Acupuncture research in Taiwan

Incidence of nerve injury following acupuncture treatments in Taiwan

OBJECTIVE

Acupuncture, a widely employed traditional therapeutic modality known for its efficacy in pain alleviation and diverse condition management, may inadvertently result in mechanical nerve injury due to its invasive nature. This research aimed to ascertain the incidence of nerve injuries post-acupuncture, identify associated risk factors, and map the distribution of nerve injury sites.

METHODS

A case-control study nested in the National Health Insurance Research Database (NHIRD) 2000-2018 two million cohort was conducted. Patients previously diagnosed with nerve injury, surgery, or degeneration before acupuncture were excluded. Cases were defined as patients receiving acupuncture and seeking medical attention for nerve injury (ICD9-CM code 950-957) within 14 days post-procedure, while control groups comprised patients undergoing acupuncture without subsequent adverse events. Invasive treatments prior to adverse events and adverse events occurring more than 14 days post-acupuncture were excluded. To ensure case-control comparability, factors such as age, gender, socioeconomic status, and medical facility environment were controlled using propensity score matching.

RESULTS

The study encompassed 14,507,847 acupuncture treatments administered to 886,753 patients, with 8361 instances of post-acupuncture nerve injury identified, representing an incidence rate of approximately 5.76 per 10,000 procedures. Age emerged as a significant risk factor, with the adjusted odds ratios escalating with age. Several comorbidities including diabetes, hypothyroidism, liver cirrhosis, chronic kidney disease, herpes zoster, hepatitis virus, rheumatoid arthritis, systemic lupus erythematosus, dementia, and cerebrovascular accidents were associated with an elevated risk of nerve injury post-acupuncture.

CONCLUSION

This study underscores the importance of meticulous patient profiling and cautious therapeutic approach in acupuncture, considering the evident influence of various demographic, systemic, and treatment-related factors on the incidence of nerve injuries.

Effects of electroacupuncture at KI3 and ST36 on the hypothalamic paraventricular nucleus in a rat model of chronic glomerulonephritis

OBJECTIVE

The hypothalamic paraventricular nucleus (PVN) acts as a critical integrating center of endocrine/autonomic responses and regulates visceral functional activities. However, its involvement in electroacupuncture (EA) treatment of chronic glomerulonephritis (CGN) remains unclear.

METHODS

Over four experiments, we randomized 111 rats into: control, untreated model (CGN) or EA-treated model (CGN + EA) groups, a model group receiving EA after PVN damage (CGN + EA + Lesion) or untreated model groups injected with adeno-associated viral vectors encoding human M4 muscarinic receptor (CGN + hM4D) or enhanced green fluorescent protein (CGN + EGFP). CGN was modeled by intraperitoneal injection of bovine serum albumin for 2 weeks. Rats in the CGN + EA and CGN + EA + Lesion groups received EA at bilateral ST36 and KI3 for 14 days. Urine/serum samples were collected to evaluate inflammatory factors and changes in renal function.

RESULTS

EA inhibited the release of interleukin (IL)-6, tumor necrosis factor (TNF)-α and IL-1β, and decreased urine protein (PRO), creatinine (Cre) and blood urea nitrogen (BUN) levels. PVN damage influenced the effect of EA on the levels of these parameters. EA appeared to inhibit the firing frequency and spectral energy of PVN neurons. In the viral vector experiment, levels of PRO, Cre, IL-6, IL-1β and TNF-α in the CGN group were increased in CGN versus control groups (p < 0.0001), decreased in CGN + hM4D versus CGN groups (p < 0.05) and did not differ between CGN + EGFP and control groups (p > 0.05).

CONCLUSION

Our findings indicate that EA at ST36 and KI3 improves CGN in this rat model by weakening the activity of PVN neurons, alleviating impairment of renal function impairment and restricting the release of inflammatory factors.

A bibliometric analysis of acupuncture research in Taiwan from 1988 to 2017

BACKGROUND

Since Taiwan's national health insurance system provides residents with easy and affordable access to clinical acupuncture treatment, this study sought to analyze trends in the publication of acupuncture-related research in Taiwan from 1988 to 2017, using a bibliometric method.

METHODS

Data on the scholarly literature from 1988 to 2017 were retrieved through Web of Science searches for the keywords acupunct*, acupoint*, electroacupunct*, electro-acupunct*, acupre*, auricular acupunc*, and auricular needle* in study titles.

RESULTS

A total of 539 acupuncture-related articles published from 1988 to 2017 were identified and analyzed. The articles had an h-index of 38 and were cited in subsequent studies 7250 times, meaning that Taiwan ranked sixth in the production of such publications among countries/regions globally. Among those articles, 99 (18.4%) had no subsequent citations, six (1.1%) were highly cited (over 100 citations), and 141 (26.1%) were cited 4 to 10 times. The highly cited articles discussed the possible pathways of acupuncture stimulation and efficacy, and received 1103 (15.2%) of the citations.

CONCLUSION

The China Medical University in Taichung, Taiwan, was the most active educational institution in Taiwan in terms of acupuncture-related research. Professor Lin Jaung-Geng was the leading acupuncture-related researcher, having the most publications, citations, and the highest h-index value. These results provided a context for analyzing the strengths of the existing research and informing prospective strategies for further studies.

Contemporary acupressure therapy: Adroit cure for painless recovery of therapeutic ailments

Since time immemorial, complementary and alternative medicines (CAM) have played a significant role in human health care. CAM is known to have a strong reputation and reliability within every culture to provide basic health care treatment for patients. CAM acts as a better therapeutic option in human being for treating various diseases and improving quality of life with apt consideration to the economic aspects. Acupressure, one of the known CAM, originated in ancient China is based on the principal of acupoints activation across the meridians which correct the imbalance between Qi. Activation of specific points on the meridians is known to facilitate reduction of pain at the local sites. It also reduces the pain from other body parts. This review outlines various types, devices and mechanisms involved in the acupressure treatment.

Attitudes toward acupuncture in Hong Kong

Purpose

– This paper aims at describing and exploring how consumers perceive acupuncture as a medical treatment in relation to biomedicine.

Design/methodology/approach

– Data were collected through an online survey using quota sampling. The attitudes of 879 Hong Kong residents aged 20 or above were surveyed. Questions were generated from a previous focus group study.

Findings

– Factor analysis found that attitude toward acupuncture consisted of five underlying dimensions, including trust in biomedicine, risks versus benefits, cure and effectiveness, qualification and skills of acupuncturists, side effects and costs and severe aftereffects. Lack of trust in acupuncturists and perceived inferiority of acupuncture to biomedicine were the major barriers of public acceptance of acupuncture. Perceived strengths of acupuncture identified were not involving taking medicine, fewer side effects and being good for preventive care.

Research limitations/implications

– This study used a convenience sample recruited through personal networks, so the findings cannot automatically be generalized to the rest of the population.

Practical implications

– There is a need to build trust in the therapy and the reputation of acupuncturists through better communication of the profession’s qualification and accreditation system, as well as dissemination of clinical evidence on a long-term basis. Consumers need to be better educated about the sensations to be expected during acupuncture and the criteria for selecting an acupuncturist.

Originality/value

– This has been the first quantitative study focusing on Hong Kong consumers’ perceptions of acupuncture.

The meridian system and mechanism of acupuncture: a comparative review. Part 3: Mechanisms of acupuncture therapies

The human body is a hierarchical organism containing many levels of mutually interacting oscillatory systems. From the viewpoint of traditional Chinese medicine, health is a state of harmony emergent from the interactions of these systems and disease is a state of discord. Hence, human diseases are considered as disturbed functions rather than changed structures. Indeed, the change from normal to abnormal structure may be beneficent rather than maleficent. For example, when one kidney becomes twice the normal size following the destruction of the other kidney, it is good and not bad for us because we might be dead otherwise. Therefore, in Part 3 of this three-part series, emphasis is mainly laid on the acupuncture mechanisms of treating disturbed physiological functions rather than disordered structures. At first, the basic tenets of conventional neuroscience and cardiology are reevaluated so that clear understanding of how nervous and cardiovascular systems work together can be obtained. Then, the general principles of diagnosis and treatment in traditional Chinese medicine from the integrative perspective of complex dynamic systems are proposed. Finally, mechanisms of acupuncture therapies for treating 14 different categories of disorders will be elucidated via the magneto-electric inductive effects of the meridian system.

The meridian system and mechanism of acupuncture--a comparative review. Part 2: mechanism of acupuncture analgesia

In traditional Chinese medicine (TCM), pain is never merely a sign of discomfort. It is usually an integral part of a particular disease or physiological malfunction. Thus pain should not be treated in isolation since it will disappear as soon as its cause is identified and removed. Hence, in this Part 2 of a three-part series, initially, clinical pathologies in modern medicine and TCM are compared. Then, the pain pathophysiologies of these two schools of thought are reviewed. In addition, certain unique features of acupuncture effects that any valid mechanism must account for are outlined. Finally, various mechanisms of acupuncture analgesia are reviewed. One plausible mechanism based on the meridian system of Part 1, i.e., the chaotic wave theory of fractal continuum in terms of the neurovascular network, is also proposed. It contends that the injury current due to acupuncture at an acupoint will trigger electromagnetic inductive effects so that the impedances of correlated neurovascular bundles are drastically changed. Two consequent scenarios are possible. (1) If the impedance of the meridian hugely mismatches with that of the brain after acupuncture, then the traveling wave of pain signal will be largely reflected back and only partially transmitted to the brain, hence pain relief can be achieved. (2) If the impedance of the meridian entirely matches that of the pain source after acupuncture, then the pain source would appear to be nonexistent to the brain, hence analgesia can be achieved. The former mechanism can be used to explain the relief for chronic pain and the latter one for acute pain. It is believed that the proposed mechanisms via match or mismatch of the impedances can explain how the acupuncture works not only in the treatment of pain, but also in various other therapies of Part 3.

The meridian system and mechanism of acupuncture-a comparative review. Part 1: the meridian system

In traditional Chinese medicine (TCM), acupuncture has been used to heal various diseases and physiologic malfunctions in clinical practice for more than 2500 years. Due to its efficacy, acupuncture has been recommended by the World Health Organization in 1980 as an effective alternative therapy for 43 different disorders. Over the past few decades, various theories of the meridian system and mechanisms have been proposed to explain how acupuncture might work. Most of these mechanisms, however, cannot yet explain conclusively why acupuncture is efficacious in treating so many different diseases. A plausible mechanism has been unavailable until recently. This is the first of a three-part series that aims to provide a comparative review of the aforementioned topics. Part 1 reviews the current indications for acupuncture, basic concepts of TCM, and the essence of the meridian system. To establish a mathematically rigorous framework of TCM, the chaotic wave theory of fractal continuum is proposed. This theory is then applied to characterize the essence of the meridian system. Parts 2 and 3 will review the possible mechanisms of acupuncture analgesia and acupuncture therapies, respectively, based on biochemical, bioelectromagnetic, chaotic wave, and neurophysiologic approaches. It is sincerely hoped that this series of review articles can promote an understanding of the meridian system and acupuncture mechanisms to help patients in a logical and passionate way.