In this edition of Research Roundup, we’ll examine how acupuncture can be used to lower hypertension, more commonly known as high blood pressure. Considering the impact of hypertension on heart disease and overall health, safe and effective therapies are warranted. Since some pharmacological agents have side effects, can acupuncture be used alone, or in combination with these agents, to modulate and reduce high blood pressure? The article examined today can be found here, and it summarizes some of the key research findings on how acupuncture treats this disease. Specifically, we’ll be focusing on ‘essential’ or primary hypertension, which really means that the cause is unknown.

According to the article, there are “numerous recommendations for controlling hypertension, including improving lifestyle, such as doing more exercise, keeping a balanced diet, and having pharmacological treatment”. Let’s see where acupuncture works to reduce hypertension. As a bonus for any acupuncturist who will read the article, it mentions specific acupoints for consideration!

Blood pressure regulation is complex. There are both neurological and neurochemical elements. It seems, according to the research, that acupuncture works on both. Some of this will get a little technical, only because the nervous system is highly interconnected and uses terminology that is confusing to everyone. Here we go. First, you need to know that blood pressure is controlled by the blood vessels and the heart and in turn, they are controlled by nerves. These nerves are grouped into two divisions, one that causes the blood vessels to constrict (a narrowing, also known as vasoconstriction) and the heart to pump harder, increasing blood pressure, and one that causes the heart to slow down; it has no direct effect on the blood vessels though. The first division is called the sympathetic nervous system and the second is called the parasympathetic. Reducing the sympathetic effect and/or increasing parasympathetic effect is the goal. According to the article, acupuncture decreases the sympathetic influence by controlling the source at both the spinal cord and thalamus (a brain structure referred to as the ‘rostral ventral lateral medulla’ and is a major source of sympathetic nervous system activity generation). It was also shown to increase parasympathetic influence, described in the article as an “increase in vagal activity”, citing the vagal nerve as the main control on decreasing the heart’s influence. That’s right – acupuncture influences both systems at the same time! Slowing the heart and relaxing the vasoconstriction (also known as vasodilation) and causing blood pressure to be lowered.

In addition to the nervous system, there are several neurochemicals that participate in hypertension, noting that the neurochemicals and the nervous system clearly work hand-in-hand. Two key findings were the reduction of norepinephrine and the reduction of renin (which is released from the kidneys and eventually triggers another neurochemical called angiotensin II) by acupuncture. Both of these, norepinephrine and the renin-angiotensin II pair, increase blood pressure directly at the blood vessels through vasoconstriction and were decreased by acupuncture.

Acupuncture is safe and can be used in conjunction with those taking blood pressure medications. Dr. Rhoads can work with your primary care provider to help get your high blood pressure under control.

References:

1. Fan H, Yang JW, Wang LQ, et al. The Hypotensive Role of Acupuncture in Hypertension: Clinical Study and Mechanistic Study. Front Aging Neurosci. 2020;12:138. Published 2020 May 25. doi:10.3389/fnagi.2020.00138

Headaches are very common medical conditions that practitioners see in clinic. The two most common forms are migraine and tension-type, accounting for roughly 90% of all headaches managed in healthcare settings. They can be particularly severe and disabling, having a significant socioeconomic impact. In Traditional Chinese Medicine (TCM), acupuncture has been widely employed for treating headaches and in this edition of Research Roundup, we’re going to explore how effective acupuncture can be for migraines, arguably the more severe of the two. In fact, migraine headaches were ranked as the “sixth most prevalent out of 328 diseases” in the world according to the 2016 Global Burden of Disease Study.3

For those who suffer migraines or other headaches, any relief or decrease in the frequency (number of headaches in a particular time frame), duration (how long the headache lasts), or severity (how painful or disabling the headache feels) is the goal of the acupuncturist. The severity of the pain (the headache) and any associated neurological symptoms, including the migraine aura, is incredibly disruptive to the individual and is “most burdensome in women between ages 15 and 49 years.”3  The long term goal is the elimination of the headache, but any relief is significant. The goal of acupuncture is not just to mask the pain or symptoms, but to get to the root of the problem, as Dr. Rhoads likes to say.

In research, the highest quality of evidence comes from a Systematic Review, where multiple research studies are analyzed for their quality and their outcomes are summarized. In the way that they are analyzed, their combined data offers more consistent and reliable conclusions on how well the therapy works. The two research papers on acupuncture therapy for migraine headaches reviewed can be found here1 and here2. These systematic reviews examined a combined 43 research papers.

Both reviews concluded that “acupuncture is an effective and safe method for migraine”, and that “the acupuncture group had greater improvements in the frequency of migraine attacks, VAS score (for measuring pain), and treatment efficiency”. In other words, acupuncture was safe, reduced the pain, and the number of migraine headaches. A reduction in the duration of the headaches was only briefly mentioned, and this may reflect the need for further studies to fully clarify.

References:

1. Ou MQ, Fan WH, Sun FR, et al. A Systematic Review and Meta-analysis of the Therapeutic Effect of Acupuncture on Migraine. Front Neurol. 2020;11:596. Published 2020 Jun 30. doi:10.3389/fneur.2020.00596

2. Li YX, Xiao XL, Zhong DL, et al. Effectiveness and Safety of Acupuncture for Migraine: An Overview of Systematic Reviews. Pain Res Manag. 2020;2020:3825617. Published 2020 Mar 23. doi:10.1155/2020/3825617

3. GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017; 390: 1211–59

In this edition of Research Roundup, we’ll examine how acupuncture can help with sleep issues. Dr. Rhoads mentioned that acupuncture could help in her last blog post, so let’s explore that a little further. This week’s article explores how effective acupuncture can be in treating insomnia, which is a common sleep issue for many people. It manifests as difficulties in getting to sleep or staying asleep. Sounds familiar. We’ve all experienced this at one time or another.

This article explores some interesting ways to evaluate how well acupuncture helps those with insomnia. What’s also fascinating about this article is the study design, or how the research was conducted. They compared one group of randomly chosen people who received acupuncture to a group that didn’t. Any differences in sleep quality would then be attributable to the acupuncture. This type of study is known as a randomized controlled trial and it represents one of the most common methods used in healthcare research. They also went a step further and compared one group of people receiving acupuncture using multiple acupoints to those receiving acupuncture at only a single point to see if that made any differences. Both groups receiving acupuncture, single-point or multiple points, were compared to the control group, who received acupuncture needles in areas that do not correspond to actual acupuncture points. These are referred to as “sham points”. No acupuncturist would needle these “sham points” in a real clinic environment. For those interested, the single acupoint chosen was Heart-7 and the multi-acupoints combination was Heart-7, Spleen-6, and Du-20 (listed as GV-20).

To understand how acupuncture could have made any difference, they chose to use a special form of magnetic resonance imaging, or MRI. Most people are familiar with MRI for visualizing body structures such as the knee or the brain. The particular type of MRI chosen for the study was functional MRI, or fMRI. It allows the researchers to observe changes in actual brain activity before and after the acupuncture for all three groups. They also used two patient questionnaires (PSQI = Pittsburgh Sleep Quality Index and AIS = Athens Insomnia Scale) as well as polysomnography, which is better known as a sleep study. It measures brain waves, heart rate, and other factors to see your sleep patterns. Most acupuncture studies don’t evaluate these many changes, which makes this one unique.

So what did they find? This study showed that the people who received the acupuncture at multiple acupoints, similar to what Dr. Rhoads would choose in practice, provided better positive sleep changes, meaning that the ability to fall asleep and stay asleep would be improved. Those receiving acupuncture at a single acupoint did only slightly better overall than those who received sham acupuncture on the questionnaires. Interestingly, they also noted changes in brain activity, as seen on the fMRI studies, were different for those receiving multiple acupoints; more brain areas were regulated and, while this requires more studies, could indicate that increases in activity in certain brain areas could be associated with better sleep quality.

For more information on this article and sham acupuncture, please see a more in-depth analysis on my blog.

This week we’re going to introduce something new to the community by offering an analysis of current research topics related to acupuncture. This research comes directly from the National Institute for Health’s database called PubMed (PubMed.gov). This database is updated constantly and is the world’s largest medical library. As acupuncture continues to be accepted and utilized, more and more high-quality research is performed and published through this system. We’re going to breakdown the information in these not-so-easy to read articles and present them in more relevant clinical applications. As patients or prospective patients (hi! I see you out there! 👋) it is important for you to understand that you are receiving evidence informed treatments and you yourself are given the opportunity to be more informed about acupuncture and how it works.

Research Roundup will be hosted by my guest author, Dr. Patrick Downie. He is a chiropractic physician and has been involved in the acupuncture education profession for over 15 years. He has taught for acupuncture colleges in Chicago, Illinois, Santa Monica, California and Sarasota, Florida. He has been a professor, department chair, and academic dean during his tenure. He currently teaches in a research-focused acupuncture doctoral program and consistently reviews the acupuncture literature. It is a great honor to have him writing for us outside of his normal academic setting, and bringing you up to speed on current research.

Acupuncture and Immunity

Of particular importance during these unusual times is the immune system. A robust immune system can defend the body against a variety of microorganisms such as bacteria and viruses. Modern lifestyle elements, such as stress, poor food choices, and lack of sleep, can impair the immune system’s ability to work at peak efficiency.

Dr. Rhoads has mentioned to you before that acupuncture can boost the immune system, but how can it do that?

A recent article published just this past April explored acupuncture’s effect on this very topic. Your immune system is complex and consists of many linked components. One very important aspect is the cells. There are many cells that work together to maintain an effective immune system. There are the B cells that produce antibodies and there are the T cells that play a role in surveillance and specifically killing target cells. While there are many types of T cells with differing functions, two, in particular, are worth noting. These are the helper T cells, usually denoted as T4 or CD 4 cells and the killer T cells, usually denoted as T8 or CD 8 cells. They work together to limit the spread of microorganisms, and their balance is critical, with too few or too many of either disrupting how well the system works. This particular article demonstrated that the study found that acupuncture can restore the CD 4/CD 8 ratio, improving the immune function of patients. The study was focused on patients with chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis, but the study is applicable in the current environment of COVID-19.

While this is just one article, it does demonstrate two things; that acupuncture does have a developing research basis, and that acupuncture works by directly affecting the body’s existing cells and systems. As with any exploration into how something works, more information from continued research is required. Acupuncture works, there is no doubt there. How it works is supported by the increasing body of evidence that the research is showing.

We hoped that you enjoyed your introduction to Rhoads to Health Research Roundup. More reviews will be posted in the coming weeks and months.