Richard C. Niemtzow

Auricular Acupuncture in the Treatment of Acute Pain Syndromes: A Pilot Study

This pilot study used a randomized controlled clinical trial design to compare the effects of standard emergency medical care to auricular acupuncture plus standard emergency medical care in patients with acute pain syndromes. Eighty-seven active duty military personnel and their dependents with a diagnosis of acute pain completed the study, which was conducted in the emergency room (ER) at Malcolm Grow Medical Center, Andrews Air Force Base, Maryland. The primary outcome measure was change in pain level from baseline, as measured by the Numerical Rating Scale. Participants in the acupuncture group experienced a 23% reduction in pain before leaving the ER, while average pain levels in participants in the standard medical care group remained basically unchanged. (p < 0.0005). However, both groups experienced a similar reduction in pain 24 hours following treatment in the ER. More research is needed to elucidate treatment effects and to determine mechanisms.

Acupuncture: The Search for Biologic Evidence with Functional Magnetic Resonance Imaging and Positron Emission Tomography Techniques

399 The subject of acupuncture is surrounded, in some circles, with notions of mysticism and movements of energy through meridian channels invisible to the naked eye and a nomenclature for the internal organs that perplexes many Western-trained scientists confronted with the Chinese literature. While a large number of randomized controlled trials provides growing evidence of the clinical efficacy of acupuncture for treating a variety of medical conditions (National Institutes of Health, 1997; Ernst and White, 1999; Stux and Hammerschlag, 2001) a reliance on apparently unverifiable concepts of energy gives rise to considerable skepticism of this alternative medical modality. Anecdotal reports of patient improvement may be sufficient to persuade the health care consumer but failure to completely demonstrate the relationship of Oriental Medicine to known physiologic systems limits the acceptance of acupuncture in mainstream medicine. Physicians who practice medical acupuncture often provide considerable benefit to patients who have reportedly “failed” to respond to contemporary Western medicine. Thus, these physicians appreciate the enormous clinical value of acupuncture. Nonetheless, historical accounts in Europe and America of such supposedly effective medical cures as “bloodletting” and “mysterious elixirs” led Western physicians to doubt medical procedures not grounded in well-researched, biologic mechanisms and continue to fuel Western cynicism toward Oriental Medicine. However, advances in sophisticated technology utilized in the fields of neuroscience and molecular biology have the potential to lead to greater understanding of the mechanisms underlying the effects of acupuncture. In their paper “A Pilot Study of Functional Magnetic Resonance Imaging of the Brain During Manual and Electroacupuncture Stimulation of Acupuncture Point (LI-4 Hegu) in Normal Subjects Reveals Differential Brain Activation Between Methods” (pages 411–419), Jian Kong et al. demonstrate the complexity of researching even the basic process of needling a major acupuncture point, Large Intestine 4 (LI 4). Nevertheless, their endeavor to explore the centrally mediated effects of acupuncture using functional magnetic resonance (fMRI) brain imaging techniques takes advantage of an opportunity that Chinese doctors from the past

Electrodermal Mapping of an Acupuncture Point and a Non-Acupuncture Point

Dear Editor: Due to controversially discussed results in the scientific literature (Ahn and Martinsen and Quintanilha et al.) concerning electrical skin impedance at acupuncture points and nonacupuncture points, a new measurement system was developed recently. Using this new electrodermal mapping system, a pilot study was performed at the Medical University of Graz (supported by the Federal Ministries of Health and of Science and Research and Eurasia-Pacific Uninet). This study was performed in 10 male volunteers, ages 20–30 years (mean age – standard deviation: 24.6 – 2.5 years) and of Caucasian descent. The aim of this study was to measure the skin resistance of an acupuncture point compared to a placebo point. The sensor of the system consists of an 8 · 6 electrode array with spring-mounted electrodes of gold-plated beryllium copper with a diameter of 0.9 mm. The point Kǒngzuı̀ (Lu6) and a placebo point on the same level of the acupoint but located on the ulnar side of the heart meridian were used. These points were determined by an experienced acupuncture practitioner. Two (2) measurements were carried out per person. The results of the electrical characterization (skin resistance) of the areas surrounding the acupuncture point and the placebo point were then compared. The measurements of skin resistance at the acupuncture point showed lower impedance values than those taken from the placebo point on the same arm (Fig. 1). A significant ( p < 0.01; analysis of variance on ranks) difference of the values was found. Measured values on the acupuncture point were significantly lower (by 106 kO; mean values placebo point: 1218 kO, mean values acupuncture point 1112 kO). In the future, attention should be paid especially to possible confounders such as the pressure of electrodes as described by Ahn and Martinsen and Quintanilha et al. In this study, we investigated only male volunteers, since it was shown by Fogari et al. that there are differences between the sexes, characterized by the lower external resistance in males than in females. With more subjects and points and avoiding the most common confounders, studies with higher quality may be achieved.

Report from the 9th International Symposium on Auriculotherapy Held in Singapore, 10–12 August 2017

Auricular interventions also known as auriculotherapy, auricular medicine and ear acupuncture depending on practice locale, has come of age and has gained the attention of the wider medical community in recent years.[...]

Acupuncture in Military Medicine

Abstract : Pain treatment and management remains one of the biggest challenges to modern medicine today. A recent Centers for Disease Control and Prevention (CDC) report found that 25 percent of U.S. adults reported experiencing a full day of pain within the past 30 days and one in 10 said their pain lasted one year or more. The most common complaints were low back pain followed by migraine or severe headache and joint pain[1]. Current research efforts to understand pain mechanisms have revealed a complex picture in which the biological mechanisms of pain reach beyond the nervous system to other areas and systems associated with depression, anxiety, and sleep, areas of the mind and psyche. A recent nationwide survey found that one in five Americans say their pain has resulted in major lifestyle changes in employment, residence, or personal freedom and mobility. Participants viewed the medical community as being only partially successful in helping patients manage their pain[2]. New, multi-disciplinary approaches to pain management have been developed and many therapies exist, however the dominant component of these approaches continues to be prescription and over-the-counter medications. While the use of medications is necessary and often effective, it does present the risk of overreliance, misuse, and abuse. Over the last decade there have been a number of reviews highlighting not only a significant rise in prescription medication, but also a sharp climb in abuse particularly for those between the ages of 18-25.

Basic Science: Mysteries and Mechanisms of Acupuncture

Every day, acupuncturists insert tiny metal needles into acupuncture points located on meridians, hoping to combat a myriad of clinical pathologies. For the most part, we practitioners are witness to a clinical benefit. Otherwise, physicians would have stopped performing this technique several thousand years ago, and we would not be using it today. However, while we witness healing, none of us has ever seen an acupuncture point let alone a meridian. Modern investigational technology, at its best, fails to provide evidence of these two very basic structures. With this in mind, I know that many of us have asked: ‘‘How does acupuncture work?’’ Perhaps we depended, somewhat, on mythical explanations influenced by the classic readings. When I hypothesized Western mechanisms that might offer an explanation, I was told, by one of my esteemed colleagues, that acupuncture does not follow Newtonian physics. I thought, perhaps, that was an excuse to avoid ‘‘drilling’’ deeper to uncover the same mechanisms that enriched our understanding of allopathic medicine. My wife, who was trained in acupuncture in China, told me that exploring acupuncture on a molecular level to seek an explanation as to ‘‘how it works’’ is, somewhat, a fallacy. She posited that, to understand acupuncture, one most explore its relationships to the environment, animal and plant life, weather, seasons, and the universe. However, I have to admit that I am an ‘‘old die hard’’; for me, natural events do have scientific explanations and placing a needle in an acupuncture point on a meridian and producing a physiological effect could be understood by using the scientific technology used to understand allopathic medicine. When Dr. Richard Hobbs approached me with the idea of a special issue of Medical Acupuncture dedicated to basic science research, I welcomed the proposal and agreed that it would be a challenging project. This was an opportunity to look at the latest methodology and mechanisms to explore nature’s secrets. A collection of high-quality basic science articles is very difficult to obtain, given the fact that, over the years, we have received and only published a few articles on this topic. Even the review of these articles is challenging for an editorial board more accustomed to, and familiar with, clinical research. Nevertheless, our editorial team rose to the task. Dr. Anne Hendren, our Consulting Editor, Ms. Julia Chapman, our Interim Managing Editor, and the Editorial Board, along with the leadership of Dr. Hobbs, succeeded in bringing this Special Basic Science Issue of Medical Acupuncture to fruition. I understand and appreciate my wife’s naturalistic point of view and might suggest that the two explanations—one scientific, the other environmental—might both elucidate how acupuncture works. While preparing and reviewing the contents of this issue, I was told by one of my patients that a ‘‘high pressure cold front’’ was coming because her headaches had become more frequent. This weather front had not yet been announced; however, before it arrived, and when it did arrive, it influenced our environment and affected our health in ways that we, perhaps, had not dreamt about in our ‘‘drilled down’’ view of acupuncture.

Great Revolutionary Leaders of Alternative Medicine: A Fascinating Journey Back in Time

699 It all began when a friend of mine took his wife to an alternative medicine clinic in Mexico because she had ovarian cancer and a dismal prognosis. The truth was difficult to accept. After a few weeks of treatment, her ovarian tumor markers regressed and her quality of life improved. What was happening at this clinic? I decided a visit was in order. On a very hot day in July 2002, I went to the clinic director’s office in San Diego, where a shuttle bus takes patients to the clinic in Mexico and brings them back. While waiting for the shuttle, I struck up a conversation with a woman who had just returned from the Mexican clinic. She was from Australia and told me: “I have breast cancer and my doctors said that I might not survive the trip coming to the States. I was so weak. There was nothing to