Symptom Assessment and Management in Patients with Lung Cancer Undergoing Conventional or Traditional Chinese Medicine Care

Patients with lung cancer may experience various symptoms as the disease progresses, which may reduce the benefits of cancer treatment,reduce treatment compliance, delay cancer treatment, reduce the quality of life(QoL), and impact survival. This review discusses comprehensive symptom assessment and management, which are crucial for high-quality lung cancer treatment. Traditional Chinese medicine(TCM) is important in relieving cancer-related symptoms in patients with lung cancer. Including patie...     

THE EFFECTIVENESS OF PRAGMATIC ACUPUNCTURE IN PATIENTS WITH PAINFUL DIABETIC NEUROPATHY:A PILOT STUDY

Background: Painful diabetic neuropathy(PDN) is a distressing and disabling complication of diabetes mellitus affecting about one-third of patients with type 2 diabetes.Objective: The aim of this study was to evaluate the effectiveness of pragmatic acupuncture treatment in patients with PDN.Methods: A single blind randomized control trial was conducted.Sixty patients(mean age(63.5±12.1) years) with PDN, recruited from two affiliated hospitals of Guiyang Traditional Chinese Medicine(TCM) College, Guizhou Province, China participated in the study.Individualized acupuncture treatment was administered by a qualified medical doctor(also a TCM acupuncturist).Fourteen sessions of pragmatic acupuncture over 2 weeks were given to two groups.Leeds Assessment of Neuropathic Symptoms and Signs(LANSS) scale was used to examine neuropathic symptoms, lower-limb pain intensity was assessed using the Visual Analogue Scale(VAS), sleep patterns was examined with the Sleep Problem Scale(SPS) and QoL was assessed with the SF36.Mann-Wihtney U tests were used for group comparisons.Results: There were significant differences(all P 0.001) in pain, LANSS and SF36 scores between the two groups.However, there was no significant difference(P0.05) in sleep disturbance between the two groups following the intervention.Conclusion: Traditional acupuncture was found to be an effective treatment strategy for pain and QoL in patients with PDN.It was also effective for alleviating the clinical symptoms associated with PDN as measured by LANSS.Therefore, traditional acupuncture may be an effective modality for managing patients with PDN.Clinicians and acupuncturists are to be aware of these findings as they may help to improve the management of patients with this condition.     

Bibliometric analysis of acupuncture research through the Web of Science database from 1990 to 2019

Background:The main points of focus of bibliometric analysis of acupuncture treatment of diseases include pain(headache,low back pain),insomnia,and knee osteoarthritis,for example.In this paper,we analyze the frontiers,hotspots,and research trends of acupuncture over the past 30 years and compare them for each of three 10-year periods.Methods:All the studies on acupuncture research in three different periods(1990–1999,2000–2009,2010–2019)were collected from the Web of Science database.The evolution of the research,hotspots,and trends in acupuncture were explored intuitively by analyzing the frequency,betweenness centrality,and subject word clustering of the three periods.Results:(1)1990–1999,the main content relating to research was the mechanism of research of acupuncture treatment of pain.Naloxone was the high-frequency subject word,and centrality included,for example,the spinal cord,enkephalin,smoking cessation,and detoxification.The results of keyword cluster analysis showed that the main research content included capsaicin-induced neurogenic edema,chemical dependency treatment,afferent fiber,and sufferers from xerostomia.(2)2000–2009,during this stage,the frequency of keywords appeared in new research content such as randomized controlled trials of acupuncture and low back pain,but pain still dominated the main research content.From the perspective of intermediary centrality,along with the rise in randomized controlled trials,there were many important meta-analyses,as well as the management of acupuncture treatment.The main elements of the keyword cluster analysis included,for example,systematic review,randomized controlled pilot study,add-on therapy,brief overview,and ovarian morphology.(3)2010–2019,during this period,compared with the previous two stages,there was increased frequency of keywords,a growth in clinical randomized controlled trials,and distribution of centrality was evident in the emergence of acupuncture in care,osteoarthritis treatment,and breast cancer research.The keyword clustering covered,for example,neural specificity,inflammatory reaction,chronic pain,sleep pattern,and consort statement.Conclusion:This article summarizes the trend of development of acupuncture from 1990 to 2019 and compares the main research categories and hotspots in each of three different 10-year periods within this span,thereby helping elucidate the research direction within the field.     

COMMENTS ON THE THERAPEUTIC TIMETABLE OF ISCHEMIC APOPLEXY AND SUPER-EARLY INTERVENTION OF ACUPUNCTURE

According to the pathological process of ischemic apoplexy, which involves its onset and development, this paper expounds the great significance of adopting various active and effective measures within the therapeutic timetable for favorable prognosis and improvement of apoplexy. The author‘s viewpoints differ from the conventional thinking towards the management of apoplexy, stressing super-early intervention with acupuncture.     

METHODS ON FORMULATION OF THE GUIDELINE FOR CLINICAL PRACTICES OF ACUPUNCTURE AND MOXIBUSTION

Objective: To introduce the methods and difficulty on formulation of the guideline for clinical practices of acupuncture and moxibustion.Methods: Based on the internationally recognized tool of the guidelines — GRADE system, combined with the characteristics of acupuncture and moxibustion science and research status, we explored suitable methods for formulation of acupuncture clinical guidelines.During determination of clinical problems, collection of evidence, assessment of recommendations, and other steps, we explored the difficulty of formulation of the guideline for clinical practices of acupuncture and moxibustion.Results: We formed a preliminary organizational structure and process on formulation of the guideline for clinical practices of acupuncture and moxibustion.     

DEVELOPMENT OF A QUESTIONNAIRE TO FACILITATE CHINESE MEDICINE PATTERN DIFFERENTIATION OF LATERAL ELBOW PAIN(TENNIS ELBOW):RESULTS FROM A DELPHI PROCESS

Background: Acupuncture is a possible alternative treatment method for lateral elbow pain(LEP).Individualized acupuncture treatment has been practiced for pain therapy; however, studies on the underlying rational for individualized acupuncture treatment are limited.Objective: To develop a questionnaire using the Delphi process that can assist acupuncturists to assess the underlying traditional Chinese medicine(TCM) pattern of LEP.Methods: First, a multi-disciplinary research team was formed to conduct the Delphi survey.A provisional version of the questionnaire was developed by(1) comprehensive literature search on acupuncture for LEP as well as symptoms and TCM patterns associated with LEP;(2) extensive literature review from text books on TCM patterns;(3) meetings of a representative of the research team with specialized acupuncturists to consult expert opinion.Panelists of the Delphi survey consisted of experts with substantial clinical and research experience in acupuncture for LEP.A total of 33 international and national experts were invited by e-mail.The Delphi survey was terminated after two rounds.In each round consensus was defined by content validity index(CVI) of ≥ 0.51(representing a 51% level of consensus).Results: Consensus was found on 72 of the 74 symptoms that could be indicative for a specific TCM pattern of LEP.Consensus was achieved from all 25 panelists who responded to the second round on all four TCM patterns that could underlie LEP, namely, Invasion of Wind-Cold Dampness, Retention of Damp-Heat, Deficiency of Qi and Blood and Stagnation of Qi and Blood.A list of symptoms that indicate one of the four TCM patterns and a list of preferred treatment modalities for each pattern were also generated via CVI of ≥ 0.51 during the Delphi process.Conclusion: The current version of the Delphi-based questionnaire appeared to have considerable face and content validities.The reliability and validity are currently being tested.     

Effect of electroacupuncture on chemotherapy-induced peripheral neuropathy in patients with malignant tumor:a single-blinded,randomized controlled trial

OBJECTIVE:To evaluate the effect of electroacupuncture on chemotherapy-induced peripheral neuropathy(CIPN), quality of life and immune status of patients with malignant tumors.METHODS:From Jan, 2013 to May, 2014, 37 patients with malignant tumors were included in this prospective single-blinded study, and randomized to receive either electroacupuncture or acupuncture treatment on basis of chemotherapy.The chemotherapy was continued for 2 courses as previous before the treatments, with 21 days as a course of treatment.Patients received acupuncture and electroacupuncture once per day starting at the day before chemotherapy for consecutive 7 days followed by 14 days off, with 21 days as a course of treatment, and continued for two courses of treatment.Then CIPN, traditional Chinese clinical symptoms,quality of life and immune status were all evaluated for each patient prior treatment and after two courses of treatment.RESULTS:The gender, age, cancer species as well as incidence(83.3% vs 84.2%) and grades of CIPN before treatments were all similar in patients receiving acupuncture or electroacupuncture(all P 0.05).After treatments, most patients with peripheral neuropathy were cured by two courses of electroacupuncture(84.2% vs 21.1%), whereas the other group of patients had similar incidences of peripheral neuropathy compared with prior-acupuncture(83.3% vs 72.2%).Besides, patients receiving electroacupuncture had lower incidence of peripheral neuropathy than those receiving acupuncture treatment(χ~2= 9.745, P = 0.002).The grades of peripheral neuropathy were significantly different in the two groups post-treatment(χ~2= 13.983, P =0.007).The total effective rates for traditional Chinese clinical symptoms were 16.7% and 84.2% in acupuncture and electroacupuncture groups, respectively(Z =-4.239, P 0.001).The electroacupuncture treatment provided a more satisfactory life for patients compared with acupuncture(Z =-4.76, P 0.001).Both electroacupuncture and acupuncture had no effects on immune function.CONCLUSION:Electroacupuncture could alleviate CIPN, and improve traditional Chinese clinical symptoms and quality of life, but did not affect immune function.     

针刺加刺络与卡马西平治疗偏头痛效应差异的观察（英文）

Objective:To observe the clinical therapeutic effect on migraine treated with acupuncture combined with blood-letting therapy.Methods:A total of 90 patients of migraine were included in compliance with the requirement and divided into a blood-letting therapy group,a western medication group,an acupuncture plus blood-letting therapy group,30 cases in each one according to the random number table.In the two control groups,the simple blood-letting therapy was exerted at Dazhui(大椎 GV14) and the oral administration with carbamazepine were provided respectively.In the acupuncture plus blood-letting therapy group,acupuncture was exerted at Baihui(百会 GV20) and other points,with blood-letting therapy combined.The treatment was given once daily and 12 treatments were as one course.After 2 courses of treatment,the score of therapeutic effect on symptoms and signs,pain score of visual analogue scale(VAS) and clinical therapeutic effect were compared among the three groups before and after treatment.Results:At the end of treatment,the scores for symptoms and signs and VAS score were reduced obviously as compared with those before treatment in the three groups(all P 0.01).Compared with the blood-letting therapy group and the medication group,the scores for symptoms and signs and VAS score were all reduced more obviously in the acupuncture plus blood-letting therapy group respectively(all P0.01) and the differences were not significant between the blood-letting therapy group and the medication group(P 0.05).The total effective rate in the acupuncture plus blood-letting therapy group was higher obviously than either the blood-letting therapy group or the medication group(both P 0.05).Conclusion:Acupuncture combined with blood-letting therapy achieves a better clinical therapeutic effect on migraine as compared with either simple blood-letting therapy or medication.Such combined treatment obtains a satisfactory therapeutic results and deserves to be promoted in clinical application.     

CORRELATES OF SYMPTOM RESPONSE TO ACUPUNTURE:THE CASE OF GULF WAR SYNDROME

Background: Gulf War Illness(GWI), or chronic multisymptom illness(CMI), is a complex illness characterized by a diverse clinical presentation that may include fatigue, sleep and mood disturbances, cognitive dysfunction, and musculoskeletal pain.First defined by the Centers for Disease Control and Prevention(CDC) after the first Gulf War(Operation Desert Shield/Storm), it is commonly seen with a highly individualistic presentation, associated with clusters of symptoms and co-morbid medicaldiagnoses.Objective: Our study team recently completed a wait-list controlled RCT project, funded by the Department of Defense(W81 XWH) and with the aim of assessing the effectiveness of acupuncture in the treatment of GWI.Methods: GWI is a complex illness with multiple manifestations thus our treatment plan offered tailored individualized treatments to target the symptoms most important to the subjects(n=104).Our main outcome is the physical component subscale of the Sf-36, but we also included validated measurements to capture changes in specific GWI symptom(such as sleep problems) as well as the patient-centered form, the MYMOP.Measurements were conducted every 2 months for the 6 months of the study.Results: As reported previously, we found improvements at the end of the study that reached statistical and clinical significance; for the higher dose group, scores from time 1(mean score=68.5) to time 4(mean score=75.7) did improve with statistical significance P≤0.003(Student's t).A seven point improvement in this physical component of the Sf-36 was also clinically significant.Conclusion: This report focuses on the correlates and predictors of response, including: expectations for treatment, baseline symptom severity, confidence and satisfaction with treatment, presence of concomitant symptoms.Individualized acupuncture treatments may be an effective therapy for GWI, but as with other conditions, effect sizes may be influenced by subjects' baseline characteristics and constitution.     

ACUPUNCTURE TREATMENT OF PERIPHERAL FACIAL PARALYSIS IN THE ACUTE STAGE

Objective: The objective is to seek the best time in treating peripheral facial paralysis by acupuncture, and to observe the efficacy of acupuncture.Methods: We selected patients who met the criteria for inclusion and then divided the patients into two groups according to the time when the patients came: the treatment group and the control group.We started the treatment when the patient came.The two groups used the same methods for treatment.The patients were treated every other day, 3 times a week, totally 12 times in 4 weeks as a course.Different symptoms and signs were observed and analyzed between the two groups.Results: The total number of patients who met the diagnostic criteria and inclusion criteria was 53, and mean age was(48.21±14.90) years.Treatment group: 15 cases cured, 14 cases markedly effective, 4 cases improved, and the efficiency rate was 87.88%.Control group: 2 cases recovered, 13 cases markedly effective, 5 improved, and the efficiency rate was 75%.The treatment group has better clinical efficacy according to statistical analysis(P0.05).Conclusion: It is proved that acupuncture is an effective treatment for peripheral facial paralysis, as acupuncture treatment can effectively improve the nerve paralysis symptoms.Using acupuncture treatment in the acute stage can help improve the facial nerve function of the patients with peripheral facial paralysis.The time point that acupuncture involved in treating facial paralysis will influence the prognosis degree of facial paralysis.Using acupuncture to treat peripheral facial paralysis in the early stage is safe.     

A manual acupuncture treatment attenuates common cold and its symptoms: a case series report from South Korea

OBJECTIVE: To investigate beneficial effects of manual acupuncture on common cold periods and its symptoms depended on the difference onset time of common cold, within 36 h or over than that. To prove effects of manual acupuncture on common cold, a retrospective chart review was conducted.METHODS: Chart data for patients with commoncold who were treated with only manual acupuncture with fulfilling Jackson scales and satisfaction at the end of each treatment were collected via multi-centers of Oriental hospitals,Oriental medicine clinics and covalent hospital in South Korea. Totally 187 patients were divided into two groups, Group Ⅰ(115 patients, within 36 h)and Group Ⅱ(72 patients, onset time of cold over than 36 h). Finally 120 patients were observed until entire resolution of cold symptoms.RESULTS: GroupⅠ showed significant decreases themediandurationsofcompletelyrecovery(3 days;95% CI 3.0-4.0) as compared with Group Ⅱ(6 days;95% CI 4.0-7.0, P 0.001). The manual acupuncture beneficially worked for reduction rate of common cold symptoms by 50% after initial treatment,decreased cold symptoms, and reduced cold duration.CONCLUSION: Manual acupuncture beneficially affected common cold and its symptoms.Moreover it is more susceptibility on the early time of onset cold.     

Efficacy and Safety of Acupuncture in the Management of Cancer

Acupuncture,as a complementary therapy,has been used to manage the cancer associated symptoms ofcancer patients.Toidentifythe efficacy andsafety of acupunctureinthe management of cancer,this reviewcrit-ically analyses the relevant publicationsincluding both experi mental and clinical studies.The majority of studiessuggest that acupuncture effectivelyrelieves some cancer relatedsymptoms suchas cancer pain,andsome adverseeffects caused by the cancer conventional treatments such as nausea,vomitin…     

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.     

Therapeutic efficacy observation on integrative acupuncture therapy for chronic urticaria

Objective: To observe the clinical effect of comprehensive acupuncture therapy for chronic urticaria. Methods: A total of 70 patients with chronic urticaria were treated with acupuncture, bloodletting after pricking and cupping [on Shenque (CV 8)]. The changes of signs and symptoms were observed before and after treatment. The therapeutic efficacy was then assessed according to the change rate of clinical symptoms scoring. Results: After treatment, 11 of the 70 cases got basic recovery, 21 cases got marked effectiveness, 27 cases got improvement and 11 cases got no effect. The total effective rate was 84.3%. There was statistical significance in symptoms score between before and after treatment (P<0.01). Conclusion: Combining acupuncture, bloodletting after pricking and cupping on Shenque (CV 8) is effective for chronic urticaria.     

Clinical study on acupuncture for quality of life in patients with age-related macular degeneration

Objective： To observe the effect of acupuncture on the quality of life in patients with age-related macular degeneration （AMD）. Methods： A total of 47 dry AMD cases （94 eyes） were randomly allocated into three groups, 22 cases （44 eyes） in the acupuncture group, 15 cases （30 eyes） in the Western medicine group and 10 cases （20 eyes） in the control group. Cases in the acupuncture group were treated with acupuncture, cases in the Western medicine group with vitamin C and E and cases in the control group received no treatment except for out-patient follow-up. Results： Acupuncture could significantly improve eye symptoms of dry AMD cases including blurred vision, drastic decrease in visual acuity, distorted vision, central scotomas, visual fatigue and dry eyes as well as other systemic symptoms related to macular degeneration. Conclusion： Acupuncture can substantially improve the quality of life in patients with dry AMD.     

Wrist–ankle acupuncture combined with pinching along the spine for children allergic rhinitis: A randomized controlled trial

Objective: To investigate the clinical effect of wrist–ankle acupuncture combined with pinching along the spine on allergic rhinitis(AR) in children.Methods: A total of 65 children with AR were collected from February 2017 through to December 2018 and they were randomly divided into a combined treatment group with wrist–ankle acupuncture, pinching along the spine and western medication(combined treatment group, 32 cases) and a western medication group(33 cases). In the western medication group, loratadine was prescribed for oral administration. In the combined treatment group, on the base of the medication as the western medication group,the wrist–ankle acupuncture was adopted in combination with pinching along the spine. Before and after treatment, the symptoms and physical signs were scored and the clinical effect was observed in the children of the two groups.Results: After the treatment and in the follow-up, the scores of the symptoms and physical signs in the combined treatment group were lower than those of the western medication group, indicating a statistical significance(all P 0.05). The total effective rate was 93.7% in the combined treatment group,which was higher than 63.63% in the western medication group, indicating a statistical significance(P 0.05).Conclusion: The combined treatment of wrist–ankle acupuncture combined with pinching along the spine and loratadine effectively relieves the clinical symptoms and the physical signs in AR children. The clinical effect of this combined treatment is better than the simple use of loratadine.     

Treatment of Visceral Pain Associated with Irritable Bowel Syndrome using Acupuncture: Mechanism of Action

Irritable bowel syndrome (IBS) is a relatively common condition characterized by abdominal pain, among other symptoms, that significantly impacts the quality of life of IBS patients. Therapeutic treatment of IBS results in limited success, and the focus is placed on relieving patients of some of the symptoms, visceral pain in particular. Acupuncture is commonly used as a treatment modality of choice. However, the debate on whether acupuncture can be effectively used for this purpose is ongoing. In this work, we critically review the available literature to establish a potential mechanism of action in treating visceral pain in IBS using acupuncture. The sources used are Google Scholar, EBSCO, Cochrane Library and PubMed as well as Chinese database sources. The keywords used in the literature search are “acupuncture,” “IBS,” “Irritable Bowel Syndrome,” and “visceral pain.” We find that the literature strongly indicates that acupuncture, by stimulating points located on the dermatomes proximal to the spinal level of the area where the sympathetic outflow of the particular gut area affected by the pain is, can interfere with the efferent signal that transports information about the noxious stimuli and interrupt the “connectivity” between the gut and brain, and as a final result, reduce or stop IBS pain. Our findings justify that clinical trials are conducted to test the utility of acupuncture in treating abdominal visceral pain in IBS.     

The difference of Park and Streitberger singleblind needles from Takakura double-blind needle

<正>In a recent study aimed at validating the Park sham needle for use as a double-blind control intervention,To and Alexander concluded that the practitioner who was performing acupuncture recognized the type of needle[1].This paper may lead the reader to misunderstand the design and purpose of placebo/sham acupuncture[2–6]     

埃德蒙顿症状评估量表在针灸治疗癌痛患者中的应用:基于肿瘤科住院患者的回顾性分析和一项前瞻性预试验（英文）

Background:As pain is the most prominent clinical symptom for cancer patients and closely related to other symptoms,it is necessary to have a comprehensive assessment on promising intervention to improve pain management.Methods:A retrospective study of 489 inpatient cancer patients(1081 visits) was conducted by querying the electronic medical record database to test the reliability and validity of the Edmonton Symptom Assessment System.Data from a pilot prospective randomized controlled study on...     

ACUPUNCTURE TREATMENT OF FIBROSITIS

Fibrositis is categorized as a form of non-articular rheumatism, manifestedmainly as a poorly defined set of symptoms including muscle pain, stiffness, trigger-point tender-ness, fatigue and depression, etc. Up to now, the satisfactory answer why fibrositis happens hasnot yet obtained and the medication of fibrositis is discouraging. But according to TCM, bodyacupuncture combined with ear acupuncture, seven star needles and cupping therapy is the mosteffective treatment for fibrositis.