Research Article2021-12-31

Effect of Dry Cupping Therapy on Pain and Functional Disability in Persistent Non-Specific Low Back Pain: A Randomized Controlled Clinical Trial

Marianna de Melo Salemi^1,*, Vanessa Maria da Silva Alves Gomes¹, Laylla Marjorye Rebouças Bezerra¹, Thania Maion de Souza Melo¹, Geisa Guimarães de Alencar¹, Iracema Hermes Pires de Mélo Montenegro², Alessandra Paula de Melo Calado³, Eduardo José Nepomuceno Montenegro¹, Gisela Rocha de Siqueira¹

J Acupunct Meridian Stud 2021; 14(6): 219-230 https://doi.org/10.51507/j.jams.2021.14.6.219

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Background: Cupping therapy is used to treat musculoskeletal conditions, including low back pain.Objectives: The study assessed the effects of dry cupping on pain and functional disability from persistent nonspecific low back pain. Methods: This was a randomized controlled trial, where participants were allocated to a cupping therapy (n = 19) or sham (n = 18) group, for five 10-minute sessions of cupping therapy, twice a week, to stimulate the acupoints related to low back pain (GV4, BL23, BL24, BL25, and BL30, BL40 and BL58) and emotional aspects (HT3 and ST36). All participants were assessed at baseline, post-treatment and follow up (a finalization period of four weeks) using a visual analogue scale (VAS) and the Oswestry Disability Index (ODI). Groups were compared using the analysis of covariance (ANCOVA) and the effect size was calculated using Cohen̓s d. Results: The cupping therapy group presented a lower mean VAS when compared to the sham, at post-treatment (mean difference: –2.36; standard error [SE]: 0.58; p < 0.001; “large” effect size: –0.94) and follow up (mean difference: –1.71; SE: 0.81; p < 0.042; ‘large’ effect size: –0.83). The cupping therapy group presented a lower mean ODI when compared to the sham post-treatment (mean difference: –4.68; SE: 1.85; p: 0.017; ‘large’ effect size: –0.87), although in follow-up, there was no difference between the groups (mean difference: 4.16; SE: 2.97; p: 0.17; “medium” effect size: –0.70). Conclusion: Dry cupping was more effective in improving pain and functional disability in people with persistent nonspecific low back pain when compared to the sham.

Perspective Article2022-08-31

Correlation Between the Sinew Channels with the Myofascial System, Pathology, and Treatment

Pablo Nava Jaimes*, Alejandro Martínez Reyes, Daniel García Lara, Abel Cristian Patiño Coyuca

J Acupunct Meridian Stud 2022; 15(4): 201-213 https://doi.org/10.51507/j.jams.2022.15.4.201

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The sinew channels are a tendon and muscle network, and their description is based on the observation presented on the Huangdi Neijing Ling Shu. However, the myofascial system is an uninterrupted series of connective tissue that is comprised of layers that run in different directions. The similarities on these pathways are compared, such as a brief description on the myofascial pain syndrome and its similitude with the Impediment disorder from the Traditional Chinese Medicine (TCM). Furthermore, we discuss the treatment of these conditions from a Traditional Chinese Medicine perspective.

Research Article2022-04-30

Trigger Point Acupuncture and Exercise for Chronic Low Back Pain in Older Adult: a Preliminary Randomized Clinical Trial

Yoichi Minakawa^1,2,*, Shogo Miyazaki^1,2, Hideaki Waki^1,2, Naruto Yoshida^1,2, Kaori Iimura³, Kazunori Itoh⁴

J Acupunct Meridian Stud 2022; 15(2): 143-151 https://doi.org/10.51507/j.jams.2022.15.2.143

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Background: Exercise therapy is the first choice non-pharmacotherapeutic approach for musculoskeletal pain; however, it often interferes with the implementation and continuation of exercise due to fear-avoidance behaviors. Trigger point acupuncture (TrPAcp) has been reported to reduce musculoskeletal pain.Objectives: To examine the efficacy of exercise combined with TrPAcp compared to exercise alone for older patients with chronic low back pain (CLBP), the most common subjective symptom reported by old people of both sexes in Japan.Methods: In this single-center randomized controlled trial conducted at Teikyo Heisei University, 15 men and women aged ≥ 65 years with low back pain for at least 3 months who met the eligibility criteria were included. The Ex+TrPAcp group received exercise and trigger point acupuncture, while the Ex group received only exercise for 3 months. The main outcome, pain intensity, was measured using the numerical rating scale (NRS). Improvement was defined as a decrease in NRS of ≥ 2 or less than moderate (NRS < 4).Results: The analysis included 7 of 8 cases in the Ex+TrPAcp group and 7 of 7 cases in the Ex group. NRS improved in 6 of 7 and 1 of 7 patients in the intervention and control groups, respectively, with a significant difference between groups (p = 0.03, φ = 0.71). Regarding adverse events due to acupuncture, one patient (14.3%) complained of heaviness after acupuncture. Nothing specific was reported with exercise.Conclusion: Compared with Ex alone, Ex+TrPAcp may be more effective therapy for older people with CLBP who do not have an exercise habit.

Case Report2021-10-31

Role of Acupuncture and Fire Cupping in Reducing the Thyroxine Dose and Improving the Thyroid Function in Hypothyroidism Patients: A Case Series

Pradeep M. K. Nair^1,*, Naga Jyothi²

J Acupunct Meridian Stud 2021; 14(5): 200-205 https://doi.org/10.51507/j.jams.2021.14.5.200

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Hypothyroidism is one of the most common endocrine disorders linked to various systemic diseases ranging from obesity to cancers. The present line of management is insufficient as reports suggest that there is persistence of symptoms and poor adherence that makes the management of said disease challenging. Acupuncture and other Traditional Chinese Medicine (TCM) therapies are proven to alleviate endocrine dysfunctions. However, reports on acupuncture and cupping therapy on hypothyroidism are very scarce. Here, we report 5 cases of hypothyroid patients aged between 38-44 yrs who were treated with acupuncture and fire cupping for a period of three months. At the baseline, the patients presented with either a weak, wiry or vacuum pulse which represents spleen Qi deficiency. Further, they presented with elevated levels of Thyroid Stimulating Hormone (TSH), and higher Body Mass Index (BMI). Acupuncture treatment at ST36, LI4, SP6, and BL20 was given bilaterally whilst CV4, LR3, LR4, SP9, ST40, SP10, GV4, KI3, ST12, and SI17 were punctured unilaterally. At the end of the time period of three months, patients progressed to normal levels of TSH, reduction in BMI and had succeeded in tapering their medication doses. Supplementing this, the patients reported marked improvement in other symptoms like fatigue, hair loss, and cold feet post-treatment. The effects were consistent even during the three month follow-up period post-interventions. The results encourage the utilization of acupuncture and fire cupping in the management of hypothyroidism. However, large scale studies are warranted to strengthen this recommendation.

Review Article2022-10-31

Acupuncture for Osteoporosis: a Review of Its Clinical and Preclinical Studies

Yimiao Tian^1,†, Lili Wang^2,†, Tianshu Xu¹, Rui Li¹, Ruyuan Zhu¹, Beibei Chen¹, Hao Zhang¹, Bingke Xia¹, Yiwen Che³, Dandan Zhao^1,*, Dongwei Zhang^1,*

J Acupunct Meridian Stud 2022; 15(5): 281-299 https://doi.org/10.51507/j.jams.2022.15.5.281

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Acupuncture has gained growing attention in the management of osteoporosis (OP). However, a comprehensive review has not yet been conducted on the efficacy and challenges of acupuncture in preliminary research and clinical trials. Therefore, an extensive literature search was conducted using electronic databases, including PubMed (www.ncbi.nlm.nih.gov/pubmed), CNKI (www.cnki.net), and Web of Science, for studies published from the beginning of 2000 to the end of May 2022. Combinations of synonyms for OP, acupuncture, traditional Chinese medicine, clinical trial, preclinical study, and animal experiments were searched. A total of 290 papers were consulted, including 115 reviews, 109 clinical observations, and 66 preclinical studies. There is accumulating evidence to support the beneficial role of acupuncture in preserving bone quality and relieving clinical symptoms based on clinical and preclinical investigations. The top ten most commonly used acupoints are BL23, ST36, BL20, BL11, CV4, GV4, SP 6, KI3, BL18, and GB39. The underlying mechanisms behind the benefits of acupuncture may be linked with the regulation of the hypothalamic-pituitary-gonadal (adrenal) axis and activation of the Wnt/β-catenin and OPG/RANKL/RANK signaling pathways. In summary, strong evidence may still come from prospective and well-designed clinical trials to shed light on the potential role of acupuncture in preserving bone loss. Future investigations are needed to explore the potential underlying mechanisms, long-term clinical efficacy, and compliance of acupuncture in OP management.

Review Article2022-06-30

Exploring Acupuncture Actions in the Body and Brain

In-Seon Lee, Younbyoung Chae^*

J Acupunct Meridian Stud 2022; 15(3): 157-162 https://doi.org/10.51507/j.jams.2022.15.3.157

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Acupuncture’s actions have been explained by biomedical research. However, the meridian system used in acupuncture needs further clarification. This review describes how acupuncture affects the body and brain. From the perspective of traditional East Asian medicine, the meridian system is closely connected with acupuncture’s treatment effects. In the body, the indications of acupoints, primarily established based on the meridian system, have spatial symptom patterns. Spatial patterns of acupoint indications are distant from the stimulated sites and strongly associated with the corresponding meridian’s route. Understanding how acupuncture works based on the original meridian system is important. From a neuroscience perspective, an acupuncture-induced sensation originates from the bottom-up action of simple needling in the peripheral receptor and the reciprocal interaction with top-down brain modulation. In the brain, enhanced bodily attention triggered by acupuncture stimulation can activate the salience network and deactivate the default mode network regardless of the actual stimulation. The application of data science technology to acupuncture research may provide new tools to uncover the principles of acupoint selection and enhance the clinical efficacy of acupuncture treatment in various diseases.

Research Article2021-10-31

Short-Term Intraocular Pressure Response to the Combined Effect of Transcutaneous Electrical Nerve Stimulation over Acupoint (Acu-TENS) and Yoga Ocular Exercise in Type 2 Diabetic Patients with Primary Open-Angle Glaucoma: A Randomized Controlled trial

Ali Mohamed Ali Ismail^1,*, Alshaymaa Shaaban Abd El-Azeim²

J Acupunct Meridian Stud 2021; 14(5): 193-199 https://doi.org/10.51507/j.jams.2021.14.5.193

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Background: Despite the adherence to medications, the control of the modifiable key risk factor—intraocular pressure (IOP)—for the progression of primary open-angle glaucoma (POAG) in diabetics is usually difficult; hence, many glaucoma patients try other alternative therapeutic options. Objectives: This randomized controlled study investigated the short-term IOP response to the combined effects of transcutaneous electrical nerve stimulation over acupoint (Acu-TENS) and yoga ocular exercise in type 2 diabetics with POAG. Methods: Eighty diabetics with bilateral POAG, ages ≥ 50 years, IOP > 21 mmHg in both eyes, and a body mass index below 30 kg/m² were included in this trial. The patients were randomly assigned to group A (n = 40; this group received 20 minutes of yoga ocular exercise followed by 20 minutes of active Acu-TENS over bilateral BL 61 and BL 62 acupoints) and group B (n = 40; this group received the same protocol as group A but with a placebo Acu-TENS). The repeated measurement of IOP were recorded before, immediately after, 30 minutes, and 60 minutes after the sessions. Results: The repeated measures analysis of variance revealed a greater significant decline of IOP in group A than group B in both eyes at the consecutive intervals of time measurements. Conclusion: According to this short-term observation, the addition of Acu-TENS to yoga ocular exercise could reduce the high IOP in diabetic patients with POAG, but further longterm trials are needed.

Research Article2021-12-31

Mechanisms of Electroacupuncture Pretreatment in Alleviating Myocardial Ischemia Reperfusion Injury: Interactions between the Cerebellar Fastigial Nucleus and Lateral Hypothalamic Area

Qing Yu^1,2, Li-bin Wu¹, Fan Zhang¹, Xiao-tong Wei¹, Pian-pian Chen¹, Shuai-ya Wang¹, Mei-yi Cai¹, Qi Shu¹, Liao-yuan Li¹, Zi-jian Wu^2,3, Rong-lin Cai^2,3,*, Ling Hu^2,3,*

J Acupunct Meridian Stud 2021; 14(6): 207-218 https://doi.org/10.51507/j.jams.2021.14.6.207

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Background: Myocardial ischemia reperfusion injury (MIRI) is an important mechanism of post-myocardial infarction injury and a main cause of death in patients with ischemic heart disease. Electroacupuncture (EA) pretreatment is effective for the prevention and treatment of MIRI, but mechanisms mediating the effects of cardiovascular disease EA treatments remain unclear.Objectives: To determine whether the lateral hypothalamus (LHA) and the cerebellar fastigial nucleus (FN) are involved in the protective effects of EA stimulation on MIRI. Methods: EA pretreatment was performed for 7 days before the establishment of the MIRI model. ST-segment changes on electrocardiograms were recorded and the Curtis–Walker arrhythmia score was used to evaluate changes in reperfusion injury. Hematoxylin–eosin staining was applied to evaluate the pathological and morphological changes in myocardial tissue. c-fos expression in the LHA and FN was determined by immunofluorescence staining. Glutamic (Glu) and γ-Aminobutyric acid (GABA) levels were measured using a high-performance liquid chromatography-electrochemical method. Results: EA pretreatment reduced ST-segment elevation, arrhythmia scores, and morphological changes in MIRI myocardial cells in rats, and decreased the c-fos protein expression in LHA/FN nuclei. MIRI was associated with an imbalance between GABA and Glu levels, whereas EA pretreatment increased GABA levels and decreased Glu levels in the LHA/FN. Conclusion: FN and LHA are involved in the EA-mediated attenuation of MIRI. Pretreatment with EA plays a protective role in the myocardium by regulating Glu and GABA release in the LHA and FN.

Research Article2022-08-31

Effects of Acupuncture in the Treatment of Dogs with Neurological Sequels of Distemper Virus

Bianca P. C. R. Santos¹, Jean G. F. Joaquim², Renata Navarro Cassu^3,*, José C. F. Pantoja¹, Stelio Pacca Loureiro Luna¹

J Acupunct Meridian Stud 2022; 15(4): 238-246 https://doi.org/10.51507/j.jams.2022.15.4.238

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Background: Acupuncture (AP) has been empirically used to relieve post-canine distemper virus (CDV) infection neurological signs in veterinary clinics.Objectives: This clinical study aimed to investigate the effects of AP combined with electroacupuncture (EA) on neurological function in dogs infected by CDV.Methods: Twenty-four CDV-infected dogs with neurological sequelae were recruited to receive weekly AP/EA sections for 24 weeks. Neurological improvements were assessed before each AP/EA session using a modified scoring system. Data were analyzed using the McNemar test, Friedman test, Fisher's exact test, and Kaplan-Meier curves (p < 0.05).Results: Neurological scores improved from seven to 24 weeks after AP/EA treatment compared with pretreatment scores (p < 0.001). Significant improvements were recorded over time for functional limb recovery, cranial nerve deficits, mental status (p = 0.025 – 0.014), and urinary function (p < 0.001). Myoclonus was improved and entirely reversed in 75% and 25% of the dogs, respectively. At the end of treatment, the proportion of dogs with normal proprioception, posture, hopping (p < 0.001), and superficial pain sensation responses (p = 0.004) was greater than pretreatment values.Conclusion: AP/EA therapy promoted significant neurological recovery in CDV-infected dogs and may be considered within the chronic phase of the disease to improve motor and sensory rehabilitation. However, these results are preliminary and must be confirmed by further investigations.

Review Article2022-02-28

The Cellular Architecture of the Primo Vascular System

Fatma El-Zahraa A. Mustafa^*

J Acupunct Meridian Stud 2022; 15(1): 4-11 https://doi.org/10.51507/j.jams.2022.15.1.4

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The primo vascular system (PVS) is of great interest to scientists in the last few years. The PVS plays a role in stem cell migration, immune function, erythropoiesis, tissue regeneration, and cancer metastasis. Discovered by Bong Han Kim in 1960, the PVS was described as a new, independent system that is distributed in the body of different animals. Since then, several cells have been discovered as important constituents of the PVS. Endothelial cells are hallmarks for the identification of the PVS, as they line the sinuses of the primo vessels and are characterized by their arrangement of rod-shaped nuclei in a parallel, broken-line fashion along the primo vessels. Immune cells as mast cells, eosinophils, neutrophils, and lymphocytes are also hallmarks for the identification of the PVS. One of the most interesting cells in the PVS are p-microcells. Primo nodes are a stem cell niche due to their p-microcells content, which express stem cell biomarkers CD133 and Oct 4. Mature erythrocytes and hematopoietic stem cells have also been observed in the PVS. Hematopoietic stem cells were observed in the PVS. Hematopoietic Stem Cells are the source of the cellular component of blood. Additionally, adrenaline and noradrenaline-producing cells, mesothelial cells, and smooth-muscle-like cells have also been described in the PVS.