ACUPUNCTURE IN MODERN MEDICINE Edited by Lucy L. Chen and Tsung O. Cheng Acupuncture in Modern Medicine http://dx.doi.org/10.5772/46017 Edited by Lucy L. Chen and Tsung O. Cheng Contributors Takashi Seki, Hsieh, Ping-Chung Leung, Wen-Long Hu, Yu-Chiang Hung, I-Ling Hung, Yutaka Takaoka, Yoichiroh Hosokawa, Aki Sugano, Akihiko Ito, Mika Ohta, Zhonghua Fu, Stephen Meyer, Yoshimasa Koyama, Ting Bao, Lizhen Wang, Peter Chin Wan Fung, Sungchul Kim, Sandra Silvério Lopes, Irmgard Simma, Tsuchiya, Lucy L Chen, Raheleh Khorsan, Tsung O. Cheng, Alexandra York Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2013 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. 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Publishing Process Manager Ana Pantar Technical Editor InTech DTP team Cover InTech Design team First published February, 2013 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechopen.com Acupuncture in Modern Medicine, Edited by Lucy L. Chen and Tsung O. Cheng p. cm. ISBN 978-953-51-1020-0 free online editions of InTech Books and Journals can be found at www.intechopen.com Contents Preface IX Section 1 Acupuncture Research 1 Chapter 1 Current Trends in Acupuncture Research: From Analgesia to Physiological Function of Brain 3 Chen Wei-Liang and Hsieh Ching-Liang Chapter 2 Nitric Oxide in Acupuncture Mechanism 35 Masahiko Tsuchiya Chapter 3 Acupuncture in Modulation of Immunity 51 Sandra Silvério-Lopes and Maria Paula Gonçalves da Mota Chapter 4 Acupuncture Effects on Bladder Activity and State of Vigilance Through GABAergic Neuronal Systems 77 Yoshimasa Koyama and Hui Wang Chapter 5 Plausible Biomedical Consequences of Acupuncture Applied at Sites Characteristic of Acupoints in the Connective-Tissue-Interstitial-Fluid System 95 Peter Chin Wan Fung Section 2 New Developments in Acupuncture 133 Chapter 6 High-Tech Equipment for Moxibustion in Modern Medicine 135 Takashi Seki, Junnosuke Okajima, Akiko Kikuchi, Shin Takayama, Masashi Watanabe, Hiroko Kusuyama, Ayane Matsuda, Soichiro Kaneko, Tetsuharu Kamiya, Atsuki Komiya, Minami Fujiwara, Nobuo Yaegasi, Tomoyuki Yambe and Shigenao Maruyama Chapter 7 New Development in Sham Acupuncture Needle 161 Sungchul Kim Chapter 8 Fu's Subcutaneous Needling, a Modern Style of Ancient Acupuncture? 179 Zhonghua Fu and Ryan Shepherd Chapter 9 Explore Laser Acupuncture’s Role 205 Wen-Long Hu, Yu-Chiang Hung and I-Ling Hung Chapter 10 New Technology: Femtosecond Laser May be Used for Future Acupuncture Therapy 221 Yutaka Takaoka, Mika Ohta, Aki Sugano, Akihiko Ito and Yoichiroh Hosokawa Section 3 Acupuncture Therapy for Clinical Conditions 233 Chapter 11 The Role of Acupuncture in Pain Management 235 Lucy Chen Chapter 12 Acupuncture in Cardiology 255 Tsung O. Cheng Chapter 13 Acupuncture for Cancer Patients: Practice and Research 277 Lizhen Wang and Ting Bao Chapter 14 Acupuncture for Addictions 297 P.C. Leung, L. Zhang, L.Y. Eliza Wong and S.Y. Ellie Pang Chapter 15 Immediate Effects of Microsystem Acupuncture in Patients with Oromyofacial Pain and Craniomandibular Disorders (CMD): A Double-Blind Placebo-Controlled Trial 317 Irmgard Simma, Jochen M. Gleditsch, Leopold Simma and E. Piehslinger Chapter 16 Acupuncture in Military Medicine 327 Alexandra M. York, Kevin G. Berry, Rick C. Welton, Joan A. G. Walter, Richard C. Niemtzow and Wayne B. Jonas ContentsVI Section 4 Assessment and Accessibility in Acupuncture Therapy 347 Chapter 17 The Evolution of Patient-Based Outcome Assessment Instruments in Acupuncture Research: Choosing Patient-Based Outcomes 349 Raheleh Khorsan, Alexandra York, Ian D. Coulter, Remy R. Coeytaux, Rachel Wurzman, Joan A. G. Walter and Kevin Berry Chapter 18 Evaluating the Geography and the Visibility Tendencies of Acupuncture Treatment Locations in Metropolitan Toronto 371 Stephen P. Meyer Contents VII Preface Acupuncture has been one of the most significant components of the healthcare system in East Asia for thousands of years. It has rapidly evolved as a therapeutic modality in the modern west medicine system over the last few decades. In the United States, acupuncture has gained much interest since President Nixon’s trip to China in 1972. A nationwide survey in 1998 showed that office visits seeking alternative therapies are twice as many as those for primary care and there are estimated five million visits to acupuncture practices alone. Acu‐ puncture needles have been classified as medical equipment, subject to the same standards for medical needles, syringes, surgical scalpels since 1996. The National Institutes of Health (NIH) organized a Consensus Development Conference on Acupuncture in 1997. The Con‐ ference recognized that acupuncture has been extensively practiced by many healthcare pro‐ viders to treat a wide variety of medical problems including pain conditions. A major benefit of acupuncture therapy is that adverse events are substantially lower than that of many medications and commonly accepted medical procedures. In the meantime, scientific research has lead to the increasing understanding of acupuncture’s mechanisms, physiolog‐ ic impacts, and therapeutic effects. These promising developments in research and clinical application of acupuncture therapy have established a new field of integrative medicine that combines complementary and alternative medicine including acupuncture with western- style medical practice. Despite the progress in acupuncture therapy as an alternative treatment modality, current clinical research on acupuncture still faces a number of challenges. For example, although many studies on acupuncture treatment have been published, their scientific merits may be limited by the study design and non-standardized acupuncture practices. It remains difficult to maintain true blindness to patients and, in some cases to investigators, in clinical trials. Non-specific needling (i.e. placing an acupuncture needle at an unintended acupoint) or sham needling may elicit some response similar to that of active acupuncture treatment, making it difficult to interpret trial outcomes because it is difficult to separate the placebo effect from the actual acupuncture effect. With regard to the practice of acupuncture, a plan for acupuncture treatment is often highly individualized for a given condition and varies from one practitioner to another. As such, it is rather difficult to compare treatment outcomes if a given clinical condition is treated with different settings including acupoints, needling techniques (e.g., electrical versus manual), duration of treatment for each session, and between-session intervals. Therefore, concerted efforts should be made to standardize acupuncture clinical trials in order to improve scien‐ tific merits of such trials. Nonetheless, it can be anticipated that complementary medicine, including acupuncture, will play a growing and positive role in pain management. This book offers comprehensive updates of current knowledge in acupuncture practice and research. 18 chapters are divided into four categories: 1) Acupuncture Research; 2) New De‐ velopments in Acupuncture; 3) Acupuncture Therapy for Clinical Conditions and 4) Assess‐ ment and Accessibility of Acupuncture Therapy. The book is intended for physicians, acupuncturists, medical students and other healthcare providers who are interested in acu‐ puncture therapy and research. These chapters are written by experienced and well-recog‐ nized acupuncture practitioners, clinicians and researchers from both private and academic settings. The topics discussed in this book provide 1) a unique look at the current status and new trends of acupuncture research, 2) comprehensive and analytic reviews of acupuncture therapy for clinical disorders and conditions, and 3) up-to-date developments reviewed by both scientists and clinicians. Finally we sincerely thank the authors for their dedication and enormous contributions to this project. We are also grateful to InTech Publisher for their support which made it possi‐ ble to publish this important book. As physicians and researchers, we hope the renewed in‐ terest in acupuncture therapy and research will take a deep root in the minds and practices of many physicians and healthcare providers in order to accelerate the integration of acu‐ puncture into modern medicine. Dr. Lucy L. Chen, M.D. Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA Dr. Tsung O. Cheng, M.D. George Washington University Medical Center, Washington, D.C., USA Dedication I dedicate this book to my family for their love and support. I also dedicate this book to my pa‐ tients for allowing me to do the most rewarding job in the world as a physician: to care for those who are suffering. Lucy L. Chen PrefaceX [...]... regulate ANS in spatial pattern [68] This axis has strong interconnection to descending 9 10 Acupuncture in Modern Medicine inhibitory pathways and may be the common pathway of analgesic and anti-inflammatory effect of acupuncture In conclusion, the anti-inflammation effect of acupuncture is evident In terms of the overlap‐ ping between cholinergic reflex and descending inhibitory pathways, acupuncture. .. by virtue of its obvious efficacy and scientific evidences on basic and clinical studies As a part of Traditional Chinese Medicine (TCM), acupuncture may be the most evident therapy among all other complementary and alternative medicines (CAMs) This chapter is going to discuss current trends in basic acu‐ puncture research and clinical trials Early findings of acupuncture analgesia inspired following... patients who had previous received ineffective acupuncture therapy [105] By treating those patients 13 14 Acupuncture in Modern Medicine within 48 hours after migraine attack, acupuncture can prevent mild migraine from exacer‐ bating to full blown one Interestingly, in this trial (n=179), most of the participants (80%) had previously received acupuncture for migraine without good success This phenomenon... “point selection” and “outcome assessment” Interestingly, compared with minimal acupuncture, individualized point selection in acu‐ puncture treatment elicited better result in pain reduction [125]; whereas fixed point brought out non-superior pain reduction [123] In both studies, acupuncture was used as a supplement to standard treatments The phenomenon that acupuncture at individualized acupoints... opioid system and descending inhibitory pathways is necessary Purification of β-endorphin, enkephalin and dynorphin in late 1970s [6] gave rise to the accelerated progress on the understanding of central endogenous opioid systems, as well as mechanism of AA The arcuate nucleus in hypothala‐ mus and periaqueduct gray (PAG) in midbrain are the major locations releasing beta-endor‐ phin and enkephalin [7] Arcuate... analgesic effect via anti-inflammation in a gradual mode whereas endogenous opioids are transmitted faster in descending inhibitory pathway 5 6 Acupuncture in Modern Medicine Another salient part of descending inhibitory pathway is serotoninergic NRM-spinal neuron Serotonin was suggested as an analgesic transmitter in an early study [14], and EA can activate these serotoninergic NRM neurons [21] This... animal models, different 7 8 Acupuncture in Modern Medicine treatment protocols (timing of needling and selection of acupoints) and tools of assessment can influence the result even when the stimulating frequency is similar Ionotropic glutamate receptors (NMDA, AMPA and KA receptors) are involved in LTP in DRG Prseynaptically tetanus burst opens the postsynapse NMDA receptors and influx of calcium through... not inserted In addition to acupuncture at the acupoints that are commonly used for relieving knee pain, the researchers also needled at distal sham points on the abdomen that did not correspond to knee pain The sham points were also covered by plastic guidance tubes In the acupuncture group, the needles were not inserted into the sham points, whereas in the sham group, the needles were inserted into... Therefore, in the acupuncture group, the patients received real needling at the true acupoints and sham needling at the sham points; in the sham group, the patients received sham needling at the true acupoints and real needling at the sham Current Trends in Acupuncture Research: From Analgesia to Physiological Function of Brain http://dx.doi.org/10.5772/55184 points In this crossover way, they can investigate... heterogeneous syndrome comprising various disorders; it is an ambiguous and indistinct term In contrast, OAK is a relatively clear and precise term to LBP The diagnosis of OAK needs to meet many clinical criteria including imaging findings Accordingly, there is less heterogeneity in OKA population than LBP 3.2.4 Post-operative Pain The prototype of modern acupuncture analgesia research is the minor surgeries such . ACUPUNCTURE IN MODERN MEDICINE Edited by Lucy L. Chen and Tsung O. Cheng Acupuncture in Modern Medicine http://dx.doi.org/10.5772/46017 Edited by Lucy L. Chen and Tsung O. Cheng Contributors Takashi. assumption [3]. Electrophysiology is a promising tool to investigate neurophysiology. Compelling evidences have clarified the acupuncture effect on electrophysiological profiles. One of the important. the important contributions of electrophysiology is to consolidate the idea that acupuncture act through high cortical conditioning. In addition to traditional histological and electrophysio‐ logical studies,