Acupuncture For Cancer Patients

RESEARCH
THE CLINIC OF THE COLLEGE OF

CHINESE MEDICINE
ACUPUNCTURE FOR CANCER PATIENTS
Kirsten Dhar The Clinic of the College of Chinese Medicine,
26-28 Finchley Rd, St Johns !ood, "ondon, #!8 6$S
Kirsten Dhar - The College of Chinese Medicine, Research and De%elo&'ent
ACUPUNCTURE FOR CANCER PATIENTS
A COLLECTION OF ABSTRACTS, STUDIES AND ARTICLES ON THE USE OF
ACUPUNCTURE FOR SYMPTOM CONTROL IN THE TREATMENT OF CANCER PATIENTS
1. Neurologicl Mec!"i#$# o% Acu&u"c'ure
(. A)#'rc'# * Nu#e "+ O'!er S,$&'o$#
-. S'u+ie# * T.o Ar'icle# .i'! Pro'ocol
/. Pi" $"ge$e"' .i'! Acu&u"c'ure
1. Neurologicl Mec!"i#$# o% Acu&u"c'ure
(c)&)nct)re *as originally tho)ght of as +eing si'&ly a 'odality
*hich can alter the +odys &erce&tion of &ain, Research into the e-act
ne)rological 'echanis's +ehind this ha%e led to ne* theories and
)nderstanding of the e-tend to *hich ac)&)nct)re can reg)late the
+odys f)nction in dealing *ith disease, rather than .)st &ain, ( great
deal of ne)ro&hysiological research has +een cond)cted in this field
and e%idence-+ased scientific *or/ has +een &)+lished, &redo'inantly
in 0er'any and the 1S(, +y 2ieglgans+erger, Ta/eshige, 3o'eran4,
5an and 'any others, (ccording to these findings, ac)&)nct)re
a&&ears to +e effecti%e in infl)encing ne)ro-endocinological f)nctions
to re+alance the syste' and reinstate ho'eostasis,
The 'echanis's +ehind ac)&)nct)re in the treat'ent of diseases and
&ain control lie in &ro'&ting the +rain to initiate &hysiological
&rocesses ai'ed to re-esta+lish the +odys ho'eostasis, 6n this
conte-t, connections +et*een higher, inter'ediate and lo*er +rain are
'ost rele%ant, *ith the li'+ic syste', in &artic)lar the a'ygdala, and
the hy&othala')s &laying an i'&ortant role,
The a'ygdala is, in si'&le ter's, the 'ediator +et*een &refrontal
corte- 7the decision 'a/ing &art of the +rain8 and the dience&halon,
na'ely the hy&othala')s, 6t is also the 'a.or inter'ediary +et*een
sensory and 'otor hierarchy, Sensory in&)t signals deri%e fro' the
sensory corte- and are &assed +ac/, %ia the entorhinal corte-, to the
a'ygdala 7li'+ic8 *here in&)t infor'ation is co'+ined *ith &re%io)s
e-&erience 7&hysical and e'otional8 and trans'itted to the &refrontal
corte- for decision 'a/ing, Decisions are &assed +ac/ to the a'ygdala
and fro' there to the hy&othala')s for e-ec)tion, The hy&othala')s,
+eing the 'ost i'&ortant control center for the +odys ho'eostasis,
and th)s s)r%i%al, e-ec)tes all decisions %ia endocrine f)nctions,
a)tono'ic f)nctions and diff)se 'od)latory f)nctions of
ne)rotrans'itters and 'od)lators 7i,e, a'ines and 'onoa'ines
acetylcholine, do&a'ine, nore&ine&hrine and serotonin in the
+rainste'8, 6n this *ay, ac)&)nct)re infl)ences electro-che'ical
acti%ity on a &resyna&tic le%el, triggering syna&ses all the *ay fro'
sensory ner%es to the s&inal cord, +rain ste', 'id-+rain and finally to
the &refrontal corte- of the higher +rain,
Recent MR6 'a&&ing of 'eridians 7energy trans'itting channels8 and
%ario)s st)dies s)ggest that ac)&)nct)re &oints are &art of the
&eri&heral ner%o)s syste' and o%erla& ner%e rece&tor endings, 9n the
+asis of this ass)'&tion, it can no* +e )nderstood ho* ac)&)nct)re
signal in&)ts &ro.ect to the +rain, Sensory ne)rons translate sti')li
7'echanical, ther'al, &ress)re, %i+rations, etc,8 into ne)ral signals %ia
de&olari4ation,
The insertion of an ac)&)nct)re needle irritates or da'ages cells in the
area ca)sing the' to release che'icals 7+radi/inin, s)+stance 3,
&rostaglandins, etc,8, *hich then acti%ate the cells 'e'+rane
&otentials, The signaling &rocess occ)rs +y recei%ing s)fficient sti')li
to initiate sensiti4ation +y alteration of cell 'e'+rane &otential *hich
*ill res)lt in an action &otential trans'itted to the C#S, There are
se%eral syna&ses in%ol%ed, after the &eri&heral syna&se in%ol%ing
sensory ne)rons, +efore a signal reaches the C#S and the higher
+rain, The 'a.or &ath*ay of ac)&)nct)re-ind)ced signaling is the
s&inothala'ic tract, the s&inoretic)lar tract and the
s&ino'esence&halic tract,
(n i'&ortant disco%ery is the acti%ation of the corte- +y ac)&)nct)re
sti')lation, This led to the hy&othesis that the ac)&)nct)re sti')l)s
&ro.ected to the higher +rain contains s)r%i%al infor'ation &ic/ed )&
+y &assing thro)gh the li'+ic syste', This allo*s the higher +rain to
iss)e a&&ro&riate co''ands to +e &assed +ac/ to the li'+ic syste'
and on to the hy&othala')s for e-ec)tion %ia endocrine, a)tono'ic
and ne)ro-che'ical f)nctions, Th)s, &ain control is only a s'all &art of
ac)&)nct)re and research into ac)&)nct)re as disease treat'ent is a
gro*ing area,
#e%er the less, &ain control is an i'&ortant as&ect for the cancer
&atient, :y )nderstanding the +io'olec)lar 'echanis's +ehind &ain
and ac)&)nct)re, *e co)ld &otentially create thera&e)tic *ays to alter
&ain 'e'ory i'&rints in the +rain, &ain &erce&tion and the +odys
f)nctions of res&onding to &ain, F)rther'ore, ac)&)nct)re is a safe
and chea& tool for oncology n)rses and other thera&ists *or/ing in
cancer care, red)cing the need for &har'ace)tical inter%ention and
s)staining the &atient thro)gho)t treat'ents s)ch as che'o- and
radiothera&y and after o&erations,
(. A)#'rc'# * Nu#e "+ O'!er S,$&'o$#
Acu&u"c'ure "+ #el%0cu&u"c'ure %or lo"g0'er$ 're'$e"' o%
1#o$o'or #,$&'o$# i" c"cer &'ie"'# * u+i' "+ 're'$e"'
lgori'!$. Filshie J, :olton T, :ro*ne D, (shley S; Royal Marsden 5os&ital, "ondon and S)rrey, 1K;
(c)&)nct, Med, 2<<6 J)n;2=728>?2-6; 3M6D> @6=A<@2B C3)+Med - inde-ed for M$D"6#$D
6#TR9D1CT69#> Since hor'one re&lace'ent thera&y gi%en for long &eriods is no*
recognised to &rod)ce serio)s side effects, &atients *ith tro)+leso'e %aso'otor
sy'&to's are increasingly )sing non-hor'onal treat'ent incl)ding ac)&)nct)re,
Se%eral rando'ised controlled trials ha%e sho*n that ac)&)nct)re red)ces
'eno&a)sal sy'&to's in &atients e-&eriencing the nor'al cli'acteric, 6t 'ay ha%e
this effect +y raising serotonin le%els *hich alter the te'&erat)re set &oint in the
hy&othala')s, Easo'otor sy'&to's can +e e-tre'e in +reast cancer &atients and
&atients *ith &rostate cancer *ho are )ndergoing anticancer thera&y, The safety of
so'e her+al 'edicines and &hytoestrogens has +een F)estioned, as they co)ld
&otentially interfere ad%ersely *ith the +ioa%aila+ility of t)'o)ricidal dr)gs, (
&re%io)s st)dy re&orts short ter' +enefit fro' ac)&)nct)re and the ai' of this
re&ort is to descri+e o)r a&&roach to long ter' treat'ent, (C131#CT1R$
(33R9(C5> (fter &iloting se%eral a&&roaches, si- *ee/ly treat'ents *ere gi%en
initially at "6=, T$B, "RA and S36 and t*o )&&er sternal &oints, +)t a%oiding any li'+
*ith e-isting ly'&hoede'a or &rone to de%elo&ing it, 6f there *ere no
contraindications, &atients *ere gi%en clear instr)ctions on ho* to &erfor' self
ac)&)nct)re )sing either se'i-&er'anent needles or con%entional needling at S36,
*ee/ly for )& to si- years, for long ter' 'aintenance, (1D6T M$T59DS (#D
R$S1"TS> ( retros&ecti%e a)dit of electronic records *as carried o)t +y a doctor not
in%ol%ed in treat'ent, ( total of @?= &atients *ere treated, &redo'inantly *ith
+reast and &rostate cancer, 9ne h)ndred and eighty t*o &atients *ere fe'ale, The
n)'+er of &re-treat'ent hot fl)shes &er day *as esti'ated +y the &atient> in the
@B? cases &ro%iding adeF)ate records, the 'ean *as @6 fl)shes &er day, Follo*ing
treat'ent, @@= 7G?H8 gained a B<H or greater red)ction in hot fl)shes and A<
72@H8 a less than B<H red)ction, Treat'ent *as a+andoned in those *ho
res&onded &oorly or not at all, The d)ration of treat'ent %aried fro' one 'onth to
o%er si- years *ith a 'ean d)ration of nine 'onths, Se%enteen &atients 7?H8
e-&erienced 'inor side effects o%er the si- year &eriod, 'ostly 'inor rashes; one
&atient descri+ed leg s*elling +)t this *as li/ely to +e d)e to a conc)rrent fract)re,
C9#C"1S69#> (c)&)nct)re incl)ding self ac)&)nct)re is associated *ith long-ter'
relief of %aso'otor sy'&to's in cancer &atients, Treat'ent is safe and costs a&&ear
to +e lo*, (n algorith' is &resented to g)ide clinical )se, !e reco''end the )se of
self ac)&)nct)re *ith needles at S36 in &reference to se'i-&er'anent needles in the
first instance, +)t &oor res&onders )se ind*elling st)ds if they fail to res&ond
adeF)ately to self ac)&)nct)re *ith reg)lar needles, 3oint location 'ay +e of less
i'&ortance than the o%erall IdoseI, and an a&&ro&riate 'ini')' dose 'ay +e
reF)ired to initiate the effect,

Elec'ro0cu&u"c'ure %or co"'rol o% $,elo)l'i1e
c!e$o'!er&,0i"+uce+ e$e#i#2 A r"+o$i3e+ 'ril. Shen J, !enger #,
0las&y J, 5ays RD, (l+ert 3S, Choi C, She/elle 30; #ational 6nstit)tes of 5ealth, "a+oratory of Clinical
St)dies, :ethesda MD, 1S(; J(M( 2<<@ Fe+ 28; 28B788>@<@6;3M6D> @@@<B@82 C3)+Med - inde-ed for
M$D"6#$D
C9#T$JT> 5igh-dose che'othera&y &oses considera+le challenges to e'esis
'anage'ent, (ltho)gh &rior st)dies s)ggest that ac)&)nct)re 'ay red)ce na)sea
and e'esis, it is )nclear *hether s)ch +enefit co'es fro' the non-s&ecific effects of
attention and clinician-&atient interaction, 9:J$CT6E$> To co'&are the effecti%eness
of electro-ac)&)nct)re %s 'ini'al needling and 'oc/ electrical sti')lation or anti-
e'etic 'edications alone in controlling e'esis a'ong &atients )ndergoing a highly
e'etogenic che'othera&y regi'en, D$S60#> Three-ar', &arallel-gro)&, rando'i4ed
controlled trial cond)cted fro' March @??6 to Dece'+er @??G, *ith a B-day st)dy
&eriod and a ?-day follo*-)&, S$TT6#0> 9ncology centre at a )ni%ersity 'edical
centre, 3(T6$#TS> 9ne h)ndred fo)r *o'en 7'ean age, =6 years8 *ith high-ris/
+reast cancer, 6#T$RE$#T69#S> 3atients *ere rando'ly assigned to recei%e lo*-
freF)ency electro-ac)&)nct)re at classic anti-e'etic ac)&)nct)re &oints once daily
for B days 7n K AG8; 'ini'al needling at control &oints *ith 'oc/ electro-sti')lation
on the sa'e sched)le 7n K AA8; or no ad.)nct needling 7n K A=8, (ll &atients
recei%ed conc)rrent tri&le anti-e'etic &har'acothera&y and high-dose che'othera&y
7cyclo&hos&ha'ide, cis&latin, and car')stine8, M(6# 91TC9M$ M$(S1R$S> Total
n)'+er of e'esis e&isodes occ)rring d)ring the B-day st)dy &eriod and the
&ro&ortion of e'esis-free days, co'&ared a'ong the A gro)&s, R$S1"TS> The
n)'+er of e'esis e&isodes occ)rring d)ring the B days *as lo*er for &atients
recei%ing electro-ac)&)nct)re co'&ared *ith those recei%ing 'ini'al needling or
&har'acothera&y alone 7'edian n)'+er of e&isodes, B, @<, and @B, res&ecti%ely;
3L,<<@8, The electro-ac)&)nct)re gro)& had fe*er e&isodes of e'esis than the
'ini'al needling gro)& 73L,<<@8, *hereas the 'ini'al needling gro)& had fe*er
e&isodes of e'esis than the anti-e'etic &har'acothera&y alone gro)& 73 K,<@8, The
differences a'ong gro)&s *ere not significant d)ring the ?-day follo*-)& &eriod 73
K,@88, C9#C"1S69#S> 6n this st)dy of &atients *ith +reast cancer recei%ing high-
dose che'othera&y, ad.)nct electro-ac)&)nct)re *as 'ore effecti%e in controlling
e'esis than 'ini'al needling or anti-e'etic &har'acothera&y alone,
Acu&u"c'ure %or #i+e e%%ec'# o% c!e$o0r+i'io" '!er&, i"
c"cer &'ie"'#. ") !; "eonard 3 2a/i' Center for 6ntegrated Thera&ies, Dand Fa+er Cancer
6nstit)te, :oston, 1S(; Se'in, 9ncol, #)rs, 2<<B ()g; 2@7A8>@?<-B; 3M6D> @6<?28<G C3)+Med - inde-ed
for M$D"6#$D
9:J$CT6E$> To re%ie* strategies and reco''endations to i'&ro%e )tili4ation of
ac)&)nct)re treat'ent for side effects of che'o-radiation thera&y in cancer centres,
D(T( S91RC$S> Research st)dies and articles, go%ern'ent re&orts, and a)thor
e-&erience, C9#C"1S69#> Recent e%idence in clinical research indicates that
ac)&)nct)re is +eneficial for che'othera&y-ind)ced na)sea, %o'iting, and cancer
&ain, 9ther &reli'inary data also s)ggests ac)&)nct)re 'ight +e effecti%e for
che'othera&y-ind)ced le)/o&enia, &ost-che'othera&y fatig)e, radiation thera&y-
ind)ced -erosto'ia, inso'nia, and an-iety, 5o*e%er, the )tili4ation rate of
ac)&)nct)re re'ains lo* des&ite the *ide )se of other co'&le'entary and
alternati%e 'edical thera&ies a'ong cancer &atients, This lo* )sage of ac)&)nct)re
in cancer &atients indicates a health care F)ality iss)e, 6M3"6C(T69#S F9R #1RS6#0
3R(CT6C$> 9ncology n)rses need to increase their a*areness of the a%aila+le
e%idence in the )se of ac)&)nct)re in the s)&&orti%e care of cancer &atients,
Acu&u"c'ure &oi"' #'i$ul'io" %or c!e$o'!er&,0i"+uce+
"u#e or 1o$i'i"g. $44o JM, Richardson M(, Eic/ers (, (llen C, Di++le S", 6ssell :F, "ao ",
3earl M, Ra'ire4 0, Roscoe J, Shen J, Shi%nan JC, Streit+erger K, Treish 6, 2hang 0; Ja'es 3, S*yers
$nter&rises, :alti'ore, Maryland, 1S(; Cochrane Data, Syst, Re%, 2<<6 (&r @?; 728>CD<<228B; 3M6D>
@662BB6< C3)+Med - inde-ed for M$D"6#$D
:(CK0R91#D> There ha%e +een recent ad%ances in che'othera&y-ind)ced na)sea
and %o'iting )sing B-5T7A8 inhi+itors and de-a'ethasone, 5o*e%er, 'any still
e-&erience these sy'&to's, and e-&ert &anels enco)rage additional 'ethods to
red)ce these sy'&to's, 9:J$CT6E$S> The o+.ecti%e *as to assess the effecti%eness
of ac)&)nct)re-&oint sti')lation on ac)te and delayed che'othera&y-ind)ced
na)sea and %o'iting in cancer &atients, S$(RC5 STR(T$0M> !e searched M$D"6#$,
$M:(S$, 3syc"6T, M(#T6S, Science Citation 6nde-, CCTR 7Cochrane Controlled Trials
Registry8, Cochrane Co'&le'entary Medicine Field Trials Register, Cochrane 3ain,
3alliati%e Care and S)&&orti%e Care S&eciali4ed Register, Cochrane Cancer S&eciali4ed
Register, and conference a+stracts, S$"$CT69# CR6T$R6(> Rando'i4ed trials of
ac)&)nct)re-&oint sti')lation +y any 'ethod 7needles, electrical sti')lation,
'agnets, or ac)&ress)re8 and assessing che'othera&y-ind)ced na)sea or %o'iting,
or +oth, D(T( C9""$CT69# (#D (#("MS6S> Data *ere &ro%ided +y in%estigators of
the original trials and &ooled )sing a fi-ed effect 'odel, Relati%e ris/s *ere
calc)lated on dichoto'o)s data, Standardi4ed 'ean differences *ere calc)lated for
na)sea se%erity, !eighted 'ean differences *ere calc)lated for n)'+er of e'etic
e&isodes, M(6# R$S1"TS> $le%en trials 7# K @2=G8 *ere &ooled, 9%erall,
ac)&)nct)re-&oint sti')lation of all 'ethods co'+ined red)ced the incidence of
ac)te %o'iting 7RR K <,82; ?BH confidence inter%al <,6? to <,??; 3 K <,<=8, +)t not
ac)te or delayed na)sea se%erity co'&ared to control, :y 'odality, sti')lation *ith
needles red)ced &ro&ortion of ac)te %o'iting 7RR K <,G=; ?BH confidence inter%al
<,B8 to <,?=; 3 K <,<@8, +)t not ac)te na)sea se%erity, $lectro-ac)&)nct)re red)ced
the &ro&ortion of ac)te %o'iting 7RR K <,G6; ?BH confidence inter%al <,6< to <,?G;
3 K <,<28, +)t 'an)al ac)&)nct)re did not; delayed sy'&to's for ac)&)nct)re *ere
not re&orted, (c)&ress)re red)ced 'ean ac)te na)sea se%erity 7SMD K -<,@?; ?BH
confidence inter%al -<,AG to -<,<@; 3 K <,<=8 +)t not ac)te %o'iting or delayed
sy'&to's, #on-in%asi%e electro-sti')lation sho*ed no +enefit for any o)tco'e, (ll
trials )sed conco'itant &har'acologic anti-e'etics, and all, e-ce&t electro-
ac)&)nct)re trials, )sed state-of-the-art anti-e'etics, (1T59RSI C9#C"1S69#S>
This re%ie* co'&le'ents data on &ost-o&erati%e na)sea and %o'iting s)ggesting a
+iologic effect of ac)&)nct)re-&oint sti')lation, $lectro-ac)&)nct)re has
de'onstrated +enefit for che'othera&y-ind)ced ac)te %o'iting, +)t st)dies
co'+ining electro-ac)&)nct)re *ith state-of-the-art anti-e'etics, and in &atients
*ith refractory sy'&to's, are needed to deter'ine clinical rele%ance, Self-
ad'inistered ac)&ress)re a&&ears to ha%e a &rotecti%e effect for ac)te na)sea and
can readily +e ta)ght to &atients tho)gh st)dies did not in%ol%e &lace+o control, #on-
in%asi%e electro-sti')lation a&&ears )nli/ely to ha%e a clinically rele%ant i'&act
*hen &atients are gi%en state-of-the-art &har'acologic anti-e'etic thera&y ,
Cli"icl o)#er1'io" o" elec'ric #'i$ul'io" o% Yo"g4u" 56l 17
%or &re1e"'io" o% "u#e "+ 1o$i'i"g i"+uce+ ), Ci#&l'i". F) J,
Meng 2N, Chen 2, 3eng 5T, "i) "M; De&t, of TCM, Cancer 5os&ital, F)dan 1ni%ersity, China; 2hongg)o
2hen Ji) 2<<6 (&r 267=8>2B<-2; 3M6D> @66=26<8 C3)+Med - inde-ed for M$D"6#$D
9:J$CT6E$> To search for an effecti%e 'ethod for controlling na)sea and %o'iting
ind)ced +y che'othera&y, M$T59DS> $ighty-eight cases of he&atic cancer *ith
inter%entional thera&y of Cis&latin *ere rando'ly di%ided into a treat'ent gro)& and
a control gro)&, == cases in each gro)&, The treat'ent gro)& *ere treated *ith an
anti-e'etic and electro-ac)&)nct)re at MongF)an 7K6 @8, and the control gro)& only
*ith the anti-e'etic, The controlling rates for na)sea and %o'iting *ere co'&ared
+et*een the t*o gro)&s, R$S1"TS> The controlling rates for ac)te na)sea, %o'iting
and delayed %o'iting in the treat'ent gro)& *ere +etter than those in the control
gro)& 73 L <,<B8, C9#C"1S69#> $lectro-ac)&)nct)re at MongF)an 7K6 @8 can
&re%ent and greatly i'&ro%e the sy'&to's of na)sea and %o'iting in the &atient
*ith che'othera&y of Cis&latin,
Co$&le$e"'r, "+ l'er"'i1e $e+ici"e i" )re#' c"cer
&'ie"'#. #ahleh 2, Ta++ara 6(; 0eorge !ashington 1ni%ersity Medical Center,
!ashington, DC, 1S(; 3alliat, S)&&ort Care 2<<A Se&;@7A8>26G-GA; 3M6D>
@6B?==2G C3)+Med - inde-ed for M$D"6#$D
9:J$CT6E$> Co'&le'entary and (lternati%e Medicine 7C(M8 is +eco'ing
increasingly &o&)lar a'ong cancer &atients, in &artic)lar those *ith +reast cancer, 6t
re&resents one of the fastest gro*ing treat'ent 'odalities in the 1nited States,
Therefore, /no*ledge of C(M thera&ies is +eco'ing necessary for &hysicians and
other health care &ro%iders, C(M enco'&asses a *ide range of 'odalities incl)ding
s&ecial diet and n)trition, 'ind-+ody a&&roaches, and traditional Chinese 'edicine,
M$T59DS> !e re%ie*ed the +io'edical literat)re on C(M )se in +reast cancer
&atients, )sing Medline search fro' @?GB )ntil 2<<2, 6n addition, consens)s re&orts
and +oo/s on C(M and +reast cancer *ere incl)ded in the re%ie*, !e e%al)ated the
&re%alence of C(M )se in +reast cancer &atients, the reasons cited for its )se, the
different a%aila+le 'odalities, and the re&orted o)tco'es, R$S1"TS> 1se of C(M in
+reast cancer &atients ranges +et*een =8H and G<H in the 1nited States, The 'ost
co''only )sed C(M 'odalities incl)de dietary s)&&le'ents, 'ind-+ody a&&roaches,
and ac)&)nct)re, The reasons cited for )sing C(M *ere to +oost the i'')ne
syste', i'&ro%e the F)ality of life, &re%ent rec)rrence of cancer, &ro%ide control o%er
life, and treat +reast cancer and the side effects of treat'ent, Se%eral st)dies
re&orted fa%o)ra+le res)lts incl)ding i'&ro%ed s)r%i%al, +etter &ain control, red)ced
an-iety, i'&ro%e'ent in co&ing strategies and significant efficacy in treating na)sea
and %o'iting, 9ther less *ell-organi4ed trials ha%e re&orted either no +enefit or
negati%e effect of C(M and &otential to-icity of so'e co''ercial &rod)cts,
S60#6F6C(#C$ 9F R$S1"TS> C(M is a gro*ing field in health care and &artic)larly
a'ong +reast cancer &atients, Kno*ledge of C(M +y &hysicians, es&ecially
oncologists, is necessary, 9ncologists sho)ld +e *illing to disc)ss the role of C(M
*ith their &atients and enco)rage &atients to &artici&ate in *ell-organi4ed research
a+o)t C(M,
Elec'ro0cu&u"c'ure %or re%rc'or, cu'e e$e#i# cu#e+ ),
c!e$o'!er&,. Choo S3, Kong K5, "i' !T, 0ao F, Ch)a K, "eong SS; De&t, of 9ncology,
#ational Cancer Center, Singa&ore; J, (ltern, Co'&le', Med, 2<<6;@27@<8>?6A-?; 3M6D> @G2@2B68
C3)+Med - in &rocessD
31R39S$> To e%al)ate the efficacy of electro-ac)&)nct)re in &re%enting
anthracycline-+ased che'othera&y-related na)sea and e'esis refractory to
co'+ination B5T7A8-antagonist and de-a'ethasone, 3(T6$#TS (#D M$T59DS>
Cancer &atients *ith refractory e'esis after their first cycle of do-or)+icin-+ased
che'othera&y *ere accr)ed into this st)dy, $lectro-ac)&)nct)re *as gi%en d)ring
the second cycle of che'othera&y, $ach &atient *as e%al)ated for the n)'+er of
e'etic e&isodes and grade of na)sea *ithin the first 2= ho)rs after che'othera&y
and electro-ac)&)nct)re, R$S1"TS> Forty-se%en of a total of A@G &atients screened
*ere eligi+le for this st)dy, 9f these, 2G &atients agreed to &artici&ate, T*enty-si-
726; ?6,AH8 of the' had significant red)ction in +oth na)sea grade and e&isodes of
%o'iting after electro-ac)&)nct)re, There *as co'&lete res&onse *ith no e'etic
e&isodes in AGH, S)+.ecti%ely, 2B 7?2,6H8 of the total 2G &atients +elie%ed that
ac)&)nct)re *as an acce&ta+le &roced)re and *as hel&f)l in red)cing e'esis,
$lectro-ac)&)nct)re *as *ell-tolerated *ith a 'edian &ain score of A of @<,
C9#C"1S69#> $lectro-ac)&)nct)re is *ell-tolerated and effecti%e as an ad.)nct in
red)cing che'othera&y-related na)sea and e'esis,
Acu&u"c'ure i" &re1e"'io" o% &o#'o&er'i1e "u#e "+
1o$i'i"g. Schlager (; (+teil)ng f)r (nasthesie, 1ni%ersitats/lini/ f)r (nasthesie )nd (llge'eine
6ntensi%'edi4in, 6nns+r)c/, ()stria; !ien, Med, !ochenschr, @??8;@=87@?8>=B=-6; 3M6D> @<<2B<==
C3)+Med - inde-ed for M$D"6#$D
6n this re%ie* the effecti%eness of the ac)&)nct)re &oint 3ericard 6 73 68 on
&osto&erati%e na)sea and %o'iting 739#E8 is descri+ed, 1se of the ac)&)nct)re,
ac)&ress)re as *ell as the laser sti')lation of 3 6 &ro%ed as efficient &ro&hyla-is of
39#E in n)'ero)s st)dies, These 'ethods are free of side effects and re&resent
therefore a good alternati%e to the &har'acological &ro&hyla-is and treat'ent of
39#E,
E1i+e"ce %or #,$&'o$ $"ge$e"' i" '!e c!il+ .i'! c"cer.
"adas $J, 3ost-!hite J, 5a*/s R, Taro'ina K; Di%ision of 3ediatric 9ncology, 6ntegrati%e Thera&ies
3rogra' for Children *ith Cancer, Col)'+ia 1ni%ersity, #e* Mor/, 1S(; J, 3ediatr, 5e'atol, 9ncol, 2<<6
Se&;287?8>6<@-@B; 3M6D> @G<<626G C3)+Med - inde-ed for M$D"6#$D
The )se of co'&le'entaryOalternati%e 'edicine 7C(M8 has +een *ell doc)'ented
a'ong children *ith cancer, This re&ort s)''ari4es the research e%idence on the
role of C(M thera&ies for &re%ention and treat'ent of the 'ost co''only re&orted
cancer-related sy'&to's and late effects a'ong children *ith cancer, S'all clinical
trials doc)'ent e%idence of effecti%eness for select thera&ies, s)ch as ac)&)nct)re
or ginger for na)sea and %o'iting, TR(1M$$" S for ')cositis, and hy&nosis and
i'agery for &ain and an-iety, Se%eral relati%ely s'all clinical trials of %arying F)ality
ha%e +een cond)cted on these C(M thera&ies in children *ith cancer, So'e her+s
ha%e de'onstrated efficacy in ad)lts, +)t fe* st)dies of her+s ha%e +een cond)cted
in children, "arger rando'i4ed clinical trials are *arranted for each of these
&ro'ising thera&ies, 1ntil the e%idence is 'ore concl)si%e, the &ro%idersI role is to
assess and doc)'ent the childIs )se of C(M, critically e%al)ate the e%idence or lac/
of e%idence, +alance the &otential ris/s *ith &ossi+le +enefits, and assist the fa'ily
in their choices and decisions regarding )se of C(M for their child *ith cancer,
P#,c!ologicl .ell0)ei"g i$&ro1e# i" .o$e" .i'! )re#'
c"cer %'er 're'$e"' .i'! &&lie+ rel8'io" or elec'ro0
cu&u"c'ure %or 1#o$o'or #,$&'o$. #edstrand $, !yon M, 5a''ar M, !i.'a
K; Di%ision of 9+stetrics and 0ynecology, Fac)lty of 5ealth Sciences, "in/o&ing 1ni%ersity 5os&ital,
"in/o&ing, S*eden; J 3sychoso', 9+stet, 0ynaecol, 2<<6 Dec;2G7=8>@?A-? 3M6D> @G22B62< C3)+Med -
inde-ed for M$D"6#$D
The ai' of this st)dy *as to e%al)ate the effect of a&&lied rela-ation and electro-
ac)&)nct)re 7$(8 on &sychological *ell-+eing in +reast cancer-treated *o'en *ith
%aso'otor sy'&to's, Thirty-eight +reast cancer-treated &ost'eno&a)sal *o'en
*ith %aso'otor sy'&to's *ere incl)ded in the st)dy, They *ere rando'i4ed to
either treat'ent *ith electro-ac)&)nct)re 7$(8 7n K @?, three of the' *ith
ta'o-ifen8 or a&&lied rela-ation 7(R8 7n K @?, fi%e of the' *ith ta'o-ifen8 o%er a
@2-*ee/ st)dy &eriod *ith si- 'onths follo*-)&, Easo'otor sy'&to's *ere
registered daily, ( %is)al analog)e scale *as )sed to assess cli'acteric sy'&to',
esti'ation of general *ell-+eing *as 'ade )sing the Sy'&to' Chec/list, and 'ood
)sing the Mood Scale, These *ere a&&lied d)ring treat'ent and at follo*-)&, 6n total
A@ *o'en co'&leted @2 *ee/s of treat'ent and si- 'onths of follo*-)&, 5ot
fl)shes *ere red)ced +y 'ore than B<H, Cli'acteric sy'&to's significantly
decreased d)ring treat'ent and re'ained so si- 'onths after treat'ent in +oth
gro)&s, 3sychological *ell-+eing significantly i'&ro%ed d)ring thera&y and at follo*-
)& %isits in +oth gro)&s, Mood i'&ro%ed significantly in the electro-ac)&)nct)re
treated gro)&, 6n concl)sion &sychological *ell-+eing i'&ro%ed in *o'en *ith +reast
cancer rando'i4ed to treat'ent *ith either (R or $( for %aso'otor sy'&to's and
*e therefore s)ggest that f)rther st)dies sho)ld +e &erfor'ed in order to e%al)ate
and de%elo& these alternati%e thera&ies,
C!e$o'!er&, "+ Acu&u"c'ure i" C"cer P'ie"'# :renda 0olian), MD,
$li4a+eth Se+estyen, MD
9:J$CT6E$> To descri+e the )se of electro-ac)&)nct)re as a co'&le'entary 'odality
in co'+ination *ith che'othera&y in the treat'ent of three ty&es of cancer,
:ac/gro)nd> Cancer &atients 'ay +enefit fro' co'&le'entary or alternati%e 'edical
thera&ies, $lectrical-ac)&)nct)re 'ay +e a 'odality that &otentiates che'othera&y,
Design, Setting, and 3atients> Case series +et*een May 2<<2 and J)ly 2<<= at t*o
1S centers incl)ding &atients *ith ')coe&ider'oid carcino'a of the &arotid gland,
s'all cell l)ng cancer, and 'etastatic o%arian cancer,
6nter%ention> 3oints *ere chosen along 'eridians s)rro)nding the cancer and
'etastatic sites, 3ositi%e &olarity *as oriented &ro-i'ally and ce&halad to the t)'or
site, *hile negati%e &olarity *as oriented distally, along the e-tre'ities, on the sa'e
'eridian, Main 9)tco'e Meas)re> (lteration of t)'or gro*th,
Res)lts> 6n all three cases, the t)'ors had a res&onse to che'othera&y that
e-ceeded e-&ectations or &re%io)s res&onse &atterns,
C9#C"1S69#> $lectro-ac)&)nct)re 'ay +e a )sef)l ad.)nct to con%entional
che'othera&y, F)rther research is needed, +oth in the la+oratory and in rando'i4ed
controlled clinical trials, to 'eas)re efficacy and e-&lore 'echanis's of action,
E%%ec' o% cu&u"c'ure o" i"'erleu9i"0( le1el "+ N6 cell0
i$$u"o0c'i1i', o% &eri&!erl )loo+ o% $lig""' 'u$our
&'ie"'# !) :, 2ho) RJ, 2ho) MS First (ffiliated 5os&ital, 5)a-i Medical 1ni%ersity Chend);
2hongg)o 2hong Ji Mi Jie 5e 2a 2hi; @??= Se&; @=7?8>BAG-? 3M6D> G866<<2 C3)+Med - inde-ed for
M$D"6#$D
This &a&er deals *ith the o+ser%ation of ac)&)nct)re thera&y affecting interle)/in-
276"-2 le%el and nat)ral /iller 7#K8 cell i'')no-acti%ity in the &eri&heral +lood of
&atients *ith 'alignant t)'o)rs, 6n this clinical-la+oratory test research, rando'i4ed
do)+le +lind 'ethod *as )sed, The &atients *ere di%ided into an ac)&)nct)re
treated gro)& 7n K 2B8 and a control gro)& 7n K 2<8, The for'er gro)& *as treated
)sing &oints, STA6, "6@@, R#6 and locations of sy'&to'atic &oints +ilaterally, They
recei%ed one treat'ent of A< 'in)tes daily for @< days, The res)lts sho*ed that the
6"-2 le%el and #K cell acti%ity *ere lo*er than nor'al in &atients *ith 'alignant
t)'o)r, +)t there *as an increase in the ac)&)nct)re gro)& after @< days of
treat'ent, Significance *as fo)nd to +e re'ar/a+le 73 L <,<@8, The difference
+et*een the t*o gro)&s *as also significant 73 L <,<@8, This increase 'ight +e
related to the 'echanis' of ac)&)nct)re that ad.)sting the +odyIs i'')ne f)nction,
Th)s, ac)&)nct)re thera&y co)ld enhance the cell)lar i'')ne f)nction of &atients
*ith 'alignant t)'o)rs and &ro%iding a +eneficial effect in anti-cancer treat'ent,
E%%ec' o% cu&u"c'ure o" T0l,$&!oc,'e "+ i'# #u)#e'# %ro$ '!e
&eri&!erl )loo+ o% &'ie"'# .i'! $lig""' "eo&l#$. M)an J, 2ho)
R, 2hen Ci Man Ji); @??A; @87A8>@G=-G 3M6D> G?2AG@2 C3)+Med - inde-ed for M$D"6#$D
$ffect of ac)&)nct)re on the T-ly'&hocyte and its s)+sets fro' the &eri&heral +lood
of &atients *ith 'alignant neo&las' has +een researched in this st)dy, B@ &atients
*ere di%ided into t*o gro)&s> one in ac)&)nct)re treat'ent and the other *itho)t
any treat'ent, =8 healthy ad)lts *ere also st)died as nor'al control gro)&, The
res)lts sho*ed that the &ercentages of 9KTAP, 9KT=P, 9KT8P cells in the
&eri&heral +lood of the B@ &atients *ere lo*er than those of the nor'al ad)lts
res&ecti%ely, (fter the ac)&)nct)re treat'ent, the &ercentages of 9KTAP, 9KT=P,
9KT8P cells *ere o+%io)sly higher than those +efore ac)&)nct)re; the control gro)&
of &atients sho*ed no significant %ariation, This res)lt re%ealed that ac)&)nct)re
see'ed to ha%e 'ore effect on 9KT=P cells than on 9KT8P cells, Fro' o)r st)dy *e
+elie%e that ac)&)nct)re can +e )sed as one of the 'any treat'ents for &atients
*ith cancer,
Cli"icl e%%ec'i1e"e## o% elec'ro0cu&u"c'ure i" co$)i"'io"
.i'! i"1#i1e '!er&, %or $##i1e li1er c"cer. Jin M, "i) D, Meng J De&t,
of Thoracic S)rgery, China-Ja&an Friendshi& 5os&ital, :ei.ing; 2hongh)a !ai Ke 2e 2hi; 2<<@ 9ct;
A?7@<8>GB6-8; 3M6D> @62<@@8G C3)+Med - inde-ed for M$D"6#$D
9:J$CT6E$> To in%estigate the clinical effecti%eness of electro-ac)&)nct)re thera&y
7$(T8 in co'+ination *ith li%er artery int)+ation che'othera&y for 'assi%e li%er
cancer, M$T59DS> ( total of @<6 &atients *ere di%ided into A gro)&s, 6n gro)& (,
&atients )nder*ent $(T in co'+ination *ith in%asi%e thera&y, 6n gro)& :, &atients
recei%ed $(T alone, 6n gro)& C, &atients )nder*ent in%asi%e thera&y of li%er artery
int)+ation che'othera&y, 6n gro)&s ( and :, s)+costal o+liF)e incision *as
&erfor'ed to e-&ose li%er cancer, and electrodes *ere inserted into the t)'o)r
)nder direct %ision, 6n gro)& (, li%er artery int)+ation *as &erfor'ed d)ring
o&eration, (fter o&eration, che'othera&y *as gi%en fro' the t)+e, "i%er artery
int)+ation che'othera&y *as &erfor'ed only in gro)& C, R$S1"TS> The effecti%e
rate *as GA,GH 728OA88, BB,6H 72<OA68 and 28,@H 7?OA28 in gro)&s (, : and C,
res&ecti%ely, C9#C"1S69#S> The effect of electro-ac)&)nct)re thera&y in
co'+ination *ith li%er artery int)+ation che'othera&y achie%es the +est res)lts,
Therefore, ac)&)nct)re is an effecti%e thera&y for 'assi%e li%er cancer,
E%%ec' o% elec'ro0cu&u"c'ure i" 're'i"g &'ie"'# .i'! li"gul
!e$"gio$, "i J5, Jin M" 2hang !, "i) JT, N)an K5 Chinese Jo)rnal for 6ntegrated Medicine;
2<<6 J)n; @2728>@=6-?; 3M6D> @68<<??6 C3)+Med - inde-ed for M$D"6#$D
9:J$CT6E$> To e-&lore the clinical effect of electro-ac)&)nct)re 7$(8 in treating
&atients *ith ling)al he'angio'a 7"508, M$T59DS> $( thera&y *as a&&lied on A6
&atients +y directly inserting the &latin)' needles into "50 thro)gh a trocar *ith
&lastic ins)lating cann)la to &rotect the nor'al tiss)es and connecting the needles
*ith the electro-che'ical thera&e)tic a&&arat)s of 'odel 2(M-:, Then electricity *as
gi%en )ntil the t)'o)r +ody got contracted and rigid, The res)lt *as assessed 6
'onths after $( *as started, R$S1"TS> (ll &atients *ere treated effecti%ely, na'ely,
the effecti%e rate *as @<<H, *ith the thera&e)tic effect reaching grade 6 in 2?
&atients 78<,6H8, grade 66 in G 7@?,=H8, and all ha%ing the f)nction of tong)e
reco%ered to nor'al, C9#C"1S69#> $( sho*s s&ecial s)&eriorities in treating "50,
&ro%ed to +ring a+o)t less in.)ry and F)ic/ reco%ery and +eing si'&le in o&eration,
$s&ecially *hen a&&lied on h)ge "50, it co)ld not only re'o%e the t)'o)r, +)t also
&reser%e the f)nction of the tong)e, so it is a +rand-ne* a&&roach that is li/ely to +e
acce&ted +y &atients,
Elec'ro0cu&u"c'ure2 Tre'$e"' Me'!o+ %or Ar$ E+e$,
Follo.i"g Surger, %or Bre#' C"cer, C, Moldo%an, et al, 76nstit)te of
9ncology, :)charest, Ro'ania8, 6nternational Medical (c)&)nct)re Conference, "ondon, $ngland,
May =-8, @?86
1&&er li'+ ede'a 7+loating fro' retention of *ater8 occ)rs follo*ing s)rgery for
+reast cancer in a&&ro-i'ately 8-A<H of the cases, $-isting 'eans ha%e relati%ely
li'ited efficiency, This st)dy &resents a treat'ent 'ethod *ith electro-ac)&)nct)re
7ac)&)nct)re in *hich *ea/ electrical c)rrents are sent thro)gh the needles8 on a
gro)& of 2@ &atients *ith )&&er li'+ ede'a, Treat'ent res&onse *as +ased on
o+.ecti%e criteria incl)ding clinical and ther'oelectric 'eas)re'ents, Co'&lete
reco%ery fro' ede'as *as o+tained in AAH of the cases, *hile &artial reco%ery *as
seen in =AH of the cases, #o res&onse *as seen in 2=H,
-. S'u+ie# * T.o Ar'icle# .i'! Pro'ocol
7 ACUPUNCTURE TO REDUCE NAUSEA DURING CHEMOTHERAPY
TREATMENT OF RHEUMATIC DISEASES (, Josefson, M, Kre)ter, De&t, of
Rhe)'atology and 6nfla''ation Research, Sahlgrens/a 1ni%ersity 5os&ital, 0ote+org, S*eden,
3)+lished> Rhe)'atology 2<<A;=2>@@=?-@@B=, 2<<A :ritish Society for Rhe)'atology
(:STR(CT
Objective. To st)dy if ac)&)nct)re, co'+ined *ith ondansetron

treat'ent, red)ces
na)sea and %o'iting associated *ith cyclo&hos&ha'ide

inf)sion in &atients *ith
rhe)'atic diseases,
Methods. Thirty-nine &atients *ere treated *ith ac)&)nct)re

at &oint 3C 6 andOor in
the ear to decrease na)sea and %o'iting,

The &atients re&orted the se%erity of
na)sea and n)'+er of +o)ts

of %o'iting at the start of che'othera&y and after =, 8,
2=,

=8 and G2 h,

Results. Co'&ared *ith ondansetron treat'ent alone, the co'+ined

ac)&)nct)re
ondansetron treat'ent significantly decreased

+oth the se%erity of na)sea and the
n)'+er of +o)ts of %o'iting

2= and =8 h after the s)+.ects had recei%ed ac)&)nct)re
at the

first treat'ent session 7na)sea> P L <,<<<@; %o'iting> P

L <,<<AB8, #early
the sa'e res)lts *ere seen =8 and G2 h

after the s)+.ects had had their last
treat'ent of ac)&)nct)re

7na)sea P L <,<<8<8, Si'ilar res)lts *ere fo)nd after 2=

to
=8 h, *hen a co'&arison *as 'ade +et*een t*o sessions close

in ti'e 7na)sea> P L
<,<<<@ after 2= h, P L <,<<<A after

=8 h; %o'iting> P L <,<<<G8,

Conclusions. 9)r res)lts clearly indicate that co'+ined treat'ent

*ith ac)&)nct)re
and ondansetron red)ces the se%erity and the

d)ration of che'othera&y-ind)ced
na)sea as *ell as the n)'+er

of +o)ts of %o'iting as co'&ared *ith ondansetron
thera&y alone,

in &atients *ith rhe)'atic diseases,

6#TR9D1CT69#

(c)&)nct)re is a scientifically acce&ted 'ethod for treating

&ain, 6t has also +een
sho*n to red)ce na)sea effecti%ely

in seasic/ness and 'orning sic/ness d)ring
&regnancy, as *ell

as in &atients &re-'edicated *ith o&ioids +efore s)rgery,

#a)sea
of %arying intensity is a %ery co''on side-effect of

che'othera&y, D)ndee et al.
re&orted that ?6H of their &atients

felt sic/ after the first che'othera&y treat'ent,
that the feeling

of sic/ness is li/ely to acco'&any any s)+seF)ent dr)g
ad'inistration,

and that tolerance did not a&&ear to de%elo& to the side-effects

of
cancer che'othera&y agents, They fo)nd that ac)&)nct)re ad'inistered

at &oint 3C
6 7Q#eig)an8 significantly i'&ro%ed

na)sea in ?GH of the @A< cancer &atients
st)died, This effect

*as a+sent *hen a &lace+o &oint *as tested,

To deter'ine if the
+eneficial effect on na)sea attri+)ted to

ac)&)nct)re is d)e to non-s&ecific effects of
attention and

clinician&atient interaction, Shen et al. &erfor'ed

a three-ar'
rando'i4ed controlled trial in @<= &atients *ith

high-ris/ +reast cancer, St)dying the
effects of electroac)&)nct)re

d)ring B days of che'othera&y and a ?-day follo*-)&
&eriod,

they fo)nd that electroac)&)nct)re *as 'ore effecti%e in controlling

e'esis
than 'ini'al needling or anti-e'etic &har'acothera&y

alone, 5o*e%er, the o+ser%ed
effect had a li'ited d)ration and

the differences +et*een the gro)&s *ere not
significant at ?-day

follo*-)&,

( re%ie* +y Mayer sho*ed that ac)&)nct)re as a
treat'ent

in general is )sef)l and &resented e%idence that ac)&)nct)re

is effecti%e
for treat'ent of che'othera&y-ind)ced na)sea and

%o'iting in cancer &atients,
3atients *ith rhe)'atic diseases are no*adays also often treated

*ith
i'')nos)&&ressi%e dr)gs, This incl)des &atients *ith

e-tra-artic)lar rhe)'atoid
arthritis 7R(8, !egeners gran)lo'atosis

and other &ri'ary %asc)litides, syste'ic
l)&)s erythe'atos)s

7S"$8, scleroder'a and 'i-ed connecti%e tiss)e disease
7MCTD8,

6'')no'od)lating treat'ent is )sed &ri'arily to s)&&ress the

acti%ity of
the disease +y do*n-reg)lation of the &roliferation

of i'')noco'&etent cells and the
secretion of &ro-infla''atory

cyto/ines, s)ch as interle)/in @ and t)'o)r necrosis
factor- ,

The side-effects of cyclo&hos&ha'ide treat'ent, an al/ylating

agent
freF)ently )sed in cases of se%ere rhe)'atic disease,

are dose de&endent, Cells of
the +one 'arro* and the ')co)s

'e'+ranes of the intestines and the )rinary
+ladder are es&ecially

sensiti%e to the action of cyclo&hos&ha'ide, Delayed na)sea
and %o'iting in connection *ith cyclo&hos&ha'ide treat'ent are

co''only
o+ser%ed in clinical &ractice, So'e &atients s)ffer

fro' na)sea .)st once, *hile the
'a.ority 'ay ha%e se%ere sy'&to's

for se%eral days after each treat'ent, To relie%e
this side-effect,

&atients are gi%en anti-e'etic dr)gs s)ch as ondansetron, 6n

s&ite of
this anti-e'etic treat'ent, 'any &atients still s)ffer

fro' se%ere na)sea and
%o'iting,

To o)r /no*ledge, no st)dies ha%e in%estigated the effects of

ac)&)nct)re
on na)sea and %o'iting in &atients *ith rhe)'atic

diseases recei%ing che'othera&y
on re&eated occasions o%er a

long &eriod of ti'e, Res)lts fro' the cancer st)dies
'entioned

a+o%e are not necessarily directly a&&lica+le to &atients *ith

rhe)'atic
diseases, F)rther'ore, in those st)dies &atients *ere

treated on only one occasion or
d)ring one &eriod,

9riginally *e intended to rando'i4e the &atients into t*o
treat'ent

gro)&s, one recei%ing ac)&)nct)re and no ondansetron and the

other +oth
ac)&)nct)re and ondansetron, 5o*e%er, rando'i4ation

did not s)cceed since al'ost
all &atients clearly e-&ressed

a *ish to ha%e a co'+ined ac)&)nct)re and
ondansetron treat'ent,

The ai' of this st)dy *as th)s to in%estigate the effect of
ac)&)nct)re in co'+ination *ith ondansetron on na)sea and %o'iting

in &atients
*ith se%ere rhe)'atic diseases treated *ith che'othera&y,

3(T6$#TS (#D M$T59DS
3atients
(n increasing n)'+er of &atients *ith rhe)'atic diseases are

treated *ith
intra%eno)s che'othera&y thro)gho)t the *orld,

The i'')no-'od)lating
'edication, 'ainly cyclo&hos&ha'ide, is

)sed in lo*er doses than is e'&loyed for
cancer treat'ent, The

dose le%el is )s)ally +et*een GB< and @B<< 'g, de&ending on
the &atients *eight and need of i'')no-s)&&ression, The

treat'ent, so-called
inter'ittent &)lse treat'ent, is 'ostly

ad'inistered as one inf)sion once a 'onth
for = 'onths )& to

2 yr, de&ending on the acti%ity of the diseaseOe-acer+ation

and on
the ra&idity of the clinical res&onse to the treat'ent,

Consec)ti%e in-&atients at the
de&art'ent of rhe)'atology *ith

the diagnosis of S"$, R(, MCTD, &ri'ary %asc)litis
or other

rhe)'atic syste'ic diseases *ith &)l'onary or ne&hritic 'anifestations
*ere in%ited to &artici&ate in the st)dy and offered ac)&)nct)re

as an additional
treat'ent against na)sea,

The incl)sion criterion *as a &rior session *ith
cyclo&hos&ha'ide

follo*ed +y e-&erience of na)sea des&ite si')ltaneo)s treat'ent
*ith ondansetron, $-cl)sion criteria *ere se%ere &sychiatric

illness, sensiti%ity to
needlestic/s o*ing to hy&eraesthesia

or &rolonged +leeding ti'e, or ly'&hatic
oede'a in the ar's,

The &atients *ho agreed to &artici&ate in the st)dy *ere
contacted

+y one of the a)thors and as/ed to fill in a st)dy &rotocol

at e%ery session
of che'othera&y, (ll &atients *ere infor'ed

a+o)t the e-&eriences of ac)&)nct)re as
a treat'ent in general

and its &ossi+le +eneficial effect on na)sea,

Se%enty-si-
&atients entered the st)dy and A? co'&leted it,

Fifteen &atients *ho had
ac)&)nct)re treat'ent only once or

t*ice *ere e-cl)ded fro' the st)dy +eca)se
cyclo&hos&ha'ide

treat'ent *as ter'inated o*ing to lac/ of effect on the
)nderlying

illness, 6n addition, @6 of the &atients *ho had tried ac)&)nct)re
treat'ent once or t*ice did not consider their na)sea to +e

tro)+leso'e eno)gh to
contin)e the ac)&)nct)re and *ere therefore

e-cl)ded fro' the st)dy, Si- &atients
dro&&ed o)t *itho)t &ro%iding

any reason,

9f the A? &atients *ho co'&leted the
st)dy, A2 *ere *o'en and

se%en 'en, The 'edian age *as =G yr 7range 2@G28,
Thirteen

&atients had S"$, @@ had &ri'ary %asc)litis, fo)r MCTD, si-

scleroder'a and
fi%e &ersons R( *ith either a'yloidosis or secondary

necroti4ing %asc)litis,

Methods
( &re-e-&eri'ental &retest&ost-test design *as )sed,

S)ch a design ena+les
F)estions to +e ans*ered o%er ti'e +y

&erfor'ing a &retest +efore the inde&endent
%aria+le is introd)ced,

6f the &ro+ands are tested +oth +efore and after the
&roced)re,

it is &ossi+le to assess a difference in the res)lts of the

de&endent
%aria+le,

( &ilot st)dy co'&rising @< &atients *as first cond)cted to

test the 'ethod
and the &rotocol, This res)lted in so'e changes

in the &rotocol to 'a/e it easier for
the &atients to fill in,

The &atients filled in the n)'+er of +o)ts of %o'iting and rated
the degree of na)sea on a fo)r-ste& scale 7< K no na)sea, @

K slight na)sea, 2 K
'oderate na)sea and A K se%ere na)sea8

at the start of the inf)sion and after =, 8,
2=, =8 and G2 h,

The three o+ser%ation ti'es of the first 2= h *ere chosen after
other st)dies, +)t as cyclo&hos&ha'ide is /no*n to gi%e a delayed

sic/ness,
o+ser%ations of =8 and G2 h after the inf)sion *ere

added,

The follo*ing infor'ation
*as entered into the st)dy &rotocol

fro' the &atients records> date of treat'ent,
dose of

cyclo&hos&ha'ide, diagnosis and consec)ti%e treat'ent n)'+er,

The
ac)&)nct)re &oints, and ti'e and d)ration of ac)&)nct)re

*ere also noted,

The
ac)&)nct)re &oints chosen *ere the 3C 6 7Q#eig)an8

andOor t*o ac)&)nct)re &oints
in the ear 7Q")ng

and Q"i%er8, These &oints are considered to +e

eF)al in their effect
on na)sea, The needles *ere inserted into

the &atients )nilaterally or +ilaterally at
least @BA<

'in +efore the cyclo&hos&ha'ide inf)sion *as started, The nor'al

ti'e
for ac)&)nct)re *as A<=B 'in, Sti')lation *as 'ade

so QDe Ni 7the needle
sensation in 'ost cases descri+ed

as a co'&le- feeling of n)'+ness, &ress)re,
tenderness and *ar'thOcold8

*as achie%ed *hen inserting and re'o%ing the
needles, +)t not

in-+et*een,

(n e-&eri'ental design of the st)dy is o)tlined in, The
&atients *ere incl)ded in all fo)r gro)&s, de&ending on the

ac)&)nct)re treat'ent
7&hase @68,

Phase 1, The &atients )nder*ent @A sessions of che'othera&y

*itho)t ac)&)nct)re
treat'ent, and se%erity of na)sea and +o)ts

of %o'iting *ere 'eas)red,

Phase 2, First session of che'othera&y *ith ac)&)nct)re and

the sa'e registrations
of side-effects *ere 'eas)red, This co)ld

in so'e cases 'ean that the ti'e inter%al
+et*een the first

ti'e of che'othera&y *itho)t ac)&)nct)re and the first ti'e

*ith
ac)&)nct)re co)ld %ary fro' =6 *ee/s )& to A 'onths,

Phase 3, The se%erity of na)sea and +o)ts of %o'iting *ere follo*ed

d)ring a series
of che'othera&y treat'ents co'+ined *ith ac)&)nct)re

treat'ent, +)t *ere not
incl)ded in the analysis, The n)'+er

of treat'ents %aried +et*een @ and B and *as
deter'ined +y &ractical

clinical reasons,

Phase 4, 9ne to t*o che'othera&y treat'ents *itho)t ac)&)nct)re

*ere then
&ro%ided again, as the intention *as to 'a/e e-tra

co'&arisons *ith &hases @, 2 and
A,

Phase 5, F)rther sessions of che'othera&y co'+ined *ith ac)&)nct)re

treat'ent
then follo*ed, The n)'+er of treat'ents %aried +et*een

A and 2= and de&ended on
ho* 'any sessions of che'othera&y the

&atients *ere )ndergoing 7+ased on the
res&onse of the disease

to the treat'ent8,

Phase 6, The last session of che'othera&y treat'ent *ith ac)&)nct)re

*as
registered,

Analysis 1, ( co'&arison of the data of these o+ser%ations 7&hase

@ and &hase 28
*as 'ade, 6f 'ore than one session *as notified

in &hase @, the analysis of the first
one *as )sed,

Analysis 2, ( co'&arison +et*een data fro' &hase A and &hase

= *as 'ade, 6n
&hase A the last session of ac)&)nct)re *as chosen

and the first of no ac)&)nct)re in
&hase =,

Analysis 3, Data fro' &hase @ *ere co'&ared *ith data fro' &hase

6,

Analysis 4, Data fro' &hase 2 *ere co'&ared *ith data fro' &hase

6,

$%ery session of che'othera&y *as ad'inistered once e%ery =6

*ee/s, St)dy
&rotocols *ere distri+)ted each ti'e the &atients

recei%ed che'othera&y treat'ent,
The &rotocols *ere +ro)ght

+ac/ at the ti'e of the ne-t che'othera&y session or
sent +y

&ost @< days after che'othera&y, in connection *ith +lood tests,

Statistical 'ethods
!ilco-ons signed ran/ s)' test for &aired o+ser%ations

*as )sed for testing
differences +et*een different treat'ents

of the &atient gro)&,

Discrete data 7degree
of na)sea8 *ere &resented as freF)encies

and the distri+)tion of %aria+les of
contin)o)s data 7n)'+er

of +o)ts of %o'iting8 *as &resented as 'eans, 'edians
and range,

$thical considerations
6t *as not necessary to o+tain ethical a&&ro%al fro' the Research

$thicIs Co''ittee,
as this st)dy *as an e%al)ation of a co''on

clinical treat'ent, The &atients *ere
infor'ed a+o)t the st)dy

and ga%e their consent %er+ally,

RESULT (c)&)nct)re significantly red)ced the se%erity, es&ecially the

d)ration, of
na)sea, as *ell as the n)'+er of +o)ts of %o'iting

follo*ing cyclo&hos&ha'ide after
2= to =8 h, The n)'+er of +o)ts

of %o'iting *as significantly red)ced at the first
session of

ac)&)nct)re, The sa'e res)lts co)ld also +e seen *hen

the interi'
+et*een treat'ents 7ondansetron alone vs ac)&)nct)reondansetron

co'+ined8 *as
short 7*ithin =6 *ee/s8 and *hen the &atients

health stat)s *as considered 'ore
sta+le,

$ighteen &atients had less than B ac)&)nct)re treat'ents, fo)rteen

&atients had 6
@<, t*o &atients had @2, t*o had @6 and

three *ere treated 2@2= ti'es, The
'edian n)'+er of ac)&)nct)re

sessions *as G 7range 22=8, The total n)'+er of
ac)&)nct)re

treat'ents *as 2?= for the A? &atients,

The effects of ac)&)nct)re on
the se%erity of na)sea and n)'+er

of +o)ts of %o'iting in &atients treated *ith
che'othera&y &rior

to ac)&)nct)re and at the first session of ac)&)nct)re are
&resented

in 7descri+ed in the Methods section as analysis @ co'&aring

data fro'
&hase @ and &hase 28, (t the start of che'othera&y

and after = and 8 h there *ere
no significant differences +et*een

treat'ent 'odalities, as 'ost &atients did not feel
na)sea at

all after that short o+ser%ation ti'e, 5o*e%er, significant

decreases in the
se%erity of na)sea *ith ac)&)nct)re *ere fo)nd

after 2= and =8 h 7P L <,<<<@8 and
after G2 h 7P L <,<@<68,

The 'ean n)'+er of +o)ts of %o'iting *as A,A *itho)t
ac)&)nct)re

co'&ared *ith <,6 *hen the &atients *ere treated *ith ac)&)nct)re

7P
L <,<<AB,

(fter recei%ing che'othera&y and ac)&)nct)re a n)'+er of ti'es,

@A sessions of
che'othera&y *itho)t ac)&)nct)re *ere

'eas)red again, and co'&ares the
treat'ent 'odalities

on t*o occasions close in ti'e 7in the Methods section
descri+ed

as analysis 2 co'&aring data fro' &hase A and &hase =8, There

*as a
significant difference in the se%erity of na)sea in the

&atients treated *ith
ac)&)nct)re after 2= h 7P L <,<<<@8,

after =8 h 7P L <,<<<A8 and after G2 h 7P L
<,<2B=8, The

n)'+er of +o)ts of %o'iting *as significantly red)ced *hen the
&atients *ere treated *ith ac)&)nct)re 7P L <,<<<G8,

9ther co'&arisonsRnot sho*n
in the ta+lesR*ere also

'ade, First, +et*een che'othera&y *itho)t ac)&)nct)re
treat'ent

and the last session of ac)&)nct)re 7descri+ed in the Methods

section as
analysis A, co'&aring data fro' &hase @ and &hase

68, #o significant differences
*ere fo)nd in the initial &eriod

after ac)&)nct)re tho)gh differences in the se%erity of
na)sea

*ere fo)nd after =8 h 7P L <,<@B@8 and G2 h 7P L <,<<8<8,

There *ere no
significant differences in the n)'+er of +o)ts

of %o'iting,

Finally, co'&arisons *ere 'ade to e%al)ate if there *as a c)')lati%e

effect of
ac)&)nct)re on the degree of na)sea and n)'+er of

+o)ts of %o'iting +et*een the
first and last sessions of ac)&)nct)re

7descri+ed in the Methods section as analysis =,
co'&aring data

fro' &hase 2 and &hase 68, $%idence of s)ch an effect *as o+ser%ed,
Significant differences *ere fo)nd in the se%erity of na)sea

after =8 h 7P L <,<<B?8
and in the n)'+er of +o)ts of %o'iting

7P L <,<<<B8, +)t not in the rest of the
o+ser%ations,

(s a *hole, the &atients /e&t their &attern of reaction to ac)&)nct)re
and *e ass)'e that each ac)&)nct)re treat'ent had a si'ilar

effect on na)sea,

D6SC1SS69#

Co'&ared *ith an efficient &har'acological anti-e'etic treat'ent

7ondansetron8, it
see's that ac)&)nct)re co'+ined *ith ondansetron

significantly decreased +oth the
se%erity and d)ration of na)sea,

as *ell as the n)'+er of +o)ts of %o'iting follo*ing
intra%eno)s

cyclo&hos&ha'ide thera&y,

The details of the )nderlying 'echanis's of
ac)&)nct)re on na)sea

and %o'iting are largely )n/no*n, (c)&)nct)re 'ay affect
the

sy'&athetic syste' %ia 'echanis's at the hy&othala'ic and +rainste'

le%els,
6ndeed, the hy&othala'ic +eta-endor&hinergic syste'

e-erts inhi+itory effects on the
%aso'otor centre, There is

e%idence that hy&othala'ic n)clei ha%e a central role in
the

'ediating effects of ac)&)nct)re and that afferent in&)t of

so'atic ner%e fi+res
has a significant effect on a)tono'ic f)nctions,

!hy there is a &otentiating anti-
e'etic effect of the co'+ination

of ac)&)nct)re and anti-e'etic 'edication cannot
+e ans*ered

at &resent, 6t is a&&arent that the )s)al anti-e'etic 'edication

is not
effecti%e eno)gh for 'any &atients, So'e of o)r &atients

7not incl)ded in this st)dy8
ha%e tried ac)&)nct)re *itho)t

ondansetron on so'e occasions, +)t fo)nd
ac)&)nct)re alone to

+e )nsatisfactory and therefore res)'ed the co'+ined
treat'ent

*ith ondansetron and ac)&)nct)re,

There are so'e li'itations in o)r st)dy that deser%e co''ents,

Se%eral &re%io)s
ac)&)nct)re st)dies ha%e +een critici4ed for

lac/ing adeF)ate control gro)&s,
(ltho)gh o)r st)dy )sed the

&atients as their o*n controls, *e had no &lace+o gro)&,
9ne

reason for this is that &lace+o needles *ere not a%aila+le *hen

this st)dy *as
initiated, 9n the other hand, it 'ay +e hard

to Qdecei%e &atients )sing the c)rrently
a%aila+le

sha' ac)&)nct)re 'ethods,

Differences in the n)'+er of ac)&)nct)re
treat'ents that &atients

)nder*ent in this st)dy de&end to a certain e-tent on *hen
the

&atients entered into the st)dy, So'e of the &atients incl)ded

here are still
)ndergoing che'othera&y and data are still +eing

collected fro' the',

The incl)sion criterion *as a &rior treat'ent *ith cyclo&hos&ha'ide

follo*ed +y
e-&erience of na)sea des&ite si')ltaneo)s treat'ent

*ith ondansetron, (s a good
'any &atients on the *ard did not

e-&erience na)sea at all or did not consider it to
+e tro)+leso'e,

they *ere th)s not incl)ded in the st)dy, The A? &ersons *ho

*ere
+oth incl)ded and co'&leted the st)dy are in o)r o&inion

a gro)& of &atients *ith a
generally 'ore se%ere na)sea &ro+le',

(nother li'itation of the st)dy concerns the
res&onse scale

)sed to assess the se%erity of na)sea, ( ceiling effect 'ay

ha%e
res)lted fro' setting the )&&er end&oint to A, since .)dging

fro' co''ents in the
&rotocols the &atients *o)ld ha%e 'ar/ed

a higher score if s)ch had +een a%aila+le,
This 'ay e-&lain

*hy so'e &atients 'ar/ed QA for na)sea +)t still

tho)ght they *ere
+etter off *ith ac)&)nct)re than *itho)t it,

F)rther'ore, the follo*-)& &eriod
&erha&s sho)ld ha%e +een e-tended

to B or G days,

!e concl)de that ac)&)nct)re co'+ined *ith ondansetron red)ces

na)sea and
%o'iting co'&ared *ith ondansetron alone and 'ay

th)s +e a treat'ent of +enefit
to &atients *ith rhe)'atic diseases

on che'othera&y, :ased on the res)lts fro' o)r
st)dy, *e reco''end

ac)&)nct)re as a treat'ent to s)&&le'ent anti-e'etic dr)gs,
(s the 'ethod is reasona+ly easy to &erfor' and carries 'ini'al

ris/, its clinical )se
co)ld +e e-tended in order to 'a/e che'othera&y

'ore end)ra+le for &atients,
5o*e%er, s)ccessf)l i'&le'entation

of this treat'ent reF)ires *ell-organi4ed
coo&eration and &lanning

a'ong the staff,
6n o)r *ard *e ha%e de%elo&ed a caref)lly &lanned

sched)le to acco''odate this
treat'ent, The treat'ent days are

concentrated to 2 days a *ee/, :lood tests are
ta/en the day

+efore the cyclo&hos&ha'ide inf)sion, *hich 'a/es it &ossi+le

to start
all inf)sions at the sa'e ti'e on each occasion, This

ena+les )s to ad'inister
ac)&)nct)re ro)tinely des&ite the hectic

*or/ing sit)ation on o)r *ard,

S)&&orted +y
grants fro' the F,R,F,-Fo)ndation, S*eden, the

S*edish Rhe)'atis' (ssociation, "egiti'erade
S.)/gy'nasters

Ri/sfSr+)nds Minnesfond and the R)ne and 1lla ('lS%

Fo)ndation,

)7 ACUPUNCTURE FOR CANCER PATIENTS * RESEARCH AND
CASE STUDIES
6#TR9D1CT69#
Co'&le'entary thera&ies can +e )sef)l ad.)ncti%e 'odalities in the treat'ent of
'any cancers, :et*een GH and A6H of cancer &atients )se co'&le'entary
thera&ies *hile +eing treated for cancer, *hen these ser%ices are co%ered +y their
ins)rance,
@,2
There is a need for f)rther research into the efficacy of co'&le'entary
thera&ies,
A
Se%eral st)dies ha%e re&orted that ac)&)nct)re can +e effecti%e in the
treat'ent of che'othera&y-related na)sea and %o'iting, &ost-che'othera&y
fatig)e, and cancer-related &ain,
=-6
So'e recent h)'an and ani'al st)dies ha%e
re&orted that ad.)ncti%e electrical ac)&)nct)re 'ay +e effecti%e in enhancing
che'othera&y,
G-?
!e &resent A cases in *hich electro-ac)&)nct)re *as added to the
con%entional che'othera&y treat'ent &lanned for the &atient and 'ay ha%e &layed a
synergistic role,
M$T59DS
#eedling techniF)e *as deter'ined +y follo*ing a &rotocol &racticed +y Dr, Jin 2h)i
and Dr, Nian Jin at the 0)ang 2ho) Medical School in the 3eo&leIs Re&)+lic of China
for the treat'ent of &atients *ith 'etastatic cancer, The &rotocol is +ased )&on the
hy&othesis that a &ositi%e charge s)rro)nding the t)'or desta+ili4es the t)'or cell
'e'+ranes, rendering the' 'ore s)sce&ti+le to che'othera&y,
First, the 'eridians that &ass thro)gh or aro)nd the t)'or are located, 3oints along
these 'eridians are selected that are @-2 c' &ro-i'al to the /no*n t)'or sites on
those 'eridians, They are needled )sing the Flying #eedle insertion techniF)e 7F)ic/
insertion )sing *rist action8, *ith a dis&ersion 'ethod 7slight co)ntercloc/*ise
rotation8, These &oints recei%e a &ositi%ely charged electrical sti')l)s, Distal &oints
are selected +y locating 'a.or &oints on each 'eridian, &refera+ly on the ar's or
legs, and are )sed to gro)nd the circ)it, The &ositi%e cli& of the sti')lator is
connected to the &ro-i'al needle and the negati%e cli& to the distal needle of the
sa'e 'eridian, ( Chinese M)lti&)r&ose $lectrical Sti')lator *as )sed 7!).in 0reat
!all Medical De%ice Co8, The follo*ing s&ecifications *ere )sed> contin)o)s &)lse
d)ration Tao K <,B 7T<,@B8 's; re&eated &)lse freF)ency selecti%ity gK@-@<< 54;
o)t&)t &ea/ %oltage E&@UK =<ET@<E at a B<<-oh' load, The sti')lator &rod)ced a
lo*-intensity and lo*-freF)ency 7<,B-2 548 &)lsed c)rrent for 2B 'in)tes,
(ll needles *ere A= ga)ge, A<-'' stainless steel, They *ere &laced to elicit a De Ni
sensation and s)+seF)ently rotated as descri+ed +elo*, The treat'ent *as
&erfor'ed 2-B ti'es &er *ee/ for A< 'in)tes each ti'e, The treat'ents contin)ed
for = 'onths for the @st &atient, 2 'onths for the 2nd &atient, and G 'onths for the
Ard &atient, D)ring this ti'e, the &atients contin)ed treat'ent *ith con%entional
che'othera&y as &rescri+ed +y the treating oncologist,
Cali+ration TechniF)es
1sing a con%entional oscillosco&e, cali+rated according to the 'an)fact)rerIs
reco''endations, *e 'eas)red the electrical o)t&)t of the Chinese M)lti&)r&ose
$lectrical Sti')lator, !e )sed a freF)ency of 2 54, The *a%efor' *as a sF)are *a%e
*ith an a%erage 'agnit)de of G< 'E and d)ration of <,B 's,
CASE REPORTS
C#e 1
( =A-year-old 'an *as diagnosed *ith TA#2+M@ &oorly differentiated
')coe&ider'oid carcino'a of the &arotid gland and had )ndergone right
&arotidecto'y and radical nec/ dissection *ith 2 &ositi%e nodes, 6t *as not &ossi+le
to o+tain clear t)'or 'argins, Follo*ing s)rgery, a &ositron e'ission to'ogra&hy
73$T8 scan &rior to initiation of che'othera&y sho*ed hy&er'eta+olic left s)+'ental
and left .)g)lar ly'&h nodes, inn)'era+le hy&er'eta+olic foci *ithin thoracic
%erte+ral +odies 7CA, T@2-"=8, ri+s, stern)', right ischi)', and right aceta+)l)',
s)ggesting osseo)s 'etastatic disease, (n e-tensi%e )&ta/e of gl)cose s)ggested
in%ol%e'ent of the 'a.ority of the "= %erte+ral +ody, The &atient *as ad%ised that
che'othera&y *o)ld not +e effecti%e for this t)'or +)t *as offered it nonetheless as
a &alliati%e 'odality, The &atient )nder*ent A co)rses of che'othera&y consisting of
car+o&latin and B-fl)oro)racil, lasting A 'onths, D)ring this ti'e he also )nder*ent
ac)&)nct)re treat'ent B ti'es &er *ee/ for A< 'in)tes 7Ta+le @8,
T)le 1, 3oints 1sed in Case @
Meri+i" Po#i'i1e Poi"'# Neg'i1e Poi"'#
Poi"'# :i'! Elec'ricl S'i$ul'io"
ST @, 2, A= @2, @@, A6
0: A< A?
T5 2< B
S6 @? @@
:" @< 2A
"6 = 2<
5)a T)o Jia Ji 3oints C2, T@, T@<, "A CG, T?, "2, :" BG
Poi"'# :i'!ou' Elec'ricl S'i$ul'io";
S3 6 sedation 'ode
K6 A,G tonification 'ode
"R A sedation 'ode
CE @G tonification 'ode
VSedation 'ode refers to hand 'ani&)lation in a co)ntercloc/*ise direction;
tonification 'ode, hand 'ani&)lation in a cloc/*ise direction,
D)ring treat'ent, rec)rrent hy&ere'ia *as noted at the t)'or site, *hich resol%ed
after ac)&)nct)re treat'ent, +)t rec)rred after 2= ho)rs, The treat'ents contin)ed
B ti'es &er *ee/ for = 'onths, Follo*-)& 3$T scan = 'onths later sho*ed &ersistent
hy&er'eta+olic acti%ity at T8 only 7Fig)res @ and 28, This *as the only acti%e
'etastatic disease, The ')lti&le lesions seen on &rior 3$T scan did not sho* any
hy&er'eta+olic acti%ity on this follo*-)& st)dy,
C#e (
( GA-year-old *o'an *as diagnosed *ith stage 6E s'all cell l)ng cancer, *ith
')lti&le li%er 'etastases, &eri&ortal, 'esenteric, and &ara-aortic ly'&hadeno&athy,
The initial l)ng 'ass *as 6 c' in dia'eter, The &atient recei%ed 6 cycles of
car+o&latin and eto&oside, res)lting in decreased t)'or si4e to = - A c' 'eas)red
+y co'&)ted to'ogra&hy 7CT8, $lectroac)&)nct)re *as added 2 ti'es &er *ee/
7Ta+le 28 to the che'othera&e)tic regi'en, Se%en 'onths later, the &atient
interr)&ted +oth che'othera&y and ac)&)nct)re for a trial of a dietary regi'en,
Fig@ 6odine-@2A 'etaio+en4ylg)anidine
7M6:08 scan of case @ +efore treat'ent
#ote ')lti&le areas of )&ta/e
7re&resenting 'etastatic sites8
incl)ding stern)', ri+s, and thoracic
and l)'+ar %erte+rae,
Fig2 M6:0 scan of case @ after =
'onths of che'othera&y and
ac)&)nct)re, 9nly @ area of acti%e
)&ta/e at T8 is sho*n,
$ight 'onths after diagnosis, the t)'or 'eas)red =,B - A,G c' on follo*-)& CT,
Che'othera&y *as restarted *ith ironotecan for = cycles and the &atient restarted
ac)&)nct)re treat'ents B ti'es &er *ee/, The ac)&)nct)re treat'ent &rotocol is
sho*n in Ta+le 2, Ten 'onths after diagnosis, the central l)ng 'ass decreased to A,<
- @,< c', There *as a 'ar/ed i'&ro%e'ent in the li%er 'etastases and near
co'&lete resol)tion of the &eri&ortal, 'esenteric, and &ara-aortic ly'&hadeno&athy,
T)le (, 3oints 1sed in Case 2
K6 2G, 2@ 22, A
ST A, @? @8, A6
S3 2< A
"R @= 2
0: 2= A?
"1 @ ?
K6 G, @< tonification 'ode
S3 6, ?,@< sedation 'ode
"R A sedation 'ode
"6 = sedation 'ode
CE @G, @8 tonification 'ode
VSedation 'ode refers to hand 'ani&)lation in a
co)ntercloc/*ise direction; tonification 'ode, hand
'ani&)lation in a cloc/*ise direction,
C#e -
( 6?-year-old *o'an *as diagnosed *ith stage 6E o%arian adenocarcino'a, ')lti&le
li%er 'etastases, and &eriaortic and &el%ic ly'&h node in%ol%e'ent +ilaterally, She
)nder*ent +ilateral oo&horecto'y and started lo*-dose che'othera&y *ith
car+o&latin and ta-ol for G cycles *ith sta+ili4ation, +)t no i'&ro%e'ent of the li%er
lesions or ly'&hadeno&athy,
Si- 'onths later, electroac)&)nct)re *as added 2 ti'es &er *ee/ according to the
&rotocol sho*n in Ta+le A, Re&eat 3$T scan @A 'onths later sho*ed co'&lete
resol)tion of +oth li%er 'etastases and ly'&hadeno&athy,
T)le -, 3oints 1sed in Case A
K6 2@, @2 @6, A
ST @?, 2? 2B, A6
S3 2@ A
"1 ? @
"R @= 2
0: 2= A?
K6 G, @< tonification 'ode
S3 6, ?, @< sedation 'ode
"R A sedation 'ode
"6 = sedation 'ode
CE @G, @8 tonification 'ode
VSedation 'ode refers to hand 'ani&)lation in a
co)ntercloc/*ise direction; tonification 'ode, hand
'ani&)lation in a cloc/*ise direction,
D6SC1SS69#
(ltho)gh these A cases o+%io)sly do not allo* )s to dra* any definiti%e concl)sions,
*e re&ort these findings +eca)se the )se of electroac)&)nct)re 'erits f)rther
research, !e cannot deter'ine *hether electroac)&)nct)re *as res&onsi+le for
t)'or regression, The che'othera&y itself 'ay ha%e +een entirely res&onsi+le for
the o+ser%ed &heno'ena, altho)gh these res)lts *ere significantly +etter than those
that *ere e-&ected, 6f ac)&)nct)re &layed so'e role in t)'or regression, the
'echanis' is s&ec)lati%e,
$lectrical sti')lation of sy'&athetic ner%e endings 'ay sti')late %asoconstriction or
sti')late an i'')ne res&onse, There is so'e e%idence that ac)&)nct)re 'ay +e
a+le to affect the sy'&athetic and &arasy'&athetic ner%o)s syste's,
@<,@@
Recent
interest in infl)encing angiogenesis and t)'or +lood s)&&ly
@2,@A
s)ggests that )sing
'ethods that create %asoconstriction 'ay ha%e a role in treat'ent, ( recent ani'al
e-&eri'ent sho*ed that electroac)&)nct)re enhanced nat)ral /iller cell acti%ity in
rats, and that this enhance'ent *as s)&&ressed +y anterior hy&othala'ic lesions in
the ani'als,
@=
$lectroac)&)nct)re 'ay also i'&ro%e i'')ne f)nction in h)'ans,
@B
(nother &ossi+le 'echanis' 'ight +e that daily one-on-one ti'e *ith the &atient for
A< 'in)tes co)ld ha%e elicited a &o*erf)l &lace+o effect,
C9#C"1S69#S
(c)&)nct)re can +e a )sef)l 'odality to co'&le'ent con%entional cancer treat'ent
and 'ay &otentiate the effects of che'othera&y, F)rther research is needed to
deter'ine efficacy and the 'echanis's of action, The res)lts of these case re&orts
are &reli'inary, and *e are a*are of the 'any li'itations of these re&orts, !e &lan
f)rther e-&loration of this &heno'enon in ani'al 'odels, and *ith a larger sa'&le
of &atients in a &ros&ecti%e, rando'i4ed controlled trial,
(CK#9!"$D0$M$#TS
!e *ish to than/ the ('erican (cade'y of Medical (c)&)nct)re 7((M(8, So'e of
these cases *ere &resented at the 2<<= ann)al 'eeting and recei%ed @st &lace for
original research, !e also *ish to than/ Drs #ancy Feders&iel, $lliot Krane, $'ily
Ratner, and Richard #ie't4o* for their energetic ad%ice and s)&&ort,
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5idetoshi M, 1chida S, 9hsa*a 5, et al, $lectro-ac)&)nct)re sti')lation to a hind&a* and a hind leg
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/. Pi" M"ge$e"' .i'! Acu&u"c'ure
I"'ro+uc'io"
3atients )ndergoing cancer treat'ent *ill, 'ost li/ely, d)ring the
co)rse of the disease s)ffer fro' &ain, Statistically, 6< to ?< &ercent of
cancer &atients reF)ire a &ain-relie%ing thera&y at so'e &oint,
5o*e%er, not all cancers &rod)ce &ain eF)ally, and so'e cancers, e%en
*hen ad%anced, 'ay not ca)se &ain at all, Cancers that are 'ore
ty&ically &ainf)l incl)de t)'ors of the +one 7either &ri'ary or thro)gh
s&read8 and the organs of the a+do'en,
Ty&es of &ain are> So'atic &ain, fro' the cancer itself, 'ay co'e fro'
a +one da'aged +y t)'or in%asion or fro' an o+str)ction in the
intestine or )rinary tract, #e)ro&athic &ain, fro' ner%e in%ol%e'ent, is
either related to direct t)'or s&read s)ch as the s&read of colon
cancer into the &el%is *here the ner%es to the legs or &el%ic str)ct)res
reside, or is secondary to irritating s)+stances that t)'ors secrete
near ner%es, #e)ro&athic &ain 'ay also res)lt fro' &ress)re on the
ner%es d)e to t)'or for'ation, S)rgery 'ay ca)se +oth so'atic and
ne)ro&athic &ain, Che'othera&e)tic dr)gs can ha%e a detri'ental
effect on sensory rece&tors in the &eri&heral ner%o)s syste',
M)cositis, so'eti'es a side effect of these dr)gs, is one e-a'&le of
so'atic &ain res)lting fro' che'othera&y, Dr)gs s)ch as anti%iral
agents or %incristine, cis&latin, car+o&latin, Ta-ol and #a%el+ine can
ca)se &eri&heral ne)ro&athy, *hich is often felt as a +)rning in the
hands and feet, (fter radiation thera&y, &ain 'ay +e d)e to s/in
da'age, +rea/do*n of ')co)s 'e'+ranes or e%en scarring of the
ner%es 7fi+rosis8, *hich can &rod)ce a ne)ro&athic &ain,
Side $ffects of 3ain Medications> #ot all &atients tolerate all analgesic
dr)gs eF)ally *ell, So'e &eo&le are allergic to certain 'edications or
de%elo& sensiti%ity o%er &rolonged &eriods of dr)g treat'ent, Side
effects %ary fro' indi%id)al to indi%id)al and can &resent yet another
+)rden on the &atient )ndergoing cancer treat'ent, !hile ?< to ?B
&ercent of &atients recei%e adeF)ate &ain control 7see> the !59
g)idelines for analgesics in cancer &atients8, there are still B to @<
&ercent of &atients *ho do not achie%e any 'ar/ed relief, There are
other *ays, thro)gh direct inter%ention, to relief &ain, These
inter%entions incl)de ner%e +loc/s *ith local anesthetics or ner%e-
destroying agents, alternati%e deli%ery syste's s)ch as ad'inistering
narcotics )nder the s/in 7s)+c)taneo)s8 or into the s&ine, s&inal local
anesthetics or other thera&ies that destroy ner%es ca)sing the &ain,
(c)&)nct)re is one 'odality *hich can +ring relief for &atients *ith
ac)te or chronic &ain and, *hilst it is not s)fficient d)ring e&isodes of
%ery se%ere &ain, it can &ro%ide an alternati%e and, i'&ortantly,
effecti%e s)&&ort for other 'ethods of &ain relief, red)cing the need
for analgesics and other 'edication, (c)&)nct)re is also effecti%e in
sy'&to's of fatig)e *hich is often a direct res)lt of &ain and re&orted
+y the 'a.ority of cancer &atients at so'e &oint d)ring their illness,
( series of different st)dies cond)cted in the 1S ha%e sho*n that ?<H
of &atients *ith ad%anced cancer e-&erience se%ere &ain and that &ain
occ)rs in A<H of all cancer &atients, regardless of the stage of the
disease, These st)dies also sho* that B<H of &atients feel they do not
recei%e satisfactory treat'ent to relie%e their disco'fort, 3ain )s)ally
increases as cancer &rogresses, The 'ost co''on cancer &ain arises
fro' t)'ors that 'etastasi4e to the +one, follo*ed +y t)'ors
infiltrating ner%es and hollo* %iscera, T)'ors near ne)ral str)ct)res
'ay ca)se the 'ost se%ere &ain, The third 'ost co''on &ain
associated *ith cancer occ)rs as a res)lt of che'othera&y, radiation or
s)rgery, 3ain can +e chronic, &ersistent or *hat is ter'ed
+rea/thro)gh &ain *hich is a +rief flare-)& of se%ere &ain and can
occ)r *hile the &atient is on reg)lar &ain 'edication,
(t the College of Chinese Medicine, "ondon, *e s&eciali4e in s&inal
ac)&)nct)re and )se, together *ith local and distal &oints along the
'eridian &ath*ays, &oints alongside the s&ine to infl)ence &eri&heral
inner%ations, 3ain occ)rs *hen ne)rons the &eri&hery get sti')lated
+y tiss)e da'age or +y infla''atory signaling 'echanis's s)ch as
&rostaglandins 730s8, 30s, &rod)ced +y ne)tro&hils at the in.)ry site,
+ind to their rece&tors on &eri&heral ner%e ter'inals and trigger a &ain
'essage to the central ner%o)s syste' 7C#S8, #on-ne)ronal cells of
the C#S s)ch as astrocytes and 'icroglia get t)rned on +y the
inco'ing 'essage and &rod)ce yet 'ore 30s and infla''atory
cyto/ines that f)rther a'&lify the &ain signal,
#ot only is ac)&)nct)re effecti%e as a co'&le'entary thera&y for &ain
+)t, thro)gh its anti-infla''atory &ro&erties often re&laces generally
acce&ted &har'acological inter%ention, The attri+)ti%e effect of
ac)&)nct)re has +een in%estigated in infla''atory diseases, incl)ding
asth'a, rhinitis, infla''atory +o*el disease, rhe)'atoid arthritis,
e&icondylitis, co'&le- regional &ain syndro'e ty&e @ and %asc)litis,
"arge rando'ised trials de'onstrating the i''ediate and s)stained
effect of ac)&)nct)re are yet 'issing in the 1K, +)t ha%e +een
cond)cted for so'e years no* in the 1S, 0er'any, Ja&an and China,
Mechanis's )nderlying the ascri+ed i'')no-sti')lating actions of
ac)&)nct)re ha%e +een in%estigated and doc)'ented, St)dies and
research sho*s that the ac)&)nct)re-controlled release of
ne)ro&e&tides fro' ner%e endings and s)+seF)ent %aso-dilati%e and
anti-infla''atory effects thro)gh calcitonine gene-related &e&tide is
hy&othesised 7see> Mediators of 6nfla''ation, Eol)'e @2 72<<A8
6ss)e 28, The co'&le- interactions *ith s)+stance 3, the analgesic
contri+)tion of W-endor&hin and the +alance +et*een cell-s&ecific &ro-
infla''atory and anti-infla''atory cyto/ines t)'or necrosis factor-X
and interle)/in-@< are disc)ssed in this conte-t, ( great deal of
in%estigations into the 'olec)lar and ne)roendocinological
'echanis's of ac)&)nct)re, +rain 'a&&ing and others are still on the
*ay any sho)ld +ring e-citing ne* insight and greater )nderstanding
of ac)te and chronic &ain,
Re#erc! E8'rc'# ), Pro%. :. <ieglg"#)erger, M8
Pl"c9 I"#'i'u'e, Mu"ic!, De&'. o% Neuro&!r$colog,
"+ C!ro"ic Pi" Re#erc!
THE USE OF ACUPUNCTURE IN CHRONIC PAIN AND
UNDERSTANDING PAIN MECHANISMS
More and 'ore research into the 'echanis's of ac)&)nct)re and ho*
it *or/s on a cell)lar and ne)rological le%el is +eing done *orld*ide,
(t the forefront of this research is the Ma--3lanc/ 6nstit)te, M)nich,
0er'any, 3rofessor Dr !alter 2ieglgans+erger, at the De&art'ent for
Clinical #e)ro&har'acology at the Ma--3lanc/ 6nstit)te, is one of the
leading fig)res in the field of &ain 'echanis' research in $)ro&e and
an ardent ad%ocate of ac)&)nct)re as an in%al)a+le tool in the
treat'ent of &atients s)ffering fro' ac)te and chronic &ain, :elo* are
s'all e-tracts fro' so'e of 3rof, 2ieglgans+egers research e-&laining
the &ath*ays of &ain and ho* the effects of ac)&)nct)re can +e
)nderstood in the conte-t of 'olec)lar ne)roendocrinology,
:!' Do :e 6"o. A)ou' T!e S''e O% C!ro"ic Pi"=
Chronic &ain syndro'es are characteri4ed +y altered ne)ronal
e-cita+ility in the &ain 'atri-, The a+ility to ra&idly acF)ire and store
'e'ory of a%ersi%e e%ents is one of the +asic &rinci&les of ner%o)s
syste's thro)gho)t the ani'al /ingdo', These ne)ro&lastic changes
ta/e &lace e, g, in the s&inal cord, in thala'ic n)clei and cortical and
s)+cortical 7li'+ic8 areas integrating &ain threshold, intensity and
affecti%e co'&onents, Chronic infla''ation or in.)ry of &eri&heral
ner%es e%o/es the reorgani4ation of cortical sensory 'a&s, #e)rons
con%eying nocice&ti%e infor'ation are controlled +y %ario)s sets of
inhi+itory interne)rons, The discharge acti%ity of these interne)rons
co)nteracts long-ter' changes in the &ain 'atri- follo*ing nocice&tor
acti%ation, i, e, it &re%ents the transition of ac)te &ain signaling to
chronic &ain states, 9)r 'ost recent research s)ggests that &ain
states 'ay +e sensiti%e to no%el fa'ilies of agents and thera&e)tic
'eas)res not &redicted +y traditional &reclinical &ain 'odels as *ell as
h)'an &ain states, The endogeno)s canna+inoid syste' &lays a
central role in the e-tinction of a%ersi%e 'e'ories, !e &ro&ose that
endocanna+inoids facilitate e-tinction of a%ersi%e 'e'ories %ia their
selecti%e inhi+itory effects on 0(:(ergic net*or/s in the a'ygdala,
Klini/ f)r (nasthesiologie, Sch'er4a'+)lan4, Klini/)' 0rosshadern, ")d*ig-Ma-i'ilians-1ni%ersitat
M)nchen, (rticle in 0er'an 72ieglgans+erger !, (4ad SC8 3M6D> @=6=8A@8 C3)+Med - inde-ed for
M$D"6#$D
U"+er#'"+i"g Neuro&'!ic Pi"
#e)ro&athic &ain is defined as a chronic &ain condition that occ)rs or
&ersists after a &ri'ary lesion or dysf)nction of the &eri&heral or
central ner%o)s syste',Tra)'atic in.)ry of &eri&heral ner%es also
increases the e-cita+ility of nocice&tors in and aro)nd ner%e tr)n/s
and in%ol%es co'&onents released fro' ner%e ter'inals 7ne)rogenic
infla''ation8 and i'')nological and %asc)lar co'&onents fro' cells
resident *ithin or recr)ited into the affected area, (ction &otentials
generated in nocice&tors and in.)red ner%e fi+ers release e-citatory
ne)rotrans'itters at their syna&tic ter'inals s)ch as "-gl)ta'ate and
s)+stance 3 and trigger cell)lar e%ents in the central ner%o)s syste'
that e-tend o%er different ti'e fra'es, Short-ter' alterations of
ne)ronal e-cita+ility, reflected for e-a'&le in ra&id changes of
ne)ronal discharge acti%ity, are sensiti%e to con%entional analgesics,
and do not co''only in%ol%e alterations in acti%ity-de&endent gene
e-&ression, #o%el co'&o)nds and ne* regi'ens for dr)g treat'ent to
infl)ence acti%ity-de&endent long-ter' changes in &ain transd)cing
and s)&&ressi%e syste's 7&ain 'atri-8 are e'erging,
De&art'ent of Clinical #e)ro&har'acology, Ma- 3lanc/ 6nstit)te of 3sychiatry, Krae&elinstrasse 2, 8<8<=
M)nich, 0er'any, 72ieglgans+erger !, :erthele (, Tolle TR8 3)+lished> C#S S&ectr)', 2<<B (&ri;
@<7=8>2?8-A<8 3M6D> @BG88?BG C3)+Med - inde-ed for M$D"6#$D
T!e Pi" M'ri8 * Pre#e"'e+ ' ICMART (>>> I"'er"'io"l
Me+icl Acu&u"c'ure Co"gre##
$'erging /no*ledge related to the di%ersity of &ain-related syste's in
the central and &eri&heral ner%o)s syste's s)ggests that +esides
YclassicalY ne)rotrans'itters, e,g,, "-gl)ta'ate, s)+stance 3, g-
a'ino+)tyric acid 70(:(8 and 'onoa'ines, +iologically acti%e
'olec)les s)ch as &e&tide hor'ones, ne)rosteroids, tro&hic factors or
cyto/ines &artici&ate in the integration of so'atosensory infor'ation
in the &ain 'atri-, These s)+stances are released syna&tically or non-
syna&tically fro' ter'inals, neigh+oring ne)rons, glia cells or
co'&onents of the i'')ne syste' or fro' the circ)lation, These
ne)ronal and hor'onal syste's, *hich act in concert to hel& the
indi%id)al to co&e *ith &ain, ha%e +een detailed +y the 'odern
ne)rosciences,
:y detailing the ')lti&licity of transd)cing and s)&&ressi%e syste's
no%el co'&o)nds and ne* regi'es for dr)g treat'ent and afferent
sti')lation to &re%ent acti%ity-de&endent long-ter' changes are
e'erging, Chronic &ain states arise fro' a %ariety of
&har'acologically distinct syste's *hich offer no%el targets for
selecti%e &har'acothera&y and a&&ear sensiti%e to fa'ilies of agents
that *ere other*ise not &redicted +y traditional &reclinical &ain 'odels
as *ell as h)'an &ain states,
The acti%ation of a nocice&tor in the &eri&heral tiss)e triggers sets of
ne)ronal e%ents *hich e-tend o%er a ti'e fra'e ranging fro'
'illiseconds to ho)rs, days or *ee/s, Most nocice&tors in the
&eri&heral tiss)e are &oly'odal> they res&ond to no-io)s heat, strong
'echanical sti')li, and to a +attery of e-ogeno)s and endogeno)s
che'ical sti')li 7incl)ding &rostaglandins, +rady/inin, hista'ine,
cyto/ines8, These ')lti'odal nocice&tors can +e sensiti4ed +y a
n)'+er of factors released +y the da'aged tiss)e leading to &ri'ary
hy&eralgesia, Sensiti4ation ca)ses s&ecific )&reg)lation of e-&ression
of ion channels and rece&tors on these str)ct)res,
( 'a.or facilitatory effect of the central ner%o)s syste' res&onding to
no-io)s sti')li in%ol%es the interaction +et*een "-gl)ta'ate and
s)+stance 3, a ne)ro&e&tide long tho)ght to ha%e a role in &ain
&erce&tion, 0(:( is a 'a.or inhi+itory ne)rotrans'itter in the
'a''alian C#S and 0(:( +inding sites and 0(:( containing ne)rons
ha%e +een characteri4ed in al'ost all &ain-related str)ct)res, $%en
slight alterations in the e-cita+ility of ')lti-rece&ti%e dorsal horn
ne)rones 7*ide-dyna'ic-range, !DR ne)rons8 can dra'atically
infl)ence the si4e of their rece&ti%e fields 'eas)red in the &eri&heral
tiss)e, i,e, the area in the &eri&hery *here a sti')l)s *ill trigger
action &otentials in this ne)ron, The e-citatory rece&ti%e fields are
'ost co''only s)rro)nded +y inhi+itory rece&ti%e fields, The si4e of
the e-citatory rece&ti%e field can +e increased +y the a&&lication of "-
gl)ta'ate into the %icinity of these ne)rons and can +e red)ced in si4e
+y the a&&lication of the inhi+itory ne)rotrans'itter 0(:(, Re&etiti%e
electrical sti')lation of the inhi+itory rece&ti%e field can ind)ce a long-
lasting s)&&ression of ne)ronal discharge acti%ity of !DR ne)rons,
!hile the earliest short-ter' res&onses are reflected in ra&id changes
of ne)ronal discharge acti%ity the long-ter' changes 'ost co''only
reF)ire alterations in gene e-&ression, The i'&ortance of !DR
ne)rons in the esta+lish'ent of hy&eralgesia and allodynia s)ggests a
strategic foc)s for dr)g treat'ent or inter%entions +y &eri&heral
sti')lation, e,g, +y ac)&)nct)re or &hysical thera&y, on this first stage
of sensory integration in the C#S, (cti%ity-de&endent 'od)lation of
gene e-&ression is a feat)re of highly integrated syste's and greatly
e-&ands the ca&acity to react in a 'ore &lastic 'anner to
en%iron'ental sti')li, 6''ediate-early-genes 76$0s8 are tho)ght to
&artici&ate as third 'essengers in the late &hase of the sti')l)s
transcri&tion cascade, They code for transcri&tion factors and alter
gene e-&ression and translation into the corres&onding &rotein
&rod)cts s)ch as en4y'es, rece&tors or ne)rotrans'itters, The
a'o)nt of se%eral 6$0-coded &roteins, &rod)ced +y central ne)rons, is
&ro&ortional to the degree of syna&tic e-citation follo*ing so'atic and
%isceral ac)te no-io)s,
Si'ilar ne)ro&lastic changes ta/e &lace in other co'&onents of the
&ain 'atri-, e,g, in areas integrating &ain threshold and intensity or its
)n&leasantness in the neocorte- or s)+cortical li'+ic areas, Chronic
infla''ation or in.)ry of &eri&heral ner%es e%o/es the reorgani4ation
of cortical sensory 'a&s, These recent ad%ances in
electro&hysiological, 'olec)lar and cell)lar +iological techniF)es ha%e
&rofo)ndly changed the face of &ain research, The ')ltit)de of
dyna'ic changes *hich occ)r d)ring chronic &ain states 'ay also offer
e-&lanations for so'e of the effects o+ser%ed follo*ing ac)&)nct)re
and treat'ent *ith related techniF)es,
!, 26$0"0(#S:$R0$R 70er'any8, Ma--3lanc/ 6nstit)te, M)nchen
O'!er A)#'rc'# "+ Re&or'# %ro$ '!e ICMART (>>>
I"'er"'io"l Me+icl Acu&u"c'ure Co"gre##. 7The follo*ing original
translations fro' 0er'an ha%e +een edited, in ter's of gra''ar and sentence
str)ct)re, *ith an endea%or to stay as tr)e to the original as &ossi+le,8
Acu&u"c'ure # Po#'0o&er'i1e "+ Po#'0'ru$'ic Tre'$e"'
S&ace/ (, De&art'ent of (nesthesia, 0eneral 5os&ital, Eienna, ()stria,
!ithin the last A< years, ac)&)nct)re has +eco'e increasingly
acce&ted *ithin orthodo- 'edicine and has gained great &o&)larity
a'ong &atients, &ri'arily as a thera&e)tic o&tion in the treat'ent of
%ario)s chronic diseases, Moreo%er, ac)&)nct)re has +een )sed
increasingly in tra)'a and in connection *ith s)rgery, 9ne of the +est
doc)'ented areas of the efficacy of ac)&)nct)re is the treat'ent of
&osto&erati%e na)sea and %o'iting, (c)&)nct)re a&&ears to +e as
effecti%e as s&ecific anti-e'etic 'edication, +oth in &re%ention and in
the treat'ent of &osto&erati%e na)sea and %o'iting, +)t *itho)t the
side effects of &har'ace)tical inter%ention, 0reat efficacy of
ac)&)nct)re has also +een sho*n for its analgesic action in treating
&ainf)l conditions d)e to s)rgery or tra)'a, $lectro-ac)&)nct)re
treat'ent &ro%ides a significant red)ction of &osto&erati%e o&ioid
reF)ire'ent and see's to +e a good alternati%e in treating headaches
after s&inal anesthesia in caesarean section, (c)&)nct)re has also
+een re&orted to +e s)&erior to &lace+o treat'ent in &re%enting
&osto&erati%e dental &ain and can red)ce &osto&erati%e &ain after total
/nee re&lace'ent +y 'ore than 2<H, (ltho)gh ac)&)nct)re is less
effecti%e than narcotic analgesics, it hel&s to alle%iate the se%erity of
co'&lications s)ch as &osto&erati%e )rinary retention, i'&air'ent of
+ronchial f)nction, intestinal &aresis, %o'iting, na)sea and &ain in =<-
8<H of cases, 6t has also +een fo)nd that electro-ac)&)nct)re
significantly atten)ates catechola'ine res&onses in co'&arison to
&lace+o treat'ents d)ring &osto&erati%e reco%ery, The effect of ear-
ac)&)nct)re 7&oint 3 2?8 on +lood &ress)re reg)lation has also +een
in%estigated and findings that +ilateral sti')lation of the 3 2?
'itigates hy&otensi%e effects after ind)ction of anesthesia, This si'&le
techniF)e has a+sol)tely no ris/s nor side effects and 'ay +e
+eneficial in &re%enting &ost-ind)ction hy&otension in &atients, Ta/ing
all these facts into consideration, one ')st concl)de that the )se of
ac)&)nct)re as &art of a co'&rehensi%e treat'ent conce&t 7co'+ined
*ith dr)g thera&y8 in the 'anage'ent of &osto&erati%e and &ost-
tra)'atic &ain see's to +e desira+le,
A'o$ic P!,#ic# "+ Neuro&!,#iolog, o" '!e Co"ce&' o%
Meri+i" ?i 5E"erg,7 !arn/e 1, 1ni%ersity of Saarland, 0er'any
6n 'odern science, the considered electro'agnetic and 'echanical
ne)ron acti%ity is, )& to no*, not s)fficient re'ar/ed>
a8 (s long as resting &otential is sta+le, electrons *ithin the cell
'e'+rane ha%e a &otential energy of a&&ro-, G<'eE, D)ring
de&olari4ation, this energy is set free as a coherent radiated
electro'agnetic oscillation *ith the F)ant)' energy of G< 'eE K @,G
- @< 54, (t the sa'e ti'e, the 'olec)le di&oles fi-ed in their
'o%e'ent &re%io)sly thro)gh the high electrostatic field of the resting
&otential of the 'e'+rane 7)& to @< EO'8 s)ddenly oscillate and, in
this *ay, send coherent electro'agnetic oscillations of different
freF)encies o)tside and inside the ne)rite,
+8 Thro)gh the high electrostatic field force of the resting &otentials, a
%ery high co'&ression of the 'e'+rane is ca)sed, (t de&olari4ation,
the 'e'+rane sna&s +ac/ to its real e-&ansion 7electrostriction8, The
des)ltory e-&ansion is ca)sing the 'echanical resonance of the
'e'+rane ele'ents *hich th)s send o)t a so)nd *a%e, (s the so)nd
*a%e r)ns thro)gh the tiss)e and the fl)ids it 'od)lates, thro)gh
&eriodic &ress)re fl)ct)ation, the dielectric constant of the 'edi)' in
the rhyth' of the so)nd freF)ency, There+y the 'e'+rane sends o)t
in addition to the coherent electro'agnetic oscillation an
electro'agnetic dis&ersion *a%e, The triggered so)nd *a%e is directly
co)&led *ith the e'ission of the dis&ersion *a%e, :oth *or/ in the
sa'e tiss)e and fl)id %ol)'e and in this *ay they a'&lify one another,
Thro)gh dielectric foc)sing, e,g, thro)gh the *alls of +lood %essels,
this radiation can +e foc)sed again, The strea' of +lood *or/s li/e an
antenna and &)lls in the electro'agnetic field analogo)s to the
*ar'th, then, g)ided for*ard, the field cond)cti%e and connecti%e
&roteins ha%e a ha+it to changing their geo'etric for', e,g, they t*ist
their side chains aro)nd an antici&ated angle of torsion, This ha&&ens
li/e*ise as a conseF)ence of s&ecific energy a+sor&tion, The
electro'agnetic radiation of so'e acti%ated en4y'es is fi-ed in
resonance to the 'icro*a%e area 7@<O@2 - @<O@A 54,8, That is e-actly
the area in *hich 'e'+ranes of ne)rons send o)t coherent oscillations
in the case of de&olari4ation,
Po#'0o&er'i1e Pi" M"ge$e"' .i'! Acu&u"c'ure 0r)+e T, Korn+erg
(, 1hle'ann C, Meissner !, Scheele J, S)rgical Clinic, Jena, 0er'any
:ac/gro)nd> (c)&)nct)re has +eco'e %ery &o&)lar in se%eral fields of
&ain 'anage'ent, es&ecially in treat'ent of chronicle &ain, The
&)r&ose of this st)dy is the assess'ent of ac)&)nct)re in the
treat'ent of &osto&erati%e &ain,
Material and 'ethods> (fter defined o&erations 7%aginal and
la&arosco&ic hysterecto'y, la&arosco&ic a&&endecto'y8, all &atients
recei%ed &atient controlled analgesia 73C(8 *ith &iritra'id and *e
rando'i4ed in three gro)&s;
0ro)& @ 7n K @88 recei%ed 3C( and ac)&)nct)re after a defined ti'e
ta+le,
0ro)& 2 7n K @G8 recei%ed 3C( and @ g 'eta'i4ol at the sa'e ti'e,
0ro)& A 7n K @G8 3C( only *as,
(t defined &oints of ti'e, &atients *ere as/ed to co''ent on &ain
intensity, na)sea and freF)ency of %o'iting )sing %is)al analog scale
7E(S8, (t the sa'e ti'e, +lood &ress)re, heart freF)ency and s/in
te'&erat)re *ere noted, (t the end of the e%al)ation, le%els of
&iritra'id ta/en *ere doc)'ented,
Res)lts> The )se of ac)&)nct)re 7gro)& @8 lead to a red)ction of
&iritra'id )se of 'ore than B< &ercent co'&ared to gro)& A, 6n gro)&
2, the inta/e of &iritra'id *as less than in gro)& A, +)t still higher
than in gro)& @, !e also noticed %ery good res)lts of ac)&)nct)re in
the treat'ent of na)sea and %o'iting,
Concl)sion> 1sing scientific and re&rod)ci+le &ara'eters, ac)&)nct)re
alone &ro%ed to +e s)fficient in the 'anage'ent of &osto&erati%e &ain,
na)sea and %o'iting, $s&ecially ')lti-'or+id &atients at ris/ of
s)ffering fro' s)rgery-related or &har'acological side effects +enefit
fro' ac)&)nct)re, !e noted no effect of ac)&)nct)re regarding +lood
&ress)re and heart rate,
Mec!"i#$# o% Acu&u"c'ure A"lge#i Pro+uce+ ),
Lo.0Fre4ue"c,Elec'ricl S'i$ul'io" o% Acu&u"c'ure
Poi"'#
:y Chif)y) Ta/eshige
I"'ro+uc'io"
Three note*orthy &heno'ena ha%e +een recogni4ed in s)rgical
ac)&)nct)re analgesia 7((8 &rod)ced +y lo*-freF)ency electrical
sti')lation of ac)&)nct)re &oints 7(3s8> @8 Conscio)sness is
'aintained, allo*ing the &atient to tal/ d)ring s)rgery; 28 Sti')lation
of s&ecific ac)&)nct)re &oints is essential to 'aintain analgesia; and
A8 (nalgesia &ersists long after sti')lation has +een ter'inated,
allo*ing the &atient to 'o%e *itho)t &ain after s)rgery, The
'echanis's +y *hich (( is &rod)ced 'ight +e clarified +y
in%estigating these &heno'ena, This re%ie* *ill e-&lore &ossi+le
'echanis's +ased on res)lts fro' ani'al e-&eri'ents,
Conscio)sness de&ends on acti%ation of the +rainste' ascending
retic)lar acti%ating syste' 7R(S8 that &rod)ces *ides&read sti')lation
of the cere+ral corte- and non-s&ecifically 'aintains conscio)sness
thro)gh the retic)lar n)cle)s in the thala')s, The R(S is acti%ated +y
collateral &ath*ays that di%erge fro' each s&ecific sensory afferent
&ath*ay that &ro.ects to each sensory corte-, #e)ro&hysiological
research has sho*n that anesthetic dr)gs )sed d)ring s)rgical
o&erations inhi+it acti%ity of the R(S, Since conscio)sness is
di'inished )nder this condition, sensory infor'ation reaching the
sensory corte- is not translated into &erce&tion, 9n the other hand, it
is also co''only o+ser%ed that nor'ally &ainf)l sti')li are
s)&&ressed on the +attlefield of *ar and on the &laying field of
aggressi%e s&orts s)ch as r)g+y, S)ch analgesia is tho)ght to +e
+ro)ght a+o)t +y acti%ation of the descending &ain inhi+itory syste'
7D36S8 originating fro' the li'+ic syste' that +loc/s &ain infor'ation
as it enters the central ner%o)s syste', Conscio)sness can th)s +e
'aintained in s)ch a condition, 6f sti')lation of a s&ecific ac)&)nct)re
&oint acti%ates the D36S thro)gh a &artic)lar &ath*ay connected to the
+rain syste' *hich s)&&resses &ain, it can +e ass)'ed that (( is
&rod)ced +y acti%ation of the D36S, This ass)'&tion has +een
e-a'ined in o)r la+oratories +y se%eral ani'al e-&eri'ents,

1. Cl##i%ic'io" o% cu&u"c'ure %%ere"' "+ e%%ere"' &'!.,#
%or &ro+uci"g cu&u"c'ure "lge#i C@@,@2,@A,@6,22,2AD
The ne)ronal str)ct)res co'&rising the ((-&rod)cing +rain &ath*ay
can +e identified *hen 'icroelectrode sti')lation ind)ces analgesia in
a 'anner that 'i'ics (( and +y tiss)e a+lation that res)lts in
s)+seF)ent +loc/age of ((, 5o*e%er, the nat)re of the analgesia
&rod)ced de&ends )&on the +rain areas sti')lated and can +e
classified into t*o categories, The first category incl)des analgesia that
@8 is nalo-one-re%ersi+le, 28 disa&&ears after hy&o&hysecto'y, A8
&ersists long after sti')lation of the ac)&oint is ter'inated, and =8
e-hi+its indi%id)al %ariation in effecti%eness, These feat)res are si'ilar
to those of ((, 6n this category, +rain &otentials are e%o/ed +y
sti')lation of ac)&oints in the sa'e areas that &rod)ce analgesia,
Sti')lation of +rain areas associated *ith the second category
&rod)ces analgesia that @8 is not nalo-one-re%ersi+le, 28 is not
affected +y hy&o&hysecto'y, A8 is &rod)ced only d)ring sti')lation,
and =8 e-hi+its no indi%id)al %ariation in effecti%eness, $%o/ed
&otentials are not o+tained fro' +rain regions &rod)cing analgesia of
this second category, +)t non-synchroni4ed ne)ronal acti%ities are
o+tained +y sti')lation of ac)&oints C@6D,
:rain regions &rod)cing analgesia of the first category a&&ear to
co'&rise an afferent &ath*ay for ac)&)nct)re, since the &it)itary
gland is in%ol%ed in this analgesia and electrical &otentials are e%o/ed
in these +rain regions +y sti')lation of ac)&oints, Si'ilarly, areas
&rod)cing analgesia related to the second category a&&ear to co'&rise
an efferent &ath*ay for ac)&)nct)re, since the &it)itary gland is not
in%ol%ed and synchroni4ed electrical &otentials are not e%o/ed in these
regions +y sti')lation of ac)&oints C@2,@6,@?D, (ll +rain regions
&rod)cing analgesia associated *ith the second category see' to +e
connected to the D36S; (( is &rod)ced +y acti%ation of the D36S that
is e-cited +y sti')lation of s&ecific ac)&oints thro)gh a &artic)lar
&ath*ay connected to the D36S, This D36S-&rod)cing analgesia related
to the second category is defined as the ac)&)nct)re eerent &ath*ay,
*hereas the &artic)lar &ath*ay fro' s&ecific ac)&oints to the D36S is
defined as the ac)&)nct)re aerent &ath*ay,
1. Acu&u"c'ure e%%ere"' &'!., C@A,@6,2=D
(( can +e a+olished +y conc)rrent lesions of the Ra&he n)cle)s and
the retic)lar &aragigantocell)lar n)cle)s that are /no*n as the origins
of the serotonergic and the noradrenergic descending &ain-inhi+itory
syste's, Sti')lation of these n)clei res&ecti%ely &rod)ces
serotonergic and noradrenergic analgesia of the second category, The
final &rod)ction of (( is ind)ced +y acti%ation of these descending
&ain-inhi+itory syste's, The descending &ain-inhi+itory &ath*ay
ser%es as the ac)&)nct)re efferent &ath*ay fro' the hy&othala'ic
%entro'edian n)cle)s 75EM8; it is di%ided into t*o &arts that connect
to the descending serotonergic and noradrenergic syste's, The
&osterior &art of the hy&othala'ic arc)ate n)cle)s 73-5(R#8 is
anato'ically connected to the 5EM, (nalgesia &rod)ced +y sti')lation
of +oth the 5EM and the 3-5(R# is associated *ith the second
category, Syna&tic trans'ission fro' the 3-5(R# to the 5EM is
a&&arently do&a'inergic, since analgesia &rod)ced +y sti')lation of
the 3-5(R# is +loc/ed +y lesions of the 5EM or +y do&a'ine
antagonists,
1). Acu&u"c'ure %%ere"' &'!., C@@,@2,2AD
The ac)&)nct)re afferent &ath*ay starts fro' an ac)&oint, ascends
thro)gh the contralateral anterolateral tract to the dorsal
&eriaF)ed)ctal central gray, and reaches the 'edial &art of the
hy&othala'ic arc)ate n)cle)s 7M-5(R#8, :rain regions +elonging to
the (( afferent &ath*ay can +e identified +y e-hi+ition of analgesia of
the first gro)& related to anato'ically /no*n connections, The rostral
and ca)dal relations +et*een these regions ha%e +een identified +y the
loss of sti')lation-&rod)ced analgesia of the ca)dal region that follo*s
lesions of the rostral region,
1c. S,"&'ic co""ec'io"# )e'.ee" cu&u"c'ure %%ere"' "+
e%%ere"' &'!.,# C2B,28D,
The final region of the ac)&)nct)re afferent &ath*ay is fo)nd in the M-
5(R#, *hich is anato'ically close to the 3-5(R#, the initial region of
the ac)&)nct)re efferent &ath*ay, Microin.ection of the do&a'ine
antagonist halo&eridol antagoni4es (( dose-de&endently *hile
'icroin.ection of do&a'ine into the 3-5(R# ind)ces a dose-de&endent
analgesia, Do&a'ine th)s see's to ser%e as the ne)rotrans'itter
+et*een the M-5(R# and the 3-5(R#, i,e, as the ne)rotrans'itter at
the interface +et*een the ac)&)nct)re afferent and efferent &ath*ays,
This &ossi+ility is f)rther s)&&orted +y ne)ronal acti%ity in the 3-5(R#,
#e)rons in the 3-5(R# that res&ond to ac)&oint sti')lation also
res&ond to ionto&horetically ad'inistered do&a'ine, *hereas ne)rons
in the M-5(R# that do not res&ond to ac)&oint sti')lation also do not
res&ond to ionto&horetically ad'inistered do&a'ine C2BD,
( +ranch of the ac)&)nct)re afferent &ath*ay ascending to the M-
5(R# di%erges at the lateral hy&othala')s 7"58 to reach the &it)itary
gland, "esions of +rain n)clei near this &ath*ay to the &it)itary, e,g,
the &reo&tic area 739(8 or the 'edian e'inence 7M$8, a+olish ((,
$lectrical &otentials are e%o/ed in these +rain areas +y sti')lation of
ac)&oints, +)t sti')lation of these &artic)lar +rain str)ct)res does not
&rod)ce analgesia C2B,28D 7Fig,@, 2 and B8, Since +oth ac)&)nct)re
analgesia and &ain relief &rod)ced +y sti')lation of the ac)&)nct)re
afferent &ath*ay to the M-5(R# -endor&hin released fro' the
&it)itary glandare a+olished +y hy&o&hysecto'y, 'ay &lay an
essential role in do&a'inergic trans'ission in the 3-5(R# C2BD,
Microin.ection of nalo-one to the 3-5(R# antagoni4es (( -endor&hin
or 'or&hine &rod)cesdose-de&endently and 'icroin.ection of
-endor&hinanalgesia dose-de&endently, (nalgesia &rod)ced +y
'icroin.ection of disa&&ears after dener%ation of the M-5(R#, +)t
analgesia &rod)ced +y 'icroin.ection of do&a'ine to the 3-5(R#
re'ains C2BD, These findings -endor&hin 'ight act &resyna&tically at
do&a'inergic syna&ses ins)ggest that the 3-5(R#, This notion is
f)rther s)&&orted +y the acti%ity of 3-5(R# ne)rons, #e)ronal acti%ity
in the 3-5(R# that occ)rs in res&onse to ac)&)nct)re sti')lation is
not affected +y ionto&horetic ad'inistration of 'or&hine or +y
-endor&hin %ia &icos&ri4er C22D,
-)ltra'icroin.ection
Since -endor&hin released fro' -endor&hin act si'ilarly in the 3-
5(R#, 'or&hine and the &it)itary gland 'ight +e the ne)roh)'oral
factor acting &resyna&tically on a-on ter'inals of the M-5(R# ne)rons
that inner%ate 3-5(R# ne)rons, (ltho)gh -endor&hin into the 3-5(R#
&rod)ces analgesia, electrical'icroin.ected sti')lation of the 39( or
M$ in the &ath*ay to the &it)itary gland does not; -endor&hin +y s)ch
sti')lation is nottherefore, the released a'o)nt of s)fficient to
acti%ate the 3-5(R# ne)rons *itho)t afferent i'&)lse fro' the
-endor&hin 'ight also act in other areas of the ((M-5(R#, Mor&hine
and afferent &ath*ay, This &ossi+ility *as e-&lored +y recording
electrical &otentials e%o/ed +y sti')lation of the ac)&oint in the final
station of the (( afferent &ath*ay, the M-5(R#, S)ch &otentials are
enhanced +y intra%eno)sly ad'inistered 'or&hine 7<,B 'gO/g8 and
are a+olished +y hy&o&hysecto'y, The a+olished e%o/ed-&otentials are
te'&orarily restored +y 'or&hine C@2D, -endor&hin released fro' the
&it)itary glandTherefore, sites res&onsi%e to 'ight +e *ides&read in
the (( afferent &ath*ay, 9&ioid rece&tors ha%e also +een re&orted in
'any regions of the ac)&)nct)re afferent &ath*ay C@,B,@<D,

(. S'i$ul'io" o% #&eci%ic cu&oi"'# %or &ro+uc'io" o%
cu&u"c'ure "lge#i C2AD
"o*-freF)ency 7@ 548 electrical sti')lation of the first dorsal finger
')scle and the anterior ti+ial ')scle in rats C@@, 2AD that are the
')scles )nderlying, res&ecti%ely, the h)'an "6 = 75eg)8 and ST A6
72)sanli8 ac)&oints, &rod)ces +eha%ioral analgesia, as e%al)ated +y
tail-flic/ latency, The intensity of electrical sti')lation ')st +e
s)fficient to ca)se ')scle contraction in order to o+tain ((, 6n contrast
to this effect, sti')lation of other ')scles does not &rod)ce +eha%ioral
analgesia, 5ence, the 5eg) and 2)sanli ac)&oints see' )niF)ely a+le
to acti%ate the D36S thro)gh the &artic)lar &ath*ay connected to the
D36S CAD,
-. Di%%ere"'i'io" o% cu&oi"'# "+ "o"0cu&oi"'# ), re#&o"#e#
o% ce"'rl "euro"l #'ruc'ure# C@@,@=,@B,@G,@8D
3otentials can +e e%o/ed s&ecifically in the +ilateral dorsal areas of the
&eriaF)ed)ctal central gray 7D-3(08 +y sti')lation of the ')scles
)nderlying the 5eg) and 2)sanli ac)&oints, +)t not +y sti')lation of
other ')scles, "esions of the D-3(0 a+olish ((, Microelectrode
sti')lation of this region &rod)ces analgesia of the first category that
can +e re%ersed +y either nalo-one or hy&o&hysecto'y, Sti')lation of
the a)ric)lar le%ator ')scle +eneath the J @8 7Chih'o8 ac)&oint in
ra++its elicits e%o/es &otentials in the D-3(0 C@@,2AD, Sti')l)s
conditions as stated a+o%e *hich lead to (( *ere confir'ed +y
&otentials in the D-3(0, Therefore, only three ac)&oints for &rod)cing
(( ha%e +een identified> 5eg), 2)nsanli, and Chih'o,
Sti')lation of ')scles +eneath 5eg) and 2)sanli also &rod)ces
nons!eciic &otentials +ilaterally in the lateral &arts of the
&eriaF)ed)ctal central gray 7"-3(08 C@GD, 3otentials in the "-3(0 are
grad)ally decreased +y @ 54 re&etiti%e sti')lation of these ')scles
and disa&&ear co'&letely @< 'in)tes after the onset of sti')lation
C@B,@GD, 5ence, &otentials in the "-3(0 are inhi+ited +y s)ch
sti')lation in a self-inhi+iting fashion, "esions of the "-3(0 do not
affect ((, +)t analgesia is &rod)ced +y sti')lation of the rostral "-
3(0, This analgesia is largely re%ersi+le *ith de-a'ethasone and the
de-a'ethasone-insensiti%e &ortion is readily +loc/ed +y nalo-one or
hy&o&hysecto'y, 5ence, ac)&oints are connected %ia the D-3(0 to the
&artic)lar &ath*ay that is not self-inhi+ited d)ring the &rod)ction of
((, 9n the other hand, ac)&oints as *ell as non-ac)&oints are
connected to the other, self-inhi+iting &ath*ay nons&ecifically, %ia the
"-3(0, The latter +rain region +elongs to a &ath*ay distinct fro' the
(( afferent &ath*ay, *hose analgesia &rod)ction is self-inhi+iting,
These res)lts i'&ly that ac)&oints and non-ac)&oints can +e
differentiated +y their connections *ith different analgesia-&rod)cing
central &ath*ays C@=,@GD,
/. Si$ilri'ie# )e'.ee" cu&u"c'ure "lge#i "+ $or&!i"e
"lge#i
(nalgesia &rod)ced +y <,B 'gO/g 'or&hine is of a si'ilar degree to
that &rod)ced +y lo* freF)ency electroac)&)nct)re, 6n addition, +oth
ty&es of analgesia are a+olished +y hy&o&hysecto'y, +y lesions of
either the (( afferent or efferent &ath*ays, +y nalo-one or +y
antagonists of trans'itters in%ol%ed in the (( efferent &ath*ay, 6n
addition, indi%id)al %ariation in effecti%eness +et*een (( and
'or&hine analgesia are highly correlated, (ni'als can +e classified as
res&onders or non-res&onders +y the &resence or a+sence of a
significant increase 73 L <,<B8 in tail-flic/ latency,

@. Ac'i1'io" o% '!e #&i"l cu&u"c'ure "lge#i %%ere"'
&'!., ), $or&!i"e C8,@@,@2,@=,@8D
3otentials e%o/ed in the D-3(0 +y sti')lation of ac)&oints are +loc/ed
+y contralateral lesions of the anterolateral tract or +y intrathecal
ad'inistration of the antiser)' to 'ethionine-en/e&halin 7Met-
en/e&halin8, These &otentials are also +loc/ed +y nalo-one, +)t not +y
the ad'inistration of antisera to le)cine-en/e&halin or dynor&hin C@8D
s)&&orting the in%ol%e'ent of a 'et-en/e&halin &ath*ay that is
acti%ated +y 'or&hine, 6n ((-res&onder ani'als, dose-res&onse
c)r%es of analgesia *ere o+tained for +oth lo* and high doses of
'or&hine, ad'inistered either intra&eritoneally or intrathecally,
5o*e%er, in non-res&onder ani'als, only a single dose-res&onse c)r%e
for higher doses of 'or&hine *as o+tained, 6n (( res&onders, +ilateral
lesions of the anterolateral tract, or lesions of the D-3(0 that is &art of
the (( afferent &ath*ay a+olished dose-de&endent res&onses to lo*
doses of 'or&hine *itho)t affecting the dose-res&onse to high doses
of 'or&hine, Therefore, 'or&hine analgesia &rod)ced +y lo*er doses
is &ro+a+ly ind)ced +y acti%ation of the (( afferent &ath*ay thro)gh
Met-en/e&halin rece&tors in the s&inal cord C@8D, S)ch rece&tors in the
s&inal (( afferent &ath*ay are li/ely to +e those that are acti%ated +y
intra&eritoneal 'or&hine at <,B 'gO/g or +y intrathecal 'or&hine at
<,<B 'gO/g, that &rod)ce 'or&hine analgesia of a degree si'ilar to
that of (( C8,@@D, This 'echanis' 'ay e-&lain the reason for the
si'ilarity +et*een (( and 'or&hine analgesia,
Su$$r,
(c)&)nct)re analgesia is &rod)ced +y acti%ation of the D36S thro)gh a
s&ecific &ath*ay connected to the ac)&oints *hile still allo*ing
'aintenance of conscio)sness, The (6S, in contrast, is acti%ated +y
sti')lation of ac)&oints or non-ac)&oints, leading to a non-s&ecific
inhi+ition of different interconnected &ath*ays, Therefore, ac)&oints
and non- ac)&oints can +e disting)ished +y their anato'ically distinct
+rain &ath*ays, The after-effects of (( 'ight +e &rod)ced -endor&hin
released fro' the &it)itary +y the actions of an increased a'o)nt of
gland on co'&onents of the ((-&rod)cing &ath*ay,
Re%ere"ce#
@, (t*eh SF, K)har MJ, ()toradiogra&hic locali4ation of o&iate rece&tors in rat +rain> the +rainste', "rain
Res @??G;@2?>@-@2,
2, (rai T, 0)o SM, Ta/eshige C, Cholecysto/inin in the analgesia inhi+itory syste' and its antagonists in
this syste', # $ho%a Med Assoc @??2;B2>B8-6G,
A, 5)ang SF, ")o C3, Ta/eshige C, 6dentity of a central analgesia &rod)cing 'echanis' in 5o-/) &oint
sti')lation *ith that in Ts)sanli &oint sti')lation, # $ho%a Med Assoc @??8;=8>=8B-=?2,
=, ")ng C5, S)n (C, Tsao CJ, Chang,M", Fan ", (n o+ser%ation of the h)'oral factor in ac)&)nct)re
analgesia in rats, A&er # Chin Med @?G=;2>2<A-2<B,
B, Mali4ia $, (ndre)cci 0, 3aol)cci D, 0rescen4i F, Fa++ri (, Fraioli F, -endor&hin and (CT5
le%els,$lectroac)&)nct)re and &eri&heral 'ancet @?G?; BAB-BA6,
6, 3ert C:, Snyder S5, 9&iate rece&tor> de'onstration in ner%o)s tiss)e, $cience @?GA;@G?>@<@@-@<@=,
G, Sato T, 5ishida F, ")o C3, Ts)chiya M, Ta/eshige C, Relations of adrenal gland and sodi)' ions in
&rod)ction of ac)&)nct)re and non-ac)&)nct)re &oints sti')lation-&rod)ced analgesia, # $ho%a Med
Assoc @?8?;=?>286-2?=,
8, Sato T, Ta/eshige C, Shi'i4) S, Mor&hine analgesia 'ediated +y acti%ation of the ac)&)nct)re-
analgesia-&rod)cing syste', Acu!unct (lectro)*her Res @??@;@6>@A-26,
?, S.ol)nd :, Tereni)s ", $ri/son M, 6ncreased cere+ros&inal fl)id le%els of endor&hins after electro-
ac)&)nct)re, Acta Physiol $cand @?GG;@<<>A82-A8=,
V@<, Snyder S5, 9&iate rece&tor in nor'al and dr)g altered +rain f)nction, +ature @?BB;2BG>@8B-@8?,
V@@, Ta/eshige C, Mechanis' of ac)&)nct)re analgesia +ased on ani'al e-&eri'ents, 6n> $cientiic "ases
o Acu!uncture, 3o'eran4 :, St)- 0 7eds8 S&ringer-Eerlag, @??<, &&,,
@2, Ta/eshige C, Mechanis' of ac)&)nct)re analgesia 7((8 ca)sed +y lo* freF)ency sti')lation of the
ac)&)nct)re &oint +ased on ani'al e-&eri'ents, 3art@> (c)&)nct)re afferent and efferent &ath*ays and
the nat)re of ((, Acu!unct $cient ,nt # @??<;@>GB-88,
@A, Ta/eshige C, Sato T, Ko')gi 5, Role of &eri-aF)ed)ctal central gray in ac)&)nct)re analgesia,
Acu!unct (lectro)*her Res @?8<;B>A2A-AAG,
@=, Ta/eshige C, Differentiation +et*een ac)&)nct)re and non-ac)&)nct)re &oints +y association *ith
analgesia inhi+itory syste', Acu!unct (lectro)*her Res @?8B;@<>@?B-2<A,
@B, Ta/eshige C, 6nhi+ition associated *ith ac)&)nct)re analgesia> inacti%ation of hy&ersensiti%e ne)rons,
Charla4onits #, 0ola M 7eds8 (lan R, "iss, 6nc,, @?8G, &&,2BB-262,
@6, Ta/eshige C, Ka'ada M, 5isa'at) T, Co''only res&onsi%e ne)rons in the &eriaF)ed)ctal gray 'atter
and 'id+rain retic)lar for'ation of ra++its to ac)&)nct)re sti')lation, in%ersion, &ress)re on +ody &arts
and 'or&hine, Acu!unct (lectro)*her Res @?8@;6> BG-G=,
@G, Ta/eshige C, Ko+ori M, 5ishida F, ")o C3, 1sa'ai S, (nalgesia inhi+itory syste' in%ol%e'ent in
nonac)&)nct)re &oint-sti')lation-&rod)ced analgesia, "rain Res "ull @??2;28>AG?-A?@,
@8, Ta/eshige C, ")o C3, 5ishida F, 6garashi 9, Differentiation of ac)&)nct)re and non-ac)&)nct)re &oints
+y difference of associated o&ioids in the s&inal cord in &rod)ction of analgesia +y ac)&)nct)re and non-
ac)&)nct)re &oint sti')lation, and relations +et*een sodi)' and those o&ioids, Acu!unct (lectro)*her
Res @??<;@B>@?A-2<?,
@?, Ta/eshige C, ")o C3, Ka'ada M, 9/a K, M)rai M, 5isa'at) T, Relation +et*een 'id+rain ne)rons
73eriF)ed)ctal central gray and 'id+rain retic)lar for'ation8 and ac)&)nct)re analgesia, ani'al hy&nosis,
6n :onica J et al 7eds8, Advances Pain Res *her A> @?G?;6@B-62@
2<, Ta/eshige C, Mera 5, 5isa'at) T, Tana/a M, 5ishida F, 6nhi+ition of the analgesia inhi+itory syste' +y
D-&henylalanine and &rogl)'ide, "rain Res "ull @??@;26>A8B-A?@,
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thala')s of conscio)s rat, +eurosci 'et @??<;@@8> 2<B-2<G,


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