1 Acupuncture Points in the Published Trials [[3], [4]]

ФЕДЕРАЛЬНОЕ ГОСУДАРСТВЕННОЕ БЮДЖЕТНОЕ ОБРАЗОВАТЕЛЬНОЕ УЧРЕЖДЕНИЕ ВЫСШЕГО ОБРАЗОВАНИЯ «АМУРСКАЯ ГОСУДАРСТВЕННАЯ МЕДИЦИНСКАЯ АКАДЕМИЯ» МИНИСТЕРСТВА ЗДРАВООХРАНЕНИЯ РОССИЙСКОЙ ФЕДЕРАЦИИ

ПОСОБИЕ для внеаудиторной самостоятельной работы

«ТРАДИЦИОННАЯ КИТАЙСКАЯ МЕДИЦИНА»

Составители: ст.преподаватель И.А. Бибик ассистент О.И.Катина ассистент Е.А. Волосенкова

Благовещенск 2016 Введение

В современных условиях значимым являются навыки «самообучения». Данное пособие представляет собой подборку текстов по теме «Традиционная китайская медицина». В приложении пособия есть упражнения к текстам, кейсы, ряд заданий творческого характера и грамматическое сопровождение (тесты с вариантами ответов). Выбор формы пособия позволяет решать указанные выше задачи. Обучающиеся смогут познакомиться с основными аспектами традиционной китайской медицины, улучшить свои знания английского языка в удобном режиме и отработать навыки извлечения информации из иноязычных источников. В пособие входят тексты по следующим ключевым темам: «Альтернативная медицина», «Акупунктура», «Банки», «Массаж», «Прижигания», «Лечение травами», «Питание», «Гимнастика». Материалы пособия могут способствовать повышению уровня владения английским языком по темам и повышению мотивации к дальнейшему изучению иностранного языка.

2 CONTENTS:

I. What are the most subjective symptoms? What are the most objective symptoms? What words are used as synonyms for the words “disease”? .4 II. ALTERNATIVE MEDICINE...... 7 III. ACUPUNCTURE...... 51 IV. MASSAGE…………………………………………………………………… 106 V. CUPPING……………………………………………………………………… 167 VI. MOXIBUSTION……………………………………………………………… 202 VII. CHINESE HERBS…………………………………………………………… 250 VIII. NUTRITION………………………………………………………………… 288 IX. EXERCISES / T’ai Chi is the APPENDIX 1) Exercises ...... 316 2) Cases...... 318 3) Project materials……………………………………………………………319 4) Grammar support tests…………………………………………………….320

3 I. What are the most subjective symptoms? What are the most objective symptoms? What words are used as synonyms for the words “disease”?

What are the most subjective symptoms?

Symptom – an indication of disease or disorder noticed by the patient himself.

The most common subjective symptoms known only to the patient by his sensation are chill, malaise, lassitude, weakness and prostration. One of the main subjective symptoms is pain which may be either mild and slight or bad, severe and even violent. The pain may be of a stabbing cutting, burning, splitting or throbbing character. It may be dull or sharp, localized or general, persistent and recurrent. Often it is radiating. Other subjective symptoms are discomfort, restlessness, fatigue. A patient may suffer from insomnia or somnolence, dizziness. Indigestion is often accompanied by nausea, anorexia and heartburn. Heart diseases are often characterized by palpitation, shortness of breath or dyspnea and respiratory distress. Irritation of the skin causes itching. common – обычный subjective – субъективный sensation – ощущение malaise – недомогание lassitude – апатичность prostration - изнеможение, слабость

Pain – an unpleasant sensation ranging from mild discomfort to agonized distress, associated with real or potential tissue damage. slight (mild) pain – слабая боль bad (severe, violent) p.- сильная боль stabbing p. – колющая боль cutting p. - режущая боль burning p. - жгучая боль splitting p. – острая боль throbbing p. - пульсирующая боль dull p. - тупая боль sharp p. – острая боль localized p. – локализованная боль generalized p. – общая боль persistent p. – постоянная боль recurrent p. – периодическая боль radiating p.- боль отдающая (в)

4 discomfort - неприятное самочувствие restlessness - беспокойное состояние fatigue - утомление insomnia - бессонница somnolence - сонливость dizziness - головокружение anorexia (loss/lack of appetite) - отсутствие аппетита heartburn - изжога palpitation - сильное сердцебиение dyspnea (shortness of breath) - одышка distress - боль, сильное недомогание respiratory distress – расстройство дыхания irritation - раздражение itching - зуд

What are the most objective symptoms? The most common objective symptoms are fever, anemia, sweating. An upper respiratory infection is usually characterized by hoarseness, sore throat, running nose, running eyes and sneezing. Most lung diseases are characterized by cough, either productive with expectoration or dry and hacking. Gastrointestinal symptoms may be vomiting, diarrhoea, constipation, regurgitation and salivation, while jaundice appears in hepatic diseases. Tumours may be characterized by lumps sores or discharge. Infectious diseases are often accompanied by rash or eruption followed by peeling or scaling of the skin. anemia – малокровие sweating (perspiration) - потение hoarseness – хрипота running eyes - слезящиеся глаза running nose – насморк sneezing - чихание cough - кашель productive cough – влажный кашель dry and hacking cough – сухой, частый кашель expectoration - отхаркиванье, мокрота regurgitation - срыгивание salivation - слюноотделение jaundice - желтуха tumour (growth) - опухоль lump - затвердение sore - язва discharge – выделения eruption (rash) – сыпь peeling (scaling) - шелушение

What words are used as synonyms for the words “disease”?

5 There are a great many words used as synonyms for the word “disease”. Some of them are illness, sickness. Malady is usually a serious and often fatal disease. Ailment and trouble usually designate chronic but not acute disease, while affection implies an attack upon a particular organ. Indisposition and disorder are also used to describe a slight disease. A short spell of indisposition is an attack, fit or bout. illness – болезнь sickness – болезнь, заболевание malady – (тяжелая) болезнь serious (grave) – серьезный fatal - смертельный ailment – нездоровье chronic – хронический acute – острый affection (affliction) – поражение attack (fit, bout) – приступ indisposition - нездоровье short spell - недлительное заболевание

II. ALTERNATIVE MEDICINE

Cancer patients could benefit from the combining of Chinese and Western medicine

Published: Tuesday 1 October 2013

Combining traditional forms of Chinese and Western medicine could offer new hope for developing new treatments for liver, lung, colorectal cancers and osteosarcoma of the bones. Experts from Cardiff University's School of Medicine have joined forces with Peking University in China to test the health benefits of a traditional Chinese medicine. The team also set-out to examine how by combining it with more traditional methods like Chemotherapycould improve patient outcomes and potentially lead to the development of new cancer treatments and therapies. "Traditional Chinese medicine where compounds are extracted from natural products or herbs has been practised for centuries in China, Korea, Japan and other countries in Asia," according to Professor Wen Jiang from Cardiff University's School of Medicine, who is the director of the Cardiff University-Peking University Joint Cancer Institute at Cardiff and led the research as part of a collaboration between Cardiff University and Peking University. "Although a few successes, most of the traditional remedies are short of scientific explanation which has inevitably led to scepticism - especially amongst traditionalists in the West. "As a result, we set out to test the success of a Chinese medicine and then consider how combining it alongside traditional methods like Chemotherapy could result in positive outcome for patients," he adds. Yangzheng Xiaoji is a traditional Chinese formula consisting of 14 herbs. The formula has been shown to be beneficial to cancer patients - however, until now how it works has remained unknown. Since 2012 the Team have investigated how the formula works, discovering that it works by blocking a pathway which stops the spread of cancer cells in the body. "The formula has been shown to be beneficial to patients with certain solid tumours, when used alone and in conventional therapies, such as Chemotherapy.

6 "It suggests that combining the formula with conventional as well as new therapies could hold the key to developing new treatments for cancer patients. "We are already looking to clinical trials in treatment of lung and other cancer types."

Going West With Eastern Medicine - Traditional Chinese Medicine Is Entering The Mainstream In Terms Western Practitioners Understand Published: Thursday 17 May 2007

In recent years, interest in complementary medicine has re-ignited in a big way as consumers turn to nature in the search of alternative remedies. In particular increasing numbers of people are beginning to seek answers to needs unaddressed by Western science by looking to the ancient knowledge of Traditional Chinese Medicines.

This accounts for the high penetration of complementary medicines in developed economies. According to World Health Organisation estimates, more than half the populations of developed countries have tried alternative medication at least once. However, most western trained practitioners have had little exposure to or training in traditional medicine and find it difficult to guide their patients in their choices.

The challenge of traditional medicine for Western practitioners

The trend of using traditional remedies as a substitute for chemically formulated drugs is set to continue with an industry growth rate of between 5 - 15 per cent a year, and much of it is no doubt due to the common layman belief that the more 'natural' a product, the fewer the side effects.

Western practitioners, however, have long been uncomfortable with this assumption and this has resulted in many alternative treatments being sidelined as 'quack medicine' lacking scientific basis. This stance is exacerbated by the dearth of research on most traditional remedies. Active ingredients and their mechanisms of action and interaction with concomitant treatments are unknown or not described in clinically accepted ways, while existing evidence based data often does not meet stringent Western criteria.

As a result the common reaction of skeptical Western medical practitioners is to follow a precautionary principle when advising patients and avoid recommending alternatives altogether. This helps to discourage uncritical enthusiasm for complementary medication among most patients and prevents the misuse of unproven or low-quality treatments. However this also denies many patients access to promising products, leaving certain medical needs unmet.

Bringing traditional medicine to the mainstream

It is possible, however, to incorporate alternative treatments into a Western medical framework - giving doctors a firm basis upon which to evaluate these treatments.

7 China. The trial produced a 2.11 odd ratio in complete responders on a functional scale and very favorable outcomes on individual neurological deficit scores. The fact that the research had been conducted on patients several months after their stroke onset suggested Neuroaid helps stroke rehabilitation by improving the brain's neuroplasticity. No such drug exists in Western Pharmacopoeia.

This made the potential contribution Neuroaid could bring to stroke survivors an exciting prospect. However it was possible that the product's entirely herbal and natural formulation - engineered along the principles of Qi - would excite a lot of disbelief in the Western medical fields.

For this reason a Western approach to the development of Neuroaid as a mainstream product was adopted. Since it was already being successfully marketed for consumption in China as a proprietary medicine, the decision was made to focus on clinical development, instead of going back to animal models to evidence the precise mechanism of action.

The first step for this was to ensure the quality and stability of the product for safe consumption in a Western context. While the existing base of usage in China over several hundred thousands patients indicated the safety of NeuroAid, it was important to also ensure safety of consumption for patients receiving Western medical care.

As for stroke, the main concern is the risk of bleeding. Several studies were implemented which showed Neuroaid did not create such risks, even in combination with aspirin as an antiplatelet agent, or when taken over several weeks. Tests were also initiated and are now implemented on the product to ensure quality, including microbial analysis and heavy metal search. Good Manufacturing Practice quality standards are also enforced.

In addition, a review of existing efficacy data from China with Western criteria was conducted, focusing on improvement measured against familiar endpoints, keeping in mind that these trials were conducted using different methodology standards than those used in the West.

With solid safety and quality data in one hand and rigorously tested efficacy data, practitioners are now able to make an informed decision to advise patients on how to integrate NeuroAid into their recovery programs.

The next step is to implement more clinical trials in compliance with Western standards, to establish the exact efficacy of Neuroaid. Plans are in the pipeline for one such study, conducted by international neurologists, to be launched soon this year. Moleac is also exploring imagery markers to establish the actual effect of the drug in improving brain neuroplasticity.

TCM perception in the future

Remedies such as NeuroAid serve the important purpose of filling a need that accepted Western medical practice does not attend to. A balance, therefore, needs to be struck between ascertaining a product's safety and efficacy, and the leap of faith in trying it to "see if it works". Recognising this need, the World Health Organisation's 2002 traditional medicine strategy outlines key goals in promoting and regulating safe and effective traditional medicine; these include safety, quality and efficacy, government policy, access, and rational usage.

The team at Moleac, or companies like Himalaya, an Ayurvedic herbal healthcare company, are part of a small group of biopharmaceutical firms who have responded to this call by pioneering attempts to consolidate existing safety evidence and further prove the efficacy of alternative

8 treatments in the context of Western medicine.

This approach to developing drugs requires an in-depth understanding of both TCM and Western medicine. On top of the usual challenges of product development, identifying a gap in Western medicine and finding a suitably promising candidate, TCM can be a long and difficult process. Coordinating the work of TCM doctors and Western clinicians - who must overcome their differing viewpoints and cultural perspectives in order to collaborate closely - is also a challenge.

However, with the dwindling pipelines and immense financial risks currently hindering many of the larger Western pharmaceutical companies, focusing on this lower-risk, clinical-based model for developing TCM may be the solution for companies seeking to bring new drugs to market faster.

And as in the case of Moleac, emphasis on consumer safety and rigorous pharmaceutical research helps medical practitioners make informed decisions on using the product, removing a key barrier to its widespread usage and ensuring it manages to reach the patients it can benefit.

Written by David Pricard, Co-Founder of Moleac, a biopharma company based at Biopolis in Singapore.

Going West With Eastern Medicine - Traditional Chinese Medicine Is Entering The Mainstream In Terms Western Practitioners Understand

Published: Thursday 17 May 2007

The challenge of traditional medicine for Western practitioners

9 As a result the common reaction of skeptical Western medical practitioners is to follow a precautionary principle when advising patients and avoid recommending alternatives altogether. This helps to discourage uncritical enthusiasm for complementary medication among most patients and prevents the misuse of unproven or low-quality treatments. However this also denies many patients access to promising products, leaving certain medical needs unmet.

Bringing traditional medicine to the mainstream

It is possible, however, to incorporate alternative treatments into a Western medical framework - giving doctors a firm basis upon which to evaluate these treatments.

One such example is Neuroaid, a Traditional Chinese Medicine aimed at supporting stroke recovery, marketed by Moleac. Western medicine today offers a plethora of products and surgical treatments that deal with preventing the causes of stroke. However, its only offering for stroke patients after the hyper-acute stage comprises physiotherapy, which leaves recent stroke patients with only a 33% chance of full recovery. No Western drug offerings address the patient rehabilitation process. When Moleac identified Neuroaid, clinical data had already been generated on the medication - a sizeable double-blind randomized clinical trial on over 600 patients had been conducted in China. The trial produced a 2.11 odd ratio in complete responders on a functional scale and very favorable outcomes on individual neurological deficit scores. The fact that the research had been conducted on patients several months after their stroke onset suggested Neuroaid helps stroke rehabilitation by improving the brain's neuroplasticity. No such drug exists in Western Pharmacopoeia.

With solid safety and quality data in one hand and rigorously tested efficacy data, practitioners are now able to make an informed decision to advise patients on how to integrate NeuroAid into

10 their recovery programs.

TCM perception in the future

Written by David Pricard, Co-Founder of Moleac, a biopharma company based at Biopolis in Singapore.

Phone App That Predicts Health Risk Using A Picture Of Your Tongue

Reply NewsMay 30th, 2012tcmpage For over 5,000 years, Traditional Chinese Medicine (TCM) has claimed to be able to predict the state of your inner health simply by looking at your tongue. Now a smartphone app that does it all for us. The traditional method bases its results on the flow and balance of positive and negative energies in the body. However, in the modern world (and with technology on our side) gadget geeks have come up with a contemporary way to check our health using the power of the tongueâ€¦ by creating a smartphone app that does it all for us.

11 Combining ancient practices with modern medicine and advanced mobile technology researchers from the University of Missouri are developing computer software that enables users to take a snap of their tongue and have it analysed for any health issues. â€œKnowing your zheng classification can serve as a pre-screening tool and help with preventive medicine,â€ said Dong Xu, the co-author of the latest study, reports Medical Daily. What is your tongue trying to tell you about your health? Scroll down to find out… The phone app aims to analyse the tongueâ€™s colour, where it gets placed into a â€˜hotâ€™ or â€˜coldâ€™ category, which then pinpoints any possible underlying health conditions. â€œHot and cold zheng doesnâ€™t refer directly to body temperature. Rather, it refers to a suite of symptoms associated with the state of the body as a whole,” adds Xu. So far, researchers have tested the app on 263 gastritis patients and 48 healthy people. “As we continue to work on the software we hope to improve its ability. Eventually everyone will be able to use this tool at home using webcams or smartphone applications. That will allow them to monitor their zheng and get an early warning about possible ailments,” adds co-author of the study, Ye Duan.

Efficacy Of Selected Complementary And Alternative Medicine Interventions For Chronic Pain

Published: Friday 1 June 2007

We review published research on commonly used complementary and alternative medicine (CAM) approaches to treating chronic pain. Our findings show that CAM therapies, as a group, have a mixed track record of efficacy. The modalities that have the best track records for pain management include biofeedback, hypnosis, and massage (mostly for low back pain and shoulder pain). In selecting a CAM modality, practitioners must weigh the pros and cons and tailor the interventions to the needs of patients with chronic pain. Other issues relevant to practitioners include additional time and energy investments, need for specialized training to administer the modality, side effects or potential toxic effects, safety in combining CAM and other modalities, likely acceptance by clients and the public, and ease of incorporation into traditional pain management practices.

The Journal of Rehabilitation Research and Development (JRRD) has been a leading research journal in the field of rehabilitation medicine and technology for over 40 years. Formerly the Bulletin of Prosthetics Research, JRRD debuted in 1983 to include cross-disciplinary findings in rehabilitation. JRRD, a scientifically indexed journal, publishes original research papers, review articles, as well as clinical and technical commentary from U.S. and international researchers on all rehabilitation research disciplines.

JRRD publishes in both print and electronic formats, increasing the journal's dissemination from a hard copy circulation of 8,000 to 2.3 million Web downloads in 2005. Currently, there are over 1,000 peer-reviewed articles available in electronic format and free for downloading. JRRD will initiate an archiving program in 2005 to make all issues of JRRD and the Bulletin of Prosthetics Research available online.

Journal of Rehabilitation Research and Developmen

A systems approach elucidates the mechanisms of action of traditional oriental medicine

Published: Wednesday 11 March 2015

12 A Korean research team at KAIST suggests that a systems approach using metabolite structural similarity helps to elucidate the mechanisms of action of traditional oriental medicine Traditional oriental medicine (TOM) has been practiced in Asian countries for centuries, and is gaining increasing popularity around the world. Despite its efficacy in various symptoms, TOM has been practiced without precise knowledge of its mechanisms of action. Use of TOM largely comes from empirical knowledge practiced over a long period of time. The fact that some of the compounds found in TOM have led to successful modern drugs such as artemisinin for malaria and taxol (Paclitaxel) for cancer has spurred modernization of TOM. A research team led by Distinguished Professor Sang Yup Lee at the Korea Advanced Institute of Science and Technology (KAIST) has focused on structural similarities between compounds in TOM and human metabolites to help explain TOM's mechanisms of action. This systems approach using structural similarities assumes that compounds which are structurally similar to metabolites could affect relevant metabolic pathways and reactions by biosynthesizing structurally similar metabolites. Structural similarity analysis has helped to identify mechanisms of action of TOM. This is described in a recent study entitled "A systems approach to traditional oriental medicine," published online in Nature Biotechnology. In this study, the research team conducted structural comparisons of all the structurally known compounds in TOM and human metabolites on a large-scale. As a control, structures of all available approved drugs were also compared against human metabolites. This structural analysis provides two important results. First, the identification of metabolites structurally similar to TOM compounds helped to narrow down the candidate target pathways and reactions for the effects from TOM compounds. Second, it suggested that a greater fraction of all the structurally known TOM compounds appeared to be more similar to human metabolites than the approved drugs. This second finding indicates that TOM has a great potential to interact with diverse metabolic pathways with strong efficacy. This finding, in fact, shows that TOM compounds might be advantageous for the multitargeting required to cure complex diseases. "Once we have narrowed down candidate target pathways and reactions using this structural similarity approach, additional in silico tools will be necessary to characterize the mechanisms of action of many TOM compounds at a molecular level," said Hyun Uk Kim, a research professor at KAIST. TOM's multicomponent, multitarget approach wherein multiple components show synergistic effects to treat symptoms is highly distinctive. The researchers investigated previously observed effects recorded since 2000 of a set of TOM compounds with known mechanisms of action. TOM compounds' synergistic combinations largely consist of a major compound providing the intended efficacy to the target site and supporting compounds which maximize the efficacy of the major compound. In fact, such combination designs appear to mirror the Kun-Shin-Choa-Sa design principle of TOM. That principle, Kun-Shin-Choa-Sa (or Jun-Chen-Zuo-Shi in Chinese) literally means "king- minister-assistant-ambassador." In ancient East Asian medicine, treating human diseases and taking good care of the human body are analogous to the politics of governing a nation. Just as good governance requires that a king be supported by ministers, assistants and/or ambassadors, treating diseases or good care of the body required the combined use of herbal medicines designed based on the concept of Kun-Shin-Choa-Sa. Here, the Kun (king or the major component) indicates the major medicine (or herb) conveying the major drug efficacy, and is supported by three different types of medicines: the Shin (minister or the complementary component) for enhancing and/or complementing the efficacy of the Kun, Choa (assistant or the neutralizing component) for reducing any side effects caused by the Kun and reducing the minor symptoms accompanying major symptom, and Sa (ambassador or the delivery/retaining component) for facilitating the delivery of the Kun to the target site and retaining the Kun for prolonged availability in the cells.

13 The synergistic combinations of TOM compounds reported in the literature showed four different types of synergisms: complementary action (similar to Kun-Shin), neutralizing action (similar to Kun-Choa), and facilitating action or pharmacokinetic potentiation (both similar to Kun-Choa or Kun-Sa). Additional structural analyses for these compounds with synergism show that they appeared to affect metabolism of amino acids, co-factors, and vitamins as major targets.

The picture presents the structural similarity analysis of comparing compounds in traditional oriental medicine and those in all available approved drugs against the structures of human metabolites. Credit: KAIST Professor Sang Yup Lee said, "This study lays a foundation for the integration of traditional oriental medicine with modern drug discovery and development. The systems approach taken in this analysis will be used to elucidate mechanisms of action of unknown TOM compounds which will then be subjected to rigorous validation through clinical and in silico experiments."

Master of Science in Oriental Medicine (MSOM) The entire Master of Science degree program in Oriental Medicine can be completed in as little as 4 academic years. This program combines the Master of Science in Acupuncture program with 810 hours of training in traditional Chinese Herbology, Nutrition and Botany. MSOM students engage in an in-depth exploration of the clinical usage of the most commonly used Chinese herbal formulas. Coursework makes use of innovative critical thinking and collaborative learning activities, while emphasizing practical skills that are directly applicable to patient care. There are two ways that Tri-State College students can complete the Master of Science in Oriental Medicine curriculum. Students should select the option that best fits their educational and professional goals and schedule: 1. Students currently enrolled in the Master of Science in Acupuncture program may begin their training in Chinese Herbology during their third year of acupuncture training. This allows them to complete the entire Program in Oriental Medicine in 4 academic years. 2. Graduates of the Master of Science in Acupuncture program may return any time after graduation to complete the Chinese Herbology portion of the Master of Science in Oriental

14 Medicine curriculum and upgrade to the Master of Science in Oriental Medicine degree. This takes approximately 2 additional years as a part-time student. The structure of Tri-State's Master of Science in Oriental Medicine program ensures that students are well trained in both acupuncture and Chinese herbology, while recognizing that these are two very different disciplines (i.e. physical medicine versus internal medicine). MSOM students graduate with a respect for each discipline, and the ability tocombine these powerful modalities to provide exceptional patient care. Upon satisfactory completion of the herbal program, Tri-State graduates may upgrade their M.S. degree from the Acupuncture Program to the M.S. degree in Oriental Medicine, and are eligible to sit for the NCCAOM certification exam in Chinese Herbology. Program Highlights  Provides a unique opportunity to study in a clinical setting beginning in the first semester.  Taught by highly experienced faculty, senior practitioners, and renowned experts in herbology, health, and wellness.  Provides in-depth examination of actions and indications of commonly used herbs and formulas recommended in the U.S.  Explores common interactions between herbal formulas and conventional pharmaceuticals.  Incorporates lifestyle counseling by utilizing Eastern and Western dietary theory treatment principles.  Offers advanced specialty topics, including musculoskeletal and channel dysfunction, gynecology, and dermatology.  Offers an Advanced Certificate in Chinese Herbology and prepares graduates to sit for the Chinese herbology certification exam offered by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM). http://www.tsca.edu/site/prospective/c/programs/oriental-medicine-program/

Growing Use Of Alternative Medicine In Pregnancy Highlights Need For More Knowledge, Australia

Published: Monday 28 February 2011

Complementary and alternative medicine (CAM) is increasingly popular in maternity care.

However, healthcare professionals need evidence-based information about its use, according to The University of Queensland's Dr Jon Adams, lead author of a review published in the latest Journal of Advanced Nursing.

Associate Professor Adams is also Executive Director of the Network of Researchers in the Public Health of Complementary and Alternative Medicine (NORPHCAM).

He said the review also showed there was a need for greater respect and cooperation between conventional and alternative practitioners, and improved communication with patients about the growing use of CAM.

University-based members of the (NORPHCAM) reviewed 19 studies covering the views of more than 3,000 maternity professionals from Australia, Canada, the USA, UK, Germany, New Zealand and Israel.

The studies, which were all based on interviews or surveys, were published between 1999 and 2009, 13 in the last five years.

15 The review raised concern that most medical professionals have no CAM training and little understanding of the pharmacological nature of alternative therapies and their possible risks to pregnant women.

"There have recently been calls for nursing and midwifery education to include CAM training," Dr Adams said.

"In addition, a number of medical organisations and registration boards, including the Royal College of Midwives and Australian Nursing Federation, have issued position statements endorsing the linking of care standards to education and knowledge of CAM.

"We hope that our research review will provide a first step in developing an evidence base on this important topic and provide vital insights for those managing, practising and receiving maternity care."

Key findings from the most recent 2008 and 2009 studies include:

- A survey of 343 midwives from Canada and New Zealand found that 72 per cent had recommended or offered CAM. The most common referrals were to homeopaths (51 per cent), acupuncturists (50 per cent), naturopaths (48 per cent), chiropractors (36 per cent), massage therapists (31 per cent) and osteopaths (20 per cent).

- All but one of the 381 obstetric departments who took part in a German survey said they offered at least one CAM therapy, with acupuncture (97 per cent), homeopathy (93 per cent) and aromatherapy (77 per cent) heading the list.

- 78 per cent of the 227 midwives who took part in an American study reported using CAM and 89 per cent would refer a patient to CAM providers.

The three most commonly used treatments were herbal preparations (85 per cent), pharmacologic/biologic treatments (82 per cent) and mind-body interventions (80 per cent).

- A study of 401 American obstetricians found that 98 per cent routinely endorsed, provided or referred patients for at least one CAM treatment. Movement therapies topped the list at 86 per cent, followed by biofeedback and acupuncture (both 80%).

Dr Adams said the popularity of CAM - including acupuncture, chiropractic, naturopathy, herbal medicine andyoga - had grown significantly in recent years.

"The use of CAM during pregnancy has been debated by practitioners and policy makers around the world and it is clear that there is a real need to develop an integrated approach to maternity care.

Source: University of Queensland

HHS Secretary And Chinese Minister Of Health Sign Memorandum Of Understanding On Traditional Chinese Medicine Research

Published: Tuesday 17 June 2008

16 HHS Secretary Mike Leavitt signed a memorandum of understanding with Chinese Vice Minister of Health Wang Guoqiang to foster collaboration between scientists in both countries in research on integrative and traditional Chinese medicine.

The signing marks the opening of a two-day traditional Chinese medicine Research Roundtable at the National Institutes of Health (NIH). The roundtable features scientific presentations by researchers from China and the United States. Topics include the synthesis of Western medicine and traditional Chinese medicine, criteria for evaluating traditional Chinese medicine practices, and the application of modern scientific tools such as proteomics (the study of proteins) to the study of traditional Chinese medicine.

"Many Americans incorporate alternative medical practices into their personal health care and are interested in the potential of a variety of traditional Chinese medicine approaches," Secretary Leavitt said. "This project will advance our understanding of when and how to appropriately integrate traditional Chinese medicine with Western medical approaches to improve the health of the American and Chinese people."

The memorandum of understanding and the establishment of the international collaboration will aid in furthering scientific research on traditional Chinese medicine.

Participants in the roundtable include a delegation from the Chinese State Administration on Traditional Chinese Medicine, academics from U.S. universities, and scientists and researchers from NIH, Indian Health Service and the Food and Drug Administration (FDA).

Thirty-six percent of Americans use some form of complementary and alternative medicine (CAM), according to the 2002 National Health Interview Survey. In the United States, traditional Chinese medicine is an alternative medical system that is considered a part of complementary and alternative medicine. Integrative medicine combines mainstream medical practices with alternative medical practices.

Traditional Chinese medicine involves numerous practices including acupuncture, tai chi, and herbal therapies. In 2007, NIH's National Center for Complementary and Alternative Medicine (NCCAM) supported nearly $20 million in research on traditional Chinese medicine practices.

Secretary Leavitt was joined at the signing by FDA Commissioner Andrew von Eschenbach, M.D., and NCCAM Director Josephine P. Briggs, M.D.

The roundtable, which was coordinated by NCCAM, National Cancer Institute's Office of Cancer Complementary and Alternative Medicine and the Fogarty International Center, is being held in advance of the Fourth Session of the United States-China Strategic Economic Dialogue, which began today in Annapolis, Md.

'Lost in translation' issues in Chinese medicine

Published: Sunday 6 July 2014

Millions of people in the West today utilize traditional Chinese medicine, including acupuncture, herbs, massage and nutritional therapies. Yet only a few U.S. schools that teach Chinese medicine require Chinese-language training and only a handful of Chinese medical texts have so far been translated into English.

17 Given the complexity of the language and concepts in these texts, there is a need for accurate, high-quality translations, say researchers at UCLA's Center for East-West Medicine. To that end, the center has published a document that includes a detailed discussion of the issues involved in Chinese medical translation, which is designed to help students, educators, practitioners, researchers, publishers and translators evaluate and digest Chinese medical texts with greater sensitivity and comprehension. "This publication aims to raise awareness among the many stakeholders involved with the translation of Chinese medicine," said principal investigator and study author Dr. Ka-Kit Hui, founder and director of the UCLA center. The 15-page document, "Considerations in the Translation of Chinese Medicine" was developed and written by a UCLA team that included a doctor, an anthropologist, a China scholar and a translator. It appears in the current online edition of the Journal of Integrative Medicine.

This photo shows the cover of the 15-page document: Credit: UCLA Authors Sonya Pritzker, a licensed Chinese medicine practitioner and anthropologist, and Hanmo Zhang, a China scholar, hope the publication will promote communication in the field and play a role in the development of thorough, accurate translations. The document highlights several important topics in the translation of Chinese medical texts, including the history of Chinese medical translations, which individuals make ideal translators, and other translation-specific issues, such as the delicate balance of focusing translations on the source-document language while considering the language it will be translated into. It also addresses issues of technical terminology, period-specific language and style, and historical and cultural perspective. For example, depending on historical circumstances and language use, some translations may be geared toward a Western scientific audience or, alternately, it may take a more natural and spiritual tone. The authors note that it is sometimes helpful to include dual translations, such as "windfire eye/acute conjunctivitis," in order to facilitate a link between traditional Chinese medical terms and biomedical diagnoses. The final section of the document calls for further discussion and action, specifically in the development of international collaborative efforts geared toward the creation of more rigorous guidelines for the translation of Chinese medicine texts. "Considerations in the Translation of Chinese Medicine," was inspired by the late renowned translator and scholar Michael Heim, a professor in the UCLA departments of comparative literature and Slavic studies. A master of 12 languages, he is best known for his translation into

18 English of Czech author Milan Kundera's "The Unbearable Lightness of Being." The new UCLA document is dedicated to him. The document, the authors say, was influenced in large part by the American Council of Learned Societies' "Guidelines for the Translation of Social Science Texts," which are intended to promote communications in the social sciences across language boundaries. It was also influenced by Pritzker's longstanding anthropological study of translation in Chinese medicine, which is detailed in her new book, "Living Translation: Language and the Search for Resonance in U.S. Chinese Medicine," recently published by Berghahn Books.

Leana Wen M.D. The Doctor Is Listening 6 Lessons We Can Learn From Eastern Chinese Medicine How a Harvard-trained doctor began to appreciate traditional Chinese medicine Posted Jan 27, 2013 As a child growing up in China, I was always aware of Traditional Chinese Medicine (TCM). TCM is what we refer to as Eastern medicine, in contrast to the Western medicine we know from U.S. hospitals. I never understood much about TCM, only that it somehow involves herbs and that many Chinese people used it. The more I progressed in my medical training in major U.S. academic centers, the more distanced I felt from TCM. Why should I learn about something that lacks evidence, when there’s so much to know about for which there is good research? Last fall, I went to China on a research trip. While my study is primarily on its Western medical system, I was so fascinated by what I learned of Eastern medicine that I spent many free evenings observing TCM practitioners. There is so much I didn’t know. As a discipline, TCM is far too complex for me to understand in my short observation, but there are some very important “lessons from the East” that are applicable to our Western medical practice: #1. Listen—really listen. The first TCM practitioner I shadowed explained to me that to practice TCM is to “listen with your whole body”. Pay attention and use every sense you have, he said. I watched this doctor as he diagnosed a woman with new-onset cervical cancer and severe anemia the moment she walked into his exam room, and within two minutes, without blood tests or CTs, sent her to be admitted to a (Western) medical service. I’ve seen expert clinicians make remarkable diagnoses, but this was something else! “How could you know what you had and that she needed to be admitted?” I asked. “I smelled the cervical cancer,” he said. “I looked and saw the anemia. I heard her speak and I knew she could not care for herself at home.” (I followed her records in the hospital; he was right on all accounts.) #2. Focus on the diagnosis. I watched another TCM doctor patiently explain to a young woman with long-standing abdominal pain why painkillers were not the answer. “Why should we treat you for something if we don’t know what it is?” he said. “Let’s find out the diagnosis first.” What an important lesson for us—to always begin the diagnosis. #3. Treat the whole person. “A big difference between our two practices,” said one TCM doctor, “Is that Western medicine treats people as organs. Eastern medicine treats people as a whole.” Indeed, I watched her inquire about family, diet, and life stressors. She counseled on

19 issues of family planning, food safety, and managing debt. She even helped patients who needed advice on caring for the their elderly parents and choosing schools for their child. This is truly “whole person” care! #4. Health is not just about disease, but also about wellness. There is a term in Chinese that does not have its exact equivalent in English. The closest translation is probably “tune-up to remain in balance”, but it doesn’t do the term justice, because it refers to maintaining and promoting wellness. Many choose to see a TCM doctor not because they are ill, but because they want to be well. They believe TCM helps them keep in balance. It’s an important lesson for doctors and patients alike to address wellness and prevention. #5. Medicine is a life-long practice. Western medicine revers the newest as the best; in contrast, patients revere old TCM doctors for their knowledge and experience. Practicing doctors do not rest on their laurels. Advertisement “This is a practice that has taken thousands of years to develop,” I was told. “That’s why you must keep learning throughout your life, and even then you will only learn just a small fraction.” Western medicine should be no different: not only are there new medical advances all the time, doctors need to continually improve their skills in the art of medicine. #6. Evidence is in the eyes of the beholder. Evidence-based medicine was my mantra in Western medical training, so I was highly skeptical of the anecdotes I heard. But then I met so many patients who said that they were able to get relief from Eastern remedies while Western treatments failed them. Could there be a placebo effect? Sure. Is research important? Of course. But research is done on populations, and our treatment is of individuals. It has taken me a while to accept that I may not always be able to explain why—but that the care should be for the individual patient, not a population of patients. “In a way, there is more evidence for our type of medicine than for yours,” a TCM teacher told me. “We have four thousand years of experience—that must count for something!” There is so much I have not covered about TCM. Its practices vary regionally, and no doubt, there are more and less capable practitioners (as there are in Western medicine). More research into TCM methods will be important. However, regardless of whether we Western doctors want to prescribe TCM treatments, we should recognize there is much to learn from Eastern medicine, including what it means to be a physician to really care for our patients. Upon my return from China, I, for one, have a newfound appreciation for Eastern medical practice a renewed understanding of holistic medical care. For more on holistic practice and the importance of partnership, please read my new book,When Doctors Don’t Listen.

Saturday, 8 February, 2003, 00:11 GMT Football turns to Eastern medicine

Bruno N'Gotty is among the players to benefit

By Thrasy Petropoulos 20 Having their tongue assessed for colour and shape and pulse taken to gauge the health of their internal organs is perhaps not what Bolton Wanderers' footballers imagined would happen to them when they visited the physio's room. Waiting for them, however, was John Brazier, the founder of the Northern Academy of Oriental Medicine, who did precisely that. And if the idea of taking eastern medicine to premiership football seems unlikely, consider that before long a queue of footballers greeted Brazier's twice-weekly visits to the Reebok stadium. Not only that, but some of the club's physiotherapists and masseuses are now looking to train in the ancient art and one player, Mike Whitlow, is It is, after all, a even taking lessons at Brazier's Lytham St Anne's-based academy. medicine based on East meets west 5,000 years of When Mark Taylor, Bolton's head physiotherapist, contacted Dr Brazier - diagnostic the title can be used if it is made clear that it is related to eastern knowledge medicine - it was with a view of complementing his traditional western methods. Yet even Taylor would not have imagined that Brazier, a former national karate champion, would prove so successful in helping to cure long- John Brazier standing problems that would not respond to treatment. One player, Ryan Baldacchino, was booked in for a third operation on his groin when he was referred to Brazier, who confidently predicted that he would cure the problem within three weeks. "In my enthusiasm it took six," recalls Brazier. "But by then he was able to train and play and he did not need an operation. "Ninety-five per cent of the time, players are amazed that I am able to accurately diagnose what they are suffering from by studying their tongue and pulse and asking them a few questions. "But it is, after all, a medicine based on 5,000 years of diagnostic knowledge." Tongue clues French defender Bruno N'Gotty was another to benefit from eastern medicine where Taylor's western methods had proved unsuccessful. "I examined the size and colour of his tongue, which tells us a lot about the internal organs," Brazier explained. "A big, fat or discoloured tongue, for instance, tells us that certain organs aren't functioning properly. Mike Whitlow is "And where in western medicine the pulse is used to measure heart training in the beat, in oriental medicine there are certain points on the wrist which discipline show how strong your lung, digestive and kidney systems are. "With Bruno, I diagnosed pulse weakness on the spleen, which is symptomatic of a digestive imbalance, and oedema - or excessive water under the skin. "In Chinese medicine the spleen exists to extract nutrients from food and distribute it to muscles and into the body generally. "Another symptom of a weak spleen is loose bowels - and Bruno was going to the toilet five times a day. "Initially I treated him with acupuncture in the stomach and legs to strengthen the spleen and kidney systems. "Then I gave him an abdominal massage which stimulates the kidneys. "And finally I did reciprocal muscle treatment on him to get his muscles working more efficiently. "After two weeks of being treated a couple of times a day he was back to full fitness."

21 Celebrity choice Chinese medicine is now the preferred choice of treatment for some high-profile celebrities. Barry Sheene, recently diagnosed with stomach and throat cancer, is exploring eastern medicine as an alternative to chemotherapy, and Richard Gere, a converted Buddhist, uses acupuncture in a quest to appear more youthful. "But the aim is prevention, not cure," said Brazier. "I did martial arts for 20 years. "And in traditional martial arts, which is self-defence, there is an element of medicine. "Your job is to keep people healthy as well as safe." http://news.bbc.co.uk/2/hi/health/2732505.stm

China A Rising Star In Regenerative Medicine Despite World Skepticism Of Stem Cell Therapies

Published: Monday 11 January 2010

Chinese researchers have become the world's fifth most prolific contributors to peer-reviewed scientific literature on clock-reversing regenerative medicine even as a skeptical international research community condemns the practice of Chinese clinics administering unproven stem cell therapies to domestic and foreign patients.

According to a study by the Canadian-based McLaughlin-Rotman Centre for Global Health (MRC), published by the UK journal Regenerative Medicine, China's government is pouring dollars generously into regenerative medicine (RM) research and aggressively recruiting high- calibre scientists trained abroad in pursuit of its ambition to become a world leader in the field.

And its strategy is working: Chinese contributions to scientific journals on RM topics leapt from 37 in year 2000 to 1,116 in 2008, exceeded only by the contributions of experts in the USA, Germany, Japan and the UK.

The accomplishment is all the more astonishing given that China's international credibility has been and still is severely hindered by global concerns surrounding Chinese clinics, where unproven therapies continue to be administered to thousands of patients.

New rules to govern such treatments were recently instituted but need to be strictly enforced in order to repair China's global reputation, according to MRC authors Dominique S. McMahon, Halla Thorsteinsdóttir, Peter A. Singer and Abdallah S. Daar.

They drew their conclusions after having gained unprecedented access to almost 50 Chinese researchers, policy makers, clinicians, company executives and regulators for interviews. The research was made possible by funding from the Canadian Institutes of Health Research.

"When you look at the issue of stem cells in China, you see the Yin-Yang of a scientific powerhouse mixed with controversial clinical application of stem cell therapies," says Dr. Singer, MRC's Director. "The overall picture at the moment is ambiguous but in the future, given the measures that have been put in place, the science can be expected to rise and the controversy to fall."

Regenerative medicine an interdisciplinary field of research and clinical applications focused on the repair, replacement or regeneration of cells, tissues or organs to restore impaired function resulting from any cause, including congenital defects, disease, trauma and aging. It uses a combination of several converging technological approaches, both existing and newly emerging, that moves it beyond traditional transplantation and replacement therapies. The approaches often stimulate and support the body's own self-healing capacity. These approaches may include the

22 use of soluble molecules, gene therapy, stem cell transplants, tissue engineering, and the reprogramming of cell and tissue types.

MRC researchers report that until May 2009 clinical trials to determine the effectiveness of stem cell therapies were not required. Now proof of safety and efficacy through clinical trials is required by China's Ministry of Health for all stem cell and gene therapies.

The change was made after international experts, joined by top Chinese researchers, protested that treatment centers were acting "against commonly accepted principles of modern scientific research" and successfully called on China to regulate new treatments and ensure patient safety.

Despite the new rules, however, stem cell treatments are still available at over 200 hospitals across China to patients of diseases such as ataxia, Lou Gehrig's disease, traumatic brain and spinal cord injury, diabetes, Parkinson's, multiple sclerosis, autism, cerebral palsy, stroke, optic nerve hypoplasia and many others.

"To our knowledge, Chinese policy makers and ethicists are working out the regulation details," says Ms. McMahon, the study's lead author. "Once that is accomplished, we still expect a delay, during which the therapies currently administered by clinics and hospitals will be evaluated individually to determine whether they meet the criteria of China's Ministry of Health."

"It is hard to say what impact these new clinical regulations will have in China, although certainly they show the government's commitment to changing the way things are done," she adds.

Beike Biotechnology Inc. (Shenzhen) is the largest of the Chinese therapy centers and claims to have treated over 5,000 patients to date, including more than 900 foreigners, offering stem cell injections into spinal fluid, for example.

The Stem Cell Center affiliated with Tiantan Puhua Neuroscience Hospital in Beijing, meanwhile, claims to activate and multiply the body's own neural stem cells through oral and intravenous medications and rehabilitation. It also offers a lumbar puncture or brain injection of bone marrow stem cells, fetal neural stem cells, or other stem cell types to allegedly improve symptoms of stroke, cerebral palsy, spinal injury, Parkinson's disease or other neurological diseases.

Controversial stem cell therapies provided at Beijing Xishan Institute for Neuroregeneration and Functional Recovery, involve injecting cells from aborted fetuses to treat spinal cord injury and a variety of central nervous system diseases. About 1,500 patients have received this treatment, including roughly 1,000 foreigners.

MRC authors say this latter stem cell therapy is the only one discussed in high-impact peer- reviewed academic journals. One study documented a spinal cord injury patient's early motor and sensory improvement, another found no improvement in seven spinal cord injury patients. Another recent publication found the therapy improved some spinal cord injuries in animals but its effectiveness in humans "is not yet established."

Despite the absence of randomized clinical trial evidence that these stem cell therapies work, an "increasingly popular but controversial" tourism industry has grown up around them.

"This is a matter of international importance, as increasing numbers of foreign patients travel to

23 China to seek unproven stem cell therapies not available in their home countries," according to the MRC. "The International Society for Stem Cell Research (ISSCR) strongly condemns the administration of unproven stem cell therapies … and has written a handbook to help doctors and patients make informed decisions about available stem cell therapies."

As for advice to last-resort patients considering Chinese clinic stem cell treatments: "This is not a medical study," says Dr. Singer. "Instead we urge such patients to consult their own medical professionals. The International Society for Stem Cell Research has certainly made their stance clear."

"These therapies are sought out by desperate, no-option patients seeking marginal improvements in their quality of life. People should get as much information as possible before committing to any procedures. Each clinic provides a different therapy for a variety of different ailments and there is no systematic evidence that these therapies work."

Chinese firsts

While unorthodox activities at Chinese clinics and controversial drug approvals have raised eyebrows both in and outside China, dedicated researchers in the country's labs have been making remarkable contributions to the field.

Among the country's scientific firsts: . By transferring the nucleus of a human skin cell into the immature ovum cell of a rabbit, researchers from a Shanghai hospital successfully produced embryonic human cells (a finding popular scientific journals held off publishing for two years due to skepticism and mistrust of Chinese scientific integrity). . China to date has created at least 25 human embryonic stem cell lines (some estimate over 70 stem cell lines), four of which are of a specialized type that at that time only two other groups worldwide had managed to create. . A Shanghai hospital cultivated and reintroduced human brain tissue in 2002 after taking a sample from the end of a chopstick implanted in a patient's frontal lobe following a disagreement at a restaurant. . Several human tissue types created artificially include blood vessel, tendon, bone, cartilage, skin, cornea and muscle fiber. Notable research underway

Current research of note includes the efforts of ChinaSCINet, a consortium of 27 medical facilities, starting phase 2 clinical trials to test the efficacy and safety of using cord blood stem cells and oral lithium to treat about 40 patients with spinal cord injuries.

Other clinical trials are underway on the use of stem cell therapies to treat patients of heart attacks, artery obstruction, and liver and neural diseases.

Elsewhere in China, studies are underway on the potential use of stem cells to treat Type 1 diabetes, Parkinson's disease, heart, liver and blood diseases, eye cataracts, and to combat aging.

Liberal research rules

Guidelines governing Chinese research are liberal but common to other countries as well.

Chinese regulations prohibit reproductive cloning, the use of human embryos past 14 days post-

24 fertilization, the fusion of human and non-human gametes (cells that fuse during fertilization), or the implantation of research embryos into human or animal uterus.

Researchers are required to obtain informed consent from subjects and institutes must have an ethics review board to approve research involving human embryonic stem cells.

Chinese fertility clinics serve as a source of discarded embryonic stem cells for some research, and cord blood banks may serve as a source of stem cells for clinical applications.

Therapeutic cloning is allowed, as is the use of surplus embryos or discarded fetal cells from abortions as well as embryos created with artificial help.

"What sets China apart from most of the rest of the world is that these regulations do not prohibit the fusion of human genetic material with nonhuman oocytes (cells from which an egg or ovum develops)," the MRC authors say.

As well, the rules for embryonic stem cell research in China are criticized internationally as having limited authority over researchers because they are not legally binding. Adherence is enforced only for those who receive government funding, which applies to most researchers, but financially independent researchers or hospitals must simply answer to their own institution's ethical review board.

MRC authors say that while there is no indication embryonic stem cell research rules are being broken, greater regulatory oversight would help ease international concerns.

Interviewees agreed that regulation enforcement is a key concern. According to one, a lack of inspection capacity cast doubt on regulatory implementation.

Huge Chinese investment in RM

Chinese data show the country now generates 400,000 graduates in science and medicine each year and recruits many high caliber scientists from abroad.

China's gross domestic expenditure on R&D in science and technology has grown from $5.9 billion in 1996 to $44 billion today. Stem cell research, tissue engineering and gene therapy are key areas receiving priority funding, largely centralized in the universities, hospitals and research institutes of China's main urban centers, especially Beijing and Shanghai.

Approximately 78% of China's R&D funding in RM is reserved for product development, with an additional 16.8% for applied research. And China has developed large primate colonies for preclinical testing, and begun clinical trials for a number of therapies.

According to the MRC, China's push for clinical applications, which has allowed it to produce new scientific knowledge quickly, has come at the expense of basic research aimed at, for example, overcoming technical challenges such as controlling how stem cells behave and differentiate.

Only 5.2% of China's budget for research and development is allocated to basic research, compared with 13 to 19% in Japan, Korea and the USA. Even the funds allocated for basic research favor 'strategic basic research' designed to encourage application.

25 China's recruitment policy a model for other developing countries

"China has catapulted itself into the field of regenerative medicine in a relatively short time," says Dr. Thorsteinsdóttir. "The government's policy of attracting highly educated Chinese nationals back to China has contributed significantly to the country's success in the field."

"I was amazed that almost all the top Chinese researchers the regenerative medicine field had been educated in the US and the UK and gained extensive working experience there in cutting edge research," she adds. "This is a policy other countries lacking relevant human resources should consider."

"New regulations may in time help restore international confidence in Chinese stem cell innovations, but it will take time to evaluate their impact," says Dr. Daar. "The creation of new RM therapies needs a clear regulatory path. There should also be a closer connection between applied research and those providing therapy."

"China is an important player in regenerative medicine," says Ms. McMahon, "Despite the media's focus on stem cell tourism, the international community needs to recognize that Chinese researchers are making important contributions to the science of this field, and China should be included in international discourses on standards and regulations."

"Regenerative medicine research in China is a source of national pride," she adds. "The Chinese rightly feel their research discoveries can achieve solutions to many global health problems. If China continues to build on its strengths and overcomes its challenges, successful, internationally acclaimed regenerative medicine treatments and therapies are more than likely."

This release is available in Chinese.

Source: Terry Collins Program on Life Sciences, Ethics and Policy,McLaughlin-Rotman Centre for Global Health

Americans Spend $34 Billion A Year On Complementary And Alternative Medicine

Written by Catharine Paddock PhD Published: Friday 31 July 2009

According to a new report based on a government survey in 2007, in the previous 12 months Americans had spent a total of $33.9 billion out of their own pockets on complementary and alternative medicine (CAM).

The report was compiled by Dr Richard L. Nahin of the National Institutes of Health's National Center for Complementary and Alternative Medicine (NCCAM) and colleagues and was published in the 30 July issue of the US Centers for Disease Control and Prevention (CDC) National Health Statistic Report.

For the purpose of the report, CAM was defined as a diverse group of medical and health care systems, practices and products that are not generally considered to be part of conventional medicine: for instance herbal supplements, chiropractic, acupuncture and meditation.

According to sources cited by a recent National Institutes of Health press release, CAM accounts for around 1.5 per cent of the $2.2 trillion that the US spends on healthcare every year, and around 11.2 per cent of out-of-pocket expenditures (where people pay for it themselves as

26 opposed to the state or insurance scheme).

For the report, Nahin and colleagues used data from the Complementary and Alternative Medicine Supplement of the 2007 National Health Interview Survey (NHIS), which is conducted by the CDC's National Center for Health Statistics.

The survey data came from 3,393 completed interviews with sample adults aged 18 years and over.

The authors used a statistical software package called SUDAAN to calculate estimates and standard errors. The package is designed to tackle the sample complexity of surveys like the NHIS so that the results are reprensentative of the US civilian, noninstitutionalized population aged 18 years and over.

The results showed that in 2007: . Adults in the US spent a total of $33.9 billion out of pocket to visit CAM practitioners and buy CAM products, classes and materials.

. Nearly two-thirds of this total went on self-care purchases of CAM products, classes and materials ($22.0 billion).

. The remaining third ($11.9 billion) was spent on practitioner visits.

. Despite the greater amount spent on self-care therapies, 38.1 million adults made an estimated 354.2 million visits to CAM practitioners.

. About three quarters of the total number of CAM practitioner visits and out of pocket expenditure on CAM practitioners was linked to manipulative and body-based therapies.

. 44 per cent of the total out of pocket expenditure on CAM (about $14.8 billion) was spent on nonvitamin, nonmineral, natural products. To put these figures in to context, £14.8 billion spent on spent on nonvitamin, nonmineral, natural CAM products is about one third of the total out of pocket expenditure spent on prescription medicine. And the $11.9 billion spent on seeing CAM practitioners is about one quarter of the total out of pocket expenditure spent on visiting "conventional" physicians.

Nahin, who is acting director of NCCAM's Division of Extramural Research, told the media that:

"These data indicate that the US public makes millions of visits to CAM providers each year and spends billions of dollars for these services, as well as for self-care forms of CAM."

"While these expenditures represent just a small fraction of total health care spending in the United States, they constitute a substantial part of out-of- pocket health care costs," he added.

While there is no previous exact survey with which comparisons can be made, the authors did discuss how these results compare with a broadly similar survey covering much the same set of CAM therapies that was done about 10 years ago by DM Eisenberg and colleagues and published in the Journal of the American Medical Association in 1998.

The greatest contrast between the surveys appears to be that Americans today spend most of their out of pocket total CAM expenditure on self-care products, classes and materials than on consulting practitioners, whereas 10 years ago it was the other way around:

27 "The present observation that about two-thirds of CAM costs were associated with self-care therapies contrasts with the findings of Eisenberg et al, who reported that the majority of CAM costs resulted from consultations with health-care professionals offering CAM services," wrote the authors.

"Costs of Complementary and Alternative Medicine (CAM) and Frequency of Visits to CAM Practitioners: United States, 2007." Richard L. Nahin, Patricia M. Barnes, Barbara J. Stussman, and Barbara Bloom. US Centers for Disease Control and Prevention. National Health Statistic Report, Number 18, July 30, 2009 (PDF download).

Additional source: NIH/National Center for Complementary and Alternative Medicine. Written by Catharine Paddock PhD

Nondrug interventions improve quality of life for Chinese cancer patients

Published: Tuesday 17 November 2015

A meta-analysis of dozens of studies of traditional Chinese medicine and other nonpharmacological interventions meant to improve patients' quality of life affirms that these approaches, on the whole, help alleviate depression, fatigue, pain, anxiety, insomnia and gastrointestinal problems in Chinese cancerpatients. Specific interventions associated with traditional Chinese medicine, such as acupuncture and therapeutic massage, reduced gastrointestinal disruptions after surgery, and acupuncture also lessened fatigue in cancer patients, the researchers report in the journal Oncotarget. "The meta-analysis confirmed that traditional Chinese medicine enhanced global quality of life for Chinese cancer patients," said University of Illinois animal sciences and pathology professor emeritus Keith Kelley, an author of the study. Dr. Qiang (Quentin) Liu, a former student of Kelley's and a U. of I. medical scholar who now is at Dalian Medical University in China, led the study with his colleagues Weiwei Tao and Xi Luo. "We think this is the most comprehensive study of traditional Chinese medicine psychobehavioral interventions and the quality of life of cancer patients published to date," Dr. Liu said. "Our findings will promote more investigations into how the body and mind are connected during disease development, and will facilitate better cancer treatments." Other interventions not associated with traditional Chinese medicine, including stress management,cognitive behavioral therapy and physical training, also were found to improve quality of life in Chinese cancer patients, the researchers report. The team started with 6,500 studies published in journals in China and 23,000 studies from Western journals. All of the research focused on nonpharmacological interventions involving adult Chinese cancer patients in China. After eliminating duplicate studies, those with nonstandard measures and those that failed to include control subjects or large enough sample sizes, the team ended up with a total of 67 studies, with 16 of them focused on traditional Chinese medicine. The latter 16 studies did not include enough studies of tai chi and qigong to allow the researchers to come to meaningful conclusions about the specific effects of those interventions, Kelley said. The total number of cancer patients included in the analysis was 6,806. "We were surprised by the limited number of papers on the use of traditional Chinese medicine psychobehavioral interventions for Chinese cancer patients that qualified for entry into this meta- analysis, particularly since the TCMs originated and are mostly practiced in China," the researchers wrote.

28 "Traditional Chinese medicine has been practiced for 2,500 years in China," Kelley said. "But what is the scientific evidence that it improves quality of life in cancer patients? This paper establishes that it does. Unfortunately, we were not able to determine what specific components of traditional Chinese medicine are the most effective." Kelley said he hopes the evidence that traditional Chinese medicine and other nonpharmacological interventions benefit cancer patients will prompt new interest in research aimed at understanding the physiological mechanisms at play.

Traditional Chinese Medical Beliefs Still Relevant In Beijing Oral Health

Published: Tuesday 27 March 2007

Traditional Chinese medical beliefs continue to have an impact on oral health in Beijing, China, says Jacqueline Hom, a dental student at the Harvard School of Dental Medicine (Boston, MA, USA), who reported her findings at the 85th General Session of the International Association for Dental Research.

Over a two-month period, she gathered ethnographic data from 67 respondents, including patients, Traditional Chinese Medicine (TCM) professionals, and dental practitioners. Each of the respondents used the concept of shang huo (rising heat) to describe oral health problems. When patients had symptoms of shang huo, such as tooth pain, gingival swelling, and a sore throat, they sought 'purging fire´ herbal medicine from the pharmacy or visited the dentist. TCM doctors regarded the concept of huo (fire) as excessive or deficient and described the consequences of patients taking inappropriate medication for huo. Chinese dentists often teach themselves TCM concepts and treatments to better serve patients with the chief complaint, "I am shang huo."

Various perspectives on shang huo illustrate how multiple medical traditions can interact within a single oral health culture. Understandings the existing oral health culture in Beijing, such as shang huo, can aid in the development of future oral health programs and assist oral health-care practitioners in serving their patients better.

This is a summary of abstract #992, "An Illustration of Chinese Oral Health Beliefs through Shang huo", by J.M. Hom, of Harvard University, Boston, MA, USA, presented at the 85th General Session of the International Association for Dental Research.

Contact: Linda Hemphill International & American Association for Dental Research

Traditional Chinese Medicine Makes Fertility Treatments Far More Effective, TAU Researchers Discover

Published: Wednesday 11 January 2012

Traditional Chinese medicine has long been used to ease pain, treat disease, boost fertility, and prevent miscarriage. Known in the Western medical community by its acronym TCM, these traditional remedies include herbal preparations and acupuncture. Now Tel Aviv University researchers have discovered that a combination of TCM therapy and intrauterine insemination (IUI) is a winning solution for hopeful mommies who are having trouble conceiving.

In the first study that measures the effectiveness of both herbs and acupuncture in combination with IUI infertilitytreatment, Dr. Shahar Lev-Ari and Keren Sela of TAU's Sackler Faculty of Medicine and the Tel Aviv Medical Center say that the results, which have been published in

29 the Journal of Integrative Medicine, show a significant increase in fertility when the therapies are administered side-by-side.

When combining IUI with TCM treatments, 65.5 percent of the test group were able to conceive, compared with 39.4 percent of the control group, who received no herbal or acupuncture therapy. The method is as "close to nature" as possible and can be used by women employing sperm donors, or after a partner's sperm is centrifuged to enhance its motility in the uterus.

Age-old therapies, contemporary medicine

Dr. Lev-Ari, a cellular biologist and head of the integrative medicine unit, works with both medical doctors and TCM practitioners at Tel Aviv Medical Center's Fertility Research Institute. He and Sela, a TCM practitioner specializing in women's health, have long been interested in how Chinese herbal and acupuncture therapies could work to boost Western-style fertility treatments, contributing to an increase in conception and take-home baby rates.

In a retrospective study, Dr. Lev-Ari and Sela followed the progress of 29 women between the ages of 30 and 45 who were receiving IUI treatment combined with TCM therapy, and compared their results to a control group of 94 women between the ages of 28 and 46 who were undergoing IUI treatment alone. In addition to their IUI treatments, the 29 women in the first group received weekly sessions of acupuncture and a regime of Chinese medicinals, which consisted of powdered or raw Chinese herbs such as PeoniaAlbae and Chuanxiong, designed to meet each woman's specific needs. All herbal preparations were approved by the Israeli Health Ministry.

In terms of both conception and take-home baby rates, the test group fared far better than the control group. Out of the 29 women in the test group, 65.5 percent conceived, and 41.4 percent delivered healthy babies. In the control group, only 39.4 percent conceived and 26.9 percent delivered. The vast difference in success rates is even more surprising when the age of the average participant was taken into account, Dr. Lev-Ari and Sela note. "The average age of the women in the study group was 39.4, while that of the control group was 37.1. Normally, the older the mother, the lower the pregnancy and delivery rates," they explain.

Promoting balance and harmony in the womb

According to the researchers, TCM is aimed at correcting imbalances in the body's natural energy flow, promoting an overall sense of well-being. There are several theories as to why Chinese medicine can be beneficial to fertility rates, including the possibility that herbal remedies and acupuncture can affect the ovulationand menstrual cycle, enhance blood flow to the uterus, and enhance endorphin production and secretion to inhibit the central nervous system and induce calm - all of which can contribute to successful conception.

Now that the researchers have established that TCM can have a major impact on the success of fertility treatments, they plan to design randomized clinical trials, including placebos, to further validate their initial findings.

Ultimate Performance Chiro & Rehab Announces that Integrative Medicine is the New Medicine

03.04.16 10:00 ET | Source: Ultimate Performance Chiro & Rehab LAKE CHARLES, La., April 03, 2016 (GLOBE NEWSWIRE) -- Over the past 50 years, more and more studies have been performed on what is commonly known as alternative therapies or complementary therapies. Although these two forms of medicine come from the same premise,

30 meaning they are different from “conventional” medicine (drugs, surgery, traditional physical therapy, etc.), their difference lies in simple terminology. Complementary medicine is the practice of methods that are used in conjunction with conventional medicine to aid in treating a condition. Alternative medicine is the practice of methods that are used in place of conventional medicine to serve as primary treatment for a condition. In many cases, these methods are the same, yet some lack the measurable scientific evidence as compared to traditional medicine. Do not let this play on words fool you though. Although some lack scientific evidence in the literature and halls of medical schools, they have been successfully utilized for thousands of years, before “conventional’ medicine even existed. It is only that modern science is just now catching up and able to measure these results. So much so that a new field of medicine based on proven evidence-based science has risen out of these once untested alternative and complementary therapies. This field is named integrative medicine and it is now being called the New Medicine. This is huge for patients wanting to seek care from the best of all of the realms existing in medicine today. It just makes sense to combine all of what we know that works. More and more practitioners are shifting their mindset from being rigid in their own set of guiding principles to opening up the possibilities of the benefits of other fields of study. With this integration, new discoveries are being made almost daily in how systems and energies of the body interact with one another, and how interconnected our being is with everything around us. Some of these new discoveries are producing results that are unheard of in the medical community and causing practitioners to rethink and question things they once thought. These practitioners are discovering new techniques across the world, in big cities and well- funded research institutions, as well as in solo practice clinics in small-town America. One clinic making these discoveries and developing new techniques is based right in your back yard. The doctors at Ultimate Performance Chiro and Rehab in Lake Charles, Louisiana are astonishing patients and other doctors with the results they are seeing every single day. By combining traditional therapies and physical medicine with ancient techniques and cutting-edge neuroscience, this clinic has become one of the leaders in the area for pain relief and neurological disorders. If you are looking for relief or maybe just some answers, this would be a good place to look. You might be surprised at what you will find.

Ultimate Performance Chiro & Rehab, (337) 421-0010

Use Of Traditional Chinese Medicine In The Management Of Urinary Stone Disease

Published: Saturday 30 January 2010

UroToday.com - As we reviewed the best level of evidence concerning the use of Chinese medicine in urinary stone disease in the English language Literature to accomplish this paper, we also faced the barrier imposed by the lack of knowledge of other languages such as Mandarim or Japanese. Had we been able to extend our research to these Asian manuscripts we might have found additional information to shed some more light on this mostly interesting but still not fully explored field.

This review also puts in evidence the fact that when dealing with concepts of diagnosis or treatment that are not universally accepted, the scientific methods may be compromised. The lack of standardization among studies regarding dosage, types of medicines, results assessment, etc. makes it quite difficult to perform a truly fair comparison between them. In this context, care

31 should be taken to improve the quality of research work from now on, especially when designing clinical trials, in order to provide the scientific community with convincing and reproducible work with good level of evidence. This seems to be the proper pathway to lead to the popularization of western folk medicine.

Written by Ricardo Miyaoka, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations, etc., of their research by referencing the published abstract.

UroToday - the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice. To access the latest urology news releases from UroToday

Why Consumers Turn To Alternative Medicine

Published: Thursday 19 November 2009

Alternative health remedies are increasingly important in the health care marketplace. A new study in the Journal of Consumer Research explores how consumers choose among the many available remedies.

"Examples of the wide array of health remedy options available to consumers include drugs, supplements,acupuncture, massage therapy, Ayurveda, and Traditional Chinese Medicine (to name a few). Such medical pluralism is common in both developed and developing countries and raises the questions: How do consumers choose among health remedies, and what are the consequences for a healthy lifestyle?" write authors Wenbo Wang (New York University), Hean Tat Keh (Beijing University), and Lisa E. Bolton (Pennsylvania State University).

The authors use "lay theories of medicine" to explain how consumers choose between Western medicine and its Eastern counterparts, Traditional Chinese Medicine (TCM) and Ayurvedic medicine.

"Western Medicine is primarily concerned with the material aspect of the body and views all medical phenomena as cause-effect sequences, relying on rigorous scientific studies and research that seeks empirical proof to all phenomena," write the authors. "On the other hand, TCM and Ayurvedic Medicine favor a holistic approach, view the mind and body as a whole system, and rely upon inductive tools and methods for treatment."

Based on a series of experiments and surveys in the United States, China, and India, the authors found that consumers prefer TCM (over Western medicine) when uncertain about the cause of an illness (i.e., diagnosis uncertainty) - because a holistic medicine tolerates uncertainty better than Western Medicine. Similarly, consumers prefer TCM (over Western medicine) because of lay beliefs that TCM offers an underlying cure (versus symptom alleviation by Western Medicine).

"These findings add to the growing debate over the regulation of health marketing and the delivery of health care, the role of direct-to-consumer advertising, and marketing efforts to promote a healthy lifestyle," the authors conclude.

Wenbo Wang, Hean Tat Keh, and Lisa E. Bolton. "Lay Theories of Medicine and a Healthy Lifestyle." Journal of Consumer Research: June 2010. A preprint of this article (to be officially

32 published online soon) can be found athttp://journals.uchicago.edu/jcr.

Source: Mary-Ann Twist University of Chicago Press Journals

Paving The Way For Greater Use Of Ancient Medical Knowledge

Published: Friday 15 March 2013

Scientists are reporting an advance toward overcoming a major barrier to tapping the potential of traditional Chinese medicine (TCM) and India's Ayurvedic medicine in developing new and more effective modern drugs. Their report appears in ACS' Journal of Chemical Information and Modeling.

Andreas Bender and colleagues explain that TCM has made key contributions to modern medicine. In the world's largest international clinical trial, for instance, scientists concluded that Artesunate, a derivative of the Chinese herb qinghao, should replace quinine as a treatment for severe malaria in both adults and children worldwide. Traditional medicines have a track record in benefiting human health that spans thousands of years. However, gaps in knowledge about how these medicines work in the body, their "mode of action" (MOA) - limit their use today. Information about a drug's MOA is important for better understanding of both the beneficial effects and side effects of treatments.

They describe an algorithm that can help explain how these substances work in the body, and use of it to help understand the MOA of traditional anti-inflammatory medicines. An algorithm is a step-by-step procedure to generally analyze data, which the scientists applied to predicting how the active chemical ingredients in traditional medicines affect biological processes. "By establishing the MOA of these compounds, the gap between Western and traditional medicine can be reduced," the report concluded.

Renhuang Pharmaceuticals Announces Breakthrough In Study Of New Form Of Anti-Depression Chinese Medicine: Lyophilized Syringin Powder For Injection

Published: Thursday 24 January 2008

Renhuang Pharmaceuticals, Inc. ("Renhuang" or the "Company", stock symbol: RHGP.OB), a leading Chinese integrated drug developer, manufacturer and distributor, announced the successful laboratory production of lyophilized syringin powder, its new powder injection anti- depression and fatigue drug. Renhuang expects this new drug to become its next revenue growth driver. At 90% purity, the syringin portion in the sample drugs meets the criteria of the State Food and Drug Administration (SFDA). Renhuang is expected to soon start clinical trials to evaluate both the efficacy and the safety of this new drug for depression and fatigue patients.

Lyophilized syringin powder for injection is developed independently by Renhuang as a new form of pure Chinese herbal medicine that does not have any of the side-effects of other synthetic anti-depression drugs commonly used by patients around the world. Renhuang is in the process to file an invention patent application for this new drug with the State Intellectual Property Office of the P.R.C (SIPO). The product is expected to be classified as a "Class One" new drug by SFDA representing a major breakthrough in anti-depression drug development worldwide. This new drug can also be used as anti-exhaustion treatment, wound stancher and healthy gland growth nutrition.

33 Mr. Li Shaoming, chief executive officer of Renhuang, said, " Although rapid economic development is raising standards of living in China and improving the lives of many, Chinese people are increasingly confronted withstress brought about by economic development and increased competition. At the same time, they are becoming more health conscious and more sophisticated in their understanding of medical treatments. Given the high risks of side effects from current anti-depression drugs, both physicians and patients around the world are yearning for anti-depression medication treatments with low or zero side-effects. This creates substantial market potential globally for our new anti-depression drug. We are very confident that this new drug will not only help Renhuang expand its market share in China but it will also increase Renhuang's brand awareness overseas."

By controlling an estimated 70% of China's natural resource of Acanthopanax (also known as Siberian Ginseng), a raw material, from which syringin is extracted, securing ample supply for the new drug and minimizing raw material cost.

According to a 2006 report by the World Heath Organization, there were about 340 million people suffering from depression in the world including more than 26 million in China as per the latest statistics from the China Association for Mental Health. Global sales of anti-depression drugs reached US $20.60 billion in 2006. Renhuang has secured prime time advertising slots on China Central Television Station (CCTV) in 2008. Advertising during the Beijing Olympics, in particular, will provide a unique platform to substantially increase Renhuang's brand recognition in China and around the world.

About Renhuang Pharmaceuticals, Inc.

Renhuang Pharmaceuticals, located in Harbin, Heilongjiang province, in Northeast China, is a leading integrated developer, manufacturer and distributor of a broad line of high-quality nutraceutical, natural medicinal and bio-pharmaceutical products. The Company provides three major product lines including the Acanthopanax-based natural medicinal products, Shark Power Health Care series (a natural marine biology product), and Traditional Medical Products, currently representing 53%, 12%, and 35% of total revenues, respectively. Renhuang has a dominant market position in Acanthopanax-derived products, controlling an estimated 70% of China's natural resource of Acanthopanax (also known as Siberian Ginseng) that grows in Heilongjiang province but does not grow in abundance anywhere else in China. Siberian Ginseng has become one of the most popular natural medicinal products in the world due to its well known ability to help people enhance overall health, improve memory, relieve stress, combat fatigue, restore energy, and increase endurance.

Renhuang distributes its products through a sales network of over 2000 sales agents organized under 70 sales centers across 24 districts that cover over 50% of the greater China. Beginning in 2007, the Company has started to sell some of its products under its own brand in Russia and expects that this new market will generate substantial revenue growth.

The Company has established a multi-channel research and development infrastructure composed of in-house researchers, a post-doctoral working center, and collaboration with well known institutions and scientists. A state of the art research center is currently supporting the development of numerous product innovations including food antiseptic, immune system and diagnostic products. Several of these products have already been submitted for approval by the State Food and Drug Administration ("SFDA"). These products are 60% more reliable than those currently on the market and are expected to have a substantial upside growth potential due to their insufficient supply in China. The Company has received numerous grants from the central and local governments, attesting to the high quality of its operations and its demonstrated ability

34 to lead in innovation and technology.

Safe Harbor Statement

This press release contains certain statements that may include 'forward-looking statements' as defined in the Securities Act of 1933, and the Securities Exchange Act of 1934. All statements, other than statements of historical facts, included herein are 'forward-looking statements.' Although the Company believes that the expectations reflected in these forward-looking statements are reasonable, they do involve assumptions, risks and uncertainties, and these expectations may prove to be incorrect. You should not place undue reliance on these forward- looking statements, which speak only as of the date of this press release. The Company's actual results could differ materially from those anticipated in these forward- looking statements as a result of a variety of factors, including those discussed in the Company's periodic reports that are filed with and available from the Securities and Exchange Commission. All forward-looking statements attributable to the Company or persons acting on its behalf are expressly qualified in their entirety by these factors. Other than as required under the securities laws, the Company does not assume a duty to update these forward-looking statements.

Renhuang Pharmaceuticals, Inc.

Researching Complementary And Alternative Medicine For Alzheimer's At Mount Sinai Center Of Excellence

Published: Thursday 11 October 2007

Mount Sinai School of Medicine has just received a major grant from the National Center for Complementary and Alternative Medicine (NCCAM), a component of the National Institutes of Health (NIH) and lead Federal agency for research on complementary and alternative medicine. This new grant creates a Center of Excellence for Research in Complementary and Alternative Medicine at Mount Sinai that will focus on Alzheimer's disease. The new Center has been awarded an estimated $8 million grant over the next five years to continue its research and study of "age defying diets." There will be an emphasis on grape-derived compounds that may be able to delay or possibly prevent the onset of Alzheimer's disease .

"The new Center will systematically explore, through basic and preclinical research, the idea that a longer, disease-free life isn't necessarily only in our genes but also partly in our hands depending upon our lifestyles," said principal investigator of the new Center's research- Dr. Giulio Maria Pasinetti, M.D., Ph.D. Professor of Psychiatry and Neuroscience, Geriatrics and Adult Development & Director of Neuroinflammation Research Center in Department of Psychiatry at Mount Sinai School of Medicine.

Protective roles of dietary grape-derived compounds in Alzheimer's disease will be the focus of new research at the Center at Mount Sinai. Preclinical studies will be conducted to identify natural compounds extracted from grapes, known as polyphenols that might have a protective role in Alzheimer's disease. Using mice genetically modified to develop Alzheimer's disease-type neuropathology and memory loss, researchers led by Dr. Pasinetti will investigate the biological mechanisms by which these grape-derived compounds may affect changes in the brain that are characteristic of Alzheimer's disease and associated with cognitive decline.

NCCAM has just added three new Centers of Excellence for Research on Complementary and Alternative Medicine (CAM) to its centers program including Mount Sinai's. The two other new Centers include- UCLA's Center of Excellence in Pancreatic Diseases and University of South

35 Carolina Research Foundation's Center for CAM Research on Autoimmune and Inflammatory Diseases

"The addition of these centers increases the robustness of our Centers of Excellence research program and confirms our continuing commitment to rigorous CAM research," said Ruth L. Kirschstein, M.D., NCCAM Acting Director. "These multidisciplinary research teams will work to uncover new insights or novel treatments for health conditions that affect many people. The science conducted will be key to understanding what CAM approaches may or may not work and informing the integration of effective CAM practices into the health care delivery system."

"It is an exciting program. We hope the research results from this new program will eventually open new research areas at Mount Sinai School of Medicine including involving the role of identifying personalized medicine in relation to lifestyle factors in the prevention of Alzheimer's disease," said Dr. Pasinetti. "We look forward to this opportunity to continue a natural compound discovery program, where we are able to identify novel natural compounds, primarily grape derived - for the prevention or treatment of Alzheimer's disease."

11 NCCAM Centers of Excellence:

Center of Excellence for the Neuroimaging of Acupuncture Effects on Human Brain Activity, Massachusetts General Hospital; Alternative Therapies for Alcohol and Drug Abuse, McLean Hospital/Harvard Medical School; Center of Excellence for Research on CAM Antioxidant Therapies, Linus Pauling Institute, Oregon State University; Center for Arthritis and Traditional Chinese Medicine, University of Maryland; Translational Research Center for CAM Therapy of Asthma, University of North Carolina; Center for Chinese Herbal Therapy, Mount Sinai School of Medicine; Center for Mechanisms Underlying Millimeter Wave Therapy, Temple University; Center on Mindfulness-Based Stress Reduction, Stress Arousal, and Immune Response in Early HIV, Osher Center for Integrative Medicine, University of California, San Francisco; UCLA Center of Excellence in Pancreatic Diseases, University of California, Los Angeles; Center for CAM Research on Autoimmune and Inflammatory Diseases, University of South Carolina Research Foundation; and Protective Roles of Grape-Derived Polyphenols in Alzheimer's Disease, Mount Sinai School of Medicine.

About The Mount Sinai Medical Center

The Mount Sinai Medical Center encompasses The Mount Sinai Hospital and Mount Sinai School of Medicine. The Mount Sinai Hospital is one of the nation's oldest, largest and most- respected voluntary hospitals. Founded in 1852, Mount Sinai today is a 1,171-bed tertiary-care teaching facility that is internationally acclaimed for excellence in clinical care. Last year, nearly 50,000 people were treated at Mount Sinai as inpatients, and there were nearly 450,000 outpatient visits to the Medical Center.

Mount Sinai School of Medicine is internationally recognized as a leader in groundbreaking clinical and basic-science research, as well as having an innovative approach to medical education. With a faculty of more than 3,400 in 38 clinical and basic science departments and centers, Mount Sinai ranks among the top 20 medical schools in receipt of National Institute of Health (NIH) grants.

Source: Mount Sinai Newsroom The Mount Sinai Hospital / Mount Sinai School of Medicine

36 http://www.medicalnewstoday.com/releases/85281.php Knowledge about alternative medicine connected to education, income

Published: Thursday 18 June 2015

People with lower educational levels and incomes are less likely to know about yoga, acupuncture, natural products and chiropractic medicine, according to a new study from San Francisco State University. Studies on the use of complementary and alternative medicine (CAM) have typically focused on learning more about who use these types of practices and why. Less is known about trends among those who do not partake, which inspired new research by Professor of Health Education Adam Burke, published inPLOS ONE on June 17. "It's very important to know why somebody is not doing a particular behavior," said Burke, who is also the director of SF State's Institute for Holistic Health Studies. "If your child isn't eating broccoli and you want him to, you need to know why. If it's just a matter of the pieces being too big, you can cut it up. But if you don't know why, the child will not eat the broccoli." The research, based on the 2007 National Health Interview Survey, looked at data from more than 13,000 respondents who said they had never used acupuncture, chiropractic, natural products or yoga, four common CAM practices. Lack of knowledge as a reason for non-use was strongly associated with lower education levels and income. Those who attended college were 58 percent less likely to indicate lack of knowledge as a reason for non-use, and individuals with higher incomes were 37 percent less likely. "The implication of this study is that the lack of access to health knowledge is a root of health inequity," Burke said. "If you are poor, you have less access to health information for a variety of reasons." Physical activity levels were also found to correlate with knowledge. People who described themselves as less physically active were significantly more likely to claim a lack of knowledge of all four complementary practices. One finding of the study that surprised Burke was that the results held true for survey respondents who experienced lower back pain. Since back pain is the medical condition most commonly linked to use of complementary health treatments, Burke and his coauthors hypothesized that back-pain sufferers would have greater knowledge about these treatments even if they opted not to use them, as their pain would compel them to learn about a variety of remedies. But Burke found that the relationship between lower education levels and lack of knowledge remained -- in other words, back pain did not seem to be a significant enough motivator to seek out these common alternative treatments. But it's especially important for people with back pain to know about CAM methods, Burke said. "Often, the solution for chronic pain is addictive prescription medications, which are problematic in all communities, especially in lower-income communities," Burke said. "Complementary methods have the potential to mitigate such addiction problems, and may help address the root problem rather than just managing the symptoms, which is a real benefit." This study indicates a greater need among doctors to follow best-practice guidelines for sharing information about integrative practices, combining conventional western and CAM approaches, Burke said. "It's highly likely that a lack of knowledge prevents some individuals from using these integrative approaches -- if they knew more, they would use them more," Burke said. "These are cost-effective treatments that have limited side effects and may actually help remediate people's problems. Especially in lower-income communities, it is important for health care providers to recommend them."

37 "Limited health knowledge as a reason for non-use of four common complementary health practices" by Adam Burke and co-authors Richard L. Nahin and Barbara J. Stussman of the National Center for Complementary and Integrative Health was published in PLOS ONE on June 17.

Gardenia Fruit Compound Starting Point For Diabetes Therapy

Published: Wednesday 7 June 2006

A Gardenia fruit extract traditionally used in Chinese medicine to treat the symptoms of type 2 diabetes does indeed contain a chemical that reverses some of the pancreatic dysfunctions that underlie the disease, researchers report in the June 7, 2006, Cell Metabolism. The chemical therefore represents a useful starting point for new diabetes therapies, they said.

Such a drug could offer a big advance, the group added, as no currently available therapy for diabetes actually targets the underlying causes of disease in insulin-producing pancreatic beta cells. Insulin controls blood levels of glucose, the body's main energy source. In those with diabetes, insulin deficiency or insulin resistancecauses blood sugar concentrations to rise.

The team discovered that Gardenia extract contains the chemical "genipin." Previously known for its ability to cross-link proteins, they now find that the chemical also blocks the function of the enzyme called uncoupling protein 2 (UCP2) through another mechanism. In both animals and humans, high concentrations of UCP2 appear to inhibit insulin secretion from the pancreas and increase the risk of type 2 diabetes.

"We think the increase in UCP2 activity is an important component of the pathogenesis of diabetes," said Bradford Lowell of Beth Israel Deaconess Medical Center and Harvard Medical School. "Our goal therefore was to discover a UCP2 inhibitor capable of working in intact cells, as such an inhibitor could theoretically represent a lead compound for agents aimed at improving beta cell function in type 2 diabetes."

Study coauthor Chen-Yu Zhang's familiarity with traditional Chinese medicine led the team to consider the extract of Gardenia jasminoides Ellis fruits. Pancreas cells taken from normal mice secreted insulin when treated with the extract, they found, whereas the cells of mice lacking UCP2 did not. The results suggested that the extract worked through its effects on the UCP2 enzyme.

"When I first saw the results, I was in disbelief," Lowell said. "I didn't think we could ever be that lucky." However, blinded repetition of the initial experiments confirmed the results every time, he said.

Through a series of chemical analyses, the researchers then zeroed in on genipin as the active compound. Genipin, like the extract, stimulated insulin secretion in control but not UCP2- deficient pancreas cells.

They further found that acute addition of genipin to isolated pancreatic tissue reversed high glucose- and obesity-induced dysfunction of insulin-producing beta cells. A derivative of genipin that lacked the chemical's cross-linking activity continued to inhibit UCP2, they reported.

That's a good sign for the therapeutic potential of genipin-related compounds, according to Lowell, as such indiscriminate cross-linking would likely have adverse effects. However, further work will need to examine whether inhibition of UCP2 itself might also have some negative

38 consequences.

In addition to the possibility of new drugs, the findings might also prove a boon to the use of Gardenia extract itself for the treatment of disease, particularly in eastern Asia, Zhang said.

Irrespective of genipin's potential for clinical applications, its benefits within the scientific community are already clear, Lowell added.

"Genipin represents an extremely useful investigational tool for studying a number of aspects of UCP2 biology," Lowell added. UCP2 plays a role in the process by which food is converted into energy storage molecules by cellular powerhouses called mitochondria in cells throughout the body.

Heidi Hardman [email protected] Cell Press

Data Gathered Reveals Extent Of Alternative Medicine Use By MS Patients

Published: Tuesday 23 April 2013

A major Nordic research project involving researchers from the University of Copenhagen has, for the first time ever, mapped the use of alternative treatment among multiple sclerosis patients - knowledge which is important for patients with chronic disease and the way in which society meets them. People with multiple sclerosis (MS) often use alternative treatments such as dietary supplements, acupuncture and herbal medicine to facilitate their lives with this chronic disease. This is the result of a new study of how MS patients use both conventional and alternative treatments which has been carried out by researchers from five Nordic countries. The results have been published in two scientific journals, the Scandinavian Journal of Public Health and Autoimmune Diseases.

"What we see is that patients do not usually use alternative treatments for treating symptoms, but as a preventative and strengthening element," says Lasse Skovgaard, industrial PhD candidate from the Faculty of Health and Medical Sciences and the Danish Multiple Sclerosis Society, who has been involved in conducting the questionnaire-based study among 3,800 people with MS in Denmark, Sweden, Norway, Finland and Iceland.

Multiple sclerosis is a chronic disease which attacks the central nervous system, and which can lead to a loss of mobility and sight. Denmark is one of the countries with the highest incidence of the disease worldwide, with approx. 12,500 MS patients. At the same time, the number of MS patients in the West is increasing, posing considerable challenges in respect of treatment, prevention and rehabilitation.

Access to knowledge bank

Together with researchers from the five other Nordic countries, Lasse Skovgaard has spent three years gathering the new data, and he is delighted at what it offers:

"Within the field of health research, it is often a question of studying the extent to which a particular type of drug affects a particular symptom. However, it is equally as important to look at how people with a chronic disease, for example, use different treatments to cope with their situation. Here, MS patients offer valuable experience. Their experiences constitute a knowledge

39 bank which we must access and learn from," he says.

Lasse Skovgaard draws attention to the significance of this new knowledge because, if people with chronic disease are better able to manage their lives, it can potentially save society large sums of money.

"There is a lot of talk about 'self-care competence', in other words patients helping themselves to get their lives to function. Here, many people with a chronic disease find they benefit from using alternative treatments, so we should not ignore this possibility," says Lasse Skovgaard.

At the same time, he emphasises that knowing more about why patients choose particular treatments is important in relation to improving patient safety because of the possible risks involved in combining conventional and alternative medicine.

Growing use of alternative treatments

According to the latest Health and Sickness Study from the Danish National Institute of Public Health (NIPH) in 2010, one in four Danes say that they have tried one or more types of alternative treatments within the past twelve months. Among MS patients, the use of alternative medicine has been growing steadily over the past fifteen years. In the researchers' latest study, more than half of the respondents say that they either combine conventional and alternative medicine or only use alternative medicine.

"We cannot ignore the fact that people with chronic disease use alternative treatments to a considerable extent, and that many of them seem to benefit from doing so. It doesn't help to only judge this from a medical point of view or say that alternative treatments are nonsense - rather, we must try to understand it," says Lasse Skovgaard.

Highly qualified women top the list

The study shows that, among MS patients using alternative treatments, there is a significantly bigger proportion of people with a high level of education compared to those who do not use alternative treatments. There is also a larger proportion of highly paid people and of younger women.

"Some critics are of the opinion that when alternative treatments are so popular, it is because they appeal to naïve people looking for a miraculous cure. But our results indicate that it is primarily the well-educated segment that is subscribing to alternative treatments. And that using alternative treatments is part of a lifestyle choice," says Lasse Skovgaard.

He hopes that the new knowledge will improve communication regarding how the chronically ill use alternative treatments in combination with conventional medicine:

"We see that so many people are combining conventional medicine with alternative treatment that it should be taken seriously by the health service. Until now, there hasn't been much focus on the doctor-patient dialogue in relation to the alternative methods used by the chronically ill to manage their lives," says Lasse Skovgaard. He says that the research group is continuing to analyse the results and, among other things, is conducting several interview studies based on the results of the questionnaires. The interview studies will, for example, provide additional knowledge on how patients perceive the risks associated with using alternative medicine and explore why some patients turn their backs completely on conventional medicine.

40 Chinese Medicine Meets Finnish Health Care Technology

Published: Tuesday 26 September 2006

China attracts interest all over the world. Finns are now exporting their health care expertise to China. A Chinese-Finnish collaboration, the Healthy China project is about the prevention of lifestyle diseases such as adult onsetdiabetes and cardiovascular diseases.

Lifestyle diseases have become more common in China with the westernisation of diet and increased prevalence of sit-down work.

"The idea behind the Healthy China project is to bring Finnish and Chinese expertise and technologies together," says technology expert Jaani Heinonen, Chief Representative of Tekes Shanghai. The Finnish coordinators of the project are Tekes and Finpro, and the Chinese partners are Shanghai's Huashan Hospital, Hudan University and key public authorities.

Healthy China has been underway for a year and a half. "So far we have mainly been assessing Chinese care models and searching for key actors for the project," says Heinonen.

A future objective is to establish a Finnish-Chinese Centre at the Key Lab of Health Technology of Huashan Hospital. The Centre would be supported by a disease management programme providing an up-to-date overview of the patient's status. Information technologies specialising in diagnosis, monitoring and risk management could then be incorporated into it - with the EBM Guidelines as a prime example. The Centre would offer a variety of services including foot examinations in diabetic patients, physiotherapy and advice related to physical activity and diet.

"Our ultimate aim is to find a comprehensive business model that enables us to expand the pilot project to other sectors," says Heinonen. Project plans currently reach 2008, the year in which expansion is planned.

Chinese medicine and Finnish technology

"Finnish health care know-how and tools are unique even on a global scale," says Heinonen. "There's a lot of research, and organisations such as the National Public Health Institute and the Finnish Heart Association have done groundbreaking work in disease prevention and health promotion.?

Finland also has many businesses that have developed products related to issues such as health monitoring and disease prevention. Finns have also excelled in functional foods. Says Heinonen, "Integrating traditional Chinese medicine with Finnish technologies is a fascinating new area."

About TEKES, THE FINNISH FUNDING AGENCY FOR TECHNOLOGY AND INNOVATION

Tekes, the National Technology Agency is the main financing organization for applied and industrial research and development (R&D) in Finland. The funds are awarded from state budget via the Ministry of Trade and Industry. The impact of Tekes activities is felt in Finland as increasing exports, a broader industrial base, more jobs and an improvement in the general welfare of society.

41 TEKES, THE FINNISH FUNDING AGENCY FOR TECHNOLOGY AND INNOVATION

P.O.Box 69 FIN-00101 Helsinki

Ancient Chinese Medicine Inspires New Tongue Analysis Software To Warn Of Disease

Published: Tuesday 29 May 2012

For 5,000 years, the Chinese have used a system of medicine based on the flow and balance of positive and negative energies in the body. In this system, the appearance of the tongue is one of the measures used to classify the overall physical status of the body, or zheng. Now, University of Missouri researchers have developed computer software that combines the ancient practices and modern medicine by providing an automated system for analyzing images of the tongue.

"Knowing your zheng classification can serve as a pre-screening tool and help with preventive medicine," said Dong Xu, chair of MU's computer science department in the College of Engineering and study co-author. "Our software helps bridge Eastern and Western medicine, since an imbalance in zheng could serve as a warning to go see a doctor. Within a year, our ultimate goal is to create an application for smartphones that will allow anyone to take a photo of their tongue and learn the status of their zheng."

The software analyzes images based on the tongue's color and coating to distinguish between tongues showing signs of "hot" or "cold" zheng. Shades of red and yellow are associated with hot zheng, whereas a white coating on the tongue is a sign of cold zheng.

"Hot and cold zheng doesn't refer directly to body temperature," said Xu, who is also on the faculty of the Bond Life Sciences Center. "Rather, it refers to a suite of symptoms associated with the state of the body as a whole."

For example, a person with cold zheng may feel chills and coolness in the limbs and show a pale flushing of face. Their voice may have a high pitch. Other symptoms of cold sheng are clear urine and loose stool. They also may prefer hot foods and drinks and desire warm environments.

In Chinese traditional medicine both hot and cold zheng can be symptoms of gastritis, an inflammation of the stomach lining frequently caused by bacterial infection.

For the study, 263 gastritis patients and 48 healthy volunteers had their tongues analyzed. The gastritis patients were classified by whether they showed infection by a certain bacteria, known as Helicobacter pylori, as well as the intensity of their gastritis symptoms. In addition, most of the gastritis patients had been previously classified with either hot or cold zheng. This allowed the researchers to verify the accuracy of the software's analysis.

"Our software was able to classify people based on their zheng status," said study co-author Ye Duan, associate professor of computer science at MU.

"As we continue to work on the software we hope to improve its ability," Duan said. "Eventually everyone will be able to use this tool at home using webcams or smartphone applications. That will allow them to monitor their zheng and get an early warning about possible ailments."

42 Can Aromatherapy Produce Harmful Indoor Air Pollutants?

Published: Sunday 23 October 2011

Spas that offer massage therapy using fragrant essential oils, called aromatherapy, may have elevated levels of potentially harmful indoor air pollutants such as volatile organic compounds (VOCs) and ultrafine particles, according to an article in Environmental Engineering Science, a peer-reviewed journal published by Mary Ann Liebert, Inc.

Fragrant essential oils, derived from plants, may release various VOCs into the air. VOC degradation caused by the reaction of these compounds with ozone present in the air can produce small, ultrafine byproducts called secondary organic aerosols (SOAs), which may cause eye and airway irritation.

Taiwanese researchers Der-Jen Hsu (National Kaohsiung First University of Science and Technology), Hsiao-Lin Huang (Chia-Nan University of Pharmacy and Science, Tainan), and Shiann-Cherng Sheu (Chang-Jung Christian University, Tainan) tested both fragrant and Chinese herbal essential oils for SOA formation in a controlled-environment study chamber under different test conditions. They also performed air sampling and analysis in spa centers that offer massage therapy using essential oils.

The authors compared SOA levels associated for the various fragrant and herbal essential oils tested and present their results in the article, "Characteristics of Air Pollutants and Assessment of Potential Exposure in Spa Centers during Aromatherapy." They conclude that the layout and ventilation within a particular spa may affect the level of indoor air pollutants produced during massage with aromatherapy.

"Dr. Der-Jen Hsu and his colleagues have done a very nice job in bringing attention to often overlooked health risks associated with luxuries intended to enhance our sense of well-being," says Domenico Grasso, PhD Editor-in-Chief and Vice President for Research, Dean of the Graduate College, University of Vermont (Burlington).

Children With Chronic Conditions Often Use Alternative Medicine

Published: Monday 14 January 2013

Children who regularly see specialists for chronic medical conditions are also using complementary medicine at a high rate, demonstrates recently published research from the University of Alberta and the University of Ottawa.

About 71 per cent of pediatric patients attending various specialty clinics at the Stollery Children's Hospital in Edmonton used alternative medicine, while the rate of use at the Children's Hospital of Eastern Ontario in Ottawa was 42 per cent. Nearly 20 per cent of the families who took part in the study said they never told their physician or pharmacist about concurrently using prescription and alternative medicine.

Sunita Vohra, a researcher with the Faculty of Medicine & Dentistry at the U of A, was the lead investigator on the study, which was recently published in the peer-reviewed journal Pediatrics. Her co-investigator was W James King from the University of Ottawa.

"The children in this study are often given prescription medicines," says Vohra, a pediatrician

43 who works in the Department of Pediatrics and the School of Public Health at the U of A.

"And many of these children used complementary therapies at the same time or instead of taking prescription medicine. We asked families if they would like to talk about the use of alternative medicine, more than 80 per cent of them said, 'yes, please.'

"Right now, these families are getting information about alternative medicine from friends, family and the Internet, but a key place they should be getting this information from is their doctor or another member of their health-care team, who would know about possible drug interactions with prescription medicines." Vohra said the study "identified a gap in communications" in dealing with pediatric patients and their families.

"It's important to get these conversations going with every patient, especially when you consider it's not widely recognized how common it is for children with chronic illnesses to use alternative medicine," says the Alberta Innovates-Health Solutions scholar.

"We need to make sure these families are comfortable telling their specialists they are taking other therapies," she said. Right now, Vohra and her colleagues at the U of A have developed curricula for undergraduate medical students about the use of alternative medicine by pediatric patients, which is considered innovative and novel. Ensuring medical students receive information about alternative medicine is key because it arms them with more knowledge about potential interactions with prescription medicine, says Vohra.

"Considering parents are saying they want this information, we have an obligation to ensure future physicians have the education and resources they need for these conversations," Vohra says.

1 Million Euros EU Funding For Chinese Medicine Research

Published: Wednesday 6 May 2009

King's College London successfully led a consortium bid for 995,100 euros of EU funding for a ground-breaking research project that will play an important role in the unification of Western and Chinese approaches to medicine.

The project entitled 'Good Practice in Traditional Chinese Medicine Research in the Post- genomic Era' (GP-TCM) will review the current status of Traditional Chinese Medicine (TCM) research, identify problems and propose solutions by applying modern methods of investigation, as well as providing a forum for the exchange of opinions, experience and expertise among scientists in the EU and China.

The three-year project aims to propose guidelines and priority areas for future research, and will lead to the formation of a new academic society, the European Society of TCM Research, which is to facilitate and foster sustainable EU-China collaboration in this area.

The research consortium consists of 29 beneficiary partner institutions and small-and-medium- sized enterprises from the EU and China. Partnerships with more than 20 additional non- beneficiary institutions, companies and independent experts are further strengthening its research.

Holistic approach

44 Dr Qihe Xu, Lecturer in the Department of Renal Medicine, Division of Gene and Cell Based Therapy, and coordinator of the project, explains: 'In contrast to the reductionist approach of Western medicine that is based on modern anatomy and cell and molecular biology, TCM uses a unique theory system and an individualised holistic approach to describe health and disease, which is based on the philosophy of Yin-Yang balance. These two medicine systems disagree with each other in many situations since they observe health from their own limited perspective. GP-TCM aims to inform best practice and harmonise research of the safety and efficacy of TCM, especially Chinese herbal medicines and acupuncture, in the EU.'

'The project will be divided into ten parts, which will review aspects of quality control, extraction and analysis of Chinese herbal medicines. Discussion fora that explore the role of functional genomics methodology in researching the safety, efficacy and mechanisms of action of Chinese herbal medicines and acupuncture are at the core of this project. New guidelines about good practice and agreed protocols in related research areas will harmonise future TCM research in the EU, and online tools and research resources will be made available to all EU member states. As an open-start and open-ending consortium, we will invite more organisations to become involved in the work.'

Share our experiences

Professor Peter Hylands, Head of the Department of Pharmacy and Director of the Centre for Natural Medicines Research, continues: 'We are delighted to be part of this unique group. In the Centre for Natural Medicines Research at King's we are examining the application of emerging technologies to the solution of difficult problems in the use of traditional medicines. This forum provides an unparalleled opportunity to share our experiences with Chinese and European colleagues and together to develop a 21st-century road map for the global development of traditional medicines.'

Professor Bruce Hendry, Professor of Renal Medicine, concludes: 'This programme grant is an excellent opportunity for King's College London to play a leading role in the unification of Western and Chinese approaches to medicinal therapeutics.'

Source: Melanie Haberstroh King's College London

According To A New Government Survey, 38 Percent Of Adults And 12 Percent Of Children Use Complementary And Alternative Medicine

Published: Thursday 11 December 2008

Approximately 38 percent of adults in the United States aged 18 years and over and nearly 12 percent of U.S. children aged 17 years and under use some form of complementary and alternative medicine (CAM), according to a new nationwide government survey (1). This survey marks the first time questions were included on children's use of CAM, which is a group of diverse medical and health care systems, practices, and products such as herbal supplements, meditation, chiropractic, and acupuncture that are not generally considered to be part of conventional medicine.

The survey, conducted as part of the 2007 National Health Interview Survey (NHIS), an annual

45 study in which tens of thousands of Americans are interviewed about their health- and illness- related experiences, was developed by the National Center for Complementary and Alternative Medicine (NCCAM), a part of the National Institutes of Health (NIH) and the National Center for Health Statistics (NCHS), a part of the Centers for Disease Control and Prevention (CDC). The survey included questions on 36 types of CAM therapies commonly used in the United States --- 10 types of provider-based therapies, such as acupuncture and chiropractic, and 26 other therapies that do not require a provider, such as herbal supplements and meditation.

"The 2007 NHIS provides the most current, comprehensive, and reliable source of information on Americans' use of CAM," said Josephine P. Briggs, M.D., director of NCCAM. "These statistics confirm that CAM practices are a frequently used component of Americans' health care regimens, and reinforce the need for rigorous research to study the safety and effectiveness of these therapies. The data also point out the need for patients and health care providers to openly discuss CAM use to ensure safe and coordinated care."

The 2007 survey results, released in a National Health Statistics Report by NCHS, are based on data from more than 23,300 interviews with American adults and more than 9,400 interviews with adults on behalf of a child in their household. The 2007 survey is the second conducted by NCCAM and NCHS --- the first was done as part of the 2002 NHIS (2).

CAM Use Among Adults

Comparison of the data from the 2002 and 2007 surveys suggests that overall use of CAM among adults has remained relatively steady --- 36 percent in 2002 and 38 percent in 2007. However, there has been substantial variation in the use of some specific CAM therapies, such asdeep breathing, meditation, massage therapy, andyoga, which all showed significant increases.

The most commonly used CAM therapies among U.S. adults were

-- Nonvitamin, nonmineral, natural products (17.7 percent)

Most common: fish oil/omega 3/DHA, glucosamine, echinacea, flaxseed oil or pills, and ginseng (3)

Alternative Medicine Finally Becoming More Mainstream

Written by Jamie Reno | Published on 5 Апрель 2016 г.  Proponents say integrative and holistic treatments such as acupuncture and diet are finally being recognized and accepted by the traditional medical world.

46 There was a time not so long ago when the term “alternative medicine” conjured up visions in many people’s minds of shamans, charlatans, and crackpots. However, times are changing. In the past few years, many doctors and conventional healthcare institutions in the United States have shown a new acceptance of treatments and philosophies that historically have not been part of mainstream medicine. In fact, now the term “alternative medicine” is out, and “integrative medicine” is in. Proponents explain that integrative medicine addresses the full range of a patient’s physical, emotional, spiritual, and environmental influences. It also deploys therapies that extend beyond the surgeries and drugs that have historically defined the American medical establishment.

Unlike some of the stalwart believers in alternative medicine, integrative medicine’s supporters do not reject conventional or allopathic medicine. They insist there is room at the table for all options. Integrative medicine advocates tell Healthline that while pills and procedures still help millions of patients, the evidence is mounting that diet and nutrition, natural therapeutics such as supplements, vitamins, herbs, and acupuncture, along with lifestyle behaviors such as exercise and smoking cessation also have a direct impact on disease. They say the more natural approach can even lead to reversals and cures. Is this idea, which for decades has been ignored in America’s medical schools, really catching on? Multiple healthcare executives, doctors, and patients interviewed for this story say yes. They say the driver of this trend is overwhelming patient demand. Some are quick to add, however, that there’s still resistance in some conventional American medical circles as well as by insurers and pharmaceutical companies. Read More: This is What Your Doctor’s Office Will Look Like in Five Years » Proponents: The Time Has Come In 1994, Dr. Andrew Weil, the Harvard-educated physician, author, lecturer, and internationally recognized pioneer of integrative and holistic health, founded the Program in Integrative Medicine at the University of Arizona. This was years before most people had even heard of integrative medicine. Weil told Healthline that today approximately half of America’s medical schools have signed on to an integrative medicine consortium. Patients are dissatisfied with the small amount of time they get with their doctors and with doctors who prescribe a pill for every ill. Dr. Andrew Weil, Program for Integrative Medicine

47 “Patients are dissatisfied with the small amount of time they get with their doctors and with doctors who prescribe a pill for every ill,” Weil said. “The integrative medicine movement is not a rejection of conventional methods. But patients are saying that the conventional model is not working, that it’s broken. And they are right.” Weil said that many doctors, too, are unhappy with the current system and are beginning to embrace this new model to varying degrees. “Pediatrics is very open to this as is family medicine,” Weil said. “Oncology is slower to embrace it. Oncologists are more defensive, perhaps because they know that their methods can cause harm to patients and are not always as effective as advertised.” Read More: The Future of Healthcare Could Be Concierge Medicine » Doctor Bridges Gap Dr. Gordon Saxe, director of research and a founding member of the Center for Integrative Medicine at the University of California, San Diego, broke the news to Healthline that a grant somewhere in the “$30 million range” from late philanthropist Andrew Krupp will establish an ambitious new research program at the university. The program will formally study how diet, natural therapeutics, and lifestyle behaviors such as exercise can treat a variety of diseases, including cancer and heart disease. Saxe described the research endowment as “far and away [the] largest for any center for integrative medicine that exists.” We know that women are more apt to use integrative medicine than men and we know that cancer patients particularly tend to use it more. Dr. Gordon Saxe, Center for Integrative Medicine He noted he had an epiphany about how food can treat and perhaps even reverse disease when his father was diagnosed with cancer. “I discovered that there are studies that show how food can have an impact on cancer and other diseases,” said Saxe, who got his Ph.D. in nutrition, then decided to go to medical school and focus on oncology. “These studies are in the medical literature. You just have to dig a little to find them,” said Saxe. He said his father’s life was extended by more than a decade thanks in part to modifications in his diet. Read More: Teaching Doctors to Cook Can Make Them Better Nutritionists » Pain Treatment at the Forefront One of the most significant shifts toward a more integrative approach to patient care can be seen in pain treatment. This is in part because pain can be tricky for doctors to identify and treat, and in part because of the opioid painkiller addiction epidemic in the United States. The Substance Abuse and Mental Health Services Administration’s 2012 National Survey on Drug Use and Health estimated that more than 2 million people in the United States who were prescribed opioid pain relievers such as Oxycodone and Vicodin in 2012 suffered from substance abuse. Dr. Robert Bonakdar, director of pain management at Scripps Center for Integrative Medicine in La Jolla, California, said that over the past few years he has seen “two to three times more referrals” in which the patient or provider is asking for integrative therapies. Bonakdar embraces many nonpharmaceutical options such as electrotherapy, tai chi, and mindfulness/meditation as well as diet and supplemental therapies such as the anti-inflammatory herbals ginger, curcumin, and boswellia. We continue to see a lot of unacceptable denial of evidence-based therapies such as biofeedback and acupuncture by insurers based on them being experimental or investigational. Dr. Robert Bonakdar, Scripps Center for Integrative Medicine "What they provide is that they may be a better fit for a patient than maybe a monotherapy prescription," he said. "For example, ginger may help that migraine patient with stomach

48 symptoms and nausea. There is also some evidence that ginger may heal some of the gastritis that can come from increasing use of NSAIDS, which can happen as headaches worsen.” Bonakdar added that there is emerging evidence that conditions such as osteoarthritis, even in those who are normal weight, have a metabolic component, especially glycemic control. Bonakdar spends a lot of time talking to his patients about the importance of a low glycemic, anti-inflammatory diet with an increase in fresh foods. “I saw a patient last week with severe arthritis of the neck, very clear on MRI. What was interesting is that for about two weeks prior to seeing me she was told by a cardiology fellow at our clinic to reduce her sugar intake by half based on their discussion,” he said. “She was amazed when she saw me that her neck pain was more than 50 percent relieved. I have seen this often enough that I no longer discount it to just chance. Even with specific areas of pathology or medical illness, we know that simple dietary shifting, such as reducing added sugars, can have a meaningful impact." Bonakdar said there has been a dramatic increase in acceptance of his type of work from the conventional medical community, with one glaring exception. "We continue to see a lot of unacceptable denial of evidence-based therapies such as biofeedback and acupuncture by insurers based on them being experimental or investigational," he said. "Hopefully with more spotlight on the evidence and how these therapies may actually reduce healthcare costs, this will also shift." Read More: How Can You Diagnose Someone Else’s Pain? » Acupuncture Broke the Ice Probably the first and best example of something that was once considered alternative but has solidified its position in conventional medicine backed by scientific research is acupuncture. Rooted in traditional Chinese medicine (TCM) and modern medical science, today’s acupuncture practices across the United States are a unique integration of the old and new. “Thirty years ago MD’s were skeptical and often dismissive of acupuncture,” said Neal Miller, a nationally certified acupuncturist from Los Angeles and past president of the Acupuncture Integrated Medicine Specialists (AIMS). Today more than half of my patients see me as their primary healthcare provider and all accept me as part of their healthcare team. Neal Miller, Acupuncture Integrated Medicine Specialists That initial skepticism changed to curiosity, Miller said, which evolved into acceptance based on clinical observations and research conducted by the National Institutes of Health (NIH) and other major medical institutions. “In the past few years many hospitals have included TCM acupuncture to treat many conditions,” Miller told Healthline. “Cleveland Clinic, UCLA, and Kaiser to name a few.” Miller, whose practice specializes in integrated orthopedics and internal medicine specialties focused on immune therapy, autoimmune diseases, cancer, and viral conditions. He said his patients used to come from word of mouth and most often as a last resort for pain relief. “Today the referrals are often from MD’s and other healthcare providers and institutions,” he said. “Today more than half of my patients see me as their primary healthcare provider and all accept me as part of their healthcare team.” Read More: Study Breaks Down Aging Process » Sometimes Patients Are Resistant to Change Dr. Gary Small, a professor of psychiatry and director of the UCLA Longevity Center at the Semel Institute for Neuroscience & Human Behavior and author of several well-received books on aging, said he brings dietary and other holistic ideas about aging to his patients more often than they do to him. “When patients come to my office, we sometimes deal with pushback on some of our ideas,” he told Healthline. “We suggest taking baby steps, try it out and see how you feel, make it fun and interesting. Once people get started they notice benefits right away. They start losing weight,

49 they sleep better, they’re exercising, they feel better, and they incorporate it into the rest of their life.” We suggest taking baby steps, try it out and see how you feel, make it fun and interesting. Once people get started they notice benefits right away. Dr. Gary Small, UCLA Longevity Center Shaw, who’s developed groundbreaking brain imaging technology that allows physicians to detect brain aging and Alzheimer's disease years before patients show symptoms, said he is less inclined to recommend medication that has side effects than to recommend a lifestyle strategy that prevents diabetes and other age-related issues. “I don’t want to wait for a study. You just need to stop smoking,” he said. “It just makes good sense.” Read More: Dreading a Colonoscopy? Other Tests Are Just as Effective » The Lifestyle Medicine Movement Dr. Marc Braman is a founding member and first executive director of the American College of Lifestyle Medicine (ACLM), the national medical specialty society for healthcare professionals committed to a lifestyle medicine-first treatment option. He said that the scientific evidence that food and lifestyle can treat our ills is indisputable. Among the evidence Braman points to is a European study of 3,759 colorectal cancer patients that concluded combined lifestyle factors, such as healthy weight, physical activity, no smoking, limited alcohol consumption, and a healthy diet, were associated with a lower incidence of colorectal cancer in European populations characterized by Western lifestyles. Despite the integrative medicine trend, Braman said future doctors in the United States are still primarily taught to consider pharmaceutical options first and this will not change overnight. Lifestyle medicine, which takes into account what the patient does on a day-to-bay basis, including nutrition, exercise, and much more, is the future of medicine. Dr. Marc Braman, American College of Lifestyle Medicine “In American medical schools, pharma still runs the show,” Braman said. “But patients want all options on the table. Lifestyle medicine, which takes into account what the patient does on a day- to-bay basis, including nutrition, exercise, and much more, is the future of medicine, and personal responsibility and taking control of your own healthcare are important components to this.” Susan Benigas, ALCM's current executive director, said the United States is in the midst of a seismic shift in healthcare, as we move from a fee-for-service to a value and outcome-based model. “Diabetes alone is a looming global pandemic with incalculable consequences, yet it's a food- borne illness,” she said. “Fifty years ago, there were 2 million Americans with this chronic condition. Today, there are over 160 million who’ve already been diagnosed or are pre-diabetic. We cannot stand by and allow this and other chronic conditions to destroy lives, and even our nation's fiscal solvency, without doing all in our power to sound the wake-up call.” Benigas said the optimal lifestyle recommendation of a predominantly whole food, plant-based diet is becoming more compelling to Americans. “An allopathic-only approach to healthcare is unsustainable, not to mention not being in the best interest of patients,” she said. Read More: Hospitals Open Emergency Rooms Specifically for Senior Citizens » Is Integrative Medicine “Inevitable” Medicine? Dr. David Leopold, director of health and wellness at Scripps Center for Integrative Medicine, said the center is having “significant difficulty keeping up with [patient] demand, which unfortunately can result in long waiting times for our patients. The growth at our center is echoed on a national level as patients increasingly seek out integrative medical centers.” Leopold cited the nutritional interventions and nonpharmacological approaches of integrative medicine as among “the best options to try to deal with some of the pressing issues and healthcare delivery.”

50 Saxe, who said his university is offering the Natural Healing and Cooking Program for doctors, medical students, and others interested in understanding the effects of dietary patterns on health and illness, likens the current boom in integrative medicine in the United State to China’s response to its current energy crisis. “China is a growing economy that has to generate more energy but has hit the limits of what they can generate using fossil fuels,” Saxe said. “Cities in China are choking and dense with foul air. The need for cleaner, softer, renewable energy will continue to increase in the future. The situation in American medicine is analogous to that. I don’t see pharma disappearing at all, I just see the increasing demands that are being placed on the system. Baby boomers are aging, and the medical community faces years of chronic disease in that population. The increase in demand has to be met by integrative medicine. It’s inevitable.”

III. ACUPUNCTURE

A form of acupuncture may help relieve chronic constipation

Published: Wednesday 27 August 2014

Nearly 1 in 6 adults worldwide may suffer from chronic constipation and, over time, the disorder can cause serious complications. Auriculotherapy, a form of acupuncture that involves stimulating targeted points on the outer ear, may help in managing constipation. Evidence from numerous clinical studies published between 2007-2013 that evaluated the effectiveness of auriculotherapy in treating patients with constipation is presented and discussed in a Review article in The Journal of Alternative and Complementary Medicine, a peer-reviewed publication from Mary Ann Liebert, Inc., publishers. The article is available free on The Journal of Alternative and Complementary Medicine website until September 25, 2014. Li-Hua Yang and coauthors from the Hospital of Nanjing University of Traditional Chinese Medicine, Jiangsu Province Hospital of Traditional Chinese Medicine, and Southeast University School of Public Health, Nanjing, China, analyzed the results of 17 published studies, comparing the effectiveness of auriculotherapy in managing and relieving constipation and in alleviating symptoms associated with constipation between affected patients and a control group. The authors present their data and conclusions in the article "Efficacy of Auriculotherapy for Constipation in Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials."

Acupuncture 'safe and effective' for chronic pain in children

Written by Honor Whiteman Published: Sunday 20 December 2015

Treating children with chronic pain is challenging; there is limited evidence on the efficacy of pain-relieving therapies among this population. But according to new research, acupuncture may be a safe and effective treatment strategy.

51 Researchers say acupuncture may be a feasible treatment option for chronic pain in children. Study leader Angela Johnson, practitioner of Chinese medicine at Rush University Medical Center in Chicago, IL, and colleagues publish their findings in the journal Alternative and Complementary Therapies. Chronic pain is defined as any pain that lasts at least 12 weeks. It is estimated that around 20- 35% of children and teenagers across the globe have chronic pain. Treating adults with chronic pain has its difficulties, but treating children with the condition is even more challenging; there is little evidence on effective drug therapies for chronic pain in children, and health professionals are often wary of providing certain treatments to youngsters because of their vulnerability during growth and the fear of possible long-term health implications. "Effective treatment of pain can be particularly difficult because it's subjective; but with children, it is increasingly difficult because a child may not be able to communicate effectively depending on the age and accurate recognition of pain," adds Johnson. As such, the search is on to identify safe and effective therapies for chronic pain in children, and with this latest study, Johnson and her team may have found one: acupuncture. Acupuncture is a practice used in traditional Chinese medicine, which involves stimulating certain pressure points on the body, most commonly with the insertion of thin needles through the skin. While acupuncture is considered an effective treatment for chronic pain in adults, there is little information on whether the procedure may be an effective form of pain relief for children. "This study looked at the effect of acupuncture in children directly, rather than examining data collected from adults," says Johnson. "This focus is especially important, since children experience pain in different ways than adults." Acupuncture reduced pain, improved quality of life Johnson and colleagues enrolled 55 children and adolescents aged 7-20 years to their study, all of whom had chronic pain conditions. Each participant attended eight sessions in which they received an individually tailored acupuncture treatment, with each treatment lasting around 30 minutes. Using the Adolescent Pediatric Pain Tool (APPT), participants rated their pain and nausea before and after each treatment. The APPT asks patients to disclose pain areas through a body outline diagram and describe pain intensity through circling words such as "no pain" and "worst possible pain." The researchers found that participants reported a significant reduction in pain throughout the entire eight sessions and from the beginning to end of each individual session, with greater pain reduction reported in the earlier sessions. What is more, through the completion of the Pediatric Quality of Life Inventory, the researchers found patients experienced improvements in overall health and reductions in social, emotional and educational problems. According to the researchers, their findings suggest acupuncture is a safe and effective treatment option for children with chronic pain. Johnson adds: "The results of this study suggest that acupuncture can have a profound positive impact on the health and well-being of children who experience the disabling effects of chronic pain.

52 Like any good doctors, we want to reduce children's suffering, and we hope that this study will be a first step in our being able to do more for these kids." Earlier this year, Medical News Today reported on a study detailing a new form of acupuncture that researchers say could reduce high blood pressure. Written by Honor Whiteman

Acupuncture As Stroke Treatment Doesn't Stick

Written by Sy Kraft Published: Monday 27 September 2010

According to the CMAJ (Canadian Medical Association Journal), acupuncture, the procedure of inserting and manipulating needles into various points on the body to relieve pain or for therapeutic purposes has not proved to be beneficial in the treatment of recovering stroke victims.

Dr. Edzard Ernst, Peninsula Medical School, Exeter, England and coauthors reviewed trials that have been published in English and Asian journals to determine if that, even though acupuncture is often used to supplement traditional stroke rehabilitation, is it clinically effective.

Ten studies were reviewed, looking at 711 patients who had strokes and were taking measures to treat post incident symptoms.

Ernst states:

Few randomized, sham-controlled trials have tested the effectiveness of acupuncture during stroke rehabilitation. The majority of the existing studies do not suggest that acupuncture is effective. The evidence from rigorous studies testing the effectiveness of acupuncture during stroke rehabilitation is negative.

Traditional Chinese medicine (TCM) is based on a pre-scientific paradigm of medicine that developed over several thousand years and involves concepts that have no counterpart within contemporary medicine, the authors wrote. What is Acupuncture? Acupuncture originates from China and has been practiced there for thousands of years. Although there are records of acupuncture being used hundreds of years ago in Europe, it was during the second half of the twentieth century it began to spread rapidly in Western Europe, the United States and Canada. Acupuncture involves the insertion of very thin needles through the patient's skin at specific points on the body - the needles are inserted to various depths. We are not sure how acupuncture works scientifically. However, we do know that it does have some therapeutic benefits, including pain relief and alleviation from nausea caused bychemotherapy.

According to traditional Chinese medical theory, acupuncture points are located on meridians through which gi vital energy runs. There is no histological, anatomical or scientific proof that these meridians or acupuncture points exist. Acupuncture remains controversial among Western medical doctors and scientists. Creating case studies that use proper scientific controls is difficult because of the invasive nature of acupuncture - a clinical study involves a placebo (sham product) compared to the targeted treatment. It is very hard to devise a sham acupuncture control that one can compare to proper acupuncture.

Click here to read about acupuncture in more detail.

53 "Acupuncture for functional recovery after stroke: a systematic review of sham-controlled randomized clinical trials" Jae Cheol Kong, Myeong Soo Lee, Byung-Cheul Shin, Yung-Sun Song, Edzard Ernst Published online ahead of print September 27, 2010 CMAJ 10.1503/cmaj.091113

Written by Christian Nordqvist Written by Sy Kraft

Acupuncture may reduce high blood pressure

Written by Catharine Paddock PhD Published: Friday 21 August 2015

A new study suggests that a form of acupuncture may benefit patients with high blood pressure and lower their risk of stroke and heart disease.

Electroacupuncture is a form of acupuncture that applies low-intensity electrical pulses through needles inserted at specific points on the body. Image credit: Chris Nugent/UCI The single-blind trial, conducted at the University of California-Irvine (UCI), is the first scientific confirmation that the ancient Chinese medical technique is beneficial for patients with mild to moderate hypertension. In the journal Medical Acupuncture, the team describes finding how electroacupuncture can lower blood pressure for up to 6 weeks in patients with hypertension. Electroacupuncture is a form of acupuncturethat applies low-intensity electrical pulses through needles inserted at specific points on the body. The researchers say their findings suggest that with regular use, electroacupuncture could help people manage their blood pressure and reduce their risk of heart disease and stroke in the longer term. Senior author John Longhurst, a cardiologist and UCI professor of medicine, says the clinical study comes after nearly 10 years of bench research into the effect of acupuncture on high blood pressure. He adds: "By using Western scientific rigor to validate an ancient Eastern therapy, we feel we have integrated Chinese and Western medicine and provided a beneficial guideline for treating a disease that affects millions in the US." 70% of treated patients experienced noticeable drop in blood pressure According to the Centers for Disease Control and Prevention (CDC), there are about 70 million American adults (29%) with high blood pressure - only about half of whom have the condition under control. Fast facts about acupuncture . Acupuncture is a traditional Chinese medicine that has been in use for over 3,000 years

54 . It uses thin needles to stimulate one or more out of hundreds of specific points on the body . US regulators approved acupuncture needles for use by licensed practitioners in 1996. Learn more about acupuncture High blood pressure costs the US some $46 billion a year. This figure covers health care services, medications and absence from work. For their study, Prof. Longhurst and colleagues recruited 65 patients with hypertension who were not taking any drugs to treat their condition. Each patient was randomly assigned to one of two groups. Both groups were treated with electroacupuncture, except that one group (the treatment group) had it applied to both sides of the inner wrists and slightly below each knee (acupoints thought to reduce blood pressure), and the other group had it applied to other acupoints along the forearm and lower leg (the control group). The trial was a single-blind trial. That means the practitioners giving the treatment knew which patients were in the treatment group and which were in the control group, but the patients did not. The results showed that 70% of the 33 patients in the treatment group experienced a noticeable drop in blood pressure. On average, the reduction was 6-8 mm/Hg for systolic blood pressure and 4 mm/Hg for diastolic blood pressure. Systolic (when the heart contracts) is the higher, and diastolic (when the heart rests between beats) is the lower number in blood pressure readings. The researchers say these improvements persisted for 6 weeks after treatment. Treatment also followed by other beneficial changes The treatment group also showed significant drops - 41% on average - in blood concentration of norepinephrine (also called noradrenaline), a hormone that constricts blood vessels and increases blood pressure and blood sugar. The treatment group also showed a 67% drop in renin - an enzyme released in the kidneys that helps control blood pressure - and a 22% drop in a hormone that regulates electrolytes (aldosterone). There were no significant blood pressure changes in the 32 patients in the control group. Prof. Longhurst notes that while the reductions in blood pressure seen in the treatment group were not large - most ranged between 4 mm/Hg and 13 mm/Hg - they were clinically significant and suggest the treatment could be especially useful for people in their 60s and older with high systolic blood pressure. He concludes: "Because electroacupuncture decreases both peak and average systolic blood pressure over 24 hours, this therapy may decrease the risk for stroke, peripheral artery disease, heart failure and myocardial infarction in hypertensive patients." Medical News Today also recently learned about a study published in the journal Endocrinology that suggests acupuncture acts in a similar way to psychiatric drugs when used to treat chronic stress. Researchers from Georgetown University Medical Center in Washington, DC, came to this conclusion after running controlled experiments with rats. Written by Catharine Paddock PhD

Acupuncture Relieves Hay Fever Symptoms

Written by Christian Nordqvist Published: Wednesday 20 February 2013

Hay fever sufferers who underwent 12 acupuncture sessions experienced fewer symptoms and required less antihistamine medication compared to a control group, researchers from Charite-University Medical Center, Berlin, Germany, reported in Annals of Internal

55 Medicine.

Hay fever, medically known as seasonal allergic rhinitis, is caused by allergies (usually) to plant pollen. Symptoms include a stuffy nose and itchy eyes. Standard treatment includes antihistamines. However, many patients find that antihistamines do not work. People who are not happy with antihistamines, as well as those who prefer more natural remedies frequently use non-standard treatments, such as acupuncture.

Acupuncture is an ancient Chinese procedure that uses special needles that are inserted into specific points on the body to either prevent or treat medical conditions. Over the last 30 years mainstream medicine has increasingly come to recognize acupuncture as both effective and safe for many disorders. However, previous studies on acupuncture treatment for hay fever have been inconsistent.

In this study, Dr. Benno Brinkhaus and team randomly selected 422 volunteers, all hay fever sufferers, into three groups: . Acupuncture plus rescue medication (RM) group . Sham acupuncture plus RM group. In sham acupuncture, the needles are inserted only superficially and into areas of skin that are not traditional acupuncture points. . RM alone group Twelve treatments were administered over eight weeks in the first year. Patients in all three groups were allowed to take antihistamine medication whenever they had hay fever symptoms.

They found that overall, those in the acupuncture plus RM group reported better improvements in their symptoms over the eight-week period of treatment, as well as needing fewer antihistamine drugs, compared to those in the other groups.

However, within eight weeks of ending their treatment, the benefits of the acupuncture were gone. Dr. Brinkhaus, a medical doctor and qualified acupuncturist, said that does not necessarily mean that acupuncture's benefits wear off.

In a Summary for Patients in the same journal, the following limitations were pointed out: . The improvements in symptoms may not have been enough to make much of a difference in people. . The researchers are not sure how acupuncture might have reduced allergy symptoms. Dr. Remy Coeytaux, co-writer of an Editorial that was published with the study, said that it is time for allergic rhinitis studies to move beyond testing real and sham versions of acupuncture, and to compare it to with other therapies.

Some doctors have wondered why the researchers did not compare acupuncture with nasal sprays containing steroids, which are strong anti-inflammatory drugs and help with many allergy symptoms.

56 Mainstream medicine has increasingly come to recognize acupuncture as both effective and safe Acupuncture recognized by WHO (World Health Organization) Acupuncture is effective in treating 28 illnesses/conditions, according to WHO. Evidence points to possible efficacy in many more, WHO adds.

A significant percentage of patients with migraines and/or headaches have found that acupuncture helps their symptoms.

Twice weekly acupuncture treatment has helped patients with the debilitating symptoms of xerostomia(severe dry mouth).

Researchers from the University of Seoul, South Korea, showed that acupuncture helps relieve some of the symptoms of Parkinson's disease. Written by Christian Nordqvist

Adventures in Acupuncture: Can It Really Help Clear Up Adult Acne?

byJasmine Garnsworthy 1 month ago

Getty Images/STYLECASTER I’ve been bitching about a recent outbreak of adult acne for months now (remember?), and while the situation is almost under control, it’s mostly due to a combination of harsh topical creams, spironolactone, and antibiotics. Now, after googling the impact of long-term antibiotic use— terrifying—I’ve ditched the pills to try some more natural treatments to keep my very angry 25- year-old skin breakout-free. In addition to seeing a herbalist (more on that here) and changing my diet, I tried, and promptly became obsessed with, acupuncture. My herbalist actually suggested I try the treatment for a more holistic path to clear skin and pointed me in the direction of Manhattan-based acupuncturist and skin-care guru Shellie Goldstein, who explained that those teeny-tiny needles are actually really commonly used to treat acne: “It’s most commonly used for pain, as well as stress and anxiety, digestive disorders, allergies—it’s really great for allergies, and it’s really great for skin conditions.” Goldstein reiterated what many holistic health experts have told me in the past: The condition of your skin closely reflects what’s going on in your digestive system. “Usually when we treat your skin, we’re actually treating your digestive system, treating the inside to get the visible results on 57 the outside,” she said. “Acne is often caused by the digestive system, so it may be that your digestive system is a bit sluggish.” After filling out a five-page medical history document, Shellie asked me to change into the towel provided, lie down, and relax. “Yes, you might feel a pinch; no, it shouldn’t hurt,” she assured me.

Getty Images We started off sticking needles into points in my arms, legs, neck, and generally nowhere near my face “to treat internal energy.” Specifically, she used a point on the legs, three fingers below the knee on the outside of the bone, which she explained is “a good digestive point to clear out heat in the digestive system.” There’s also a point between the first and second toe, and a correlating point on the hand between the thumb and the first finger that are great for acne. If you don’t think you will be able to get to a professional acupuncturist, Shellie also recommended a battery-operated wand-like tool that you can use at home to perform acupressure daily for similar results, so take note of these points, people! Next up, we used points on the face to directly address the acne: “There’s a good one on the forehead where the hairline angles that open the energy in the face and is good lymphatic drainage points to treat acne.” The whole session went for about an hour, and while there was a little pain when the needles were inserted, that went away immediately—I actually fell asleep about thirty minutes in. It’s been a week since my little foray into facial acupuncture, and my skin’s looking great—not a single blemish, which is highly unordinary for me. If you suffer from severe acne, though, it can take up to a few months of regular appointments to clear the skin, being sure to book in sessions when you’re hormonal and likely to break out. “If you’re suffering from serious acne, it’s good to come in for acupuncture weekly. For most women it’s [worse] right before their period, and then you may want to come twice a week if you can. Usually, we give it three cycles in these situations—you measure by your menstrual cycle or by the calendar month—because it takes about thirty days for the skin cells to move from the bottom of the skin to the top. The results you see are on the surface, but the changes are really being made underneath, so you need three cycles for the biggest difference.” Unlike a lot of acne treatments (ahem, antibiotics), acupuncture is fairly risk free, apart from the possibility of a little bruising. Shellie’s office charges from $120 to $190 per session, depending on the experience level of the practitioner you see, which seems to be the going rate for most cities. Oh, and if you are looking for a good acupuncturist (and you’re not in New York to visit Shellie) there are some things to watch out for: “You want to make sure they’re licensed,” Goldstein cautioned. “Usually states have a state organization, so you can call there to get recommendations, or get in touch with a local school. Make sure the practitioner you’re seeing has had success treating your condition in the past. It’s OK to ask them what their success rate is with your particular problem.”

British Fertility Society Issues New Guidelines On The Use Of Acupuncture And Chinese Herbal Medicine In Fertility Treatment, UK

Published: Wednesday 10 March 2010

The British Fertility Society has issued new guidelines in the journal Human Fertility on the use of acupunctureand Chinese herbal medicine in fertility treatment. The guidelines found that there is currently no evidence that having acupuncture or Chinese herbal medicine treatment around the time of assisted conception increases the likelihood of subsequent pregnancy.

58 To determine the effectiveness of acupuncture and Chinese herbal medicine, the guideline authors carried out a thorough review of all published randomised controlled trials that looked at the effectiveness of acupuncture when carried out in conjunction with fertility treatment. They found there are no published randomised controlled trials on the effectiveness of using Chinese herbal medicine in conjunction with fertility treatment and therefore the guidelines conclude there is currently no evidence to support the use of this in fertility treatments.

For studies on the effect of acupuncture, 14 trials (a total of 2670 subjects) were included in the meta-analysis. These trials were split into three categories depending on the time when acupuncture was administered: a) around the time of egg removal; b) on the day of embryo transfer; c) on the day of embryo transfer and again 2-3 days later. The authors examined the effect of acupuncture treatment on the live birth rate, clinical pregnancy rate and the miscarriage rate compared to controls. No matter at which point in the process acupuncture was given, there was no significant difference in the live birth rate, clinical pregnancy rate or miscarriage rate between patients that had received acupuncture and those that had not. The guidelines conclude there is no evidence of benefit or harm to patients from receiving acupuncture around the time of assisted conception.

The guidelines also comment that there is a great deal of variability in the clinical design of studies examining acupuncture effectiveness, in particular in the type of control they employed, the specific acupuncture point studied, the timing of the acupuncture treatment and whether they controlled for the placebo effect. There is as yet no consensus regarding what constitutes a good placebo in trials examining the effects of acupuncture. Any further studies should attempt to explore the potential placebo as well as treatment effect of this complimentary therapy, as it could be that the added time and attention given to the patient as a result of receiving the treatment induces relaxation, which may affect outcomes.

Prof Adam Balen, Chair of the British Fertility Society's Policy and Practice Committee, said:

"The British Fertility Society wants to ensure that all women receive the safest treatment when undergoing fertility procedures, while also maximising their chances that the treatment will be successful. Before any treatment can be accepted into mainstream medicine and used on patients, it is essential that it has been tested in randomised controlled trials to ensure that it does actually work and does not cause any harmful side-effects.

"Following a thorough analysis of the evidence, the British Fertility Society concludes that there is currently no evidence that acupuncture or Chinese herbal medicine, when used in conjunction with assisted fertility treatment, have any beneficial effect on live birth rate, pregnancy rate or miscarriage rate. Patients should be made aware of this fact before commencing treatment.

"Furthermore, in the studies included in this analysis, there is a great deal of discrepancy in the experimental design and the acupuncture technique used. Any future randomised controlled trials in this area need to ensure that they use a standardised acupuncture method, have a large sample size and include adequate controls to account for any placebo effects."

General information

One in seven couples in Western countries has difficulty conceiving and many will seek medical help in the form of assisted reproductive technologies, which result in the birth of more than 10,000 children each year in the UK. Traditional Chinese medicine, especially in the form of acupuncture and herbal medicine, is widely used to treat many common conditions and has been explored in assisted reproduction.

59 In its original form, the use of acupuncture and Chinese herbal remedies was based on the principles of traditional Chinese medicine, which is a 3000-year old holistic system. Traditional Chinese medicine combines medicinal herbs, acupuncture, food therapy, massage and therapeutic exercise for both treatment and prevention of disease. Traditional Chinese medicine drug treatment consists typically of complex prescriptions of a combination of several components and follows a completely different rationale to many conventional treatments. Herbal medicine is the most important part of traditional Chinese medicine. Acupuncture involves the insertion of fine needles into the skin along the meridians and provides a means of altering the flow of energy through the body. In a typical treatment, between four to ten points are needled for 10-30 minutes. Needles can be stimulated by manual twirling or with a small electric current (electro-acupuncture).

Source British Fertility Society

During Pregnancy Acupuncture Found To Lessen Depression Symptoms, Stanford Study Shows

Published: Tuesday 23 February 2010

Acupuncture appears to be an effective way to reduce depression symptoms during pregnancy, according to a first-of-its-kind study from Stanford University School of Medicine researchers. The study authors, led by Rachel Manber, PhD, professor of psychiatry and behavioral sciences, said they hope the results will raise awareness of the problem of depression during pregnancy and provide patients and physicians an alternative to antidepressants. "This standardized acupuncture protocol could be a viable treatment option for depression during pregnancy," they wrote in a paper that will appear in the March issue ofObstetrics & Gynecology.

Up to 14 percent of pregnant women may have major depressive disorder, a condition characterized by feelings of dread, gloom and hopelessness, and a loss of interest in normally pleasurable activities. Some women suffer from depression before becoming pregnant, stop taking their medication and then experience a relapse; in other women, pregnancy itself may cause depression.

Clinicians aren't exactly sure how pregnancy leads to the disorder, but an influx of hormones could be the culprit. Some women might also feel overwhelmed by the major changes in their life, which could trigger depression. "Pregnancy just by its nature can bring out some underlying psychiatric and emotional issues," said co-author Deirdre Lyell, MD, assistant professor of obstetrics and gynecology.

Depression, if left untreated, can pose risks to both mother and baby. The mom-to-be could stop taking care of herself or her fetus, and might even engage in self-destructive behavior. Studies have also linked depression during pregnancy to poor birth outcomes and postpartum depression. "Treatment of depression during pregnancy is critically important so that a woman can maintain her sense of well-being and take good care of herself, her fetus and, someday, her child," said Lyell.

The use of antidepressants during pregnancy doubled between 1999 and 2003, according to a 2007 American Journal of Obstetrics and Gynecology study, but many women avoid taking medication because of safety concerns. In fact, Manber said, 94 percent of the depressed women

60 involved in her study expressed reluctance to take antidepressants.

"Because there's this concern about medication among pregnant women and their physicians, it's important to find an alternative," said Manber.

For this study, the researchers recruited 150 women whose pregnancies were between 12 and 30 weeks gestation and who met the criteria for major depressive disorder. The women were randomized to receive one of three treatments: acupuncture specific for depression; control acupuncture, during which needles were inserted in points not known to help alleviate depressive symptoms; or massage. All of the women received eight weeks of therapy and were assessed for depression at the four- and eight-week marks by an interviewer who was unaware of the treatment each woman received.

The researchers found that women who received the depression-specific acupuncture experienced a bigger reduction in depression symptoms than the women in the other groups. The response rate - defined as having a 50 percent or greater reduction in symptoms - was 63 percent for the women receiving depression-specific acupuncture, compared with 44 percent for the women in the other two treatment groups combined.

The researchers weren't surprised by what they found - a pilot study yielded similar results, and other studies have shown acupuncture is an effective treatment for depression in the general public - but they were pleased with the results.

"I don't think that one-size-fits-all treatments are appropriate for everyone, but acupuncture should be considered as an option," said Lyell. "I hope that people will respect the rigorous methodology used in this blinded, randomized, controlled trial and accept the result: Traditional acupuncture was associated with a significant improvement in depression." Both Manber and Lyell said they plan to continue their research on women's health during pregnancy and postpartum. Lyell recently presented work showing that practitioners under- identify and under-acknowledge depression during pregnancy, and she's now analyzing birth- outcome data to look for correlations between depression, treatment and obstetric outcomes. This study was funded by the Agency for Healthcare Research & Quality. Other Stanford authors on the study include Rosa Schnyer, DAOM; Andrea Chambers, PhD; Maurice Druzin, MD; Erin Carlyle; Christine Celio; Jenna Gress; Mary Huang; Tasha Kalista and Robin Martin-Okada. Source: Michelle Brandt Stanford University Medical Center

Growing Number Of Acupuncture-Transmitted Diseases: Experts Call For Infection Control Guidelines

Written by Stephanie Brunner Published: Friday 19 March 2010

In an editorial on bmj.com today, experts are demanding further funding to establish appropriate infection control guidelines to deal with the growing number of acupuncture-transmitted diseases.

The number of reported cases is described as "the tip of the iceberg" by Professor Patrick Woo and colleagues from the University of Hong Kong.

Acupuncture is one of the most widely practiced strands of alternative medicine. It is based on the theory that inserting and manipulating fine needles at specific points in the body helps to

61 promote the flow of Qi or energy.

Professor Woo is the lead author. He argues that acupuncture may pose risks to patients as needles are inserted up to several centimeters beneath the skin.

Most patients recover from infections. However, Professor Woo explains that 5 to 10 percent of the reported pyogenic bacterial infections end up with serious problems including:

• joint destruction • multi-organ failure • flesh eating disease • paralysis

Most infections caused are bacterial. But Woo comments there have been outbreaks of hepatitis B, and perhaps cases of hepatitis C and HIV that are believed to have been transmitted via acupuncture.

He comments that in the 21st century a new clinical syndrome has emerged, known as acupuncture mycobacteriosis. This is an infection caused by mycobacteria that rapidly grow around the acupuncture insertion point as a result of contaminated cotton wool swabs, towels and hot-pack covers. There is a long incubation period but the infection usually leads to large abscesses and ulcers.

The authors say in closing that "to prevent infections transmitted by acupuncture, infection control measures should be implemented, such as use of disposable needles, skin disinfection procedures, and aseptic techniques. Stricter regulation and accreditation requirements are also needed."

"Acupuncture transmitted infections: the tip of the iceberg of a global emerging problem" Patrick C Y Woo, professor, Ada W C Lin, specialist, Susanna K P Lau, associate professor, Kwok-Yung Yuen, chair of infectious diseases BMJ 2010; 340:c1268 bmj.com Written by Stephanie Brunner

Loss Of Smell Due To Post-Viral Infection May Be Effectively Treated With Acupuncture

Published: Friday 2 April 2010

Traditional Chinese acupuncture (TCA), where very thin needles are used to stimulate specific points in the body to elicit beneficial therapeutic responses, may be an effective treatment option for patients who suffer from persistent post-viral olfactory dysfunction (PVOD), according to new research in the April 2010 issue ofOtolaryngology - Head and Neck Surgery.

Olfactory dysfunction can arise from a variety of causes and can profoundly influence a patient's quality of life. The sense of smell determines the flavor of foods and beverages and also serves as an early warning system for the detection of environmental hazards, such as spoiled food, leaking natural gas, smoke, or airborne pollutants. The loss or distortions of smell sensation can adversely influence food preference, food intake, and appetite.

Approximately 2 million Americans experience some type of olfactory dysfunction. One of the most frequent causes of loss of smell in adults is an upper respiratory tract infection (URI).

62 Patients usually complain of smell loss following a viral URI. The smell loss is most commonly partial, and reversible. However, occasionally patients may also present with parosmia (a distortion of the sense of smell), phantosmia (smelling things that aren't there), or permanent damage of the olfactory system.

To date, there is no validated pharmacotherapy for PVOD, but attempts have been made to establish a standardized treatment. In the literature, systemic and topical steroids as well as vitamin B supplements, caroverine, alpha lipoic acid, and other drugs were used to treat patients. The researchers point out that in addition to these treatments, complementary and alternative medicines are currently being employed by many patients on their own, and that exploration into their usefulness by traditional Western medicine should be validated.

In the current study, 15 patients presenting to an outpatient clinic with PVOD were treated by TCA in 10 weekly 30-minute sessions. Subjective olfactometry was performed using the Sniffin' Sticks test set. Treatment success was defined as an increase of at least six points in the sticks test scores. The effects of TCA were compared to matched pairs of people suffering from PVOD who had been treated with vitamin B complex. Eight patients treated with TCA improved olfactory function, compared with two treated with vitamin B complex.

The authors acknowledge that their study is limited by its size, and that further studies should be conducted in a larger population. However, the authors write "…the observed high response rate of about 50 percent under TCA was superior to that of vitamin B complex or that of spontaneous remission, and offers a possible new therapeutic regimen in postviral dysosmia."

Source: Jessica Mikulski American Academy of Otolaryngology -- Head and Neck Surgery

Acupuncture May be an Effective Alternative for Treating Seasonal Allergies

News From The Annals Of Internal Medicine: Feb. 19, 2013

Published: Wednesday 20 February 2013

Patients receiving acupuncture treatments for seasonal allergic rhinitis reported statistically significant improvements in symptoms and decreased use of medication compared to patients having standard treatment or sham acupuncture, but the clinical significance of the observed improvements is uncertain. Allergic rhinitis (stuffy or runny nose caused by allergies) is an extremely common condition that affects approximately 20 percent of the U.S. population. Despite the availability of effective medications such as antihistamines, patients suffering from allergic rhinitis often seek alternative therapies for symptom relief. Researchers randomly assigned 422 patients between the ages of 16 and 45 to receive 12 treatments of either acupuncture plus rescue medication (n=212); sham acupuncture plus rescue medication (n=102); or rescue medication alone (n=108) over an eight-week period during two consecutive allergy seasons. All patients in the trial could take up to two doses of cetirizine per day. If their symptoms were not adequately controlled with cetirizine, participants could be treated with an oral corticosteroid, but use of other anti-allergy medications was prohibited. After the first eight weeks, patients assessed their symptoms and reported use of medications. Patients in the acupuncture plus rescue medication group had statistically significant improvements in disease- specific quality of life and medication use compared with the other two groups. This difference

63 waned at the 16-week follow-up. While the researchers cannot be sure if patient expectations about acupuncture affected their outcomes, the author of an accompanying editorial suggests that future acupuncture research should, as this study did, use acupuncture protocols that represent true clinical practice and compare acupuncture to other proven therapies rather than to sham acupuncture alone.

*A link to the summary for patients is free to the public.

2. Researchers Assess the Benefits and Risks of Redefining a Positive CT Result for Lung Cancer

Using a threshold of 7 or 8 mm to define a positive lung cancer result in a baseline round of computed tomography (CT) could decrease false positive screening results. However, prospective research is needed to determine whether increasing the threshold may delay diagnosis of cancer in some patients. In CT screening for lung cancer, the positive result of the initial low-dose CT indicates whether further diagnostic work-up is needed before the first scheduled repeated screening. A definition that is too inclusive may cause excessive diagnostic work-up and unnecessary treatment, while a definition that is too restrictive may delay diagnosis. In the past decade, the frequency of identifying a noncalcified nodule (NCN) of any size on the initial baseline CT scan has almost tripled. This is mostly due to technological advances in CT scanners and the use of large computer monitors to display the CT images. Changing the size threshold for a positive screening could help reduce the harms associated with unnecessary, invasive work-up of false positive screening tests. Researchers reviewed medical records for a cohort of 21,136 patients who had a baseline CT performed between 2006 and 2010 to assess how using a more restrictive threshold in the baseline round of screening would affect the number of positive results and delayed diagnoses. Of the participants undergoing baseline screenings, 57 percent had at least one NCN discovered. By using the current definition of 5 mm, 16 percent (3,396 of the 21,136 patients) had a positive result. Of those, 8 were diagnosed with lung cancer within 12 months of baseline enrollment. Increasing the threshold to 6, 7, 8, and 9 mm would have lowered the frequency to 10, 7, 5, and 4 percent respectively, thus decreasing further work-up by 36, 56, 68, and 75 percent respectively. The authors of an accompanying editorial express concern that nodule size may not be the best indicator of cancer risk. Other variables, such as presence of emphysema or nodule spiculation could predict which nodules are likely to be cancerous. The editorialists call for development of a comprehensive computer-based risk calculator that integrates nodule and demographic information.

3. Task Force Reviews Evidence to Inform Recommendations for Treating Open-Angle Glaucoma

** Draft recommendation posted for public comment.

A panel of experts commissioned to review evidence on glaucoma treatment to inform an upcoming U.S. Preventive Services Task Force recommendation found insufficient evidence to directly compare the effectiveness of medical, laser, and surgical treatments for open-angle glaucoma. Glaucoma is an acquired degeneration of the optic nerve that is the second most common cause of blindness worldwide. Open-angle is the most common type of glaucoma where an increase in pressure on the optic nerve occurs slowly over time. Open-angle glaucoma tends to run in families, with African Americans being at a high risk. The researchers reviewed published evidence to assess treatments' effectiveness at decreasing intraocular pressure and preventing optic nerve damage, vision loss, and visual impairment. High-level evidence suggests that both medical and surgical treatments for glaucoma decrease intraocular pressure and protect against worsening visual field loss, with surgical treatment (trabeculectomy) being slightly more

64 effective. Reviews comparing timolol with travoprost and latanoprost showed the prostaglandins to be more effective at decreasing intraocular pressure. However, prostaglandins were also more likely to cause eye redness. The reviewers found insufficient evidence linking treatment of any kind to patient-reported outcomes or visual impairment.

Sanford doc uses acupuncture for pain management as an alternative to meds  BLAIR EMERSON Bismarck Tribune  Apr 9, 2016 Gary Elhard has been experiencing lower-back pain for the past few years, mainly in the left side of his back — especially while walking. Elhard, who works half-days at Bill Barth in Mandan, recently started an alternative medicine regimen offered by a physician at Sanford Health: acupuncture. He’s had three treatments and reports his back pain has subsided. “I’d always thought I’d like to try it,” he said during his third treatment with Dr. Anthony Tello late last month. Tello, an internal medicine specialist at Sanford, has been practicing acupuncture for 20 years at the hospital. The vast majority of his cases involve pain management, including chronic pain and migraines. He said the treatment is becoming more popular among patients seeking an alternative to taking medications. Tello sees patients in an exam room on the hospital’s fourth floor. He said most are referred to him by word-of-mouth or by other doctors, and each week he sees three to five new or returning patients. During a recent acupuncture session with Elhard, Tello asked him to rank his pain level. “Right after my first treatment, I felt better,” Elhard said. After his second session, he felt a lot better. At his most recent appointment, he said his pain has gotten 60 percent better with the acupuncture treatments. Acupuncture involves the insertion of very thin needles into various parts of the body. Some are inserted just a few millimeters below the skin. The needles are flexible and not hollow, making them less painful than those used for injections, according to Tello. In addition to “dry needling,” Tello performs electroacupuncture. In this variation, a machine emits an electrical charge similar to transcutaneous electrical nerve stimulation therapy, or TENS. In preparation for this session, Tello marked several points on Elhard’s back, about 2 inches apart. “It’s the same spot every time because we’re getting good results,” he said as he inserted medium-size needles about an inch into Elhard’s skin. He then plugged in an electroacupuncture machine and hooked tiny clips like jumper cables onto each needle. “Let’s start on the left side. Tell me when you start to feel it,” said Tello, turning a knob on the machine until Elhard said he could feel the surge of electricity through the needles into his skin. Several minutes into the session, the skin around the needle points started turning red. “I can tell it’s working,” Tello said. If you were to ask Tello exactly how acupuncture works, he’d give you two explanations. One involves Chinese medicine, which has been around for 3,000 years and is based on the concept of Qi. “Qi is a belief in traditional Chinese medicine to be an energy that flows through the body,” Tello said. “It flows through meridians, and diseases interrupt that flow of energy. If you believe in traditional Chinese medicine and their theory, there’s a disruption of that flow of energy through those meridians; and what we’re trying to do in acupuncture is restore that energy.” In contrast, Tello said, Western alternative medicine assumes acupuncture points affect neurotransmitters, which in turn control pain. Under that theory, if the pain receptors are reset, the pain is managed, he said.

65 Tello said he and other physicians at Sanford ran a discussion on homeopathic medicine and alternative medicine in the early 1990s. “Many times you get into situations where the traditional Western medicine is not working. So you ask yourself, ‘Well, what else can I offer my patients?’ — especially in the area of pain management,” he said. Tello signed up for an acupuncture course in California after that conversation and has been practicing it ever since. When he started, he said some physicians at the hospital thought it was quackery. “Physicians are scientifically trained,” he said. “All these studies, you have to have proof. Traditional Chinese medicine is totally different. You have to have an open mind going into it, because when we talk about energy flowing through meridians in the body it’s like, ‘Is that just hocus pocus?’ You don’t know.” Tello said acupuncture isn’t a cure-all, and it doesn’t work for all patients. He also warns of sham operations, in which people claim they’re acupuncturists and just stick needles anywhere. “And then it doesn’t work,” said Tello. He said he thinks Elhard will need two more treatments before his back pain is completely gone. Treatment times vary for each person, he said. After Elhard’s most recent treatment, Tello told him: “You’ll be dancing in the streets soon.” Reach Blair Emerson at 701-250-8251 or [email protected]

The Secret to Flawless Skin Could Lie in Acupuncture and Chinese Medicine

Wednesday, March 30, 2016 at 7:45 a.m. By Olivia Fleming

Styling by Olivia Fleming Herring & Herring Acupuncturist Sandra Lanshin Chiu likens the human face to a car: Fixing what's wrong with it takes a bit of poking around under the hood. "I'm like a mechanic who has to figure out the right tools," she explains. At Treatment by Lanshin, her wellness center in Williamsburg, Chiu offers "elevated" holistic solutions for skin problems like acne, eczema, wrinkles, sagging skin, and rosacea, prescribing an intricate formula of acupuncture and Chinese medicine to correct internal disruptions in the digestive, hormonal, and nervous systems — which, she says, are at the root of most skin problems, and why changing your cleanser or buying the latest cure-all cream is not the answer. "By the time a problem has erupted on the dermis, months and possibly years of accumulated imbalance of the internal organs has taken effect," says Chiu, who earned her master's degree in traditional Chinese medicine from the Pacific College of Oriental Medicine in San Diego. "Topical steroids, skin-stripping washes, antibiotics, and birth control hormones may offer temporary relief, but they do not truly correct the issue. That's why skin problems often return with a vengeance once a person decides to discontinue such meds."

66 My own struggle with rosacea — an incurable skin condition affecting more than 16 million Americans — led me down a depressing path of expensive prescription creams, medicinal- strength essential oils, and hokey face masks that all promised the moon but got me nowhere. For six years I avoided dairy, red wine, spicy foods, and hot saunas in an effort to keep the redness at bay. At one particularly low point I even washed my face with a soap of pine tar and sulfur after reading online about its "miracle" healing properties. Nothing worked.

According to Diana Hermann, who is board-certified in Chinese herbal medicine and acupuncture and practices at Fort Collins Clinic in Colorado, rosacea reflects a (metaphorical) internal imbalance of heat. Acupuncture and herbs can effectively clear this pathogenic heat (which, according to Chinese theory, is responsible for fever, inflammation, and dry skin) to reduce symptoms of redness, flushing, and acne-like blemishes, while preventing or minimizing the progression of rosacea. "Acupuncture clears heat from the lungs and stomach to reduce flushing and heat rising to the face," Hermann explains, adding that a pooling of heat in the face and head inhibits proper circulation throughout the rest of the body. But heat blockage is usually the expression of a breakdown in function elsewhere in the body. "My job is to figure that out," says Chiu. "Is this from a dysfunction in the digestive system? Or excess and long-term stimulation to the nervous system, like emotional stress, blocking normal function of the liver system? Or is it due to a weakness of the kidney and adrenal system? Usually rosacea does not exist alone — there are always corresponding symptoms occurring in tandem — and this goes for most skin conditions. Once I determine what systems are not functioning properly, I design a strategy using acupuncture and herbal therapy to correct the problem." My problem, it turned out, was in my gut. Chiu traced my rosacea to a two-week course of antibiotics back in 2010, which she believes caused a major bacterial imbalance in my digestive system that had been brewing ever since. She prescribed whey-free probiotics and once-weekly acupuncture to clear any heat buildup. The needles hurt, but not in the same way stabbing yourself while sewing might. As Chiu slid the needles into each meridian, or energy point, on my body, I could feel a sharp sting, similar to when you hit your funny bone and a tingling sensation travels up your elbow's ulnar nerve. I'm told this means it's working, and several seconds later any discomfort from the needles disappeared, leaving me to slip in and out of sleep for my hour-long appointment. Four weeks later, the rosacea had vanished. Six months on, there is still no sign of it. Depending on your skin issue, some treatments may take longer — from a few months up to a year — but the goal is always the same: to eliminate prescription medications and trial-and-error topical creams. Dylan Stein, owner of Manhattan-based Dylan Stein Acupuncture, treats acne, rosacea, and psoriasis. He notes that "some very stubborn cases" may require an additional period of consolidating treatments to ensure symptoms don't return. "Each person is unique, and no timeline is set in stone," Stein says. "But the ultimate goal of any acupuncturist should be to have you walk out of the office one day and not need to come back." Chiu agrees, but "transforming a problem that surfaced last month is far easier than one that's been around for ten years," she says. Ultimately, clients with the highest success rates are those who make the necessary changes to emotional patterns and lifestyle factors that contribute to the issue. "Almost all of my skin clients are driven, smart, and high-functioning — but at the same time they tend to be self-critical and easily frustrated with themselves and their circumstances," explains Chiu. She teaches that skincare is both physical and emotional, where "positive, appreciation-driven, self-loving regard" can actually help the skin to heal. It seems beauty isn't only skin-deep after all. [This is part of the spring 2016 edition of Sheer, a quarterly style supplement by the Village Voice devoted to exploring and sharing the most dynamic elements of New York City’s fashion and design worlds, from the iconic to the as yet undiscovered. Check out the rest of Sheer's featured stories here.]

67 Young Patients With Chronic Illnesses Find Relief In Acupuncture

Published: Wednesday 10 February 2010

Doctors at Rush University Medical Center are offering pediatric patients diagnosed with chronic illnessesacupuncture therapy to help ease the pain and negative side effects like nausea, fatigue, and vomiting caused by chronic health conditions and intensive treatments. The confluence of Chinese and Western medicine at Rush Children's Hospital is part of a study to analyze and document how acupuncture might help in reducing pain in children and increase quality of life.

"Treating children with acupuncture is a new frontier," said Dr. Paul Kent, pediatric hematology and oncology expert, Rush Children's Hospital. "We are looking to see if there is an effective pain management therapy we can offer that does not have the serious side effects that can be caused by narcotics and other serious pain medications."

The lack of options for pain management in children has been reported as one of the most difficult aspects of providing care to pediatric patients. Research indicates that up to 70 percent of pediatric patients experience pain and those with chronic illnesses often do not have adequate relief or prevention of pain.

"Acupuncture could be a potential solution to this dilemma of controlling pain in pediatric patients," said Angela Johnson, Chinese medicine practitioner at Rush.

Acupuncture is the use of tiny, hair-thin needles which are gently inserted along various parts of the body. The therapy is based on the premise that patterns of energy flowing through the body are essential for health. This energy, called Qi, flows along certain pathways. It is believed that placing the tiny needles at points along the pathways reduce pain and improve the healing process.

The National Institute of Health (NIH) has published a statement concluding that acupuncture is effective for treating adults for nausea following chemotherapy and for pain after dental surgery. The agency also said that the therapy might be useful in treating other health issues such as addiction, migraines, headaches, menstrual cramps, abdominal pain, tennis elbow, fibromyalgia, arthritis, low-back pain, carpal tunnel syndrome andasthma. In some pediatric studies, both patients and parents have stated that acupuncture treatments were both helpful and relaxing.

Rush will be offering acupuncture therapy to pediatric patients between the ages of 5-20 years of age, who are experiencing pain. A practitioner who is licensed in acupuncture by the State of Illinois and certified by the National Certification Commission for Acupuncture and Oriental Medicine will be giving the treatments. Study participants will receive eight acupuncture treatments at no charge.

"Many children with chronic or acute health issues turn to complementary or integrative approaches after all other conventional treatment options are exhausted," said Johnson. "Parents should be aware that integrative therapies like acupuncture can be helpful from the onset of disease and can have a tremendously positive influence on a child's quality of life."

About Rush University Medical Center

68 Rush University Medical Center is an academic medical center that encompasses the more than 600 staffed-bed hospital (including Rush Children's Hospital), the Johnston R. Bowman Health Center and Rush University. Rush University, with more than 1,730 students, is home to one of the first medical schools in the Midwest, and one of the nation's top-ranked nursing colleges. Rush University also offers graduate programs in allied health and the basic sciences. Rush is noted for bringing together clinical care and research to address major health problems, including arthritis and orthopedic disorders, cancer, heart disease, mental illness, neurological disorders and diseases associated with aging.

Source: Rush University Medical Center

Australasian Acupuncture and Chinese Medicine Annual Conference

Perth, Australia 20-22 May 2016 Presented by Australian Acupuncture & Chinese Medicine Association Register Acupuncture and Chinese medicine practitioners throughout the Asia-Pacific region will gather in Perth from 20-22 May 2016 for the Australasian Acupuncture and Chinese Medicine Annual Conference (AACMAC). The peak annual convention is a must-attend event for practitioners, researchers and the profession with international guest speakers to include Dr Stephen Boyanton PhD LAc (China/United States) and Professor Charlie Xue, the chair of Chinese Medicine Board of Australia(Australia). AACMAC 2016 will offer an engaging and clinically relevant academic program with practical workshops, industry seminars, and social and networking activities. Delegates will deepen their understanding of current practices and leave with an awareness of the latest research, techniques and treatment protocols. The conference also offers a valuable opportunity to broaden networks within the greater health community, allowing for greater collaboration, understanding and connections. Regular Registration is open until 25 April. Don’t miss out on your spot!

Acupuncture 'could treat inflammation and save lives' Written by Marie Ellis Published: Monday 24 February 2014

In Western medicine, the jury is still out on whether acupuncture delivers health benefits. But now, a new study adds further evidence of its worthiness, as scientists have shown a direct connection between acupuncture and physical mechanisms that heal sepsis, a common condition in hospital intensive care units that springs from infection and inflammation. The researchers, from Rutgers New Jersey Medical School, published their results in the journal Nature Medicine. They note that sepsis causes around 250,000 deaths in the US each year, making it a major cause of death. "But in many cases patients don't die because of the infection," says lead author Luis Ulloa, an immunologist at Rutgers. "They die because of the inflammatory disorder they develop after the infection. So we hoped to study how to control the inflammatory disorder." Although acupuncture has been practiced for thousands of years in Eastern countries, it is relatively new to Western medicine. The technique works by stimulating specific points on the body with tiny needles that penetrate the skin. Researchers from this latest study say they already knew that stimulating the vagus nerve - a major nerve in the body - activates mechanisms in the body that reduce inflammation.

69 As such, they tested whether electroacupuncture - a form of acupuncture that involves sending a small electric current through the nerves - reduces inflammation and organ injury in mice with sepsis. This type of electrification has been approved by the FDA for treating pain in humans. Half of septic mice who received electroacupuncture survived By increasing the electrical current, Ulloa explains that it heightens the effect of needle placement. As predicted, when they performed the electroacupuncture on septic mice, the researchers found that cytokines - molecules that help reduce inflammation - were stimulated.

In mice, the researchers demonstrated that treating the body with acupuncture stimulates cytokines, which help reduce inflammation, reducing deaths from sepsis. The team notes that whereas none of the mice that did not receive acupuncture survived, half of the mice that did receive the treatment survived for at least a week. Though they were pleased with their results, upon further investigation into why the acupuncture worked so well, Ulloa and his colleagues found that when they removed adrenal glands, which produce hormones in the body, the electroacupuncture stopped being effective. This finding initially dashed their hopes for using this technique in humans because most human sepsis cases carry with them reduced adrenal function. Though electroacupuncture might help a small number of patients with functioning adrenal glands, it would not work in many others. Not deterred, the scientists looked into the anatomical changes that took place when the technique was carried out with fully functional adrenal glands. They found these changes included raised levels of dopamine, which is a neurotransmitter that influences the immune system. However, simply adding dopamine by itself did not help reduce the inflammation. It was not until they used a drug called fenoldopam - which mimics the effects of dopamine - that they were able to succeed in reducing deaths caused by sepsis by 40%. Potential treatment for other inflammatory diseases The team notes that, even without acupuncture, fenoldopam was able to achieve the reduction in deaths. They say their findings are significant because they provide evidence of acupuncture's benefits beyond what has been shown before, and they also show uses for treating other inflammatory diseases besides sepsis, such as rheumatoid arthritis, osteoarthritis and Crohn's disease. Additionally, they say they have provided a potential avenue for developing drugs for humans that could reduce sepsis deaths. Because there is currently no FDA-approved drug to treat sepsis, Ulloa says this finding is advantageous.

70 But Ulloa adds: "I don't even know whether in the future the best solution for sepsis will be electroacupuncture or some medicine that will mimic electroacupuncture." However, he says their findings have opened up new roads for both acupuncture and a drug for treating sepsis. Medical News Today recently reported on a study that suggested both real and fake acupuncture relieves side effects of breast cancer drugs. Written by Marie Ellis

Acupuncture Curbs Severity Of Menopausal Hot Flushes

Published: Monday 7 March 2011

Traditional Chinese acupuncture curbs the severity of hot flushes and other menopausal symptoms, suggests a small study published today in Acupuncture in Medicine.

The effects did not seem to be related to changes in levels of the hormones responsible for sparking themenopause and its associated symptoms, the study shows.

The authors base their findings on 53 middle aged women, all of whom were classified as being postmenopausal - they had spontaneously stopped having periods for a year. Their somatic (hot flushes) urogenital (vaginal dryness and urinary tract infection) and psychological (mood swings) symptoms were measured using a five point scale (MRS).

Twenty seven of the women received traditional Chinese acupuncture twice a week for 10 weeks, with needles left in position for 20 minutes without any manual or electrical stimulation. The rest were given sham acupuncture.

Hormone levels of oestrogen, follicular stimulating hormone (FSH), and luteinising hormone (LH) were measured before the study began and after the first and last acupuncture sessions in both groups to see if these changed.

The results showed that those women given traditional acupuncture had significantly lower MRS scores for somatic and psychological, but not urogenital, symptoms at the end of the 10 weeks than their peers given the sham treatment. The symptom registering the sharpest fall in severity was that of hot flushes.

Furthermore, the effects seemed to be cumulative, with stronger results seen between the first and last sessions.

Oestrogen levels also rose, while LH levels fell in the group treated with traditional Chinese acupuncture. Low levels of oestrogen and high LH and FSH levels are characteristic of the menopause, as the ovaries start to fail.

But because of the differences between the groups in these various hormones to start with, there was little evidence to suggest that any hormonal fluctuations were themselves responsible for the changes in symptom severity, say the authors.

They suggest that the explanation for the reduced severity of hot flushes might be that acupuncture boosts the production of endorphins, which may stabilise the body's temperature

71 controls.

The authors caution that their study was small and that they did not monitor how long symptom relief lasted, but they suggest that traditional Chinese acupuncture could be an alternative for those women unable or unwilling to use hormone replacement therapy to ease troublesome menopausal symptoms.

Source Acupuncture in Medicine (British Medical Journal)

Acupuncture may reduce severity and frequency of menopausal hot flashes

Written by Honor Whiteman Published: Saturday 19 July 2014

For women going through menopause, hot flashes can be one of the most uncomfortable symptoms. But a new study suggests that acupuncture may help to reduce the severity and frequency of hot flashes among menopausal women. Hot flashes, also known as hot flushes, are a sudden feeling of heat over all or parts of the body. They may also cause redness on the face and neck, red blotches on the arms, back and chest, and heavy sweating or cold shivers. Many health conditions can cause hot flashes, but they are most common among women going through menopause.

The study found that menopausal women who underwent acupuncture experienced a reduction in the severity and frequency of hot flashes for up to 3 months. The most effective treatment for hot flashes is hormone therapy - the use of medication that contains estrogen or progesterone. However, such treatment can increase the risk of other health conditions, including stroke, heart disease and cancer. In this latest study, recently published in the journal Menopause, researchers wanted to see how acupuncture affected the regularity and severity of hot flashes a woman experienced while going through natural menopause. Acupuncture is a form of alternative medicine that is more than 2,500 years old. It incorporates a number of procedures that stimulate anatomical points on the body as a form of healing. The most common form of acupuncture involves the use of thin, metallic needles that penetrate the skin. The technique is most commonly used to help treat chronic pain, but past research has indicated it can help reduce inflammation and may even boost weight loss.

72 Acupuncture 'reduced severity and frequency of hot flashes for up to 3 months' The research team analyzed 104 studies that assessed the effectiveness of acupuncture. The team included 12 of these studies in their research, involving 869 women between the ages of 40-60 who were going through natural menopause. The women included in the study underwent various forms of acupuncture, including acupressure, electroacupuncture, laser acupuncture, ear acupuncture and traditional Chinese medicine acupuncture. The investigators found that women who underwent acupuncture experienced a reduction in the severity and frequency of hot flashes for up to 3 months. Furthermore, the treatment appeared to have a beneficial effect on hot flashes regardless of the number of doses, sessions or duration of treatment received. However, the researchers note that sham acupuncture reduced the frequency of hot flashes as much as true acupuncture. The team is unable to explain why acupuncture appears to help alleviate hot flashes among menopausal women, but they hypothesize that acupuncture may trigger a reduction in the concentration of beta-endorphin - a neuropeptide found in the cells of the central and peripheral nervous system - in the hypothalamus of the brain. They say lower levels of beta-endorphin may activate the release of calcitonin gene-related peptide (CGRP), which regulates body temperature. Commenting on the team's findings, Dr. Margery Gass, executive director of The North American Menopause Society (NAMS), says: "More than anything, this review indicates that there is still much to be learned relative to the causes and treatments of menopausal hot flashes. The review suggests that acupuncture may be an effective alternative for reducing hot flashes, especially for those women seeking non- pharmacologic therapies." A 2012 study, also published in the journal Menopause, suggested that hypnosis can also minimize the occurrence of hot flashes during menopause by around 75%. Written by Honor Whiteman

Acupuncture To Improve In Vitro Fertilization Rates: Review Finds Mixed Results

Published: Thursday 4 July 2013

Acupuncture, when used as a complementary or adjuvant therapy for in vitro fertilization (IVF), may be beneficial depending on the baseline pregnancy rates of a fertility clinic, according to research from the University of Maryland School of Medicine. The analysis from the University of Maryland Center for Integrative Medicine is published in the online edition of the journal Human Reproduction Update.

"Our systematic review of current acupuncture/IVF research found that for IVF clinics with baseline pregnancy rates higher than average (32 percent or greater) adding acupuncture had no benefit," says Eric Manheimer, lead author and research associate at the University of Maryland Center for Integrative Medicine. "However, at IVF clinics with baseline pregnancy rates lower than average (less than 32 percent) adding acupuncture seemed to increase IVF pregnancy success rates. We saw a direct association between the baseline pregnancy success rate and the effects of adding acupuncture: the lower the baseline pregnancy rate at the clinic, the more adjuvant acupuncture seemed to increase the pregnancy rate."

IVF is a process that involves fertilizing a woman's egg with sperm outside the womb and then implanting the embryo in the woman's uterus. According to the researchers, acupuncture is the most commonly used adjuvant, complementary therapy among couples seeking treatment at fertility clinics in the United States.

73 This new analysis examined 16 studies with more than 4,000 patients and builds on the Center for Integrative Medicine's 2008 review of acupuncture and IVF, published in the British Medical Journal. That study found positive results for using acupuncture for women undergoing IVF when acupuncture was performed during embryo transfer.

"The University of Maryland School of Medicine is an international leader in investigating the risks and benefits of complementary and alternative therapies. This new analysis is another example of our faculty's commitment to using comprehensive scientific study to further understanding and inform clinicians and patients who are considering these integrative therapies," says E. Albert Reece, M.D., Ph.D., M.B.A., vice president for medical affairs at the University of Maryland and the John Z. and Akiko K. Bowers Distinguished Professor and dean of the University of Maryland School of Medicine.

According to the authors, international differences may be one factor in varying baseline pregnancy rates in the studies they analyzed. For example, they say European clinics may have lower IVF pregnancy rates than U.S. clinics because European countries are increasingly moving towards single embryo transfers.

"Another potential explanation for the different effects of acupuncture in trials with higher versus lower baseline rates may be that in IVF settings where the baseline pregnancy rates are already high, the relative added value of additional co-interventions, such as acupuncture, may be lower," adds Manheimer.

The researchers say that more study is needed to examine if acupuncture might be a useful add- on procedure in IVF clinics with lower baseline rates, including considerations of safety and cost-effectiveness. Although acupuncture is a safe procedure, research has not determined whether any benefits on IVF success rates resulting from adding acupuncture are worth the extra costs involved with administering acupuncture.

Amblyopia: Can Laser Acupuncture be an Option? Marzio Vanzini , Michele Gallamini Open Access DOI: http://dx.doi.org/10.1016/j.jams.2016.01.017 Open access funded by International Pharmacopuncture Institute Publication History Published Online: February 17, 2016Accepted: January 13, 2016Received in revised form: January 11, 2016Received: November 20, 2015 User License

74 Figure 1 Acupuncture points in the published trials [[3], [4]].

Figure 2 Selected acupoints. Abstract This paper describes the results of the treatment of amblyopia in young patients using an unconventional laser-acupuncture technique. After obtaining satisfactory results in the treatment of a 14-year-old amblyopic girl, the treatment was applied to 13 amblyopic children aged 3– 11 years, with an encouraging outcome. An ultralow-light-intensity laser with a square-wave modulated emission was applied over a sequence of acupuncture points. Each session lasted 75 <15 minutes, and the treatment was performed once a week in 6-week cycles. Patients were followed for several years to evaluate the long-term results and/or to extend the treatment. All except two of the treated patients showed a rapid increase in visual acuity after several treatment sessions. Some required retreatment for regressions in visual acuity. The need for medium-term treatment cycles seems, however, to suggest that results may not be stable for all individuals. Although acupuncture has already been proved to be effective in the treatment of amblyopia, the results reported in this paper suggest that acupunctural stimulation using a novel type of ultralow-light-intensity laser can provide similar, if not better, results to conventional acupuncture stimulation, but with higher patient compliance.

1. Introduction Although it is widely accepted that it is very difficult to achieve functional improvement of the visual system at the end of its complete development—age 10/12 years at the latest—a traditional Chinese medicine (TCM) approach was used to treat a teenage (14-year old) girl with reduced visual acuity. As she suffered from a congenital depigmentation of the retina, her visual acuity of 20/40 in both eyes (BE) was considered to be the highest visual acuity possible. Traditional techniques had not provided any significant benefit. It was, therefore, decided to apply unconventional TCM techniques [1][1]. The girl had best corrected visual acuity (BCVA) BE of 20/40 and after 15 sessions of treatment with a variety of TCM techniques (needle acupuncture, laser acupuncture, and Ma Litang hammer) over a 10-month period, to our surprise and enthusiasm, she achieved a BCVA BE of 20/25 with the same slight optical correction. She was further treated (4 sessions) over 2 months in the autumn of 2008. BCVA BE was 20/25 at the beginning of treatment, and at the end, BCVA was 20/28 in the right eye and 20/22 in the left eye. Over a further 2-year period (March 2009–May 2011), she was treated 28 times: BCVA BE was 20/25 at the beginning, and by the end it was 20/22. Without any further treatment after 2011, she was examined again at the end of 2014 when her BCVA BE measured 20/33. While the deficit was not fully compensated or stable, the observed modifications encouraged us to study and test the possibility of treating amblyopia with protocols derived from acupuncture theory, without any exceptions in the selection of patients and with better results expected in younger ones. Since then the technique has been simplified, and the most effective and repeatable form investigated, based on a theoretical approach and through the analysis of significant reported experiences. The use of a novel type of ultralow-light-level laser (ULLLL) was deemed to be particularly interesting, rather than either needle insertions or the Ma Litang hammer, for the purpose of achieving higher compliance by young patients and shortening treatment session length. The American Academy of Ophthalmology [2][2] has quite recently (2012) carried out a survey of the pathology and, in the framework of the “Preferred Practice Patterns,” proposed optical correction, patching, pharmacological penalization, optical penalization, Bangerter filters, surgery to remove the causes of amblyopia, acupuncture, and vision therapy for the treatment of amblyopia. The abovementioned document reports the use of acupuncture for amblyopia treatment in two clinical trials: The first study found acupuncture over a 15-week period to be as effective as occlusion for 88 children aged 7–12 years who had anisometropic amblyopia [3][3]. In this randomized controlled trial, children had 20/40–20/125 BCVA and no strabismus. The second study examined the effect of adding acupuncture to refractive correction for 83 children aged 3– 7 years who had untreated anisometropic amblyopia (20/40–20/200) [4][4]. At 15 weeks, there was a greater improvement in visual acuity using refractive correction with acupuncture compared with refractive correction alone. In both studies, the acupuncture technique consisted

76 of five acupuncture needles placed and manipulated for 15 minutes 5 times/wk for 15 weeks. In both the above studies, the selected acupoints, needle insertion, manipulation of the needles, and application protocol are indicated. Five acupoints, unilateral GV20 (baihui), bilateral EX-HN5 (taiyang), bilateral BL2 (cuanzhu), unilateral LI4 (hegu), and bilateral BL59 (fuyang), were selected on the basis of the theory and literature reports of TCM as referenced by the authors. The locations of the acupoints are shown in Table 1Table 1 and Fig. 1Fig. 1. Table 1Acupuncture points in the published trials [[3], [4]]. Acupoint Location (see Fig. 1Fig. 1) Baihui On top of the head, 7 cun above the occipital hairline and 5 cun behind GV20 (unilateral) the frontal hairline EX- Taiyang At the temporal dimple and 1 cun behind the midpoint of a line from the HN5 (bilateral) lateral end of the eyebrow to the external canthus Cuanzhu BL2 In the supraorbital notch and at the median end of the eyebrow (bilateral) Hegu At the dorsum of the hand, and between the first and second metacarpal LI4 (unilateral) bones Fuyang 3 cun above the site between the Achilles tendon and the lateral BL59 (bilateral) malleolus

Figure 1 Acupuncture points in the published trials [[3], [4]]. 2.1.1. Patients Thirteen young patients (2 males and 11 females), with a mean age of 7 years (range 3–11 years), were recruited into the study after obtaining formal written consent from their parents, and the patients underwent treatment. All patients were amblyopic or had BCVA < 20/20 (Snellen fraction). Patients with any of the following conditions were excluded from the present study:  • eye diseases  • vision deficits not previously corrected  • use of optimal correction spectacles for <6 months  • absence of stabilized BCVA  • patch occlusion of the best eye  • strabismus  • a previous history of conventional treatments These patients, inhomogeneous for clinical conditions and/or applied treatment, were not included in the present report that deals with patients receiving laser-acupuncture treatment only.

77 2.1.2. Measurements Visual acuity was measured via the Snellen fraction, always by the same operator, in the same ward, by the same visual acuity tester, and under identical conditions. All patients wore the prescribed spectacles when needed. For each participant, visual acuity was tested first in the amblyopic eye and then in the healthy eye. Thirty minutes after treatment, the visual acuity was measured in the amblyopic eye. Anisometropia, astigmatism, and myopia were corrected fully, whereas hyperopia was either fully corrected or symmetrically undercorrected by no more than 1.50 D. Glasses had to be worn all day. Whenever a change in the visual defect was detected, new glasses were prescribed. One treatment session was performed weekly by the same operator—a certified acupuncturist ophthalmologist (MD)—until visual acuity was stabilized or could be improved no further.

2.1.3. Laser acupuncture Based on the above experiences and our first case of a young girl, we have been treating children with amblyopia using acupunctural techniques, using Biolite (RGM SpA, Genoa, Italy), a new internationally patented ULLLL used to perform laser acupuncture. The ULLLL treatment affords much higher compliance than needling, especially in children. Biolite features a modulated red light (λ = 635 nm) square-wave pulsed emission with an average optical power of approximately 0.02 mW over a 0.13-cm2 spot [[5], [6]]. The extremely low average power is generated through the combination (logical AND) of two square-wave modulations of the 3-mW laser diode emission: a 100-Hz (duty cycle 1%) and a 1- Hz (duty cycle 50%) modulation. The former modulation (100 Hz) is electronically generated, whereas the latter (1 Hz) is manually generated by the operator (using a push button) emitting a half-second flash every second. A converging/diverging lens, absorbing around 30% of the emitted power, focuses the beam at approximately 30 mm from the probe tip on a 0.13-cm2 spot. The resulting values of power (0.015 mW), power density (0.115 mW/cm2), and energy dosimetry at 20 seconds (0.3 mJ; 2.3 mJ/cm2) are well below any known effectiveness threshold [7][7]. Nevertheless, there is sound evidence of acupunctural effectiveness most probably linked to the square-wave modulation of the emission [8][8], and its capability to propagate seems to depend on mechanical effects induced through the fibroblast within the ubiquitous extracellular matrix, according to patterns that very likely correspond to the acupuncture meridians [[9], [10], [11]]. The choice of the two modulation frequencies is linked to known responses observed in electroacupuncture [[12], [13]].

2.1.4. Acupoint selection and application protocol in our study The acupoint selections made in the previous studies were modified for the following reasons:  • GV20 was deemed not to be useful as it is located in the scalp and was therefore discarded.  • BL1, in our opinion, is more effective than BL2 and can be safely selected for laser acupuncture, which does not need needle application. Furthermore, BL1 is the interconnecting point of LI, ST, TB, and GB meridians.  • LI1 was added to LI4 (bilateral) owing to its well-known efficacy in improving blood flow in the cerebral [14][14] and central retinal arteries.  • In addition, BL64 and BL67 were added to BL59 as they are known to activate the cortical regions involved in visual perception [[15], [16], [17]]. Furthermore, BL64 is specific for eye affections deriving from kidney DeQi depletion.  •

78 ST1, GB1, GB20, and TB23 were added as they are known to be specific to eye and vision pathologies [[16], [17], [18], [19], [20], [21]].  • SP2 was added as, according to the TCM, it tonifies the spleen meridian in relation to the macula in the “five-circle” TCM theory. The corresponding selection is shown in Table 2Table 2 and Fig. 2Fig. 2. Table 2Selected acupuncture points. Acupoint Location (see Fig. 2Fig. 2) EX- At the temporal dimple and 1 cun behind the midpoint of a line from the Taiyang HN5 lateral end of the eyebrow to the external canthus BL1 Jing Ming In a depression, 1 cun above the inner canthus of the eye LI1 Shang Jang 1 cun posterior to the corner of the nail on the radial side of the index finger At the dorsum of the hand, and between the first and second metacarpal LI4 Hegu bones BL59 Fuyang 3 cun above the site between the Achilles tendon and the lateral malleolus Below the tuberosity of the fifth metatarsal bone at the junction of the red BL64 Jing Gu and white skin BL67 Zhi Yin 0.1 cun posterior to the corner of the nail on the lateral side of the little toe ST1 Chengqi Below the pupil, between the eyeball and the infraorbital ridge Tong Zi0.5 cun lateral to the outer canthus of the eye in a depression on the lateral GB1 Liao side of the orbit In a depression between the upper portion of the sternocleidomastoid muscle GB20 Fengchi and the trapezius, level with GV16 TE23 Sizhukong In a depression at the lateral end of the eyebrow On the medial side of the big toe, distal and inferior to the first metatarsal SP2 Dadu digital joint in a depression at the juncture of the red and white skin

Figure 2 Selected acupoints. View Large Image | View Hi-Res Image | Download PowerPoint Slide The above criteria were derived from specifically referenced documents and from several TCM textbooks [[22], [23], [24], [25], [26], [27], [28], [29], [30], [31]]. Unfortunately, some of the latter are out of print or generally not easy to find. The protocol and preliminary evidence were proposed at the fifth European Congress for Integrative Medicine in Florence, Italy (20–22 September 2012). The acupoints were stimulated bilaterally. Each of the selected points was stimulated with 20 half-second flashes (flash repetition rate 1/s) using Biolite. The tip of the emitting probe was kept at approximately 30 mm from the skin (spot area 0.13 cm2) and perpendicular to the selected acupoint.

2.2. Results As is quite normal for this kind of pathology, the range of deficits was rather wide and the patients were not homogeneous by age, sex, or anthropometrics. Rather than attempting a

79 statistical assessment, it was preferred to present the 13 cases as individual experiences (Table 3Table 3). Table 3Amblyopia patients' main data. Name AL BA BY BM BS BA RS CF CG CA PA MG PD Age (y) 7 11 5 9 9 6 8 9 3 6 5 8 5 Sex M F F M F F F F F F F F F (M/F) sf. sf. cyl. cyl. sf. cyl. sf. cyl. +2.50 = cyl. +3.50 = Refracti +1.5 +0.5 −0.50 = +2.5 sf. +0.50 = +2.5 Non cyl. Non +1 cyl. on right0 None 0 cyl. −1 0 +3.5 cyl. +2 0 e +0.50 e +0.50 eye 0 90° 95° 90° 180° 80° 95° 90° 20° 90° sf. sf. cyl. sf. cyl. Refracti −1 = c −0.50 = +2.5 sf. +0.50 = cyl. +1 Non sf. + Non on left None None yl. +3cyl. −1 None 0 +1.5 cyl. +4 +3 e 2 e eye 0 90° 90° 90° 180° 90° 90° First treatment Evaluation in Month/ May/ Jan/ Feb/ Apr/ Oct/ Feb/ Mar/ Jun/1 Mar/11 Jan/13 Sep/12 May/11 Jun/12 year 13 12 14 14 13 12 12 2 BCVA 20/2 20/2 20/2 20/3 20/2 20/3 20/25 20/22 20/24 20/33 20/40 20/28 20/30 RE 2 0 5 3 8 3 BCVA 20/2 20/2 20/2 20/2 20/2 20/3 20/20 20/13 20/25 20/33 20/13 20/28 20/33 LE 2 5 5 0 8 3 Number of treatments Session 7 4 11 8 6 10 8 12 6 9 9 8 5 s Evaluation out Month/ Jul/1 Feb/ Jun/1 Jun/ Dec/ Mar/1 Jun/1 May/ Jul/1 May/11 Nov/12 Jun/11 Jul/12 year 3 12 4 14 13 3 2 12 2 BCVA 20/2 20/2 20/2 20/2 20/2 20/2 20/20 20/20 20/20 20/20 20/33 20/22 20/22 RE 0 0 5 8 0 5 BCVA 20/2 20/2 20/2 20/2 20/2 20/2 20/20 20/13 20/22 20/20 20/13 20/22 20/30 LE 0 0 5 0 0 5 Second treatment Evaluation in Month/ Sep/1 Jun/1 Jun/1 Oct/1 Mar/ Nov/11 Sep/11 Jan/13 year 3 3 3 4 13 BCVA 20/2 20/2 20/23 20/22 20/22 20/33 20/28 20/22 RE 2 8 BCVA 20/2 20/2 20/20 20/13 20/22 20/13 20/28 20/25 LE 2 5 Number of treatments Session 8 4 6 4 7 14 4 s Evaluation out Month/ Jan/1 Dec/11 Jun/1 Oct/11 Jul/1 Nov/ Jun/13 Mar/

80 year 4 3 3 14 13 BCVA 20/2 20/2 20/20 20/21 20/20 20/33 20/22 20/20 RE 2 5 BCVA 20/2 20/2 20/20 20/13 20/20 20/13 20/22 20/20 LE 2 2 Third treatment Evaluation in Month/ Jun/1 Oct/12 May/14 year 4 BCVA 20/2 20/21 20/20 RE 2 BCVA 20/2 20/13 20/22 LE 2 Number of treatments Session 7 4 10 s Evaluation out Month/ Jul/1 Dec/12 Nov/14 year 4 BCVA 20/2 20/21 20/20 RE 0 BCVA 20/2 20/13 20/22 LE 0 Control visit Month/ Oct/1 Sep/ Mar/ Mar/ Oct/1 Mar/ Oct/1 Nov/14 Apr/14 year 4 14 15 15 4 15 3 BCVA 20/2 20/2 20/2 20/2 20/2 20/20 20/21 20/20 20/20 RE 0 0 8 0 2 BCVA 20/2 20/2 20/2 20/2 20/2 20/20 20/13 20/20 20/20 LE 0 0 0 0 2 P P P N N P P P P P P P P BCVA = best corrected visual acuity; LE = left eye; N = negative result; P = positive result; RE = right eye. The case reported in the “Introduction” is not included because the patient was treated with many different techniques that cannot be compared with the ULLLL treatment applied to the 13 young patients. As can be observed in Table 3Table 3, the patients were kept under observation for quite a long period of time. The results obtained—11 remarkable improvements—are also reported in Table 3Table 3 and encourage us to proceed further in refining the technique, which, besides being effective and devoid of any known side effects, is readily accepted by the patients, as it is absolutely painless and its application process is fast. It should be noted, however, that the 13 patients underwent a total of 171 laser-acupuncture sessions for an average of 13.15 sessions/patient, and one of the two nonrespondent patients (female BS, 9 years old) discontinued the treatment after the first cycle of just six laser- acupuncture sessions. It seems reasonable to suggest that after a longer cycle, she would probably have experienced some benefit.

3. Discussion

81 3.1. Amblyopia prevalence, its social relevance, and recommended intervention age The document by the American Academy of Ophthalmology [2][2] states that “Amblyopia is an important public health problem because of its prevalence among children and because visual impairment from amblyopia is lifelong and can be profound. Both amblyopia and treatment can have a substantial impact on quality of life [[32], [33], [34]]. Prevalence estimates range from 0.8% to 3.3% depending on the population studied and the definition used” [[35], [36], [37], [38], [39], [40], [41], [42]DOI: http://dx.doi.org/10.1016/j.ophtha.2009.04.034, [43], [44]]. Amblyopia, more commonly known as “lazy eye,” is defined as a unilateral or, less commonly, a bilateral reduction of BCVA that occurs in the setting of an otherwise normal eye. The causes of amblyopia lie both in the eye and in vision-related cortical activities: whenever the perceived or interpreted visions do not match, the “blurred” perceived vision is discarded, resulting in the “lazy eye” condition. The lazy eye condition also leads to the development of an incorrect visual system. The process of development and integration of visual functions starts at 6–7 months and is completed by the age of 10–12 years. The first sentence of the same chapter of the abovementioned document actually states that “Success rates of amblyopia treatment decline with increasing age,” clearly stressing the need for treatment suitable for very young children. It is confirmed to some extent that the effects may reside in functional adaptive control in the “plastic phase,” although good results were found even at the age of 14 years. The same technique was tested on adults, although no significant results were observed.

3.2. Rapidity and stability of the improvement The results of treating amblyopic children with laser acupuncture, in our experience, are sometimes obtained very rapidly. Thirty minutes after the treatment, an improvement can often be observed in visual acuity. This benefit may last, with slight decay, into the following week. After a few treatment sessions, usually once a week for 6 weeks (hence, much faster than in the 2 traditional acupuncture trials reported), the improvement is substantial and stabilizes for up to several months. Sometimes, further sessions are required at an interval of several months.

3.3. Side effects and patient compliance The treatment is devoid of any side effects and is totally painless, and young patient compliance is very high. Compared with optical penalization or patching techniques, this laser-acupuncture treatment is generally accepted much more readily by children and their parents, and, by allowing binocular vision to be retained, it avoids the risk of strabismus. While acupuncture has been shown to be effective, needling around the eyes certainly does not meet with compliance by young patients; they might more agreeably be treated with ULLLL, which appears to be as effective as classical acupuncture.

3.4. Action mechanisms As mentioned with reference to the two trials involving acupuncture treatment of amblyopia, “Acupuncture for amblyopia requires further investigation, including an evaluation of cost- effectiveness [45][45]. The effect of acupuncture on strabismic amblyopia has not been studied. The mechanism of action for acupuncture in the treatment of amblyopia is unknown.” Although far from providing a full explanation of a possible mechanism, as mentioned in the paragraph describing acupoint selection, it is suggested that the increased blood perfusion of the eye [14][14] and the observed activation of the vision-related cortical areas [[15], [16], [17]] might be a part of the action mechanism.

3.5. Application in current routine and protocol optimization The encouraging results obtained to date with Biolite and the indications of the American Academy of Ophthalmology for acupuncture, in the absence of any side effects, indeed point to the possible application of this treatment in current therapeutic practice.

82 We submit that our study can also serve the purpose of ameliorating the application protocol— selected acupoints and number and frequency of sessions, which has been modified but needs to be optimized.

Lower Back Pain May Respond Better To Acupuncture Therapy Than Conventional Therapy Written by Christian Nordqvist Published: Monday 24 September 2007

If you suffer from lower back pain you might find that six months of acupuncture gives you superior results to conventional therapy, says a report in Archives of Internal Medicine (JAMA/Archives), September 24th issue. However, the study also indicates that sham acupuncture seems to be effective as well.

The authors explain "Low back pain is a common, impairing and disabling condition, often long- term, with an estimated lifetime prevalence of 70 percent to 85 percent. It is the second most common pain for which physician treatment is sought and a major reason for absenteeism and disability."

Although acupuncture is becoming increasingly popular as an alternative therapy, to date its usefulness as a treatment for low back pain has been unclear, say the researchers.

Michael Haake, Ph.D., M.D., University of Regensburg, Bad Abbach, Germany, and team carried out a randomized clinical trial with 1,162 patients, their average age was 50. They had all had chronic low back pain for about eight years (average).

They were divided into three groups:

1. Verum acupuncture, two 30-minute sessions per week, ten sessions total - 387 patients This consisted of needling fixed points and additional points to a depth of 5 millimeters to 40 millimeters based on traditional Chinese medicine

2. Sham acupuncture, two 30-minute sessions per week, ten sessions total - 387 patients This consisted of inserting needles superficially - 1 to 3 millimeters into the lower back, but avoiding all the known verum points or meridians.

3. Conventional therapy, two 30-minute sessions per week, ten sessions total - 388 patients This consisted of a combination of drugs, physical therapy and exercise.

For those who had a partial response to treatment - 10% to 50% pain reduction - five additional sessions were offered.

The authors wrote "A total of 13,475 treatment sessions were conducted (verum acupuncture, 4,821; sham acupuncture, 4,590; conventional therapy, 4,064),"

59.9% (232) of those in the verum group received five additional sessions, as well as 54% (209) in the sham group and 52.5% (192) in the conventional group.

The researchers defined a Response Rate as a 33% pain improvement and a 12% functional ability improvement.

The authors noted "At six months, response rate was 47.6 percent in the verum acupuncture group, 44.2 percent in the sham acupuncture group and 27.4 percent in the conventional therapy

83 group. Differences among groups were as follows: verum vs. sham, 3.4 percent; verum vs. conventional therapy, 20.2 percent; and sham vs. conventional therapy, 16.8 percent."

The researchers concluded "The superiority of both forms of acupuncture suggests a common underlying mechanism that may act on pain generation, transmission of pain signals or processing of pain signals by thecentral nervous system and that is stronger than the action mechanism of conventional therapy. Acupuncture gives physicians a promising and effective treatment option for chronic low back pain, with few adverse effects or contraindications. The improvements in all primary and secondary outcome measures were significant and lasted long after completion of treatment."

Archives of Internal Medicine 2007;167(17):1892-1898. Written by Christian Nordqvist

Ear acupuncture 'boosts weight loss'

Written by Belinda Weber Published: Tuesday 17 December 2013

Ear acupuncture can help people lose weight, with better results if practitioners stimulated five points instead of just one, researchers from Korea claim in a study published in the BMJ journalAcupuncture in Medicine. Auricular acupuncture was first used in France in 1956 by Dr. Paul Nogier. He noticed that patients' backache was cured when they received a burn on the ear. Intrigued, he started mapping the ear, pinpointing the spots that correlate to various organs or systems in the body. Dr. Nogier pictured the ear as a curled up fetus with its head pointing downwards, and began treating his patients by applying pressure to the spot associated with each organ. For the study, the researchers compared the efficacy of acupuncture treatments in helping obese patients lose weight, comparing the standard Korean five point treatment with acupuncture using a single point of stimulation. They also included a control group who were given a "sham" treatment. In a randomized controlled clinical trial, 91 Koreans were recruited - 16 men and 75 women - all of whom had a body mass index (BMI) equal to or greater than 23. None of the participants had received any other weight control treatments in the last 6 months. The participants were randomly divided into three groups, one group to receive the five point acupuncture treatment, another the one point acupuncture treatment and the third group, the control "sham" treatment. Needles and trickery For the trial, the first group had small indwelling needles positioned at the five ear acupuncture sites - Shen-men, stomach, spleen, hunger, endocrine. These were covered with surgical tape and would remain in place for a week. The following week, new needles would be inserted into the corresponding points on the other ear, with the process being repeated over the course of the 8 week trial. The second group of participants followed the same treatment process but only had one needle inserted - at the hunger point. The remaining group believed they were receiving the five point treatment, but the needles were removed removed immediately after insertion, although the surgical tape remained. The same doctor performed the procedure on all three groups. All three groups were then asked to follow a restricted diet and asked not to take additional exercise during the trial.

84 BMIs, waist circumference, body fat mass, percentage body fat and blood pressure were all measured at the start and end of the trial, and at the midway point. During the trial, 24 people dropped out - 15 of whom were in the control group, perhaps suggesting that they found it difficult to regulate their hunger and cope with the restricted diet. But of the participants who completed the trial, there were significant differences in results. At the midway point, there were already noticeable differences in BMI with the five point treatment group showing a 6.1% reduction, the one point group a 5.7% reduction while the sham group showed no reduction at all. Both active treatment groups also showed weight loss. These findings were supported by the final results, which also showed that the five point treatment group had reduced measures of body fat. The researchers did note that there were no significant differences in blood pressure between the three groups. The researchers conclude: "Both five-needle acupuncture treatment generally used in Korean clinics and one-needle treatment at the hunger point appear to be effective in reducing body weight in the short term." They suggest that the five-needle treatment may be more effective at reducing waist circumference and abdominal fat. Written by Belinda Weber

In Vitro Fertilization Aided By Acupuncture

Written by Peter M Crosta Published: Friday 8 February 2008

According to a study published in BMJ and available on bmj.com, rates of pregnancy and live birth among women undergoing in vitro fertilization can be improved when acupuncture is given with embryo transfer.

In vitro fertilization (IVF) is a technique in which egg cells are fertilized by sperm outside the woman's womb and then transferred back to the womb.

Ten to 15% of couples seek fertility treatment because they have difficulty conceiving at some point in their reproductive lives; IVF is a common treatment option. About 200,000 babies worldwide were conceived through IVF in the year 2000. Due to the cost, time, and stress of IVF, new drugs and technologies have been developed in order to improve success rate. However, progress has been limited.

The study, conducted by researchers at the University of Maryland School of Medicine and the VU University in Amsterdam, was motivated by acupuncture's history of being used in China for centuries to regulate the female reproductive system. Ultimately, the researchers desired to determine whether acupuncture given with embryo transfer improves the pregnancy rates and live birth rates among women undergoing IVF.

A systematic review of seven trials involving 1,366 women undergoing IVF allowed researchers to compare acupuncture - administered within one day of the embryo transfer procedure - with sham (fake) acupuncture or no additional treatment. A broad selection of women at various ages and different causes and durations ofinfertility were included in the trials, and the overall quality of trials was good, according to the researchers.

The researchers found that the odds of pregnancy were increased by 65% when acupuncture is administered along with the embryo transfer process compared to sham acupuncture or no additional treatment. In other words, for every ten women treated, one additional pregnancy is

85 expected. However, the acupuncture benefit was smaller or non-significant in trials where the baseline pregnancy rates were already high.

The authors of the study note that in general, their review suggests that acupuncture given with embryo transfer can improve rates of pregnancy and live birth among women undergoing IVF. At about $12,400 per cycle in the US, the burden of expensive IVF procedures may be reduced even if the increased likelihood of success with acupuncture is small.

Further studies are needed to confirm these preliminary findings and to research the relationship between baseline rates of pregnancy and the effectiveness of additional acupuncture.

Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis Eric Manheimer, Grant Zhang, Laurence Udoff, Aviad Haramati, Patricia Langenberg, Brian M Berman, Lex M Bouter BMJ, February 7, 2008 doi:10.1136/bmj.39471.430451.BE Click Here to See Article Online Written by Peter M Crosta

Neuronal activation by acupuncture at Yongquan and sham acupoints for DOC: A PET study

Published: Tuesday 20 May 2014

Acupuncture is a traditional Chinese medicine technique that is often used to help improve the level of consciousness in patients with disorder of consciousness (DOC). However, the responses to stimulation of acupoints in patients with DOC are not fully understood. Hao Zhang and colleagues from China Rehabilitation Research Center found that acupuncture at the Yongquan acupoints induced stronger neuronal activity than acupuncture at the sham acupoints shown on positron emission tomography (PET). These researchers believe that acupuncture at the Yongquan acupoints may increase synaptic activity in some areas of the brain. The putamen, cingulate cortex, frontal lobe and cerebellum are involved in conscious thought. This may explain the mechanism by which acupuncture at the Yongquan acupoints results in improvement of patients with DOC. These finding have been published in Neural Regeneration Research (Vol. 9, No. 5, 2014).

This shows brain activation during acupuncture at the Yongquan acupoint in patients with disorder of consciousness (transverse

86 section). The red color indicates areas of activation. P: Putamen. Credit: Neural Regeneration Research Article: " Neuronal activation by acupuncture at Yongquan (KI1) and sham acupoints in patients with disorder of consciousness: a positron emission tomography study," by Hao Zhang1, Xinting Sun1, Sujuan Liu2, Yingmao Chen3, Feng Ling4 (1 Department of Neurorehabilitation, China Rehabilitation Research Center, Beijing, China; 2 Department of Hyperbaric Oxygen, Fuxing Hospital, Beijing, China; 3 Department of Nuclear Medicine, Chinese PLA General Hospital, Beijing, China; 4 Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China) Zhang H, Sun XT, Liu SJ, Chen YM, Ling F. Neuronal activation by acupuncture at Yongquan (KI1) and sham acupoints in patients with disorder of consciousness: a positron emission tomography study. Neural Regen Res. 2014;9(5):500-501.

Plastic handles on disposable acupuncture needles would curb risk of needle buckling

Published: Tuesday 19 August 2014

Replacing copper coil handles on all disposable acupuncture needles with plastic stick handles would not only substantially curb the risk of needle buckling, but would also save tonnes of copper wire and millions of metres of medical grade stainless steel, concludes research published in Acupuncture in Medicine. Single use, disposable acupuncture needles were introduced in the late 1970s, prompted by concerns about the risk of infection of reusable needles. Since that time, they have gradually been adopted worldwide. In clinical practice it is often difficult for the acupuncturist to insert a long needle into tissue, because long fine needles are prone to buckling. Acupuncturists have therefore either resorted to larger needles, which can be more painful for the patient, or to holding the needle shaft during insertion, which poses an infection risk, and contravenes World Health Organization recommendations, say the researchers. Minimising the risk of buckling during the procedure is therefore important to enhance patient comfort and safety, they say. In a bid to find out which handle type might therefore be the best option to resist buckling, they compared the strength of two of the most commonly used designs: copper coil and plastic. They did this by assessing the load needles with each of these handles could sustain, and the stiffness of the stainless steel wires used in different lengths of acupuncture needle. The results showed that the stiffness of the stainless steel wires in both types of needles was similar. But needles with copper coil handles were far more prone to buckling than those with plastic handles, and required more steel wires. The average buckling force of plastic handle needles was almost 47% higher than that of copper coil handle needles for those of 30 mm length, and almost 31% higher for those of 60 mm length. Replacing copper coil handles with plastic handles would also be more eco friendly, say the researchers. Currently, around 2 billion disposable acupuncture needles are used annually. Most are manufactured in China, and at least half of them, with copper coil handles. Based on this level of usage, switching to plastic handles could save up to 100 tonnes of copper wires and 20 million metres of medical grade stainless steel every year, the researchers calculate. They admit that plastic handles are less easy to use for electroacupuncture, but a new design of needle has recently been developed, which should overcome this, they say. "The evidence for the discontinuation of the widespread practice of using copper coil handles in disposable acupuncture needles is overwhelming," write the authors. At the very least the practice should be re-evaluated, they conclude.

87 The Effectiveness Of Acupuncture For Exercise Tolerance In Heart Failure

Published: Saturday 3 July 2010

Acupuncture can improve exercise tolerance in patients suffering from chronic heart failure. This was determined in a clinical pilot study by the team headed by Dr. Johannes Backs, physician and study director at the Department of Internal Medicine III (Cardiology, Angiology, and Pneumology - Medical Director: Professor Dr. Hugo Katus) of Heidelberg University Hospital. The needles do not increase the heart's pump function, but they seem to have an influence on skeletal muscle strength and thus can increase the walk distance that heart patients can cover. The results of the clinical study, which was conducted with a comparison group treated with placebo acupuncture using dull needles, have been published in the prestigious medical journal Heart.

Acupuncture influences the autonomic nervous system

Chronic weakness of the heart muscle is one of the most frequent diseases and causes of death in Europe. Patients with this disease suffer in particular from a reduction in work capacity. Shortness of breath and fatiguebrought on by physical exercise are signs of the disease.

The disease is much more complex than previously assumed. It is not only the weakening pump function of the heart muscle that is responsible for the symptoms. What is known as the autonomic or vegetative nervous system and various nerve transmitter substances become imbalanced, which further worsens the course of the disease. This is precisely where acupuncture may intervene, by bringing these processes back into balance- it influences the autonomic sympathetic nervous system (excitation), boosts the parasympathetic nervous system (relaxation), and also has an anti-inflammatory affect. Thus far there have been hardly any studies of whether acupuncture can thus influence such life-threatening diseases such as heart failure.

Needles fight exhaustion

The scientists examined patients with heart failure who were treated with the conventional medications and were in stable condition. In addition, patients in the acupuncture group were given ten sessions of acupuncture focusing on the acupuncture points which boost general strength according to Traditional Chinese Medicine and are also known to influence the sympathetic and parasympathetic nervous systems and inflammation markers. The control group was treated with special placebo needles that simulate a needle prick but do not break the skin. After this therapy, the acupuncture patients could cover a greater walk distance in the time allowed than the placebo patients. They recovered more quickly and tended to feel subjectively less exhausted. However, the measurable work capacity of the heart was unchanged.

Inflammation messengers cause muscle fatigue

We already know from other studies that heart patient's ability to tolerate exercise is independent of the pump function of the heart. It appears rather that easily becoming fatigued stems primarily from the muscles. Inflammation messengers in the blood are increased in chronic heart failure and make the muscles tired. They activate what are known as ergoreceptors in the muscle that signalize to the body that the muscle cannot sustain the workload. "The blood level of a certain messenger, tumor necrosis factor alpha (TNF alpha) actually drops after the real acupuncture treatment. Since TNF alpha leads to a reduction of muscle mass and muscle strength among

88 other things, this would explain the positive effect on skeletal muscle function," explains Dr. Arnt Kristen, one of the authors of the study.

Better long-term prognoses through acupuncture?

"Most studies on the effectiveness of acupuncture have methodological weaknesses, as there are no placebo controls and the study participants are not 'blinded'. This means that the patients know which treatment they are given and may therefore have certain expectations," according to Backs. "In our studies, all patients thought they had received 'real' acupuncture." A fascinating question for the future will be whether relatively low-cost acupuncture can improve the prognosis for cardiac patients over the long term.

References: Arnt V. Kristen, Boris Schuhmacher, Kathrin Strych, Dirk Lossnitzer, Hans-Christoph Friederich, Thomas Hilbel, Markus Haass, Hugo A. Katus, Antonius Schneider, Konrad M. Streitberger, Johannes Backs. Acupuncture Improves Exercise Tolerance of Heart Failure Patients - a Placebo-Controlled Pilot Study.

Source: Dr. Johannes Backs University Hospital Heidelberg

UM Study Shows Chinese Acupuncture Affects Brain's Ability To Regulate Pain

Published: Tuesday 11 August 2009

Acupuncture has been used in East-Asian medicine for thousands of years to treat pain, possibly by activating the body's natural painkillers. But how it works at the cellular level is largely unknown.

Using brain imaging, a University of Michigan study is the first to provide evidence that traditional Chineseacupuncture affects the brain's long-term ability to regulate pain.

The results appear online ahead of print in the September Journal of NeuroImage.

In the study, researchers at the U-M Chronic Pain and Fatigue Research Center showed acupuncture increased the binding availability of mu-opoid receptors (MOR) in regions of the brain that process and dampen pain signals - specifically the cingulate, insula, caudate, thalamus and amygdala.

Opioid painkillers, such as morphine, codeine and other medications, are thought to work by binding to these opioid receptors in the brain and spinal cord.

"The increased binding availability of these receptors was associated with reductions in pain," says Richard E. Harris, Ph.D., researcher at the U-M Chronic Pain and Fatigue Research Center and a research assistant professor of anesthesiology at the U-M Medical School.

One implication of this research is that patients with chronic pain treated with acupuncture might be more responsive to opioid medications since the receptors seem to have more binding availability, Harris says.

These findings could spur a new direction in the field of acupuncture research following recent

89 controversy over large studies showing that sham acupuncture is as effective as real acupuncture in reducing chronic pain.

"Interestingly both acupuncture and sham acupuncture groups had similar reductions in clinical pain," Harris says. "But the mechanisms leading to pain relief are distinctly different."

The study participants included 20 women who had been diagnosed with fibromyalgia, a chronic pain condition, for at least a year, and experienced pain at least 50 percent of the time. During the study they agreed not to take any new medications for their fibromyalgia pain.

Patients had position emission tomography, or PET, scans of the brain during the first treatment and then repeated a month later after the eighth treatment.

Notes: Additional authors: Jon-Kar Zubieta, M.D., Ph.D., David J. Scott, Vitaly Napadow, Richard H. Gracely, Ph.D, Daniel J. Clauw, M.D. Funding: Department of Army, National Institutes of Health Reference: Journal of NeuroImage, Vol. 5, No. 83, 2009

Source: Shantell M. Kirkendoll University of Michigan Health System

Activation of functional brain areas of stroke patients improved by acupuncture at Waiguan

Published: Wednesday 6 August 2014

Both acupuncture at Waiguan (SJ5) and sham acupuncture can activate/deactivate several brain regions in patients with ischemic stroke, but there are some difference in Brodmann areas 4, 6, 8, Brodmann areas 7, 39, 40, Brodmann areas 18, 19, 22 and Brodmann areas 13, 24, 32, 28. Most studies addressing the specificity of meridians and acupuncture points have focused mainly on the different neural effects of acupuncture at different points in healthy individuals. Dr. Ji Qi and co-workers from School of Traditional Chinese Medicine, Southern Medical University in China examined the effects of acupuncture on brain function in a pathological context, and compared the effects between Waiguan and sham points in 16 patients with ischemic stroke. Compared with sham acupuncture, acupuncture at Waiguan in stroke patients inhibited Brodmann area 5 on the healthy side. These findings, published in Neural Regeneration Research (Vol. 9, No. 3, 2014), indicated that the altered specificity of sensation-associated cortex (Brodmann area 5) is possibly associated with a central mechanism of acupuncture at Waiguan for stroke patients. Article: " Acupuncture at Waiguan and sham points influences activation of functional brain areas of ischemic stroke patients: a functional magnetic resonance imaging study" by Ji Qi1, Junqi Chen2, Yong Huang1, Xinsheng Lai3, Chunzhi Tang3, Junjun Yang4, Hua Chen5, Shanshan Qu1 (1 School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong Province, China; 2 Department of Rehabilitation, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong Province, China; 3 School of Acupuncture-moxibustion and Tuina, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China; 4 School of Chinese Medicine, Hongkong Baptist University, Hongkong, China; 5 School of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong Province, China)

90 Qi J, Chen JQ, Huang Y, Lai XS, Tang CZ, Yang JJ, Chen H, Qu SS. Acupuncture at Waiguan and sham points influences activation of functional brain areas of ischemic stroke patients: a functional magnetic resonance imaging study. Neural Regen Res. 2014;9(3):293-300.

Acupuncture, Acupressure And Aromatherapy Efficient In Tackling Pain

Written by Petra Rattue Published: Tuesday 27 September 2011

Many patients suffering from chronic pain try alternative and complementary treatments as these are often viewed as natural and therefore risk-free.

Prof. Edzard Ernst (Exeter, UK) warned at the EFIC Congress 'Pain in Europe VII' that patients are being bombarded with misinformation on the subject but that in fact very few alternative pain treatments are supported by well-founded evidence. However, evidence was presented during the Congress that therapies, such asacupuncture, acupressure and aromatherapy are efficient in tackling pain.

Acupuncture after surgery: More than placebo

Acupuncture can work against acute pain, for instance after surgery. Findings of two review papers reveal that acupuncture applied at certain times following an operation actually achieves a moderate reduction in pain relief. According to Dr. Winfried Meissner (Jena, Germany):

"The same goes for ear acupuncture, whereby patients sometimes subjectively do not notice immediate pain reduction, but verifiably require fewer additional analgesics. A role is certainly played by nonspecific or placebo effects, as for example the presence of a therapist or the expectations of patients. However, our own studies show that acupuncture, even in patients under narcosis where no placebo effect can come into play, produces similar effects in the brain as pain relievers. That is a clear indication of a specific analgesic effect through acupuncture."

Complex placebo effects in acupuncture

A study that assessed the extent of the placebo effect in acupuncture studies opens up entirely new opportunities for research. Researchers discovered that the part of the placebo phenomena on the overall effect of acupuncture is potentially greater than the specific effect. Earlier studies also revealed placebo-acupuncture to be more effective than placebo-tablets, however, this raised the question of how placebo-acupuncture could be executed. Most studies treated patients in placebo control groups by inserting needles into parts of the body that were not acupuncture points (sham acupuncture), however, the actual inserting also produces physiological effects. Newer studies therefore started using non-penetrating telescopic blunt needles (placebo needles) for control purposes that produce the same piercing feeling as 'real' needle.

PD Dr. Konrad Streitberger (Bern, Switzerland) explained at the EFIC Congress:

"Studies using functional magnetic resonance imaging (fMRI) showed that real acupuncture not only causes stronger activation or deactivation response patterns than placebo treatment in pain associated areas of the brain, but also that this effect can be modulated by a positive expectation.

91 This shows that different mechanisms are at work in acupuncture whose complex relationships we do not fully understand and that will still require extensive research."

Positive influence of acupressure in chronic neck pain

Acupressure, like acupuncture but without the use of needles works by applying finger pressure onto reflex points that lie directly within the area of pain or slightly outside. A new study presented by a Japanese research group revealed that both approaches, acupuncture as well as acupressure significantly reduced chronic neck pain. Treating reflex points in pain areas also achieves an additional positive influence on the autonomic nervous system as it lowers the heart rate and increases heart rate variability. Both are indicators of the organism's adaptability to changing external conditions.

Eucalyptus or lavender: effects on pain and inflammation

Certain essential aromatic oils have analgesic and anti-inflammatory properties. During the Congress, Korean scientists revealed their study results of the effect of rosemary, marjoram (oregano), lavender, eucalyptus and basil essential oils on mice. Depending on the kind of irritation, eucalyptus and lavender proved to be the strongest painkillers with eucalyptus proving to have even stronger analgesic effects compared to a similar dose of morphine. According to the scientists, an additional plus-point was that "eucalyptus oil was also analgesic when the mice were pre-treated with naloxone, an agent that cancels the analgesic effect of opioids in the body, whereas the effect of lavender and basil oil was blocked." Written by Petra Rattue

Acupuncture May Be Beneficial In Relieving Indigestion During Pregnancy

Written by Stephanie Brunner Published: Wednesday 10 June 2009

A small study published in Acupuncture Medicine reports that acupuncture may be beneficial in easing symptoms of indigestion which are very frequent in pregnant women. The hormonal changes in the body during pregnancy cause heartburn, stomach pain and discomfort, reflux, belching and bloating. Between 45 to 80 percent of women are reported to experience those symptoms.

The symptoms are likely to increase with the evolution of the pregnancy. Many mothers-to- be are reluctant to take medicine due to fear of harming the developing fetus. Even though, in most cases the discomfort is not severe, it does affect the quality of life.

In this study, forty two pregnant women with symptoms of indigestion were assigned randomly to either conventional treatment (counseling on nutrition and indigestion cures) or conventional treatment in addition to acupuncture sessions once or twice a week.

All of the women were between fifteen to thirty weeks of pregnancy, and aged fifteen to thirty nine.

At the beginning of the study, the symptoms were evaluated and recorded, and then every two weeks until the conclusion of the research after eight weeks.

In the end, the study assessed twenty women in the acupuncture group and sixteen in the conservative treatment group, since six women dropped out before the research was completed.

92 Results showed that the women in the acupuncture group had less severe symptoms and required less medication than women in the conventionally treated group.

The average intensity of heartburn which was the most frequent symptom, halved for three out of four of the twenty women receiving acupuncture.

This measures to a proportional drop of forty four percent for those in the traditionally treated group.

Seven of the women in each group took antacids. On average, the ones receiving acupuncture needed 6.3 fewer doses. Those receiving conventional treatment increased their intake by 4.4 doses, on average.

Once their treatment was finished, fifteen of the women receiving acupuncture reported that their diet had improved by fifty percent. In comparison, less than one in three reported that improvement in the other group.

In addition, fourteen of the women receiving acupuncture mentioned their sleep had a fifty percent improvement. There was just one in four in those treated conservatively.

The authors concede that additional research involving larger numbers is required to validate these findings. They suggest that acupuncture could be beneficial. They write: "It is simple to apply and if used in an appropriate manner, can reduce the need for medication."

"Acupuncture for dyspepsia in pregnancy: a prospective, randomised, controlled study" Joa˜o Bosco Guerreiro da Silva, Mary Uchiyama Nakamura, Jose´ Antonio Cordeiro, Luiz Kulay Jr, Rassen Saidah doi:10.1136/aim.2009.000497 Acupunct Med Written by Stephanie Brunner

Acupuncture Prevents Depression After Antidepressant Cessation 21 April 2016

Acupuncture prevents depression relapses for patients completing progressive antidepressant medication cessation. Researchers find acupuncture effective in both the short and long-term for improving positive patient outcomes for patients ceasing antidepressant medication intake. The total effective rate, short-term withdrawal syndrome rate, and long-term relapse rates improve significantly with the implementation of acupuncture into patient management.

Auricular Acupoint Acupuncture alleviates depression and prevents relapses for patients withdrawing from antidepressant drug use. Research conducted at the Anhui University of Chinese Medicine

93 demonstrates that acupuncture minimizes risks associated with cessation of antidepressant drug use. The findings were published in the Shanghai Journal of Acupuncture and Moxibustion. Two groups of patients underwent identical progressive medication reduction protocols. One group received acupuncture in addition to medication reduction. Results were tabulated based on the Hamilton Depression Scale (HAMD), measured at three time points: before treatment, one week after completion of medication cessation, one year after medication cessation. Let’s look at short and long-term results and then go over how the researchers achieved clinical successes. Acupuncture produced a 50% improvement in short-term withdrawal syndrome outcomes. The withdrawal syndrome occurrence rate measured one week after cessation of medication use was 3.3% for patients receiving acupuncture and 53.3% for patients that did not receive acupuncture. Acupuncture produced additional short-term benefits. A total of 93.3% of patients receiving acupuncture successfully completed medication cessation measured at the one week time point. For patients that did not receive acupuncture, that number drops to 73.3%. Long-term results are significant. At the one year time point, the relapse rate for patients receiving acupuncture treatments during progressive medication withdrawal was 13.3%. The relapse rate jumps to 40.0% for patients that did not receive acupuncture during progressive medication reduction. Antidepressant medication dose reductions were adjusted every two weeks for all patients in the study. The initial reduction involved cutting medication dosage by 50%. After two weeks, the reduction was 25% of the original dose. After another two weeks, the dosage was adjusted to 12.5% of the original amount. In the final stage, medication was completely eliminated from patient care. Acupuncture was applied to the following acupoints for all patients in the treatment group:  Baihui, DU20  Yintang, extra  Shenting, DU24  Shuigou, DU26  Neiguan, PC6  Jianshi, PC5  Shanzhong, CV17  Hegu, LI4  Zusanli, ST36  Sanyinjiao, SP6 Supplementary acupoints were added for specific differential diagnostic considerations within the Traditional Chinese Medicine (TCM) system:  Heart and liver fire excess: Zhongchong (PC9), Taichong (LV3)  Liver qi stagnation with spleen deficiency: Taichong (LV3), Zhongwan (CV12)  Heart and stomach deficiency: Shenmen (HT7), Qiuxu (GB40)  Hot phlegm misting heart orifice mania: Neiguan (PC6), Fenglong (ST40)  Heart and spleen deficiency: Shenmen (HT7), Zusanli (ST36) Manual acupuncture techniques were applied to elicit deqi at the acupoints. Electroacupuncture was applied to DU20 and Yintang with a continuous wave. Auricular acupuncture was added to ear Shenmen. Total needle retention time was thirty minutes. Acupuncture was administered once per day for the first two weeks followed by once every other day for an additional two weeks. Next, acupuncture was administered for another two weeks a rate of once every third day.

The study demonstrates that acupuncture reduces risks associated with antidepressant medication cessation. In the short-term, withdrawal syndrome rates decrease markedly. In the long-term, relapse rates drop sharply with acupuncture. Importantly, the total success rate for patients achieving medication cessation increases significantly with the addition of acupuncture to the regimen of healthcare.

94 Lab Findings Related laboratory studies support these findings. Researchers document that acupuncture regulates neural progenitor cells (NPs), which are hippocampal brain cells. They add that acupuncture increases hippocampal neurogenesis, the process wherein neurons are generated. The findings demonstrate that electroacupuncture at acupoints DU20 and GB34 (Yanglingquan) on stress induced rats regulates two major subclasses of NPs. Stress caused cell death and “impaired the proliferation” of the NP subclasses (QNPs, ANPs). The researchers note that electroacupuncture “alleviated depressive-like and anxiety-like behaviors in the rat” group, restored proliferation of ANPs, and limited cell death of QNPs in the hippocampus. The researchers conclude that electroacupuncture is “beneficial to the division of hippocampal NPs. . . . The present study revealed that chronic EA (electro-acupuncture) treatment exerted significant antidepressant effects in a rat model of depression. Further, the mechanisms underlying antidepressant effects of EA were associated with preserving the QNPs from apoptosis and ameliorating the impaired ANPs proliferation in hippocampus.” The researchers add that this is an “underlying mechanism of antidepressant-like effects of EA (electroacupuncture).”

Acupuncture: How Does Acupuncture Work?

Written by Christian Nordqvist Last updated: Wed 17 February 2016

Acupuncture originates from China and has been practiced there for thousands of years. Although there are records of acupuncture being used hundreds of years ago in Europe, it was during the second half of the twentieth century it began to spread rapidly in Western Europe, the United States and Canada. Acupuncture involves the insertion of very thin needles through the patient's skin at specific points on the body - the needles are inserted to various depths. The medical community is not in conclusive agreement about how acupuncture works scientifically. However, we do know that it does have some therapeutic benefits, including pain relief and alleviation from nausea caused by chemotherapy. According to traditional Chinese medical theory, acupuncture points are located on meridians through which gi vital energy runs. There is no histological, anatomical or scientific proof that these meridians or acupuncture points exist. Acupuncture remains controversial among Western medical doctors and scientists. Creating case studies that use proper scientific controls is difficult because of the invasive nature of acupuncture - a clinical study involves a placebo (sham product) compared to the targeted treatment. It is very hard to devise a sham acupuncture control that one can compare to proper acupuncture. While some studies have concluded that acupuncture offers similar benefits to a patient as a placebo, others have indicated that there are some real benefits. This article in a peer-reviewed British Medical Journalexplains that the principles of acupuncture are firmly grounded in science, and you don't need Chinese philosophy either to make it work, or to practice it. According to WHO (World Health Organization) acupuncture is effective for treating 28 conditions, while evidence indicates it may have an effective therapeutic value for many more. People with tensionheadaches and/or migraines may find acupuncture to be very effective in alleviating their symptoms,according to a study carried out at the Technical University of Munich, Germany. Another study at The University of Texas M. D. Anderson Cancer Center found that twice weekly acupuncture treatments relieve debilitating symptoms of xerostomia - severe dry mouth - among patients treated with radiation for head and neck cancer.

95 How does acupuncture work?

Traditional Chinese medicine explains that health is the result of a harmonious balance of the complementary extremes of yin and yang of the life force known as gi or chi. Qi is said to flow through meridians (pathways) in the human body. Through 350 acupuncture points in the body, these meridians and energy flows may be accessed. Illness is said to be the consequence of an imbalance of the forces. If needles are inserted into these points with appropriate combinations it is said that the energy flow can be brought back into proper balance. In Western societies and several other parts of the world, acupuncture is explained including concepts ofneuroscience. Acupuncture points are seen by Western practitioners as places where nerves, muscles and connective tissue can be stimulated. Acupuncture practitioners say that the stimulation increases blood flow while at the same time triggering the activity of our own body's natural painkillers. How did acupuncture become popular in the USA? James Reston, who worked for the New York Times had his appendix removed (appendectomy) during a visit to China in 1971. After surgery he experienced some discomfort and was treated for this with acupuncture. He was surprised to find that the acupuncture treatment helped his discomfort tremendously. He subsequently wrote an article that year titled "Now, About My Operation in Peking". Many believe this article triggered intense interest in acupuncture in the USA. Reston wrote that the acupuncturist "inserted three long, thin needles into the outer part of my right elbow and below my knees and manipulated them...That sent ripples of pain racing through my limbs and, at least, had the effect of diverting my attention from the distress in my stomach. Meanwhile, Doctor Li lit two pieces of an herb called ai, which looked like the burning stumps of a broken cheap cigar, and held them close to my abdomen while occasionally twirling the needles into action. All of this took about 20 minutes, during which I remembered thinking that it was rather a complicated way to get rid of gas... but there was a noticeable relaxation of the pressure and distension within an hour and no recurrence of the problem thereafter." However, a search in The New York Times shows that acupuncture was first reported in 1854, and about once yearly until 1971. How is acupuncture treatment carried out? Acupuncture generally involves several weekly or fortnightly treatments. Most courses consist of up to 12 sessions. A visit to an acupuncturist will involve an exam and an assessment of the patient's condition, the insertion of needles, and advice on self-care. Most sessions last about 30 minutes. The patient will be asked to lie down, either face-up, face-down or on his/her side, depending on where the needless are inserted. The acupuncturist should use single-use disposable sterile needles. As each needle is inserted the patient should feel them, but initially without pain. However, when the needle reaches the right depth there should be a deep aching sensation. Sometimes the needles are heated or stimulated with electricity after insertion. Once inserted, the needles will remain there for about twenty minutes. 96 What are the health benefits and risks of acupuncture? All therapies have benefits and risks. The possible benefits of acupuncture are: . When performed correctly it is safe . There are very few side effects . It is a very effective combination treatment . It is effective in controlling some types of pain . It may be considered for patients who do not respond to pain medications . It is a useful alternative for patients who do not want to take pain medications. The possible risks of acupuncture are: . It is dangerous if the patient has a bleeding disorder . It the dangerous if the patient is taking blood thinners . There may be bleeding, bruising and soreness at the insertion sites . The needle may break and damage an internal organ (very rare) . Unsterilized needles may infect the patient . When inserted deeply into the chest or upper back there is a risk of collapsed lung (very rare). Who may benefit from acupuncture treatment? Even though acupuncture is commonly used on its own for some conditions, it is becoming very popular as a combination treatment by doctors in Western Europe and North America. The use of acupuncture to alleviate pain and nausea after surgery is becoming more widespread. Even the US Air Force began teaching "Battlefield Acupuncture" to physicians deploying to Iraq and Afghanistan in early 2009. Using acupuncture before and during surgery significantly reduces the level of pain and the amount of potent painkillers needed by patients after the surgery is over, a study revealed. Acupuncture is also starting to make inroads into veterinary medicine. This article explains how a marewhich had an infection in her ankle was treated by a vet at Virginia-Maryland Regional College of Veterinary Medicine at Virginia Tech with a combination of acupuncture and traditional therapy. As more and more physicians accept acupuncture, a wider range of illnesses and condition are being considered for acupuncture treatment. A study found that acupuncture may help indigestion symptoms commonly experienced by pregnant women. Some studies have revealed that there are conditions for which acupuncture appears to have no beneficial effect. A study carried out by researchers at Daejon, Busan, South Korea, and Exeter, United Kingdom, found that acupuncture cannot be shown to have any positive effect on hot flashes during the menopause. However, acupuncture does offer effective relief from hot flashes in women who are being treated with the anti-estrogen tamoxifen following surgery for breast cancer, another study found. As it is very difficult to devise clinical studies that measure the effectiveness of acupuncture against a placebo, it is hard to create a definitive list of conditions in which acupuncture may be effective. However, some studies have indicated that acupuncture may help in treating low back pain (according to the SPINE trial), fibromyalgia (Mayo Clinic trials), migraines, postoperative dental pain (the Cochrane review), hypertension (Center for Integrative Medicine at UC Irvine study) and osteoarthritis (according to researchers at the University Medical Center in Berlin, Germany), as well as chemotherapy-induced nausea and vomiting. Other studies have shown that acupuncture may help women with painful periods. A Cochrane trial found that although acupuncture helps people with headaches, fake acupuncture also seems to help them. Exercise and electro-acupuncture treatments can reduce sympathetic nerve activity in women with polycystic ovarian syndrome, a study found. Recent developments on acupuncture from MNT news Acupuncture has 'similar mode of action to psychiatric drugs'

97 In a controlled experiment with rats, acupuncture was effective against treating chronic stress, according to a report in the journal Endocrinology - with the results suggesting a mode of action similar to that of anti-anxiety and antidepressant drugs. Acupuncture may reduce high blood pressure A new study suggests that a form of acupuncture may benefit patients with high blood pressure and lower their risk of stroke and heart disease. Acupuncture 'safe and effective' for chronic pain in children Treating children with chronic pain is challenging; there is limited evidence on the efficacy of pain-relieving therapies among this population. But according to new research, acupuncture may be a safe and effective treatment strategy. Fibromyalgia sufferers might benefit from tailored acupuncture Fibromyalgia affects an estimated 5 million Americans, 80-90% of whom are women. The disorder is characterized by widespread pain and diffuse tenderness. Although there is no cure, tailored acupuncture might provide some welcome respite, according to a new study. Written by Christian Nordqvist http://www.medicalnewstoday.com/articles/156488.php

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98 Professional Development Integrated Medicine

Have a question? Call us at 713-780-9777 or email us at [email protected] Acupuncture

Herbology Tai Chi & Qi-Gong ACAOM means a lot to me. ACAOM marked the beginning of a stage of my life that gave me the tools to become the professional I am now. I love my school and there is not a day I don’t think about ACAOM and my fellow classmates. Carmona Tack, Alumni Carmona Tack runs a private practices and serves a clinic in his home of Costa Rica. He was appointed by the Costa Rican Ministry of Health to develop the country’s first acupuncture licensing program.

Scott Fitzpatrick, LAC, Dipl OM (NCCAOM), Alumni The years at ACAOM were well spent and the curriculum was broad and diverse. Our ability to assess patient aliments using ancient techniques and being able to combine our diagnostics with amazing new technologies truly makes for better patient outcomes. Applications are currently being accepted. Don’t wait. Now is the time to expand your acupuncture education.

BJOG Release: Acupuncture Does Not Help Relieve Birth Pains Published: Thursday 29 April 2010

99 A new review published in BJOG: An International Journal of Obstetrics and Gynaecology states that the available evidence does not show that acupuncture helps diminish pain during labour.

The use of acupuncture to manage pain in labour started in the 1970s but the evidence of its benefits remains unconvincing. However, its use and that of other forms of complementary and alternative medicine (CAM) continue to be popular in pregnancy.

Researchers from Korea and the UK undertook a systematic review and meta-analysis of trials of acupuncture use published in 19 electronic databases from around the world. Their study focused on women who received acupuncture alone (mainly: classical acupuncture, electroacupuncture and auricular acupuncture; studies on related forms of acupuncture such as acupressure and moxibustion therapy were excluded) or those receiving acupuncture and a conventional form of analgesia for pain relief in labour.

Ten randomised controlled trials (five from Europe, three from China and two from Iran) were identified as meeting the inclusion criteria and the results were analysed. Researchers note that the heterogeneity of the studies (large variation in the results from one study to another) made interpretation difficult but the results show that there is little convincing evidence that women who had acupuncture experienced less labour pain than those who received no pain relief, a conventional analgesia, a placebo or sham acupuncture.

In the trials which compared acupuncture to women using conventional pain relief, it was observed that the women who received acupuncture required less meperidine (otherwise known as pethidine or Demerol - a synthetic opiate) or other forms of analgesia. A possible explanation for this finding is that the women felt that they were already being treated and therefore did not need another form of pain relief.

Dr Hyangsook Lee, from the Acupuncture and Meridian Science Research Centre, Kyung Hee University, Seoul, Korea; said "In our previous systematic review of three randomised controlled trials (RCTs) in 2004, acupuncture appeared to be a promising analgesic option for women in labour. To update the evidence for or against acupuncture for labour pain management, this time we searched 19 databases and subsequently analysed 10 RCTs involving women receiving acupuncture alone, or as an adjunct to conventional analgesia, for pain relief in labour.

"In this review, acupuncture did not seem to have any impact on other maternal or fetal outcomes, nor was it associated with harm. However, there was no convincing evidence that women receiving acupuncture experience less labour pain than those in the control groups. Acupuncture might reduce the use of other forms of pain relief such as meperidine, but the evidence is limited. To summarise, the current evidence does not appear to recommend the use of acupuncture for labour pain."

Co-author Professor Edzard Ernst from the Peninsula Medical School, Universities of Exeter and Plymouth, said "Labour is a good subject to study the analgesic effects of acupuncture. Our analyses show that the effects of acupuncture perceived by women are largely due to placebo. Acupuncture has many qualities that maximise placebo effects: it involves touch and is invasive and, psychologically, is attached to the mysticism of the East. Our findings are in keeping with much of the recent research on acupuncture which demonstrates that the more one controls for such confounders, the smaller the effect of acupuncture gets."

Professor Philip Steer, BJOG editor-in-chief said, "Pain is a very subjective response. Labour pain can be so intense that the woman feels she would do anything to minimise the sensation of

100 pain. Acupuncture is a drug-free approach and that may explain why some women prefer its use during labour. This research has shown that there were no adverse outcomes to mother and baby for those who had acupuncture to control pain during labour.

"This review of previous research into the usefulness of acupuncture in providing pain relief to women during labour shows that in a very small number of cases, acupuncture may be of help (usually for very short periods of time after treatment) and this may be down to a psychological rather than a physiological effect. Generally, the consensus is that the evidence does not support its use. In contrast, there is good evidence showing a benefit from emotional support during labour, so we should concentrate our efforts on making sure that all women have the benefit of one to one care at this crucial time."

Notes

BJOG: An International Journal of Obstetrics and Gynaecology is owned by the Royal College of Obstetricians and Gynaecologists (RCOG) but is editorially independent and published monthly by Wiley-Blackwell. The journal features original, peer-reviewed, high-quality medical research in all areas of obstetrics and gynaecology worldwide. Please quote 'BJOG' or 'BJOG: An International Journal of Obstetrics and Gynaecology' when referring to the journal and include the website: as a hidden link online.

Reference "Acupuncture for pain relief in labour: a systematic review and meta-analysis." Cho S-H, Lee H, Ernst E. BJOG 2010; DOI: 10.1111/j.1471-0528.2010.02570.x.

Source Royal College of Obstetricians and Gynaecologists

Lazy Eye Appears To Respond Well To Acupuncture In Many Cases

Written by Christian Nordqvist Published: Monday 13 December 2010

Acupuncture may eventually become another optional treatment apart from patching for lazy eye, also known as amblyopia, especially among older children who have a poorer response to patching, say researchers from China in Archives of Ophthalmology. Approximately 0.3 to 5% of people globally are affected by lazy eye, the authors report as background information.

Lazy eye is a condition that appears during early childhood - the eyesight in one of the eyes does not develop as it should. In the majority of cases only one eye is affected. When a child has amblyopia their brain focuses on one eye much more than the other; in fact, the lazy eye may be ignored altogether. Lack of stimulation of that eye may result in the visual brain cells not maturing normally. Amblyopia is the most common cause of monocular blindness (partial or total blindness in one eye) in the USA.

Between one-third and a half of all lazy eye cases are caused by variations in the degree of myopia (nearsightedness) or hyperopia (farsightedness) between the two eyes (anisometropia). These variations are more effectively corrected with glasses or contact lenses when a child is aged up to seven years. Unfortunately, when the child is older, for example from 7 to 12, visual correction alone is only effective in about 30% of cases.

101 The addition of patching one eye - known as occlusion therapy - can improve children's response rates considerably as long as they comply with the doctors instructions. Patching the eye brings with it emotional problems, and also a risk of reverse amblyopia.

Jianhao Zhao, M.D., of Joint Shantou International Eye Center of Shantou University and Chinese University of Hong Kong, Shantou, China, wanted to see how effective acupuncture was compared to patching for the treatment of lazy eye. The authors wrote that acupuncture has been successfully used for dry eye and myopia treatment.

They carried out a randomized, controlled trial with 88 children. They were assigned to one of two groups: . Acupuncture Group - 43 children. They were given five treatment sessions each week, which targeted five needle insertion sites, also known as acupoints. . Patching Group - 45 children. Their good eye was patched for two hours each day. They had to do near-vision activities with their lazy eye for one hour each day. Near vision activities include reading or typing. After a total of 15 weeks' worth of treatment: . Visual acuity improved by 2.3 lines in the Acupuncture Group . Visual acuity improved by 1.8 lines in the Patching Group . 75.6% (31) of the children in the Acupuncture Group experienced an improvement of at least two lines . 66.7% (28) of the children in the Patching Group experienced an improvement of at least two lines . In the Acupuncture Group lazy eye was considered as resolved in 41.5% of cases . In the Patching Group lazy eye was considered as resolved in 16.7% of cases No serious side effects were detected in either group. In both groups, treatment was well tolerated, the authors wrote. The Acupuncture Group children had their treatment after school so that their studies were not disrupted.

The authors wrote: "Although the treatment effect of acupuncture appears promising, the mechanism underlying its success as a treatment for amblyopia remains unclear." The authors believe that well targeted acupuncture may alter the activity of the part of the brain that receives data from the eyes - the visual cortex. They add that the treatment may also enhance blood flow to the eye and surrounding tissues. The generation of compounds that support the growth of retinal nerves may also be stimulated.

The researchers concluded: "The findings from this report indicate that the treatment effect of acupuncture for amblyopia is equivalent to the treatment effect of patching for amblyopia. However, only patients with anisometropic amblyopia were involved in our study and the follow-up period was relatively short. Moreover, acupuncture itself is a very complicated system of therapy.

Differences exist among acupuncturists, and there are divergent manipulation modes, stimulation parameters, treatment styles and subjective sensations evoked by acupuncture stimulation. Because of the good results obtained in our study, the acupoints that we used could be considered for use in clinical practice." "Randomized Controlled Trial of Patching vs Acupuncture for Anisometropic Amblyopia in Children Aged 7 to 12 Years" Jianhao Zhao, MD; Dennis S. C. Lam, MD, FRCOphth; Li Jia Chen, PhD; Yunxiu Wang, BMed; Chongren Zheng, DEpid; Qiaoer Lin, DN; Srinivas K. Rao, FRCS; Dorothy S. P. Fan, FRCS;

102 Mingzhi Zhang, MD; Ping Chung Leung, MD; Robert Ritch, MD, FRCOphth Arch Ophthalmol. 2010;128(12):1510-1517. doi:10.1001/archophthalmol.2010.306

Written by Christian Nordqvist

New study on acupuncture to reduce pain and inflammation in children with acute appendicitis

Published: Sunday 17 May 2015

Acupuncture was shown to lessen pain and reduce the underlying inflammation in pediatric patients with a diagnosis of acute appendicitis, according to a study published in the Journal of Alternative and Complementary Medicine, a peer-reviewed publication from Mary Ann Liebert, Inc., publishers. The article is available free on the Journal of Alternative and Complementary Medicine website until June 12, 2015. Alan L. Nager, MD, MHA and coauthors from Children's Hospital Los Angeles and the Keck School of Medicine of the University of Southern California assessed subjective pain among pediatric patients immediately before and 20 minutes after treatment by a licensed acupuncturist. The researchers also measured two biomarkers of inflammation in blood samples taken before, during, and 30 minutes after needle placement. In the article "Effects of Acupuncture on Pain and Inflammation in Pediatric Emergency Department Patients with Acute Appendicitis: A Pilot Study," the authors report that the patients' subjective pain decreased, likely due to the acupuncture treatment. Furthermore, one of the inflammatory biomarkers (white blood cell count) "showed a modest and noticeable drop," suggesting "that the effectiveness of acupuncture may have a biophysiological basis."

Quality of acupuncture needles is less than perfect and must improve

Published: Thursday 13 February 2014

The quality of acupuncture needles is high, but should still be universally improved to avoid potential problems, such as pain and skin reactions, finds research published online in Acupuncture in Medicine(AiM). Despite improvements to the manufacturing process, surface irregularities and bent tips have not been completely eliminated, say the researchers. In China, traditional Chinese medicine including acupuncture, accounts for 40% of all medical treatment, while in the West, acupuncture is one of the most frequently used complementary therapies. An estimated 1.4 billion acupuncture needles are used each year worldwide, with China, Japan, and Korea the main suppliers. China provides up to 90% of the world's needles. The growing popularity of acupuncture in recent decades has led to an increased focus on the safety and quality of this therapy, and adoption of single-use disposable needles has reduced the risk of infection. But a study of widely used acupuncture needles published a decade ago in AiM showed that several had surface irregularities or distorted points which could have led to allergic or painful reactions. Since then, there has been no further research in this area. A team of researchers in Australia therefore looked at the surface conditions and other physical properties of the two most commonly used stainless steel acupuncture needle brands. Scanning electron microscope images were taken of 10 randomly chosen needles from each brand, while further images were taken after each of these needles underwent a standard manipulation - the equivalent of using them on human skin - with an acupuncture needling practice gel.

103 The researchers also compared forces and torques during the needling process. The images revealed significant surface irregularities and inconsistencies at the needle tips, especially for needles from one of the brands which had been manufactured in China. Metallic lumps and small, loosely attached pieces of material were observed on the surfaces of some needles. Some of this residue disappeared after the acupuncture manipulation. If these needles had been used on patients, the metallic residue could have been deposited in human tissues, potentially causing reactions, such as dermatitis, although these reactions are reported extremely rarely, say the authors. Malformed needle tips could also have caused other problems, including bleeding, bruising, or strong pain during needling, which are quite common, they suggest. Acupuncture, overall, is very safe, but it should be made even safer, say the researchers. "Acupuncture needle manufacturers, including the well established ones, should review and improve their quality control procedures for fabrication of needles," they conclude. In an accompanying podcast, Dr Mike Cummings, medical director of the British Medical Acupuncture Association and associate editor of the journal, comments that the pictures taken for the current study indicate that the needles "look as awful as they did 10 years ago." He adds: "We don't know if [this problem] is common to all needles, but it seems like it does happen with acupuncture needles." But he emphasises that acupuncture is safe, pointing out that "It's highly unlikely that [poor needle quality] will affect patient health." If people experience pain during acupuncture, they should ask their practitioner to check on the quality of the needles they use, he advises.

The Evidence Mounts For Acupuncture To Treat Period Pains

Published: Thursday 18 February 2010

A new study published in BJOG: An International Journal of Obstetrics and Gynaecology analyses the evidence base for the use of acupuncture to treat period pains and concludes that the available evidence is promising.

Around 40 - 50% of young women have experienced primary dysmenorrhoea, or menstrual cramps, the cause of which is usually unknown (when the causes are known, it is referred to as 'Secondary' dysmenorrhoea, eg. uterine fibroids, pelvic infection, endometriosis etc). For some women, the pain can become more severe or may last for longer as they grow older. There are also other related symptoms such as nausea, diarrhoea,migraine, backache and mood swings. Common treatments include exercise, applying heat onto the lower abdomen or the use of painkillers. The use of acupuncture to treat dysmenorrhoea has in recent years been the subject of study but results have so far been inconclusive.

Researchers from the Oriental Hospital at Kyung Hee University Medical Centre in Korea conducted a systematic review of all randomised control trails (RCTs) on the use of acupuncture to treat dysmenorrhoea. A wide search of papers published internationally up till July 2008 was undertaken. The RCTs that were chosen examined women of reproductive age with primary dysmenorrhoea, comparing those who were treated with acupuncture with a control group, which included no treatment, placebo treatment, or pharmacological or non-pharmacological treatments (eg. psychological interventions). The types of acupuncture evaluated were classical acupuncture, electroacupuncture, laser acupuncture, electrical auricular acupuncture, auricular acupuncture, auricular acupressure and acupoint injection.

27 relevant studies involving 2,960 subjects met the study criteria. According to researchers, the

104 data reviewed showed that acupuncture was the preferred option for reducing pain when compared to pharmacological treatment or herbal remedies. The researchers observe that there is convincing evidence on the effectiveness of using acupuncture to treat pain as it stimulates the production of endorphins and serotonin in the central nervous system.

Researchers note however, that there were methodological flaws in some studies, so these results should be interpreted with some caution. For this reason, further research is needed into the effects of acupuncture on dysmenorrhoea and researchers recommend that future clinical trials follow standard guidelines in their reporting.

Professor Philip Steer, BJOG editor-in-chief, said "Some women suffer from intense period pains so much so that they are unable to function normally. It isn't just pins and needles.

"Women with primary dysmenorrhoea should consult their GPs or gynaecologists on the best treatment available to them. Complementary therapies should not be used exclusively, at the expense of conventional treatment, unless significant improvements have been made and your doctor tells you otherwise."

Notes

Reference

Please cite this paper as: "Acupuncture for primary dysmenorrhoea: a systematic review." Cho S-H, Hwang E-W. BJOG 2010; DOI: 10.1111/j.1471-0528.2010.02489.x.

Source Royal College of Obstetricians and Gynaecologists

Women With PCOS Benefit From Acupuncture And Exercise

Published: Tuesday 8 February 2011

Acupuncture and physical exercise improve hormone levels and menstrual bleeding pattern in women with polycystic ovary syndrome (PCOS), reveals research from the University of Gothenburg, Sweden.

PCOS is a common disorder that affects up to 10% of all women of child-bearing age. Women with PCOS frequently have irregular ovulation and menstruation, with many small immature egg follicles in the ovaries. This causes the ovaries to produce more testosterone which, in turn, leads to troublesome hair growth and acne.Obesity, insulin resistance and cardiovascular disease are also widespread among these patients.

In the current study, published in the American Journal of Physiology-Endocrinology and Metabolism, a group of women with PCOS were given acupuncture where the needles were

105 stimulated both manually and with a weak electric current at a DELETE"VERY" low frequency that was, to some extent, similar to muscular work. A second group was instructed to exercise at least three times a week, while a third group acted as controls. All were given information on the importance of regular exercise and a healthy diet.

"The study shows that both acupuncture and exercise reduce high levels of testosterone and lead to more regular menstruation," says docent associate professor Elisabet Stener-Victorin, who is responsible for the study. "Of the two treatments, the acupuncture proved more effective."

Although PCOS is a common disorder, researchers do not know exactly what causes it. "However, we've recently demonstrated that women with PCOS have a highly active sympathetic nervous system, the part that isn't controlled by our will, and that both acupuncture and regular exercise reduced levels of activity in this system compared with the control group, which could be an explanation for the results."

Source: Elisabet Stener-Victorin University of Gothenburg

IV. MASSAGE

Abdominal Massage Shown To Benefit Constipation In MS

Published: Tuesday 14 July 2009

Trail results have highlighted the benefit of abdominal massage in the management of constipation - a common symptom in people with multiple sclerosis (MS).

In the latest study, reporting in the International Journal of Nursing Studies, 60 people with constipation were split into two groups and given a combination of laxatives and abdominal massage, or were given laxatives alone for eight weeks. It was found that the group of people being treated with a combination of laxatives and abdominal massage had reduced severity of abdominal symptoms, including constipation and pain, than the group taking laxatives alone.

The MS Society has recognised the importance of finding new ways to manage common MS symptoms such as constipation. Last year more than £120,000 was spent on a project to help develop a better approach to managing a variety of bowel syndromes for people with MS and formed part of the MS Society's Symptom Relief Research Initiative.

Source MS Society

Advanced Cancer Patients Benefit From Immediate Positive Effect On Pain And Mood When Massage Therapy Used

Published: Wednesday 17 September 2008

A new study from the National Institutes of Health finds that massage therapy may have immediate benefits on pain and mood among patients with advanced cancer. The study appears in the September 16, 2008 issue ofAnnals of Internal Medicine.

106 In a randomized trial of 380 advanced cancer patients at 15 U.S. hospices, improvement in pain and mood immediately following treatment was greater with massage than with simple touch.

"When patients near the end of life, the goals of medical care change from trying to cure disease to making the patient as comfortable as possible," said Jean S. Kutner, MD, MSPH, Associate Professor of Medicine, Division of General Internal Medicine at the University of Colorado Denver School of Medicine. "This study is important because it shows massage is a safe and effective way to provide immediate relief to patients with advanced cancer."

Pain and depressed mood are common problems for patients with advanced cancer. While drug therapies can reduce symptoms, they don't always work and often have troublesome side effects. Researchers think that massage may interrupt the cycle of distress, offering brief physical and psychological benefits. Physically, massage may decrease inflammation and edema, increase blood and lymphatic circulation, and relax muscle spasms. Psychologically, massage may promote relaxation, release endorphins, and create a positive experience that distracts temporarily from pain and depression.

Researchers caution that while massage may offer some immediate relief for patients with advanced cancer, the effects do not last over time, demonstrating the need for more effective strategies to manage pain at the end of life.

About the American College of Physicians and Annals of Internal Medicine

Annals of Internal Medicine (http://www.annals.org/) is one of the five most widely cited peer- reviewed medical journals in the world. The journal has been published for 81 years and accepts only seven percent of the original research studies submitted for publication. Annals of Internal Medicine is published by the American College of Physicians (http://www.acponline.org/), the largest medical specialty organization and the second-largest physician group in the United States.

ACP members include 126,000 internal medicine physicians (internists), related subspecialists, and medical students. Internists specialize in the prevention, detection, and treatment of illness in adults.

Source: Angela Collom American College of Physicians

Chronic Low Back Pain Symptoms Eased With Massage Therapy

Written by Christian Nordqvist Published: Wednesday 6 July 2011

People with chronic low back pain have improved symptoms, better function and few side effects with massage therapy, researchers from Group Health Research Institute reported in Annals of Internal Medicine. The investigators say theirs is the first study to compare relaxation (Swedish) and structural massage - both types were found to work well.

Trial leader, Daniel C. Cherkin, PhD, said:

107 "We found that massage helps people with back pain to function even after six months. This is important because chronic back pain is among the most common reasons people see doctors and alternative practitioners, including massage therapists. It's also a common cause of disability, absenteeism, and 'presenteeism,' when people are at work but can't perform well."

400 Group Health Cooperative patients with chronic low back pain took part in the trial. Chronic in this case was defined as pain that persisted for over three months. There was no identified cause for their pain (nonspecific). They were selected at random into one of three groups: . Structural massage group - weekly one hour sessions for 10 weeks . Relaxation (Swedish) massage group - weekly one hour sessions for 10 weeks . Usual care group - this group would carry on with their ongoing treatment, which usually involved drugs. Ten weeks later, 1 in every 3 patients in the massage groups said their back pain had either gone or got much better, compared to just 1 in every 25 in the usual care group.

Questionnaire feedback also showed that just over two-thirds of those in the massage groups had significantly better back function at 10 weeks compared to just over one-third in the usual care group.

Those in the massage groups also spent less time laid up bed than those in the usual group, they were more active and used smaller quantities of anti-inflammatory drugs.

Dr. Cherkin said:

"As expected with most treatments, the benefits of massage declined over time. But at six months after the trial started, both types of massage were still associated with improved function."

No significant benefits from the massage were detectable after 12 months.

Dr. Cherkin added:

"We found the benefits of massage are about as strong as those reported for other effective treatments: medications, acupuncture, exercise, and yoga," Dr. Cherkin said. "And massage is at least as safe as other treatment options. So people who have persistent back pain may want to consider massage as an option."

Previous studies had only looked at structural massage in relation to back pain. Relaxation massage, also known as Swedish massage, which is supposed to promote a feeling of relaxation throughout the whole body, is much more widely available and is taught in schools that specialize in massage. The structural massage therapist has to identify specific pain-related soft tissues, such as ligaments and muscles. Structural massage requires considerably more training and tends to cost a great deal more. However, insurance plans are more likely to cover structural massage rather than the Swedish type.

Dr. Cherkin's colleague Karen J. Sherman, PhD, MPH, said:

"The massage therapists assumed structural massage would prove more effective than relaxation massage. They were surprised when patients in the relaxation group got so much relief from their back pain."

108 Further researcher should find out why structural and relaxation massages are effective: . Do both have specific effects, such as calming the CNS (central nervous system) or tissue - or does just one do that? . They may have non-specific effects that may help the patient become involved in his/her own healing. Examples include spending time in a relaxing environment, being touched, receiving care from a caring therapist, being advised on self care, better awareness of one's own body, etc. . Possibly a combination of non-specific and specific effects may be involved in reducing the back pain symptoms. "A Comparison of the Effects of 2 Types of Massage and Usual Care on Chronic Low Back Pain - A Randomized, Controlled Trial" Daniel C. Cherkin, PhD; Karen J. Sherman, PhD, MPH; Janet Kahn, PhD; Robert Wellman, MS; Andrea J. Cook, PhD; Eric Johnson, MS; Janet Erro, RN, MN; Kristin Delaney, MPH; and Richard A. Deyo, MD, MPH Annals of Internal Medicine July 5, 2011 vol. 155 no. 1 1-9 Written by Christian Nordqvist

Massage Actually Impairs Blood Flow To The Muscle After Exercise

Published: Friday 8 May 2009

A Queen's University research team has blown open the myth that massage after exercise improves circulation to the muscle and assists in the removal of lactic acid and other waste products.

"This dispels a common belief in the general public about the way in which massage is beneficial," says Kinesiology and Health Studies professor Michael Tschakovsky. "It also dispels that belief among people in thephysical therapy profession. All the physical therapy professionals that I have talked to, when asked what massage does, answer that it improves muscle blood flow and helps get rid of lactic acid. Ours is the first study to challenge this and rigorously test its validity."

The belief that massage aids in the removal of lactic acid from muscle tissue is so pervasive it is even listed on the Canadian Sports Massage Therapists website as one of the benefits of massage, despite there being absolutely no scientific research to back this up.

Kinesiology MSc candidate Vicky Wiltshire and Dr. Tschakovsky set out to discover if this untested hypothesis was true, and their results show that massage actually impairs blood flow to the muscle after exercise, and that it therefore also impairs the removal of lactic acid from muscle after exercise.

This study will be presented at the annual American College of Sports Medicine conference in Seattle, Washington May 27-30, 2009

Source: Stephanie Earp Queen's University

Massage For Childbirth Prep May Reduce Episiotomy Rate

Published: Thursday 26 January 2006

109 Low-tech, at-home preparation in the last month before childbirth could help pregnant mothers avoid one of the more common surgeries performed on women in the United States, a new review suggests.

The review looked at studies in which women used a massage technique in the last four or five weeks of pregnancy to train the lower genital tract for childbirth. During perineal massage a women kneads the tissue below the vagina to prepare the tissue to expand more easily during birth. There was a 15 percent reduction in episiotomies among the women who practiced perineal massage the review found, based on results from three trials, including data from 2,434 women.

The findings appear in the most recent issue of The Cochrane Library, publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Lead reviewer Dr. Michael Beckmann and his colleagues also discovered an added benefit: Three months after birth, women who had practiced massage were less likely to report perineal pain -- whether or not they had an episiotomy.

Those positive results were most clear for mothers having their first vaginal birth. But Beckmann said the statistical trend of the research suggests that the benefits would also hold true for the other, smaller sub-groups of women in the study -- given larger sample sizes, more time and research.

An episiotomy is performed in up to 35 percent of vaginal births in the United States each year, affecting as many as 1 million women. But Beckmann said the number of episiotomies performed around the world is dropping following a general shift toward reserving the surgical procedure for emergencies.

A May 2005 article in the Journal of the American Medical Association cast doubt on many of the rationales offered for routine episiotomy. That evidence review found episiotomy does not reduce pain or improve healing in the short term, or prevent incontinence or impaired sexual function in the long term - when compared with natural tears.

Many expectant mothers have heard about Kegel exercises to strengthen the pelvic-floor muscles before birth, but perineal massage isn\'t as well-known or recommended as often.

\"It\'s not standard in obstetrics, but there is interest in this area,\" said Beckmann, an obstetrician with the QE2 Jubilee Hospital in Queensland, Australia.

\"It\'s amazing the number of women who are fearful about cuts and tears and afraid of an episiotomy,\" said Sally Avenson, a certified nurse midwife in western Washington state.

As more women demand greater control and involvement in their childbirth plan, Avenson said, preventing an episiotomy -- or the spontaneous tears that can occur at childbirth -- has gained mainstream attention, and become a goal for all providers who care for pregnant women.

Perineal massage is now common in some corners of maternal health care, Beckmann said, so \"it\'s nice to see there\'s some evidence behind it.\" He now says expecting women should be provided information on perineal massage and its likely benefits.

110 In the three reviewed studies, women practiced perineal massage for as little a four minutes three to four times a week, and as much as 10 minutes daily, beginning in week 34 of their pregnancy.

Pregnant women may not hear about perineal massage from their obstetrician, but midwives have recommended the practice for years. Avenson, a lecturer with the University of Washington\'s department of Family and Child Nursing, said it is difficult to separate the effect of perineal massage alone. But she includes the technique in her discussions about \"perineal management.\"

\"It goes along with a plan for exercise and nutrition. You can\'t isolate the perineum from health,\" she said.

\"It\'s not anything where I guarantee you won\'t tear, but it is something you have power to do,\" said Avenson, who\'s led her own midwifery practice for 25 years.

Beckmann MM, et al. Antenatal perineal massage for reducing perineal trauma (Review). The Cochrane Database of Systematic Reviews 2006, Issue 1.

Michael Beckmann [email protected] Center for the Advancement of Health

Pediatric Tuina – Ancient Chinese Massage for Kids

Posted by Sarah Bentley on Wed, Jan 11, 2012 @ 02:10 PM

I have twin boys, Daniel and Jack. While my smaller one, Jack, was 3 months old, he suffered from colic after breastfeeding almost once a day. When he was in pain, he would cry and his belly would be very tight to the touch. I began to massage his abdomen beside the belly button three to five times on both sides; after a minute or so of loud crying, he would gradually calm down and then immediately fall in sleep. I found this ancient massage technique to be very helpful and after about two weeks of massage combined with Chinese herbs, the colic never 111 returned.

This technique is called “Na Du Jiao” which means “Grasping Belly Corner”, and it is one of the numerous massage techniques of Chinese Pediatric Tuina (traditional massage). Chinese Pediatric Tuina has been applied for over one thousand years in China. Its popularity has grown in the last three to four hundred years.

Pediatric massage is applied on specific points of various parts of the body, such as the face, abdomen, back and extremities depending on the disorders. Lotion can be used to protect the skin and ease the treatment. Each session lasts about 20 – 30 minutes. In most cases, the treatment should be given once a day or every other day. Since the pediatric tuina technique is very simple, parents are encouraged to learn and practice some of the major techniques, so they can repeat the treatments at home.

In Chinese medicine, children are regarded with “pure Yang constitution” which means they grow and develop fast in physique and intelligence. At the same time, they are also “young Yang and Yin constitution” meaning they have imperfect organic function and physical bodies, which is why they get sick easily, especially with digestive and respiratory problems. As a parent, it often seems that stomach aches (bloating, vomiting, nausea, constipation, diarrhea) or colds (coughing, asthma, allergies) as well as bed wetting & night time crying are ubiquitous during childhood.

Pediatric tuina is a safe manual therapy; it is gentle without side effects and great to relieve most discomforts experienced during childhood. Besides that, it is also excellent at preventing other diseases. Providing regular and simple pediatric tuina for your kids can strengthen their digestive and immune systems and support their natural body constitution. Children who have picky appetites or easily catch colds are great candidates for pediatric tuina. It is most effective for children from birth to seven years old. For older kids, acupuncture is a good combination as well. A lot of times, a Chinese herbal formula is suggested to be combined to provide even better and faster results.

Tips for a successful tuina or acupuncture treatment for your child:

 It’s best if your child doesn’t come to his/her appointment on an empty or full stomach.  Plan for your child to take it easy after his/her treatment.  Sometimes after receiving an acupuncture treatment your child may feel a little lightheaded or “woozy.” If that is the case, please have him/her sit for a while in our waiting area. In a few minutes he/she will be relaxed and clear-headed. Requesthttp://blog.aoma.edu/Pediatric-Tuina-Ancient-Chinese-Massage-for-Kids? utm_content=30677600&utm_medium=social&utm_source=twitter Appointment

112 Effect of Chinese massage (Tui Na) on isokinetic muscle strength in patients with knee osteoarthritis

Author: Zhu Qingguang, Li Jianhua, Fang Min, Gong Li, Sun Wuquan, Zhou Nan Brief: OBJECTIVE: Chinese massage (Tui Na) is one of the most popular Traditional Chinese Medicine remedies for knee osteoarthritis (OA). Several studies have subjectively evaluated the effect of Chinese massage on knee OA through self-assessment questionnaires; however, very few studies have objectively assessed the effect by measuring knee muscle strength. The purpose of this study was to assess the efficacy of Chinese massage in improving knee extensor and flexor muscle strength in patients with knee OA. METHODS: Thirty patients with knee OA received Chinese massage therapy three times per week for 2 weeks. Patients completed pre- and post-treatment Visual Analogue Scale (VAS) pain questionnaires, and pre- and post-treatment knee muscle strength was evaluated using the Biodex Multi-Joint System 3. Isokinetic muscle strength measurements were performed at 60 degrees/s and 180 degrees/s. The peak torque (PT), peak torque/body weight (PT/BW), total work (TW), average power (AP), hamstring/quadriceps (H/Q), and range of motion (ROM) values were recorded separately for flexors and extensors. RESULTS: Chinese massage therapy significantly improved knee pain as assessed by the VAS in patients with knee OA (P < 0.05). Post-treatment values were significantly greater than pretreatment values in the extensor muscles for PT (right P = 0.013, left P = 0.001), PT/BW (right P = 0.008, left P = 0.001) and TW (right P = 0.036, left P = 0.004) at 60 degrees/s. The AP increased significantly after treatment in the flexor muscles in the right knee (P = 0.009) and the extensor muscles in the left knee (P = 0.001). There were no significant differences in pre- and post-treatment ROM and H/Q at 60 degrees/s and 180 degrees/s. CONCLUSION: Chinese massage therapy decreased pain and may improve extensor muscle strength in patients with knee OA, but does not appear to improve ROM. 2 Key words: Tui Na; Muscle strength; Osteoarthritis, knee; Range of motion, articular

Massage May Help Dementia Patients With Agitation

Published: Thursday 2 November 2006

Massage could offer a drug-free way to treat agitation and depression among dementia patients, but there are still too few studies about the practice to know for sure, according to a review of recent research.

In two studies, hand massage and gentle touching during conversation helped ease agitation and restore appetite in dementia patients over short periods of about an hour.

"Although the available reliable evidence supports the use of massage and touch, it is so limited in scope that it is not possible to draw general conclusions about benefits in dementia," say lead authors Dr. Niels Viggo Hansen and colleagues.

"However, even if touch therapy aims only to reintroduce something which has been lost in the professionalization and institutionalization of care, it may still turn out to be a relatively effective, inexpensive and low-risk intervention," said Viggo Hansen, of the Knowledge and Research Center for Alternative Medicine, part of Denmark's Ministry of Health.

The review appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and

113 quality of existing medical trials on a topic.

The Cochrane reviewers could only find two small studies, involving a total of 110 participants, of high enough quality to include in the review. Although the effect on behavior in the two studies was short-lived, some researchers and caregivers suggest that massage might also improve memory and cognition in those with dementia.

Cynthia Bologna, a Petaluma, Calif., massage therapist who works extensively with people with dementia, said she often works with patients to bring about short-term effects such as relaxation.

However, Bologna has noticed some long-term effects and said her clients "respond with recognition to the quality of my touch" even when they don't remember her name or recognize her from visit to visit. "So whereas I'm not sure about long-term cognitive memory, it seems as though their sensory memory is being enhanced," she said.

Viggo Hansen N, Jorgensen T, Ortenblad L. Massage and touch for dementia The Cochrane Database of Systematic Reviews 2006, Issue 4.

Massage Therapy May Have Immediate Positive Effect On Pain And Mood For Advanced Cancer Patients

Published: Wednesday 24 September 2008

A new study found that massage therapy may have immediate benefits on pain and mood among patients with advanced cancer. The study, sponsored by the Institute of Medicine and the National Institutes of Health, was a randomized trial of 380 advanced cancer patients at 15 U.S. hospices. In the study, patients had improvement in pain and mood immediately following treatment that was greater with massage than with simple touch.

Pain and depressed mood are common problems for patients with advanced cancer. While drug therapies can reduce symptoms, they don't always work and often have troublesome side effects. Researchers think that massage may interrupt the cycle of distress, offering physical and psychological benefits. Physically, massage may decrease inflammation and edema, increase blood and lymphatic circulation, and relax muscle spasms. Psychologically, massage may promote relaxation, release endorphins, and create a positive experience that distracts temporarily from pain and depression.

Researchers caution that while message may offer some immediate relief for patients with advanced cancer, the effects do not last over time, demonstrating the need for more effective strategies to manage pain at the end of life.

American College of Physicians

Providing Consolation For Bereaved Relatives Through Hand And Foot Massage

Published: Friday 26 March 2010

114 Receiving soothing massages for eight weeks after the death of a loved one can provide much- needed consolation during an intense, stressful period of grieving, according to a study in the April issue of the Journal of Clinical Nursing.

Eighteen people who had lost a relative to cancer took part in the study. Participants ranged from 34 to 78 years of age and included widows, widowers, daughters and sisters. Nine chose foot massage, eight chose hand massage and one asked for both. Only three had previous experience of soft tissue massage.

"Details about the massage study were included in an information pack provided by the palliative care team when people's relatives died" says lead author Dr Berit S Cronfalk from the Stockholms Sjukhem Foundation, a Swedish palliative care provider.

Relatives were offered a 25-minute hand or foot massage once a week for eight weeks and could choose whether the sessions took place at home, work or at the hospital.

"Soft tissue massage is gentle, but firm" explains Dr Cronfalk, who carried out the research with colleagues from the Karolinska Institutet. "This activates touch receptors which then release oxytocin, a hormone known for its positive effects on well-being and relaxation.

"In this study the hand or foot massage was done with slow strokes, light pressure and circling movements using oil lightly scented with citrus or hawthorn.

"The relatives were then encouraged to relax for a further 30 minutes."

Baseline data was collected on the participants during a 60-minute interview before the programme started and a further 60-minute interview was conducted a week after the massage programme finished.

The interviews with the participants, which have been published in the Journal's annual complementary therapy issue, showed that they derived considerable benefits from the programme.

The relatives' comments could be divided into four key themes: . A helping hand at the right time

"I was happy to find the leaflet about the study in the folder…Straight away I felt it was for me. And as I phoned it felt great just to speak with a professional."

"Honestly, I didn't know what to expect. I just felt I needed to do something to get rid of that pain and it seemed like a good alternative." . Something to rely on

"I almost longed for it. It started at the beginning of the week…the massage became something to look forward to."

"She [the therapist] has cared for him and now she cared for me." . Moments of rest

"I could focus on my grief during the massage and that helped me handle the rest of the week."

"I was just lying there… and no one expected me to talk about my feelings."

115 . Moments of retaining energy

"I gained strength… Through my weakness, strength emerged."

"I suddenly realised that I could go through my thoughts in a much calmer way…I was more sensible in my thinking." A follow-up six to eight months after the study showed that 17 of the relatives had moved forward with their lives, but one had suffered further emotional problems after the death of another close family member.

"All the people we spoke to used the word consolation" says Dr Cronfalk.

"The massages provide physical touch and closeness and helped to diminish the feelings of empty space and loneliness that people felt.

"Study participants also told us that the massages helped them to balance the need to grieve and the need to adapt to life after the loss of their relative."

Source: Annette Whibley Wiley-Blackwell

Swedish Massage Benefits Osteoarthritis Patients

Published: Tuesday 12 December 2006

Massage therapy is a safe and effective way to reduce pain and improve function in adults with osteoarthritis of the knee, researchers at the Yale Prevention Research Center and at the University of Medicine and Dentistry of New Jersey (UMDNJ) report in the first clinical trial to assess the effectiveness of this treatment.

The 16-week study conducted to identify the potential benefits of Swedish massage on osteoarthritis patients with pain, stiffness and limited range of motion was published in the December 11 Archives of Internal Medicine. Osteoarthritis is a chronic condition that affects 21 million Americans and causes more physical limitation than lung disease, heart disease and diabetes mellitus, according to the Centers for Disease Control and Prevention (CDC).

The 68 study participants, who were at least age 35 with x-rays confirming their diagnosis of osteoarthritis of the knee, were randomly assigned either to an intervention group that received massage therapy immediately, or to a wait-list control group that received massage after an initial eight-week delay. Both groups were encouraged to continue previously prescribed medications and treatments.

Participants in the massage intervention group received a standard one-hour Swedish massage twice a week for four weeks, followed by Swedish massage once a week for the next four weeks at the Siegler Center for Integrative Medicine at the Saint Barnabus Ambulatory Care Center in Livingston, New Jersey. After the first eight weeks of massage therapy, participants had improved flexibility, less pain and improved range of motion.

The primary study outcomes were changes in the Western Ontario and McMaster Universities

116 Osteoarthritis Index pain and functional scores, as well as changes in the Visual Analog Scale assessment of pain. Measures of pain, stiffness, and functional ability were all significantly improved by the intervention as compared to the control group.

Those who only continued with their usual care without massage showed no changes in symptoms. During weeks nine through 16, they received the massage intervention and experienced benefits similar to those receiving the initial massage therapy. When reassessed eight weeks after completion of the massage intervention, the benefits of massage persisted and remained significant, although the magnitude of effect was somewhat reduced.

"Massage is free of any known side effects and according to our results, clearly shows therapeutic promise," said senior investigator of the study David L. Katz, M.D., associate adjunct professor in the Department of Epidemiology & Public Health at Yale School of Medicine and director of Yale's Prevention Research Center. "So-called 'alternative' treatments like massage are most important when conventional treatments are far from ideal. Currently available non- steroidal anti-inflammatory drugs are often not well-tolerated by older adults with osteoarthritis. Cox-II inhibitors like Vioxx were developed as substitutes for traditional anti- inflammatory drugs, but pose highly-publicized toxicity problems of their own."

Katz conducted the study with Adam Perlman, M.D., executive director of the Institute for Complementary and Alternative Medicine at the UMDNJ-School of Health Related Professions. The research was the result of a CDC grant to Katz at the Prevention Research Center at Yale. Perlman, who directed the study at UMDNJ, said the significant improvement in symptoms after eight weeks of massage persisted even after the study was completed.

"Our results suggest that massage therapy can be used in conjunction with conventional treatment for osteoarthritis," said Perlman. "Ultimately, massage may be shown to lessen a patient's reliance on medications and decrease health care costs."

Perlman and Katz say that further study of the cost-effectiveness and the lasting impact of the intervention is warranted. They have begun collaborating on a follow-up study.

"Our hope is to show that this treatment is not only safe and effective, but cost-effective," said Perlman. "That could serve to change practice standards so that massage is a more common option for the many patients with osteoarthritis of the knee."

In addition to Katz and Perlman, other authors on the study included Alyse Sabina, Anna-leila Williams and Valentine Yanchou Njike, M.D., all of the Yale Prevention Research Center.

Citation: Archives of Internal Medicine, Vol. 166, No. 22 (December 11, 2006)

Yale News Releases are available via the World Wide Web at http://www.yale.edu/opa

For further information please go to: Yale University

Winter Weather Causing You Pain? Simple At-Home Massage Techniques Can Keep Bodies Feeling Strong All Winter Long

Published: Thursday 28 January 2010

117 With a season of record-breaking snowfalls and eight weeks of winter to go, Washingtonians have become all too familiar with the icy sidewalks, the sore muscles, and the coughs and colds that come along with winter weather. But for those feeling the effects of a recent fall or tighter joints due to a lack of exercise, therapeutic massage - including simple tips you can do at home - can offer much-needed relief.

"We tend to be less active in the cold weather months, catch more colds and flus, and get depressed more easily. Massage is proven to help with all these winter ailments," says Winston Moore, massage therapist and the Regional Operations Manager for Massage Envy, which has 19 locations in the Baltimore/Washington, DC area. "Massage increases circulation, boosts the immune system and causes your body to release more stress-fighting hormones. With winter not even half over, we can all use that right about now," adds Moore.

Massage Envy reports a significant increase in clients with aches and pains, and many are weather-related. Integrating therapeutic massage as a regular health practice can not only help alleviate pain but increase overall wellness during the cold weather months and beyond.

But what happens when you're snowed in? Moore says fighting the winter woes can be easier than you think, and can be had with simple items from around the house. Here are a few simple tips that he recommends:

- Simple stretches and movements can help your muscles warm up before you do any activity. Similar to a resistance band, hold the ends of a beach towel in each hand. While standing, place under one foot and pull up until taut to stretch the leg muscles. Stretching is key before any strenuous activity to avoid potential injury.

- Stress can play a large role in the quality of your sleep. If you have more trouble falling asleep in the winter, try using a tennis ball to help stretch tense muscles and promote relaxation. While lying face up in bed place a tennis ball in the crook of your neck and apply pressure for about ten minutes.

- The feet contain many nerve endings that refer to different parts of the body. To help alleviate pain in your feet, massage a golf ball into each foot while sitting on the couch or at your desk. Remove your shoes and place a golf ball on the ground. Roll along the bottom of the foot while applying pressure. Repeat for 10-15 minutes to help relieve tension and relax your body.

- If experiencing strain or soreness, ice is great for soothing muscles. Because pain may indicate injury, be advised that ice should always be applied prior to heat. If applying heat causes more pain to the trouble area, this could indicate something more serious and medical attention should be sought. Try using a bag of frozen vegetables to relieve exacerbated muscle and avoid the mess of ice cubes.

Source Massage Envy

Adequate doses of massage treatment necessary for relief of neck pain Published: Wednesday 12 March 2014

Neck pain is a common and debilitating condition, and massage therapy is commonly used to treat it, yet there is little quality research on the optimal dose of therapeutic massage for neck pain.

118 Randomizing 228 patients with chronic neck pain to five different groups receiving various doses of massage for a five-week period, researchers found the benefits of massage treatments for chronic neck pain increase with dose. Specifically, they found that patients who received 30-minute treatments two or three times weekly were not significantly better than a wait-listed control group in terms of achieving a clinically meaningful improvement in neck dysfunction or pain. In contrast, patients who received 60-minute treatments two or three times weekly showed significant improvement in neck dysfunction and pain intensity compared to the control group. Compared with their control counterparts, massage participants were three times more likely to have clinically meaningful improvement in neck function if they received 60 minutes of massage twice a week and five times more likely if they received 60 minutes of massage three times a week. The authors conclude patients who receive massage treatment for chronic neck pain may not be realizing benefits from treatment because they are not receiving an effective treatment dose. Five-Week Outcomes From a Dosing Trial of Therapeutic Massage for Chronic Neck Pain By Karen J. Sherman, PhD, MPH, et al Group Health Research Institute, Seattle

AMTA Consumer Survey Shows Men Neglecting Massage Therapy In Past Year

Published: Friday 24 September 2010

Results from the 14th annual consumer survey conducted by the American Massage Therapy Association® (AMTA®) indicate the use of massage among men has dropped from 18 percent in 2009 to 10 percent in 2010, a drop that is attributed to the lagging economy these past two years. The survey results were announced at the AMTA National Convention in Minneapolis, September 22-25, 2010.

Recent statistics have indicated men have been putting off their healthcare appointments this year including visits for regular check-ups, screenings and vaccinations. According to the Agency for Healthcare Research and Quality (AHRQ) about 57 percent of men have visited a physician within the past year, compared with about 74 percent of women. This trend is now impacting massage therapy in men.

Massage use among women only dropped from 26 percent in 2009 to 25 percent in 2010. Because of the lower use of massage by men, the percentage of all adults who had a massage in the previous 12 months dropped from 22 percent in 2009 to 18 percent in 2010.

"We know from our AMTA survey results in the last 14 years that massage therapy usage has been on an overall upward trend, as people are realizing the health benefits of massage to manage pain and keep them active, as well as being an excellent means to relieve stress" says Kathleen Miller-Read, AMTA president. "We believe that as the economic climate improves, men will return to massage therapy as part of their regular health maintenance plan."

Americans Are Reaching to Massage for Pain Relief

There have been a growing number of people in recent years seeking massage as part of health care and an increase in physician referrals to massage therapists. Because of this trend and a steadily rising number of massage therapists working in health care environments, this year's AMTA convention includes educational sessions on massage for the relief of pain stemming from a variety of causes, as well as for pregnancy, sports injuries and cancer. The vast majority of Americans, 86 percent, still agree that massage can be effective in reducing pain, a number that has held strong from 2009, while 84 percent agree massage can be beneficial for health and

119 wellness. More than half of the men and women surveyed said they have had a massage to relieve pain.

Americans Still See the Benefits of Massage, Particularly Those Who are Stressed

About 40 percent of stressed out Americans are getting massages to relieve their stress, which has increased from 32 percent in 2009. "Stress, among other factors, is a popular reason why people get massage," says Miller-Read. "In a year where the economy is such a stress inducer, AMTA is pleased that people are increasingly turning to massage for stress relief." Source: American Massage Therapy Association (AMTA)

Circulation improved, muscle soreness eased by massage therapy

Published: Wednesday 23 April 2014

Massage therapy improves general blood flow and alleviates muscle soreness after exercise, according to a study by researchers at the University of Illinois at Chicago. The study, reported online in advance of print in the Archives of Physical Medicine and Rehabilitation,also showed that massage improved vascular function in people who had not exercised, suggesting that massage has benefits for people regardless of their level of physical activity. Improved circulation and relief of muscle soreness are common claims made for massage's benefits, but no studies have substantiated such claims, even though massage therapy is increasingly used as an adjunct to traditional medical interventions, said Shane Phillips, UIC associate professor of physical therapy and principal investigator on the study. "Our study validates the value of massage in exercise and injury, which has been previously recognized but based on minimal data," said Nina Cherie Franklin, UIC postdoctoral fellow in physical therapy and first author of the study. "It also suggests the value of massage outside of the context of exercise." The researchers had set out to see if massage would improve systemic circulation and reduce muscle soreness after exercise. Healthy sedentary adults were asked to exercise their legs to soreness using a standard leg press machine. Half of the exercisers received leg massages, using conventional Swedish massage techniques, after the exercise. Participants rated their muscle soreness on a scale from 1 to 10. As expected, both exercise groups experienced soreness immediately after exercise. The exercise-and-massage group reported no continuing soreness 90 minutes after massage therapy. The exercise-only group reported lasting soreness 24 hours after exercise. Exercise-induced muscle injury has been shown to reduce blood flow. In this study, brachial artery flow mediated dilation (FMD) - a standard metric of general vascular health, measured in the upper arm - was taken by ultrasound at 90 minutes, 24, 48 and 72 hours after exercise. For the exercise-and massage-group, FMD indicated improved blood flow at all time points, with improvement tapering off after 72 hours. As expected, the exercise-only group showed reduced blood flow after 90 minutes and 24 and 48 hours, with a return to normal levels at 72 hours. "We believe that massage is really changing physiology in a positive way," said Franklin. "This is not just blood flow speeds - this is actually a vascular response." Because vascular function was changed at a distance from both the site of injury and the massage, the finding suggests a "systemic rather than just a local response," she said. "The big surprise was the massage-only control group, who showed virtually identical levels of improvement in circulation as the exercise and massage group," said Phillips.

120 "The circulatory response was sustained for a number of days, which suggests that massage may be protective," said Phillips. For people with limited mobility or those with impaired vascular function, further research may show that regular massage offers significant benefits, the authors say.

Massage And Other Hands On Therapies Can Help Reduce Pain

Published: Friday 15 January 2010

Massage, manipulation and other hands-on approaches can safely and effectively help with pain management.

The January issue of Mayo Clinic Women's HealthSource discusses the uses and benefits of massage, spinal manipulation, and Rolfing, as well as the Alexander technique and the Feldenkrais method.

Massage: Almost everyone feels better after the soothing strokes of a massage. This process involves applying pressure to the body's soft tissues by rubbing, kneading or rolling. There are a variety of techniques and styles, such as deep tissue massage, where deeper layers of muscle and connective tissue are manipulated. Another approach focuses on trigger points -- muscle "knots" that are painful when pressed.

Massage can help reduce pain, muscle soreness and swelling. It can improve circulation, joint flexibility and range of motion. Massage has been shown to help those with chronic back pain, migraines, knee osteoarthritis and cancer.

Spinal manipulation: Also called spinal adjustment, this therapy is used to treat restricted spinal mobility. The goal is to restore spinal movement, improving function and relieving pain. The practitioner uses his or her hands to apply a controlled force or thrust to a joint of the spine. Some techniques are more rhythmic and less abrupt than others.

Spinal manipulation can provide short- and long-term relief for pain, especially if the pain hasn't improved with self-care. Manipulation may also boost psychological well-being and everyday functioning. Some evidence shows that the therapy may improve headache symptoms and neck pain.

Rolfing: Rolfing manipulates the fascia -- the protective tissue that surrounds the muscles. It aims to improve posture and realign the body.

Patients lie on a massage table while the practitioner uses hands, knuckles, thumbs, elbows and knees to manipulate the patient's tissues. It can be painful.

There's little research on the effectiveness of Rolfing in relieving pain. Some patients report that Rolfing helps with flexibility and improves their posture. It may relieve stress and anxiety.

Alexander technique and Feldenkrais method: These therapies use different approaches, but both aim to help patients become more aware of their habitual or everyday movements. The theory is that changing movement can help with pain and other health problems.

Both therapies use touch and direction to help the patient become more aware of movement. An Alexander session might begin with the patient seated in a chair. The practitioner helps the

121 patient adjust head, neck and spine positions.

With Feldenkrais, the patient may be lying down, sitting on a chair or standing. The practitioner guides the participant through a series of movements designed to improve flexibility and coordination. Research suggests that the Alexander technique can provide long-term relief for back pain.

These hands-on therapies probably won't replace pain relief medications but they could help manage chronic pain. A combination of approaches often works best in achieving long-term pain control.

Source: Mayo Clinic

Massage For The Cure Day Only A Month Away

Published: Monday 30 June 2008

On Monday, July 28, all 18 Greater Atlanta-area Massage Envy clinics will provide free 1-hour therapeutic massage sessions to any man or woman to benefit the Susan G. Komen for the Cure Greater Atlanta Affiliate.

"Anyone who makes an appointment for July 28 will receive a free, one-hour therapeutic massage from any of the 18 Atlanta-area Massage Envy clinics," said Norm Klemmer, North Georgia Regional Developer for Massage Envy.

Klemmer said every Massage Envy clinic in the Atlanta area will be fully-staffed with licensed massage therapists and every penny collected during the fundraiser will be donated to Komen Greater Atlanta. The money will be spent on breast cancer research and local breast health programs serving Atlanta women. During 2008, Massage Envy will make a minimum guaranteed donation of $250,000 to Susan G. Komen for the Cure through the Massage for the Cure program. This is the first year for Massage for the Cure in Atlanta.

Think Ahead - Reservations for appointments will be accepted beginning at 8 AM., Monday, July 21. Massage Envy clinics are open from 8 AM until 10 PM. Participation in Massage for the Cure Day is first come-first serve, but reservations will only be taken beginning July 21.

Contact - To get a free 1-hour massage session and also help in the fight against breast cancer, call 1-866-917-3689 and be connected with the Massage Envy clinic closest to you - or get the address and phone number of all Atlanta-area clinics at http://www.massageenvy.com.

Locations - Atlanta Massage Envy Clinics - Alpharetta, Austell, Buckhead, Camp Creek, Cumming Town Center, Dunwoody-Sandy Springs, Johns Creek, Kennesaw, Mall of Georgia, Merchants Festival, Midtown, Sugarloaf, Windy Hill @ Powers Ferry, Roswell East, Roswell West, Snellville, Stockbridge.

Reminders - Don't miss your chance to reserve an appointment when clinics begin booking on July 21. Register to receive an email reminder on July 20 by going here and selecting Atlanta.

About Susan G. Komen for the Cure

Nancy G. Brinker promised her dying sister, Susan G. Komen, she would do everything in her power to end breast cancer forever. In 1982, that promise became Susan G. Komen for the Cure

122 and launched the global breast cancer movement. Today, Komen for the Cure is the world's largest grassroots network of breast cancer survivors and activists fighting to save lives, empower people, ensure quality care for all and energize science to find the cures. Thanks to events like the Komen Race for the Cure, we have invested more than $1 billion to fulfill our promise, becoming the largest source of nonprofit funds dedicated to the fight against breast cancer in the world. For more information about Susan G. Komen for the Cure, breast health or breast cancer.

About Massage Envy

Massage Envy Limited, LLC is a national franchise of massage clinics dedicated to providing professional and affordable therapeutic massage services to consumers with busy lifestyles at convenient times and locations. Founded in 2002, Massage Envy is now a $20 million-a-year company with 770 licensed franchises in 44 states.

Massage Envy

Massage May Help Ease Pain And Anxiety After Surgery

Published: Tuesday 18 December 2007

A 20-minute evening back massage may help relieve pain and reduce anxiety following major surgery when given in addition to pain medications, according to a report in the December issue of Archives of Surgery, one of the JAMA/Archives journals.

Many patients still experience pain following major surgery despite the availability of pain- relieving medications, according to background information in the article. Pain may be under- treated because patients fear becoming dependent on medications, are concerned about side effects, believe that they should endure pain without complaining or worry about bothering nurses. Physicians and nurses may administer ineffective doses of pain relievers because of personal biases, cultural attitudes or a lack of knowledge.

Allison R. Mitchinson, M.P.H., N.C.T.M.B., of the Department of Veterans Affairs, VA Ann Arbor Healthcare System, Ann Arbor, Mich., and colleagues conducted a randomized controlled trial involving 605 veterans (average age 64) undergoing major surgery (chest or abdominal operations) between 2003 and 2005. Patients were randomly assigned to one of three groups for the five days following surgery: 203 received routine care; 200 received a daily 20-minute back massage; and 202 received 20 minutes of individual attention each day from a massage therapist, but no massage. "The purpose of this group was to assess the effect of emotional support independent of massage," the authors write. Patients were asked daily to rate the intensity and unpleasantness of their pain, plus their level of anxiety, on scales of one to 10.

"Compared with the control group, patients in the massage group experienced short-term (preintervention vs. postintervention) decreases in pain intensity, pain unpleasantness and anxiety," the authors write. "In addition, patients in the massage group experienced a faster rate of decrease in pain intensity and unpleasantness during the first four postoperative days compared with the control group." There were no differences in long-term anxiety, length of hospital stay or the amount of pain-relieving medications used among the three groups.

"The effectiveness of massage in reducing both the intensity and unpleasantness of pain suggests that it may act through more than one mechanism," the authors write. "Massage may ameliorate suffering by helping to relieve the anxiety that so effectively synergizes with pain to create

123 distress." It could also generate mood-boosting endorphins or create a competing sensation that blocks pain, they note.

"Historically, massage was a common experience for postsurgical patients," the authors write. "As health care systems have become more complex and administrative demands on nursing time have increased, the tradition of nurse-administered massage has been largely lost. With the recent emphasis on assessing pain as the fifth vital sign tempered by renewed concerns for patient safety, it is time to reintegrate the use of effective and less dangerous approaches to relieve patient distress."

Archives of Surgery 2007;142(12):1158-1167.

Massage therapy: A profession on the rise

Published: Tuesday 1 March 2005

Massage therapists elicit an impressive level of goodwill and increasing popularity among American adults. Fully two out of five adults have visited a massage therapist and 12% received at least one massage in 2004, putting massage on a par with consumer use of chiropractic and physical therapy services.

These results come from a January 3 to 11, 2005 national telephone survey of a representative sample of 1,027 adults age 21 and older. The study was commissioned by Associated Bodywork & Massage Professionals (ABMP) and conducted by Harstad Strategic Research, Inc., the national public opinion research firm in Boulder, Colo.

\"Experiencing a massage therapy session is its own best advertisement for changing perceptions,\" says Bob Benson, President of ABMP. According to the survey, receiving a massage promotes favorable regard of its value: 96% of those who received at least one massage in 2004 have favorable feelings toward massage therapists as compared to 72% of previous users and 32% of those who have never had a massage.

More impressive than Americans\' lopsidedly favorable feelings is their trend in feelings toward massage therapists over the past decade. A 45% plurality say their feelings have changed for the better over the past 10 years, 3% say for the worse, 40% say no difference, and 12% are not sure. This 15-to-1 better-to-worse feelings ratio is promising confirmation of growing acceptance and goodwill toward massage therapists.

\"What is striking about the overall survey results is that there are very few detractors, few negative expressions about massage,\" Benson says. Most of those who haven\'t yet received a massage simply haven\'t felt a need for it. According to the survey, 51% have favorable feelings about massage therapists versus just 6% with unfavorable feelings.

124 by health insurancewhile more than 90% of massage therapy sessions are paid out of the client\'s own pocket.\" Massage therapists are especially popular among adults under age 50 (58% favorable) and women (also 58% favorable). Indeed, those favorably-disposed include two-thirds of women under age 45 and two-thirds of women with at least two years of college. Those least favorable and least familiar with massage therapists are age 65 plus (37% favorable).

The market strength among younger adults bodes well for massage therapists as these Americans age. \"The combination of these baby boomers reaching peak earning years just as their bodies begin to creak suggests that massage demand will only grow,\" Benson says. For the amount of stress relief, restoration, and relief of muscular soreness massage provides, that service remains a relative bargain. The survey found that the median price nationally for a one hour massage is just $60. Prices vary regionally and by setting; charges in spa settings tend to be higher than elsewhere.

The finding of 12% of adults visiting a massage therapist has a statistical margin of error of plus- or-minus 2%, at the 95% confidence level. In other words, the chances are 95% that the response about utilization of massage in 2004 would be between 10% and 14% if all adults in telephone- equipped households were interviewed. This 12% finding contrasts with two recent studies of the same behavior which produced widely divergent estimates. An August 2004 Opinion Research Corporation study commissioned by the American Massage Therapy Association estimated 21% received a massage that year while a 2002 National Institutes of Health study found only 5% of adults received a massage for health reasons during the prior 12 months.

\"A lot has to do with how the questions are framed and phrased,\" says Paul Harstad, President of Harstad Strategic Research, Inc. \"The NIH survey asked about massage received \'for your own health,\' which phrasing may have limited affirmative answers since many people receive a massage for relaxation or enjoyment and may not perceive it as for their health per se. The Opinion Research Corporation survey solely asked about receiving a massage. It isn\'t clear whether that survey distinguished between massage work provided by a massage therapist versus other health care professionals, whose inclusion would drive up the affirmative response rate.\"

\"In the 2005 telephone survey conducted for ABMP, visitation with massage therapists was posed in a battery amongst other healthcare providers -- which approach often reduces any possible respondent resistance or inclination to provide socially acceptable answers. Respondents were not told at the outset of the interview who commissioned the survey, nor could they have

Research Says Massage May Help Infants Sleep More, Cry Less And Be Less Stressed

Published: Monday 13 November 2006

New research by a team at the University of Warwick says that massage may help infants aged under six months sleep better, cry less and be less stressed.

The team of researchers from Warwick Medical School and the Institute of Education at the University of Warwick was led by Angela Underdown. They looked at nine studies of massage of young children covering a total of 598 infants aged under six months. They found the various studies showed a range of significant results including indications that infants who were massaged cried less, slept better, and had lower levels of stresshormones such as cortisol compared to infants who did not receive massage. One of the studies examined also claimed that massage could affect the release of the hormone melatonin, \"which is important in aiding infants\' sleeping patterns,\" Underdown said. She added that:

125 \"Given the apparent effect of infant massage on stress hormones, it is not surprising to find some evidence of an effect on sleep and crying,\" said Angela Underdown of the University of Warwick.

One study also provided evidence that massage could help build better relationships between infants and mothers who had postnatal depression, although the reviewers said more research is needed to confirm this effect.

One other study indicated that massage, eye contact and talking had a significant effect on growth and a significant reduction in illnesses and clinic visits for infants receiving little tactile stimulation in an orphanage but this was an unusual set of circumstances and the other studies, where infants were receiving normal levels of tactile stimulation, found no effect on growth.

The studies mainly involved infant massage by parents who were trained by health professionals in appropriate technique. Parents who wish to massage their babies can learn how to do this at locally run classes.

The review entitled \"Massage Intervention for promoting mental and physical health in infants under six months (Review)\" appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. See:

Contact: Peter Dunn University of Warwick

Want a Shaman With That Massage? Skin Deep By BEE SHAPIRO APRIL 19, 2016

Photo

Carlos Gomez, a shaman, performs a cleansing using seven essential oils and palo santo sound bowls in the couples suite at Hotel Faena’s Tierra Santa Healing House in Miami Beach. CreditMax Reed for The New York Times Apparently it’s no longer enough to simply book a spa massage when you’re on vacation. For a new wave of wellness-seeking millennials, only the latest, and often personalized, forms of treatments will do.

126 “Fifteen years ago, we used to do sugar scrubs and chocolate facials — it was only about indulgence,” said Kristi Dickinson, the director of spa and fitness at Rancho Valencia in Rancho Santa Fe, Calif. “Today, people are looking to the spa as a lifestyle resource.” That means that, along with a massage, a guest may sign up for the hotel’s “neuroplasty program,” which creates a specialized regimen (often a combination of meditation, exercise and yoga) to boost brain function. And if you suspect it’s only millennials who are interested in the new and New Age, you would be wrong. Ms. Dickinson’s clients are often in the 40 to 60 age range. “Now their friend at the golf club is doing the latest meditation, too,” she said. Below, a selection of New Age-y hotel spa services worth noting this season. The Arts of Healing A slick new hotel seems to sprout in Miami Beach every season, but the Faena Hotel aims to stand out. Its spa, exotically named the Tierra Santa Healing House, isn’t content with meditation gurus. The wellness director, Vivianne Garcia-Tunon, enlisted a well-known Mexican shaman, Carlos Gomez, to headline its Shaman Purification Ritual. Mr. Gomez has since trained the Tierra Santa staff (he is in residence at the hotel once a quarter if you want to book him in person) on the art of copaleada, which is about cleansing and purifying the body before healing. “We use copal, which is a resin and is similar to an incense,” Ms. Garcia-Tunon said, “and the shaman salutes the earth, the heavens, the sun, north, south, east and west. And as the client journeys through this, the shaman is invoking all these different spirits from the heaven.” The ritual can be paired with a “unique healing arts” treatment, like the spa’s sound bowl therapy, which is said to heal through vibrations. Be prepared to spend about two hours and $400. “Everybody is extremely stressed,” Ms. Garcia-Tunon said. “Maybe vacationers don’t want to spend their time drinking by the pool every day. They’ll go home tired, and the vacation will defeat the purpose. They want to feel and look rejuvenated.” Photo

Hotel Faena’s Tierra Santa Healing House spa was modeled after Alan Faena’s home in Punta Del Este Tierra Santa. CreditMax Reed for The New York Times Faena Hotel Miami Beach, 3201 Collins Avenue, Miami Beach, 305-534-8800; faena.com. One Treatment Does Not Fit All Besides the neuroplasty regimens, Ms. Dickinson will be incorporating a somatotype program into the Rancho Valencia spa menu next month. Clients will be categorized as one of three body types (ecto, endo or meso, based on their body shape and other characteristics), according to rules laid down by the somatotype founder, William H. Sheldon (who died in 1977), with specific products recommended for each. “The idea is to replenish the nutrients and minerals you need specifically for your body type,” Ms. Dickinson explained. That means that plenty of algae and essential oils are deployed in treatments like the Vitality Ritual (90 minutes, $275), which begins with dry-skin brushing and is followed by a body cleanse, mineral-heavy body wrap, head massage and breathing meditation. Photo

127 Rancho Valencia Resort & Spa. Rancho Valencia, 5921 Valencia Circle, Rancho Santa Fe, Calif., 858-759- 6490; ranchovalencia.com. A Soothing Rush In need of a (holistic) bump? Coca leaves, the raw material from which cocaine comes, is the star ingredient in the signature Inkaterra Therapy treatment (three hours, $190) at the Inkaterra Machu Picchu Pueblo hotel’s Unu spa. NYT Living Newsletter Get lifestyle news from the Style, Travel and Food sections, from the latest trends to news you can use. Along with a detox session in an Andean sauna, the service features a lymphatic drainage massage with coca oil followed by a body mask of coca leaf. Sandra Masias, the product and service manager of Inkaterra Hotels, says that coca leaf contains “alkaloids that activate skin cells, circulation and, in turn, the lymphatic system, helping the body eliminate waste.” To complete the buzz-building experience, your limbs will be slathered with coca cream before you exit the treatment room. Photo

The coca leaf body mask from Inkaterra Machu Picchu Pueblo Hotel’s UNU Spa. Inkaterra Machu Picchu Pueblo Hotel, Aguas Calientes, Peru, 51-1-610-0400; inkaterra.com. Continue following our fashion and lifestyle coverage on Facebook (Styles and Modern Love), Twitter (Styles, Fashion, and Vows), and Instagram. A version of this article appears in print on April 21, 2016, on page D4 of the New York edition with the headline: Want http://www.nytimes.com/2016/04/21/fashion/vacation-massage-spa.html?smid=fb- nytwell&smtyp=cur&_r=0

128 Adults Demonstrate Modified Immune Response After Receiving Massage, Cedars-Sinai Researchers Show Published: Wednesday 8 September 2010

Researchers in Cedars-Sinai's Department of Psychiatry and Behavioral Neurosciences have reported people who undergo massage experience measureable changes in their body's immune and endocrine response.

Although there have been previous, smaller studies about the health benefits of massage, the Cedars-Sinai study is widely believed to be the first systematic study of a larger group of healthy adults.

The study is published online here. It also will be published in the October printed edition of the Journal of Alternative and Complementary Medicine.

"Massage is popular in America, with almost 9 percent of adults receiving at least one massage within the past year," said Mark Rapaport, M.D., chairman of the Department of Psychiatry and Behavioral Neurosciences. "People often seek out massage as part of a healthy lifestyle but there hasn't been much physiological proof of the body's heightened immune response following massage until now."

In the study, 29 subjects received 45 minutes of Swedish massage and 24 received 45 minutes of light touch massage. Each participant underwent informed consent, a physical and mental evaluation and was deemed to be physically healthy and free of any mental disorder. Massage therapists were trained in how to deliver both Swedish and light touch using specific and identical protocols.

Prior to the massage, study participants were fitted with intravenous catheters in order to take blood samples during the study session. Then participants were asked to rest quietly for 30 minutes. Following the rest period, blood samples were collected from each person five minutes and one minute before the massage began. At the end of the 45-minute massage session, blood samples were collected at one, five, 10, 15, 30, and 60 minutes after the massage.

"This research indicates that massage doesn't only feel good, it also may be good for you," said Rapaport, the principal investigator of the study and the Polier Family Chair in Schizophrenia and Related Disorders. "More research is ahead of us but it appears that a single massage may deliver a measurable benefit."

Among the study's results:

- People in the Swedish massage group experienced significant changes in lymphocytes , (lymphocyte numbers and percentages white blood cells that play a large role in defending the body from disease.

- Swedish massage caused a large decrease (effect size -.74) in Arginine Vasopressin (AVP) a hormone believed to play a role in aggressive behavior and linked to helping cause increases in the stress hormone cortisol.

- Swedish massage caused a decrease in levels of the stress hormone cortisol.

- Swedish massage caused a notable decrease in most cytokines produced by stimulated white blood cells.

129 Source: Cedars-Sinai Medical Center

A massage robot based on Chinese massage therapy Author(s): Lei Hu (School of Mechanical and Electrical Engineering, Harbin Engineering University, Harbin, China) Yun Wang (School of Mechanical Engineering and Automation, Beihang University, Beijing, China) Jie Zhang (School of Mechanical Engineering and Automation, Beihang University, Beijing, China) Jun Zhang (China Academy of Chinese Medical Sciences, Beijing, China) Yan Cui (School of Mechanical Engineering and Automation, Beihang University, Beijing, China) Lvzhong Ma (School of Mechanical Engineering, Jiangsu University, Beijing, China) Junyuan Jiang (Department of Orthopaedics, The Second Hospital of Beijing Municipal Corps, Chinese People's Armed Police Forces, Beijing, China) Liming Fang (Department of Orthopaedics, The Second Hospital of Beijing Municipal Corps, Chinese People's Armed Police Forces, Beijing, China) Bangcheng Zhang (School of Mechanical and Electrical Engineering, Changchun University of Technology, Beijing, China) Citation: Lei Hu, Yun Wang, Jie Zhang, Jun Zhang, Yan Cui, Lvzhong Ma, Junyuan Jiang, Liming Fang, Bangcheng Zhang, (2013) "A massage robot based on Chinese massage therapy", Industrial Robot: An International Journal, Vol. 40 Iss: 2, pp.158 - 172 DOI

Abstract: Purpose – As Chinese massage is increasingly popular, many physicians are needed these days. In order to promote the experience and skills of experts and reduce labour intensity during massage, a massage robot, which could reproduce the expert techniques with individualized manipulation parameters and enhanced safety control strategies, is presented in this paper.

Design/methodology/approach – The kinematic and force features of key massage techniques, such as Thumb Kneading, Pressing, Rolling, Vibrating and Pinching, are summarized by analyzing the massage processes of expert physicians, and a mathematical model for robotic massage is established. With safety issues taken into account, the overall system structure of the massage robot is proposed. The system generally consists of a positioning platform and a massage end‐effector which implements the massage techniques, and the end‐effector is further divided into a parallel mechanism and a massage hand to accommodate different techniques. Visual tracking is used for positioning acupuncture points by recognizing markers on a massage vest worn by the patient. A pain threshold value is introduced to individualize therapy schemes and a force‐position control method based on the pain threshold is presented.

Findings – VAS (Visual Analogue Scale) tests for lumbar muscle strain are carried out using the massage robot, and the treatment effect of the massage robot based on traditional Chinese massage therapy theory is initially validated.

130 Research limitations/implications – The treatment effect of the massage robot needs to be assessed clinically for more occasions and more clinical experiments will be conducted, to optimize the configuration and control strategy to meet the clinical needs in future work.

Originality/value – The robotic massage system presented in this paper is acting on acupuncture points based on traditional Chinese massage therapy theory, with human manipulation techniques reproduced and expert experiences incorporated. The massage robot can take the place of a massager to perform Chinese massage. Most of the massage robotic systems published in the world perform only one massage technique and the whole massage process is not completely considered. By comparison, the authors' massage robot could perform five techniques. Furthermore, the authors have designed the procedure of robotic massage specifically for patients who suffer from lumbar muscle strain.

Keywords: Robots, Massage, Massage robot, Chinese massage therapy, Massage technique, Force ‐ position control,Pain threshold Type: Research paper Publisher: Emerald Group Publishing Limited

Effect of Chinese massage (Tui Na) on isokinetic muscle strength in patients with knee osteoarthritis

131 Adults Demonstrate Modified Immune Response After Receiving Massage, Cedars-Sinai Researchers Show

Published: Wednesday 8 September 2010

The study is published online here. It also will be published in the October printed edition of the Journal of Alternative and Complementary Medicine.

Among the study's results:

- People in the Swedish massage group experienced significant changes in lymphocytes , (lymphocyte numbers and percentages white blood cells that play a large role in defending the body from disease. - Swedish massage caused a large decrease (effect size -.74) in Arginine Vasopressin (AVP) a hormone believed to play a role in aggressive behavior and linked to helping cause increases in the stress hormone cortisol. - Swedish massage caused a decrease in levels of the stress hormone cortisol. - Swedish massage caused a notable decrease in most cytokines produced by stimulated white blood cells.

132 Source: Cedars-Sinai Medical Center

Biofeedback More Effective Than EGS And Massage For Chronic Rectal Pain

Published: Thursday 1 April 2010 A new study conducted by Italian researchers, in collaboration with the University of North Carolina at Chapel Hill, finds that biofeedback is more effective than two other treatments for a type of chronic rectal pain called levator ani syndrome.

"The importance of this work is that chronic rectal pain is relatively common and has been very frustrating to treat - nothing seems to work for more than a small fraction of patients," said William E. Whitehead, Ph.D., professor in the UNC School of Medicine and co-director of the UNC Center for Functional GI & Motility Disorders.

"This research shows how to select the patients who are going to respond to treatment and which treatment is the most effective," Whitehead said.

The study is published in the April 2010 issue of the journal Gastroenterology. The lead author is Giuseppe Chiarioni, M.D., from the University of Verona.

Levator ani syndrome is a condition characterized by a dull ache high in the rectum. Patients may also have a feeling of constant pressure and occasional burning, and it may be uncomfortable to sit. This pain often gets worse during bowel movements because of pressure on a muscle in the pelvic floor called the levator ani.

In the study, 194 patients in Italy who sought treatment for this condition were randomized to receive a course of one of the three most commonly recommended treatments: biofeedback, electrogalvanic stimulation (EGS) or digital massage combined with warm baths. Overall 57 percent of patients treated with biofeedback reported adequate relief, compared to 26 percent for EGS and 21 percent for massage. The research showed that the patients most likely to improve could be identified by a physical examination: for those who reported tenderness when their doctor pressed on their pelvic floor muscles, 87 percent reported adequate relief following biofeedback compared to 45 percent for electrogalvanic stimulation and 22 percent for massage.

The UNC Center for Functional GI & Motility Disorders offers the biofeedback treatment to patients at its Pelvic Floor Biofeedback Clinic at UNC Hospitals, Whitehead said. Steve Heymen, Ph.D., is the center's director of biofeedback services. For more information, visit here. Source University of North Carolina at Chapel Hill School of Medicine

Massage Eases Anxiety, But No Better Than Simple Relaxation Does

Published: Wednesday 10 March 2010

A new randomized trial shows that on average, three months after receiving a series of 10 massage sessions, patients had half the symptoms of anxiety. This improvement resembles that previously reported with psychotherapy, medications, or both. But the trial, published in the journal Depression and Anxiety, also found massage to be no more effective than simple relaxation in a room alone with soft, soothing music.

133 "We were surprised to find that the benefits of massage were no greater than those of the same number of sessions of 'thermotherapy' or listening to relaxing music," said Karen J. Sherman, PhD, MPH, a senior investigator at Group Health Research Institute. "This suggests that the benefits of massage may be due to a generalized relaxation response." Massage therapy is among the most popular complementary and alternative medical (CAM) treatments for anxiety, she added. But this is the first rigorous trial to assess how effective massage is for patients with generalized anxiety disorder.

The trial randomly assigned 68 Group Health patients with generalized anxiety disorder to 10 one-hour sessions in pleasant, relaxing environments, each presided over by a licensed massage therapists who delivered either massage or one of two control treatments: . Relaxation therapy: breathing deeply while lying down . Thermotherapy: having arms and legs wrapped intermittently with heating pads and warm towels All three treatments were provided while lying down on a massage table in a softly lighted room with quiet music. All participants received a handout on practicing deep breathing daily at home. Unlike the two control treatments, massage was specifically designed to enhance the function of the parasympathetic nervous system and relieve symptoms of anxiety including muscle tension.

Using a standard rating scale in interviews, the researchers asked the patients about the psychological and physical effects of their anxiety right after the 12-week treatment period ended and three months later, Dr. Sherman said. All three of the groups reported that their symptoms of anxiety had decreased by about 40 percent by the end of treatment - and by about 50 percent three months later. In addition to the decline in anxiety, the patients also reported fewer symptoms of depression and less worry and disability. The research team detected no differences among the three groups; but the trial did not include a control group that got no treatment at all. "Treatment in a relaxing room is much less expensive than the other treatments (massage or thermotherapy), so it might be the most cost-effective option for people with generalized anxiety disorder who want to try a relaxation-oriented complementary medicine therapy," Dr. Sherman said. The National Center for Complementary and Alternative Medicine (NCCAM), part of the National Institutes of Health, funded this study. Dr. Sherman's co-authors were Senior Investigator Daniel C. Cherkin, PhD, Assistant Investigator Andrea J. Cook, PhD, Senior Research Associate Evette J. Ludman, PhD, and Project Manager Rene Hawkes of Group Health Research Institute; Peter P. Roy-Byrne, MD, and Susan Bentley, DO, of the University of Washington; and Marissa Z. Brooks, MPH, LMP, of Portland State University and private practice.

Source: Rebecca Hughes Group Health Cooperative Center for Health Studies

Massage Found To Reduce Inflammation Following Strenuous Exercise

Published: Friday 3 February 2012 Most athletes can testify to the pain-relieving, recovery-promoting effects of massage. Now there's a scientific basis that supports booking a session with a massage therapist: On the cellular level massage reducesinflammation and promotes the growth of new mitochondria in skeletal muscle. The research, involving scientists from the Buck Institute for Research on Aging and McMaster University in Hamilton Ontario appears in the online edition of Science Translational

134 Medicine. The study involved the genetic analysis of muscle biopsies taken from the quadriceps of eleven young males after they had exercised to exhaustion on a stationary bicycle. One of their legs was randomly chosen to be massaged. Biopsies were taken from both legs prior to the exercise, immediately after 10 minutes of massage treatment and after a 2.5 hour period of recovery. Buck Institute faculty Simon Melov, PhD, was responsible for the genetic analysis of the tissue samples. "Our research showed that massage dampened the expression of inflammatory cytokines in the muscle cells and promoted biogenesis of mitochondria, which are the energy- producing units in the cells," said Melov. He added that the pain reduction associated with massage may involve the same mechanism as those targeted by conventional anti-inflammatory drugs. "There's general agreement that massage feels good, now we have a scientific basis for the experience," said Melov. Study participants were recruited at McMaster University in Hamilton, Ontario, Canada. Lead author Mark Tarnopolsky, MD, PhD, from the Department of Pediatrics and Medicine said the research provides much needed validation for a practice that is growing in popularity. "The potential benefits of massage could be useful to a broad spectrum of individuals including the elderly, those suffering from musculoskeletal injuries and patients with chronic inflammatory disease," said Tarnopolsky. "This study provides evidence that manipulative therapies, such as massage, may be justifiable in medical practice." About 18 million individuals undergo massage therapy annually in the U.S., making it the fifth most widely used form of complementary and alternative medicine. Despite several reports that long-term massage therapy reduces chronic pain and improves range of motion in clinical trials, the biological effects of massage on skeletal tissue have remained unclear.

Massage Therapy Helps Manage Pain In Children With Sickle Cell Disease

Published: Thursday 13 August 2009

Massage offers both physical and psychological benefits and is used at Nationwide Children's Hospital in many areas including Rehabilitation, Physical Medicine and in patients who have received organ transplants, just to name a few. Researchers at Nationwide Children's recently published a study in the Journal of Pediatric Psychology that revealed the benefits of massage in reducing pain, anxiety and depression in children with Sickle Cell Disease.

Sickle Cell Disease is an inherited blood disorder that affects the red blood cells, causing the cells to become hard and pointed instead of soft and round. More than 70,000 Americans suffer from this genetic disorder and it is considered an international health problem.

Kathleen Lemanek, PhD, and Mark Ranalli, MD, conducted the first study that measured the effects of massage in children with Sickle Cell Disease in a home setting. Eighteen of patients' parents were trained by massage therapists, while 16 participants were used as a control group. They found children in the experimental group were significantly less depressed, less anxious and suffered from less pain after receiving massages from their parents.

"It's important to note that massage may not be right for all patients with Sickle Cell Disease or even patients who may suffer from chronic pain," said Dr. Lemanek, pediatric psychologist at Nationwide Children's Hospital. "You have to consider personal characteristic and comfort levels of both the parents and child first before determining if massage is right."

"Massage is an inexpensive and easy way to manage pain, which is a big part of having Sickle Cell Disease ," said Dr. Ranalli, attending physician in Hematology, Oncology and Bone Marrow

135 Transplant at Nationwide Children's and a faculty member at The Ohio State University College of Medicine. "Pain management for Sickle Cell Disease typically includes hydration, nonsteriodal anti-inflammatory drugs and narcotics. Massage as a pain management technique can relax the muscles, increase circulation and help medication take a more effective route."

Researchers measured both the children and their parents' anxiety levels throughout this study and were surprised to find that parents who gave massages to their children had significantly higher anxiety levels at the end of the study. The requirement to provide a nightly massage and the stress of managing symptoms at home may have temporarily increased parents' anxiety. However, if benefits are experienced overtime with regular massages, caregivers may experience a sense of control in reducing pain, consequently lowering their anxiety.

"Even though parents' anxiety levels were increased, parents from the study said they would continue to use massage as a pain management tool," said Dr. Lemanek, who is also a faculty member at The Ohio State University College of Medicine. "When your kids are in pain, despite medication, and parents feel hopeless like they have exhausted all options, massage can help them feel in control of the disease. When your child looks at you in pain, massage gives you the opportunity to do something to actively try and help."

Source: Nationwide Children's Hospital

Massaging Muscles Facilitates Recovery After Exercise

Published: Wednesday 13 August 2008

Researchers testing the long-held theory that therapeutic massage can speed recovery after a sports injury have found early scientific evidence of the healing effects of massage.

The scientists have determined that immediate cyclic compression of muscles after intense exercise reduced swelling and muscle damage in a study using animals.

Though they say it's too soon to apply the results directly to humans in a clinical environment, the researchers consider the findings a strong start toward scientific confirmation of massage's benefits to athletes after intense eccentric exercise, when muscles contract and lengthen at the same time.

"There is potential that this continuing research will have huge clinical implications," said Thomas Best, a professor of family medicine at Ohio State University and senior author of the study. "If we can define the mechanism for recovery, the translation of these findings to the clinic will dictate how much massage is needed, for how long, and when it should be performed after exercise."

Anecdotal evidence suggests massage offers many health benefits, but actual testing of its effects at the cellular level is more difficult than one might think. In this study with rabbits, the researchers used one mechanical device to mimic movements associated with a specific kind of exercise, and a second device to follow the exercise with a simulated consistent massaging motion on the affected muscles. They compared these animals to other animals that performed the exercise movements but did not receive simulated massage. All animals were sedated during the experiments.

"We tried to mimic Swedish massage because anecdotally, it's the most popular technique used by athletes," said Best, who is also co-medical director of the OSU Sports Medicine Center and

136 a team physician for the Department of Athletics. "A review of the research in this area shows that despite the existing anecdotal evidence - we know athletes use massage all the time - researchers don't know the mechanism of how massage improves recovery after exercise and injury."

Swedish massage combines long strokes, kneading and friction techniques on muscles and various movements of joints, according to the American Massage Therapy Association.

After the experimental exercise and massage were performed in the study, the researchers compared the muscle tissues of all of the animals, finding that the muscles in animals receiving simulated massage had improved function, less swelling and fewer signs of inflammation than did muscles in the animals that received no massage treatment after exercise.

Research Says Massage May Help Infants Sleep More, Cry Less And Be Less Stressed

Published: Monday 13 November 2006

New research by a team at the University of Warwick says that massage may help infants aged under six months sleep better, cry less and be less stressed.

\"Given the apparent effect of infant massage on stress hormones, it is not surprising to find some evidence of an effect on sleep and crying,\" said Angela Underdown of the University of Warwick.

137 Contact: Peter Dunn University of Warwick

Abdominal Massage Shown To Benefit Constipation In MS

Published: Tuesday 14 July 2009

Trail results have highlighted the benefit of abdominal massage in the management of constipation - a common symptom in people with multiple sclerosis (MS).

It was found that the group of people being treated with a combination of laxatives and abdominal massage had reduced severity of abdominal symptoms, including constipation and pain, than the group taking laxatives alone.

The MS Society has recognised the importance of finding new ways to manage common MS symptoms such as constipation.

Last year more than £120,000 was spent on a project to help develop a better approach to managing a variety of bowel syndromes for people with MS and formed part of the MS Society's Symptom Relief Research Initiative.

Source MS Society

Advanced Cancer Patients Benefit From Immediate Positive Effect On Pain And Mood When Massage Therapy Used

Published: Wednesday 17 September 2008

In a randomized trial of 380 advanced cancer patients at 15 U.S. hospices, improvement in pain and mood immediately following treatment was greater with massage than with simple touch.

138 promote relaxation, release endorphins, and create a positive experience that distracts temporarily from pain and depression.

About the American College of Physicians and Annals of Internal Medicine

Source: Angela Collom American College of Physicians

Chronic Low Back Pain Symptoms Eased With Massage Therapy

Written by Christian Nordqvist Published: Wednesday 6 July 2011

Trial leader, Daniel C. Cherkin, PhD, said:

"We found that massage helps people with back pain to function even after six months. This is important because chronic back pain is among the most common reasons people see doctors and alternative practitioners, including massage therapists. It's also a common cause of disability, absenteeism, and 'presenteeism,' when people are at work but can't perform well."

139 Ten weeks later, 1 in every 3 patients in the massage groups said their back pain had either gone or got much better, compared to just 1 in every 25 in the usual care group.

Questionnaire feedback also showed that just over two-thirds of those in the massage groups had significantly better back function at 10 weeks compared to just over one-third in the usual care group.

Those in the massage groups also spent less time laid up bed than those in the usual group, they were more active and used smaller quantities of anti-inflammatory drugs.

Dr. Cherkin said:

"As expected with most treatments, the benefits of massage declined over time. But at six months after the trial started, both types of massage were still associated with improved function."

No significant benefits from the massage were detectable after 12 months.

Dr. Cherkin added:

Dr. Cherkin's colleague Karen J. Sherman, PhD, MPH, said:

Further researcher should find out why structural and relaxation massages are effective: . Do both have specific effects, such as calming the CNS (central nervous system) or tissue - or does just one do that? . They may have non-specific effects that may help the patient become involved in his/her own healing. Examples include spending time in a relaxing environment, being touched, receiving care from a caring therapist, being advised on self care, better awareness of one's own body, etc. . Possibly a combination of non-specific and specific effects may be involved in reducing the back pain symptoms. "A Comparison of the Effects of 2 Types of Massage and Usual Care on Chronic Low Back Pain - A Randomized, Controlled Trial" Daniel C. Cherkin, PhD; Karen J. Sherman, PhD, MPH; Janet Kahn, PhD; Robert Wellman, MS; Andrea J. Cook, PhD; Eric Johnson, MS; Janet Erro, RN, MN; Kristin Delaney, MPH; and

140 Richard A. Deyo, MD, MPH Annals of Internal Medicine July 5, 2011 vol. 155 no. 1 1-9 Written by Christian Nordqvist

Massage Actually Impairs Blood Flow To The Muscle After Exercise

Published: Friday 8 May 2009

A Queen's University research team has blown open the myth that massage after exercise improves circulation to the muscle and assists in the removal of lactic acid and other waste products.

This study will be presented at the annual American College of Sports Medicine conference in Seattle, Washington May 27-30, 2009

Source: Stephanie Earp Queen's University

Massage For Childbirth Prep May Reduce Episiotomy Rate

Published: Thursday 26 January 2006

Low-tech, at-home preparation in the last month before childbirth could help pregnant mothers avoid one of the more common surgeries performed on women in the United States, a new review suggests.

There was a 15 percent reduction in episiotomies among the women who practiced perineal massage the review found, based on results from three trials, including data from 2,434 women.

141 The findings appear in the most recent issue of The Cochrane Library, publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Many expectant mothers have heard about Kegel exercises to strengthen the pelvic-floor muscles before birth, but perineal massage isn\'t as well-known or recommended as often.

\"It\'s not standard in obstetrics, but there is interest in this area,\" said Beckmann, an obstetrician with the QE2 Jubilee Hospital in Queensland, Australia.

\"It\'s amazing the number of women who are fearful about cuts and tears and afraid of an episiotomy,\" said Sally Avenson, a certified nurse midwife in western Washington state.

In the three reviewed studies, women practiced perineal massage for as little a four minutes three to four times a week, and as much as 10 minutes daily, beginning in week 34 of their pregnancy.

\"It goes along with a plan for exercise and nutrition. You can\'t isolate the perineum from health,\" she said.

142 \"It\'s not anything where I guarantee you won\'t tear, but it is something you have power to do,\" said Avenson, who\'s led her own midwifery practice for 25 years.

Beckmann MM, et al. Antenatal perineal massage for reducing perineal trauma (Review). The Cochrane Database of Systematic Reviews 2006, Issue 1.

The Cochrane Collaboration is an international nonprofit, independent organization that

Massage May Help Dementia Patients With Agitation

Published: Thursday 2 November 2006

In two studies, hand massage and gentle touching during conversation helped ease agitation and restore appetite in dementia patients over short periods of about an hour.

Cynthia Bologna, a Petaluma, Calif., massage therapist who works extensively with people with dementia, said she often works with patients to bring about short-term effects such as relaxation.

Viggo Hansen N, Jorgensen T, Ortenblad L. Massage and touch for dementia The Cochrane Database of Systematic Reviews 2006, Issue 4.

143 Massage Therapy May Have Immediate Positive Effect On Pain And Mood For Advanced Cancer Patients

Published: Wednesday 24 September 2008

Pain and depressed mood are common problems for patients with advanced cancer. While drug therapies can reduce symptoms, they don't always work and often have troublesome side effects. Researchers think that massage may interrupt the cycle of distress, offering physical and psychological benefits. Physically, massage may decrease inflammation and edema, increase blood and lymphatic circulation, and relax muscle spasms. Psychologically, massage may promote relaxation, release endorphins, and create a positive experience that distracts temporarily from pain and depression.

American College of Physicians

Some Forms Of Massage Help Against Low-Back Pain But Not All Techniques Live Up To The Promises Made For Them

Published: Monday 29 March 2010

Most people have experienced back pain - and many hope that massage will relieve it. But not all forms of massage have been scientifically proven to help against low back pain. That is what the German Institute for Quality and Efficiency in Health Care (IQWiG) pointed out in information published on http://informedhealthonline.org/ .

Back pain often affects the lower back and can be a big physical and psychological burden. "The cause of back pain is not always immediately clear," explains Professor Peter Sawicki, the Institute's Director. "But low back pain usually gets better on its own within a few weeks." Back pain is only rarely caused by a more serious health problem.

Classic massage, Thai massage and acupressure could help against low back pain

If low back pain does not get better on its own, massage therapy could be a worthwhile option. "Research suggests that classic massage, Thai massage and acupressure can relieve low back pain that has lasted longer than several weeks," says the Institute's Director. In classic (Swedish) massage the affected area of skin and muscles are massaged, in Thai massage the limbs are pulled and stretched, and acupressure involves applying pressure to certain points on the body. "But relying on massage alone does not appear to be the best approach when it comes to back pain", adds Sawicki. Research indicates that people could benefit more if they combine massages

144 with exercises and stretching. In some trials this combination of approaches led to better pain relief and mobility compared to massage alone.

Not all massages are the same

"Not all forms of massage have been scientifically proven to help against chronic back pain though," concludes Sawicki. "So it is worth finding out about the different techniques before deciding to have a certain type of massage." An overview of the most common forms of massage is now available on http://informedhealthonline.org/ .

Source: Hilda Bastian Institute for Quality and Efficiency in Health Care

Why Massage Is In Americans' Futures

Published: Wednesday 25 October 2006

More than one out of every 6 Americans gets a massage each year, that's 25 million more Americans than 10 years ago, according to an annual survey commissioned by the American Massage Therapy Association(R) (AMTA(R)). In the past, relaxation was the leading motivator for massage, but increasingly Americans are looking to massage therapy for medical reasons (30 percent) such as injury recovery, pain reduction, headache control, and overall health and wellness.

"About one third of Americans still think massage is a luxury, but our latest survey shows that 40 percent have had a massage to relieve pain," says Mary Beth Braun, president of the AMTA. "And while we have seen a strong interest in massage therapy for health reasons from all age groups, there's been a real increase in understanding of the value of massage among Generation Y. It looks like their interest will grow stronger as this group ages."

In fact, 72 percent of Generation Y respondents disagree that massage is just a luxury; ninety-two percent say they believe massage can be an effective way to relieve pain, while 48 percent of 18- to 24-year-olds have already had a massage to relieve pain.

"Younger people are telling us that massage can be a valuable part of their personal health routine," says Braun. "As they come to rely more and more on massage for therapeutic reasons, as well as for stress relief, they'll need to know how best to find professional massage therapists who can be relied upon to provide the best possible service."

Finding a professional massage therapist who is well-trained and knowledgeable can make or break a person's massage experience. AMTA offers a professional massage therapist locator service (http://www.findamassagetherapist.org) and encourages consumers to look for an AMTA massage therapist. The organization also recommends asking massage therapists specific questions, including if they are licensed to practice massage, if they are Nationally Certified in Therapeutic Massage and Bodywork and where they received massage therapy training.

Why people get massages

According to AMTA's annual survey, more than 39 million Americans received a massage in the last year, and almost one out of three people (30 percent) who had a massage in the past 5 years

145 received massages for "medical/health reasons" other than stress relief. More than half (53 percent) who discussed massage with their healthcare providers say their doctor recommended they get massage therapy.

-- Men and respondents 65 and older are especially likely to get massages for medical/healthcare reasons.

-- Women indicated massage therapy was their first choice when asked "what gave you the greatest relief from pain?" (24 percent versus 22 percent who chose medications as their number one pain-relief choice).

-- Men placed medications first (24 percent) and massage second (19 percent). -- Almost one out of three (32 percent) of Hispanic respondents chose massage therapy as their preferred choice of pain relief, and more than half (57 percent) of Hispanics have had a massage to relieve pain. -- The number of people who indicated having their massage paid by an insurance company or a co-pay doubled from 5 percent last year to 10 percent this year.

"Relaxation/stress reduction" (26 percent) and "because it was free or a gift" (21 percent) are also common reasons for having massage as shown in ten years of consumer surveys. "Massage is a hot topic," says Braun of the AMTA. "As the medical community increasingly recognizes its benefits, and as more insurance companies begin to include it in their plans, massage will become a more common component of people's health and wellness practice."

Types of massage

While finding the right massage therapist is critical, consumers also need to understand how massage can help them by understanding what types of massage are best-suited to their individual needs. "The more people know about massage," notes Braun, "the better they'll be able to take advantage of its benefits."

There are many types of massage and AMTA recommends that people discuss with their massage therapists their physical condition and what they hope to achieve from their massage. The four most common types of massage are:

Swedish massage: a gentle, relaxing massage using a system of long strokes, kneading and friction techniques.

Deep tissue massage: beneficial for muscle damage from an injury, such whiplash or back strain.

Sports massage: helps prevent athletic injury, keeps the body flexible and may aid in healing the body in the event of an injury.

Chair massage: massage of the upper body, while fully clothed and seate in a special portable chair and is meant to relax and improve circulation.

About AMTA

146 to improve the professional climate for massage therapists. The association also helps consumers and healthcare professionals locate qualified massage therapists nationwide, through AMTA's Find a Massage Therapist(R) free national locator service available at http://www.findamassagetherapist.org .

Adequate doses of massage treatment necessary for relief of neck pain

Published: Wednesday 12 March 2014

Neck pain is a common and debilitating condition, and massage therapy is commonly used to treat it, yet there is little quality research on the optimal dose of therapeutic massage for neck pain. Randomizing 228 patients with chronic neck pain to five different groups receiving various doses of massage for a five-week period, researchers found the benefits of massage treatments for chronic neck pain increase with dose. Specifically, they found that patients who received 30-minute treatments two or three times weekly were not significantly better than a wait-listed control group in terms of achieving a clinically meaningful improvement in neck dysfunction or pain. In contrast, patients who received 60-minute treatments two or three times weekly showed significant improvement in neck dysfunction and pain intensity compared to the control group. Compared with their control counterparts, massage participants were three times more likely to have clinically meaningful improvement in neck function if they received 60 minutes of massage twice a week and five times more likely if they received 60 minutes of massage three times a week. The authors conclude patients who receive massage treatment for chronic neck pain may not be realizing benefits from treatment because they are not receiving an effective treatment dose. Five-Week Outcomes From a Dosing Trial of Therapeutic Massage for Chronic Neck Pain By Karen J. Sherman, PhD, MPH, et al Group Health Research Institute, Seattle

AMTA Consumer Survey Shows Men Neglecting Massage Therapy In Past Year

Published: Friday 24 September 2010

"We know from our AMTA survey results in the last 14 years that massage therapy usage has been on an overall upward trend, as people are realizing the health benefits of massage to

147 manage pain and keep them active, as well as being an excellent means to relieve stress" says Kathleen Miller-Read, AMTA president. "We believe that as the economic climate improves, men will return to massage therapy as part of their regular health maintenance plan."

Americans Are Reaching to Massage for Pain Relief

Americans Still See the Benefits of Massage, Particularly Those Who are Stressed

About 40 percent of stressed out Americans are getting massages to relieve their stress, which has increased from 32 percent in 2009.

"Stress, among other factors, is a popular reason why people get massage," says Miller-Read. "In a year where the economy is such a stress inducer, AMTA is pleased that people are increasingly turning to massage for stress relief." Source: American Massage Therapy Association (AMTA)

Circulation improved, muscle soreness eased by massage therapy

Published: Wednesday 23 April 2014

148 As expected, both exercise groups experienced soreness immediately after exercise. The exercise-and-massage group reported no continuing soreness 90 minutes after massage therapy. The exercise-only group reported lasting soreness 24 hours after exercise. Exercise-induced muscle injury has been shown to reduce blood flow. In this study, brachial artery flow mediated dilation (FMD) - a standard metric of general vascular health, measured in the upper arm - was taken by ultrasound at 90 minutes, 24, 48 and 72 hours after exercise. For the exercise-and massage-group, FMD indicated improved blood flow at all time points, with improvement tapering off after 72 hours. As expected, the exercise-only group showed reduced blood flow after 90 minutes and 24 and 48 hours, with a return to normal levels at 72 hours. "We believe that massage is really changing physiology in a positive way," said Franklin. "This is not just blood flow speeds - this is actually a vascular response." Because vascular function was changed at a distance from both the site of injury and the massage, the finding suggests a "systemic rather than just a local response," she said. "The big surprise was the massage-only control group, who showed virtually identical levels of improvement in circulation as the exercise and massage group," said Phillips. "The circulatory response was sustained for a number of days, which suggests that massage may be protective," said Phillips. For people with limited mobility or those with impaired vascular function, further research may show that regular massage offers significant benefits, the authors say.

Massage And Other Hands On Therapies Can Help Reduce Pain

Published: Friday 15 January 2010

Massage, manipulation and other hands-on approaches can safely and effectively help with pain management.

The January issue of Mayo Clinic Women's Health Source discusses the uses and benefits of massage, spinal manipulation, and Rolfing, as well as the Alexander technique and the Feldenkrais method.

149 Rolfing: Rolfing manipulates the fascia -- the protective tissue that surrounds the muscles. It aims to improve posture and realign the body.

Patients lie on a massage table while the practitioner uses hands, knuckles, thumbs, elbows and knees to manipulate the patient's tissues. It can be painful.

There's little research on the effectiveness of Rolfing in relieving pain. Some patients report that Rolfing helps with flexibility and improves their posture. It may relieve stress and anxiety.

Both therapies use touch and direction to help the patient become more aware of movement. An Alexander session might begin with the patient seated in a chair. The practitioner helps the patient adjust head, neck and spine positions.

These hands-on therapies probably won't replace pain relief medications but they could help manage chronic pain. A combination of approaches often works best in achieving long-term pain control.

Source: Mayo Clinic

Massage For The Cure Day Only A Month Away

Published: Monday 30 June 2008

150 Contact - To get a free 1-hour massage session and also help in the fight against breast cancer, call 1-866-917-3689 and be connected with the Massage Envy clinic closest to you - or get the address and phone number of all Atlanta-area clinics at http://www.massageenvy.com .

Reminders - Don't miss your chance to reserve an appointment when clinics begin booking on July 21. Register to receive an email reminder on July 20 by going here and selecting Atlanta.

About Susan G. Komen for the Cure

Nancy G. Brinker promised her dying sister, Susan G. Komen, she would do everything in her power to end breast cancer forever. In 1982, that promise became Susan G. Komen for the Cure and launched the global breast cancer movement. Today, Komen for the Cure is the world's largest grassroots network of breast cancer survivors and activists fighting to save lives, empower people, ensure quality care for all and energize science to find the cures. Thanks to events like the Komen Race for the Cure, we have invested more than $1 billion to fulfill our promise, becoming the largest source of nonprofit funds dedicated to the fight against breast cancer in the world. For more information about Susan G. Komen for the Cure, breast health or breast cancer, visithttp://www.komen.org or call 1-877 GO KOMEN.

About Massage Envy

Massage Envy Massage May Help Ease Pain And Anxiety After Surgery

Published: Tuesday 18 December 2007

151 the five days following surgery: 203 received routine care; 200 received a daily 20-minute back massage; and 202 received 20 minutes of individual attention each day from a massage therapist, but no massage. "The purpose of this group was to assess the effect of emotional support independent of massage," the authors write. Patients were asked daily to rate the intensity and unpleasantness of their pain, plus their level of anxiety, on scales of one to 10.

Archives of Surgery 2007;142(12):1158-1167.

Massage therapy: A profession on the rise

Published: Tuesday 1 March 2005

More impressive than Americans\' lopsidedly favorable feelings is their trend in feelings toward massage therapists over the past decade. A 45% plurality say their feelings have changed for the

152 better over the past 10 years, 3% say for the worse, 40% say no difference, and 12% are not sure. This 15-to-1 better-to-worse feelings ratio is promising confirmation of growing acceptance and goodwill toward massage therapists.

\"The massage therapy profession has worked to legitimize its standing among complementary therapies, distancing itself from out-dated, negative stereotypes. Massage now generally enjoys a receptive, welcoming climate,\" Benson says. Compared to the 12% of adults who reported visiting a massage therapist in 2004, the survey found that 13% went to a chiropractor and 10% to a physical therapist. Of those who received massage in 2004, their average number of visits was nine -- quite similar to frequency numbers for individuals accessing chiropractic (10) and physical therapy (11) services. \"What\'s especially impressive about these comparisons,\" Benson says, \"is that most chiropractic and physical therapy treatments are reimbursed by health insurancewhile more than 90% of massage therapy sessions are paid out of the client\'s own pocket.\" Massage therapists are especially popular among adults under age 50 (58% favorable) and women (also 58% favorable). Indeed, those favorably-disposed include two-thirds of women under age 45 and two-thirds of women with at least two years of college. Those least favorable and least familiar with massage therapists are age 65 plus (37% favorable).

\"In the 2005 telephone survey conducted for ABMP, visitation with massage therapists was posed in a battery amongst other healthcare providers -- which approach often reduces any

153 possible respondent resistance or inclination to provide socially acceptable answers. Respondents were not told at the outset of the interview who commissioned the survey, nor could they have

Providing Consolation For Bereaved Relatives Through Hand And Foot Massage

Published: Friday 26 March 2010

Receiving soothing massages for eight weeks after the death of a loved one can provide much- needed consolation during an intense, stressful period of grieving, according to a study in the April issue of the Journal of Clinical Nursing.