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Acupuncturist
The American
Volume  | Summer 2013
AAAOM’s Official Publication for Practitioners of Oriental Medicine
Inside
Acupuncture Improves Working Memory and Reduces Anxiety
Clinical Therapeutic Effect of “Ji Liu Nei Xiao Pill” for
Uterus Fibroid
Case Study on Management of Benign Prostatic Hypertrophy
SAR 2013 Conference
A Study on Scientific Writing: The Materials and Methods Section
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Volume  | Summer 2013
The American Acupuncturist is
published quarterly by the
American Association of Acupuncture
& Oriental Medicine (AAAOM)
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Bethesda, Maryland 20814-3998
toll free 866-455-7999
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email [email protected]
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Original Research

Acupuncture Improves Working Memory and Reduces Anxiety:
A Report of a Randomized, Clinical Trial
Jason Bussell PhD, LAc
© Copyright The American Acupuncturist 2013
ISSN: 1520-7714

Clinical Therapeutic Effect of “Ji Liu Nei Xiao Pill” for
Uterus Fibroid
Tang Ling, Wang DongMei, Gu HuiXia, Liu Li, Wang XanXia,
He ZhiPing Beijing University of Chinese Medicine
Translated by Doreen G.F. Chen, MD, CMD, LAc
Resource Directory

ACAOM—Accreditation
Commission for Acupuncture
and Oriental Medicine
Selection of Clinical Research Abstracts Presented at the
2013 Society for Acupuncture Research Conference: Impact of
Acupuncture Research on 21st Century Health Care
Jennifer A. M. Stone, LAc
14502 Greenview Drive, Suite 300B
Laurel, MD 20708
phone 301-313-0855
fax 301-313-0912
www.acaom.org
Case Study
CCAOM—Council of Colleges
of Acupuncture and Oriental Medicine
Perspectives
600 Wyndhurst Avenue, Ste. 112
Baltimore, MD 21210
phone 410-464-6040
fax 410-464-6042
www.ccaom.org
NCCAOM—National Certification Commission of Acupuncture and Oriental Medicine
76 South Laura Street, Suite 1290
Jacksonville, FL 32202
phone 904-598-1005
fax 904-598-5001
email [email protected]
www.nccaom.org
SAR—Society for Acupuncture Research
130 Cloverhurst Court
Winston Salem, NC 27103
phone: 336-306-6888
www.acupunctureresearch.org

A Case Study on the Management of Benign Prostatic
Hypertrophy Using Acupuncture and Chinese Herbal Medicine
Connie L. Christie, MA, Dipl OM (NCCAOM), LAc


A Study on Scientific Writing: The Materials and Methods Section
Jennifer A. M. Stone, LAc
Society for Acupuncture Research 2013 Conference:
Public Health Aspects
Elizabeth Sommers, PhD, MPH, LAc
Book Review

Evaluating the Economics of Complementary and
Integrative Medicine
Reviewed by Elizabeth Sommers, PhD, MPH, LAc
3
From the Editor: Jennifer A. M. Stone, LAc
6
In Memoriam: Al Loren Stone, DAOM, LAc
7
AAAOM Board of Directors & Mission Statement
28
Index to Advertisers
29
Trudy McAlister Foundation 2013 Scholarships
 
The American Acupuncturist
1
2
T h e A m e r i c a n A c u p u n c t u r i s t Summer 2013
From the Editor
Jennifer A. M. Stone, LAc
Welcome to the summer 2013 issue of The American
Connie L. Christie, MA, Dipl OM (NCCAOM), LAc. Christie provides
Acupuncturist. We are very pleased to present our new feature, the
an interesting and informative review of prostate problems from a
English translation of a selected Chinese research paper, previously
Western medical perspective that is a valuable resource for AOM
published in the World Chinese Medicine Journal, titled “Clinical
professionals who treat prostate issues. Details on more serious
Therapeutic Effect of ‘Ji Liu Nei Xiao Pill’ for Uterus Fibroid.” In
prostate problems that should be ruled out are discussed.
addition, we include a report, “Acupuncture Improves Working
In the spring issue of The American Acupuncturist, I wrote a
Memory and Reduces Anxiety: A Report of a Randomized,
short study on how to write a scientific discussion section for a
Clinical Trial,” as well as an original case study, “Management
scientific manuscript. In this issue, I have prepared a study on
of Benign Prostatic Hypertrophy Using Acupuncture and Chinese
writing a methods section for this kind of paper. In future issues,
Herbal Medicine.”
I will include a short informative study on additional parts of the
We also present a report on the 2013 Society of Acupuncture
scientific manuscript to serve as a resource for AOM students, new
Research Conference that was held in April in Ann Arbor, Michigan.
authors, and new investigators. These perspectives are available to
The Conference was a great success! Researchers from at least
the general public in our open access issues of the journal on the
20 different countries gathered together to present their findings
AAAOM website, www.aaaomonline.org.
and discuss current issues surrounding acupuncture research.
The book we have chosen to review in this issue is Evaluating the
Many editorial board members and peer reviewers who lend their
Economics of Complementary and Integrative Medicine by Patricia
services to The American Acupuncturist were in attendance. I have
Herman, ND, PhD, reviewed by Elizabeth Sommers, PhD, MPH, LAc.
prepared a short summary on a few selected abstracts from the oral
Elizabeth’s expertise in public health makes her the perfect person
presentations presented at the conference that I think will interest
to review this book. She provides a valuable chart that compares
our readers.
different types of analysis, benefits, limitation and examples.
The Chinese research paper, “Clinical Therapeutic Effect of
‘Ji Liu Nei Xiao Pill’ for Uterus Fibroid,” was translated into English
by Doreen Chen, MD, CMD, LAc. It was originally published in the
Elizabeth recommends the book as a valuable resource for AOM
professionals.
Thank you authors, peer reviewers, and our translator for their
World Chinese Medicine Journal and written by Tang Ling, Wang
contributions to this issue. We continue to welcome submission
DongMei, Gu HuiXia, Liu Li, Wang XanXia, He ZhiPing from Beijing
of articles at any time on research topics, case studies, literature
University of Chinese Medicine, Dong Zhi Men Hospital, Beijing,
reviews, and opinion papers by both established authors and
China. The study reports on 60 cases of uterine fibroids collected
first-time authors. When considering submission to the journal,
randomly and divided into two groups, half in a Chinese medicine
please refer to our Author Guidelines, www.aaaomonline.
treatment group and the other half in the Western medicine
org/?page=authorguidelines. If you have questions or need more
treatment group.
information, please contact Associate Editor Lynn Eder, leder@
Jason Bussell, PhD, LAc reports on “Acupuncture Improves
aaaomonline.org.
Working Memory and Reduces Anxiety: A Report of a Randomized,
Clinical Trial,” which examines the impact of acupuncture on
memory. Ninety subjects of varied ethnicity were recruited from
Respectfully,
local universities around the Chicago area and randomized into two
Jennifer A. M. Stone, LAc
groups. One group received an acupuncture treatment that was
Editor in Chief, The American Acupuncturist
tailored for reduction in anxiety and improved memory. The other
group received a needleless placebo. Please take a look at the full
text of this article to see the amazing results.
Our case study, “Management of Benign Prostatic Hypertrophy
Using Acupuncture and Chinese Herbal Medicine,” is written by
 
The American Acupuncturist
3
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The American Acupuncturist is published quarterly, providing a professional venue for
both published and first time authors. We welcome articles on clinical research, case
studies, translated works, legislative issues, education developments, commentaries,
literature reviews, and other current topics of importance to AOM. We value your
AOM perspective. Please review the Author Guidelines at http://www.aaaomonline.
org/?page=authorguidelines which also includes the submissions link.
Editor in Chief
Editorial Board
Jennifer A. M. Stone, LAc
John K. Chen, PhD, PharmD, OMD, LAc
Evergreen Herbs
Indiana University School of Medicine
E-mail: [email protected]
Managing Editor
Michael J. Jabbour, MS, LAc
E-mail: [email protected]
Senior Editor
Adam Burke, PhD, MPH, LAc
Institute for Holistic Health Studies
San Francisco State University
Peter Johnstone, MD, FACR
Indiana University School of Medicine
Lixing Lao, PhD, LAc
Center for Integrative Medicine
University of Maryland Medical School
Will Morris, PhD, DAOM, LAc
Academy of Oriental Medicine at Austin
Rosa N. Schnyer, DAOM, LAc
School of Pharmacy, University of Texas at Austin
Associate Editor
Lynn Eder, MFA
E-mail: [email protected]
Senior Field Editor
Janet Borges, MSTCM, Dipl Ac & CH (NCCAOM), LAc
Misha Ruth Cohen, OMD, Dipl Ac & CH (NCCAOM), LAc
UCSF Institute for Health and Aging
Sherman Cohn, Esq.
Georgetown University Law Center
Kevin V. Ergil, MA, MS, Dipl OM (NCCAOM), LAc
Finger Lakes School of Acupuncture and Oriental Medicine
of NYCC
John Fang, DAOM, LAc
Graduate School of Traditional Oriental Medicine, Emperor’s College
Steve Given, DAOM, LAc
American College of Traditional Chinese Medicine
Valerie Hobbs, Dipl OM & CH (NCCAOM), LAc
Southwest Acupuncture College
Jeannie Kang, MSTOM, DNBAO, DNBIM, LAc
Serenity, TATC
David W. Miller, MD, LAc
East-West Integrated Medicine, LLC
Karen Reynolds, MS, RN, LAc
Balance Restored Center for Integrative Medicine
Tammy Sajdyk, PhD
Indiana University School of Medicine
Elizabeth Sommers, PhD, MPH, LAc
Boston University
Naomi Takazawa, LAc, Licensed Moxibustionist
Tokyo, Japan
Dawn Upchurch, PhD, LAc
UCLA School of Public Health
S. Prasad Vinjamury, MD (Ayurveda), MAOM
Southern California University of Health Sciences
Jun Wang, PhD, DOM
San Francisco State University
 
The American Acupuncturist
5
In Memoriam: Al Loren Stone, DAOM, LAc
With the untimely passing of Al Stone, DAOM, LAc on May 24th, the field
of acupuncture and Oriental medicine lost a dedicated and revered pioneer,
teacher, practitioner and advocate.
Al’s accomplishments and reputation for excellence will long be felt and
appreciated. Over the years, Al dedicated a significant amount of time and
energy towards building the AAAOM presence, particularly in the areas of web
technology and herbal medicine regulation.
To honor Al and his work, AAAOM has created the Stone Memorial Fund. Its
purpose is to support a prominent and informative web presence for our field.
AAAOM thanks and recognizes Al for his life’s work, dedication, and persistence
in promoting our profession.
www.aaaomonline.org/StoneMemorialFund
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T h e A m e r i c a n A c u p u n c t u r i s t Summer 2013
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2013 AAAOM Board of Directors
Executive Committee
Michael Jabbour
MS, LAc
President
[email protected]
Kimberley Benjamin
LAc
Vice President
[email protected]
Jane Yu
MAOM, Dipl OM (NCCAOM),
LAc, Secretary
[email protected]
John Barrett
Dipl Ac (NCCAOM), LAc
Treasurer
[email protected]
Jeannie Kang
MS, DNBAO, DNBIM, LAc
Immediate Past President
[email protected]
C. Daer Reid
LAc
[email protected]
Ann Wang
CMD (China), LAc
[email protected]
Jennifer Minor
MA, MTCM, Dipl OM
(NCCAOM), LAc
[email protected]
Joshua Saul
Student Organization
President
[email protected]
Directors-at-Large
Public Directors
American Association
of Acupuncture and
Oriental Medicine
Mission Statement
Hannah Seoh
MPH, MS
[email protected]
Jay Sexton
AB, MBA, JD
[email protected]
The American Association of
Acupuncture and Oriental
Medicine (AAAOM) is a national
membership organization of
2013 AAAOM Committees/Chairs
acupuncture and Oriental
medicine (AOM) practitioners
and supporters that serves to
Committee
Chair
Email
Conference
Deborah Lincoln, MSN, RN, Dipl Ac (NCCAOM)
[email protected]
Education and Credentialing
Michael Jabbour, MS, LAc
[email protected]
Essential Health Benefits
Jeannie Kang, MS, DNBAO, DNBIM, LAc
[email protected]
Executive
Michael Jabbour, MS, LAc
[email protected]
Finance
John Barrett, Dipl Ac (NCCAOM), LAc
[email protected]
Good Preparation and Dispensing
Kevin Ergil, MA, MS, Dipl OM (NCCAOM), FNAAOM, LAc
Governance
Jay Sexton, AB, MBA, JD
Herbal Medicine
Eric Buckley, DOM
advocacy in our commitment to
[email protected]
Insurance
Mark Evans, LAc
facilitate access to the highest
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Inter-Professional Standards
William Hendry, DOM, LAc
quality of healthcare in the
[email protected]
Media and Public Education
Kari Auer, MA
United States.
[email protected]
Membership
Jane Yu, MAOM, Dipl OM (NCCAOM), LAc
[email protected]
Public Policy
Jeannie Hoyt
[email protected]
advance the profession and
practice of AOM. The mission
of the AAAOM is to support
our members and the AOM
community through education,
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[email protected]
media support, and legislative
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 
The American Acupuncturist
7
Acupuncture Improves
Working Memory and
Reduces Anxiety: A Report of a
Randomized, Clinical Trial
By Jason Bussell PhD, LAc
Jason Bussell earned his MSOM from the Midwest College
Abstract
and his PhD in acupuncture from the Guangzhou University
Introduction: To investigate whether acupuncture
can improve memory and reduce anxiety. Design,
Setting, and Subjects: A two-group, randomized,
single-blind study involving 90 undergraduate
university students. Interventions: Subjects completed
the State-Trait Anxiety Inventory (STAI) form Y-1
(State Anxiety, SA) and Y-2 (Trait Anxiety, TA).
Then each subject laid on a treatment table for 20
minutes. The acupuncture group had needles inserted
into select acupoints; control subjects did not.
Subjects then completed the STAI form Y-1 again
and also completed the Automated Operation Span
Task (AOSPAN)—a computerized test of working
memory. Main outcome measures: Performance on
the AOSPAN and STAI scores. Results: Acupuncture
group scored 9.5% higher than control on the
AOSPAN Total Correct Score (65.39 vs. 59.90
p=0.0134) and committed 36% fewer math errors
(2.68 vs. 4.22, p=0.0153). Acupuncture subjects also
reported lower SA after intervention than control
(26.14 vs. 29.63, p=0.0146). Conclusion: This
acupuncture protocol improves working memory and
reduces anxiety.
of Chinese Medicine. He served three terms as president
of the Illinois Association of Acupuncture and Oriental
Medicine and is currently on the Illinois State Government’s
Board of Acupuncture. Jason has authored The Asian Diet:
Simple Secrets for Eating Right, Losing Weight, and Being
Well, published by Findhorn Press. He is also the creator
of Supplemental Herb Songs: A 2-CD Collection of Songs
to Help Students and Practitioners Learn Herbal Formulas,
published by CD Baby. [email protected]
Keywords: acupuncture, working memory, anxiety, AOSPAN, STAI
8
T h e A m e r i c a n A c u p u n c t u r i s t Summer 2013
Introduction
Innovation
A recent study demonstrates that an acupuncture protocol can
improve memory and test taking and reduces anxiety immediately
after administration. The study report was published in the Elsevier
Journal of Acupuncture and Meridian Studies1 and the findings were
presented at the Society for Acupuncture Research 2013 conference. The full report can be viewed at http://www.jams-kpi.com.
All prior research into memory has studied impaired human or
animal subjects. This is the first study to examine acupuncture’s
ability to improve memory in healthy subjects. All previous research
investigated the effect of a course of acupuncture on memory. This
is the first study to examine the effect of one single acupuncture
treatment on WM. It is also the first to investigate the connection
between acupuncture’s ability to improve memory and its ability to
reduce anxiety.
Working Memory
Working memory (WM) was originally described by Baddeley
and Hitch.2 WM is basically short-term memory plus attentional
control. It is comprised of three constituent systems: the phonological loop, where people keep repeating information to themselves in
their mental voice to keep it in their short-term memory; the visual
sketchpad, where people keep information in their short-term
memory by thinking about how it looks; and the central executive,
which decides how much mental attention to devote to actively
remembering this information and how much attention is devoted
to performing other tasks.3 WM has been associated with predicting
such diverse capabilities as reading comprehension,4 arithmetic
calculation,5 note taking,6 language comprehension,7 learning
a computer language,8 learning to spell,9 following directions,1
building vocabulary,1 writing,1 complex learning,1 and reasoning
ability.1 WM capacity is correlated with aptitude in many areas. It
is measured by Operation Span Task (OSPAN) tests such as the
Automated Operation Span Task.
Anxiety Impairs WM
Anxiety has been shown to impair performance in math,5,15
reading,16 and OSPAN task measures of WM.17 Anxiety impairs test
performance and can be a serious problem for students. According
to the American Test Anxiety Association, up to 38% of students
have performance impaired by anxiety. Students with high test
anxiety score approximately 12 percentage points lower than their
peers on school examinations.18 Reducing subjects’ anxiety should
help improve their test performance.
Acupuncture Reduces Anxiety
Studies have shown that acupuncture can reduce many types of
anxiety, including generalized anxiety,19 depressive anxiety,20,21
and pre-operative anxiety.22–26 Pilkington, Kirkwood, Rampes,
Cummings, and Richardson27 conducted a review of the literature
regarding acupuncture and anxiety. They reviewed hundreds of
studies and found the consensus to be promising for many types
of anxiety. However, they also noted that there is a need for further
research.
Hypotheses
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reduction in anxiety.
Methodology
Participants:
During 2011, 90 subjects of varied ethnicity were recruited from
local universities around the Chicago area via solicitation flyers.
Inclusion criteria was that all subjects must: be undergraduate
university students aged 18-30; be willing to receive acupuncture;
have not received acupuncture in the three months prior to testing;
be free of any serious medical problems; not be taking any psychoactive medication; not be pregnant or breastfeeding; and be fluent
in the English language. Subjects received financial compensation
for their participation. All subjects were treated in accordance with
the NIH guidelines for research on human subjects.
Instruments and Measures:
The State-Trait Anxiety Inventory (STAI) consists of two forms:
Y-1 for state anxiety (SA) and form Y-2 for trait anxiety (TA). The
STAI has shown test-retest reliability and external validity28 and is
one of the most widely-used anxiety measurement instruments in
the world.29
The Automated Operation Span Task (AOSPAN) is a computerized test of WM that has demonstrated good internal reliability
and external validity.30 Subjects are presented with a math problem
to perform in their head, and then they must answer the problem
on the computer. After answering the question, they are shown a
letter to remember for one second. Then they are presented with
another math problem followed by another letter. After a set of
between three and seven of these math-letter pairs, subjects are
shown a recall screen and must use the mouse to select the letters
they were shown in the correct order. The math-letter sets and
recall screens are presented serially in sets of three to seven in each
set, with a total number of 75 letters and math problems each. The
AOSPAN Absolute Score and the Total Correct Score both reflect
the accuracy of the letter recall.
The Total Correct Score counts all correct letter responses, while
the Absolute Score only gives credit for letters recalled correctly
when the entire set is recalled correctly. For example, if a set has
seven math-letter pairs and the subject recalls six of the letters correctly, the Total Correct Score would be six and the Absolute Score
would be zero. The AOSPAN also monitors performance on the
math problems. It provides a numerical score for the total number
 
The American Acupuncturist
9
“Care was taken to reduce the likelihood that control subjects would know that they
were in the control group. When control subjects were presented with the AOSPAN,
they were told, ‘Now we will have you take the first memory test.’ This was intended
to raise the possibility in subjects’ minds that they might still receive acupuncture and
take the test again.”
of math errors and subcategorizes the totally number into accuracy
errors and speed errors (failure to answer in the allotted time).30 The
AOSPAN can be understood as a test of how well subjects can keep
information in the back of their minds while actively processing
other tasks and vice versa.
Variables
The independent variable was whether or not the participant
received acupuncture for 20 minutes while laying on a treatment
table for 20 minutes. The dependent variables analyzed were: initial
SA (SA1), SA after the variable period (SA2), TA, change from SA1
to SA2 ( SA), AOSPAN Total Correct Score, AOSPAN Absolute
Score, AOSPAN Math Total Errors, AOSPAN Math Speed Errors,
and AOSPAN Math Accuracy Errors.
Procedure
Subjects were randomized ahead of time into acupuncture and
control groups with a computer randomization program (www.
random.org). Each subject was tested individually and seen for only
one appointment. At the start of the appointment, subjects had the
study design partially explained to them. They were told, “You will
fill out some self-evaluation questionnaires, take some computerized
memory tests, and you may receive acupuncture at some point.”
Then they completed demographic questionnaire and informed
consent forms. All subjects completed STAI forms Y-1 and Y-2.
After this, all subjects laid on a treatment table.
Subjects randomized into the acupuncture group and then
received acupuncture according to clean needle technique (CNT)
from an experienced, licensed acupuncturist at: Sishencong (EXHN1), Shenting (GV24), Yintang (EX-HN3), Shenmen (Ht7),
Neiguan (PC6), and Taixi (Kd3). All treatments were administered
by the same acupuncturist. Sishencong (EX-HN1), Shenting
(GV24) and Yintang (EX-HN3) were needled with DBC Spring
needles size 15 mm long and 0.20 mm thick. Neiguan (PC6),
Shenmen (Ht7), and Taixi (Kd3) were needled bilaterally with
DBC Spring needles size 30 mm long and 0.20 mm thick. The
needles were inserted with even method to the depths specified in
the Manual of Acupuncture by Peter Deadman and Mazin Al-Khaf31
and were retained for 20 minutes. There was no requirement for
needling sensation to be obtained. After 20 minutes, the needles
were removed and disposed according to CNT.
Acupoints were chosen in an effort to calm the spirit and improve
cognition. According to the Manual of Acupuncture, Sishencong
10
T h e A m e r i c a n A c u p u n c t u r i s t Summer 2013
(EX-HN1) benefits the eyes and ears, calms the spirit, and is
indicated for treating poor memory. Shenting (GV24) benefits the
brain and calms the spirit. Additionally, the GV channel travels to
and through the brain. Yintang (EX-HN3) calms the spirit and is
indicated to reduce anxiety and agitation. Shenmen (Ht7) calms
the spirit, regulates and tonifies the Heart, and is indicated for
poor memory, fear, and fright. Additionally, the Heart organ is the
house of the spirit. Neiguan (PC6) is indicated for poor memory,
apprehension, fear and fright. Taixi (Kd3) was chosen because of
the kidney’s association with the marrow and brain and because its
low position on the body balances the effect of all the points on the
upper body. In this treatment, Tai Xi (Kd3) was chosen to ground
the treatment and the patient’s consciousness.31
Subjects in the control group were instructed to lay on the
same table for 20 minutes. The same acupoints were touched and
swabbed with cotton and alcohol, but no needles were inserted into
the subjects. They were not led to believe that they were receiving
acupuncture at this point, but they were not certain that they
would not receive acupuncture later in the session. The amount
of verbal and physical contact was consistent between groups,
as Finness et al. have shown that differences in these areas can
establish a placebo effect and alter outcomes.32
Care was taken to reduce the likelihood that control subjects
would know that they were in the control group. When control
subjects were presented with the AOSPAN, they were told, “Now
we will have you take the first memory test.” This was intended to
raise the possibility in subjects’ minds that they might still receive
acupuncture and take the test again. After this variable period,
all subjects completed the STAI Y-1 again (to see if subjects were
more relaxed than before the intervention) and then completed the
AOSPAN. To motivate subjects to use their best effort, they were
told that a strong performance on the memory tests would enter
them into a drawing for a cash prize.
This study protocol was approved by the Institutional Review
Board of the National University of Health Sciences. Clinical Trial
ID = NCT01492738.
Statistical Analysis
The unpaired t-test was used to compare mean values between
groups and subgroups. Regression analysis was used to examine
interactions between SA, TA, and all parameters of AOSPAN
performance.
Acupuncture Improves Working Memory and Reduces Anxiety: A Report of a Randomized, Clinical Trial
Results
Ninety subjects met inclusion criteria and participated. The control
group had 46 subjects (22 males, 24 females) and a mean age of
21.3 years. The acupuncture group had 44 subjects (16 males, 28
females) and a mean age of 20.5 years. There were no significant
differences in gender makeup or age between the two groups.
Results are presented as Mean Value ± Standard Deviation. Results
were deemed significant with a p-value < 0.05. There were no
adverse effects reported by any participants. All tables are taken
from the aforementioned article in the Journal of Acupuncture and
Meridian Studies.
STAI
The STAI provided numeric values for: Initial State-level anxiety
(SA1), Trait level anxiety (TA), and State-level anxiety after the variable period (acupuncture or rest, SA2). The difference between SA1
and SA2 was calculated and termed SA. There were no significant
differences in SA1 or TA between groups. The mean SA2 was
significantly lower in the acupuncture group vs. the control group
(26.14 ± 4.5 compared to 29.63 ± 8.2, p=0.0146).
STAI State-Anxiety Score After Intervention
Figure 1: Mean State-Level Anxiety After Intervention (SA2)
The values obtained for TA ranged from 23 to 63. Using a median
split, subjects with TA below 43 were classified as Low-Anxious (LA,
n=62) and those with TA at or above 43 were considered as HighAnxious (HA, n=28). Within the acupuncture group, the reduction
in SA ( SA) was greater for those considered to be HA (9.93 ± 6.40,
n=14) compared to those considered LA (6.53 ± 5.02, n=30), but this
was not quite statistically significant (p= 0.0623).
AOSPAN
The AOSPAN provided numeric values for Total Correct Score of letter
memory, Absolute Score of letter memory, Total Number of Math
Errors, Math Speed Errors, and Math Accuracy Errors. The highest
possible Total Correct and Absolute Correct score were each 75.
Subjects who received acupuncture performed better than the control
on the AOSPAN. The Total Correct Score for the acupuncture group
was 9.5% higher than those in the control group (65.39 ± 7.38 compared to 59.70 ± 13.12, p=0.0134). Mean AOSPAN Absolute Score
was 45.87 ± 18.36 in control group and 52.20 ± 14.28 in acupuncture
group (p=0.072). For the subgroup of males, AOSPAN Absolute Score
was 44.14 ± 16.73 in the control group (n=22) and 55.13 ± 15 in the
acupuncture group (n=16, p=.044). The acupuncture group committed 36% fewer math errors than the control group (2.68 ± 2.3 vs. 4.22
± 3.44, p=0.0153). The mean number of math speed errors was 1.24
± 1.59 in the control group and 0.80 ± 1.3 in the acupuncture group
(p=0.153). The mean number of math accuracy errors was 2.98 ± 2.52
in the control group and 1.89 ± 1.71 in p (p=0.0188).
Figure 2: AOSPAN Total Correct Score
P=0.0146
AOSPAN Total Correct Score
Control
Acu
Control
Acu
(SA2 values for Control and Acupuncture group. Bars represent Standard
Error of Measurement (SEM) of 1.21 and 0.67 for Control and Acupuncture
groups respectively. Acupuncture group had 12% lower anxiety than Control
group after the variable period.)
Mean SA1 was 35.98 ± 7.26 in the control group and 33.75
±7.14 in the acupuncture group (p=.146, not significant). Mean TA
was very similar between groups: 38.46 ± 10.6 in the control group
and 37.86 ± 10.39 in the acupuncture group (p=.789, not significant). The mean SA was -6.35 ± 7.49 in the control group and
-7.61 ± 5.65 in the acupuncture group (p=0.33, not significant).
(AOSPAN Total Correct Scores for Control and Acupuncture groups. Bars
represent SEM of 1.93 and 1.11 for Control and Acupuncture groups respectively.
Acupuncture group scored 9.5% higher than Control group.)
 
The American Acupuncturist
11
Acupuncture Improves Working Memory and Reduces Anxiety: A Report of a Randomized, Clinical Trial
“Taken as a whole, males performed worse
than females on every measure of the
AOSPAN. But when broken down into
acupuncture and control groups, males
who received acupuncture outperformed
females on nearly every measure.”
AOSPAN Total Number of Math Errors
Figure 3: AOSPAN Total Number of Math Errors
Control
Acu
Table 2: AOSPAN Performance by TA among Control and
Acupuncture Groups (Mean)
Absolute
Correct
P=0.0153
(AOSPAN Total Math Errors for Control and Acupuncture groups. Bars represent
SEM of 0.51 and 0.39 for Control and Acupuncture groups respectively.
Acupuncture group committed 36% fewer math errors than Control group)
Regression analysis was performed. There were no significant
correlations found between: SA1 and AOSPAN performance, TA
and AOSPAN performance; SA2 and AOSPAN performance;
SA1 and SA; nor between SA and AOSPAN performance.
Other trends
UÊÊÊÊ*ÀiۈœÕÃÊÀiÃi>ÀV…Ê…>ÃÊŜܘÊ̅>ÌÊÃÕLiVÌÃÊ܈̅ʅˆ}…Ê/Ê«iÀvœÀ“Ê
worse on tests of WM.15,33,34 This study confirmed these results.
Subjects with low TA outperformed subjects with high TA on all
parameters of the AOSPAN; but that difference was much less
pronounced in the acupuncture group.
Table 1: AOSPAN Performance by TA (Mean)
Absolute
Correct
Total
Correct
Total
Math
Errors
Speed
Errors
Accuracy
Errors
LA
(n=62)
50.45
(± 16.74)
63.44
(± 9.96)
3.19
(± 2.49)
0.92
(± 1.26)
2.27
(±1.93)
HA
(n=28)
45.68
(± 16.45)
60.36
4.07
(± 12.99) (± 3.96)
1.25
(± 1.86)
2.82
(± 2.75)
Difference
-4.77
(9.45%)
-3.08
(4.8%)
+ 0.33
(+36%)
+ 0.55
(+.24%)
+ 0.88
(+27%)
Using a median split, subjects with TA below 43 were classified as Low-Anxious
(LA) and those with TA of 43 or above were classified as High-Anxious (HA).
LA individuals, as a whole, outperformed HA individuals on every measure,
although the results are not statistically significant.
12
T h e A m e r i c a n A c u p u n c t u r i s t Summer 2013
Total
Correct
Total
Math
Errors
Speed
Errors
Accuracy
Errors
LA
(n=32)
47.59
(± 17.84)
61.31
(± 11.53)
3.56
(± 2.37)
0.91
(± 0.10)
2.66
(±1.94)
HA
(n=14)
41.93
(± 19.59)
56
(± 15.99)
5.71
(± 4.92)
2.0
(± 2.35)
3.71
(± 3.47)
Difference
- 5.96
(-11.8%)
-5.31
(-8.6%)
+ 1.86
(60.4%)
+ 1.09
(120%)
+ 1.05
(39.5%)
LA
(n=30)
53.50
(± 15.19)
65.70
(± 7.50)
2.80
(± 2.59)
0.93
(± 1.51)
1.87
(±1.87)
HA
(n=14)
49.43
(± 12.15)
64.71
(± 7.35)
2.43
(± 1.60)
0.5
(± 0.65)
1.93
(± 1.38)
Difference
-4.07
(-7.6%)
-0.99
(-1.5%)
-0.37
(-13.2%)
-0.4.3
(-43%)
+ 0.06
(3.2%)
This chart compares Control Group LA subjects to Control HA and compares
Acupuncture LA to Acupuncture HA. The impairment in performance
observed in HA subjects compared to LA subjects was much less for the
Acupuncture group than for the Control Group, although this difference was
not statistically significant.
UÊÊÊ/…iʈ“«ÀœÛi“i˜ÌÊvœÕ˜`ʈ˜Ê̅iÊ>Vի՘VÌÕÀiÊ}ÀœÕ«ÊÜ>ÃʓœÀiÊ
pronounced for males than for females. Taken as a whole, males
performed worse than females on every measure of the AOSPAN.
But when broken down into acupuncture and control groups,
males who received acupuncture outperformed females on nearly
every measure.
Acupuncture Improves Working Memory and Reduces Anxiety: A Report of a Randomized, Clinical Trial
Table 3: AOSPAN Gender Differences (Mean)
Absolute
Correct
Total
Correct
Total
Math
Errors
Speed
Errors
Accuracy
Errors
Female
(n=52)
49.12
(± 16.84)
62.71
(± 10.26)
2.96
(± 2.32)
0.78
(± 0.89)
2.17
(± 1.89)
Male
(n=38)
48.76
(± 16.75)
62.16
(± 12.10)
4.16
(± 3.72)
1.34
(± 1.98)
2.82
(± 2.59)
Total math errors male vs. female p = 0.0638
Math speed errors male vs. female p = 0.0772
Why No Sham (Placebo) Group
AOSPAN performance by females compared to males. As a whole, females
outperformed males on every measure of the AOSPAN, although not to the
point of statistical significance.
Table 4: AOSPAN Performance by TA among Control and
Acupuncture Groups (Mean)
Absolute
Correct
Total
Correct
Total
Math
Errors
“This research shows only the shortterm effects of one acupuncture
treatment. Future study should
investigate: A) how long these effects
last and B) how much more effective a
course of treatment may be compared
to just one treatment.”
Speed
Errors
Accuracy
Errors
Female
Control
(n=25)
47.46
(± 19.97)
60.58
(± 12.62)
3.04
(± 2.26)
0.83
(± 0.70)
2.21
(± 1.93)
Female
Acu (n=27)
50.54
(± 13.84)
64.54
(± 7.48)
2.89
(± 2.41)
0.75
(± 1.04)
2.14
(± 1.88)
Difference
+ 3.08
(6.4%)
+ 3.96
(6.5%)
- 0.15
(-4.9%)
- 0.08
(-9.6%)
- 0.7
(-3.2%)
Male
Control
(n=22)
44.14
(± 16.73)
58.73
(± 13.83)
5.5
(±4.07)
1.68
(± 2.12)
3.82
(± 2.84)
Male Acu
(n=16)
55.13
(± 15.01)
66.88
(± 7.21)
2.31
(± 2.15)
0.88
(± 1.71)
1.44
(± 1.31)
Difference
+ 10.99
(24.9%)
+ 8.15
(13.9%)
- 3.19
(-58%)
- 0.80
(-47.6%)
- 2.38
(-62.3%)
Absolute score for Male Control vs. Male Acu P=0.0442
This chart compares AOSPAN performance by Control females to
Acupuncture females and compares Control males to Acupuncture
males. The improvement in AOSPAN performance for subjects receiving
acupuncture was more pronounced for males than for females.
Sham acupuncture does not exist. Placebo acupuncture is not
an inert intervention. The two most common methods for
administering sham acupuncture are superficial needling or
“off-site” needling, both of which have been shown via functional MRI to have measurable effects. Placebos are supposed
to have no effect at all, but sham acupuncture does not meet
this criteria.
Some studies have shown that sham acupuncture is as
effective as verum (true) acupuncture and that both are more
effective than placebo medication.35–37 Other studies have
shown that the addition of either verum or sham acupuncture
to standard medication provides superior benefit than standard
medication alone but that the addition of verum acupuncture
affects greater benefit than sham.38,39 Others have shown that
while both sham and verum may be helpful, they may work
through different biomechanisms.40 At least one study even
reported that sham acupuncture was more effective than
verum.37 Clearly, these techniques are not inert. Lundeberg
et al. reviewed the literature regarding “placebo” acupuncture
and concluded that it does not serve to elucidate acupuncture’s
effects but rather introduces a potential bias which interferes
with understanding its true effects.41
Discussion
This study shows that acupuncture improves memory and
reduces anxiety but that those effects are not correlated. It was
not the case that the subjects with the lowest anxiety performed
best nor was it the case that those with the greatest reduction
in anxiety performed best. These two effects were not related.
This suggests that acupuncture improves performance in WM
through another mechanism than merely reducing anxiety.
This study validates previous research showing that acupuncture reduces anxiety and improves memory. This research is
unique, however, in that it is the first study to show that one
acupuncture treatment has a measurable improvement on WM.
continued on page 32
 
The American Acupuncturist
13
Clinical Therapeutic Effect
of “Ji Liu Nei Xiao Pill” for
Uterus Fibroid
By Tang Ling, Wang DongMei, Gu HuiXia, Liu Li, Wang
XanXia, He ZhiPing, Beijing University of Chinese
Medicine, Dong Zhi Men Hospital, Beijing, China
Published in World Chinese Medicine, 2012,7(5)
Translated by Doreen G.F. Chen, MD, CMD, LAc
Doreen Guo-Fong Chen, MD, CMD, LAc received eight
years of Western medical education in the U.S. and
China. In 1960, she graduated from the advanced class
for Western MDs to study CM assigned by the Chinese
Ministry of Health. In 1980, Dr. Chen was a visiting scholar
at the Department of Pediatric Cardiology of the New
York Hospital. In 1985, Dr. Chen obtained the New York
State acupuncture license and operated three clinics. Dr.
Chen is a strong advocator for integrative medicine. She
took the first and second term as the president of the
United Alliance of NY Licensed Acupuncturists (UANYLA).
She is a long-time supporter and member of AAAOM
and is honorary chair of the Chinese Advisory Council
of AAAOM. She is also a senior advisor to the World
Federation of Chinese Medicine Societies.
14
T h e A m e r i c a n A c u p u n c t u r i s t Summer 2013
Uterus fibroid (UF) is an overgrowth of the smooth
muscle on the uterus, which is considered as a benign
tumor. It contains fibroid tissue and becomes hard. It
is a commonly seen tumor in the female reproductive
system,1 and its occurrence rate remains high2. It
often causes heavy menstruation and a prolonged
menstrual period3 that can affect a woman’s daily life.
Meantime, modern Western medicine (WM) has
applied use of anti-estrogen medication or surgical
removal of the uterus, but this has not resolved the
root of the problem and the chances of re-occurrence.
In addition, side effects of the medicine and high
medical expenses are a problem. Therefore, finding
an effective, reasonable, and low cost therapeutic
treatment is important and practical.
In Chinese medicine (CM), there is no such diagnostic term
as “uterus fibroid,” but it belongs to the gynecological category
described as “Zhen Xia” (mass in abdomen), “Tai Xi” (morbid
leukorrhea), “Beng Lou” (metrostaxis), etc. Professor Xiao ChenZong has stated his principle and strategy of treatment using
CM for UF as ”Benefit the Qi; Remove the Stasis,” which is a
combination strategy of nourishing and attacking, i.e., put the
nourishing in the attacking, while putting the attacking on top of
the nourishing. Prof. Xiao has developed a herbal formula in pill
form called “Ji Liu Nei Xiao.” It has achieved a good therapeutic
effect on UF and has been broadly used in China.
In our hospital research clinic, we have studied 60 cases of UF
patients from November 2010 to September 2011. The following is
our report of the results:
I) Material and Method:
1.1 Clinical material: The 60 cases of UF were collected randomly
and divided into two groups. Thirty cases were in the CM
treatment group and 30 cases were in the WM treatment
group. Both groups were treated according to the standards
for diagnosis and therapeutic effectiveness from both the WM
national standards and the “the principle of clinical guidance
in new products in CM.” These 60 cases had been clinically
examined by gynecologists and examined by color Doppler
ultrasound to measure the inner and outer size of the UF and to
study the circulation flow image (CDFI).
1.2 In reference to the 2002 issue of “The Clinical Research
Guidance to CM” and according to CM diagnostic standard,
the establishment of diagnosis for UF was as follows: a) irregular menstruation, including delayed, prolonged, or abnormal
period; b) fatigue and tiring easily; c) menstruation with dark
color and blood clots; d) loose stool; e) tongue color dark red,
tongue body fat coated with white or yellowish coating, and
teeth marks on the side edge of the tongue; f ) pulse deep and
threaded or sticky. A patient had to manifest 4 of these agreed
items among the 6 items plus the ultrasound or Doppler exam
to confirm a diagnosis of UF before their case could be included
in the study. The age of the CM group ranged from 23 to 45
years old, averaging 40.2 yrs. The age of the WM group ranged
from 19 to 44 years old, averaging 40.7 yrs. The course of treat-
ment had to be at least eight weeks. The information collected
from the two groups was not much different (P<0.05), which
indicated its comparability.
1.3 Treatment method: The CM treatment group was given 6gm
of the “Ji Liu Nei Xiao” pills (manufactured by Dong Zhi Men
Hospital) twice a day. If the patient’s menstruation was too
heavy during the period, she would stop taking the pills for a
few days. One month constituted a course of treatment. Each
group received three months of treatments. The WM treatment
group was given oral Mefestone (manufactured by the Ju Su
You Chow pharmaceutical company, no. 120090137) 0.5gm
each time, three times a day (best taken one half hour before the
three meals), also with a total treatment time of three months.
1.4 Standard for evaluation: Before and after the three month
course of treatment of patients in each group, every patient
was given a gynecological examination. This included color
Doppler circulation flow image (CDFI) and a high sensitive
color Doppler image exam to measure the size of the uterus and
the size of the fibroid body (using formula 4 abc/3cm³ for
calculation, and also using abc to indicate the 3 dimensions of
the radius of the measurement). These were then graded into
four results for record: 1) no change as ineffective, 2) fibroid
shrunk <50% as effective, 3) fibroid shrunk >50% as significantly effective, 4) fibroid totally disappeared as cured.4
1.5 Statistical calculation: Double person double time calculation
for input figures applied SPSS 13.0 statistic software method to
calculate the P value, with double examination. If the P value
was <0.05, this would be considered as statistically significant.
II) Final Results:
The comparison of the treatment results of the two groups was statistically significant (P<0.05).
This indicated the CM treatment group has a better effective rate (see chart).
Group
cases
cured
CM Treatment
30
8
WM Treatment
30
4
* P value <0.05
x²=4.36
significantly effective
no effect
total effectiveness
18
4
86.67%*
15
11
63.33%
Discussion
“In the book Lin Shu (“The Origin of
an Illness”), it is stated that anything
accumulated at the beginning must
be because the body itself was weak.
Therefore, any outside intruder will
come to attack.”
UF is a commonly seen issue in women’s reproductive organs (90%
in the uterus body, 8% in the uterus neck). Research has indicated
that the occurrence and growth of the UF was closely related to the
level of estrogen and progesterone.5 Most scholars believe that using
anti-estrogen or suppressing progesterone was the main approach of
treatment, especially the use of Mefestone, which, when combined
with the PR in our body, could completely suppress the biological
reaction of progesterone. Also, by suppressing the estrogen through
the biofeedback mechanism of the axis of middle brain-pituitarysex gland, you could suppress the growth of the UF.6
 
The American Acupuncturist
15
Clinical Therapeutic Effect of “Ji Liu Nei Xiao Pill” for Uterus Fibroid
That was the Western medical approach, but it did not solve all
of the problems. There were still the issues of side effects, recurrence, and the high medical expenses.
Although there were no diagnostic terms for UF, UF has, as
previously indicated above, belonged to the CM category as “Zhen
Xia,” “Tai Xia,” and “Beng Lou.” In the book Lin Shu (“The
Origin of an Illness”), it is stated that anything accumulated at the
beginning must be because the body itself was weak. Therefore, any
outside intruder will come to attack. It starts from the outside layer
of the body, then progresses to the inner layer through the vessels
or channels(经络), then deeply further into the “Fu Chong (伏
冲),” then at the outside of the organs of the body, including the
gastrointestinal, urinary, and reproductive organs, finally reaching
the inter space of the origin “Mu Yuan”(募原).
The theory of “the evil Qi invaded from the outer shallow layer
then proceeds into the inner deeper organs” has its practical meaning and makes common sense. So in CM the earliest documentation of the pathogenesis of illness stated that “it is the accumulation
of evil Qi due to the weakness of the righteous Qi.” The same
book also states, “a strong healthy person has no accumulation of
evil Qi, but when that person gets weak in his/her righteous Qi,
then illness will happen” and “stasis blood accumulated will become
a lump and mass, then eventually become like a rock (Zhen).” This
often happens in women and especially applies to the menstrual
period.
The anger hurts the liver, the rebellion Qi causes blood stasis;
worry and depression hurts the spleen and weakens the Qi flow
that will cause stagnation of the blood. If the remaining blood does
not clean up and remains in the body then from time to time it
accumulates and builds up to become a lump or tumor. So this is
the theory in CM for the pathogenesis of the UF.
Professor Chen-Zong Xiao, based on his numerous years of
clinical experiences and the theory for the pathogenesis of UF in
CM, developed the “Ji Liu Nei Xiao” pills for the treatment of UF.
His basic principle of his treatment is to nourish and strengthen the
Qi and to activate the blood flow so as to resolve the stagnation of
blood and ultimately to dissolve the fibroid. His strategy is to combine the nourishing in the attacking, while putting the attacking
on top of the nourishing. Professor Xiao researched and developed
this “Ji Liu Nei Xiao” pill for the treatment of UF, which has now
clinically gained good results and has been popularized in China.
The basic herbs in “Ji Liu Nei Xiao Pill 肌瘤内消丸” are:
鬼箭羽 Ramulus Euonymi
生牡犡 Raw Oyster Shell
生首乌 Polygonacese
Nourish the blood, resolve swollen,
dissolve lump.
荔枝核 Litchi Seed
Move the Qi, dissolve lump
黄芪
Nourish the Qi, move the
stagnation
Astragalus Root
川牛夕 Achyranthes Root
Connect to the Right People and
Opportunities with
NYCC’S CAREER
OPPORTUNITIES DATABASE...
16
Move the blood, resolve stagnation; nourish kidney
Combining these herbs can take care
of the weakness and the strong. Treat the
disease by looking into both its root cause
and symptoms.
References:
1. Liu XiuFong. Clinical observation of CM differential
diagnosis in assistance to WM treatment in UF. Liao
Ning Journal of CM. 2011;38(6):1160.
2. Wan Min, Observation of 30 cases of UF underwent
radioactive knife surgery under the ultrasound guidance.
Report from Bon Fu Medical College. 2007;32(4):449.
FREE!
For more information:
PHONE: 1-315-568-3039
WEB SITE: www.nycc.edu
} Dissolve blood stasis, nourish the
Ying and
制鳖甲 Cocked Turtle Shell } Clean the heat
THE CAREER CONNECTION
Finger Lakes School of
Acupuncture & Oriental Medicine
of New York Chiropractic College
Career Development Center
Promote blood circulation, dissolve
blood stasis, Soften the hard,
resolve the lump
3. Dou Shao Li, Dian Jing, et al. Clinical Analysis of 46
cases of UF underwent electric knife surgery. China
Journal of Endoscopy. 2011;17(8):888.
Sell your Acupuncture Practice
Hire an Acupuncture Associate/IC
Sell Acupuncture Equipment
Rent Acupuncture Office Space
Send postings by:
FAX: 1-315-568-3566
E-MAIL: [email protected]
T h e A m e r i c a n A c u p u n c t u r i s t Summer 2013
4. Chen Quan Xing. Clinical Effectiveness of Mifistone
with Gui-Zhi,Fu-Ling capsule in the treatment of UF.
Report from Tai San Medical Hospital. 2009;30(3):209.
5. Xia L, Coon JS et al. Regulates Growth of Uterine
Leiomyoma Smooth muscle cells. Reprod. Sci.
2010;17(9):791-797.
6. Gun Zong Hua. Clinical observation of small dosage of
mifistone in the treatment of UF. Sang Dong Medicinal
Medica. 2011;51(18):89.
A Study on Scientific Writing:
The Materials and Methods Section
By Jennifer Stone, LAc, Editor in Chief
A scientific paper is usually comprised of these sections:
Abstract
Introduction
Materials and Methods
Results
Discussion/Conclusion
Acknowledgments
Literature Cited
Scientific writing is direct and orderly. The materials and methods section structure should:
ÊÊÊUÊÊÊÊDescribe in detail the materials used in the study and include all tools: needles, herbs, surveys and questionnaires. (It’s not
necessary to include all questions in the questionnaire if it is a proven measure previously used in research (ex. SF-MPQ, FACIT, etc.)
ÊÊÊUÊÊÊÊiÃVÀˆLiÊ̅iʅՓ>˜ÊÃÕLiVÌÃ]Ê>}i]Êiˆ}ˆLˆˆÌÞÊVÀˆÌiÀˆ>]Ê`i“œ}À>«…ˆVÃ]ÊiÌV°
ÊÊÊUÊÊÊÊvÊޜÕÊ`ˆ`Ê>Êwi`ʜÀÊÃÕÀÛiÞÊÃÌÕ`Þ]Ê«ÀœÛˆ`iÊ>Ê`iÃVÀˆ«Ìˆœ˜ÊœvÊ̅iÊÃÌÕ`ÞÊÈÌi]ʈ˜VÕ`ˆ˜}Ê̅iÊ«ÀiVˆÃiʏœV>̈œ˜]Ê̜ܘ]ÊÃÌ>ÌiÊ>˜`ÊVœÕ˜ÌÀÞ°ÊÊ
If an online internet survey was used, include details on who received the surveys, inclusion/exclusion criteria, how many
surveys were sent out, how many were completed and returned, how many were included in the data analysis.
ÊÊÊUÊÊÊÊvÊ̅iʓ>˜ÕÃVÀˆ«ÌʈÃÊ>ʓiÌ>‡>˜>ÞÈÃʜÀÊÀiۈiÜ]ʈ˜VÕ`iÊ̅iÊÃi>ÀV…Êi˜}ˆ˜iÃÊ>˜`ÊÃVˆi˜ÌˆwVÊ`>Ì>L>ÃiÃÊ̅>ÌÊÜiÀiÊÃi>ÀV…i`Ê>˜`Ê̅iÊ
inclusion/exclusion criteria for the studies that were discussed in the results section.
ÊÊÊUÊÊÊÊÝ«>ˆ˜Ê…œÜÊ̅iʓ>ÌiÀˆ>ÃÊÜiÀiÊÕÃi`ʈ˜Ê̅iÊÃÌÕ`Þ
ÊÊÊUÊÊÊÊiÃVÀˆLiÊ̅iÊÀiÃi>ÀV…Ê«ÀœÌœVœ°Ê˜VÕ`iʅœÜÊÃÕLiVÌÃÊÜiÀiÊÀ>˜`œ“ˆâi`Ê­iݰʘՓLiÀÃÊ«ˆVŽi`ʜÕÌʜvÊ>ʅ>ÌʜÀÊLœVŽÊ
randomization). Include controls, treatment, variables that were measured, etc.
ÊÊÊUÊÊÊÊÝ«>ˆ˜Ê…œÜÊ̅iÊ`>Ì>ÊÜiÀiÊVœiVÌi`]ʅœÜʓi>ÃÕÀi“i˜ÌÃÊÜiÀiʓ>`i]Ê>˜`Ê܅>ÌÊV>VՏ>̈œ˜ÃÊÜiÀiÊ«iÀvœÀ“i`Ê
ÊÊÊUÊÊÊÊ-Ì>ÌiÊ܅ˆV…ÊÃÌ>̈Ã̈V>ÊÌiÃÌÃÊÜiÀiÊ`œ˜iÊ̜Ê>˜>ÞâiÊ̅iÊ`>Ì>
The materials and methods section should always be written in past tense and in 3rd person. The description of preparations,
measurements, and the protocol should be organized clearly and chronologically. Only include information relevant to the
description of the materials and methods. Do not include any personal thoughts in this section; only describe what took place.
Personal thoughts should be reserved for the discussion section.
A materials and methods section should clearly explain the details of the study so that another researcher can read the manuscript
and replicate the study exactly.
In acupuncture research, remember to describe what brand of needle was used including: manufacturer, length and gauge, points
used, how the treatment was determined, depth of insertion, style of needling, length of time needles were retained, etc.
Example: Six acupuncture needles, Seirin Corp., Shizuoka, Japan, No. 3(0.20) x 30mm were inserted bilaterally into acupoints San
Yin Jiao (SP6), Zusanli (ST36), and Tai Xi (KI3) at a depth of 1.5cm and gently rotated until daqi was observed. Needles were retained
for 20 minutes. Acupoints were chosen through consensus by a group of 4 TCM experts, each with over 20 years of TCM practice.
When describing an herbal formula, include the formula name if it is a patent herb formula. Also include the brand, manufacturer,
dose, and each individual herb included in the formula. Some writers choose to list the indications for the herbal formula or each
herb or acupoint although it is not necessary. If a writer chooses to list indications, it should not be listed in the materials and
methods section. Indications should be reserved for the introduction or discussion section. Remember, the materials and methods
section is a description of exactly what was done and how it was done so another researcher can duplicate the protocol exactly.
continued on page 36
 
The American Acupuncturist
17
Society for Acupuncture Research 2013 Conference:
Public Health Aspects
By Elizabeth Sommers, PhD, MPH, LAc
As the acupuncture and Oriental medicine (AOM)
profession evolves in the U.S. and internationally,
so do the corresponding research paradigms. It was
inspiring and gratifying to see the variety of approaches
to research and evaluation presented at the April
2013 Society for Acupuncture Research International
Conference held in Ann Arbor, Michigan. In addition
to presentations on both clinical studies and other
more advanced concepts concerning the mechanisms
of acupuncture, the conference incorporated a
variety of public health-related perspectives, such
as studies of the economics of acupuncture, factors
influencing utilization (e.g., transportation issues,
sociodemographics, need for care), and comparative
effectiveness research. These diverse approaches more
fully inform us about the nature of acupuncture as it
is practiced “on the ground” in clinical settings and in
communities.
Presentations spanned the spectrum of acupuncture research—
from the cellular (micro) level to the population (macro) level. This
diversity of perspectives gives us a more comprehensive understanding and appreciation of acupuncture. In addition to the ongoing
process of continuous improvement of treatment, these innovative
approaches to understanding and describing acupuncture lend
themselves to the broader medical and public health community.
Going beyond the randomized clinical trial paradigm, studies on
utilization can edify us about who uses acupuncture and why they
seek this type of treatment.
Economic evaluations provide information for policymakers,
insurers, and other third party payers. These types of studies enable
health departments to better determine the cost benefits related
to acupuncture. At a time when healthcare dollars are more scarce
and hotly debated, evidence about cost savings associated with
acupuncture is crucial.
These types of approaches have been developed through health
services research, which is based on principles of public health.
Although public health is sometimes misinterpreted as charity
for the poor, it is more appropriately viewed as being related to
improving the general health and well-being of society. The three
basic tenets of public health—access, affordability, and acceptability
of care—are used as the bases for determining how to best study
and evaluate any treatment or intervention. Health services research
examines all levels of an intervention (effectiveness, acceptance,
cost) in order to provide a thorough picture of evidence that can be
used by policymakers.
In his keynote speech, “The Elusive Nature of Facts and the
Subtle Effects of Power: Why We Need More Than the Natural
Sciences for Acupuncture Research,” Volker Scheid, PhD made an
eloquent argument for appreciating the contributions of medical
humanities to acupuncture research. His thesis supported the need
for truly holistic and comprehensive investigation of the underlying
assumptions and goals of research. In other words, just as we have
learned the principles of traditional Asian medicine and how to
use them in the clinical
setting, we can further
develop and refine
our understanding
by learning how to
be better informed
readers, consumers, and
architects of research.
A panel discussion
entitled “Impact of
Acupuncture Research
on 21st Century Health
Care” included remarks
(Left to right): Angela Tu, Deborah Lincoln, Jennifer Stone, Doreen Chen, Joanna Zhang. Photo by Buffalo Child
18
T h e A m e r i c a n A c u p u n c t u r i s t Summer 2013
from Kristen Huntley, PhD; Wayne Jonas, MD; Lixing Lao, PhD,
MD; Volker Scheid, PhD and Claudia Witt, MD. Discussants
reviewed a variety of perspectives that contribute to today’s
understanding of acupuncture research. These perspectives range
from federal (National Institutes of Health and National Center for
Complementary and Alternative Medicine), public health, military
medicine, epidemiology, and anthropology.
Although issues such as these are sometimes confined to a certain
niche at AOM conferences, Society for Acupuncture Research
organizers effectively and strategically integrated public health
concerns into the fabric of the conference. International colleagues
in Europe, Canada, and Australia provide foundations and directions for further development of them. Some of these contributions
were evident at this conference, making it truly visionary for our
profession.
Elizabeth Sommers, PhD, MPH, LAc is director of research
and education at Pathways to Wellness in Boston, MA. She is
on the faculty at Boston University School of Public Health in
Health Policy and Management and co-chairs the American
Public Health Association’s group on Complementary and
Alternative Health Practices. She
has published numerous papers on
public health aspects of acupuncture. Areas of interest include
acupuncture studies related to
health economics, recovery from
substance use, and promoting
health for people living with HIV/
AIDS. She was guest co-editor for
the 2013 public health issue of the
European Journal of Integrative
Medicine.
(Left to right): Robert Davis, Helene Langevin, Ryan Milley, Rosa Schnyer, Deborah Lincoln, Jennifer Stone.
Photo by Buffalo Child
Enhancing the profession by–
Protecting acupuncture scope of practice
Increasing public and professional awareness
Providing discounted CEUs on educational conferences
Offering business support resources
Providing discounts to AOM vendors
Since 1981, AOM practitioners have fought for what our profession has
achieved today. As a member of your national professional organization,
you will be supporting our continued efforts. You sacrificed a lot for your
right to practice; make those sacrifices mean something—advance the
profession by joining today!
Join the AAAOM today!
aaaomonline.org
1-866-455-7999
The American Association of Acupuncture
and Oriental Medicine offers you the
opportunity to have all of this.
 
The American Acupuncturist
19
Selection of Clinical Research Abstracts Presented at the 2013
Society for Acupuncture Research Conference: Impact of
Acupuncture Research on 21st Century Health Care
By Jennifer Stone, LAc, Editor in Chief
Approximately 200 researchers representing over
30 countries gathered to present their data at the
Society for Acupuncture Research 2013 International
Conference: Impact of Acupuncture Research on 21st
Century Health Care held this past April in Ann Arbor,
Michigan. Thirty-two oral presentations were featured,
and over 100 posters were presented. The following is a
sampling of the abstracts of the oral presentations.
Clinical Research Abstracts:
Acupuncture in Patients with Seasonal Allergic Rhinitis Results
of a Randomized Controlled Trial, presented by Benno Brinkhaus,
Institute for Social Medicine, Epidemiology, and Health Economics,
Charité University Medical Center, Berlin
Brinkhaus and colleagues conducted this three group randomized, controlled trial involving 422 patients suffering from seasonal
allergic rhinitis. The study interventions were acupuncture plus
rescue medication (RM, Cetirizine) (n=212), sham acupuncture plus RM (n=102), or rescue medication alone (n=108).
Acupuncture led to improvements in disease-specific quality of
life and antihistamine intake after 8 weeks of treatment compared
to sham acupuncture and rescue medication alone in the first and
second year.
A Randomized Comparative Effectiveness Clinical Trial of
Acupuncture as an Adjunctive Therapy in Patients with
Depression, presented by Lin lin Sun, Beijing University of Chinese
Medicine, and colleagues
Dr. Sun and colleagues examined whether acupuncture plus the
antidepressant paroxetine is more effective than paroxetine alone
in patients with depression. Eighty-eight patients were randomized into three groups: electroacupuncture (EA), EA + paroxetine
(Paxil), and paroxetine alone. The results indicated that acupuncture as an adjunctive therapy for patients with depression may be
both safe and more effective than pharmaceuticals alone.
Management of Gulf War Syndrome Symptoms with
Acupuncture: Report on Preliminary Findings of an Ongoing
Waitlist Control RCT, presented by Lisa Conboy, New England
School of Acupuncture
Conboy and colleagues conducted a preliminary analysis of
symptom improvement in GWI veterans associated with acu20
T h e A m e r i c a n A c u p u n c t u r i s t Summer 2013
puncture treatment. A preliminary analysis of symptom improvement
comparing baseline scores to 6 month data collection indicates statistically significant improvements in the severity of veterans’ self reported
main (p<0.01) and secondary (p<0.009) complaints.
How Acupuncturists and Physicians View the Presence of In-Patient
Acupuncture Care at Beth Israel Medical Center: A Qualitative
Phenomenological Study, presented by Basia Kielczynska, Beth Israel
Medical Center, New York
Kielczynska and colleagues surveyed the “living experience” of
acupuncturists while they provided acupuncture inpatient care and
interacted with medical staff in a hospital-based acupuncture fellowship
program. Researchers discovered that (1) Acupuncturists were excited
about integrative practice opportunities, disappointed about limited
interactions with medical staff, creative in adjusting to restrictions of
hospital setting, and ambivalent about clinical research opportunities;
(2) Acupuncturists considered their in-patient care limited but effective,
and they expressed pride in holism of their practice; and (3) Physicians’
support for acupuncture care depended more on the clinical results
and patient satisfaction than on their understanding of the philosophy
behind acupuncture or acupuncture clinical research, and different
departments of the hospital represented distinct “cultures,” some of
which were more receptive to acupuncture than others.
Acupuncture in a Managed Care Program: Evaluating Clinical
Outcomes, Member Satisfaction, and Costs of Care, presented by
Elizabeth Sommers, Boston University School of Public Health
Sommers and colleagues evaluated a community health center and
clinic specializing in acupuncture partnered with a large managed
care organization to determine whether acupuncture treatment might
influence clinical outcomes and costs of care for patients referred for
the following conditions: pain, headache, menstrual or menopausal
symptoms, carpal tunnel syndrome. Preliminary results indicate that
offering acupuncture in a community health setting is acceptable and
desirable by patients and physicians. Favorable clinical and cost of care
outcomes were observed in this ongoing project.
Adjuvant Whole Systems Traditional Chinese Medicine Improved
Fresh, Non Donor In Vitro Fertilization: A Retrospective Chart Review,
presented by Lee Hullender Rubin, Oregon College of Oriental
Medicine
Data from records of 1,069 fresh, non-donor cycles from a private
infertility clinic were reviewed. The main outcome measure was live
birth beyond 24 weeks gestation. In this retrospective review of records,
researchers found that whole systems TCM pre-treatment prior to ET
and acupuncture on the day of ET significantly improved live births in
fresh, non-donor IVF cycles.
Selection of Clinical Research Abstracts Presented at the 2013 Society for Acupuncture Research Conference
Basic Science Abstracts:
Central Mechanism of Instant Analgesia Effect of Aupoints on
Shao Yang Meridians to Migraine Patients, presented by Yang Jie,
Acupuncture and Tuina School, Chengdu University of Traditional
Chinese Medicine
Jie and colleagues examined patients who matched the inclusion criteria and randomly divided them into 2 groups: Group
A received acupuncture on the shaoyang meridian once (GB20,
SJ5, GB34); Group B was a waiting list group. Positron emission
tomography computed tomography (PETCT) was performed to
detect the cerebral glucose metabolism among the 40 patients after
the first administration of puncturing. Then the difference among
them was analyzed by SPM2, which was used to discuss the central
mechanism of instant analgesic effect of puncturing at acupoints.
The researchers discovered that the effect of puncturing at the acupoints on the shaoyang meridian could influence the regions related
with pain, including middle cingulate gyrus, posterior cingulate
gyrus, insula, hippocampus, and parahippocampal gyrus.
Increased Nerve Growth Factor Signaling in Sensory Neurons
of Early Diabetic Rats is Corrected by Electroacupuncture,
presented by Stefania Lucia Nori, Department of Pharmaceutical
and Biomedical Sciences FARMABIOMED NANOMATES,
University of Salerno, Via Ponte don Melillo, 84084 Fisciano, Italy
Diabetes was induced in rats by streptozotocin (STZ). One week
after STZ, EA treatments were started and continued for three
weeks. NGF and NGF receptors protein and mRNA, NGF signaling pathways and the presence of NGF-regulated transient receptor
potential vanilloid receptor 1 (TRPV1) were analyzed in dorsal
root ganglia (DRGs). NGF receptors expression and colocalization
was analyzed in spinal cord and skin. Researchers found that STZ
increased NGF and NGF receptors expression, activated c-Jun
N-terminal kinase (JNK) and p38 kinase and increased TRPV1
in DRG; EA in diabetic rats decreased both NGF and NGF
receptors, normalized JNK and p38 activation, decreased TRPV1
and activated the transcription factor Nf- B. Expression of p75
neurotrophin receptor was increased in diabetic skin, while receptor
tyrosine kinase A was increased in the spinal cord. EA in diabetic
animals counteracted both these STZ-induced deregulations.
Effects of a Topical Chinese Herbal Formula TLSJ Gel for Bone
Cancer Pain in Rats, presented by Lixing Lao, University of
Maryland School of Medicine
A bone cancer pain rat model was used to investigate the effects
and mechanisms of the herbal analgesic gel Tong Luo San Jie
(TLSJ) on bone cancer pain. The rat model was established by
inoculating Walker 256 rat carcinoma cells directly into the right
tibial medullary cavity of Sprague Dawley rats (150 -170 g); PBS
tibial inoculation was used as control. Cancer-bearing rats were
treated twice a day with external TLSJ gel (0.5 g/cm2/day) or
inert gel for 21 days (n=10/group). Mechanical threshold and paw
withdrawal latency (PWL) were respectively assessed with von Frey
filaments and Hargreaves’ Method. The data demonstrated that
TLSJ treatment significantly restored bone cancer-induced decrease
of PWL and mechanical threshold compared to inert gel. It also
decreased the level of blood serum ICTP and BAP and inhibited
osteoclast activities.
Doses of Caffeine Relevant to Dietary Human Intake can Inhibit
the Acupuncture-Induced Analgesia, presented by Ari More,
Universidade Federal de Santa Catarina, Brasil
Recently, the role of adenosine receptors in acupuncture analgesia (AA) has been shown, and caffeine, one of the world’s most
commonly consumed dietary ingredients, is an antagonist of these
receptors. In this study, the post-incisional pain model was used
to investigate caffeine’s influence on AA. Mice were treated with
acupuncture needling after administration of acute or chronic of
caffeine. We found that acute pre-administration of caffeine (10
mg/kg, i.p.) completely reversed AA in both types of acupuncture.
In the chronic pre administration, we used two doses that mimicked the average daily caffeine consumption in Western countries
and China. Interestingly, the “Western dose” of caffeine (70 mg/kg/
day) administered during eight days in the drinking water reversed
AA, and the “Chinese dose” (4 mg/kg/day) administered during the
same period did not. These results indicate that the use of caffeine
can inhibit the analgesic effect of different forms of acupuncture.
Also, our findings suggest that doses of caffeine relevant to dietary
human intake levels could be a confounding factor in the context of
acupuncture research.
Effects of Electroacupuncture at Neiguan (PC6) on Blood
Pressure in Myocardial Infarction Rats, presented by Haiping
Deng, Shanghai University of Traditional Chinese Medicine, China
Shanghai Research Center of Acupuncture & Meridian, China
To observe the effects of electroacupuncture at Neiguan on blood
pressure in myocardial infarction rats, male SD rats (weighing 250300g) were randomly divided into an electroacupuncture group,
a model group, and a control group. In the electroacupuncture
group and the model group, the myocardial infarction model was
established by permanent ligation of the left anterior descending
(LAD) of left coronary artery. In the electroacupuncture group,
rats were treated 30 min/d for consecutive 5d with EA at both
“Neiguan” after the day of the operation, 2-15 Hz, 1-4mA. ECG
had been recorded before and after the operation and after the
treatment. Artery catheterization method for measuring femoral
arterial and right carotid arterial systolic pressure, diastolic pressure,
mean arterial blood pressure, and pulse pressure was used.
Results suggested that electroacupuncture at Neiguan plays a
role in the improvement of systolic pressure, diastolic pressure, and
mean arterial blood pressure of the right carotid artery in myocardial infarction rats.
 
The American Acupuncturist
21
A Case Study on the
Management of Benign Prostatic
Hypertrophy Using Acupuncture
and Chinese Herbal Medicine
By Connie L. Christie, MA, Dipl OM (NCCAOM), LAc
Connie L. Christie, MA, Dipl OM (NCCAOM), LAc, and
certified Rolfer® is the owner of Affinity Acupuncture and
Rolfing in Spokane, WA. She specializes in women’s and
men’s hormonal health and pain relief and rehabilitation.
A graduate of California State University, Northridge, and
Yo San University in Los Angeles, she will complete the
Doctor of Acupuncture and Oriental Medicine at Oregon
College of Oriental Medicine in August 2013. Contact
info: [email protected].
Abstract
Benign prostatic hypertrophy (BPH), otherwise known
as benign prostatic hyperplasia, is an enlargement of the
prostate, a condition that often occurs in aging men.
In the United States alone, more than fifty percent of
men over the age of sixty reportedly suffer from some
symptoms of BPH, ranging from mild discomfort
to intolerable pain and refractory urinary retention.
This case study documents the use of acupuncture
and Chinese herbal medicine to treat a 67-year-old
male diagnosed with BPH and the distressing urinary
symptoms of pain, straining, urgency, nocturia and
impotence for two and a half years. The patient was
diagnosed and treated for Liver qi stagnation and
Kidney yin deficiency. The patient had positive results
as documented by the “AUA Symptom Index for BHP.”
This case study supports the premise that acupuncture
and herbal medicine may be beneficial in reducing
or alleviating these symptoms of BPH, treating both
acute symptoms and the root patterns implicated in the
disease. Further research is needed to investigate the role
of TCM in the treatment of BPH.
Keywords: benign prostatic hypertrophy, acupuncture, Chinese
herbal formulas
22
T h e A m e r i c a n A c u p u n c t u r i s t Summer 2013
Biomedical Perspective
Benign prostatic hypertrophy (BPH), otherwise known as benign
prostatic hyperplasia, is defined as enlargement of the prostate. The
condition of BPH refers to the histological proliferation of smooth
muscle and epithelial cells within the prostate. The prostate grows
throughout a man’s life with two main growth phases: the first
during puberty and the second around the age of 25. This second
growth phase can years later contribute to BHP.1 As the prostate
enlarges, the surrounding tissue stops it from expanding and
thereby applies pressure to the urethra. As the prostate changes, the
bladder also undergoes changes, becoming thicker and irritated.
There are a number of studies that have reviewed casualty
factors for BPH. Some of these studies have suggested a hereditary
component while others have suggested differences in race.2 A study
performed in Sweden supports the hypothesis of a relationship
between high insulin levels and metabolic syndrome with development of BPH.3 The role of hormones, specifically DHT (dihydrotestosterone), was examined in a study conducted in 2000.4
The functional androgen-signaling axis is essential to prostate
development. Within this axis, DHT plays a role in normal
prostate development and can contribute to pathologic growth in
the aging male. According to the American Urological Association,
BPH rarely causes symptoms before the age of 40, but more than
half of men in their sixties and up to ninety percent in their seventies and eighties have some symptoms of it.2
BPH is the most common benign tumor in men and, although
not necessarily life-threatening, the symptoms can range from mild
discomfort to intolerable pain.2 In addition, it can be problematic
if urine is retained, as this can cause bacterial growth and infection.
Symptoms typically become more prevalent with age and appear as
changes in urinary flow. Common symptomatology includes nocturia, straining to urinate, an interrupted or weak urinary stream
and the feeling of incomplete bladder emptying. Urgency, leakage,
and dribbling after urination also occur. Even a small amount of
urine in the bladder can cause contraction and create urgency and
frequent urination.
Before arriving at a diagnosis of BPH, it is essential to rule out
other diagnoses, including urinary tract infection, neurological
disorder, stricture disease, and prostate or bladder cancer.2 To
confirm the diagnosis of BPH, the following main diagnostic tools
are utilized:
1) The American Urological Association Symptom Index, which is
attached in Appendix 1, is not only a valuable diagnostic tool
to evaluate obstructive and irritating voiding symptoms but
also essential to establish a baseline prior to treatment.
2) Digital Rectal Examination (DRE) to determine the size and
condition of the prostate gland.
3) Prostate Specific Antigen (PSA) Blood Test is performed to rule
out prostate cancer. Current research debates the benefits of
using PSA as a test of prostate cancer.5
4) Cystoscopy may also be performed to obtain information on
prostate size, as well as the location and degree of obstruction.
Biomedical treatment of BPH consists of watchful waiting when
the symptoms are mild, i.e., a score of less than 7 on the AUA.
When watchful waiting is insufficient, the drug finasteride has been
shown to be effective in reducing symptoms of BPH.4 Ultimately,
surgery is indicated in life-threatening circumstances such as refractory urinary retention, large bladder deverticula, or a sequelae to
BPH of recurrent urinary tract infections, recurrent gross hematuria, bladder stones or chronic kidney disease.2
Incidentally, the 5 alpha-reductase inhibitors (finasteride) which
reduce DHT have been the only pharmaceutical class to halt the
BPH disease process by reducing prostate volume and improving
symptoms.4 Recent studies are investigating the use of alpha blockers and 5-reductase inhibitors to manage BPH.4
Oriental Medicine Perspective
Research with acupuncture has shown it to be beneficial in treating
voiding issues associated with the prostate. One study hypothesized
that acupuncture regulates the nerves related to the prostate.6
Several studies on treating chronic prostatitis/chronic pelvic pain
syndrome with acupuncture confirm that acupuncture relieves
voiding symptoms and improves quality of life.7,8 A double-blinded
randomized control trial is currently underway to explore the
efficacy of electroacupuncture at a specific point for mild and
moderate BPH.9 This trial follows a pilot study that showed a
reduction of the International Prostate Symptom Score (IPPS) and
improvement of difficult urination in patients with BPH.
Historically, benign prostatic hyperplasia, being a modern
Western disease category, has not been treated by Chinese medicine. Instead, TCM focuses on the clinical patterns of urinary
symptoms. BPH has been described and treated as Long Bi or
urinary retention. It is often treated in stages of severity of urinary
symptoms.10,11 The first stage is nocturia, discomfort in the peroneal
region, and no residual urination. This is the Chinese disease
categorization of Ye Niao Duo Zheng.10 The second stage, Niao Bi,
is pronounced urinary obstruction with dysuria, residual urine, and
actual prostate enlargement. The final stage, Lin Zheng, manifests as
urinary incontinence and polyuria.
Chinese herbal formulations are commonly prescribed for the
first two stages.12 In general, use of Chinese herbal medicine is
well documented for Long Bi.13 The three most common herbal
treatment methods by modern Chinese doctors are to nourish the
yin, clear heat, and eliminate qi stagnation.13 One correlative study
found the majority of BPH symptom parameters to correspond to
Kidney yin and yang deficiency and qi stagnation.10,11,15
BPH tends to be relapsing by nature. Therefore, several authors
believe treatment should be separated into two distinct categories:
acute exacerbations and chronic experience.10,11,15
Several studies in China have shown various Chinese herbal
formulations to be effective in treating BPH in rats.16,17 One of the
 
The American Acupuncturist
23
A Case Study on the Management of Benign Prostatic Hypertrophy Using Acupuncture and
Chinese Herbal Medicine
The patient experienced occasional belching and had hemorrhoids and occasional hard stools, which loosened when he did
yoga routinely. The patient engaged in Bikram yoga five times a
week and had an energy level of 8/10, with 10 being abundant
energy for the day. His urination was frequent and he had slight
post-urination dribbling.
The patient stated that he was sleeping well but was waking up
twice nightly to urinate. He also said he was eating a balanced diet,
did not consume alcohol, and drank two cups of coffee per week.
Examination revealed a red tongue, no coat with a deep central
crack, and several horizontal branches and swollen sides. His pulse
was wiry and rapid on the right and slippery on the left.
studies verifies the efficacy of Lui wie di huang tang (Rehmannia Six
decoction) in treating BPH in rats, of which a variation is used in
this case study.18 Another study, comparing the use of formulations
to treat Kidney deficiency patients and patients with blood and
phlegm stasis, found that both approaches decreased the size of the
prostate gland.19
Methods
Case History: A 67-year-old male sought treatment in June 2012
for the following symptoms: hesitant, urgent and painful urination that included straining and frequency. He also complained of
occasional impotence.
He reported that these symptoms had been occurring for two
and a half years and had been getting worse for the past year. In
addition to the symptoms just indicated, the patient reported that
he had been under severe distress in the three months prior to
seeking treatment due to a job loss and marital disharmony. The
patient appeared angry and frustrated, with a dry, withered face.
The patient presented with a diagnosis of BPH from his physician
based on a DRE.
The patient weighed 153 lbs and was 5’10.” He reported no serious injuries and only one surgery, a vasectomy, 20 years prior. He
was not on any medication except an over the counter nutritional
supplement for prostate and kidney health that he had been taking
for the past year. The patient stated he saw no improvements while
taking the supplement but continued taking it for the duration of
his treatment.
TCM Diagnosis and Treatment
This patient’s TCM diagnosis was Liver qi stagnation and Kidney
yin deficiency with some phlegm and blood stasis. Liver qi stagnation was indicated by urinary blockage, the patient’s swollen tongue
sides, wiry pulse, stressful lifestyle, and angry mannerisms. Kidney
yin deficiency was evident in his dry skin and stools, withered face,
red and coatless tongue with deep cracks, frequent scanty urination, dribbling of urine, and micturition stops and starts. Blood
stasis was reflected in age in general, his wiry pulse, and prostatic
hypertrophy. Phlegm stasis was manifested as enlarged prostate. In
general, the etiology of this patient’s patterns was from emotional
frustration and aging. Bikram yoga, performed in a room heated to
approximately 105°F (40.6°C), had further depleted his yin.
Treatment principles for this patient were to soothe the Liver
and tonify the Kidney yin, while invigorating the blood, resolving
phlegm, softening hardness, and opening the water passages.
Table 1. Acupuncture Treatment
Point
Function
Depth
Needling method
Note
Yintang
calm the shen
0.3 cun
reinforcing method
Hegu LI-4
harmonize the yin, move the qi
0.5 cun
reducing method
Zhongji CV-3
benefit urination, stop dribbling and regulate
the lower jiao
1.5 cun
reinforcing method
angle needle toward root
of penis
Guanyuan CV-4
tonify the Kidneys and strengthen yin
1.0 cun
reinforcing method
angle needle toward root
of penis
Sanyinjiao SP-6
tonify the Spleen, Liver and Kidney yin and
move the blood
0.5 cun
reinforcing method
Taixi KI-3
nourish Kidney yin
0.5 cun
reinforcing method
Taichong LV-3
soothe the Liver, drain the Liver channel,
invigorate the blood and resolve pain
0.3 cun
reducing method
ZulingQi GB-41
promote the smooth flow of qi
0.3 cun
reducing method
Qianlieyanxue (extra point,
prostate point)
empirical point for benefiting the prostate
1.5 cun
even method, angle
45° inward
24
T h e A m e r i c a n A c u p u n c t u r i s t Summer 2013
15
located midway between
huiyin CV-1 and the anus
A Case Study on the Management of Benign Prostatic Hypertrophy Using Acupuncture and
Chinese Herbal Medicine
The patient received nine acupuncture treatments: one per
week for 6 weeks and then one treatment every 3 weeks for 3
sessions, with needles retained for 30-40 minutes. The needles
used were 0.16x30mm, spring type, Acuzone brand, Korea. Table
1 describes the points needled and methods used.20 After two
weeks of acupuncture, the patient was prescribed an herbal formula
(Formula One) for six weeks to reinforce the acupuncture treatment
and assist with the branch symptoms of pain, straining, urgency,
and weak urinary flow.
Table 2 presents this formula, modified from a formula created
by Yan De-Xin for qi stagnation and blood stasis.11 Chuan lian
zi (Fructus Toosendan) was substituted for chen xiang (Lignum
Aquilariae Agallochae) and qing pi (Pericarpium Citri Reticulatae)
for chen pi (Pericarpium Citri Reticulatae) because of the stronger
Liver pattern in the patient. Dong kui zi (Semen Abutilonis Seu
Malvae) and kai xin guo (Semen Pistachionis) were omitted because
they were unavailable and che qian zi (Semen Plantaginis) was
added to further strengthen the effects of promoting urination,
clearing heat, and resolving dampness.
Table 2. Formula One (focus on branch treatment)
Herb
Rationale
Chuan lian zi (Fructus
Toosendan) 3%
regulates Liver qi, relieves pain
Qing pi (Pericarpium Citri
Reticulatae) 6%
regulates Liver qi, breaks up qi stagnation
Dang gui wei (Radix
Angelicae Sinensis tail)
9.4%
nourishes and invigorates the blood and
directs it downward
Huai niu xi (Radix
Chyranthis Bidentatae)
9.4%
tonifies Liver and Kidneys, invigorates the
blood and directs it downward
Wang bu liu xing (Semen
Vaccariae Segetalis) 9.4%
invigorates the blood, transforms stasis
and softens hardness
Shi wei (Folium Pyrrosiae)
16%
promotes urination, dissolves phlegm
Hua shi (Talcum) 9.4%
promotes urination, clears heat, resolves
dampness
Mu dan pi (Cortex Radicis
Moutan) 9.4%
cools and invigorates the blood, disperses
stasis, clears heat
Shan zhi zi (Fructus
Gardenia Jasminoidis)
9.4%
drains damp-heat downward, sedates fire,
relieves irritability
Tao ren (Semen Pruni
Persicae) 9.4%
invigorates the blood, removes stasis,
moistens the intestines
After six weeks on Formula One, the patient’s herbal prescription
was then changed. A second formula, Formula Two, a modified
variation of zhi bai di huang tang (Anemarrhena, Phellodendron,
and Rehmannia decoction) described in Table 3, was prescribed to
treat the patient’s root disharmony by nourishing the kidney yin
and soothing the Liver.21 This patient has a Liver constitution and
is prone to Liver qi stagnation. Liver qi stagnation accumulates
damp phlegm. Along with his age, this stagnation had generated
heat and contributed to consuming his yin. Kidney deficiency is
known to be the root cause of BHP because it results in the failure
to transform and transport fluids in the lower jiao. Furthermore,
the deficient heat cooks and thickens the fluids making it increasing
more difficult to transform and eliminate them thereby leading to
accumulation of dampness and phlegm enlarging the prostate.13
Table 3. Formula Two (focus on root treatment)
Herb
Rationale
Sheng di huang (Radix
Rehmanniae
nourishes the yin and blood, cools the
blood and tonifies the Kidneys
Shan Zhu Yu (Fructus
Corni Officinalis) 10.2%
tonifies the Liver and Kidneys
Shan Yao (Radix
Dioscoreae Oppositae)
10.2%
strengthens the Spleen, stabilizes the
Kidneys and nourishes the essence
Fu ling (Sclerotium Poriae
Cocos) 7.7%
strengthens the Spleen and drains
dampness
Mu dan pi (Cortex
Moutan Radicis) 7.7%
cools the blood and moves blood stasis
Ze xie (Rhizome Alismatis
Orientalis) 7.7%
regulates water passage
Zhi mu (Radix
Amenarrhenae
Asphodeloidis) 5.1%
nourishes the yin, generates fluids, clears
deficient heat
Huang bai (Cortex
Phellodendri) 2.6%
clears deficient heat and dries dampness
Chai hu (Radix Bupleuri)
7.7%
moves Liver qi, eliminates stagnation
Xiang fu (Rhizome Cyperi)
7.7%
moves Liver qi, eliminates stagnation
Wang bu liu xing (Semen
Vaccariae Segetalis) 7.7%
invigorates the blood, transforms stasis
and softens hardness
Yin yang huo (Herbaa
Epimedii) 5.1%
tonifies the Kidneys and boosts the yang
 
The American Acupuncturist
25
A Case Study on the Management of Benign Prostatic Hypertrophy Using Acupuncture and
Chinese Herbal Medicine
Both formulas were composed of KPC herbal granules with
a standard 5:1 concentration. The patient was advised to take 5
grams twice per day, dissolved in 8 ounces of boiling water, once
after breakfast and again after dinner. To stop consuming his yin,
the patient was advised to stop or greatly curtail his Bikram yoga
practice. He was also advised to walk in the woods and practice
simple deep breathing exercises to manage his stress.
Results
This case study demonstrated generally positive results. The
patient’s score on the “AUA Symptom Index for BHP” went from
an indicated IPSS of 32 (severe symptoms) to a 7 (mild symptoms)
and his impotence was resolved. The patient reported less pain
and better erectile function by the second acupuncture treatment.
At that time, the first herbal formula was prescribed. The patient
continued to report symptomatic relief. By the third week of acupuncture treatments, (a week into his herbal formula) he reported
no nocturia, little straining, and a stronger urination flow.
After another two weeks receiving both treatments, the patient
related that he had less urgency to urinate and that about half the
time he felt that his bladder could completely empty. After six
weeks, due to limited funds, the patient cut back on his weekly
acupuncture treatments and began receiving treatments only once
every three weeks. At that time, while using the formulas but with
reduced acupuncture treatments, he continued to report improvement in his urinary symptoms. However, he started to complain
about signs of erectile dysfunction again.
After three prescriptions (6 weeks into treatment) of Formula
One, the most severe symptoms of painful, hesitant, urgent, straining and frequent urination had subsided. The patient’s prescription
was then changed to Formula Two. After one month on Formula
Two, the patient continued to report minimal urinary discomfort
and stated that he no longer experienced impotence. Regarding his
chief complaints, this patient reported that he experienced satisfactory resolution.
Following the primary course of treatment, it was recommended
that the patient continue on Formula Two and be evaluated every
six weeks. He was advised that if he experienced another acute
episode of urinary discomfort, he should return to Formula One
until it subsided. The patient was also instructed to be mindful
of how he allowed external events to affect him internally and to
continue to engage in stress management techniques.
Discussion / Prognosis
This case study documents and further supports success in an area
where biomedicine offers no treatment besides watchful waiting,
drugs, and surgery. Acupuncture and Chinese herbal medicine
are demonstrated herein as effective for the management of the
acute symptomatic stage of BPH and suggest an alternative to
biomedicine for long term management. This study demonstrated
26
T h e A m e r i c a n A c u p u n c t u r i s t Summer 2013
a significant resolution by IPPS standards of the most troublesome
symptoms, including pain, a weak, straining and hesitant urinary
stream, incomplete emptying of the bladder, and nocturia.
The patient’s baseline IPPS before treatment was 32—severe and
requiring medical intervention, with signs and symptoms of urinary
distress over a one month period as defined in Appendix 1. The
patient reported that the over the counter nutritional supplement
for prostate and kidney health he had been taking for the past year
had produced no symptomatic relief. It was therefore not considered a variable in the treatment protocol. Since he had purchased a
large supply, he continued with the supplement in lieu of disposing
of it.
The patient’s post-treatment score of 7 after 3 months of treatment with acupuncture and Chinese herbal formulas showed great
improvement over the initial evaluation per the IPPS index. The
patient’s biomedical status went from needing intervention in the
form of drugs or surgery to watchful waiting.
This case study indicates that acupuncture and Chinese herbal
medicine may relieve the disturbing symptoms of BPH and further
supports the premise that acute symptoms and root patterns are not
separate but intertwined. Success was achieved by treating acute
exacerbations separately from the more chronic symptoms. Since
BPH tends to be relapsing by nature, a patient must be committed
to long-term vigilance and treatment. In this case, a strong formula
was used to focus on the branch urinary symptoms and, once
those subsided, the formula was changed to deal with the patient’s
constitution and root disharmony of Kidney yin deficiency and
Liver qi stagnation. In addition, by treating the patient’s Liver qi
stagnation and Kidney yin deficiency, he once again had normal
erectile function.
The patient’s positive response to treatment contributed to a
positive prognosis as did the fact that he was highly compliant with
his treatment plan. The patient’s overall health, as reported on his
intake forms, supports a history of good Kidney jing. He has not
suffered from serious ailments or diseases. He has led a healthy
lifestyle, eats and sleeps well, and consumes limited alcohol and
caffeine. He has found acupuncture and herbal remedies to be
successful and he was compliant.
Conclusion
This case study presents further optimistic results for treating BPH
with acupuncture and Chinese herbal formulas and could be used
as a reference for other practitioners treating BPH. The patient
achieved significant resolution of urinary symptoms and restoration of his erectile function. Further research is recommended
to investigate and document the role of Chinese medicine in the
treatment of benign prostatic hypertrophy.
A Case Study on the Management of Benign Prostatic Hypertrophy Using Acupuncture and
Chinese Herbal Medicine
Appendix 1
The AUA Symptom Index for BHP and the Disease-Specific Quality-of-Life Question
Reprinted from the Journal of Urology (1992), 148(5), Barry, M. J., Fowler Jr, F. J., O’Leary, M. P., Bruskewitz, R. C., Holtgrewe, H. L., Mebust, W.
K. and Cockett, A. T. (The Measurement Committee of the American Urological Association), ‘The American Urological Association Symptom
Index for Benign Prostatic Hyperplasia’, pp. 1549-1557. (c) American Urological Association, 1992. Reproduced with permission.
Patient name: __________________________________ DOB: _______________ ID: _______________ Date of assessment: _____________________
Initial Assessment ( ) Monitor during: ___________________ Therapy ( ) after: ___________________ Therapy/surgery ( ) ______________________
AUA BPH Symptom Score
Not
at all
Less than
1 time in 5
Less than
About half
half the time the time
More than
half the time
Almost
always
1. Over the past month, how often have you had a sensation
of not emptying your bladder completely after you
finished urinating?
0
1
2
3
4
5
2. Over the past month, how often have you had to urinate
again less than 2 hours after you finished urinating?
0
1
2
3
4
5
3. Over the past month, how often have you found you stopped 0
and started again several times when you urinated?
1
2
3
4
5
4. Over the past month, how often have you found it
difficult to postpone urination?
0
1
2
3
4
5
5. Over the past month, how often have you had a
weak urinary stream?
0
1
2
3
4
5
6. Over the past month, how often have you had to push
or strain to begin urination?
0
1
2
3
4
5
7. Over the past month, how many times did you most
typically get up to urinate from the time you went to bed
at night until the time you got up in the morning?
0
1
2
3
4
5
Total Symptom Score:
IPSS Score:
0-7: Mild symptoms
8-19: Moderate symptoms
20-35: Severe symptoms
The Disease-Specific Quality-of-Life Question (bother score):
“If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that?”
Delighted (0); Pleased (1); Mostly satisfied (2); Mixed (3); Mostly disappointed (4); Unhappy (5); Terrible (6)
Treatment Decisions:
IPSS 7, or no bothersome symptoms: watchful waiting
IPSS 8: discuss treatment options; consider referral to Urology for further testing
 
The American Acupuncturist
27
A Case Study on the Management of Benign Prostatic Hypertrophy Using Acupuncture and
Chinese Herbal Medicine
References
1. Isaacs JT. Etiology of benign prostatic hyperplasia. European Urology. 1994;5:6-9.
2. Meng MS, Stoller M, Walsh T. Urologic disorders: Benign prostatic hyperplasia. In McPhee,
Current Medical Diagnosis and Treatment, 50th ed. (pp. 921-926). New York, NY: McGraw
Hill Lange, 2011.
3. Harmarsten J, Hogsted B. Clinical, anthropometric, metabolic and insulin profile of men
with fast annual growth rates of benign prostatic hyperplasia. Blood Pressure. 1999:29-36.
4. Bartch G, Rittmaster RS, Klocker, H. Dihydrotesterone and the concept of 5-alpha reductase
inhibition in benign prostatic hyperplasia. European Urology. 2000;37:367-380.
5. Barry, M. Clinical practice: Prostate-specific-antigen testing for early diagnosis of prostate
cancer. New England Journal of Medicine. 2001;344(18):1373-1377.
6. Yang Y, Jingli K. Clinical studies on treatment of chronic prostatis with acupuncture and
mild moxibustion. Journal of Traditional Chinese Medicine. 2005;25(3):177-181.
7. Chen R, Nickel, JC. Acupuncture ameliorates symptoms in men with chronic prostatitis/
chronic pelvic pain syndrome. Urology. 2003;61(6):1156-1159.
12. Hsu H. Treatment of Prostatomegaly with Chinese herbal medicine. International Journal of
Oriental Medicine. 2000;25(1):45-47.
13. Maciocia G. Benign prostatic hyperplasia: Modern Chinese literature. In Maciocia, The
Practice of Chinese Medicine (pp. 918-922). London, England: Churchill Liveringstone, 2008.
14. Zhang C, Chen TB, Qin GZ, Ding SL, Li YF. Correlation between traditional Chinese
medicine syndrome differentiation and urodynamic parameters in benign prostate
hyperplasia. Zhonghua Nan Ke Xue. 2007;13(2):185-188.
15. Flaws B, Sioneau P. The Treatment of Western Diseases with Chinese Medcine: A Textbook &
Clinical Manual (pp. 81-88). Boulder, CO: Blue Poppy Press, 2001.
16. Zheng H, Xu W, Lin J, Peng J, Hong Z. Qianliening capsule treats benign prostatic
hyperplasia via induction of prostatic cell apoptosis. Chinese Journal of Integrative Medicine.
2012;18(11):824-830.
17. Huang YP, Du J, Hong ZF, Chen ZQ, Wu JF, Zhao JY. Effects of kangquan recipe on sex
steroids and cell proliferation in rats with benign prostatic hyperplasia. Chinese Journal of
Integrative Medicine. 2009;15(4):289-292.
8. Rosted P. Chronic prostatitis/chronic pelvic pain syndrome and acupuncture: A case report.
Acupuncture in Medicine. 2007;25(4):198-199.
18. Shin IL, Lee MY, Ha HK, Seo CS, Shin HK. Inhibitory effect of yukmijihwang-tang, a
traditional herbal formula against testosterone-induced benign prostatic hyperplasia in rats.
BMC Complementary Alternative Medicine. 2012; 20(12):48.
9. Wang Y, Liu Z, Yu J, Ding Y, Liu X. Efficacy of electroacupuncture at zhongliao point
(BL33) for mild and moderate benign prostatic hyperplasia: Study protocol for a randomized
controlled trial. Trials. 2011;12:211.
19. Xie JS, Shen ZY, Wang WJ. Clinical study on comparison of tonifying kidney replenishing vitality and removing blood stasis and resolving mass in the treatment of prostatic
hyperplasia. Zhonghua Nan Ke Xue. 1994;14(9):519-521.
10. Lin A. A Handbook of TCM Urology & Male Sexual Dysfunction. Boulder, CO: Blue Poppy
Press, 1992.
20. Deadman P, Baker K, Al-Khafaji M. A Manual of Acupuncture. Journal of Chinese Medicine
Publications, 1998.
11. Yan DX. Aging and Blood Stasis, A New TCM Approach to Geriatrics. Boulder, Colorado: Blue
Poppy Press, 1995.
21. Bensky D, Barolet R. (1990). Chinese Herbal Medicine Formulas & Strategies. Seattle, WA:
Eastland Press, 1990.
Thank you AA Advertisers!
In the same way that your business depends on us as practitioners, our business is made possible by the products
and services you offer. AAAOM extends heartfelt appreciation to those advertisers that have traveled the distance
in giving your support, and we extend a sincere welcome to those of you that recently joined our family.
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800-487-9296
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4
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Inside Front Cover
33
T h e A m e r i c a n A c u p u n c t u r i s t Summer 2013
The Career Connection
315-568-3039
2
Inside Back Cover
16
Trudy McAlister Foundation Announces
Four Scholarships in 2013 Awards
Trudy McAlister Foundation 2013 Scholarship Recipients
Carrie Lovemark
Katie Ngan
Elaina Stover
Joanne White
The Trudy McAlister Foundation (TMF) is pleased to announce
As the Foundation is determined to continue to provide an
the recipients the Trudy McAlister Foundation scholarships.
increasing number of scholarships, we ask the support of
Two scholarships for $3000 each and two scholarships for
individuals, vendors, and national organizations to help us
$2000 each were awarded.
make the opportunity of an Oriental medicine education
The recipients of the 2013 TMF Scholarships are: Carrie
Lovemark, Five Branches University; Katie Ngan, Southern
California University of Health Sciences; Elaina Stover, AOMA
Graduate School of Integrative Medicine; Joanne White, New
available to deserving, committed students. The Board and
Advisors for the Foundation are Gene Bruno, OMD, LAc;
William B. Pettis, MS, DOM, LAc; Roni Wilbur, MSOM, LAc;
Pamela Lee, PhD; and William Prensky, MD, OMD.
England School of Acupuncture.
A goal of the foundation is to provide generous assistance
to deserving students of Oriental medicine and, at the same
time, grow and preserve funds for future scholarships. Each
year the Foundation Board announces the scholarships
in national publications and requests that the Council of
Colleges for Acupuncture and Oriental Medicine notify
colleges about these scholarships.
Remember, the nonprofit Foundation has 501(c)(3) status
and contributions from suppliers, manufacturers, individuals,
colleges, vendors and organizations can be made directly to
the Trudy McAlister Foundation and via the website. All who
contribute are recognized on our website.
More information is available at
www.trudymcalisterfoundation.org
 
The American Acupuncturist
29
BOOK REVIEW
Evaluating the Economics of Complementary and
Integrative Medicine
by Patricia Herman, ND, PhD
Reviewed by Elizabeth Sommers, PhD, MPH, LAc
Acupuncturists in the U.S. are faced
with economic realities related to
Paperback, 100 pages
patients’ challenges with out-of$15.95
pocket payment for services, insurers’
Available at Amazon and
requirements for documentation,
www.SamueliInstitute.org
and demands from research funders.
The need to upgrade our understanding of economics has never been
more salient. The new handbook by Patricia Herman ND, PhD,
Evaluating the Economics of Complementary and Integrative Medicine,
is a valuable resource as both a text and a reference. Her descriptions and examples effectively demystify health economics and
offer valuable insight into understanding how to design or interpret
cost-related studies.
Herman’s book is replete with relevant examples and illustrations
of economic principles and is useful for both students and practitioners. Using a variety of studies of interest to the community of
complementary and integrative health proponents, she provides
definitions and de-constructs concepts and terminology. Although
the book contains references to studies of chiropractic, massage,
naturopathic care, Alexander technique, homeopathy, and music
therapy, there are substantial references related to a number of
aspects of Chinese and Asian medicine, including acupuncture,
moxibustion, and Tai Qi.
The book begins with an overview of the fundamentals of
economic analysis. One of these is the perspective from which an
evaluation is done. Perspectives encompass the spectrum of those
affected by health costs—individual consumers, health insurers,
employers, hospital and health care providers, and society itself.
Consideration of costs will include direct medical costs (including costs of any of the following: medication or outpatient visits,
hospital stay, lab or diagnostic tests, emergency room visits); direct
non-medical costs (intervention-related costs such as transportation,
patient’s time, childcare); or indirect costs (usually from a broad
societal perspective including changes in work-related productivity
or an individual’s ability to contribute to society).
All these factors are taken into consideration in determining the
type of economic evaluation to conduct. The major four types of
complete economic evaluation are cost effectiveness analysis, cost
utility analysis, cost benefit analysis, and cost consequence analysis.
Costs, in whatever forms we decide to measure them, become the
numerator in each of these approaches. The denominators represent
a variety of impacts to health, as illustrated in the table on the
following page.
ISBN: 978-1479390359
2012
30
T h e A m e r i c a n A c u p u n c t u r i s t Summer 2013
“Sham procedures frequently result in
small, non-negligible effects. Thus, by
comparing a relatively larger effect (due
to true acupuncture) with a smaller effect
(related to the sham comparison), study
results often fail to achieve significance
from a statistical perspective.”
The value of Herman’s book lies not only in describing principles
of health economics but also in its visionary approach to conceptualizing future research on acupuncture and Asian medicine.
By incorporating and appreciating the importance of economic
evaluation, researchers can reach beyond the limited paradigm
of the randomized clinical trial that relies on sham or placebo
comparators. A critical point against sham or placebo-controlled
trials is that economic analyses are most appropriately conducted by
comparing an intervention to the current standard of care, not to a
placebo. Just as this is relevant for all types of health-related studies
of biomedical interventions, I expect we’ll be seeing this manifest in
acupuncture studies as well.
Furthermore, recent studies have indicated that sham or placebo
comparators may indeed have physiological effects and thus are not
inert.6 Imaging studies using magnetic resonance or other scanning
approaches have recorded effects associated with sham procedures.
Biomarkers and hemodynamic indicators such as blood pressure
also provide evidence of physiological changes, which become
evident following sham procedures.7 Sham procedures frequently
result in small, non-negligible effects. Thus, by comparing a relatively larger effect (due to true acupuncture) with a smaller effect
(related to the sham comparison), study results often fail to achieve
significance from a statistical perspective. Although clinicians and
patients may observe favorable health-related outcomes, the final
results may not show a difference that achieves a large enough
difference between true and sham procedures, thus leading to the
false conclusion that true acupuncture procedures are no better
than comparison or placebo procedures.
Herman’s book offers insight into the world of health economics.
Like our own science of Asian medicine, health economics offer a
holistic, comprehensive and inclusive approach to understanding
the ramifications of our medicine. More importantly, for society
and the public’s health, economic analyses represent additional
Book Review: Evaluating the Economics of Complementary and Integrative Medicine
Type of Analysis
Health Impact Measured
Advantages
Limitations
Examples
Cost effectiveness
analysis (CEA)
Standardized unit of health
outcome (e.g., years of
life saved, changes in
hemoglobin A1c)
Can directly use units of health
outcome as determined by
effectiveness trials; if health
outcome is widely accepted metric
for a particular disorder, CEA
can use that outcome to directly
compare results across a number of
therapeutic interventions
Does not allow direct cost
comparisons over a variety
of interventions available
for different disorders;
although intervention may
favorably impact a number
of health parameters for a
given disorder, CEA could
not accommodate multiple
outcomes
Cost per reduction
in breech birth
presentations
following moxibustion
of BL671
Cost utility analysis
(CUA)
Global health status (broad
measures of health)
By incorporating a broad
measure of health, allows direct
comparisons across a number of
different therapeutic approaches;
integrates measurements related
to quality of life
Challenge of actually
defining and interpreting
“utility”
Studies of
acupuncture for a
variety of conditions
(osteoarthritis,
rhinitis)2,3
“Utility” defined as
strength of individual’s
health preferences in the
context of uncertainty
Cost benefit analysis
(CBA)
All benefits measured in
monetary terms
Costs can be directly subtracted
from benefits to give net monetary
benefit of one intervention versus
another intervention; allows for
comparisons to be conducted
across different therapies; can
incorporate benefits that are not
health-related per se (e.g., patient
empowerment)
Requires monetary value
to be placed on health
states
Use of naturopathic
care for low back
pain4
Cost consequence
analysis (CCA)
Method for reporting
results of a comprehensive
economic evaluation
Based on inclusive list of cost
components and associated
outcomes for multiple therapies;
can include specific health
outcomes as well as quality of life
measures
Full information may
not be available for
each intervention being
considered
Comparison of
acupuncture,
manual therapy,
injections, and other
pain management
techniques for back
pain and knee injury5
and innovative frameworks for evaluating and improving care
and treatment. I highly recommend Evaluating the Economics of
Complementary and Integrative Medicine as a guide and resource for
continuing to explore our dynamic field of Asian medicine.
6. Linde K, Niemann K, Meissner K. Are sham acupuncture interventions more effective
than (other) placebos? A re-analysis of data from the Cochrane Review on placebo effects.
Forshende Komplementarmedizin 2010;17:259-264.
References
Elizabeth Sommers, PhD, MPH, LAc is director of research and
education at Pathways to Wellness in Boston, MA. She is on the
faculty at Boston University School of Public Health in Health
Policy and Management and co-chairs the American Public
Health Association’s group on Complementary and Alternative
Health Practices. She has published numerous papers on
public health aspects of acupuncture. Areas of interest include
acupuncture studies related to health economics, recovery from
substance use, and promoting health for people living with HIV/
AIDS. She was guest co-editor for the 2013 public health issue of
the European Journal of Integrative Medicine.
1. Van Den Berg I, Kaandrop GC, Bosch JL, Duvekot JJ, Arends LR, Hunink MG.
Cost-effectiveness of breech version by acupuncture-type interventions on BL 67, including
moxibustion, for women with a breech fetus at 33 weeks gestation: A modeling approach.
Complementary Therapies in Medicine 2010 April;18(2):67-77.
2. Reinhold T, Witt CM, Brinkhaus JS, Willich SN. Quality of life and cost-effectiveness
of acupuncture treatment in patients with osteoarthritis pain. European Journal of Health
Economics 2008;9(3):209-219.
3. Witt CM, Reinhold T, Jena S, Brinkhaus B, Willich SN. Cost effectiveness of acupuncture
treatment in women and men with allergic rhinitis: A randomized controlled study in usual
care. American Journal of Epidemiology 2009;169(5):562-571.
4. Herman PM, Szczurko O, Cooley K, Mills EJ. Cost- effectiveness of naturopathic care for
chronic low back pain. Alternative Therapies in Health and Medicine 2008;14(2):32-39.
7. Choi EM, Jiang F, Longhurst JC. Point specificity in acupuncture; Chinese Medicine
2012,7;4.http://www.cmjournal.org/content/7/1/4. Accessed 3/12/13.
5. Brown APL, Kennedy ADM, Torgerson DJ, Campbell J, Webb JAG, Grant AM. The
OMENS Trial: Opportunistic evaluation of musculoskeletal physician care among orthopaedic outpatients unlikely to receive surgery. Health Bulletin 2001;59(3):199-210.
 
The American Acupuncturist
31
Acupuncture Improves Working Memory continued from page 13
One limitation of this study design is that subjects in the
control group did not know that they were in the control group,
but subjects in the acupuncture group did know that they were
in the active group. To reduce any potential effect this difference
may create, future research may incorporate a placebo-pill for the
control group so that every subject believes they are receiving an
active treatment.
This research shows only the short-term effects of one
acupuncture treatment. Future study should investigate: A) how
long these effects last and B) how much more effective a course
of treatment may be compared to just one treatment. Future
study may also investigate the relative effectiveness of different
point combination and manipulation methods. The trends found
in gender differences and HA/LA groups approached statistical
significance and may reach significance in a larger sample. For
this reason, it would also be beneficial to reproduce this exact
study using a larger number of subjects. Future study should also
examine subjects of different ages as there is no reason to assume
that these benefits are limited to individuals aged 18-30.
This research presents a new use for acupuncture services. It
is helpful not only for those who are functioning sub-optimally,
but it can help healthy individuals perform even better. With
further study, we might learn that acupuncture may improve
performance on the SAT, GRE, MCAT, board exams, and other
important tests.
Conclusion
This study shows that this acupuncture protocol does improve
working memory and does reduce anxiety. However, those effects
were found to be unrelated. This technique may be helpful for
those who suffer with anxiety and those who wish to improve
their memory.
References
1. Bussell J. The effect of acupuncture on working memory and anxiety. Journal
of Acupuncture and Meridian Studies. 2013; Article in Press DOI: 10.1016/j.
jams.2012.12.006.
2. Baddeley AD, Hitch G. Working memory. In: Bower GH, ed. The psychology of learning
and motivation: Advances in research and theory. Vol 8. New York: Academic Press;
1974:47–89.
3. Baddeley AD. Is working memory still working? Am Psychol. 2001;56(11):851–864.
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Disclosure Statement
This was a self-funded study that was conducted as part of the author’s
PhD dissertation. There were no financial conflicts of interest.
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A Study on Scientific Writing continued from page 17
Example: Traditionals, Zizyphus Sleep Formula, Suan
Zao Ren Tang, distributed by Kan Herb Company, Scotts
Valley, CA. Lot 0610-07, was used in this study. The dose
given to the subjects was: 2 tablets, 3 times a day for 5
days on an empty stomach (1 hour before/2 hours after
eating). Herbs include: Sour jujube seed (dry fried) (Suan
Zao Ren (chao)), Sichuan lovage rhizome (Chuan xiong),
Poria (Fu ling), Anemarrhena rhizome (Zhi mu), Chinese
Licorice root (Gan cao).
When preparing to write a scientific paper, refer to these
guidelines but before you begin, PLEASE search for
more information online. There are so many fantastic
resources for people writing scientific papers. Many of
these resources are on the websites of major research
institutions and universities.
Here are a few:
How to Write the Methods Section of a Research Paper
by Richard H Kallet, MSc, RRT, FAARC
http://cancer.dartmouth.edu/documents/pdf/methods_
section.pdf
Scientific Writing Booklet
http://cbc.arizona.edu/sites/default/files/marc/
Sci-Writing.pdf
http://abacus.bates.edu/~ganderso/biology/resources/
writing/HTWsections.html#methodsstructure
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T h e A m e r i c a n A c u p u n c t u r i s t Summer 2013
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