Xueyong Shen

Adverse Events of Acupuncture: A Systematic Review of Case Reports

Acupuncture, moxibustion, and cupping, important in traditional Eastern medicine, are increasingly used in the West. Their widening acceptance demands continual safety assessment. This review, a sequel to one our team published 10 years ago, is an evaluation of the frequency and severity of adverse events (AEs) reported for acupuncture, moxibustion, and cupping between 2000 and 2011. Relevant English-language reports in six databases were identified and assessed by two reviewers. During this 12-year period, 117 reports of 308 AEs from 25 countries and regions were associated with acupuncture (294 cases), moxibustion (4 cases), or cupping (10 cases). Country of occurrence, patients sex and age, and outcome were extracted. Infections, mycobacterial, staphylococcal, and others, were the main complication of acupuncture. In the previous review, we found the main source of infection to be hepatitis, caused by reusable needles. In this review, we found the majority of infections to be bacterial, caused by skin contact at acupoint sites; we found no cases of hepatitis. Although the route of infection had changed, infections were still the major complication of acupuncture. Clearly, guidelines such as Clean Needle Technique must be followed in order to minimize acupuncture AEs.

Electroacupuncture inhibition of hyperalgesia in an inflammatory pain rat model: involvement of distinct spinal serotonin and norepinephrine receptor subtypes

BACKGROUND Although acupuncture analgesia is well documented, its mechanisms have not been thoroughly clarified. We previously showed that electroacupuncture (EA) activates supraspinal serotonin- and norepinephrine-containing neurones that project to the spinal cord. This study investigates the involvement of spinal alpha(2)-adrenoceptors (α2-ARs) and 5-hydroxytryptamine (serotonin) receptors (5-HTRs) in EA effects on an inflammatory pain rat model. METHODS Inflammatory hyperalgesia was induced by injecting complete Freunds adjuvant (CFA, 0.08 ml) into the plantar surface of one hind paw and assessed by paw withdrawal latency (PWL) to a noxious thermal stimulus. The selective α2a-AR antagonist BRL-44408, α2b-AR antagonist imiloxan hydrochloride, 5-HT2B receptor (5-HT2BR) antagonist SB204741, 5-HT3R antagonist LY278584, or 5-HT1AR antagonists NAN-190 hydrobromide, or WAY-100635 were intrathecally administered 20 min before EA or sham EA, which was given 2 h post-CFA at acupoint GB30. RESULTS EA significantly increased PWL compared with sham [7.20 (0.46) vs 5.20 (0.43) s]. Pretreatment with α2a-AR [5.35 (0.45) s] or 5-HT1AR [5.22 (0.38) s] antagonists blocked EA-produced anti-hyperalgesia; α2b-AR, 5-HT2BR, and 5-HT3R antagonist pretreatment did not. Sham plus these antagonists did not significantly change PWL compared with sham plus vehicle, indicating that the antagonists had little effect on PWL. Immunohistochemical staining demonstrated that α2a-ARs are on primary afferents and 5-HT1ARs are localized in N-methyl-d-aspartic acid (NMDA) subunit NR1-containing neurones in the spinal dorsal horn. CONCLUSIONS The data show that α2a-ARs and 5-HT1ARs are involved in the EA inhibition of inflammatory pain and that the NMDA receptors are involved in EA action.

Effectiveness of moxibustion treatment as adjunctive therapy in osteoarthritis of the knee: a randomized, double-blinded, placebo-controlled clinical trial

IntroductionOur objective was to compare the effectiveness and safety of traditional Chinese moxibustion to that of sham moxibustion in patients with chronic knee osteoarthritis (KOA) pain.MethodsWe conducted a randomized placebo-controlled trial involving 110 patients with KOA who met the inclusion criteria. These patients randomly received either active moxibustion (n = 55) or sham moxibustion control (n = 55) at acupoints Dubi (ST 35), extra-point Neixiyan (EX-LE 4), and an Ashi (tender) point three times a week for 6 weeks. Effects were evaluated with Western Ontario and McMaster Universities’ Osteoarthritis Index (WOMAC VA 3.1) criteria at the end of the course of treatment and 3, 12, and 24 weeks after the initial treatment.ResultsThe WOMAC pain scores showed greater improvement in the active treatment group than in control at weeks 3 (P = 0.012), 6 (P <0.001), 12 (P = 0.002), and 24 (P = 0.002) as did WOMAC physical function scores of the active treatment group at week 3 (P = 0.002), 6 (P = 0.015), and 12 (P <0.001) but not 24 (P = 0.058). Patients and practitioners were blinded successfully, and no significant adverse effects were found during the trial.ConclusionsA 6-week course of moxibustion seems to relieve pain effectively and improve function in patients with KOA for up to 18 weeks after the end of treatment. Moxibustion treatment appears to be safe, and the usefulness of the novel moxa device was validated.Trial registrationCurrent controlled trial: ISRCTN68475405. Registered 4 April 2014.

ATP Release from Mast Cells by Physical Stimulation: A Putative Early Step in Activation of Acupuncture Points

In Chinese medicine acupuncture points are treated by physical stimuli to counteract various diseases. These stimuli include mechanical stress as applied during the needle manipulation or tuina, high temperatures as applied during moxibustion, and red laser light applied during laser acupuncture. This study aimed to investigate cellular responses to stimuli that might occur in the tissue of acupuncture points. Since they have a characteristically high density of mast cells that degranulate in response to acupuncture, we asked whether these processes lead to ATP release. We tested in in vitro experiments on mast cells of the human mast-cell line HMC-1 the effects of the physical stimuli; mechanical stress was applied by superfusion of the cells with hypotonic solution, heat was applied by incubation of the cells at 52°C, and red laser light of 657 nm was used for irradiation. We demonstrate that all the stimuli induce ATP release from model human mast HMC-1 cells, and this release is associated with an intracellular free Ca2+ rise. We hypothesize that ATP released from mast cells supplements the already known release of ATP from keratinocytes and, by acting on P2X receptors, it may serve as initial mediator of acupuncture-induced analgesia.

Effect of different LLLT on pituitrin-induced bradycardia in the rabbit

The objective of this paper was to observe the effect of low-level combined- or single-laser irradiation on bradycardia produced by pituitrin in rabbits. A combined-laser apparatus was made. A 10.6-μm CO2 laser and a 650-nm semiconductor laser, transmitted by different optical fibers, converged to output and irradiate on the Neiguan (PC6) acupuncture point in rabbits with bradycardia produced by pituitrin. Thirty minutes after the model was set, the heart rates of the combined-laser Neiguan group made quicker recoveries than those of the model control group, the laser-control group, or the single-laser Neiguan group (P<0.05), and the heart rates of the single-CO2-laser Neiguan group were similar to those of the normal group (P>0.05). However, there were significant differences between the 650-nm-laser Neiguan group and the normal control group (P<0.05). The combined-laser irradiation certainly has a curative effect on bradycardia produced by pituitrin. A single CO2 laser could accelerate the recovery from bradycardia, while single 650-nm-laser irradiation on the Neiguan acupoint does not produce such an effect.

Interactions of Na+,K+-ATPase and co-expressed δ-opioid receptor

To investigate interference of delta-opioid receptor with the Na(+),K(+)-ATPase in a simple model system, we used the Xenopus oocytes as an expression system. Our results indicate that expression of the delta-opioid receptor (DOR) results in reduction of endogenous sodium-pump activity. Stimulation of DOR by the DOR agonist [(D)-Pen(2,5)]-enkephalin (DPDPE) had no pronounced additional effect on pump activity. Qualitatively similar results were obtained in experiments with a variety of co-expressed exogenous sodium pumps. We suggest that reduced pump activity with DOR expression is brought about by an interaction of the pump with DOR. Direct interaction is also supported by co-immunoprecipitation, not only in the Xenopus oocytes but also in rat hippocampal neurons. The interaction may be responsible for altered agonist sensitivity of DOR; activation of the sodium pump led to an increase of the K(m) value for DOR activation by DPDPE from about 0.17 to 0.27muM. In conclusion, pump activity not only affects neural activity directly but our results also suggest that pump activity is affected through functional interaction with DOR that will modulate pain sensation.

Modulation of extracellular ATP content of mast cells and DRG neurons by irradiation: studies on underlying mechanism of low-level-laser therapy.

Low-level-laser therapy (LLLT) is an effective complementary treatment, especially for anti-inflammation and wound healing in which dermis or mucus mast cells (MCs) are involved. In periphery, MCs crosstalk with neurons via purinergic signals and participate in various physiological and pathophysiological processes. Whether extracellular ATP, an important purine in purinergic signaling, of MCs and neurons could be modulated by irradiation remains unknown. In this study, effects of red-laser irradiation on extracellular ATP content of MCs and dorsal root ganglia (DRG) neurons were investigated and underlying mechanisms were explored in vitro. Our results show that irradiation led to elevation of extracellular ATP level in the human mast cell line HMC-1 in a dose-dependent manner, which was accompanied by elevation of intracellular ATP content, an indicator for ATP synthesis, together with [Ca2+]i elevation, a trigger signal for exocytotic ATP release. In contrast to MCs, irradiation attenuated the extracellular ATP content of neurons, which could be abolished by ARL 67156, a nonspecific ecto-ATPases inhibitor. Our results suggest that irradiation potentiates extracellular ATP of MCs by promoting ATP synthesis and release and attenuates extracellular ATP of neurons by upregulating ecto-ATPase activity. The opposite responses of these two cell types indicate complex mechanisms underlying LLLT.

Effects of infrared laser moxibustion on cancer-related fatigue: A randomized, double-blind, placebo-controlled trial

Fatigue is the most common symptom negatively affecting the quality of life of patients with cancer. The objective of the current study was to evaluate the preliminary efficacy and safety of 10.6‐μm infrared laser moxibustion for cancer‐related fatigue (CRF).

Regulation of the cardiovascular function by CO2 laser stimulation in anesthetized rats

Physical stimulation of body surface points is known to affect various organ functions. In traditional Chinese medicine, so-called acupoints were defined. These points can be physically stimulated to effectively treat various diseases. Here we describe for the first time the effect of CO2 laser stimulation at the acupoints Neiguan (PC-6), Quchi (LI-11), Zusanli (ST-36), and Taichong (LR-3) on heart rate and mean arterial blood pressure in anesthetized rats. CO2 laser stimulation increased the skin surface temperature to 54°C. Our results revealed that the laser stimulation at the left or right PC-6 and LR-3 increased heart rate and mean arterial pressure. There was no response of heart rate and mean arterial pressure during and after stimulation of the left LI-11, but laser stimulation at the right LI-11 slightly increased heart rate and mean arterial pressure. On the other hand, laser stimulation at the left and right ST-36 decreased heart rate and mean arterial pressure. The effects on mean arterial pressure were more pronounced than those on heart rate. After full spinal cord transection, all heart-rate and mean-arterial-pressure responses were attenuated or completely abolished. These results suggest that CO2 laser stimulation at either the left or right PC-6, ST-36, and LR-3, as well as at the right LI-11 can modulate the cardiovascular functions in anesthetized rats, and its modulatory site might be supraspinal.

Effects of electroacupuncture on depression in a rat model.

OBJECTIVE To investigate the antidepressant-like effect of electroacupuncture (EA) in a validated rat model. METHODS Wistar Kyoto rats, a valid animal model of depression, were randomly divided into two groups, EA (n = 7) and placebo control (n = 6). EA treatment was given once a day, 5 days a week, for 3 weeks. Two acupoints, GV14 (Dazhui) and GV20 (Baihui), respectively on the cervical spine and scalp, were selected. EA frequency was held constant at 2Hz (2 pulses/second), pulse width 0.3-ms, and intensity was adjusted to 3 mA. Forced swim tests (FST), open field tests (OFT; e.g., a. rearing and grooming, b. distance traveled within a central area, c. time spent in central area, and d. total distance traveled), and the Morris Water Maze test (MWM) were conducted 3 weeks after the initial treatment. RESULTS In the FST, there was significant difference between EA and control (P < 0.05) in immobility. In the OFT, there were significant differences between EA and control (P < 0.05) in rearing and grooming (P < 0.05). In the MWM, there were significant differences between treatment and control in frequency of crossing the platform (P < 0.05) and its surrounding area (P < 0.05). CONCLUSION Our data demonstrate that EA enhances memory and improves depression-related behaviors in a rat model of depression. This suggests that the modality may have therapeutic effects on depression in humans. Electroacupuncture may act on depression by protecting nerve cells in the hippocampus.