Acupuncture for Rheumatoid Arthritis and Inflammation

The Evidence is Promising

Poking needles under your skin doesn’t exactly sound soothing, but some people swear by the use of acupuncture for their rheumatoid arthritis (RA). Such anecdotal evidence suggests this therapy might be effective in relieving RA discomfort. Yet with few good-quality studies available, proving acupuncture’s safety and benefit has been a challenge.

Many reviews of studies done so far have not found a statistically significant benefit on pain, swollen joints or other measures of disease when compared to a control treatment. Many of the studies that did find positive outcomes weren’t well conducted. Yet there has been enough potential noted for this therapy that researchers say it warrants further study.

Acupuncture’s Effect on Inflammatory Markers

Acupuncture involves inserting tiny needles into a person’s skin. A version known as electro-acupuncture adds a mild electric current. The needles are inserted at some of the 2,000 mapped points along what are called meridians or channels.In Chinese terms, acupuncture restores the optimal flow of energy – called Qi (pronounced chee) – in the body.

In a 2011 Chinese study looking at electro-acupuncture and traditional acupuncture, both significantly lowered tumor necrosis factor-α (TNF-α) and vascular endothelial growth factor (VEGF). “Both TNF-α and VEGF are associated with chronic inflammation,” explains Nathan Wei, MD, director of the arthritis treatment center in Frederick, Md. “In particular, TNF-α appears to play a pivotal role in the chronic inflammation and joint destruction that characterizes RA. That’s why so many of the biologic medications target TNF-α.”

In a 2008 Arthritis & Rheumatism review of eight acupuncture studies involving a total of 536 patients with RA, five studies reported a reduction in erythrocyte sedimentation rate (ESR), three saw a reduction in C-reactive protein (CRP), and one study described a significant drop in both. Both ESR and CRP are markers of inflammation in the body. Several of the studies also reported decreased pain and a reduction in morning stiffness.

How acupuncture affects inflammatory markers like TNF-α is unknown. “No one has figured out one single mechanism for acupuncture’s effects,” says Jeffrey I. Gold, PhD, director of the pediatric pain management clinic at Children’s Hospital in Los Angeles.

Gold explains that MRI studies show that acupuncture sites specifically induce responses in various portions of the brain. Acupuncture can possibly effect any organ or system: immunological, neurological, hormonal and psychological. “It doesn’t only block pain signals,” he says.

Experts do know that acupuncture relieves pain by stimulating the release of endorphins, the body’s own natural painkillers, says Jamie Starkey, lead acupuncturist for the Tanya I. Edwards, MD Center for Integrative and Lifestyle Medicine at Cleveland Clinic. “We’re activating the peripheral nervous system, which then activates the central nervous system, so that the brain begins to release endorphins.” Acupuncture may relieve pain locally, she says, by not only releasing neurotransmitters, but also by having an anti-inflammatory effect. “How exactly it happens, we are still researching.”

Taking the Acupuncture Route

“The more studies that come in showing the drop in inflammatory markers through acupuncture treatments, the more rheumatologists will take note,” says Starkey. In a 2010 Mayo Clinic survey, 54% of rheumatologists said they would recommend acupuncture as an adjunct treatment. 

Here are some things to consider if you’re thinking of jumping on the acupuncture bandwagon:

Choose Carefully

“Find an acupuncturist who comes highly recommended by your rheumatologist or physician, family friends, and colleagues so you know firsthand what their experience was like,” says Starkey. If you don’t know anyone to ask, search The National Certification Commission for Acupuncture website for a certified clinician in your area. 

Acupuncturists have to be licensed by their state medical board, so you can check there as well. “Ideally, try to find someone who has experience working with RA patients,” says Starkey.  

Know What’s Covered

Some insurance companies cover acupuncture for certain diagnoses, but others do not. Prices for acupuncture vary, depending on your area and can run $75 to $200 per treatment.

Expect Several Treatments

“We tend to see substantial results within three to six treatments,” says Dr. Gold. But each patient responds differently and treatments vary depending on the stage of the disease.

Understand the Limit

Acupuncture doesn’t work on everyone, says Starkey. “In my clinical work, we see a 20% non-response rate.” But,acupuncture has many styles and practitioners. “If it doesn’t work right away, don’t dismiss the whole field of acupuncture,” says Dr. Gold. “Try a different style.”

This article originally appeared on arthritis.org and was written by Dorothy Foltz-Gray

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Acupuncture and Seasonal Allergies

Symptoms of running nose, sneezing, and watery itchy eyes that recur during specific parts of the year (especially Spring and Fall) are a cause of much suffering of a large segment of the U.S. population. Millions of dollars are spent on medications and the allergy shots for the treatment of seasonal allergies.

Western medicine views seasonal allergies as a form of immediate hypersensitivity reaction which occurs when anti-bodies produced by lymphocytes interact with airborne particles such as pollen. Western medicine describes the locations of lymphocytes in addition to being in the blood stream as also in Peyer's patches in the gastrointestinal tract, spleen, lymph nodes, and bone marrow. Interestingly in my practice of acupuncture the Spleen, Stomach, and Large Intestine meridians are utilized a great deal. One sees an interesting overlap of Western and Chinese medical thought. Also, Chinese medical thought sees sweets as being harmful to the Spleen (Chinese sense of the Spleen) function. In my practice sweets are often a major factor in the persistence and intensity of seasonal allergy symptoms.

I find it gratifying to treat seasonal allergies with acupuncture. There is often a quick response. Often patients get some relief during the first visit while lying on the exam table with their acupuncture needles in place. Patients are asked to score their nose stuffiness on a zero to ten scale. Zero meaning no stuffiness at all and 10 being the worst possible stuffiness for the patient. A score may be determined before and after the acupuncture treatment. Patients can also determine the effectiveness of acupuncture treatment by tracking the number of sneezes per day and the number of itching episodes around their eyes. After an initial series of treatments, patients come in for further treatments on an as needed basis. Some patients come back in once or twice a year for a booster while others may come more often. In general, patients do better if they avoid sugar and milk in their diets. They have better and longer lasting responses. I have seen many patients who failed medication and allergy shots respond to acupuncture. Patients continue with whatever standard treatments they are currently undergoing while getting acupuncture treatments. Most patients end up significantly reducing or eliminating their dependence on allergy medications.

There are many different ways of performing acupuncture, for example TCM (Traditional Chinese Medicine), Japanese, Korean, French Energetics, Worsley 5 Elements, ear, hand, etc. In choosing an acupuncturist the specific style a practitioner uses is not so important as the success rate a practitioner obtains with whatever style they use. Prospective patients should speak with the acupuncturist and inquire about past experience in treating seasonal allergies and their success rate.

In conclusion, it is my opinion that acupuncture is an excellent treatment option for seasonal allergies.

this article originally appeared on medicalacupuncture.org and was written by  Patrick J. LaRiccia, M.D.


 

The Chinese Medicine Meridian System

So, what is a meridian anyway? This is one of the first questions students of Chinese medicine want to understand. Simply put, a meridian is an ‘energy highway’ in the human body. Qi (chee) energy flows through this meridian or energy highway, accessing all party of the body. Meridians can be mapped throughout the body; they flow within the body and not on the surface, meridians exist in corresponding pairs and each meridian has many acupuncture points along its path.

The term ‘meridian’ describes the overall energy distribution system of Chinese Medicine and helps us to understand how basic substances of the body (Qi, blood and body fluids) permeate the whole body. The individual meridians themselves are often described as ‘channels’ or even ‘vessels’ which reflects the notion of carrying, holding, or transporting qi, blood and body fluids around the body.

It is tempting to think of the meridians of the human body the same way as we think of the circulatory system, as the meridians are responsible for the distribution of the basic substances throughout the body just like the circulatory system, but here is where the similarities end. Conventional anatomy and physiology would not be able to identify these pathways in a physical sense in the way that blood vessels can be identified.

It is more useful to consider the meridian system as an energetic distribution network that in itself tends towards energetic manifestation. Meridians can be best understood as a process rather than a structure.

Practitioners of Chinese Medicine must be as knowledgeable about these meridian channels as the Western Doctor is about anatomy and physiology of the physical body. Without this thorough understanding, successful acupuncture treatments would be difficult. A practitioner of Chinese Medicine must know how and where to access the qi energy of the body to facilitate the healing process.

There are twelve main meridians, or invisible channels, throughout the body with Qi or energy flows. Each limb is traversed by six channels, three Yin channels on the inside, and three Yang channels on the outside. Each of the twelve regular channels corresponds to the five Yin organs, the six Yang organs as well as the Pericardium and San Jiao. These are organs that have no anatomical counterpart in Western medicine but also relate to processes in the body. It is also important to remember that organs should not be thought of as being identical with the physical, anatomical organs of the body.

Each meridian is a Yin Yang pair, meaning each Yin organ is paired with its corresponding Yang Organ: the Yin Lung organ, for example, corresponds with the Yang large intestine.

Qi flows in a precise manner through the twelve regular meridians or channels. First, Qi flows from the chest area along the three arm Yin channels (Lung, Pericardium, and Heart) to the hands. There they connect with the three paired arm Yang channels (Large Intestine, San Jiao and Small Intestine) and flow upward to the head. In the head they connect with their three corresponding leg Yang Channels (Stomach, Gall Bladder and Bladder) and flow down the body to the feet. In the feet they connect with their corresponding leg Yin channels (Spleen, Liver, Kidney) and flow up again to the chest to complete the cycle of Qi.

• Arm Tai Yin channel corresponds to the Lung
• Leg Tai Yin channel corresponds to the Spleen
• Arm Shao Yin channel corresponds to the Heart
• Leg Shao Yin corresponds to the Kidney
• Arm Jue Yin corresponds to the Pericardium
• Leg Jue Yin corresponds to the Liver
• Arm Yang Ming corresponds to the Large Intestine
• Leg Yang Ming corresponds to the Stomach
• Arm Tai Yang corresponds to the Small Intestine
• Leg Tai Yang corresponds to the Bladder
• Arm Shao Yang corresponds to the San Jiao
• Leg Shao Yang Channel corresponds to the Gall Bladder

The arm and leg channels of the same name are considered to ‘communicate’ with each other in Chinese medicine. Thus, problems in a given channel or organ can be treated by using various points on the communication ‘partner’. As an example: a problem with the lungs can be treated by using points on the Spleen channel as they are both Tai Yin channels.

In addition to the twelve regular meridians there are ‘Extraordinary Meridians’ that are not directly linked to the major organ system but have various specific functions:

1) they act as reservoirs of Qi and blood for the twelve regular channels, filling and emptying as required

2) they circulate jing or ‘essence’ around the body because they have a strong connection with the Kidneys

3) they help circulate the defensive Wei Qi over the trunk of the body and, as such, play an important role in maintaining of good health

4) they provide further connections between the twelve regular channels

The meridian system of the human body is a delicate, yet intricate web of interconnecting energy lines. If a person masters an understanding of this meridian system they will know the secrets of the flow of Qi energy in the body.

For a colored map of the meridians of the body visit Acupuncture Chart – Main Meridians.

This article originally appeared on http://www.acos.org/articles/the-chinese-medicine-meridian-system/