Dr. Peng Li's Presentation Summarizing 50 years of Acupuncture Research Cont'd 2

These are the results of their clinical study on acupuncture in hypertensive patients. I've successfully treated hypertensive patients in my clinic discussed here. For the record, I did not use electroacupuncture.
For more info on my practice, please click here.

Clinical Inertia: It Can Be Good For Your Health

This article cites a fascinating study in JAMA that looks at the benefits of the "less is more" approach to certain aspects of medicine. The authors "Phillips et al¹ intended to limit the discussion of inertia to disorders in which abnormal values may be the only manifestation of the disease, such as diabetes, hypertension, and dyslipidemia." This is a key characteristic of the conditions that can be treated to the point of danger in the name of prevention.

October 20, 2011, 10:20 am
When Doing Nothing Is the Best Medicine
By DANIELLE OFRI, M.D.

“Don’t just do something; stand there!”

It’s one of those phrases that attending physicians will spout off to their medical students while on rounds, trying to sound both sagacious and clever at the same time. It sometimes grates, but it does make a valid point, because so much of medicine is about “doing something.”

Sore throat? Prescribe an antibiotic.

New headache? Get a CT scan.

P.S.A. at the upper limit of normal? Get a biopsy.

Blood pressure still high? Add on another medication...

Of course, every “thing” a doctor does also has side effects — rampant bacterial resistance from antibiotic overuse; major increases in radiation exposure from unnecessary CT scans; incontinence or impotence from prostate cancer treatments that may do nothing to prolong life; toxic drug interactions from multiple medications, particularly in the elderly.

The admonishment “Don’t just do something; stand there!” reminds us that we should stop and think before we act, that there are many instances in which doing nothing is greatly preferable to doing something...

They focused on three common medical conditions — diabetes, elevated cholesterol and hypertension — for which there are established clinical guidelines for doctors to follow and “quality measures” that evaluate medical care. For all three illnesses, “lower is better” is the dominant mantra.

But while “lower is better” is probably true for large populations, that is not always the case for individual patients. In fact, there are some clinical trials in which aggressively lowered blood sugar or blood pressure have been associated with higher rates of dying.

Of course there are myriad situations where aggressive intervention is required, but it is helpful to have the reminder that sometimes less harm is done if you leave "well enough" alone.
(for more information about my practice, please click here.

Treating Hypertension (High Blood Pressure) in the Acupuncture Clinic

This is the abstract from a study on hypertensive patients from Professor John Longhurst's lab. It is a sort of summary of his findings discussed here and here.
A few comments... He uses electroacupuncture because he says it's easier to make it standard across patients. This was something I noticed repeatedly at the conference: most researchers are using electroacupuncture. I had a few different discussions with Dr. Longhurst, and he thinks that if you don't do electroacupuncture, you're really not stimulating because the stimulus goes away during the session. I don't agree with that. I think that the needles provoke a "micro-injury" just by being there and work just fine, even if you don't repeatedly stimulate them. Manual acupuncture, without electro, is my standard operating procedure. I use electro acupuncture if I'm following a specific protocol, for example for infertility or PCOS, or in musculoskeletal cases where the patient has reached a "plateau." I hardly ever start with electrical stimulation because of the tendency for it to aggravate the condition and the patient. I would never have the heart to do electrical stimulation at P6, as they do in this study. It's such a sensitive spot, I will try their other choice of LI11 and LI10 which is equally effective according to their work.
1

Acupuncture Treatment of Hypertension
John C. Longhurst, MD, PhD and Peng Li, MD, Department of Medicine, University of California, Irvine
Heart disease in both men and women has become the major cause of death and disability in both developed and developing countries. Coronary atherosclerosis, the leading cause of heart disease, has a number of risk factors that increase its incidence. These include hypertension, hypercholesterolemia, diabetes mellitus, family history, obesity, physical inactivity and chronic stress. Hypertension, in particular, is reversible if patients are treated early and blood pressure is lowered to normal levels. Although a number of drug therapies have been shown to be valuable in lowering this risk factor, many patients do not take medications faithfully because of their common side effects and need for daily dosing. As such, there is a strong rationale developing alternative regimens to control blood pressure. One such therapy is acupuncture. Acupuncture is a form of integrative medicine that has substantial evidence demonstrating its mechanisms of action to lower sympathetic outflow, one of the major causes of elevated blood pressure. For example, studies in our laboratory show that, through an opioid mechanism in the brain stem, acupuncture can lower reflex elevations in blood pressure. Furthermore, we have shown that low frequency, low intensity electroacupuncture at some acupoints, such as P5-P6 and S36-S37, is most effective in lowering elevated blood pressure for prolonged periods of time. In the last decade several studies have been conducted showing that acupuncture is capable of lowering blood pressure to a small extent for the period of time during which it is applied. Although these studies indicate a possible role for acupuncture in treating hypertension, they have been confounded by use of a variety of different acupoints, some of which may not have strong cardiovascular actions, use of manual acupuncture, which unlike electroacupuncture cannot be standardized between patients, the use of very frequent acupuncture, which because of patient incompliance could limit success for long-term treatment, and the absence of regular follow-up, which does not provide an understanding of the duration of acupuncture’s action. To overcome these obstacles, we have embarked on a program of treatment of patients with mild to moderate hypertension using 30 min of low intensity (2 mA), low frequency (2 Hz) electroacupuncture at P5-P6 and S36-S37, a modality and site of action that we have shown has the greatest action on sympathetic outflow and elevated blood pressure in our experimental studies. Furthermore, all patients were off antihypertensive medications for the duration of the study and agreed to acupuncture treatment once weekly for an eight week period with a further follow-up for an additional eight weeks to determine acupuncture’s duration of action. Ambulatory automated blood pressure monitoring demonstrated that both average and 24 hour peak systolic and mean arterial blood pressures were lowered by electroacupuncture after 4-6 weeks of therapy by as much as 11-18 mmHg and that the duration of action of lasted for up to 4 weeks after termination of acupuncture in 73% of individuals treated. Conversely, 69% of a group of control hypertensive subjects treated at LI6-LI7 and GB37-GB39 (cardiovascular inactive acupoints demonstrated in our experimental studies), , did not demonstrate any change in blood pressure. These studies, guided by our results in experimental studies, suggest that low intensity and low frequency electroacupuncture applied once weekly at 2 acupoints demonstrated to have a strong influence on sympathetic activity after 4-6 weeks demonstrate a profound and prolonged antihypertensive response in many patients with mild or moderate hypertension. Additional work is needed to determine the optimal frequencies of repetitive stimulation during the initial period of intervention as well as during follow-up therapy for reinforcement of the blood pressure lowering action of acupuncture. Supported by grants from the NIH, HL063313 and HL072125-10, the Dana and Adolph Coors Foundations.

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Treating High Blood Pressure in the Acupuncture Clini

This is the latest data on the patient we've been following on this blog here and here. He is maintaining control of his blood pressure very nicely in spite of the fact that he hasn't been able to exercise as much as I recommend, nor has he taken the excess weight off. But he has followed through with his monthly acupuncture and takes his herbs religiously.
I did HRV monitoring on him when he came in on Wednesday and his LFR/HFR decreased from .68 to .57.
His SD1/Sd2 went down from .39 to .29 (not a positive result)
But his Sample Entropy went from 1.11 to 1.48 which, in my opinion is the most sensitive marker.
(Brief primer: LFR/HFR stands for Low Frequency/High Frequency HRV. If this decreases, it is interpreted to mean that the stress response in decreased. So decrease in LFR/HFR=decreased stress. The other measure SD1/Sd2, is a nonlinear method, if this ratio increases =decreased stress.)
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Blood Pressure Management and Acupuncture

This is another case study. This patient had severe peripheral neuropathy in her feet when she presented to the clinic. She suspected that it was due to a statin she was taking so discontinued it. She also had blood pressure that was out of control and wanted to try another approach.
The graph below shows her Blood Pressure the week before she came in to see me. Her first visit was 6/23/2011. Her last visit was 7/11/2011. The blood pressures for those days I took in my clinic. I didn't end up seeing her after those 4 visits, but contacted her to find out how she was doing and she gave me the last three readings.
So the acupuncture helped her blood pressure, but her blood pressure also was lowered because her feet improved dramatically so she wasn't in so much pain. This obviously helped her blood pressure also. (If I can get it together, I'll try to post her HRV readings in a later post since they were fascinating also.)



(For more information about my practice, please click here.)

Looking For Methods to Mitigate Alzheimer's Disease

From today's New York Times, an article looking at various conditions that, if mitigated, will help to avoid Alzheimer's. I won't copy much of the article.
But the following I will file in the "I Did Not Know That" file,(in bold.) I knew there were other reasons to avoid menopausal hormones, but this reason I was unaware of.

The panel found the strongest evidence for only one conclusion: that the herb gingko biloba does not prevent Alzheimer’s. There was moderate evidence that neither vitamin E nor drugs called cholinesterase inhibitors, used to treat dementia symptoms, decrease risk of Alzheimer’s. And there was moderate evidence that the gene ApoE4 significantly increases Alzheimer’s risk, as does menopause therapy with estrogens and progestins.

(for info on my practice, please click here.)

Typical Patient who comes to my Acupuncture Clinic

I thought I might start to feature some case studies of some of my patients. This patient is particularly interesting. She is in her mid sixties and came in for help with Neuropathy of her feet. Her other problems include high cholesterol and high blood pressure. It turns out that the neuropathy was made much worse by Lipitor. She finally convinced her physician to discontinue it, and she was doing better but then he put her on another statin. Her neuropathy got so intense that she couldn't walk without a cane and was crying out from the pain. She stopped it and came into the clinic to see me.
I gave her treatment for stress and for the neuropathy in her feet. I saw her for the first time on a Thursday, and by the following Monday the pain in her feet was much improved, and her blood pressure had remained below 140 systolic and below 80 diastolic. She can walk without a cane now.
Of course it is hard to tell if the acupuncture helped or if it was tincture of time being off of the statin. Similarly with the blood pressure, it might have come down with the lessening of the pain in her feet.
I will continue to treat her for both problems, at least for awhile, and try to get her blood pressure low enough that she can consider cutting back on medications.
Interestingly, she had Clostridia dificil last year. A nasty life threatening type of colitis that is usually caused by antibiotics. And sure enough, she had been treated for 6 months with antibiotics for a bladder infection. She was also diagnosed with COPD because of a dry cough, when dry cough is a typical side effect of Lisinopril, something I've seen quite a bit in my clinic. The cough went away once she discontinued the Lisinopril, COPD, um, gone.
These are the types of medical histories that make people open to alternative medicine. First, do no harm.
(For more information about my practice, please click here.)

Acupuncture for High Blood Pressure

Here is the update for one of my patients being treated with acupuncture and herbal therapy for hypertension. He comes in once a month for treatment and takes Great Yin and Gastrodia Relieve Wind from Health concerns. His blood pressure has remained under control without medications. In addition, his constipation is gone (often a side effect of effective acupuncture treatment.)

Neuro pathways involved in acupuncture decreasing Blood Pressure

This is a nice study that looks at the pathways involved in acupuncture's effect on blood pressure. I have had good results in my clinic in patients with hypertension as long as they are willing to follow through with their visits! Once their blood pressure has come down, monthly visits suffice usually with herbal supplementation.

To learn more about acupuncture, HRV, and my practice please click here.

Neural mechanism of electroacupuncture's hypotensive effects
Auton Neurosci. 2010 Oct 28;157(1-2):24-30. Epub 2010 May 5.
Neural mechanism of electroacupuncture's hypotensive effects. Li P, Longhurst JC
Department of Medicine, Susan-Samueli Center for Integrative Medicine, University of California, Irvine, California 92697, USA. pengli@uci.eduAbstract

EA at P 5-6 and S 36-37 using low current and low frequency may be able to reduce elevated blood pressure in a subset of patients (∼70%) with mild to moderate hypertension. The effect is slow in onset but is long-lasting. Experimental studies have shown that EA inhibition of cardiovascular sympathetic neurons that have been activated through visceral reflex stimulation is through activation of neurons in the arcuate nucleus of the hypothalamus, vlPAG in the midbrain and NRP in the medulla, which, in turn, inhibit the activity of premotor sympathetic neurons in the rVLM. The arcuate also provides direct projections to the rVLM that contain endorphins. Glutamate, acetylcholine, opioids, GABA, nociceptin, serotonin and endocannabinoids all appear to participate in the EA hypotensive response although their importance varies between nuclei. Thus, a number of mechanisms underlying the long-lasting effect of EA on cardiovascular function have been identified but clearly further investigation is warranted.

Good results with Acupuncture for a patient with High Blood Pressure

On a more anecdotal basis, I saw a patient today who has been coming to me for about 6 months to treat high blood pressure. He had no desire to take medications, and so was seeking some other alternatives. He is 67 and works in a stressful job as a taxi cab dispatcher. He had spent some time in Asia earlier in his working life so was open to acupuncture as an alternative.
He came twice weekly for 6 weeks and then weekly for 2 months. I treated him with classic points for decreasing rising yang, and also points that have been shown to calm the autonomic nervous system in studies, like sishencong and 6MC. We added daily herbal supplements in addition to the acupuncture treatments. In his particular case a Yin tonic was key. He now comes in once a month and has maintained his blood pressure in a healthy range. Here is a chart of his BP ( bit blurry, sorry!) It may not look super dramatic, but it's the difference between taking medications and not.

(To read more about acupuncture and my practice, please click here.)

Acupuncture: is it effective for treatment of insulin resistance?

Acupuncture: is it effective for treatment of insulin resistance?
Diabetes Obes Metab. 2010 Jul;12(7):555-69.
Liang F, Koya D.Department of Endocrinology & Metabolism, Kanazawa Medical University, Ishikawa, Japan.

This study out of Japan looks at the literature concerning acupuncture and conditions related to Insulin Resistance and concludes that acupuncture might very well improve insulin sensitivity, though, of course, calls for better, controlled, studies. This review analyses 234 English publications listed on the PubMed database between 1979 and 2009 on the effectiveness of acupuncture as a treatment for IR.
A few quotes

"Insulin resistance (IR) is closely associated with obesity, type 2 diabetes mellitus (T2DM), hypertension, polycystic ovary syndrome (PCOS), non-alcohol fatty liver diseases (NAFLD) and metabolic syndrome and is also a risk factor for serious diseases such as cardiovascular diseases. Pharmacological treatments available for IR are limited by drug adverse effects."

" Numerous experimental studies have demonstrated that acupuncture can correct various metabolic disorders such as hyperglycemia, overweight, hyperphagia, hyperlipidemia, inflammation, altered activity of the sympathetic nervous system and insulin signal defect, all of which contribute to the development of IR. In addition, acupuncture has the potential to improve insulin sensitivity."

(To read more about acupuncture and my practice, please click here.)

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.

(To read more about acupuncture and my practice, please click here.)
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.

The Stress Response (Autonomic Balance) and Acupuncture

A recent study from Columbia looks at a topic that is near and dear to me, i.e. autonomic balance, or the stress response, and acupuncture. In my own study (see my website) I found that there was more likely to be a decreased stress response during acupuncture treatment sessions in patients who benefited from acupuncture. Those patients who did not "get better" with acupuncture were less likely to see a decrease in their stress response. This study was performed on healthy volunteers, so, of course they couldn't draw any correlation with efficacy or outcomes. But I'm thrilled that the correlation of Heart Rate Variability (HRV) with acupuncture is being explored in various centers.

"The Acute Effects of Acupuncture Upon Autonomic Balance in Healthy Subjects. The Acute Effects of Acupuncture Upon Autonomic Balance in Healthy Subjects. Carpenter RJ, Dillard J, Zion AS, Gates GJ, Bartels MN, Downey JA, De Meersman RE. Department of Rehabilitation Medicine, College of Physicians and Surgeons of Columbia University and Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY 10027, USA.Am J Chin Med. 2010;38(5):839-847. Abstract

"Restoration of the sympathovagal (S/V) balance, involving a lowering of sympathetic and/or an augmentation of vagal modulation or a combination of both is associated with improvements in cardiovascular morbidity and mortality. To determine whether acupuncture exerts a favorable influence upon resting blood pressure and sympathovagal balance, a single-blind cross-over investigation was used to study the acute effects of acupuncture on S/V balance in normal healthy subjects. The ANOVA revealed a significant lowering of the sympathovagal balance (LF:HF) during rest for the acupuncture treatment from pre (4 +/- 2 nu) to post (2.2 +/- 1.8 nu)(p < style="font-weight: bold;">These findings are of importance since acupuncture treatments are non-pharmacological and have no known detrimental side-effects. This investigation employed healthy volunteers, yet acupuncture has been found to have more potent effects in animal models of hypertension and or in the presence of an autonomic imbalance ." (emphasis mine)

I have successfully treated patients for high blood pressure with acupuncture. I wish I was set up to be able to have HRV readings on all patients, especially those with high blood pressure or other autonomic disturbances. That is something that I'm working towards in my practice.
For other posts on autonomic balance and acupuncture:
http://ksparrowmd.blogspot.com/2010/04/heart-rate-variability-and-acupuncture.html
http://ksparrowmd.blogspot.com/2009/10/acupuncture-autonomic-nervous-system.html
http://ksparrowmd.blogspot.com/2009/10/heart-rate-variability-tens-and-body.html