of internal and biological active points of meridian structures interaction have been proposed. These models allowed specification of diseases for which reflex diagnostics and reflex therapy methods are most effective and also increased the efficacy of these procedures. Good results for the prediction and early diagnosis of diseases from the reaction energy of biologically active points (acupuncture points) are obtained using fuzzy logic decision making.

J Acupunct Meridian Stud. 2011 Sep;4(3):175-82. Al-Kasasbeh R, Korenevskiy N, Ionescou F, Alshamasin M, Kuzmin A. Faculty of Engineering Technology, Al-Balqa Applied University, Jordan.

Full Title: Complementary and Alternative Medicine for Patients with Chronic Fatigue Syndrome: a Systematic Review.

ABSTRACT: BACKGROUND: Throughout the world, patients with chronic diseases/illnesses use complementary and alternative medicines (CAM). The use of CAM is also substantial among patients with diseases/illnesses of unknown etiology. Chronic fatigue syndrome (CFS), also termed myalgic encephalomyelitis (ME), is no exception. Hence, a systematic review of randomised controlled trials of CAM treatments in patients with CFS/ME was undertaken to summarise the existing evidence from RCTs of CAM treatments in this patient population. METHODS: Seventeen data sources were searched up to 13th August 2011. All randomised controlled trials (RCTs) of any type of CAM therapy used for treating CFS were included, with the exception of acupuncture and complex herbal medicines; studies were included regardless of blinding. Controlled clinical trials, uncontrolled observational studies, and case studies were excluded. RESULTS: A total of 26 RCTs, which included 3,273 participants, met our inclusion criteria. The CAM therapy from the RCTs included the following: mind-body medicine, distant healing, massage, tuina and tai chi, homeopathy, ginseng, and dietary supplementation. Studies of qigong, massage and tuina were demonstrated to have positive effects, whereas distant healing failed to do so. Compared with placebo, homeopathy also had insufficient evidence of symptom improvement in CFS. Seventeen studies tested supplements for CFS. Most of the supplements failed to show beneficial effects for CFS, with the exception of NADH and magnesium. CONCLUSIONS: The results of our systematic review provide limited evidence for the effectiveness of CAM therapy in relieving symptoms of CFS. However, we are not able to draw firm conclusions concerning CAM therapy for CFS due to the limited number of RCTs for each therapy, the small sample size of each study and the high risk of bias in these trials. Further rigorous RCTs that focus on promising CAM therapies are warranted.

BMC Complement Altern Med. 2011 Oct 7;11(1):87. Alraek T, Lee MS, Choi TY, Cao H, Liu J.

Full Title: Complementary and Alternative Medicine for Patients with Chronic Fatigue Syndrome: a Systematic Review.

ABSTRACT: BACKGROUND: Throughout the world, patients with chronic diseases/illnesses use complementary and alternative medicines (CAM). The use of CAM is also substantial among patients with diseases/illnesses of unknown etiology. Chronic fatigue syndrome (CFS), also termed myalgic encephalomyelitis (ME), is no exception. Hence, a systematic review of randomised controlled trials of CAM treatments in patients with CFS/ME was undertaken to summarise the existing evidence from RCTs of CAM treatments in this patient population. METHODS: Seventeen data sources were searched up to 13th August 2011. All randomised controlled trials (RCTs) of any type of CAM therapy used for treating CFS were included, with the exception of acupuncture and complex herbal medicines; studies were included regardless of blinding. Controlled clinical trials, uncontrolled observational studies, and case studies were excluded. RESULTS: A total of 26 RCTs, which included 3,273 participants, met our inclusion criteria. The CAM therapy from the RCTs included the following: mind-body medicine, distant healing, massage, tuina and tai chi, homeopathy, ginseng, and dietary supplementation. Studies of qigong, massage and tuina were demonstrated to have positive effects, whereas distant healing failed to do so. Compared with placebo, homeopathy also had insufficient evidence of symptom improvement in CFS. Seventeen studies tested supplements for CFS. Most of the supplements failed to show beneficial effects for CFS, with the exception of NADH and magnesium. CONCLUSIONS: The results of our systematic review provide limited evidence for the effectiveness of CAM therapy in relieving symptoms of CFS. However, we are not able to draw firm conclusions concerning CAM therapy for CFS due to the limited number of RCTs for each therapy, the small sample size of each study and the high risk of bias in these trials. Further rigorous RCTs that focus on promising CAM therapies are warranted.

BMC Complement Altern Med. 2011 Oct 7;11(1):87. Alraek T, Lee MS, Choi TY, Cao H, Liu J.

Full Title: Attitudes towards complementary and alternative medicine in chronic pain syndromes: A questionnaire-based comparison between primary headache and low back pain.

ABSTRACT: BACKGROUND: Complementary and Alternative Medicine (CAM) is widely used and popular among patients with primary headache or low back pain (LBP). Aim of the study was to analyze attitudes of headache and LBP patients towards the use of CAM. METHODS: Two questionnaire-based surveys were applied comparing 432 primary headache and 194 LBP patients. RESULTS: In total, 84.75% of all patients reported use of CAM; with significantly more LBP patients. The most frequently-used CAM therapies in headache were acupuncture (71.4%), massages (56.4%), and thermotherapy (29.2%), in LBP thermotherapy (77.4%), massages (62.7%), and acupuncture (51.4%). The most frequent attitudes towards CAM use in headache vs. LBP: "leave nothing undone" (62.5% vs. 52.1%; p= 0.006), "take action against the disease" (56.8% vs. 43.2%; p= 0.006). Nearly all patients with previous experience with CAM currently use CAM in both conditions (93.6% in headache; 100% in LBP). However, the majority of the patients had no previous experience. CONCLUSION: Understanding motivations for CAM treatment is important, because attitudes derive from wishes for non-pharmacological treatment, to be more involved in treatment and avoid side effects. Despite higher age and more permanent pain in LBP, both groups show high use of CAM with only little specific difference in preferred methods and attitudes towards CAM use. This may reflect deficits and unfulfilled goals in conventional treatment. Maybe CAM can decrease the gap between patients' expectations about pain therapy and treatment reality, considering that both conditions are often chronic diseases, causing high burdensfor daily life.

BMC Complement Altern Med. 2011 Oct 7;11(1):89. Gaul C, Schmidt T, Czaja E, Eismann R, Zierz S.

Full Title: Methodological issues in evaluating auricular acupuncture therapy for problems arising from the use of drugs and alcohol.

Auricular acupuncture is an accessible, non-confrontational therapy that appears to be effective when used in drug and alcohol treatment facilities, hospitals and prisons in the UK, Europe and the USA. Despite being popular, research evidence on its effectiveness is lacking, and as a result services are underfunded and risk being withdrawn. There are methodological problems in researching auricular acupuncture. In these days of evidence-based medicine, most studies in this area are explanatory randomized controlled trials, which is limited in capturing the complete benefits of the intervention. Furthermore, there is lack of consensus over definitions of the concept of 'addiction' and whether or not this should be perceived as a 'disease' that can be 'cured' by an intervention such as auricular acupuncture. Basic concepts such as these need to inform development of outcome measures, which should include retention of clients in treatment as an indicator of success. It is argued here that the best approach will integrate research on physical effects with research on subjective experience of those with drug and alcohol problems. The challenge is to design large scale, high quality, pragmatic randomized controlled trials to assess the effectiveness of auricular acupuncture over the longer term in settings that mimic the delivery of treatment in practice and are informed by acupuncture's own diagnostic traditions, using a combination of objective, quantitative methods and subjective, qualitative methods.

Cowan D. Faculty of Healthand Social Care, London South Bank University, 103 Borough Road, London SE1 0AA, UK. david.cowan@lsbu.ac.uk

Full Title: Management of primary chronic headache in the general population: the Akershus study of chronic headache.

Primary chronic headaches cause more disability and necessitate high utilization of health care. Our knowledge is based on selected populations, while information from the general population is largely lacking. An age and gender-stratified cross-sectional epidemiological survey included 30,000 persons aged 30-44 years.

Respondents with self-reported chronic headache were interviewed by physicians. The International Classification of Headache Disorders was used. Of all primary chronic headache sufferers, 80% had consulted their general practitioner (GP), of these 19% had also consulted a neurologist and 4% had been hospitalized. Co-occurrence of migraine increased the probability of contact with a physician. A high Severity of Dependence Scale score increased the probability for contact with a physician. Complementary and alternative medicine (CAM) was used by 62%, most often physiotherapy, acupuncture and chiropractic. Contact with a physician increased the probability of use of CAM. Acute headache medications were taken by 87%, while only 3% used prophylactic medication. GPs manage the majority of those with primary chronic headache, 1/5 never consults a physician for their headache, while approximately 1/5 is referred to a neurologist or hospitalized. Acute headache medication was frequently overused, while prophylactic medication was rarely used. Thus, avoidance of acute headache medication over use and increased use of prophylactic medication may improve the management of primary chronic headaches in the future.

J Headache Pain. 2011 Oct 13. Kristoffersen ES, Grande RB, Aaseth K, Lundqvist C, Russell MB. Head and Neck Research Group, Research Centre, Akershus University Hospital, 1478 Lørenskog, Oslo, Norway.

Full Title: De-qi, not psychological factors, determines the therapeutic efficacy of acupuncture treatment for primary dysmenorrhea.

OBJECTIVE: To study the impact of De-qi (, obtaining qi) and psychological factors on the efficacy of acupuncture treatment for primary dysmenorrhea, with an attempt to explore the relationship among De-qi, psychological factors, and clinical efficacy. METHODS: The patients with primary dysmenorrhea were randomly assigned to a group of acupuncture with manual manipulation (manipulation group, n=67) and an acupuncture group without manipulation (non-manipulation group, n=64). Pain intensity and pain duration were used as measures for evaluating the therapeutic efficacy of the acupuncture treatment. De-qi, the sensations a patient experienced during the acupuncture treatment, was scored on a 4-point scale by the subjects. In addition, the psychological factors, including belief in acupuncture, the level of nervousness, anxiety, and depression, were quantitatively assessed. The personality of the subject was assessed using the Eysenck personality questionnaire (EPQ) and 16 personality factor questionnaire (16PF). RESULTS: Complete data were obtained from 120 patients, 60 patients in each group. There were statistically significant differences in pain intensity (W=2410.0, P<0.01) and pain duration (W=3181.0, P<0.01) between the two groups. The number of De-qi acupoints (W=1150.5, P<0.01) and the average intensity of De-qi (W=1141.0, P<0.01) were significantly higher in the manipulation group as compared with their non-manipulation counterparts. The correlation coefficients between De-qi and therapeutic efficacy of acupuncture were greater than those between psychological factors and therapeutic efficacy. CONCLUSIONS: Compared with the psychological factors, De-qi contributed more to the pain-relieving effect of acupuncture in subjects with primary dysmenorrhea. Moreover, manual manipulation is a prerequisite for eliciting and enhancing the De-qi sensations, and De-qi is critical for achieving therapeutic effects.

Chin J Integr Med. 2011 Oct 12. Xiong J, Liu F, Zhang MM, Wang W, Huang GY. Institute of Integrated Traditional and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.

Full title: Subjective Well-being in Patients With Chronic Tension-type Headache: Effect of Acupuncture, Physical Training, and Relaxation Training.

BACKGROUND: Episodic tension-type headache is a common problem affecting approximately 2 of 3 of the population. The origin of tension-type headache is multifactorial, but the pathogenesis is still unclear. In some individuals episodic tension-type headache transforms into chronic tension-type headache (CTTH). Subjective symptoms related to the central nervous system might affect patients subjective well-being and quality of life. OBJECTIVE: This study compared 3 nonpharmacologic treatments; acupuncture, relaxation training, and physical training on subjective well-being in patients with CTTH. METHODS: Ninety consecutive patients with CTTH were randomly allocated to acupuncture, relaxation training, or physical training. At baseline 88 age-matched and sex-matched healthy controls were compared with the patients with CTTH. Subjective, central nervous system-related symptoms that might affect patients' subjective well-being and quality of life were assessed with the Minor Symptom Evaluation Profile, which contains 24 self-administered standardized items with visual analog scale responses. Fifteen items are categorized into 3 dimensions: contentment, vitality, and sleep. Assessments were made before treatment, immediately after, and 3 and 6 months after the last treatment. RESULTS: Baseline values of the total score of the 24 items and the 3 dimensions were generally lower in patients with tension-type headache compared with the reference group. No significant differences were found among the 3 treatment groups during the baseline period. All treatments proportionally improved the subjective, central nervous system-related symptoms in patients with CTTH. The 3-month follow-up, the total score of the Minor Symptom Evaluation Profile was significantly improved in the physical training group compared with the acupuncture group (P=0.036). Total mean over period was also highest in the physical training group compared with the acupuncture group (P=0.025). The vitality and sleep dimension was significantly improved at the 6-month follow-up in the relaxation training group compared with the acupuncture group (P=0.04). CONCLUSIONS: Physical training and relaxation training seem to be preferable nonpharmacologic treatments for improvement of central nervous system-related symptoms and subjective well-being for patients with CTTH.

Clin J Pain. 2011 Jun;27(5):448-56. Söderberg EI, Carlsson JY, Stener-Victorin E, Dahlöf C. Departments of *Clinical Neuroscience and Rehabilitation/Physiotherapy †Physiology/Endocrinology ‡Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg §Gothenburg Migraine Clinic, Göteborg, Sweden.

Background: Sometimes pregnant women take it on themselves to hasten labor to alleviate the discomforts of pregnancy. This study sought to identify how frequently women attempt to induce labor through nonprescribed methods, and what factors are associated with the use of such methods. Methods: Surveys were distributed to postpartum women who had delivered at a Midwestern academic hospital. Women were asked what methods they had used to induce labor on their own, where they heard about these methods, and whether they had discussed it with their physician. Information about demographics and mode and timing of delivery was also collected. Results: Of the 201 women who responded, 99 (49.3%) did not try to induce labor themselves, whereas 102 (50.7%) used some type of nonprescribed method to induce labor. The most common method was walking (43.3%), followed by intercourse (22.9%), ingesting of spicy food (10.9%), and nipple stimulation (7.5%). Very few respondents used laxatives, heavy exercise, masturbation, acupuncture, or herbal preparations to induce labor. Women who used any nonprescribed method to induce labor were younger, had a lower parity, greater gestational age, and were more likely to have had a vaginal birth. Conclusions: A substantial portion of women used nonprescribed methods to induce labor, often without discussing them with a physician. Maternity caregivers may want to inquire about such issues, especially where interventions may do more harm than good. (BIRTH 38:2 June 2011).

Birth. 2011 Jun;38(2):168-71. doi: 10.1111/j.1523-536X.2010.00465.x. Epub 2011 Mar 10. Chaudhry Z, Fischer J, Schaffir J. Zaid Chaudhry is a Medical Student at the Ohio State University College of Medicine; Jane Fischer is Staff Nurse and Program Director at the Women & Infants' Program, Ohio State University Medical Center; and Jonathan Schaffir is Associate Professor of Clinical Obstetrics & Gynecology at the Ohio State University College of Medicine, Columbus, Ohio, United States of America.

Acupuncture has been used in numerous diseases and for many types of symptoms. It has been also used for obstetric complaints, such as nausea and vomiting, insomnia and low back and girdle pain. There has long been concern that some points-called forbidden-might harm pregnancy owing to a potential abortifacient effect, but it is difficult to confirm this proposition. The small number of available publications on this topic seems to show that this is not correct. Animal research examining possible harmful effects and a systematic review would be welcome to throw some light on this question.

Acupunct Med. 2011 Jun;29(2):135-6. Epub 2011 Mar 20. da Silva AV, Nakamura MU, da Silva JB. Rio Preto Medical College, Rua Pernambuco, 3147 Redentora, São José do Rio Preto,SP CEP 15015-770, Brazil; jbgsilva@hotmail.com.

Electroacupuncture (EA) is becoming more common as a treatment for chronic musculoskeletal pain. It can be associated with adverse events related to the small electric currents used, in addition to the adverse events related to needle penetration of tissues. This paper reports a case of minor tissue damage following high intensity EA for 30 min with a device delivering a waveform that does not appear to be completely charge-balanced. This case highlights a rare but preventable adverse event. Manufacturers should be encouraged to develop EA stimulators that use charge-balanced waveforms.

Acupunct Med. 2011 Jun;29(2):147-51. Cummings M. Medical Director, British Medical Acupuncture Society, Royal London Hospital for Integrated Medicine, 60 Great Ormond Street, London WC1N 3HR, UK; BMASLondon@aol.com.

Full title: Acupuncture and massage therapy for neuropathic pain following spinal cord injury: an exploratory study.

OBJECTIVE: The study sought to explore the possibility of using acupuncture and massage therapy for relieving neuropathic pain following spinal cord injury (SCI). Design 30 individuals with SCI and neuropathic pain were assigned to treatment of either massage or acupuncture, with 15 individuals in each group. Both groups received treatment twice weekly for 6 weeks. Treatments were evaluated at the end of treatment and 2 months later (follow-up). RESULTS: Data were analysed on an intention-to-treat basis. Within the groups, ratings of present pain, general pain, pain unpleasantness and coping improved significantly at the end of treatment after acupuncture compared to baseline values, and following massage therapy ratings of pain interference on the Multidimensional Pain Inventory improved. At follow-up no significant improvements were seen. Between-group differences were seen regarding ratings of worst pain intensity at the end of treatment, and regarding pain unpleasantness and coping with pain at follow-up, both in favour of acupuncture. At the end of treatment, eight of the 15 individuals receiving acupuncture and nine receiving massage reported an improvement on the Patient Global Impression of Change Scale, and at follow-up six patients in the acupuncture group and one patient in the massage group still reported a favourable effect from the treatment. Few side effects were reported and neither dropout from the study did this due to adverse events. CONCLUSION: Neuropathic pain following SCI is often only partially responsive to most interventions. Results from this study indicate, however, that both acupuncture and massage therapy may relieve SCI neuropathic pain. For this reason, larger randomised controlled trials are warranted for assessing the long-term effects of these treatments.

Acupunct Med. 2011 Jun;29(2):108-15. Epub 2011 Apr 6. Norrbrink C, Lundeberg T. Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm 18288, Sweden; cecilia.norrbrink@ki.se.

BACKGROUND: Although acupuncture sensation (also known as de qi) is a cornerstone of traditional acupuncture therapy, most research has accepted the traditional method of defining acupuncture sensation only through subjective patient reports rather than on any quantifiable physiological basis. Purpose To preliminarily investigate the frequency of key sensations experienced while needling to specific, quantifiable tissue levels (TLs) guided by ultrasound (US) imaging. METHODS: Five participants received needling at two acupuncture points and two control points at four TLs. US scans were used to determine when each TL was reached. Each volunteer completed 32 sets of modified Southampton Needle Sensation Questionnaires. Part one of the study tested sensations experienced at each TL and part two compared the effect of oscillation alone versus oscillation + rotation. RESULTS: In all volunteers, the frequency of pricking, sharp sensations was significantly greater in shallower TLs than deeper (p=0.007); the frequency of sensations described as deep, dull and heavy, as spreading, and as electric shocks was significantly greater in deeper TLs than shallower (p=0.002). Sensations experienced did not significantly differ between real and control points within each of three TLs (p>0.05) except TL 4 (p=0.006). The introduction of needle rotation significantly increased deep, dull, heavy sensations, but not pricking and sharp sensations; within each level, the spectrum of sensation experienced during both oscillation + rotation and oscillation alone did not significantly differ between acupuncture and control points. CONCLUSION: The preliminary study indicates a strong connection between acupuncture sensation and both tissue depth and needle rotation. Furthermore, the new methodology has been proven feasible. A further study with an objective measurement is warranted.

Acupunct Med. 2011 Jun 4. Park JJ, Akazawa M, Ahn J, Beckman-Harned S, Lin FC, Lee K, Fine J, Davis RT, Langevin H. 1Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.

Full title: Discrimination accuracy between real and sham needles using the Park sham device in the upper and lower limbs.

OBJECTIVE: To evaluate the blinding effectiveness of the Park sham acupuncture device using participants' ability to discriminate between the real and sham acupuncture needles in the (1) upper limb (TE points) compared with pure guessing and (2) lower limb (BL points) compared with pure guessing. METHODS: 20 healthy acupuncture-naïve university students and staff were recruited through convenience sampling. Participants made Yes-No judgements on whether the real or sham needle was administered to four TE acupoints on the dominant upper limb, and four acupoints along the BL meridian on the dominant lower limb. The proportion of correct judgements, P(C), for each participant was calculated to indicate the discrimination accuracy of participants in distinguishing between the real and sham needles. Separate P(C) were computed for the upper limb acupoints and lower limb acupoints. The data were also pooled to calculate a P(C) for a combination of both body regions. RESULTS: The participants' discrimination accuracy between the real and sham needles was not statistically significant from P(C)=0.5 (chance level) for the lower limb alone and combined body regions' acupoint comparisons (lower limb: t(19)=0.00, unadjusted p=1.00; combined: t(19)=1.75, unadjusted p=0.10). However, the participants' discrimination accuracy was statistically significant from P(C)=0.5 for the upper limb acupoints alone comparison (t(19)=2.36, unadjusted p=0.03). CONCLUSIONS: This study showed that the Park sham device is more likely to blind participants in differentiating between the real and sham needles in the lower limb (BL meridian) acupoints than in the upper limb (TE meridian). However, the participants' ability to differentiate between the needle types for the upper limb acupoints was significantly different from chance levels.

Acupunct Med. 2011 Jun 7. Tan CW, Sheehan P, Santos D. School of Health Sciences, Queen Margaret University Edinburgh, Edinburgh, UK.

Full title: Acupuncture for hot flushes in perimenopausal and postmenopausal women: a randomised, sham-controlled trial.

OBJECTIVES: To determine the effect of acupuncture in treating hot flushes in perimenopausal or postmenopausal women. METHODS: The study was a randomised single-blind sham-controlled clinical trial. Perimenopausal or postmenopausal women with moderate or severe hot flushes were randomised to receive real or sham acupuncture. Both groups underwent a 4-week run-in period before the treatment. The real acupuncture group received 11 acupuncture treatments for 7 weeks, and the control group underwent sham acupuncture on non-acupuncture points during the same period. Both groups were followed for 8 weeks after the end of treatment period. Changes from baseline in the hot flush scores at week 7, measured by multiplying the hot flush frequency and severity, were the primary outcome. Hot flush frequency, severity and menopause-related symptoms measured with the Menopause Rating Scale Questionnaire were regarded as secondary outcomes. RESULTS: 54 participants were randomised into the real acupuncture group (n=27) and the sham acupuncture group (n=27). The mean change in hot flush scores was -6.4±5.2 in the real acupuncture group and -5.6±9.2 in the sham group at week 7 from values at the start of the acupuncture treatment (10.0±8.1 vs 11.7±12.6), respectively (p=0.0810). No serious adverse events were observed during the whole study period. CONCLUSIONS: Compared to sham acupuncture, acupuncture failed to show significantly different effects on the hot flush scores but showed partial benefits on the hot flush severity. Further consideration is needed to develop appropriate strategies for distinguishing non-specific effects from observed overall effectiveness of acupuncture for hot flushes. Whether acupuncture has point-specific effects for hot flushes should be also considered in designing future researches.

Acupunct Med. 2011 Jun 8. Kim DI, Jeong JC, Kim KH, Rho JJ, Choi MS, Yoon SH, Choi SM, Kang KW, Ahn HY, Lee MS. 1Department of Obstetrics and Gynecology, College of Traditional Korean Medicine, Dongguk University, Seoul, South Korea.

This systematic review aims to summarize all reported cases of cardiac tamponade after acupuncture. Five electronic databases and our own files were searched for reports of cardiac tamponade after acupuncture. No restrictions in time or language were imposed. Data were extracted by two independent reviewers according to predefined criteria. We found a total of 26 cases. In 14 patients, the complications were fatal. In most instances, there is little doubt about causality. We conclude that cardiac tamponade is a serious, often fatal complication after acupuncture. As it is theoretically avoidable, acupuncturists should be trained to minimize the risk.

Int J Cardiol. 2011 Jun 16;149(3):287-9. Epub 2010 Nov 19. Ernst E, Zhang J.

Full title: Placebo studies and ritual theory: a comparative analysis of Navajo, acupuncture and biomedical healing.

Using a comparative analysis of Navajo healing ceremonials, acupuncture and biomedical treatment, this essay examines placebo studies and ritual theory as mutually interpenetrating disciplines. Healing rituals create a receptive person susceptible to the influences of authoritative culturally sanctioned 'powers'. The healer provides the sufferer with imaginative, emotional, sensory, moral and aesthetic input derived from the palpable symbols and procedures of the ritual process-in the process fusing the sufferer's idiosyncratic narrative unto a universal cultural mythos. Healing rituals involve a drama of evocation, enactment, embodiment and evaluation in a charged atmosphere of hope and uncertainty. Experimental research into placebo effects demonstrates that routine biomedical pharmacological and procedural interventions contain significant ritual dimensions. This research also suggests that ritual healing not only represents changes in affect, self-awareness and self-appraisal of behavioural capacities, but involves modulations of symptoms through neurobiological mechanisms. Recent scientific investigations into placebo acupuncture suggest several ways that observations from ritual studies can be verified experimentally. Placebo effects are often described as 'non-specific'; the analysis presented here suggests that placebo effects are the 'specific' effects of healing rituals.

Philos Trans R Soc Lond B Biol Sci. 2011 Jun 27;366(1572):1849-58. Kaptchuk TJ. Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, , 330 Brookline Avenue, Boston, MA 02215, USA.

The purpose of this study was to investigate the use and perceived benefit of complimentary and alternative medicine (CAM) and physiotherapy treatments tried by people with chronic fatigue syndrome (CFS) to ease painful symptoms. This study used a descriptive, cross-sectional design. People with CFS who experienced pain were recruited to this study. Participants were asked during a semistructured interview about the treatments they had tried to relieve their pain. Each interview was conducted in the home of the participant. Fifty participants were recruited, of which, 10 participants were severely disabled by CFS. Eighteen participants were trying different forms of CAM treatment for pain relief at the time of assessment. Three participants were currently receiving physiotherapy. Throughout the duration of their illness 45 participants reported trying 19 different CAM treatments in the search for pain relief. Acupuncture was reported to provide the most pain relief (n=16). Twenty-seven participants reported a total of 16 different interventions prescribed by their physiotherapist. The results of this study suggest some physiotherapy and CAM treatments may help people manage painful CFS symptoms. Future research should be directed to evaluating the effectiveness of interventions such as acupuncture or gentle soft tissue therapies to reduce pain in people with CFS.

Physiother Theory Pract. 2011 Jul;27(5):373-83. Epub 2010 Nov 1. Marshall R, Paul L, Wood L. Physiotherapist, Research Assistant, Nursing & Health Care, Faculty of Medicine, University of Glasgow, Glasgow, Scotland, United Kingdom.

Full title: Patient characteristics and variation in treatment outcomes: which patients benefit most from acupuncture for chronic pain?

OBJECTIVES: The aim of this study was to identify patients' characteristics that increase or decrease their benefit from acupuncture treatment of chronic pain. METHODS: Patients with chronic low back pain, headache, neck pain, or pain due to osteoarthritis of the knee or hip, were included in 4 multicenter, randomized, controlled studies, all conducted in Germany. All patients received routine care; the patients randomized to the acupuncture group received additional acupuncture treatment. Data were pooled, and the main outcome was defined as the 3-month change from baseline of the SF-36 bodily pain subscale. To identify predictors for treatment effects and effect modifiers (ie, variables that interact with the form of treatment), patients' characteristics and their interaction with treatment were included in a mixed linear model to predict treatment outcome. RESULTS: A total of 9,990 patients who were treated by 2,781 physicians were analyzed. The outcome was markedly improved in the acupuncture group (P<0.001). Age, education, duration of illness, baseline pain, and some concomitant diseases predicted treatment outcome in both groups. Patients' characteristics that enlarged the acupuncture effect (ie, acted as effect modifiers) were being female (P=0.028), living in a multi-person household (P=0.002), failure of other therapies before the study (P=0.049), and former positive acupuncture experience (P=0.005). DISCUSSION: Future research to clarify the modifying effects with special focus on patients' expectations and other psychological variables is needed.

Clin J Pain. 2011 Jul-Aug;27(6):550-5. Witt CM, Schützler L, Lüdtke R, Wegscheider K, Willich SN. *Institute for Social Medicine, Epidemiology, and Health Economics, Charité Medical Center, Berlin †Carstens-Foundation, Essen ‡Institute for Medical Biometry and Epidemiology, University Hospital Eppendorf, Hamburg, Germany.

Abstract Background: Several systematic reviews of acupuncture as a treatment of insomnia have recently emerged. Their results are far from uniform. Aim: To summarize and critically evaluate these reviews with a view of defining the reasons for their discrepant conclusions and providing an overall verdict about the therapeutic value of acupuncture for insomnia. Methods: Thirteen electronic databases (Medline, Embase, Amed, CINHAL, Health Technology Assessments, DARE, Cochrane, six Korean/Chinese databases) were searched for relevant articles and data from the included reviews were extracted according to pre-defined criteria. Their methodological quality was assessed using the 'Overview Quality Assessment Questionnaire'. Results: Ten systematic reviews of acupuncture for insomnia were published between 2003 and 2010. They differed in numerous respects. Several reviews draw strongly positive conclusions. Owing to these several caveats, the best evidence is, however, not clearly positive. Conclusion: The evidence for acupuncture as a treatment of insomnia is plagued by important limitations, e.g. the poor quality of most primary studies and some systematic reviews. Those that are sensitive to such limitations, fail to arrive at a positive verdict about the effectiveness of acupuncture.

Eur J Gen Pract. 2011 Jun;17(2):116-23. Epub 2011 Apr 4. Ernst E, Lee MS, Choi TY. Complementary Medicine, Peninsula Medical School, University of Exeter, Exeter, UK.

To identify the effect of acupuncture on skin sympathetic nerve activity (SSNA), 17 healthy subjects (7 male and 10 female) underwent LI4 acupuncture and sham needle insertion during resting or elevated SSNA conditions. In Protocol 1 (resting SSNA), subjects received a 10min sham followed by 10min of LI4 acupuncture during resting conditions. In Protocol 2 (elevated SSNA), subjects performed 10min of submaximal intermittent handgrip (2:4s work to rest interval at 37±3% of maximal voluntary contraction) during sham and LI4 acupuncture conditions. SSNA (peroneal nerve microneurography), heart rate (ECG), and mean arterial blood pressure (finger photoplethysmography) were measured and normalized to baseline. SSNA, heart rate, and mean arterial blood pressure were not significantly altered during resting conditions (Protocol 1). During handgrip (Protocol 2), SSNA significantly increased with the sham treatment (+15.3±8.8, +11.1±5.9, and +24.3±13.0% at minutes 1, 5, and 10, respectively), while LI4 acupuncture attenuated this increase (-1.6±7.6, 0.0±4.3, and +2.2±11.2% at minutes 1, 5, and 10, respectively). Heart rate and mean arterial blood pressure increased during handgrip (Protocol 2), but no differences were observed between sham and LI4 acupuncture treatments. These results suggest that acupuncture does not affect resting SSNA in healthy subjects, however if SSNA is acutely elevated above baseline levels, acupuncture has the capacity to attenuate the increased SSNA.

Auton Neurosci. 2011 Jul 5;162(1-2):84-8. Epub 2011 May 26. Toma K, Walkowski S, Metzler-Wilson K, Wilson TE. Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, USA.

PURPOSE OF REVIEW: Complementary and alternative medicine (CAM) is widely used for the treatment of infertility; however, few reviews have evaluated the quality of evidence underlying the use of CAM fertility treatments. This review summarizes and evaluates the evidence underlying the use of these therapies for male and female infertility. RECENT FINDINGS: A wide range of CAM treatments are used by subfertile couples. Their use depends upon the region studied and the type of fertility problems encountered. Acupuncture, the most commonly used CAM fertility treatment in the USA, has the most literature-based support. Few randomized trials have been performed to evaluate other CAM fertility treatments. SUMMARY: CAM is used commonly to treat infertility; however, additional high-quality studies need to be conducted to demonstrate the safety and effectiveness of these therapies before clear recommendations can be made by physicians about their safety and effectiveness.

Curr Opin Obstet Gynecol. 2011 Jun;23(3):195-9. Weiss DA, Harris CR, Smith JF. Department of Urology, USA bDepartment of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California, USA.

Full title: Complementary and alternative medicine: Perception and use by physiotherapists in the management of low back pain.

BACKGROUND AND PURPOSE: The aim of this survey was to investigate complementary and alternative medicine (CAM) use by physiotherapists for the treatment of low back pain (LBP). METHODS: Questionnaires (n=1000) were distributed to physiotherapists randomly selected from the UK's Organisation of Chartered Physiotherapists in Private Practice (OCPPP). Results were analysed by SPSS. RESULTS: A response rate of 46% was obtained (n=459). 94.3% of respondents stated that they currently treated LBP; the most common CAMs used by physiotherapists were acupuncture (46.9%) and massage (2.1%). Physiotherapists perceived acupuncture, massage, osteopathy, chiropractic and yoga to be effective in the treatment of LBP, but were unsure about the effectiveness of other CAMs. DISCUSSION AND CONCLUSION: Physiotherapists in this sample often use acupuncture and massage to treat LBP, but appear to have little knowledge of other CAMs. Physiotherapists use mainstream methods such as mobilization and massage which could be perceived as CAM depending on the physiotherapists' perceptions and training, as these therapies have also been used and investigated by CAM practitioners. More research is required on the use of CAM as little is known regarding the effectiveness of these therapies on LBP.

Complement Ther Med. 2011 Jun;19(3):149-54. Epub 2011 Apr 27. Hughes CM, Quinn F, Baxter GD. School of Health Sciences, University of Ulster, Shore Road, Newtownabbey, Co., Antrim BT37 OQB, United Kingdom.

Full title: Changes of gene expression profiles in the cervical spinal cord by acupuncture in an MPTP-intoxicated mouse model: Microarray analysis.

It has been shown that acupuncture at acupoints GB34 and LR3 inhibits the degeneration of nigrostriatal neurons in a 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) mouse model of Parkinson's disease. The degeneration of spinal cord was reported to be induced in the MPTP-treated pre-symptomatic mouse. In this study, the gene expression profile changes following acupuncture at the acupoints were investigated in the cervical spinal cord of an MPTP-induced parkinsonism model using a whole transcript array (Affymetrix GeneChip mouse gene 1.0 ST array). It was shown that 8 of the probes up-regulated in MPTP, as compared to the control, were down-regulated after acupuncture at the acupoints. Of these 8 probes, 6 probes (4 annotated genes in 6 probes: Ctla2a, EG383229, Ppbp and Ube2l6) were exclusively down-regulated by acupuncture at the specific acupoints except for 2 probes as these 2 probes were commonly down-regulated by acupuncture at both the acupoints and the non-acupoints. In addition, 11 of the probes down-regulated in MPTP, as compared to the control, were up-regulated by acupuncture at the acupoints. Of these 11 probes, 10 probes (5 annotated genes in 10 probes: EG665033, ENSMUSG00000055323, Obox6, Pbp2 and Tmem150) were exclusively up-regulated by acupuncture at the specific acupoints except for the Fut11 because the Fut11 was commonly up-regulated by acupuncture at both the acupoints and the non-acupoints. The expression levels of the representative genes in the microarray were validated by real-time RT-PCR. These data suggest that the expression of these exclusively regulated 16 probes (9 genes) may be, at least in part, affected by acupuncture at the acupoints in the cervical spinal cord which can be damaged by MPTP intoxication.

Gene. 2011 Jul 15;481(1):7-16. Epub 2011 Apr 1. Choi YG, Yeo S, Hong YM, Kim SH, Lim S. Research Group of Pain and Neuroscience, WHO Collaborating Center for Traditional Medicine, East-West Medical Research Institute, Kyung Hee University, Seoul, Republic of Korea; Department of Basic Oriental Medical Science, College of Oriental Medicine, Kyung Hee University, Seoul, Republic of Korea.

Full Title: Acupuncture as an adjunct therapy in the treatment of eating disorders: a randomised cross-over pilot study.

OBJECTIVE: This study examines the role of acupuncture as an adjunct therapy in the treatment of eating disorders in female patients. DESIGN: A randomised cross-over study was used in this study. The two treatments phases were the private multi-disciplinary outpatient eating disorder facility in Melbourne, Australia, only (referred to as their treatment as usual) and a continuation of their treatment as usual supplemented by acupuncture. PARTICIPANTS: Patients receiving treatment at a private multi-disciplinary outpatient eating disorder facility in Melbourne, Australia were asked to participate in the study. Nine consenting women (5 with Anorexia Nervosa, 4 with Bulimia Nervosa), aged (mean and SD) 23.7 (9.6) years, participated in the study. MAIN OUTCOME MEASURES: The main outcome measure was the Eating Disorder Inventory-3. Secondary outcome measures were the Becks Depression Inventory-2, State Trait Anxiety Inventory and the Eating Disorder Quality of Life Scale. RESULTS: There was evidence that acupuncture improved the participants' Quality of Life as measured by the physical/cognitive and psychological components of the Eating Disorder Quality of Life scale. There was also evidence of decreases in anxiety (both State and Trait as measured by the State Trait Anxiety Intervention) and perfectionism (as measured by the Eating Disorder Inventory-3). CONCLUSION: This pilot study shows potential of the benefit of acupuncture as an adjunct therapy in the treatment of eating disorders particularly in the area of quality of life.

Complement Ther Med. 2010 Dec;18(6):233-40. Fogarty S, Harris D, Zaslawski C, McAinch AJ, Stojanovska L. Victoria University, Melbourne, Australia. sarah.fogarty@live.vu.edu.au

In November 2007, the Society for Acupuncture Research (SAR) held an international symposium to mark the 10th anniversary of the 1997 NIH Consensus Development Conference on Acupuncture. The symposium presentations revealed the considerable maturation of the field of acupuncture research, yet two provocative paradoxes emerged. First, a number of well-designed clinical trials have reported that true acupuncture is superior to usual care, but does not significantly outperform sham acupuncture, findings apparently at odds with traditional theories regarding acupuncture point specificity. Second, although many studies using animal and human experimental models have reported physiological effects that vary as a function of needling parameters (e.g., mode of stimulation) the extent to which these parameters influence therapeutic outcomes in clinical trials is unclear. This White Paper, collaboratively written by the SAR Board of Directors, identifies gaps in knowledge underlying the paradoxes and proposes strategies for their resolution through translational research. We recommend that acupuncture treatments should be studied (1) "top down" as multi-component "whole-system" interventions and (2) "bottom up" as mechanistic studies that focus on understanding how individual treatment components interact and translate into clinical and physiological outcomes. Such a strategy, incorporating considerations of efficacy, effectiveness and qualitative measures, will strengthen the evidence base for such complex interventions as acupuncture.

Evid Based Complement Alternat Med. 2011;2011:180805. Langevin HM, Wayne PM, Macpherson H, Schnyer R, Milley RM, Napadow V, Lao L, Park J, Harris RE, Cohen M, Sherman KJ, Haramati A, Hammerschlag R. Department of Neurology, University of Vermont, Burlington, VT 05405, USA.

Full Title: Ethnic differences in complementary and alternative medicine use among patients with diabetes.

OBJECTIVE: To evaluate the effect of ethnicity as a predictor of the use of complementary and alternative medicine (CAM) among patients with diabetes. DESIGN AND SETTINGS: A 16-item questionnaire investigating CAM use was distributed among patients attending the Taking Control of Your Diabetes (TCOYD) educational conferences during 2004-2006. Six TCOYD were held across the United States. Information of diabetes status and sociodemographic data was collected. CAM use was identified as pharmacologic (herbs and vitamins) and nonpharmacologic CAMs (e.g., prayer, yoga, and acupuncture). RESULTS: The prevalence of pharmacologic and non-pharmacologic CAMs among 806 participants with diabetes patients was 81.9% and 80.3%, respectively. Overall, CAM prevalence was similar for Caucasians (94.2%), African Americans (95.5%), Hispanics (95.6%) and Native Americans (95.2%) and lower in Pacific Islanders/others (83.9%) and Asians (87.8%). Pharmacologic CAM prevalence was positively associated with education (p=0.001). The presence of diabetes was a powerful predictor of CAM use. Several significant ethnic differences were observed in specific forms of CAM use. Hispanics reported using frequently prickly pear (nopal) to complement their diabetes treatment while Caucasians more commonly used multivitamins. CONCLUSIONS: Treatment with CAM widely used in persons with diabetes. Ethnic group differences determine a variety of practices, reflecting groups' cultural preferences. Future research is needed to clarify the perceived reasons for CAM use among patients with diabetes in clinical practice and the health belief system associated with diabetes by ethnic group.

Complement Ther Med. 2010 Dec;18(6):241-8. Villa-Caballero L, Morello CM, Chynoweth ME, Prieto-Rosinol A, Polonsky WH, Palinkas LA, Edelman SV. Family and Preventative Medicine Department, School of Medicine, University of California, San Diego, CA, United States.

Full Title: Does acupuncture improve quality of life for patients with pain associated with the spine? A systematic review.

This paper aimed to evaluate the effectiveness of acupuncture for qualities of life (QoL) in patients suffering from pain associated with the spine (PAWS). Acupuncture has been shown to reduce pain severity, but its effect on QoL is unknown. PubMed, CINAHL, and Cochrane Central Register of Controlled Trials as well as EMBASE were searched. Published randomized controlled trials on PAWS comparing acupuncture with waiting-list or sham interventions were considered. Eight out of 186 trials were included. For physical functioning, acupuncture was better than waiting-list at immediate and short-term followups; and was better than sham interventions at immediate assessment (SMD?=?0.40. 95% CI 0.06 to 0.74). For mental functioning, acupuncture was better than waiting-list at short-term followup and sham interventions at intermediate-term followup (SMD?=?0.27. 95% CI 0.03 to 0.51). A similar effect was observed on pain reduction. Discrepancies in point selection for relieving anxiety and insufficient training of trial acupuncturists were also identified. Acupuncture has a moderate effect on the improvement of physical functioning and pain for PAWS patients in the short term; but the effect for mental functioning is small and delayed. Future trials should address point selection and consistency in the qualifications of trial acupuncturists.

Evid Based Complement Alternat Med. 2011;2011:301767. Lu SC, Zheng Z, Xue CC. Traditional & Complementary Medicine Research Program, Health Innovations Research Institute and Discipline of Chinese Medicine, School of Health Sciences, RMIT University, Bundoora, VIC 3083, Australia.

Full Title: A randomised, placebo-controlled trial of manual and electrical acupuncture for the treatment of tinnitus.

The aim of this study was to examine the effects of manual/electrical acupuncture treatment on tinnitus in a randomised, single-blinded, placebo-controlled design. Fifty patients (46 males, 4 females) suffering from tinnitus were investigated. The patients were randomly assigned to three groups: a manual acupuncture group (MA), an electrical acupuncture group (EA), and a placebo group (PL). The frequency of tinnitus occurrence, tinnitus intensity, and reduction of life quality were recorded before treatment (Baseline), after 6 treatments (After-Treatment), and 1 month after the completion of treatment (1-Month-After). Standard audiometric tests were conducted on each patient at Baseline and After-Treatment. The patients also provided an overall subjective evaluation of treatment effectiveness at each stage. Eight to ten acupoints were selected at each treatment by an experienced acupuncturist. Six treatments were performed, each separated by an interval of 1 week. Analysis of variance and t-tests were used to statistically compare the data. The frequency of tinnitus occurrence and the tinnitus loudness were significantly decreased After-Treatment compared with Baseline in the EA group (P<0.009). Life quality was improved After-Treatment and at 1-Month-After compared with Baseline in both MA and EA groups (P<0.038). However, no significant differences were detected among the three groups (P>0.079). The audiogram did not show any significant changes after treatment in either group (P>0.091). The overall subjective evaluation indicated significant improvements After-Treatment compared with Baseline in both MA and EA groups (P<0.011). Furthermore, After-Treatment subjective evaluation was significantly better in the EA group compared with either the MA or PL group (P<0.011). These results indicate that there is no statistically significant differential effect of manual or electrical acupuncture on tinnitus treatment efficacy, however, electrical acupuncture does confer some relative advantages.

Complement Ther Med. 2010 Dec;18(6):249-55. Wang K, Bugge J, Bugge S. Center for Sensory-Motor Interaction, Orofacial Pain Laboratory, Aalborg University, Fredrik Bajers Vej 7 D-3, DK-9220 Aalborg, Denmark. kelun@smi.auc.dk

Full Title: Acupuncture for promoting intelligence of children--an observation on 37 cases with mental retardation.

OBJECTIVE: To observe the effect of acupuncture on intelligence quotient (IQ) in children with mental retardation (MR). METHODS: One hundred children with MR were randomly divided into an acupuncture group and a control group, 50 in each. There were 37 and 36 cases with complete data in the former and latter group respectively. Four-week treatment constituted a course, the comprehensive therapeutic effect of two groups was compared after 3 courses of treatment, and the influence of acupuncture on IQ was estimated. RESULTS: The total effective rate in the acupuncture group was 78.4%, better than 30.56% in the control group, the difference being significant (P < 0.01). Both groups were improved in IQ but the effect of the former group was better than that of the latter group (P < 0.05). CONCLUSION: Acupuncture can obviously improve IQ of children suffering from MR.

J Tradit Chin Med. 2010 Sep;30(3):176-9. Tian YP, Qi R, Li XL, Wang YL, Zhang Y, Ji T, Hou CY, Wang LJ. Affiliated Hospital of Gansu College of TCM, Lanzhou, Gansu 730020, China. tianypw@126.com

Full Title: Acupuncture reduces symptoms of dry eye syndrome: a preliminary observational study.

OBJECTIVE: The aim of this study was to evaluate the effect of acupuncture treatment on dry eye syndrome. DESIGN: This was a prospective observational study. SETTING: The study was conducted at a clinical evaluation center for acupuncture and moxibustion of the Korean Institute of Oriental Medicine, Republic of Korea. SUBJECTS: The subjects were patients with dry eye disease (N?=?36), defined by Schirmer test scores of <10?mm/5?min and tear film break-up times (BUTs) of <10 seconds. TREATMENTS: Participants were treated with acupuncture three times per week for 4 weeks. MEASURE OF EFFECTIVENESS: Schirmer test scores, BUTs, symptom scores, ocular surface disease index (OSDI) scores and dry eye symptom questionnaires were compared before and after treatment to evaluate the efficacy of acupuncture treatment. RESULTS: After treatment, symptom scores, OSDI scores and the number of dry eye symptoms were all significantly lower (p? J Altern Complement Med. 2010 Dec;16(12):1291-4. Jeon JH, Shin MS, Lee MS, Jeong SY, Kang KW, Kim YI, Choi SM. Acupuncture, Moxibustion, and Meridian Research Center, Korea Institute of Oriental Medicine, Daejeon, South Korea.

Full Title: A study on the basic drugs and points for point application in summer to treat the diseases with attacks in winter.

OBJECTIVE: To study the basic prescriptions of drugs and points for point application in summer to treat the diseases with attacks in winter and the law governing their compatibility. METHODS: A database was set up by collecting and sorting out the relevant literature, and the analysis was made with the complex network. RESULTS: It was found that Bai Jie Zi (Semen Sinapis Albae), Xi Xin (Herba Asari), Gan Sui (Radix Euphorbiae Kansui) and Yan Hu Suo (Rhizoma Corydalis) were used as the basic prescriptions of drugs, Feishu (BL 13), Dazhui (GV 14) and Shanzhong (CV 17) were selected as the basic prescription of points. CONCLUSION: The knowledge obtained from the complex networks on the basic prescriptions of drugs and points for point-application in summer to treat diseases with attacks in winter can provide a data support for working out operation norms and carrying on verification research.

J Tradit Chin Med. 2010 Sep;30(3):180-4. Fang YG, Zhou XZ, Liu BY, Wang YY. Institute of TCM China Clinical Basic Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China.

Acupuncture is often advocated as a treatment for depression, and several trials have tested its effectiveness. Their results are contradictory and even systematic reviews of these data do not arrive at uniform conclusions. The aim of this review is to critically evaluate all systematic reviews of the subject with a view of assisting clinical decisions. Thirteen electronic databases were searched to identify all relevant articles. Data of these systematic reviews and the primary studies they included were extracted independently by the two authors according to predefined criteria. Eight systematic reviews including seventy-one primary studies were found. Five of the reviews arrived at positive conclusions and three did not. All the positive reviews and most of the positive primary studies originated from China. There are reasons to believe that these reviews are less than reliable. In conclusion, the effectiveness of acupuncture as a treatment of depression remains unproven and the authors' findings are consistent with acupuncture effects in depression being indistinguishable from placebo effects.

Eval Health Prof. 2010 Dec 7. Ernst E, Lee MS, Choi TY.

OBJECTIVE: To observe clinical therapeutic effect of acupuncture plus cupping for treating insomnia in college students. METHODS: Ninety two college students suffering from insomnia were randomly divided into a treatment group (52 cases) and a control group (40 cases). Acupuncture plus cupping was used for profiting the brain and tranquilizing the mind in the treatment group, and conventional differentiation of symptoms and signs was used in the control group. Therapeutic effect, number of treatment, self-rating sleeping scaling (SRSS), and subtracted rate were evaluated after one month of treatment. RESULTS: There was a significant difference in effective rate between the two groups (P < 0.05). For the cases with moderate insomnia, the effective rate was obviously better in the treatment group than that in the control group (P < 0.05), and for the cases with slight and moderate insomnia, the average treatment number was remarkably less in the former than that in the latter (P < 0.01). SRSS was reduced in both groups (P < 0.01, P < 0.05) with a significant difference between the two groups (P < 0.05). The subtracted rate in the former was more than that in the latter (P < 0.05). Conclusion: The therapeutic effect in the treatment group was better than that in the control group, showing superiority in the cases with moderate insomnia with less treatments and more improved and cured rates.

J Tradit Chin Med. 2010 Sep;30(3):185-9. Zhang YF, Ren GF, Zhang XC. Hospital of Liaocheng University, Liaocheng, Shandong 252059, China.

Full Title: Acupuncture effect on thermal tolerance and electrical pain threshold: a randomised controlled trial.

OBJECTIVE: The aim of this study was to test whether acupuncture could modify the threshold of tolerance to thermal and electrical stimuli. METHODS: A randomised placebo-controlled single-blind trial was conducted in 36 healthy volunteers randomly distributed to control (no treatment), conventional acupuncture and sham acupuncture groups. The subjects were blind to the group allocation. The authors measured before and after treatment the pain threshold with the Painmatcher (Cefar Medical AB, Lund, Sweden) and the cold tolerance with the cold pressor test, together with the Visual Analogue Scale pain score. RESULTS: Electrical stimulation threshold and cold pressor tolerance both increased significantly in the control and the true acupuncture groups, but not the sham group. The changes in the true acupuncture group were highly statistically significant and amounted to 24% (pain threshold) and 44% (cold tolerance) increases in threshold. The changes in the true group were significantly greater than the control group but not significantly different from the sham group. The changes in the sham and control groups were not significantly different from each other. CONCLUSION: Acupuncture at true, appropriate points was more effective than no intervention in raising pain threshold and tolerance in volunteers, and acupuncture at inappropriate points had an intermediate effect which was not significantly different from either. Thus acupuncture analgesia may not be a point specific effect.

Acupunct Med. 2010 Dec 7. Amand M, Nguyen-Huu F, Balestra C. Department of Environmental & Occupational Physiology, Haute École Paul-Henri Spaak, I.S.E.K. (Institut Supérieur d'Ergothérapie et de Kinésithérapie), Brussels, Belgium.

Metabolomics represent a global understanding of metabolite complement of integrated living systems and dynamic responses to the changes of both endogenous and exogenous factors and has many potential applications and advantages for the research of complex systems. As a systemic approach, metabolomics adopts a "top-down" strategy to reflect the function of organisms from the end products of the metabolic network and to understand metabolic changes of a complete system caused by interventions in a holistic context. This property agrees with the holistic thinking of Traditional Chinese Medicine (TCM), a complex medical science, suggesting that metabolomics has the potential to impact our understanding of the theory behind the evidence-based Chinese medicine. Consequently, the development of robust metabolomic platforms will greatly facilitate, for example, the understanding of the action mechanisms of TCM formulae and the analysis of Chinese herbal (CHM) and mineral medicine, acupuncture, and Chinese medicine syndromes. This review summarizes some of the applications of metabolomics in special TCM issues with an emphasis on metabolic biomarker discovery.

Planta Med. 2010 Dec;76(17):2026-35. Zhang A, Sun H, Wang Z, Sun W, Wang P, Wang X. National TCM Key Lab of Serum Pharmacochemistry, Heilongjiang University of Chinese Medicine, Heping Road 24, Harbin, China.