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Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.
Resources:
British Acupuncture Council evidence based factsheet about Dentistry including specific research, trials and mechanisms of action for acupuncture in this condition.
Helen Page under construction
More detail on neurotransmitters in acupuncture for pain is in our blog.
Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.
Resources:
Evidence Based Acupuncture – Factsheet on Chronic Pain
Helen Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.
Cough may have many different causes and usually represents a symptom, whereby there are other aspects of the system involved, concerning infection, post-viral, allergy, neurological and other causes. Below are some studies regarding different types of chronic cough, and acupuncture’s effect on these. Some of the underpinning mechanisms of action of acupuncture may help a symptom when caused by different underlying factors, mechanisms of action are discussed below.
Interpreting the research:
When reading health research, it is important to know that Systematic Reviews or Meta Analyses of a large number of high-quality research studies are the very best way to be able to say to what extent a given treatment can address a condition, symptom, or set of symptoms. The next best level of evidence is the individual Randomised Controlled Study (RCT) which uses a systematic technique to compare two or more groups of patients receiving different treatments (or a treatment against a “control”, or no treatment). In acupuncture trials, the nature of the control group is of particular interest as it is hard to blind a patient to whether they are having a needle inserted or not, and even more challenging to blind the researcher/team to this.
The means and quality of how research is carried out varies considerably from country to country, and in terms of how an intervention is compared to another intervention (or a control). Of note is the fact that “sham” acupuncture (where needles are placed in apparently inert locations rather than traditional acupuncture points) is not really an inert process as it has physiological effects, so that comparing sham and “true acupuncture” may therefore not give a clear picture alone; but and form a part of a research body where acupuncture versus no treatment, vs conventional treatment or vs a different approach/modality also form part of the evidence base.
The n= figure (where quoted in research) tells you how many people were participants in the study, and usually the larger a study (when it is of good quality and design), the more likely it is to be reliable and applicable to larger populations. When (statistical) “significance” is discussed in view of studies it has a very particular meaning – it is the confidence in the data (using statistical tests) that tells us how likely a result could have just come about by chance. The lower the possibility of a chance result, the more likely it is due to the intervention in the experiment. When you are reading a trial/study, the “p” is the number telling us of significance, and this must be under 5% (or p less than 0.05) to mean we can say it is a (statistically) “significant” result.
Post infectious cough
Li et al (2015, n=90) looked at the clinical efficacy of acupuncture using points from the Lung and Stomach Meridians in treating post-infectious cough. Two treatment groups abd a control were used, whereby 2 groups received acupuncture, while the control group received oral medication. They found the total effective rate was highest in the group treated with points from both the Lung and Stomach Meridians, showing significant improvement in both daytime and nighttime cough.
Lee’s (2024) presentation regarding a large systematic review and meta-analysis to be presented at ISPOR (2024 – to be followed by the paper) looked at 30 RCT’s (n=2835) and concluded “Acupuncture, when combined with conventional treatment (medication and lifestyle guidance), significantly improved cough severity and cough-related quality of life compared to conventional treatment alone” and with a low side effect profile.
Xiong et al (2021, n=929) carried out a meta-analysis and systematic review of 11 RCT’s to evaluate the clinical efficacy and safety of acupuncture in treating cough-variant asthma. In spite of issues with quality of some studies (they call for further, high quality RCTs), they were able to conclude that acupuncture may relieve symptoms of cough, phlegm, and diaphragmatic congestion, and demonstrated improvement in both lung function-related indicators, and immune inflammation indicators.
For Suppressing Cough in a Medical Scoping Setting
Zhang et al (2019, n=100) investigated transcutaneous electric acupoint stimulation (LI4; PC6; LU7) to supress coughing during flexible bronchoscopy (FB). They compared TEAS+midazolam to midazolam alone, finding lower cough scores, and the need for less lidocaine and fentanyl in the TEAS+midazolam (acupoint plus drug) group. This meant that adding transcutaneous electric acupoint stimulation was more effective for cough suppression than was midazolam alone. They’d found increased β-endorphin levels in the TEAS group, and theorised that, as one of the body’s natural painkillers, which works on μ-opioid receptors, this was the mechanism of both a painkilling and an anti-tussive (anti-cough) effect.
Post Viral Respiratory Issues
Researchers have started to look at the place of acupuncture alongside conventional medicine, as an adjuvant (add-on) alongside medical care – to support patients post-COVID. There may be a place for this in their ongoing management, and Williams et al (2022) reference previous research is post-viral conditions and conclude that “acupuncture is a viable adjunctive health care modality as part of a multidisciplinary approach” to approaching disease management and improving quality of life in Long COVID patients. Trager et al (2022); Hollifield et al (2022); Yin et al, (2021) have also presented case studies, showing promise in this arena and now well-designed RCTs should be designed to investigate further.
Cough Symptom after Surgery
May & May’s (2022) case study stated that “when the underlying etiology of the cough is not well understood, a nonconventional approach can sometimes be promising. In this article, a cough of unknown etiology resistant to conventional treatments seems to be suppressed with the use of acupuncture techniques” [sic]. They reference the need for larger studies, but the pragmatic fact that this as a low-risk approach based on clinical judgement, where improved quality of life was seen, acupuncture may be beneficial for such chronic coughs that are unresponsive to usual therapies.
Cough Symptom in Lung Cancer Patients
Note: acupuncture is an adjunct that should be used with the knowledge of your medical team alongside your mainstream hospital care.
An RCT (Zhang et al, 2024; n=130) used acupuncture alongside routine nursing care (as an add-on) for cough symptoms in lung cancer patients. The intervention group received both routine nursing and acupuncture, while the control group received only routine nursing. The symptoms of cough in the intervention group were significantly improved, although the expectoration and shortness of breath had no significant change. A promising start, with more research is needed to see how this might complement medical-led care.
Other Studies
Chronic Spastic Bronchitis: Promise was found in an older study in helping patients lower their doses of corticosteroid over a period of three years, although this was an observational study, rather than an RCT (Sliwinski et al, 1984).
Xie et al (2019, n=171) found promise for acupuncture alongside routine care for the treatment of postoperative chronic cough in patients with non-small cell lung cancer. This was a retrospective (not RCT) study, to address the symptom of cough after their lung operation but nonetheless indicative of a trend that should inform future research.
Animal Models
Wang et al (2023), looked at a chronic cough model, finding that electroacupuncture significantly reduced cough frequency, lung tissue damage, and inflammation. It worked by downregulating a specific pathway in the nervous system (TRPV1) involved in cough reflexes.
References:
Hollifield, M., Cocozza, K., Calloway, T., Lai, J., Caicedo, B., Carrick, K., Alpert, R. and Hsiao, A.F., 2022. Improvement in long-COVID symptoms using acupuncture: a case study. Medical Acupuncture, 34(3), pp.172-176.
Lee, B (2024). Acupuncture for the Treatment of Chronic Cough: A Systematic Review. Presented at ISPOR Europe 2024, Copenhagen, Denmark, 3-6 November 2024. Available at: https://www.ispor.org/conferences-education/conferences/upcoming-conferences/ispor-europe-2024/program/plenary-sessions/session/euro2024-4016/141909 [Accessed 1 October 2024].
LI, X. and Shi, Z., 2015. Acupuncture Treatment Based on Lung-stomach Theory in Treating Post-infectious Cough. Shanghai Journal of Acupuncture and Moxibustion, pp.211-213.
May G, May M M (May 30, 2022) A Possible Treatment for Persistent Cough Status Post-pulmonary Carcinoid Tumor Resection. Cureus 14(5): e25499. DOI 10.7759/cureus.2549
Sliwinski, J. and Matusiewicz, R., 1984. The effect of acupuncture on the clinical state of patients suffering from chronic spastic bronchitis and undergoing long-term treatment with corticosteroids. Acupuncture & electro-therapeutics research, 9(4), pp.203-215.
Trager, R.J., Brewka, E.C., Kaiser, C.M., Patterson, A.J. and Dusek, J.A., 2022. Acupuncture in multidisciplinary treatment for post-COVID-19 syndrome. Medical Acupuncture, 34(3), pp.177-183.
Wang, G.X., Zhou, J., Chen, Y.M., Xu, L.D., Tao, S.M., Ma, J., Sun, Y.H., Wu, M.S., Chen, Z.W., Zhu, Y.F. and Xie, M.R., 2023. Mechanism of electroacupuncture at acupoints of the lung meridian through PKA/PKC regulation of TRPV1 in chronic cough after lung surgery in guinea pigs. Journal of Thoracic Disease, 15(4), p.1848.
Williams, J.E. and Moramarco, J., 2022. The role of acupuncture for long COVID: mechanisms and models. Medical Acupuncture, 34(3), pp.159-166.
Xie, M.R., Zhu, Y.F., Zhou, M.Q., Wu, S.B., Xu, G.W., Xu, S.B. and Xu, M.Q., 2019. Analysis of factors related to chronic cough after lung cancer surgery. Thoracic cancer, 10(4), pp.898-903.
Xiong, J., Qi, W., Yang, H., Zou, S., Kong, J., Wang, C., Zhou, Y. and Liang, F., 2021. Acupuncture Treatment for Cough‐Variant Asthma: A Meta‐Analysis. Evidence‐Based Complementary and Alternative Medicine, 2021(1), p.6694936.
Yin, X., Cai, S.B., Tao, L.T., Chen, L.M., Xiao, S.H., Fan, A.Y. and Zou, X., 2021. Recovery of a patient with severe COVID-19 by acupuncture and Chinese herbal medicine adjuvant to standard care. Journal of Integrative Medicine, 19(5), pp.460-466.
Zhang, W., Yang, Y.X., Yu, W. and Qi, S.H., 2019. Cough Suppression during flexible bronchoscopy using transcutaneous electric acupoint stimulation: A randomized controlled study. Evidence‐Based Complementary and Alternative Medicine, 2019(1), p.5650413.
Zhang, C.X., Bu, M.R., Wu, X.M., Liao, R.R., Wei, J.H., Zhou, J. and Ye, Z.J., 2024. Efficacy of acupuncture for a cough-related symptom cluster in patients with lung cancer: A randomized controlled trial. European Journal of Oncology Nursing, 70, p.102598.
Helen You may also wish to look at our pages on Hypertension/High Blood Pressure ; Stroke ; Angina, Arrhythmias, Coronary Heart Disease, and Heart Failure
Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.
About the research: It is worth noting that in research, randomised controlled studies (RCT) are the most reliable in terms of quality of evidence, with a systematic review or meta analysis of numerous studies being the best way of seeing the overall picture of the state of the evidence. Below we have a selection of the available research, which does include some larger RCTs, and reviews of the literature alongside smaller studies. The n= figure tells you how many people were participants in the study.
Interpreting the research:
When reading health research, it is important to know that Systematic Reviews or Meta Analyses of a large number of high-quality research studies are the very best way to be able to say to what extent a given treatment can address a condition, symptom, or set of symptoms. The next best level of evidence is the individual Randomised Controlled Study (RCT) which uses a systematic technique to compare two or more groups of patients receiving different treatments (or a treatment against a “control”, or no treatment). In acupuncture trials, the nature of the control group is of particular interest as it is hard to blind a patient to whether they are having a needle inserted or not, and even more challenging to blind the researcher/team to this.
The means and quality of how research is carried out varies considerably from country to country, and in terms of how an intervention is compared to another intervention (or a control). Of note is the fact that “sham” acupuncture (where needles are placed in apparently inert locations rather than traditional acupuncture points) is not really an inert process as it has physiological effects, so that comparing sham and “true acupuncture” may therefore not give a clear picture alone; but and form a part of a research body where acupuncture versus no treatment, vs conventional treatment or vs a different approach/modality also form part of the evidence base.
The n= figure (where quoted in research) tells you how many people were participants in the study, and usually the larger a study (when it is of good quality and design), the more likely it is to be reliable and applicable to larger populations. When (statistical) “significance” is discussed in view of studies it has a very particular meaning – it is the confidence in the data (using statistical tests) that tells us how likely a result could have just come about by chance. The lower the possibility of a chance result, the more likely it is due to the intervention in the experiment. When you are reading a trial/study, the “p” is the number telling us of significance, and this must be under 5% (or p less than 0.05) to mean we can say it is a (statistically) “significant” result.
Acupuncture and the Cardiovascular System
According to several systematic reviews and meta-analyses, acupuncture has shown beneficial effects on various aspects of the cardiovascular system, such as blood pressure, heart rate, cardiac output, vascular tone, and blood flow.
Essential hypertension (high blood pressure)
Hypertension is a common cardiovascular disease that affects about one billion people worldwide. Li et al, 2014 carried out a systematic review and meta-analysis of 4 RCTs (n=386) that compared acupuncture with sham acupuncture for treating essential hypertension, in order to assess the effectiveness and safely of acupuncture as an adjunctive approach for the condition, using statistical methods to pool the results and compare the average blood pressure changes between the groups. Acupuncture was found to significantly lower systolic blood pressure (SBP) and diastolic blood pressure (DBP) in patients taking antihypertensive medications, but not in patients who were not taking medications. Acupuncture was generally safe and well-tolerated, with only minor adverse events reported. The authors concluded that acupuncture could be a promising adjunctive therapy for hypertension, but more large-scale and long-term trials are needed to confirm its efficacy and safety.
Acupuncture was found to be a promising adjunctive therapy for essential hypertension in Yin et al’s (2007) a double-blind, randomized, controlled trial, where acupuncture was assessed for its benefits as an add-on to conventional antihypertensive managements such as medication or lifestyle modification on patients with high blood pressure. In the small (n=30) study, the real acupuncture group showed a significant decrease in mean BP after 8 weeks. Auricular (ear) acupuncture has also been shown to reduce preoperative blood pressure (BP) elevation in different age groups in a prospective RCT (Ma et al, 2023; n=120).
A meta-analysis of studies compared approaches to treating essential hypertension (31 trials; n=2649; Tan et al, 2019), concluded that acupuncture may be useful in addressing hypertension, albeit that quality of the studies was limited and further research was warranted. Another analysis of 10 trials in BP amongst stroke patients (Hong et al, 2020; n=847) concluded that acupuncture may be a suitable treatment option for regulating BP after stroke but also noted the low-quality in the data and as need for further well-designed trials.
Niu et al, (2019) examined 13 systematic reviews of 14 non-drug therapies (including acupuncture) in addressing high blood pressure. They concluded that massage and acupuncture plus an antihypertensive drug may benefit people who wanted to lower their blood pressure; once again methodological issues around available research limited the strength of the recommendations.
Angina Pectoris
A systematic review and meta-analysis of 12 studies (Lu et al, 2022; n=1203) looked at treating cardiovascular disease complicated with depression, and found that acupuncture reduced HAMD (Hamilton scale for depression) score, SDS (self-rating depression scale) score and also reduced the attack frequency of angina pectoris and the VAS (visual analogue scale) score for angina pain. They concluded that acupuncture could be a good complementary and alternative therapy for CVD complicated with depression.
Atrial Fibrillation
Lomuscio et al, 2011 (n=80) concluded that acupuncture prevented arrhythmic recurrences after cardioversion in patients with persistent AF, and was safe and well tolerated.
Li et al, (2022) made a meta-analysis and systematic review of RCTs that had compared acupuncture with pharmacological conversion for treating atrial fibrillation. They looked at 11 papers, and concluded that “ acupuncture significantly effectively benefitted the patients with atrial fibrillation”, and overall combining the pharmacological (medicinal) cardioversion with acupuncture was significantly more beneficial than was the pharmacological approach alone.
Following Valve Surgery: Cardioprotective Effects
Feingold et al, 2023 (n=100) carried out an RCT with 100 patients undergoing primary valve surgery via sternotomy. They found acupuncture after valve surgery to be feasible, well tolerated, and having clinical benefit. Specifically, there were no adverse events, and the acupuncture group had reduction in pain, nausea, stress, and anxiety, as well as reduced postoperative stress and anxiety and reduced postoperative atrial and fewer hours in the intensive care unit than those patients on standard care alone.
Yang et al, (2010, n-=60) conducted an RCT to investigate the cardioprotective effects of electroacupuncture (EA) pretreatment on patients undergoing heart valve replacement surgery. They measured the levels of cardiac troponin I (CTnI) which is a protein released into the blood when the heart muscle is damaged (e.g. during a heart attack). Other outcomes, such as blood pressure, heart rate, use of drugs, and length of stay in the intensive care unit (ICU) were also compared between a pretreatment group and a control (no acupuncture) group. They found that EA pretreatment significantly lowered the levels of CTnI in acupuncture patients after surgery vs control, therefore EA pretreatment reduced the amount of heart injury caused by the surgery. EA pretreatment also reduced the use of drugs such as inotropes, after surgery (indicating more improved heart function after surgery, shortened stay in ICU; versus the non-acupuncture group.
Coronary Artery Disease, PCI procedure
Ho et al, (1999, n=44) looked at the PC6 point also (note, Nei-Kuan is an alternative spelling), in their case they examined that effect upon Left Ventricular Function in Patients with Coronary Artery Disease (CAD). The left ventricle is the main pumping chamber of the heart, and in CAD, the blood vessels that supply heart become narrowed or blocked by fatty deposits called plaque. The study measured how much blood the left ventricle pumps out with each contraction (left ventricular ejection fraction, LVEF) in 22 patients with coronary artery disease and 22 normal subjects. Acupuncture caused an increase in the LVEF in patients with coronary artery disease, especially in the first 15 minutes of stimulation. This persisted for 15 minutes after acupuncture, but became insignificant after one week. They concluded acupuncture at PC6 could temporarily improve left ventricular function in CAD patients, but more studies were needed to confirm its long-term effects and mechanisms.
An RCT (Wang et al, 2015), aimed to understand if pretreatment with electroacupuncture (EA) could reduce the damage to the heart muscle caused by percutaneous coronary intervention (PCI). PCI is used to treat CAD by inserting a thin, flexible tube called a catheter, where it’s x-ray guided to the and a small balloon is inflated to widen the narrowed coronary artery, and possibly a small metal mesh tube (“stent”) placed like a scaffold to keep it open. However, PCI can cause damage the heart muscle (ischemia-reperfusion injury). Wang et al (2015) compared EA with sham EA in 204 CAD patients undergoing PCI. They found that EA: significantly lowered the levels of cTnI (cardiac troponin I); reduced the use of drugs (inotropes); shortened the length of stay in the intensive care unit (ICU); and decreased the rate of MACCE (major adverse cardiac/cerebrovascular events) at 24 months after PCI, compared to sham EA. They concluded that EA prior to PCI “significantly reduced cTnI release and protected patients with CAD from subsequent myocardial injury after PCI procedure.”
Mechanisms of action
Li et al (2014) proposed a possible mechanism of action for the lowering of blood pressure, in that acupuncture could regulate the renin-angiotensin-aldosterone system (RAAS), which is involved in blood pressure regulation, by stimulating specific acupoints that correspond to the kidney and liver meridians. The other mechanism is based on the Western medicine theory of modulating the autonomic nervous system (ANS), which controls the heart rate and vascular tone. They further hypothesized that acupuncture might activate the parasympathetic branch of the ANS, thus lowering the sympathetic activity and reducing the release of stress hormones that constrict the blood vessels.
Li et al, (2022), theorised about specific points in the process of cardioversion, whereby acupuncture in addition to medication was shown to benefit the outcome. In particular a specific point on the arm called Neiguan (pericardium 6), which has mechanisms of action including: Downregulating the amygdala (involved in stress response) in the brain; desensitising the nucleus tractus solitarius, (area in the brain that controls heart rate and blood pressure); reducing levels of inflammatory substances in the blood, including CRP, IL-8, and TNF-α (which can cause swelling and pain, damage the heart tissue and make AF worse); improving the index of heart rate variability (HRV) – is a measure of how well the heart adapts to different situations.
Yang et al (2010) in their RCT on cardioprotective effects of EA for valve surgery discussed possible mechanisms for how EA pretreatment could protect the heart from injury, such as activating certain pathways in the brain and nerves that regulate blood flow and inflammation. Specifically, they put forward the way in which EA at Neiguan (PC-6) can influence the neuroendocrine system and the inflammatory response, which are both involved in the pathogenesis and progression of coronary artery disease. Stimulating this point can activate certain pathways in the brain and nerves that regulate blood pressure, heart rate, vascular tone, and stress hormones, as well as reduce the levels of substances in the blood that cause inflammation, such as cytokines, chemokines, and adhesion molecules.
Li et al (2012) also discussed PC6, and the sympathoexcitatory cardiovascular reflex responses, which are reactions that make the heart beat faster and stronger when the body is under stress or danger. Point PC6 can reduce the sympathoexcitatory cardiovascular reflex responses, reducing this effect and relaxing the heart muscle to modulate the response to an appropriate level. They also discuss brain activity that may govern the cardiovascular response, and be influenced by acupuncture, namely some parts of the brain that are involved in acupuncture, such as the rostral ventrolateral medulla (RVLM), the arcuate nucleus (ARC), and the ventrolateral periaqueductal gray (vlPAG), which are parts of the brain that control the blood pressure, heart rate, and stress response. Acupuncture can do this by activating some pathways in the brain that send messages to the heart and blood vessels to relax, and can also make these pathways less sensitive to signals from other organs or tissues that can trigger these reflexes. Acupuncture can have a long-lasting effect on these reflexes, even after the needles are removed. Acupuncture can do this by changing some proteins or chemicals in the brain that are involved in these reflexes, such as opioids, serotonin, or nitric oxide.
Another mechanism of action involved adenosine receptors, as examined by Malik et al (2019); EA activates the A2a adenosine receptors in the RVLM (rostral ventrolateral medulla of the brain), making the nerve cells in the RVLM less active and less likely to increase the blood pressure and heart rate. This process is dependent on the body’s natural opioids, and the fact that EA can increase the amount of opioids in the RVLM, can help activate the A2a adenosine receptors. This process has been proven further by the fact that if the opioids are deliberately blocked by some drugs, EA’s effect on the A2a adenosine receptors is also blocked.
Animal model studies have shown physiological effects from auricular (ear) acupuncture on the Heart point, whereby using this point regulates
cardiovascular function (heart rate, blood pressure). Cardiac related nerve cells were shown to be regulated by the use of Heart (auricular point), lowering blood pressure in the arteries, by means of activating a certain type of nerve cell receptor (baroreceptor sensitive neurons) in part of the brainstem (nucleus tractus solitarius) (Gao et al, 2011).
Acupuncture has been shown in many mechanism-of-action trials to be
sympathoinhibitory (able to downregulate the sympathetic nervous system) and lower the stress response in brain and nervous system (Middlekauff et al, 2002).
Animal Models
In a rat model, Su et al (2022) used PC6 point to study atrial fibrillation, in order to understand the mechanism of action whereby electroacupuncture at this point was demonstrated in many previous studies to benefit AF. EA at PC6 was shown to affect the brain and the nerves that control the heart in different ways: making it harder for AF to start or continue by changing how the heart cells react to certain chemicals, such as ACh and CaCl2, that can trigger AF; improving the HRV; balancing the activity of the sympathetic and vagal nerves, which are part of the nervous system that controls the heart rate and blood pressure (the sympathetic nerve makes the heart beat faster and stronger, while the vagal nerve makes it slower and weaker); reducing the sympathetic nerve activity and increase the vagal nerve activity, which can help lower the heart rate and make it more stable; affecting the expression of c-Fos, which is a protein that shows how active certain brain regions are, and decreasing the activity of some brain regions that are involved in stress and blood pressure regulation, such as PVN, RVLM, and DMV; whilst increasing the activity of another brain region that is involved in heart rate regulation.
Summary
Several hypotheses have been proposed based on anatomical, physiological, pharmacological, and neuroscientific evidence. One of the main mechanisms is the modulation of the autonomic nervous system, which regulates the heart rate, blood pressure, and vascular tone. Acupuncture can activate specific reflexes that involve peripheral nerves, spinal cord, brainstem, hypothalamus, and other brain regions to inhibit sympathetic activity and enhance parasympathetic activity. This can result in vasodilation, decreased cardiac output, and reduced blood pressure.
Another mechanism is the release of endogenous substances that have cardiovascular effects, such as endorphins, enkephalins, serotonin, nitric oxide, and angiotensin II. These substances can act on various receptors and channels to modulate vascular tone, cardiac contractility, inflammation, and oxidative stress.
A third mechanism is the stimulation of angiogenesis and neurogenesis in the heart and brain tissues. Acupuncture can increase the expression of growth factors and cytokines that promote the formation of new blood vessels and nerve fibres. This can improve blood supply and oxygen delivery to the ischemic areas and enhance tissue repair and regeneration.
References
Feingold, K.L., Moskowitz, J.T., Elenbaas, C., Andrei, A.C., Victorson, D., Kruse, J., Grote, V., Patil, K.D., Shafiro, T., Grimone, A. and Lin, F., 2023. Acupuncture after valve surgery is feasible and shows promise in reducing postoperative atrial fibrillation: The ACU-Heart pilot trial. JTCVS Open.
Gao XY et al. Acupuncture-like stimulation at auricular point Heart evokes cardiovascular inhibition via activating the cardiac-related neurons in the nucleus tractus solitarius. Brain Res. 2011;1397:19-27.
Ho, F.M., Huang, P.J., Lo, H.M., Lee, F.K., Chern, T.H., Chiu, T.W. and Liau, C.S., 1999. Effect of acupuncture at nei-kuan on left ventricular function in patients with coronary artery disease. The American journal of Chinese medicine, 27(02), pp.149-156.
Hong, S., Ahn, L., Kwon, J. and Choi, D.J., 2020. Acupuncture for Regulating Blood Pressure of Stroke Patients: A Systematic Review and Meta-Analysis. The Journal of Alternative and Complementary Medicine, 26(12), pp.1105-1116.
Li, D.Z., Zhou, Y., Yang, Y.N., Ma, Y.T., Li, X.M., Yu, J., Zhao, Y., Zhai, H. and Lao, L., 2014. Acupuncture for essential hypertension: a meta-analysis of randomized sham-controlled clinical trials. Evidence-Based Complementary and Alternative Medicine, 2014.
Li, J., Li, J., Chen, Z., Liang, F., Wu, S. and Wang, H., 2012. The influence of PC6 on cardiovascular disorders: a review of central neural mechanisms. Acupuncture in Medicine, 30(1), pp.47-50.
Li, Y., Song, J., Wu, B., Wang, X., Han, L. and Han, Z., 2022. Acupuncture versus pharmacological conversation in treatment of atrial fibrillation in a randomized controlled trial: a systemic review and meta-analysis. European Journal of Medical Research, 27(1), pp.1-14.
Lomuscio, A., Belletti, S., Battezzati, P.M. and Lombardi, F., 2011. Efficacy of acupuncture in preventing atrial fibrillation recurrences after electrical cardioversion. Journal of cardiovascular electrophysiology, 22(3), pp.241-247.
Lu, L., He, W., Guan, D., Jiang, Y., Hu, G., Ma, F. and Chen, L., 2022. Acupuncture in treating cardiovascular disease complicated with depression: A systematic review and meta-analysis. Frontiers in Psychiatry, 13, p.1051324.
Ma, J., Zhang, Y., Ge, Q. and Wu, K., 2023. The effect of auricular acupuncture on preoperative blood pressure across age groups: a prospective randomized controlled trial. Clinical and Experimental Hypertension, 45(1), p.2169452.
Malik, S., Samaniego, T. and Guo, Z.L., 2019. Adenosine receptor A2a, but not A1 in the rVLM participates along with opioids in acupuncture-mediated inhibition of excitatory cardiovascular reflexes. Frontiers in Neuroscience, p.1049.
Middlekauff, H.R., Hui, K., Yu, J.L., Hamilton, M.A., Fonarow, G.C., Moriguchi, J., MacLellan, W.R. and Hage, A., 2002. Acupuncture inhibits sympathetic activation during mental stress in advanced heart failure patients. Journal of cardiac failure, 8(6), pp.399-406.
Niu, J.F., Zhao, X.F., Hu, H.T., Wang, J.J., Liu, Y.L. and Lu, D.H., 2019. Should acupuncture, biofeedback, massage, Qi gong, relaxation therapy, device-guided breathing, yoga and tai chi be used to reduce blood pressure?: recommendations based on high-quality systematic reviews. Complementary therapies in medicine, 42, pp.322-331.
Su, Y., Huang, J., Sun, S., He, T., Wang, T., Fan, M., Yu, H., Yan, J., Yao, L., Xia, Y. and Zhang, M., 2022. Restoring the Autonomic Balance in an Atrial Fibrillation Rat Model by Electroacupuncture at the Neiguan Point. Neuromodulation: Technology at the Neural Interface.
Tan, X., Pan, Y., Su, W., Gong, S., Zhu, H., Chen, H. and Lu, S., 2019. Acupuncture therapy for essential hypertension: a network meta-analysis. Annals of translational medicine, 7(12).
Wang, Q., Liang, D., Wang, F., Li, W., Han, Y., Zhang, W., Xie, Y., Xin, W., Zhou, B., Sun, D. and Cao, F., 2015. Efficacy of electroacupuncture pretreatment for myocardial injury in patients undergoing percutaneous coronary intervention: a randomized clinical trial with a 2-year follow-up. International journal of cardiology, 194, pp.28-35.
Yang, L., Yang, J., Wang, Q., Chen, M., Lu, Z., Chen, S. and Xiong, L., 2010. Cardioprotective effects of electroacupuncture pretreatment on patients undergoing heart valve replacement surgery: a randomized controlled trial. The Annals of thoracic surgery, 89(3), pp.781-786.
Yin, C., Seo, B., Park, H.J., Cho, M., Jung, W., Choue, R., Kim, C., Park, H.K., Lee, H. and Koh, H., 2007. Acupuncture, a promising adjunctive therapy for essential hypertension: a double-blind, randomized, controlled trial. Neurological research, 29(sup1), pp.98-103.
Resources:
British Acupuncture Council evidence based factsheet about Angina, Atrial Fibrillation, Heart Failure and Coronary Heart Disease with research, trials and mechanisms of action for acupuncture in this condition.
British Acupuncture Council evidence based factsheet about Hypertension with research, trials and mechanisms of action for acupuncture in this condition.
British Acupuncture Council evidence based factsheet about Stroke with research, trials and mechanisms of action for acupuncture in this condition.
Helen Page under construction
Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.
Cystitis in an inflammation of the bladder than can cause pain and urinary symptoms. See also our page on urinary and bladder issues.
Mechanisms of Action in Pain and Inflammation
Acupuncture stimulates the body to create its own natural painkilling substances, such as Beta Endorphins (β-Endorphin). In studies acupuncture has been shown to stimulate the production of natural painkillers called opioid-like peptides (OLPs), including β-Endorphin: For example, this was shown in an RCT in 90 patients with a range of painful disorders (Petti et al, 1998). The same study showed acupuncture also and enhanced the activity of immune cells (lymphocytes, natural killer cells and monocytes) that help fight infections and diseases (Petti et al, 1998).
References
Petti, F.., Bangrazi, A., Liguori, A., Reale, G. and Ippoliti, F., 1998. Effects of acupuncture on immune response related to opioid-like peptides. Journal of Traditional Chinese Medicine 18(1), pp.55-63.
Helen
Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.
Chronic obstructive pulmonary disease (COPD) is group of lung diseases where the airways become permanently narrowed, making it difficult to empty air out of the lungs. It also known as emphysema.
Research and Resources on COPD and Acupuncture:
A scholarly search of the available research papers on the terms “acupuncture” + “COPD” OR “emphysema” yields over 11,800 papers, and narrowing this to “RCT” to identify Randomised Controlled Trials, gives over 1090 results; of which 39% have been carried out since 2017 (Google Scholar). This suggests that acupuncture is being used traditionally and currently in this area, research is being done, the pace of which is increasing in recent years, and as such there is a recognition of a need to scientifically appraise any merit it may have in the field.
The British Acupuncture Council has produced an evidence based factsheet about COPD including specific research, trials and mechanisms of action for acupuncture in this condition.
Interpreting the research:
When reading health research, it is important to know that Systematic Reviews or Meta Analyses of a large number of high-quality research studies are the very best way to be able to say to what extent a given treatment can address a condition, symptom, or set of symptoms. The next best level of evidence is the individual Randomised Controlled Study (RCT) which uses a systematic technique to compare two or more groups of patients receiving different treatments (or a treatment against a “control”, or no treatment). In acupuncture trials, the nature of the control group is of particular interest as it is hard to blind a patient to whether they are having a needle inserted or not, and even more challenging to blind the researcher/team to this.
The means and quality of how research is carried out varies considerably from country to country, and in terms of how an intervention is compared to another intervention (or a control). Of note is the fact that “sham” acupuncture (where needles are placed in apparently inert locations rather than traditional acupuncture points) is not really an inert process as it has physiological effects, so that comparing sham and “true acupuncture” may therefore not give a clear picture alone; but and form a part of a research body where acupuncture versus no treatment, vs conventional treatment or vs a different approach/modality also form part of the evidence base.
The n= figure (where quoted in research) tells you how many people were participants in the study, and usually the larger a study (when it is of good quality and design), the more likely it is to be reliable and applicable to larger populations. When (statistical) “significance” is discussed in view of studies it has a very particular meaning – it is the confidence in the data (using statistical tests) that tells us how likely a result could have just come about by chance. The lower the possibility of a chance result, the more likely it is due to the intervention in the experiment. When you are reading a trial/study, the “p” is the number telling us of significance, and this must be under 5% (or p less than 0.05) to mean we can say it is a (statistically) “significant” result.
The Research:
This is an area of research with fewer RCT’s than many other areas of acupuncture so far, although the pace of research is increasing. There have been systematic reviews in this area, including one which concluded that health-related quality of life (HRQL) improvements were seen in COPD patients receiving body acupuncture therapy (Hsieh et al, 2019), improved quality of life was also a conclusion in XIao et al’s (2020) systematic review of 11 RCT’s.
However in terms of addressing symptomatic issues, Wang et al, (2018) looked at 19 RCT’s and whilst there were positive trends in some areas of symptoms, further high-quality RCT’s were called for in order to draw stronger conclusions. A more recent systematic review (Fernández-Jané et al, 2020) looking at acupuncture techniques in this field reached the same conclusion as Wang et al, as did von Trott et al (2020) regarding breathlessness and exercise tolerance in 12 studies, again seeing a positive trend in acupuncture groups, but noting the RCT’s examined overall were low-powered and further quality research warranted. Chu et al (2021) also concurred with this in their recent review of systematic reviews.
Recently Wang et al (2021) put forward a protocol for a systematic review of moxibustion (acupuncture adjunct technique) in COPD – the forthcoming result will be of interest.
Regarding Your Individual Condition and Symptoms:
Whilst the scientific studies are of great interest to researchers and acupuncturists in terms of comparing protocols, for the patient not versed in research they are less accessible, which is why when we asked “can acupuncture work for my (condition or symptom) we are not able to give a simple yes or no response. We are able to tell you what experience we have had in our decades of experience in practise, of the types of outcomes we have seen in similar cases, and give you an idea of our level of experience and knowledge in that area, and how this could relate to your own individual situation. For this, we recommend booking a free telephone consultation where we can answer any questions you have and give a realistic appraisal of what acupuncture may be able to provide.
Resources:
British Acupuncture Council evidence based factsheet about COPD including specific research, trials and mechanisms of action for acupuncture in this condition.
References:
Chun, L., Li, X., Feng, Z., Xie, Y. and Li, J., 2021. Role of Acupuncture in the Treatment of COPD: An Overview of Systematic Reviews. International Journal of General Medicine, 14, p.1079.
Fernández-Jané, C., Vilaró, J., Fei, Y., Wang, C., Liu, J., Huang, N., Xia, R., Tian, X., Hu, R., Wen, L. and Yu, M., 2020. Acupuncture techniques for COPD: a systematic review. BMC complementary medicine and therapies, 20, pp.1-18.
Hsieh, P.C., Yang, M.C., Wu, Y.K., Chen, H.Y., Tzeng, I.S., Hsu, P.S., Lee, C.T., Chen, C.L. and Lan, C.C., 2019. Acupuncture therapy improves health-related quality of life in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. Complementary therapies in clinical practice, 35, pp.208-218.
von Trott, P., Oei, S.L. and Ramsenthaler, C., 2020. Acupuncture for breathlessness in advanced diseases: a systematic review and meta-analysis. Journal of pain and symptom management, 59(2), pp.327-338.
Wang, J., Li, J., Yu, X. and Xie, Y., 2018. Acupuncture therapy for functional effects and quality of life in COPD patients: a systematic review and meta-analysis. BioMed research international, 2018.
Wang, Y., Huang, M., Tang, L., Xu, L., Wu, J., Wang, F. and Zhang, Y., 2021. Moxibustion for stable chronic obstructive pulmonary disease: A protocol for systematic review and meta-analysis. Medicine, 100(17).
Helen Page under construction
Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.
Research and Resources on Colds, Flu, and Acupuncture:
A scholarly search of the available research papers on the terms “acupuncture” + “colds” OR “flu” yields over 15,800 papers, and narrowing this to “RCT” to identify Randomised Controlled Trials, gives over 800 results; of which 27% have been carried out since 2017 (Google Scholar). This suggests that acupuncture is being used traditionally and currently in this area, this is an area of increasing research, and therefore an examination of its potential role could be useful.
Interpreting the research:
When reading health research, it is important to know that Systematic Reviews or Meta Analyses of a large number of high-quality research studies are the very best way to be able to say to what extent a given treatment can address a condition, symptom, or set of symptoms. The next best level of evidence is the individual Randomised Controlled Study (RCT) which uses a systematic technique to compare two or more groups of patients receiving different treatments (or a treatment against a “control”, or no treatment). In acupuncture trials, the nature of the control group is of particular interest as it is hard to blind a patient to whether they are having a needle inserted or not, and even more challenging to blind the researcher/team to this.
The means and quality of how research is carried out varies considerably from country to country, and in terms of how an intervention is compared to another intervention (or a control). Of note is the fact that “sham” acupuncture (where needles are placed in apparently inert locations rather than traditional acupuncture points) is not really an inert process as it has physiological effects, so that comparing sham and “true acupuncture” may therefore not give a clear picture alone; but and form a part of a research body where acupuncture versus no treatment, vs conventional treatment or vs a different approach/modality also form part of the evidence base.
The n= figure (where quoted in research) tells you how many people were participants in the study, and usually the larger a study (when it is of good quality and design), the more likely it is to be reliable and applicable to larger populations. When (statistical) “significance” is discussed in view of studies it has a very particular meaning – it is the confidence in the data (using statistical tests) that tells us how likely a result could have just come about by chance. The lower the possibility of a chance result, the more likely it is due to the intervention in the experiment. When you are reading a trial/study, the “p” is the number telling us of significance, and this must be under 5% (or p less than 0.05) to mean we can say it is a (statistically) “significant” result.
Regarding Your Individual Condition and Symptoms:
Whilst the scientific studies are of great interest to researchers and acupuncturists in terms of comparing protocols, for the patient not versed in research they are less accessible, which is why when we asked “can acupuncture work for my (condition or symptom) we are not able to give a simple yes or no response. We are able to tell you what experience we have had in our decades of experience in practise, of the types of outcomes we have seen in similar cases, and give you an idea of our level of experience and knowledge in that area, and how this could relate to your own individual situation. For this, we recommend booking a free telephone consultation where we can answer any questions you have and give a realistic appraisal of what acupuncture may be able to provide.
Resources:
British Acupuncture Council evidence based factsheet – Colds and Flu including specific research, trials and mechanisms of action for acupuncture in this condition.
Helen
Chronic Fatigue Syndrome (CFS) is also known as Myalgic Encephalomyelitis (ME).
Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.
A scholarly search of the available research papers on the terms “acupuncture” + “chronic fatigue” yields over 11,500 papers, and narrowing this to “RCT” to identify Randomised Controlled Trials, gives over 1,200 results; of which one third of these have been carried out since 2017 (Google Scholar). This suggests that acupuncture is being used traditionally and currently in this area, research has been carried out, the pace of which is increasing in recent years, and as such that it has been recognised its potential role is worthy of appraisal in a scientific manner.
Interpreting the research:
When reading health research, it is important to know that Systematic Reviews or Meta Analyses of a large number of high-quality research studies are the very best way to be able to say to what extent a given treatment can address a condition, symptom, or set of symptoms. The next best level of evidence is the individual Randomised Controlled Study (RCT) which uses a systematic technique to compare two or more groups of patients receiving different treatments (or a treatment against a “control”, or no treatment). In acupuncture trials, the nature of the control group is of particular interest as it is hard to blind a patient to whether they are having a needle inserted or not, and even more challenging to blind the researcher/team to this.
The means and quality of how research is carried out varies considerably from country to country, and in terms of how an intervention is compared to another intervention (or a control). Of note is the fact that “sham” acupuncture (where needles are placed in apparently inert locations rather than traditional acupuncture points) is not really an inert process as it has physiological effects, so that comparing sham and “true acupuncture” may therefore not give a clear picture alone; but and form a part of a research body where acupuncture versus no treatment, vs conventional treatment or vs a different approach/modality also form part of the evidence base.
The n= figure (where quoted in research) tells you how many people were participants in the study, and usually the larger a study (when it is of good quality and design), the more likely it is to be reliable and applicable to larger populations. When (statistical) “significance” is discussed in view of studies it has a very particular meaning – it is the confidence in the data (using statistical tests) that tells us how likely a result could have just come about by chance. The lower the possibility of a chance result, the more likely it is due to the intervention in the experiment. When you are reading a trial/study, the “p” is the number telling us of significance, and this must be under 5% (or p less than 0.05) to mean we can say it is a (statistically) “significant” result.
The Research:
A number of systematic reviews have been carried out in this area, these include Wang, T. et al (2017, 31 RCT’s); Wang, J.J. et al, (2009, 28 RCT’s); Yin et al, (2020, 10 RCT’s); Kim et al, (2017, 11 RCT’s); Son (2009, 53 RCT’s); all concluded along the lines that whist overall the trends appeared positive, this is a tentative conclusion as further studies are needed due to the fact that a number of RCT’s examined suffer from poor quality research design; and in some cases findings were contradictory.
A protocol for a systematic review on the efficacy and safety of moxibustion for chronic fatigue syndrome was published this year (Xue et al, 2021), this will be of interest as moxibustion is the using of a warming herb on acupuncture points (commonly employed by traditional acupuncturists as an adjunct to acupuncture treatment). Furthermore, a protocol for an overview of systematic reviews in this area has been published recently (Tang et al, 2021), the forthcoming result of this will be of interest within the context of the existing research body.
Mechanisms of action:
Acupuncture studies have shown it can: provide pain relief by stimulating nerves in body tissues and leading to endorphin release (natural painkilling substances), as well as downregulating the brain and nervous system’s reaction to stress and pain (Zhao 2008; Zijlstra et al, 2003; Pomeranz, 1987).
Acupuncture stimulates the body to create its own natural painkilling substances, such as Beta Endorphins (β-Endorphin). In studies acupuncture has been shown to stimulate the production of natural painkillers called opioid-like peptides (OLPs), including β-Endorphin: For example, this was shown in an RCT in 90 patients with a range of painful disorders (Petti et al, 1998). The same study showed acupuncture also and enhanced the activity of immune cells (lymphocytes, natural killer cells and monocytes) that help fight infections and diseases (Petti et al, 1998).
Acupuncture can activate mast cells at acupoints, which release histamine, serotonin, adenosine, and other mediators that modulate nerve transmission and inflammation (Li et al, 2022)
Zijlstra et al (2003) reviewed the effects and mechanisms of acupuncture in treating various inflammatory diseases and conditions. They proposed the mechanisms of action:
Acupuncture has been shown in animal models to promote the release of factors that involved in the reduction of inflammation (vascular and immunomodulatory factors – (Kim et al, 2008; Kavoussi and Ross, 2007 [review article]; Zijlstra et al, 2003), and also to affect levels of serotonin (in an animal model), and other peptides in the brain and nervous system and modulate blood flow in the brain and elsewhere in the body, in humans (Zhong and Li, 2007; Shi et al, 2010).
Electroacupuncture (EA) has been shown in a rat model (Li et al, 2008) to have anti-inflammatory benefits by modulating the hypothalamic-pituitary-adrenal (HPA) axis, (HPA axis regulates the stress response and immune function). Specifically, Li et al outlined that EA sets off a cascade in the brain (via corticotropin-releasing hormone, and adrenocorticotropic hormone) to produce cortisol, which reduces inflammation and oedema.
Regarding Your Individual Condition and Symptoms:
Whilst the scientific studies are of great interest to researchers and acupuncturists in terms of comparing protocols, for the patient not versed in research they are less accessible, which is why when we asked “can acupuncture work for my (condition or symptom) we are not able to give a simple yes or no response. We are able to tell you what experience we have had in our decades of experience in practise, of the types of outcomes we have seen in similar cases, and give you an idea of our level of experience and knowledge in that area, and how this could relate to your own individual situation. For this, we recommend booking a free telephone consultation where we can answer any questions you have and give a realistic appraisal of what acupuncture may be able to provide.
Resources:
British Acupuncture Council evidence based factsheet about Chronic Fatigue Syndrome including specific research, trials and mechanisms of action for acupuncture in this condition.
References:
Kavoussi B, Ross BE. The neuroimmune basis of anti-inflammatory acupuncture. Integr Cancer Ther. 2007 Sep;6(3):251-7.
Kim HW, Uh DK, Yoon SY et al. Low-frequency electroacupuncture suppresses carrageenan-induced paw inflammation in mice via sympathetic post-ganglionic neurons, while high-frequency EA suppression is mediated by the sympathoadrenal medullary axis. Brain Res Bull. 2008 Mar 28;75(5):698-705.
Kim, H.G., Ryoo, D.W., Jeong, S.M., Kim, S.J., Baek, S.W., Lee, C.H., Yoon, J.Y., Goo, B.H., Kim, M.J., Park, Y.C. and Seo, B.K., 만성피로증후군에 대한 침치료의 체계적 문헌 고찰 A Systematic Review of Acupuncture for Chronic Fatigue Syndrome. Journal of Acupuncture Research Volume 34 Issue 2 / Pages.93-112 / 2017
Li, A., Lao, L., Wang, Y., Xin, J., Ren, K., Berman, B.M., Tan, M. and Zhang, R., 2008. Electroacupuncture activates corticotrophin-releasing hormone-containing neurons in the paraventricular nucleus of the hypothalammus to alleviate edema in a rat model of inflammation. BMC Complementary and Alternative Medicine, 8(1), pp.1-8.
Li, Y., Yu, Y., Liu, Y. and Yao, W., 2022. Mast cells and acupuncture analgesia. Cells, 11(5), p.860.
McAteer, R., Skef, S. and Wilson, S., 2019. What nonpharmacologic treatments have shown to be effective for systemic exertion intolerance disease (chronic fatigue syndrome)?. Evidence-Based Practice, 22(2), pp.12-14.
Petti, F.., Bangrazi, A., Liguori, A., Reale, G. and Ippoliti, F., 1998. Effects of acupuncture on immune response related to opioid-like peptides. Journal of Traditional Chinese Medicine 18(1), pp.55-63.
Pomeranz B. Scientific basis of acupuncture. In: Stux G, Pomeranz B, eds. Acupuncture Textbook and Atlas. Heidelberg: Springer-Verlag; 1987:1-18.
Shi H, Li JH, Ji CF, Shang HY, Qiu EC et al.[Effect of electroacupuncture on cortical spreading depression and plasma CGRP and substance P contents in migraine rats]. Zhen Ci Yan Jiu. 2010 Feb;35(1):17-21.
Son, C.G., 2009. Systemic review of RCTs focusing on chronic fatigue. The Journal of Korean Medicine, 30(6), pp.80-85.
Tang, L., Jiang, T., ZHu, F.Y., Liu, Z. and Wu, X., 2021. Acupuncture therapy on chronic fatigue syndrome based on radar plot: A protocol for an overview of systematic reviews. Medicine, 100(14).
Wang, J.J., Song, Y.J., Wu, Z.C., Chu, X.O., Wang, X.H., Wang, X.J., Wei, L.N. and Wang, Q.M., 2009. A meta analysis on randomized controlled trials of acupuncture treatment of chronic fatigue syndrome. Zhen ci yan jiu= Acupuncture Research, 34(6), pp.421-428.
Wang, T., Xu, C., Pan, K. and Xiong, H., 2017. Acupuncture and moxibustion for chronic fatigue syndrome in traditional Chinese medicine: a systematic review and meta-analysis. BMC complementary and alternative medicine, 17(1), pp.1-11.
Xue, K., Wang, Y., Wang, X., Chen, P., Xiao, C., Fu, J. and Cui, J., 2021. The efficacy and safety of moxibustion for chronic fatigue syndrome: A protocol for systematic review and meta-analysis. Medicine, 100(18).
Yin, Z.H., Wang, L.J., Cheng, Y., Chen, J., Hong, X.J., Zhao, L. and Liang, F.R., 2020. Acupuncture for chronic fatigue syndrome: an overview of systematic reviews. Chinese journal of integrative medicine, pp.1-7.
Zhao ZQ. Neural mechanism underlying acupuncture analgesia. Prog Neurobiol. 2008 Aug;85(4):355-75.
Zhong G.-W. Li W. Effects of acupuncture on 5-hydroxytryptamine1F and inducible nitricoxide synthase gene expression in the brain of migraine rats. Journal of Clinical Rehabilitative Tissue Engineering Research. 2007;11(29)(pp 5761-5764)
Zijlstra FJ, van den Berg-de Lange I, Huygen FJ, Klein J. Anti-inflammatory actions of acupuncture. Mediators Inflamm. 2003 Apr;12(2):59-69.
Helen
Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.
CTS is a common condition (Atroshi et al, 1999), a type of compression neuropathy causing possible tingling, burning or dull sensations and symptoms in the hands. It is caused by the median nerve being compressed as is passes through the wrist(s). Common treatments include splinting, local steroid injections, painkillers, sometimes surgery is required.
A scholarly search of the available research papers on the terms “acupuncture” + “carpal tunnel” yields over 9,000 papers, and narrowing this to “RCT” to identify Randomised Controlled Trials, gives over 1000 results; of which over a third have been carried out since 2017 (Google Scholar). This suggests that acupuncture is being used traditionally and currently in this area, research has been carried out, the pace of which is increasing in recent years, and as such that it has been recognised its potential role is worthy of appraisal in a scientific manner.
Interpreting the research:
When reading health research, it is important to know that Systematic Reviews or Meta Analyses of a large number of high-quality research studies are the very best way to be able to say to what extent a given treatment can address a condition, symptom, or set of symptoms. The next best level of evidence is the individual Randomised Controlled Study (RCT) which uses a systematic technique to compare two or more groups of patients receiving different treatments (or a treatment against a “control”, or no treatment). In acupuncture trials, the nature of the control group is of particular interest as it is hard to blind a patient to whether they are having a needle inserted or not, and even more challenging to blind the researcher/team to this.
The means and quality of how research is carried out varies considerably from country to country, and in terms of how an intervention is compared to another intervention (or a control). Of note is the fact that “sham” acupuncture (where needles are placed in apparently inert locations rather than traditional acupuncture points) is not really an inert process as it has physiological effects, so that comparing sham and “true acupuncture” may therefore not give a clear picture alone; but and form a part of a research body where acupuncture versus no treatment, vs conventional treatment or vs a different approach/modality also form part of the evidence base.
The n= figure (where quoted in research) tells you how many people were participants in the study, and usually the larger a study (when it is of good quality and design), the more likely it is to be reliable and applicable to larger populations. When (statistical) “significance” is discussed in view of studies it has a very particular meaning – it is the confidence in the data (using statistical tests) that tells us how likely a result could have just come about by chance. The lower the possibility of a chance result, the more likely it is due to the intervention in the experiment. When you are reading a trial/study, the “p” is the number telling us of significance, and this must be under 5% (or p less than 0.05) to mean we can say it is a (statistically) “significant” result.
Research and Resources on Carpal Tunnel Syndrome and Acupuncture:
A number of systematic reviews have been done in this area, including Badia and Santafé, 2020, a Spanish study examining 21 articles and concluding that “acupuncture and electroacupuncture are a therapeutic option for mild to moderate CTS with a medium level of scientific evidence, tending towards a high level, and with a medium level of recommendation.” Wu et al’s systematic review (2020) looked at 10 RCT studies in this area, drawing a similar conclusion for symptom relief. A Korean systematic review to examine reporting quality of 9 RCT’s in this area (Hyun et al, 2020) concurred with Badia and Santafé, that the evidence quality was moderate, and also concluded that traditional point PC7 was the most commonly employed in this area.
Mechanisms of Action
A review article (Kavoussi & Ross, 2007) suggests that the anti-inflammatory actions that have been demonstrated to be brought about by acupuncture may be mediated via activation of the vagus nerve, alongside deactivation of inflammatory macrophages and other proinflammatory cytokines. The researchers concluded that “The use of acupuncture as an adjunct therapy to conventional medical treatment for a number of chronic inflammatory and autoimmune diseases seems plausible and should be validated by confirming its cholinergicity”.
Acupuncture can activate mast cells at acupoints, which release histamine, serotonin, adenosine, and other mediators that modulate nerve transmission and inflammation (Li et al, 2022)
Acupuncture stimulates the body to create its own natural painkilling substances, such as Beta Endorphins (β-Endorphin). In studies acupuncture has been shown to stimulate the production of natural painkillers called opioid-like peptides (OLPs), including β-Endorphin: For example, this was shown in an RCT in 90 patients with a range of painful disorders (Petti et al, 1998). The same study showed acupuncture also and enhanced the activity of immune cells (lymphocytes, natural killer cells and monocytes) that help fight infections and diseases (Petti et al, 1998).
Other studies (Zijlstra et al, 2003) have revealed that acupuncture some of the pain modulating and anti-inflammatory effects exhibited in acupuncture may be due to the fact that it has been shown to stimulate certain substances in the body which act as vasodilators, neurotransmitters and painkillers (beta-endorphins, CGRP and substance P) and further stimulate cytokines and nitric oxide, all of which play roles in inflammatory states.
Zijlstra et al (2003) reviewed the effects and mechanisms of acupuncture in treating various inflammatory diseases and conditions. They proposed the mechanisms of action:
Regarding Your Individual Condition and Symptoms:
Whilst the scientific studies are of great interest to researchers and acupuncturists in terms of comparing protocols, for the patient not versed in research they are less accessible, which is why when we asked “can acupuncture work for my (condition or symptom) we are not able to give a simple yes or no response. We are able to tell you what experience we have had in our decades of experience in practise, of the types of outcomes we have seen in similar cases, and give you an idea of our level of experience and knowledge in that area, and how this could relate to your own individual situation. For this, we recommend booking a free telephone consultation where we can answer any questions you have and give a realistic appraisal of what acupuncture may be able to provide.
Resources:
British Acupuncture Council evidence based factsheet about Carpal Tunnel Syndrome including specific research, trials and mechanisms of action for acupuncture in this condition.
References:
Atroshi, I., Gummesson, C., Johnsson, R., Ornstein, E., Ranstam, J. and Rosen, I., 1999. Prevalence of carpal tunnel syndrome in a general population. Jama, 282(2), pp.153-158.
Badia, M. and Santafé, M.M., 2020. Acupuncture and electroacupuncture in the treatment of carpal tunnel syndrome: systematic review. Journal of Invasive Techniques in Physical Therapy Vol, 3(1).
Hyun, J.Y., Shin, J.E., Im, C.J. and Park, J.Y., 2020. A Systematic Review on the Reporting Quality of Acupuncture Treatment for Carpal Tunnel Syndrome. Korean Journal of Acupuncture, 37(3), pp.131-144.
Kavoussi B, Ross BE. The neuroimmune basis of anti-inflammatory acupuncture. Integr Cancer Ther 2007; 6: 251-7.
Li, Y., Yu, Y., Liu, Y. and Yao, W., 2022. Mast cells and acupuncture analgesia. Cells, 11(5), p.860.
Petti, F.., Bangrazi, A., Liguori, A., Reale, G. and Ippoliti, F., 1998. Effects of acupuncture on immune response related to opioid-like peptides. Journal of Traditional Chinese Medicine 18(1), pp.55-63.
Wu, I.X., Lam, V.C., Ho, R.S., Cheung, W.K., Sit, R.W., Chou, L.W., Zhang, Y., Leung, T.H. and Chung, V.C., 2020. Acupuncture and related interventions for carpal tunnel syndrome: systematic review. Clinical rehabilitation, 34(1), pp.34-44.
Zijlstra, F.J., van den Berg-de Lange, I., Huygen, F.J. and Klein, J., 2003. Anti-inflammatory actions of acupuncture. Mediators of inflammation, 12(2), pp.59-69.
Helen Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.
Bell’s Palsy affects approximately 1 in 5,000 people per year in the UK; it is a condition whereby one side of facial muscles suddenly become weakened.
Research and Resources on Bell’s Palsy and Acupuncture:
A search on scientific papers for “acupuncture” + “Bell’s Palsy” reveals over 2000 results, of which 180 show up as “RCT”‘s* (see below), of these 51 have been carried out since 2017 . From this we can deduce that acupuncture is being used traditionally and currently in this area; that scientific researched is ongoing, with the pace of research increasing – indicating an area worthy of scientific appraisal and consideration.
The British Acupuncture Council have produced an evidence-based factsheet on Bell’s Palsy and acupuncture research, including details of the research studies done (link below) and you can also find and read the original research from this resource.
Any research articles referred to on this page (and on the BAcC helpsheets) are listed in full in the References section at the foot of the relevant page. Within the text, where studies are quoted as sources of the information being given, the first author’s name and the year of the paper is used (as authors usually have numerous publications), with the full title, journal, etc listed in the References section, in alphabetical order by Author surname to enable identifying and finding the original source paper.
About the research:
When reading health research, it is important to know that Systematic Reviews** or Meta Analyses of a large number of high-quality research studies are the very best way to be able to say to what extent a given treatment can address a condition, symptom, or set of symptoms. The next best level of evidence is the individual Randomised Controlled Study* (RCT) which uses a systematic technique to compare two or more groups of patients receiving different treatments (or a treatment against a “control”, or no treatment). In acupuncture trials, the nature of the control group is of particular interest as it is hard to blind a patient to whether they are having a needle inserted or not, and even more challenging to blind the researcher/team to this.
The means and quality of how research is carried out varies considerably from country to country, and in terms of how an intervention is compared to another intervention (or a control). Of note is the fact that “sham” acupuncture (where needles are placed in apparently inert locations rather than traditional acupuncture points) is not really an inert process as it has physiological effects, so that comparing sham and “true acupuncture” may therefore not give a clear picture alone; but and form a part of a research body where acupuncture versus no treatment, vs conventional treatment or vs a different approach/modality also form part of the evidence base.
The n= figure (where quoted in research) tells you how many people were participants in the study, and usually the larger a study (when it is of good quality and design), the more likely it is to be reliable and applicable to larger populations. When (statistical) “significance” is discussed in view of studies it has a very particular meaning – it is the confidence in the data (using statistical tests) that tells us how likely a result could have just come about by chance. The lower the possibility of a chance result, the more likely it is due to the intervention in the experiment. “p” is the number telling us of significance, and this must be under 5% (or p less than 0.05) to mean we can say it is a (statistically) “significant” result.
Regarding Your Individual Condition and Symptoms:
Whilst the scientific studies are of great interest to researchers and acupuncturists in terms of comparing protocols, for the patient not versed in research they are less accessible, which is why when we asked “can acupuncture work for my (condition or symptom) we are not able to give a simple yes or no response, we are able to tell you in the decades of experience we personally have at the clinic of the types of outcomes we have seen in similar cases, and give you an idea of our level of experience and knowledge in that area, which is why the research data do not tell the whole story and if you want to find out more specific information in how this could relate to your own individual situation, we recommend booking a free telephone consultation where we can answer any questions you have and give a realistic appraisal of what acupuncture may be able to provide.
Resources: British Acupuncture Council evidence based factsheet about Bell’s palsy including specific research, trials and mechanisms of action for acupuncture in this condition.
Helen