Acupuncture and its Complementary Role in the Treatment of - - PowerPoint PPT Presentation

Acupuncture and its Complementary Role in the Treatment of Cardiovascular Diseases.

Roger Wang A.P.

• Dr. Huimin Wang A.P.

Wang Acupuncture Jacksonville, FL http://wangacupunctureclinic.com

How Does Acupuncture Work?



How Does Acupuncture Work?

• 1. Conduction of electromagnetic signals:1



strategic conductors of electromagnetic signals.



electromagnetic signals to be relayed at greater-than- normal rates.



Endorphins, immune system.

• 2. Activation of the body’s Natural Opioid System1:

 Acupuncture releases opioids. 2-3

How Does Acupuncture Work?

3. Stimulation Of The Hypothalamus And The Pituitary Gland:1, 4

 Wide range of effects.

4. Change In The Secretion Of Neurotransmitters And Neurohormones.1, 5 5. Modulate the activity within specific brain areas to affect perception of pain.6-9

9

How Does Acupuncture Work?

PCC = left posterior cingulate cortex rAI = right Anterior Insula

How Does Acupuncture Work?

• 6. Eastern perspective: flow of qi in meridians.

Who Offers Acupuncture?

 Mayo Clinic  Johns Hopkins Hospital  Massachusetts General Hospital  Brigham and Women's Hospital  Cleveland Clinic  University of Texas MD Anderson Cancer

Center

 Memorial Sloan-Kettering Cancer Center  And many more . . .

Example from Our Experience: Migraines

 86 yo female with severe migraine headaches:

 Twice a week, each time lasting 2 days.  Pain level 10/10  No movement, no food, eye closed lying in bed.

 After 11 treatments, no pain. Recurred 11 months later

with 5/10 intensity.

 Treated twice and no pain for 12 months.  Now only treat as needed.

Example from Our Experience: Neck Pain

 42 yo female walks in crying. CC was neck pain

radiating to right arm, with pain level “11/10,” according to the patient.

 History of disk herniation in cervical spine.  After 1 treatment, pain level 1/10.

Example from Our Experience: Low Back Pain

 70 yo female dragged into clinic by relatives because

she’s skeptical about acupuncture.

 She experienced back pain 9-10/10  Poor candidate for back surgery, with high risk of

paralysis.

 3 Treatments, no pain. Still pain free to this day (5

years so far).

Example from Our Experience: Bursitis

 62 yo female from NY with bursitis who sort treatments

from about half a dozen acupuncturists in NY with no relief.

 Pain level 8/10.  After 1 treatment no pain. Pain free since Jan 2013.

Example from Our Experience: IBS

 74 yo female with abdominal pain for 40 years. Pain is

continuous and between 5-8/10. Unable to sleep or eat due to pain.

 Diagnosis was IBS.  Unable to find relief from all the doctors she’s been to

for the last few decades.

 Acupuncture relieved her pain 95%, but needs

treatment every week to stay pain free.

Example from Our Experience: Undiagnosed

 53 yo female with

 34 year history of episodes of hot spells in which she

must lie face down on the floor. Retains consciousness.

 1-3 time/day on many days, each time for 15-20 minutes.  All tests and exams and imaging studies show no

abnormalities.

 Also evaluated for mental health with no diagnosis.

 1 year treatment, now back to normal.

Example from Our Experience:

Unknown

 56 yo male with 8 year history of eyes closing when making right

• turns. Happens when either walking or driving.

 Eyes are fine when walking straight or making a left turn. Also fine

when turning head right or left while stationary.

 Eyelids will only open again when manually forced to by hands.  No diagnosis and no treatment.  Three treatments, each treatment provided relief lasting 2 days.  Did not continue treatment due to financial reasons.

Our Experience: Insomnia

 45 yo male lawyer complaining of insomnia due to

continuous stress at work. Only able to sleep for 3-4 hours each night.

 After each acupuncture treatment, able to sleep

normally for about 2 to 3 nights.

Our Experience: Systems with Disorders we can treat

 Musculoskeletal  Neurological  GI  Respiratory  HEENT  Dermatology  Genital Urinary system  Obstetrics/Gynecology  Immune System  Endocrine  Cardiovascular  Mental Health  Etc. . .

Little known fact about acupuncture to outsiders:

 Diverse field with many approaches. Efficacy is method specific.

Interpretation of Studies

What are the Indications?

 According to a VA Literature Review in 2014.10  Pain:10



Positive Effect:

 Headache in General and Migraine Specifically.  Chronic Pain.  Dysmenorrhea

What are the Indications?

 Potentially positive effect:10

 Osteoarthritis  General Pain  Cancer Pain  Labor pain  Prostatitis  Plantar Heel  Tempomandibular  Pregnancy pain

10

What are the Indications?

 Wellness:10

 Potential Positive Effect:

 Insomnia  Smoking cessation  Post-Operative Nausea and Vomiting  Restless Legs

10

What are the Indications?

 Mental Health:10

 Potential Positive Effect:

 Depression  Schizophrenia  Anxiety  PTSD

10

What are the Indications?

 Cochrane Review:11-19

 migraine prophylaxis  tension-type headache  neck disorders  low back pain  peripheral joint osteoarthritis  fibromyalgia  chemotherapy-induced nausea or vomiting.  Pain management for women in labor  postoperative nausea and vomiting

What are the Indications?

According to Johns Hopkins Integrative Medicine & Digestive Center:20

 Acute and chronic pain, including repetitive motion injuries

(e.g. carpal tunnel syndrome, trigger finger, and tendonitis), TMJ and teeth grinding, traumatic and post-surgical pain

 Autoimmune disorders, including rheumatoid arthritis,

fibromyalgia and chronic fatigue, Sjogren’s syndrome, Hashimoto’s thyroiditis, Graves’ disease, Raynaud’s phenomenon, scleroderma, Crohn’s disease, Systemic lupus erythematosus, autoimmune hepatitis, and multiple sclerosis

What are the Indications?

According to Johns Hopkins Integrative Medicine & Digestive Center:20

 Cognitive issues, such as lack of concentration, poor

memory, ADD, and inability to focus

 Dermatological conditions, such as eczema, psoriasis, and

cystic acne

 Energy problems, such as fatigue, lack of motivation, and

chronic fatigue syndrome

 Gastrointestinal conditions, including heartburn; abdominal

pain; irritable colon; diarrhea; constipation

What are the Indications?

According to Johns Hopkins Integrative Medicine & Digestive Center:20



Gynecological and obstetric issues, including PMS; painful periods; morning sickness, fetal breech presentation, support for delivery in late pregnancy, support for lactation difficulties



Infertility and reproductive problems of women and men



Insomnia and sleep disorders



Musculoskeletal issues, such as low back pain; muscle, tendon, or joint pain; sports injuries



Neurological conditions including chronic headaches; sciatica; nerve injuries



Respiratory problems, such as asthma; sinusitis; allergic rhinitis

What are the Indications?

According to Johns Hopkins Integrative Medicine & Digestive Center:20 “This list is not exhaustive. If you have a health concern not listed above, give us a call and we will be happy to discuss your case.”20

What are the Indications?

According to the World Health Organization:21

 Adverse reactions to radiotherapy and/or chemotherapy  Allergic rhinitis (including hay fever)  Biliary colic  Depression (including depressive neurosis and depression

following stroke)

 Dysentery, acute bacillary  Dysmenorrhoea, primary  Epigastralgia, acute (in peptic ulcer, acute and chronic

gastritis, and gastrospasm)

What are the Indications?

According to the World Health Organization:21

 Facial pain (including craniomandibular disorders)  Headache  Hypertension, essential  Hypotension, primary  Induction of labour  Knee pain  Leukopenia  Low back pain  Malposition of fetus, correction of  Morning sickness

What are the Indications?

According to the World Health Organization:21

 Nausea and vomiting  Neck pain  Pain in dentistry (including dental pain and temporomandibular

dysfunction)

 Periarthritis of shoulder  Postoperative pain  Renal colic  Rheumatoid arthritis  Sciatica  Sprain  Stroke  Tennis elbow

Cardiovascular Indications.

According to the above sources:

 Raynaud’s phenomenon20  Hypertension, essential21  Hypotension, primary21  Stroke21

Cardiovascular Indications.

According to Our Clinical Experience:

 Stroke Recovery  Peripheral Neuropathy (due to PAD or other causes)  Hypertension  Hypotension  Certain types of arrhythmia (possible parasympathetic and

sympathetic regulation)22, 23

 Raynaud’s phenomenon  Chest Pain (CAD already ruled out by physician)

Arrhythmia: Case 1

 Urologist from Chicago sort treatment for arrhythmia.  Before treatment, skipped beats 12-15/min  3 treatments, down to 3-5/min

Peripheral Neuropathy: Case 2

 64 yo female with peripheral arterial disease and

peripheral neuropathy.  Numbness, burning, tingling and pain 8-9/10 on both feet

 After 12 treatments, 1/10 on both feet.

Stroke: Case 3

Patient # Treatment Started Recovery 1 11 days 100% 2 6 months 50-60% 3 2 years 30% 4 5 years 5% Start of treatment following event vs. extent of stroke recovery. Note: all are thrombotic strokes The earlier you start acupuncture, the better the prognosis.

Migrianes: Case 4

 85 yo female with Migraines for 70 years.  Severity 10/10  Frequency 2x/week, each time lasting 1-2 days.  Tried everything, to no effect.  Treatment after 6-7 weeks, pain is down to 1-2/10.

Now gets treatment every 6 months or so to maintain therapeutic effect.

Cervical Spondylopathy: Case 5

 45 yo female comes into office crying from neck pain

radiating to right arm and hand. Pain level is 11/10, according to the patient. Radiology report shows degenerative disk disease at C4-C5, C5-C6, C6-C7, as well osteophytes from C3-C7

 After 1st treatment, pain is down to 2-3/10. After 5

treatments, pain is down to 0-1/10. Patient has been pain for more than 1 year now.

Trigeminal Neuralgia: Case 6

 Ex- Navy SEAL with Trigeminal Neuralgia, pain level

9/10 for 1 hour per day, such that he becomes incapacitated and “rolls around on the floor in agony.” (according to patient)

 After 6 Treatments, maximum pain level 5-6/10,

duration 30 min to 1 hour. Patient had no pain on the last day of treatment.

 Had to go to Afghanistan after 6 treatments. Even

though patient is still in pain, he is now able to function.

Recap: Acupuncture’s indications according

• ur experience and methods.

 Pain relief:

 Migraines.  Neck Pain  Back Pain

 Musculoskeletal conditions/Sports Injuries  Neurological Conditions  GI conditions  Much more . . .

For a more complete list, visit our website: http://wangacupunctureclinic.com.

Recap: Acupuncture’s indications according

• ur experience and methods.

 Cardiovascular indications:

 Stroke Recovery  Peripheral Neuropathy (due to PAD or other causes)  Hypertension  Hypotension  Certain types of arrhythmia  Raynaud’s phenomenon  Chest Pain

Chinese Medicine vs. Western Medicine

Chinese Medicine Western Medicine

• Natural
• Ancient
• Technologically Advanced
• Based on Science

These two approaches complement each other.

References

1. How Does Acupuncture Affect the Body. New York Presbyterian Hospital Website. https://nyp.org/health/cam-acupunc.html. Published 2008. Accessed March 17th, 2014 2. Han JS. Acupuncture and endorphins. Neurosci

• Lett. 2004 May 6;361(1-3):258-61.

3. Wang SM1, Kain ZN, White P. Acupuncture analgesia: I. The scientific basis. Anesth Analg. 2008 Feb;106(2):602-10

References

4. Cho ZH1, Hwang SC, Wong EK, et al. Neural substrates, experimental evidences and functional hypothesis of acupuncture

• mechanisms. Acta Neurol
• Scand. 2006 Jun;

113(6):370-7. 5. Yu LL1, Liu RP, Gao XY, et al. Development of studies on neurochemical mechanism of acupuncture underlying improvement of

• depression. Zhen Ci Yan Jiu. 2011 Oct;36(5):

383-7.

References

6. Huang W, Pach D, Napadow V, et al. Characterizing acupuncture stimuli using brain imaging with FMRI--a systematic review and meta-analysis of the literature. PLoS One. 2012;7(4):e32960. doi: 10.1371/journal.pone.

• 0032960. Epub 2012 Apr 9.

7. Liu H1, Xu J, Shan B, et al. Determining the precise cerebral response to acupuncture: an improved FMRI study. PLoS One. 2012;7(11):e49154. doi: 10.1371/ journal.pone.0049154. Epub 2012 Nov 9.

References

8. You Y1, Bai L, Dai R, et al. Altered hub configurations within default mode network following acupuncture at ST36: a multimodal investigation combining fMRI and MEG. PLoS

• One. 2013 May 17;8(5):e64509. doi: 10.1371/

journal.pone.0064509. Print 2013. 9. Zyloney CE1, Jensen K, Polich G, et al. Imaging the functional connectivity of the Periaqueductal Gray during genuine and sham electroacupuncture

• treatment. Mol Pain. 2010 Nov 16;6:80.

References

10. Hempel S, Taylor SL, Solloway MR, et al. Evidence Map of Acupuncture. Washington (DC): Department of Veterans Affairs; 2014

• Jan. http://www.ncbi.nlm.nih.gov/books/NBK49060/

Accessed March 17th 2014. 11. Furlan AD, van Tulder MW, Cherkin D, Tsukayama H, Lao L, Koes BW, Berman BM. Acupuncture and dry-needling for low back

• pain. Cochrane Database of Systematic

Reviews 2005, Issue 1. Art. No.: CD001351. DOI: 10.1002/14651858.CD001351.pub2

References

12. Linde K, Allais G, Brinkhaus B, Manheimer E, Vickers A, White AR. Acupuncture for migraine

• prophylaxis. Cochrane Database of Systematic

Reviews 2009, Issue 1. Art. No.: CD001218. DOI: 10.1002/14651858.CD001218.pub2. 13. Trinh K, Graham N, Gross A, Goldsmith CH, Wang E, Cameron ID, Kay TM, Cervical Overview

• Group. Acupuncture for neck disorders. Cochrane

Database of Systematic Reviews 2006, Issue 3. Art. No.:

• CD004870. DOI:

10.1002/14651858.CD004870.pub3

References

14. Manheimer E, Cheng K, Linde K, Lao L, Yoo J, Wieland S, van der Windt DAWM, Berman BM, Bouter LM. Acupuncture for peripheral joint osteoarthritis. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.:

• CD001977. DOI:

10.1002/14651858.CD001977.pub2 15. Linde K, Allais G, Brinkhaus B, Manheimer E, Vickers A, White AR. Acupuncture for tension-type headache. Cochrane Database of Systematic Reviews 2009, Issue 1.

• Art. No.: CD007587. DOI:

10.1002/14651858.CD007587.

References

16. Deare JC, Zheng Z, Xue CCL, Liu JP, Shang J, Scott SW, Littlejohn G. Acupuncture for treating fibromyalgia. Cochrane Database of Systematic Reviews 2013, Issue 5.

• Art. No.: CD007070. DOI:

10.1002/14651858.CD007070.pub2. 17. Ezzo J, Richardson MA, Vickers A, Allen C, Dibble S, Issell BF, Lao L, Pearl M, Ramirez G, Roscoe JA, Shen J, Shivnan JC, Streitberger K, Treish I, Zhang G. Acupuncture-point stimulation for chemotherapy-induced nausea or vomiting. Cochrane Database of Systematic Reviews 2006, Issue 2. Art. No.: CD002285. DOI: 10.1002/14651858.CD002285.pub2.

References

18. Jones L, Othman M, Dowswell T, Alfirevic Z, Gates S, Newburn M, Jordan S, Lavender T, Neilson JP. Pain management for women in labour: an overview of systematic reviews. Cochrane Database of Systematic Reviews 2012, Issue 3. Art. No.: CD009234. DOI: 10.1002/14651858.CD009234.pub2. 19. Lee A, Fan LTY. Stimulation of the wrist acupuncture point P6 for preventing postoperative nausea and

• vomiting. Cochrane Database of Systematic Reviews

2009, Issue 2. Art. No.: CD003281. DOI: 10.1002/14651858.CD003281.pub3.

References

20.

• Acupuncture. Johns Hopkins Integrative

Medicine & Digestive Center Website http://www.hopkinsmedicine.org/integrative_medici ne_digestive_center/services/acupuncture.html. Accessed March 17th, 2014 21. Acupuncture: Review and Analysis of Reports on Controlled Clinical Trials. World Health Organization. http://apps.who.int/medicinedocs/en/d/Js4926e/5.ht ml . Published 2003. Accessed March 17th, 2014.

References

22. Lombardi F1, Belletti S, Battezzati PM, Lomuscio

• A. Acupuncture for paroxysmal and

persistent atrial fibrillation: An effective non- pharmacological tool? World J Cardiol. 2012 Mar 26;4(3):60-5 23. Li J1, Li J, Chen Z, et al. The influence of PC6 on cardiovascular disorders: a review of central neural

• mechanisms. Acupunct Med. 2012 Mar; 30(1):47-50.