.Hullender Rubin LE1, Opsahl MS2, Wiemer KE2, Mist SD3, Caughey AB3.
Author information
AbstractPatients undergoing IVF may receive either acupuncture or whole-systems traditional Chinese medicine (WS-TCM) as an adjuvant IVF treatment. WS-TCM is a complex intervention that can include acupuncture, Chinese herbal medicine, dietary, lifestyle recommendations. In this retrospective cohort study, 1231 IVF patient records were reviewed to assess the effect of adjuvant WS-TCM on IVF outcomes compared among three groups: IVF with no additional treatment; IVF and elective acupuncture on day of embryo transfer; or IVF and elective WS-TCM. The primary outcome was live birth. Of 1069 non-donor cycles, WS-TCM was associated with greater odds of live birth compared with IVF alone (adjusted odds ratio [AOR] 2.09; 95% confidence interval [CI] 1.36 to 3.21), or embryo transfer with acupuncture only (AOR 1.62; 95% CI 1.04 to 2.52). Of 162 donor cycles, WS-TCM was associated with increased live births compared with all groups (odds Ratio [OR] 3.72; 95% CI 1.05 to 13.24, unadjusted) or embryo transfer with acupuncture only (OR 4.09; 95% CI: 1.02 to 16.38, unadjusted). Overall, IVF with adjuvant WS-TCM was associated with greater odds of live birth in donor and non-donor cycles. These results should be taken cautiously as more rigorous research is needed.

Copyright © 2015 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.


KEYWORDS:Chinese herbal medicine; acupuncture; embryo transfer; in-vitro fertilization; live births; traditional Chinese medicine


PMID: 25911598 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/25911598

By Larry Dossey, Deepak Chopra and Rustum Roy

The current healthcare debate has brought up basic questions about how medicine should work. On one hand we have the medical establishment with its enormous cadre of M.D.s, medical schools, big pharma, and incredibly expensive hospital care. On the other we have the semi-condoned field of alternative medicine that attracts millions of patients a year and embraces literally thousands of treatment modalities not taught in medical school.

One side, mainstream medicine, promotes the notion that it alone should be considered "real" medicine, but more and more this claim is being exposed as an officially sanctioned myth. When scientific minds turn to tackling the complex business of healing the sick, they simultaneously warn us that it's dangerous and foolish to look at integrative medicine, complementary and alternative medicine, or God forbid, indigenous medicine for answers. Because these other modalities are enormously popular, mainstream medicine has made a few grudging concessions to the placebo effect, natural herbal remedies, and acupuncture over the years. But M.D.s are still taught that other approaches are risky and inferior to their own training; they insist, year after year, that all we need are science-based procedures and the huge spectrum of drugs upon which modern medicine depends.

If a pill or surgery won't do the trick, most patients are sent home to await their fate. There is an implied faith here that if a new drug manufacturer has paid for the research for FDA approval, then it is scientifically proven to be effective. As it turns out, this belief is by no means fully justified.

The British Medical Journal recently undertook an general analysis of common medical treatments to determine which are supported by sufficient reliable evidence. They evaluated around 2,500 treatments, and the results were as follows:

13 percent were found to be beneficial

23 percent were likely to be beneficial

Eight percent were as likely to be harmful as beneficial

Six percent were unlikely to be beneficial

Four percent were likely to be harmful or ineffective.

This left the largest category, 46 percent, as unknown in their effectiveness. In other words, when you take your sick child to the hospital or clinic, there is only a 36 percent chance that he will receive a treatment that has been scientifically demonstrated to be either beneficial or likely to be beneficial. This is remarkably similar to the results Dr. Brian Berman found in his analysis of completed Cochrane reviews of conventional medical practices. There, 38 percent of treatments were positive and 62 percent were negative or showed "no evidence of effect."

For those who have been paying attention, this is not news. Back in the late 70's the Congressional Office of Technology Assessment determined that a mere 10 to 20 percent of the practices and treatment used by physicians are scientifically validated. It's sobering to compare this number to the chances that a patient will receive benefit due to the placebo effect, which is between 30 percent and 50 percent, according to various studies.

We all marvel at the technological advances in materials and techniques that allow doctors to perform quadruple bypass surgeries and angioplasties without marveling that recent studies indicate that coronary bypass surgery will extend life expectancy in only about three percent of cases. For angioplasty that figure sinks to zero percent. Those numbers might be close to what you could expect from a witch doctor, one difference being that witch doctors don't submit bills in the tens of thousands of dollars.

It would be one thing if any of these unproven conventional medical treatments were cheap , but they are not. Angioplasty and coronary artery bypass grafting (CABG) alone cost $100 billion annually. As quoted by President Obama in his drive to bring down medical costs, $700 billion is spent annually on unnecessary tests and procedures in America. As part of this excess, it is estimated that 2.5 million unnecessary surgeries are performed each year.

Then there is the myth that this vast expenditure results in excellent health care, usually touted as the best in the world (most recently by Rush Limbaugh as he emerged from a hospital in Hawaii after suffering chest pain). But this myth has been completely undermined. In 2000 Dr. Barbara Starfield, writing in the Journal of the American Medical Association, estimated that between 230,000 and 284,000 deaths occur each year in the US due to iatrogenic causes, or physician error, making this number three in the leading causes of death for all Americans.

In 2005 the Centers for Disease Control and Prevention reported that out of the 2.4 billion prescriptions written by doctors annually, 118 million were for antidepressants. It is the number one prescribed medication, whose use has doubled in the last ten years. You would think, therefore, that a remarkable endorsement is being offered for the efficacy of antidepressants. The theory behind standard antidepression medication is that the disease is caused by low levels of key brain chemicals like serotonin, dopamine, and norepinephrine, and thus by manipulating those imbalanced neurotransmitters, a patient's depression will be reversed or at least alleviated.

This turns out to be another myth. Prof. Eva Redei of Northwestern University, a leading depression researcher, has discovered that depressed individuals have no depletion of the genes that produce these key neurotransmitters compared to people who are not depressed. This would help explain why an estimated 50 percent of patients don't respond to antidepressants, and why Dr. Irving Kirsch's meta-analysis of antidepressants in England showed no significant difference in effectiveness between them and placebos.

You have a right to be shocked by these findings and by the overall picture of a system that benefits far fewer patients than it claims. The sad fact is that a disturbing percentage of the medicine we subject ourselves to isn't based on hard science, and another percentage is risky or outright harmful. Obviously, every patient deserves medical care that is evidence-based, not just based on an illusory reputation that is promoted in contrast to alternative medicine.

We are not suggesting that Americans adopt any and all alternative practices simply because they are alternative. These, too, must demonstrate their effectiveness through objective testing. But alternative modalities should not be dismissed out of hand in favor of expensive and unnecessary procedures that have been shown to benefit no one absolutely except corporate stockholders.

Addendum To 'The Mythology Of Science-Based Medicine

MRI studies reveal the neurological mechanisms of acupuncture on human health. Research published in Autonomic Neuroscience demonstrates that stimulation of specific acupuncture points induces hemodynamic changes in specific brain networks. The researchers add that brain networks accessed by specific acupuncture points relate to specific medical disorders and suggest an “acupoint-brain-organ” pathway. 

Functional magnetic resonance imaging (fMRI) studies reveal specific acupuncture point effects in the brain through blood-oxygen-level dependent (BOLD) measurements. In a meta-analysis of 82 fMRI studies, researchers found a large body of evidence supporting acupuncture point specificity. This applies to both manual acupuncture and electroacupuncture. True acupuncture point stimulation induced specific cortical effects whereas sham acupuncture did not. In addition, the researchers note that acupuncture point stimulation produces significantly “more positive and negative hemodynamic signal response(s) in brain regions compared with sensory stimulation used as a control condition.”

Many important findings were confirmed. Acupuncture exerted a stimulus that “could induce beneficial cortical plasticity in carpal tunnel syndrome patients.” It was also demonstrated that acupuncture relieved pain “by regulating the equilibrium of distributed pain-related central networks.”

The researchers note that a fundamental principle of Traditional Chinese Medicine (TCM) is that “specific acupoints have therapeutic effects on target organ systems remote from the needling site….” Recent fMRI investigations support this principle. The researchers note that “fMRI investigations regarding several acupoints have demonstrated that acupuncture stimulation at disorder-implicated acupoints modulates the activity of the disorder-related brain regions.”

In TCM, acupuncture point Neiguan (PC6) is indicated for the treatment of nausea and vomiting. The fMRI research supports this ancient principle. The researchers note, “Acupuncturing at Neiguan (PC6) could selectively evoke hemodynamic response of insula and cerebellar-hypothalamus in order to exert modulatory effects on vestibular functions, indicating the specific treatment effect on nausea and vomiting.” 

Acupuncture point GB37 (Guangming), located on the lower leg, is indicated for the treatment of vision related disorders within the TCM system. The name of the point, Guangming, is translated as bright light and indicates the acupoint’s use in the treatment of visual disorders. It is categorized as a Luo-connecting point and has the TCM functions of regulating the liver and clearing vision. The point is indicated for the treatment of hyperopia (farsightedness), myopia (nearsightedness), night blindness, and eye pain. The research demonstrates that GB37 increases neural responses in the occipital cortex. The researchers add that it was “discovered that modulations in vision-related cortex (BA18/19) were responsive to the specificity of GB37….” This connection between fMRI findings and TCM indications confirms the specificity of GB37 for the treatment of visual disorders.

A broad body of research suggests “that acupuncture at different acupoints may modulate relatively specific cerebral areas,” according to the researchers. Acupoints demonstrating this phenomenon in fMRI include:

• Hegu (LI4)
• Zusanli (ST36)
• Taichong (LV3)
• Taixi (KI3)
• Qiuxu (GB40)
• Guangming (GB37)
• Jiaoxin (KI8)
• Auricular Brain Stem
• Sanyinjiao (SP6)

Many examples of acupoint cortical specificity were included in the research. The following are some highlights. The researchers note, “Acupuncture at the three classical acupoints of Hegu (LI4), ST36 and Taichong (LV3) produced extensive deactivation of the limbic-paralimbic-neocortical brain network as well as activation of its anti-correlated activation network.” Differentiation between the points was noted as the following, “LI4 was predominant in the pregenual cingulated and hippocampal formation, ST36 response was predominant in the subgenual cingulate, and LV3 in the posterior hippocampus and posterior cingulated….” Taixi (KI3) mediated the executive network, Qiuxu (GB40) activated the auditory network, and “Jiaoxin (KI8) was associated with (the) insula and hippocampus in pain modulation.” 

The mechanisms of cerebral action of true acupuncture were found distinct from sham acupuncture. The researchers note, “Acupuncture at Taichong (LR3) could specifically activate or deactivate brain areas related to vision, movement, sensation, emotion, and analgesia compared with sham acupuncture.” They add, “Several studies have found that there were different brain responses between traditional acupoints and sham points….” It was found that “ST36 could induce greater activation in ventrolateral periaqueductal gray (PAG) and produced linearly time-variant fMRI activities in limbic regions, such as amygdale and hippocampus….” Needling acupuncture point Erjian (LI2) activated the insula and operculi but this did not occur with sham acupuncture. Other research examples were cited. The researchers concluded, “These results provided evidence to support that acupoints may have its own functional specificity to sham point.”

A multiplicity of fMRI studies investigated the effects of deqi. The elicitation of deqi by acupuncture needling techniques is often described by patients as electrical, dull, or heavy. Deqi is often described by licensed acupuncturists applying manual acupuncture as a pulling or tugging sensation on the needle. The fMRI research shows “ that acupuncture with deqi induced extensive deactivation in limbic-paralimbic-neocortical network (LPNN) and activation in somatosensory regions of (the) brain.” Other research suggests that the bilateral postcentral gyrus, insula, ipsilateral inferior frontal gyrus, inferior parietal lobule, claustrum, and contralateral ACC are related to deqi elicitation. In addition, the researchers note that deqi sensations are directly “correlated with activation in sensorimotor and cognitive (dorsomedial prefrontal cortex) processing, and deactivation in DMN (default-mode network regions).”

The depth of needling affects cerebral responses to acupuncture. It was found that deep needling of KI3 elicits “more extensive connectivity related to therapeutic effect(s) of acupuncture in mild cognitive impairment patients” when compared with superficial needling. Other important clinical findings were documented. Acupuncture successfully regulated DMN and motor-related networks in stroke patients. The application of acupuncture to acupoints LR3 and LI4 activated cognitive related regions in Alzheimer’s disease and mild cognitive impairment (MCI) patients. The study notes that abnormal functional connectivity in the temporal regions of the hippocampus, thalamus, and fusiform gyrus for mild cognitive impairment patients “significantly improved.”

The mechanisms by which laser acupuncture exerts antidepressant effects was revealed in fMRI. The DMN (default mode network) is at its peak activity level when the brain is a rest and deactivates when the brain is task or goal oriented. Laser acupuncture to Ququan (LR8), Qimen (LR14), and Juque (DU14) stimulated both the anterior and posterior DMN in depressed and non-depressed individuals. However, posterior DMN modulation was wider in depressed individuals receiving laser acupuncture at the parieto-temporal-limbic cortices.

Acupuncture has also been shown to regulate DMN activity in Alzheimer’s disease patients. In addition, brain activation induced by acupuncture in healthy patients is different than brain activation induced in Parkinson’s disease patients. One study was found showing that “acupuncture may regulate the cardiovascular system through a complicated brain network from the cortical level, the hypothalamus, and the brainstem to improve body pain and vitality in primary hypertension patients.”

The researchers note that fMRI assists in understanding the neural effects of acupuncture. The researchers conclude, “Acupuncture could induce hemodynamic changes in a wide cortico-subcortical network, large portions of which are overlapped with the disorder-related areas, indicating that there maybe exist a specific pathway connecting “acupoint-brain-organ” underlying acupuncture induced therapeutic effects.”


Reference:
He, Tian, Wen Zhu, Si-Qi Du, Jing-Wen Yang, Fang Li, Bo-Feng Yang, Guang-Xia Shi, and Cun-Zhi Liu. "Neural mechanisms of acupuncture as revealed by fMRI studies." Autonomic Neuroscience (2015).


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