1. health and fitness
2. therapy

Acupuncturist
The American
Volume 57 | Fall 2011
全美中医公会官方出版物
AAAOM’s Official Publication for Practitioners of Oriental Medicine
アメリカ鍼灸漢方医学協会公式出版物
침술과 한의학의 미국 협회의 공식 간행물
Inside
The Use of Zero Balancing within the Context of Acupuncture
Acupuncture & Herbal Therapies in the Treatment of ED
Acupuncture’s Effects on Post-Radiation Cystitis and Prostatitis
Award-Winning Evaluation of “Analgesic Effect of Auricular Acupuncture”
Acupuncture as an Adjunctive Therapy in Preventing RSA
V57
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Volume 57 | Fall 2011
The American Acupuncturist is
published quarterly by the
American Association of Acupuncture
& Oriental Medicine (AAAOM)
PO Box 96503 pmb 93504
Washington, DC 20090-6503
toll free 866-455-7999
fax 866-455-7999
email [email protected]
Perspectives
11
www.aaaomonline.org
The Use of Zero Balancing within the Context of Acupuncture
Celeste Homan, MS, MAc, LAc
© Copyright The American Acupuncturist 2011
Conversations
ISSN: 1520-7714
9
Interview with AAAOM-SO President Jane Yu
Michael Jabbour, CSP, MS, LAc
Original Research
Resource Directory
ACAOM—Accreditation
Commission for Acupuncture
and Oriental Medicine
14502 Greenview Drive, Ste 300B
Laurel, MD 20708
phone 301-313-0855
fax 301-313-0912
www.acaom.org
15
19
Acupuncture
and Herbal Therapies in the Treatment of
Erectile Dysfunction K. Shane Haggard LAc
cupuncture’s Effects on Relieving Symptoms for Post-radiation
A
Cystitis and Prostatitis
Elisabete Alves de Souza, DAOM and Brian Lawenda, MD
26
Evaluation of “Analgesic Effect of Auricular Acupuncture for Cancer Pain: A Randomized, Blinded, Controlled Trial” By David Alimi, et al.
Stephanie Barrows, MAOM (candidate) and Amber Berg, ADS,
MAOM (candidate), PhD (candidate)
Case Study
CCAOM—Council of Colleges
of Acupuncture and Oriental Medicine
29
Acupuncture as an Adjunctive Therapy in Preventing Recurrent
Spontaneous Abortion Lynn M. Almloff, DAOM, LAc
600 Wyndhurst Avenue, Ste. 112
Baltimore, MD 21210
phone 410-464-6040
fax 410-464-6042
www.ccaom.org
NCCAOM—National Certification Commission of Acupuncture and Oriental Medicine
Treating Autoimmune Disease with Chinese Medicine
Reviewed by Kathleen Lumiere, DAOM, LAc
76 South Laura Street, Suite 1290
Jacksonville, FL 32202
phone 904-598-1005
fax 904-598-5001
email [email protected]
www.nccaom.org
SAR—Society for Acupuncture Research
825 South 8th St, Suite 1106
Minneapolis, MN 55404
www.acupunctureresearch.org
Book Reviews
32
34
Shonishin: Japanese Pediatric Acupuncture
Reviewed by Fred Jennes, MEd, DiplAc, DiplCH (NCCAOM), LAc
36
AAAOM-SO Update
40
Index to Advertisers
3
President’s Message: Jeannie Kang, MSTOM, DNBAO, DNBIM, LAc
7
From the Editor: Jennifer A. M. Stone, LAc
9
AAAOM Board of Directors & Mission Statement
The American Acupuncturist is published quarterly, providing a professional venue for
articles on clinical research, translated works, legislative issues, education developments,
commentaries, critical reviews, and other current topics of importance to AOM. We value
your AOM perspective. Please consider submitting your article for potential publication in
The American Acupuncturist. Submit to the AAAOM through our online submissions system.
v 57
The American Acupuncturist
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2 T h e A m e r i c a n A c u p u n c t u r i s t Fall 2011
Message from the President
Jeannie Kang, MSTOM, DNBAO, DNBIM, LAc
Dear Colleagues,
It is hard to believe that we are six months into the second year of my presidency. The past 18 months since I became AAAOM’s president have
passed very quickly. Thanks to all of our dedicated volunteers, we have accomplished so much and are now in the last phase of our organization’s
transformation. I would like to take this opportunity to share with you what the newly-organized AAAOM is doing for our membership.
As president, I have remained steadfast about investing your membership dollars as wisely and economically as possible during these
difficult economic times. I am very pleased to tell you that we have been able to dramatically reduce our operational expenses. One significant
achievement towards this end is that the AAAOM administration office is now “virtual.” Last July, I went to Sacramento with two other board
members, Kimberly Benjamin and Mori West, to close down our physical office space. A special thank you goes to the journal’s Associate Editor
Lynn Eder for her enormous assistance in closing the office.
Another accomplishment is that all our organization’s files have been scanned, sorted, and are now stored safely in a cloud server so
that AAAOM’s institutional memory is fully preserved and accessible to the current and next generations. It is our hope, with the help of our
committee chairs and subject-matter experts, that in the coming months we can fully organize all of this information and maximize its utility.
As part of our effort to rebuild and revamp our membership services, I want to introduce and welcome Eleanor Peebles, our new membership
services director. She will aid us in addressing your inquiries in a timely manner and increase our membership satisfaction. Additionally, I want to
thank Mori West and the other members of her team for their work in strengthening our membership department.
Due to a lower than anticipated turnout at our May conference, and despite the great progress and achievements that came out of this starstudded event, we did not meet our revenue generation goals. As a result, we have taken this challenge as an opportunity to look closely at how
we want to structure our future membership conferences. The Board decided that, rather than hold another full conference next spring, we will
devote the next 18 months to the planning and promotion of a spring, 2013, national membership conference.
In April, 2012, the AAAOM will hold a “leadership meeting” in Chicago, where the boards of other AOM and affiliated national organizations
will meet to plan and strategize on how all these professional organizations can work together to better serve their members and more effectively
meet our common goals. While the leadership meeting will not have a banquet, exhibition hall, or CEU classes, AAAOM will still host its
annual public business meeting for members who would like to attend. By providing sufficient planning time for a successful 2013 membership
conference, this currently scaled-down format will give AAAOM time to focus on our goal of building a strong and sustainable national AOM
organization through increased collaboration with our state and strategic allies.
AAAOM’s top priority right now is to increase revenue generation and new membership enrollment by improving our membership services.
As this organizational change stabilizes, we intend to hire an executive director and, potentially, an association management company to assume
the many duties that the AAAOM board of directors has been doing on a volunteer basis. AAAOM will continue to work towards achieving the
profession’s needs regarding reimbursement issues, increased and better job opportunities, and advocating for national regulation reform that
better serves the AOM community and our patients.
At the Baltimore conference we announced our support for federal inclusion in Essential Health Benefits (EHB) as being essential to our service
to the AOM community in this country. Although the decisions made by the Institute of Medicine and the applicable federal agencies regarding
AOM’s inclusion in EHB will not be made until later this year, this is a very exciting and promising opportunity for our profession. We look forward
to increasing the awareness and the participation of all our community stakeholders in this important federal initiative. (An article in September’s
Acupuncture Today, “Cost-Effective Essential Health Benefits: Expanding Consumer Choice and Access to Care with Acupuncture,” describes this
direction in greater detail.)
We thank you in advance for your support during this time and appreciate your awareness and action for the EHB effort. We must show the
lawmakers in D.C. that we are present, we are here to stay, and we intend to continue to serve our patients and this country as safe, and effective
health care providers.
Yours in Health,
Jeannie Kang, MSTOM, DNBAO, DNBIM, LAc
President, AAAOM Board of Directors
v 57
The American Acupuncturist
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4 T h e A m e r i c a n A c u p u n c t u r i s t Fall 2011
親愛なる会員の皆さんへ
私が会長になってはや1年と6カ月になろうとは、信じられない思いです。私がAAAOMの会長になってからの18カ月間は、あっと
いう間に過ぎました。熱心なボランティアの皆さんに感謝します。私たちは多くのことを成し遂げました。今は当会の変革の最
終段階です。この機会に、新たに組織されたAAAOMが会員のために何をしているのか、皆さんにお知らせしたいと思います。
経済的に困難なこの時期、会長として、私は皆さんからの会費を、できる限り知恵を絞り倹約しながら投資することを肝に銘じ
てきました。私は運営にかかる費用を劇的に削減できたことを、皆さんにお伝えできることを大変うれしく思います。このゴー
ルに向けて達成できた特筆すべきこととして、AAAOMの事務所が“仮想”（”virtual”）のものとなったことが一つ挙げられま
す。去る7月に、私は2名の理事（キンバリー・ベンジャミン（Kimberly Benjamin）、モリ・ウエスト（Mori West））とともにサ
クラメントへ出向き、実在する事務所を閉鎖してきました。事務所閉鎖にあたり、多大なるご助力をいただいたリン・エダー
（Lynn Eder）に深謝いたします。
もう一つ達成したのは、当会のファイルを全てスキャンし、整理して、今ではクラウド・サーバーに安全に保管してあるという
ことです。これでAAAOMの組織としての記録が完全に保存されたことになり、現世代および次世代にわたりアクセスが可能にな
りました。私たちの委員会の委員長や当該専門家の助けを得ながら、数か月以内にはこの情報を完全に編制し、最大限に実用化
できるものと期待しています。
私たちの会員向けサービスを再建・刷新する努力の一環として、エレノア・ピーブルズ（Eleanor Peebles）を新しい組織部長に
迎えたいと思います。彼女は皆さんの問い合わせに迅速に対応し、会員満足度を高める手助けをしてくれることでしょう。加え
て、組織部の強化に努めてくれたモリ・ウェスト（Mori West）と彼女のチームメンバーに感謝したいと思います。
私たちの5月の学会は、参加人数が思いのほか少なかったため、キラ星のようなイベントに結実した素晴らしい前進と達成が見ら
れたにもかかわらず、収益には繋がりませんでした。結果として、私たちは今回の挑戦を、未来の会員向け学会の構成を詳細に
検討する機会と捉えることとしました。理事会は、来春また大きな学会を行うよりも、この先18カ月間を、2013年の全国規模の会
員向け学会の計画と宣伝に充てることにしました。
2012年の4月には、シカゴで“リーダーシップ・ミーティング”を開催します。そこでは他のAOMや提携する組織の理事が全国
から集まり、これら全ての職業団体がよりよい会員サービスを実現し、私たち共通のゴールにうまく到達することを目指して計
画と戦略を練る予定です。リーダーシップ・ミーティングには、宴会や展示ホール、またCEUのクラスはありませんが、AAAOM
は、毎年行っている公開ビジネスミーティングは、希望者のために開催する予定です。規模を縮小することで、2013年の会員向
け学会を成功させるために十分計画を練る時間をとることにより、州政府や戦略的盟友（strategic allies）との協働作業を増やすこ
とを通して、強く持続可能な全国AOM組織を作るという私たちのゴールに焦点を充てる時間がAAAOMにもたらされることでしょ
う。
AAAOMが目下最優先課題としているのは、収益の増加と、会員サービス向上による新規会員登録です。この組織的変化が安定し
てきたら、私たちは執行理事（executive director）と、可能であればこれまでAAAOMの理事会がボランティアベースで行ってきた
多くの任務を引きうけてくれる協会管理会社を雇う予定です。AAAOMは保険償還問題や雇用機会の創出と改善、AOMコミュニテ
ィや私たちの患者に対してより良いサービスを提供するための国の法律改正の要求など、同業者の要求実現に向けて引き続き活
動します。
鍼灸がEssential Health Benefits (EHB)に全国規模で包含されることは、この国のAOMコミュニティに対する私たちのサービスにとっ
てきわめて重要であるとして、私たちはボルティモア学会においてこの動きに支持を表明しました。EHBにAOMを含めるかどう
かについての米国医学研究所（Institute of Medicine）や国の関係機関による決定は、今年遅くまでなされませんが、これは私たち同
業者連にとって大変エキサイティングで有望な機会を提供するものです。私たちは私たちのコミュニティの全利害関係者が、連
邦政府が主導しているこの重大な動きのことを知り、関与することを期待しています。（Acupuncture Todayの9月号掲載記事“対
費用効果の高いEssential Health Benefits:鍼灸治療を包含するケアに対する消費者の選択・アクセスを増す”がこの経緯について更に
詳しく述べています。）
今のこの時期、皆さんからのご支援をどうぞ宜しくお願いします。皆さんがEHBに向けた努力について知り、行動を起こしてくだ
さることに感謝します。私たちはワシントンD.C.の立法者に、私たちが存在していること、ここに住んでいること、そして安全で
効果的なヘルスケア・プロバイダーとして、私たちの患者とこの国に奉仕し続けるつもりであるということを、示さなければな
りません。
あなたの健康のために奉仕します（Yours in Health）
ジニー・カーン（Jeannie Kang), MSTOM, DNBAO, DNBIM, LAc
AAAOM理事会会長（President, AAAOM Board of Directors）
Translated by Naomi Takazawa Naomi Takazawa is a member of the journal’s Editorial Board
and director of the Takazawa Acupuncture and Moxibustion Clinic in Tokyo, Japan
v 57
The American Acupuncturist
5 Editor-in-Chief
Jennifer A. M. Stone, LAc
Indiana University School of Medicine
E-mail: [email protected]
Managing Editor
Michael J. Jabbour, MS, LAc
E-mail: [email protected]
To the editor,
Senior Editors
Peter Johnstone, MD, FACR
Indiana University School of Medicine
Lixing Lao, PhD, LAc
Center for Integrative Medicine
University of Maryland Medical School
Will Morris, PhD, DAOM, LAc
Academy of Oriental Medicine at Austin
Rosa N. Schnyer, DAOM, LAc
School of Pharmacy, University of Texas at Austin
Associate Editor
Lynn Eder, MFA
E-mail: [email protected]
Editorial Board
Joe C. Chang, MAOM, DiplOM (NCCAOM), LAc
Carl R. Darnall Army Medical Center
John K. Chen, PhD, PharmD, OMD, LAc
Evergreen Herbs
Misha Ruth Cohen, OMD, Dipl Ac & CH (NCCAOM), LAc
UCSF Institute for Health and Aging
Steve Given, DAOM, LAc
School of Acupuncture and Oriental Medicine,
Bastyr University
Fred Jennes, MEd, Dipl Ac & CH (NCCAOM), LAc
Colorado School of Traditional Chinese Medicine
Jeannie Kang, MSTOM, DNBAO, DNBIM, LAc
Serenity, TATC
Karen Reynolds, MS, RN, LAc
Balance Restored Center for Integrative Medicine
Tammy Sajdyk, PhD
Indiana University School of Medicine
Elizabeth Sommers, PhD, MPH, LAc
Boston University
Naomi Takazawa, LAc, Licensed Moxibustionist
Tokyo, Japan
Dawn Upchurch, PhD
UCLA School of Public Health
S. Prasad Vinjamury, MD (Ayurveda), MAOM
Southern California University of Health Sciences
Jun Wang, PhD, DOM
San Francisco State University
Field Editors
Janet Borges, MSTCM, Dipl Ac & CH (NCCAOM), LAc,
Senior Editor
Joseph Adams, LAc
Carol DeMent, Dipl Ac (NCCAOM), EAMP, LAc
Jeannette Painovich, DAOM, LAc
Denise Slavich
Abigail Thomas-Costello, LMT, LAc
Rebecca Wallace, RYT, LAc
6 T h e A m e r i c a n A c u p u n c t u r i s t Fall 2011
Thank you for publishing the article titled “The U.S. Acupuncture
Workforce: The Economics of Practice.” It is refreshing to see that
people are starting to take an interest in the economic viability of the
practice of acupuncture and Oriental medicine in relation to student
loan debt. The research put forth in this article helps us to better
understand what practitioners can reasonably expect to earn after
graduation in relation to the expected debt accrued as a student. I
commend the authors for their painstaking efforts.
Sadly, our AOM education does not teach one the skills needed
to create and run a successful practice or work in the health care
field. As shown in the NCCAOM’s 2008 Job Task Analysis, most
students do not feel well prepared in those areas that are needed
to survive in the workforce (http://www.nccaom.org/wp-content/
uploads/pdf/JTA%202008%20Report.pdf , p. 29, Graph 17: Perceived
Preparedness to Practice: Collaboration with Other Providers,
Practice Management, Risk management and Legal / Ethical Issues).
This fact, coupled with heavy student loan burdens, is a recipe for a
disastrous success rates amongst our practitioners.
As this article states, “California, New York, and Florida - account
for approximately 15,050 or 52.8% of all LAcs in the nation (Zabik,
2009). Approximately 37.7% of the LAcs in these three states earn
less than $20,000 per year (Acupuncture Today, September 2010). For
these graduates, the reality of paying back their student loan debt
may be viewed as beyond their reach.”
If a large percentage of our graduates are not able to make
enough money to pay off their loans, then we should seriously
consider that the price of our education may be grossly inflated. I
would go so far as to state that the acupuncture educational system
is in need of a serious re-evaluation from the ground up. One cannot
seriously argue that it takes a master’s degree to successfully practice
AOM, with the understanding that a nurse can take care of critically
sick patients with only an associate’s degree.
If we are not producing practitioners who make at least as much
money as a massage therapist, then why do our schools cost
manyfold more in tuition? Is the information acquired in acupuncture
school really that valuable? If our practitioners are earning what
the market will bear for our services, it would seem that the market
disagrees.
Sincerely,
Eric Raymond Buckley, DOM
Correction:
In the article in vol. 56, “The U.S. Acupuncture Workforce: The
Economics of Practice, by Steven Stumpf, et al.,” Table 2, line 5
should read: “New Patients per Week,”
From the Editor
Jennifer A. M. Stone, LAc
Welcome to Vol. 57 of The American Acupuncturist. I am excited
to tell you about a collaboration agreement between AAAOM and
the Society of Integrative Oncology (SIO). SIO is a collection of MDs,
NDs, LAcs and other health care providers who share an interest in
oncology. Much current AOM research is in the area of oncology.
These studies are designed to investigate treatments and therapies
that support the cancer patient before, during, and after their cancer
treatments. SIO will hold its 2011 annual conference in Cleveland at
the Case Western Reserve University School of Medicine. (NCCAOM
PDAs are available for conference attendees.)
Included in this issue is the manuscript from the winning team in
the student research competition at the AAAOM May conference in
Baltimore. The winners were a group of students from the American
College of Oriental Medicine in Houston, TX. They presented a
critical assessment of “Analgesic Effect of Auricular Acupuncture
for Cancer Pain: A Randomized, Blinded, Controlled Trial” by David
Alimi, and colleagues, Journal of Clinical Oncology, Vol. 21, No 22
(November 15), 2003. The students discussed their research design
for evaluating the merits of Alimi’s study. Readers, I know you’ll
be impressed! I was a judge for this research competition, and I
was sitting next to another judge, Tammy Sajdyk, PhD, a program
manager at the Indiana Clinical Translational Science Institute.
Tammy told me that the students’ presentations were just as good if
not better than many of the MD or PhD initiated presentations and
protocols she evaluates at the university.
This issue contains a great example of MD and DAOM research
collaboration in the oncology setting by Elizabete Alves de Sousa,
DAOM. It is a collaborative study using students from the Pacific
College of Oriental Medicine in San Diego. She reports her findings
from a clinical trial held at the Balboa Naval Hospital, San Diego.
Her co-author, Brian Lawenda, MD is a prominent researcher in the
area of radiation oncology and a board member of the Society of
Integrative Oncology. They collaboratively examined the impact of
acupuncture on symptoms for post radiation cystitis and prostatitis.
Exploring the theme of male genitourinary conditions, Shane
Haggard, LAc presents an interesting case review on promising
results from acupuncture and herbal supplements to treat erectile
dysfunction. All patients were treated at a traditional TCM clinic.
Celeste Homan, MS, MAc, LAc gives readers a well-articulated
perspective on the use of a form of structural acupressure, Zero
Balancing, that can be a valuable tool for the AOM practitioner. She
discusses how using this technique can be both a diagnostic tool
and a research tool. Lynn Almloff, DAOM discusses a case study on
successful delivery of a full term fetus using TCM for a previously
infertile patient who had recurrent spontaneous abortions.
In this issue we feature an interview by Vice President Michael
Jabbour with Jane Yu, current president of the AAAOM-SO group.
The interview explores some important concerns in the AOM
profession from a student’s point of view. Very enlightening.
We have two terrific book reviews in this issue. The first is
Shonishin: Japanese Pediatric Acupuncture by Stephen Birch, PhD,
LAc reviewed by Fred Jennes LAc.. Fred shows us how useful this
book can be if for treatment of pediatric patients, and he especially
likes the DVD that shows how the gifted, animated author/lecturer
“masterfully performs ‘the dance’ with his young patients.”
The second book review is about Treating Autoimmune Disease
with Chinese Medicine, by Wanzhu Hou, CMD, DiplCH, DiplAc,
LAc. Reviewer Kathleen Lumiere, DAOM, LAc discusses the ways in
which the author describes autoimmune disease from both Western
allopathic and traditional Chinese medicine points of view. She gives
us all the reasons why this book is a “must have” for anyone with a
basic understanding of biomedicine.
Lastly, I received a “letter to the editor” that I want to share
with you from Eric Buckley, DOM, who comments and elaborates
on the summer, vol. 56 article, “The U.S. Acupuncture Workforce:
The Economics of Practice” by Steven Stumpf, EdD, et al., which
discusses factors that determine the economics of successful practice
in our profession.
I would like to thank all the contributors to this issue of The
American Acupuncturist and reach out to authors and researchers
alike for continued submission of articles. We are looking for
topics such as case studies, discussions of AOM classics, opinion
papers, clinical research, and commentaries. More information on
submission, including the journal’s “Author Guidelines,” can be
found at www.aaaomonline.org.
Sincerely yours,
Jennifer A. M. Stone, LAc
Editor-in-Chief
v 57
The American Acupuncturist
7 2011 AAAOM Board of Directors
Executive Committee
Jeannie Kang
MS, DNBAO, DNBIM, LAc
President
[email protected]
Michael Jabbour
CSP, MS, LAc
Vice President
[email protected]
Janet Borges
MSTOM, Dipl Ac&CH
(NCCAOM), LAc
Secretary
[email protected]
Kimberley Benjamin
LAc
Treasurer
[email protected]
Deborah Lincoln
MSN, RN, Dipl Ac
(NCCAOM)
Advisor to the Executive
Committee
[email protected]
Jessica M.S. Gregory
MSAOM, Dipl OM
(NCCAOM), LAc
[email protected]
Irwin Tjiong
MBA, Dipl OM
(NCCAOM), LAc
[email protected]
Ann Wang
CMD (China), LAc
[email protected]
Jane Yu
MAOM, DiplOM
(NCCAOM), LAc
Student Organization
President
[email protected]
Mori West
CMRS
[email protected]
Richard Charles Niemtzow
MD, PhD, MPH
[email protected]
Directors-at-Large
Public Directors
The American Association of Acupuncture & Oriental Medicine, established in 1981.
OUR MISSION
To promote excellence and
integrity in the professional
practice of acupuncture and
Oriental medicine, in order
to enhance public health
and well-being.
OUR PURPOSES
To support the continued development of the profession of acupuncture and Oriental medicine.
To establish a favorable legal and regulatory environment for the practice and integration of
acupuncture and Oriental medicine into mainstream healthcare in the United States.
To increase access to acupuncture and Oriental medicine services.
To educate the public, legislators, regulators, and health professionals about the benefits of
acupuncture and Oriental medicine.
To encourage adherence to high ethical and professional standards on the part of licensed or
certified acupuncturists or practitioners of Oriental medicine.
8 T h e A m e r i c a n A c u p u n c t u r i s t Fall 2011
Interview with AAAOM-SO
President Jane Yu
AAAOM-SO President Jane Yu, MAOM, Dipl OM
(NCCAOM), LAc received her master’s degree from
the Academy of Oriental Medicine at Austin, TX,
in 2009. She participated in an international TCM
training program in Chine for several weeks in 2007,
studying with doctors in the Teaching Hospital of
Chengdu University of TCM in Sichuan province.
Jane currently maintains a private acupuncture
practice in Austin, specializing in emotional conditions related to tension and stress such as anxiety
and insomnia.
MJ: What motivated you to step up and volunteer for
the AAAOM?
Interviewed by
AAAOM
Vice President
Michael Jabbour,
CSP, MS, LAc
JY: I felt that I wanted to bring my awareness of the concerns
and priorities of current students and new graduates to the
organization. I know from personal experience that new
practitioners have to overcome many challenges and obstacles to
begin a successful career.
When I started acupuncture school in 2005 after completing
my undergraduate degree, I immediately noticed a significant
difference between my classmates and myself—I was one of
the youngest students. Many of them were not only older but
had found their way to acupuncture and Oriental medicine
(AOM) through dissatisfaction with a previous career (nursing,
computer science, etc.). By my final year of schooling, I saw
that more students were attending the school directly after their
undergraduate education.
After graduation I realized I did not feel ready to open a private
practice. Our education focused mainly on clinical training
and put less emphasis on building a successful small business,
which is what having a private practice meant to us. I did not
have skills brought over from a previous professional life, so this
seemed all the more challenging. I had to seek resources and
assistance to identify and overcome obstacles such as marketing
v 57
The American Acupuncturist
9 “I joined the AAAOM because I wanted to assist our professional organization
in becoming an important resource for graduates in these areas”
and building a client base as well as patient management. I joined
the AAAOM because I wanted to assist our professional organization in becoming an important resource for graduates in these areas
MJ: Is there a specific accomplishment you are looking to achieve
during your term on the board?
JY: Relevant and professional communication is very important to
me. During my term on the board, I am dedicating my time and
energy to improving the quality and frequency of communications
to the SO and the professional AAAOM membership. In order for
our organization to speak authoritatively on behalf of the profession, we need to stay familiar with the concerns of the AAAOM
membership, and in the same way, the members need to be
aware of what AAAOM is doing for them. To that end, the SO is
working on leveraging existing social media sites such as Facebook
and Twitter, as well as creating forums on the AAAOM’s website
[aaaomonline.org/forums]. Additionally, the SO has been assisting
with updating and re-organizing AAAOM the website so that it is
more user-friendly, attractive, and useful for prospective patients
and practitioners.
MJ: What is the single most important thing you would like
AAAOM and the other affiliated AOM organizations to achieve in
the next five years and why?
JY: I want my AOM professional organizations to influence policies
that increase the acceptance of AOM into mainstream health care.
Not much can be accomplished by just a single individual. Our
profession is what we, as a unified group, shape it to be, and this
requires that we demonstrate to the world our support of both our
profession and our patients. We need to speak with one voice.
More specific examples of what I want to work towards are coverage
by all health insurance providers, the option to be employed in
integrated health care facilities, hospitals and multi-discipline
clinics, and that these employment options and the income levels of
LAcs be competitive with other medical professionals. Most AOM
graduates have student loans or other debt as a result of their education and training. So that we can pay off these loans, grow our
businesses, and lead fulfilled lives, our professional organizations
need to do everything in their power to insure that our profession
has competitive reimbursement and job opportunities.
MJ: If you had one area of mainstream medicine you would like
to see acupuncture and Oriental medicine integrated into, which
would it be, and why?
JY: I would like to see greater integration of AOM at in-patient
facilities like hospitals and nursing homes. While studying at a
hospital in China I remember being shown a MRI or CT scan of
a patient who had suffered a stroke. The image showed how the
affected area shrunk over time. This information was used to adjust
the acupuncture and herbal treatments being administered. I saw
this as particularly noteworthy because the results achieved by using
10 T h e A m e r i c a n A c u p u n c t u r i s t Fall 2011
both the biomedical tools and the acupuncture and herbs were
greater than the use of just one approach.
During or after illness strikes is the most critical time for AOM
to be utilized. But it is in that specific time period in the disease
progression that AOM is currently not generally accessible to
patients. I believe that greater integration in mainstream medicine,
and in particular integration when patients need us, will greatly
improve outcomes for patients in this country.
MJ: In your work with AAAOM, please tell me about the
accomplishment you are most proud of.
JY: I am proud to be involved in the effort to include our medicine
in health care reform as an Essential Health Benefit. This EHB
stands for the inclusion of acupuncture into federal programs as the
health care reform progresses. I believe this campaign, and others
like it, are the first steps for AOM recognition in mainstream health
care, and including it will ensure that our medicine is accessible to
the public regardless of their income levels.
This could be the first step to insure that patients have access to our
medicine as well as wider acceptance in health insurance programs
and increased participation in established medical institutions.
MJ: Can you provide words of advice and inspiration to your
fellow students who want to participate in these activities but
are unsure how?
JY: If you are a self-motivated individual who wants to shape the
future of your profession, I invite you to bring your energy and
expertise to the AAAOM Student Organization board.
The Student Organization was formed in 2006 by several motivated students who organized themselves into the first national
student caucus and created the infrastructure of the SO. Since that
time, this group has been growing rapidly, with 12 chapters active
today, as we attempt to better represent the 8000+ students in
the AOM profession by serving as a conduit for scholarships and
outreach opportunities.
All AOM students are invited to participate in activities at their
local AOM college chapter or start a chapter at their own school.
If students reading this are looking for more information about
participating or starting a chapter, please contact us at
[email protected]
The Use of Zero Balancing
within the Context of
Acupuncture
By Celeste Homan, MS, MAc, LAc
Celeste Homan, MS, MAc, LAc
received her master’s degree from
Tai Sophia Institute in 1998 where she
has been teaching since 2002 and
is a member of the core faculty. She
has completed trainings in advanced
acupuncture and Chinese medical
aromatherapy with Jeffrey Yuen in
New York. Celeste holds a certificate
in advanced massage and bodywork
from the Baltimore School of Massage
and is certified in Zero Balancing.
Prior to studying acupuncture, Celeste
worked as an electrical engineer
designing computer systems and
holds an MS in Electrical Engineering
from The Johns Hopkins University.
She has a private practice in southern
Howard County, Maryland. Contact
the author for more information about
ZB: [email protected]
Abstract
This article explores a form of structural acupressure
called Zero Balancing (ZB) to use as a clinical tool
within the context of acupuncture treatment. ZB
techniques can be used for assessment and treatment. As
an assessment tool, ZB provides a kinesthetic experience
of the flow of qi through the channels. As a treatment
tool, ZB techniques can be used to directly stimulate
a single acupuncture point in place of a needle. Other
techniques are used to have a broader effect, treating
the trajectory of a channel as a whole. The entire ZB
protocol can be viewed from a Waike perspective—a
specialty of external medicine which involves the
release of internal and external pathogenic factors to
the exterior. The practice of ZB allows a practitioner
to develop an enhanced quality of touch that furthers
the healing effects of treatment. This article provides an
introduction to the method of Zero Balancing. Several
ZB techniques are briefly described, and measures of
efficacy are provided.
Keywords: channel theory, healing touch, acupressure,
Zero Balancing, fulcrum
Introduction
There are three foundational principles of Chinese medicine; yin/
yang and five phase theory, internal organ theory, and channel
theory (Wang, 2008, p. 2). Of these interdependent concepts,
channel theory can be said to bring the other two theories to
life, mapping them to the acupuncture points and enabling us to
better incorporate a patient’s physical signs and symptoms into
v 57
The American Acupuncturist
11 The Use of Zero Balancing within the Context of Acupuncture
our diagnosis and treatment plan. Channel theory directs our
Fulcrums can also be used as a part of the treatment design
attention back to the body in search of the physical manifestation
process. When a point is being considered for treatment, the
of the organ functions and phase relationships.1 Palpation of the
practitioner can stimulate the point with a fulcrum and then ask for
channels is an invaluable assessment tool but tends to be done in a
patient feedback. For example, there are many points that can be
Fullrarely
textincorporating
of this article
is available
ONLY
members
journal
subscribers.
static manner,
the dynamic
movements
of qi to AAAOM
used to release
constrictionand
of the
chest such
as GB 22, SP 21, and
that more accurately
indicate
functioningmember
of the channels
a
LU
1. After
applying print
a fulcrum
one of these
points,go
theto:
practitioTo become
anthe
AAAOM
andasreceive
the
complete
or toonline
journal,
whole. Thewww.aaaomonline.org
acupressure techniques of Zero Balancing (ZB) include
ner can ask the patient about their breathing. His information can
palpation while providing gentle traction and small movements of
then be used to decide where to insert needles for retention. In this
the patient’s
body.
It offers a method
for incorporating
the moving
if LU 1 has the greatest effect, the practitioner may choose
For
library-only
subscriptions,
please
contactexample,
[email protected]
nature of qi.
to insert a needle at LU 1 and another at LU 7 as a distal point
along the same trajectory.
Developed by Fritz Smith, MD, a former student of Professor
J. R. Worsley, Zero Balancing is a form of structural acupressure
This issue contains full-text content of the
following:ZB Techniques
Additional
performed on patients when they are reclining, face up, on the
A more
is the half-moon vector (HMV). The
treatment table. An -entire
session with
can take
anywhere from
20-40
Interview
AAAOM-SO
President,
Jane
Yu,complex
LAc, p.technique
9
HMV
is
performed
while
standing
at the foot of the treatment
minutes, but individual parts of the protocol can easily be incortable
with
the
patient
lying
in
a
supine
position. The practitioner
Book
Review:
Shonishin:
Japanese
Pediatric
Acupuncture,
p.
32
porated into an acupuncture session. There are two interrelated
grasps
the
patient’s
feet
by
cupping
them
under the patient’s heels.
concepts that must be understood to perform ZB techniques:
- Book Review: Treating Autoimmune Disease
withfinger
Chinese
Medicine,
p.
34
The
index
makes
contact
with
the
Calcaneal
tendon where it
fulcrums and interface. The fulcrum is the basic working tool
meets the bone. The patient’s feet and legs are lifted a few inches off
of ZB. Interface describes
the practitioner’s
state of
or
- AAAOM-SO
Update,
p.awareness
36
the table. The practitioner then applies gentle traction by pulling
intention when applying a fulcrum.
the feet toward her while simultaneously lifting and dorsi-flecting
Index
to
Advertisers,
p.
40
The simplest fulcrum can be thought of as a balance point as
the feet
with a seesaw. The practitioner applies gentle pressure with one
slightly
finger; the amount of pressure applied varies according to the
to create
patient’s needs. For the patient, the sensation should feel pleasant
a curved
as when receiving a massage. Too little pressure or tension has no
moveeffect, and too much is counterproductive, causing the patient to
ment. The
become tense. The fulcrum is established by varying the amount of
practitioner
pressure until movement is initiated—holding the pressure steady
visualizes
for three to five seconds and then releasing. One exercise used to
the cervical,
demonstrate the practitioner’s experience is to create a thick mixture
thoracic,
of water and corn starch. The surface of this mixture seems hard
lumbar, and
when tapped; but if the finger is pressed slowly into the surface at
sacral curves
a slight angle, the surface tension gradually releases allowing the
of the spine
finger to penetrate.
while drawing energy through the body to support these strong
The practitioner’s intention is the key to providing the right
vertical flows. When the fulcrum has been created, the practitioner
amount of force. In Zero Balancing, this intention is called “intermay experience a sensation similar to stepping onto a moving
face.” Interface is defined as “the juxtaposition of energy fields with
sidewalk. Tension is held for 3-5 seconds and then gradually
clarity of boundaries” (Smith, 2005, p. 194). To work at interface,
released. With experience, the practitioner becomes able to visualize
the practitioner maintains an awareness of four distinct things: the
obstruction along the channel trajectories by observing the patient’s
sensations of movement at the point of contact, representing the
resistance to subtle changes in the direction and strength of
qi of the patient, the sensations of movement within her own body
the traction.
representing her own qi, the physical boundaries of her patient, and
After completing the HMV to the feet, the practitioner moves
the physical boundaries of her own body. Conceptually, there is no
to
the side of the table at the level of the patient’s hips and stands
exchange of energy; rather, there is an experience of separation with
angled
toward the patient’s face. Reaching around the patient’s
communication. Creating a mental image of the physical structures
waist,
the
practitioner begins opening the rib cage by cradling it in
surrounding the point of contact can be very helpful in maintaining
both
hands.
During this part of the session, each of the practitiointerface.
ner’s fingers is making contact with the ribs while maintaining the
When a simple fulcrum is applied to an acupuncture point, the
quality of touch associated with interface. Making several passes
effect can be the same as using a needle. This can be demonstrated
from the area just below the scapula to the lumbar vertebrae, gentle
by observing changes based on the four inspections (to see, to hear,
pressure is applied to evaluate for areas of tension or flaccidity.
to ask and to feel), the same clinical process as is used to evaluate
When these areas are found, they are held for a period of 3-5
the efficacy of using a needle.
seconds, providing a fulcrum at each point of contact as previously
described. In addition to palpable changes at the point of contact,
the practitioner is carefully observing for additional signs of
12 T h e A m e r i c a n A c u p u n c t u r i s t Fall 2011
“When a simple fulcrum is applied to an acupuncture point, the effect can be the same
as using a needle. This can be demonstrated by observing changes based on the four
inspections (to see, to hear, to ask and to feel), the same clinical process as is used to
evaluate the efficacy of using a needle.”
Full text of this article is available ONLY to AAAOM members and journal subscribers.
become
an AAAOM
member
receive the
print
or as
online
journal,
to:
movementTo
which
include eyelid
fluttering, changes
to theand
breath,
The complete
spinal curves can
be seen
areas where
yang qigo
accumulates
and kriyas www.aaaomonline.org
or involuntary movements representing the release of
and manipulation of these curves can be said to activate the du
held energetic patterns.
mai (Yuen, 2003, p. 27). The du mai forms a circulation with the
For library-only subscriptions, please [email protected]
mai called the microcosmic orbit (Chia, 1985, p. 62). This
Techniques to Release the Pelvis
fundamental circulation is the focus of Taoist longevity practices
The sacroiliac joint is released in a similar manner by applying
and is depicted in Figure 2. Because ZB manipulates these curves it
fulcrums directly to This
the sacrum
and
to
the
pelvic
bones.
Although
canfollowing:
be seen to influence this important circulation.
issue contains full-text content of the
fulcrums are applied to soft tissue, the intention with Zero
- Interview
with AAAOM-SO
President,
Jane Yu, LAc, p. 9
Balancing is often directed
to the skeletal
structures of the
body.
Each technique is designed to initiate movement and then allow the
- Book
Review:
patient to integrate the
change,
flowing Shonishin:
from one areaJapanese
of the body Pediatric Acupuncture, p. 32
into the next. The pelvis
is further
released
using the
hip fulcrums Disease with Chinese Medicine, p. 34
- Book
Review:
Treating
Autoimmune
of ZB. These fulcrums involve evaluating and medially rotating
the hip joint while providing
gentle traction
to the
- AAAOM-SO
Update,
p.leg.
36A more
advanced technique adds pressure to the gluteal area while holding
- Index
to Advertisers,
p.the
40sacroiliac
this hip fulcrum. When
combined
with releases to
joint, these techniques are extremely effective in releasing the entire
pelvis. This can be verified by re-evaluating the free movement of
Figure 2. Microcosmic Orbit
the area and the rotational range of motion of the hips.
of the Ren and Du Mai.
Releasing the Neck
A curved pull is also applied to the head and neck of the patient.
This HMV is performed by cradling the patient’s head with the
fingertips while the back of the practitioner’s hands rest on the
table. Gentle traction is applied while lifting the head slightly and
visualizing the curves of the spine. Tension is maintained for several
seconds and then released. A similar technique adds a rotation to
the HMV turning the head slightly while maintaining tension. The
practitioner imagines pouring the patient’s head from one hand
into the other. The free hand then reaches under the neck to the
area of the Mastoid process on the opposite side and pulls the fingertips across the posterior muscles of the neck while maintaining
the traction and curve. Taken together, these techniques improve
the range of motion of the neck in flexion, extension, and rotation.
This is verified by performing evaluations of these motions before
and after treatment.
Influencing the Ren and Du Mai
The application of ZB techniques to the torso, feet, and neck can
be understood to directly influence the spinal curves. The major
muscle groups that support these curves are illustrated in Figure 1.
The figure illustrates that the balance between the cranial region,
the thoracic region, and the pelvic region are maintained by these
muscle groups. These muscles directly influence a person’s posture
and define the spinal curves. ZB manipulates the spinal curves
by influencing these muscle groups. Based on palpation, in this
author’s experience, areas of tension relax and areas of flaccidity
become more vibrant. Impressive change is the change to a patient’s
posture with repeated treatment.
Figure 1. Postural relationships
to major muscle groups.
Courtesy of Stanley Keleman
Implementing a Waike Strategy with ZB
The following three treatment principles, as outlined by J. C. Yuen
in his Waike strategy, (Yuen, 2007) may be accomplished by ZB
techniques alone or in combination with acupuncture techniques.
1. Ensure the availability of yang qi to clear the pathogenic factor.
With acupuncture, this is typically done by treating DU 4
followed by DU 14. Activating the du mai (already mentioned) is
necessary to ensure the availability of yang qi. Fulcrums are often
applied directly to DU 4 and DU 14 if they are found, through
palpation, to be obstructed locally. The du mai can be further
supported by applying gentle fulcrums to each inter vertebral
space all the way along the spine.
2. Open the orifices above and below. The neck fulcrums previously
described provide direct stimulation of TH 16 and BL 10. As
these are window points, they can be used to open the portals
in the upper aspect of the body (Yuen, 2007). The HMV to the
feet directly influences the urinary bladder meridian all along the
posterior surface of the leg, opening up BL 56 and BL 57, which
help regulate the lower orifices. Direct palpation and treatment
of BL 40 is also common.
v 57
The American Acupuncturist
13 The Use of Zero Balancing within the Context of Acupuncture
ZB protocol to specifically address emotional aspects of healing
3. Treat local and distant areas to move a pathogenic factor toward
(Raheem, 1991). Dr. Raheem engages the client in a dialogue while
the antique points. Within the ZB protocol, fulcrums are first
continuing the acupressure session in order to bring insight into life
applied to the torso and then applied distally when traction is
lessons and habituated ways of behaving. With or without dialogue
applied to the limbs. Another common technique is to gently
of this
article
is well
available
ONLY
members
and
the skillful touch
associated
withjournal
ZB can besubscribers.
a valuable tool in these
squeeze Full
along text
each finger,
toward
the jing
points, near
the to AAAOM
situations. print or online journal, go to:
end of the
Tosession.
become an AAAOM member and receiveclinical
the complete
www.aaaomonline.org
Influencing
the Primary Meridians
Conclusions
Regarding For
the primary
meridians,subscriptions,
it is worth noting that
with contact
[email protected]
can be used as an adjunctive technique to acupuncture or as
library-only
please
the exception of the urinary bladder meridian, each of them has a
the primary modality. For patients who can not tolerate needles,
deep pathway that goes through the diaphragm. So releasing the
ZB can be used to effectively treat individual acupuncture points.
diaphragm has an effect on all of these flows. In fact, deep pathways
This approach is especially useful with pediatric patients and can be
This
issue
contains
full-text
content
of
the
following:with the addition of essential oils, homeopathy, or
of all of the yin meridians affect the free movement of qi into and
supplemented
out of the chest. With experience, palpating and holding the rib
herbal medicine as needed. As an assessment tool ZB can be used
- Interview with AAAOM-SO President, Jane
Yu, LAc, p. 9
cage offers valuable insights into the cause of restriction in this area.
to evaluate the potential influence of acupuncture points during the
From a five phase perspective,
practitioners
may notice
a sudden Pediatric
treatment
planning process.
- Book Review:
Shonishin:
Japanese
Acupuncture,
p. 32
change in odor or color when releasing the rib cage that directs
The basic ZB protocol can be used to activate the du mai to supBook Review:
Treating
Autoimmune
with
Chineseorbit.
Medicine,
p.the
34du mai can also be used
them to the element- involved.
The positive
effect on
the pulse may Disease
port the
microcosmic
Activating
be immediate evidence of its effectiveness.
to ensure the availability of yang qi within the context of a Waike
- AAAOM-SO Update, p. 36
As with acupuncture, emotional catharsis with treatment is not
treatment strategy. The Waike principle of releasing pathogenic
uncommon. The quality
of touch
associated withp.ZB
factors to the exterior is supported by ZB techniques applied to the
- Index
to Advertisers,
40can be very
helpful in supporting patients who are experiencing this level of
neck, pelvis, and limbs. The quality of touch associated with ZB
vulnerability. The clarity of boundaries associated with interface
provides the acupuncturist with a valuable clinical tool for supmay create a safe setting for these phenomena to occur. The
porting the emotional needs of patients and for engaging them in a
important thing is to maintain physical contact with the patient
kinesthetic experience of their own energy body.
at interface and to allow enough time for the process to come to
1. “If you’re going to practice Acupuncture, and have the flexibility of dealing with and treating
completion. It is not unusual for the patient’s emotional expression
all kinds of conditions, it is my contention that you really need to know all of the Meridians of
to go on for as long as ten or fifteen minutes.
Acupuncture. I do believe that’s one of the shortcomings of contemporary Acupuncture, in the
way it’s taught. Why TCM in particular has a greater dependence on Herbal Medicine is because
This author has found that patients report a profound sense of
of the inability to integrate all of the Meridians that are available to Acupuncturists within their
emotional well being after these events occur. Aminah Raheem’s
practice.” (Yuen, 2005, p. 2).
work with process acupressure represents an adaptation of the
THE CAREER CONNECTION
Connect to the Right People and
Opportunities with
NYCC’S CAREER
OPPORTUNITIES DATABASE...
Chia M. (1985). Taoist ways to transform stress into vitality.
Huntington, New York: Healing Tao Books. Smith F. (2005). Alchemy of touch. Taos, NM: Redwing
Books.
Wang J Y, Robertson J. (2008). Applied channel theory in
Chinese medicine. Seattle, WA: Eastland Press Inc.
Yuen J C. (2003). Channel systems of Chinese medicine:
Sinew Channels. Boston: The New England School of
Acupuncture Continuing Education Department.
„ Sell your Acupuncture Practice
„ Hire an Acupuncture Associate/IC
„ Sell Acupuncture Equipment
„ Rent Acupuncture Office Space
For more information:
PHONE: 1-315-568-3039
WEB SITE: www.nycc.edu
14 Note: From Emotional Anatomy by Stanley Keleman, 1985,
p.109, 141. Berkeley, CA. Center Press. Copyright by
Stanley Keleman. Reprinted with permission.
Raheem A. (1991). Soul return: Integrating body, psyche and
spirit. Lower Lake, CA: Asian Publishing.
FREE!
Finger Lakes School of
Acupuncture & Oriental Medicine
of New York Chiropractic College
Career Development Center
References:
T h e A m e r i c a n A c u p u n c t u r i s t Fall 2011
Send postings by:
FAX: 1-315-568-3566
E-MAIL: [email protected]
Yuen J C. (2005). Channel systems of Chinese medicine: The
eight extraordinary vessels. Boston: The New England School
of Acupuncture Continuing Education Department.
Yuen J C. (Speaker) (2007). Bi-obstruction syndrome (CD
Recording). Columbia, MD: Maryland Acupuncture
Society.
Acupuncture and Herbal
Therapies in the Treatment
of Erectile Dysfunction
By K. Shane Haggard LAc
K. Shane Haggard, LAc is licensed in
Indiana and holds NCCAOM certification. For over twenty years Shane
worked in administrative directorship
roles in the Western health care system
before studying acupuncture and
Oriental medicine. In 1997 he designed
and implemented the acupuncture
detox program at Fairbanks Hospital,
Indianapolis, IN, and served as a NADA
consultant for the Acupuncture Task
Force of the Medical Licensing Board,
Indianapolis, IN. Shane assisted in
the reversal of the physician referral
mandate in 2008 and has served as
Abstract
This review of individual cases shows the possible
efficacy of acupuncture and herbal therapies to treat
“erectile dysfunction” (ED). Eight patients are discussed,
and their progress using the whole medicine system,
traditional Chinese medicine (TCM, acupuncture,
and herbals) is reviewed. Acupuncture treatments were
tailored for each patient based on TCM diagnosis.
Seventy-five percent of patients self-reported positive
results in as few as two treatments. All outcome data was
gathered via patient self-report. This review may support
the use of acupuncture as an appropriate treatment
option for symptoms of ED.
Keywords: acupuncture, traditional Chinese medicine, erectile
dysfunction
an officer in the Indiana acupuncture
association. He currently participates
Introduction
as co-investigator in both animal
Erectile dysfunction (ED) is defined as the inability to achieve
or maintain an erection firm enough for sexual intercourse
(NKUDIC). The National Institutes of Health (NIH) estimates
that ED affects as many as 30 million men in the United States
(JAMA, 1997). Moreover, the incidence only increases with age
with about 45 of men in their 50s, 17% of men in their 60s, and
nearly 47% of men older than 75 experiencing total impotence
(Saigal, 2006). This rate also increases significantly in men with
diabetes (Saigal, 2006). Overall, it is believed that one in ten men
have ED (NKUDIC).
The reasons for such a high rate of incidence are varied. Scientific
research shows that ED can occur for a number of reasons ranging
from psychosomatic issues, medication side effects, organic conditions, disease, surgery, hormonal imbalances, and injury to lifestyle
choices. (NKUDIC)
and human studies research at the
Indiana University School of Medicine,
Indianapolis, IN.
v 57
The American Acupuncturist
15 Acupuncture and Herbal Therapies in the Treatment of Erectile Dysfunction
Typical Western treatments include oral medications (with
Methods
significant side effects), use of a penile vacuum pump, intra-urethral
This examination is a case review of eight patients, who presented
suppositories, injection therapies, and surgical implants. Many of
to the TCM clinic specifically seeking treatment for ED between
these options carry a myriad of side effects and/or minimal efficacy
January, 2006,
and September,
No ED
patients were
Full text of this article is available ONLY to AAAOM
members
and 2010.
journal
subscribers.
in their long-term use. Thus it is important to maintain the search
excluded from this examination. At each visit, patients were asked
becometreatments.
an AAAOM member and receive the complete print or online journal, go to:
for new orTo
underutilized
to report any improvement in erectile function. Patient charts were
There iswww.aaaomonline.org
current evidence to support the use of traditional
reviewed, and patients’ reports were analyzed.
Chinese medicine (TCM) to increase the likelihood of achievlibrary-only
subscriptions,
please contactClinical
[email protected]
Observations
ing positiveFor
results
in males suffering
from erectile dysfunction
(Engelhard, 2003). This article provides an overview of the
Four patients presented to the clinic with a diagnosis of ED
information available regarding the use of acupuncture, herbs, and
from their allopathic medical provider. Four were self-reported
supplements for eight
cases
of
ED
treated
in
a
TCM
clinic.
as following:
experiencing ED symptoms, which included inability to
This issue contains full-text content of the
obtain and/or maintain an erection during sexual intercourse or
Erectile Dysfunction
from awith
Chinese
Medicine
- Interview
AAAOM-SO
President, Jane
Yu, LAc,Patients’
p. 9 average age was 62 (ranging from 32-72
masturbation.
Perspective
years of age). History and physical examinations were gathered and
- Book Review: Shonishin: Japanese Pediatric Acupuncture, p. 32
Traditional Chinese medicine is an ancient whole medicine system
TCM diagnostic tools were used to collect information, including
that promotes healing
by
creating
a
stable
healthy
homeostasis
observation
the tongue,
palpation p.
of the
- Book Review: Treating Autoimmune Disease
with of
Chinese
Medicine,
34radial pulse, physical
in the body. TCM theory states that qi (vital energy, life force)
observation, and smell.
- AAAOM-SO
36
moves through the body
via meridiansUpdate,
and can bep.manipulated
to
Symptoms varied in severity and intensity, from mild heat signs
bring the body into homeostasis. TCM theory attributes healthy
such as rapid pulse and red tongue to mild agitation with extremely
- Index
to kidneys,
Advertisers,
p.it40
sexual function primarily
to the
however,
is not the only
over-heated signs such as rapid surging pulse, bright crimson
organ manipulated during ED treatment. In the TCM system of
tongue, as well as extreme agitation. Patients also presented with
medicine, erectile disfunction is called “yang wei,” translated as
damp symptoms such as moist, warm, sticky skin, scallops on
“flaccidity.” ED involves the Three Treasures: jing, qi, and shen
tongue, and swollen slippery-coated tongues. Kidney pulses were
(spirit). The kidneys specifically house jing, which is essential to
not rooted or absent. Spleen (SP) pulses ranged from slippery and
reproduction and life and is considered the constitutional basis of
full to slow and disappearing. Heart pulses were full and surging or
the physical body. Jing must be restored and stimulated throughout
disappearing and erratic.
life as it is consumed on a daily basis; it is believed that when the
Patients reported co-morbid psychosocial conditions of anxiety
jing is totally depleted one has come to the end of life.
accompanied by high to moderate levels of stress. Greater than
Qi is essential to all functions of the body. There are numerous
50% reported mild to moderate depression resulting from their
types of both qi and its functions. The important aspects here are
ED as well as external factors unrelated to the ED such as work,
its ability to move blood and retain it in the vessels; it is considered
personal stress and anxiety.
the “commander of blood” in TCM.
Treatment Strategy
Various written materials such as Principles of Chinese Medical
Andrology (Damone, 2008) in conjunction with personal clinical
The treatment strategy consisted primarily of acupuncture with
observations indicate ED in TCM can be and is generally caused
minimal supplementation of herbals and supplements. During the
by kidney (KD) yang vacuity, KD yin vacuity, heart (HT) vacuity,
course treatments, patients were asked to refrain from the use of
spleen (SP) vacuity, liver (LV) qi depression, or dampness of phlegm
pharmaceuticals to achieve erection. Patients who were using such
with or without heat, just to name a few conditions.
pharmaceuticals agreed to suspend use for a period of six weeks
to give the TCM treatments the opportunity to work. Points were
In TCM theory, an excess internal fire can burn up yin reserves,
selected based on each individual’s specific needs, but each person
blood, and fluids, which inhibit the penis from filling with blood
also received similar points known to aid in the treatment of ED.
to achieve a full, maintainable erection. Additionally, excessive
Treatments were administered weekly, with varying numbers of
phlegm can block channels within the penis, resulting in poor to
sessions. Patients would self-report results. Treatment protocols
no erection. Kidney essence is necessary to maintain healthy erectile
were tailored to accommodate individual TCM diagnosis. Because
function.
TCM theory treats the whole person (body, mind, and spirit), focus
For the purpose of this analysis it is important to explain “shen,”
was placed on the mental status of the patient, with an emphasis on
loosely translated as “spirit.” Shen is housed in the heart. When
stress levels, anxiety, and depression—all of which appears to play a
shen is unbalanced, a condition known as “shen disturbance” will
part in ED as indicated by the patients.
present. This can take the form of anxiety, sleep disturbance, dream
disturbance, an overall state of unrest, and potential agitation of
Herbal Treatments
ED. If left untreated, shen disturbance, can progress into insomnia,
Few herbal supplements were used with this particular group in
depression, and amplified stress. (It should be noted that healthy
an effort to see the full impact of the acupuncture treatments. The
shen [spirit] is reliant on the strength of jing [essence] and qi [life
intent of this review is specifically for the use of acupuncture to
energy].)
16 T h e A m e r i c a n A c u p u n c t u r i s t Fall 2011
Acupuncture and Herbal Therapies in the Treatment of Erectile Dysfunction
treat ED. Patients who presented already using an herbal formula
oxide in the body, aiding the erectile function (Lebret, 2002). It
were allowed to continue that specific regiment. However, no
should be noted both Yohimbe and L-Arginine are not Chinese
additional supplements were added to the treatments.
herbs and therefore will not be found in the Chinese pharmacopoeia. Sea Horse formula, a Plum Flower Classic Formula
The combination
of
supplements
and
herbs
used
were:
a
tincture
Full text of this article is available ONLY to AAAOM
members and journal subscribers.
(Mayway Corp, Oakland, CA) is no longer available because the
of Yohimbe (traditional African herb), Sea Horse Formula (Chinese
To L-Arginine
become(amino-acid).
an AAAOM
member
and receiveproduct
the complete
print or online
journal,
go
to:used
contains an endangered
species. Sea
Horse has
been
formula), and
Yohimbine,
an alkaloid
in TCM to invigorate the kidneys, promote circulation, and is
www.aaaomonline.org
found in an
African tree bark, has shown in scientific studies
believed to be an aphrodisiac.
to benefit erectile dysfunction. (Tam, 2001 and Lebret, 2002).
For
library-only
subscriptions,
please
contact
[email protected]
L-Arginine is an amino acid believed to increase the levels of nitric
Only three patients involved in this analysis utilized one or
more of the herbals listed in Table 1.
Table 1
This issue contains full-text content of the following:
Age
Number of
Treatments
(weekly)
67
5
66
26
65
3
32
7
56
Supplements Maintenance Reported Improvement TCM Diagnosis
Interview
with
AAAOM-SO President, Jane Yu, LAc, p. 9
Treatments
- Book Review: Shonishin: Japanese Pediatric Acupuncture, p. 32
no
no
minimal to no results
Spleen Damp/Blood Stag/Mild Heart Shen
- Book
Review:yes-bi-weekly
Treating Autoimmune
withDamp/Heart
ChineseShen/Jing
Medicine,
p. 34 Stag
no
yes-with follow up Disease
Spleen
Deficient/Blood
- AAAOM-SO Update, p. 36
no
yes
Heart Shen Disturbance/Dry Heat/Jing Deficient
no
no
yes
Liver Fire/Blood Stag/Jing Deficient/Heart Shen
14
Yohimbe
no
yes
Spleen Damp/Jing Deficient/ Heart Shen
69
35
no
yes-bi-weekly
yes
Extreme Heart Shen/Spleen Damp/Damp Turbidity/ Blood Stagnation
72
39
no
no
minimal to no results
Spleen Damp-Deficient/Blood Deficient/Liver Fire
66
24
L-Arginine
no
yes, then decreased
Extreme Spleen Damp/ Raging Liver Fire/Extreme Heat/
yes-Sea
- Index
to Advertisers, p. 40
Horse/initially
only
Acupuncture
An average of 19 total treatments, ranging from
3-39 treatments per patient, were administered.
Pre-sterilized disposable needles (DBC Spring
10 .20x30mm; DBC Corp., Japan and Seirin®
0.20x30mm; Seirin Corp., Japan) were inserted at
varying levels based on point selection. Each was
rotated back and forth gently for 1-5 seconds until
resistance of the needle was achieved. The needles were
retained in the body for 20 minutes.
Different acupuncture points were selected along
the conception vessel (CV), governing vessel (GV),
spleen (SP), stomach (ST), urinary bladder (UB),
kidney (KD), heart (HT), liver (LV), and pericardium
(PC) channels. These were utilized during acupuncture
sessions based on the patient’s condition and presentation at the time of treatment. The points were drawn
from a collective of points commonly utilized in the
treatment of ED. Each treatment utilized 8-12 acupuncture points and was tailored for each individual
case. Not any one distinctive protocol was utilized in
all cases.
Table 2
Acupuncture Points
Utilization for ED
Huiyin (CV 1)
boost kidney essence, clear heat, and diminish damp
Ming Men (GV 4)
invigorate the kidney and supplement the essence
Buan Yuan (CV 4)
root the kidney and dispel the cold
Sanyinjiao (SP 6)
free qi stagnation, supplement the SP, and regulate the
blood chamber
Zusanli (ST 36)
regulate the central qi, disperse stagnation, and transform
damp
Shen Shu (UB 23)
supplement the kidney, dispel damp, strengthen lumbar and
spine
Taixi (KD 3)
enrich KD yin, invigorate the original yang
Qi Hai (CV 6)
regulate qi and boost the origin, supplement KD vacuity,
dispel damp turbitity
Shen Men (HT 7)
quiet the heart and spirit, clear fire, clear heart heat
Tai Chong (LV 3)
extinguish LV fire, clear LV yang, discharge heat in lower
burner, soothe LV
Zhong Ji (CV 3)
regulate blood chamber, recitfy the lower burner
Yinlingquan (SP 9)
regulate spleen, transform damp, regulate the waterways
Shan Zong (CV 17)
regulate qi and down bear counterflow, transform phlegm
Nei Guan (PC 6)
clear heat and loosen chest
from: A Manual of Acupuncture,Journal of Chinese Medicine Publications, June, 1998
v 57
The American Acupuncturist
17 Acupuncture and Herbal Therapies in the Treatment of Erectile Dysfunction
“Qi is essential to all functions of the
Results
text oftreatments,
this article
is available
ONLY to AAAOM members and journal subscribers.
Within twoFull
acupuncture
six patients
(75%) reported
body. There are numerous types of
become
an AAAOM
member
and receive the complete print or online journal, go to:
noticing a To
change
in obtaining
and/or maintaining
an erection,
both qi and its functions. The important
with notable
quality improvement within 24 to 48 hours post-treatwww.aaaomonline.org
ment. Changes were maintained in varying degrees throughout the
aspects here are its ability to move
week, ranging
the ability tosubscriptions,
maintain the enhanced
erection
Forfrom
library-only
please
contact [email protected]
blood and retain it in the vessels; it is
to a decrease in efficacy obtained post treatment as the week carried
on. Two patients (25%) reported minimal to no enhanced erectile
considered the ‘commander of blood’
functioning (see Table 1). One patient had significant organic
This issue contains full-text content of the in
following:
TCM.”
co-morbidity conditions that would have impacted the results,
presenting with a cardiac
condition
and AAAOM-SO
diabetes. Additionally,
one Jane Yu, LAc, p. 9
- Interview
with
President,
patient continued to ingest large quantities of alcohol, which could
- BookThree
Review:
Shonishin:
Japanese
have affected the outcome.
patients
utilized supplements
in Pediatric Acupuncture, p. 32
conjunction with the acupuncture treatments. One patient reported
- Book Review: Treating Autoimmune Disease with Chinese Medicine, p. 34
enhanced erectile function with the use of Seahorse formula and
Acknowledgement: The author appreciates Tammy J. Sajdyk, PhD
Yohimbine within hours
of ingestion. The
use of p.
L-Arginine
was
- AAAOM-SO
Update,
36
for her assistance with this article.
inconclusive; the patient was unable to notice any significant
- Indexuse.
to Advertisers, p. 40
enhancement with routine
All patients included in this review reported initially with high
References:
levels of stress, anxiety; some included depression. Psychosocial
Damone B. Principles of Chinese medical andrology, an integrated approach to male reproductive
conditions (shen disturbance) were treated simultaneously.
and urological health. Blue Poppy Press, Inc. Boulder, Colorado. 2008
Deadman P, Baker K, Al-Khafaji M. A manual of acupuncture. East Sussex: Journal of Chinese
TCM theory indicates several factors should be observed to
Medicine Publications; 1998
maintain a healthy sex life as men age. Patients were cautioned
Engelhard P F, Daha L K, Zils T, Simak R, Konig K, Pluger, H. Acupuncture in the treatment
against excessive ingestion of fatty or sugar-laden foods. Patients
of psychogenic erectile dysfunction: first results of a prospective randomized placebo-controlled
were also instructed not to engage in excessive sexual activities and/
study. International Journal of Impotence Research. 15 (5):343-6. 2003 Oct.
or excessive masturbation. Additionally, they were encouraged to
Lebret T, Herve J M, Gorny P, Worcel M, Botto H. Efficacy and safety of a novel combination of
L-arginine glutamate and yohimbine hydrochloride: a new oral therapy for erectile dysfunction.
practice meditation daily to decrease stress and anxiety.
European Urology. 41(6):608-13; discussion 613. 2002 June.
Conclusion
TCM is a complex medical system administered to achieve and
maintain a balanced health. This individual case review of eight
patients demonstrates how two TCM modalities may have facilitated a positive result in erectile dysfunction. TCM therapies may
be an appropriate treatment option for ED that may not respond to
traditional Western therapies or for patients who are unable to use
the recommended pharmaceuticals typically prescribed for ED.
Lin A. A handbook of TCM urology and male sexual dysfunction, Blue Poppy Press, Inc. Boulder,
Colorado. 1999
National Institutes of Health (NIH) Consensus Conference. NIH Consensus Development
Panel on Impotence. Journal of the American Medical Association. 1993;270:83–90.
National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), Erectile
Dysfunction/What is Erectile Dysfunction. Internet: http://kidney.niddk.nih.gov/kudiseases/
pubs/ED/
Saigal C S, Wessells H, Wilt T. Predictors and prevalence of erectile dysfunction in a racially
diverse population. Archives of Internal Medicine. 2006;166:207–212.
Sionneau, P. Gang, L. The treatment of disease in TCM, Vol. 6. Diseases of the urogenital system
and proctology, Blue Poppy Press, Inc. Boulder, CO, 1999
Tam S W, Worcel M, Wyllie M. Yohimbine: a clinical review. Pharmacology & Therapeutics. 2001
Sept;91(3):215-43.
Zhu Y, Ni L, Treatment of impotence by Chinese herbs and acupuncture, Journal of Traditional
Chinese Medicine. 1997 Sept;17(3):226-37.
(CITES) CONVENTION ON INTERNATIONAL TRADE IN ENDANGERED SPECIES
OF WILD FAUNA AND FLORA International Workshop on CITES Implementation for
Seahorse Conservation and Trade Mazatlan (Mexico), 3-5 February 2004 http://www.cites.org/
common/com/AC/20/E20i-24R.pdf
18 T h e A m e r i c a n A c u p u n c t u r i s t Fall 2011
Acupuncture’s Effects on
Relieving Symptoms for Postradiation Cystitis and Prostatitis
By Elisabete Alves de Souza, DAOM
and Brian Lawenda, MD
Elisabete Alves de Souza, DAOM
holds a master’s and a doctoral degree
in acupuncture and Oriental medicine
from Pacific College of Oriental
Medicine, San Diego, California,
where she conducted a clinical trial at
Balboa Naval Hospital San Diego in
urology and radiation. She also holds
a master’s degree in Education from
the Universidade Federal do Rio de
Janeiro, Brazil. Research activities
include eating disorders and nutrition.
Brian Lawenda, MD is a board certified radiation oncologist practicing in
Las Vegas, NV. Following his residency
training in radiation oncology at
Harvard Medical School, Dr. Lawenda
studied acupuncture and herbal
medicine through the prestigious
Helms Medical Institute.
Abstract
Background: The aim of this study was to assess the
response to acupuncture of patients who had moderateto-severe urinary symptoms persisting after 12 months
following the completion of radiation therapy for
prostate cancer treatment.
Methods: A RCT (n=10) was conducted over an
eight week period using three arms (verum, sham/
placebo, and control). Subjects received two treatments
during week one followed by one treatment each week
thereafter for a total of nine treatments using points
on kidney, bladder, spleen, liver, and lung meridians
expected to treat cystitis/prostatitis. Outcome measures
were assessed with an International Prostate Symptom
Score every 2 weeks during treatment and every two
weeks after treatment for a total of 16 weeks. A paired
t-test was performed to determine significant changes in
IPSS before and after the 4-months treatment period in
the randomized arms.
Results: Both verum acupuncture and sham
acupuncture treatment appear to improve the IPSS
scores over the 4-month test period.
Conclusions: Due to the very small sample sizes and
large score variances within the groups, it was impossible
to say whether the Verum acupuncture treatment
protocol or Sham protocol gave more improvement.
Keywords: acupuncture, radiation prostatitis, radiation cystitis,
prostate cancer
v 57
The American Acupuncturist
19 Acupuncture’s Effects on Relieving Symptoms for Post-radiation Cystitis and Prostatitis
Introduction
The Need for Acupuncture Treatment for Postradiation Cystitis and Prostatitis
Estimates of the number of males in the United States who will
experience prostatitis during their lifetime, range up to 50%. Many
Patients treated for cystitis/prostatitis have developed post-radiation
urologic disease
experts
think
that
5%
to
10%
of
males
will
experiproblems since
radiation was
firstjournal
used as anti-cancer
therapy.
Full text of this article is available ONLY to AAAOM
members
and
subscribers.
ence prostatitis at one time, making it one of the most common
Although professionals on radiation have made great improvements
To become
an AAAOM
member
and receiveinthe
complete
print
or online
journal,
go to:
urologic diseases
in the United
States. According
to the National
minimizing
exposure
of healthy
tissues to
the radiation
beam,
www.aaaomonline.org
Institutes of
Health, prostatitis accounts for 25% of all office visits
post-radiation complications still occur. The common side effects of
involving the genitourinary system by young and middle-aged men
post-radiation therapy of the prostate include incontinence, among
For
library-only
subscriptions,
please
contactother
[email protected]
(Ashbury et
al., 1998).
Undoubtedly,
awareness of prostate
disease
symptoms. Acupuncture is needed post-radiation in order to
is on the rise, and as a result increasing numbers of men will be
minimize cystitis, and results for the verum acupuncture pre-post
seeking noninvasive treatment, such as acupuncture.
mean IPSS scores are shown on Table 3.
The purpose of this
study
was to
assess thefull-text
response to
acupunc-of the The
development of integrative Eastern and Western medicine
This
issue
contains
content
following:
ture of patients who had moderate-to-severe urinary symptoms,
provide distinct advantages as a complementary system and sup- Interview
with
President, Jane
Yu,care
LAc,
9
persisting after 12 months
following
theAAAOM-SO
completion of radiation
portive
for p.
post-radiation
cystitis/ prostatitis patients, improvtherapy for prostate cancer treatment. A further objective was to
ing their quality of life and alleviating their symptoms.
- Book Review: Shonishin: Japanese Pediatric Acupuncture, p. 32
provide a comprehensive review of TCM studies on the treatment
of prostate cancer and
symptoms
and toTreating
show that Autoimmune
TCM treatment Disease with Chinese Medicine, p. 34
- Book
Review:
has effective results on radiation cystitis and prostatitis in North
American society. - AAAOM-SO Update, p. 36
- Index to Advertisers, p. 40
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internalize fluids for becoming jin before releasing to the exterior. Keeping both organs functioning properly allows the wei
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20 T h e A m e r i c a n A c u p u n c t u r i s t Fall 2011
Toll-Free 1.800.729.8509
Email [email protected]
“Although professionals in the field of radiation have made great improvements
in minimizing exposure of healthy tissues to the radiation beam, post-radiation
complications still occur.”
Material and Methods
acupuncture points were used in each treatment. In addition,
Full
of thisin article
is available
ONLY
members
and journal
subjects received
five individualized
points subscribers.
based upon a TCM
Ten subjects
weretext
randomized
a three arms:
a) Verum arm
apply to AAAOM
and six standard
regarded journal,
as universally
To become
AAAOM
member
and receivediagnosis
the complete
printpoints
or online
gobeneficial
to:
true acupuncture
points. b)an
Sham
arm introduce
non-penetrating
for
these
symptoms.
For
the
sham/placebo
acupuncture
group
sham needles
at sham points. c) Wait-list control arm was observed
www.aaaomonline.org
a total of five sham/placebo non-penetrating needles were used
and then received Verum acupuncture after a sixteen weeks observaat points
not located on any acupuncture channel. The wait-list
tion period.For library-only subscriptions, please contact
[email protected]
control continued their standard of care until week 17 and then
A single-blind design was used, where only the patients were
received verum acupuncture.
blind to the treatment; the investigators still knew whether a verum
Urinary symptom assessments were performed on subjects every
or a sham treatmentThis
was being
An experimental
issueadministered.
contains full-text
content of the
following:
two
weeks using a standard IPSS form. The assessments were
design was conducted over an 8-week period using a three arms
recorded
(verum, sham/placebo,
and control)
protocol.
Subjects received
- Interview
with
AAAOM-SO
President, Jane Yu, prior
LAc,top.the
9 initial treatment and then once every two
weeks
thereafter,
for
eight weeks. Following the completion of the
two treatments during week 1, followed by one treatment each
8-week
intervention
(verum
or sham acupuncture only), subjects
Book
Review:
Shonishin:
Japanese
Pediatric
Acupuncture,
p. 32
week thereafter for a total of nine treatments. Outcomes measures
were
assessed
by
telephone,
every
two weeks for seven additional
were assessed with an International Prostate Symptom Score every
- Book Review: Treating Autoimmune Disease
with Chinese Medicine, p. 34
weeks.
2 weeks during treatment and every 2 weeks after treatment for
For the verum acupuncture, the acupuncturist used sterile disposa total of 16 weeks. This
study was a controlled
- AAAOM-SO
Update,clinical
p. 36trial that
able
needles. Needle size was 40 gauge and 1-1.5 inch (25mm or
tested the given hypothesis of identifying and examining the effects
40mm)
as indicated, to allow for proper needle depth. The protocol
Index
to
Advertisers,
p.
40
of acupuncture on the subjective cystitis/prostatitis patients who
of
points
used was CV 4, 9, 14, 17; Ki3, 6, 21; LI 4,11; Lu5, 9;
received adjuvant radiation therapy for prostate cancer.
TB5;
Ht6,
7; St36, 40; Sp3, 6, 9, 10; Gb34; Liv3. (Table 1).
Treatment was provided by acupuncturists licensed by the state
of California. For the verum acupuncture group, a total of 10-12
Table 1: Research Design*
Study Protocols
Points Location
Verum Acupuncture
Channel — Points
Sham Acupuncture
Channel — Points
Chest
CV17, Ki21
None
Abdomen
CV9, CV4, CV14
RPS III: 5 cun lateral to the CV meridian and to the lateral side of the rectus
abdominus muscle 1.5 cun below the umbilicus
Arm — Upper Limb
LI11, Lu5, Lu9, TB5, Ht6, Ht7
RPS V: At the end crease of the auxiliary fold
Hand
L14
RPS IV: At the dorsum of the hand between the 3rd and 4th metacarpal
bone in the depression distal to the bases of the metacarpals (wrist)
Leg — Lower Limb
St36, St40, Sp6, Sp9, Sp10, Gb34
RPS II: Between the adductor longus and the Sartorius muscle,
approximately 9 cun above the line parallel to Xuebai (Sp10)
Foot
Ki3, Ki6, Sp3, Liv3
RPS I: At the dorsum of the foot between 3rd and 4th metatarsal bone and
midline of the tendon of extensor muscle digitorum longus
Total Number of Points
Obligatory
6
5
Total Number of Points
Combination
10 to 12
Does not apply
Needle Size
1 or 1.5" (25mm or 40mm) with tube guide
Same as verum acupuncture group
Insertion depth
½ cun
Nonpenetrating
Stimulation
None
None
Method of Insertion
Perpendicular
Same as verum acupuncture group
Treatment Frequency
Two treatments first week, one treatment after for
7 weeks; total treatments = 9
Same as verum acupuncture group
Duration of Needling
30 minutes long from the time of last insertion
Same as verum acupuncture group
Practitioners
Two licensed acupuncturists will rotate
throughout the project
Same as verum acupuncture group
*This research protocol follows STRICTA (Standards for Reporting Interventions in Controlled Trials of Acupuncture) protocol.
v 57
The American Acupuncturist
21 Acupuncture’s Effects on Relieving Symptoms for Post-radiation Cystitis and Prostatitis
Pattern and combined pattern points can be seen in Table 2.
11), Zhaohai Kid (Ki-6), Yanglingquan (Gb-34), Waiguan (TB-5),
Full text of this article is available ONLY to AAAOM
members
and Zusanli
journal
subscribers.
Shuifen (Cv-9),
Xuehai (Sp-10,
(St-36).
Table 2: Pattern and Combined Pattern Points
For emotional
causes
and ramifications
the heart
To become an AAAOM member and receive the
complete
print
or online nourishing
journal, go
to:
and
calming
the
spirit,
selected
points
have
been
used
from
the
Study Protocols
Verum Acupuncture
Sham Acupuncture
www.aaaomonline.org
heart channel, the liver channel, the spleen channel, the stomach
channel,
the liver channel, and the conception channel: Yinxi (Htsubscriptions,
[email protected]
Needle sizeFor library-only
1 or 1.5"
(25mm or
Sameplease
as verum contact
6),
Shenmen
(Ht-7), Taichong (Liv-3), Sanyinjiao (Sp-6), Fenglong
40mm) with tube
acupuncture group
guide
(St-40), Juque (Cv-14).
Obligatory points
Unilateral: St36
N/A
To enrich and supplement kidney essence, selected points from
This issue
full-text content of the following:
(Right),contains
CV4, SP6 (Left)
the kidney channel, the spleen channel, and the conception channel
Bi-lateral: LI-11, L14,
have Yu,
beenLAc,
used:p.
Tai9Xi (Ki-3), Zhaohai Kid (Ki-6), Sanyinjiao
- Interview
with AAAOM-SO President, Jane
Lv8
(Sp-6), Guanyuan Ren (Cv-4).
Patterns
Channel — Points
Channel — Points
Needle gauge
34
- Book40Review: Shonishin:
Japanese Pediatric Acupuncture, p. 32
Damp-heat and stagnation GB34, ST28, CV9
N/A
Methodological Assumptions
- BookST40
Review: TreatingN/A
Autoimmune Disease
with
34
Damp phlegm
Clinical
trialsChinese
to evaluateMedicine,
the efficacy p.
of acupuncture
are compliHeart Qi Xu
Heart Yin Xu
Kidney Yang Xu
HT7, CV14 Update, N/A
- AAAOM-SO
p. 36
HT6, K13
N/A
- Index
to Advertisers, p.
40
KI-3
w/Sp Xu: SP3
w/damp phlegm:
ST40
Kidney Yang Xu
K1-6, K1-3
w/Lu Yin Xu: Lu5
w/Ht Yin Xu: Ht6
Liver Qi and/or blood
stasis
LV3, SP10
N/A
Lung Qi Xu
Lu9, CV17, KI27
N/A
Lung Yin Xu
Lu5, K16
N/A
Spleen Qi Xu
SP3, CV12
N/A
Wind damp heat
SP9, TB5
N/A
For warming and supplementing kidney qi and kidney yang,
selected points from the kidney channel, the spleen channel, and
the conception channel have been used: Tai Xi (KI-3), Shinning
Sea (KI-6), Youmen Kid (KI-21), Taibai (Sp-3), Sanyinjiao (Sp-6),
Yinlingquan (Sp-9), Xuehai (Sp-10), Guanyuan (CV-4), Shuifen
(CV-9), Shanzhong (CV-17).
To transform phlegm and soften hardness in a practice of
Chinese andrological patterns, selected points from the spleen
channel, the stomach channel, conception channel, the lung, and
the liver channel have been used: Tai Bai (Sp-3), Feng Long (St-40),
Juque Ren (Cv-14), Taiyan (Lu-9), Tai Chong (Liv-3).
To course the liver and rectify qi, selected points from the liver
channel, the large intestine channel, the gallbladder channel, the
conception channel, the lung channel, and the kidney channel have
been used: Tai Chong (Liv-3), Quchi (LI-11), Yang Ling Quan (Gb34), Shanzhong Ren (Cv-17), Chize (Lu-5), Youmen Kid (Ki-21).
To clear heat and disinhibit dampness, which is very common in
the clinical practice of Chinese andrology, points were chosen from
the large intestine channel, the kidney channel, the gall bladder
channel, the triple burner channel, the conception channel, the
spleen channel, and the stomach channel: Hegu (LI-4,Quchi (LI22 T h e A m e r i c a n A c u p u n c t u r i s t Fall 2011
cated by several characteristics that impact the methodological
rigor. Assuring adequate sample size, appropriate outcome
measures, adequate treatment protocols, and appropriate control
procedures are necessary to ensure the internal validity of a trial.
Sample sizes in clinical trials of acupuncture have tended to
be small, raising concerns that these experiments have been
inadequately powered to detect true differences between treatment groups, and may account for the apparent ineffectiveness of
acupuncture in some studies (Moher, Dulberg, & Wells, 1994). To
address this issue, rates of potentially eligible participants admitted
to NMCSD, as well as rates of completion of the trial and reasons
for non-completion. This information, along with pilot data about
the expected effect size of the intervention, will help guide the
design of a more definitive clinical trial by providing the number
of participants that can be expected to be eligible to enroll in and
complete the study protocol.
Results from Verum, Sham, and No-Treatment
Acupuncture Protocol
For the verum group, mean change in the International Prostate
Symptoms Score (IPSS) was significantly greater than zero, providing evidence that the treatment is effective in reducing symptoms of
radiation cystitis and prostatitis. (Table 3)
Table 3: Verum Acupuncture — Pre-Post Mean IPSS Scores
Verum Acupuncture
Group
Pre-treatment
IPSS
Post-treatment
IPSS
Change
Subject 1
25
17
8
Subject 4
22
21
1
Subject 10
27
18
9
Subject 13
31
25
5
Group mean
26.25
20.25
6
For the sham group, a similar t-test was performed providing
evidence that the sham treatment is able to reduce symptoms of
“Many researchers have assumed that the sham treatments in clinical trials are inert
when they are not. This opens the door to difficult questions about how to interpret
results in a sham trial in acupuncture.”
radiation cystitis and prostatitis. The variance in raw score is higher
Figure 1: Verum, sham, and no-treatment groups
Full
text
ofVerum
this article
is available
ONLY
in this group
than
in the
Acupuncture
group, because
one to AAAOM members and journal subscribers.
30
subject hasTo
thebecome
IPSS score far
the group
mean. Nevertheless,
anbelow
AAAOM
member
and receive the complete print or online journal, go
to:
n Verum
the change score for this subject is exactly the same as group mean.
www.aaaomonline.org
n Sham
25
(Table 4)
ForAcupuncture
library-only
subscriptions,
Table 4: Sham
— Pre-Post
Mean IPSSplease
Scores
Sham Acupuncture
Group
Subject 2
[email protected]
Pre-treatment
IPSS
Post-treatment
IPSS
Change
34
29
5
This issue contains full-text content of the following:
10
- Interview
with AAAOM-SO
President,
Jane Yu, LAc, p. 9
22
13
9
Subject 8
32
22
10
- Book
Review: Shonishin:
Japanese
Pediatric Acupuncture, p. 32
Group mean
Control
15
Subject 5
Subject 11
n
5
16
8
8
0
- Book
Review: Treating
Autoimmune
Disease with Chinese
Medicine,Post
p. 34
Pre
26
18
8
Change
- AAAOM-SO Update, p. 36
- Index to Advertisers, p. 40
For the no-treatment group, mean change in the IPSS was not
significantly greater than zero, indicating no significant change.
(Table 5)
Table 5: No-Treatment Group — Pre-Post Mean IPSS Scores
Control group
Pre-treatment
IPSS
Post-treatment
IPSS
Change
Subject 3
18
17
1
Subject 9
19
14
5
Group mean
18.5
15.5
3
The difference in outcome between the treatment group and
sham group was not significant. The result does not show that the
verum treatment protocol produces a significantly better outcome
than the sham protocol nor does it show that the sham protocol has
better outcome than the treatment protocol. It is impossible to say
whether protocol gave more improvement because of the very small
sample sizes and large score variances within the groups.
Summary of Findings
To evaluate the pilot data, the experimental groups (verum, sham,
and no-treatment) were analyzed separately to compare the beforetreatment IPSS scores with the post-treatment scores. Change in
IPSS was significant at the .05 levels for the verum treatment and
sham groups. No significant difference was found between the
outcomes of the verum and sham groups. (Figure 1)
Figure 1 explains how the data were analyzed with the paired
t-test function from IPSS for the verum acupuncture group, related
to mean and variance for pre- and post-test score set. Thus, the
mean change of IPSS (M = 6, SD =3.56) is significant at the 0.05
level. The 95% confidence interval is calculated to be 5.66, corresponding to a mean IPSS change in the range (0.34, 11.66).
For the sham acupuncture group, related to mean and variance
for pre- and post-test score set: N = 4, the mean change of IPSS
(M = 8, SD = 2.16) was significant for this group as well. The
t-statistic for this group = 7.41, with a two-tail probability p =
0.005. The 95% confidence interval is IPSS in the range (4.56,
11.44). The variance in raw scores is higher in the sham group
than in the verum acupuncture group, because subject 11 has IPSS
score far below the group mean. Nevertheless, the change score for
this subject is exactly the same as the group mean. The standard
deviation of the mean change for this group (2.16) is lower than the
verum acupuncture group.
For the no-treatment/control group related to mean and variance
for pre- and post test Score Set: N = 2, mean change of the no-treatment group was 3, SD = 2.83. The t-statistic = 1.5 and the two-tail
p = 0.37. The t-statistic = 1.5 was far below the critical value (12.7)
which would have been needed to reject the null hypotheses. The
no-treatment group did not show significant change in IPSS.
To summarize the results from the three arms: the verum
acupuncture group change is significant at p = 0.043 because the
t-statistic (3.37) is greater than the two- tailed critical value (3.18).
The sham group was significant at p = 0.005 where t-statistic =
7.4 > 3.18. The control group, or no treatment, does not show
significance (p = 0.37).
To prepare for a future larger study, a power analysis was
performed to estimate the sample sizes required at various desired
effect sizes. Depending on decisions about the clinical significance
of various effect sizes, it was found that further research will require
v 57
The American Acupuncturist
23 Acupuncture’s Effects on Relieving Symptoms for Post-radiation Cystitis and Prostatitis
2. A hypothetical study requiring a power analyses of .9 and an
sample group sizes between N =13 and N=50. (Power analysis is
Fullthetext
of this
available
ONLY
and
journal
subscribers.
effect sizemembers
of one standard
deviation
(corresponding
to IPSS score
used to judge
probability
thatarticle
statisticalistest
detects a true
H1 to AAAOM
chance
of 3.56). Based
on or
the online
pilot study
showed for
Verum
[or equivalent]
that will reject
false H0). Power
analysisand
uses the
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an aAAAOM
member
receive the
complete
print
journal,
gotheto:
acupuncture group, a SD = 3.56 IPSS score. It was calculated
data collected in the pilot study to calculate the number of subjects
www.aaaomonline.org
that a statistical power of 0.90 could be obtained with an effect
needed to confirm a treatment effect of a specified size with a specisize of a SD by using a study group of 13 subjects.
fied statistical
significance.
It
also
gives
an
indication
whether
the
For library-only subscriptions, please contact [email protected]
experiment and the t-test analysis can detect an effect of practically
3. A hypothetical study requiring a power of .9 and an effect size
useful size.
of one half SD (corresponding to 1.78 points mean change in
A paired t-test was performed to determine if the verum
IPSS). Variance was taken from the pilot study, where SD = 3.56
This
issue
contains
content
acupuncture treatment
was
effective.
For thefull-text
verum group,
mean of the following:
IPSS score. It was calculated that a statistical power = 0.90 and
change in the IPSS was
significantly
greater
than
zero;
T=3.37,
= 0.50
- Interview with AAAOM-SO President, Janeeffect
Yu, size
LAc,
p. 9SD could be obtained using a study group of
showing two tail p=0.043 and providing evidence that the treatN = 44 subjects. Such a design would allow for faster recruitment
ment is effective reducing
symptoms
of Shonishin:
radiation cystitis
and
- Book
Review:
Japanese
Pediatric
Acupuncture,
p. 32
of the
necessary number
of participants, and increase the external
prostatitis.
validity of the study.
- Book
Review:
Autoimmune
Disease with Chinese Medicine, p. 34
For the sham treatment
group,
mean Treating
change in the
IPSS was
Importance of the Results for Future Clinical Trial
T=7.41, showing two
tail p=0.005 andUpdate,
providingp.
evidence
- AAAOM-SO
36 that the
sham treatment was able to reduce symptoms of radiation cystitis
Protocol, Implications, and Applications of Findings
and prostatitis. For the
no-treatment
group, meanp.change
- Index
to Advertisers,
40 in the
The specific aim was to implement and evaluate a research protocol
IPSS was not significantly greater than zero; T=1.5, showing two
for demonstrating the efficacy of acupuncture therapy to improve
tail p=0.37, did not indicate a significant change. Further analysis
prostatitis recovery. In this study, we have documented significant
was done to quantify the power of this test and the expected power
improvement for subjects with symptoms of cystitis and prostatitis
with the larger groups.
after a series of manual acupuncture treatments and a follow-up
Desired Future Sample Size
This research evaluated the efficacy of acupuncture treatment
compared to sham, but did not investigate the method of action
of acupuncture. Design of that kind of future study will depend
on re-thinking the sham acupuncture protocol; if treatment points
are not standardized, the sham treatment may not in all cases
specify predefined non-active points. Nevertheless, although the
sham effect is not well understood, we do not think the treatment
protocol should be unnecessarily limited to over-simplistic cases,
because there are theoretical problems in constructing a sham
protocol. Future research can be designed to clarify the effects of
various kinds of sham protocols. Obviously, the sham effect is
worthy of investigation in its own right, and for these studies, the
usual clinical practice could be regarded as a useful baseline.
While this pilot study was conducted at a single center for
oncology radiation, it is possible that the larger clinical trial be
multi-center. Statistical power analysis results were compared for
three different study cases:
1. Pilot study itself (with n = 4 in the treatment group). Here, there
is a 62% probability of detecting a true H or a 38% chance of
missing even a large effect.
during the two months thereafter. In the verum acupuncture
group, the improvements were registered in almost all subscales
of the IPSS.
Although there was no invasive manipulation, no skin penetration, and placements were deliberately designed to avoid stimulation of verum points associated with the treatment protocol, there
was still a strong effect from the sham treatment. This may suggest
that the improvement that took place in the group of patients that
received sham treatment result from the placebo effect, regardless
of whether the improvement should be attributable to a spontaneous reduction of symptoms severity or to a real psychobiological
placebo effect in which the brain anticipates the outcome. A study
done by Pyne and Shenker (2008) found the most likely explanation for the sham is the phenomenon of placebo. More work
needs to be performed to explore these differences, and this could
lead to a novel treatment to maximize the therapeutic benefits of
acupuncture.
Overall, potential benefits of the proposed research to the
subjects and other study participants may benefit immediately,
as acupuncture is expected to have an overall balancing effect.
Participants may benefit through physical improvement, which may
lead to improved functional outcomes.
“Nevertheless, although the sham effect is not well understood, we do not think the
treatment protocol should be unnecessarily limited to over-simplistic cases, because
there are theoretical problems in constructing a sham protocol. Future research can
be designed to clarify the effects of various kinds of sham protocols.”
24 T h e A m e r i c a n A c u p u n c t u r i s t Fall 2011
Acupuncture’s Effects on Relieving Symptoms for Post-radiation Cystitis and Prostatitis
More fully understanding the pathophysiologies and identifying
Many researchers have assumed that the sham treatments in
Full
of this
is available
ONLY
members
and
journal changes,
subscribers.
effective biomarkers,
as well
as behavioral
have to evolve
clinical trials
are text
inert when
theyarticle
are not. This
opens the door
to to AAAOM
inthe
parallel.
This may require
another
level journal,
of collaboration
between
difficult questions
about how
interpret results
of a sham
trialreceive
in
To become
antoAAAOM
member
and
complete
print or
online
go to:
scientists and people interested in clinical research in acupuncture
acupuncture. Implications that sham is inert introduce bias against
www.aaaomonline.org
and would be an important effort for advancing the field of acufinding the tested therapy to be effective. The common conclusion
research. Rather than an alternative to such management,
from trialsFor
that the
verum
treatment
was
no
better
than
placebo
is
library-only subscriptions, please contactpuncture
[email protected]
acupuncture provides intervention for patients who want to reduce
misleading to the reader and is inaccurate.
their need for services, increase their adaptability, and decrease their
The human body has protective and reparative mechanisms that
utilization of medications.
are triggered by injury and responds with analgesic mechanisms.
This
issue
contains
full-text
content
of
the
following:
Future
studies will have to face the fact that although a fixed
It cannot be ruled out that these effects may affect the problems
acupuncture
protocol
near the site of the injury
as
well
as
other
parts
of
the
body.
Even
- Interview with AAAOM-SO President, Jane Yu, LAc,
p. 9 is easy for clinical trials, it is not necessarily
the best management for subjects suffering from cystitis/prostatitis.
knowing there was no invasive manipulation, there was a strong
The best
clinical management
effect from the sham- treatment.
This may
suggest thatJapanese
affects of the
Book Review:
Shonishin:
Pediatric
Acupuncture,
p. 32 of particular subjects may require
individualized treatment protocols where research investigation will
sham treatment result from the placebo effect rather than unknown
- Book Review: Treating Autoimmune Disease
p. 34 in all participants.
requirewith
strictChinese
adherence Medicine,
to a specific protocol
physiological mechanism.
Moreover, this study anticipates further large-scale clinical studies
This research had-the
potential to evaluate
the feasibility
AAAOM-SO
Update,
p. 36 of
in TCM for radiation cystitis and prostatitis, particularly in this
conducting a scientific investigation of acupuncture on radiation
era of shortened hospital stays, limited funding for health care, and
cystitis/ prostatitis population.
it had the
to
- Index toLikewise,
Advertisers,
p. potential
40
interest of the general population in less invasive, complication-free,
collect valuable pilot data about acupuncture to possibly improve
alternative forms of treatment. Studies of the efficacy of therapies
functional outcomes for individuals with this disease.
that have fewer side effects that can potentially improve physiologiWhile the precise (pathophysiological) effects of acupuncture
cal function deserve our highest priority.
that may occur for the findings are yet to be completely elucidated,
This study highly recommends the integration of Western and
the evidence to date warrants more rigorous clinical evaluation
Oriental medicine research. Future investigation is needed to fully
of acupuncture on relieving symptoms for radiation cystitis and
evaluate the efficacy and pathomechanism of action of acupuncture
prostatitis. This research is developing a methodology for measurefor this disease. For health conditions known to be responsive to
ment of outcomes as measured by symptoms. This method can be
control and sham treatment, this means designing a study conused for other future studies of treatment variables.
trolled trial of adequate size to fairly test the hypothesis.
The credibility of the practice of TCM is increasing through
The result of this research is intended to enhance practice of
controlled clinical trials of adequate design and execution, leading
acupuncture and Oriental medicine. Specifically, the investigation
to results supportive of evidence-based practice. For health condiassessed the response to acupuncture of subjects who had moderate
tions known to be responsive to control and sham treatment, this
to severe urinary symptoms, and examined acupuncture’s effectivemeans designing a controlled-study of adequate size to fairly test
ness for relieving symptoms and eventually opening potential
the hypothesis (Birch, 2006). This clinical study confirmed that
benefits.
TCM treatments are beneficial to radiation cystitis and prostatitis
patients, and the research outcomes can be useful to biomedical
researchers, Chinese medicine practitioners, and patients as well.
References
The sham method used in this study closely resembles the real
Ashbury F D, Findlay R, Reynolds B, McKerracher K. (1998). A Canadian survey of cancer
(verum) method of acupuncture; this might be the main reason
patient experiences: Are their needs being met? Journal of Pain & Symptom Management. 16;
298-306.
why subjects were not able to differentiate between the two
Kirsch I, Sapirstein G. (1998). Placebo effect significant in treating depression. Retrieved from
treatments. All the subjects who received sham believed they had
http://advance.uconn.edu/1998/981005/10059813.htm
received verum acupuncture. This could have many explanations:
Moher D, Dulberg C S, Wells G A. (1994). Statistical power, sample size, and their reporting in
as the sham/placebo needle pricked the skin in an acupoint, there is
randomized controlled trials. Journal of the American Medical Association (JAMA). 272; 122-124.
a chance that the stimulation of the blunted needle could stimulate
Pyne D, Shenker N G. (2008). Demystifying acupuncture. Rheumatology (Oxford). 47(8);
1132-1136.
the same effects of the real acupuncture but it has been difficult to
identify the physiological activity of sham/placebo needle at the
acupoint.
Sham interventions are usually used in order to control for
placebo effects so that the specific effect of the therapy can be
examined. Regarding the method proposed, as the control group
in this study is valid to be useful in future studies as a non-invasive
control group.
v 57
The American Acupuncturist
25 Evaluation of “Analgesic Effect
of Auricular Acupuncture for
Cancer Pain: A Randomized,
Blinded, Controlled Trial”
By David Alimi, et al.
In early 2011, the Student Organization of the American Association of Acupuncture and Oriental Medicine held a competition open to
current AOM students. The requirement was for teams of AOM students to review evidence-based research exploring the applicability of
AOM in integrative medicine. At the May, 2011, AAAOM Whole Medicine conference in Baltimore, MD, the teams presented their reports
to a panel of AOM professionals. Representing the American College of Acupuncture and Oriental Medicine in Houston, TX, the winning
team presented an evaluation of “Analgesic Effect of Auricular Acupuncture for Cancer Pain: A Randomized, Blinded, Controlled Trial” by
David Alimi and colleagues. [Journal of Clinical Oncology, Vol. 21, No 22 (November 15), 2003.
By Stephanie Barrows, MAOM (candidate) and
Amber Berg, ADS, MAOM (candidate), PhD
(candidate)
Stephanie Barrow earned her BS at the University
of Houston Downtown and is a master’s student at
the American College of Acupuncture and Oriental
Medicine (ACAOM) where she serves as liaison
between Student Government and AAAOM-ACAOM.
In her consulting practice, Stephanie blends TCM
theory with women’s studies and divine principles
to help open the doorway for balanced physical,
emotional, and spiritual enrichment for her clients.
Stephanie may be contacted at [email protected].
Amber Berg is in her final year as a graduate student
at ACAOM where she is completing her internship in
the school acupuncture clinic. Her studies began in
Hawaii, where she earned a BA in psychology/business. A candidate in the PhD program in Eco-Applied
Psychology at Oregon State University, Amber is also
an acupuncture detoxification specialist and a certified
KISO method practitioner. Amber can be contacted at
[email protected].
26 T h e A m e r i c a n A c u p u n c t u r i s t Fall 2011
Abstract
In 2007, the Center for Disease Control reported that
cancer led to 562,875 deaths in the United States,
making cancer the second leading cause of death in the
country. Many cancer patients experience neuropathic
pain, which is frequently resistant to pharmaceutical
intervention.
The team’s hypothesis for this study was that Alimi, et
al. used standardized true and sham auricular acupuncture points, adequate trial design, and adequate reporting protocols in order to provide conclusive evidence
that auricular acupuncture is effective in treating
cancer pain. After reviewing the study, the team offered
recommendations on possible improvements to this
trial model. Many elements of this study are effective
and increase the credibility of the researchers’ findings.
However, there are some areas that could use some
improvement. When evaluating the merits of this study,
blinding, point selection, sham techniques, sample size,
and reporting were selected as our criteria.
Keywords: cancer, pain, acupuncture, auricular
“Many elements of this study are effective and increase the credibility of the
researchers’ findings... When evaluating the merits of this study, blinding, point
selection, sham techniques, sample size, and reporting were selected as our criteria.”
Introduction
on the ear. The signal’s location and intensity corresponded with
Fullteam
text
of this
available
ONLY
and
journal
pain areas ofmembers
the body. If an
electrical
signalsubscribers.
was recorded at a point
The ACAOM
selected
this article
study foris
two
main reasons.
First, to AAAOM
the complete
ear, the clinician
designated
it as a “true”
acupuncture
become
an AAAOM
and receiveonthe
print
or online
journal,
go to:point.
cancer has To
a significant
impact
on Americanmember
lives. The American
Likewise,
if
there
was
no
signal,
the
clinician
designated
the point
Cancer Society
projected over 1.5 million new cancer cases in
www.aaaomonline.org
as a placebo or “sham” acupuncture point. The points used on each
2010.1 Many cancer patients experience neuropathic pain, which is
were determined by computer randomization, which was
2
frequently For
resistant
to pharmaceutical
intervention. In
these cases,
library-only
subscriptions,
please
contactpatient
[email protected]
also
the
method for assigning test groups.
integrative medical interventions such as auricular acupuncture
The patients were asked to retain the implants, or seeds, and
have been tested and successfully applied.
maintain
a log of analgesic consumption as well as the date that
Second, the clinical
trialissue
itself was
well-designed
and content
successfullyof the following:
This
contains
full-text
these
implants
fell out. Approximately thirty days after the initial
reported. Proper trial protocols are prerequisite in establishing the
treatment,
the
patients
validity of a study’s findings,
especially
testing interventions
- Interview
withwhen
AAAOM-SO
President, Jane Yu, LAc, p. 9 returned. The clinician performed another
evaluation and administered and additional treatment, using the
such as acupuncture, which are considered alternatives to “real”
same points
from the previous
Book
Review:
Shonishin:
Japanese
Pediatric
Acupuncture,
p. 32 visit. The patients continued to
Western medicine. In their article, Alimi and his colleagues criticize
maintain
their
log.
the substandard design of previous trials, asserting that inadequate
- Book Review: Treating Autoimmune Disease
Chinese thirty
Medicine,
p. 34
Afterwith
approximately
more days,
the patients returned for
design invalidates the otherwise positive findings.
a
final
evaluation.
The
data
in
the
study
did
in fact support the
Alimi, et al. designed
their clinical trial
to test two
hypotheses:
- AAAOM-SO
Update,
p. 36
authors’
hypothesis
that
auricular
acupuncture
reduces the intensity
“that there are specific points that should be treated for a given
of
pain
in
cancer
patients.
Index
to
Advertisers,
p.
40
patient with given symptoms; and that insertion of needles at these
In the group receiving true acupuncture, the mean pain intensity
points alleviates the symptoms.”3 The team investigated whether
dropped from 58 to 37 on the Visual Analog Scale. In the group
the researchers used standardized auricular acupuncture points,
receiving acupuncture at placebo points, the mean pain intensity
adequate trial design, and adequate reporting protocols in order to
only dropped from 58 to 55. Finally, in the group receiving seeds at
provide conclusive evidence that auricular acupuncture is effective
placebo points, the mean pain intensity actually rose from 57 to 58.
in treating cancer pain. After reviewing the trial and reporting
This supports the trial hypothesis that acupuncture at true auricular
on these findings, the team offers recommendations on possible
points significantly reduces cancer pain when compared to placebo.
improvements to this trial model.
Methods
Discussion
“Analgesic Effect of Auricular Acupuncture for Cancer Pain: A
Randomized, Blinded, Controlled Trial” by David Alimi, et al.
was conducted over a sixty-day period using patients from the
Pain Management Unit (PMU) at the Institut Gustave Roussy in
Villejuif, France. The purpose of this randomized, blinded study
was to test if auricular acupuncture reduced pain in cancer patients,
compared to placebo.
Of the 432 patients in the PMU, ninety adult participants were
selected to receive auricular acupuncture for their pain symptoms.
The inclusion criteria included the presence of chronic peripheral
or central neuropathic pain, for which the patients were receiving
analgesic drug treatment, and a pain intensity rating above 30 mm
on a Visual Analog Scale, graduated from 0 to 100 mm. Patients
were excluded if they were participating in another clinical trial at
the time of recruitment or if they had previously received auricular
acupuncture for any reason.
After an initial evaluation, the ninety participants were then randomly assigned to three groups. One group received steel implants
at true auricular acupuncture points, a second group received steel
implants at placebo auricular points, and a third group received ear
seeds at placebo auricular points.
The locations of true and placebo acupuncture points were determined with an electronic microvoltmeter by recording electrical
signals on the ear, which was administered to 150 distinct locations
Many elements of this study are effective and increase the credibility of the researchers’ findings. However, there are some areas that
could use some improvement. When evaluating the merits of this
study, blinding, point selection, sham techniques, sample size, and
reporting were selected as our criteria.
Blinding: Alimi and his colleagues noted a limitation in their
trial. They used only one acupuncturist to perform evaluations
and treatments. This is a limitation because the acupuncturist sees
which points register a response and which do not. Although it is
unlikely that the acupuncturist will remember every active point for
all ninety patients over the sixty day period, there is still insufficient
acupuncturist blinding and therefore room for bias. Blinding
was, however, achieved successfully with nurses, the data analyst,
and to some extent the patients. The patients were only partially
blinded—regarding point selection and the nature of their assigned
test group—but they were not blind to type of instrument used
during their treatment. A steel implant looks and feels significantly
different from an ear seed. This leaves room for bias with the
patient and with the practitioner because the instruments used for
each group are not identical.
Point Selection: When selecting points for treatment, the
researchers use a model that divides the ear into 150 distinct areas,
claiming that all auricular acupuncturists use this model. However,
they do not acknowledge the auricular acupuncture points that
v 57
The American Acupuncturist
27 Evaluation of “Analgesic Effect of Auricular Acupuncture for Cancer Pain
guidelines were included in the journal article, including objectives,
were standardized during a joint venture between the World Health
Full
text
of
this
article
is
available
ONLY
to
AAAOM
and
journal
subscribers.
method for members
randomization,
participant
flow,
and limitations. The
Organization and the Chinese Acupuncture and Moxibustion
4
in the article
alsoor
reflects
mostjournal,
of the points
the
AssociationTo
in become
1989. Using
such as and
these are
anstandardized
AAAOMpoints
member
receiveinformation
the complete
print
online
gointo:
STRICTA checklist, such as number of needles, number of treatbeneficial because the therapeutic values have been proven, the
www.aaaomonline.org
ments, and the rationale for the interventions. However, the followcollection of points covers all sections of the body, they are sufthree points in the checklist were not addressed: Item 2b: Names
ficient for cancer
pain
of
any
etiology,
and
auricular
points
are
more
For library-only subscriptions, please [email protected]
(or location if no standard name) of points used (uni/bilateral), Item
accessible than body points.
2e: Needle stimulation, e.g., manual, electrical. ([Were the patients
Sham Techniques: As mentioned, neither the patients nor the
asked to press on the seeds or implants?), and Item 5: Description of
acupuncturist were blind to the type of auricular acupuncture
This
issue
contains
full-text
content
of
the
following:
participating
acupuncturists (qualification or professional affiliation,
instrument administered during treatment. One way to improve
years in acupuncture practice, other relevant experience).
blinding in a clinical- trial
is to givewith
the appearance
that treatments
Interview
AAAOM-SO
President, Jane Yu, LAc, p. 9
The team believes that the study was thoroughly and wellbetween test groups could be identical. This can be difficult to
reported
due to the inclusion
- BookbutReview:
Japanese
Pediatric
Acupuncture,
p. 32of the majority of the aspects in
achieve with acupuncture,
there areShonishin:
currently devices
that
the CONSORT and STRICTA checklists. This thoroughness
can help.
- Book Review: Treating Autoimmune Disease
with Chinese
34 credibility, of the
of reporting
elevates theMedicine,
quality, and p.
therefore
Non-penetrating needles could improve the potential for a
clinical trial.
double blind study. -An
example of such
a needle is
AAAOM-SO
Update,
p.the
36Park
Sham Device, which is made of two telescoping plastic tubes to
Conclusion
- Index
to Advertisers,
hold the needle, a sticky
circular
base to place onp.
the40
patient’s skin,
Overall, this was a very well-designed and well-reported clinical
and a 50-50 mixture of normal acupuncture needles and blunt
5
trial. The merits of this trial greatly increase the credibility of
sham needles.
the research conclusions. Effective elements of the trial include
The circular disc is applied to the patient’s skin at the proper
the randomization process, analyst and nurse blinding, selection
acupuncture point, and a needle is loaded into the guide tube. The
of sample size, and the compliance with CONSORT reporting
acupuncturist can tap the needle into the device and manipulate it
guidelines. Elements of the trial that need improvement include the
as desired without knowing whether they just used a real needle or
use of standardized auricular acupuncture points, clinician blinding,
a sham needle. A similar device designed for auricular application
improved sham techniques, a more population-appropriate sample
would have improved the blinding in this study.
representation, and compliance with STRICTA checklist Items 2b,
Sample Size: Alimi and his colleagues state that they selected
2e, and 5.
their sample size based on their previous experience. However,
their lack of elaboration compelled us to investigate whether
Special Thanks
their experience led them in the right direction. We evaluated the
The ACAOM team thanks both our families, for lovingly cheering
study based on the Power Formula6 and a table published by the
them on during late night planning sessions, and our professors,
University of Florida.7 Both resources confirmed that Alimi, et
Dr. Kay Garcia, Dr. Tuan Nugyen, Dr. Baisong Zhong, and Dr. Leslie
al. had an adequate sample to demonstrate statistical significance.
Graham for their guidance and encouragement during this process.
However, they did not amply justify the proportion of cancer types
We also thank the ACAOM administration: Dr. John Paul Liang, Dr.
represented in the study.
Shen Ping Liang, Hwan Jan, and Sam Raia.
Approximately two-thirds of the study participants were women
We especially thank our faculty advisor, Dr. Bing You, for guiding
who had breast cancer. This would be appropriate if two-thirds of
us
through our project and for helping us represent ACAOM in
cancer cases were female breast cancer. The authors did not state
Baltimore.
Your support before, during, and after the presentation
whether this proportion reflected the prevalence of female breast
kept
us
motivated
to learn more about our field and actively
cancer in the patient population at the Pain Management Unit.
participate in its advancement. We look forward to working together
If the United States is any indicator, then this is not an approprion more projects.
ate proportion. According to the American Cancer Society, 13.6%
Last, but not least, we thank the American Association of
of cancer patients in 2010 were treated for female breast cancer.
Acupuncture
and Oriental Medicine’s Student Organization for this
Over 66% of the patients participating in the trial were females
8
amazing,
life-changing
opportunity! We especially thank Marie
with breast cancer. This does not accurately represent the populaFruchtnicht, Theresa Long, and Kathleen Funk for their planning and
tion of cancer patients, which limits the ability to generalize the
fundraising efforts that made our trip to the conference possible
trial’s outcomes.
and Erica Chu (AOMA) for her enthusiastic support of ACAOM’s new
Reporting: The Alimi study was published in the Journal of
AAAOM-SO chapter. In a very short period of time, you all pulled
Clinical Oncology in 2003. The article included many elements
together and accomplished absolute greatness!
of adequate reporting. We based our standards for reporting on
9
the CONSORT and STRICTA guidelines. All the CONSORT
Continued on page 37
28 T h e A m e r i c a n A c u p u n c t u r i s t Fall 2011
Acupuncture as an Adjunctive
Therapy in Preventing Recurrent
Spontaneous Abortion:
A Case Study
By Lynn M. Almloff, DAOM, LAc
Lynn M. Almloff, DAOM, LAc earned
her DAOM degree at the Oregon
College of Oriental Medicine. She
has been in private practice since
1997 and is currently practicing in
Virginia Beach and Newport News,
VA. Dr. Almloff is the president of the
Acupuncture Society of Virginia and a
representative to the Council of State
Associations. She also serves as the
vice chair for the Advisory Board on
Acupuncture in the Commonwealth
of Virginia.
Abstract
Approximately 15% of clinical pregnancies end in
spontaneous abortion. Eighty percent of these occur
within the first trimester. When a woman has three or
more successive spontaneous abortions it is considered
to be habitual or recurrent. A 37-year -old female had a
history of three successive spontaneous abortions—two
within the first eight weeks of pregnancy and one in
the 12th week of pregnancy. She had been diagnosed
with low progesterone levels. At her next pregnancy
she sought acupuncture treatment during her 4th
week and continued with treatment through week 32.
Additionally, she had progesterone supplementation.
The patient gave birth to a full term healthy boy. Studies
should be done to determine the efficacy of acupuncture
in preventing spontaneous recurrent abortion when
used alone and/or when used with progesterone
supplementation.
Keywords: acupuncture, pregnancy, abortion, miscarriage, habitual
spontaneous abortion
Introduction
Miscarriage is termed “spontaneous abortion” in biomedicine.
Spontaneous abortion is the most common complication of
pregnancy. It is defined as the passing of a pregnancy prior to
completion of the 20th week and the loss of all or any part of the
products of conception with or without a fetus weighing less than
500g. It is considered a threatened abortion when there is bleeding of intrauterine origin, with or without contractions, without
dilation of the cervix, and without expulsion of the products of
v 57
The American Acupuncturist
29 Acupuncture as an Adjunctive Therapy in Preventing Recurrent Spontaneous Abortion: A Case Study
tions. A spontaneous abortion within the first month of pregnancy is
conception. An abortion is referred to as complete when all of the
called an chan, which means hidden labor. If a spontaneous abortion
products of conception are lost, and as incomplete when some but
occurs within one and three months it is called duo tai, which means
not all of the products of conception are lost. If there is bleeding of
falling fetus. A spontaneous abortion occurring in the second or third
intrauterine origin before the 20th week, and the cervix is dilated
text of
ofthe
this
article
is available
ONLY to AAAOM
members
andchan
journal
subscribers.
trimester is referred
to as xiao
(small labor)
or ban chan (half
without theFull
expulsion
products
of conception,
it is referred
Spontaneous recurrent
is referred
as hua
to as an inevitable
abortion.an
A missed
abortion
is when the
embryo
To become
AAAOM
member
and
receivelabor).
the complete
print orabortion
online(RSA)
journal,
gototo:
8
tai,
which
means
slippery
fetus.
or fetus dies,
but
the
products
of
conception
are
not
expelled.
A
The
purpose
of
this
case
report
is to
www.aaaomonline.org
septic abortion refers to an infection of the uterus and sometimes
discuss the use of acupuncture during pregnancy in a case of repeated
1
surrounding
areas.
abortion (RSA).
For
library-only subscriptions, please contactspontaneous
[email protected]
The true incidence of spontaneous abortion is not known.
Case Description
Approximately 15% of clinically evident pregnancies and 60% of
chemically evident pregnancies end in spontaneous abortion. Of
Chief
Complaint: Spontaneous Recurrent Abortions
This issue contains full-text content of the
following:
these, 80% occur within the first 12 weeks of pregnancy. The posPresent History: A 37-year-old Caucasian female presented to my
sibility of spontaneous
abortion decreases
as the gestationPresident,
increases. Jane Yu, LAc, p. 9
- Interview
with AAAOM-SO
office when she was four weeks pregnant. She sought acupuncture
If a viable fetus of six weeks or less is detected on an ultrasound, the
treatment to prevent miscarriage. She has a 3-year-old son who was
Book Review:
risk of spontaneous -abortion
is 15-30%.Shonishin:
At 7-9 weeksJapanese
gestation thePediatric Acupuncture, p. 32
conceived naturally and carried to full term. She and her husband
risk decreases to 5-10%. After nine weeks of gestation the risk of
had been trying to have a second child for two years. She had three
- Book
Review:
spontaneous abortion
is less than
5%.2 Treating Autoimmune Disease with Chinese Medicine, p. 34
spontaneous abortions within seven months. The first occurred at
Recurrent or habitual
spontaneous abortion
is the
loss of
- AAAOM-SO
Update,
p. 36
eight weeks and was determined to be due to low progesterone. She
three or more pregnancies (less than 500g) in succession.
conceived the following month and again spontaneously aborted at
- Index
to Advertisers,
p. 40
Abnormalities related
to recurrent
abortion can only
be identified
eight weeks again due to low progesterone. She conceived the folin about half of the couples. A woman who has three previous
lowing month and used progesterone supplementation. Despite the
spontaneous abortions, in which no cause has been defined, still
progesterone supplementation, she spontaneously aborted at twelve
has a 70-80% chance of carrying a fetus to term. This likelihood
weeks. The third spontaneous abortion was determined to be due to a
is reduced to 65-70% when a woman has more than four
chromosomal abnormality (trisomy) of the fetus.
spontaneous abortions.3
The patient then had difficulty conceiving. She began fertility
The most common etiology of spontaneous abortion in the
treatment using ovulation induction medications. She did two cycles
first trimester is a genetic abnormality. As a group, the autosomal
of Clomid, which caused ovarian cysts to form. She then had an
trisomies (an extra chromosome within the set) account for over
Intrauterine Insemination (IUI), without ovulation induction, which
half of the losses. Trisomy 16 is the most common form. Polyploidy
failed. She was then given Follistim to stimulate her ovaries. She
(more than two sets of chromosomes), usually in the form of
over-stimulated; therefore, the IUI was cancelled. In the next cycle of
triploidy (three sets of chromosomes), is found in 20% of spontaneFollistim, she ovulated early, on day nine or ten, thereby missing the
ous abortions.4
opportunity to inseminate. During the following cycle of Follistim,
Other etiologic factors of spontaneous abortion are maternal
she was given Ganirelix to prevent her from ovulating early. She then
infections, endocrine disorders, cardiovascular disorders, connechad an IUI which failed. She took the next month off from artificial
tive tissue disorders, uterine defects, immunologic disorders, and
reproductive techniques (ART) and unexpectedly conceived.
malnutrition. Emotional disturbance as a cause of spontaneous
No reports of blood work were made available.
abortion is considered to be speculative. Toxins and trauma can also
Review of Systems: EENT, respiratory, cardiovascular, gastrointestilead to spontaneous abortion.5
nal, urinary, musculoskeletal, neurologic, and endocrine systems were
The treatment for recurrent spontaneous abortion depends on
all within normal limits.
the etiology. Appropriate testing to determine etiology should be
Past History: During the intake the patient reported that she had
done before the next conception. In the case of genetic error, IVF
suffered with depression and obsessive compulsive disorder (OCD)
with genetic testing of the embryos prior to implantation can be
for ten years. She was taking 50mg of Zoloft per day, which she said
performed. If there is an anatomic abnormality of the reproductive
controlled her symptoms.
tract it can be surgically corrected. Hormonal abnormalities can
Personal History: She complained of low energy and had a difficult
be corrected with supplementation. Infections can be treated with
time
waking after 7-8 hours of uninterrupted sleep. She complained
antibiotics. Toxicity due to known factors such as smoking, alcohol,
of
always
feeling cold. Prior to pregnancy she ate three meals per day
or recreational drugs is discouraged. Testing for immunologic
consisting
of two servings of grains, two servings of proteins, one fruit,
factors is not readily available and treatment is under investigation.
and
one
vegetable.
She drank three cups of water and two cups of
Autoimmune responses can be treated with heparin and low dose
coffee
per
day
and
four
glasses of wine per week. Once pregnant, she
aspirin,6 although recent research has shown that aspirin used alone
discontinued the coffee and wine and ate less due to nausea. She had
is as effective as when combined with heparin.7
no history of smoking or recreational drug use.
In Chinese medicine, spontaneous abortion is given different
Medications and Supplements: Zoloft 50mg/day, pre-natal vitamin,
terms depending on the timing and number of spontaneous aborprogesterone IM 1ml containing 50mg/day, and baby aspirin, which
30 T h e A m e r i c a n A c u p u n c t u r i s t Fall 2011
Acupuncture as an Adjunctive Therapy in Preventing Recurrent Spontaneous Abortion: A Case Study
was prescribed by her doctor to prevent potential clotting of blood.
Discussion
Menstrual History: Menarche occurred at age 13. Her periods
The most common underlying etiology for RSA is a deficiency
came regularly every 28 days. She bled for three days with a moderof the kidneys. Qi and blood deficiency, heat in the blood, and
ate flow. She had no complaints of pain or clotting.
blood stasis may also cause RSA (4). Other concurrent factors
of this
article
is available
ONLY to AAAOM
members and journal subscribers.
PhysicalFull
Examtext
Findings:
Height:
5’7” Weight:
126 pounds
are a deficiency of the spleen, weakness in the ren and chong, and
Topale,
become
an AAAOM
member
and receive
the complete
print or online journal, go to:
Tongue was
dry, and scalloped.
Pulses were
very deficient
in
sinking
qi.11
the kidneywww.aaaomonline.org
position both right and left. They were slightly wiry in
If a woman has a history of spontaneous abortion, an investigathe middle position.
tion should be done as to the reason. If physical uterine and cervical
ForDeficient
library-only
subscriptions,
contactdisorders,
[email protected]
Diagnosis:
kidney yin
and yang, deficientplease
qi and blood,
inherited genetic disorders, sperm and ova defects due to
and liver qi stagnation. The kidney deficiency was evidenced by
occupational toxic exposure, and complications from other diseases
the deficiency in the pulse in the kidney positions on both the
or medications are all ruled out, then the AOM practitioner should
right and left side. The
yin
deficiency
was
also
supported
by
the
investigate
and treat any TCM pathogenesis.12 Since there is always
This issue contains full-text content of the
following:
eventual difficulty in conceiving and dryness of her tongue. The
a weakness in the kidneys with spontaneous abortion, it is advisable
Interview
withher
AAAOM-SO
President,
Jane
Yu, LAc,the
p.kidneys
9
yang deficiency was -supported
by both
difficulty in waking
in
to strengthen
before conception.13 Both kidney yin and
the morning after 7-8 hours of uninterrupted sleep and habitual
yang should be treated in the case of RSA.
- Book
Japanese
Pediatric Acupuncture, p. 32
spontaneous abortion.
The qiReview:
deficiencyShonishin:
was supported
by her comIt is advisable to avoid pregnancy for a minimum of three to
plaint of low energy-and
her
scalloped
tongue.
The
blood
deficiency
four
cycles inMedicine,
order to restore
the balance between yin
Book Review: Treating Autoimmune Diseasemenstrual
with Chinese
p. 34
was supported by her pale dry tongue. The liver qi stagnation was
and yang. Kidney yin should be treated in the pre-ovulatory phase
supported by the wiry
pulse in the middle
position
well as her
- AAAOM-SO
Update,
p.as36
and kidney yang should be treated in the post-ovulatory phase.14
secondary complaint of depression.
The pre-ovulatory phase also known as the follicular phase is when
- Index
to Advertisers,
Treatment Principles:
Treatment
principle wasp.
to 40
tonify qi and
estrogen is dominant. The post-ovulatory phase also known as the
blood, tonify the kidneys, raise yang, and soothe the liver.
luteal phase is when progesterone is dominant. Therefore, tonifying
kidney yang post ovulation has the same effect as progesterone
Methods: The patient declined herbal treatment. Acupuncture
supplementation.
treatment used: Diji Sp 8: Harmonizes the blood, regulates the
uterus; tonify; bilateral.9 Baihui Du 20: Raises yang and counters
Once conception occurs it is important to strengthen kidney
prolapse; even. Taixi KI 3: Source point of kidney, tonifies both
yang, since kidney yang deficiency is the main reason for early stage
kidney yin and yang; tonify; bilateral. Neiguan PC 6: Harmonizes
spontaneous abortion. In this case, with back-to-back pregnancies,
the stomach and alleviates nausea and vomiting; reduce; bilateral.
the patient had three prior spontaneous abortions. The first two
Taichong LR 3: Spreads liver qi, regulates the lower jiao, indicated
were determined to have been due to a progesterone deficiency.
for nausea, vomiting, incessant uterine bleeding and uterine
At her third consecutive pregnancy she was given progesterone
prolapse; even; bilateral. Zusanli ST 36: Harmonizes the stomach,
supplementation. Progesterone IM is prescribed until the 10th
tonifies qi, nourishes blood and yin, revives yang, indicated for
week of pregnancy to prevent spontaneous abortion. She lost the
nausea and vomiting; tonify; bilateral.
third consecutive pregnancy at 12 weeks due to trisomy. The fact
that the pregnancy progressed past the eight week period of her
Other points used as needed: Qimen LR 14: Harmonizes
previous losses indicates that the progesterone was working. From
the liver and stomach, indicated for vomiting; reduce; bilateral.
an AOM perspective she was kidney qi and yang deficient.
Zhongwan Ren 12: Harmonizes the middle jiao, descends rebellion,
indicated for nausea and vomiting; reduce. Sishencong: Calms the
The etiology of her kidney deficiency was likely that being in her
spirit; even.10
late 30s, her work, and having a young child depleted the patient’s
kidneys. Subsequently, having three spontaneous abortions in a
Tai Chi Brand surgical stainless steel size 0.25x25 needles were
seven month period further depleted her kidneys.
used. Needles were inserted and manipulated until qi was obtained.
For tonification, the needle was then rotated once to the right and
Differential diagnosis: The patient did not have heat in the
retained. For reduction, the needle was rotated once to the left and
blood. If this was so, she likely would have had bleeding with a hisretained. For even technique, there was no rotation and the needle
tory of prolonged menstrual bleeding or bleeding between menses.
was retained. Retention time of needles was 30 minutes.
She also would have exhibited other possible heat symptoms such
as a red tongue and difficulty sleeping. She did not have blood stasis
The patient had a total of 12 treatments from week 4 through
or she would have had either a purplish tongue or red spots on the
week 32. She was treated weekly until week 12. She then had
tongue. Additionally, she would likely have passed clots and had
one treatment per month until her seventh month of pregnancy.
stabbing pain during her menses.
She had varying degree of nausea with vomiting throughout her
pregnancy. Ren 12 and LR 14 were used for nausea and vomiting
The patient came for acupuncture treatment at the beginning of
until week 12 and then discontinued. There were no adverse effects
her next pregnancy. She also was taking progesterone supplementafrom the acupuncture treatment.
tion IM. The acupuncture treatment may provide similar effects of
the progesterone of maintaining the pregnancy by tonifying the qi
Results: A follow up with this patient confirmed that she had
and lifting the yang.
given birth to a full term healthy boy.
Continued on page 40
v 57
The American Acupuncturist
31 Book Review
Shonishin: Japanese Pediatric Acupuncture
by Stephen Birch, PhD, LAc
Reviewed by Fred Jennes, MEd, DiplAc, DiplCH (NCCAOM), LAc
ISBN: 978-3-13-150061-8
Keywords: pediatrics, shonishin, erzhen
One of the more daunting questions
asked of a practitioner of Oriental mediStuttgart-New York:
cine is, “Can you treat my child?” This
Thieme Publishing Group,
very question can cause even veteran
2011.
practitioners to blanche, make mumbled
apologies, or say “Sorry, I don’t treat
children under twelve.” And is it any
wonder? At many schools, training in pediatric acupuncture is
usually brief and mostly academic—few parents bring their sick,
young children to the school clinic and instead seek the services of a
Western pediatrician.
For the few practitioners who bravely attempt to take on these
young patients, their efforts are generally rewarded with squalling
and squirming as the infant or toddler confronts the horrible
Hard cover, 260 pages,
includes a DVD
Acupuncture in the Treatment of Children (Eastland Press, 1999),
or they adopted a non-invasive, tui-na approach as described in
Fan Ya-Li’s work, Chinese Pediatric Massage Therapy (Blue Poppy
Press, 2003). While these both provide basic instruction in treating
children, Birch’s more expansive and comprehensive work gives
the practitioner the best hope of eventually becoming versed in
treating these difficult patients. As Charles (Chip) Chace says in
the introduction, “Steve brings the sensibilities of a professionally
trained clinical researcher to the task of unpacking the shonishin
practice with consummate skill. This is evident in both his writing and in the DVD that accompanies the text. The two media
combine to bring the technique to life.” Like Birch’s previous
work, co-authored with Kiiko Matsumoto-Euler, Hara Diagnosis:
Reflections on the Sea (Paradigm Publications, 1988), the book is
thorough, well-written, and full of practical information.
“Performing pediatric acupuncture will never be an easy task. However, if one
is inclined to help these young patients, Birch’s book is an indispensible tool
and strongly recommended for the practitioner who wishes to take on these
challenging patients.”
prospect of a stranger coming at him/her with a bright, pointy
thing that really hurts. One colleague not-so-jokingly said that he
keeps an ample supply of duct tape on hand for just such occasions. Thus most practitioners give up on the idea of performing
acupuncture on children and, instead, choose to either not see these
young patients or take the relatively safer course of prescribing
herbal medicine for them.
With the publication of Stephen Birch’s Shonishin: Japanese
Pediatric Acupuncture, the practicing acupuncturist now has a
valuable resource for providing help to young patients. Prior to
this book, practitioners wanting learn how to provide acupuncture
treatment to children relied on Julian Scott’s earlier landmark work,
32 T h e A m e r i c a n A c u p u n c t u r i s t Fall 2011
The book is divided into five sections, along with an Appendix
and a DVD. The first section, “Overview and History,” explains
that, according to Birch, shonishin is a Japanese rendering of the
Chinese term erzhen, meaning “children’s needle,” which we learn
is not a needle at all but a rather diverse set of instruments that are
used to tap, scrape, stroke, and prod patients. These myriad tools
are beautifully illustrated in photographs throughout the book, and
they take the shape of everything from an elegant, flat blade, to a
serrated fish, to cute little manikins, to the more prosaic blunt rod.
The second section, “Treatment Principles and the Tools of
Treatment” gets down to business. Here Birch, the researcher, is
in his element. Through scientific graphs he discusses the concept
of “The Therapeutic Dose,” which is critical in determining how
Book Review: Shonishin: Japanese Pediatric Acupuncture
much treatment to administer. Too little treatment, especially in an
insensitive patient, and there is no therapeutic effect; too aggressive
treatment in a sensitive patient will create a tip-over effect, making
the symptoms much worse.
Many case studies illustrate the author’s points throughout this
section and in the later sections of the book. To Birch’s credit, many
of these case studies painfully describe his struggles in finding an
effective treatment, documenting the challenges he faced in treating
each patient. This honest approach to the case study—a time-honored tradition from early practitioners of East Asian medicine—is
a refreshing change from books where overblown case studies hype
only the author’s successes, not the hard-earned wisdom that comes
through initial failures. Birch’s straightforward approach to the case
study makes this an excellent learning resource for both novice and
seasoned practitioners by removing the ego issues that often get in
the way of effective teaching.
Section Three, “Root Treatment Approaches and Techniques,”
discusses the Core Treatment Model, which is the essence of shonishin. It also lists the necessary precautions that must be taken when
working with children, especially those with dangerous conditions
such as a high fever. The techniques of tapping, stroking, pressing
and scratching, as well as their applications, are introduced and
described, along with a number of “tricks “ such as the use of
Shenzhu GV-12 to quiet a fussy child. Of special interest in this
section is what Birch refers to as “The Dance of Treatment,” where
the practitioner applies the treatment as a constantly moving dance,
touching here, scraping there, all the while laughing, and joking
with both patient and parents. This makes the treatment a source of
entertainment as opposed to a grim imposition of a protocol. This
part also includes a remedial section that will refresh the reader’s
knowledge of both meridian-based and five-phase-based diagnostic
and differentiation tenets and their relevance for both pediatric and
adult patients.
The fourth section, “Symptomatic Treatment Approaches and
Techniques,” goes into great detail about Japanese tools and techniques that can be used in addition to the non-invasive techniques
described in the previous section. Filiform needling, dermal needle
techniques, moxibustion, and bloodletting are all discussed, which
puzzles this reviewer since these are the very modalities that often
create emotional trauma in young patients. As Birch himself says in
this section, referring to the use of the filiform needle, “… inserting
needles can be difficult on babies and children because they find
it painful and distressing. This is not only stressful for the child
and his or her parents, but also for the practitioner.” Aside from
an apparent endorsement of Seirin® needles and tacks, which are
prominently pictured throughout this section, there appears to
be no real purpose to this section of the book except to perhaps
dutifully describe other Japanese acumoxa techniques, even if they
are not altogether appropriate for pediatric usage.
Section Five, “Treatment of Specific Problems/Diseases,” goes
into great detail about the management of specific pediatric ail-
ments. Of special interest are chapters on respiratory, digestive, and
ear problems—common presentations in children that can be quite
challenging to treat. Each chapter in this section provides a detailed
case history format that gives the reader a step-by-step, visit-by-visit
scenario describing the patient’s presentation, the treatment plan,
and the results. Few treatments are successful immediately, and the
rich narrative that Birch provides takes the reader into both the
treatment room and the author’s mind to show how he derives an
appropriate plan to remedy both the symptoms and signs he must
address at each visit.
The Appendix contains the usual index and bibliography, both
of which are detailed and helpful. It also features an Additional
Information section with resources for locating equipment, contact
information for professional groups for further communication and
study, and a glossary of shonishin terms—a must for those unfamiliar with the techniques and tools of the art.
What makes this book especially valuable is the DVD. It
is divided into five chapters which illustrate and reinforce the
information Birch sets down in his book. The setting is a weekend
workshop taught by Birch and features him lecturing to a group
of students and demonstrating shonishin techniques on a variety
of young patients. Anyone who has attended a Birch workshop
knows that he is a gifted teacher, and even when he is a “talking
head” on the video, Birch is an animated lecturer. What is striking
about this particular seminar is how effortlessly and masterfully he
performs “The Dance” while working with his young patients. He
coos, makes “whooshing” sounds (which he tongue-in-cheek says
is an important component of the treatment), and brings smiles to
the faces of his patients, their parents, and his students. While the
audio and video quality of the DVD could be better, the result is
an instructional and clinical tour de force by a skilled teacher and
gentle practitioner.
Performing pediatric acupuncture will never be an easy task.
However, if one is inclined to help these young patients, Birch’s
book is an indispensible tool and strongly recommended for the
practitioner who wishes to take on these challenging patients.
Fred Jennes, LAc is a licensed acupuncturist and herbalist in
Colorado. He has taught at the Colorado School of Traditional
Chinese Medicine, served as a commissioner and vice chair of
ACAOM, and has served on many national and state committees
supporting Oriental medicine. He has authored two books and
numerous scholarly articles for professional journals, and currently
serves on the Editorial Board of The American Acupuncturist.
v 57
The American Acupuncturist
33 Book Review
Treating Autoimmune Disease
with Chinese Medicine
by Wanzhu Hou, CMD, DiplCH, DiplAc, LAc
Reviewed by Kathleen Lumiere, DAOM, LAc
This slender volume, Treating
copyright: 2011
Autoimmune Disease with Chinese
ISBN 10: 0-443-06974-3
Medicine, by Wanzhu Hou, CMD LAc
ISBN 13: 978-0-443-06974-1 DiplAC & CH (NCCAOM), with
Churchill Livingstone
Guangpi Xu, CMD DiplAc & CH
$66.78
(NCCAOM), and Hanjie Wang, MD,
is densely packed with information
invaluable to the Chinese medical
professionals who are concerned with autoimmune disorders. It
sets a standard for the melding of biomedical understanding with
modern Chinese medicine clinical practice.
Making the assertion that a basic knowledge of biomedicine,
including disease pathology, is necessary for the Chinese medical
practitioner, this knowledge sharpens Chinese medicine pattern
differentiation and enables the practitioner to choose the best
treatment possibilities to avoid mistreatment. The introduction
Hardbound, 320 Pages
entiations and treatments. Rather than being lost in the diagnostic
generalities of either form of medicine, this combination allows the
practitioner to arrive at more focused conceptions of disease states
as they present within individual patients.
Years ago a friend of author Wanzhu Huo related Chinese
medicine to an antique gun firing scattershot, which only served
to frighten away the birds. After three decades of practice and
scholarship, Dr. Huo instead finds scientifically informed Chinese
medicine to be more akin to “shooting many hawks with a single
arrow.” To extend the analogy, an archer’s aim, skill, and experience
all contribute to the arrow’s successful flight.
The first two chapters of this book guide the practitioner to look
in the right direction.
Chapter one covers basic immunology and immune system
disorders including descriptions of cell-mediated and humoral
immunity, antigens, antibodies, complement, and the four main
“Making the assertion that a basic knowledge of biomedicine, including disease
pathology, is necessary for the Chinese medical practitioner, this knowledge sharpens
Chinese medicine pattern differentiation and enables the practitioner to choose the
best treatment possibilities to avoid mistreatment. ”
gives the example of degenerative and rheumatoid arthritis as both
having similar signs and symptoms. Because Western medicine
recognizes cellular differences between these diseases, it provides
diagnostic refinement which enables appropriate Chinese medical
interventions. In addition, biomedical science provides a revealing
view into some of the mechanisms for the time-tested effectiveness
of Chinese medicine—a boon to anyone who has tried to explain
phlegm-damp obstruction to a Western patient.
The structure of the book exemplifies the integration of Western
and Chinese medical models. Each section begins with a biomedical
diagnosis and then gives potential Chinese medicine pattern differ34 T h e A m e r i c a n A c u p u n c t u r i s t Fall 2011
types of immune hypersensitivity, all in twelve closely written
pages. Although readers may be tempted to flip forward to the
chapters pertaining to their particular pathologies of interest, this
background information is not to be missed. It outlines some of the
main features of immunology, which are crucial when choosing one
therapeutic approach over another.
The more extensive second chapter presents a discussion of
autoimmunity from an expert Chinese medical perspective. The
central thesis, and the basis for many of the subsequent treatment
recommendations, is the claim that “[…] Yin deficiency is a
prerequisite for a patient to develop an autoimmune disease. If
Book Review: Treating Autoimmune Disease with Chinese Medicine
there is no Yin deficiency an autoimmune disease may not occur.”
Since every phenomenon may be categorized as being either yin or
yang in relation to something else, it’s helpful to have the authors’
application of the terms to autoimmune disorders. Yin is defined as
encompassing “formed substances, such as organs, tissues, cells and
body fluids, that is, visible and measurable things.” Yang, on the
other hand, pertains to “the physiological function of visible things,
such as the ability of hydrochloric acid and enzymes to digest
food in the stomach or the function of thyroxine in regulating
metabolism. “Physiological function,” the authors state, “is based
on substance.”
Throughout descriptions of multiple pathologies the primacy of
yin deficiency is maintained. The central mechanism of yin deficiency is cellular attrition by apoptosis. Apoptosis, or programmed
cell death, is an internal regulatory function which eliminates
damaged tissues. When apoptosis causes more cellular loss than is
regained, there is on balance a lack of substance, and therefore a
yin deficiency. Lest this seem like an irresolvable debate between
function and form, what decided these authors on the accuracy of
their categorization appears to have been positive clinical outcomes
with treatments for yin deficiency and worsening of autoimmune
symptoms with treatments which tonify qi or yang.
This generality, of course, is not absolute, nor does the etiology
of all autoimmune disease end with yin deficiency. Other factors
include blood stasis arising from either excess (acute) or deficiency
(chronic) heat, later stage qi and yang deficiency, phlegm-dampness
and fluid retention.
Once the broad theoretical field is within the practitioner’s sights,
the focus narrows to the pathologies themselves. Fifteen major
diseases are addressed in Treating Autoimmune Disease with Chinese
Medicine. Most are single diagnoses such as Hashimoto’s thyroiditis;
however, there is a chapter on mental illness—a frequent comorbidity with autoimmune disorders.
To give a better idea of the book’s utility, it may help to look at
one of these chapters more in depth. In chapter eleven, multiple
sclerosis (MS) is explained as a common, complex, and often
devastating disease. It is characterized by an immune system assault
on myelin sheaths surrounding nerve tissue, which may penetrate
to the axonal membrane. Without the aid of myelin sheaths, nerve
signals become disordered causing dysfunctions from paraesthesia
to pain. Supportive glial cells are also destroyed. Furthermore,
scarring follows in the wake of the inflammatory process, blocking
the formation of new myelin and permanently disrupting smooth
nerve conduction.
Western diagnosis is arrived at through clinical orthopedic and
neurological exams, with MRI (magnetic resonance imagery) being
the gold standard. Chinese medical etiology posits external or
internal pathogenic factors of wind, cold, heat, and dampness as
blocking the channels in early stage MS. (Interestingly, biomedicine
hypothesizes MS may originate with Epstein-Barr viral infection.)
Yin deficiency results from injury to tissues by these pathogenic
factors or is preexisting. Yin deficiency is a necessary
prerequisite for lingering pathogens which create more heat
and can lead to blood stasis. General treatment principles flow
from these processes.
The diagnostic skills of the practitioner determine which signs
and symptoms indicate Chinese medicine patterns. For MS these
include wind/cold/damp invasion, damp heat, liver and kidney yin
deficiency, liver wind (tremor), and blood stasis; these differential
diagnoses are the single arrows which can shoot many hawks.
Treatment recommendations are standard for these patterns;
however, the authors avoid herbs that upregulate helper T cells and
could therefore exacerbate autoimmune reactions.
A section on case studies and case analyses follows the pattern
differentiations and treatments. These are especially detailed and
clear, serving as practical applications of theory in an already strong
reference work. The last section in this chapter is titled “Lifestyle
Prescriptions and Health Issues.” It sums up the main biomedical
mechanisms as well as Chinese medicine diagnoses and therapies
spanning herbs, diet, food, and exercise. The organization of
this chapter on MS is consistent for each separate autoimmune
condition. Explanation is aided by figures, a glossary of terms, and
multiple indexes.
One of the distinguishing traits of the book, and evidence of
excellent design, is its structure, which manages to be both rational
and intuitive. The book presupposes a graduate level understanding
of Chinese medicine and a basic understanding of biomedicine. For
someone with that level of training, Treating Autoimmune Disease
with Chinese Medicine is an eminently usable book and should be a
treasured addition to a working library.
Kathleen Lumiere DAOM, LAC received a BA with an emphasis
on philosophy and writing from The Evergreen State College
in 1989. She received her master’s degree in Acupuncture and
Oriental Medicine and a certificate in Chinese herbal medicine
from the Northwest Institute of Acupuncture and Oriental
Medicine in 2000. In 2008 Kathleen received a doctorate, specializing in teaching, research, and oncology, from Bastyr University.
She has maintained a private practice in Seattle since 2001 and is
a clinical supervisor and core faculty member at Bastyr.
v 57
The American Acupuncturist
35 American Associate of Acupuncture & Oriental Medicine Student Organization
AAAOM-SO Update
I first became involved with AAAOM at their 2008
Annual Conference in Chicago, where I attended as a
representative of my school. I was inspired to participate
at the national level by one of my teachers who felt it was
important for students to help shape the future of this
health field.
The variety of different disciplines and the breadth of
knowledge and experience of the attendees astounded
me. I had come from a TCM school based in zang-fu theory.
I never realized there was an entire school of Five-Element
theory or that there were acupuncturists who did not
utilize Chinese herbs. At this conference, I learned about
the history of our profession as it developed in the United
States. (see Sherman Cohn’s two essays on the history of
acupuncture in the U.S. in The American Acupuncturist,
vols. 54 & 55) It shocked me to learn that, early on,
practitioners were arrested for practicing medicine without
a license (no licensing was available to them in their state).
It was a revelation to me that the rights and privileges of
our profession have not always been in place.
I attended the 2009 and 2010 conferences, where, at the
2010 event, I was elected AAAOM-SO secretary. The reason
I ran for this office is that I felt compelled to join other
students working with this organization because I believe it
is critical to help carry our profession forward and not lose
the momentum created by our predecessors. For the next
term, 2011-2012, I was elected as the SO president.
The AAAOM-SO represents student interests on important
issues of the profession and fosters their involvement on
a national level. The AAAOM-SO group is comprised of
hundreds of dedicated student members in twelve chapters
around the U.S., with eight officers on its board. These
officers represent student interests to the AAAOM Board
of Directors and volunteer many hours to provide benefits
and resources relevant to all students of acupuncture and
Oriental medicine.
During the 2011 Annual Conference in Baltimore, the
Student Organization organized many activities for
students. Our first Student Research Contest, which
received many well-articulated presentations, was a great
success. The winning team, juried by AOM professionals at
36 T h e A m e r i c a n A c u p u n c t u r i s t Fall 2011
the conference, was from the American College of Acupuncture
and Oriental Medicine in Houston, Texas. (Read about their
presentation in this issue.) AAAOM-SO also announced the
winners of its second essay contest. The two winners were each
awarded scholarships provided by Sokenbicha Tea.
During this 2011-2012 term, the Student Organization has
been helping to complete the organizational re-structuring
of AAAOM. We are focused on re-establishing our bond with
the general AOM student membership and are creating new
networks of communication so students across the country
can interact with each other. We have set up forums available
on http://www.aaaomonline.org and provide up-to-date
information on our Facebook community.
Another major project the SO is actively participating in is the
Essential Health Benefit objective. This is an important next
step for our field, as it will provide a foundation for recognition
in mainstream medicine. We have contributed to the creation
of a white paper submitted by AAAOM to the Institute of
Medicine to demonstrate the scientifically recognized safety,
efficacy, and cost-effectiveness of our practice. The SO will be
deeply involved in its support campaign taking place in fall,
2011. We encourage and support local chapters to organize
fundraisers and support campaigns for this endeavor.
If you would like to provide an update about your school’s
AAAOM-SO chapter for publication in the next AAAOM-SO
Update in The American Acupuncturist, please contact
AAAOM-SO at [email protected].
Jane Yu
AAAOM-SO President
R E A C H
T H E
H I G H E S T
L E V E L
Doctor of Acupuncture and Oriental
Medicine D E G R E E P RO G R A M
■ Learn from recognized TCM experts
Dr. Shunfa
Jiao, inventor
of head
acupuncture
and FBU
faculty
member,
teaching
doctoral class
and Stanford MD professors
■ Option of earning your Ph.D. in China
Quarterly
Admissions
■ Enhance your expertise with the
classics taught by clinical specialists
■ Broad core program with multiple specialization
options
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■ Explore the latest integrative medicine research
■ Flexible program with monthly 4-day modules
■ Doctoral modules available to LAc’s as CEU courses.
See schedule at www.fivebranches.edu/news/818
Graduate School of Traditional Chinese Medicine
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[email protected]
w w w. f i ve b r a n c h e s . e d u
Evaluation of “Analgesic Effect of Auricular Acupuncture for Cancer Pain continued from page 28
References
Austin, Texas, with a BA in biology. She can be contacted at kho@
1. Cancer trends progress report - incidence [Internet]. U.S. National Institutes of Health:
National Cancer Institute [updated 2011, March 24; cited 2011 April 20]. Available from:
http://progressreport.cancer.gov/doc_detail.asp?pid=1&did=2009&chid=93&coid=920&mid=
#measuring
acaom.edu.
Full text of this article is available ONLY to AAAOM members and journal subscribers.
J. Lefeber, BA is a student at the ACAOM and a patient
To become an AAAOM member and receiveDonald
the complete
print or online journal, go to:
safety research intern at the Community Medical Foundation for
2. Alimi, D, Rubino,
C,
Prichard-Leandri,
E,
Fernand-Brule,
S,
Dubreuil-Lemaire,
M,
Hill,
C.
www.aaaomonline.org
Analgesic effect of auricular acupuncture for cancer pain: a randomized, blinded, controlled trial.
J Clin Onc. 2003 Nov 15;21 (22):4120-4126.
Patient Safety. In May, 2011, Mr. Lefeber was inducted into the
Xi Science Research Organization, which is acknowledged
For library-only subscriptions, please contactSigma
[email protected]
3. Ibid, Alimi, et al.
4. World Health Organization. Report of the working group on auricular acupuncture nomenclature. Lyon, France, 28 -30; November 1990.
for its insights and research interests in the field of integrative
medicine. Its aim is to develop a new model for integrated or
comprehensive
5. AcuPrime.com [Internet].This
c2011 [cited
2011contains
April 15]. Park full-text
sham placebo content of the
issue
following: medicine, building on the synergy of Western and
acupuncture device. Available from: http://www.acuprime.com/en/products/
Eastern medicine’s efforts to prevent illness and treat patients. He
placebo-park-sham-research-needle--device/park-sham-device-research-tools/
- Interview with AAAOM-SO President, Jane
LAc, p. 9at [email protected]
may Yu,
be contacted
park-sham-placebo-acupuncture-device
6. Hulley, S, & Cummings, S, eds. Designing clinical research. Baltimore, Maryland: Williams &
- Book Review: Shonishin: Japanese Pediatric
Acupuncture,
p. 32
Valondra
Nimrod is a first
year
Wilkins; 1988.
7. Israel, Glenn D. 1992. Sampling the evidence of extension program Impact. Program Evaluation
- Book Review: Treating Autoimmune
and Organizational Development, IFAS, University of Florida. PEOD-5. October.
8. Op. cit., U.S. National Institutes of Health: National Cancer Institute
- AAAOM-SO Update, p. 36
9. MacPherson H, Altman D G, Hammerschlag R, Youping L, Taixiang W, White A, Moher
D. STRICTA Revision Group. Revised Standards for Reporting Interventions in Clinical
- Index to Advertisers, p. 40
Trials of Acupuncture (STRICTA): extending the CONSORT statement. PLoS Med. 2010 Jun
8;7(6):e1000261
Contributors:
Kim Ho is an intern at the American College of Acupuncture and
student at ACAOM, holding dual
positions
as Chinese
director ofMedicine,
Event Planning
Disease
with
p. for
34 the AAAOM-Student
Organization as well as the AAAOM-ACAOM Houston chapter.
A native of Houston, Texas, she earned her BS in business with
a concentration in health services management from Devry
University. Upon graduation Valondra will open a group practice
specializing in women’s health and do research on the effects of
HIV/T-cell count with acupuncture. Valondra may be reached at
[email protected].
Oriental Medicine. She graduated from the University of Texas,
v 57
The American Acupuncturist
37 Announcement
Integrative Oncology and the Role of Chinese Medicine:
Introducing the Association of Integrative Oncology and Chinese Medicine (AIOCM)
As the movement towards integrative medicine grows, the need to bring together Chinese
medicine and medical oncology is great. Recent data show that one in three people will be
diagnosed with cancer in their lifetime. In 2010, cancer diagnosis and treatment in the U.S. was
estimated to have cost over $124 billion; it is expected to rise to over $158 billion by 2020. (National
Cancer Institute).
Professionals in all areas of Chinese medicine strive to contribute to the field of integrative
oncology. To that end, we are pleased to announce the inauguration of the Association of
Integrative Oncology and Chinese Medicine (AIOCM) to bring the full potential of traditional and
modern Chinese medicine to the forefront in cancer treatment.
As Chinese medicine practitioners research the large Chinese pharmacopeia, for example, new
discoveries into herb-derived compounds and isolates show great promise in treating cancer. More
research must be done; more scholarship must be demonstrated so that a specialised field of trained
and qualified herbal practitioners can provide meaningful impact on patient care.
The first step toward full integration of disciplines is an evidence-based approach to training,
qualification, and development of competency standards. The goal of AIOCM is to establish a
process to provide clinical training, internships, and research opportunities in integrative oncology.
This will lead to a board certification process and public policy changes to assure Chinese medicine
practitioners have the proper skills and respect from both patients and the oncology medical
community.
The AIOCM is committed to advancing the knowledge, science, and practice of Chinese medicine
in integrative oncology. We encourage all interested practitioners, academics, and researchers to
take up this cause and help develop a more fully integrated approach to cancer treatment.
All interested persons are invited to join AIOCM in this important and exciting effort. Please see
aiocm.org for details.
38 T h e A m e r i c a n A c u p u n c t u r i s t Fall 2011
TM
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v 57
The American Acupuncturist
39 Thank you AA Advertisers!
In the same way that your business depends on us as practitioners, our business is made possible by the products
and services you offer. AAAOM extends heartfelt appreciation to those advertisers that have traveled the distance
in giving your support, and we extend a sincere welcome to those of you that recently joined our family.
INDEX TO ADVERTISERS
Active Herb39
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Acupuncture as an Adjunctive Therapy continued from page 31
Kan Herb Company
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Conclusion
There have been several studies on acupuncture during pregnancy.
Acupuncture treatment did not alleviate all nausea and vomitEfficacy has been shown for low back pain, pain relief during labor,
ing, which lasted throughout her pregnancy. The patient declined
and nausea and vomiting. The benefit of acupuncture for emotional
Chinese herbal medicine. She had 12 treatments from week 4
disorders during pregnancy remains inconclusive.17 There are no
through week 32. A follow-up with this patient confirmed that she
studies published in English that evaluate the efficacy of acupuncture
had given birth to a full term healthy boy.
for spontaneous abortion. Studies should be done to determine the
This case raises several questions. Was it the acupuncture that
efficacy of acupuncture alone and/or acupuncture plus progesterone
texttoofgothis
article
available
ONLY to AAAOM members and journal subscribers.
helped theFull
pregnancy
to full
term oris
was
it the progesterone?
supplementation in the prevention of spontaneous abortion. If there
Or was it due
a combination
of the acupuncture
and the
To to
become
an AAAOM
member
and receivewas
the
complete
or onlinewas
journal,
to:
scientific
evidenceprint
that acupuncture
effective go
at preventing
progesterone? The only other pregnancy in which she took the
spontaneous abortion, obstetricians may be more likely to refer their
www.aaaomonline.org
progesterone ended due to a chromosomal defect. If that fetus had
patients to an AOM practitioner.
normal chromosomes,
would shesubscriptions,
have carried to full please
term without
For library-only
contact [email protected]
acupuncture treatment? Research of acupuncture should be done to
1. DeCherney A H, Nathan L, Goodwin T M, Laufer N, editors. Current diagnosis & treatment
determine the efficacy of these modalities in preventing spontaneobstetrics & gynecology. 10th ed. New York: McGraw-Hill, 2007. p.25
ous abortions.
2. Ibid. p.259
issue
contains in
full-text
content
following:
A recent review ofThis
the use
of acupuncture
pregnancy
includedof the
3. McPhee S J, Papadakis M A, Tierney L M Jr, eds. Current medical diagnosis & treatment. 47th ed.
New York: McGraw-Hill, 2008. p. 671
16 studies, eight randomized
controlled
trials (RCTs), and
eight
- Interview
with AAAOM-SO
President,
Jane
Yu, LAc, p. 9
4.
Op. cit. DeCherney A H. (2007). p. 259
systemic reviews. These included the use of acupuncture for nausea
5 Ibid. DeCherney
A H. (2007). p.
p. 264
and vomiting, back -pain,
emotional
disorders
and pain
relief during
Book
Review:
Shonishin:
Japanese
Pediatric
Acupuncture,
32
15
6.
Ibid.
DeCherney
A
H.
(2007).
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labor. However, the effect of acupuncture in the prevention of
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Chinese
Medicine,
p.aspirin
34 for recurrent pregnancy loss: Results
7. Laskinwith
C A, et al.
Low molecular
weight heparin and
spontaneous abortion
was notReview:
reviewed.Treating Autoimmune Disease
from the randomized, controlled HepASA trial. J Rheumatol, 2009 Feb;36(2):279-87
A search of the databases
PubMed, EBSCO,
- AAAOM-SO
Update,Classical
p. 36 Chinese
8. Maciocia G. Obstetrics & gynecology in Chinese medicine. New York: Churchill Livingstone, 1998.
Medicine and the OCOM Article Index with a search for the terms
p.547
“acupuncture and miscarriage,”
miscarriage,”
- Index to“habitual
Advertisers,
p. 40 “recurrent
9. O’Connor J, Bensky D. Acupuncture, a comprehensive text. Seattle: Eastland Press, 1998. p. 286
miscarriage,” “abortion,” “recurrent abortion,” “habitual abortion,”
10. Deadman P, Al-Khafaji M, Baker K. A manual of acupuncture. 2nd ed. Hove (East Sussex):
Journal of Chinese Medicine Publications, 2008.
“spontaneous abortion,” and “recurrent spontaneous abortion”
11. Op. cit. Maciocia G. 1998. p. 548
resulted in one article in English. This was a case study of a woman
12. Lyttleton J. Treatment of infertility with Chinese medicine. Edinburgh: Churchill Livingstone,
who had recurrent miscarriages received acupuncture and allergy
2004. p. 312
elimination technique during her next pregnancy. This patient’s
13. West Z. Acupuncture in pregnancy and childbirth. Edinburgh: Churchill Livingstone, 2008. p.
outcome was birth of a healthy girl. The case focused more on aller126
gies, which were determined to be a factor in prior miscarriages,
14. Op. cit. Lyttleton J. 2004. p. 313
and that the allergy elimination technique effectively corrected the
15. Smith C, Dahlen H. Caring for the pregnant woman and her baby in a changing maternity
allergic process. Acupuncture was attributed to moving blood and
service environment: The role of acupuncture. Acupunct Med. 2009; 27,3,123-5.
qi.16 However, no acupuncture protocol was listed.
16. Stanford R. Recurrent miscarriage syndrome treated with acupuncture and an allergy elimination/desensitization technique. Alternative Therapies. 2009;15:5,62-3.
17. Op. cit. Smith C. (2009)
40 T h e A m e r i c a n A c u p u n c t u r i s t Fall 2011