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Heart And Circulatory

Acupuncture in Angina Pectoris: Does Acupuncture Have a Specific Effect?

33 patients with stable angina pectoris were randomized to either genuine or sham acupuncture, and received electroacupuncture by another acupuncturist, and the change in skin temperature was recorded. It was found that the change in skin temperature correlated significantly with the degree of improvement following both genuine and sham acupuncture.

Fourteen patients with no decrease in skin temperature exhibited a significantly better response to acupuncture than 19 patients who showed a decrease in skin temperature (G II). In the former group, there was a 15% median improvement in exercise tolerance (G II 0%), a 67% improvement in anginal attack rate (G II 38%), and an 84% improvement in nitroglycerine consumption (G II 50%).
CONCLUSION: both genuine and sham acupuncture have a specific effect on some angina pectoris patients in addition to the effect of pharmacological therapy.
Ballegaard S. Meyer CN. Trojaborg W. Journal of Internal Medicine 1991; 229(4):357-62

Stress Response
Acupuncture Lowers Stress Response in Heart Patients
The sympathetic nervous system (SNS) is a large group of nerves responsible for the maintenance and regulation a number of involuntary yet vital muscle and organ functions in the body. Among its primary functions, the SNS regulates a person's heartbeat. It is also responsible for the "fight-or-flight" response. In an emergency or otherwise stressful situation, the SNS is usually called into action, transmitting messages that get the heart to pump faster, increasing blood pressure and delivering oxygenated blood to the parts of the body needed to fight or escape a threat.

Although the fight-or-flight response is an invaluable survival tool, repeated stress can undermine the sympathetic nervous system and cause it to malfunction. In patients with advanced heart failure, SNS activity is two to three times greater than normal; the greater the activity, the worse the prognosis is for the patient. This disorder can put an even greater strain on an already-weakened heart, leading to a host of ailments such as chest pain, breathing problems, fatigue and, eventually, death.

Traditionally, a class of drugs known as beta blockers has been used to regulate heart rate and blood pressure. However, some heart patients do not respond well to beta blockers; other people cannot take them at all because of the side-effects they can produce. While animal studies indicate that acupuncture works quite well in extreme cases of elevated SNS activity, human trials in this area - especially trials conducted in the United States - are virtually nonexistent. Dr. Holly Middlekauff, an associate professor of medicine at UCLA, and a team of investigators decided to expand on the amount of research on this subject by examining the use of acupuncture in blocking sympathetic nerve activity in a group of people with advanced heart failure. Their research, presented at the American Heart Association's 2001 Scientific Sessions conference in Anaheim, California, found that acupuncture can effectively inhibit SNS activity, and that with further study, it could be used as a complement to (or replacement for) traditional drug therapy.

Twenty-two advanced heart failure patients (both men and women, average age 43) were used in the study. Before receiving treatment, all of the patients were tested to determine how their hearts would respond to stress. They were subjected to four minutes of anxiety-producing situations, which included solving mathematical problems that had to be answered verbally, and a color/word conflict test in which each had to correctly identify a color while ignoring an incorrect written cue. "We chastised them when they were wrong," Middlekauff said.

Blood pressure, heart rate and sympathetic nerve activity were measured in each patient immediately after taking the test. Results showed that SNS activity increased approximately 25% as a result of the mental stress.

After the test, the researchers divided the patients into three groups. The patients received either authentic acupuncture delivered for 20 minutes at established acupuncture points; sham acupuncture delivered at non-acupuncture points; or no-needle acupuncture, in which the patients were told they'd receive acupuncture, but were in fact only tapped by a needle holder on the back of the neck. The mental stress test was repeated after the acupuncture treatments, with the same measurements taken at the conclusion of the second test.
While patients in the sham and no-needle group experienced the same increases in heart rate, blood pressure and SNS activity after taking the second test as they had after taking the test the first time, patients in the authentic acupuncture group showed no increase in SNS activity.
Middlekauff concluded, "Real acupuncture essentially eliminated the sympathetic response in heart failure patients after only one session. Now I would like to see what a full course would do."

1) Effect of acupuncture-point stimulation on diastolic blood pressure in hypertensive subjects: a preliminary study.
Abstract: Electrical stimulation of four specific acupuncture points was examined in order to determine the effect of this stimulation on diastolic blood pressure in 10 subjects with diastolic hypertension. Subjects were randomly divided into two groups: (I) an Acu-ES group, which received electrical stimulation to four antihypertensive acupuncture points, and (2) a Sham-ES group, which received electrical stimulation applied to non-acupuncture-point areas.
A repeated-measures analysis of variance revealed a significant, immediate post-stimulation reduction of diastolic blood pressure for the Acu-Es group versus the Sham-ES group.
Physical Therapy, 1991 Jul, 71(7):523-9. UCLA Biomed

2) Hypertension
The hemodynamic and neurohumoral correlates of the changes in the status of hypertension patients under the influence of acupuncture

Abstract: Acupuncture with needles produced a hypotensive action in 360 patients with initial essential hypertension. This effect registered in 82.1% of the patients and there was also a reduction in circadian excretion of adrenaline, an inhibition in the activity of plasma rennin, and normalization of lipid metabolism. The hypotensive effect in the majority of the patients persisted for 12 months.
Akhmedov TI; Terapevticheski Arkhiv, 1993

3) Eight-seven patients with different types of diseases were treated with acupuncture, and the changes of their blood pressure were investigated. The results showed that the total level of systolic pressure in the 87 cases decreased (P < 0.05). Especially, the systolic pressure in patients accompanied with hypertension decreased significantly.
It is suggested that when acupuncture is adopted to treat other diseases, it can also decrease the systolic pressure in patients with hypertension.
Guo W, Zhenjiang Medical College, Zhenjiang 212001

4) A pilot randomized controlled trial by the New England Research Institute (RCT) (n=192) was designed to gather preliminary data regarding the efficacy of acupuncture for treating mild to moderate hypertension without the use of pharmacologic therapy.
Patients were stratified by antihypertensive medication history and allocated randomly to one of three acupuncture treatment groups, each delivered twice weekly for 6 weeks: 1) Standardized Acupuncture, 2) Individualized Acupuncture, or 3) Sham Acupuncture (Control group). All patients were diagnosed by non-treating acupuncturists using a TCM protocol, but only those in the Individualized group were treated accordingly. The primary endpoint was change in systolic BP, adjusted for baseline level, from baseline to 4 months post-randomization. In addition, use of conventional medical treatments was monitored in order to test whether acupuncture reduces the need to introduce or resume pharmacologic treatment.

Results: Mean blood pressure decreased 4.8/4.8 mm Hg from baseline; 42% of patients had blood pressures below 140/90 at 10 weeks without use of anti-hypertensives. Individualized acupuncture subjects experienced the largest decrease in diastolic blood pressure (-6.12 mm Hg vs. -4.72 for Control patients) A trend toward greater improvement in diastolic blood pressure from 2 weeks to 10 weeks was observed in the patients randomized to Individualized treatments

1) Acupuncture in the treatment of paralysis in chronic and acute stroke patients--improvement correlated with specific CT scan lesion sites.

A total of 20 stroke patients received acupuncture, including 10 chronic and 10 acute patients; 19 of the 20 patients (95%) could be correctly classified regarding beneficial response to acupuncture, versus poor response, based on CT scan lesion site data, alone. Patients with beneficial response had damage to less than half of the motor pathway areas on CT scan, especially in the periventricular white matter area (PVWM) at the level of the body of the lateral ventricle.
Overall, 8 of the 20 patients receiving acupuncture had beneficial response with measurable objective improvement in motor function, including 3 of the 10 chronic patients treated at >3 months post-stroke, and 5 of the 10 acute patients treated at <3 months post-stroke. Among the 8 patients with beneficial response, significant improvements were observed in knee flexion, knee extension, and shoulder abduction. Neither age, nor months post-stroke when acupuncture was begun, was significantly correlated with the total number of improved tests, post-acupuncture. Most improvements were sustained for at least 4 months after the last acupuncture treatment.
Naeser MA, Alexander MP, Boston University School of Medicine, Acupunct Electrother Res. 1994 Oct-Dec;19(4):227-49.

2) A randomized controlled trial on the treatment for acute partial ischemic stroke with acupuncture
A randomized, controlled trial was carried out with 30 patients, aged 46-74, after appropriate screening. Patients were randomly assigned to a treatment with or without acupuncture. Acupuncture was applied 3 times/week for 4 weeks. A significantly better neurologic outcome was observed in the acupuncture group on day 28 and day 90. The improvement in neurologic status was greatest in patients with a poor neurologic score at baseline.
Neuroepidemiology. 1993;12(2):106-13.

3) Inpatient Stroke Rehabilitation Study
The study was conducted at the Daniel Freeman Rehabilitation Center’s inpatient stroke rehabilitation unit in Los Angeles. In the trial, 29 patients who had suffered a stroke within the previous 60 days that resulted in hemiparesis (weakness on one side of the body) were randomized to either a control group or an acupuncture group. The control group received conventional stroke rehabilitation care (consisting of three hours of physical, occupational, and/or speech therapy, six days per week) for the duration of the inpatient stay. The acupuncture group received the same care as the control group, along with an additional 30 minutes of acupuncture therapy, seven days per week, for two weeks during the inpatient stay.

Patients were evaluated at baseline (within three days of being admitted to the stroke rehabilitation unit) and after being discharged. At baseline and after the completion of the study, evaluations were performed by therapists, who were blinded to the randomization of each patient.
Close inspection revealed that acupuncture patients experienced “significantly greater” lower extremity motor function compared to the control group. Acupuncture patients also fared slightly better than control patients in terms of lower extremity joint pain. Other improvements were seen when the researchers compared functional independence scores. While the average score of patients in the control group increased 8.5 points between baseline and discharge, the average score of acupuncture patients increased 11.2 points. In all seven activities of daily living measured on the scale, the average score of patients receiving acupuncture was between .1 and .8 points higher than control patients. The authors noted that “patients who received acupuncture as an adjunct to standard rehabilitation demonstrated significantly greater improvement in tub/shower transfer mobility and a trend for greater improvement in toilet transfer mobility.”

4) Acupuncture or laser acupuncture was effective to reduce severity of paralysis in 66.3% of the 193 cases reviewed.
The best results were observed when acupuncture treatments were initiated within 24 to 36 hours post stroke onset in ischemic infarct cases and after bleeding was controlled in hemorrhagic cases. Acupuncture's effect to increase cortisol levels (Cheng, McKibbin, Roy, 1980; Shi, Bu, Lin, 1992) may contribute to less brain edema in acute stroke, hence less brain damage. Acute patients are treated at least 3 times per week, and chronic patients 2 times per week for 20 to 40 treatments over a 2- or 3-month period.

The Swedish study observed that when acupuncture was initiated 4 to 10 days post stroke, there was a savings of $26,000 per stroke patient as a result of fewer days in hospital and rehabilitation facilities (Johansson, Lindgren, Widner, et al., 1993; Johansson, 1993).

These patients also had better motor function, activities of daily living, and quality of life measures at 1 and 3 months and 1 year post stroke as well as better postural control at 2 years post stroke compared with those cases treated only with PT beginning at 4 to 10 days post stroke (p < .01 and beyond).

5) Stroke
Abstract: 32 cases of ischemic stroke were treated by acupuncture. The clinical efficacy and the change of nail-fold microcirculation before and after the treatment were observed.

Result: The total effective was 93.75%. Before the treatment, the microcirculation of nail-fold was markedly abnormal, and the criteria of hemorheology was abnormally elevated. But after the treatment, together with the recovery of nail-fold microcirculation and hemorheology, the clinical symptom and sign of the patients also improved. Thus it showed that acupuncture method had the function of changing the microcirculation and the hypercoagulability of the patients' blood, further promote the recovery of the function of affected cerebral tissue.
Chung-Kuo Chung Hsi i Chieh Ho Tsa Chih, 1992 Apr, 12(4):216-8, 196