Effect of acupuncture on heart rate variability: a systematic review

Acupuncture in Traditional Chinese Medicine: A Complementary Approach for Cardiovascular Health

Cardiovascular diseases (CVDs) are increasingly prevalent in clinical settings. With the continuous improvement of people's living standards, the gradual acceleration of the pace of life, and the deterioration of the living environment in recent years, the incidence of CVDs is increasing annually. The prevalence of CVDs among individuals aged 50 and above is notably elevated, posing a significant risk to patients' well-being and lives. At this juncture, numerous clinical treatment choices are available for managing CVDs, with traditional Chinese medicine (TCM) therapy standing out as a practical, safe, and reliable option. Over the recent years, there has been growing acknowledgement among both medical professionals and patients. With the expanding integration of TCM in the treatment of various clinical conditions, the use of TCM in managing CVDs has gained significant attention within the medical community, potentially emerging as an efficacious approach for addressing cardiovascular diseases. This article conducts a comprehensive review of the TCM approach, particularly acupuncture, as a supplementary treatment for CVDs, highlighting its ability to effectively lower blood pressure, decrease coronary artery events, mitigate arrhythmias, and enhance cardiac function when used alongside conventional medication. The review underscores the promise of acupuncture in enhancing cardiovascular health, although variations in research methodologies necessitate standardized applications.

Efficacy and Safety of Acupuncture for Restless Legs Syndrome in Patients with End-Stage Renal Disease: A Randomized-Controlled Trial at Hospital-Based Hemodialysis Center

Background: Restless legs syndrome (RLS) is frequent in patients with hemodialysis (HD) and occurs predominantly in its most severe forms. The study was conducted to evaluate the efficacy and safety of acupuncture for RLS in patients with end-stage renal disease (ESRD) at hospital-based HD center. Methods: This single-blind, randomized controlled trial was performed on patients with HD and RLS who were randomly assigned to the experimental group and control group. Data were collected using the International Restless Legs Syndrome Rating Scale (IRLSRS), Insomnia Severity Index (ISI), and heart rate variability (HRV) records at baseline, after the therapeutic course (12 times/4 weeks), and 1-week follow-up. Result: A total of 47 patients were evaluated with IRLSRS score from 11 to 30 in this study. There were 41 patients enrolled in the study based on inclusion/exclusion criteria and allocated randomly into two groups. A total of 35 participants completed the trial, including 18 subjects in the experimental group and 17 subjects in the control group. The comparison of IRLSRS and ISI showed a significant reduction between two groups after acupuncture treatment (p = 0.002, p = 0.003). The ISI after 1-week follow-up also revealed significant decrease (p = 0.003). This HRV results showed that high frequency (HF%) increased significantly (p = 0.021) and low frequency (LF%) decreased significantly in the acupuncture group (p = 0.021). The generalized estimating equation showed that the IRLSRS improved by 2.902 points (p < 0.001) in the acupuncture group compared with the control group and by 1.340 points (p = 0.003) after 1-week follow-up. There were no adverse effects observed during HD in this study. Discussion: The authors conclude that acupuncture could effectively improve the symptoms of RLS significantly. The results from this study provide clinical evidence on the efficacy and safety of acupuncture to treat the patients with RLS at the HD center.

Acupuncture Treatment for Generalized Anxiety Disorder by Activating the Vagus Nerve and Improving Heart-Rate Variability and Heart-Rhythm Coherence, A Case-Series Study

Objective

The goal of this case series was to observe the effectiveness of acupuncture for reducing sympathetic stress and anxiety-related symptoms in generalized anxiety disorder. The effect of acupuncture on the balance of the autonomic nervous system was also examined.

Materials and Methods

This was a case-series study with 10 participants enrolled. Each participant received acupuncture treatment 2 times per week for 4 weeks. Participants were evaluated with the Generalized Anxiety Disorder-7 (GAD-7) scale and the Body Perception Questionnaire-Short Form (BPQ-SF) before and after the treatment program. Heart-rate variability heart-rhythm coherence (HRC) was also assessed during each acupuncture session.

Results

Five participants completed the program. Both GAD-7 and BPQ mean scores showed significant reductions. The mean HRC high-coherence ratio also increased significantly after acupuncture treatment. No adverse effects occurred.

Conclusions

Acupuncture may be an effective therapy for sympathetic stress and anxiety-related symptoms. The mechanism of action may be through activating the vagus nerve and improving the HRC high coherence ratio. It is feasible to conduct larger clinical trials with random controls, longer treatment durations, and long-term follow-ups to support the results of this study.

What is the analgesic range of acupuncture stimulus for treating acute pain?

Introduction

Since the analgesic effect of acupuncture stimulation is derived from different mechanisms depending on the type of pain, it is important to know which acupuncture points to stimulate. In this study, to confirm the effect of acupuncture stimulation on acute pain from a neurological point of view, somatosensory evoked potential and sensory threshold changes were evaluated to identify the nerve range that is affected by acupuncture stimulation on LI4 (Hapgok acupuncture point, of the radial nerve) during acute pain.

Methods

The subjects were 40 healthy men and women aged 19-35 years. The study was designed as a randomly controlled, crossover trial with acupuncture stimulation at LI4 as the intervention. The washout period for acupuncture stimulation was 2 weeks, and the subjects were divided into two groups, i.e., an acupuncture stimulation group and a nonstimulation group, with 10 men and 10 women in each group. Somatosensory evoked potential measurement was carried out for 5 min by alternately applying 2 HZ-pulse electrical stimulation to the thumb and the little finger of the hand acupunctured with a 64-channel electroencephalogram. The verbal rating scale was used before and after each acupuncture stimulation session.

Result and discussion

The results of the study confirmed that the somatosensory evoked potential amplitude value of the thumb was significantly decreased and that the intensity of sensory stimulation corresponding to a verbal rating scale score of 6 was significantly increased only in the thumb after acupuncture stimulation. Therefore, the results show that acupuncture treatment for acute pain is more effective when direct acupuncture stimulation is applied to the painful area.

Effects of Self-Administered Acupressure on Fatigue Following Traumatic Brain Injury: A Randomized Controlled Trial

BACKGROUND

Fatigue is a common symptom after a traumatic brain injury (TBI) and may persist for weeks or years. However, nonpharmacological management strategies for fatigue alleviations are almost nonexistent; thus, effective fatigue management programs are needed urgently.

PURPOSES

We aimed to evaluate the effects of self-administered acupressure programs on post-TBI fatigue and heart rate variability and identify the possible correlation between the improvements in fatigue symptoms and the changes in heart rate variability.

DESIGN

This randomized controlled trial included 2-point acupressure (TPA; n = 27), 5-point acupressure (FPA; n = 27), and usual care (UC, control; n = 27) groups who underwent several assessments before and after the study intervention. Heart rate variability was evaluated at baseline, weeks 2 and 3, and treatment completion.

METHODS

The TPA and FPA groups self-administered acupressure (3 minutes per acupoint; bilateral), thrice daily for 4 weeks, whereas the UC group received routine treatment without acupressure.

RESULTS

Both the TPA and FPA groups exhibited substantial improvements in fatigue symptoms compared with the baseline findings in the UC group. In addition, the TPA and FPA groups exhibited increased high-frequency power and mean number of times per hour in which the changes in successive normal sinus intervals (RR) gradually exceeded 50 ms (pNN50). Changes in high-frequency power and pNN50 were correlated with improvements in post-TBI fatigue symptoms.

CONCLUSION

Acupressure may alleviate chronic fatigue and enhance parasympathetic activity in TBI survivors. The enhancement of parasympathetic activity may be correlated with improvements in post-TBI fatigue symptoms.

RELEVANCE TO CLINICAL PRACTICE

Healthcare providers should incorporate self-administered acupressure into the care plans for TBI survivors to improve their fatigue symptoms.

Effect on Satisfactory Seizure Control and Heart Rate Variability of Thread-Embedding Acupuncture for Drug-Resistant Epilepsy: A Patient-Assessor Blinded, Randomized Controlled Trial

This randomized controlled trial investigates the efficacy of thread-embedding acupuncture (TEA) compared to sham TEA in treating drug-resistant epilepsy (DRE). Fifty-four DRE outpatients were randomly divided into two groups: TEA (27 patients) and sham TEA (27 patients). Both groups received four sessions of TEA or sham TEA, spaced four weeks apart, targeting GV20, GV14, BL15, BL18, ST40, and GB34 acupoints. Antiseizure medications were maintained at consistent doses throughout the study. Outcome measures included satisfactory seizure control, seizure freedom, and heart rate (HR) and heart rate variability (HRV) measurements. TEA demonstrated a significantly higher rate of satisfactory seizure control at follow-up compared to the sham TEA group (37% vs. 3.7%, p = 0.003). While no significant intergroup differences were observed in HR, HRV, and HRV components at each stage, the TEA group experienced a significant decrease in HR and a significant increase in HRV posttreatment. This study demonstrates TEA's effectiveness in managing DRE and suggests its impact may relate to heightened parasympathetic nerve activity. Further research with extended follow-up periods is necessary to validate these findings.

A randomized-controlled trial assessing the effect of intraoperative acupuncture on anesthesia-related parameters during gynecological oncology surgery

CONTEXT AND OBJECTIVES

The present study examined the impact of intraoperative acupuncture on anesthesia-related parameters in patients undergoing gynecological oncology surgery.

METHODS

Participants underwent preoperative integrative oncology (IO) touch/relaxation treatments, followed by intraoperative acupuncture (Group A); preoperative IO treatments without acupuncture (Group B); or standard care only (Group C). Mean arterial pressure (MAP), heart rate (HR), MAP variability (mean of MAP standard deviation), bispectral index (BIS), and calculated blood pressure Average Real Variability (ARV) were measured intraoperatively.

RESULTS

A total of 91 patients participated: Group A, 41; Group B, 24; Group C, 26. Among patients undergoing open laparotomy, Group A showed lower and more stable MAP and HR compared to Group B, (MAP, p = 0.026; HR, p = 0.029) and Group C (MAP, p = 0.025). Mean BIS, from incision to suture closing, was lower in Group A (vs. controls, p = 0.024). In patients undergoing laparoscopic surgery, MAP was elevated within Group A (p = 0.026) throughout surgery, with MAP variability significantly higher in Group A (P = 0.023) and Group B (P = 0.013) 10 min post-incision (vs. pre-incision). All groups showed similar intraoperative and post-anesthesia use of analgesic medication.

CONCLUSION

Intraoperative acupuncture was shown to reduce and stabilize MAP and HR, and reduce BIS in gynecology oncology patients undergoing laparotomy, with no impact on perioperative analgesic medication use. In the laparoscopic setting, intraoperative acupuncture was associated with elevated MAP. Further research is needed to explore the hemodynamic and BIS-associated benefits and risks of intraoperative acupuncture, and the impact on the use of analgesic drugs in response to these changes.

A Biophysical Model for Cardiovascular Effects of Acupuncture-Underlying Mechanisms Based on First Principles

According to recent translations by medical professionals of the foundational texts of Chinese Medicine, the acupuncture channel system can be reconciled with the neurovasculature. From there, the underlying mechanisms of the effects of acupuncture can be drawn from established physiology and known physical laws. A large body of research has been carried out using cardiovascular markers to measure the effects of acupuncture. Three of these parameters are re-viewed and explored anew in detail. The focus is on changes in microcirculation, blood pressure, and heart rate variability. The physiological mechanisms accounting for the observed changes are proposed to be ascending vasodilatation, resetting of the baroreceptor reflex, and re-organization of heart beating patterns around intrinsically assigned attractor sets.

Acupuncture Improves Heart Rate Variability, Oxidative Stress Level, Exercise Tolerance, and Quality of Life in Tracheal Collapse Dogs

Among the respiratory disorders in dogs from small breeds, tracheal collapse is one of the most commonly found in clinical practice. Presently, acupuncture is widely used as an alternative treatment which was shown to bring about positive effects in the treatment of human respiratory diseases. The present study demonstrated the effect of acupuncture on tracheal collapse dogs. We hypothesized that acupuncture can help dogs suffering from tracheal collapse by improving various parameters including heart rate variability, serum biomarkers for oxidative stress, exercise performance, and quality of life. Twenty client-owned dogs from small breeds with tracheal collapse disease were enrolled. The study was divided into two 5-week periods. During the first period, the dogs received normal veterinary care but received no acupuncture treatment (NAC). After completing that period, all forms of treatment were withheld for one week before the beginning of the second period. In the second period, all dogs restarted normal veterinary care and underwent acupuncture treatment (AC) once a week for five consecutive weeks. Blood was collected at the beginning and end of each of the two periods for malondialdehyde (MDA) level measurement. Heart rate variability (HRV) was recorded at the 1st, 3rd and 5th weeks of both periods. Exercise tests were performed at the beginning and end of AC period and questionnaire interviews with the owners were accomplished at the end of each period. The results showed that acupuncture can alleviate clinical signs of tracheal collapse, reduce MDA level, and improve sympathovagal balance. We suggest that acupuncture treatment could be used as an adjunct treatment for canine tracheal collapse.

Efficacy of Acupuncture in the Treatment of Elderly Patients with Hypertension in Home Health Care: A Randomized Controlled Trial

Objective: To evaluate the efficacy of acupuncture in helping antihypertensive drugs lower the hypertension of elderly patients in home health care. Design: Randomized controlled trial. Setting: Subjects were recruited from Branch of Linsen, Chinese Medicine, and Kunming, Taipei City Hospital, Taipei, Taiwan. Subjects: A total of 70 participants with hypertension in home health care were assigned randomly to the acupuncture group (35 participants) or the control group (35 participants). Interventions: The acupuncture group received antihypertensive drugs plus acupuncture twice a week for 12 weeks, and the control group received antihypertensive drugs only. Acupuncture points SP10, SP6, LR3, ST36, and LI4 were used bilaterally. Each acupuncture treatment session lasted 30 min. All the subjects were instructed not to alter their diet, physical activity, or use of drugs. Outcome measurements: Blood pressure (BP), heart rate variability, and the Constitution in Chinese Medicine Questionnaire (CCMQ) were assessed at baseline and at 6 and 12 weeks from the baseline between 9 am and 10 am in all subjects. Results: A total of 31 participants in each group completed the study. Within-group differences were observed in systolic BP (SBP) (p < 0.001), diastolic BP (p < 0.001), standard deviation of normal sinus beat intervals (SDNN) (p = 0.01), low frequency (p = 0.05), high frequency (p = 0.01), total power (TP) (p = 0.01), percentage of successive intervals that differ by more than 50 msec (PNN50) (p = 0.01), qi deficiency (p = 0.003), blood stasis (p = 0.02), and qi depression (p = 0.03) constitution. Significant between-group differences were observed in SBP (p = 0.001), SDNN (p = 0.008), and TP (p = 0.04). Conclusions: This study suggested that in the home health care hypertension population, antihypertensive drugs plus acupuncture may be more beneficial in lowering BP and in regulating autonomic nervous system activity than drugs alone. A longer follow-up and larger sample size should be considered in future studies to reveal the precise effect of acupuncture followed by evidence-based practice.

The Effect of Acupuncture and Moxibustion on Heart Function in Heart Failure Patients: A Systematic Review and Meta-Analysis

Background

Acupuncture and moxibustion (A&M) has been used for treating heart failure in China since the Han Dynasty. This ancient therapy can be applied to many diseases according to the WHO recommendations. Although there are many clinical reports on the treatment of heart failure by A&M, its effectiveness is still not fully demonstrated. We aimed to systematically review the related randomized controlled trial (RCT) studies and conduct a meta-analysis.

Methods

The PubMed, MEDLINE, EMBASE, AMED, CENTRAL, CNKI, Wanfang, and Weipu databases were searched electronically until December 2018. The data were extracted, and the risk of bias was evaluated. Meta-analysis, subgroup analysis, and metaregression were performed. Heart function was the main outcome assessed. The details of the intervention were also investigated.

Results

Thirty-two RCTs involving 2499 patients were included. Most studies had an unclear risk regarding blinding and allocation concealment. Compared with the traditional treatment group, the experimental group had a higher efficacy rate (odds ratio (OR) = 2.61, 95% confidence interval (95%CI): = [1.84; 3.72], I² = 0%, p < 0.0001) and a significantly improved left ventricular ejection fraction (LVEF) (mean difference (MD) = 6.34, 95%CI = [4.11, 8.57], I² = 93%, p < 0.0001), cardiac output (CO) (MD = 1.02, 95%CI = [0.65, 1.39], I² = 94%, p < 0.0001), 6-minute walk test (6MWT) (MD = 43.6, 95%CI = [37.43, 49.77], I² = 0%, p < 0.0001), and reduced brain-type natriuretic peptide (BNP) (MD = −227.99, 95%CI = [−337.30, −118.68], I² = 96%, p < 0.0001). Adverse events were inadequately reported in most studies.

Conclusions

A&M may be a promising intervention as an adjunctive therapy to medication for treating heart failure. However, the evidence was inconclusive. Further large and rigorously designed RCTs are needed for verification.

Acupuncture for Histamine-Induced Itch: Association With Increased Parasympathetic Tone and Connectivity of Putamen-Midcingulate Cortex

Previous studies have suggested that acupuncture is effective for ameliorating itch intensity. However, factors associated with the antipruritic effects of acupuncture have yet to be clarified. In a randomized, sham-controlled, crossover trial, we investigated the antipruritic effects of acupuncture against histamine-induced itch in healthy volunteers. Autonomic changes using heart rate variability (HRV) and brain connectivity using functional magnetic resonance imaging (fMRI) were also assessed to identify physiological factors associated with the acupuncture response. Acupuncture significantly reduced itch intensity and skin blood perfusion as assessed by laser Doppler perfusion imaging compared to sham control, indicating the antipruritic effects of acupuncture. In responder and non-responder analysis, the power of normalized high frequency (HF norm) was significantly higher, while the power of normalized low frequency (LF norm) and LF/HF ratio were significantly lower in responders compared to non-responders, suggesting the acupuncture response involved parasympathetic activation. In fMRI analysis, the putamen and the posterior part of the midcingulate cortex (pMCC) were positively connected to itch and negatively correlated with itch intensity in responders. These results suggest that parasympathetic activity and functional connectivity of the putamen and pMCC could be associated with antipruritic response to acupuncture.

Use of Acupuncture in an Infant with Restlessness and Agitation

Abstract: Background: We are reporting here about a 3-month-old boy with a history of failure to thrive, hypertrophic obstructive cardiomyopathy and neurological misbehaviour including hypotension in body muscles, who was found to have screaming attacks, agitation and restlessness. Methods/Results: Body and ear acupuncture was used both as supporting and integrative therapy to reduce the phases of restlessness and screaming and, simultaneously, the use of hypnotic drugs, as well as to improve the baby’s thriving. Conclusions: Our case has proved that standardised ear and body acupuncture applied by trained acupuncturist paediatricians is a helpful non-pharmacological treatment tool. While acupuncture is typically used in the outpatient setting, it can equally be used in the inpatient setting, as exemplified by the positive outcome of the presented case.

Evaluation of Autonomic Nervous System Function Using Heart Rate Variability Analysis During Transient Heart Rate Reduction Caused by Acupuncture

Objective: Human studies have demonstrated that heart rate (HR) decreases during acupuncture stimulation, and pharmacologic studies have shown that this autonomic nervous system (ANS) response is parasympathetic-dominant. It has become clear that significant changes occur in the ANS after acupuncture, based on HR variability (HRV). However, it is inconclusive, according to HRV analysis, if acupuncture induces a significant change in autonomic function during stimulation. The aim of this study was to investigate ANS function using HRV analysis during HR reduction induced by manual acupuncture stimulation to the muscles. Materials and Methods: In this study, electrocardiograms of 25 adult men were analyzed. After resting for 20 minutes, participants underwent 15-20-mm deep acupuncture stimulation at the Shousanli (LI 10) point at 1 Hz for 2 minutes. Instantaneous HR was recorded. The index of parasympathetic nervous activity high-frequency (HF) normalized units (HFnu) and the ratio of sympathovagal balance (low frequency [LF]/HF) were calculated by HRV analysis. Results: HR during acupuncture was significantly lower, compared to HR both before and after acupuncture. HFnu during acupuncture were significantly higher, compared to HFnu both before and after acupuncture. The LF/HF ratio during acupuncture was significantly lower, compared to the ratio before acupuncture, and remained low after acupuncture, compared to before acupuncture. Conclusions: Acupuncture stimulation to the muscle can effectively reduce HR, increase HFnu, and decrease LF/HF that depends on autonomic regulation of both sympathovagal balances.

Comparative Assessment of the Heart's Functioning by Using the Akabane Test and Classical Methods of Instrumental Examination

Acupuncture physicians have studied the application of reflexotherapy to cardiology. However, no one has investigated the connection of ancient Chinese diagnostic methods with modern tools. A total of 102 patients (54 men and 48 women) with heart pathology, namely, sick-sinus syndrome, Wolff-Parkinson-White syndrome, and atrioventricular blockade, were studied using the usual instrumental methods (transesophageal electrophysiological study of the heart, echocardiography), after which they underwent Akabane thermopuncture testing as in traditional Chinese medicine. The results of cardio examination from one side of the Akabane test with that from the other side were compared by means of a multiple stepwise regression analysis. We revealed the effects on the characteristic pattern of acupuncture channel lesions inherent in a definite heart pathology, i.e., the most vulnerable acupuncture channel (AC), of such factors as disturbances of the contractile, conductive, or automatic heart functions, and changes in the chambers' size or circulation volume. Сhanges in the indices of the left and the right branches of these channels usually reflect the opposing natures of the changes in these indicators, which should be considered in reflexotherapy. The main value of the Akabane test along with the use of mathematical analysis lies in early, quick, and inexpensive detection of the above-mentioned heart disturbances.

Feasibility study of transfer function model on electrocardiogram change caused by acupuncture

Background

Acupuncture treatments that regulate the heart are used to treat various clinical disorders and conditions. Although many studies have been conducted to measure quantitatively the effects of acupuncture, thus far, models that describe these effects have not been established. The purpose of this study was to derive a transfer function model of acupuncture stimulation within the electrocardiograms based on the periods before, during, and after acupuncture.

Methods

Fourteen healthy subjects were included in this clinical trial. Five-minute electrocardiograms were captured before, during, and after acupuncture at HT7. For each period, signal-averaged electrocardiograms were created from all of the subjects’ 5-min electrocardiograms for that period. Individual transfer functions, which has the highest average goodness of fit, were derived for each period pair. By averaging individual transfer functions, generalized transfer functions were derived.

Results

The transfer function with the highest average goodness of fit was a fraction with 4th order numerator and 5th order denominator. Fourteen individual transfer functions were derived separately for each pair of periods: before and during acupuncture, during and after acupuncture, and before and after acupuncture. Three generalized transfer functions were derived by averaging individual transfer functions for each period pair.

Conclusion

The three generalized transfer functions that were derived may reflect the electrocardiogram changes caused by acupuncture. However, this clinical trial included only 14 subjects. Further studies with control groups and more subjects are needed.

This clinical trial has been registered on the Clinical Research Information Service, Republic of Korea (No. KCT0001944). The first enrolment of subject started at 2 June 2015 and this trial was retrospectively registered at 14 June 2016

Effect of Transcutaneous Acupoint Electrical Stimulation on Post-Hemorrhoidectomy-Associated Pain, Anxiety, and Heart Rate Variability: A Randomized-Controlled Study

Hemorrhoidectomy is the current best treatment for severe hemorrhoids, but it causes significant postoperative pain and anxiety, which is associated with heart rate variability (HRV). Transcutaneous acupoint electrical stimulation (TAES) was assumed to alleviate pain and anxiety, and modify the autonomic nervous system. This study aimed to examine the effects of TAES intervention on postoperative pain, anxiety, and HRV in patients who received a hemorrhoidectomy. A randomized-controlled trial with five repeated measures was conducted. The TAES group ( n = 39) received four 20-min sessions of electrical stimulation at chengshan (BL57) and erbai (EX-UE2) after hemorrhoidectomy, whereas the control group ( n = 41) did not. Data were collected using Visual Analogue Scale (VAS), State Anxiety Inventory (STAI), and HRV physiological signal monitor. TAES resulted in a significant group difference in pain scores, anxiety levels, and some HRV parameters. The findings indicate that TAES can help reduce pain and anxiety associated with hemorrhoidectomy. TAES is a noninvasive, simple, and convenient modality for post-hemorrhoidectomy-associated pain control and anxiety reduction.

Acupuncture and Moxibustion have Different Effects on Fatigue by Regulating the Autonomic Nervous System: A Pilot Controlled Clinical Trial

In order to investigate the different effects of acupuncture and moxibustion on chronic fatigue syndrome (CFS) and alterations in the autonomic nervous system by measuring heart rate variability (HRV). Forty-five participants were recruited and randomly divided into 3 groups using a randomization schedule. The control group (CG, n = 15) and the acupuncture group (AG, n = 15) were treated by manipulation acupuncture, and the moxibustion group (MG, n = 15) was treated by indirect moxibustion. Primary outcomes were the scores of the Fatigue Assessment Instrument (FAI). Secondary outcomes were the HRV parameters which can reflect activity of the autonomic nervous system. This trial considered both instantaneous changes and long-term effectiveness. FAI scores decreased after the 4th and 10th treatments in the 3 groups. The decrease in FAI in the MG was greater than that in the AG. Acupuncture was more effective in instantaneous changes of HRV and moxibustion in long-term aspects. Both acupuncture and moxibustion improved fatigue in CFS patients, but moxibustion was more effective. The possible mechanism of the intervention may be through activation of the vagus nerve. Moxibustion was more effective than acupuncture in long-term treatment of CFS.

Acupuncture for heart failure: A systematic review of clinical studies

BACKGROUND

Acupuncture has been used for treating heart failure mainly in combination with conventional treatments, but evidence for its effectiveness and safety has not been well established. Our aim was to review randomized controlled trials (RCTs) on acupuncture for heart failure and assess the clinical evidence.

METHODS

Electronic databases such as Medline, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) and certain Chinese & Korean databases were searched until October 2015. The main outcomes assessed were mortality, New York Heart Association (NYHA) function classifications, and acupuncture-related adverse events. The details of acupuncture intervention were also investigated.

RESULTS

Among 4107 publications, seven RCTs were included; most of them showed considerable methodological flaws. We could not conduct a meta-analysis because of the heterogeneity of the included studies. In one acute heart failure study, acupuncture shortened intensive care unit (ICU) stay by 2.2days (95% CI 1.26, 3.14) and reduced the risk ratio of re-admission to 0.53 (95% CI 0.28, 0.99). However, mortality was not affected. Hemodynamic parameters also showed improvement. Another study reported an improved left ventricular ejection fraction by 9.95% (95% CI 3.24, 16.66). In five chronic heart failure studies, acupuncture improved exercise capacity, quality of life, hemodynamic parameters, and time domain heart rate variability parameters. Acupuncture decreased NT-pro BNP levels by 292.20 (95% CI -567.36, -17.04). No adverse effects were reported.

CONCLUSIONS

The effectiveness of acupuncture as a therapy for heart failure is currently inconclusive. Further large and rigorous clinical trials are needed to establish its clinical utility.

Adjuvant Chinese Herbal Products for Preventing Ischemic Stroke in Patients with Atrial Fibrillation

OBJECTIVE

Chinese herbal products (CHPs) are widely used for atrial fibrillation (AF) in Taiwan. We investigated the effect of adjuvant CHPs in preventing ischemic stroke in patients with AF.

METHODS

Taiwanese patients in the Health Insurance Database newly diagnosed with AF during 2000-2011 were enrolled. Medication treatment with/without CHPs was administered within 7 days after the AF diagnosis. The clinical endpoint was an ischemic stroke. The Chi-square test, Fisher's exact test, and Student t test were used to examine differences between the traditional Chinese medicine (TCM) and non-TCM cohorts. Cox proportional hazard regression was used to assess the risk for ischemic stroke between two cohorts.

RESULTS

Three hundred and eleven patients underwent TCM treatment and 1715 patients did not. Compared to non-TCM users, TCM users had a lower incidence of stroke (12.59% vs. 1.93%, respectively) and lower risk of stroke [CHA2DS2-VASc score = 0-2 (hazard ratio = 0.20; 95% confidence interval = 0.06-0.65)]. Compared to non-TCM users, the stroke risk was significantly lower in TCM users with AF who were female or younger than 65 years, but not in males, people more than 65 years old, or people with comorbidities. Compared to TCM users, non-TCM users who received conventional treatment had a higher ischemic stroke risk. The risk for AF-related hospitalization was significantly lower in TCM users (0.64%) than in non-TCM users (38.1%).

CONCLUSIONS

Users of TCM with AF have a lower risk of new-onset ischemic stroke. Therefore, adjuvant CHP therapy may have a protective effect and may be used in AF patients to prevent ischemic stroke.

A literature review of heart rate variability in depressive and bipolar disorders

OBJECTIVE

Autonomic nervous system dysfunction has the potential to adversely impact general medical health and is known to exist in a number of psychiatric disorders. It reflects alterations in the function of several regions of the central nervous system. Measurement of heart rate variability provides a non-invasive tool for studying autonomic function. While the literature relating to the technical process of heart rate variability and aspects of depressive disorders has been reviewed in the past, research relating to both depressive and bipolar disorders has not been comprehensively reviewed. This paper critically considers the published research in heart rate variability in both depressive and bipolar affective disorders.

METHOD

A literature search using Medline, EMBASE, PsycINFO, ProQuest Psychology and references included in published literature was conducted using the following keywords: 'heart rate variability and autonomic, combined with depression, depressive disorder, bipolar, mania and sleep'.

RESULTS

The evidence demonstrates that, using heart rate variability measures, significant distortions of autonomic function are evident in both depressive and bipolar disorders and from most of their pharmacological treatments.

CONCLUSION

The autonomic dysfunction evident in both unipolar and bipolar affective disorders, and many psychotropic medications, has significant implications for our understanding of the neurophysiology of these disorders, their treatment and associated general health.

Effect of acupuncture on sleep quality and hyperarousal state in patients with primary insomnia: study protocol for a randomised controlled trial

INTRODUCTION

Primary insomnia (PI) is commonly defined as a state of having disturbed daytime activities due to poor night-time sleep quality. Studies have demonstrated that it is a disorder of 24 h hyperarousal, expressed in terms of physiological, cognitive and cortical activation. Acupuncture is considered to be beneficial to restore the normal sleep-wake cycle. The aim of the trial is to assess the therapeutic effects of acupuncture on sleep quality and hyperarousal state in patients with PI.

METHODS AND ANALYSIS

This study is a randomised, patient-assessor-blinded, sham controlled trial. -88 eligible patients with PI will be randomised in a ratio of 1:1 to the intervention group (real acupuncture) and control group (sham acupuncture, superficial insertion at irrelevant acupuncture points). Acupuncture intervention will be given to all participants three times a week for 4 weeks, followed up for 8 weeks.The primary outcome measures are the Pittsburgh Sleep Quality Index (PSQI) and Hyperarousal scale (HAS). The secondary outcomes are Fatigue scale-14 (FS-14), polysomnography (PSG), heart rate variability (HRV) and Morning Salivary Cortisol Level (MSCL). Outcomes will be evaluated at baseline, post-treatment period and 8 weeks follow-up. All main analyses will be carried out on the basis of the intention-to-treat principle.

ETHICS/DISSEMINATION

This protocol has been approved by the Medical Ethical Committee of Beijing Traditional Chinese Medicine Hospital (Beijing TCM Hospital) on 5 January 2015. The permission number is 2014BL-056-02. The study will present data concerning the clinical effects of treating primary insomnia with acupuncture. The results will help to demonstrate if acupuncture is an effective therapy for improving sleep quality in association with a decreased hyperarousal level as a possible underlying mechanism. The findings from this study will be shared with the healthcare professionals, general public and relevant organisations through publication of manuscripts and conference presentations.

TRIAL REGISTRATION NUMBER

ISRCTN16079489; Pre-results.

[Influence of Therapeutic Qi on Heart Rate Variability in Acupuncture: a Randomized Controlled Study]

BACKGROUND

In a recent acupuncture study, volunteers were able to sense stimulation by ‘therapeutic Qi' even when mechanical and psychological causes were excluded. Here, we investigated if ‘therapeutic Qi' also influences the heart rate variability.

METHODS

This was a controlled, randomized, single-blind crossover study with 30 volunteers. Using a special device, an acupuncture needle was inserted in the acupuncture point Pe6. With another device, the protruding end of the needle was fixed so that no transmission of mechanical movement to the tip was possible when the handle was touched. During the experimental intervention, the therapist touched the handle of the needle to stimulate Qi. During the control intervention, the needle was left untouched. During the null intervention, no needle was inserted. Before and after the interventions, parameters of heart rate variability (HRV) were measured.

RESULTS

Between the 3 interventions no significant differences in HRV parameters were observed. From pre- to post-measurement the heart rate decreased in the control and experimental interventions (-2 min(-1), d = 0.24 and -2 min(-1), d = 0.24, respectively), RMSSD increased significantly when the needle was touched and Qi was stimulated (+9.7 ms, d = -0.32).

CONCLUSION

Within this setting the subjectively perceived stimulation with therapeutic Qi could not be confirmed by using objective HRV measures.

Evaluating validity of various acupuncture device types: a random sequence clinical trial

BACKGROUND

Although various placebo acupuncture devices have been developed and used in acupuncture research, there is controversy concerning whether these devices really serve as appropriate placebos for control groups.

METHODS/DESIGN

The proposed study is a single-center prospective random sequence participant- and assessor-blinded trial with two parallel arms. A total of 76 participants will be randomly assigned to Group 1 or Group 2 in a 1:1 ratio. Group 1 will consist of Sham Streitberger's needle, Real Streitberger's needle, and Phantom acupuncture session. Group 2 will consist of Park Sham device with real needle, Park Sham device with sham needle, and no treatment session. Participants will have a total of three acupuncture sessions in a day. The primary endpoint is blinding test questionnaire 1. Secondary endpoints are the Bang's blinding index, the Massachusetts General Hospital Acupuncture Sensation Scale index, and physiological data including heart rate, heart rate variability, and skin conductance response.

DISCUSSION

This trial will evaluate the relevance of using placebo acupuncture devices as controls using a validation test procedure.

TRIAL REGISTRATION

Clinical Research Information Service: KCT0001347 .

Atrial fibrillation cardioversion following acupuncture

Atrial fibrillation (AF) is the most common arrhythmia and it is an independent risk for serious events. Acupuncture has been growing in popularity in the West, and there are reports of its benefits in treating AF. We report a 57-year-old man who was admitted after having an allergic reaction to amiodarone administered to treat paroxysmal AF with fast ventricular response. Cardioversion with intravenous propafenone was uneventful. Before an attempt of electric cardioversion, he was treated with acupuncture as additional therapy to peroral propafenone. After acupuncture treatment consisting of 10 treatments during 30 days period, both immediate cardioversion to sinus rhythm and no paroxysmal AF during 30 days period were recorded.

Tai Chi Chuan modulates heart rate variability during abdominal breathing in elderly adults

Tai Chi Chuan (TCC) practice is currently intentionally applied in clinical populations, especially those with cardiovascular diseases because of its potential benefits on the autonomic nervous system. The long-term effect of TCC practice on heart rate variability (HRV) remains largely unknown. In this study, we recruited 23 TCC practitioners whose experience averaged approximately 21 years and 19 controls matched by age, sex and education to examine the effect of TCC practice on the autonomic nervous system during a resting state and during an abdominal breathing state. HRV was measured by traditional electrocardiogram (ECG) recording. The results showed that the low frequency, total power frequency, and normalized low frequency components and the low-frequency/high-frequency ratio were significantly higher, whereas the normalized high frequency was significantly lower in the TCC practitioners relative to controls during the abdominal breathing state. However, we did not detect any significant difference in the HRV measures during the resting state between the two groups. Additionally, TCC experience did not correlate with HRV components either in the abdominal state or the resting state in the TCC group. Considering all of these findings, we suggest that TCC improves vagal activity and the balance between sympathetic and parasympathetic activity during the relaxation state. This study also provides direct physiological evidence for the role of TCC practice in relaxation.

Acupuncture Affects Autonomic and Endocrine but Not Behavioural Responses Induced by Startle in Horses

Startle is a fast response elicited by sudden acoustic, tactile, or visual stimuli in a variety of animals and in humans. As the magnitude of startle response can be modulated by external and internal variables, it can be a useful tool to study reaction to stress. Our study evaluated whether acupuncture can change cardiac autonomic modulation (heart rate variability); and behavioural (reactivity) and endocrine (cortisol levels) parameters in response to startle. Brazilian Sport horses (n = 6) were subjected to a model of startle in which an umbrella was abruptly opened near the horse. Before startle, the horses were subjected to a 20-minute session of acupuncture in acupoints GV1, HT7, GV20, and BL52 (ACUP) and in nonpoints (NP) or left undisturbed (CTL). For analysis of the heart rate variability, ultrashort-term (64 s) heart rate series were interpolated (4 Hz) and divided into 256-point segments and the spectra integrated into low (LF; 0.01–0.07 Hz; index of sympathetic modulation) and high (HF; 0.07–0.50 Hz; index of parasympathetic modulation) frequency bands. Acupuncture (ACUP) changed the sympathovagal balance with a shift towards parasympathetic modulation, reducing the prompt startle-induced increase in LF/HF and reducing cortisol levels 30 min after startle. However, acupuncture elicited no changes in behavioural parameters.

Efficacy and Safety of Acupuncture for Acute Low Back Pain in Emergency Department: A Pilot Cohort Study

Introduction. Low back pain (LBP) is one of the most common complaints in the emergency department (ED). There are several research articles providing evidence for acupuncture for treating chronic LBP but few about treating acute LBP. This study assessed the efficacy and safety of acupuncture for the treatment of acute LBP in the ED. Materials and methods. A clinical pilot cohort study was conducted. 60 participants, recruited in the ED, were divided into experimental and control groups with 1 dropout during the study. Life-threatening conditions or severe neurological defects were excluded. The experimental group (n = 45) received a series of fixed points of acupuncture. The control group (n = 14) received sham acupuncture by pasting seed-patches near acupoints. Back pain was measured using the visual analog scale (VAS) at three time points: baseline and immediately after and 3 days after intervention as the primary outcome. The secondary outcomes were heart rate variability (HRV) and adverse events. Results. The VAS demonstrated a significant decrease (P value <0.001) for the experimental group after 15 minutes of acupuncture. The variation in HRV showed no significant difference in either group. No adverse event was reported. Conclusion. Acupuncture might provide immediate effect in reducing the pain of acute LBP safely.

Acupuncture lowers blood pressure in mild hypertension patients: a randomized, controlled, assessor-blinded pilot trial

OBJECTIVES

To preliminarily assess the effects of acupuncture on prehypertension and stage I hypertension, and to provide data for further research.

DESIGN

A randomized, controlled, assessor-blinded study with an 8-week intervention period and a 4-week follow-up.

INTERVENTIONS

Participants were patients with systolic blood pressure (SBP) of 120-159mmHg or diastolic blood pressure (DBP) of 80-99mmHg.Thirty participants were allocated to acupuncture group or untreated control group at a 1:1 ratio. The acupuncture group received standard acupuncture twice weekly for 8 weeks, and was followed-up for 4 weeks after treatment; the control group did not receive any type of anti-hypertensive treatment for 12 weeks.

MAIN OUTCOME MEASURES

Primary outcome measure was SBP and DBP at post-treatment. The secondary outcomes were SBP and DBP at follow-up; Euro Quality of life (EQ-5D), heart rate variability (HRV), body mass index (BMI), and blood lipid profile.

RESULTS

DBP (-5.7mmHg; P=0.025), but not SBP (-6.0mmHg; P=0.123), was significantly different between groups at post-treatment. Both DBP (-7.8mmHg; P=0.004) and SBP (-8.6mmHg; P=0.031) were significantly different at follow-up. Among the HRV indices, only high frequency power was significantly different between groups at weeks 4 and 8 (P=0.047 and P=0.030, respectively). There were no differences between groups in EQ-5D, BMI or lipid profile.

CONCLUSION

The results of this study show that acupuncture might lower blood pressure in prehypertension and stage I hypertension, and further RCT need 97 participants in each group. The effect of acupuncture on prehypertension and mild hypertension should be confirmed in larger studies.

TRIAL REGISTRATION

KCT0000496.

Efficacy and safety of acupuncture for dizziness and vertigo in emergency department: a pilot cohort study

Background

Dizziness and vertigo account for roughly 4% of chief symptoms in the emergency department (ED). Pharmacological therapy is often applied for these symptoms, such as vestibular suppressants, anti-emetics and benzodiazepines. However, every medication is accompanied with unavoidable side-effects. There are several research articles providing evidence of acupuncture treating dizziness and vertigo but few studies of acupuncture as an emergent intervention in ED. We performed a pilot cohort study to evaluate the efficacy and safety of acupuncture in treating patients with dizziness and vertigo in ED.

Methods

A total of 60 participants, recruited in ED, were divided into acupuncture and control group. Life-threatening conditions or central nervous system disorders were excluded to ensure participants’ safety. The clinical effect of treating dizziness and vertigo was evaluated by performing statistical analyses on data collected from questionnaires of Dizziness Handicap Inventory (DHI), Visual Analog Scale (VAS) of dizziness and vertigo, and heart rate variability (HRV).

Results

The variation of VAS demonstrated a significant decrease (p-value: 0.001 and p-value: 0.037) between two groups after two different durations: 30 mins and 7 days. The variation of DHI showed no significant difference after 7 days. HRV revealed a significant increase in high frequency (HF) in the acupuncture group. No adverse event was reported in this study.

Conclusion

Acupuncture demonstrates a significant immediate effect in reducing discomforts and VAS of both dizziness and vertigo. This study provides clinical evidence on the efficacy and safety of acupuncture to treat dizziness and vertigo in the emergency department.

Trial registration

ClinicalTrials.gov ID: NCT02358239. Registered 5 February 2015

The Effects of Guided Imagery on Heart Rate Variability in Simulated Spaceflight Emergency Tasks Performers

Objectives. The present study aimed to investigate the effects of guided imagery training on heart rate variability in individuals while performing spaceflight emergency tasks. Materials and Methods. Twenty-one student subjects were recruited for the experiment and randomly divided into two groups: imagery group (n = 11) and control group (n = 10). The imagery group received instructor-guided imagery (session 1) and self-guided imagery training (session 2) consecutively, while the control group only received conventional training. Electrocardiograms of the subjects were recorded during their performance of nine spaceflight emergency tasks after imagery training. Results. In both of the sessions, the root mean square of successive differences (RMSSD), the standard deviation of all normal NN (SDNN), the proportion of NN50 divided by the total number of NNs (PNN50), the very low frequency (VLF), the low frequency (LF), the high frequency (HF), and the total power (TP) in the imagery group were significantly higher than those in the control group. Moreover, LF/HF of the subjects after instructor-guided imagery training was lower than that after self-guided imagery training. Conclusions. Guided imagery was an effective regulator for HRV indices and could be a potential stress countermeasure in performing spaceflight tasks.

Vagus nerve stimulation: a new bioelectronics approach to treat rheumatoid arthritis?

There has been a marked improvement in the treatment of rheumatoid arthritis (RA), but most patients do not achieve disease remission. Therefore, there is still a need for new treatments. By screening an adenoviral short hairpin RNA library, we discovered that knockdown of the nicotinic acetylcholine receptor type 7 (α7nAChR) in RA fibroblast-like synoviocytes results in an increased production of mediators of inflammation and degradation. The α7nAChR is intimately involved in the cholinergic anti-inflammatory pathway (CAP). This led us to study the effects of α7nAChR activation in an animal model of RA, and we could show that this resulted in reduced arthritis activity. Accordingly, stimulation of the CAP by vagus nerve stimulation improved experimental arthritis. Conversely, we found aggravation of arthritis activity after unilateral cervical vagotomy as well as in α7nAChR-knockout mice. Together, these data provided the basis for exploration of vagus nerve stimulation in RA patients as a novel anti-inflammatory approach.