Can acupuncture treat Parkinson’s disease?

Tiejun Tang

Today is World Parkinson's Day. This week is Parkinson’s disease awareness week of UK. Parkinson’s disease (PD) is the second most common age-related neurodegenerative disorder after Alzheimer’s disease. An estimated seven to 10 million people worldwide have PD. There are an estimated 127,000 people in the UK living with PD.

There's currently no cure for Parkinson's disease. Physiotherapy can relieve muscle stiffness and joint pain through manipulation and exercise. Language therapy can help to improve speaking. Levodopa usually used to improves movement problems, but it often causes a lot of side effects. Long-term use of levodopa is also linked to problems such as uncontrollable, jerky muscle movements (dyskinesias) and "on-off" effects, where the person rapidly switches between being able to move (on) and being immobile (off).

Acupuncture is widely used to treat PD in many countries. Many clinical trials and laboratory research reports were published in the past two decades. These reports showed us two facts: 

1. Acupuncture is effective in PD treatment:

Shulman LM ^[1] used acupuncture to treat 20 cases of PD. On the patient questionnaire, 85% of patients reported subjective improvement of individual symptoms including tremor, walking, handwriting, slowness, pain, sleep, depression, and anxiety; Ren XM ^[2] used acupuncture combined with madopar to treat 50 cases of PD. A total effective rate of 92% was achieved with obvious alleviation of motor disorder in the treatment group, which was significantly higher than that in the madopar control group. The result indicates acupuncture can enhance therapeutic effects of western medicine and lessen the dose of the medicine needed; Arankalle DV^[3]  used electro-acupuncture to treat a case of PD. Assessments were based on the Berg Balance Scale (BBS) and Parkinson's Disease Questionnaire-39 items. The patient  improvement on the BBS, his quality of life showed improvement particularly on the 'activities of daily living', 'cognition' and 'communication' dimensions;  Iseki C ^[4] reported acupuncture can alleviate the nonmotor symptoms of PD including pain, depression, and autonomic Symptoms; Fukuda S ^[5] reported acupuncture have an immediately effects on tongue pressure including swallowing reflex latency in PD;  Lee SH ^[6] reviewed 25 randomized controlled trials (RCTs) on the topic of acupuncture treat PD. The results showed acupuncture was effective in relieving PD symptoms compared with no treatment and conventional treatment alone, and acupuncture plus conventional treatment had a more significant effect than conventional treatment alone; Yeo S ^[7] used electro-acupuncture to treat 10 patients in the hospital. The acupoints GB34 and LR3 were selected. After 8 weeks treatment the Unified Parkinson's Disease Rating Scale (UPDRS) sub-scores and the depression scores for the patients had statistically decreased compared to the scores before acupuncture treatment; moreover, 8 weeks later, these scores remained stable. A positive correlation was found between the UPDRS and the mean magnetic resonance signal change for the thalamus.

2.    These effects were supported by many scientific research reports:

Wang L ^[8] reported 29 PD patients were under the auditory evoked brain stem potential (ABP) examination, the latent period of V wave and the intermittent periods of III-V peak and I-V peak were significantly shortened after acupuncture treatment. The difference of cumulative scores in Webster's scale was also decreased in correlation analysis; My ex colleague Huang Y^[9] used positron emission tomography (PET) and the 18-flourodeoxyglucose tracer to study cerebral effects of acupuncture in PD. Five patients received scalp-acupuncture and Madopa, while the other five had Madopa only. PET scans before and after acupuncture show increased glucose metabolisms in parietal, temporal, occipital lobes, the thalamus, and the cerebellum in the light-diseased hemisphere, and in parietal and occipital lobes of the severe-diseased hemisphere. No changes were observed in the Madopa-only group. This indicated acupuncture in combination with Madopa may improve cerebral glucose metabolism in PD; in the other report ^[10] she used single photon emission computed tomography (SPECT) measures of 99mT-ECD and 99mTc-TRODAT-4, before and after scalp acupuncture treatment. Patients who received levodopa and complementary acupuncture had increased regional cerebral blood flow (rCBF) in the frontal lobe, the occipital lobe, the basal ganglion; Yang JL^[11] investigated the role of acupuncture in neurotoxin-induced PD mice. The mice were evaluated for behavioral changes, in terms of time of landing, after acupuncture treatment. The animals were sacrificed and their brains assayed for dopamine and its metabolites and tyrosine hydroxylase (TH) expression by using HPLC and immunohistochemistry/Western blotting. The results showed that the time of landing of the three groups with treatment was significant longer than normal group. Nonetheless, the acupuncture group had a shorter time of landing than sham acupuncture group. The number of TH (+) neurons and the expression of TH proteins were significantly higher in the acupuncture group than in the sham acupuncture group. These results conclude that acupuncture possibly attenuates neuronal damage in MPTP-induced PD mice, which suggests acupuncture may be useful as a complementary strategy when treating human PD; Yeo S^[12] investigated the reported association between acupuncture point GB34 and PD. They use fMRI methods examined the neural responses of 12 patients with PD and 12 healthy participants before and after acupuncture stimulation. The results showed acupuncture stimulation increased neural responses in regions including the substantia nigra, caudate, thalamus, and putamen, which are impaired caused by PD; Wang S^[13] investigated the effect of electro-acupuncture at Fengfu (GV16) and Taichong (LR3) acupoints in rat models of PD. Reverse transcription-PCR demonstrated that brain-derived neurotrophic factor and glial cell line-derived neurotrophic factor mRNA expression was significantly increased in the substantia nigra of rat models of PD, and that abnormal behavior of rats was significantly improved following electro-acupuncture treatment. These results indicated that electro-acupuncture treatment up-regulated brain-derived neurotrophic factor and glial cell line-derived neurotrophic factor mRNA expression in the substantia nigra of rat models of PD;  Wattanathorn J^[14] aimed to determine the effect of laser acupuncture at HT7 on memory impairment, oxidative stress status, and the functions of both cholinergic and dopaminergic systems in hippocampus of animal model of PD. The results showed that laser acupuncture at HT7 enhanced memory and neuron density in CA3 and dentate gyrus. The decreased AChE, MAO-B, and MDA together with increased GSH-Px in hippocampus of a 6-OHDA lesion rats were also observed; Park JY^[15] reported that p53 signalling mediates the protective effects of acupuncture treatment in a mouse model of PD. They found that the acupuncture treatment in the mouse PD model results in significant recovery to the normal in the context of behaviour and molecular signatures. The gene network associated with p53 signalling is closely involved in the protective effects of acupuncture treatment in PD. These data suggest that p53 signalling mediates the protective effects of acupuncture treatment in PD.

Traditional Chinese medicine believes PD is mostly due to liver & kidney yin deficiency this lead to liver yang excess. In some conditions it might combined with blood stasis and/or phlegm heat. Bases on these TCM philosophy acupuncturists select different acupoints in different conditions. Body acupuncture, scalp acupuncture and electro- acupuncture can be selected. If Chinese herbal medicine were added it will obtained a better treatment effect.

World Parkinson’s Day, be aware of PD !

 Reference:

1. Shulman LM. Acupuncture therapy for the symptoms of Parkinson's disease. Mov  Disord. 2002; 17(4):799-802.
2. Ren XM. Fifty cases of Parkinson's disease treated by acupuncture combined with madopar. J Tradit Chin Med. 2008; 28(4):255-7.
3. Arankalle DV. Effect of electroacupuncture on function and quality of life in Parkinson's disease: a case report. Acupunct Med. 2013; 31(2):235-8.
4. Iseki C. Acupuncture Alleviated the Nonmotor Symptoms of Parkinson's Disease including Pain, Depression, and Autonomic Symptoms. Case Rep Neurol Med. 2014;2014:953109.
5. Fukuda S. Immediate effects of acupuncture on tongue pressure including swallowing reflex latency in Parkinson's disease. Acupunct Med. 2016; 34(1):59-61.
6. Lee SH. Clinical effectiveness of acupuncture on Parkinson disease: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore). 2017; 96(3):e5836.
7. Yeo S. A study of the effects of 8-week acupuncture treatment on patients with Parkinson's disease. Medicine (Baltimore). 2018; 97 (50):e13434.
8. Wang L. Effect of acupuncture on the auditory evoked brain stem potential in Parkinson's disease. J Tradit Chin Med. 2002
9. Huang Y. Complementary acupuncture treatment increases cerebral metabolism in patients with Parkinson's disease. Int J Neurosci. 2009; 119(8):1190-7.
10. Huang Y.  Complementary acupuncture in Parkinson's disease: a spect study. Int J Neurosci. 2010; 120(2):150-4.
11. Yang JL. Neuroprotection effects of retained acupuncture in neurotoxin-induced Parkinson's disease mice. Brain Behav Immun. 2011; 25(7):1452-9.
12. Yeo S. Acupuncture stimulation on GB34 activates neural responses associated with Parkinson's disease. CNS Neurosci Ther. 2012; 18(9):781-90.
13. Wang S. Electroacupuncture-regulated neurotrophic factor mRNA expression in the substantia nigra of Parkinson's disease rats. Neural Regen Res. 2013; 25; 8(6):540-9.
14. Wattanathorn J. Laser Acupuncture at HT7 Acupoint Improves Cognitive Deficit, Neuronal Loss, Oxidative Stress, and Functions of Cholinergic and Dopaminergic Systems in Animal Model of Parkinson's Disease. Evid Based Complement Alternat Med. 2014:937601. doi: 10.1155/2014/937601.
15. Park JY. p53 signalling mediates acupuncture-induced neuroprotection in Parkinson's disease. Biochem Biophys Res Commun. 2015; 460(3):772-9.

How to treat infant constipation ?

Tiejun Tang

I am a regular contributor of Your wellness Magazine since 2017. In next issue I was asked to answer a question about infant constipation. I would like to share this topic in here. I hope this small paragraph can help more parents and their babies. 

Question:

My son, who is two, often suffers from constipation. What can I do to help?

Answer:

Infant constipation is quite common. The main reasons of infant constipation are: 1) Food ingredients are not suitable; 2) Long-term lack of diet; 3) Intestinal function problems; 4) Digestive tract developmental malformation. We need to find out what reason caused his constipation. 

Your question is too simple. We need more information to analysis his diagnosis. How often of his bowel movement? How is his diet? Does he have abdominal pain? Does he have barium enema examination? If his constipation is due to unsuitable food ingredients, I suggest you just change his diet. Let him eat more vegetables and fruits which rich of fibers. Drinking more water and add some honey which can help to release constipation.

Acupuncture and Chinese herbal medicine can release constipation easily. But it is quite difficult to do acupuncture for a two years old infant. He maybe couldn’t accept the taste of herb decoction. In this condition we can do infant Tuina massage for small baby. It also will get good effect to release constipation of babies. You can find a local Chinese medicine practitioner do to this infant massage. You also can learn this manipulation and practice on your son by click the video below.

Read more Q&A please click here

Can acupuncture treat autism?

Tiejun Tang

This week is the World Autism Awareness Week. It's estimated about 1 in every 100 people in the UK is autistic. More boys and men are diagnosed with autism than girls and women.

There is currently no effective medication to treat autism. Applied Behaviour Analysis (ABA) is often used in schools and clinics to help autistic children. In recent years stem cell therapy is applied to autism treatment, but its effect is still uncertain according to the latest report. ^[1]

Can acupuncture help autism patients? How can it help? What is the best treatment approach for autism? The following evidence based research reports will answer these questions.

Does it work?
Chen WX^[2] reported 2 cases of child autism spectrum disorder (ASD) treated with electro acupuncture. After 24 sessions over 8 weeks treatment positive changes in "irritability" and "stereotypy" were noted in case 1, and positive changes were found for both cases in "sensory motor," "sensory response".The positive changes in case 1 included much improved "social relatedness, communication, and stereotypy behaviour"; Allam H^[3] used scalp acupuncture to treat 20 ASD children.The results showed a significant improvement in cognitive and expressive language skills after treatment; Chan AS^[4] reported a randomized clinical trial (RCT). They applied seven-star needletotreat 32 children with ASD and the results showed that the treatment group demonstrated significant improvement in language and social interaction, but not in stereotyped behaviour or motor function, compared to the control group.

Wong VC^[5] reported a randomized, double-blind, sham-controlled, clinical trial. Children with ASD were randomly assigned to an electro-acupuncture (EA) group or a sham electro-acupuncture (SEA). After a four-week (12 sessions) course of electro-acupuncture the results showed there were significant improvements in the language comprehension domain, self-care caregiver assistant domain in the EA group compared to the SEA group. As for the parental report, the EA group also showed significantly better social initiation, receptive language, motor skills, coordination, and attention span.

Lee MS. ^[6] aimed to assess the effectiveness of acupuncture as a treatment for ASD.They searched 15 databases,11 RCTs. Two RCTs found that acupuncture plus conventional language therapy was superior to sham acupuncture plus conventional therapy. Two other RCTs found that acupuncture produced significant effects compared with conventional language therapy or complex interventions. Three RCTs suggested that acupuncture plus conventional therapies had beneficial effects compared with conventional therapy alone. Four more RCTs reported that subjects who received acupuncture experienced significant effects compared with subjects who were waitlisted or received no treatment. The results of these studies provide mixed evidence of acupuncture's effectiveness as a treatment for ASD symptoms.

Lee B^[7] searched 13 databases published up to December 2016. Twenty seven RCTs were included and 1736 participants were investigated. The outcome measures were the overall scores on scales evaluating the core symptoms of ASD and the scores for each symptom, such as social communication ability and skills, stereotypies, language ability, and cognitive function. The results showed that acupuncture complementary to behavioural and educational intervention significantly decreased the overall scores on the Childhood Autism Rating Scale (CARS) and the Autism Behaviour Checklist. Acupuncture as a monotherapy also reduced the overall CARS score.

How it works?

Zhao ZQ^[8] used electro-acupuncture to treat 55 childhood with autism (4.52±2.73 years). All patients were examined by single photon emission computed tomography (SPECT) before and after treatment to evaluate its effectiveness. The results showed that intracerebral multiple focal radioactivity distribution defect areas of autism patients were observed to be partially filled. Significant differences in the ratios of regional cerebral blood flow and global cerebral blood flow before and after treatment were observed. The symptoms of patients also improved.Khongrum J^[9] applied laser acupuncture at HT7 to treat the Valproic Acid-Rat Model of Autism. The results showed that laser acupuncture HT7 decreased oxidative stress, interleukin 6 (LI-6) gene expressions, and gamma-aminobutyric acid transaminase T (GABA-T) activity but increased the expressions of glutamic acid decarboxylase (GAD) proteins together with the density of Purkinje cells in the cerebellum. Therefore, laser acupuncture at HT7 is the potential strategy to improve the cerebellar disorders in VPA-rat model of autism.

Zhang R^[10] applied transcutaneous electrical acupoint stimulation (TEAS) to treat 76 autistic children, the plasma level of arginine-vasopressin (AVP) and oxytocin (OXT) were detected before and after treatment. The result found the AVP and OXT level was significantly higher in the TEAS group than in the control group. Li LY^[11]analyzed the molecular mechanism of acupuncture treated ASD, because acupuncture can induce activation gene expression of brain-derived neurotrophic factor (BDNF) in many neurological disorders. In view of these findings, they hypothesise the potential therapeutic effect of acupuncture-induced activation of BDNF in the treatment of ASD.

What is the best protocol ?

Abo Almaali ^[12] analyzed acupuncture point's combination and protocols of thirteen articles. The most frequently used acupuncture points are EX-HN1 (5), GV-17 (4), PC-6 (4), LR-3 (3), KI-3 (3), HT-7 (3), Lu-9 (3), GV-20 (2), GV-24 (2), GV-24.5 (2), GB-13(2), GB-19 (2), KI-4 (2), LR-4 (2), ST-36 (2), SP-3 (2), SP-6. The most frequently used meridians are Du meridian (12), Gallbladder meridian (9), Kidney meridian (8), Pericardium meridian (7), Extra points (7), Liver meridian (7), Heart meridian (6), Ren meridian (6), and Bladder meridian (6).

Why it can help?

The clinical manifestation of autism was described in traditional Chinese medicine classics of thousand years ago. It was called Wu Chi (five retardations). TCM theory believes the five retardations were due to kidney essence deficiency. Kidney essence can nourish the brain. Du meridian is an important connection between kidney and brain. Brain development also relies on the normal function of each organ. Acupuncture can balance yin-yang and regulate the function of zang fu organs by stimulating certain points on certain meridians. That is why it can give a lot of help in autism treatment. 

Reference: 

1. Dario Siniscalco. Stem cell therapy in autism: recent insights. Stem Cells Cloning. 2018; 11: 55–67.
2. Chen WX. Electroacupuncture for children with autism spectrum disorder: pilot study of 2 cases. J Altern Complement Med. 2008; 14(8):1057-65.
3. Allam H. Scalp acupuncture effect on language development in children with autism: a pilot study. J Altern Complement Med. 2008; 14(2):109-14.
4. Chan AS. Seven-star needle stimulation improves language and social interaction of children with autistic spectrum disorders. Am J Chin Med. 2009; 37(3):495-504.
5. Wong VC. Randomized controlled trial of electro-acupuncture for autism spectrum disorder. Altern Med Rev. 2010; 15(2):136-46.
6. Lee MS. Acupuncture for children with autism spectrum disorders: a systematic review of randomized clinical trials. J Autism Dev Disord. 2012 Aug; 42(8):1671-83. doi: 10.1007/s10803-011-1409-4.
7. Lee B The Efficacy and Safety of Acupuncture for the Treatment of Children with Autism Spectrum Disorder: A Systematic Review and Meta-Analysis. Evid Based Complement Alternat Med. 2018 Jan 11; 2018:1057539.
8. Zhao ZQ. Evaluating the effectiveness of electro-acupuncture as a treatment for childhood autism using single photon emission computed tomography. Chin J Integr Med. 2014; 20(1):19-23.
9. Khongrum J. Laser Acupuncture at HT7 Improves the Cerebellar Disorders in Valproic Acid-Rat Model of Autism. J Acupunct  Meridian Stud. 2017;10 (4):231-239.
10.  Zhang R. Transcutaneous electrical acupoint stimulation in children with autism and its impact on plasma levels of arginine-vasopressin and oxytocin: a prospective single-blinded controlled study. Res Dev Disabil. 2012; 33(4):1136-46.
11.  Li LY. Could acupuncture have a role in the treatment of autism spectrum disorder via modulation of BDNF expression and activation? Acupunct  Med. 2014; 32(6):503-5.
12. Abo Almaali. Analysis of Evidence-Based Autism Symptoms Enhancement by Acupuncture. J Acupunct Meridian Stud. 2017; 10(6):375-384.