Acupuncture Therapy in Diseases Failing to Respond to Western Medicine: Six Case Reports

Abstract Six patients were selected in this investigation in order to study the therapeutic effect of manual and electrical acupuncture treatment on several chronic diseases after failure of conventional therapy. The post-therapeutic assessment of the patients was classified as: a) marked improvement, b) improvement, c) transient improvement, or d) failure. Acupuncture treatment is simple, effective and without side effects, and its efficacy is clearly demonstrated. Key words: acupuncture, migraine, chronic diarrhoea, bronchial asthma, pre-menstrual syndrome, schizophrenia, hay fever.

Introduction Previous studies1,2,3 have suggested that acupuncture could treat arthritis which is unresponsive to conventional therapy. Although acupuncture has been used with great success in the west for treatment of pain of different causes4, a variety of acute and chronic diseases are also shown to be amenable to treatment by acupuncture. These cases indicate that the advantage of acupuncture treatment further appears to be free of the contraindications, side effects and pharmacological burden which accompany the use of Western orthodox medicine.

The aim of this investigation is to describe and to estimate the therapeutic effect of acupuncture treatments on a group of diseases which responded poorly to other forms of conventional therapy. Patients and methods Six patients were selected in this study for acupuncture treatment after they had been examined thoroughly by a number of specialists and had failed to respond to conventional treatment. The study consisted of a 3-5 week therapy period, in which 6-10 acupuncture sessions were given to each patient and in some cases repeated until a satisfactory result had been achieved or until no further progress was made.

Stainless steel disposable acupuncture needles (1-1.5 cm in length, 0.32 mm in diameter and 30 in gauge) were used. To ensure minimal pain, the needles were inserted swiftly through the skin, to a range of 4mm-1cm in depth, and were left in situ for 15-25 minutes during each session of treatment.

During the process of treatment for each patient, proper placement of the acupuncture needles was determined by the appearance of deqi which is a sensation of dull soreness, heaviness, numbness or tingling. The needles were inserted and twirled manually or stimulated electrically (with a low frequency of 3-6 Hz, and square pulses of 1.0ms) to obtain one or more of the sensations described above. In most cases, 4 to 9 acupuncture points were stimulated in each individual case and the selection of these points was generally as follows:

Some points were selected at or near the site of the disease as "local points"5,6,7. Some points were selected in most cases as "general basic points" from the traditional Chinese acupuncture chart8. Some points which are said to be effective for a particular disease or symptom on the basis of the traditional theory were selected as "specific points". Some points, known as "distal points" were chosen at a site far away from the area of the disease.

Therapeutic assessment Clinical assessment of each patient was carried out at the beginning and at the end of each course of treatment by noting objective functional changes. The patients were instructed to fill in diary sheets before and throughout their participation in the treatment. After acupuncture treatment sessions had been terminated, post-therapeutic evaluations in each case were based on the following criteria: Failure: no noticeable response to at least 3 sessions of treatment. Transient improvement: in which the treatment reduced or eliminated the symptoms and signs of the disease, but these returned unchanged within 1 to 3 days and this pattern showed no further change with subsequent treatments. Improvement: significant reductions in the patient's symptoms were noted. Activity had improved and requirements for Western medications had been reduced or obviated.

Marked improvement: all the patient's symptoms had and blood, achieved by combining local and distal points. disappeared completely, or had decreased by over 75% The patient reported great improvement and a reduction in compared with the state before treatment, and activity and frequency and severity of her symptoms. With the continuwell-being had improved so that patients were able to carry ation of the treatment, there was no recurrence of signs and out normal activities. symptoms for about eight months after the last session of 6 treatments. For the first time for 5 years, she received no Management of the six cases medication. Each patient was diagnosed on the basis of history and Post-therapeutic response: marked improvement. clinical features obtained in relation to traditional Chinese medical syndromes, together with examination of pulses at Case Two (chronic diarrhoea) both radial arteries. Treatment was decided upon accord- A 32-year old Asian woman normally resident in Britain for ing to traditional Chinese point selection methods and the past 14 years, had suffered from persistent diarrhoea, adjusted according to progress at each treatment session. 4-6 times per day, during the past 3 years, which had The treatments in 6 patients illustrate the success and resulted in weight loss and deterioration of general health. effectiveness of acupuncture treatment compared with the Her condition was thoroughly investigated by her local GP failure of conventional Western remedies. and internists, without reaching any definite diagnosis, and conventional treatment had not been effective to clear the Case One (migraine) diarrhoea. A 41-year old housewife had suffered from migraine for CHRONIC DIARRHOEA16 over 10 years and had experienced recurrent episodes of severe headache, nausea and vomiting, orbital pain and
1. Chronic diarrhoea is an increased stool frequency and fluidity (whether diarrhoeal stool is bloody, fatty or watery) lasting for more than two weeks. earache. She had been treated by Western orthodox medicine without success. Her attacks increased steadily in severity, in spite of her taking 16 mg of ergotamine daily;
2. It may be due to: an infection (such as parasites, bacteria and viruses), non-infection (such as antibiotics, high blood pressure she eventually chose to seek acupuncture treatment as a last medication, cancer drugs, Crohn's disease, colitis, endocrine resort. diseases, food additives and allergies, previous surgery, radiation of the abdomen or gastrointestinal tract, tumours, heredity) or unknown causes. MIGRAINE11
3. Careful history, physical examination and investigations
1. Migraine affects an estimated 5 million people in the UK and it is (Laboratory tests, X-ray, ultrasound examination and abdominal CT the most frequently encountered illness in the NHS and private scan and endoscopy) can determine the likely cause of most chronic practice which results in neither disability nor death. diarrhoea and direct subsequent diagnostic evaluation and treatment.
2. The headache is never the sole symptom of migraine, nor is it a necessary feature of migraine attacks. However, the outstanding
4. The key to Western treatments of chronic diarrhoea is to determine feature of the migraine syndrome is periodic headache, usually its cause. unilateral in onset, but which may become generalised.
3. In migraine there is a close relationship between personality and Treatment physical symptoms. Not only are the duration, frequency and occurrence of migraines extremely variable, but the intensity varies, The patient received 6 acupuncture treatments (twice sometimes in the same person, from an intolerable pain causing the weekly). The following acupuncture points were needled: patient to border on prostration or coma, to a light discomfort. • Local points: Tianshu ST-25, Guanyuan REN-4 and Qihai
4. Migraine causes considerable morbidity and disruption of REN-6. everyday life, with over 60% of sufferers being absent from work at • Distal points: Zusanli ST-36, Shangjuxu ST-37, Gongsun least once a year ; it costs the National Health Service in the U.K. millions of pounds per year. 9 SP-4 and Sanyinjiao SP-6. • Immune enhancing points included Quchi L.I.-11 and Treatment Dazhui DU-14. Six acupuncture sessions (2 sessions per week) were given Results and the following acupuncture points were used: Traditional Chinese acupuncture theory emphasises that • Local points, which were tender on pressure, included chronic diarrhoea is a characteristic of insufficiency of the Shangguan GB-3, Yangbai GB-14, Fengchi GB-20 and Jianjing Spleen and Kidney yang, affecting the functions of transGB-21 which were needled bilaterally. portation and transformation of food. Therefore, acupunc • The distal points selected were Hegu L.I.-4, Taichong ture treatment in this case was used as a tonification method LIV-3, Neiting ST-44, Yanglingquan GB-34, Zulinqi GB-41 to strengthen the transportation functions of the Spleen and and Yanggu SI-5. Stomach and adjust the function of the Large Intestine to Results relieve the diarrhoea. According to Chinese medicine theory, the acupuncture After the first 3 sessions of treatment, the diarrhoea treatment of migraine includes the dispersion of "wind", ceased, the patient was more active, seemed to regain good removal of obstruction in the channels and regulation of qi general health and continued to do so with each treatment. Three months after the last session of acupuncture treatment, her bowel habits had returned to normal, and her strength and energy were improved dramatically, with a significant increase in weight from 53 to 64 kg. Post-therapeutic response: marked improvement. Case Three (bronchial asthma) This 63-year old man had sffered from chronic bronchial asthma for 20 years. His clinical history was typical, according to the physician's report, which indicated that the chest X-ray was normal but the forced expiratory volume in the 1st second (FEV1) and peak expiratory flow rate (PEFR) were slightly improved after inhalation of Salbutamol aerosol. The patient, a non-smoker, gave a typical history of exercise-induced asthma and his symptoms were poorly controlled with oral aerosol bronchodilator. BRONCHIAL ASTHMA18 Bronchial asthma is a lung disease characterised by periodic attacks of wheezing lasting minutes to days alternating with periods of relatively normal breathing. It may be caused by a specific allergy such as allergy to dust, mould and dander, or systemic physical diseases such as cardiovascular diseases (heart failure, hypertension, blood disease etc). It can develop at any age and many risk factors contribute to the aetiology such as family history of asthma and /or eczema and other allergies. The typical picture of bronchial asthma consists of: dyspnoea (aggravated by exercise), wheezing (sudden onset, sequence of episodic attacks worse at night or in early morning and aggravated by exercise and exposure to cold air) and productive cough. Investigations for bronchial asthma include: pulmonary function test, chest X-ray, complete blood picture and arterial blood gas. The treatment is targeted at prevention by avoiding allergens and controlling symptoms with bronchodilators and anti-inflammatory medications.

Treatment The patient received 8 sessions of acupuncture treatment (twice weekly for 3 weeks and then one session a week). The acupuncture points used in this case were: Local point: Shanzhong REN-17. Specific point for soothing asthma: Dingchuan (M-BW-1). Distal points: Kongzui LU-6, Lieque LU-7, Hegu L.I.-4 and Feishu BL-13.

Results The patient had been instructed to record his symptoms in the diary sheets before the commencement of treatment and then throughout the course of treatment. In the first week of treatment the response was uneven, but after the third session the patient showed a significant improvement in distance walked, which ranging from 33 to 220 meters and also in his ability to perform normal daily tasks, such as shaving, washing and dressing. A 6-month follow-up showed that the patient was using much less medication and experiencing only mild attacks of bronchial asthma with a significant reduction in their frequency. Post-therapeutic response: improvement. Case Four (pre-menstrual syndrome) A 36-year old woman was diagnosed as suffering from premenstrual syndrome. She had had a 5-year history of irregular menstrual cycle, sometimes with long periods of amenorrhoea or with heavy and prolonged menses. She suffered from dysmenorrhoea, with backache, which varied from slight to severe. Prostaglandin inhibiting drugs were frequently used, but with slight improvement. The patient also had a history of frequency, urgency and dysuria which were accompanied by occasional stress incontinence and vaginal yeast infection. During the past few months, she had suffered from insomnia, frequent awakening, restlessness, excessive sweating and night terrors with occasional 'panic attacks'. The patient developed anorexia in each pre-menstrual week, which was accompanied by occasional nausea and vomiting. PRE-MESTRUAL SYNDROME (PMS)10 PMS covers a vast number of symptoms produced by the pathological, physiological, physical and psychological changes of the menstrual cycle. The main cyclical symptoms of PMS are irritability accompanied by somatic complaints such as sense of swelling, bloating, backache, headaches, weight gain, fatigue, anxiety and depression. The commonest time for PMS cyclical symptoms is during the few days before menstruation, hence the title, but these symptoms may continue until the full menstrual bleeding has begun. PMS affects 40% of women, 10% of whom are severely incapacitated10. Various Western treatments such as oral contraceptives, diuretics, bromocriptine and lithium have been proved unsuccessful and inconclusive.

On examination, the patient was so sensitive to her illness that she burst into tears for no apparent reason. The patient had coldness of the feet and hands, tachycardia and frank dyspnoea following mild exertion such as climbing stairs. Pulse diagnosis revealed an insufficiency of qi and blood with dysfunction of the Liver and the extra-ordinary Conception vessel. The pulse was thready and forceless. Treatment Eight twice weekly acupuncture sessions were given, followed by 2 booster acupuncture sessions of one per month. Acupuncture points from the Conception vessel and the Liver channel were selected as the main points to nourish the Liver, Spleen and Kidney. The following points were used: Local points: Zhongji REN-3 and Guanyuan REN-4. Distal points: Zusanli ST-36 and Sanyinjiao SP-6. Specific points for pain : Hegu L.I.-4 and Neiting ST-44. The specific point for nausea and vomiting was Neiguan P-6.

Results A significant improvement in the patient's symptoms was achieved in the first 3 sessions and subsequent treatments were successful in correcting the insufficiency of qi and normalising the Penetrating (Chong) and Conception (Ren)vessels, resulting in a normal menstrual cycle, normal pulse rhythm, normal appetite and normal frequency of micturition. Six months later, the patient was still maintaining good health. Post-therapeutic response: marked improvement. Case Five (schizophrenia) A young adult of 36 years of age was diagnosed 10 years ago as a schizophrenic by a psychiatrist. He had symptoms which seemed to have resulted from breakdown in the mental process by which he differentiated his inner self from the outside world. He experienced thoughts generated in his mind as voices coming from outside, usually accompanied or followed by a delusion that individuals, organisations or natural or unnatural forces were responsible. SCHIZOPHRENIA15
1. Schizophrenia is one of the most chronic and disabling relapsing psychotic disorders that primarily affects thought and behaviour. The characteristic symptoms are: a. positive symptoms (abnormal thoughts and perceptions) such as delusions, hallucinations, disordered thinking (e.g. frequent derailment or incoherence), grossly disorganised or catatonic behaviour and b. negative symptoms such as blunted (or flat) affect, anhedonia, attention deficit and avolition. Schizophrenia affects up to 1% of the population with an incidence of 18-20 cases per 100,000 per year (up to 600,000 people in the UK). Usually the illness develops in late adolescence, when people reach their early twenties, but schizophrenia can develop in later life, and children as young as nine have suffered from the condition. In the UK schizophrenia consumes a significant amount of the total health budget with direct and indirect annual costs total of £1.7 billion. Western treatment consists of : Drug therapy: Typical antipsychotics (neuroleptics or conventional antipsychotics)such as oral treatment with the first generation of antipsychotics (chlorpromazine, haloperidol) which are supplanted by a variety of intramuscular depot preparations such as Depixol (flupenthizol) and Modecate (fluphenazine). Psychological therapy: cognitive behavioural therapy. Many patients are offered group psychotherapy and most cases can be adequately managed in the community, usually in their own homes by liaison between community psychiatric nurses, general practitioners, psychiatrists and social services.

The patient's interpretation of his environment was so disturbed that he believed that everyday objects and occurrences possessed a special and sinister meaning intended specifically for him. At the time of examination, the patient had lost his emotion and feeling, making him apathetic, indifferent and self-centred. He had suffered from insomnia for the past two weeks and also had feelings of being emotionally distant, separate or cut off from himself and other persons (depersonalisation). In spite of orthodox modern treatment and rehabilitation, the patient retained his symptoms and was disabled socially. Treatment The aim of acupuncture treatment was to achieve a damping of his acute symptoms and behaviour disturbance by the use of manual and electrical acupuncture. The treat ment consisted of six sessions, 3 given in the form of one session daily followed by one session every weekend. The following sites were used in the treatment: Specific points : Xinshu BL-15, Shenmai BL-62, Shenmen HE-7, Dazhui DU-14, Baihui DU-20, Renzhong DU-26, Fenglong ST-40, Anmian 1 (N-HN-22a) and Anmian 2 (N-HN-22b). Symptomatic points used for electrical stimulation included: Hegu L.I.-4 and Shenmen HE-7. Local points used in treatment of hallucination included: Ermen SJ-21 and Shenmen HE-7. Distal points, which were needled manually, included Zhongzhu SJ-3, Waiguan SJ-5 and Zulinqi GB-41.

Results Acupuncture treatment was very effective in calming the depressive symptoms and had some eliminating effect on the hallucinations. Acupuncture helped the patient to sleep better after the initial 2 sessions, and with further treatment he slept 7 hours each night. He has maintained good health for the last 4 months. Post-therapeutic response: improvement. Case Six (hay fever) An 18-year old woman had a 4-year history of hay fever, with attacks that were usually seasonal. During the physical examination, she had sneezing, running eyes, blocked nose and sore throat.

Treatment The patient had 7 sessions of acupuncture treatment, 4 sessions given on the basis of one session per day and followed by one session each weekend, Acupuncture points used were: Local points: Yintang (M-HN-3) and Yingxiang L.I.-20. Distal points: Taichong LIV-3, Hegu L.I.-4, and Lieque LU-7. Specific point for allergy: Xuehai Sp10. Specific points for blocked nose: Tinggong SI-19, Juliao ST-3 and Baihui DU-20.

Results With the first session of acupuncture treatment, the patient experienced substantial relief of her symptoms: for the first time she could breathe through her nose during the attack instead of through her mouth. After the following sessions the patient suffered no further symptoms and she maintained good health without further attacks for about 3 months after her first visit. Discussion Acupuncture may yet prove to be valuable in medical practice as an effective therapy for acute and chronic illnesses1,2,3,11,12 where modern Western medicine is not indicated or effective. It should be stated that the patients in this study had mostly been to their general practitioners for many years with their complaints and they or even their doctors were not satisfied with the treatment they had received. This investigation attempted to clarify the therapeutic effect of acupuncture treatment on various diseases, but did not investigate the effect of acupuncture on the pathological process of these diseases. On the basis of the findings of this study, it is concluded that the most surprising effect of acupuncture on many illnesses was its achievement in eliminating symptoms, in most instances after only one session of treatment. The insertion of the needle into the acupuncture point produced rather typical sensations and the patient experiencing these sensations during the first treatment would be quite aware whether the needle had been placed "correctly" in the subsequent sessions of treatment. In Case One the patient responded rapidly to the first session with further improvement during subsequent sessions, demonstrating a continuous and cumulative effect. Loh and colleagues13 studied the effect of acupuncture in 48 patients suffering from chronic migraine and muscle tension, and compared prophylactic acupuncture with medical treatment. They found that the condition of 24 of 41 patients improved after acupuncture, this improvement being very marked in 9, whilst 9 of 36 patients improved on medical treatment, the improvement being marked in three. Our previous research work on migraine11 and this case study agreed with the observation of Loh and colleagues, as they concluded "acupuncture is of beneficial treatment for headache and migraine for some patients and its more widespread use is justified". O'Connor and Bensky14 stated that acupuncture has a direct effect on the digestive system, and following stimulation of Zusanli ST-36 an increase in the parasympathomimetic activity was observed. The autonomic nervous system consists of two divisions: the sympathetic nervous system, which is the "yang" component, and the parasympathetic nervous system, which is the "yin" component. It is known that the autonomic nervous system is the regulator, adjuster and co-ordinator of vital activities, including those of the digestive system. Autonomic effects and the increase in the perfusion of the organs, which can be altered by the autonomic nervous system, might be considered to be one of the most important means by which acupuncture influences the physiological function of the human body. This would explain, in Case Two, the effect of acupuncture in the treatment of chronic diarrhoea. In the treatment of bronchial asthma (Case Three), chemical or humoral theory was the basis for explaining the effect of acupuncture. The exact nature of the neurotransmitters and hormones involved in this process is still not well understood. It is known that the vagal over-reaction caused by immunological or inflammatory stimuli in asthmatic patients produces chemical mediators (histamine, kinin, 5hydroxytryptamine and prostaglandin), which have an effect on autonomic centres and the hypothalamus, causing bronchial constriction. Acupuncture stimulates an increased amount of circulating adrenaline followed by increasing amounts of cortisol, both of which find their way towards their target organ, in this case the bronchial tree, bringing the asthmatic attack under control. The patient with pre-menstrual syndrome, Case Four, responded well to acupuncture therapy compared to the failure of orthodox medicine. As pointed out by O'Connor and Bensky14, following acupuncture, the level of adrenocorticotrophic hormone (ACTH), as well as the level of cortisol in the blood, increased. Therefore, the autonomic and endocrinological effects of acupuncture eliminated the symptoms of PMS. On the other hand, it is most important to see that mental and psychiatric diseases respond well to acupuncture treatment. In Case Five, acupuncture treatment achieved its target in treating the symptoms of schizophrenia caused by stress and noxious stimuli. The mechanism of acupuncture in this case was to counter imbalance and to restore balance in the patient's body by stimulating the natural healing process. The patient in Case Six had a common allergic disorder, characterised by an acute inflammation of the mucus lining of the nose, which spread to the throat. With acupuncture treatment, and even after the first session, the patient was able to breathe through her nose for the first time. Follow-up for the next 3 months showed no recurrence of symptoms. In conclusion, all patients participating in this study were sufficiently motivated to obtain relief, grateful that something had been done for them, and they did not resent the discomfort involved. Previous reports1,2,3,11,12 indicated that acupuncture has been very useful in the treatment of various types of arthritis, and the current investigation showed that acupuncture has again proved to be of beneficial treatment for many diseases. Although this type of investigation has limited value in assessing therapeutic efficacy, it should provide additional data that will help to define the active role of acupuncture in the treatment of chronic illnesses that do not respond well to modern Western therapy. References 1 Tukmachi ESA. Acupuncture treatment of osteoarthritis (case reports). Acupuncture in Medicine 1999; 17(1): 65-7. 2 Tukmachi ESA. Frozen shoulder: a comparison of western and traditional Chinese approaches and a clinical study of its acupuncture treatment. Acupuncture in Medicine 1999; 17(1): 9-21. 3 Tukmachi ESA. Acupuncture and rheumatoid arthritis. Rheumatology 2000; 39: 1153-1154. 4 Thomas M. Treatment of pain with acupuncture: factors influencing outcome. [Thesis submitted to Departments of Physiology and Surgery KS III, Karolinska Institute] Stockholm, Sweden; 1995. p.19-25. 5 Baldry, P. E Acupuncture, Trigger Points and Musculoskeletal Pain. (1989) Edinburgh: Churchill Livingstone. P.122-5. 6 McDonald AJR. Abnormally tender muscle region and associated painful movement. Pain (1980); 8: 197-205. 7 Travell JG. Myofacial trigger points: clinical view. In: Advances in Pain Research and Therapy. Bonica JJ, Abe-Fessart D. Eds., vol. 1, New York: Raven Press, pp 919-26. 8 The Academy of Traditional Chinese Medicine. An Introduction to Chinese Acupuncture. Peking. (1975). 9 Mullis DR. Migraine Trust. Pamminerva Med. (1982); 24:25-28. 10 Magos AL , and Studd JWW. Assessment of menstrual cycle symptoms by trend analysis. Am. J. Obstet. Gynecol (1986);155: 271-277. 11 Tukmachi, ESA. Migraine and Acupuncture: Clinical Approach. International Journal of Alternative and Complementary Medicine. (1994); 12(3): 15-19. 12 Tukmachi ESA. Treatment by acupuncture and dietary modification: Hot flushes in breast cancer patients. The Journal of Chinese Medicine (2000); 64: 22-31. 13 Loh L, Nathan, PW, Scott, GD and Zilkha KJ. Acupuncture versus medical treatment for migraine and muscle tension headaches. J. Neurol. Neurosurg. Psychiat. (1984); 47:333-337. 14 O'Connor J and Bensky D. Research concerning the effects of acupuncture. Am. J. Chin. Med. (1975) 3: 377-395. 15 Timms P W & Fry AH Homelessness and mental health. Health Trends, (1989) 21, 70-71. 16 Fine KD. Diarrhea. In: Sleisenger & Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management, 6th edition. Edited by Feldman M, Scharschmidt BF, Sleisenger MH. Philadelphia: WB Saunders Co., 1997:128-152. 17 Fleming DM, Crombie DL. Prevalence of Asthma and hay fever in England and Wales. British Medical Journal, 1987, 294:279-83. 18 Oxford Handbook of Clinical Medicine. Eds., Hope RA, Longmore JM, Hodgetts TJ, Ramrakha, PS. Oxford University Press. Oxford, New York, Tokyo. 1997. P 344-6. Dr. Tukmachi MBChB, DTM (Dublin), PhD (London), is a Research Associate at the Department of Rheumatology, Selly Oak Hospital, Birmingham University. He studied and researched traditional Chinese acupuncture in both London and China. Since 1992, he has been practising acupuncture privately at the Nuffield Hospital, Stoke-on- Trent .