Kaplan: acupuncture no use in hypertension again!

[Guest guest]

In a message dated 11/1/2006 10:36:47 P.M. Central Standard Time,

writes:

 

No doubt the Quackbuster lobby will hail Kaplan as an expert in

acupuncture who now believes it is worthless in hypertension.

 

 

 

 

Dear Phil:

 

I am interested in how you phrased this last line.

 

Given the results of the SHARP study, do you have any basis to believe that

acupuncture does lower blood pressure on a relatively permanent basis?

 

Guy Porter

 

 

 

[Guest guest]

Hi All,

 

Early in Jan 2005 we discussed a very poor trial on acupuncture in

hypertension in which a Dr Norman Kaplan (who has no publications of

worth in any aspect of acupuncture - see: http://tinyurl.com/u5low ) was an

author.

 

Having received a copy of the original report from Sean Walsh, it was my

opinion that no reputable peer-reviewed journal would accept that paper. It

seems that the journals agreed with that opinion. Kaplan himself wrote [

Acupuncture for Hypertension?: Can 2500 Years Come to an End

Kaplan, Norman M. http://www.saha.org.ar/articulos/acupuncture.htm ]

" With only a fraction of the money and personnel used in the SHARP trial,

we tried such a study but, not surprising, in retrospect, we failed, producing

only an abstract 2 that, as a manuscript, could never find a place in a

reputable journal. " .

 

However, Kaplan persists in his attempt to discredit AP as a therapy for

hypertension. See the article, above and http://tinyurl.com/u5low

Unfortunately, he can now cite the results of a much larger trial (Macklin et

al (abstract below) to support his thesis:

 

Macklin EA, Wayne PM, Kalish LA, Valaskatgis P, Thompson J, Pian-Smith

MCM, Zhang Q, Stevens S, Goertz C, Prineas RJ, Buczynski B, Zusman

RM. Stop Hypertension with the Acupuncture Research Program (SHARP):

results of a randomized controlled clinical trial. Hypertension.

2006;48:838-845. Abstract : Case studies and small trials suggest that

acupuncture may effectively treat hypertension, but no large randomized

trials have been reported. The Stop Hypertension with the Acupuncture

Research Program pilot trial enrolled 192 participants with untreated blood

pressure (BP) in the range of 140/90 to 179/109 mm Hg. The design of the

trial combined rigorous methodology and adherence to principles of

traditional Chinese medicine. Participants were weaned off

antihypertensives before enrollment and were then randomly assigned to 3

treatments: individualized traditional Chinese acupuncture, standardized

acupuncture at preselected points, or invasive sham acupuncture.

Participants received <=12 acupuncture treatments over 6 to 8 weeks.

During the first 10 weeks after random assignment, BP was monitored

every 14 days, and antihypertensives were prescribed if BP exceeded

180/110 mm Hg. The mean BP decrease from baseline to 10 weeks, the

primary end point, did not differ significantly between participants randomly

assigned to active (individualized and standardized) versus sham

acupuncture (systolic BP: -3.56 versus -3.84 mm Hg, respectively; 95% CI

for the difference: -4.0 to 4.6 mm Hg; P=0.90; diastolic BP: -4.32 versus -

2.81 mm Hg, 95% CI for the difference: -3.6 to 0.6 mm Hg; P=0.16).

Categorizing participants by age, race, gender, baseline BP, history of

antihypertensive use, obesity, or primary traditional Chinese medicine

diagnosis did not reveal any subgroups for which the benefits of active

acupuncture differed significantly from sham acupuncture. Active

acupuncture provided no greater benefit than invasive sham acupuncture in

reducing systolic or diastolic BP.

 

No doubt the Quackbuster lobby will hail Kaplan as an expert in

acupuncture who now believes it is worthless in hypertension.

 

Back to the bunker again!

 

Best regards,

 

 

 

 

 

[Guest guest]

Who decided that invasive " sham " acupuncture was a viable model by

which to define against? This is a terribly poor model, and virtually

all of the research coming out with these so called " non-acupoints " is

conducted by MD's (prob w/ as little as an 100 hour training). This is

not Acupuncture, but reads like it.

Tymothy

 

 

Chinese Medicine , " "

< wrote:

>

> Hi All,

>

> Early in Jan 2005 we discussed a very poor trial on acupuncture in

> hypertension in which a Dr Norman Kaplan (who has no publications of

> worth in any aspect of acupuncture - see: http://tinyurl.com/u5low )

was an

> author.

>

> Having received a copy of the original report from Sean Walsh, it

was my

> opinion that no reputable peer-reviewed journal would accept that

paper. It

> seems that the journals agreed with that opinion. Kaplan himself

wrote [

> Acupuncture for Hypertension?: Can 2500 Years Come to an End

> Kaplan, Norman M. http://www.saha.org.ar/articulos/acupuncture.htm ]

> " With only a fraction of the money and personnel used in the SHARP

trial,

> we tried such a study but, not surprising, in retrospect, we failed,

producing

> only an abstract 2 that, as a manuscript, could never find a place in a

> reputable journal. " .

>

> However, Kaplan persists in his attempt to discredit AP as a therapy

for

> hypertension. See the article, above and http://tinyurl.com/u5low

> Unfortunately, he can now cite the results of a much larger trial

(Macklin et

> al (abstract below) to support his thesis:

>

> Macklin EA, Wayne PM, Kalish LA, Valaskatgis P, Thompson J, Pian-Smith

> MCM, Zhang Q, Stevens S, Goertz C, Prineas RJ, Buczynski B, Zusman

> RM. Stop Hypertension with the Acupuncture Research Program (SHARP):

> results of a randomized controlled clinical trial. Hypertension.

> 2006;48:838-845. Abstract : Case studies and small trials suggest that

> acupuncture may effectively treat hypertension, but no large randomized

> trials have been reported. The Stop Hypertension with the Acupuncture

> Research Program pilot trial enrolled 192 participants with

untreated blood

> pressure (BP) in the range of 140/90 to 179/109 mm Hg. The design of

the

> trial combined rigorous methodology and adherence to principles of

> traditional Chinese medicine. Participants were weaned off

> antihypertensives before enrollment and were then randomly assigned

to 3

> treatments: individualized traditional Chinese acupuncture,

standardized

> acupuncture at preselected points, or invasive sham acupuncture.

> Participants received <=12 acupuncture treatments over 6 to 8 weeks.

> During the first 10 weeks after random assignment, BP was monitored

> every 14 days, and antihypertensives were prescribed if BP exceeded

> 180/110 mm Hg. The mean BP decrease from baseline to 10 weeks, the

> primary end point, did not differ significantly between participants

randomly

> assigned to active (individualized and standardized) versus sham

> acupuncture (systolic BP: -3.56 versus -3.84 mm Hg, respectively;

95% CI

> for the difference: -4.0 to 4.6 mm Hg; P=0.90; diastolic BP: -4.32

versus -

> 2.81 mm Hg, 95% CI for the difference: -3.6 to 0.6 mm Hg; P=0.16).

> Categorizing participants by age, race, gender, baseline BP, history of

> antihypertensive use, obesity, or primary traditional Chinese medicine

> diagnosis did not reveal any subgroups for which the benefits of active

> acupuncture differed significantly from sham acupuncture. Active

> acupuncture provided no greater benefit than invasive sham

acupuncture in

> reducing systolic or diastolic BP.

>

> No doubt the Quackbuster lobby will hail Kaplan as an expert in

> acupuncture who now believes it is worthless in hypertension.

>

> Back to the bunker again!

>

> Best regards,

>

>

>

>

>

[Guest guest]

Hi All, & Guy,

 

I wrote:

> No doubt the Quackbuster lobby will hail Kaplan as an expert in

> acupuncture who now believes it is worthless in hypertension.

 

Guy Porter replied:

> Dear Phil: I am interested in how you phrased this last line. Given the

> results of the SHARP study, do you have any basis to believe that

> acupuncture does lower blood pressure on a relatively permanent basis?

> Guy Porter

 

Re Kaplan's crusade to remove AP from the treatment protocols in

hypertension and the SHARP trial (Macklin et al) that may be used to

support that crusade:

 

Medline has 179 hits for the profile: hyperten* AND (acupunct* OR

electroacup* OR electro-acup*). Some of the relevant ones are below. For

the others, see: http://tinyurl.com/uj3yr

 

Though ST36 is the best-known (and most researched) hypotensive

acupoint, Medline hits show that many acupoints also have hypotensive

effects. Hypotensor points include: ST36-Zusanli; Earpoints Erjian (Ear

Apex), HT, Jiangyagou (Hypotensor Groove); [Earpoint ST had no effect];

HT01-Jiquan; LV03-Taichong; SI19-Tinggong; BL40-Weizhong; GV26-

Shuigou/Renzhong [which also has marked Hypertensive effects in shock];

KI01-Yongquan; LI04-Hegu; LI11-Quchi; PC06-Neiguan [which also is an

anti-shock (hypertensor) point in cardiac shock or circulation failure]; SP06-

Sanyinjiao.

 

Some time ago, a CHA poll indicated great between-practitioner variation in

the clinical value of AP in hypertension. Some reported mediocre results but

others reported good results. See:

health./surveys?id=1558806

and

health./surveys?id=1558879

 

I understand that modern Chinese methods to treat people with

hypertension rarely if ever rely on AP alone. Instead, they include

appropriate western hypotensor drugs, CHM (such as Zhuyu Tongfu (ZYTF)

Serial Recipe, or formulas to treat LV Yang Rising, etc), advice on

appropriate changes of diet and lifestyle, advice on relaxation techniques,

advice on DIY earpoint massage or use of ear-seeds on key points, such as

Earpoint HT and Hypotensor Groove, etc. Above all, classical (and modern)

Chinese medicine would not try to treat " hypertension " per se, but would try

to address the root and branch of the presented pattern of S & Ss on a case-

by-case (individual) basis. That approach, IMO, cannot be researched easily

in RTCs, such as those reported by Kaplan's group, or the SHARP trial.

 

See : " Hypertension 1996 : One Medicine, Two Cultures: Evaluation of

hypertension treatment by Traditional " , a very useful

overview by Qiao Wangzhong, Beijing University of Traditional Chinese

Medicine, China at http://tinyurl.com/yy4nlu [My summary of that article is at

the end of this mail]

 

Though I am no expert in the area, IMO it is far too early to dump AP as

being of no value in helping people with hypertension, especially if it is used

as part of an interated approach to treating the whole person.

 

Best regards,

[see selected Medline hits, below]

 

Anon [Options in mild to medium hypertension. Acupuncture lowers blood

pressure][Article in German] MMW Fortschr Med. 2005 Dec 1;147(48):6.

PMID: 16389852 [PubMed - indexed for MEDLINE]

 

Feng GM, Xing DJ, Sun QX. [Effects of acupuncture on blood pressure,

SOD,LPO and five kinds of trace elements to stenosis of renal artery

caused hypertension in rats][Article in Chinese] Zhongguo Zhong Xi Yi Jie

He Za Zhi. 1994 Dec;14(12):739-41. Third Teaching Hospital, Norman

Bethune University of Medical Sciences, Changchun. Changes of blood

pressure, superoxide dismutase (SOD), lipid peroxidation (LPO) and

concentration of five kinds of trace elements including Cu, Zn, Fe, Ca, Mg

were observed before or after AP treatment in the stenosis of renal artery

caused hypertension in rats [correction of mice]. It was demonstrated that

AP in the points of ST36-Zusanli, PC06-Neiguan, SP06-Sanyinjiao and

KI01-Yongquan in mice could reduce the blood pressure significantly and

influence the concentrations of SOD, LPO and five kinds of trace elements

in the stenosis of renal artery caused hypertension in mice. The possible

mechanisms of AP in reducing the blood pressure and influencing the

changes of SOD, LPO and five kinds of trace elements were also

discussed. PMID: 7719110 [PubMed - indexed for MEDLINE]

 

Ganoniuk (?Gaponiuk) PIa, Leonova MV, Sherkovina TIu, Iotova VG. [The

effect of auricular electroacupuncture on the initial manifestations of

cerebral circulatory failure in hypertension patients][Article in Russian] Vopr

Kurortol Fizioter Lech Fiz Kult. 1990 Nov-Dec;(6):31-4. Hypertensive

subjects with stage I-II of the disease received a course of differentiated ear

electro-AP (EAAP) or auricular AP (AAP). Though clinical findings and the

trend in cerebral hemodynamics reflected positive results of both modalities,

EAAP was superior especially in essential hypertension stage II. PMID:

2077733 [PubMed - indexed for MEDLINE]

 

Gao XY, Zhu B. [Analysis on blood-pressure-decreasing effect of electric

pulse stimulation of auricular acupoint Jiangyagou in the patient of

hypertension][Article in Chinese] Zhongguo Zhen Jiu. 2005 Jul;25(7):474-6.

Institute of Acupuncture & Moxibustion, China Academy of TCM, Beijing

100700, China. xinyangao2001 OBJECTIVE: To investigate

the blood-pressure-decreasing action of stimulating earpoint Jiangyagou

(Hypotensor Groove) in the patient of hypertension. METHODS: One

hundred and twenty-nine cases of stage I - III hypertension were treated by

electric pulse stimulation of earpoint Jiangyagou with a MEDI/calma Nerve

and Muscle Stimulator, 20-30 min each time, once daily. After treatment of

3 courses (21 days), changes of blood pressure were observed. RESULTS:

Of the 129 cases, 44 cases were markedly effective, 73 cases were

effective and 12 cases were ineffective, the total effective rate being

90.70%. The systolic pressure was decreased by (18.64+/-1.48) mmHg and

the diastolic pressure by (8.01+/-0.68)mmHg on average, with very

significant differences before and after treatment in both the systolic

pressure and the diastolic pressure. CONCLUSION: Electric pulse

stimulation of Jiangyagou can effectively decrease both the systolic

pressure and diastolic pressure in the patient of hypertension. PMID:

16309134 [PubMed - in process]

 

Gaponiuk (?Ganoniuk) PIa, Leonova MV. [The clinical efficacy of auricular

electroacupuncture in treating hypertension patients][Article in Russian]

Vopr Kurortol Fizioter Lech Fiz Kult. 1990 Jan-Feb;(1):13-5. Auricular

electro-AP using 10 Hz alternating impulse current generated by Rampa-2

apparatus has been employed to treat 98 patients with essential

hypertension stage I-II. The treatment resulted in the fall of both systolic and

diastolic pressure (p<0.01). The symptoms relieved in stage I hypertension

by 66+/-2.4%, in patients with stage II by 57+/-1.1%, thus allowing

discontinuation of the drugs in the former group and reduction of their intake

in the latter one. PMID: 2336820 [PubMed - indexed for MEDLINE]

 

Huang H, Liang S. Acupuncture at otoacupoint heart for treatment of

vascular hypertension. J Tradit Chin Med. 1992 Jun;12(2):133-6. People's

Hospital, Shiyan City, Hubei Province. The immediate, short-term and long-

term depressor effects, the immediate effects on cardiac functions in grade

II and grade III vascular hypertension, and the effects on angiotensin II in

grade III vascular hypertension by AP at otoacupoint Heart were studied in

30 cases of vascular hypertensive patients. The immediate depressor effect

of AP at otoacupoint Stomach was also recorded for comparison. It was

found that AP at otoacupoint Heart produced marked immediate depressor

effect, and the short-term effective rate was 100%, the long-term effective

rate was 63.3%, as well as evident immediate effects on cardiac functional

activities in grade II and grade III hypertension and marked effects on

angiotensin II in grade III hypertension. AP at otoacupoint Stomach

produced no depressor effect on vascular hypertension. PMID: 1495338

[PubMed - indexed for MEDLINE]

 

Jin YX, Fu Q, Guo XQ. Effects of electroacupuncture of " zusanli " acupoint

on high blood pressure and blood hyperviscosity in stress rats. J Tongji Med

Univ. 1992;12(4):209-15. Dept of Physiology, Shanghai Medical University.

Elevation of blood pressure (BP) and blood viscosity (BV) was induced in

unanesthetized Wistar rats by fixing and hanging. Electro-AP of ST36-

Zusanli acupoint or microinjection of GABA (60ug/10uL) into the IV ventricle

of the brain could lower the high BP and BV induced by fixed-hanging,

which could be blocked by a microinjection of GABAA receptor antagonist

bicuculline (60ug/10uL). The results showed that the depressant effect of

electro-AP of ST36 acupoint on high BP and blood hyperviscosity induced

by fixed-hanging might be mediated by the activation of GABAA receptors in

the brain. PMID: 1289567 [PubMed - indexed for MEDLINE]

 

Kim DD, Pica AM, Duran RG, Duran WN. Acupuncture reduces

experimental renovascular hypertension through mechanisms involving

nitric oxide synthases. Microcirculation. 2006 Oct-Nov;13(7):577-85.

Program in Vascular Biology, Dept of Pharmacology and Physiology,

UMDNJ-New Jersey Medical School, Newark, 07101-1709, USA.

kimda OBJECTIVE: To test the hypothesis that AP on ST36-

Zusanli reduces hypertension by activating nitric oxide synthase signaling

mechanisms. METHODS: The authors used the two-kidney, one-clip renal

hypertension (2K1C) hamster model with electro-AP treatment. RESULTS:

Thirty-minute daily electro-AP treatment for 5 days reduced mean arterial

pressure from 160.0+/-7.6 to 128.0+/-4.3 mmHg (mean+/-SEM), compared

to 115.0+/-7.2 mmHg in sham-operated hamsters. Electro-AP increased

periarteriolar NO concentration from 309.0+/-21.7 nM to 417.9+/-20.9 nM in

the 2K1C hamster cheek pouch microcirculation when measured with NO-

sensitive microelectrodes. Hypertension reduced endothelial nitric oxide

synthase (eNOS) and neuronal nitric oxide synthase (nNOS) proteins

relative to the sham-operated control, as measured by Western blotting.

Electro-AP prevented the reduction of eNOS and nNOS associated with

hypertension and showed even higher eNOS and nNOS expressions than

sham-operated control in stomach and cheek pouch tissues, which are on

the stomach meridian. Analysis of liver tissue, a non-stomach-meridian

organ, indicated that electro-AP did not have a significant benefit in terms of

enhanced expressions of eNOS and nNOS in the treated 2K1C

hypertensive group. CONCLUSIONS: Activation of eNOS and nNOS is one

of the mechanisms through which electro-AP at ST36 reduces blood

pressure; this reduction works through the stomach meridian. PMID:

16990216 [PubMed - in process]

 

Kriukov NN, Levin AV, Kulidzhanov AIu. [Possibilities provided by

chronopuncture in treatment of arterial hypertension in the young][Article in

Russian] Klin Med (Mosk). 2006;84(3):31-3. The aim of the study was to

evaluate the effectiveness of anti-hypertensive therapy with application of

chronopuncture as a non-drug method of arterial pressure correction in

patients with essential hypertension (EH). An offered and introduced utility

model was applied. Its application leads to achievement of maximal anti-

hypertensive effect of reflexotherapy, which shortens the treatment and

increases the effectiveness of AP in treatment of EH. PMID: 16758918

[PubMed - indexed for MEDLINE]

 

Ku YH, Zou CJ. Tinggong (SI19), a novel acupoint for 2Hz

electroacupuncture-induced depressor response. Acupunct Electrother Res.

1993 Apr-Jun;18(2):89-96. Dept of Physiology, Beijing Medical University,

P.R. China. In urethane-anesthetized, tubocurarine-immobilized and

artificially ventilated rats, the specific electro-AP (EA, 2 Hz, 3 V) being

delivered to bilateral " SI19-Tinggong-LI11-Quchi " induced a depressor

response, while 10 Hz-EA, and 2 Hz-EA to either non-acupoints, " LI04-

Hegu-LI11-Quchi " or " LV03-Taichong-LI11-Quchi " did not. Pretreatment of

either phentolamine, Propranolol or methyl atropine (i.v.) markedly reduced

the depressor response, indicating that the sympathetic vasoconstrictor

nerve, the cardia sympathetic nerve and cardiac vagal nerve all are involved

in the hypotensive response. PMID: 7902643 [PubMed - indexed for

MEDLINE]

 

Li P, Sun FY, Zhang AZ. The effect of acupuncture on blood pressure: the

interrelation of sympathetic activity and endogenous opioid peptides.

Acupunct Electrother Res. 1983;8(1):45-56. Experimental hypertension was

produced by intravenous infusion of norepinephrine in 13 conscious dogs.

Electro-AP at ST36-Zusanli points showed a significant decrease in blood

pressure, while the heart rate was not affected. The depressor effect was

naloxone (0.2 mg/kg iv) reversible, and accompanied by an increased blood

flow at the mesenteric artery, so it is suggested that the depressor effect

was due to inhibition of the sympathetic vasoconstrictor tone. This inhibition

was mediated by endogenous opioid peptides released by AP. The location

of this mediation was further analyzed. The central mechanism was

evidenced by the ineffectiveness of AP in reducing blood pressure in

anesthetized dogs. On the other hand, the demonstration of opiate

receptors in the blood vessels by radio-receptor assay provided evidence of

peripheral mediation of blood pressure by opioids. The blood vessel might

be a target organ for the plasma opioids, which can also be increased by

AP. PMID: 6135303 [PubMed - indexed for MEDLINE]

 

Li T, Zhao JG, Tian GJ, Zhang L, Liu SJ. [Clinical observation on effect of

acupuncture on nervous functions of the patient after operation of.

hypertensive cerebral hemorrhage][Article in Chinese] Zhongguo Zhen Jiu.

2006 Apr;26(4):247-9. First Affiliated Hospital of Tianjin College of TCM,

Tianjin 300193, China. litaons0070 OBJECTIVE: To probe the

best therapy for the patient after operation of hypertensive cerebral

hemorrhage. METHODS: One hundred cases were randomly divided into a

treatment group and a control group, 50 cases in each group. The control

group were treated by routine western medicine (Mannitol, Nifedipine and

Caftriaxone sodium and so On), and the treatment group by the medication

of the control group plus AP 9 days after operation. AP was given at PC06-

Neiguan, GV26-Shuigou/Renzhong, SP06-Sanyinjiao, HT01-Jiquan and

BL40-Weizhong, etc, combined with scalp AP, with " restoring

consciousness and inducing consciousness " needling method, for 10 days.

The nervous function defect was assessed by Chinese Stroke Scale and

the criteria for assessment of therapeutic effects. RESULTS: AP could

improve significantly nervous function defect. The total effective rate was

86% in the treatment group and 14.0% in the control group with a significant

difference between the two groups (P < 0.01). CONCLUSION: The

therapeutic effect of the treatment group is better than that of the control

group. AP combined with western medicine has cooperation for treatment of

hypertensive intracerebral hemorrhage with a better therapeutic effect.

PMID: 16642607 [PubMed - indexed for MEDLINE]

 

Liu H, Zhang GP, Song SJ, Ding MP, Zhou JF, Bie XD, Liu JR, Zhang Y, Li

ZH, Gao HF, Liu GG, Fei LT. [Clinical study on Zhuyu Tongfu serial recipe

combined with acupuncture and massotherapy in treating hypertensive

cerebral hemorrhage.][Article in Chinese] Chin J Integr Med. 2005

Sep;11(3):167-72. The Second Hospital Affiliated to Medical College,

Zhejiang University, Hangzhou 310009, China. zhangguoping

OBJECTIVE: To observe the clinical efficacy and mechanism of Zhuyu

Tongfu (ZYTF) Serial Recipe combined with AP and massotherapy in

treating hypertensive cerebral hemorrhage (HCH). METHODS: One

hundred and eighteen patients with hypertensive cerebral hemorrhage, on

the basis of conventional Western medicine treatment, were randomly

divided into ZYTF combined with AP and massotherapy group (treated

group) and simple Western medicine group (control group); the clinical

efficacy, neurofunction deficit scoring (NDS) alterations and hematoma

absorption rate of both groups were observed, and also the plasma

superoxide dismutase (SOD) activity, plasma lipid peroxidase (LPO)

content, erythrocyte glutathion peroxidase (GSH-Px) activity, hematocrit (Ht)

and the whole blood viscosity (Va) change were also observed. RESULTS:

In the treated group, the clinical efficacy, NDS improvement and hematoma

absorption rate were superior to that of the control group; comparison

between the two groups after treatment showed that plasma SOD activity

and GSH-Px activity got more elevated and plasma LPO content, Ht and Va

more lowered in the the treated group than those in the control group.

CONCLUSION: ZYTF combined with AP and massotherapy has better

effect, its therapeutic mechanism was possibly correlated to the elevation of

plasma SOD activity, GSH-Px activity and lowering of plasma LPO content,

Ht and Va. PMID: 16181528 [PubMed - indexed for MEDLINE]

 

Radzievskii SA, Fisenko LA, Lebedeva OD. [The effect of acupuncture on

the hemodynamics and tolerance for physical loads in patients with

cardiovascular diseases][Article in Russian] Vopr Kurortol Fizioter Lech Fiz

Kult. 1991 Mar-Apr;(2):30-3. Discontinuation of chemotherapy substituted

for a course of AP and electro-AP in 124 patients with coronary heart

disease, essential hypertension and neurocirculatory dystonia resulted in a

positive response of cerebral and peripheral hemodynamics, myocardial

contractility and diastolic function. Myocardial hypertrophy regressed,

exercise tolerance enhanced. Reflex activation of stress-limiting systems

arresting excess adrenergic action on circulation is probably responsible for

these phenomena. PMID: 1887620 [PubMed - indexed for MEDLINE]

 

Syuu Y, Matsubara H, Kiyooka T, Hosogi S, Mohri S, Araki J, Ohe T, Suga

H. Cardiovascular beneficial effects of electroacupuncture at Neiguan

(PC06) acupoint in anesthetized open-chest dog. Jpn J Physiol. 2001

Apr;51(2):231-8. Oriental Medicine Laboratory, School of Social Welfare,

Kyushu University of Health and Welfare, Nobeoka, 882-8508 Japan.

syuuy PC06-Neiguan is a traditional acupoint in the bilateral

forearms, overlying the median nerve trunk. PC06 electro-AP (EA) has been

believed to affect cardiovascular function and used in TCM to improve or

treat a wide range of health conditions and diseases, including angina

pectoris, myocardial infarction, hypertension, and hypotension. However,

few physiological studies have assessed the beneficial effects of PC06 EA

on the cardiovascular function. In the present study, we investigated its

effects on the cardiovascular function in normal open-chest dogs under

pentobarbital and fentanyl anesthesia. We also obtained left ventricular (LV)

pressure-volume (P-V) data with a micromanometer catheter and a

volumetric conductance catheter. Mean arterial pressure, end-diastolic

volume, heart rate, stroke volume, cardiac output, and end-systolic pressure

gradually decreased by 5 to 10% over 1.5 h without PC06 EA. PC06 EA at

40 Hz, however, increased these cardiovascular variables by 10 to 15%,

especially end-systolic elastance (Ees) by 40% (p<0.05) over 15 to 60 min.

After PC06 EA was stopped at 1 h, these facilitated cardiovascular variables

decreased below the pre-EA level. This beneficial effect of electro-AP may

contribute to the effectiveness of the AP in TCM. PMID: 11405917 [PubMed

- indexed for MEDLINE]

 

Uhrig S, Hummelsberger J, Brinkhaus B. [standardized acupuncture

therapy in patients with ocular hypertension or glaucoma--results of a

prospective observation study][Article in German] Forsch

Komplementarmed Klass Naturheilkd. 2003 Oct;10(5):256-61.

Augenarztliche Praxis, Wiesbaden, Deutschland. BACKGROUND:

Glaucoma is one of the most frequent causes of blindness worldwide. The

main risk factor for this optic nerve disease is high individual intraocular

pressure. OBJECTIVE: The aim of this observational study was to

investigate the effect of AP therapy on individual internal eye pressure in

glaucoma and ocular hypertension patients. MATERIAL AND METHODS:

18 patients (11 female; age 38-75 years) with a diagnosis of glaucoma

(n=3) or ocular hypertension (n=15) were included in this study. Patients

received one session of a standardized AP treatment (acupoints LV03,

LI04, GB37). Target parameters were the change in intraocular pressure

and the compatibility of treatment. Measurements of intraocular pressure

were carried out 15 min before, 15 min after, and 24 h after AP. RESULTS:

Compared with the mean intraocular pressure in both eyes before treatment

(21.94+/-2.4 mm Hg), patients showed a significant decrease 15 min after

treatment (-2.67+/-1.34 mm Hg) as well as 24 h after treatment (-2.5+/-2.13

mm Hg). There was no significant difference between the mean intraocular

pressure at 15 min after treatment and at 24 h after treatment. No adverse

events were observed. CONCLUSION: The results of this study indicate

that AP therapy may be a valid treatment option for glaucoma and ocular

hypertension patients. Additional and, if possible, randomized studies

investigating the effectiveness of AP in the treatment of the above-

mentioned conditions still need to be conducted. Copyright 2003 S. Karger

GmbH, Freiburg. PMID: 14605482 [PubMed - indexed for MEDLINE]

 

Wang J, Shen LL, Cao YX, Zhu DN.Effects of electroacupuncture on

pressor response to angiotensin-(1-7) by amino acid release in the rostral

ventrolateral medulla. Acupunct Electrother Res. 2003;28(1-2):25-34. Dept

of Physiology and Pathophysiology, Shanghai Medical College of Fudan

University, Shanghai 200032, P.R. China. Unilateral microinjection of

Angiotensin-(1-7)[Ang-(1-7)] into the rostral ventrolateral medulla (RVLM) of

anesthetized rats caused an increase in mean arterial pressure (MAP)

accompanied by an increased release of excitatory amino acid (EAA)

glutamate. In contrast, microinjection of Ang779, a selective antagonist of

Ang-(1-7) receptor, into the RVLM caused a decrease in MAP accompanied

by a deceased release of EAA glutamate as well as an increased release of

inhibitory amino acid (IAA) glycine, taurine and gamma-aminobutyric acid.

After electro-AP (EA) stimulation at ST36-Zusanli for 20 min, the above

effects of Ang-(1-7) or Ang779 attenuated. These results suggest that

attenuation of EA on the pressor effect of Ang-(1-7) or the depressor effect

of Ang779 may be through regulating the corresponding amino acid

neurotransmitter release in the RVLM. PMID: 12934958 [PubMed - indexed

for MEDLINE]

 

Williams T, Mueller K, Cornwall MW. Effect of acupuncture-point stimulation

on diastolic blood pressure in hypertensive subjects: a preliminary study.

Phys Ther. 1991 Jul;71(7):523-9. Havasu Samaritan Regional Hospital,

Lake Havasu City, AZ 86403. Electrical stimulation of four specific AP points

(LV03, ST36, LI11, and Earpoint " Groove for Lowering Blood Pressure " )

was examined in order to determine the effect of this stimulation on diastolic

blood pressure in 10 subjects with diastolic hypertension. Subjects were

randomly divided into two groups: (1) an Acu-ES group, which received

electrical stimulation applied to the four antihypertensive AP points, and (2)

a Sham-ES group, which received electrical stimulation applied to non-AP-

point areas. A repeated-measures analysis of variance revealed a

significant, immediate poststimulation reduction of diastolic blood pressure

for the Acu-Es group versus the Sham-ES group. Further studies are

needed to determine whether there are other AP points, stimulation

characteristics, or modalities that can enhance this treatment effect and

whether the treatment effect can last for a clinically significant period of

time. PMID: 2052631 [PubMed - indexed for MEDLINE]

 

Wu YH, Zhu GQ, Lin XY, Oyang L, Su H, Wu B. [Effect of needling quchi

and taichong points on blood levels of endothelin and angiotension

converting enzyme in patients with hypertension][Article in Chinese]

Zhongguo Zhong Xi Yi Jie He Za Zhi. 2004 Dec;24(12):1080-3. Second

Affiliated Hospital of Guiyang College of TCM, Guiyang 550003.

wuyuanhua OBJECTIVE: To observe the effect and explore

the mechanism of needling LI11-Quchi and LV03-Taichong points in

treating hypertension patients and the influence on blood levels of

angiotension converting enzyme (ACE) and endothelin (ET) levels.

METHODS: Sixty hypertension patients were randomly divided into LV03

needling (group A), LII1 needling (group B) and control (group C, treated by

Captopril). Changes of plasma ET was determined by radioimmunoassay

(RIA) and serum ACE content was measured by chemical colorimeter.

RESULTS: The effect of LOWERING systolic pressure at 15 min after

needling in Group B was better than that in Group A (P < 0.01), but it was

inferior to the latter at 120 min after withdrawal of needle (P < 0.05), while

after one course treatment, the effect in Group B and C was obviously

better than that in Group A (P < 0.05 and P < 0.01). Content of serum ACE

significantly increased in Group B and that of plasma ET significantly

decreased in Group A, showing significant difference between the two

groups, all P < 0.01. CONCLUSION: Needling LI11 and LV03 show

hypertensive effect (that is a typo; from the results, above, it should read

" HYPOTENSIVE effect " ), the former is obviously higher than that of the

latter. They could regulate the blood level of ACE and ET, protect and repair

vascular endothelial cells, but the key links of their mechanism might be

different. PMID: 15658649 [PubMed - indexed for MEDLINE]

 

Xu F, Liu X, Liu Z, Chen J, Dong B. [The role of ear electroacupuncture on

arterial pressure and respiration during asphyxia in rabbits][Article in

Chinese] Zhen Ci Yan Jiu. 1992;17(1):36-8, 32. Dept of Physiology, Luzhou

Medical College, Sichuan. This paper reports the study of the effect of ear

electro-AP (EA) inserted in the " Erjian " point on arterial pressure and

integrated phrenic nerve discharge (IPND). The result showed that the

arterial pressure was decreased and frequency of IPND was increased. The

differences as follows: During spontaneous breathing, the blood pressure

and IPND were -36.56+/-26.63 mmHg and, 2.42+/-1.42 spikes/10S

(p<0.001); in excitatory period, -24.31+/-6.01 mmHg and, 2.16+/-1.12

spikes/10S (p<0.01) and in inhibitory period -18.26+/-7.04 mmHg (P less

than 0.01) and, 2.07+/-1.07 spikes/10S (p<0.05). The lasting time was 26

min, 330S and 280S. We observed 20 cases with hypertension by ear

electro-AP. The systolic pressure and diastolic pressure of hypertension

patients were decreased (p<0.001) and respiratory rate increased (p< 0.05).

PMID: 1394954 [PubMed - indexed for MEDLINE]

 

Zhang YL, Li CP, Peng M, Yang HS. [Effect of acupuncture combined with

medicine on neuropeptide Y in the patient of hypertension][Article in

Chinese] Zhongguo Zhen Jiu. 2005 Mar;25(3):155-7. Zhuhai Hospital of

Guangdong Provincial TCM Hospital, Zhuhai 519015, China.

xi_wnsheng OBJECTIVE: To search for a method for

increasing therapeutic effect on hypertension and study on the mechanism.

METHODS: Seventy-five cases were randomly divided into the treatment

group (n=45) treated by AP plus medicine, and the control group (n=30)

treated by medicine. Their blood pressure and plasma neuropeptide Y

(NPY) before and after treatment were investigated. RESULTS: Blood

pressure and NPY content in both the two groups decreased significantly (P

< 0.01), and the treatment group in decreasing blood pressure and NPY

content was superior to the control group (P < 0.05). CONCLUSION: AP

and medicine have cooperation in treatment of hypertension, which is

performed possibly through decreasing NPY. PMID: 16312917 [PubMed - in

process]

 

Zhou Y, Wang Y, Fang Z, Xia C, Liu B, Chen Q, Zhang F. [influence of

acupuncture on blood pressure, contents of NE, DA and 5-HT of SHR and

the interrelation between blood pressure and whole blood viscosity][Article

in Chinese] Zhen Ci Yan Jiu. 1995;20(3):55-61. Institute of Acupuncture and

Meridian, Anhui College of TCM, HeFei. Twenty spontaneous hypertensive

rats (SHR) with systolic blood pressure (SBP) >or= 20 kPa were chosen

and divided randomly into two groups (AP group and control group). The

former was APd on bilateral LI11-Quchi, ST36-Zusanli. Another 46

immature SHRs which were about 7-week-old with SBP ranged from 16

kPa to 20 kPa were given 10% high molecular weight dextran (HMWD) or

normal saline by intervention respectively. The results showed: 1. After

three course of AP, SHRs' SBP dropped remarkably from 25.493+/-0.73

kPa to 19.547+/-0.555 kPa (P < 0.01); 2. After three courses of AP, NE and

5-HT contents in plasma were lowered (P < 0.05, < 0.01) and DA content in

plasma was increased (P < 0.05) compared with that in the control group. 3.

After three course of AP, NE content in brainstem, hypothalamus, cerebral

cortex increased (P < 0.005-0.01) and DA content in brainstem, cerebral

cortex increased remarkably (P < 0.005-0.01) compared with that in the

control group. 5-HT content in brainstem, hypothalamus, and cerebral

cortex increased obviously compared with that in the control group. 4. After

1 or 2 hours of intervention of 10% HMWD to immature SHR, the whole

blood viscosity and blood pressure rise remarkably compared with normal

saline group. The experiment implies that the mechanism of lowering the

blood pressure of SHR by AP lies in that it can adjust NE, DA and 5-HT

contents in plasma and CNS to adjust the activity of sympathetic, reduce

whole blood viscosity etc. PMID: 8758831 [PubMed - indexed for MEDLINE]

 

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[' summary of " Hypertension 1996 : One Medicine, Two

Cultures: Evaluation of hypertension treatment by Traditional Chinese

Medicine " , a very useful overview by Qiao Wangzhong, Beijing University of

Traditional , China at http://tinyurl.com/yy4nlu ]

 

(1) A brief review of TCM Tx of hypertension: There are still many problems

& difficulties, especially in Tx. Effects of (western) hypertensors sometimes

are not satisfactory; their side effects still bother people.

 

TCM has many ways to treat hypertension, including Medication, AP,

Qigong Therapy, Cupping Therapy, Moxibustion, Magnet Therapy,

Massage, Dietary Therapy, etc. Among these therapeutic methods,

medication & AP are used more commonly. All these therapeutic methods

are effective to Tx hypertension & alleviate related symptoms. Also, they

can prevent & treat complications of hypertension.

 

1.1 Medication: In TCM, medication method most commonly used to Tx

hypertension. Chinese scientists have found many medicinal herbs &

compound formulae with hypotensor effects. For example, Shanghai

researchers have screened 498 medicinal herbs & 103 compound

formulae. They found 136 herbs, for example, Stephania tetrandra,

Apocynus lancifolium, Menispermum dauricum, Clerodendreon

trichotomum, Uncaria sinensis, Pheretima asperillum, etc. & 56 formulae,

like Decoction of Gastrodia elata & Uncaria sinensis, Decoction of longspur

epimedium & Curculigo orchioides, etc. to have hypotensor effects. CHMs

can not only be taken by mouth, but also can be used externally, as used in

External Application, Inhalation Therapy & Soaking Therapy.

 

External Application refers to therapeutic method of applying medicines to

patient's body on certain parts / certain acupoint to treat diseases. Soaking

Therapy treat patient by soaking patient's body partly in medicinal liquid;

usually, part chosen are patient's feet. Inhalation Therapy refers to method

to let patient to breathe in odour of medicines. In these Txs, effective

elements of medicines are absorbed into patient's body through skin /

through air passage. On other hand, medicines stimulate patient's body

from exterior, & give body a regulation. All these can result in reducing BP.

 

It has been proved that Chinese medicinal herbs lower hypertension mainly

through increasing secretion of urine by KI, dilating blood vessels, regulating

blood supplies of internal organs & brain, regulating functions of nervous

system, cardiovascular system & endocrine system (13) (18).

 

1.2 AP lowers BP mainly through blocking Beta-acceptor & regulating

adrenaline-angiotensin system (19) [31]. AP Therapy includes body

needling, head needling, ear needling, plum-blossom needle therapy, laser-

needle therapy, hydro-AP therapy, etc. All these therapies are used in China

to Tx hypertension. Among these methods, body needling is used most

commonly. acupoints usually chosen to treat hypertension are ST36, SP06,

LV03, PC06, LI11, LV02, LI04, GB20, ST09, K103, BL23, BL18, GV20,

CV06, ST40, etc. Effective rate of AP for hypertension is about 72-80%;

effects are better for Stage 1; effects are not very good in Stage 2 or 3.

 

1.3 Qigong Therapy (knowledge & skill of regulating respiration &

concentration of mind) is practised for physical training, & to prevent & treat

diseases. Qigong therapy in prevention & Tx of hypertension has a history

of more than 40 years. Shanghai Institute of hypertension treated 516

patients of hypertension w Qigong for one year, total efficiency is 86.2%;

Beijing TCM Hospital reported that they treated 136 cases of hypertension

w " Standing Qigong " , result was that 91.9% of cases responded to Tx. It is

generally considered that Qigong lowers hypertension mainly by regulating

whole body, especially by regulating functions of central nervous system

[32] [39].

 

1.4 Moxibustion Therapy (applying an ignited cone / stick of mugwort / other

medicinal herbs over certain acupoints) is sometimes used to Tx

hypertension. Usually, acupoints chosen in moxibustion are ST36, KI01,

GV20, SP06, CV12, etc.

 

1.5 Cupping Therapy (applying partial vacuum cups) is used to Tx

hypertension. Usually acupoints chosen are those of BL Channel & LI11,

ST36, etc.

 

1.6 Magnet Therapy (applying a magnet over / on certain acupoints): To Tx

hypertension, acupoints chosen are same as those chosen in AP therapy.

 

1.7 Massage therapy is sometimes used to treat hypertension. It has been

observed that massage can drop hypertension to some degree.

 

Moxibustion, Cupping, Magnets, & Massage Therapy lower BP mainly

through physically stimulating body, reflexively regulating CNS, & therefore

leading to a series of reactions, & BP is then descended.

 

1.8 Dietary Therapy (in which patients take foods that have some

hypotensive effect) is used mainly as an accompanying Tx by patient

themselves. It can help patients to take celery, sea cucumber, jellyfish &

sunflower seeds.

 

2. Evaluation of TCM Tx of Hypertension

 

2.1 Pros & Cons of TCM therapy: TCM has many methods prevent & treat

hypertension, as already mentioned above. These methods have some

advantages:

 

2.1.1. Advantages

(a) TCM treats by regulating whole body, rather than by simply lowering

BP. Hypertension is dt feedback regulation which takes place when

blood supplies to some important organs, like HT, brain & KI, are

not in balance. This regulation is a compensatory reaction, but it is

imperfect & leaves a pathological state of hypertension. So proper

Tx for hypertension is to normalise blood supply of HT, brain & KI.

Simply lowering hypertension may lead to a new imbalance of blood

supply. TCM treats hypertension based on Syndrome

Differentiation, this is just to regulate functions of whole body,

promote its self-balance function. Holistic & dialectical concept of

TCM accord w principle of hypertension Tx. TCM therapies can not

only lower hypertension, control it in a normal range, prevent & treat

various complication of hypertension, but also make various

imbalance states of body return to normal.

 

(b) Usually, although effects of TCM therapies are a little slower, they

are mild, persistent & steady. TCM therapies are mainly safe

natural therapies, w little side effects, so these methods are

especially suitable for patients w complications of LV damage / KI

failure. When treated w TCM therapy, BP drops gradually & slowly

& patient will not feel uncomfortable. There are no side effects

when a patient is treated for a long time.

 

2.1.2. Disadvantages

(a) it is a little inconvenient for patient to take decoctions by mouth, &

taste are also unfavourable.

(b) the mechanism by which some TCM therapies drop hypertension is

unknown. This make it very hard for some people, even some

medical workers to accept TCM therapy.

© It is very hard to learn principles & methods of Syndrome

Differentiation; if a doctor has not grasped these principles &

methods, therapeutic effects will be reduced greatly.

 

2.2 Tx based on Syndrome Differentiation versus Tx based on hypertension

symptoms only: Effects of TCM therapy depend greatly on Tx based on

Syndrome Differentiation. Many medicinal herbs & formulae are effective to

Tx hypertension. If these medicines are used not according to principle of

Syndrome Differentiation, therapeutic effects would be unsatisfactory /

disease would not respond to these medicines.

 

In fact, whether Chinese medicines work / not is related closely to patient's

body states. Under different body states, effects of medicines will be

different. Patient's body state is what we call " TCM Syndrome " / " Syndrome

state " . Clinically, hypertension may differ in pathological changes, in

degrees of severity, in stages, & in complications. In TCM, pathogens &

pathogeneses are complicated; they have many types. Therefore, doctors

should choose appropriate therapy for each Syndrome. It is forbidden to

apply single fixed therapy to treat every case. However, people also found

that if doctors, under guidance of principles of Tx based on Syndrome

Differentiation, add a few medicines already known to be effective for

hypertension into main prescription, therapeutic effects will promoted.

 

2.3 About criterion of therapeutic effects: TCM is basically a

phenomenonological medicine; medical phenomena are very important to

TCM. Clinical phenomena are valuable index for a TCM Dx & to evaluate

therapeutic effects. These phenomena include patients' subjective feelings,

i.e. subjective symptoms. According to TCM, these symptoms should be

taken to evaluate effects of therapeutic methods. Generally speaking,

alleviation of some symptoms usually reflects that patient's life quality is

improved, & it also reflects that patient's body has returned to a new

balance state. It has been observed that alleviation of subjective symptoms

usually accompanies BP reduction. So it is needed & practicable to take

patients subjective symptoms as standards for evaluation of therapeutic

effects, especially in Tx by TCM.

 

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