Clinical Practice Guideline of Acupuncture for Bell’s Palsy

Backgroud: Acupuncture is common used for Bell’s palsy in clinic, however, recent systematic reviews all shows that there is no sufficient evidence to support the effectiveness of acupuncture for Bell’s palsy because ofthe poor quality and heterogeneity. It’s urgently necessary to develop a guideline of acupuncture for Bell’s palsy based on principles of evidence-based medicine to optimize acupuncture treating, standardize outcomes evaluating and to improve the quality of acupuncture for patients with Bell’s palsy under general circumstances. Objective: To improve the accuracy of diagnosing and managing Bell’s palsy, optimize acupuncture treating and outcomes evaluating for patients with Bell’s palsy, and to improve the quality of acupuncture for patients with Bell’s palsy in most instances. Methods: This guideline was developed using an explicit and transparent a priori protocol based on supporting evidences and experts’ consensus. The guideline developing Group followed the protocol through all stages of the development process: proposed clinical questions, searched clinical evidences, evaluated levels of evidences, developed recommendations, peer reviewed and consummated, and finally formed the draft of this guideline. Results: (1)The guideline development group made a Grade A recommendation that ①With a course of Bell’s palsy within 3 months, the patients with mild facial palsy may be treated with any one of acupuncture, western drugs, or acupuncture combing with western drugs, whereas the patients with severe facial palsy may be treated with acupuncture or acupuncture combing with western drugs. With a course of more than 3 months, acupuncture is more suitable. ②Acupuncture should be applied as early as possible for Bell’s palsy. ③The principle of selecting acupoints for Bell’s palsy is to select local points, points of corresponding meridians and those according to differentiation. Generally, the points of yangming meridians are the main ones. ④The various methods of acupuncture and moxibustion are adopted for Bell’s palsy, including filiform needling, moxibustion, electro-acupuncture, etc. Two or more methods are usually used together in clinical practice. (2) The development group formed expert consensus on the principles of acupuncture treatment for Bell’ palsy. Bell’s palsy is suitably treated according to the stages, differentiation and symptoms.     

An Inquiry into the Action of Acupuncture on the Human Body by Means of Pharmacology

The science of traditional acupuncture was the summary of the law of action of acupuncture made by our predecessors in their long term clinical practice, which plays a very important guiding role in clinic. In order to make the charm of this ancient acupuncture therapy ever lasting, bringing it into line with the modem science and technology is necessary. In the study of the mechanism of acupuncture, people are apt to relate it with modem pharmacology. The action of drug on the human body has the characters of time-effect, specificity, and tolerance. Does acupuncture have these characters when it acts on the human body？     

PRIMARY RESEARCH ON FRACTAL GEOMETRY OF MERIDIAN THEORY

In meridian theory of traditional Chinese medicine(TCM),the geometrical descrip-tions can be traced back to the remote ancient times in China,mainly in The Yellow Emperor‘s In-ternal Classic(The Internal Classic in short).Euclid‘s geometry,topology and other classic mathe-matics are all at their wit‘s end to explain the high complexity and non-clinear phenomenon of the meridian .In recent over2000years.the meridian phenomenon has been being the challenge to funda-mental mathematics.Fractral geometry,founded by Mandelbrot(1975),is a branch of learning for investigating irreg-ular geometrical curves.It has successfully solved some qualitative and quantitative problems about the topographical structure of molecular Brown‘s movement curve and other irregular complicated curves and geomtrical characters.The characteristics of geometrical topographical structure of meridian and its phenomenon belong to the research category of Fractal Geometry.The author of this paper believes that Fractal Geometry may provide a useful mathematical tool and a possible way for revealing the enigma of acup-moxibus-tion meridian theory.The human body is of basic characters of Fractal Geonetry in structure,while meridian is the ex-pression form of Fractal structure of the human body.The basic Fractal geometrical characters of meridian are:self-similarity,self-affinity,symmetry,minute structure and self-avoidance,which has bee applied for thousands of years in clinic,suchas“taking the acupoints on the right side of the body in cases of disorders appearing on the left side and vice versa”.The basic characters of meridians are1)symmetry of the 12regular meridians on the bilateral sides of the body(symmetry);2)similarity in characters and actions of acupoints of the same one meridian(self-similarity);3)taking acupoints on the lower part of the body when disorders occuring on the upper part of the body;and taking acupoints on the upper part of the body if disordera appear-ing on the lower part(self-affinity);4)micro-acupuncture system including hand-acupuncture,foot-acupuncture,scalp-acupuncture,auricular acupuncture and eye-acupuncture(minute structure);and acupuncture,scalp-acupuncture,auricular acupuncture and eye-acupuncture(minute structure);and acupuncture,scalp-acupuncture,auricular acupuncture and eye-acupuncture(minute structure);and acupuncture,scalp-acupuncture,auricular acupuncture and eye-acupuncture(minute structure);and acupuncture,scalp-acupuncture,auricular acupuncture and eye-acupuncture(minute structure);and5)systematical running of needling sensation(self-avoidance).     

Prof. CHEN Han-ping： A Thinker in Principles and Practice of Acupuncture-moxibustion

The Thinker (Le Penseur) is known as the masterpiece of Auguste Rodin, a distinguished French sculptor, signifying the intellectual activity and creativity of human being. Having put forward a way of "viewing the Earth from the Moon" in developing preclinical and clinical studies of acupuncture, Prof. CHEN Han-ping brought about imaginations to acupuncture scholars with his ideas on the soul, principle, skills and orientations of acupuncture. He deserves the title of "the thinker in principles and practice of acupuncture"[1-3]. The academic ideas of Prof. CHEN Han-ping are now summarized as follows.     

ACUPUNCTURE FOR 575 CASES OF SCIATICA CAUSED BY PROLAPSE OF LUMBOVERTEBRAL DISK

The sciatica caused by the prolapse of lumbovertebral disk which is a common disease is difficult to treat. During more than 20 years of the authors‘ clinical practice, they‘ ve received about a thousand of such patients. The observation was done on 575 cases whose data were relatively complete. The result of acupuncture was good. The report is as follows.……     

EVIDENCE-BASED MEDICINE AND THE CLINICAL STUDY ON ACUPUNCTURE AND MOXIBUSTION

In this article, the authors hold that the evidence-based medicine(EBM) is a new medical action produced at the historic moment in clinical practice, which is promoting development of the medicine and even the whole life science in a fully new train of thought end method. Further the briefly introduced contents are the effect of EBM, the difficulty of utilizing in the acupuncture clinical practice and how to resolve them. It is highly recommended that the doctors of the acupuncture science field should study EBM and its effect and difficulties in practice as earlier as possible, insistently assimilate new knowledge and keep abreast of the times‘ progress to facilitate the further development of acupunctology.     

ACUPUNCTURE RELIEVES PAIN IN REFLEX SYMPATHETIC DYSTROPHY:PITFALLS IN THE ANALYSIS OF RESULTS

Objective: Despite thousands of years of utilizing acupuncture for relief of pain, there is considerable controversy whether acupuncture deserves to be considered an efficacious modality along with medications and operations.Many publications claiming to answer this most important question have inspired more controversy regarding experimental design, designation of adequate controls and avoiding the dreaded placebo effect.Methods: We present a retrospective series of patients all of whom have severe chronic pain of the extremities with the unequivocal diagnosis of reflex sympathetic dystrophy.The patients were included if they had 15 treatments with acupuncture.The patients were treated in a single practice of acupuncture by two of the authors.There was no standardization of treatment given to each patient.The treatments were modified at each session.Objective date collected included the pain level on a 0 to 10 visual analogue scale and other functional data such as range of motion and daily activities.Results: At each treatment time, the acupuncture treatment significantly decreased the pain level from the value before the treatment to the pain level after the acupuncture treatment.Firsttreatment pre-treatment pain level: 7.43±2.15, post treatment 3.86±2.76(P0.0019).Over the course of the initial 15 treatments, the pre-treatment pain level did not significantly decline.Treatment number 15 had an average pain level of 6.5±1.51(P0.40).Conclusions: The treatment with acupuncture unequivocally caused a significant reduction in pain level on each treatment day; however, 15 treatments with acupuncture did not significantly produce a lasting effect.However, reviewing each individual charted data and analyzing the individual patient course gives a more accurate picture of the effect of acupuncture on patients with c omplex pain problems.     

DEVELOPMENT OF CLINICAL STUDIES ON ACUPUNCTURE TREATMENT OF SHOULDER PAIN IN PATIENTS WITH WIND STROKE

In the present paper, the authors review some new results of acupuncture treatment of shoulder pain in stroke patients from ① application of filiform needle with different needling manipulations, ② selection and combination of acupoints, and ③ some special needling methods including point-injection. Generally, if acupuncture therapy is used in combination with other rehabilitation methods, the therapeutic effect of shoulder-pain-relief will be much better. Regarding the acupoint selection, both local acupoints and those of the yang meridians are primarily used in clinical practice. Further studies on treating shoulder pain of hemiplegia based upon the basic theory of TOM are necessary.     

CLINICAL APPLICATION OF ACUPUNCTURE THERAPY

In the present paper, the authors review some major effects of acupuncture in the treatment of clinical diseases and sum up some results of experimental researches on the mechanisms of acupuncture. Up to now, clinical practice and experimental researches demonstrate that acupuncture possesses good analgesic effect, integrative regulation effect on the functional activities of the body and     

CLINICAL SIGNIFICANCE OF“TREATING VITALITY” AND “RESERVING VITALITY”

"Treating vitality"and"reserving vitality"are very important manipulations during acupuncture treatment of diseases. "Treating vitality" comprises adjusting and treating both the acupuncture doctor's and the patient's vitality; while "reserving vitality" demands the acupuncture doctor carefully to experience the sensations of 'excess' or 'deficiency' under the needle, wait for the arrival of qi, observe the patient's responses, and then perform reducing or reinforcing needling manipulations in accordance with the state of excess- or deficiency- syndrome. "Treating vitality" and "reserving vitality" impenetrate the whole process of acupuncture treatment all along. Through years' clinical practice, the author of the present paper discusses the functions of the two aspects in every stage of acupuncture treatment, including before acupuncture, during needle insertion, during retention and withdrawal of the needle. The purpose of this paper is to explain the clinical significance of treating and reserving vitality and arouse many acupuncture doctors' attention.     

Hypothesis,modern researches and clinical applications of cutaneous regions in traditional Chinese medicine

As one of the most important concepts in traditional Chinese medicine, cutaneous regions have a close relationship with skin in modern medicine. According to the doctrine of traditional Chinese medicine, the cutaneous regions are the corresponding projections of twelve meridians in the superficial layer of the body and play an important role in body surface-viscera correlation. The symptoms of visceral disorders will reflect on cutaneous regions and one of the major patterns of manifestation is referred visceral pain accompanied by tenderness and hyperalgesia on the body surface. On the contrary, cutaneous regions participate in the treatment of visceral disorders. As major clinical applications of the cutaneous regions hypothesis, superficial acupuncture, subcutaneous needling, massage （tuina）, moxibustion, and wrist-ankle acupuncture have achieved favorable therapeutic outcomes in clinical practice. Modern researches have gained insights into the biological background of cutaneous regions, however, further studies are needed to clarify the mechanisms.     

Professor LIAN Yu-lin＇s Clinical Experience in Acupuncture

Professor LIAN Yu-lin dedicates himself to the cause of TCM and acupuncture, and puts forward some original ideas on the basic theory of acupuncture.In clinical practice, he devotes himself to the study of some difficult and complicated illnesses in acupuncture,with excellent results.     

针刺结合分筋术治疗肩关节周围炎100例

Scapulohumeral periarthritis belongs to Bi syndrome of the tendon in Chinese Medicine. The combination of acupuncture andTuinahas a preferable curative effect in the treatment of this disease[1-3].However, the studies on treatment with acupuncture and tissue separating manipulation are quite limited.     

Introduction to HUA Xue-gui＇s Experience in Acupuncture Treatment of Tinnitus and Deafness

Doctor HUA Xue-gui, an associate chief physician in Shanghai Research Institute of Acupuncture and Meridian, has been engaged in clinical practice and scientific research of acupuncture for over 30 years. She has created a set of unique and complete acupuncture modalities for neurotic tinnitus and deafness. The authors are honored to have studied with Doctor HUA and have achieved a lot. Now, Doctor HUA＇s experience is summarized as follows.     

BRIEF ANALYSIS ON THEORETIC EVIDENCE OF FOUR-GATE POINTS IN TREATMENT OF DISEASE

In the present paper, the authors expound the approaches of four-gate points on treatment of diseases and the relevant theoretic evidence. The analysis and discussion were carried on in the aspects of the origins of four-gate points and the relationships of four-gate points with primary qi, running course of meridian, qi and blood and biaoben qijie of meridian and collateral. Being the major points in clinic, four-gate points provide extensive indications and good therapeutic effects, which are supported thoroughly by the theoretic evidence.     

WEI JIA''''S EXPERIENCE IN TREATING ASTHMA WITH ACUPUNCTURE GUIDED BY THE THEORY OF "MUTUAL REINFORCING IN TREATMENTS"

The article gives Professor Wei's experience of using theory of mutual reinforce-ing therapies in acupuncture and moxibustion on treating asthma. There are different 8 kinds of thera-pies such as acupuncture, plum-blossom needles, embedding of catgut in point, cupping on Ashipoint, external application on points, suppurative moxibustion, injection in points, etc. All of thesemethods have both advantages and backdraws. Prof. Wei tells us how to make full use of them, sothat we are able to improve the curative effect to its possible extend. This theory is important not onlyin acupuncture and moxibustion but also in guiding our practice in other fields of T. C. M.     

Analysis of the Frequency of Clinical Acupoint Use Based on ‘Traditional Chinese Medical Acupuncture-moxibustion Information Databank'

The frequencies of use of 361 human acupoints in 74 academic journals of traditional Chinese medicine published between 1949 and 2010 are arranged in order using ‘Traditional Chinese Medical Acupuncturemoxibustion Information Databank'. The frequencies of use are divided into five grades: most frequent use, more frequent use, frequent use, less frequent use and infrequent use. The most frequently used acupoints and infrequently used acupoints are summarized and analyzed to help point selection for clinical acupuncture and selection of acupuncture research projects in the future.     

COMMENTS ON ACUPUNCTURE TREATMENT OF DISEASES ACCORDING TO SEASONAL CONDITIONS IN 《THE INTERNAL CLASSIC》

In the present paper, the author gives some comments on acupuncture treatment of diseases from 1 ) selecting acupoints based on seasonal conditions; 2) performing reinforcing or reducing needling manipulations in accordance with the waxing and wanning of the moon; 3 ) conducting acupuncture treatment in accordance with the time and the state of disease; and 4) performing acupuncture treatment based on the prosperity or decline of the meridian-qi, which are described in medical book The Yellow Emperor‘ s Internal Classic.     

Acupuncture Treatment for 98 Cases of Ventricular Premature Beat

Ventricular premature beat is a commonly encountered arrhythmia, which can occur in patients with and without cardiac diseases. In TCM, ventricular premature beat falls into the category of palpitation and obstruction of qi in the chest. The authors treated it with acupuncture and obtained satisfactory thera- peutic effects. A summary follows.