Austrian Acupuncture and HRV study Part 3: moxibustion and Moxsafe

The third part of the Austrian Study looks at moxibustion on CV4 (a point on the lower abdomen corresponding to Dan Tien) and heart rate variability (HRV.) There appears to be an effect on HRV with moxa on Dan Tien. This is interesting, but how it is of interest clinically is uncertain since the effect is fairly small. I am quite interested in trying the new Moxsafe system from Seirin, however.
Twenty healthy Chinese volunteers were evaluated at the Beijing University of Chinese Medicine. Two different kinds of moxibustion were performed at the acupoint Guanyuan (CV4). Ten volunteers received a new form of needle moxibustion called Moxsafe, basically a metal holder for moxa applied directly to a needle. Ten volunteers received traditional stick moxibustion to CV4. Both showed a significant decrease in heart rate. The effect was slightly more pronounced using the new needle-moxa-system.. Total HRV was significantly increased only when Moxsafe was used. LF/HF ratio was insignificantly altered using both methods.

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Austrian Acupuncture and HRV study Part 2

I seem to have taken quite a hiatus from blogging due to travel. It was an unintended break, but I regret the lapse all same.
The second part of the Austrian study
(Transcontinental and Translational High-tech Acupuncture Research Using Computer-based Heart Rate and “Fire of Life” Heart Rate Variability Analysis by Gerard Litscher published in Journal of Acupuncture Meridian Studies )looks at blue laser and the effect of blue laser on Neiguan, a very commonly used acupuncture point for heart issues and angina pectoris, and nausea from all causes. They compared subjects (healthy volunteers) using real laser and then an inactive laser wand so the subjects could not tell the difference. The heart rate decreased in subjects when the real laser was used, but not inactive laser. Heart rate variability, HRV, was not affected with either type of stimulation.
It would be a fortuitous advance for acupuncture research if we could find a laser that had the same potency as needles themselves because of this ability to "blind" the patients to actual versus sham laser. It appears that the blue laser has some qualities of needles, but is not identical since needling Neiguan does affect HRV.1
1.Chin J Physiol. 2008 Jun 30;51(3):167-77.Links
Effects of acupuncture at Neiguan (PC 6) of the pericardial meridian on blood pressure and heart rate variability.
Chang S, Chao WL, Chiang MJ, Li SJ, Lu YT, Ma CM, Cheng HY, Hsieh SH.

Department of Electrical Engineering, National Tsing Hua University, Hsinchu, Taiwan, ROC. shyang@ee.nthu.edu.tw


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Austrian Acupuncture and HRV study Part 1

I will be discussing this study from a center at the University of Graz that looks at HRV and acupuncture, laser acupuncture, and moxibustion. The author kindly sent me a full copy of his study.
Transcontinental and Translational High-tech Acupuncture Research Using Computer-based Heart Rate and “Fire of Life” Heart Rate Variability Analysis by Gerard Litscher published in Journal of Acupuncture Meridian Studies
The first of four parts shows that acupuncture and acupressure on Yin Tang (the point between the eyebrows) calms the nervous system, showing a decrease in heart rate and a decrease in the LFR/HFR ratio of HRV.
The study explores acupuncture, acupressure and placebo acupuncture on Yin Tang (the point between the eyebrows prescribed to calm the spirit) and the Heart Rate Variability (HRV) response. HRV has been shown to be a fair correlate with the physiological stress response. Within certain parameters, the more variability in the heart rate the healthier the subject. Low Frequency/High Frequency ratio is shown to decrease with a decrease in the stress response or increase in restorative function.
What they found was that heart rate decreased significantly during acupuncture and acupressure on Yintang. The sham acupuncture point also decreased heart rate but less so. The Low Frequency/High Frequency ratio (LFR/HFR) ratio decreased with acupressure but decreased more in females.
The results reinforce the use of this particular point to "calm the spirit."

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Drugs causing the problems they're supposed to prevent

From the NYTimes:

"In the past month, the Food and Drug Administration has concluded that in some cases two types of drugs that were supposed to be preventing serious medical problems were, in fact, causing them.
One is bisphosphonates, which is widely used to prevent the fractures, especially of the hip and spine, that are common in people with osteoporosis. Those drugs, like Fosamax, Actonel and Boniva, will now have to carry labels saying they can lead to rare fractures of the thigh bone, a surprising new discovery that came after another surprise — that they can cause a rare degeneration of the jawbone.
The other is Avandia, which is widely prescribed for diabetics, whose disease puts them at risk for heart attacks and heart failure. Two-thirds of diabetics die of heart problems, and a main reason for taking drugs like Avandia is to protect them from that..."

They then go on to quote experts who feel that the FDA doesn't do enough to track drugs after they've been turned loose on the (unsuspecting) public. Since drugs only undergo a relatively short testing period, it would, of course make sense to continue tracking drugs once on the market. Where that money will come from I have no idea in this political climate, especially since the FDA has shown to be infiltrated with people from the drug industry with a vested interest. (See blog post "When oversight means overlook")
Given the shortcomings, and lack of oversight in the FDA I think it makes utmost sense as a health care consumer to wait at least 7 years before taking any newly released drug. Let others be the guinea pigs and if possible, take the version of any medication that is tried and true if given a choice. It's often cheaper, too.
I like to think that attitudes are changing among physicians, and that they're less willing to prescribe newly minted drugs, but I'm not sure if there is any evidence for that. I understand the drug companies rushing drugs to market, after all there is a boat load of money to be made. But I'm not sure I understand the eagerness of physicians to enable them. It could be pressure from patients themselves, who knows. But they should remind themselves of their oath to "first do no harm" and consider counseling weight bearing exercise and dietary changes before bisphonphonates and Avandia.

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Austrian Study on Acupuncture and Heart Rate Variability(HRV) with Laser and Moxa

The author of the following article was kind enough to send it to me in its entirety. It is an ambitious study that looks at a few different acupuncture modalities and HRV both short term and long term. I will devote a few posts to this paper going forward but just wanted to leave you with his initial quotation from one of the ancients. I'm a bit surprised that I had never read this before with my intense interest in HRV as a measure of health. It is another reminder of the astonishing acumen of the ancient Chinese practitioners.
Transcontinental and Translational High-tech Acupuncture Research Using Computer-based Heart Rate and “Fire of Life” Heart Rate Variability Analysis
Gerhard Litscher*, the Asian-Austrian High-tech Acupuncture Research Network† Research Unit of Biomedical Engineering in Anesthesia and Intensive Care Medicine and TCM Research Center Graz, Medical University of Graz, Graz, Austria

Variable heartbeat has been considered a sign of good health since the third century by oriental physicians and the scientist Wang-Shu Ho. Ho stated,“If the pattern of the heartbeat becomes regular as the tapping of woodpecker or the dripping of rain from the roof, the patient will be dead in four days”[1]. His statements were based on the manual pulse diagnosis...

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Increased Yin-Deficient Symptoms and Aggravated Autonomic Nervous System Function in Patients with Metastatic Cancer.

This is a truly fascinating study. It is a veritable "East Meets West" extravaganza. They are looking at both symptoms of Yin Deficiency and Autonomic dysfunction as measured by Heart Rate Variability, and metastastic disease. Yin deficiency is a part of some very prominent conditions in Traditional Chinese Medicine for example, Tuberculosis, High Blood Pressure, Menopausal Hot Flashes. As an anecdotal example, one of my current patients being treated for hypertension had remarkable and sustained lowering of both systolic and diastolic blood pressure with the addition of a powerful Yin tonic. To try to correlate the symptoms of Yin Deficiency with metastasis, not only broadens the reach of TCM diagnosis, but adds to our understanding of the yin yang imbalance. What drew my attention to it was the attention paid to Autonomic Dysfunction and it is food for thought that there was a definite correlation with Yin Deficiency and autonomic imbalance. It gives us one more lens to try to make sense of vexing conditions that be difficult to treat.

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Here are some excerpts of the abstract.
1. J Altern Complement Med. 2010 Sep 28.
Increased Yin-Deficient Symptoms and Aggravated Autonomic Nervous System Function in Patients with Metastatic Cancer.Lin SC, Chen MX.
1 Department of Nursing, Show Chwan Memorial Hospital , Changhua, Taiwan .
Abstract Objectives: The objectives of this study were to investigate the
differences in severity of yin-deficiency syndrome (YDS) and function of the
autonomic nervous system (ANS) between patients with cancer with metastasis and
those without metastasis. ...
Interventions: The severity of YDS in each subject was evaluated using a questionnaire containing 12 items about symptoms and signs related to YDS. The severity of each symptom or sign was rated on a 4-point scale. Outcome measures: The total score on the questionnaire represented the severity of YDS. ANS function in each subject was evaluated by measuring heart rate variability (HRV), including time and frequency domains. ...
Results: The patients with metastasis had significantly higher average total YDS score and heart rate compared with the patients without metastasis. In contrast, they had significantly lower HRV, including standard deviation of the 5-minute average R-R
interval, total power, very-low-frequency power, and low frequency (LF) power,but not high-frequency (HF) power and LF/HF ratio. Conclusions: The results of this study indicate that patients with metastatic cancer have more severe YDS and
impaired ANS function than those without metastasis.

Do Marathons Wreck Your Knees?

I feel obliged to link to this article since knee arthritis is one of the most studied uses for acupuncture and because I have a number of marathon runners as patients. The upshot seems to be that there is no conclusive evidence that marathons hurt your knees. In fact, active participants had less cartilage loss in their knees than sedentary counterparts. The active ones also had more bone spurs, and some microscopic changes in the cartilage, but their significance is uncertain and could be a positive adaptation. I like this conclusion and it makes sense to me, frankly. Of course any one person can have dramatically different outcomes, and I can't help wonder if the conditions under which you run makes a difference too.

http://well.blogs.nytimes.com/2010/10/13/phys-ed-do-marathons-wreck-your-knees/

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Alcohol Intake and Acupuncture in.... rats...

I just love this study. It is a study done in South Korea in conjunction with Brigham Young University published in Alcohol Clinical Experimental Research. 2010 Sep 2. The title of the study is "Acupuncture Inhibits GABA Neuron Activity in the Ventral Tegmental Area and Reduces Ethanol Self-Administration." (But I thought Mormon's didn't drink? I kid.)
They used one single acupuncture point, Heart 7, and found that needling this point decreased the rats' self administration of alcohol. Their conclusions were "These findings suggest that DOR-mediated opioid modulation of VTA GABA neurons may mediate acupuncture's role in modulating mesolimbic DA release and suppressing the reinforcing effects of ethanol."

They did look at the ventral tegmental area GABA neuron firing rate. I only have access to the abstract, so do not know how they managed all of it, but it tells me something that I've certainly seen clinically. That is that acupuncture can help to decrease alcohol intake. Now I know why. A hearty "thank you" to the researchers and rats involved in this really interesting experiment. Now I know how to explain this to my patients! It's their ventral tegmental area GABA neuron firing that was modified!

Acupuncture article in NYtimes: Acupuncture and Osteoarthritis of the Knee Another Look

I've been meaning to comment on this blog post from the New York Times http://well.blogs.nytimes.com/2010/08/23/studying-acupuncture-one-needle-prick-at-a-time/?scp=4&sq=acupuncture&st=cse for some time now. It covers a number of issues concerning acupuncture research. It first cites a recent study from MD Anderson School of Medicine exploring osteoarthritis of the knee and the effectiveness of acupuncture. The link to that article is here.http://onlinelibrary.wiley.com/doi/10.1002/acr.20225/abstract. The study is actually trying to determine if the clinical attention given to the patients affected outcome, thus getting at the ever present problem of "placebo" in acupuncture research. What they found in the study is that acupuncture worked about the same as sham acupuncture. Because of that, the study's lead author concludes that acupuncture does not work, since in your typical drug study if the drug works the same as a placebo the determination is that the drug does not work. ( We will leave aside the issue that many drugs on the market now,Prozac for example, work no better than placebo and still enjoy widespread use.) But another way to parse the outcome of the study is that acupuncture works even if poorly administered. In this particular study the sham acupuncture was less stimulative, shallow needling, so the acupuncture defenders can claim that acupuncture was performed. The NYTimes article goes on to mention the German Insurance Company studies which showed that drug (analgesic) usage was dramatically reduced with acupuncture and sham acupuncture in back pain patients versus the controls, and that only 15% of acupuncture patients needed pain medication versus 29% of sham 59% of controls. German Insurance Companies now pay for acupuncture as a result of these studies, btw. The article also mentions the study comparing effexor to acupuncture covered in this blog post.(http://www.blogger.com/post-edit.g?blogID=6188135334037051688&postID=1694074355474832229)
The placebo issue still plagues acupuncture research, and keeps the discussion from going further than whether we can trust the studies, and then whether acupuncture really works or not. It gets tiresome, especially given the scant funding for acupuncture research. One veteran British acupuncture researcher I met at the latest Society for Acupuncture Research conference is recommending that we simply design studies comparing one dosage of acupuncture (time, frequency, length of treatment, point selection) to another so we can finally get beyond the underlying premise of the MD Anderson study, ie that it's the clinical setting or attitude that is determining outcome. You would think that the animal studies would put some of the placebo chatter to rest a bit, but it doesn't seem to.
I have no interest in dispensing placebos, nor am I interested in delivering acupuncture using specific points, if it would be just as effective to use any random points on everyone. It would save lots of time and the effort of charting. I am dedicated to studying and learning what the actual mechanisms of acupuncture are so that we can use it more effectively in a no nonsense approach. If studies repeatedly indicate that one point is as good as another, so be it. But I don't think we're there yet.
In the spirit of "first doing no harm" however, I wish that other treatment modalities were held to the high standard that acupuncture is and were better scrutinized for bias, placebo and safety.

Supplements, a visual depiction of efficacy

Click on the link to see the evidence behind some popular supplements. Not an extensive list, by any means, but interesting nonetheless.
http://www.informationisbeautiful.net/visualizations/snake-oil-supplements/