Gesa Meyer-Hamme

Low Level Laser Therapy for the Treatment of Diabetic Foot Ulcers: A Critical Survey

Diabetic foot ulcers as one of the most common complications of diabetes mellitus are defined as nonhealing or long-lasting chronic skin ulcers in diabetic patients. Multidisciplinary care for the diabetic foot is common, but treatment results are often unsatisfactory. Low level laser therapy (LLLT) on wound areas as well as on acupuncture points, as a noninvasive, pain-free method with minor side effects, has been considered as a possible treatment option for the diabetic foot syndrome. A systematic literature review identified 1764 articles on this topic. Finally, we adopted 22 eligible references; 8 of them were cell studies, 6 were animal studies, and 8 were clinical trials. Cell studies and animal studies gave evidence of cellular migration, viability, and proliferation of fibroblast cells, quicker reepithelization and reformed connective tissue, enhancement of microcirculation, and anti-inflammatory effects by inhibition of prostaglandine, interleukin, and cytokine as well as direct antibacterial effects by induction of reactive oxygen species (ROS). The transferral of these data into clinical medicine is under debate. The majority of clinical studies show a potential benefit of LLLT in wound healing of diabetic ulcers. But there are a lot of aspects in these studies limiting final evidence about the actual output of this kind of treatment method. In summary, all studies give enough evidence to continue research on laser therapy for diabetic ulcers, but clinical trials using human models do not provide sufficient evidence to establish the usefulness of LLLT as an effective tool in wound care regimes at present. Further well designed research trials are required to determine the true value of LLLT in routine wound care.

Can Medical Herbs Stimulate Regeneration or Neuroprotection and Treat Neuropathic Pain in Chemotherapy-Induced Peripheral Neuropathy?

Chemotherapy-induced neuropathy (CIPN) has a relevant impact on the quality of life of cancer patients. There are no curative conventional treatments, so further options have to be investigated. We conducted a systematic review in English and Chinese language databases to illuminate the role of medical herbs. 26 relevant studies on 5 single herbs, one extract, one receptor-agonist, and 8 combinations of herbs were identified focusing on the single herbs Acorus calamus rhizoma, Cannabis sativa fructus, Chamomilla matricaria, Ginkgo biloba, Salvia officinalis, Sweet bee venom, Fritillaria cirrhosae bulbus, and the herbal combinations Bu Yang Huan Wu, modified Bu Yang Huan Wu plus Liuwei Di Huang, modified Chai Hu Long Gu Mu Li Wan, Geranii herba plus Aconiti lateralis praeparata radix , Niu Che Sen Qi Wan (Goshajinkigan), Gui Zhi Jia Shu Fu Tang (Keishikajutsubuto), Huang Qi Wu Wu Tang (Ogikeishigomotsuto), and Shao Yao Gan Cao Tang (Shakuyakukanzoto). The knowledge of mechanism of action is still limited, the quality of clinical trials needs further improvement, and studies have not yielded enough evidence to establish a standard practice, but a lot of promising substances have been identified. While CIPN has multiple mechanisms of neuronal degeneration, a combination of herbs or substances might deal with multiple targets for the aim of neuroprotection or neuroregeneration in CIPN.

A survey of chinese medicinal herbal treatment for chemotherapy-induced oral mucositis.

Oral mucositis is one of the common side effects of chemotherapy treatment with potentially severe implications. Despite several treatment approaches by conventional and complementary western medicine, the therapeutic outcome is often not satisfactory. Traditional Chinese Medicine (TCM) offers empirical herbal formulas for the treatment of oral ulceration which are used in adaptation to chemotherapy-induced mucositis. While standard concepts for TCM treatment do not exist and acceptance by conventional oncologists is still low, we conducted a review to examine the evidence of Chinese herbal treatment in oral mucositis. Eighteen relevant studies on 4 single herbs, 2 combinations of 2 herbs, and 11 multiherbal prescriptions involving 3 or more compounds were included. Corresponding molecular mechanisms were investigated. The knowledge about detailed herbal mechanisms, especially in multi-herbal prescriptions is still limited. The quality of clinical trials needs further improvement. Meta-analysis on the existent database is not possible but molecular findings on Chinese medicinal herbs indicate that further research is still promising for the treatment of chemotherapy-induced oral mucositis.

An acupuncture research protocol developed from historical writings by mathematical reflections: a rational individualized acupoint selection method for immediate pain relief.

While balancing yin and yang is one basic principle of Chinese medicine, balancing methods for combination of meridians and acupoints had been described throughout the history of Chinese medicine. We have identified six historical systems for combinations of acupuncture points in historical writings. All of them represent symmetrical combinations which are defined by the steps in the Chinese Clock. Taking the historical systems as a basis, we calculated the possible combinations that fit into these systems they revealed, leading to a total of 19 systems offering new balancing combinations. Merging the data of these 19 systems, there are 7 combinatorial options for every meridian. On the basis of this data, we calculated 4-meridian combinations with an ideal balance pattern, which is given when all meridians balance each other. We identified 5 of these patterns for every meridian, so we end up with 60 patterns for all the 12 meridians but we find multiple overlapping. Finally, 15 distinct patterns remain. By combining this theoretical concept with the Image and Mirror Concept, we developed an acupuncture research protocol. This protocol potentially solves some problems of acupuncture trials because it represents a rational reproducible procedure independent of examiner experience, but the resulting treatment is individualized.

Mathematical Reflections on Acupoint Combinations in the Traditional Meridian Systems

The meridian system is a systematic order of empirical knowledge functioning as a rational ground for a balanced treatment by combining meridians. In TCM theory, a continuous circulation of Qi through 12 meridians is postulated, described as the Chinese clock (CC). On this basis, combinations of meridians and acupoints had been described in historical writings. The most common is the interior/exterior system beside the neighbouring system, the opposite clock system, and three systems, developed out of the theory of the six stages. All of these represent symmetrical combinations, which were defined by the steps in the CC. We calculated the possible combinations that fit into the systematics of the historical descriptions, leading to 19 systems. Merging the data of the 19 systems, possible steps in the CC clock for balancing a meridian are 1, 2, 3, and 6. Step 4 is not possible. Step 5 is a combinatory possibility but has no widespread tradition except for activating the yin extraordinary vessels. These possibilities can be plotted on the CC as a powerful tool for daily practice. Only two meridians might be excluded as potentially balancing meridians, so it seems almost impossible to define noneffective acupuncture points as controls in clinical trials.

Immediate Pain Relief in Adhesive Capsulitis by Acupuncture—A Randomized Controlled Double-Blinded Study

Objective Primary adhesive capsulitis (AC), or frozen shoulder, is an insidious and idiopathic disease. Severe pain is predominant in the first two of the three stages of the condition, which can last up to 21 months. Design, Setting, and Subjects Sixty volunteers with primary AC were randomly assigned to acupuncture with press tack needles compared with press tack placebos in a patient- and observer-blinded placebo-controlled study. The participants were subsequently offered classical needle acupuncture in an open follow-up clinical application. Thirty-four volunteers received conservative therapy, including 10 classical needle acupuncture treatments over 10 weeks, 13 volunteers received conservative therapy without classical needle acupuncture. All subjects agreed to follow-up after one year. Methods Acupuncture treatment was performed using a specific distal needling concept, using reflex areas on distant extremities avoiding local treatment. Results An immediate improvement of 3.3 ± 3.2 points in Constant-Murley Shoulder Score (CMS) pain subscore was seen in the press tack needles group and of 1.6 ± 2.8 points in the press tack placebos group (P <0.02). Conservative therapy including classical needle acupuncture significantly improved the pain subscore within 14.9 ± 15.9 weeks compared with 30.9 ± 15.8 weeks with only conservative therapy (P < 0.001). Conclusion The efficiency of distal needling acupuncture on immediate pain reduction was demonstrated in patients with AC and confirmed the applicability of press tack needles and press tack placebos for double-blind studies in acupuncture. Subsequent clinical application observation proved that results obtained with press tack needles/press tack placebos can be transferred to classical needle acupuncture. Integrating acupuncture with conservative therapy showed superior effectiveness with respect to the time course of the recovery process in AC compared with conservative therapy alone.

Structured literature review of acupuncture treatment for peripheral neuropathy

摘要目的总结现有的针刺治疗周围神经病变资料, 通过系统综述进行荟萃分析。方法文献查找范围涉及11 个数据库。 以针刺或电针治疗的由糖尿病、 化学疗法、 人体免疫缺损病毒及其他不明原因引起的周围神经病变的临床研究文献均被纳入。 以样本量、 随机方法、 对照组、 盲法、 针刺方法及结果评价方法作为荟萃分析的指标。结果纳入的26 个临床文献中, 无高质量的随机临床试验。 所有研究都存在方法缺陷。 9 个研究的样本量偏小, 25 个研究未使用随机方法, 8 个研究缺少对照组, 11个研究的对照不完善, 24 个研究缺少盲法, 并且针刺和结果评价的方法过于多样化。结论所有针刺治疗周围神经病变的研究都给出了有效的结果, 然而目前的数据并不足以做出荟萃分析, 期待设计完备的随机对照盲法试验。AbstractObjectiveTo summarize existing evidence on acupuncture treatment for peripheral neuropathy (PN) and potentially generate a meta-analysis by performing a structured literature review.MethodsLiterature searches were conducted on 11 databases. All identified clinical studies of acupuncture and electroacupuncture for peripheral neuropathy due to diabetes, chemotherapy, human immunodeficiency virus (HIV) and unknown cause were included. Study criteria such as sample size, randomization, controls, blinding, acupuncture patterns and outcome measurements were examined for the requirements of the meta-analysis.ResultsAmong the 26 studies included, no high quality randomized clinical trial was found. There were methodical limitations in all studies. Small sample size was found in 9 studies, lack of randomization in 25, lack of controls in 8, inadequate controls in 11, and lack of blinding in 24 studies, as well as a high variability of acupuncture patterns and outcome measurements.ConclusionNearly all acupuncture pilot studies on peripheral neuropathy give positive results encouraging further investigation, but a meta-analysis is not possible on the existent data. Randomized, controlled, blinded clinical trials with adequate design and significance still have to be performed.

ACUDIN – ACUpuncture and laser acupuncture for treatment of DIabetic peripheral Neuropathy: a randomized, placebo-controlled, partially double-blinded trial

BackgroundDiabetic peripheral neuropathy (DPN) is the most common complication of diabetes mellitus with significant clinical sequelae that can affect a patient’s quality of life. Metabolic and microvascular factors are responsible for nerve damage, causing loss of nerve function, numbness, painful sensory symptoms, and muscle weakness. Therapy is limited to anti-convulsant or anti-depressant drugs for neuropathic pain and paresthesia. However, reduced sensation, balance and gait problems are insufficiently covered by this treatment. Previous data suggests that acupuncture, which has been in use in Traditional Chinese Medicine for many years, may potentially complement the treatment options for peripheral neuropathy. Nevertheless, more objective data on clinical outcome is necessary to generally recommend acupuncture to the public.MethodsWe developed a study design for a prospective, randomized (RCT), placebo-controlled, partially double-blinded trial for investigating the effect of acupuncture on DPN as determined by nerve conduction studies (NCS) with the sural sensory nerve action potential amplitude as the primary outcome. The sural sensory nerve conduction velocity, tibial motor nerve action potential amplitude, tibial motor nerve conduction velocity, the neuropathy deficit score, neuropathy symptom score, and numeric rating scale questionnaires are defined as secondary outcomes. One hundred and eighty patients with type 2 diabetes mellitus will be randomized into three groups (needle acupuncture, verum laser acupuncture, and placebo laser acupuncture). We hypothesize that needle and laser acupuncture have beneficial effects on electrophysiological parameters and clinical and subjective symptoms in relation to DPN in comparison with placebo.DiscussionThe ACUDIN trial aims at investigating whether classical needle acupuncture and/or laser acupuncture are efficacious in the treatment of DPN. For the purpose of an objective parameter, NCS were chosen as outcome measures. Acupuncture treatment may potentially improve patients’ quality of life and reduce the socio-economic burden caused by DPN.Trial registrationGerman Clinical Trial Register (DRKS), No. DRKS00008562, trial search portal of the WHO (http://apps.who.int/trialsearch/).

Acupuncture analgesia involves modulation of pain-induced gamma oscillations and cortical network connectivity

Recent studies support the view that cortical sensory, limbic and executive networks and the autonomic nervous system might interact in distinct manners under the influence of acupuncture to modulate pain. We performed a double-blind crossover design study to investigate subjective ratings, EEG and ECG following experimental laser pain under the influence of sham and verum acupuncture in 26 healthy volunteers. We analyzed neuronal oscillations and inter-regional coherence in the gamma band of 128-channel-EEG recordings as well as heart rate variability (HRV) on two experimental days. Pain ratings and pain-induced gamma oscillations together with vagally-mediated power in the high-frequency bandwidth (vmHF) of HRV decreased significantly stronger during verum than sham acupuncture. Gamma oscillations were localized in the prefrontal cortex (PFC), mid-cingulate cortex (MCC), primary somatosensory cortex and insula. Reductions of pain ratings and vmHF-power were significantly correlated with increase of connectivity between the insula and MCC. In contrast, connectivity between left and right PFC and between PFC and insula correlated positively with vmHF-power without a relationship to acupuncture analgesia. Overall, these findings highlight the influence of the insula in integrating activity in limbic-saliency networks with vagally mediated homeostatic control to mediate antinociception under the influence of acupuncture.

Systematische Leitbahn-Kombinatorik (Teil 1)

ZusammenfassungIn der Theorie der chinesischen Medizin wird der Physiologie des Menschen eine endlos kontinuierliche Zirkulation des Qi durch die zwölf Leitbahnen in drei Zyklen zugrunde gelegt und in der sogenannten Chinesischen Organuhr (CO) graphisch dargestellt. Die Behandlung einer Leitbahn hat somit potentiell Auswirkungen auf alle anderen, bei Behandlung mehrerer Leitbahnen muss daher der Erhalt der Balance zwischen den Leitbahnen berücksichtigt werden. Auf der Basis dieses Postulates wurden in historischen Schriften und modernen Lehrbüchern folgende systematische Kombinationen von Leitbahnen beschrieben: Das Innen-Außen-System, das System der benachbarten Leitbahnen, das System der in der CO gegenüberliegenden Leitbahnen sowie drei Systeme, die auf der 6-Stadien-Lehre (6-Schichten-Lehre) basieren. In diesen sechs Systemen hat jede Leitbahn nur einen Partner. Es entstehen sechs Leitbahnpaare, entweder sechs Yin/Yang- oder drei Yin/Yin- plus drei Yang/Yang-Kombinationen. Bei graphischer Darstellung in der CO zeigte sich eine Rotationssymmetrie von 30°, 60° oder 120°, bei Verwendung von maximal zwei alternierenden Schritten. Auf dieser Grundlage wurde berechnet, ob weitere Kombinationen der Systematik der historischen Systeme entsprechen. Dabei wurden mathematisch insgesamt 19 Systeme (inklusive der sechs bekannten) ermittelt, die teilweise neue balancierte Leitbahn-Kombinationen eröffnen. Kumulativ ergibt sich, dass für jede Leitbahn genau sieben Leitbahnen balanciert kombinierbar sind. Diese liegen auf der CO 1, 2, 3 oder 6 Schritte von der zu behandelnden Leitbahn entfernt. Schritt 4 ist mathematisch nicht möglich, Schritt 5 verliert die Balance, wenn mehr als zwei Leitbahnen kombiniert werden. Durch Darstellung auf der CO steht so ein pragmatisches Werkzeug zur schnellen Ermittlung der sieben balancierten Behandlungsoptionen zur Verfügung.AbstractIn TCM theory, an endless continuous circulation of Qi through twelve channels in three cycles is postulated. The treatment of a channel has an effect on all other channels, so in case of treatment of more than one channel the balance between the channels has to be taken into account. On this basis, systematic combinations of meridians had been described in historical writings and modern textbooks. Our investigation discovered six historical systems. The most common is the interior/exterior system beside the neighbouring system, the opposite clock system, and three systems, developed out of the theory of the six stages. All have in common that they build a symmetrical combination in the 12-meridian circle of the Chinese clock (CC) with a rotation symmetry of 30°, 60°, or 120°. Every channel pairs with only one other and no channel is left over, so there are always six pairs of channels. A maximum of two alternating steps are used, leading to six yin-yang or to three yin-yin plus three yang-yang combinations. We calculated the possible combinations that fit into the systematics of the historical descriptions, leading to 19 systems including the 6 historical systems. Compilation of the data of the 19 systems showed that possible steps in the CC for balancing a channel are 1, 2, 3, and 6. Step 4 is not possible. Step 5 is a combinatory possibility but looses its balance, when more than two channels are combined. These seven possibilities can be plotted on the CC as a powerful tool for daily practice.