Acupuncture and Homeostasis of Body Adaptive Systems - Acupuncture Bibliography

Philip A.M. Rogers MRCVS

These notes are for participants at the Helsinki Seminar (Feb 8-9, 1997) on the effects of acupuncture (AP) on immune and neuroendocrinologic functions.
They are mainly abstracts and titles taken from international databases, especially :
MEDLINE Focus-On-Vet-Med
and from the WWW:
http://www.med-vetacupunture.org
http://acupuncture.com/

Table of contents

AP Points Mentioned in the Notes

A. Acupuncture (AP) in Traditional Chinese Medicine (TCM)
1.Nomenclature
2.General Concepts
3.Research on the Channels and Vessels
4.Research on Deqi / Propagated Channel Sensation
5.Research on the AP Points
6.Texts

B. Acupuncture (AP): General Information

C. Confirmed or Suspected Adverse Effects of AP

D. AP and Immunity
1.General
2.Fever
3.Cancer
4.Blood Diseases
5.Allergies
6.Tissue Regeneration

E. AP Analgesia (APA)
1.General Data
2.Head Area
3.Limbs
4.Abdomen
5.Postoperative Conditions
6.Skin

F. AP in Pain and Painful Conditions
1.General
2.Traumatic Pain
3.Head, Eyes, Ears
4.Vertebral, Spinal and Paraspinal
5.Limb
6.Muscles
7.Herpes/Postherpetic
8.Cancer

G. AP in Detoxification / Withdrawal
1.From Drugs & Alcohol
2.From Smoking

H. AP and the Cardiovascular System
1.General
2.Blood Pressure
3.Heart Rhythm
4.Haemorrhage/Shock
5.Sleep Disorders
6.Physical Stamina
7.Cardiac Angina
8.Coronary Heart Disease (Chd)
9.Cardiovascular Accident (Chd, Apoplexy, Stroke)
10.Limbs
11.Skin

I. AP and the Digestive / Gastrointestinal Tract
1.Mouth
2.Oesophagus
3.Abdomen
4.Stomach / Diaphragm
5.Nausea / Vomiting
6.Ap And The Intestines
7.Obesity
8.Spleen / Pancreas / Diabetes

J. AP and Neurology
1.General Mechanisms Of AP
2.AP and The Autonomic Nervous System (Ans)
3.APA and Neurology
4.AP and Fos-Neurons

K. AP and Spinal Trauma, Paralysis, Polio, Epilepsy, Spasm
1.Spinal Trauma, Spasticity, Paralysis
2.Polio, Post-Polio Syndrome
3.Cerebral Palsy, Epilepsy, Spasm
4.Peripheral Paralysis, Facial Paralysis

L. AP and the Psyche
1.Shen, Psychosomatic Disorders, Mental Retardation
2.Mental Disorder, Schizophrenia
3.Stuttering

M. AP and the Urogenital / Adrenal System
1.Gynaecology (Animal And Human)
2.Obstetrics (Animal And Human)
3.Male/Prostate
4.Urinary/Kidney
5.Urinary/Bladder

N. Hormones, Miscellaneous 

AP Points Mentioned in the Notes

The following AP points are mentioned in the notes:
An Fu (Contentment and Good Fortune): In cattle, this is asingle dorsal midlime point, between the dorsal spines of vertebrae T10-11 (needle 3 cm forwards and downwards).
Baihui (Hundred Meetings): single point, in centre of lumbosacral space in animals (powerful point for abdominal organs and lumbar/sacral/hinslimb problems); Human Baihui (GV20) is on the top of the head.
Ba Liao BL31-34, four points over the 4 sacral foramina in humans, with similar functions to BL27-30, respectively.
Cuo Chan (Hastening birth point): Extra Point 3 cun lateral to CV04
FeiYu (Lung Point): In cattle, bilateral points, in the 6th intercostal space, in the groove between the longissimus dorsi and iliocostal muscles (needle 3 cm inwards and downwards).
SanTai (Three Terraces): In cattle, a single dorsal midline point, between the dorsal spines of vertebrae T4-5 (needle 3 cm forwards and downwards).
Su Qi(Revive Breath): In cattle, this is a point combination of one main point in the dorsal midline, between the dorsal spines of vertebrae T8-9 (needle 3 cm forwards and downwards) and six secondary points (three on each side) in the intercostal spaces 7-9 inclusive, in the groove between the longissimus dorsi and iliocostal muscles (needle 3 cm inwards and downwards).
Tianping In the thoraco-lumbar space in animals; point used in abdominal APA and for problems of the abdominal organs.
A 01 Shixuan (Strange Point): at the nailbed of each finger-nail
A 09 Sifeng(Strange Point): in middle of palmar surface of proximal joint crease of fingers 2-5
BL01 Jingming
BL10 Tianzhu
BL11 Dazhu
BL13 Feishu
BL15 Xinshu
BL16 Dushu
BL17 Geshu
BL18 Ganshu
BL19 Danshu
BL20 Pishu
BL21 Weishu
BL22 Sanjiaoshu
BL23 Shenshu
BL24 Guanyuanshu
BL25 Dachangshu
BL27 Xiaochangshu
BL32 Ciliao
BL40 Weizhong
BL43 Gaohuangshu
BL44 Yishe
BL54 Zhibian
BL55 Heyang
BL57 Chengshan, Yu Yao
BL58 Feiyang
BL60 Kunlun
BL62 Shenmai
BL64 Jinggu
BL67 Zhiyin
CV01 Huiyin
CV03 Zhongji
CV05 Shimen
CV04 Guanyuan
CV06 Qihai
CV07 Yinjiao
CV08 Shenque
CV12 Zhongwan
CV13 Shangwan
CV14 Juque
CV15 Jiuwei
CV17 Danzhong
CV23 Lianquan
CV24 Chengjiang
EX-LE12 Qiduan
GB02 Tinghui (Hearing Confluence)
GB14 Yangbai
GB20 Fengchi
GB21Jianjing (Shoulder Well)
GB25 Jingmen
GB26 Daimai
GB30 Huantiao
GB34 Yanglingquan
GB37 Guangming
GB 39 Xuanzhong (Suspended Time)
GB41 Zulinqi
GV01 Changqiang
GV04 Mingmen
GV11 Shendao
GV08 Jinsuo
GV12 Shenzhu
GV13 Taodao
GV14 Dazhui
GV15 Yamen
GV16 Fengfu
GV20 Baihui
GV25 Suliao
GV26 Renzhong
HT01 Jiquan
HT03 Shaohai
HT05 Tongli
HT06 Yinxi
HT07 Shenmen
KI01 Yongquan
KI02 Rangu
KI03 Taixi
KI04 Dazhong
KI05 Shuiquan
KI05 Shuiquan
KI06 Zhaohai
KI07 Fuliu
KI08 Jiaoxin
KI10 Yingu
KI14 Siman
L 14 Zuzhongping (Strange Point): 1 cun below ST36
LI01 Shangyang
LI04 Hegu
LI05 Yangxi
LI07 Wenliu
LI08 Xialian
LI10 Shousanli ? Yuji
LI11 Quchi
LI14 Binao (Upper Arm)
LI15 Jianyu (Shoulder Bone)
LI16 Jugu
LI18 Futu
LI20 Yingxiang
LU03 Tianfu
LU05 Chize
LU06 Kongzui
LU09 Taiyuan
LU10 Yuji
LU11 Shaoshang
LV01 Dadun
LV02 Xinjian
LV03 Taichong
LV08 Ququan
LV13 Zhangmen
LV14 Qimen
M-BW12 Yishu (Pancreas Shu) [1.5 cun lat to T8]
N-BW10 Pirexue
NA15 Jiansanzhen (New Point): 1 cun above anterior axillary fold
PC03 Quze
PC04 Ximen
PC05 Jianshi
PC06 Neiguan
PC07 Daling
PC08 Laogong
SI03 Houxi
SI18 Quanliao
SI19Tinggong (Listening Palace)
SP01 Yinbai
SP04 Gongsun (Grandfather Grandson, the family name of Huangdi)
SP06 Sanyinjiao
SP08 Diji
SP09 Yinlingquan
SP10 Xuehai
SP21 Dabao
ST01 Chengqi
ST02 Sibai
ST04 Dicang
ST06 Jiache
ST08 Touwei
ST12 Quepen
ST17 Ruzhong
ST18 Quanliao
ST25 Tianshu
ST29 Guilai
ST34 Liangqiu
ST36 Zusanli
ST37 Shangjuxu
ST40 Fenglong
ST41 Jiexi
ST42 Chongyang
ST44 Neiting
ST45 Lidui
TH01 Guangchong
TH04 Yangchi
TH05 Weiguan
TH06 Zhigou
TH10 Tianjing
TH15 Tianliao
TH17 Yifeng
TH21 Ermen
TH23 Sizhukong
Z 09 Taiyang (Great Yang): in the temporal fossa
Z 03 Yintang (Seal Palace): midpoint between the eyebrows
Z 06 Yuyao (Fish Loins): directly above pupil, in middle of eyebrow
Jiao: Burning Space, Burner, Heater; tha TH (Triple Heater, Three Burning Spaces) has three Jiao: Upper, Middleand Lower. Each Jiao has its own organs and functions.
Bu-Xie:Bu: to nourish, strengthen, reinforce, tonify; Xie: to calm, weaken, reduce, drain, sedate
Xu-Shi:Xu: a hypoenergetic state, Depleted, Empty, Weak, Deficient, Vacant, Lethargic; Shi: a hyperenergetic state; Replete, Full, Strong, Excessive, Full, Exuberant
Xue: Cavity, Hole, Hollow, AP point: the interface between the internal and external Qi environment of the body; the place where Qi-Xue-imbalance can be diagnosed by physical examination or electrical methods; the place to apply needle or moxa to treat disorders of the related organs or functions.

A. Acupuncture (AP) in Traditional Chinese Medicine (TCM)

1. NOMENCLATURE

• Akerele_O (1991) WHO and the development of AP nomenclature: overcoming a Tower of Babel. AJCM 19(1):89-94. Programme Manager, Traditional Med Programme, World Health Organization, Geneva, Switzerland. At present, WHO does not have an official policy on AP. The Organization's policies are usually developed after a debate has taken place on a particular health issue. There has not yet been a debate on AP. This paper reviews WHO's efforts to produce a standard AP nomenclature as a first step towards ensuring that a debate on AP takes place in an atmosphere of greater understanding of the contribution that AP can make in the delivery of health care.
• WHO (1990) A standard international AP nomenclature: memorandum from a WHO meeting. Bull World Health Organ 68(2):165-169. The WHO Scientific Group to Adopt a Standard International AP Nomenclature met in Geneva from 30 Oct to 3 Nov 1989. The main features of the recommended nomenclature are the use of the English translation of the name of each Channel and an alphanumeric code derived from the English names, and the use of the Chinese phonetic alphabet (Pinyin) names and the Han character names of the Channels and AP points. This standard nomenclature will facilitate the teaching, research and clinical practice of AP, as well as exchange of information globally.

2. GENERAL CONCEPTS
Altman_S (1992) The incorporation of AP into a small animal practice. Probl Vet Med Mar 4(1):223-233. Successful use of AP in small animal practice on a day-to-day basis depends on an organized approach. The staff must be trained to answer telephone inquiries and client questions and to obtain a good history before appointments are scheduled. Colleagues must be ethically and professionally assured of a veterinarian's AP credentials and capabilities, so that they will become a source of patient referrals. A proper examination must be conducted that incorporates traditional western veterinary practices with AP, and the results must be properly recorded. A diagnosis should be established before therapy is initiated, and a plan of treatment set up. The prognosis, projected costs, length of treatment regimen, other means of treating the condition, and any possible sequelae should be discussed with the client. The patient should be monitored during the course of treatment, and reevaluated to determine whether or not changes in AP prescription or additional modes of therapy or supportive care are needed. Communication with the client and the referring veterinarian should be a priority.

Chinese Pain Centre (1996) How Does AP Work?. Adapted from WWW. Chinese Pain Centre, 2219 S. Hacienda Blvd., Suite #203, Hacienda Heights, CA, USA. AP is a method of encouraging the body to promote natural healing and to improve functioning. This is done by inserting needles and applying heat or electrostimulation at very precise AP points. In TCM, Qi Channels run in regular patterns through the body and over its surface. These Channels (meridians) are like rivers flowing through the body to irrigate and nourish the tissues, Xue flow and nervous pulses also follow Channels to run through the body to various parts, structures and organs. Qi-Stasis (obstructed movement of these Qi rivers) is like a dam that backs up the flow in one part of the body and restricts it in others. Any Stasis (stagnation, obstruction, blockage), or Xu of Qi, Xue and nervous pulses would eventually lead to disease.

The Channels can be influenced by needling the AP points: the AP needles Clear the Stasis (unblock the obstruction at the dams) to reestablish the regular flow of Qi-Xue through the medians. AP treatments can therefore help the body's internal organs to correct imbalances in their activities of digestion, absorption and Qi production, and in the circulation of their Qi through the Channels.

Modern science explains the functions of AP in 2 major ways:
1.        Needling the AP points stimulates the nervous system to release chemicals in the muscles, spinal cord, and brain. These chemicals will either change the experience of pain, or they will trigger the release of other chemicals and hormones which influence the body's own internal regulating system.
2.        In TCM Yin represents "-" (negative) and Yang represents "+" (positive). The main principle of TCM is to keep the Yin-Yang balance or bring Yin-Yang back to balance. Yin-Yang balance is the healthy state of the body. Modern science reveals that the very basic unit of the body is cell. Cell movements follow the movement of electrons. The electrons inside cells act according to regular patterns. We call these electrons in living bodies bioelectrons.

Qi flow in the Channels is the direct or indirect transportation of bioelectrons. Channels are the conduits where bioelectons move more often than other parts of the body. When positive and negative charges in the bioelectronic movements are not balanced, the cells would act abnormally: this is Yin-Yang imbalance. In TCM it is defined as "disease". It is the start of the movement of electrons in the physiological cells. WM admits to a "disease" only when radical change of the movement of cellular electrons has occurred.
All the external factors, such as mechanical, physical, chemical, biological and internal factors such as mental, hereditary, constitutional can cause and force the body's bioelectrical movement turn to imbalance would lead to disease.

AP can force the bioelectrons resume to their normal and regular movement patterns and Yin-Yang balance. The more AP treatment the patient have the longer the normal movement pattern of the bioelectrons can remain, until finally the electrons inside cells would not follow the abnormal movement pattern any more. Only at this point the problem can be deemed as solved and treated completely.
Dale_RA (1994) Forms of Qi (Vital Energy) in AP. (Adapted from WWW: A condensed version from the 1994 AJA 22(3)). Ralph Alan Dale, AP Educ Centre, 3805 Northeast 167th St., North Miami Beach, FL 33160-3540 USA.

Concepts of Qi-Shui (vital energy and matter) are fundamental in TCM. Conventional allopathic WM has no comparable concepts. While allopathic WM organizes human physiology according to specialized functions, TCM is concerned more with dynamic interrelationships, especially the patterns of Qi.

The 5 main TCM forms of Qi-Shui (Qi, Xue, Jing, Shen and Jin-Ye).
Qi-Energy is the Vital Matter-Energy of every living organism and the source of all movement and change in the universe.

Xue-Blood is the Fluid that circulates in the vascular system, but the Qi within the Xue also vitalizes its nourishing function and its flow. Qi-Xue have mutually interdependent functions.

Jing-Essence is the Essential Qi of all living organisms. It is derived both from Yuanqi (inherited energy, Source-, or Original-, or Ancestral Qi) and from the energy we acquire daily, mainly from air and food (LU-Qi and Nutritive Qi

Shen-Spirit is the material/non-material mental-emotional-motivational aspect of consciousness that is stored in HT (the TCM concept of HT, not the WM concept, which views the organ as simply a pump). The HT has many other functions including the seat of the Shen-Spirit. Other organs and organ systems are capitalized to further illustrate this distinction.

Jin-Ye-Fluids are the normal functional secretions of the body. They include tears, sweat, saliva, milk, mucus, hydrochloric acid and genital secretions. Jin are the lighter, purer and more Yang Fluids which, via LU, moisten and nourish the skin and muscles; Ye are the denser, more Yin, turbid fluids which are processed in SP and ST to moisten and nourish the Zang-Fu (internal organs), bones, brain and orifices (mucus for sensory orifices and others).

Functions of Qi
All 5 substances are interdependent; however, Qi is central to each of them since it is both the prime activator as well as the recipient of their various functions. The 5 main functions of Qi in the body are to:
1.        Nourish growth and development;
2.        Warm and maintain appropriate temperature;
3.        Defend against Perverse Qi (External pathogens), stress, trauma etc;
4.        Control Xue and Jin-Ye;
5.        Transform and metabolize Qi, Xue and Jin-Xue.

Channel Theory
In TCM, Qi-Xue (Energy and Blood) circulates along a system of conduits, the Main ones being the Channels (meridians), as well as through the blood vessels. Qi-Xue is vital; it gives life to all living matter. The Qi-Xue conduits resemble those of the vascular- or nervous- system, since each has a network of main Channels and minor capillaries. There are 12 Main bilateral Channels, each intimately connected with its own Fu (Hollow Bowel) or Zang (Solid Organ), and each manifesting its own characteristic Qi, e.g. LV-Qi, SP-Qi, etc.

Hun_YC1 (1934) The Duty of Oriental and Western Medicine: Part 1. Adapted from WWW 1996. Hun Young Cho was a practitioner of both TCM and WM. This interpretation of the difference between TCM and WM comes from his book "Oriental Medicine, A Modern Interpretation", translated into English by Kihyon Kim. It was originally published in Korean in 1934 and should be read with that understanding in mind.

The Duty of TCM and WM: There is a worldwide trend towards TCM. In Tokyo and other areas, serious discussions on reviving Oriental Med are under-way. In Korea, people are still receiving Oriental Med treatments, so discussions on reviving Oriental Med with the implication of re-establishing it are not relevant. However, further development, elevation and improvement of Oriental Med is the vital question confronting us. The first thing that is needed when discussing the subject of Oriental Med, above anything else, is the proper understanding of TCM itself. Whether one promotes, discards, disagrees with or supports TCM, without correct understanding of the medicine itself, one should not criticize its validity. To properly understand TCM, critical comparisons to WM are absolutely necessary.

It is true that bias cannot be avoided in discussing TCM while looking only from the perspective of TCM. Also, a biased opinion cannot be avoided in discussing methods outside of WM when coming from a contemporary scientific standpoint. Hence, through comparing and contrasting TCM and WM to properly understand TCM and after clearly recognizing its medical value, society should be educated so that they can have a strong faith in the significance of the existence of TCM. As the public recognizes its value, public and Govt support can be acquired. Subsequently, necessary facilities such as Research Insts, learning centres, schools, hospitals, etc. will be established. I recognized this point early and devoted every possible effort for 7 yr so far for the modernization, scientific verification and socialization of TCM. At this time, I am writing an outline of my humble opinions open to the friendly criticisms and guidance of the readers.

One often hears of developments of WM or Mod Med technology, but the moaning of the sick among us is becoming louder and louder. The increase in the so-called modern diseases such as tuberculosis, neurasthenia and digestive disorders of the digestive system should give us all cause for concern. So-called modern diseases imply that these diseases have increased in recent times among the people of civilized countries. On deeper inspection, it signifies that WM is unable to control these diseases. Undoubtedly, living conditions in a complex society make it easy for people to catch these diseases. The invention of fighter planes was followed with the creation of anti-aircraft guns. When battleships showed their prowess, submarines and torpedo boats were devised. Even with the power of modern science, a weakness of WM that it can do little to alleviate the diseases caused by stress in modern society.

In a country like the USA, non-pharmaceutical, natural Med schools have considerable influence and try to treat diseases without using drugs from modern hospitals. Recently in Japan, there has been a sudden rise in the use of many kinds of folk medicines. This development illustrates that WM has been unable to satisfy those patients who are receiving these natural treatments. However, since we have received great benefits from WM, I am not trying to slight or attack WM. Through its development of serology, many effective preventive measures, such as smallpox vaccines, exist because of WM. Developments in microbiology have helped national health institutions to prevent epidemics and many other diseases. Thus, innumerable people have avoided the misery of epidemics. We must praise the strong points of WM and at the same time supplement the weak points. In my opinion, the method of complementing WM can be adopted only from TCM.

TCM is rooted in philosophy and WM is rooted in natural science. TCM is holistic; WM is analytical. The former puts its effort into the observation of living phenomena and the latter puts emphasis on the investigation of the structure of matter. Accordingly, their methods are different and their roles are divided: the strengths of TCM are the weaknesses of WM and the strengths of WM are weaknesses in TCM. Although WM is better in defending and eliminating External pathogens that threaten life, TCM is better in cultivating the fundamental life force (Qi) to increase health. One can compare the duties of WM and TCM in protecting life or health of the human body to the duties of laws and morals in maintaining peace and order in a society. If both do not support each other, a prosperous society cannot be expected. Faith in the omnipotence of WM based on surgery for acute diseases, or on drugs to cure syphilis, malaria, etc, while disregarding TCM is a biased faith. Unconditional defence of TCM and attack and deprecation of WM in cases where TCM Herbal Med easily cured chronic illness is an equally narrow opinion.

Morality is fundamental and law is temporary. In a similar way, TCM is a "root-treating Med" and WM is a "manifestation-treating Med." The Govt exercises power, for example, in unavoidable situations for the safety of the public, but morality has a more effective function than law in the daily life of all people.
It is natural for the authorities to adopt WM for prevention of epidemics and forensic Med, but TCM has contributed more in quantity than all the free Med treatments by the Govt for the health of each individual.

Holistically Treating Med and Locally Treating Med: TCM is a "holistic Med approach" while WM is a "localized (symptomatic) approach." For example, the cause of sinusitis in WM is attributed to an increase in pyogenic bacteria in the sinus cavities (maxillary, ethmoidal, frontal and sphenoidal), which creates pus. Thus, performing surgery in that region has become the method of treatment.

In TCM, on the other hand, the cause of sinusitis is not found in the nasal region. One's constitution and many physiological abnormalities are holistically observed and synthesized in order to inquire and identify the cause of sinusitis in that person. Even in the treatment, TCM does not directly perform artificial treatment such as surgery on the diseased region. Rather, physiological abnormalities are holistically and naturally regulated in order to eliminate the disease phenomenon in the nasal region.

Besides the experience of the author in the healing of sinusitis without surgery, many researchers have confirmed the effectiveness of TCM herbs.

Let us now put aside whether that treatment is superior or inferior and study the theoretical basis of holistic Med treatment.

It is not incorrect to say that the cause of sinusitis is the pyogenic bacteria acting on the sinus, but thinking one step further, it is true that in any healthy body, pyogenic, pneumonia, diphtheria and influenza bacteria are always present in the nasal and the sinus cavities. Therefore, the cause of sinusitis is not in the pyogenic bacteria but in the reduction of resistance that suppresses and restrains pyogenic bacteria. Sinusitis is called Bi Yuan (nose-pool) and, if severe, Nao Lou (brain discharge). The cause of it can be largely categorized as follows: 1.        Sinusitis due to Internal Injury (Yang Xu sinusitis and Yin Xu sinusitis, which originate from physical constitution);

Hun_YC2 (1934) The Duty of Oriental and Western Medicine: Part 2. 2.        Sinusitis due to External Invasion (e.g. due to the common cold). Regardless of its causal nature (Internal or External), sinusitis that accompanies an abnormality of the urogenital system is called Taiyang Bi Yan and sinusitis that accompanies an abnormality in the digestive system is called Yangming Bi Yan.

Specific TCM treatment for this sinusitis will be discussed elsewhere. Holistic or allopathic treatment can be better or worse, depending on the type of a disease. Sometimes the former must be used, sometimes the latter. Sometimes both must be combined. Thus, viewed from the standpoint of Med, both TCM and WM are necessary.

Due to overly venerating localized or analytical Med, strange events can often occur when viewed from the standpoint of holistic Med. The most appropriate example of this is the #606 (penicillin) injection incident regarding a dentist which was repeatedly reported in the newspaper recently. It became a judicial issue and the judgement which was passed made #606 injections by dentists unlawful. This is a truly humorous thing when viewed from a TCM standpoint. It is like lawfully preventing a dentist, who has been granted the privilege to treat dental disorders, from eliminating the cause of the dental disorder. The reason is that an abnormality often occurs in the tooth region due to syphilis, which is easily treated with penicillin. My point is not a discussion of the question of #606 injection privilege, but rather, of the fault of limiting the treatment of the dental disorder to the mouth by isolating dentistry away from treating the cause.

In the Channel theory of TCM, abnormalities or diseases of the reproductive and urinary system react on the CV, GV, BL and KI Channels. Erosion of the nose, loss of the voice and decaying of the tooth root occur often when syphilis invades those regions. Anyone can observe, if they pay close attention, that women develop toothaches and certain abnormalities in the mouth during pregnancy and menstruation. Since the oral region is at the end of the CV, disorders of the reproductive system are clearly reflected in that region and disorders of the tooth-root due to syphilis are a common occurrence. From holistic concepts, it is a major contradiction not to let dentists eliminate the cause of dental disorder. When treating the disease of a human being, who by nature is a holistic organism, such a blunder seems quite obvious due to adopting the "locally treating" theory.

Naturally Treating Med and Artificially Treating Med: One can view TCM as the "natural Med" and WM as the "artificial Med." In a strict sense, natural treatment cannot be a medicine. Also, a purely artificial treatment cannot exist apart from the natural healing power of a living body. It is classified in such a way only through its main focus. The former guides and promotes natural healing power to eliminate disease through the normal functions of the living body itself and the latter puts effort in artificially adopting emergency measures to eliminate the disease.

Here too, we cannot discuss the superiority or inferiority of TCM and WM. Depending on the disease, artificial Med must be used in many cases. Most surgical disorders must be treated by WM.

Orthopaedic Med or optometry, which can be viewed as semi-Med, can easily treat disorders that are quite difficult to treat using TCM. However, it is not proper to advocate the superiority of surgery for all diseases just on those grounds. For example, application of 1-2 packs of TCM herbs has cured many cases of appendicitis and otitis without surgery. In such cases, some doctors of WM say: "Diseases of humans are self-healing (heal naturally), so a cure with TCM herbs means only that the disease was such that it could have been healed on its own, without surgery." This is a statement that will remain unsettled no matter how much one argues. Even if the disease is at the level where Western doctors feel surgery is absolutely necessary, the disease cured by TCM herbs cannot be returned to the original state to be tested. It is also impossible to return a person to life who died because of surgery to check to see whether they could have lived without surgery. Here, we can only wait for fair judgement from the public to see which is correct.

In TCM, appendicitis is called terms such as Xue-Stasis (Shang Han Theory), Xue-Hernia (Hernial disorder) and Inguinal carbuncle (External Medicine). They all have the same meaning, but the treatment methods are flexible depending to the medical terminology.

Another example of Western technique is the application of ice for a febrile disease. Everyone knows that large quantities of heat are consumed when ice is melting and as a general rule, a temperature over 42oC (107.6oF) can be fatal. To prevent this from occurring, cold ice is artificially applied to the head and heart region in order to reduce the heat. This method is not without some benefits, but it has the following disadvantages:

• 1. Physics already has proven that evaporating-heat requires 7 times more calories than melting-heat. Therefore, consuming heat through sweating rather than through the ice is the wisest method.
  2.The best method to reduce heat of the human body is by sweating; applying ice hinders sweating.
  3.To make one area extremely cold when the whole body is warm is not a good idea. Doesn't glass or pottery immediately break when temperatures differ in different parts?.

Aside from these points, WM has many other disadvantages when assessed through TCM. In these situations, resolutely adopting the "naturally treating Med" is correct.An injection is artificial while taking medicine internally is natural. For example, insulin (pancreatic hormone) injection is given in diabetes. It is natural for all substances other than air to be assimilated into the body through digestive organs, but injecting a certain substance directly into blood vessels is unnatural. In WM, a hormone preparation must be injected because of the concern for the change in its properties if it is passed through the digestive tract. However, in natural Med, instead of borrowing the pancreatic hormone from other animals, the person's pancreatic endocrine function is promoted. "Earth controls Water(10)" shows the opposing relationship between the pancreas (SP, Earth) and KI (Water). Thus, this endocrine relationship was known in the Orient millenia ago.

To explain the TCM treatment of diabetes in modern terms, the treatment method chosen is to ingest TCM herbs through the digestive organs to have a kind of external hormonal function toward the central endocrine nerves of the pancreas to recover pancreatic endocrine function and to totally restore glucose assimilating function.

Structural (Immobile) Med v Phenomenal (Mobile) Med: WM is "structural Med" and TCM is "phenomenal Med." WM is "immobile (fixed) Med" and TCM is "mobile (flexible) Med." The foundation of the former is in anatomy and the basis of the latter is in the study of Syndromes. The former looks for the cause of illness within the changes in the organism's structure and the latter identifies it by the abnormalities in physiological phenomena. Here also, the relative superiority and inferiority between WM and TCM should not be discussed since aspects of their roles are different. To give a few examples of the diseases that are treated more advantageously with "phenomenal Med" or "mobile Med," I would first of all cite mental illness. Mental illness is a subtle reactive phenomenon to a physiological abnormality. Therefore, to look for the cause of illness in the structures of the brain and the spine can only be considered an impossible task.

Hun_YC3 (1934) The Duty of Oriental and Western Medicine: Part 3. Mental illness, when correctly observed and treated from the standpoint of phenomenal Med, is an illness that can be cured with one to 2 packs of herbs at the time of onset.

The cause of mental illness is diagnosed through observing symptoms of mental illness such as: type of emotional expression; type of illusion or fantasy; movement; pulse quality; facial colour; season of onset; time of progression or decline in the condition of illness; foods enjoyed commonly and abnormal sensation or location on the Channel conduit.

Another example of the disadvantages of "immobile Med" over "mobile Med" is the use of Ca injections for lung disease. From anatomical reports, areas of a cadaver where traces of the tuberculosis organism were overcome are >80%. Since calcification surrounded the bacteria in those areas, Ca injections were given to the tuberculosis patient. This is very inconsistent in TCM because: 1. Even if Ca is needed, it should be taken through the digestive organs with Ca containing foods and assimilated more naturally through other organs. Injecting Ca directly into the bloodstream does not seem beneficial. 2. Tuberculosis bacteria are Yang-type (in contrast to gonorrhoea, which are Yin-type); they are most active when the body temperature is high. This is supported by the fact that LU tuberculosis becomes worse during summer and in the afternoon, dangerous during adolescence and is aggravated during excitement. Since the rise in body temperature by a Ca injection can be proven by the thermometer, it is definitely detrimental to treatment of the disease.

Root-Treating Med and Manifestation-Treating Med: TCM is the "root-treating Med" and WM is the "manifestation-treating Med." TCM is superior to treat the root cause of a disease and WM is superior in emergency management. Take, for example, the condition of hyperchlorhydria or excess secretion of stomach acid. WM is superior in neutralizing the already secreted excess amount of stomach acid with something like Na bicarbonate to prevent harm to the stomach wall, but TCM is a must in order to regulate physiological abnormality to fundamentally stop the over-secretion of stomach acid. Hyperchlorhydria in TCM is called Tun Suan Syndrome and its cause is said to be, "Wood overacting on Earth" or "LV (Wood) overacting on SP (Earth)". In other words, acid digestive juices of LV Channel system are said to overcome alkaline digestive juices of SP Channel system (which includes the pancreas). The secretion of digestive juices is regulated to prevent Shi and Xu through the external hormonal function of TCM herbs. Since most kinds of chronic disorders are like that, Root-treating Med is the superior treatment here.

Defensive Med and Health-Cultivating Med: WM is "defensive Med" and TCM is "health-cultivating Med." In artificially defending against external disturbance through disinfection, sterilization, serum injection, etc, TCM cannot compare with WM. In strengthening resistance toward disease by cultivating the internal life force and balancing physiological regulation, WM cannot compare with TCM. When examining these points, TCM and WM absolutely must not oppose each other, but must mutually cooperate to give the best possible Med treatment.

Internal Med and External Med: TCM is "internal Med" and WM is "external Med." The doctor of TCM even tries to treat the external or structural disorders with internal Med and the Western doctor tries to treat the internal disorder through surgical treatment (external intervention). Many cases (such as skin disorders) need Internal treatment when the cause of External disorder is Internal; Other cases need surgical treatment when the Internal disease is in the late stage.

Therefore, if TCM and WM communicate and complement each other well, we can avoid leisurely treating external disorders which could be quickly treated with surgery and we can avoid great sacrifices resulting from surgery for internal disorders which could be cured simply with internal medication.

Standardized Med and Adaptable Med: The proof of validity of any treatment system is best judged by its results; in that respect, there is only one medicine, the medicine that works. In another sense, however, the unity of Med can be subdivided into 2 types; standardized Med and adaptable Med. WM chooses "standardization" and TCM chooses "adaptation." WM, needless to say, does not ignore the uniqueness of individuals, but it is true that when observing the disease, an isolated discipline called pathology is established to always try to put the disease into the frame of certain universally valid rules of science. It even tries to establish a universal treatment method. Undoubtedly, if that were possible, it would be very fortunate from the standpoint of Med application, but it is a difficult problem. For example, in a common cold, there can be among its symptoms, existence or absence of sweat, cough, sputum, nasal congestion, dryness of nose, nasal phlegm, loss of appetite, indigestion, constipation, diarrhoea, chills, etc., the combination of which are clinically different Syndromes in TCM. Thus, the "Common Cold" can present as many different Syndromes which should not be treated in the same way, e.g. by the same medicines. That is the reason for the development of the Shang Han Theory in TCM. Whether it is a LU disease or neurasthenia, the symptoms and treatment methods are not uniform. Very few patients present with exactly the same problems: the best treatment is aimed at the specific needs of the subject at that time.
Beriberi is another example. In WM, the cause is said to be deficiency of vitamin B1. Signs of beriberi may appear in animals not supplied with vitamin B1 and the tissues of beriberi patients are deficient in vitamin B1. WM treats beriberi by giving vitamin B1. However, regardless of the route, or dose of the vitamin used, many cases are not cured. This is a weakness of standardized WM. TCM also recognises a relationship between beriberi and vitamin B1 deficiency. However, TCM sees the cause of the clinical problem not so much as a lack of dietary vitamin B1 (which is possible), but rather as a decline in the ability of the patient to assimilate and use B vitamins. The cause of decline in the assimilative function is in a person's physical constitution and abnormalities in weather conditions such as environmental temperature or Damp. This is supported by the fact that beriberi occurs often during Damp weather and is more severe for the person living in a Damp environment; thus, the relationship between weather and beriberi.
A person's constitution determines why person A gets beriberi and person B does not, though they eat the same foods and lead the same lifestyle in the same family. Therefore, the treatment method does not become fixed by a diagnosis of beriberi in TCM.

Hun_YC4 (1934) The Duty of Oriental and Western Medicine: Part 4.
When viewed from the standpoint of WM which tries to identify the "principal disease" and the "principal Med," it is not unreasonable to have thoughts of ambiguity or insufficiency and to doubt that TCM may treat diseases. Having a guiding principle within the ambiguity is the special characteristic of TCM. This is not limited to medicine, but is true in all aspects of Oriental culture.

India's poet Tagore has said that Oriental civilization is like the forest and the Western civilization is like the brick house. It is a most fitting comment. No matter how large a brick house is, the number of bricks can be calculated. But when one confronts a large forest, its vastness is indescribable. The types and shapes of plants and trees that exist cannot be known and are all different. However, within its complicated distinctive features, we can still find the uniform rule of nature. Plants that breed in Damp ground are located in areas of high humidity, plants of shaded ground in dark, dry areas and plants of sunshine in bright, open areas. Not even a branch or a leaf diverges from this rule. In this way, TCM can make sense of paradox and the profound laws within vastness. TCM, while disapproving of universally valid treatment methods, includes principles which have universally valid legitimacy.

Med Used by Govt and Med Used by Common People: WM, in contrast to TCM, is the Med most appropriate for use by the Govt. For the prevention of epidemics in a country or for judicially related Med needs such as blood type, finger prints, autopsy, etc., WM is most effective. That is why the support of the Govt has always been given to WM. TCM is always at a disadvantage compared to WM, which has formed a trinity with Govt, academic authority and monetary resources.

WM and TCM should not oppose each other. It is not a matter of which one is superior. Though the duties undertaken and the direction of contribution may differ, from a medical viewpoint, TCM and WM are like the two wings of the same bird. When both fully communicate, complement and cooperate, then it will be possible to fly to great heights, to give the best medical treatment.

Jaggar_D (1992) History and basic introduction to veterinary AP. Probl Vet Med Mar 4(1):1-11. This chapter offers a brief introduction to the basic principles of AP and a description of its development since its probable origin in China circa 3,000 yr ago. The AP paradigm and its theories of health are compared and contrasted with those of orthodox Euroamerican medicine. TCM is asserted as distinct in its reliance on astute observations of a patient that tend to be more detailed and subtle than those to which practitioners of orthodox western medicine are accustomed. TCM also tends to adopt a more holistic approach. The historic account of the development of veterinary AP begins with a brief history of human AP followed by a discussion of the history of veterinary AP as it developed in China, and subsequently spread to Korea, Japan, Europe, North America, and elsewhere. The International Veterinary AP Society is mentioned with regard to its role in promoting and coordinating veterinary activities in countries outside Asia.

Joshi_YM (1992) AP: a critical evaluation. J Assoc Physicians India Mar 40(3):184-189. Bhatia General Hospital, Bombay. TCM has used AP-therapy for >3000 yr. Mainly due to cultural barriers, AP was rejected in the West. However, research in the last decade has shown the physiological basis of AP. Although it is mainly used in the West to treat chronic musculoskeletal, it also has a place in the treatment of disorders unrelated to pain, such as functional gastrointestinal disorders, bronchial asthma and addiction to alcohol and nicotine. Published controlled trials have many methodological flaws which could be rectified by a standardised AP technique. Since TCM and WM differ in their concepts of anatomy, physiology and systems of diagnosis, it is impossible to reconcile them into a common language. However, it is possible for them to co-exist.

Kass_R1 (1990) TCM and Pulse Diagnosis In San Francisco Health Planning: Implications For a Pacific Rim City: Part 1. Adapted from WWW (Acupuncture.com). [Richard Kass, Dissertation, Social Welfare Dept, Univ of California, Berkeley. Copyright, (c) April 1990. Questions, comments, or requests may be addressed to: Michael Broffman LAc or Michael McCulloch LAc at [email protected] Pine Street Chinese Benevolent Assoc, 124 Pine Street, San Anselmo, CA 94960: WebMaster].

The purpose of this dissertation was twofold:
1. to provide background material on the Asian American culture and dual health care system in San Francisco; 2. to examine how TCM Pulse Diagnosis (a renowned ancient diagnostic technique) can be used to help integrate the dual health care system in San Francisco. The overarching vision for the project is a culturally responsive health care system in San Francisco which effectively controls the spread of chronic disease.

Data collection was carried out at On Lok Senior Health Services in San Francisco. 10 subjects were examined by 2 TCM physicians; one using a Traditional hand palpation method and the other using a computer assisted pulse detection device. The physicians examined the pulse of the same 10 subjects and attempted to:
1. obtain the same pulse readings on a given subject (a test of the reliability of Pulse Diagnosis);
2. match subjects with their corresponding Med files on the basis of pulse analysis alone (a test of the validity of Pulse Diagnosis);
3. precautions against experimenter bias were observed: a. the subjects sat behind a screen with only the diagnostically relevant area of their wrists visible to the 2 physicians (a special glove was worn); b. no contact was allowed between the 2 examining physicians at any time during the study; c. the pulse examination schedule was altered in the middle of the day in order to avoid any detectable patterns.
In the sections on general and individual pulse assessment, the physicians achieved significant results. There was some validity to TCM Pulse Diagnosis; one of the physicians achieved a significant result.
Acknowledgments: The kind cooperation of John Shen, On Lok Senior Health Services staff and clients, Dr Michael Broffman LAc, and Dr Michael McCulloch LAc is greatly appreciated.

TCM Pulse Diagnosis: Introduction & Review of Current Literature.
TCM physicians use palpation to differentiate 31 pulse patterns at 18 positions on the right and left wrists. This delicate technique reportedly provides:
1.        A genuine early diagnosis of functional disorders which, if left untreated, eventually will produce degenerative or malignant organic changes;
2.        The specific and comprehensive, all-inclusive determination of all factors having a bearing on complex pathological processes (at the roots of chronic or constitutional diseases);
3.        Specific and comprehensive and direct appreciation of the immediate effects of any applied drug or therapeutic measure or agent (indispensable for the immediate follow-up of any therapeutic measure, as well as in the assaying of new drugs) (Porkert 1983).

TCM Pulse Diagnosis is the main technique in TCM diagnosis (Broffman & McCulloch, 1986). One problem with TCM Pulse Diagnosis in the USA is that it tends to be unreliable; rarely will 2 physicians come up with identical pulse assessments for a given patient. This circumstance has: 1. discouraged physicians from performing comprehensive pulse examinations on their patients jeopardizing treatment success); 2. increased scepticism toward TCM (Pulse Diagnosis and other aspects of TCM are suspected of being invalid); 3. been a barrier to the scholarly investigation of TCM (clinical trials which are not based on accurate and comprehensive pulse diagnoses are inconclusive).

Advocates of TCM Pulse Diagnosis contend that the problem lies in the application of the technique and not with the technique itself. They argue that: 1. Pulse Diagnosis is extremely difficult to learn (few physicians have the tactile acuity to detect subtle variations at 3 levels of palpation pressure); 2. few physicians are willing to devote the necessary time to master the technique (5-10 yr of supervision is often needed).

Several electronic devices are said to accurately measure the energy at AP points and Channels, as well as make such technology more accessible to physicians (Laub 1983; Lee & Wei 1983; Broffman & McCulloch 1986; Tiller 1982). These devices and their associated techniques have not become an accepted part of conventional Med for 3 major reasons: 1. the techniques are often unreliable (Kenyon 1984); 2. no body of scholarly research exists to show their effectiveness; 3. the metaphysical theory upon which these devices are based is untenable to most health professionals in WM. Although several recent studies have supported the efficacy of this technology (Tsuei et al 1984; Sullivan et al 1984), none have appeared in major Med journals.

An evaluation of both traditional and electronic pulse-taking techniques was undertaken in this dissertation research. The aim was to: 1. assess the validity of TCM Pulse Diagnosis; 2. determine if electronic devices can be used to increase the accessibility (with respect to requisite training) of this diagnostic method; 3. assess whether TCM Pulse Diagnosis can be used to help integrate the dual health care system in San Francisco. Significant positive results would place TCM on a stronger scientific footing and suggest a greater role for TCM in the orthodox Med system in San Francisco.

Investigation of TCM Pulse Diagnosis
Ten subjects from On Lok Senior Health Services in San Francisco participated in this study of TCM Pulse Diagnosis. These subjects were recruited on the basis of the contents of their Med file at this centre; a Med file was considered appropriate for the study if it: 1. did not contain references to physical or physiological conditions at the pulse examination area that might constitute a confounding variable; 2. referred to such conditions at the pulse examination, but these conditions could be controlled. Of great concern was any Med file reference (direct or indirect) to: pulse beat abnormalities, the consistency of the radial artery (e.g. hypertension), the physical condition of the area surrounding the wrist area (e.g. an overweight individual has fatter wrists), abnormal shaking at the wrist area (e.g. some manifestations of Parkinson's Disease), the sex of an individual (e.g. women generally have smaller wrist bones).

The aim was to eliminate or obscure unfair clues that could positively influence the physicians' attempt to correctly match anonymous Med files with subjects on the basis of pulse analysis alone.

The following selection criteria were used to select the subjects: all were female Asian Americans; age and weight differences were minimized (the mean age was 80.5 yr); no subject suffered from skin problems at the wrist area; all had a history of hypertension; all were free of pulse beat abnormalities; all were free of shaking Syndromes at the wrist area; each subject suffered from a unique set of disease conditions (so as to enable the physicians to distinguish one subject from another).

Kass_R2 (1990) TCM and Pulse Diagnosis In San Francisco Health Planning: Implications For a Pacific Rim City: Part 2.

Materials and Equipment.
Med files at On Lok Senior Health Services in San Francisco (see Appendix E) contain comprehensive Med information on every client who visits the centre. These files are updated regularly (usually daily) and are considered an accurate and comprehensive account of what disease conditions plague On Lok clients at any given time. The files were used in this investigation to verify the health condition of each subject at the time of his/her pulse examination. The following bits of information were deleted from each file in order to avoid any confounding variables: name, age, height, weight, pulse rate, and blood pressure information.
An electronic pulse-taking device developed by Dr Laub (1983), working in conjunction with Dr Broffman and Dr McCulloch (1986) was used by one of the 2 TCM physicians taking part in the study. This device detects radial artery pulse signals at the same 18 positions palpated by TCM physicians millenia ago. Pulse images are digitized by the device and written to disk as a computer file. Each image can then be printed out (see Appendix D), matched with one of the 31 recognized pulse patterns in TCM (Porkert, 1983), and used for diagnostic purposes.

Pulse Assessment Form A (see appendix B) was used in the test of Pulse Diagnosis reliability. This form is divided into 3 main sections.

General Pulse Section.
The first section (general pulse section) assesses the radial artery pulse as it appears at 3 spatial locations (Cun/Inch, Guan/Gate, and Chi/Foot) and 3 depth locations (superficial, middle, and deep) in the left and right wrist area. This assessment is general in nature and does not separate out unique characteristics of the pulse at the various spatial and depth locations.
A total of 11 pulse categories are considered in this section. Each category is associated with 2 qualitative dimensions:
1.        Depth (Floating or Deep): a floating pulse is found in the superficial region of a pulse position; a deep pulse is found in the deep position;
2.        Intensity (Strong or Weak): a strong pulse refers to a forceful beat; a weak pulse refers to a delicate beat);
3.        Amplitude (Big or Small): a big pulse refers to a large (long) stroke; a small pulse refers to a small (short) stroke;
4.        Frequency (Fast or Slow): a fast pulse refers to frequent beats; a slow pulse refers to infrequent beats;
5.        Rhythm (Rhythmic or Arrhythmic): a rhythmic pulse refers to uniform cycles of the pulse; an arrhythmic pulse refers to irregular cycles;
6.        Length (Long or Short): a long pulse has a wide base; a short pulse has a thin base;
7.        Type (Yang or Yin): a Yang pulse is characterized by an expanded pulse; a Yin pulse is characterized by a deflated pulse;
8.        Temperature (Hot or Cold): a Hot pulse is associated with an energetic pulse rate (strong, rapid); a Cold pulse is associated with a lethargic pulse rate (weak, slow);
9.        Qi Quantity (Shi or Xu): a Shi (Excess) pulse contains a large amount of Qi; a Xu (Weak) pulse contains a small amount of Qi;
10.        Texture (Hard or Soft): a hard pulse has a pointed top; a soft pulse has by a round top;
11.        Width (Wide or Thin): a wide pulse has a large peak; a thin pulse has a narrow peak.

Sub Pulse Type Section.
Section 2 (sub pulse section) provides for a more detailed analysis of 4 of the 11 pulse categories in section one (depth, intensity, amplitude, and frequency). Depending on what decisions were made in this prior section, each physician chooses from among the pertinent "Sub 1" and "Sub 2" qualitative dimensions described below:
1) For floating pulses: simple, flooding, or none (sub 1) and soft, bowstring hollow, leathery, or none (sub 2).
2) For deep pulses: simple, hidden, or none (sub 1) and weak, prison, or none (sub 2).
3) For either strong or weak pulses: full, feeble, thready, or none (sub 1) and slippery or none (sub 2).
4) For either big or small pulses: long, short, or none (sub 1).
5) For slow pulses: simple or none (sub 1) and knotted or none (sub 2) For fast pulses: simple or none (sub 1) and rapid, agitated, or none (sub 2).

Individual Pulse Section
The third section of Pulse Assessment Form A (individual pulse section) describes the pulse as it is found at each of the 3 spatial locations (inch, gate, and foot) at the left and right wrist area. The same 11 pulse categories are used to analyze these 6 spatial locations. The various depth location findings (superficial, middle, and deep) at each spatial location are taken into account in this assessment:
1) depth: floating or deep;
2) intensity: strong or weak;
3) amplitude: big or small;
4) frequency: fast or slow;
5) rhythm: rhythmic or arrhythmic;
6) length: long or short;
7) type: Yang or Yin;
8) temperature: Hot or Cold;
9) quantity: shih or Cold;
10) texture: hard or soft;
11) width: wide or thin.
Assessment Form B (see Appendix C) was used in the assessment of Pulse Diagnosis validity. This form allowed each physician 3 opportunities (1st, 2nd, & 3rd choice) to correctly match a given Med file (coded A-J) with a given pulse (Coded 1-10). The level of certainty associated with each attempted match was indicated by the attachment of one of 3 symbols (*=confident, +=fairly sure, -=doubtful) to each proclaimed match.

Procedure
In August of 1988 data collection for the pulse analysis component of the study was completed at On Lok Senior Health Services in San Francisco. 10 subjects were examined by 2 TCM physicians; one using the Traditional hand palpation method and the other using a computer assisted electronic device.

The 2 TCM physicians were selected on the basis of their extensive experience of this form of diagnosis and because Dr McCulloch had used an electronic method of Pulse Diagnosis (Broffman & McCulloch 1986).
The 2 physicians examined the pulse of the same 10 subjects and attempted to: 1. obtain the same pulse readings on a given subject (a test of the reliability of Pulse Diagnosis); 2. correctly match subjects with their corresponding Med files on the basis of pulse analysis alone (a test of the validity of Pulse Diagnosis).
The 2 TCM physicians made their respective pulse examinations over the course of a single day in a specially prepared room at On Lok Senior Health Services.

3 precautions against experimenter bias were observed: 1. the subjects sat behind a screen with only the diagnostically relevant area of their wrists visible to the 2 physicians (a special glove was worn); 2. no contact was allowed between the 2 examining physicians at any time during the study; 3. the pulse examination schedule was altered in the middle of the day in order to avoid any detectable patterns. All pulse examinations were timed by the research assistant.

The matching of the 10 Med files to the 2 sets of pulse profiles (one traditional set and one electronic set) occurred after all pulse examinations had been completed. The physicians were given as much time as needed to fill in the 2 assessment forms, and were allowed to consult any resource materials. The assessment process took each physician circa 2 h.

Kass_R3 (1990) TCM and Pulse Diagnosis In San Francisco Health Planning: Implications For a Pacific Rim City: Part 3.

Data Analysis
Reliability of Pulse Diagnosis
The following hypotheses were constructed to test the extent of correlation (reliability) between TCM pulse readings and electronic pulse readings:

H(0)=matches between TCM pulse readings and electronic pulse readings are the result of chance alone; the evidence does not suggest that TCM pulse-taking is reliable.

H(1)=matches between TCM pulse readings and electronic pulse readings are not the result of chance alone; the evidence suggests that TCM pulse-taking is reliable.

An exact correspondence between how Dr Broffman evaluated a given pulse category for a given subject and how Dr McCulloch evaluated the same category was considered a match in all 3 sections of Assessment Form A. The normal approximation to the binomial (Parzen 1960, p239) was employed to determine whether the results obtained (or more extreme results) were better than chance alone would normally produce. The probability of at least x matches is the sum of the binomial probabilities [x + (x + 1) + (x + 2)...] which can be approximated by a normal distribution. A probability value of The % of correct matches in all 3 sections were calculated as an additional way to assess the reliability of the 2 methods of pulse analysis. The results for the 3 sections were:
87 matches of a possible 110 matches, 24 (79% of possible matches) were achieved in the general pulse assessment section. The probability of this result or more extreme results occurring by chance alone is p In the sub pulse section:
4/5 possible matches (80% of possible matches) were achieved in the depth/sub 1 category (p=.023 for 4 or more matches);
1/4 possible matches (25% of possible matches) were achieved in the depth/sub 2 category (p=.52 for 1 or more matches);
2/7 possible matches (29% of possible matches) were achieved in the intensity/sub 1 category (p=.56 for 2 or more matches);
1/2 possible matches (50% of possible matches) were achieved in the intensity/sub 2 category (p=.75 for one or more matches);
2/7 possible matches (29% of possible matches) were achieved in the amplitude/sub 1 category (p=.74 for 2 or more matches),.
7/7 possible matches (100% of possible matches) were achieved in the frequency/sub 1 category (p=.0078), and.
7/7 possible matches (100% of possible matches) were achieved in the frequency/sub 2 category (p=.0002).

463 matches out of a possible 660 matches (70%) were achieved in the individual pulse section (p (Note: Possible matches in the general pulse section is equal to the number of subjects (10) X the number of choices/subject (11) on Assessment Form A. Possible matches in the individual pulse section is equal to the number of subjects (10) X the number of choices/subject. Possible matches in the sub pulse section is equal to the number of subjects for whom a match occurred in a previous pulse assessment stage: 1. the number of matches in the depth, intensity, amplitude, and frequency main pulse categories became the possible match numbers for corresponding Sub 1 responses; 2. the number of matches in the sub 1 pulse category became the number of possible matches for corresponding sub 2 responses. The decision not to examine results in cases where no match was achieved in a previous section was made to simplify interpretation (e.g. if a general interpretation of the pulse is disparate as reflected in a no match, the interpretation of a corresponding lower level match (which represents a finer look at this general assessment) is unclear.

Validity of Pulse Diagnosis.
WM theory contends that palpation of the radial artery pulse at the right and left wrist areas can reveal no diagnostic information about the ST, LU, SP-pancreas, GB etc, as claimed by TCM physicians. The following hypotheses were constructed to test this contention:
H0=correct matches between Med files and pulse profiles are the result of chance alone; the evidence does not suggest that TCM diagnosis is valid.
H1=correct matches between Med files and pulse profiles are not the result of chance alone; the evidence suggests that TCM diagnosis is valid.

Pulse/Med file matching results were considered significant in this study if the probability of occurrence by chance alone was Dr Broffman used the hand palpation method to achieve 2 correct 1st choices (p=.264 for 2 or more 1st choice matches to occur by chance alone), one correct 2nd choice (p=.322 for 3 or more 1st & 2nd choice matches to occur by chance alone), and 3 correct 3rd choices (p=.047 for 6 or more 1st, 2nd, & 3rd choices to occur by chance alone). Dr McCulloch used a computer assisted electronic device to achieve 2 correct 1st choices (p=.264 for 2 or more 1st choice matches to occur by chance alone).

Discussion
Several methodological approaches were considered in this investigation of TCM Pulse Diagnosis; a design in which: 1. both TCM physicians used hand palpation methods; 2. both physicians used electronic pulse detection methods; 3. one physician used the hand palpation method and the other used the electronic pulse detection method.

The first 2 alternatives were rejected in favour of the third for 2 major reasons: 1. testing an electronic device was an essential part of this research 25; 2. only one experienced electronic device operator was available in the San Francisco Bay area. The results achieved for the chosen approach (palpation/electronic) do not necessarily suggest what levels of validity and reliability would have been achieved had one of the other 2 approaches mentioned above (palpation/palpation; electronic/electronic) been used in the study.

In other words, a low reliability finding in this investigation would not rule out the possibility that a high level of reliability could have been achieved if the electronic/electronic approach had been used. Lack of reliability in this investigation could be explained in any of the following 8 ways:
1) electronic assessments of the pulse are accurate but hand palpation assessments are not as a consequence of improper palpation technique;
2) electronic assessments of the pulse are accurate but hand palpation assessments are not as a consequence of faulty interpretation of pulse findings; 3) hand palpation assessments of the pulse are accurate but electronic assessments are not as a consequence of improper sensor placement;
4) hand palpation assessments of the pulse are accurate but electronic assessments are not as a consequence of faulty equipment;
5) hand palpation assessments of the pulse are accurate but electronic assessments are not as a consequence of faulty interpretation of pulse findings; 6) both electronic and hand palpation assessments are inaccurate as a consequence of improper measurement techniques;
7) both electronic and hand palpation assessments are inaccurate as a consequence of faulty interpretation of pulse findings;
8) both electronic and hand palpation assessments are inaccurate as a consequence of Pulse Diagnosis being nothing more than an artifact;

A high level of reliability in the chosen palpation/electronic approach, however, does suggest that a high level of reliability would have been achieved if the electronic/electronic approach had been used.
Kass_R4 (1990) TCM and Pulse Diagnosis In San Francisco Health Planning: Implications For a Pacific Rim City: Part 4.

Significant Results
In both the first section (general pulse) and third section (individual pulse) of Pulse Assessment Form A the physicians achieved a significant p In section 2 (sub pulse section) a significant p=.023 result (80% of possible matches) was obtained in the depth/sub 1 pulse category; a significant p=.0078 result (100% of possible matches) was obtained in the frequency/sub 1 pulse category; and a significant p=.0002 result (100% of possible matches) was obtained in the frequency/sub 2 pulse category.

No significant findings were obtained in the remaining 4 categories (depth/sub 2, intensity/sub 1, intensity/sub 2, amplitude/sub 1), which represented 25%, 29%, 50%, and 29% of possible matches respectively.
The above findings suggest that Pulse Diagnosis reliability goes down as more subtle levels of distinction are attempted.

Other results suggest that there may be some validity to TCM Pulse Diagnosis; in the pulse/Med file matching effort Dr Broffman was able to achieve a statistically significant result. Although this additional information was available to the 2 physicians, there is no evidence that they took the information into account in their selection process. Both Dr Broffman and Dr McCulloch achieved correct 1st choice matches on this subject, but this could be coincidental and unrelated to a confounding variable. A second analysis was made in which the subject in question was not factored into the results. It also questionable whether the use of second and third choice selections in the determination of statistical significance is a viable methodological approach. A statistically significant result was obtained only after second and third choice selections were taken into account; this may indicate an inherent lack of precision in TCM Pulse Diagnosis that limits its clinical usefulness.

An alternative explanation links apparent diagnostic imprecision to incomplete symptom recording in On Lok Med files rather than any inherent weakness in TCM Pulse Diagnosis. Often symptoms that are useless from a WM viewpoint can be the key that unlocks a diagnosis in TCM. For example, chronic canker sores helps in the diagnosis of a HT Syndrome in TCM.

Minor symptoms such as this could very well be left out of Western oriented On Lok Med files; thus putting the TCM physicians at a distinct disadvantage in their matching efforts. If more minor symptoms had been recorded in On Lok Med files the 2 physicians may have achieved better results.

(Note: A 1/3 correct rate is not deemed acceptable by most physicians (Western as well as alternative practitioners) and patients, suggesting that only first choice selections should be included in a test of Pulse Diagnosis validity).

Also, the physicians might have fared better had they been Western-trained in addition to being experts in TCM. Neither their prior training nor currently available resource books afforded them much help in accurately translating Western disease conditions into TCM nomenclature; a process which was vital to the achievement of good results.

The physicians did not have extensive experience diagnosing very old individuals (mean age 80.5) who suffered from so many acute and chronic disease conditions; this may have been another impediment to their success. TCM physicians typically cross-check the findings of Pulse Diagnosis with other physical indicators in the body (such as the face and tongue), and with the patient's symptom-history (TCM-Syndrome). When contradictory findings are found at any of these other sites the Pulses are reexamined and any errors are corrected. This recovery process could render TCM Pulse Diagnosis a useful method, even if the technique and/or its implementation is less than perfect. Had the physicians been allowed to look at each patient's tongue as well as examine her pulse they may have achieved better results.

Conclusion.
More research on TCM Pulse Diagnosis is needed before a definitive statement can be made on the reliability and validity of its use. Although preliminary investigation suggests that there may be some scientific basis for this ancient technique, its diagnostic reliability needs to be improved substantially in key areas. It is unclear whether low reliability in this study are the result of operator error, faulty equipment, or improper interpretation of pulse findings.

One of the key findings in this investigation was that the complex nature of traditional hand palpation virtually rules out its effective use by Western physicians in San Francisco; accurate pulse assessments by individuals who have only a superficial training in TCM diagnostic techniques is not a realistic objective.

The electronic pulse-taking device, however, appears to hold great promise even though it did not successfully show its diagnostic capabilities in the test of Pulse Diagnosis validity. The positive results achieved in the general and individual sections of Pulse Assessment Form A (the test of reliability) suggest that further refinements in this technique could eventually lead to an effective and easy to use tool for Pulse Diagnosis in a more integrated dual health care system in San Francisco.

Although the basics of Pulse Diagnosis (e.g. hard versus soft pulse) can be learned in a relatively short time, detection and interpretation of more subtle pulse forms are needed in order to perform an accurate and comprehensive diagnosis.

The electronic device is interfaced with a PC. This offers the possibility to develop a partially or completely automated system of interpreting pulse patterns according to the 30 recognized wave forms in TCM.
Efforts in this direction are already being made, and preliminary results are encouraging. This would greatly reduce the training needed to operate a device and shorten the time needed to take the pulses and interpret them to circa 10 min. If this feature can be developed, TCM Pulse Diagnosis could become: 1. highly accessible to Western physicians, and; 2. an effective means of helping bridge the gap between Western and TCM systems of Med.

KORYO AP EXPERT SYSTEM (KAES 2) SOFTWARE: Modern technology and ancient art, the true synthesis of East and West. Adapted from WWW.

OUTLINE.
WHAT DOES KAES 2 DO?.
WHO IS KAES 2 FOR?.
THE TECHNICAL STUFF.
MENU.
A SCREEN SHOT.
HOW CAN KAES 2 BE ORDERED.
EXPERT REVIEWS.
RELATED ARTICLES AND WWW SITES.
WHAT DOES KAES 2 DO?.

KAES 2 is a fun and interactive experience which provides you with treatments for 90 diseases using a fuzzy logic that can think through the many "shades of grey" inherent within TCM theory.
KAES 2 disease nomenclature is based on those set forth by WHO.
KAES 2 provides ranked listing of 6 possible treatment strategies including Moxibustion.
Uses deductive logic engine. That means that the computer does more than spit out answers, it chooses more than one treatment plan and offers you options.
Provides explanation to validate conclusions and recommendations.
Prints one report/patient including data, disease, symptoms, diagnosis and therapy.
Displays anatomical charts of over 800 AP points and provides explanation for each point.

HOW DOES KAES HELP THE PRACTITIONER?.
Contains useful administrative features in data inputted and printed-out in Patient History.
Through the extensive symptoms and question asking battery, KAES 2 helps improve and refine the information gathering process.
Through the one-panel, "Results Diagnosis Window," KAES 2 contains all of the information required to truly understand a problem, treatment principle, and a ranking of treatment choices to be explored and selected as is appropriate for the patient.".
Because of KAES 2's rapid diagnosis and printed report, it allows even greater quality of analysis and therapy while at the same time allowing for a higher quantity of patients to be seen.

WHO CAN BENEFIT FROM KAES 2?.
MDs interested in learning about TCM.
Provides practitioners schooled in WM a simple way to ask the right questions to come up with a Syndrome differentiation consistent with TCM theory, and of course the appropriate points to needle.
Students of TCM.
A quick and fun way to associate Syndromes with diagnosis, AP point locations and needling depths.
Teachers of TCM.
Makes a great teaching aid, very intuitive and easy to use.
Registered acupuncturists and practitioners of TCM.
Especially useful when a patient brings in a Western diagnosis, since the diseases are organized by Western differentiation.
TECHNICAL STUFF.
KAES 2 software comes on 2 x 3.5" installation disks.
KAES 2 looks and feels like a Macintosh or Windows 95 menu-driven program.
NOW works with Windows. Requires at least 500 KB free memory and 2 MB RAM.
KAES 2 is available for updates, and has a money-back guarantee.
Other first-of-a-kind software soon available for TCMs.
Basic technical support available via fax. But, KAES can be learned in 5 min.

Liao_SJ (1992) AP for low back pain in Huangdi Neijing Suwen (Yellow Emperor's Classic of Int Med, Book of Common Questions). AETRIJ Oct-Dec 17(4):249-258. New York Univ Dental Coll, New York. In Huangdi Neijing Suwen, among the materials which heretofore have no English translation, there are 3 Chapters on pain. One of them was devoted entirely to the low back pain. This is certainly an indication of its importance even >2300 yr ago. Since it still plagues us today, we have translated that Chapter of this TCM classic to see what we can learn from the ancients. We attempted to second-guess the ancients in the diagnosis of the various sets of symptoms, in the light of western medicine. We discussed the difficulties in interpreting the archaic text. We pointed out that there were associations of the Mais (the Channels and Vessels) with various Syndromes (sets of symptoms) but the AP points were vaguely described and had no names. We inserted our selections of currently used AP points to match the described loci.

Liao_SJ (1992) The origin of the Five Elements in the traditional theorem of AP: a preliminary brief historic enquiry. AETRIJ 17(1):7-14. New York Univ Dental Ctr, New York. The Five Xing (Phases) are essential in the theory of traditional AP and TCM. The word Xing has been translated as Element. However, it actually denotes a phase of movement and activity. The word Element implies a stationary state. Some of the evidence in ancient Chinese literature was reviewed to support the hypothesis that Five Xing were originally meant to be the Five Xing Xin (Moving Stars, i.e., Planets). By the 4th century BC, associations of the Stars with human events gradually evolved. However, between the 4th and the 6th century AD, when the Taoist scholar-physicians expanded the Five Xing into abstractive concepts, they used the 5 basic materials (Fire, Earth, Metal, Water and Wood), and their characteristic attributes or associations, to depict the Five Xing. Since they were basically alchemists and not astronomers, they apparently minimized the relationship between the Five Moving Stars and human illnesses. We propose that the usage of the word Element be discontinued and the word Xing be employed as is.

Limehouse_JB (1992) An Introduction to TCM. Probl Vet Med Mar 4(1):53-65. This chapter introduces veterinarians to TCM. TCM has its own unique approach to describing medical conditions. The Chinese have described naturally occurring medical phenomena accurately for millennia. Ancient theories and concepts allowed them to treat conditions without the knowledge we currently have of neurophysiology. The terminology used in the study of TCM will help show the difference between TCM and medicine as it is practised in the west. TCM encompasses Qi and its functions, the Channels, and the Five Xing (Phases). It will be shown how knowledge and application of these concepts can be used to diagnose and treat disease.

Ma_XL3 (1996) Clinical Point Selections. Adapted from WWW (Acupuncture.com). Dr Xiu Ling Ma, Instructor at Emperor's Coll of TCM, Santa Monica California. She recently arrived in the USA from the PRC and has done a wonderful job of truly enriching the educational experience of her students. This chapter of Acupuncture.com represents the notes that she wrote for young acupuncturists as to which points are appropriate to which diseases, and best of all, why. Certain AP points came up often at the beginning of the class, and at this time, a more full explanation of the therapeutic actions of these points were given. Most reasons given for each point chosen is listed on the document called Therapeutic Explanations. We hope that you'll get as much out of these notes that we did. Notes on: Therapeutic Explanations; Local and Distal point treatments; Symptoms and their points; Four Needle Treatments; Dental; Toothache; Endocrine/Immune; Allergic Rhinitis; Gynaecology; Dysmenorrhoea; Amenorrhoea; Ben Lou; Pre-menstrual Syndrome; Musculoskeletal; Acute Lumbar Ms Sprain; Chronic Low Back Pain; Bi Syndromes; Torticollis; Periarthritis of Shoulder; Cervical Spondylopathy; Neurological; Headache; Sciatica; Nose, Throat and Eyes; Sore Throat; Myopia; Conjunctivitis; Tinnitus/deafness; Psychotherapy; Schizophrenia; Neurosis

McWilliams_C01 (1996) A Rational View of Chinese AP, Massage, and Med Gymnastics: Part 1. Adapted from WWW (Acupuncture.com). [Charles McWilliams has been a researcher and teacher of TCM philosophy for >20 yr: WebMaster]. Years of teaching-experience have shown that the dead and lifeless words, commonly found in standard or "essential" textbooks of Chinese AP (e.g. Yin-Yang, Qi-Xue, Perverse Qi, Channel, Five Phase Theory, etc) serve as immediate points of confusion for newcomers who want to learn and understand TCM. Also, most textbooks either present the indelibly allied treatment methods of massage (Tui-Na, An-Mo) and Med gymnastics as subsidiary or inferior in application, or leave it out altogether as though it is not part and parcel to the scope of conduit therapy. These misrepresentations, now replete in our literatures, are because Westernized analytic thought has all too often been used to "explain" the phenomena of TCM. Some of the most essential and core theories have been left entirely out of our textbooks due to a paralysing paradigm. The author will show how TCM science in relation to a fundamental understanding of quantum physics can quickly bring the student into our marvellous paradigm of TCM Healing. Dr Charles McWilliams (DAc DHom, is Academic Dean of the PanAmerican Inst of BioEnergetic Med, Ltd, and Director of the Jade Island Acad of Massotherapy & Aesthetics. He formed and licensed in the State of Florida the first school of Oriental and Homeopathic Therapy in 1981.

Introduction
WM and TCM have been referred to as antithetical systems by many authors (1,2,3,4,5,6,7,12,13,16). WM culture has been dominated by the view of intellectual and technological superiority. The human body is viewed as a machine composed of parts, is to be analyzed by its parts, and repaired by its parts, piece by piece. Their concept of homeostasis is only relatively new, yet it is viewed subservient to its properly maintaining parts, e.g. the endocrine glands and ANS. This view is now, however, being slowly eclipsed by a more holistic and ecological conception with a view that science is now showing increasing interrelatedness and interdependence on all living phenomena, save that of space and the cosmos. For millenia, TCM and philosophy have been mainly holistic and universal. The entire universe of which man and earth is a part, is viewed as interrelated. The human organism is a microcosm of the universe and its operations are reflected in nature and the cosmos (astrologically speaking). This dynamic way of thinking, the Asian scholar Joseph Needham aptly called "correlative thinking." (7) The TCM view of our body has always been mainly functional and focused on interrelation of the organism (anatomy, physiology, pathology), to the earth (agriculture, dietetics, herbology), and to the cosmos (meteorology, climatology, and cosmology). The 2 scientific Med systems are in essential opposition, while recently modern physics continues to substantiate concepts of the Chinese naturalists >4000 yr old(2,3,6,7). This century's almost entirely independent histories of science and culture, as applied in WM and TCM, were determined at the outset at the epochal transition between the Arien and Piscean Ages. One was a cultural revolution that began with Confucian and Taoist philosophy (circa 500 BC), and the other was Greek philosophy that began around the same period with such intellectuals as Pythagoras, Plato, Hippocrates, and Aristotle. These intellectual revolutions were essentially formations of world-views, or paradigms, of whose systems are now legion.

The Western student, versed in mechanistic and materialistic viewpoints, has inordinate difficulty to grasp the dictums as presented in Westernized texts on TCM, which from the outset should become axioms. Without knowledge of basic TCM theory (Yin-Yang and Five Phase Theory of Qi relationships etc), the acupuncturist has no theoretical foundation upon which to base their practice. This is because its foundation has suffered a Westernized, fragmented paradigm, imported essentially by missionaries and authors writing as spectators to TCM practices, rather than Western students of TCM savants.

The advent of quantum physics, however, as the author will point out, provides valuable new tools and concepts which will quickly immerse the AP student in a working framework and living dynamic that can not only be applied in practice, but in day-to-day life itself.

Secondly, in part 2 of this article, the author will show where exhaustive studies of the ancient and modern classics of AP have revealed and made clear that the AP format as presented by many of these same, confused occidental authors, has set wrong standards for practice within the framework of TCM. Because Vietnamese became a part-Westernized language, we have our French and Vietnamese colleagues to thank for bridging the gap in our misunderstandings, although its profound applications have yet to be universally applied in theory and in practice which this article hopes to initiate within the Pan American regions.

Ideograms.
Yin-Yang, is the first and most essential concept generally taught in the TCM, whose healing arts include AP, macrobiotics, herbalism, dietetics, massage, etc. Yin-Yang are complementary but opposite states or conditions. Yin describes states of matter or Qi which are negative, female, dark, cold, and wet. Yang describes states which are positive, masculine, light, warm, and dry. The ventral area and lower half of the body, below the waist, is Yin; the dorsal area and upper half of the body is Yang. Likewise, the Solid Organs (LU, SP, HT, KI, PC, LV) and glands are Yin (the Zang); the Hollow Bowels (LI, ST, SI, BL, TH, GB) are Yang (the Fu). The Channels, conduits of Qi (vital energy) that connect the Zang-Fu, also are divided into opposites, Yin-Yang.

The idea of Yin-Yang is symbolized in the form of the so-called Chinese "monad", the symbol of a closed circle divided by a S-curve into equal halves. Yin-Yang are terms used to express a fundamental premise of Chinese thought: to convey the idea of the polar quality of all effects. That polarization of reality had consciously been realized by the priests of the Shang period (second millennium BC).

Tsou-Yen was a famous feudal lord of the alchemical school circa 350-270 BC. His Yin-Yang Chia set out the doctrine of Yin-Yang as the controller of all cyclical movements and of destiny. According to Needham(7), he may have been the sole originator of the Five Phase Theory. He propounded Confucius' "middle kingdom" (China), naming it the spiritual red continent, which held the whole world in place. The division of phenomena and effects into 2 polarised Yin-Yang groups, which can transform one into the other making a polar unity, had already served to regulate the order of Chinese cultures for >1000 yr earlier.

McWilliams_C02 (1996) A Rational View of Chinese AP, Massage, and Med Gymnastics: Part 2. From those times, practically to the present, Yin-Yang is an essential concept of Chinese consciousness, e.g. the Qi (energetic) phenomena of life, with their Yin-Yang polarity and Change (transformation).

It is easy to understand how Chinese cosmology is viewed by the Westerner upon the principle of dualism. Its origins can be found in the story of Ormuz and Ahriman of the Persians, the masculine-feminine principle of the ancient Egyptians, the subdivision of the Hindu God Brahma into male and female elements for the creation of the world, as well as Plato's theory of universal dualism. Western thinking is essentially a Dialectic: The contradiction between 2 conflicting forces viewed as the determining factor in their continuing interaction. Or, effectively, a method of argument or exposition that systematically weighs contradictory facts or ideas with a view to the resolution of their real or apparent contradictions. This process is especially associated recently with Hegel of arriving at the truth by stating a thesis, developing a contradictory antithesis, and combining and resolving them into a coherent synthesis. Hegel's critical method for the investigation of this process is much in the same way as "scientific process." A scientist makes a discovery, prepares a thesis or paper for presentation, which is then retorted by his or her colleagues. Retort after retort, it may or may not become a "discovery," or accepted phenomena.

This method, psychologically, adequately conforms to the process of aberrated thinking. Aberration is a term that refers to a defect in optical lenses that produces inexact focusing. Aberrated cognition is thinking that is preceded by effort, and countered by counter effort. It is a term commonly applied to neuroses. Memory patterns are entangled with elements of fear, which in turn form the basis of the personality's operational dynamic. The flow of life is thus encountered as day-to-day threat, in which case, thought is preceded with effort, and countered as counter-effort. These become the inherent part of the personality or symptom complex as "defects of character" (31) with its aim to be eliminated in Zen Buddhism, Taoist meditation, the practice of Gongfu, Ninja, Karate, etc. These thought complexes are also the notorious problems teachers have in training a student in TCM or philosophy.

The Western process of discovery is thus a basic pattern of everlasting conflict, a paradigm symptomatic of today's societal strife. It is a materialistic idealism that is never ideal. It posits a one Absolute, e.g. "God," versus its polar opposite, the material, atomicity of matter. In this paradigm, one arbitrarily separates the formless from the formed, the non-absolute from the absolute. When issues of the absolute intercede into expected material outcomes, it is then totally ignored and handed over to the religious or mystic, or explained as an integral part of "nature," or perhaps "chaos" theorems.

The Western corollary of fragmenting states of life, into 2 extremes, is antithetical to the Chinese scientific paradigm, and is disturbing to its understanding. Chinese science posits that the universe is eternal and cyclic. Chinese cosmology depicts the process of change and evolution out of the Taiqi, the great ultimate, or primal monad, into the Yin (formerly called Kun or negative principle) and Yang (formerly called Qien or positive principle or modality) which then in turn produces the Five Phases as colour or form (Se). In summary: Tao -> Taiqi (Great Ultimate, Primal Monad) -> Yin-Yang -> Taishi (The inception of Qi, vapour) -> Five Phases -> Se (colour & form).

Yin-Yang
The concept of Yin-Yang is generally confusing to the student of TCM philosophy. As regards its metaphysical function, Yin depicts female activity and tends towards inertia, receptivity, cold, and darkness. At first, the student might consider the earth to be a Yin manifestation, as it receives Qi (sunlight and energy) from the sky to feed its inhabitants and warm its surface. However, the earth also emits Qi, due to the green house effect. This ascending radiation from the earth (Yin) towards the sky (Yang) is a Yang phenomenon. Consequently, from the physical point of view, it is Yang (dilating, expanding in force from centre outwards), yet all Yin phenomena are declared to be centripetal. Given this, the sky or heavens is declared as Yang from a metaphysical point of view, yet is Yin from a physical point of view due to its intense cold, blue colour, etc.

All created things and functions can be assessed as to their Yin or Yang state of activity. TCM texts describe salt as essentially Yin, correlated with the Water Phase. If a person places salt on a small cut, he will see the edges of the wound approach one another, or place salt on fresh beef it will soon contract, dry and harden, both centripetal phenomena.

From the knowledge of these principles, students should be able to distinguish Yin-Yang in all phenomena, in all beings and things, in all states of health and disease, in all foods and herbs, in all domains and levels without exception. TCM states that Yin-Yang are the ultimate causes and effects of diseases, and the principles on which all diagnosis and practical treatments should be derived. Yet, once students pass their examinations and begin to face real disorders and disease on a daily basis, Yin-Yang concepts often become a mere philosophical amusement. When young graduates begin to practice, it is not unusual that they forget or abandon this most basic theory. Theory and practice become separated. This is unfortunate, as unpractised theory is useless, and the practice of the healing arts which is not guided by principle is vicarious at best, dangerous at worst. Huangdi Neijing Suwen, Chapter 5-8 says: "Regulation and treatment without method show that the rules of Heaven are not being followed, and calamities and visitations upon earth will reach their utmost".

Throughout history, mental and cultural decay occur when major shifts occur, when dynasties and empires collapse. Historical data and future generational developments are picked up, piece by piece, by successive generations. Confucius called this "rectifying the words," to rediscover the real meaning of words, to redefine them by reference to present realities in context to what they referred originally. As Confucius said, the important aspect of words is not that they make knowing possible, but that they make morality and dignity possible for human betterment.

The functioning of the Yin-Yang divisions (correlates of our organs) of a living individual is non-sequential, non-fragmental, and simultaneous. In this view it transcends time. This is obvious without regards for the Yin-Yang sectors: the organs, regardless of their Yin-Yang values, are observed to function simultaneously. The only Yin-Yang value that can be assigned is in terms of time, it is a linear function of rhythm or physiological cyclogeny.

McWilliams_C03 (1996) A Rational View of Chinese AP, Massage, and Med Gymnastics: Part 3. Thus, certain energies respond to solar variations, others respond to lunar variations. At one point in time they can be essentially Yin, at another point of time essentially Yang. The energies are forever transforming. Only the human mind appears to sequester or fix phenomenology into predictive elements as regards static past events. This is essentially a function of memory which distorts into aberrated cognition as previously mentioned.

Other Chinese scholars, often ignored, recorded exceptional viewpoints. For millenia, TCM viewed Shui (Substance, matter) as constituted by and emitting wave particles (feng-Qi); that light (kuang), electricity (tien), and magnetism (tzu) are energetic (neng) manifestations of these wave particles. All matter is simultaneously waves and particles, as modern physics now recognizes. Also, space (yu) and time-motion (chou) do not exist in themselves, but are interdependent aspects of a whole, space-time-motion continuum, as Einstein recently showed. For millenia, the Masters of the Orient stated essentially that matter is condensed light.

Ta Tai Li Chi (Record of Rites of the Elder Tai, circa 73-49 BC) inscribes a most exemplary passage which was later incorporated into the Confucian Canon Li-Chi: "The bright radiates Qi, therefore there is light outside it. The dark imbibes Qi, therefore there is light within it. Thus it is that Fire and the sun which have external brightness, while Metal and Water have an internal brightness. That which irradiates is active, that which imbibes irradiation is reactive. Thus Yang is active and Yin reactive".

One of the central metaphors from which to study TCM philosophy is the term Se: it means both form and colour. It encodes the proposition that all forms, or what we call phenomenal appearances are colour forms. This metaphor is the best door to understanding TCM. How it has eluded the textbooks for so long is in itself phenomenal. Colour is a central phenomenon from which to understand, both a Chinese perspective, and the hard science model, e.g. quantum physics. It is in many respects the most highly developed of the physical sciences that has now bridged the gap between hard Western science and soft Chinese philosophy(6,14). From a Western perspective, the understanding of the phenomenon of electromagnetic radiation is crucial to comparatively evaluating Chinese and Western sciences. And in our modern era, we have little choice if our profession is to gain respect and become part of tomorrow's mainstream.

The Chinese viewpoint of colour is much easier to comprehend because anyone can readily see it. It is the only quality present in all things exterior to the human mind. We can readily see an object's colours, but do not have to dialectically quantify its Yin or Yang properties. There are many objects of which we cannot sense by taste, touch, or odour, but which we can sense by their colour. Salt appears white as a crystal, until it becomes thick enough to see that it is yellow (or examine it through a prism or spectroscope). We therefore know that it is warm and moist. That is why it will exacerbate Yang-hypertension, even though an ancient reference ascribes it as Yin. Pure water, which is scientifically described as the only substance that has "no taste or odour", is clear until it becomes thick enough to see a hint of blue, and therefore we know it is cooling and expansive. Hence, it is only logical to use colour as the foremost phenomenon from which to derive the state of energy of any phenomenology.

Energy-matter (Qi-Substance) is a polar continuum. Within Yang there is Yin, and within all Yin is the hidden Yang. Qi and Substance are 2, polar aspects of the same thing, however opposite, in that one can transform the other, and identical because one does not exist without the other. Qi (Yang) and Substance (Yin-atoms) are an aspect of the entire optical universe and are thus a complete polarity. (What is believed to be the earliest mention of the Five Phases and its interrelation to matter, is an inscription written on a Jade sword handle, thought to be of the Chi State Province, circa 400 BC: "When the Qi of the Phases is settled, condensation occurs; this condensations acquires spirit; a spirit comes down and is born; comes down and is fixed; it acquires strength; with strength is acquires intelligence; with intelligence comes growth; growth brings full stature; with stature it becomes a man. Thus Heaven supports him from above, Earth from below; he who follows the Tao of Heaven and Earth shall live; he who violates the Tao of Heaven and Earth shall perish").

In Chinese science, the colour continuum runs from red (Yang) to black (Yin). These 2 themes are commonly found in their decorating and architecture. Red correlates to Qi, black to Shui. Each Qi level of a subject or object, co-occurs with a colour. No colour=no form; no form=no colour. Qi (energy, vapour) is Yang; Shui (Substance, matter) is Yin.

The shift of Qi (Yang) to predominance of Yin is from red to violet-black. This is symptomatic of an increased interaction, mixing, or blending of Qi and Shui (energy and matter). Red is the colour of Qi maximally separate from, and just beginning to enter or gently dominating Shui. Red is Hot, spicy, energizing, and ready to donate its Qi. Violet-black, is the colour of matter deeply invaded by Qi, solid and secure. The spectrum continuum is basically from red to white (Yangqi (energy) is dominant within form), from green to violet-black (Yin Shui (matter) is dominant over and withholds Qi).

Heat (infrared) - red - orange - yellow - white - green - blue - indigo - violet - black (ultraviolet).
Colour therefore, is a substantive metaphor which agrees with our Western scientific paradigm of quantum physics. Within colour, Yin-Yang correlates are self-explanatory, obvious, and immediately applicable. It can be applied to AP therapeutics, Oriental massage therapy, dietetics, herbalism, aesthetics, and practical living, immediately, once the principles are grasped.

Wu-Xing: the Five Phases (Earth, Metal, Water, Fire, Wood)
The second basic standard for the teaching of TCM philosophy is that of Wu-Xing, the Five Phases (Elements). The role of the Five Phases is second only to that of Yin-Yang. The Five Phases define energetic qualities which Change and evolve into one another with time. The word Element is a misnomer, as it was derived from European missionaries of this and last century who visited China with their Westernized habit of cognition, which later contributed significantly to misdirected AP development in Europe. This has only of late been corrected to the term Phase by the German sinologist Manfred Porkert(1), and by the French authors Maurice Mussat(9), Nguyen Van Nghi(10), Chamfrault et al(8,11). Again, this points to the development of wrong conventions applied to Chinese philosophy by Western spectators and how the habit of continued use creates a wrong set of values upon which to teach AP and TCM.
McWilliams_C04 (1996) A Rational View of Chinese AP, Massage, and Med Gymnastics: Part 4.

From a Western viewpoint, the understanding of the core of Chinese metaphysical thought regarding nature and medicine, can be attained adequately by understanding energy from a quantum perspective. Since the days of the Nixon era ("AP discovery" in the West), Chinese science has failed to assess correctly the role of Yin-Yang and the Wu-Xing. This has led to debates on the validity of Chinese Med science. This failure is the result of a very polarized perception which generally regards the Western scientific method more valid and superior. That perception is a causal method, which stems from the Greek, analytical mode of thinking or cognition.

The evolution of Western science from the classical Greek thought came from a Renaissance toward the end of the middle ages, in part due to Arabic transmissions to Europe. It is basically a materialistic view of the universe, wherein everything of any substance or significance is matter. That every thing of the universe consists of matter, physical solids, gases and liquids. Light and heat are considered only a reaction of matter, yet now in terms of electromagnetic radiation through a "vacuum." The relation of these physical things is conceived as cause and effect. From Newton to Einstein, energy has increasingly acquired an identity of its own. Yet, the philosophical basis of western science is a closed system made final by Aristotle. Its elements had already been taught by Pythagoras, Parmenidies, Democritos and Plato. Our very languages are permutations of Egyptian, Babylonian, Persian and Hindu (sanskrit) thought.

The Greek analytical mode of thinking is the main theme of intellect and education today. For that reason, Western students immediately experience a crisis in cognition when beginning to study TCM (and even homeopathy). The Basic Standards (as Manfred Porkert terms them) of Yin-Yang and Five Phases, appear dead, fragmented, and lifeless. As pivotal agents of the Five Phases (Elements), concepts of Yin-Yang, Hot-Cold, dry-moist etc, hardly agree with the periodic table of the elements, covalent and ionic bonds, acids and bases, etc which Westernized comparative attempts, like macrobiotics, notoriously reversed and confused when trying to synthesize into a rational dialectic.

This same crises of paradigm shift, or irresolute dichotomy is encountered when a Western scientist tries to rectify his world view with religion and the afterlife. Religionists and idealists encounter the same dichotomy when their viewpoint is confronted with hard science. According to Holbrook(6), both systems of cognition are essentially "death paradigms," leading to monumental crises ecologically, spiritually, and morally. Confucian philosophy has thus adequately predicted today's state of world affairs.

By denying the basics of life to supply and demand economics, materialistic science portrays humans as passive effects of more fundamental aspects of environment, selection, and survival while suppressing human beings as having little or few spiritual capacities, innate intelligence or inherent faculties as from rebirth or reincarnation, etc. The Western world view of a God, pure being who perfectly thinks, knows and sees all, and absolutely causes all movement and phenomena, relegates humans of less value, making them less responsible for their actions, less able to perform feats or acts of god, etc. This degrading train of logic makes human beings effectively a non-god, since their god is external of themselves. In other words, the Western view is a material universe with human beings seeking to gain spiritual understanding, whereas in the Chinese view, we are already spiritual beings, temporarily suspended in a material existence. As Confucius stated, "of all things in the universe, human beings are the most precious.".

Confronted with these facts, the student of TCM needs a door in which to enter the marvellous system of TCM thought. The Chinese scientific paradigm is richly metaphoric and not of immediate service to the Westernized student. A metaphor is a figure of speech in which a word or phrase that ordinarily designates one thing is used to describe another. Metaphors have been used richly by Zen masters to teach students the core of TCM thought. Thus, the student must either abstain from substituting Western equivalents for Chinese synthetic terms which destroys their integral significance, or come up to the times in terms of modern physics to appreciate their significance.

The study of the Five Phases or Forces is essentially a part of astronomy and astrology. The concepts were essentially those of the savant naturalists who were able to influence the feudal lords. The Five Phases were changing states of Qi (energetic manifestations), as manifested in natural cycles, such as the seasons, from where colour correlates were formed. Thus the Yellow Emperor, Huangdi, apparently chose that colour for himself and for Earth since he ruled over a region where that river and its yellow banks were essential to trade and commerce. The colours were generally chosen based on the colour of the ascendant (sunrise) for that time or season of the year.

The extensions of the colour correlates to that of the human body were evident in light of the fact how certain organs were functioning as the temperature and climate changed through the seasons. Colour and form (se) were seen to be so inextricably linked, it became a guiding basis for the interrelated systems.
Seasonal and cosmic cyclical processes are by convention, the bases of all geocentric astronomies, and to this, the author takes no issue. Debates abound on sidereal, tropical, and lunar astrologies as to which system is best. The metaphysician, which an acupuncturist must admit to be, must simply chose which convention of cyclical standards suits his or her practice. Five Phase Theory is more than adequate and works from theory to practice with only a few exceptions. Elaborations have been contributed to by masters of the art down through the centuries. Tsou-Yen's depiction is certainly a proto-science, but since it was so widely believed and elaborated upon by the Han Confucianists, it serves as a striking parallel to conventions accepted by Greek elemental theory. No doubt, as Needham points out, Tsou-Yen's school rested on astronomy and calendrical science, as is reputed, yet he was the only one who knew of the alchemical transmutations of the Five Virtues; he was the authentic source of Confucian Han speculations about the Five Phases.

Thus, the AP student should study thoroughly Dr Porkert's excellent presentation of the Five Phases and Orbisiconography as part of "Standards of Value for Phenomena of Microcosmic Dimensions"(1). The author has exhaustively put together a comprehensive Quantum, Chinese colour synthesis in his book Photobiotics (14) where the student can easily enter into our marvellous dimensional paradigm through a practical understanding of modern physics(6).

McWilliams_C05 (1996) A Rational View of Chinese AP, Massage, and Med Gymnastics: Part 5.

Part 2: A rational view of Traditional Chinese AP
In the 1950s the committees of the Univ of Peking and Hanoi, in particular the doctors of the Inst de Recherche Experimentale de la Med Orientale de Hanoi presented a new epoch in the understanding of the circulation of Qi based on an exhaustive study of the classics both ancient and modern. The outcome of the studies, published in 3 volumes (Trung y Hoc, Edition Medecine Hanoi, 1961-63), proposes and presents a radical shift in AP and acupressure methodologies as well as rectifies the translations errors and misconceptions due to Greek-analytic cognition, replete in Western literatures on AP. The information is also missing entirely in such new editions as "Essentials of AP," and "Outline of Chinese AP," published in mainland China.

The materials presented by the Hanoi Inst are not straightforward. They need interpretation, since the disorders listed with the conduit Syndromes are direct translations. We must also note that the clinical disorders seen in modern western settings differ from those found on the southern regions of the Pacific rim. Types of "Perverse Qi" also differ, since we must often deal with "perverse freon" (toxic Qi), household pollution, and electric smog. Because natural body reactions to External pathogens (sweating etc) are suppressed by climate control, over-the-counter drugs and antibiotics, restrictive polyester clothing, and chemical cosmetics and toiletries etc, Perverse-Qi becomes transformed with subsequent sub-Channel-Stasis.

One of the essentials of TCM relates to Qi-conduit theory, and the location of sensitive points (Shu-Xue, Ahshi-Xue) on their pathways. Qi-conduits are the theoretical the basis of TCM. Qi-conduit theory is the sole basis for the use of Chinese herbal medicine, AP, acupressure, moxibustion, massage, Qigong, Taiqi and other mental and physical therapies. The Jing-Luo-Mai (Channels, Collaterals and Vessels) are the Qi-conduits. In TCM, Jing means Channel (passage or conduit); Luo means Collateral (Connection, Attachment, Net: the Vessel that conducts Qi between the Yin-Yang Paired Channels within each Phase). Jing-Luo means "guiding the rhythmic manifestation of Qi on definite paths". Together, the Jing-Luo-Mai designate the entire Qi-conduit system which reaches every part, level and cell in the body.

Conduit anatomy and physiology is entirely metaphysical or optic, whereas their pathology is both sensorineural and physical. As the Hanoi Inst clearly presents, one cannot use traditional AP and massage therapy adequately without a thorough knowledge of the conduits, ramifications, and pathogenesis. As they guide Qi-Xue to the Zang-Fu, head, trunk and 4 extremities, the conduits, both Main and secondary (sub-Channels), are integrated in the practice of both massage and AP. In TCM, one must know the Qi-conduits in order to comprehend adequately the different relations of the different parts of the body and the evolution and treatment of disease. Thus, expert practice of AP and massage demands deep knowledge of the conduits (the 12 Main Channels, the 8 Extraordinary Vessels and the 52 Secondary Vessels).

An outline of a good study-plan to enable students of Chinese AP, massage, or Med gymnastics to properly learn the elements of traditional Chinese anatomy, physiology and pathogenesis follows:

1.        Quantum physics
Revolutionary new understandings in science and cosmology have developed in the last 20 yr. Physics has advanced to unprecedented discoveries, leaving biology and medicine far behind in their quagmires of biochemistry and biophysics. Only in Europe, have these issues begun to be addressed. The student is advised to study the following texts in order to appreciate and immediately understand the underpinnings of TCM:
1.        Capra F (1975) The Tao of Physics. Shambala Publishers.
2.        Zurkov G (1979) The Dancing Wu Li Masters. William Morrows Co.
3.        McWilliams (1994) PhotoBiotics, The Revolutionary Quantum Energy Dieting & Lifestyle Through Colour. Promotion Publishers (1-800-231-1776).
4.        Porkert M (1974) Theoretical Foundations of Chinese Med. MIT Press.

2.        Physiology
Students no longer need be confused about the types of Qi of TCM. Central to its understanding are the energetics of the TH. A complete description of its physiology has been in print for >15 yr (5,27,28). Its understanding is pivotal in AP and massage therapy as it is the source of the Yongqi and Weiqi.
From surveying ancient Chinese texts on AP, it becomes obvious the TCM savants were seeing forms of Qi not accessible to the naked eye. One can only conclude these savants possessed some form of clairvoyance. The forms of Qi and Channels were described by their colour and conduits.

a.        Weiqi (Defensive, Guardian Energy): Qi disengaged by TH during alimentation permeates the aura and the superficial layers of the body. Weiqi is distributed mainly in the longitudinal and transverse Luo and the distinct and Tendino-Muscular Channels, where its circulation is horary (solar), and in the Extraordinary Vessels (GV, CV etc), where its circulation follows lunar rhythms. It regulates the immune system to ward off the attack of the Perverse-Qi, controls the superficial circulation of Xue and thermal regulation of body heat, vasomotor responses, and is fundamental to maintain homeostasis. Its properties are essentially infrared.

b.        Yongqi (Nutritive Qi): Qi disengaged by TH during alimentation is transformed by LU into Yongqi, mainly that supplied by the 5 flavours, which nourish the Zang-Fu and is distributed by the 12 Main Channels as commonly listed in the Westernized textbooks. The energetic properties of Yongqi are essentially optical as shown by Russian studies (17). Although Yongqi can be manipulated AP needling, its energy is to be supplemented with moxibustion and herbs. The student is advised early on, that Yongqi is disturbed only with difficulty, and that many of the maladies considered to be that of the Main Channels, are disturbances of the Tendino-Muscular and distinct Channels. In practice, "one risks very dangerous perturbation of the malady by inconsiderate tonification or dispersion" (Trung y Hoc, Traite de Medecine Chinoise). Yongqi is fostered by dietetics and Med gymnastics.

c.        Yuanqi (Source, Original, Ancestral or Hereditary Qi, called chromosomal energy in some French texts): Qi disengaged by KI circulates in the Extraordinary Vessels. Its properties were in the ultraviolet range (violet-black) by Fritz Popp(16). Qi is amenable to needle manipulation, but is to be conserved by righteous practices and lifestyles, and fostered with proper dietetics and tonic herbs, e.g. ginseng, dong quai, astragalus, etc.

Electromagnetic Spectrum of Qi (according to McWilliams): Infrared - Colour - Black; Weiqi - Yongqi - Yuanqi; Infrared - Optical - Ultraviolet.

McWilliams_C06 (1996) A Rational View of Chinese AP, Massage, and Med Gymnastics: Part 6.

3.        Anatomy of the conduits
The Qi Channels (meridians) are defined as "any of the lines of longitude(18)". They are better defined as conduits (Channels to convey Qi (energy)) by Porkert(1). The Main Channels (Main, distinct, and Tendino-Muscular) are mainly longitudinal, whereas the reticular Luo-Collateral Vessels are latitudinal.
The conduits have been known to conduct electricity since the 1950s(19). This emerged into a comprehensive system of diagnosis and treatment, led by the author's mentor Reinhold Voll. However, recent German and Russian studies(16,17) have verified the light-conducting ability of the conduits in the human body. The colours of the organs and conduits were described in Huangdi's Neijing Suwen (Yellow Emperor's Internal Med Classic) as early as 2600 BC, emphasizing the interrelationship of colour and form in diagnosis and treatment: "Green is the colour of the East, it pervades LV and lays open the eyes and retains the essential substances within LV; it conforms to the 4 seasons and the planet Jupiter. Red is the colour of the south, it pervades HT and lays open the ears and retains the essential substances within HT; it conforms to the 4 seasons and the planet Mars. Yellow is the colour of the centre; it pervades SP and lays open the mouth and retains the essential substances within SP; it conforms to the 4 seasons and the planet Saturn. White is the colour of the West, it pervades LU and lays open the nose and retains the essential substances within LU; it conforms to the 4 seasons and corresponds to Venus, the evening star. Black is the colour of the North, it pervades KI and lays open the 2 lower orifices and retains the essential substances within KI; it conforms to the 4 seasons and corresponds to the morning star Mercury.".

Thus, colour as Qi (energy), is distinguished from Shui (matter), it being understood that energy and matter are opposite polarities, yet ultimately indistinguishable aspects of the same phenomena. Humans and their organs are linked to the earth and cosmos by colour wave-particle emissions and their optical conduits are the Channels proper.

a.        365 strategic AP points along the Channels and Vessels. In TCM, an AP point is called "Xue" (cavity, foramen, hole, opening). The full TCM name of each point is a metaphor of its Qi properties, nature or location, for example Feng-chi Xue (GB20) means Wind-Pond Point, used to treat disorders caused by Wind; Lan-wei Xue (a new extra-Channel point) means Gut-Tail (Appendix) Point (used to treat appendicitis and LI problems). The AP points proper are vortices of Qi that interface between the External and Internal environment; they are strategic points to manipulate Yongqi and Weiqi. Dr Wai Shui emphasises that referring to points by their European alphanumeric codes (LI04, ST36, GV14 etc) is not only deplorable, but marks one as unworthy of practicing the art of AP! The Chinese ideogram imparts a metaphor, which thus imparts the intention to heal. Serious acupuncturists should learn the Chinese names and meanings of the AP points.

b.        The 12 Tendino-Muscular Channels. These superficial Channels follow the course of the Main Channels. Their Qi meets the Main Channels (Yongqi) at the Antique Points, Luo points, and the Wind Gates. Problems of the Tendino-Muscular Channels leads to chronic rheumatism (to be explained) and immunocompromises the patient. Their symptomatology includes muscle stiffness and adhesions, dermatites, athlete's foot, leucoderma, age spots, dimming of vision, dry skin, hair loss and other aesthetic complaints, not to mention susceptibility to colds, flu, and bacterial infections. Moxibustion, massage, and Med gymnastics invigorate Qi circulation.

c.        The 15 Longitudinal Luo-Collateral Vessels: These Vessels begin at the Luo points on the extremities and converge into the interior. Their function is to support the circulation of Weiqi. Their symptomatologies are independent of the Main Channels and include perceptible pain and swelling along the conduit, arthritis and rheumatism, dental caries, angina pectoris, intercostal neuralgia, icy cold feet, and various forms of madness. Their circulation is invigorated by massage and Med gymnastics.

d.        12 Transversal Luo-Collateral Vessels: These are short Vessels that connect the Main Channel of a Zang (Yin-Solid Organ) with its coupled Fu (Yang-Hollow Bowel). Each Luo Vessel has a special Luo point. In AP and acupressure, to treat imbalance between the Zang-Fu Pairs, the Luo point is used to move Yongqi between the Paired Channels.

e.        12 Distinct Channels: These Channels distribute the Weiqi deep into the body and thus are the bridge between the Tendino-Muscular Channels and Luo Vessels which harbour Weiqi, with that of the Main Channels which harbour the Yongqi. Their symptomatology is a mix between External diseases caused by the Perverse-Qi (e.g. headache), and Internal diseases (e.g. migraine with vomiting and gastrointestinal signs). Their conduits begin at the large joints, converge to the head, neck and shoulders, and descend deep into the body. Their symptoms of attack include head and neck problems combined with symptoms of the abdomen and chest: vertigo, tinnitus, hay fever, nosebleeds, migraine, heartburn, insomnia, constipation, etc. Their conditions generally require herbs and dietetics, as well as AP and massage, since the illnesses are both Internal and External.

f.        12 Main Channels: These are the common Channels as found in the usual Western texts. They circulate the Yongqi to nourish the cells, tissue-systems, Zang and Fu. Their anatomy and pathophysiology constitutes the final phases of study before the practice of AP.

g.        8 Extraordinary Vessels (Yuan-Ancestral Channels): These transport the vital Yuanqi (Source Qi). They connect intimately with the Curious organs, KI, and endocrine glands. They represent the final phases of AP study.

h.        8 Chakras: The origin point of the Channel circuits as part of ascetic and psychic studies (PCT (30) or past life regression; meditation practices, Hua-to, etc.).

4.        Pathogenesis.
The Trung Y Hoc of Hanoi defines essentially 9 classes of maladies:

a.        The 6 Perverse-Qi (Perverse Energies, Ta Khi): These are 6 types of Perverse-Qi (Evil Qi, climatological energies) that penetrate first and foremost the sub-Channels, following the Main Channels in the general order of progressive illness: Tendino-Muscular -> Luo Vessels -> Distinct Channels -> Main Channels -> Extraordinary Vessels.

The superficial penetration of Perverse-Qi into the sub-Channels, in the acute phases, includes the dermatites, athlete's foot, itch and rash, tingling and numbness, spasms and contractures, cramps, wry neck, and sharp pains as part of the symptomatology of the Tendino-Muscular Channels. The deeper the penetration, the more severe and life threatening the malady. Diseases due to attack of the Main Channels include: ascites, generalized edema, meningitis, frostbite, chills and fever, severe fevers, stroke, cardiac arrest, shock, etc. and are generally not amenable to AP in a Western environment.
McWilliams_C07 (1996) A Rational View of Chinese AP, Massage, and Med Gymnastics: Part 7.

b.        The Latent Perverse-Qi (Perverse Energies, Phuc Khi): These are maladies that occur outside their seasonal appearance that lay dormant and Static in the Channels only to erupt during periods of stress, causing mixed symptomatologies and unusual complaints. They can be classed under a broad category of rheumatism and include sc geloses (Ahshi or sensitive points), myogeloses, and limitations in range of motion. The latent Perverse-Qi Syndromes of the sub-Channels as seen today in AP and massage practices are often of this latent perverse type. They are wholly unrecognized as such and account for much of our inadequacies and unsuccessful treatments. They can be classified and staged as outlined by our modern savant, Dr Wu Wei Ping (25), and amended by the author as follows:

Stage 1: Pain: The first stage of Perverse-Qi penetration is pain of all types: boring, stinging, burning, shooting, etc. The attack is confined to the Tendino-Muscular Channels and Luo Vessels as seen in sports injury, strain, fatigue, itching and rash, headaches, etc. These are self-limiting complaints of the acute nature.

Stage 2: Disordered Sensibility: As the Perverse Qi penetrates more deeply due to improper treatment or lifestyle, 2 types emerge: Mou or Xu type. Mou (Fullness) type is: spontaneous itching and eruptions; eczemas; dandruff; hair loss; dry, pale skin, blebs, bulla; deformities of the nails, trichomycosis; nerve tics, facial neuralgias, TMJ, throbbing headaches, etc. Xu (Weak) type is: obesity with paraesthesia in the buttocks (GB) as seen in "couch potatoes," persons of sedentary habit - small back and pelvis as seen in lumbagos (BL); scalp (GB and GV), as seen in thinning and dry hair, split ends, dull/diffuse headaches, etc.

Stage 3: Swelling: Tissue edema due to attack of the organic liquid; lymph stasis, lymphedema; cellulite with spongiform patterns and toxic deposits; fetid foot, axillary and body odours; tissue puffiness as seen in obesity; haemorrhoids and crotch odours; swelling and flab in axillae and breasts; swelling and waddles of the neck; swelling and bloat of the belly.

Stage 4: Spasms: Specifically, myogeloses and TPs, hardened and indurated striated muscle tissue. Here the Perverse Qi is firmly embedded in the Jing-Luo, yet remains distal without attacking (migrating) into the Zang-Fu (internal organs and bowels). Vigorous massage (tui-na) generally leads to after treatment soreness and sometimes corporeal symptoms, e.g. headache, nausea, ST upset, due to the migrating Perverse Qi as the Weiqi reacts and neutralizes it. Steam sauna and sweating are of enormous benefit to prevent healing crises. Stage 4 today is epidemical due to societal stress factors combined with irregular lifestyles, electric smog, and devitalized diet. Massotherapists know very well the diffuse muscle soreness, indurations and attendant irregularities seen in practically every client.

Stage 5: Paresis and atrophy: Historically, disorders of geriatrics, but today becoming increasingly symptomatic under such Syndrome cliches as love handles, mid-drift bloat, grocery tumour, pot belly, Venus Syndrome, turkey waddles, and associated loci of flabby, floppy, flaccid and limp cutaneous and sc tissue. The latent Perverse Qi becomes deeply entrenched into the sc spaces and seasonally contributes to colds and flu lasting 1 wk to 1 mo, and in time contributes to the rapid mortality if succumbed to cancer or cardiovascular disorder. Early treatment and expulsion requires vigorous massage, sudorification, and gymnastics.

The latent perverse maladies of the sub-Channels are often managed by the special, strange, and extraordinary points. These points lie outside the Channels of the Main Channels. These points are critical to the employment and mobilization of Weiqi. Some of these points (the "family points") have been handed down from savant to pupil. As any acupuncturist who has studied under the feet of a Master knows, these points become the practitioner's stock and trade. They go by such names as Release the Spring, Stirring Deafness, Mutism Gate (Yamen), Energy Gate (Qimen), Wind and baldness, etc. They are effective in pain relief and resolution of self-limited complaints, often by the use of a single needle. Weiqi is easily mobilized while Yongqi is not so easily aroused. The quantity of Weiqi is, however, limited. Its mobilization is confined to just 1 or 2 punctures, which is why the master acupuncturist strives for the least punctures, while the amateur punctures at many points, often and notoriously in vain.

c.        Curious Perverse-Qi (Perverse Energy, Di Khi): These are maladies occurring outside the seasonal Syndromes. In the Dong Y(10) they correspond to many occidental bacterial and viral infections, specifically, food poisonings, dysenteries, cholera, salmonellosis, "Jack in the Box" sickness, etc and to that of putrefaction: mainly, candidiasis, dysbiosis, and parasitosis. To the curious Perverse Qis, the author also adds death orgone (DOR), as discovered by Wilhelm Reich. Essentially they can be viewed as toxic photons that emanate off electromagnetic appliances, X-ray machines, and nuclear power plants. Exposure to these rays, as the savant Dr Wu Wei Ping pointed out, disturb the pulses and thus the diagnosis, similar in effect to cortisone. These toxic photons are of a sedentary nature, remaining in locales for days to weeks and are strongly attracted to water and metallic rods. They are intrinsically associated with weather patterns and strange and peculiar epidemics which Reich warned, as early as the 1950s, when television and nuclear energy was on the horizon. They are known intuitively to some Japanese, which is why they cherish such ornaments and architecture as running and falling water which can clear DOR and Perverse-Qi from working and living environments. Running water can drain off these toxic photons. Student are advised to read the listed reference(29).

d.        Organic Liquid (Than Dich): This is the impure (unrefined) Nutritive Qi, obtained from the digestive tract. Organic liquid, being an impure essence, is obtained mainly by meat eating and is associated intrinsically with animal fat. The Western habit of consuming inordinate quantities of dead flesh contributes to the epidemic of obesity. Proper circulation and elimination of liquid depends on respiration and sweating. Today, insufficient respiration and suppression of the sweating process by climate control, restrictive polyester clothing, chemical cosmetics and toiletries put restrict respiration and sweating. This leads to sc infiltration (Stasis Syndrome) causing cellulite and fatty accumulation; corporeal disfigurement (obesity); cutaneous eruptions (acne, oily skin) and odours; KI insufficiency and fatigue; lymphotoxicosis; and cardiac impairment by edema and hypertension. Mobilization is best accomplished by massage, Qigong (respiratory therapy), gymnastics, cold baths, and steam saunas.
McWilliams_C08 (1996) A Rational View of Chinese AP, Massage, and Med Gymnastics: Part 8.

e.        The 7 Passions (Emotions, Psychic Elements, That Tinh): These are very prominent energetic disorders due to psychic maladaptation to high stress urban environments and economies. They are: Sadness, Grief, Joy, Anger, Reflection, Inquietude/Nervousness, Fear. The emotions guide and modulate the Qi phases and thus disturb their ruling organs. Two main dysfunctions occur due to misdirected passion/emotion: suspension of respiration, leading to disturbances of the organic liquid; and muscle tension, causing disturbances of the Weiqi. These two dysfunctions are best treated with massage and Med gymnastics. Zen, meditation, yoga, and past life regression can resolve the imbalanced passions (restore emotional balance)(30).

f.        Nutritive Qi (Alimentary Energy) & Fatigue: A proper diet nourishes the organs by virtue of the pure elements releasing 5 flavours (Yongqi) and the impure elements producing Weiqi and the organic liquid. The diet must be adjusted to one of the 3 Main Constitutions: Yang, Yin, or nervous(27). An improper diet and fatigue damage the all-important TH leading to premature aging, dysbiosis, and malignancy.

h.        Sexual Relations: Also, called "affairs of the bedroom." Regulation of sexual practice and hygiene preserves longevity, whereas excessive sex depletes the KI-Qi and Yuanqi (Source, Original, Ancestral Qi), leading to premature aging and genital infections (warts, gonorrhoea, lymphogranuloma inguinale, etc.).
i.        Heredity: essentially, genetic disorders and defects of WM.

According to the TCM research committee(10,15) the proper study of TCM must be based on the above categories of maladies.

4. CONDUIT THERAPEUTICS.
AP was originally a method to treat disease due to the penetration of Perverse-Qi "attacking" the Jing-Luo. Therefore, it is the utmost necessity to determine the location of the Perverse-Qi and to know whether to perform AP, massage, moxibustion, and/or Med gymnastics. The technique of conduit therapy essentially falls into 4 categories:
1.        AP: The Suwen and Lingshu(8) outline main methods of AP: 1. needling to allow Perverse-Qi to escape from the body to relieve the affliction; 2. needling to regularize Qi according to the theories of Yin-Yang and the Five Phases (Wu-Xing). As late as 1000AD, schools developed using the Five Phase points to manipulate and balance Yongqi in cases of Internal disease. The Master acupuncturist, Wu Wei Ping(24) said there are many schools which are faithful to the "Law of the Five Phases" and to other methods. He says: "The French schools of AP arbitrarily determine that for each Channel there is a Dispersion point and a Tonification point. They did this without giving any logical reason for so doing. That idea is all the more strange since Chinese formularies do not indicate that the points which the French have selected have any particular effect on the balance of Qi".

The research committee of Hanoi advises of indiscriminate practice so as not to damage the Yongqi. The author proposes that AP is the final phase of TCM studies. As any practitioner ultimately learns once experienced in this art, intention is crucial to the flow of Qi (life energy).

The use of needles, as this article points out, has more efficacy and indications to treat the Syndromes of the sub-Channels in today's world. This dynamic is generally unrecognized and has profound implications in both practice and education.

2.        Moxibustion: The original ideograms for AP combine 2 characters: to needle and to burn. Moxibustion is a large part of the art but has regretfully fallen into widespread disuse due to inconveniences and difficulties in clinical presentation due to odour and safety considerations. Other forms of thermotherapy are in use but are generally less effective.

3.        Massage: Massage is a technique for the generalized treatment of the sub-Channels and many paediatric disorders. Its efficacy is generally underestimated if not unrecognized in the West. There are two main forms: Tui-Na (mainly sedation) and An-mo (mainly tonification).

4.        Medical Gymnastics: Dao Yin: Movements designed to maintain and improve health, they are considered as various forms of "self massage" which require mental concentration, relaxation, and calming (23). Largely ignored in the solo practice, but encompasses a broad category of Spa and rehabilitation therapies:

a.        Taiqi quan: healing exercise therapy.
b.        Qigong: breathing exercise (respiratory therapy). Vital for the circulation of Qi and the organic liquid, used extensively in China for rehabilitation in chronic disease, also promotes hair growth, reverses hair loss, relieves neurasthenia and insomnia, offsets constipation and ulcers; improves digestion and restores the vital Yongqi and Weiqi.
c.        Water Showers: hydrotherapy techniques similar to the European practices (Kneipp Cure) which "hardens" the Weiqi, preventing colds and flu, combating fatigue, enhancing moods, revitalizing Shen-mental spirits, and accelerating metabolism.
d.        Sunbaths: improve circulation, unlock the Jing-Luo, loosen the joints and aid digestion.
e.        Recreational Exercise: gardening, nature walks, outdoor hobbies, etc.
f.        Therapeutic Gymnastics: Wu Chin Hsi (5 Animal Plays), Pa Tuan Chin (8 Sets of Embroidery), etc.

The rules for conduit therapy were given in the Yellow Emperor's Internal Med Classic (circa 2500 BC):
1.        The Suwen, Chapter 10, says: "Man has 12 groups of large ducts or main Channels and 364 small ducts, and 12 of lesser importance. They all protect against the entry of Perverse-Qi (the Six Evils) into the body. When AP is applied, it dissipates the Perverse-Qi(8)". "Those who give their bodies a good cure first treat their skin and hair; the next treatment concerns itself with the muscles and the flesh; the next with the Main Channels of the Six Fu (Hollow Bowels), and the next with the Main Channels of the Five Zang (Solid Organs, viscera). The treatment of the Five Zang should take place halfway between life and death".
This chapter gives clear advise on the TCM concepts of hygiene and spa therapies. The skin and hair are the first order to hygiene and therapy. Following are the muscles, in the form of massage, gymnastics, and AP. If the sickness has penetrated deeply, the Fu (hollow bowels) are attended to with Herbal Med. And in severe illness, that between life and death, the Five Zang (solid organs, viscera) are primary in treatment. In TCM, there are Six Levels (layers) of Qi: Yangming (Sunlight Yang, LI-ST), Shaoyang (Lesser Yang, TH-GB), Taiyang (Greater Yang, SI-BL); Taiyin (Greater Yin, LU-SP), Jueyin (Middle or Absolute Yin, PC-LV) and Shaoyin (Lesser Yin, HT-KI). These pertained to the layers and Channels affected during the process of the penetration of Perverse-Qi, e.g. External pathogen.

McWilliams_C09 (1996) A Rational View of Chinese AP, Massage, and Med Gymnastics: Part 9.
Weiqi circulating in the skin is the first barrier to External illness which is why a "good cure first" is one that treats the skin, mainly by sudorification (sweating) and hydrotherapy. The second good cure is that of massage and Med gymnastics. Following that, AP and Herbal Med.

The Suwen, Chapter 5 says: "If sickness is only at the Exterior (has penetrated only to the level of the skin), it is necessary to provoke perspiration in order to disperse it. If the Perverse-Qi is ferocious and has penetrated deep to the Interior, it is necessary to puncture the Mu-Front points, to disperse it on the spot".

2.        Treat the conduits to regularize Qi. This is the Great Law of needle manipulation by Bu-Xie(24). Bu-Xie is a specific type of needle manipulation to supply (Bu) or drain (Xie) Qi: in Xu use Bu to supply (reinforce) Qi in Qi-Xu (Weakness); in Shi use Xie to calm or retire Qi in Qi-Shi (Excess). Bu-Xie must not be confused with the rules of Xing-fen (to tonify or stimulate) and Chih-Shih (to disperse or inhibit). Bu-Xie is a systemic, overall balancing concept, with Xing-fen and Chih-Shih as modulations towards that goal for local and immediate effect.

The Suwen, Chapter 5, says: "Those who are experts in using the needle for AP follow Yin, the female principle, in order to draw out the Yang. And they follow Yang, the male principle, in order to draw out Yin.".
Thus my calling out to acupuncturists and students of TCM is to study well the concepts so elucidated. One should follow the Confucian rule of rectifying words, so that mental images do not become that aberrated domain where "words become objects." The English language is inadequate to convey many of the concepts of TCM philosophy except by inflection, metaphors, or life experience. This is why Oriental arts were mainly taught "at the feet of a master.".

Now we are entering an era when mental telepathy will soon become common place. This has been proven repeatedly by almost identical inventions that have appeared in two or more places almost simultaneously. Light is transforming the planet in many different directions. It is time that AP takes a quantum leap in its dimensions for the betterment of humanity. As we advance into a new epoch, the Aquarian age, we witness destiny again repeating itself with many forms of mental and cultural decay among our youth, our leaders, and many once cherished or admired institutions. However, in our great Uranian age of electronic data, we will not suffer from the looting and sequestering of the forbidden knowledge. The student now has, more than ever before, a wealth of data upon which to draw.

REFERENCES.
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De L'Astronomie a La Medecine Chinoise, Edicions Coquemard AngoulÙme, 1963.
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14. McWilliams, Charles: PhotoBiotics, The Revolutionary Quantum Dieting and Lifestyle through Colour; Promotion Publishing (800-231-1776), 1994.
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16. Popp, Becker, Konig, Peshka, et.al.: Electromagnetic BioInformation; Urban & Schwarzenburg, 1979.
17. Pankratov, Sergei: Meridians Conduct Light; Raum & Zeit, 1989.
18. Webster's Dictionary, 1980.
19. Voll, Reinhold (1975) 20 Years of EAP Therapy using Low Frequency Current Pulses. AJA 3(4).
20. Ilza Veith: The Yellow Emperor's Classic of Internal Med; Univ of California Press, 1972.
21. De Nguyen: Dong Y Duoc; Edition Saigon 1957-59.
22. Wallnofer, Heinrich: Chinese Folk Med; Crown Publishers, 1977.
23. Zhou, Dahong: The Chinese Exercise Book; Hartley & Marks Publishers, 1984.
24. Wu Wei P'ing: Chinese AP; Health Science Press, 1962.
25. Lavier, J. Chin MicroMassage; Thorsons Publishers, 1977.
26. Walleczek, J.: The Immune System and ELF Electromagnetic Fields; Frontier Perspectives, Fall 1992.
27. McWilliams, Charles: Treatise of AP, Volume V, Dietetics & Energetic Properties of Foods; Health Science Research, 1982.
28. Chamfrault, A. & Nguyen Van Nghi: TraitE de Medecine Chinoise, Tome VI, L'EnergEtique Humaine en Medecine Chinoise, Edicions Coquemard AngoulÙme, 1969.
29. DeMeo, James: The Orgone Accumulator Handbook; Natural Energy Works, 1989.
30. McWilliams, Charles: Photocognitive Therapy Lesson Course & Video Presentations; PanAmerican Inst, 1995.
31. Gallavardin, Jean-Pierre: Psychism and Homeopathy; World Homeopathic Links, 1982.

Michel_W (1993) [Early Western observations of moxibustion and AP]. Sudhoffs Arch Z Wissenschaftsgesch 77(2):193-222. Inst of Languages and Cultures, Kyushu Univ, Fukuoka-City, Japan. Earlier research has maintained that the earliest passage of written information about AP and moxibustion to Western Europe took place around the middle of the 17th century. But an investigation into the letters, "historias", dictionaries, grammars etc. of the Jesuit mission in Japan, which started in 1549, shows that the missionaries there already enjoyed a considerable knowledge of both methods of treatment. These sources also reveal indications of the use of needles and moxa on horses as well as the use of "hammer-needles", a Japanese invention which was later described in detail by Willem ten Rhijne and Engelbert Kaempfer. Also some central Sinojapanese terms of anatomy, physiol and pulse diagnosis in the light of their European interpretations, and a hitherto unknown outline of Japanese medicine found in an early French book on the Chinese Pulses are presented.

Partington_M (1992) Avian AP. Probl Vet Med Mar 4(1):212-222. In both ancient and present-day China, avian AP has been used in domestic fowl kept as food animals only. For the progressive western veterinarian, there is a place for AP as a complement to the practice of conventional avian medicine. The nature and origin of the class Aves render them more responsive than mammals to traditional AP techniques. When AP is appropriately applied, the response is positive and rewarding. A working familiarity with avian anatomy and taxonomy is a prerequisite to location and manipulation of avian points. A descriptive text of currently documented avian AP points is presented.

Partington_M (1995) AP and TCM. Proceedings 16th Annual Conference Mid-Atlantic States Assoc of Avian Vets, 119-125 and Avian AP. Ibid 127-155.

Smith_A1 (1996) Five Phase Pulse Diagnosis: The Art of Science Or The Science of Art?: Part 1. Adapted from WWW. [Reproduced with permission from the Editor, Pacific J of Oriental Med. Andrew Smith MEd BA(Mil) DipAc. Details are contained in the author's M Educ Thesis (1993), Univ of Canberra: Pulse Diagnosis in Traditional AP: WebMaster].

TCM Pulse Diagnosis was examined in a sample of 100 patients randomly selected from the author's AP clinic. Patients' symptoms, the TCM Pulses, diagnostic criteria (pertaining to Five Phases), AP points selected and patients' comments after each treatment were coded into a numerical format suitable for stepwise multiple regression and cross-tabulation analysis.

The analysis indicated that the interpretation of pulse qualities, from which the treatment protocol was based, predicted the diagnostic criteria when used in accordance with the theories pertaining to AP. Statistically, the selection of AP points could not be predicted from the diagnostic criteria when using Pulse Diagnosis. Also, the analysis indicated that the patient's comments after AP were independent of the initial patient symptoms.

More research is needed to fully understand the process of Pulse Diagnosis. However the analysis suggests that Pulse Diagnosis should be incorporated into AP curricula in both traditional AP courses and Med AP courses.

INTRODUCTION.
Traditional AP utilises Pulse Diagnosis as one of the "4 methods of examination" when establishing information about a patient's signs and symptoms (NH&MRC 1989; Maciocia 1991; Kaptchuk 1983). Within the author's clinic, the subsequent selection of points to treat those symptoms is mainly based upon the resulting diagnostic criteria taken from the pulses. Ultimately the process of AP used by the author is designed to stimulate the natural healing response of the patient.

The National Health and Med Research Council (NH&MRC, 1989) suggest that the education and training of practitioners are important in insuring the safety of patients receiving such care.

However debate exists as to whether Med acupuncturists, or acupuncturists versed in the TCM approach, should practise AP (Richardson and Vincent, 1989; Stephen, 1978; Hadley, 1988; Rogers, 1985b; Christie, 1991; Lewith, 1986; Rogers, 1991a). Med acupuncturists do not learn Pulse Diagnosis in their courses and generally apply what is termed "Cookbook AP" within their clinic.

Cookbook AP is generally said to be less efficacious than the very individualised approach of TCM (Ng 1978). The author considers this to be so because, without the holistic synthesis, diagnosis and treatment of TCM Syndromes, there is no adequate methodology in Cookbook AP to account for the relationships linking the symptoms, the diagnostic criteria, the points selected and the resultant patient comments at the conclusion of the AP process.

AP Education
A minimum standard of training has been recommended as being acceptable for non-Med practitioners of AP. The training course for non-Med acupuncturists, formally endorsed by the New South Wales Higher Education Board (NSWHEB) as being acceptable as a Bachelor of Applied Sci, has Pulse Diagnosis as a significant component of the AP curricula (Rogers C 1992).

AP education in Australia is offered in 2 forms and to 2 different groups (NH&MRC, 1989). Courses teach AP as a therapy or AP as a total system of health care, and, the students are either already trained and practising as health care providers or have no previous training or expertise (NH&MRC, 1989). Some courses teach AP to trainees already otherwise trained as health practitioners (NH&MRC, 1989). AP taught and practised to those medically trained is regarded as an auxiliary or adjunct to the conventional Med techniques utilised by that person.

Other courses purport to teach AP as a complete Med system (NH&MRC, 1989). These particular courses offer both basic training over a 4-yr-period as an AP therapist. In May 1987, official ratification of accreditation was granted by the NSW Dept of Educ to AP Colls (Australia) for their 4-yr AP training programme, which, at that time, was presented in conjunction with the Inst of Nursing Studies, Sydney Coll of Advanced Educ (AP Ethics and Standards Org Submission to the Minister for Health for the Registration of AP, 1988).

The emphasis of the course curricula for AP of the Univ of Technology Sydney, for example, is to teach the philosophies and techniques of AP as taught and practised in the PRC. Moreover the establishment of 2 Univ courses of traditional AP is in accordance with the recommendations of the National Health and Med Research Council (NH&MRC, 1989).

In 1987 the AP Ethics and Standards Organisation (AESO) were requested by the Peoples Republic of China to apply for membership of the World Federation of AP/Moxibustion Societies as the representatives of AP in Australia (AESO Submission to the Ministers of Health for the Registration of AP in Australia, 1988).

Each of the above teaching methodologies, that is, medical compared with traditional AP, differ in the emphasis placed on applying the traditional process of Pulse Diagnosis as a diagnostic method. The NH&MRC (1989, p66) suggested that the theoretical concepts behind traditional Chinese AP cannot be sustained scientifically. However Rogers (1991, pp151-152) suggests that scepticism and/or vested interest among the more influential members of the Med profession inhibit active promotion of AP and such procedures for many reasons: a. The public perception of professional/scientific authority would be weakened. Competent AP teachers/clinicians would have to be found raising questions as to who would be competent to select/grade them. b. Academic undergraduate curricula would have to be re-scheduled to incorporate time for AP at the expense of other course work. c. Research teams would have to recruit expert AP specialists and fund AP research in the face of a multi-national, multi-million dollar drug industry which has a powerful influence on funding of orthodox research, sponsorship of drug-related professional seminars/conferences for cooperative practitioners. d. The National Health Med/Dent/Vet hospitals, physiotherapy clinics and the general professions would have to establish AP services.

The above concerns apply equally to Vet AP which is based mainly on human AP principles (Rogers P 1991c). The choice of points for particular conditions is very similar to the choice for similar human conditions (Rogers P 1985a) hence the disagreement surrounding the diagnostic methodology to be used exists whether AP is to be used for humans or animals (Palmer R 1992).

The author has used Pulse Diagnosis as the main method of obtaining an indication of the points necessary to treat various conditions in a Primary Health Care setting. The author's use of Pulse Diagnosis is based upon the Five Phase Theory underpinning AP rather than the classic 28 pulse qualities commonly described in AP texts. It is within the context of a traditional AP clinic that the treatments have emerged.

Smith_A2 (1996) Five Phase Pulse Diagnosis: The Art of Science Or The Science of Art?: Part 2.
Science or Folklore?

Much of the confusion surrounding the scientific basis of AP centres on which particular process should be utilised (Advances in AP, 1979; Pinto, 1978; Pomeranz and Stux (eds), 1989; Vincent and Richardson, 1986; Schoonover Smith, 1988; Bensoussan, 1991). That is, should the selection of AP points used to treat a particular symptom or symptoms be based on the criteria drawn from the conventional Med diagnostic procedures or from so called traditional theories?.

The debate is compounded in two ways: 1. Many versed in the "scientific method" suggest that most "scientific papers" which claimed results for AP which were statistically significant, did not satisfy the scientific method adequately. Therefore the results of many AP studies "non-scientific or largely anecdotal". 2. Acupuncturists versed in the "scientific method" suggest that most "scientific" papers which concluded that the effects of AP were not statistically different from those in placebo-Control groups were fatally flawed in their experimental design: the controls were stimulated in biologically active points with effects similar to the selected "real AP points"; thus both groups responded but there was no difference between the treatments. (In many such trials, 50-80% of subjects responded in both groups, whereas in most trials only 20-40% of subjects in negative placebo groups would be expected to respond). Therefore such trials should be reinterpreted as confirming significant clinical responses from peripheral stimulation (Rogers, unpublished). 3. Acupuncturists pursuing the TCM approach almost always respond by suggesting that the process of AP cannot be considered within the "scientific method" without compromising its holistic integrity (Chu 1979). In particular the TCM diagnostic method of Pulse Diagnosis is regarded by traditionalists as being essential to allow assessment of the patient's state of well-being (TCM Syndrome) at the time of each consultation and to dictate the most appropriate AP points to be used at that time.

The author found in clinical practice that AP point selection based on Pulse Diagnosis suggests the need to select different points for different patients who may present with similar symptoms.

It is from the subjective interpretation by the author of the iconography gained from Pulse Diagnosis, in accordance with the theories underpinning AP, that the ensuing process of AP occurs. That is, within the author's clinic, the process of AP involves the procedures of eliciting diagnostic criteria from Pulse Diagnosis, followed by the selection of appropriate AP points and, finally, determining the efficacy of the treatment. Figure 1 illustrates the process of AP utilised by the author in his statistical analysis of Pulse Diagnosis: patient symptoms and history -> Pulse Diagnosis -> Diagnostic Criteria -> AP points selected -> Patient comments after treatment.

The Process of AP
The author found through stepwise multiple regression and cross-tabulation analysis that there may be a scientific basis for using the ancient art of Pulse Diagnosis in traditional AP. Hence the author's purpose in attempting a statistical analysis of traditional AP treatments was to further the educational base for AP training programmes and to indicate the educational implications of the traditional approach to AP if introduced into the curricula of AP courses. There may be implications for incorporating Pulse Diagnosis into the design and conduct of AP courses throughout Australia and overseas. It also may influence the assimilation of AP into the primary health care sector in a way that can complement WM.

Method: Research Design
The study was an Ex Post Facto consideration of the relationship between:
a.        symptoms a patient communicates (NPS);
b.        diagnostic criteria (DC) as determined from Pulse Diagnosis;
c.        points used for the first treatment (PUF) as determined from Pulse Diagnosis;
d.        points used for the second treatment (PUS) as determined from the Pulse Diagnosis;
e.        patients' comments after the first treatment (NPC); and.
f.        patients' comments after the second treatment (NC).

Despite the weaknesses of Ex Post Facto research as a research method, and the limitations as described in the author's thesis, the author considered that an Ex Post Facto study was the most appropriate research design for maintaining the integrity of traditional AP and Pulse Diagnosis within the clinic setting. Other research designs such as the use of an experimental double-blind controlled study were not considered to be appropriate in this instance. The author did not want to create an artificially induced clinical environment and thereby alter the process of AP normally utilised in private practice. Central to the author's thesis was the need to study the concept of Pulse Diagnosis as a diagnostic procedure within the context of the process of AP as described.

The problem then was to indicate whether patient symptoms improved after having a course of AP using points selected from Pulse Diagnosis. The diagnostic criteria obtained from Pulse Diagnosis was considered the key to point selection and subsequent improvement in symptoms rather than the selection of AP points based on the patients' symptoms alone.

The two hypotheses tested were as follows:
Hypothesis 1:        The diagnostic criteria taken from the pulses do not statistically significantly predict the AP points used in the treatment at 0.05 level of significance.
Hypothesis 2:        The patients' comments after AP are independent of whether the patients' symptoms improved or not.

In formulating the hypotheses, the level of significance (p) used throughout the statistical analysis was .05. The assumptions underpinning the hypotheses were:
a.        patients do not need to be of any specific gender or culture to experience improvement in symptoms;
b.        patients need have no particular beliefs about AP in order to experience improvements in symptoms;
c.        AP has its own philosophical foundations which, while differing from the theories and concepts underpinning the bio-Med model, have their own theories and nomenclature.

The significance of the study was to provide the basis for further research into the nature of Pulse Diagnosis and to indicate that the symptoms a patient communicates are not related to the AP points selected to treat those symptoms. Also, there were implications for AP education should relationships exist in accordance with the hypotheses, e.g. if the study suggests that Pulse Diagnosis may have a coherent basis to its application which is predicted in a scientific framework.

Procedure
100 patients' cards were randomly sampled from the author's AP clinic. All of the information pertaining to the variables under consideration in the study for the first 2 treatments were coded into a numerical format suitable for data entry into the SPSS-X (footnote 1) computer program.

The palpation of various pulses on the radial arteries of the wrists and at other sites around the body served as the main form of diagnosis for this study. Pulses were palpated at 7/9 Continent Pulse sites around the body in the order listed:

Smith_A3 (1996) Five Phase Pulse Diagnosis: The Art of Science Or The Science of Art?: Part 3.
a.        in the depression midway between the calcaneal tendon and the medial malleolus of both feet;
b.        at the highest point on the dorsum of the foot at the point where the dorsalis pedis artery can be palpated;
c.        on the dorsum of the foot in the angle formed by the first and second metatarsals, just anterior to the articulation with the first and second cuniforms;
d.        on the wrist crease at the proximal border of the pisiform bone in the depression at the radial side of the flexo carpi ulnaris tendon;
e.        near the junction of the first and second metacarpals;
f.        between the middle of the tragus and the mandibular joint where a depression is formed when the mouth is open; and.
g.        on either sides of the temples.

At the conclusion of this process the author would then palpate the radial pulses concurrently on both wrists in accordance with the diagnostic concepts associated with TCM Pulse Diagnosis. This enabled the author to determine a profile of the patients' health in such a way that specific points could be selected for needling to thereby stimulate a healing response.

Various qualities within the pulses were subjectively interpreted by the author to reflect the patients' health within the framework of traditional Chinese AP. A maximum of 10 diagnostic criteria (DC1-10) were allowed for each patient as interpreted by the author from either the 9 Continent Pulses or the Wrist Pulses. A total of 150 different pulse qualities were recorded and listed alphabetically along with the frequency of occurrence. The author used 2-3 needles for most treatments. However some treatments required only one needle and others required 4-5. Hence the points were given the coding of PUF1-5 to allow for the possibility of 5 needles being used for one treatment.

Table 1 summarises the number of criteria pertaining to each of the major variables under consideration in the study:
Variable         Number of Criteria.
Patient Symptoms         267.
Diagnostic Criteria (taken from Pulses)         150.
Points First Treatment         64.
Points Second Treatment         70.
Comments First Treatment         116.
Comments Second Treatment         105.
Table 1: Number of Criteria Pertaining to Each Variable.

Recoding
It was necessary to recode some of the major variables as the study progressed to facilitate an appropriate framework within the overall encoding structure for the computer program.

Patient symptoms (NPS) were divided into 6 categories with an appropriate numerical code as follows:
a.physiological: coded 1; b.comment not recorded: coded 2; c.musculoskeletal: coded 3; d.physiological/stress: coded 4; e.emotional/stress: coded 5; and f.musculoskeletal/stress: coded 6.

Patient comments after the first treatment (NPC) were re-classified into 4 categories as follows:
a.improvement: coded 1; b.no change in condition: coded 2; c.condition worse: coded 3; and d.comment not recorded: coded 4.

Individual pulses from which the diagnostic criteria were gained also were coded as follows:
a.        in the depression midway between the calcaneal tendon and the medial maleollus of both feet: coded P1;
b.        at the highest point on the dorsum of the foot at the point where the dorsalis pedis artery can be palpated: coded P2;
c.        on the dorsum of the foot in the angle formed by the first and second metatarsals, just anterior to the articulation with the first and second cuniforms: coded P3;
d.        on the wrist crease at the proximal border of the pisiform bone in the depression at the radial side of the flexo carpi ulnaris tendon: coded P4;
e.        near the junction of the first and second metacarpals: coded P5;
f.        between the middle of the tragus and the mandibular joint where a depression is formed when the mouth is open: coded P6;
g.        on either sides of the temples: coded P7; and.
h.        the pulse qualities taken from the 6 separate Wrist Pulses on each wrist were given a collective coding of P8.

The complexity of the Wrist Pulses necessitated the qualities being categorised together thus distinguishing them from those taken from sites around the body already described.

The final matrix incorporating the various codings to each variable was entered into the SPSS-X programme. The data pertaining to each patient was listed alongside the corresponding patient number and the data was analyzed as follows:
a.        Stepwise Multiple Regression: P1-8 predicting DC1-10;
b.        Stepwise Multiple Regression: DC1-10 predicting PUF1-5; and.
c.        Crosstabulation of NCP against Symptoms (S1-6).

Results
The study has been predicated on the use of Pulse Diagnosis as a diagnostic tool. The author used the pulses to establish the most suitable AP points for needle insertion in order to treat a range of patient symptoms (footnote 2) (Smith, 1993).

Pulse Diagnosis is a complex art and, as such, requires a considerable degree of sensitivity in the finger tips. This is because many different qualities may be discerned from each individual pulse as well as the combination of pulses collectively. Resulting from this is a profile of the patient's health within the parameters of TCM. Pulse Diagnosis assists the practitioner to select and stimulate the most appropriate points from a range of suitable points in order to effect a corresponding improvement in that person's health.

Due to the complexity of interpreting pulse qualities, the pulses discerned from different parts of the patient's body (the 9 Continent Pulses) have been listed individually and separately from the Classical 6 pulses which are discerned from each wrist. The 9 Continent Pulses have been listed as P1 to P7 respectively while the Wrist Pulses have been listed collectively as P8. This means that P8 represents all of the diagnostic criteria deduced from the Pulse Diagnosis other than that information gained from the 9 Continent Pulses. The author considered that the complexity of attempting to quantify the myriad permutations and combinations of the Wrist Pulses (P8) alone into meaningful data was beyond the scope of the study.

The results from the SPSS-X analysis were categorised into 2 sections as follows:
a.        Section 1.
1.        Statement of Hypothesis 1.
2.        Stepwise Multiple Regression: P1-8 Predicting DC1-10.
3.        Stepwise Multiple Regression: DC1-10 Predicting PUF1-5.
b.        Section 2.
1.        Statement of Hypothesis 2.
2.        Crosstabulation of NPC against Symptoms (S1-S6).

Section 1.
Hypothesis 1.
The diagnostic criteria taken from the pulses do not statistically significantly predict the AP points used in the treatment at p<.05 level of significance.

Stepwise Multiple Regression: P1-8 Predicting DC1-10.
Analysis of this data was to indicate that the pulses (P1-P8) predict the diagnostic criteria (DC1-10).

The information concerning the Stepwise Multiple Regression is summarised below in the form of a matrix showing those predictions which were statistically significant at .05 level of significance:
Smith_A4 (1996) Five Phase Pulse Diagnosis: The Art of Science Or The Science of Art?: Part 4.

Table 2: Matrix of P1-P8 Predicting DC1-DC10.The frequency of prediction by the pulses were as follows:
a.Pulse 8 (P8): 9 predictions; b.Pulse 1 (P1): 4 predictions; c.Pulse 4 (P4): 3 predictions; d.Pulse 7 (P7): 3 predictions; and e.Pulse 3 (P3): 1 predictions.

Conversely consideration of the Table 2 illustrates the frequency of the diagnostic criteria being predicted by the pulses as follows:

1.DC1: predicted by only one pulse (P8); 2.DC3: predicted by 3 pulses (P1, P3 and P8); 3.DC4: predicted by 2 pulses (P1 and P8); 4.DC5: predicted by 2 pulses (P1 and P4); 5.DC6: predicted by 3 pulses (P4, P7 and P8); 6.DC7: predicted by 4 pulses (P1, P4, P7 and P8); 7.DC8: predicted by only one pulse (P8); 8.DC9: predicted by 2 pulses (P7 and P8); 9.DC10: predicted by only one pulse (P8).

Analysis of Table 2 indicates that the following clustering occurred:
a.Pulses 4, 7 and 8 predicted DC6 and DC7; and b.Pulses l and 8 predicted DC3 and DC4.
Stepwise Multiple Regression: DC-DC10 predicting PUF1-5.

Analysis of this data was to indicate that the Diagnostic Criteria (DC1 to DC10) do not predict the points used for the first treatment. DC10 was excluded from the analysis due to insufficient data pertaining to DC10. The equations concerning PUF5 were deleted from the analysis due to insufficient data pertaining to PUF5.

Table 3 summarises the results of the Stepwise Multiple Regression:

Entered Variable
DC-DC9
DC6
DC-DC5; DC7-DC9
DC-DC9
DC-DC9

Dependent Variable
PUF
PUF2
PUF2
PUF3
PUF4

Significance.
.7015.
.0463.
.4310.
.9173.
.9172.

Table 3. DC-DC10 predicting PUF-5.

Section 2.
Statement of Hypothesis 2.

The patients' comments after AP are independent of whether the patients' symptoms improved or not.

Crosstabulation of NPC against Symptoms (S1-6).

The results pertaining to the cross-tabulation of NPC against S2 have been deleted from the analysis due to S2 representing Comments Not Recorded. The cross-tabulation utilised 59% of the data pertaining to NPC due to the author only considering those patients who improved or did not improve. Table 4 summarises the relevant data:

Variable
NPC-S1
NPC-S3
NPC-S4
NPC-S5

Significance
0.9564
1.0000
0.7996
0.7374

Contingency Coeff.
0.04324.
0.01611
0.06833.
0.07777.

Table 4: Cross-tabulation of NPC against Symptoms (S1-6).
Discussion.
The results indicate through the use of stepwise multiple regression prediction analysis that the Wrist Pulses (P8) was the most predictive of the diagnostic criteria. The pulses taken from the wrist (as distinct from any of the 9 Continent Pulses) involve palpating a complex and subtle arrangement of qualities, more so than for each individual 9 Continent Pulse or the collective of the 9 Continent Pulses. This applies particularly with Pulse Diagnosis taken in accordance with the Five Phase Theory due to the vast array of discernible qualities which may be palpated.

The iconography of the qualities of the pulses is interpreted by the practitioner and represents a profile of the patient's health in terms of TCM. It makes sematic sense that the bulk of the diagnostic criteria are predicted by the Wrist Pulses(P8) due to the greater iconography associated with taking those Wrist Pulses.

However the results indicated that several of the 9 Continent Pulses predicted various diagnostic criteria. In combination with the Wrist Pulses, the 9 Continent Pulses were useful in diagnosis. More research is needed to accurately determine the frequency of prediction of the diagnostic criteria by the 9 Continent Pulses and the Wrist Pulses.

The stepwise multiple regression indicated that the diagnostic criteria did not predict the points used for the treatment. The only exception to this was DC6 (6th diagnostic criteria) predicting the second point used in the treatment (PUF2). The author considered the prediction of PUF2 by DC6 to be an aberration.

Pulse Diagnosis is considered by the author to pertain to that individual patient at the specific time of diagnosis. Literally any AP point may be used by the practitioner if it is in accordance with the complex matrix of diagnosis as indicated by the pulses. The individual point functions are not the only criteria to be considered by the practitioner in the selection process (Smith, 1993).

The intricate relationships of one point to all of the others chosen means that the prediction and ultimate selection of points is an extremely subtle and subjective task. While some statistical evidence suggests that the pulses predict the diagnostic criteria, the relationship of the diagnostic criteria to the final selection of AP points is complicated and diverse when using Pulse Diagnosis as the major form of diagnosis from which points are selected.

While the author acknowledges that the determination of the diagnostic criteria precedes the selection of the most suitable AP points, the complexity of interpreting the subtlety and subjectivity of such a process suggests that a different research model other than Ex Post Facto may need to be utilised to obtain more meaningful data.

More research is needed to determine the statistical relationship of the diagnostic criteria with the points selected. Crosstabulating patient symptoms against patient comments indicated that the comments at the end of the treatments were independent of whether the patients symptoms improved or not. Although the study did provide some evidence that the process of traditional AP begins with the patient elucidating various symptoms it is the patients comments that conclude the process.

The patients' symptoms were not related to the process of traditional AP when Pulse Diagnosis was used as the main form of diagnosis. This makes sense, as the author's treatments were based on the diagnostic criteria as described by the pulses rather than by the patient's symptoms.

While it is clear that further research is required into Pulse Diagnosis as a diagnostic technique, the study indicates a possibility that Pulse Diagnosis HAS a scientific basis. This in itself may indicate that educational institutions which teach AP may find it useful to include in their curricula the theory and practice of Pulse Diagnosis if not already doing so.

Conclusion
The Wrist Pulses were statistically more predictive of diagnosis than the 9 Continent Pulses. However, when combined with the Wrist Pulses, the 9 Continent Pulses had some use in diagnosis.

Smith_A5 (1996) Five Phase Pulse Diagnosis: The Art of Science Or The Science of Art?: Part 5.
The author could not confirm that the diagnostic criteria predict the points used for the treatment. A more sophisticated computer programme may be required over and above the SPSS-X to examine his relationship further.

The patient's comments after the treatment were statistically independent of whether the patients improved or not.

More research is needed in this field to determine the efficacy of the Wrist Pulses as a diagnostic tool. Also, research is needed to clarify the frequency of prediction of the diagnostic criteria by the 9 Continent Pulses and the specific clustering which occurred of the diagnostic criteria in relation to the pulses.

Statistically, there was some evidence to suggest a scientific framework underpinning Pulse Diagnosis. Pulses taken in accordance with Five Phase Theory rather than the classic 28 pulse qualities, may be a more appropriate method of taking pulses as a means of TCM diagnosis. The evidence suggests that Five Phase Pulse Diagnosis is a valid form of Pulse Diagnosis.

The qualitative approach to AP uses philosophical concepts from millenia of clinical use. However, the diagnostic art of Pulse Diagnosis is centred on a coherent methodology which may have a scientific basis. While the Ex Post Facto method of research has proved useful for the study, it did not seem fully adequate to explain the qualitative paradigm to which Pulse Diagnosis and AP belong.

Educational institutions which teach AP may find it useful to include in their curricula the theory and practice of Pulse Diagnosis if not already doing so. Integrating Pulse Diagnosis into the Med and Vet AP courses may help to juxtapose the many advantages of AP with the advantages of Mod Med. It may also help the graduates of AP courses to better understand the mechanisms underpinning the AP effect within the qualitative paradigm of traditional AP.

Understanding that AP has a coherent methodology while still being inherently different from WM may assist people in developing the confidence to learn more about their health within the paradigm of TCM. The AP and Med professions should work together to disseminate information about the benefits of AP that may appeal to the general public. Combining the many benefits of WM with the drug-free and low cost advantages of AP may improve the quality of choice and accessibility of well-being in the provision of primary health care within Australia.

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Vincent CA & Richardson PH (1986) The Evaluation of Therapeutic AP: Concepts and Methods. Pain Vol 24.

Conversations: Palmer R Conversation with the author dated 9th December 1992.

Letters: Rogers C Letter to the author dated 24th September 1992.

Footnotes
1 Statistical Package for Social Scientists.
2 Specific details are contained in the author's M Educ Thesis (1993), Univ of Canberra: Pulse Diagnosis in Traditional AP.

Stone_A1 (1996) Western and Eastern Med compared. Adapted from WWW (Acupuncture.com).

Ever seen that drawing of 2 silhouettes looking at each other? One moment you see 2 faces, the next moment, its a vase. Which is it? Obviously it is just a matter of your perception or the way your brain links together visual clues.

That's the difference between WM and TCM. Diagnosing the same patient with a lump in her breast, the doctor of WM will see a cyst, lesion, fibroid or cancer whereas the doctor of TCM will see a Stasis of Qi, Xue, or Phlegm. The doctor of WM will seek to prove the diagnosis with a biopsy of the hardened tissue. The doctor of TCM will feel the unique quality of the Pulses at the radial artery which may feel "wiry" or hard, like a guitar string bouncing up and down beneath the fingers (as opposed to other pulses that can feel softer and more flowing), observe the colour and shape of the tongue (looking for purple in particular, with possibly a thick yellow coating). For diagnostic purposes, he/she will also use seemingly unrelated symptoms such as sensations of constriction in the chest, abdominal bloating, heightened emotional sensitivity, a tendency to be angered easily, and frequent headaches at the top or the sides of the head. This allows the doctor of TCM to diagnose a Syndrome of "Qi, Xue or Phlegm Stasis." That example shows that there are very different ways of organizing the information from the same symptoms, the same signs and the same patient.

Both WM and TCM have their place. Within each discipline, a huge amount of time-tested information has its own logic and usefulness. Some believe that the greatest strength of WM is in it's trauma care and therapies for acute problems, while TCM excels in the areas of chronic problems and preventive Med.

Qi is an internal substance, a central concept in TCM that the scientific world is still struggling to accept. In the West we could describe this as bio-electric energy. You can't look at it under a microscope, you can't detect it with any scientific instruments, you can't isolate it from a substrate. This isn't to say that one cannot feel it, or see it, but these are intuitive human qualities that practitioners of TCM develop over years of practice. Many westerners can also perceive this Qi (energy). Martial artists sometimes feel it as heat in the palms of their hands, or warm liquid moving through the body. It is the invisible substance in mountain air that clears the mind with just one deep breath. A young mother witnesses it in the form of light coming from her baby's eyes.

AP seeks to treat health by balancing the levels of Qi. Qi flows in specific conduits in the body, the Channels, collaterals and Vessels. Needles inserted along the Channels influence the Qi that flows to the Zang-Fu (internal solid organs and hollow bowels). It can treat Internal diseases which affect both the structure and function of the Zang-Fu. AP can work also on in External diseases, such colds, 'flu, chills and on specific areas of pain (Ahshi points, TPs) that may be associated with External or superficial or local problems (for example, pulled muscles, sport-injuries). A needle inserted near the area of a pulled tendon or overstrained muscle will increase the flow of Qi to that area which removes pain and quickens the healing process.

Another difference between TCM and WM is that TCM treats the Yang and WM treats the Yin.

Everything in the universe can be described in terms of Yin or Yang. This is one of the underlying philosophies of TCM. The TCM characters for Yin-Yang mean, literally, the shady side of the hill and sunny side of the hill respectively.
Stone_Ac1 (1996) Symptomatic Diagnosis: Part 1.Adapted from WWW (Acupuncture.com).

These are notes from a class in which we organized information by the symptoms themselves but not by Zang-Fu differentiation, Eight Principles (Yin-Yang, Hot-Cold, Shi-Xu, Internal-External), Six Channels, or Four Levels. The class moved rapidly, and I haven't had the chance to organize this information or check the spelling on these formulas as well as I'd like. This page is an interesting way to organize information, but it should be cross-checked against other sources for more reliable accuracy.

Multiple Sclerosis doesn't exist in TCM, nor does epilepsy, or ulcerative colitis. These are all Western differentiations. TCM would treat these Syndromes as perhaps Channel Qi-Xue-Stasis, LV-Wind or Damp-Heat in the Lower Jiao. These treatments are based on the perspective of TCM, not on WM. This page was uploaded to show the different way in which practitioners of TCM might approach a Syndrome.

1.        Aversion to Wind and Cold along with chills
Note: Difference between Chills and Aversion to Cold is this: Chills will not be relieved by warm clothing. Aversion to Cold is.

External Syndrome (99% of cases): Wind-induced fever and chills, though it can be combined with other factors: Muscle aches, headache; Wind with Cold; Chills and aches. Formula: Ma Huang Tang (Pungent and warm). Wind with Heat: Fever and sore throat. Formula: Yin Qiao San (Pungent and cool). Wind with Damp: stuffiness, aching in joints. Formula: Qian Wei Qiang Hua Yin (Warm and Dry).

Yang-Collapse (KI and HT most effected): Feeble or faint pulse; Very low energy; Confusion and disorientation; Cold sweat, Cold body, Cold extremities; Low blood pressure; Patient prefers fetal position; Diarrhoea with undigested food; Clear copious urine. Treatment principle: Restore Yang from Collapse. Formula: Shen Fu Tang.

Yang-Xu (not as severe as collapse) (HT, SP, KI): Aversion to Cold; Fatigue. Qi-Xu Sx + Cold Sx. HT-Yang-Xu (Palpitations, SOB, fatigue, cyanosis). Formula: Gui Zhi Tang with more Zhi Gan Cao. SP-Yang-Xu: add Li Zhong Tang. KI-Yang-Xu: add Jin Gui Shen Qi Tang AKA Ba Wei Di Huang Wan.

True Heat, Pseudo Cold: A Shi Syndrome due to many etiologies which pushes the Yin from the Interior to the Exterior: Cold Sx externally; Aversion to Cold; Cold skin (which warms upon prolonged touch); Warm Sx internally; Doesn't desire warm clothes; Bad breath, constipation. T: Red with yellow coat. P: Forceful and Rapid. Formula: Bai Hu Tang.

Phlegm-Stasis: A Syndrome in which a Yin Evil blocks the flow of Yangqi (Yangqi-Stasis), leading to aversion to Cold. Thirst, with no desire to drink; Aversion to Cold. T: Thick greasy white coat. P: Slippery. Formula: Er Chen Tang.

2.        Shivers or "Severe Chills"
External Syndrome: Severe Stasis caused by External factors, skin pores close, Weiqi pushes up against the closed pores in an attempt to expel the pathogen. This creates shivering. Formula: Ma Huang is the king herb, Ma Xing Shi Gan Tang.

Febrile Disease is due to attack of pathogenic Heat (usually the Wei-Heat and Qi-Heat according to Wen Bing theory).

3.        Alternating fever and chills
Shaoyang disease: Bitter taste in mouth; Dry mouth; Chest and hypochondriac discomfort; Irritability. T: Red tip with thin yellow coat. P: Wiry. Treatment Principle: "Harmonize Interior and Exterior" which means Disperse the Exterior and Clear the Interior. Formula: Xiao Chai Hu Tang.

Malaria: Very regular cycle between fever and chills; Patient is very weak and needs to sleep after each cycle. Formula: Qing Hao and Zhong San are king herbs.

4.        Aversion to Heat without chills: An Internal-Shi Syndrome of LU and ST
Hot Phlegm in LU (Bronchitis): Fever; Cough; Chest pain; Sputum is thick and yellow, brown, or green; Thirst; Constipation. T: Red with thick greasy yellow coat. P: Rapid and slippery. Treatment Principle: One can Clear Heat from LU by purging constipation. Formula: Ma Xing Shi Gan Tang.

Yangming Jing (ST-Channel); No chills because the pathogen is too far Interior: "4 Big Symptoms": Big thirst, Big fever, Big sweats, Big pulse. Formula: Bai Hu Tang (Bitter and Cold).

Yangming Fu (LI-organ): Heat leads to Fever, Constipation, Bloating; Palpable hardnesses in abdomen (dry stool). P: Deep, strong, slow (slow due to Stasis). Formula: Da Cheng Qi Tang.

Ying- or Xue- Syndromes (PC): High fever (104 degrees F. and above); Mental manifestations (confusion, delirium, etc); T: Red tongue with scanty, or no coat (Yin Xu). Formula: King herbs include: Xi Jiao, Ling Yang Jiao and Shui Niu Jiao (Herbs must go to the PC).

5.        Tidal fever (Low grade fever which comes and goes like the tide)
Yin-Xu: Low grade fever in the afternoon or evening; Five Centre Heat. Formula: Liu Wei Di Huang Wan.

Qi-Xu (Qi-Xu of SP-ST): Low grade fever at no regular time; Fever + Qi-Xu symptoms. Formula: Bu Zhong Yi Qi Tang.

Xue-Stasis (Late stage Stasis leads to Xue-Xu, as in late stage cancer): Low grade fever in evening; Aches; Dry skin; Dark circles under eyes; Tumour formation. T: Purple. P: Choppy and thready. Treatment Principle: Clear Xue-Stasis.

Yangming Fu Syndrome (LI-organ): Low fever possible, due to Stasis; Fever; Constipation. Formula: Da Ching Qi Tang, or any of the related "Ching Qi Tang" formulas.

6.        Five Centre Heat
Yin-Xu with Heat-Xu: Five Centre Heat, which is Heat manifesting on the Yin surfaces of the body, such as the palms, bottom of the feet, and the chest; Night sweats, Hot flashes. T: Red, narrow, scanty coat. P: Thin and rapid. Treatment Principle: Nourish Yin, Clear Heat. Formula: Liu Wei Di Huang Wan (Tonifies Yin), Zhi Bai Di Huang Wan (Clears Heat-Xu). Important herbs: Huang Bai, Zhi Mu. Bitter and Cold, they cool both Heat-Xu and Heat-Shi.

Xue-Xu leading to Heat-Xu (Think LV-SP): Five Centre Heat especially in the afternoon and evening; Fatigue, poor appetite, palpitations, dizziness, vertigo, pale complexion. T: Pale. P: Thready, soft, or choppy. Treatment Principle: Nourish Xue. Formula: Si Wu Tang.

7.        Night Sweats (Think HT, since sweat is the Jin-Fluid of HT)
HT-Xue-Xu: Night sweats, palpitations, insomnia, pale complexion fatigue; T: Pale; P: Weak. Treatment Principle: Tonify HT-Xue, astringe sweat. Formula: Si Wu Tang, plus an astringent such as Wu Wei Zi, Long Gu, My Li, Fu Xiao Mai, Gui Pi Tang.

Yin-Xu with Heat-Xu: Night sweats, palpitations, insomnia, pale complexion fatigue; T: Pale; P: Weak. Treatment Principle: Tonify Yin. Formula: Liu Wei Di Huang Wan + astringent such as Fu Xiao Mai.

8.        Obesity
Phlegm-Damp Stasis (Excess Syndrome): Obesity, excessive appetite, likes sweet and fatty, greasy food; heavy sensations in body, foggy thinking; Aversion to Heat; T: Flabby; thick, greasy coat; P: Wiry/slippery (Wiry can suggest Phlegm, Heat, or food Stasis). Left untreated, the Phlegm can lead to Heat, leading to Yin Xu, leading to Wind, leading to stroke. Treatment Principle: Remove Damp and Phlegm. Formula: Wen Dan Tang + Ping Wei San. These formulas are combined to lose weight, more gentle and safe than Ma Huang based formulas.

Qi-Xu (Xu Syndrome): Fatigue, weak voice, shortness of breath, Phlegm-Damp Stasis; Aversion to Cold, edema, puffy face, poor digestion, sleepy, hypofunctions. Not necessarily an overeating problem. T: Pale with white coating. P: Thready and weak. Treatment Principle: Tonify Yang, raise metabolism.
Stone_Ac2 (1996) Symptomatic Diagnosis: Part 2.

9.        Emaciation
Xu of SP-ST (Stressed digestive problems): Anaemia, malnutrition, indigestion, thin constitution with indigestion. Poor appetite, chronic loose stool, fatigue, shortness of breath, weak voice; Sallow or pale complexion. T: Pale. P: Weak. Treatment Principle: Tonify SP. Formula: Si Jun Zi Tang, Ba Zhen Tang, Stress carminative herbs.

Qi-Xue-Xu (Digestive problems less stressed): Anaemia, malnutrition. Pale face, nails, tongue, lips, fatigue, dizziness, vertigo. Yangqi-Xue unable to rise to nourish head. T: Pale. P: Thready/Weak. Formula: Ba Zhen Tang; tonic herbs for stress, such as He Shou Wu, E Jiao, Ji Xue Teng.

LU-Yin-Xu (Any Yin Xu leads to a certain amount of emaciation): Thin, emaciated body, Chronic dry cough, e.g. allergies; Lung TB, AIDS, both lead to this sort of emaciation. Cough with blood-streaked sputum, Haematemesis, Dry mouth, tidal fever, night sweats, Five Centre Heat. T: Red with scanty coat. P: Thready, rapid. Treatment Principle: Tonify Yin. Formula: Bai He Gu Jin Tang for LU-Yin-Xu; Liu Wei Di Huang Wan for any Yin-Xu.

ST-Heat (genetic, or acquired, usually chronic): Excessive appetite, hypermetabolism, bad breath, thin constitution; Craves Cold drinks; Irritability; Scanty urine; tends to be constipated. T: Red with dry coat. P: Thready, rapid, forceful. Formula: Jing Wei Tang for ST-Heat; Yu Niu Jiao for ST-Yin Xu due to ST-Heat.

LV-Fire (Excess Heat): Easily angered; Chest and hypochondriac pain or burning; Bitter taste, dry mouth; Insomnia, restlessness; Dark yellow urine, constipation. T: Red with yellow coat. P: Wiry, rapid, forceful. Formula: Long Dong Xie Gan Tang.

10.        Fatigue
Summer Heat, often associated with Damp, because the Heat causes SP-Xu, leading to production of Damp: Symptoms follow excessive sweats, sun stroke; they always involved exposure to climatic Heat; fatigue and weakness in extremities; Dehydration, shortness of breath; fever; Weak voice, thirst; Dusky face colour if Damp is involved; Possible loose stool. T: Possible greasy coat. P: Weak and rapid, may be soft. Formula: Qing Su Yi Qi Tang.

Damp-Stasis, maybe associated with SP-Xu if the symptoms stress it: Sluggish and heavy sensations. Cloudy, foggy head. SP-Qi-Xu: indigestion, loose stool, bloating, low appetite. T: Greasy coat. P: Soft and slippery. Treatment Principle: Dry Damp, stimulate digestion. Formula: Ping Wei San; then later, tonify SP.

Qi-Xue-Xu: Fatigue and Pale colour; Pale skin, face, lips, nails etc; Dizziness, palpitations. T: Pale. P: Deep thready, weak. Formula: Ba Zheng Tang.

11.        Flaccidity of Neck and Head due to weak muscles; a serious condition, wherein the patient is unable to raise the head.
Zhong Qi-Xu: More often effects children with severe malnutrition, Jing-Xu, Down's Syndrome: severe emaciation; Pale or sallow complexion; disorientation, confusion, extreme fatigue; indigestion, loose stool; Middle Jiao Xu leads to Zhong-Xu.

Bone Marrow Xu (a critical Xu Syndrome): Comes due to old age, sexual hyperactivity, associated with tinnitus, low back pain, difficulty in walking or straightening back. T: Pale with scanty coating. P: Deep, very weak, or feeble. Treatment Principle: Tonify KI-Jing. Formulas: Herbs made of animal products to quickly tonify.

12.        Involuntary Twitching of Head Muscles
LV-Wind, LV-Fire (Acute Shi Syndrome): Twitching, acute, dizziness, bodily twitches in extremities especially. Red face, eyes, bitter taste in mouth. T: Red with yellow coat. P: Rapid and wiry. Treatment Principle: Dispel Wind, Clear Heat. Formula: Ling Jiao Gou Teng Tang.

LV-Wind (Chronic Xu Syndrome) e.g. Parkinson's: Tidal Fever, Night sweats, insomnia, fatigue. T: Red with scanty coat. P: Thready and rapid. Treatment Principle: Tonify Yin, Calm LV, Dispel Wind. Formula: Da Ding Feng Zhu.

13.        Tinnitus Cranii (Noise in the head)
Bone marrow Xu: Tinnitus; Weakness/soreness in the lower back and/or knees; Vertigo/Dizziness possibly associated with ear tinnitus. T: Pale with scanty coat. P: Deep, thready, weak. Etiology: Constitution, age, oversexed, Jing-Xu fails to produce Jing. Treatment Principle: Tonify Jing. Formula: Zhou Gui Wan,
He Che Da Zao Wan. Animal products are good for Jing Xu.

Damp-Heat Stasis: Tinnitus; Headache, heavy sensation in head; Naseau/Vomiting; Low appetite; Dizziness; Quan Yang (carbuncles on head). T: Red with greasy yellow coat. P: Slippery, rapid. Etiology: Shi Syndromes due to diet of sweet, greasy, alcohol, or over indulgence creates Damp-Heat in Channels which obstructs the flow of (causes Stasis of) Yangqi. Upper Jiao Stasis effects the head Channels. Treatment Principle; Clear Heat, Dry Damp. Formula: Huang Lian Jie Tu Tang plus blood activators for sharp fixed pain.

LV-Qi-Stasis: Tinnitus triggered by anger or emotion; distention or pain in the hypochondrium, chest tightness; bitter taste in mouth; irritability, restlessness. T: Normal. P: Wiry and rapid. Etiology: Anger leads to disturbance in flow of Qi and leads to Qi-Stasis in the head. Treatment Principle: Soothe LV-Qi. Formula: Xiao Yao Wan; Long Dan Xie Gan Tang if Fire is present.

14.        Sore Gums
KI-Xu and SP-Xu (teeth and gums): Sore gums aggravated mostly by Cold drinks and weather, sometimes Hot drinks as well. Teeth feel weak while chewing. T: Pale. P: Deep and Weak. Etiology: Old age, chronic Syndromes. Treatment Principle: Tonify SP and KI. Formula: Zuo Gui Yin, Ruo Gui Yin, Liu Wei Di Huang Wan, Ba Wei Di Huang Wan, Chew and eat walnuts (Hu Tao Ren).

Wind-Cold: Sore gums, prefer warm drinks and food to Cold. T: White slippery coat (slightly greasy). P: Floating and Tense. Formula: Xi Xin (individual herb) can be chewed raw, or decocted as a tea; Ma Huang Xi Xin Fu Zi Tang.

15.        Bleeding Gums (ulcerative gingivitis)
Yangming Heat & Fire (acute Shi Syndrome in ST-LI): Swollen, red aching bleeding gums; Fresh, bright red blood; Bad breath, prefers Cold drinks, constipation. T: Red body, thick yellow coat. P: Forceful and rapid. Formula: Qing Wei Tang + Yu Niu Jiao + herbs to cool and activate Xue.

ST-Yin-Xu (Xu Syndrome, chronic): Swollen gums with pale blood, gums not bright red, sometimes painful, sometimes not. T: Red with scanty coat. P: Slippery, rapid, thready. Formula: Yu Niu Jiao + herbs to cool and activate Xue.

KI-Yin-Xu with Heat-Shi (a chronic Syndrome in old age): Slightly sore gums combined with loose teeth; Dizziness, tinnitus; Sore back and weak knees; T: Red body with scanty coat. P: Thready and rapid. Formula: (with Heat): Zhi Bei Di Huang + Gu Sui Bu and/or Xu Duan; (without Heat): Rou Gui Yin or Zuo Gui Yin + Gu Sui Bu and/or Xu Duan.

SP-Qi-Xu (SP unable to govern Xue, chronic Xu-Syndrome): Pale gums, lips, and nails due to Xue Xu; Easily bruised. T: Pale with white coat. P: Soft, weak. Formula: Gui Pi Tang (#1 Formula: for purpura-bruising).

16.        Dark Black Teeth (Black from inside of teeth, not a stain due to coffee etc)
Xue-Heat in the Lower Jiao: High fever, delirium, semi-conscious, coma, convulsions; Irritability; Shrivelling and dry lips. T: Red with very dry coat, shrunken. P: Extremely rapid. Etiology: Heat has damaged Yin and Jin/Ye, ST-Qi damaged (shrunken mouth). KI unable to nourish teeth, turning them black, the colour of KI. Formula: Salty, Cold, sweet and moist herbs, Fu Mai Tang, Pa Ting Fen Zhu Tang.
Stone_Ac3 (1996) Symptomatic Diagnosis: Part 3.

17.        Stiffness of Neck
Wind-Cold: More chills than fever, etc. T: White slippery coat (slightly greasy). P: Floating and Tense. Formula: Ge Gen Tang.

Wind-Cold-Damp (a Bi-Syndrome such as arthritis): Heavy sensation in the head, head ache, aching joints, fever/chills sometimes. T: Greasy coat. P: Floating and slippery. Formula: Ge Gen Tang + Qiang Huo, Jian Huang and/or Sang Zhi.

Xue-Heat: High fever, stiffness of head; irritability, delirium; Possibly associated with convulsions, muscle spasms. "Extreme Heat leads to LV-Wind". Formula: Ling Yang Ge Gen Tang.

18.        Goitre (Thyroid gland Enlargement)
Phlegm-Stasis and Qi-Stasis: Swelling of thyroid, which is soft without pain; Sense of obstruction in throat; Chest constriction and hypochondriac distending pain; Irritability. T: Greasy white coat. P: Wiry and slippery. Etiology: Stress -> Qi-Stasis -> impaired metabolism of Jin-Ye -> Phlegm-Stasis in throat. Formula: Ban Xia Huo Po Tang + Hai Zao and Kun Bu.

Qi-Xue-Stasis: Tumours or cancer of the thyroid gland developing from Phlegm-Stasis and Qi-Stasis (see above); Swelling is harder than simple Phlegm and Qi-Stasis; More defined pain and sense of obstruction effecting ability to breath and/or swallow; Chest constriction and hypochondriac distending pain; Irritability. T: Dark purple. P: Deep and choppy. Etiology: Prolonged Qi-Stasis with Phlegm leads to hardening of the Phlegm leading to tumour formation. Formula: Ban Xia Huo Po Tang + Blood activators such as E Zhu, San Lin, Dan Shen, Ru Xiang, Mo Ya and anti-cancer herbs.

Yin-Xu of HT and LV: Typical hyperthyroidism, swollen thyroid, though not hard; Palpitations, insomnia, nervous, trembling; Easily sweats, shortness of breath, irritability, dizziness/vertigo; Dry eyes, hot flashes, night sweats; Nocturnal emissions, premature ejaculation; irregular menstruation. T: Red with scanty coat. P: Wiry and rapid, or thready and rapid. Treatment Principle: Tonify Yin and Clear Fire. Formula: Suan Zao Ren Tang, Zhi Bai Di Huang, Tian Wang Bu Xing Tang, Yi Guan Jiang.

19.        Edema of the extremities
Heat-Damp-Stasis ("Heat Bi-Syndrome"): Edema in small joints; Acute achy swollen arthritis; Combined with fever, thirst and irritability; T: Red body with yellow greasy coat. P: Slippery and rapid. Formula: Bai Hu Tang + Gui Zhi and Cang Zhu.

Cold-Damp-Stasis ("Cold Bi-Syndrome"): Cold, achy arthritis with edema. T: Greasy white coat. P: Slow. Formula: Wu Tou Tang.

Qi-Stasis: Pitting edema; Chest constriction and hypochondriac distending pain. T: Pale with white coating. P: Wiry. Etiology: Because this a Channel pathology, the etiology is often External Wind. Treatment Principle: Harmonize Ying and Weiqi. Formula: Xiang Su San (Xiang Fu activates Qi; Su Ye Dispels Wind).

Qi-Xue-Stasis (Post-stroke sequelae, paralysis, hemiplegia): Edema (mostly lower extremities), weakness, numbness; Colour of the skin at affected site is purple. T: Pale with purple spots. P: Wiry, choppy. Etiology: Phlegm remaining in Channels after stroke. Formula: Huang Qi Gui Zhi Tang.

20.        Stiffness of the extremities
Wind-Cold and Damp: Cold, achy arthritis. T: Greasy white coat. P: Slow. Formula: Gui Zhi Tang, Ge Gen Tang.

Heat and Phlegm: High fever, stiffness of extremities; Irritability, delirium; Possibly associated with convulsions, muscle spasms. "Extreme Heat leads to LV-Wind". Formula: Ling Yang Ge Gen Tang.

21.        Flaccid Paralysis of Extremities "Wei Syndrome", usually without pain
Body Damaged by LU-Heat: Follows febrile disease; Usually Lower extremities; Low grade fever and impaired Yin; T: Red with yellow or scanty coat. Treatment Principle: Tonify Yin and Jin Ye. Formula: Shao Shen Mail Men Dong Tang + San Miao San, Qing Zao Jie Fei Tang; AP points: Yangming points (ST for legs, LI for arms).

Qi-Xu of SP-ST: Weakness (not paralysis) of limbs, normal movement, but very weak; Bloating, indigestion, loose stool, aversion to Cold, pale complexion. T: Pale. P: Thready and weak. Prevalent during post illness recovery period. Formula: Bu Zhong Yi Qi Tang.

LV-Xu and KI-Xu: Old age, or after illness; Hyposensitivity of extremities leading to weakness leading to paralysis; Sore lower back, dysmenorrhoea, premature ejaculation; Dizziness, vertigo, fatigue. T: Pale. P: Deep, thready, weak. Jing Xu, sometimes combined with Qi or Yin-Xu. Treatment Principle: Tonify Jing and LV (for tendons). Formula: Zuo Gui Yin, You Gin Gui Yin, Da Bu Yin Wan.

Xue-Stasis: Weakness leading to numbness; Possible spasm leading to paralysis. T: Purple. P: Choppy, thready. Etiology: Post-stroke sequelae or tissue trauma; Phlegm remains in Channels after stroke. Treatment Principle: Promote Xue circulation. Formula: Tao Hong Si Wu Tang.

22.        Varicoses of the Lower Extremities
Heat-Damp-Stasis (acute Syndrome): Varicose veins are combined with red, swollen legs. Veins are Hot and burning; Fever, bitter taste in the mouth, irregular bowel movements. T: Red with yellow greasy coating. P: Wiry/rapid. Etiology: Excessive alcohol intake, Damp and Heat producing foods. Treatment Principle: Clear Heat, drain Damp. Formula: San Miao San. AP points: Local points around the varicose veins like Hua Toe Jia Jie; Points around the spine. Needles are considered more effective than herbs for this sort of varicose condition.

Cold-Damp-Stasis (chronic Syndrome): Varicose veins are combined with heavy extremities and distension; Blue or purple veins, chronic; Copious urine, loose stools. T: White Greasy coat. P: Soft. Etiology: Standing up too much, working environment. Treatment Principle: Remove Cold and Damp. Formula: Ji Ming San.

Qi-Xu and Xue-Stasis: Chronic physical weakness or Qi-Xu; Chronically carrying heavy things and/or standing for a long time; Purple veins. Not as "big" as in Damp-Cold-Stasis; Achy, but not distended; Fatigue, shortness of breath, pale complexion. T: Pale. P: Weak. Treatment Principle: Harmonize Ying, tonify Qi, Activate Xue. Formula: Bu Yang Huang Wu Tang.

23.        Feet Pain
LV-Xu and KI-Xu (old age, jing xu): Pain in heel (key symptom); No skin change; Pain worse by walking or fatigue; Tinnitus, Sore back. Formula: Hu Jian Wan (Patent formula).

Cold-Damp-Stasis: Achy joints exasperated by Cold and Damp. T: White coat. P: Soft. Formula: Dang Gui Si Ni Tang.

24.        Back Pain
Cold-Damp-Stasis (Bi Syndrome): Pain which can radiate to neck; back feels heavy, stiff; symptoms aggravated by Cold Damp weather. Formula: Qiang Huo Ji Sheng Tang.

Qi-Xue-Stasis due to recent trauma (acute): Sudden onset of pain; Limited range of motion, acute symptoms; Could develop into chronic pain. P: Tense. Formula: Yuen Lian Bai Yao, Huo Lou Xiao Ling Dan.

Qi-Xue-Stasis due to past trauma (chronic): Dull aching on & off, numbness aggravated by rest (Xu beneath). T: Purple. P: Thready and/or choppy. Treatment Principle: Tonify and activate Qi-Xue. Formula: Du Huo Ji Sheng Wan + Tao Ren and Hong Hua.

25.        Weak lower back and knees
KI-Xu and LV-Xu: Formulas: Zuo Gui Wan, Rou Gui Wan, Bao Wei Di Huang Want, Liu Wei Di Huang Wan.

Jing-Xu: Infertility, tinnitus, vertigo, sore back, premature ejaculation, amenorrhoea, grey hair, premature aging. Formulas: KI/LV formulas plus Zi He Che, Lu Rong.

Yin-Xu: Emaciation, tidal fever, Heat signs, Five Centre Heat. Formulas: KI/LV formulas plus Huang Bai, Zhi Mu.

Yang-Xu: Cold signs such as Cold hands and feet. Formula: tonic formulas for KI-LV, plus Fu Zi, Ba Ji Tian, Bu Gu Zi.

Qi-Xu: Weakness of the Lower Gates (BL/urethral sphincter, LI/anal sphincter etc.) incontinence, premature ejaculation, urination problems. Formula: tonic formulas for KI-LV, plus astringent herbs such as Sang Pian Xiao, Yi Zhi Ren, Wu Wei Zi, Fu Peng Zi.
Stone_Ac4 (1996) Symptomatic Diagnosis: Part 4.

26.        Chest Pain (often with HT disorder)
HT-Qi-Xu: Mild pain; Neurosis, HT Syndrome; dull achy chest pain on one or both sides; Chest congestion, palpitations; Spontaneous sweats, fatigue. T: Pale. P: Weak and thready. Treatment Principle: Tonify HT Qi. Formula: Bao Yuan Wan.

Cold-Stasis (Yang-Xu) Painful: CHD, chest pain, usually on the left side which could radiate to he right, back shoulder, and arm. Pale complexion, spontaneous sweats, Cold extremities. T: Pale, swollen, teeth marks. P: Deep, slow, knotty and intermittent. Treatment Principle: Tonify HT-Yang, promote circulation of Xue. Formula: Gua Luo Xie Bai Bai Jiu Tang.

HT-Xue-Stasis (still a form of Yang-Xu): Typical Angina pectoris. Intense pain that can make the patient lose consciousness due to its intensity. Spontaneous Cold sweats, fear, fatigue. T: Pale purple. P: Deep, thready, choppy, knotty, intermittent. Herb: Dan Shen for chest pain. Formula: Xue Fu Zhu Yu Tang, Ge Xian Zhu Yu Tang.

Phlegm-Stasis in LU: Cough; Excess Phlegm, pain with cough.

27.        Tumour Formation in the abdomen
Qi-Xue-Stasis: Enlargement of LV and SP; Abdominal mass begins soft, but becomes harder as time goes by. Distention, emaciation, fatigue; Dark dull facial complexion. low appetite, dry skin. T: Purple spots. P: Wiry, tense. Cancerous tumours tend to be more Xue Stasis than Qi-Stasis. Treatment Principle: Activate Xue (Yin Xu unimportant now). Formula: Ge Xian Zhu Yu Tang + Shi Xiao San.

Phlegm-Stasis: Abdominal mass, no pain yet distended and uncomfortable. Mass is movable and soft, but patient dislikes touch. T: Pale. P: soft and Slippery. Formula: Ban He Wan, Er Chan Tang.

Zhongqi-Xu (sinking, or organ prolapse): Pulling down, or bearing down sensation; Qi-Xu symptoms. Formula: Bu Zhong Yi Qi Tang.

28.        Tenesmus
Damp-Heat and toxic Heat-Stasis: Tenesmus, diarrhoea, abdominal pain, blood and mucus in stool; Pus and burning sensation in anus, possible fever; Yellow scanty urine. T: Red with yellow coat. P: Slippery and rapid. Formula: Dan Gui Xhao Yao Tang.

29.        Constipation
Yangming-Heat (Yangming Fu-LI): Fever, constipation, abdominal discomfort; dislikes palpation; feels mass in abdomen. P: Deep, strong and slow due to Stasis. Treatment Principle: Purge Heat and Stasis. Formula: Da Ching Qi Tang.

Qi-Stasis: Constipation; depression, easily angered, chest congestion, discomfort in hypochondrium; distention and discomfort in breast, water retention (due to digestive problems, secondary to the Stasis). Formula: Chai Hu Su Gan Tang + lubricative herbs such as Tao Ren or Huo Ma Ren.

Qi-Xu: Constipation, sometimes loose; extreme fatigue especially after a bowel movement; Weak voice; possible rectal prolapse. T: Pale with white coat. P: Weak. Formula: Bu Zhong Yi Qi Tang.

Xue-Xu and Yin-Xu: Chronic, old age patients; Constipation, emaciation, dry skin; palpitations, pale complexion. T: Pale, or Red or Narrow. P: Thready and rapid. Herbs: Dang Gui, Sheng Di Huang, Rou Cong Ren. Formula: Wu Ren Wan. Sheng Ye Cheng Qi Tang.

30.        Incontinence of Feces (all serious Syndromes)
Heat and toxin Stasis: Xue-Heat and toxin; High fever, delirium; Semi consciousness, coma, severe diarrhoea with pus and blood. T: Red with yellow coat. P: Rapid. Treatment Principle: Clear Xue-Heat. Formula: Xi Jiao Di Huang Tang.

Yang-Xu of SP-KI: Chronic Diarrhoea/dysentery; Diarrhoea with mucus, incontinence of feces; Fatigue, Cold, low back pain. T: Pale. P: Deep, thready, weak. Formula: Zheng Ren Yang Zhong Tang.

SP-Qi-Sinking (Extreme Xu Syndrome): Incontinence of feces, rectal prolapse, tired disoriented. T: Pale. P: Feeble. Formula: Shen Fu Tang.

31.        Incontinence of urine
KI-Qi-Xu (Common in old age and those recovering from serious illness): Frequent urination and incontinence, mostly in the evening; Xu symptoms of KI-Qi and/or KI-Yang. T: Pale. P: Deep, weak especially in KI positions.

LU-SP Qi-Xu: The problem begins with SP-Qi sinking and is worsened by the spasmatic action of the abdomen with coughing.

32.        Cloudy Urination (see 35 below)
Damp-Heat-Stasis (Turbid Damp-Shi, acute): Cloudy urine with white or yellow urine; Frequent, burning, urgent, painful urination; fever, thirst. T: Red with yellow coat. P: Wiry and thready. Formula: Ba Zheng San + Shi Chang Pu, Pi Xie Feng Qing Yin.

Xu of KI-Yin or KI-Yang (Xu Syndrome in which the Jing-Essence leaks out with the urine): Chronic cloudy urine (KI unable to govern the KI-Jing-Essence). Treatment Principle: Tonify KI, Astringe Jing-Essence. KI-Yin-Xu symptoms: Scanty yellow urine. T: Red. P: Thready and rapid. Formula: Zhi Bai Di Huang Wan + Pi Xia, Fu Pen Zi, Wu Wei Zi, Tu Si Zi (all astringents); or KI-Yang-Xu symptoms: Copious clear urine. T: Pale. P: Deep and weak. Formula: You Gui Yin or Wan + Pi Xia, Fu Pen Zi, Wu Wei Zi, Tu Si Zi (all astringents).

33.        Frequent Urination in Evening (often found in the elderly).
KI-Qi-Xu, or KI-Yang-Xu (see 32 above). Formula: Sang Piao Xie San + You Gui Wan; for prostate problems: Kai Kit Wan.

34.        Oliguria, or difficult urination.
Damp-Heat: Cloudy yellow urine; Frequent, burning, urgent, painful urination; incontinence. Formula: Ba Zheng San + Shi Chang Pu, Pi Xie Feng Qing Yin.

LU-Qi-Stasis (LU unable to descend the Water): Cough, dyspnea, chest congestion, constipation. T: Red. P: Soft and rapid. Formula: Qing Feng Wan.

Zhong Qi-Xu (SP-Qi Sinking): Urination lacking strength, sluggish stream; fatigue, bearing down sense; Urine, frequent but small amounts; Loose stool. T: Pale. P: Thready and weak. Formula: Bu Zhong Yi Qi Tang.

KI-Qi-Xu: difficult urination, sluggish stream, incontinence; frequent urination; Kidney problems in WM. Treatment Principle: Tonify KI. Formula: Ba Wei Di Huang Wan.

Stasis of Urinary Tract (esp. after abdominal surgery or trauma): Sluggish, difficult urination; Abdominal distention of pain. T: Purple, possible with raised purple bumps. P: Choppy. Formula: Chong Xian San.

35.        Seminal Fluid in Urine (see 32 above)
Damp-Heat-Stasis: This section is what WM would call a STD, or sexually transmitted disease: Frequent, cloudy, sluggish, burning urine; White sticky discharge after urination; Bitter taste in mouth; Thirst, chest congestion, sluggish BM. T: Red with Yellow greasy coat. P: Soft and rapid (if more Damp), or Slippery and rapid (if more Heat). Treatment Principle: Dry Damp, Clear Heat. Formula: Pi Xie Feng Qing Yin.

KI-Yin-Xu with Empty Heat: Frequent, cloudy, burning urine; White or red discharge after urination; Dizziness, vertigo, insomnia, restlessness; Tidal fever; Yin-Xu symptoms: T: Red with dry coat. P: Thready and rapid. Treatment Principle: Tonify Yin and Jing. Formula: Shi Bai Di Huang Wan + astringents such as Tu Si Zi, Jing Yin Zi, Wu Wei Zi.

Xu of KI-Qi or KI-Yang (very weak people, not an STD): Frequent, copious, clear urine; seminal fluid discharge after urination; Premature ejaculation, impotence, nocturnal emissions. T: Pale. P: Deep and weak. Formula: You Gui Wan and astringents.

36.        Blood in Seminal Fluid
Yin-Xu with intense Empty Heat: Blood in ejaculate; Distention & pain in testes or penis; Burning sensation in urinary tract; emaciation; thirst, irritability. T: Red with scanty coat. P: Thready and rapid. Treatment Principle: Tonify Yin, Clear Fire, harmonize Xue, stop the Bleeding. Formula: Zhi Bai Di Huang Wan or Da Bu Yin Wen + E Jiao or bleeding.

Damp-Heat-Stasis (STD): Blood in ejaculate; Frequent painful urination; Pain, burning, itching in UT; Spasms of pain in testicles; Blood in urine. T: Greasy yellow coat. P: Slippery, wiry, rapid. Formula: Bai Zhen San + Da Qing Ye, Huang Qin, Huang Bai, Zhi Zi, Bai Bu.
Stone_Ac5 (1996) Symptomatic Diagnosis: Part 5.

37.        Thin, scanty ejaculate (WM differentiation: low sperm count)
KI-Qi-Xu, or KI-Yang Xu: infertility, very chronic fatigue, pale complexion, sore or weak lower back, senility, hair loss and loose teeth, hearing loss, frequent urination-especially in the evening. T: Pale. P: weak in KI (3rd, Chi) position. Treatment Principle: Tonify KI-Qi, KI-Yang and KI-Jing-Essence. Formula: You Gui Wan.

Cold Stasis (a Yang-Xu Syndrome): Scanty semen; infertility, very chronic fatigue, pale complexion, sore or weak lower back, senility, hair loss and loose teeth, hearing loss, frequent urination-especially in the evening; Cold extremities, testicles. Formula: You Gui Wan + Fu Zi, Ba Ji Tian, Suo Yang.

38.        Inability to ejaculate during intercourse
Yin-Xu with Empty Heat: distention in scrotum; Possible nocturnal emissions, irritability, scanty urine, constipation, thirst. T: Red. P: Thready and rapid. Treatment Principle: Tonify Yin to move Stasis. Formula: Zhi Bai Di Huang Wan + Mu Tong, Wang Bu Liu Xin.

Xue-Stasis due to chronic stress, Qi-Stasis leading to Xue Stasis. LV-Qi-Stasis (LV Channel passes through the gonads): easily angered, chest congestion; Varicoses of scrotum (varicocele). T: Purple. P: Deep and choppy. Formula: Xu Fu Zhu Yu Tang + Jiu Zi, Chi Cuang Zi.

39.        Premature ejaculation.
Xu of KI-Qi or Ki-Yang : impotence, sore back, hair loss, loose teeth, senility. T: Pale. P: weak at KI (3rd, Chi) position. Formula: You Gui Wan, Ba Wei Di Huang Wan.

Xu of HT and SP: Neurosis (if there's a psychological component); Impotence, emaciation, fatigue, pale complexion; Palpitations, insomnia, forgetfulness; indigestion. T: Pale. P: Weak. Formula: Gui Pi Tang.

40.        Nocturnal Emissions (more Heat)/Spermatorrhoea (more Cold).
Xu of HT and SP: Impotence, emaciation, fatigue, pale complexion; Palpitations, insomnia, forgetfulness; indigestion. T: Pink or red. P: Weak or thready. Treatment Principle: Clear Heat, Subdue Fire and Calm Shen-Spirit. Astringe Jing-Essence. Formula: Tian Wan Bu Xing Tang + Bai Shao, E Jiao.

LV-Fire (nocturnal emissions): Bitter taste in mouth; Dark urine; Easily angered. P: Wiry. Formula: Long Dan Xie Gan Tang.

KI-Qi-Xu (Spermatorrhoea): Tinnitus, dizziness, fatigue, sore or weak lower back. Formula: You Gui Wan + astringent herbs.

Damp-Heat-Stasis: Irritability, fever, itching; burning sensation in lower abdomen, or testicles; Scanty yellow urine. T: Yellow greasy coat. P: Wiry, slippery. Formula: Long Dan Xie Gan Tang + Ba Zhen Tang.

41.        Impotence
KI-Yang-Xu: Cold testes, soreness and weakness in the lower back and knees; Poor memory, hearing and hair loss, loose teeth, aversion to Cold and Cold extremities. Qi-Xu symptoms: T: Pale and swollen with teeth marks. P: Deep thready, weak, especially in KI (3rd, Chi) positions. Etiology: Age, too much sexual activity, constitutional weakness. Treatment Principle: Warm and stimulate KI-Yang. Formula: You Gui Yin or Wan.

HT-SP-Xu (Psychogenic, in WM): Palpitations, shortness of breath, emaciation, insomnia, restlessness, vivid dreams, fatigue, indigestion, bloating, loose stools. T: Pale. P: Thready. Etiology: Thinking or worrying too much creates SP-Qi-Xu which leads to Qi-Xue-Xu, which creates a HT-Xue-Xu, leading to various neurosis. Also, the Qi-Xue can't support the Jing-Essence, which leads to impotence. Treatment Principle: Tonify HT and SP. Formula: Gui Pi Tang + tonic herbs for KI which warm SP, such as Bu Gu Zi, Ba Ji Tian, Xian Ma.

Impotence due to fear: frustration, easily panicked, insomnia, vivid dreams and nightmares, erection up until intercourse begins. Tongue and Pulse can be normal. Treatment Principle: Calm Shen-Spirit. Formula: Ting Zhi Wan + Shi Chang Pu, Ren Shen, Yuan Zhi.

42.        Persistent Erection
LV-Damp-Heat (lasts d or even mo): Penis is dark purple, distended pain, difficult urination, scanty dark yellow urine, fear, bitter taste in mouth, thirst, constipation. T: Red with yellow coat. P: Wiry, slippery, rapid. Treatment Principle: Clear Heat, Dry Damp. Formula: Long Dan Xie Gan Tang.

Yin-Xu with intense Empty Heat: emaciation, high sex drive, distention and pain, though slight compared to Damp-Heat in LV; Sometimes scanty urine; Malar flush, nervousness, hyperactive, easily anxious. T: Red and narrow, scanty coat. P: Thready and rapid. Treatment Principle: Tonify Yin, Clear Heat. Formula: Zhi Bai Di Huang Wan.

43.        Cold in the external genitalia (both men and women)
KI-Yang-Xu with Internal Cold or Mingmen-Xu: KI-Yang-Xu Symptoms: Impotence, premature ejaculation (male); Low sexual desire (female). T: Pale with teeth marks. P: Deep, slow and weak. Formula: Ba Hui Di Huang Wan + Lu Rong and Wu Zhu Yu.

44.        Flaccid retraction of the penis
Cold-Stasis: Cold extremities and body, purple lips, severe muscle aches and abdominal cramping, maybe diarrhoea. T: Normal. P: Deep, slow and weak, or deep, slow and tense. Etiology: Constitutional Yang-Xu + pathogenic Cold or just pathogenic LV-Cold leading to Cold-Stasis which blocks Qi-Xue in the Channels that pass through the genital area. Treatment Principle: Warm and remove Cold Stasis. Formula: Wu Zhu Yu Tang or Dang Gui Si Ni Tang.

Yang-Collapse (a critical Syndrome: LV is dying): Spontaneous Cold sweats; Semiconsciousness or unconsciousness. Treatment Principle: Obviously the penile retraction will be secondary to the more immediate need to rescue and restore the Yang before the patient expires. Formula: Gui Yang Tang.

45.        Itching and Burning in the genitalia
LV-Damp-Heat: Burning, difficult, dark, painful and frequent urination; cloudy urine, fever thirst. T: Yellow greasy. P: Slippery, wiry, rapid. Treatment Principle: Clear Damp, clear Heat. Formula: Long Dan Xie Gan Tang.

Heat-Fire-Stasis: Burning and Heat in genitals, fever, mouth ulcers, thirst, more Heat symptoms. T: Red, especially the tip. P: Rapid. Treatment Principle: Clear Heat, Clear Fire. Formula: Da Chi San.

Xue-Stasis: Severe, excruciating pain, burning in urinary tract; KI, or urinary tract stones, bloody urine, cloudy urine; Pain referred to the abdomen or lower back. T: Purple spots. P: Deep and choppy. Formula: Tao Hong Si Wu Tang + Ba Zhen San.

46.        Light menstrual flow
Qi-Xue-Xu: Light flow, delayed cycle; abdominal aching, fatigue, dizziness. T: Pale. P: Thready. Anaemia. Heavy flow possible in Qi-Xu with no Xue-Xu. Formula: Ba Zhen Tang.

Phlegm-Damp-Stasis: Light flow, obese patient, irregular cycles; heavy sensation in body. T: Swollen tongue body with greasy coat. P: Soft and slippery. Formula: Chuang Gui Er Chen Tang.

47.        Dark Purple Flow or Thick Flow.
Qi-Xue-Stasis: Dark purple flow with clots, sever abdominal pain, sever PMS symptoms. T: Purple. P: Choppy. Formula: Tao He Cheng Qi Tang.

Heat-Stasis and Xue-Stasis: Thick dark clotted flow; Severe abdominal pain, fever, mental symptoms. Formula: Tao He Si Wu Tang.

Cold-Stasis leading to Xue-Stasis: Thick dark clotted flow; Severe abdominal pain, fever, mental symptoms; Lower back Cold, patient prefers warmth. T: White coat. P: Deep and tense. Formula: Wen Jing Tang.

Stone_Ac6 (1996) Symptomatic Diagnosis: Part 6.48.        Thick Menstrual Flow
Qi-Xue-Stasis: Dark purple flow with clots, severe abdominal pain, severe PMS symptoms. T: Purple. P: Choppy. Formula: Tao He Cheng Qi Tang.

Heat-Stasis and Xue-Stasis: Thick dark clotted flow; Severe abdominal pain, fever, mental symptoms. Formula: Tao He Si Wu Tang.

Cold-Stasis leading to Xue-Stasis: Thick dark clotted flow; Severe abdominal pain, fever, mental symptoms; Lower back Cold, patient prefers warmth. T: White coat. P: Deep and tense. Formula: Wen Jing Tang.

Damp-Heat-Stasis: Dark thick flow, strange odour, vaginal burning and itching; Phlegm-Stasis; Thick, though not dark flow; Congestion, dizziness, leucorrhea. T: Greasy coat. P: Slippery.

49.        Thin flow (the quality of the blood, see "light" flow)

50.        Early menstruation (early in the month, not early in life)
Xue-Heat: Bright red, copious flow. Could lead eventually to very dark red if the Heat goes untreated.

Yin-Xu, Xue-Heat: scanty quality, red.

Xue-Stasis leading to Xue-Heat: Clots, abdominal pain. Early or late period, heavy or light amount, spotting.

Qi-Xu: Light and thin flow; Abdominal pulling or bearing down sensation, fatigue. P: Weak.

51.         Late menstruation (In the month, not in life)
Cold-Stasis and Xue-Stasis: Abdominal pain, patient desires warmth, flow with clots. T: Purple. P: Deep, slow, possibly choppy.

Phlegm-Damp-Stasis: Delayed, or lack of menses; Pale red thick flow; Obesity, indigestion. T: Greasy coat. P: Soft.

Qi-Xue-Xu

52.        Amenorrhoea (Lack of period)
KI-Qi-Xu: Congenital KI-Qi-Xu (Primary amenorrhoea); No period as of the 15th birthday; Emaciation, Lower back pain, fatigue; slow development. P: Weak. T: Pale. Treatment Principle: Tonify KI.

Qi-Xue-Xu: Usually found after an illness or postpartum; No pain, no period; Palpitations; Fatigue, weakness. P: Weak. Treatment Principle: Tonify Qi-Xue. Formula: Ba Zhen Tang.

Qi-Xue-Stasis: Amenorrhoea after traumatic injury or stress; Lots of distention and pain; fatigue, depression, anger. T: Varies. P: Deep and wiry.

Damp-Phlegm-Stasis: Menopausal symptoms; Delayed cycle, quantity of flow is light; Amenorrhoea, weight gain, water retention. T: Pale with white greasy coat. P: Soft and slippery.

53.         Metrorrhagia (heavy flow)
Qi-Xue-Xu: Heavy quantity, thin quality and light colour.

Xue-Heat: Dark Red flow.

Xue-Stasis: Irregular flow, spotting, dark purple colour clots, pain in abdomen, which gets better after the onset of the flow. T: Purple. P: Deep and choppy, or wiry and slippery.

54. Irregular Menstrual cycle
LV-Qi-Stasis (95% of cases): Formula: Xiao Yao San.

KI-Qi-Xu

55.        Fever during menstruation
LV-Qi-Stasis with LV-Fire (most common): Fever alternating with chills, more often before period, sometimes during; Early or irregular cycle, irritation, dizziness; Thirst, dry mouth. T: Red with yellow coat. P: Wiry and Rapid.

Yin-Xu Fever: Fever after illness postpartum; this fever tends to happen before or during the period; Emaciation, irritability, dry mouth, thirst. T: Red and thin. P: Thready and rapid.

Wind-Cold: The Chong Mai and CV are weak just before menses. Taiyang Syndrome. Formula: Gui Pi Tang even if there's no sweating. Xiao Chai Hu Tang if fever is also associated with chills.

Xue-Stasis before or during period: Abdominal pain, dark complexion; Flow is purple with clots. Formula: Xue Fu Zhu Yu Tang.

Qi-Xu or Qi-Xue-Xu Fever: Fever before or during the period. Light colour and thin quality, scanty quantity. T: Pale. P: Weak. Formula: Bu Zhong Yi Qi Tang

Szathmary_L (1996) Diagnostic Possibilities of Oral AP in Vet Med. Magy Allatorv Lapja Feb 51(2):75-79. L Szathmary, Allatkorhaz Gazdasagi Munkakozosseg, Ady E, U12, H-8200 Veszprem, Hungary. Oral AP points in humans become sensitive when disease develops in the related organs (inner hollow and compact organs, sinuses, organs of sense, lymphoid organs, vertebral segments and a determined skin area). From work with AP over many years, he recorded diagnostic aspects of certain oral signs of dogs. These points in the mouth not only become sensitive, but also show other changes (ulcer, inflammation, swelling of solitary salivary glands) when a disease occurs in the related organs. Thus, considering functional circuits, from the oral status, he diagnosed diseases of the organs belonging to the functional circuit. In some cases, this method can also help in differential diagnosis.

Walker_C (1995) TCM Training in Beijing. Summary of Paper to the BMAS autumn meeting at the Commonwealth Inst, London, October 1995. Adapted from WWW. The author was given extended study leave from his general practice in Merseyside to attend a 3-mo Diploma in AP Course at the International AP Training Centre in Beijing. The course involved 137 h of lectures, mainly on TCM, but covering EAP- analgesia, ear and scalp AP, plum-blossom needling, cupping and Qigong. The 168 h of classical training was in small groups at one of the 10 Beijing hospitals or at the centre's clinics. Having completed the course and found it a clinical experience difficult to rival, the author suggests that much of benefit has been lost from traditional AP in its westernisation.

Wang_LL7 (1996) Clinical Observation of the Effect of Health-preserving Moxibustion on Delaying Aging. Nanjing Coll of TCM, 210029, PRC. Adapted from WWW. Clinically moxibustion had a health-promoting effect in aged people without apparent organic diseases. It lessened aging symptoms and improved physiologic functions of the senile body. TCM holds that KI-Qi-Xu (Weakness) from middle-age is an important cause of senility; SP-Xu and Xue-Stasis also play a role. Health-preserving moxibustion of CV08 and ST36 warms the Yang, reinforces Qi and promotes blood circulation to Clear Stasis (obstruction) in the Channels. It is thus a method for protection of one's health.

Yang_JMc01 (1996) The Diagnosis and Treatment of Arthritis in TCM: Part01. Adapted from WWW (Acupuncture.com). [The author, Mr Jwing-Ming Yang, has translated TCM concepts into words and ideas that are better understood in the Western world. For more information on how arthritis is described in the terms that practitioners of TCM use, please see the article on "Bi Syndromes" among the Clinical Point Selections: WebMaster].

Bi means pain, and many of "Bi Syndromes" overlap with the differential diagnosis of arthritis in WM.
Although we understand how some forms of arthritis start, we do not understand other forms. This section summarizes the known possible causes and contributes some ideas from TCM and Qigong.

1.        Weakness (Xu) of the Internal Organs: The condition of the internal organs is closely related to health. In TCM, the Five Zang (Yin Solid Organs: HT, LV, LU, KI, and SP) are considered the main ones for health and longevity. Illness, even death, can occur if any of these Zang fails to function properly. Also, all of the Five Zang are mutually interrelated. A problem with one always involves a problem with one or more of the others. For example, gouty arthritis is caused by the improper functioning of LV and KI.

2.        Defective Genes: Some forms of arthritis are caused by defective genes, e.g. are inherited. In TCM, genetic inheritance is Yuanjing, the Source-, or Original-, or Ancestral- Essence. Jing-Essence controls the production of hormones, from which Qi is generated. When this Qi is fed to the brain, the Shen-Spirit is raised. When all of these conversion processes are functioning normally, the immune system is strong and sickness is less likely. One of the main goals of Qigong is learning how to convert Jing-Essence into Qi efficiently and lead it to the brain.

3. Weak Joints: Weak joints can come from heredity or from lack of exercise. The body is a living machine; the more you use it, the better its condition. TCM teaches that even if you have inherited a weak joint it is still possible to strengthen it through Qigong. Exercise brings Qi to the joint by the movement of the muscles and tendons. This nourishes the joint and rebuilds it.

4. Injury: In WM, some forms of arthritis are caused by injury to the joints. Although the injury may not be serious, it may have significant results. The injury can affect the muscles, tendons, ligaments, or even the cartilage and bone. In TCM, if any joint injury, even a minor one, is not treated, the normal smooth Qi circulation in the joint area will be affected. If the situation persists, the Qi imbalance can cause problems such as arthritis.

5.        Aging: Aging has always been the cause of many sicknesses, including arthritis. In old age, the body Qi level is low. Since the system is being deprived of the required amount of Qi, it starts to degenerate. One of the main goals of Qigong practice is learning how to slow down the aging process by building up the Qi in the body.

6.        Qi-Xu: Qi-Xu causes many problems. It can be caused by emotional depression and sadness, which can lead the Qi inward and make the body Yin. This deprives the outer body of Qi. When this happens, you will generally feel Cold. If the problem persists for a long time, the muscles and tendons will be affected by the lack of Qi, and the joints will be weakened. Qi-Xu can have other causes, such as the weather. For example, body Qi is weaker (Xu) in the winter, and therefore, arthritis can be more serious then. Qi-Xu also can be caused by working for long periods in a Damp area, or by exposing joints to the Cold.

7.        Tension: Tension includes both mental tension and physical tension, which are related and cannot be separated. Constant mental and physical tension can increase the pressure on the joints. For example, some people are very tense and grind their teeth in their sleep, which can cause arthritis in the jaw. A lot of body tension is caused by the emotional disturbance which is related to your mental reaction to stressful events. For this reason, learning how to regulate your mind is an important part of the treatment of arthritis.

8.        Other Possible Means of Preventing or Curing Arthritis
As well as those already discussed, other methods can prevent or cure arthritis. Although many of them are still awaiting scientific confirmation, they may be worth your consideration. However, you must understand that everybody has his or her own unique characteristics, and his or her own unique inheritance. As well as the habits and lifestyle that each person has developed, everyone's mental and physical structure is different. For example, some people are affected by allergies while others are not. What this means is that you cannot necessarily use the same method to treat different people, even when they have the same disease. Even modern WM has found that the same treatment will not work equally well on all patients. Therefore, do not automatically brush off some of the treatment methods we will discuss. After all, WM is only in its infancy, and it may come to understand and accept these alternative remedies.

1.        Diet: In Qigong, food has a significant influence on the condition of the Qi in the body. For this reason, diet is one of the main concerns of TCM. "You are what you eat." Improper diet is one of the main causes of gouty arthritis. The Chinese have found many different herbs that can ease the pain and reduce the swelling of arthritis. It has recently been discovered that protein, calories, and fats can reduce the inflammation of arthritis. Certain fish oils may interfere with the process of inflammation and therefore reduce the symptoms of rheumatoid arthritis(5,6).

2.        Change of Residence: Since environmental Qi can affect the Qi of the body, arthritis sufferers should give serious consideration to this method. If the local climate is too Damp or too Cold, it may exaggerate arthritis. Body Qi can be significantly affected by the electromagnetic fields generated by modern technology; adverse EMFs can cause many disorders, including some forms of cancer. People who live near high tension power lines tend to get cancer more often than those who do not. Perhaps similar environmental effects on arthritis will be found.

3.        Change of Lifestyle: Lifestyle affects how the Qi circulates in the body. If one often feels ill, especially mentally, one might need to change lifestyle. How one thinks and coordinates the Qi pattern in the body with the natural Qi is very important for health. Whenever Qi circulation is against the "Dao" (nature), one will be sick. Walking for an hour, or doing Qigong exercises every morning, improves Qi circulation.

4.        Clothing: What you wear also affects the Qi in your body. In the winter you must stay warm, and especially protect your joints. Joints that are left unprotected can loose Qi very quickly. It has been discovered that many man-made fibres can adversely affect the Qi distribution and circulation in the body. For example, polyester causes Qi-Stasis and prevents the body's Qi from exchanging with the environmental Qi.

Yang_JMc02 (1996) The Diagnosis and Treatment of Arthritis in TCM: Part02. Yin are the feminine qualities in the universe; Yang are the masculine qualities.

Yin
passive
dark
inside

Yang
active
light
outside

As applied to WM.

Yin
Anatomy

Yang
Physiology

As applied to TCM.

Yin
Xue (Blood)

Yang
Qi (Energy)

When applied to Med in general, WM acts upon the Yin of the body, the substance of the body, the cells and chemicals. TCM works more on the Qi that animates those cells.

What WM tends to diagnose and treat is the effect that the disease state has on the body itself. The TCM Practitioner diagnoses and acts upon the Qi that creates the disease state.

In ancient Greece, where Western civilization was born, the Med of the day mimicked Oriental Med in that they looked at the body with analogies to nature in much the same way that Oriental Med still does. However, with the invention of the microscope and the discovery of the cell, WM became very materialistic in its approach to the human body.

When I say materialistic, I'm not talking about an unhealthy attachment to money, but the sense that only the material of the body is real, nothing else. If you can't touch it, see it under a microscope or conceive of it in chemical equations then it doesn't exist. It is a discipline that is based on the philosophy that only what exists in the physical realm is real. This is materialism. This is Yin in TCM.
TCM acts upon the Yang of the body, on its vital energies (Qi). Yin-Yang are always connected. Acting on the Yin affects the Yang, and visa-versa. TCM states that: "Xue is the mother of Qi and Qi rules the Xue." That statement is true if we regard Jin-Ye Fluids such as Xue as Yin (material, visible) and Qi as the Yang (immaterial, invisible).

By acting upon the Qi, pathology involving the Xue is rectified. In TCM, it is a deeper, more causal approach to Med than WM. It is this difference between acting upon the body's Qi (Energy) and acting upon the body's Shui (Substance) that makes up the most significant difference between these 2 major Med disciplines.

Currently, in the West, much research is being done on the effects of AP, TCM herbs and even disciplines such as Qigong. It is the opinion of the author that much of this research is presenting false results due to one simple fact, and that is that it only measures the body's reaction to TCM from the materialistic Yin standpoint. To record this and call it knowledge is OK, but to limit the understanding of TCM to what is discovered in research is misguided.

I've seen many people research TCM to determine not how the herb or AP treatment works from the Oriental perspective, but from how it "really" works, which is to say how it works from the Western perspective.

If we give an AP treatment that is designed solely to activate the Qi in the body, many unusual aches and pains within the patient will be abated. When modern Western research attempts to determine what happened to take away the pain they'll look toward endorphin release in the nervous system, the body's natural pain killers. They may even find a higher prevalence of these pain killers in the blood stream which confirms that this is what AP "really" does, but this is only the body's response to what "really" happened from the Oriental viewpoint. This is the law of Yang controlling Yin. What "really" happened is the Qi that wasn't moving well, was activated to move better. However, this is never understood, nor researched. And I believe that this is truly unfortunate.

It is because of this materialistic approach to Med that so many alternative treatments are written off to the placebo effect, or the end of symptoms because the patient believes that they are supposed to end.

And it is this same approach that so many very real diseases avoid understanding by WM. Chronic Fatigue Syndrome, Irritable Bowel Syndrome (IBS), Fibromyalgia are but a few common conditions that WM considers "idiopathic" which means that the cause is unknown. In TCM, the cause is quite simply a Stasis of the flow of Qi due to a small variety of factors.

The fact is, the cause is not physical, however the symptoms are. WM can see and measure certain changes in the body's chemistry and functional activities with these conditions, but cannot act upon these changes for lack of understanding of their cause. The symptoms are too divergent and unrelated from a materialistic standpoint. But when you factor in Qi and its properties, all these conditions make perfect sense.

When reading research on TCM, readers should keep in mind that research measures only the body's physical response to changes induced by the changes in the flow of Qi in the body. Research gives only half the story; the other half is what Acupuncture.com is all about.

Finally, I applaud practitioners of WM who are sincere enough about their patients' treatment that they are beginning to use AP. I caution these practitioners, and patients who seek their assistance, to understand that sticking needles into muscles that hurt to take away the pain is among the most superficial applications of TCM available. We're glad that MDs can help you in this manner, but we're also peeved that some MDs will poo-poo TCM for any internal or idiopathic problems.

TCM has a great deal to offer the Western discipline of Internal Med, perhaps more than the "pain control" applications that are finally being accepted in WM. 10 yr ago, using AP for muscular pain control too, was considered quite silly. In another 10 yr, I hope that we'll see a greater acceptance of TCM's true genius, and this is in the area of Internal Med.

For patients who live in areas where acupuncturists are not allowed to practice, then only MDs will be available for AP treatments. MDs with a scanty 200 h education in AP will probably be successful at taking away your muscular pain; that is easy. But for other problems, it is a good idea to find a practitioner who has been trained in TCM theory. Many MDs have been; they may be able to help the Yang in your body as well as the Yin.

If you can not find an acupuncturist, seek out a school of Chinese martial arts such as Gongfu, Taiqi and others. They often know of practitioners of TCM who practice "underground." There are certain legal problems with this, but sometimes pain can motivate one to seek out help wherever it can be found. Perhaps someday AP and TCM will be accepted better everywhere and practitioners will be able to practice legally. Until then, we have the WWW (Acupuncture.com).

Yang_JMc03 (1996) The Diagnosis and Treatment of Arthritis in TCM: Part03. Clothing made of polyester can accumulate a considerable charge of static electricity in the winter. This builds up an electromagnetic field and affects the Qi circulation in your body. Many other ways can improve the arthritic condition. For example, sexual activity can stimulate the adrenal glands to produce more corticosteroid, a hormone that reduces joint inflammation and pain. It is believed that sexual activity may also trigger the release of endorphins, a naturally occurring painkilling substance(7).

References
1."Med for the Layman - Arthritis," Clinical Centre Office of Clinical Reports & Inquiries, Building 10B, Room 1C255, Bethesda, Maryland, 20892. 2."The Complete Med Guide," Benjamin F Miller MD, Simon and Schuster, New York, 1978. 3."Arthritis, Rheumatic Diseases, and Related Disorders," USDH and Human Services, Public Health Service, NIH. 4."An Overview of Arthritis and Related Disorders," Caring, January 1989. 5."Arthritis and Diet," Arthritis Foundation, 1314 Spring Street, NW, Atlanta, GA 30309. 6."Can Diet Relieve Arthritis," Univ of California, Berkeley, Wellness Letter 6(8). 7."Arthritis and Your Love Life," 8, Mens' Health, 1989.

From the book entitled "Qigong for Arthritis", YMAA Publication Centre, Jamaica Plain.

3. RESEARCH ON THE CHANNELS AND VESSELS

Chen_MF; Wu CC; Jong SB; Lin CC (1994) Radionuclide venography by sc injection of Tc-99m pertechnetate at AP point KI03: a case report. AJCM 22(3-4):337-340. Dept of Nuclear Med, Kaohsiung Med Coll, Taiwan, ROC. Recently, we developed a new method of radionuclide venography of lower limbs, namely SC-RNV, by sc injection of Tc-99m pertechnetate at AP points K-3. In this study, we applied this method to evaluate the venous drainage of lower limbs in a patient with severe varicose veins and edematous swelling of the left lower extremity. For comparison, an ascending radionuclide venography by iv injection of Tc-99m MAA (IV-RNV) was also done. The SC-RNV showed normal venous drainage of the right side but complete obstruction of the left popliteal vein with a prominent collateral flow, compatible to the findings of IV-RNV. SC-RNV may be useful as an alternative method of venography as previously suggested.

Chen_MF; Wu CC; Jong SB; Lin CC (1993) Differences in AP point SP10 and non-AP point after sc injection of Tc-99m pertechnetate. AJCM 21(3-4):221-229. Dept of Nuclear Med, Kaohsiung Med Coll, Taiwan, ROC. A new method of radionuclide venography, namely SC-RNV, by sc injection of Tc-99m pertechnetate at AP points was recently developed in our Lab. The time-activity curve of SC-RNV can be divided into 3 phases as: the phase of diffusion of radioisotopes through the sc space, the phase of entrance of radioisotopes into intravascular space to reach a peak level and the phase of equilibrium state of radioisotopes in the intravascular space. In this study, we used the 3 phases of SC-RNV to evaluate the absorption of Tc-99m pertechnetate injected sc in the AP point SP10 and in a non-AP point near SP10. The absorption of Tc-99m pertechnetate via SP10 was significantly greater than that of non-AP point, evidenced by shorter phase 1, higher peak activity and greater accelerating rate of phase 2. This suggests that the absorption of radioisotopes from AP point is faster and greater than that of non-AP point.

Draehmpaehl_D; Ottensmeier A; Kleinpeter A; Kiupel M (1993) Vessels, Nerves, Muscular and Tendinous Spindles as the Aims of AP by Cats and Dogs and Their Therapeutic Properties. Monatsh Veterinarmed Oct 48(10):537-551. Heidekampweg 100, D-10117 Berlin, Germany. Histology and mesoscopy showed coincidence of reduced electrical cutaneous resistance with nerve-vascular-bundles piercing the superficial fascia of the trunk in dogs and cats. A comparison of AP Channels at the carcasses revealed in many regards morphological reference structures (large blood vessels, muscular and tendinous spindles). Their courses and those of the chains of muscular function which have other therapeutic possibilities were stressed. New aspects of the courses of the Channels implicate distributional pattern of cutaneous blood vessels also. The Channels of BL and GV on the back and ST, KI, SP and CV on the abdomen are discussed especially. Osteological differences between species raise questions concerning the localisation of AP points and their sphere of action.

Hou_TZ1; Dawitof M; Wang JY; Li MD (1994) Experimental evidence of a plant Channel system: 1: Bioelectricity and AP effects on electrical resistance of the soybean (Glycine max). AJCM 22(1):1-10. Xinjiang Acad of Forestry Science, Urumqi, Xinjiang, China. Experiments were conducted on the bioelectrical potential and resistance of soybean (Glycine max) roots, stems, leaves and pods. Results showed a higher potential and lower electrical resistance associated with the leaf cushion, main vein and small vein areas in comparison with other parts of the plant. When 2 needles were inserted into one of the low resistance points, i.e., the leaf cushion area, the electrical resistance decreased 26% on the main vein and 4.5% on the mesophyll of the soybean leaf for at least 5 h after AP. These characteristics, similar to those of Channel transmission lines in humans and other animals, suggest that a Channel system might also exist in plants.

Hou_TZ2; Re ZW; Li MD (1994) Experimental evidence of a plant Channel system: 2: The effects of needle AP on the temperature changes of soybean (Glycine max). AJCM 22(2):103-10. Xinjiang Acad of Forestry Science, Urumqi, China. When stainless steel needles were inserted opposite each other in the stem near the unifoliolate buds of soybean plants and retained there for the whole experiment, leaf temperatures increased for 2 d consecutively. After AP, the mean temperature of the main vein on d 1 and d 2 increased 0.59oC and 0.48oC, respectively, while the temperature of mesophyll increased only 0.50oC and 0.47oC on d 1 and d 2. These results are very consistent with studies on the human Channel system. This is our 2nd report on experimental evidence that plants may have a Channel system as is known to exist in mammals.

Hou_TZ3; Luan JY; Wang JY; Li MD (1994) Experimental evidence of a plant Channel system: 3: The sound characteristics of phylodendron (Alocasia) and effects of AP on those properties. AJCM 22(3-4):205-214. Xinjiang Acad of Forestry Science, Urumqi, China. The sound characteristics of phylodendron leaves were studied by measuring their power with a laser beam. Phylodendron leaves produced sound waves at relatively low frequencies (from 50-120 Hz). Those leaves accepted external sound wave stimulations, with frequencies lower than 150 Hz giving the strongest responses. When the plants were under stress, such as drought, the sound emissions from the plant's leaves increased circa 20-30 dB, while the range of response to external sound wave stimulation decreased 10-20 dB. However, these increased emissions returned to normal 6 min after watering. When stainless steel needles were inserted into the petiole of the plant, spontaneous sound production increased circa 40 dB for the main vein and 6 dB for the mesophyll. This is our third report on experimental evidence that plants may have a Channel system as in humans and other animals.

Kovacs_FM; Gotzens V; Garcia A; Garcia F; Mufraggi N; Prandi D (1992) AP and radioactive pathways of hypodermically injected technetium-99m [letter]. J Nucl Med Nov 33(11):2060.

Lazorthes_Y; EsquerrÚ JP; Simon J; Guiraud G; Guiraud R (1990) AP Channels and radiotracers. Pain Jan 40(1):109-112. Clinique de Neurochirurgie, CHU Rangueil, Toulouse, France. AP is frequently used and in particular to treat pain. One of the cornerstones of its use, at least in Western countries, is the concept of the AP Channel. Yet, their existence has never actually been proven. Recently, a report was published stating that injection of a radiotracer at an AP point allows the visualization of the corresponding Channel in the shape of a radioactive path which is apparent on scintiscans. The present work confirms the appearance of radioactive paths after the injection of a radiotracer at AP points. However, the cross-checks made with the method used (counting the radioactivity of the venous blood, studying radioactivity of the organs which normally take up the tracer, scintiscan study of the complete Channel paths as they are described in TCM and studying the effect of venous blockade on the observed radioactive paths) show that the radioactive paths in fact correspond to vascular drainage of the radiotracer.

Wu_B1; Hu X; Xu J; Yang B; Li W; Li B (1993) [Localization of the Channel track over body surface by the method of blocking the AP effect with mechanical pressure]. Chen Tzu Yen Chiu 18(2):128-131, 114. Fujian Inst of TCM, Fuzhou, PRC. Mapping the Channel course with objective methods is important in Channel research. Therefore, selecting a proper indication to plot out the Channel track over the body surface during AP is significant for elucidating the essence of Channel. The purpose of this paper was to plot out the Large Intestine Channel track by blocking the AP effect with mechanical pressure, when electroretinogram (ERG) was taken as a responsive indication. The plotting out the track was carried out on 5 subjects with marked propagated sensation along Channels (PCS) and 5 without PCS. The pressure was applied on LI07, LI10, LI11, LI14 and LI15 respectively, when LI04 was punctured. Under such condition the variation of ERG amplitude decreased markedly or even disappeared. But the variation rate of ERG amplitude was still distinctly increased when the pressure was applied on both sides of any above points. The difference is highly significant (p <.01). When the proper objective indication was used, the Channel track on the body surface during AP was plotted, not only in subjects with marked PCS, but also in those without PCS. Its course basically coincided with that of the Channel described in the books of TCM. One can safely say that the Channel track on the human body surface is a real phenomenon. This work provides a new approach to objectively map the Channel course; the work has broad prospects for further application.

Yan_Z; Chi Y; Wang P; Cheng J; Wang Y; Shu Q; Huang G (1992) Studies on the luminescence of Channels in rats and its law of changes with "Syndromes" and treatment of AP and moxibustion. Chung i tsa chih (JTCM) Dec 12(4):283-287. Inst of Biophysics, Chin Acad of Sci, Beijing, PRC. We previously reported the discovery of 14 Channels in the human body, which possessed the biophysical property of high emission of light. In this study we found the same property on the CV and GV Channels in healthy rats. Also, we discovered that the luminance of the related Channels in rat models with different "Syndromes" varied greatly. For instance, a markedly low luminance appeared on the GV Channel in animals with experimental Syndrome of Yang-Xu (Yang deficiency) induced by cortisol; while in animals with experimental Syndrome of Xue-Xu (Blood Deficiency) induced by blood-letting, an apparently low luminance occurred on the CV Channel. The intensity of the emitted light on GV and CV Channels increased after AP treatment, but not significantly. This phenomenon conforms to TCM theory that the GV Channel is the "Sea of Yang Channels", while the CV Channel is the "Sea of Yin Channels".

Yang_JM01 (1996) The 12 Main Qi Channels: Part 1. Adapted from WWW (Acupuncture.com) from the book by Jwing-Ming YANG: "Chinese Qigong Massage", YMAA Publication Centre, Jamaica Plain.

This chapter briefly reviews the 12 Main Qi Channels along with the 8 Extraordinary Vessels and the Yin-Yang organs. The body has 6 Yang organs and 6 Yin organs. Each Yang organ is associated with a Yin organ by a special Yin-Yang relationship.

Paired Yin-Yang organs belong to the same phase in the Five Phases. Their Channels are sequential to each other in the circulation of Qi, their functions are closely related, and disease in one usually affects the other. In TCM, the Channel corresponding to the Yang organ is often used to treat disorders of its related Yin organ. In the limbs, the Yang Channels are on the external side of the limbs while the Yin Channels are on the internal side. Generally speaking, the lateral sides of the limbs are more Yang and are more resistant and prepared for an attack, while the medial sides are more Yin and weaker.

To distinguish different levels of the Yin-Yang characteristics, the Main Channels and their organs are further subdivided into the Six Channels (Six Levels). The Yang organs are divided into Taiyang (Greater Yang), Shaoyang (Lesser Yang) and Yangming (Yang Brightness, Sunlight). The Yin organs are divided into Taiyin (Greater Yin), Shaoyin (Lesser Yin) and Jueyin (Absolute Yin). In the following discussion, all of the classifications will be shown in the title, for example: LU Channel of Hand Taiyin.

1.        LU - Lung Channel (Hand Taiyin)
LU (Yin) and LI (Yang) are paired Metal organs. They correspond with the westerly direction, the season of autumn, climatic Dryness, the colour white, the pungent taste, the rank odour, the emotion of sadness, and the sound of weeping. Their opening is the nose, and they govern skin and hair.

In Qigong practice, as LU belongs to Metal, LU can regulate heartburn. HT belongs to Fire. In HT-Qi-Shi (Excess), deep breathing can lead HT-Fire to LU, and therefore cool the heartburn. LU is the first organ to sense the weather change from Damp, Hot summer into Dry and cool autumn. If LU cannot readjust to fit the new situation smoothly, one may catch a cold. LU makes contact with the outside world through the nose and skin. LU-Qi comes from the air; it controls the overall Qi state of the body.

Regulated breathing is a strategy to lead Qi to the extremities, such as skin and hair. Proper regulation of breathing strengthens Weiqi (Defensive- or Guardian- Qi) and generates an expansive Qi shield to protect the body. One also can raise or lower one's Qi state through breathing. For example, in an emotional Qi-Shi, such as when one is angry, deep breathing can calm the excited state.

LU is sensitive to emotional changes, especially when one is sad or angry. LU also controls the skin, and the part of liquid metabolism which distributes liquid to the skin.

Because LU is usually the first to be attacked by Perverse-Qi (exogenous diseases, or "Evils"), LU is called the Delicate Organ. These diseases can also cause what is called the Non-Spreading of LU-Qi. The main symptom of a LU problem is coughing, which is a form of Rebellious Qi (since LU-Qi normally flows downward). If coughing is also accompanied by lassitude, shortness of breath, light foamy phlegm, and weakness in the voice, it is called LU-Qi-Xu. However, the Syndrome is referred as LU-Yin Xu if the cough is dry, with little phlegm, the throat and mouth parched, and other Yin-Xu symptoms are present (such as night sweats, low grade fever, red cheeks, etc).

2.        LI - Large Intestine Channel (Hand Yangming)
LI (Yang) and LU (Yin) are paired Metal organs (Table 2-1). They correspond with the westerly direction, the season of autumn, climatic Dryness, the colour white, the pungent taste, the rank odour, the emotion of sadness, and the sound of weeping. Their opening is the nose, and they govern skin and hair. The main function of LI is the metabolism of water and the passing of water. It extracts water from the waste material received from the SI, sends it on to the BL, and excretes the solid material as stool. Many disorders affecting this organ are categorized as SP and ST Syndromes. Certain abdominal pains are considered manifestations of LI Qi- or Xue- Stasis.

In Qigong, the Dan Tian in the lower abdomen is considered the residence of Yuanqi (Source Qi). In order to keep this Qi at its residence, this area must be strong and healthy. The Qi circulating around the intestines must not be stagnant. When you practice Qigong you must learn how to regulate your breathing to smooth the Qi flow in LI and LU. This will allow you to relax the front of your body and regulate the Qi flow in the other organs.

3.        ST - Stomach Channel (Foot Yangming)
ST (Yang) and SP (Yin) are paired Earth organs. They correspond with the centre, the season of long summer (the end of summer), climatic Dampness, the colour yellow, the emotion of pensiveness, the taste of sweetness, fragrant odour, and the sound of singing. Their opening is the mouth and they control the flesh and the limbs.

The Yin/Yang relationship between SP and the ST is a very good example of the relationship between organs. The ST receives food while SP transports nutrients. The ST moves things downward while SP moves things upward. The ST likes Damp while SP likes dryness.

Most ST disorders are caused by Shi states, though some Syndromes relate to ST-Xu (many of which originate in SP). ST-Fire causes painful, burning sensations in the stomach, unusual hunger, bleeding of the gums, constipation, and halitosis.

Once saliva has begun the process of digestion, food passes to the ST, located in the middle TH (Middle Jiao) area. The ST breaks down food, and then sends it to the SI and LI, where Nutritive-Jing-Essence is absorbed and converted into Qi, and circulated through the entire body.

The ST is related to the emotion of pensiveness. When one is upset, ST will not function normally. In Qigong, regulating the mind is the first step to maintaining ST in a healthy condition. The type of food eaten is the second consideration. The proper amount and quality of food helps to obtain high quality Qi to circulate in the body.

4.        SP - Spleen-Pancreas Channel (Foot Taiyin)
SP (Yin) and the ST (Yang) are paired Earth organs. They correspond with the central direction, the season of long summer (the end of summer), climatic Dampness, the colour yellow, the emotion of pensiveness, the taste of sweetness, fragrant odour, and the sound of singing. Their opening is the mouth and they control the flesh and the limbs.

SP is the main organ of digestion. Its function is to transport nutrients and regulate the Xue (regulate means to keep it within the Channels). SP controls the transformation of food into nourishment.

In SP-Xu, the weak SP can not play its full role in extracting and processing Nutritive Qi from food; thus, nourishment which should be available to the body, is reduced. This causes general fatigue, lassitude and a pasty complexion. The upper abdomen is considered the province of SP. SP-Qi-Xu manifests as a sense of malaise or fullness in that area. Because the transportive function of SP should distribute its Qi upward, SP-Xu usually causes diarrhoea. SP-Qi is also regarded as the Middle Qi, and it holds the Zang-Fu (hollow bowels and solid organs/viscera) in place. A weak Middle Qi may cause prolapsed ST, KI, etc. In more serious cases, SP-Yangqi-Xu may occur, manifested in diarrhoea, Cold limbs, and abdominal pain that can be soothed by the warmth of frequent Hot drinks.

If any of the above symptoms are accompanied by bleeding, especially from the digestive tract or uterus, it is called SP Not Controlling the Xue.

Yang_JM02 (1996) The 12 Main Qi Channels: Part 2.

Cold and Damp Harassing SP is a manifestation characterized by a pent-up feeling in the chest and a bloated sensation in the abdomen, lassitude, lack of appetite and taste, a feeling of Cold in the limbs, a dark yellowish hue to the skin, some edema and diarrhoea or watery stool. The Cold and Damp prevent SP from performing its transforming and transporting functions. This leads to a great disturbance in water metabolism and is one of the origins of Phlegm.

In Qigong, one of the final goals is to regulate the Qi flow to its normal level in the Five Zang (Yin Solid Organs). Among them, SP is the last and the hardest organ to regulate. If one can regulate SP-Qi to a normal and healthy level, one will have grasped the key to health and longevity.

5.        HT - Heart Channel (Hand Shaoyin)
HT (Yin) and SI (Yang) are paired Fire organs, balancing each other. They are called "Sovereign Fire", in contrast to PC and TH ("Ministerial Fire"). They correspond with the southerly direction, the summer season, climatic Heat, the colour red, the emotion of happiness, the sound of laughter, the taste of bitterness, and the odour of burning. Their point of entry is the tongue, they control the blood vessels and are reflected in the face.

Almost all HT disorders are Xu Syndromes, associated with weakness (Deficiency, Depletion). The 4 major types of HT weakness are HT-Qi-Xu, HT-Yang-Xu, HT-Xue-Xu, and HT-Yin-Xu.

The main functions of HT are associated with the Shen-Spirit and the blood vessels. HT governs the blood vessels and moves Xue through them. It also stores the Shen-Spirit, and is the organ usually associated with mental processes. Therefore, some forms of emotional distress, dizziness, palpitations, shortness of breath, and lack of vitality are common symptoms of HT ailments. HT Qi-Xu is symbolized by general lassitude, panting and shallow breathing, and frequent sweats. If the face is swollen and ashen grey or bluish-green, and the limbs are Cold, it is called HT-Yang-Xu. The symptoms of restlessness, irritability, dizziness, absentmindedness, and insomnia are typical signs of HT-Xue-Xu. In HT-Yin-Xu, developments with a flushed feeling in the palms and face, low grade fever, and night sweats will occur.

The symptom of HT-Shi arises from HT-Fire-Shi. This is manifested by fever, occasionally accompanied by delirium, a racking pulse, intense restlessness, insomnia or frequent nightmares, a bright red face, a red or blistered and painful tongue, and often a burning sensation during urination. The latter symptom is the result of Heat being transferred from HT to the SI, which interferes with the SI role in metabolism and the body's management of water.

Qigong teaches that the mind is associated with HT, and that it is also directly related to the Shen-Spirit. The term HT (Xin) is usually used to represent the emotional mind or ideas. The Middle Dan Tian at the solar plexus is considered the residence of the Fire-Qi. This Fire is used to nourish the brain and the Shen-Spirit at its residence, the Upper Dan Tian or third eye. In TCM, HT is the temple of the Shen-Spirit because it supplies Fire-Qi and can nourish Shen without limit.

Generally speaking, HT is very sensitive during the summertime: HT is a Yin Channel; when the summer Yang comes it can increase HT Qi and cause problems. Emotional disturbances, such as excitement from happiness, are considered harmful to HT as well, especially during the summer time. Qigong emphasizes regulating HT in the summer.

6.        SI - Small Intestine Channel (Hand Taiyang)
SI (Yang) and HT (Yin) are paired Fire organs which balance each other. They are called "Sovereign Fire", in contrast to PC and TH ("Ministerial Fire"). They correspond with the southerly direction, the summer season, climatic Heat, the colour red, the emotion of happiness, the sound of laughter, the taste of bitterness, and the odour of burning. Their point of entry is the tongue. They control the blood vessels and are reflected in the face.

The major function of the SI is to separate waste material from the nutritious elements in food. The nutritious elements are then distributed throughout the body and the waste is sent on to the LI.

The SI and LI are located in the Lower Dan Tian. In order to store Yuanqi converted from Yuanjing (Source Essence), the abdomen must be healthy and the Qi circulation in the area of the SI and LI must be smooth and natural. The best way to reach this goal is through abdominal breathing exercises. One such exercise is to lead the Yuanqi upward following the HT and SI Channels to Subdue HT-Fire.

7.        BL - Bladder Channel (Foot-Taiyang)
BL (Yang) and KI (Yin) are paired Water organs. They correspond with the winter season, climatic Coldness, the southerly direction, the colour black, the emotion of fear, the taste of salt, the smell of decay, and the sound of groaning. Their sensory organ is the ear. Their opening is the urethra. They control the bones, marrow, and brain, and their health is reflected in the hair of the head.

The main function of BL is to transform Fluids into urine for excretion.

In Qigong, BL has never enjoyed serious attention. However, its pairmate (KI) is one of the most important organs, one which all Qigong practitioners train most often. The reason is that KI houses the Yuanjing (Source Essence).

8.        KI - Kidney Channel (Foot-Shaoyin)
KI (Yin) and BL (Yang) are paired Water organs. They correspond with the winter season, climatic Coldness, the southerly direction, the colour black, the emotion of fear, the taste of salt, a rotten smell, and the sound of groaning. Their sensory organ is the ear. Their opening is the urethra. They control the bones, marrow, and brain, and their health is reflected in the hair of the head.

KI stores Yuanjing (Source Essence), which controls growth, development, and reproductive functions. KI plays the primary role in water metabolism and control of body liquids. KI also holds the body's most fundamental Qi of Yin-Yang.

Because KI houses the basal Yin-Yang of the body, any disorder, if sufficiently chronic, will involve KI. More significantly, a disease of KI will usually lead to problems in other organs. Methods of strengthening KI are therefore used by both TCM and Qigong to increase or maintain vitality and health. The symptoms of KI-Yang Xu or KI-Yin Xu are typical symptoms of the disorder, and will appear to a certain extent as Yang-Xu or Yin-Xu Syndromes in any organ.

It is easy to memorize the symptoms of KI-Yin-Xu if one learns the correspondences of KI and remembers that Yin is the Jin-Ye and the constructive, nourishing aspect of the body. Usually, the lower back is weak and sore, tinnitus (ringing in the ears) and loss of hearing acuity occurs and the face is ashen or dark, especially under the eyes. Dizziness, thirst, night sweats and low grade fevers are common. Also, men have little semen and tend toward premature ejaculation, while women have little or no menstruation.

Symptoms of KI-Yang-Xu are significantly associated with loss of energy or warmth. As in KI-Yin-Xu, tinnitus (ringing in the ears), dizziness and soreness in the lower back are common. However, the soreness is characterized by a feeling of Cold, lassitude, and fatigue with weakness in the legs. Men may tend toward impotence; clear and voluminous urine or incontinence may occur in both sexes.
Yang_JM03 (1996) The 12 Main Qi Channels: Part 3.

KI-Yin-Xu usually generates similar disorders in HT and LV, while KI-Yang-Xu disturbs the functions of SP and LU. The progression could be in the opposite direction. When this Syndrome is associated with LU, it is called "KI Not Receiving Qi," a wheeze characterized by difficult breathing, mainly during inhalation. This Syndrome also manifests as a faint voice, coughing, puffiness in the face and spontaneous sweats, plus KI-Yang-Xu symptoms.

KI has an important role in the metabolism of water. If these functions are disrupted, the Syndrome of KI-Xu will lead to Spreading Water (oedema).

Yuanjing (Source Essence) in Qigong is considered the Origin of all human vitality (Yuanqi, Source Qi). Jing-Essence is converted to Qi, which supplies the entire body and nourishes the brain and Shen-Spirit. In both TCM and Qigong, KI houses Yuanjing. In order to protect this, one must strengthen KI. Only when KI is strong can one keep Jing-Essence at its home. Therefore, keeping KI healthy has become one of the main aims of Qigong.

Maintaining KI in a healthy state includes protecting the physical KI from degeneration, and maintaining a smooth and correct level of Qi flow. In order to reach this goal, the diet must be considered. For example, too much salt injures KI, and eating too much eggplant weakens KI. Also, the condition of the body is important. Overwork without proper rest increases tension on KI and causes stasis of Qi flow (KI-Qi-Stasis). In winter, KI has more tension than in summer. Thus, Qi flow is more stagnant (KI-Qi-Stasis is more common) in winter than in the summer. Consequently, back pain problems increase in the winter.

In order to protect KI, Qigong practitioners have studied the relationship of KI to nature, food, and even to emotional states. They have developed massage techniques and specific exercises to increase Qi circulation in KI during the winter. Since the health of KI is related to the emotions as well, learning how to regulate the mind in order to regulate the Qi has become one of the major training goals in Qigong.

9.        PC- Pericardium (Circulation-Sex) Channel (Hand Jueyin)
PC (Yin) and TH (Yang) are paired Fire organs. They are called "Ministerial Fire," as compared with HT and SI ("Sovereign Fire"). Though the PC has no separate physiological functions, it is generally mentioned with regard to the delirium induced by high fevers.Regulation of Qi in the PC is very important in Qigong. The purpose of the PC is to regulate the HT-Qi via the Laogong cavity. HT is the most vital organ in the body; to function normally, HT must have a proper level of Qi circulation. HT-Qi can be raised easily to an abnormal HT-Shi state by illness, emotional disturbance, exercise, or injury. PC function is to drain the excess Qi (HT-Shi) from HT and direct it to PC08 (the Laogong cavity, in the centre of the palm). Qi-Shi is released naturally from PC08, thus regulating HT-Qi. PC08 is used in Qigong massage to reduce body temperature in fever.

Qigong recognises 5 Gates (centres, cavities, holes, AP points) where body Qi communicates with the surrounding environment. These Gates regulate the level of body Qi. Two of these 5 Gates are the Laogong (PC08) cavities, used to regulate the HT-Qi. Two others are the Yongquan (KI01) cavities, used to regulate KI-Qi. The fifth one is the face. The face has connections to many organs. Whenever any organ Qi is not normal, it shows on the face.

10.        TH - Triple Heater (TH) Channel (Hand-Shaoyang)
Sanjiao=Three Jiao (Burning Spaces, Burners, Heaters). TH (Yang) and PC (Yin) are paired Fire organs. They are called "Ministerial Fire," as compared with HT and SI ("Sovereign Fire"). At least as far back as the 3rd century AD, in the "Classic of Difficulties" (Nanjing) the TH was regarded as "having a name but no form." In the Neijing, the TH was considered an organ that coordinated all the functions of water metabolism. In other traditional documents, the TH was considered as 3 regions of the body that were used to group the organs. The Upper Jiao includes the chest, neck, and head as well as the functions of HT and LU. The Middle Jiao is the region between the chest and the navel, and includes the functions of the ST, LV, and SP. The Lower Jiao spans the lower abdomen, and the functions of KI and BL. Therefore, the Upper Jiao has been compared to a mist which spreads the Xue and Qi, the Middle Jiao is like a foam which churns up food in the process of digestion, and the Lower Jiao resembles a swamp where all the impure substances are excreted.

Regulating the Qi to a normally "smooth-flow" state is one of the main Qigong training methods for maintaining health. It is normally done through Wai Dan exercises, and it is believed that the Qi must flow around internal organs smoothly in order for them to maintain their normal functions. This means that in order to keep Qi flow smooth and the organs healthy, you must first learn how to regulate and relax muscles that are holding and related to a given organ. External movements also exercise internal muscles. One of the main external exercises is regulating the TH by lifting your hands up above your head and then moving them down slowly. These up and down arm movements extend and relax the internal muscles and thereby increase Qi flow.

11.        GB - Gallbladder Channel (Foot-Shaoyang)
GB (Yang) and LV (Yin) are paired Wood organs. They correspond with the direction east, the spring season, climatic Wind, the colour green, the emotion of anger, the taste of sourness, the goatish odour, and the sound of shouting. Their point of entry is the eyes. They control the sinews (muscles and joints), and their health is reflected in the finger and toe nails.

The main function of the GB is storing and excreting the bile produced by LV. Together with HT, the GB controls decision-making.

The main disease related to the GB is a disorder affecting the flow of bile, usually caused by Damp and Heat. This is commonly manifested by pain in the region of LV, an oppressive sensation of fullness in the abdomen, and yellowish eyes, skin, urine, and tongue.

The GB has never enjoyed serious attention during Qigong training. Its paired partner LV however, has received much more attention.

12.        LV - Liver Channel (Foot-Jueyin)
LV (Yin) and the GB (Yang) are paired Wood organs. They correspond with the direction east, the spring season, climatic Wind, the colour green, the emotion of anger, the taste of sourness, the goatish odour, and the sound of shouting. Their point of entry is the eyes. They control the sinews (muscles and joints), and their health is reflected in the finger and toe nails.

The main task of LV is to spread and regulate Qi throughout the entire body. Its unique character is moving, flowing and free (like leaves and branches (Wood) in the Wind). Therefore, depression or frustration can disturb the functioning of LV. LV also stores Xue when the body is at rest. This characteristic, together with its control over the lower abdomen (Lower Jiao), makes it the most critical organ in regards to women's menstrual cycle and sexuality.

Depression or long-term frustration can cause LV-Stasis, stagnating the LV function of spreading Qi, and result in continuing depression, a bad temper, and a painful, swollen feeling in the chest and sides. If this Syndrome worsens, it may cause disharmony between LV and the ST and/or SP. This disorder is symbolized by the "rebellion" of Qi in the latter organs, whereby Qi moves in the opposite direction than is normal.
Yang_JM04 (1996) The 12 Main Qi Channels: Part 4. For example, the ST-Qi normally descends; rebellious ST-Qi means hiccoughing, vomiting, etc. SP-Qi normally moves upward; rebellious SP-Qi means diarrhoea.
Depression of LV-Qi is the main cause of many women's disorders, including menstrual irregularities, swollen and painful breasts, etc.

One of the main functions of LV is to store Xue and to nourish and moisten it. In LV-Xue-Xu, LV cannot handle the function of moistening. This is generally shown as dry and painful eyes with blurred or weak vision, lack of suppleness or pain in moving the joints, dry skin, dizziness, and infrequent or spotty menstruation. If LV-Yin Xu is serious, the Syndromes Rising LV-Fire or LV-Yang-Shi Ascending occur. These occurrences are evidenced in ill-temper, restlessness, headache, vertigo, red face and eyes, and a parched mouth. If LV-Yin-Xu is so bad that it can not secure LV-Yang, many of the symptoms appear as disorders of the head. Weakness in the lower joints may occur also.

LV is one of the Five Zang (Yin Solid Organs); it receives its Qi from its Wood-Pairmate GB. The Qigong practitioner wants to regulate LV-Qi. When LV-Qi is regulated, GB-Qi is regulated also, because LV and GB are connected physically, and their Channels are connected directly in the Wood Yin-Yang Pair. Many methods can regulate LV-Qi. Wai Dan Qigong works through the limbs. For example, when the arms are moved up and down, the internal muscles surrounding LV will be moved and the Qi around LV will be circulated smoothly. In Nei Dan Qigong, LV is closely related to the mind. When the mind is regulated, the Qi circulation in LV will be normal and therefore LV will function properly.

Important Points
1.        SP, LV and HT are the organs with the most direct relationship with the Xue. SP filters the Xue (modifying the blood's structure), LV stores the Xue, and HT moves it. Any problem associated with Xue will involve at least one of these organs.
2.        LV and KI are closely related. Their Channels cross in many places. LV stores Xue; KI stores Jing-Essence. These substances, both of which are Yin, influence reproductive functions.
3.        HT (Upper Jiao, Fire) and KI (Lower Jiao, Water) keep each other in check and are depend on one another. HT-Shen-Spirit and KI-Jing-Essence cooperate to establish and maintain human consciousness.
4.        The transportive and digestive functions of SP (also called Middle Qi) depend on the strength of KI-Yang. SP and LV also are interdependent. The digestive function of SP is associated with the distributive functions of LV. Disharmony between SP and LV causes many digestive troubles.
5.        Although LU governs Qi, LU-Qi must mix with KI-Jing-Essence before Yuanqi can be produced. LU governs Qi, LV spreads Qi and KI provides its basis.

Yang_JMa01 (1996) The Eight Extraordinary Qi Vessels: Part 1. Adapted from WWW (Acupuncture.com) from the book by Jwing-Ming YANG: "Chinese Qigong Massage", YMAA Publication Centre, Jamaica Plain.
The 8 Extraordinary Vessels and the 12 Main Channels (meridians) comprise the main part of the Channel Qi system. Most of the 8 Extraordinary Vessels branch out from the 12 Main Channels and share the function of circulating Qi throughout the body. These Vessels form a web of complex interconnections with the Channels. At the same time, each has its own functional characteristics and clinical utility independent of the Channels. TCM emphasizes the 12 Main organ-related Channels and only 2 of the 8 Vessels (the GV and the CV). The other 6 Vessels are not used very often, because they are not understood as well as the other Channels. A lot of research needs to be done on them. Although they were discovered >2000 yr ago, little has been written about them. Research on the Extraordinary Vessels is under-way today, especially in Japan, but the results of one researcher often contradict those of another.

The important points are summarized below from the very few original TCM texts available. I have used my own judgement to select ideas and details, as references from TCM texts are very scarce and references from Western AP texts are tentative, esoteric, or in disagreement with one another. Before reviewing these 8 Vessels, we will first define them and summarize their functions.

The 8 Extraordinary Vessels
The 8 Vessels are called "Qi Jing Ba Mai." Qi means Extraordinary, odd, strange, or mysterious. Jing means Channel or meridian. Ba means 8 and Mai means Vessel. Qi Jing Ba Mai is then translated as "Extraordinary Channels and 8 Vessels" or "Extraordinary Vessels". "Extraordinary or Odd" has a meaning of strange in Chinese. It is used simply because these 8 Vessels are not well understood. Many Chinese doctors explain that they are "Odd" simply because four Vessels are not paired (GV, CV, Chong Mai and Dai Mai). Since these 8 Vessels also contribute to the maintenance of homeostasis, some times they are called "Homeostatic Vessels." French acupuncturists call them "Miraculous Vessels" because they were able to create therapeutic effects when all other techniques had failed. Also, because each of these Channels exerts a strong effect upon psychic functioning and individuality, t he command points are among the main psychological points in the body. For this reason, they are occasionally called "The 8 Psychic Channels.".

These Vessels (Mai) are:

1. Du Mai
2. Ren Mai
3. Chong Mai
4. Dai Mai
5. Yangqiao Mai
6. Yinqiao Mai
7. Yangwei Mai
8. Yinwei Mai

(Governing Vessel, GV)
(Conception Vessel, CV)
(Thrusting Vessel)
(Girdle-Belt Vessel)
(Yang Heel Vessel)
(Yin Heel Vessel)
(Yang Linking Vessel)
(Yin Linking Vessel)

General Functions of the 8 Vessels
1.        They serve as Qi Reservoirs
It is difficult to generalize the characteristics and functions of the 8 Vessels because they are so different from each other. However, in his Nanjing, Bian Que specified one of the main characteristics of the 8 Vessels. He reported that: "The 12 Main (organ-related) Qi Channels constitute rivers; the 8 Extraordinary Vessels constitute reservoirs". These reservoirs, especially CV and GV, absorb Qi-Shi (Excess) from the main Channels, and then return it when they are weak (Xu). Because of the few TCM texts, as well as the lack of modern, scientific methods of Qi research, it is difficult to determine the precise behaviour and characteristics of these 8 Vessels. They can be understood on different levels, and they perform different functions and contain every kind of Qi such as Ying Qi, Weiqi, Jing Qi, and even Xue.

The 8 Vessels supply Qi if it becomes weak (Qi-Xu) in the 12 Main Channels. That reserve of Qi is easily mobilised by AP needling the cavities (special AP points, called Hui-Connection points) which connect the 8 Vessels to the 12 Channels. Hui-Connection points behave like the gates of a reservoir, which can be used to adjust the strength of the Qi flow in the rivers and the level of Qi in the reservoir. Sometimes, when it is necessary, the reservoir will release Qi by itself. For example, when a person has a physical or mental shock, Qi is weakened (Qi-Xu) in some of the main Channels. This causes particular organs to be stressed, and Qi-Stasis occurs rapidly around these organs. When this happens, the reservoir must release Qi to increase Qi circulation in the weak (Xu) Channel and to prevent further damage.

2.        Guard Specific Areas Against Perverse-Qi ("Evil Qi").
Weiqi (Defensive- or Guardian- Qi) protects the body from External attack (trauma, invasion by outside intruders, Perverse-Qi ("Evil Qi") etc). Among the 8 Vessels, the Chong Mai, the GV, and the CV play major roles in guarding the abdomen, thorax, and the back.

3.        Regulate the Changes of Life Cycles.
The Suwen, Chapter 1, says: "The Chong Mai and the CV also regulate the changes of the life cycles which occur at 7 yr intervals for women and 8 yr intervals for men.

4.        Circulate Jing Qi to the Entire Body, particularly the 5 "Yuan-Ancestral Organs".
One of the main functions of the 8 Extraordinary Vessels is to deliver Jingqi (Essence-Qi, which has been converted from Yuan-Jing (Source Essence) and KI-Jing (sexual Essence)) to the entire body, including the skin and hair. They must also deliver Jingqi to the 5 Yuan-Ancestral Organs: brain, marrow (spinal cord, bone marrow), LV-GB, uterus, and Xue.

1.        Du Mai (The Governing Vessel, GV)
The GV is the confluence of all the Yang Channels, over which it is said to "govern." Because it controls all the Yang Channels, it is called the "Sea of Yang Channels". This is appropriate, as its conduit flows up the midline of the back, a Yang area, and in the centre of all Yang Channels (except the ST Channel which flows in the front). The GV governs all the Yang Channels, which means that it can be used to increase the Yangqi of the body.

Since the GV is the "Sea of Yang Channels" and it controls or governs the back, the area richest in Weiqi, it also controls the circulation of the body's Weiqi to guard against External evil intruders. The circulation of Weiqi starts from GV16 and moves down the GV to CV01. It is said that it takes 21 d for Weiqi to flow from GV16 to CV01, and 9 d from CV01 to the throat, making it a monthly cycle.

In TCM, Weiqi is Yangqi and therefore represents the Fire of the body. Its quick and ubiquitous circulation keeps the Fire going in the body and controls the loss of body heat. Weiqi also is linked inextricably with the Jin-Ye that flow outside the Channels, in the skin and flesh. Consequently, through the breathing (under control of LU), Weiqi controls the opening and the closing of the pores, and also controls sweating.

The GV also controls nourishment of the 5 Yuan-Ancestral organs, which include the brain and spinal cord.

Yang_JMa02 (1996) The Eight Extraordinary Qi Vessels: Part 2. This is one of the ways in which KI "controls" the brain, in TCM.

Because of their importance to health, the GV and the CV are considered the 2 main Qi Channels to be trained in Qigong, especially in Nei Dan. Training related to these 2 Vessels includes:
1.        How to fill them with Qi so that you have enough to regulate the 12 Channels;
2.        How to open up areas of Stasis in these 2 Vessels so that the Qi flows smoothly and strongly;
3.        How to effectively direct the Qi to nourish the brain and raise the Shen-Spirit;
4.        How to effectively govern the Qi in the 12 Channels, and nourish the organs;
5.        How to use raised Shen-Spirit to lead the Weiqi to the skin and strengthen the Weiqi shield covering the body.

In Nei Dan Qigong training, when you have filled up the Qi in these 2 Vessels and can effectively circulate the Qi in them, you have achieved the "Small Circulation". In order to do this, you must know how to convert the KI-Jing-Essence into Qi, circulate this Qi in the GV and CV, and finally lead this Qi to the head to nourish the brain and Shen-Spirit.

2.        Ren Mai (The Conception Vessel, CV)
Ren means "direction, responsibility." Ren Mai (CV) has a major role in Qi circulation, monitoring and directing all of the Yin Channels (and the ST Channel). CV connects with Chong Mai and Yinwei Mai, and can increase the Yinqi of the body. CV nourishes the uterus (one of the 5 Yuan-Ancestral organs) and the whole genital system. The Neijing says that the CV and Chong Mai contain both Xue and Jing-Essence, and both flow up to the face and around the mouth. They contain more Xue than Jing-Essence in men, and thus promote the growth of the beard and body hair. Because women lose blood with their menstruation, they contain proportionately less Xue and hence, no beard or body hair.

The Suwen says that CV and Chong Mai both control the life cycles every 7 yr for women and every 8 yr for men. It is the changes taking place in these Vessels at those intervals that promote the major alterations in our lives.

CV also controls the distribution and "dispersion" of Weiqi all over the abdomen and thorax via many small Qi branches (Luo). CV also plays an important role in the distribution of Jin-Ye in the abdomen.
In Qigong, CV and GV are the most important among the Qi Vessels, and must be trained first. CV seldom has significant Qi-Stasis. However, it is important to increase the amount of Qi in store; this increases one's ability to regulate the Yin Channels.

3.        Chong Mai (The Thrusting Vessel)
Thrusting Vessel is an appropriate translation of Chong Mai; it evokes images of copulation, the merging of the penis-Yang (GV) and the vagina-Yin (CV) in the perinaeum (near Huiyin CV01). Chong Mai is one of the most important Vessels in successful Qigong training, especially in Marrow Washing. There are three main reasons for this.

1.        Chong Mai intersects two CV points: CV01 (Huiyin, "Meeting Yin", the cavity (point) where Qi of Yang and Yin is transferred) and CV07 (Yinjiao=Yin Junction, the point where Yuanqi (Source Qi, Water-Qi, or Yinqi) meets the Fire-Qi (created from food and air). Chong Mai also connects with 11 KI points. KI is considered the residence of Yuanjing (Source Essence), which is converted into Yuanqi (Source Qi).

Yang_JMa03 (1996) The Eight Extraordinary Qi Vessels: Part 3.

2.        Chong Mai connects directly with the spinal cord and reaches up to the brain. The major goal of Marrow Washing Qigong is to lead the Qi into the marrow and then to the head, to nourish the brain and Shen-Spirit.

3.        The third reason is found in Qigong practice. There are 3 common training paths: Fire, Wind, and Water. In Fire-Path Qigong, the emphasis is on the Fire- or Yang- Qi circulating in the GV and therefore strengthening the muscles and organs. The Fire-Path is the main Qi training in Muscle-Tendon Changing (Yi Jin Jing) Qigong. However, the Fire-Path can also cause the body to become too Yang, and therefore speed up degenerative processes. In order to adjust Fire to a proper level, Marrow Washing Qigong is trained also. This uses the Water-Path, in which Qi separates from the route of the Fire-Path at the Huiyin (CV01) point (cavity), enters the spinal cord, and finally reaches up to the head. The Water-Path teaches how to use Yuanqi to cool down the body, and then to use this Qi to nourish the brain and train the Shen-Spirit. Learning to adjust the Fire and Water-Qi circulation in the body is called Kan-Li, which means Water-Fire.

Chong Mai and CV: One of the main functions of Chong Mai is to connect, to communicate, and to mutually support the CV. Because of this mutual Qi support, both can effectively regulate KI-Qi. KI houses Yuanqi (Source Qi) and is one of the most vital Yin organs.

4.        Dai Mai (The Girdle-Belt Vessel)
The major purpose of the Dai Mai is to regulate the GB-Qi. It also controls Qi's horizontal balance. If you have lost this balance, you will have lost your centre and balance both mentally and physically. In Qigong, the Dai Mai also controls the strength of the waist area. When Qi is adequate and circulating smoothly, back pain will be avoided. Also, because KI is nearby, Dai Mai controls Qi circulation around KI, maintaining KI health. Dai Mai runs through the area of the Lower Dan Tian. In order to lead Yuanqi (Source Qi) from KI to the Lower Dan Tian, the waist area must be healthy and relaxed. This means that the Qi flow in the waist area must be smooth. The training of the Dai Mai has been highly developed, and will be discussed in a later YMAA Book.

5.        Yangqiao Mai (The Yang Heel Vessel)
While the preceding 4 Vessels (GV, CV, Chong Mai and Dai Mai) are located in the trunk, the Yangqiao Mai and the next 3 are located in the trunk and legs. (Also, each of these 4 Vessels is paired). For millions of years, humans have walked on the legs, which preform much more strenuous work than the arms. Possibly, because of this, as evolution proceeded, the legs gradually developed these Vessels to supply Qi support and regulate the Channels. If this is true, it may be that, as time goes on and man uses his legs less and less, in a few million years these Vessels will gradually disappear.

The Yangqiao Mai intersects with other Qi Channels and it regulates the Yang Channels, such as the BL, GB, SI and LI. The Yangqiao Mai also connects with GV. The Qi in this Vessel is supplied mainly through exercising the legs, which converts the food essence or fat stored in the legs. This Qi is then led upward to nourish the Yang Channels. In Qigong, since this Vessel also connects with the brain, certain leg exercises can be used to cure headaches. Since a headache is caused by Qi-Shi in the head, leg-exercises draw this Qi downward to the leg muscles and relieve pressure in the head.

Most training that relates to this Vessel is Wai Dan. Wai Dan Qigong is considered Yang, and specializes in training the Yang Channels, while Nei Dan Qigong is considered relatively Yin and emphasizes the Yin Channels more.

6.        Yinqiao Mai (The Yin Heel Vessel)
The Yinqiao Mai connects with two KI points. Therefore, one of the major sources of Qi for this Vessel is the conversion of KI-Jing-Essence into Qi. In Qigong, the other major Qi source is the Jing-Essence of the external kidneys (testicles). In Marrow Washing Qigong, one of the training processes is to stimulate the testicles in order to increase the hormone production and increase the conversion of the Jing-Essence into Qi. At the same time, you would learn how to lead the Qi in this Vessel up to the head to nourish the brain and Shen-Spirit. With this nourishment, you would be able to reach Buddhahood or enlightenment. From a health and longevity point of view, the raised Shen-Spirit will be able to efficiently direct Qi of the entire body and maintain health.

7.        Yangwei Mai (The Yang Linking Vessel)
The Yangwei Mai regulates the Qi mainly in the Yang Channels: BL, GB, TH, SI, and ST. It also connects with two GV points (GV15 and GV16). The Yangwei Mai and Yangqiao Mai are not emphasized much in Qigong, except in Iron Shirt training where these Vessels, and the GV, are trained.

8.        Yinwei Mai (The Yin Linking Vessel)
The Yinwei Mai connects with the 3 Foot-Yin Channels: KI, SP and LV. The Yinwei Mai also communicates with two CV points. This Vessel is not trained much in Qigong.

Yu_C1; Zhang KJ; Lu G; Wang QL; Shi ZS; Xu JQ; Xie HS; Liu ZJ; Wang YS (1993) Study on the Characteristics of Animal Channels and AP points. Xumu Shouyi Xuebao Jan 24(1):45-51. Beijing Agr Univ, Beijing, PRC. Many scientific studies have shown that the AP Channels exist in humans. Their anatomical courses are relatively stable and they have predictable biophysical characteristics of acoustic-, photo-, thermal-, electrical- and isotope-migration. In contrast, reports on the objective locations and biophysical characteristics of animal Channels are scarce. This study aimed to examine the objective existence and superficial locations of the Channels in various types of animals. 12 sheep, 10 goats, 13 pigs, 11 cats and 7 donkeys were used to determine the low impedance line (LIL) and high procussion sound line (HPSL) on the skin surface along the vertical lines of the dorsal line, using impulsive electrical method and high procussion sound method. Two LILs and two HPSLs were found in each side of all tested animals. They were relatively stable, parallel symmetrically with the dorsal line. The routes of LILS were almost coincident with those of HPSLs, which are similar to those of the classical Channels. The data support the objectivity of the Channels in different species of animals. 12 LILs were found on the body surface of donkeys. Their locations were relatively stable; most coincided basically with those of the corresponding human Channels. Electrical impedance at Qiangfeng in rabbits was lower than that of its surrounding points. The analgesic effect of laser AP was almost inhibited by pressing the AP point. The signal from laser stimulation indicates conduction along the Channels.

Yu_C2; Zhang K; Lu G; Xu J; Xie H; Lui Z; Wang Y; Zhu J (1994) Characteristics of AP Channels and AP points in Animals. Rev Sci Tech OIE Sep 13(3):927-933. C Yu, Agr Univ Beijing, Coll Vet Med, Beijing 100094, PRC. Biophysical aspects of the Channels and AP points in humans and animals have been studied recently. The authors aim to add to data on the objective existence and superficial locations of the Channels in 12 sheep, 10 goats, 13 pigs, 11 cats, 8 rabbits and 7 donkeys. Using electrical impulses and high percussion sound, low impedance lines (LILs) and high percussion sound lines (HPSLs) were measured on the skin surface along the vertical planes of the dorsal line.

Zhang_D1; Gao H; Wen B; Wei Z (1990) Research on the AP principles and Channel phenomena by means of infrared thermography. Chen Tzu Yen Chiu 15(4):319-323. Inst of AP and Moxibustion, China Acad of TCM, Beijing, PRC. Thermography offers a good prospect for wide use in the study of AP and Channels and their practical significance. Thermography also has the advantages of being straight-forward, objective and simple. It is suitable for research on AP and Channels. We aimed to research the principles of AP and Channel phenomena, and thus, to elucidate the mechanism of AP effect. We used thermography to study the method of AP, the specificity of AP points, needling without manipulation, "MiuCi" needling, manual AP and EAP, the thermal characteristics of Channels etc. (Results were not available).

Zhang_D (1992) [Application of infrared thermography for study of AP and Channels]. Chung Kuo Chung Hsi I Chieh Ho Tsa Chih Sep 12(9):551-554. In Chinese.

Zhang_LS; Tang YZ; Zhang ZX (1983) The skin impedance of the common AP points in sheep. Chung kuo Nung Yeh K'o Hsueh (Sci Agric Sin (Beijing): Nung yeh ch'u pan she. 5:83-87. Beijing, PRC.

Zhu_Z (1990) Study on the morphological basis of physiological and biophysical characteristics of AP Channel. Chen Tzu Yen Chiu 15(4):332-334, 296. Biophysics Chinese Acad of Sciences, Beijing, PRC.

4. RESEARCH ON Deqi/PROPAGATED CHANNEL SENSATION
Lin_JG (1991) [Evaluation of the depth of Deqi for various AP loci on human thorax and correlation between Deqi and electric resistance]. Chung-Hsi-I-Chieh-Ho-Tsa-Chih Oct 11(10):628-630.

Lin-_ZG4; Wang QF (1994) Depth of getting Qi in clinical practice. Chung Kuo Chung Hsi I Chieh Ho Tsa Chih Feb 14(2):94-95, 69. AP Research Centre, China Med and Pharmaceutical Coll, Taibei. This study used the T-test to determine the depth of getting the Qi sensation (Deqi) in AP points (DGQ) in relation to the patient's build (fat, medium and thin). Differences of DGQ of the neck, trunk, upper-limb and lower limb were studied also in relation to those 3 types of build. Fat and thin people had deeper and more superficial DGQ-values, respectively.

Liu_R; Zhuang D; Yang X; Li Y; Zhang D; Wen B; Zhang R (1990) [Objective observation on phenomena of sensation along Channels (PSC) and QI reaching to affects area (QiRA): the influence of AP points on infrared thermal image of face]. Chen Tzu Yen Chiu 15(3):245-249. Inst of AP and Moxibustion, China Acad of TCM, Beijing, PRC. 33 patients and 9 volunteers were observed. 18/33 patients felt PSC and Qi reaching to face (QiRA) induced by needling of AP points. The QiRA rate was 80% in patients with face diseases. During AP of LI04, most patients felt QiRA to their faces and sensed heat in face. The infrared thermal image showed that the temperature of face skin increased and the "hot-spots" coincided basically with the pathway of the Yangming (LI-ST) Channels. Those effects were greater than those in the other subjects needled at LI04 or PC07 but who did not feel PSC (or sensed Qi reaching) to the face. The difference between the 2 groups was statistically significant. The responses in raising face temperature induced by needling AP points were not due to natural variation. The PSC and QiRA are objective phenomena.

5. RESEARCH ON THE AP POINTS
Cho_SH; Chun SI (1994) The basal electrical skin resistance of AP points in normal subjects. Yonsei Med J Dec 35(4):464-474. Dept of Rehab Med, Yonsei Univ Coll of Med, Seoul, Korea. The inhibitory component of the skin against given electrical current, also called as the electrical skin resistance, is subject to change in response to many factors, especially pain. In order to find out more definite relationship between pain and skin resistance, one should measure in the state devoid of any external disturbing stimuli to get the "basal skin resistance (BSR)", which is different from point to point on the body surface. Also, "active points" have more consistent BSR characters than other points and most share same locations with "AP points" which are easy to localize accurately and repeatedly in normal subjects. Therefore, the comparison of BSR of certain AP points of normal subject and pain-suffering subjects is expected to be able to figure out any pain-induced BSR changes. In 10 normal subjects, measurement at 16 AP points (8 asymmetrical pairs) showed inconsistent asymmetrical distribution of the BSR values with significant order among themselves, including left SP06 at their lowest position. However, neither the measuring system itself nor any of the 16 points was statistically reliable enough for diagnostic purposes. So the measuring device needs to be improved and more AP points need to be explored to complete our pain-related BSR map. Also, research is needed on the meaning of the above BSR distribution pattern.

Comunetti_A; Laage S; Schiessl N; Kistler A (1995) Characterisation of human skin conductance at AP points. Experientia Apr 51(4):328-331. Pharma Clinical Research, F. Hoffmann-La Roche AG, Basel, Switzerland. Some physicians use the electrical conductance of the skin, particularly at the AP points, for diagnostic purposes. This paper deals with the quantification of the skin conductance at some AP points under well defined conditions using the electrode materials gold, graphite, silver and brass. The observed current response appeared to be best described by 2 exponentials.

Wu_CC1; Jong SB (1990) [Radionuclide study of AP points]. Kao Hsiung I Hsueh Ko Hsueh Tsa Chih Dec 6(12):678-686. Dept of Nuclear Med, Kaohsiung Med Coll, Taiwan, ROC. Channel theory is an important part of TCM. Channel research, using radionuclides, has given several significant findings: 1. By sc injection (SC) of Tc-99m pertechnetate at AP points KI03 and BL60, it was found that certain AP points may be closely related to the venous drainage. 2. A new technique of radionuclide venography, namely SC-RNV of the lower limbs, was established through the above study. The SC-RNV subsequently proved to be clinically available in diagnosis of DVT and calf varicose veins. By SC injection of Tc-99m pertechnetate at various AP points (APP) and non-AP points (non-APP) it seemed that not every APP is closely related to venous drainage, and so is not the non-APP. As for the mechanism of SC-RNV, through SC injection of T1-201 chloride and Ga-67 citrate at KI03 respectively, it was found that the Na-K pumping system may play a major role in the drainage of soft tissue fluid from the APP into th venous flow. We now continue to investigate the Channel with radionuclide and hope to understand more clearly the physiological function of the APP, especially its relationship with the veins.

Wu_CC2; Jong SB; Lin CC; Chen MF; Chen JR; Chung C (1990) Subcutaneous injection of 99mTc pertechnetate at AP points KI03 and BL60. Radioisotopes Jun 39(6):261-263. Dept of Nuclear Med, Sch of Pharmacy, Kaohsiung Med Coll, ROC. AP points are anatomically related to the nerves and vessels but the physiological role of blood vessels in the formation of AP points remains unknown. This study used injection of 99mTc pertechnetate sc at KI03 and BL60 and also into the points themselves. With injection into the points, a lower-limb venography like what was obtained by iv injection of 99mTc macroaggregated albumin was found. Some AP points may play a role in drainage of tissue fluid from soft tissue into the veins.

Wu_CC3; Chen MF; Lin CC (1994) Absorption of sc injection of Tc-99m pertechnetate via AP points and non-AP points. AJCM 22(2):111-118. Dept of Nuclear Med, Tainan Municipal Hospital, Kaohsiung, Taiwan, ROC. SC-RNV, a new method of radionuclide venography by sc injection of Tc-99m pertechnetate at AP points KI03, was developed in our Lab. To further investigate whether KI03 is the best point for SC-RNV, Tc-99m pertechnetate was sc injected at KI03 on one foot and at one of the 11 other AP points or 3 non-AP points (NAPs) on the opposite foot, simultaneously, in 157 subjects without evidence of venous disorder. The absorption of radioisotopes from each injection site was evaluated by analysing the time-activity curve at a region of interest set upon over the lower leg above the injection site. The absorption of radioisotopes via KI03 was better than that via NAPs, evidenced by higher peak activity and greater absorption rate. However, there was no significant difference between KI03 injection and other AP point injections except LV02 and LV03. Absorption of radioisotopes via APs was better than via NAPs. This together with the fact that KI03 is easier to detect than other APs in feet, suggests that KI03 is a good point for SC-RNV.

6. TEXTS

• Aluigi_MC (1989) Anatomical instructional atlas for AP, mesotherapy, biomesotherapy on horses, dogs, cows, swine. Rimini, Italy: Luise 155pp.
• Hwang_YC (1992) [Veterinary] AP atlas. Probl Vet Med Mar 4(1):16-33. Dept of Anatomy, School of Veterinary Med, Tuskegee Inst, Alabama 36088, USA.
• Kothbauer_O; Meng A (1990) Basis of veterinary AP: especially AP of cattle, pigs and horses. Welsermuhl Publishers, Wels, Austria 334pp.
• Proceedings0 (1990) Abstracts and short papers of the 6th Int Symp on AP and Electro-therapeutics. New York City, October 25-28. AETRIJ 15(3-4): 255-282.
• Proceedings1 (1991) Program and abstracts of 7th Int Symp on AP and Electro-therapeutics. October 17-20, New York City. AETRIJ 1991; 16(3-4): 179-228.
• Westermayer E; Gunther F; Westermayer H (1993) Textbook of veterinary AP. Karl F Haug, Heidelberg

B. Acupuncture (AP): General Information

Alltree_J (1993) Physiotherapy and AP: practice in the UK. Complementary Therapies in Med Jan 1(1)34-41. A descriptive study of practice of chartered physiotherapists using AP in the UK was conducted by postal questionnaire. A 77% response rate was achieved. Two patterns of practice emerged from the study: respondents who had undertaken long AP courses were more likely (p <.001) to use pulse diagnosis, tongue diagnosis and Five Phase Theory when compared with those who had not. They placed more importance on traditional diagnosis (p <.001) and less on Western diagnosis (p=.004). The commonest methods for selecting AP points used by all respondents included a knowledge of Channels, prescriptions and tender points. These different patterns of practice could be used as a basis for treatment schedules to facilitate future research. AP was rarely used in isolation, most frequently being combined with exercises and manual therapy. Stress, gastrointestinal conditions, gynaecological conditions, headache, migraine and neck pain were among conditions perceived to respond well to AP and are recommended as future areas for research.

Andersson_S (1992) [A new survey of AP: with more training, AP can be used as a therapeutic complement]. Lakartidningen 4 Mar 89(10):785-792. Fysiologiska Inst, Goteborgs Univ, Sweden.

Andersson_S (1993) The functional background in AP effects. Scand J Rehab Med Suppl 29:31-60. Dept of Physiology, Univ of Goteborg, Sweden.

Anon (1990) Needles about! The art of AP. Br Dent J Dec 169(11):378. The ancient art of AP is becoming more and more popular, and cost-factors prompt practitioners to reconsider the benefits of a medical technique that is safe, simple and cheap. The British Med AP Society put their case at a press conference in October.

Anon_JTCM (1992) The detailed articles of the Plan for the Proficiency Examination for Int AP & Moxibustion Professionals (for Trial Implementation): Chinese Int Examination Centre for AP & Moxibustion. JTCM Mar 12(1):76-80.

Baldry_P (1993) Comp Med: The Practice of AP Needs Tighter Safeguards. BMJ Jul 31 307(6899):326-326; Comment on: BMJ 1993 4 Sep 307(6904):624.

Beal_MW1 (1992) AP and related treatment modalities: Part I: Theoretical background. J Nurse Midwifery Jul-Aug 37(4):254-259. Yale Univ School of Nursing, New Haven, CT 06536-0740. An introduction to the therapeutic applications, history, and theory of AP and several related treatment modalities is presented. The practices of AP, moxibustion, acupressure, and shiatsu are described. The underlying concept of treatment of imbalances of Qi (life energy), is presented along with the flow of Qi in Channels (pathways), and the theories of Yin and Yang, Five Phases, and Eight Principle Patterns.

Bennet_R (1990) [AP and scientific point of view: there are no short cuts to health]. Lakartidningen 25 Jul 87(30-31):2418. In Swedish.

Birkeflet_O (1992) [AP for nurses?]. Sykepl Fag 7 Dec 80(6):3-7.

Cier_JF1 (1990) [AP]. Bull Acad Natl Med Oct 174(7):1041-1044. In French.

Cier_JF2 (1991) [Definition of AP]. Bull Acad Natl Med Nov 175(8):1295-1298. In French.

Cignolini_A (1990) Problems of teaching and diffusion of Chinese AP in Europe. JTCM Mar 10(1):9-12.

Csiszar_R (1993) Basics of AP in the oral cavity: oral AP. Fogorv Sz Jul 86(7):233-238. Magyar Oralakupunktura Orvosok Tarsasaga, Budapest. In Professor Gleditsch's TCM doctrines, Qi Channels encircle and connect the mouth-cavity and its nearby areas. Appropriate knowledge of Channel points is decisive in diagnosing disorders of the mouth-cavity. Persons working on the mouth-cavity have an increasing responsibility to recognise and correctly interpret the connections between mucous membrane disorders and disorders in remote organs and Channel-organ systems.

Dorr_K (1992) Critical analysis of veterinary literature (until 1990) concerning diagnostic or therapeutic use of AP in cattle. Doctoral Thesis, Tierarztliche Hochschule Hannover. In German; Summary in English. Includes bibliographical references (pp114-132).

Friesjung_R (1994) Ear-AP Treatment in Vet Med. Tierarztl Umsch Feb 49(2):78. Werrastr 1, D 30519 Hannover, Germany.

Fu_S (1990) Present situation of Chinese AP and moxibustion education and its prospective strategy. JTCM Mar 10(1):3-5.

Gadsby_JG (1993) Kirlian photography diagnosis: a recent study. Complementary Ther in Med Oct 1(4):179-184. Leicester AP Services, 47 Milton Crescent, Leicester LE4 0PA, UK. This article examines the development and diagnostic applications of Kirlian photography analysis. A case study is presented which examines 100 Kirlian photographs within a complementary therapy practice. The results of this investigation aim to strengthen the knowledge base of Kirlian photography diagnosis with orthodox and complementary therapies in medicine.

Ge_S (1990) Treatment of alopecia areata with AP. JTCM Sep 10(3):199-200. Dept of AP, Shen Yang Hospital, PLA Air Force, PRC.

Gofman_SS (1991) [The treatment of occupational fluorosis by AP reflexotherapy]. Gig Tr Prof Zabol 11:40-42. The article contains the electrodiagnostic data on 26 Ear-points in 24 fluorosis-affected patients. It was established that the greatest electrical polarity asymmetry was found in points 13, 25, 28, 31, 54, 37, 39 and 40. Palpation of the Ear- and body- points also showed unfavourable conditions in the respective painful point of the organ. Basing on the results of the AP procedures, needle therapies of 80 occupational fluorosis cases were performed. The therapeutic patterns elaborated by the author were also proposed, which proved perfect results at different stages of the disease.

Gu_JC; Zhang LM (1992) AP and moxibustion in primary health care in rural China [letter]. World Health Forum 13(1):51.

Hao_LC (1987) AP and moxibustion for farm animals. Feeding a billion: frontiers of Chinese agriculture. Sylvan Wittwer [et al]. East Lansing: Michigan State Univ Press, 405-413.

Holmdahl-MH (1993) AP: contacts between East and West: Experience and science. Scand J Rehab Med Suppl 29:19-29. Dept of Anaesthesiology, Univ Hospital, Uppsala, Sweden.

Hu_Ra1 (1990) [Basic research on auricular AP]. Chung-Hsi-I-Chieh-Ho-Tsa-Chih Jun 10(6):379-382.

Illarionov_VI; Kosoverov EO (1994) [The evaluation and interpretation of the thermal AP test]. Vopr Kurortol Fizioter Lech Fiz Kult Mar-Apr 2:27-28. In Russian.

Johnson_IS (1993) Complementary Med: AP Has Weak Scientific Foundations. BMJ Sep 4 307(6904):624. Leicestershire Hospice, Leicester LE2 4HD, UK.

Kaptchuk T (1996) Some Thoughts on Efficacy Beyond the Placebo Effect. Adapted from WWW. Originally printed in the Anglo-Dutch Inst for Oriental Med Magazine. [Ted Kaptchuk OMD, Assoc Director, Centre for Alt Med Research at Harvard Med Sch. He is the author of "The Web That Has No Weaver": WebMaster].

One of the most often asked questions concerning complementary and Alt Med interventions is whether they are anything more than placebo effects. This question could more accurately be stated as follows: are any positive effects produced by an unconventional Med intervention greater than the effects of a sham intervention in a randomized clinical trail (RCT)?.

The question whether an intervention has greater effectiveness than a placebo was asked for the first time in the Med literature before World War II. It became a common question with the systematic introduction of the randomized controlled trial after World War II. Only from the early 1960s, with the phocomelia produced by thalidomide, did the comparison of an intervention with placebo become the defining and legally necessary question for scientific Med and Govt regulatory agencies. The bioMed concept of efficacy underwent a gradual and subtle shift. The question of efficacy evolved from demonstrable clinical effects and gradually become an issue of a demarcation line defined by a placebo intervention in a clinical trial.

There are many approaches to this question and many issues are still being debated. The main approach to this question is the perspective of fastidious efficacy, a name coined by Alvan Feinstein. Assuming that clinical outcome "is equal to its active effect plus its placebo effect", the fastidious approach takes an additive/subtractive approach for defining the boundary line of efficacy. The assumption of fastidious efficacy, embedded in the adoption of the RCT, both creates the question of what is beyond the placebo and supplies the answer with its "blinded-placebo-controlled" approach. Its answer is quantitative and precise and has the objectification that a chemomechanistic biology requires. Whether this information accurately portrays clinical Med is problematic as the method assumes that real and non-specific effects are stable, separable, linear and relatively constant during a clinical trial.

Most reviewers of AP's efficacy using this perspective tend to be either slightly positive or inconclusive. Unfortunately, most clinical trials upon which these opinions are based have major flaws. For example, it is unclear whether the quality of AP, the quality of therapist and the length of time for a reasonable expectation of outcome were adequately taken into account when these randomized clinical trials were performed. A second approach towards approaching this question is the perspective of pragmatic efficacy, a term created by Schwartz and Lellouch. This model of randomized clinical trials assumes that various non-specific effects are interactive among themselves and among any real effects and that is, therefore, difficult to make a clear distinction between real and placebo. The pragmatic approach blurs the real-placebo dichotomy embedded in the question, generates a less scientifically-satisfactory answer but may be of greater clinical relevance. The growth of the outcomes research movement is consistent with this pragmatic efficacy perspective. I am unaware of any genuine pragmatic trials where the practitioner can practice without any restraints on "optimal" treatment for AP. Many hybrid-pragmatic trials attempted to compare AP to another real treatment, but all other factors (including use of "Cookbook AP") were "standardised", so that it is not "optimal" AP. (Optimal AP must be adapted to the individual needs of the patient at that time). Well done pragmatic trials in other complementary fields such as manipulative therapy are very positive and more "expert" pragmatic trials in AP are needed.

A third approach to the question is what Tambiah calls "performance efficacy." This approach is cultural and anthropological and accepts symbols, belief, suggestion, expectation and persuasion as central to illness and health. This approach avoids any reliance on objectivity, controls and measurement. The contrived environment of an experiment might be the only clearly labelled sham from this perspective. This approach raises the question of who decides what is a sham. Performance efficacy is grounded in the language of solidarity, holism and unity; it is immune to the distancing and neutrality requirement of randomization, blinding and p values. This method generates clear answers about the experience of a self-selected, biased, individual person and has nothing to do with generalizability and replicability.

This approach turns the question of what is beyond the placebo on its head; instead, it asks: who decides whether a therapy is merely sham or more than sham? Patient satisfaction surveys of Comp Med point to the possibility that one answer to what is beyond the placebo is that sham intervention is defined in the eyes of the beholder, who may or may not recognize the scientific method as the final arbitrator. Generally speaking, patient survey of satisfaction with Alt Med is very high, always in the range of 80%.

There are few published surveys of patients' satisfaction with AP, as compared with TCM, but I suspect the satisfaction rate is equally high. The performance perspective also raises fundamental questions as to whether or not randomization introduces significant bias; whether informed consent itself is a potent non-specific effect and whether patient preference itself can have decisive clinical effects.

References.
Beecher, HK. The powerful placebo. JAMA 159 (1955) 17:1602-1955.
Bergmann, JF. 1994 A Randomized clinical trial of the effect of informed consent on the analgesic activity of Placebo and Anproxen in cancer pain. Clinical Trials and Meta-Analysis 29:41-47.
Diehl HS, AB Baker and DW Cowan. Cold vaccines. An evaluation based on a controlled trial. JAMA 111 (1983) 13:1168-1173.
Feinstein, AR. Clinical Epidemiology. Philadelphia: WB Saunders, 1985.
Lillenfeld, AM. Ceteris parabus: the evolution of the clinical trial. Bulletin of the History of Med 56 (1982) 1-18.
Llewellyn-Thomas, HS. Patient's willingness to enter clinical trials: measuring the association with perceived benefit and preference for decision participation. Social Sci ad Med 32 (1991) 1:35-42.
Harris L and Assoc. 1987. Health Information and the User of Questionable Treatments: A Study of the American Public. Washington, DC: US Dept. of Health and Human Services.
Meade TW, S Dyer, W Browne et al. 1995. Randomized comparison of chiropractic and hospital outpatient management for low back pain results from extended follow up. BMJ 311:349-51.
Patel M, F Butzqiller, F Paccaud et al. 1989. A meta-analysis of AP for chronic pain. International J Epidemiology 18; 4:900-904.
Schwartz D and J Lellouch. 1967. Explanatory and pragmatic attitudes in therapeutical trials. J Chron Dis 20, 8:637-648.
Tamblah, SJ. Magic, science, religion and the scope of rationality. Cambridge: Cambridge Univ Press, 1990.
ter Riet G, J Kleijnen and P Knipshild. 1990. AP and chronic pain: a criteria-based meta-analysis. J Clin Epidemiol 43:1191-1199.
Uhionhuth EH et al. Drug, doctor's verbal attitude and clinic setting in the symptomatic response to. Psychopharmacologia (Berl) 9: (1966) 392-418.
Wenneberg JE. 1990. What is outcomes research. In: AC Gelijps (ed) Modern Methods of Clinical Investigation. Washington, DC: National Acad Press.

Klazsik_G (1992) [AP in primary care (letter)]. Orv_Hetil 21 Jun 133(25):1587. In Hungarian.

Knottenbelt_JD (1993) Perspectives in AP. S Afr Med J Apr 83(4):241-242. Groote Schuur Hospital, Cape Town, S Africa.

Kornev_MA; Pugach PV; Aleksandrov SI (1991) [Anatomo-topographical characteristics of various AP points in children]. Arkh Anat Gistol Embriol Jan 100(1):85-88. To ensure the safety of AP therapy for children, a layer-by-layer study was made of tissue topography up to the limits of needle depth at important AP points in young children. Peculiarities of the following points were described: GV20, TH05, PC06, SP09, SP06, LI04, ST36, HT07 and GB34.

Kudriavtsev_A; Vlasik T (1994) Gentle and strong AP: a short review of the two main approaches to treatment. Inst of Clinical Cardiol, Acad of Med Science, Moscow, Russia. AJCM 22(3-4):221-233. Secondary Qi pathways have been known for centuries. Although AP at their points can be very effective in many diseases, AP therapy, surprisingly, is used very seldom. In this article we present some methods allowing the relief of these pathways in their most limited sites. Such approaches are referred to as gentle AP which intends to clear Qi Channels. Also, methods of working with principal Channels using the Five Xing (Phase) points are presented. These methods, considering energy imbalance at a level of the whole organism, are called strong AP because of their strong influence on the Energy of the body.

Landa_NM; Makarenkova GA (1990) [The work experience of a paediatric office of AP in a polyclinic]. Med Sestra Aug 49(8):14-17. In Russian.

Lidicka_M (1990) [Possibilities of using AP in pediatrics]. Cesk Pediatr Feb 45(2):110-111. Okresni ustav narodniho zdravi, Praha. In Czech.

Limanskii_IuP (1990) [The hypothesis of AP points as polymodal receptors of the ecoceptive sensitivity system]. Fiziol Zh Jul-Aug 36(4):115-121. Hypothesis is proposed that the human brain has the sensory system (ecoceptive sensory system) which responds to changes of the Earth EMFs (EEFs) and meteorologic factors (MFs). AP points are activated easily by adequate somatosensory stimuli (mechanical, temperature) and EMFs (EAP, magneto-AP). They can act as polymodal receptors of the ecoceptive sensory system. The sensory endings of AP points are excited by sharp changes of EEFs and MFs. Through neuronal brain stem structures, especially through hypothalamus, stimulation of the AP points starts the adaptive mechanisms intended to compensate for deviations in the functional systems of the brain, provoked by prolonged environmental influences, such as exposure to EEFs and unsettled weather.

Lisenyuk_VP; Samosyuk IZ; Yakupov RA (1993) Computerized AP medical system. AETRIJ Apr-Jun 18(2):97-101. Dept of Neuropathol and Reflexotherapy Kiev State Sch for Post-Graduate Studies of Physicians, Ukraine. Long-term experience of AP applications at 9 specialized centres, and analysis of over 30000 cases have allowed development of original algorithms for prescribing AP therapy on the principles of balancing Channel Qi, functional indicators and specific effects of AP points, anatomical location, segmental sensory innervation of pathological foci, and optimal combination of body-AP points with the micro-AP systems. This served as the basis for the creation of computer software to increase the efficiency of AP treatment used by a wide range of practitioners.

Lu_S (1992) AP treatment of soft tissue injury. JTCM Sep 12(3):228-232. Beijing College of AP, Moxibustion, Orthopaedics and Traumatology, PRC.

Lu_S (1991) Scalp AP therapy and its clinical application. JTCM Dec 11(4):272-280. Dept of AP and Moxibustion, Beijing College of AP, Moxibustion, Orthopaedics and Traumatology, PRC.

Ma_Y; Liu W (1994) Studies on Xie (Reducing) and Bu (Reinforcing) manipulation of AP during the past 4 years. JTCM Sep 14(3):226-232. Inst of AP and Moxibustion, China Acad of TCM, Beijing, PRC.

Ma_Y; Wang C (1992) Clinical application of point-through-point AP. JTCM Jun 12(2):154-157. Dept of AP and Moxibustion, Hospital of Shandong College of TCM, Jinan, PRC.

Marcus_P (1991) AP treatment for industry. Occup Health (Lond) Nov 43(11):341-344. The general public has become increasingly interested in a variety of "alternative" therapies. These can range from the well-established to the downright eccentric. One of those which has the most scientific research to support it is AP. Dr Paul Marcus explains what AP treatment is, what medical conditions it is best used for and the importance of using medically qualified acupuncturists.

Mendelson_G (1991) Laser-AP [letter]. Med J Aust 3 Jun 154(11):779.

Moldovan_CI2 (1996) Low Energy Laser-AP: A Novel Model of Enegetic Interaction. Corneliu I Moldovan MD DSc, Bucharest AP & Homeopathy Centre, 4-6 Visarion Street, Bucharest 1, ROMANIA; Tel: +40-1-650.42.44; Fax: +40312.95.45. Adapted from WWW. The scope and the purpose of this work are to provide the description of Low Energy Laser (LEL) light interaction with the skin electric charges, mainly registered at AP loci. A novel spatial electrostatic imaging technique that allows the visualization of the surface load distribution using static discharges upon a nematic liquid (LCTV) transducer, has been developed. Significant modification pattern of skin electric activity after laser irradiation has been monitored at 16 AP points location, by digital electrometry and digital photopletismography. These patterns allow to detect and measure the alteration of the spatial distribution of the electrostatic loads generated by the electret behaviour of the derma as well as the surface electric potentials and the dermal microcirculation. LEL acts at the AP cutaneous gate by: Dipole polarization depending mainly on the laser wavelength and time of exposure. Micro-electric potentials' generation by electric charges transfer, depending on the dermal microcirculation that is laser-activated. Electrostatic induction depending on the laser source frequency. Bio-effects of laser irradiation depend on the optical (scattering-absorption) and the thermal properties of the tissue. These tissue-specific parameters control the wavelength-dependent depth of penetration and the tissue effect. This study indicates the electrostatic mechanisms that involved AP points may play a major role in the Laser-AP Bio-effects.

Multykh_VE; Samsygin VIu (199.) [Experience with the use of AP by mobile health units]. Anesteziol Reanimatol Mar-Apr 2:58-59. In Russian.

Nagai_T (1990) [The situation of AP in Germanic countries]. Kitasato Arch Exp Med Dec 63(4):33-42. Dept of Haematology and Genetics, Fac of Hygiene, Kitasato Univ, Kanagawa, Japan.

Norheim_AJ (1993) [Attitudes to AP: a questionnaire study among medical students in Tromso]. Tidsskr Nor Laegeforen Mar 113(9):1055-1057. Medisinstudiet FagomrÕdet medisin, Universitetet i Tromso, Norway. In February 1992, 80% of the medical students at Tromso Univ filled in a questionnaire concerning attitudes to AP. 63% of the students would recommend AP when the diagnosis was migraine, while 14% of the students would support a patient who tried AP as cancer therapy. 86% of the students thought that placebo could account for 25-50% of the effect of AP. Most of the students wanted more scientific documentation, although 75% said that AP already was, or at least should be, part of the ordinary health care system. The main result of this study was a generally positive attitude towards AP. The students want to learn the method, and they will recommend AP for their future patients.

O'Neill-A (1994) Danger and safety in medicines. Social Science and Med Feb 38(4):497-507. Dept Health Adm Educ, Lincoln School Health Sci, La Trobe Univ, Carlton South 3053, Victoria, Australia. Inaugural-Dissertation / Tierarztliche Hochschule Hannover; 1988 [no. 41]. Convictions about established medical safety and the danger of alternative remedies and practitioners are discussed in this article. While most alternative medicines continue to be denounced as unscientific and unsafe, government reviews have concluded that chiropractic and osteopathy and (more recently) AP should be registered occupations and that qualifying courses of tertiary education should be instituted in Australia. This paradoxical result follows the widespread adoption of AP and spinal manipulation by established practitioners of medicine and physiotherapy. The practices become intrinsically dangerous as their efficacy is accepted. Consequently, the argument is that only established practitioners are safe enough to use them. But alternative groups can use the established announcement of danger to represent the desirability of official action to protect the public. The article concludes with a review of the idea that therapies become dangerous as they are introduced.

Omura_Y (1994) Accurate localization of organ representation areas on the feet & hands using the bi-digital O-ring test resonance phenomenon: its clinical implication in diagnosis & treatment: Part I. AETRIJ Jun-Sep 19(2-3):153-190. Heart Disease Research Foundation, New York. Accuracy of the widely used organ representation areas, currently used in different schools of foot and hand reflexology was evaluated using Bi-Digital O-Ring test resonance phenomenon. Our previous study indicated that mapping organ representation areas of the tongue using Bi-Digital O-Ring Test resonance phenomenon between 2 identical substances often provided more reliable clinical information for both diagnosis and treatment than the 2 widely used, but crude, traditional schools of Chinese tongue diagnosis. This same method was applied for the mapping of the organ representation areas on the feet and hands. We succeeded in mapping the following areas on human feet: 1. Middle (3rd) toe on the sole side represents the following starting from the tip: a.Head; b.Face with eye, ear, nose, and mouth (1st Digit); c.Neck and organs within the neck (narrow space between 1st crease after the 1st digit and crease at the junction of the beginning of the sole); 2. 2nd and 4th toe represent upper extremities, the beginning tip being fingers and hands. The crease at the base of these toes represents the shoulder. The 2nd toe represents right upper extremity, and the 4th toe represents left upper extremity; 3. 1st and 5th toes in both the right and left feet represent lower extremities with the tip being the toes and soles of feet. The crease at the base of these toes represents the inguinal area. The 1st toe of each foot represents right lower extremity, and 5th toe represents left lower extremity. The sole of the foot is divided into the following 3 distinctive sections: 1. Upper (1st) section represents organs in the chest cavity including 2 thymus glands, trachea, 2 lungs, with the heart between them, and with the oesophagus appearing as a narrow band outside of the lung near and below the 1st and 2nd toe depending upon the individual. Chest section occupies the first 20-33% (on a relatively long foot) of the entire sole. The boundary between the chest and gastrointestinal system can be estimated by extending the length of the entire toe or up to 25% longer to the sole, but it can be accurately determined using a diaphragm tissue microscope slide as a reference control substance. 2. Middle (2nd) section represents GastroIntestinal system, including lower end of the oesophagus, liver, stomach, spleen, gallbladder, pancreas, duodenum, jejunum, ileum, appendix, colon, and anus.

Orlova_MV (1991) [Kinetics of human blood ceruloplasmin properties under the effect of microcurrents at AP points (letter)]. Biofizika Jul_Aug 36(4):732-733. In Russian.

Price_JR (1994) The placebo effect: Use outside trials may be unethical [letter]. BMJ 10 Sep 309(6955):667.

Resch_KL; Ernst E (1995) [Proving the effectiveness of complementary therapy: Analysis of the literature exemplified by AP]. Fortschr Med Feb 113(5):49-53. Post-graduate Med Sch, Univ of Exeter, UK. At present, AP may be considered one of the most popular forms of complementary medicine worldwide. However, in relation to the number of reviews on the subject, comparatively few controlled clinical trials have been reported. An analysis of all the controlled clinical trials listed in MEDLINE between 1987 and March 1994 (n=39) that met certain basic requirements revealed that they addressed a wide variety of diseases and/or symptoms with no major focus (apart from the symptom of pain, which of course is highly complex in nature). In agreement with the findings of other meta-analyses, most of the more recent papers are still of indifferent quality. Besides the inherent problem that the term AP subsumes within itself a substantial number of different techniques (and even philosophies), an obvious methodological deficit can be observed. Many groups seem to attach too little importance to choosing an appropriate control model, although seminal papers addressing this problem were already published in the early eighties. Similar remarks apply to inadequacies in study design, which should be at least single-blind. These findings may help to explain why the effectiveness of AP has still not been definitively shown.

Robinson_C (1990) Getting started in AP [news]. Aust Vet J Oct 67(10):423.

Rothman_KJ; Michels KB (1994) The continuing unethical use of placebo controls. NEJM 11 Aug 331(6):394-398. Boston Univ School of Public Health, MA 02118.

Rothschild_R; Quitkin FM (1992) Review of the use of pattern analysis to differentiate true drug and placebo responses. Psychother Psychosom 58(3-4):170-177. Dept of Psychiatry, Columbia Univ, New York, NY, USA. Placebo response in patients assigned active drug is a troubling source of variance in antidepressant studies. This paper summarizes a series of studies utilizing pattern analysis to distinguish between placebo and true drug responses. Analysis of the persistence, speed, and timing of onset of patients' improvement during antidepressant therapy reveals distinct patterns of response which are likely to be attributable to placebo and true drug effects. While true drug effects seem to be characterized by a 2-week delay in onset followed by persistent improvement, placebo effects seem to be characterized by abrupt, transient improvement. Gradual responses on placebo may be due to spontaneous remission. The heuristic and clinical implications of pattern analysis are discussed.

Rubens_D; Gyurkovics D; Hornacek K (1996) The cultural production of Biotherapy: psychic healing and the natural Med movement in Slovakia. Dept of Anthropology, State Univ of New York at Buffalo. Adapted from WWW. Despite powerful opposition, natural Med (NM) has found a toe-hold in the state-run bioMed system in the Slovak Republic. The Med-leader of the NM movement aims to use his ministerial post as NM "supreme expert" and his interlocking NM clinical and research facilities to achieve a complex, unified health care system under control of Med doctors. This health care model simultaneously reinforces bioMed hegemony and moves classical Med from the centre by substituting a bioenergetic paradigm. Among other diagnostic and healing modalities, NM includes AP, herbal therapy, bee therapy, reflexology and iridology. However, its paradigm is biotherapy, the focus of this paper. Biotherapy is a form of psychic healing or therapeutic touch. It is based on bioenergetic and information-processing principles. Conceptually, biotherapy unifies psyche, soma and energy dimensions of the human body and places the human in an extended transpersonal social, physical and cosmological environment. Biotherapy is a reconstruction of a folk healing tradition in more scientific and medical terms, whose appropriation simultaneously secularized and re-consecrated this tradition by re-locating its practice from lay healers to Med doctors, from the once-religious realm to the now-venerated scientific realm, from deviant-science to normal-science. As part of the creation of an academic secular parapsychology in the former Soviet Bloc in the late 1960s, the reconfiguration of psychic healing into biotherapy illustrates the use of the privileged discourse of science for a cultural production that seems to have both supported and subverted the regime.

Sensabaugh_SM (1986) Acupuncture for veterinary technicians. Vet Tech Nov-Dec 7(10):434-436, 438-439.

Shang_C (1993) Bioelectrochemical oscillations in signal transduction and AP: an emerging paradigm. AJCM 21(1):91-101. Renal Unit, Massachusetts General Hospital, Charlestown 02129, USA. Several converging points from recent research on cellular signal transduction, pattern formation, bioelectromagnetism and AP are reviewed. An organism is not only a system of molecules and cells, but also a system of oscillations. Bioelectrochemical oscillations are generally important in morphogenesis and physiology. They precede the morphological changes in development or pathology. Converging discoveries and hypotheses in different fields, and a perspective on their potential application in
bioMed are also discussed in this article.

Shul'ga_AP; Gus'kov SV (1990) [Effect of prolonged magnetic AP on computer operators during shift work]. Fiziol Cheloveka Sep-Oct 16(5):142-146.

Smith_C (1992) AP: an ancient treatment modality under scientific scrutiny [news]. JAVMA 1 Nov 201(9):1321-1325.

Smith_FW Jr (1992) Neurophysiological basis of AP. Cardiopet Inc., Floral Park, New York. Probl Vet Med Mar 4(1):34-52. Research has shown that the benefits of AP are real. AP effects are due to local effects, stimulation of neuroendocrine systems, and modulation of the body's electromagnetic (EM) energy. The exact mechanisms activated depend on point selection, type of stimulation, and probably time of day. The effectiveness of the treatment will depend on the disease entity treated and the skill and knowledge of the acupuncturist. Knowledge should include both the fundamental principles of Chinese medicine and the more recent scientific understanding of AP's physiologic basis.

Stefanatos_J (1990) Bioenergetic medicine: homeopathy and acupuncture for animals. American Holistic Veterinary Medical Association, 83pp.

Sternfeld_M; Finkelstein Y; Eliraz A; Hod I (1990) Cell membrane activities and regeneration mechanisms as therapy mediators in moxibustion and AP treatments: theoretical considerations. Med Hypotheses Mar 31(3):227-231. Kaplan Hospital, Pulmonary Unit, Rehovot, Israel. AP needling or moxibustion, the major modalities of physical TCM, include mini-destruction of tissue or increased permeability of cell membrane. Both action potential activities and the release of cellular metabolites responsible for regeneration occurs. These phenomena are eventually abolished by local and systemic inhibitory elements being metabolites or neurogenic. The inhibitory effect induced by the AP and moxibustion and directed to the manipulation site of these modalities may affect other anatomical sites and reduce or prevent neoplastic growth and neuromuscular or cardiac membrane activity disturbances.

Stulbaum_AW (1992) The scientific rationale, clinical practice, and future of AP in the US [letter]. AETRIJ Jul-Sep 17(3):229-231.

Tang_D (1991) [Experimental AP-study and its role in AP education: suggestion offering the course of experimental AP in AP education]. Chen Tzu Yen Chiu 16(1):76-78, 68. Dept of AP and Moxibustion, Tianjin Coll of TCM, PRC. Experimental AP-study (EAS) is a new subject which probes the Channel and principle of AP with the help of modern scientific technique and experimental method. In Channel research, the basic responsibility of EAS is to expand the essence of the Channel. For nearly 50 yr, the research has concentrated mainly on detection of the Channels, the phenomena of Channels and the relationship between Channel-points and viscera, etc. In the research on the principle of AP, EAS has accumulated many data to prove the therapeutic effect of AP. Many factors influence the effect of AP. Thus, it is a basic task for EAS to programme the experimental procedure according to the principles of diagnosis and treatment based on an overall analysis of symptoms and signs, so that the best circuits can be chosen. At its best, EAS has significance in three important areas in the training of modern specialists in AP: 1. It can help students to get a deeper understanding on the thought of traditional AP and realize the advantage of AP, thus, encourage their faith on this medical means. 2. It can enrich the contents of AP medicine and broaden the outlook of students, because it introduces modern science and experimental methods into traditional theory. 3. It can train students' ability in scientific research through strengthening the practicability of AP. Therefore, its active significance in AP education has been accepted by AP specialists in our country. More and more colleges of TCM offer this subject, which is welcomed widely.

Troshin_OV (1993) [The functional properties of the cochlear-vestibular AP points of the external auditory canal]. Fiziol Zh Im I M Sechenova Mar 79(3):47-53. Ear-AP points inside the ear were studied in 60 healthy subjects. The points were found to have obvious advantages as compared with the commonly accepted Earpoints.

Ueki_S; Iwai Liao Y; Han KS; Higashi Y (1995) Histological study of the circulatory system of human dental pulp from individuals under local anaesthesia and EAP-analgesia. Okajimas Folia Anat Jpn Mar 71(6):335-343. Dept of Orthodontics, Osaka Dental Univ, Japan. Dental pulp from patients under AP-analgesia (APA) or local infiltration analgesia was studied using transmission electron microscopy (TEM). Vessels in the dental pulp of patients who received infiltration anaesthesia were constricted, congested, static and thrombotic, making it difficult to differentiate lymphatic circulation. However, dental pulp from AP-patients showed normal arterioles, capillaries, and venules, as well as some lymph capillaries and small efferent lymphatic vessels that measured circa 8 um and 100 um in diameter, respectively. The lymphatic endothelial walls had many intercellular gaps, an imperfect basal lamina, and a few discontinuous pericytes. Between the openings in the lymphatic vessels, there were bundles of junctional filaments extending towards the dental pulp connective tissue. Thus, the lymphatic system, which contains mainly B-3-alpha capillaries, is a leaky tissue. It regulates fluid in the dental pulp.

Vari_SG; Shi WQ; Pergadia VR; Duffy JT; Miller JM; Vanderveen MJ; Weiss AB; Fishbein MC; Grundfest WS (1993) Effects of Pulsed Midinfrared Lasers on Bovine Knee-Joint Tissues. Proceedings of Lasers in Orthopaedic, Dental and Vet Med 1880:17-28. SG Vari, Cedars Sinai Med Ctr, Dept Laser Res & Technol Dev, Los Angeles, CA 90048.

Verhoef_MJ; Sutherland LR (1995) General practitioners' assessment of and interest in Alt Med in Canada. Soc Sci Med Aug 41(4):511-515. Dept of Community Health Sci, Faculty of Med, Univ of Calgary, Alberta, Canada. Canadian physicians' opinions of Alt Med have, as yet, not been assessed. The objectives of this pilot study were to assess general practitioners': 1. desired involvement in Alt Med; 2. perceived demand for Alt Med; and 3. beliefs on the efficacy of different alternative approaches. The study design was a cross-sectional survey of 400 randomly selected Alberta and Ontario general practitioners. Of the 384 eligible physicians, 200 (52%) completed the questionnaire. 73% of physicians felt that they should know the main alternative treatments. However, with respect to other issues, physicians desired less involvement with Alt Med. 65% perceived a demand for Alt Med from their patients, in particular chiropractic. Alt Med was perceived to be needed most for musculoskeletal problems and chronic pain or illness. Chiropractic, hypnosis and AP (for chronic pain) were believed to be most efficacious, while homeopathy and reflexology were considered to be least efficacious. Undergraduate, graduate clinical and continuing Med education will need to address alternative treatments in order to provide physicians with up-to-date and relevant information.

Vincent_C; Lewith G (1995) Placebo controls for AP studies. J R Soc Med Apr 88(4):199-202. Academic Dept of Psychiatry, St Mary's Hospital Med Sch, London, UK. Many studies of AP treatment are seriously flawed by methodological problems. Poor design, inadequate measures and statistical analysis, lack of follow-up data and sub-standard treatment are all too common. However, the major problem, which many investigators consider to be still unresolved, is the definition of an appropriate placebo control. The use of inappropriate placebo controls has bedeviled AP research and led to serious misinterpretation of the results of clinical trials. Different solutions have been proposed, but there is no agreed way to assess the adequacy of control conditions or to decide which placebo to use in a particular trial. We propose that assessing the credibility of treatments and control conditions may provide a way forward to a more rigorous, consensus approach. (Rogers Note: Many "research studies" which showed little or no significant difference between effects of "active" and "placebo" points used placebos which were too near (or in the same neurotome as) the active points. In many cases both sets of points had significant clinical or physiological effects)."

Wang_B (1990) The basic knowledge indispensable for a qualified AP doctor. JTCM Mar 10(1):6-8. Shanghai Inst of TCM, PRC.

Wang_L (1992) Some important links in promoting the curative effect of AP. JTCM Mar 12(1):64-67. Inst of AP, China Acad of TCM, Beijing, PRC.

Wertlen_LE (1993) Playing ostriches about AP? [letter]. S Afr Med J Nov 83(11):861.

Worell_AB; Farber WL (1993) The Use of AP to treat Feather Picking in Psittacines. 1993 Annual Conference, Assoc of Avian Vets :121-126. AB Worell, All Pets Med Ctr, Canoga Pk, CA 91304 USA.

Xu_R (1990) The application of bloodletting in AP therapy. JTCM Dec 10(4):274-275. Taizhou Hospital, Zhejiang Province, PRC.

Zukauskas_G; Dapsys K (1991) Bioelectrical homeostasis as a component of AP mechanism. AETRIJ 16(3-4):117-126. Psychiatric Problems Research Lab, Rep N. Vilnia Psych Hosp, Vilnius, Lithuanian Rep. Low frequency electrostimulation and super-high frequency EMF were applied to AP points of ST Channel in dogs. The stimulation effect on Bioelectrical potentials of 5 AP points of ST, SP, LV, KI, SI Channels and non-AP skin zones was studied in dogs in which autonomic ganglia or neuromuscular junctions were blockaded. The influence of ganglio-blockading and myo-relaxing drugs on Bioelectrical potentials of AP points was also researched. The results are discussed from the neurohumoral and bioelectrical hypotheses points of view. Conclusion: Both mechanisms of AP supplement each other. The principle of bioelectrical homeostasis as a component of AP mechanism is proposed. Bioelectrical homeostasis along with other kinds of homeostasis forms a system of first level homeostats which is united into 2nd level homeostat by the ANS.

C. Confirmed or Suspected Adverse Effects of AP

Anon (1992) Hepatitis B associated with an AP clinic. Commun Dis Rep CDR Wkly 27 Nov 2(48):219.

Baek_SY; Lee MG; Choi HY; Cho KS; Auh YH (1992) Radiography, US, and CT of AP needles in the abdominal organs. J Comput Assist Tomogr Sep-Oct 16(5):834-835. Dept of Diagnostic Radiology, Asan Med Centre, Univ of Ulsan College of Med, Seoul, South Korea.

Blanchard_BM (1991) Deep vein thrombophlebitis after AP [letter]. Ann Intern Med 1 Nov 1; 115(9):748.

Broch_OJ; Gogstad A; Humerfelt S (1993) [AP, quality control and ethics]. Tidsskr Nor Laegeforen 30 May 113(14):1758.

Chiu_ES; Austin JH (1995) Images in clinical medicine: AP-needle fragments. NEJM 2 Feb 332(5):304. Columbia Univ, College of Physicians and Surgeons, New York, NY 10032-3784.

Fujiwara_T; Tanohata K; Nagase M (1994) Pseudoaneurysm caused by AP: a rare complication [letter]. Am J Roentgenol Mar 162(3):731.

Garcia_AA; Venkataramani A (1994) Bilateral psoas abscesses following AP [letter]. West J Med Jul 161(1):90.

Gerard_PS; Wilck E; Schiano T (1993) Imaging implications in the evaluation of permanent needle AP. Clin Imaging Jan-Mar 17(1):36-40. Dept of Radiol, Maimonides Med Centre, Brooklyn, New York 11219. Traditional Chinese AP involves placing needles into the sc tissues along predefined Channels, and later totally removing the needles. A peculiar form of AP exists called "Hari", which involves the permanent placement of fine needles into the sc tissues. Although this form of AP is uncommon, it is still practised in both the Orient and the West. After treatment, the patient's skin is imbedded with hundreds of these fine needles, which remain in the skin for the rest of the patient's life. Several reports have appeared describing their curious radiologic appearance. We present plain films, sonograms, and CAT findings of 3 patients who have undergone this form of AP, and describe their implications in radiographic and clinical evaluation.

Gi_H; Takahashi J; Kanamoto H; Matsubayashi K; Mikuni N; Okamoto S (1994) [Spinal cord stab injury by AP needle: a case report]. No Shinkei Geka Feb 22(2):151-154. Dept of Neurosurgery, Osaka Red Cross Hospital. Neurosurgeons very rarely encounter cases of spinal cord injury caused by a broken AP needle. We report such a case in a man, aged 45-yr, referred to our clinic because of urinary retention. The problem arose circa 2 wk after AP therapy (a needle was broken during treatment). The patient showed no motor weakness, or sensory disturbance. Sensorimotor disturbances were present in all of the reported 7 cases of longitudinal stab injuries (posterior puncture). In transverse stab injuries (lateral puncture), however, 2 cases did not show motor weakness but sensory disturbance. In our case, CT imaging and X-ray showed the needle transversely stabbing the spinal cord at C1/2. The centrifugal pathway for micturition in the spinal cord lies in the middle third of the lateral columns and in the width of the central canal. Surgery relieved the patient from his complaint. The urinary retention may have been due to the needle stabbing the bilateral descending fibres.

Gray_R; Maharajh GS; Hyland R (1991) Pneumothorax resulting from AP. Can Assoc Radiol J Apr 42(2):139-140. Dept of Radiol, Wellesley Hospital, Toronto, Ont. The authors report 2 cases of pneumothorax secondary to lung puncture, which was caused by AP needles. Radiologists should be alert to this possible cause of pneumothorax, particularly when needle fragments can be seen in radiographs of the soft tissues.

Hasegawa_J; Noguchi N; Yamasaki J; Kotake H; Mashiba H; Sasaki S; Mori T (1991) Delayed cardiac tamponade and haemothorax induced by an AP needle. Cardiol 78(1):58-63. Dept of Int Med, Tottori Univ Sch of Med, Yonago, Japan. A 52-year-old man presented with cardiac tamponade a few years after accidental breakage of an AP needle that had not been removed. Thoracotomy showed haemopericardium with penetration of the pulmonary artery by the very fine needle which was barely detected on the chest roentgenogram. This lesion was not suspected on the basis of roentgenography, 2-dimensional echocardiography, or computed tomography, but was detected by the presence of other thick needles in the neck, chest and abdomen. This case showed a possible threat of stealthy and migrating foreign bodies, such as very fine AP needles.

Hasegawa_O; Shibuya K; Suzuki Y; Nagatomo H (1990) [AP needles, straying in the CNS and presenting neurological signs and symptoms]. Rinsho Shinkeigaku Oct 30(10):1109-1113. Dept of Neurol, Yokohama City Univ Hospital. AP is used to treat many diseases in Japan. "Okibari" is one method of AP treatment: a fine stainless steel or silver needle is inserted as a permanent implant into the sc tissue. A 57-yr-old pharmacist was knocked down by a motorcycle in 1971, since then, moderate weakness of left extremities and stiffness of muscles remained as sequelae. She was consequently treated with AP. Many small needles were inserted permanently in the nuchal, occipital and other areas of the body 10-12 yr before she developed gradual clumsiness and dysesthesia in her right hand in 1984. When she was admitted for the first time in 1985, neurological examination revealed left Horner's syndrome and diminished deep sensation in her right extremities with pseudo-athetosis of her right hand, along with spastic paresis of left extremities and right carpal tunnel syndrome. An old needle which had strayed into left dorsal medulla was considered to be the cause of these symptoms. In 1988 loss of temperature and pain sensation in the right side of her body below the shoulder, and diminished deep sensation of left extremities were appended, and weakness of her left extremities became aggravated. Pseudo-athetosis of her right hand was less prominent. Plain X-rays showed many needle shadows. CT scan also showed needle shadows in the left dorsal medulla, right cerebellum and in the subarachnoid space of left dorsal C1-C2 level. [Rogers comment: Mobile permanent metallic implants near vital structures, such as the eyes, blood vessels, spinal cord or brain, are potentially dangerous as a method of therapy].

Hollander_JE; Dewitz A; Bowers S (1991) Permanently imbedded sc AP needles: radiographic appearance. Ann Emerg Med Sep 20(9):1025-1026. Emergency Dept, Bronx Municipal Hospital Centre, Albert Einstein Coll Med, New York. During the evaluation of a victim of a motor vehicle accident, routine radiographs of the patient's cervical spine, chest, and pelvis revealed multiple radiopaque foreign bodies along his posterior neck, chest, abdomen, and pelvis. Repeat examination of the patient disclosed no evidence of foreign bodies. Further questioning revealed that the patient had received AP therapy 5 yr earlier in Korea. We discuss the radiographic findings of permanently imbedded sc AP needles and their differential diagnosis. The medical complications of AP are reviewed.

Hu_Ja1 (1990) Is it possible for AIDS to be transmitted by AP treatment?. JTCM Dec 10(4):306-307. Inst of AP and Moxibustion, China Acad of TCM, Beijing, PRC.

Huet_R; Renard E; Blotman MJ; Jaffiol C (1990) [Unrecognized pneumothorax after AP in a female patient with anorexia nervosa (letter)]. Presse Med 22 Sep 19(30):1415. In French.

Hung_VC; Mines JS (1991) Eschars and scarring from hot needle AP treatment. J Am Acad Dermatol Jan 24(1):148-149. Division of Dermatology, Los Angeles County, Univ of Southern California Med Centre, CA, USA.

Johansen_M; Nielsen KO (1990) [Perichondritis of the ear caused by AP]. Ugeskr Laeger Jan 152(3):172-173. Ear Dept, Sonderborg Hospital. A case of perichondritis and necrosis of the cartilage of the outer ear after AP of the ear is presented. Repeated cultures showed growth of Pseudomonas aeruginosa. Despite intensive antibiotic treatment and extensive surgical toilet, the patient developed a severely deformed outer ear.

Keane_JR; Ahmadi J; Gruen P (1993) Spinal epidural haematoma with subarachnoid haemorrhage caused by AP. AJNR Am J Neuroradiol Mar-Apr 14(2):365-366. Dept of Neurol, Los Angeles County-Univ of Southern California Med Centre. Unintentional AP needling of the thoracic spinal canal produced a spinal epidural haematoma and subarachnoid haemorrhage. This case shows that patients sometimes are reluctant to disclose folk medical treatments to Western physicians, and the proper diagnosis may depend upon the prowess of the neuroradiologist.

Matsui_S; Matsuoka K; Nakagawa K; Kohno K; Sakaki S (1992) [Cervical spinal cord injury caused by a broken AP needle: a case report]. No Shinkei Geka Apr 20(4):499-503. Dept of Neurological Surgery, Ehime Univ Med Sch, Japan. Spinal cord injury is a rare but considerable complication of AP. A case with cervical spinal cord injury caused by a broken AP needle was reported and 16 previously reported cases including our case were reviewed. A 49-yr-old woman was treated by herself with AP on the nuchal region for occipitalgia, and the needle was accidentally broken during the treatment. 6 h later she noticed pain and numbness in the right upper and lower extremities. Neurological examination revealed slight impairment of temperature, pain and touch sensation on the right extremities. Plain X-ray film and CT scan showed a broken needle in the interspinous ligament between C1/C2 vertebrae, the tip of the needle appearing to be in the spinal canal. The needle was removed surgically 19 d after the accident. Intraoperative fluoroscopic monitoring with injection of dye enabled the needle to be found without difficulty. Postoperative course was uneventful, and her pain and sensory impairment gradually disappeared. Once the diagnosis for cervical spinal cord injury by an AP needle is made, the needle should be removed surgically as soon as possible, especially before the development of motor symptoms. This is because movement of the needle in the spinal cord is considered to be a main possible cause of the development and progression of symptoms.

Morrone_N; Freire JA; Ferreira AK; Dourado AM (1990) [Iatrogenic pneumothorax caused by AP]. Rev Paul Med Jul-Aug 108(4):189-191. Clinica Pneumologica do Hospital do Servidor, Sao Paulo. A 68 year-old white male patient with previous diagnosis of pulmonary emphysema was submitted to AP. The needles were inserted into the precordial area and the patient immediately complained of worsening dyspnea. 4 d later pneumothorax was detected by chest X-rays. A thoracic tube was inserted with total lung expansion.

Murata_K; Nishio A; Nishikawa M; Ohinata Y; Sakaguchi M; Nishimura S (1990) Subarachnoid haemorrhage and spinal root injury caused by AP needle: case report. Neurol Med Chir (Tokyo) Nov 30(12):956-959. Dept of Neurosurgery, Shimada Municipal Hospital, Shizuoka, Japan. The authors report a case of subarachnoid haemorrhage and spinal root injury caused by an AP needle buried in the posterior neck circa 30 yr before onset. A 33-yr-old female presented with sudden onset of severe occipital headaches. Plain x-ray films of the cervical spine revealed a fine gold needle, circa 1.5 cm in length, between the C1 and C2 vertebrae. The needle was piercing the spinal nerve root through the dural vein, and was removed. Postoperatively, the pain exacerbated by neck movement disappeared.

Nezhentsev_MV; Suslova GA; Aleksandrov SI (1991) [Problem of combined use of drugs and AP]. Sov Med 8:34-37. In Russian.

Norheim_AJ (1994) [Complications of AP therapy: A study of the literature from 1981-92]. Tidsskr Nor Laegeforen Apr 114(10):1192-1194. Inst for samfunnsmedisin Univ i Tromso, Norway. This study presents the adverse affects of AP as recorded in the Medline database for 1981-92. Pneumothorax is the most common mechanical organ injury caused, while hepatitis dominates the infections. Neither pneumothorax nor hepatitis is reported from any Nordic country. Most of the adverse effects of AP seem to be associated with insufficient basic medical knowledge, a low standard of hygiene and inadequate education in AP. The study confirms adverse effects of AP in certain circumstances. Serious adverse effects are few, and AP can be considered as a fairly harmless form of treatment.

Ogata_M; Kitamura O; Kubo S; Nakasono I (1992) An asthmatic death while under Chinese AP and moxibustion treatment. Am J Forensic Med Pathol Dec 13(4):338-341. Dept of Legal Med, Faculty of Med, Kagoshima Univ, Japan. A 29-yr-old Japanese man with bronchial asthma died while undergoing Chinese AP and moxibustion treatment. The autopsy findings of the lungs were compatible with a diagnosis of severe asthma. Further, on immunohistochemical examination, hypoxic brain damage and an unusual distribution of pulmonary surfactant were found. In contrast, only minor haemorrhages in the right semispinal muscle and round-shaped bruises were seen due to Chinese AP and moxibustion treatment. Thus, it was concluded that the man had died from a severe asthmatic attack.

Otsuka_N; Fukunaga M; Morita K; Ono S; Nagai K; Katagiri M; Harada T; Morita R (1990) Iodine-131 uptake in a patient with thyroid cancer and rheumatoid arthritis during AP treatment. Clin Nucl Med Jan 15(1): 29-31. Dept of Nuclear Med, Kawasaki Med Sch, Okayama, Japan. On whole body scan, a patient with thyroid carcinoma had abnormal accumulation of I-131 in areas of both feet and hands. The sites of abnormal accumulation of I-131 were similar to those on bone scintigraphy. Radiography of the lesions showed typical findings of rheumatoid arthritis, and the presence of small gold needles for AP treatment was shown. There were no findings of bone metastases. Although the mechanism of accumulation of I-131 in this patient is unknown, interpreters of I-131 whole body scintigraphs should keep this case in mind when viewing the graphs of patients which have had AP treatment. The authors can only speculate on a common blood flow mechanism for enhanced HMDP and I-131 uptake in this arthritic patient who had been treated by AP.

Phoon,_WO; Phoon FN; Lee J (1998) History of blood transfusion, tattooing, AP and risk of hepatitis B surface antigenaemia among Chinese men in Singapore. American Journal of Public Health Aug 78:958-960.

Rosted_P (1994) [Risks and adverse effects of AP therapy]. Ugeskr Laeger Dec 156(49):7335-7339. 40 published articles on side-effects related to AP are reviewed. Several serious complications of AP are described, e.g. pneumothorax, bacterial endocarditis, hepatitis and spinal lesion. Contraindications for the use of AP are discussed.

Sakai_Y; Watanabe E; Kobayashi S; Sekiguchi J; Ohmori K (1994) Removal of a retained AP needle in the paraspinal muscle using a neuronavigator [letter]. Plast Reconstr Surg Dec 94(7):1097-1098.

Sato_M; Yamane K; Ezima M; Sugishita Y; Nozaki H (1991) [A case of transverse myelopathy caused by AP]. Rinsho Shinkeigaku Jul 31(7):717-719. Dept of Neurol, Ota-Atami Hospital. A 54-yr-old man received insertion of an AP needle into the region extending from the posterior neck to the back on 2 occasions to treat shoulder stiffness. 2 wk after the 2nd AP, he developed fever, dysarthria and disturbance of micturition, finally reaching the condition of tetraplegia. He was immediately admitted to an emergency room in our hospital, and was diagnosed as sepsis with DIC, ARDS, heart failure, renal failure, liver failure, and myelitis. After 4 wk, he recovered with transverse myelopathy as a residual deficit. Neurological findings showed transverse myelopathy below the level of Th2 at that time. Cervical CT scan revealed an irregular low density at the periphery of the cervical vertebra from the C2-C4 level. Cervical MRI revealed an irregular swelling of his spinal cord from the C2-C7 level. We explained the mechanism of transverse myelopathy in this case as follows. After the AP, he suffered a focal infection of the region of needle insertion, and then the infection expanded to the cervical vertebra, thus causing osteomyelitis, sepsis, and finally cervical myelitis. Direct injury of the spinal cord and nerve roots as a complication of AP was previously reported, but indirect injury of the spinal cord due to myelitis had not been reported except our present case. Careful attentions should be paid to the complications of AP.

Scheel_O; Sundsfjord A; Lunde P; Andersen BM (1992) Endocarditis after AP and injection-treatment by a natural healer [letter]. JAMA 1 Jan 267(1):56.

Sorensen_T (1990) [Ear perichondritis caused by AP therapy (letter)]. Ugeskr Laeger 12 Mar 152(11):752-753. In Danish.

Southworth_SR; Hartwig RH (1990) Foreign body in the median nerve: a complication of AP. J Hand Surg [Br] Feb 15(1):111-112. Med Coll of Ohio, USA. Fracture of an AP needle caused a foreign body within the carpal tunnel of a patient who then developed median neuropathy. The needle fragment was recovered from within the median nerve during carpal tunnel release, with rapid post-operative relief of symptoms. Development of peripheral neuropathy is a potential complication of AP.

Sullivan-Fowler_M; Austin TL; Hafner AW (1988) Alternative therapies, unproven methods, and health fraud: a selected annotated bibliography. Am Med Assoc, Div of Library and Info Management, 47 pp. Chicago, Ill.

Suzuki_H; Baba S; Uchigasaki S; Murase M (1993) Localized argyria with chrysiasis caused by implanted AP needles: Distribution and chemical forms of silver and gold in cutaneous tissue by electron microscopy and x-ray microanalysis. J Am Acad Dermatol Nov 29(5 Pt 2):833-837. Dept of Dermatol, Surugadai Nihon Univ Hospital, Tokyo, Japan. A case of localized argyria with chrysiasis caused by implanted AP needles in a 41-yr-old Japanese woman was studied by electron microscopy and x-ray microanalysis. Large amounts of Ag granules with Se and S were detected around eccrine secretory cells in much greater amounts than around ductal cells. Many granules were also observed along the outer edge of the basement membrane but never within cells or intercellular spaces. The granules were also present around blood vessels, lymphatics and nerve fibres and in elastic fibres. Small numbers of Au fragments were also seen, mostly within macrophages. Ag deposited extracellularly as selenide and sulphide, whereas free Au was found intracellularly.

Tanii_T; Kono T; Katoh J; Mizuno N; Fukuda M; Hamada T (1991) A case of prurigo pigmentosa considered to be contact allergy to chromium in an AP needle. Acta Derm Venereol 71(1):66-67. Dept of Dermatol, Osaka City Univ Med Sch, Japan. A 53-yr-old male developed prurigo pigmentosa on his back, after undergoing AP for 3 yr. The eruptions were ceased on discontinuing the therapy but recurred with its resumption. The AP needle contained 18% chromium. Erythema was induced by patch testing with potassium dichromate, and a flare-up was observed in the area of the patch test on resumption of AP. We consider that the eruptions were induced by contact allergy to the chromium component of the AP needles.

Wright_RS; Kupperman JL; Liebhaber MI (1991) Bilateral tension pneumothoraces after AP [see comments]. Comment in: West J Med Jun 154(6):736-737. West J Med Jan 154(1):102-103. Dept of Med, UCLA Med Centre.

Yuzawa_M; Hara Y; Kobayashi Y; Ishiyama S; Tozuka K; Nakamura S; Tokue A (1991) [Foreign body stone of the ureter as a complication of AP: report of a case]. Hinyokika Kiyo Oct 37(10):1323-1327. Dept of Urol, Jichi Med Sch, Japan. A 47-yr-old female was admitted to our clinic with the suspicion of ureteral foreign body. She had undergone AP for left lumbago 12 yr earlier. Plain X-ray film revealed a linear shadow and calcified shadows laterally to left third lumber vertebra. Computed tomographic scan and pyelogram showed them located in the left ureter. Left ureterolithotomy was performed successfully. The removed stone was accompanied by an AP needle. Including our case, 12 cases of foreign bodies as a complication of AP in the upper urinary tract reported in the Japanese literature were reviewed.

D. AP and Immunity

1. GENERAL
Bihari_A1; Kumar A; Garg SK (1995) Enhancement of Antibody Production by EAP in Goats Immunized with Salmonella Typhimurium. Indian J of Animal Sci Jan 65(1):6-8. Vet Hosp, Udaipur, Rajasthan, India. EAP stimulation at ST36, SP06, LI04 and GV14 in goats (group A), or GB39, SP10, LI11 and LV03 (group B) caused a significant increase in antibody titre from 1:7.5 (control) to 1: 22.5 and 1:20, respectively, against Salmonella O antigen at d 5 postinoculation. The antibody titre gradually increased, respectively, to 1:1440 and 1:1120 at d 14 against 1:320 of controls. Thereafter it declined to 1:120, 1:90 and 1:15, respectively, by d 30. There was no significant difference in antibody titre between two groups of AP-stimulated animals.

Cui_M (1992) Present status of research abroad concerning the effect of AP and moxibustion on immunologic functions. JTCM Sep 12(3):211-219. Inst of Information and Library, China Acad of TCM, Beijing. Japan is one of the countries that have done extensive research on the effect of AP and moxibustion on the immunologic functions. With China first, Japan ranks 2nd among the countries in this study. Concerning research in this field concerned the level abroad can scarcely reach that in China. Scholars abroad fail to base their research on TCM theory. Also not only the type of diseases studied, and the indexes observed are far less than those in China, but also the scope of their research is far narrower. However, certain diseases under study (for instance, AIDS) and certain indexes under observation (for instance, analysis of changes in T subsets of lymphocytes with monoclonal antibodies), as well as certain aspects of their investigation are worthy of consideration by scholars in China.

Fujiwara_R; Tong ZG; Matsuoka H; Shibata H; Iwamoto M; Yokoyama MM (1991) Effects of AP on immune response in mice. Int J Neurosci Mar 57(1-2):141-150. Dept of Immunol and Anaesthesiol, Kurume Univ Sch of Med, Fukuoka, Japan. The effect of AP points stimulation on the induction of plaque-forming cells (PFC) in spleen cells of BALB/c mice was investigated in vivo and in vitro tests. In in vivo experiment, mice were immunized with 2 x 10(8) sheep red blood cells (SRBC) and the PFC was markedly increased by daily (once/d for 4 d) AP stimulation. The enhancement of PFC by AP was completely blocked by preadministration of procaine, hexamethonium, naloxone, propranolol, but not by phentolamine. The enhancement of PFC by AP was also observed in spleen cells of non-immunized mice when spleen cells of the AP-treated mice were cultured with SRB in vitro. Enhancement of PFC in spleen was observed after stimulation with AP, and a similar effect was also found in bone marrow cells of normal mice, but not in thymic cells. The spleen cells of mice given AP showed no enhancement of PFC after treatment with anti-Thy 1.2 antibody and complement. Also, these helper T cells were found to be not restricted by the H-2 gene complex. The helper T cells induced by AP lacked H-2 restriction; thus they may be derived from the bone marrow, but not from the thymus. AP activation of the sympathetic nervous system activated helper T cells (probably from bone marrow).

Hu_G; Chen H; Hou Y; He J; Cheng Z; Wang R (1993) A study on the clinical effect and immunological mechanism to treat Hashimoto's thyroiditis by moxibustion. Chung i tsa chih (JTCM) Mar 13(1):14-18. Shanghai Res Inst of AP & Channels, PRC. 71 cases of Hashimoto's thyroiditis were treated by moxibustion; immune function and thyroid function were studied. Moxibustion reduced thyroid antibodies in peripheral blood of patients with hypothyroidism and restored their thyroid function. Moxibustion lowered thyroid antibody secretory levels and FROMCC (antibody-dependent cell-mediated cytotoxicity) activities of lymphocytes. Also, the action of moxibustion in reducing the secretion of thyroid antibodies was related to its action of regulating the proportions of T lymphocyte subsets. Success of moxibustion to treat Hashimoto's thyroiditis is probably due to its effect in regulating the relationship among subsets of T lymphocytes.

Hu_GS; Chen HP; Hou YJ (1991) [Effect of moxibustion on the antibody-dependent cell-mediated cytotoxicity activity in peripheral blood of patients with Hashimoto's thyroiditis]. Chung Hsi I Chieh Ho Tsa Chih Jul 11(7):403-404, 388. Shanghai Research Inst of AP and Channel, PRC. To investigate the immune regulating effect of moxibustion on the patients with Hashimoto's thyroiditis, 35 patients were treated by moxibustion and the changes of antibody-dependent cell-mediated cytotoxicity (ADCC) activity in the peripheral blood of the patients and their relationship with thyroid microsomal antibody (MCA) before and after treatment were observed. The activity of ADCC and the combining rate of MCA were higher than normal and they were closely related to each other. After treatment, both of them declined remarkably and the relationship between them remained the same. The efficacy of moxibustion to treat Hashimoto's thyroiditis may be related to its effect of decreasing the activity of ADCC and the titre of anti-thyroid antibodies.

imm_Bianchi_M; Jotti E; Sacerdote P; Panerai AE (1991) Traditional AP increases the level of beta-End in immune cells and influences mitogen induced proliferation. AJCM 19(2):101-104. Dept Pharmacol, Univ of Milano, Niguarda Ca Granda Hospital, Italy. We measured beta-End levels in peripheral blood mononuclear cells and mitogen-induced T-lymphocyte proliferation in patient who underwent treatment with traditional AP. Traditional AP increased both the levels of the opioid in the immune cells and lymphocyte proliferation. Our data are consistent with the hypothesis that traditional AP modulates immune responses in man.

Kho_HG; Van Egmond J; Eijk RJ; Kapteyns WM (1991) Lack of influence of AP and transcutaneous stimulation on the immunoglobulin levels and leucocyte counts after upper-abdominal surgery. Eur J Anaesthesiol Jan 8(1):39-45. Inst for Anaesthesiol, Univ of Nijmegen, The Netherlands. The changes in immunoglobulins (IgA, IgG and IgM) and total and differential leucocyte counts in the peripheral blood during, and for 6 d after, surgery were evaluated in 29 male patients submitted to standardized upper-abdominal surgery performed under 2 different anaesthetic techniques. Group 1 received stimulation of ear and paravertebral points, supplemented by small doses of fentanyl (mean 1.2 ug/kg, range 0.0-5.7) and Group 2 received moderate-dose fentanyl (mean 22.9 ug/kg, range: 17.5-29.8). All were induced with thiopentone 5 mg/kg, intubated after vecuronium 0.1 mg/kg and ventilated with 67% nitrous oxide in oxygen. Inhalation anaesthesia was not used. Surgery was followed by a fall in immunoglobulins, lymphocyte and eosinophil counts and a rise in leucocyte and neutrophil counts in both groups (p <.01). No recovery was observed until the last assessment on d 6 after surgery in IgA, IgG, leucocyte, neutrophil and lymphocyte counts in both groups, whereas IgM and eosinophil counts recovered by d 4. Monocyte and basophil counts were unchanged in either group. AP and transcutaneous stimulation analgesia performed for major abdominal surgery did not influence the body's immune system either during or after surgery as measured by the levels of immunoglobulin and total and differential WBC counts.

Kobayashi_K (1995) Induction of heat-shock protein (hsp) by moxibustion. AJCM 23(3-4):327-330. Dept of Chemistry, Meiji Coll of Oriental Med, Kyoto, Japan. Rats were treated by moxibustion at the point of hip muscle, and intramuscular temperature was kept at 40oC for 15 min. The rats were killed under deep anaesthesia and the muscular tissues were excised immediately, 3 h and 24 h after stimulation. Proteins were extracted from the homogenized and centrifuged tissues of the stimulated rats and control rats. 2-dimensional gel electrophoresis of the proteins was carried out. Heat-shock protein (hsps) with molecular weight of 70,000, 85,000 and 100,000 (hsps 70, 85 and 100 respectively) were detected in rats killed 3 h after stimulation by moxibustion. Protein patterns were analyzed and the ratios of the hsps were obtained.
Krost_W (1991) [Chronic infections and irritations and their relief with Voll's EAP method]. Zahnarztl Prax 8 Nov 42(11):436-438. In German.

Kudo_T; Kato Y; Masuno H; Honjo H; Kitazawa K (1987) The effect of repeated AP stimulation on canine lymphocyte response. Jap J of Vet Sci 49(6):1009-1013. Dept Vet Surg, Gifu Univ, 1-1 Yanagido, Gifu 501-11, Japan. 20 normal healthy mongrel dogs were divided equally into four groups: 1=AP needling at ST36 bilaterally (needles left in situ for 30 min (treated once only); 2=Same as 1 but treated once/d for 5 d; 3=EAP (1 volt, 2 Hz, 1 msec, positive square wave), as in 1; 4=Same as 3 but treated once/d for 5 d. Haematology and cellular immunological responses were determined after repeated AP stimulations. ANAE positive cells, the stimulation index of lymphocytes undergoing blastogenesis by incubation with phytohaemagglutinin and the gamma-globulin of serum protein all decreased within several days after repeated EAP stimulations, representing a decrease in basal immunological response. Repeated EAP stimulation at ST36 in healthy dogs depressed the immunological responses, probably due chiefly to the T-cells.

Lin_JG; Yang SH; Tsai CH (1995) AP protection against experimental hyperbilirubinemia and cholangitis in rats. AJCM 23(2):131-137. Graduate Inst of Chinese Med Science, China Med Coll, Taichung, Taiwan, ROC. Effects of AP on experimental hyperbilirubinemia and cholangitis were studied in male rats (n=33). The experimental group were treated with AP, 18, 12 and 6 hr before and 6, 12 and 18 hr after an oral dose of alpha-naphthyl-isothiocyanate (ANIT, 100 mg/Kg). Rats were killed 48 h after challenge. Serum and liver samples were taken for biochemical and histological analysis, respectively. Rats treated with ANIT had elevated bilirubin, SGOT and SGPT as well as cholangitis. Rats which got AP plus ANIT had significantly less biochemical and morphological indices of liver injury. AP therapy prevents ANIT-induced hyperbilirubinemia and cholangitis.

Liu_J (1993) Treatment of adolescent acne with AP. JTCM Sep 13(3):187-188. China-Mongolia Hospital of Zhalantun City, Inner Mongolia, PRC.

Lundeberg_T; Eriksson SV; Theodorsson E (1991) Neuroimmunomodulatory effects of AP in mice. Neurosci Lett Jul 128(2):161-164. Dept of Physiol II, Karolinska Inst, Stockholm, Sweden. The purpose of this study was to assess the effect of AP on the immunological response. The induction of anti-sheep red blood cells (SRBC) plaque-forming cells (PFC) was used as a measurement of the immune response to treatment. In normal non-immunized mice, enhancement of PFC was seen after a single AP treatment when spleen cells from stimulated mice were cultured with SRBC in vitro. After 3 AP treatments, spleen cells from mice did not show PFC enhancement after treatment with anti-Thy-1.2 antibody and complement, nor after the removal of non-adherent cells. Serum obtained from mice 1 h after AP stimulation enhanced the PFC of normal spleen cells in vitro, but the enhancement was abolished by the addition of propranolol. AP, by activation of the ANS, modulates the immune response.

Okazaki_M; Sakamoto H; Suzuki M; Oguchi K (1990) Effects of single and multiple moxibustion on activity of platelet function, blood coagulation and fibrinolysis in mice. AJCM 18(1-2):77-85. Dept of Pharmacol, Showa Univ, Sch of Med, Tokyo, Japan. The effects of single and multiple moxibustion on platelet function, blood coagulation and fibrinolytic activity in ddY mice were studied. The increase in platelet aggregation and ATP-release after a single moxibustion was dependent on moxa weight and the kind of platelet stimulus. Blood coagulative activity tended to increase in the early phase after a single moxibustion. However, multiple moxibustion maintained the homeostasis on blood coagulation and fibrinolytic activity. The effects of moxibustion on platelet functions and coagulative and fibrinolytic activities cause an enhancement of the phagocytic activity in the host defense mechanism.

Okazaki_M; Aizawa S; Yamauchi M; Oguchi K (1990) Effects of single moxibustion on cutaneous blood vessel and microvascular permeability in mice. AJCM 18(3-4):121-130. Dept of Pharmacol, Showa Univ Sch of Med, Tokyo, Japan. The effects of a single cone moxibustion on cutaneous blood vessel and microvascular permeability in ddY mice were studied by microscopy and by the dye leakage technique. Moxibustion induced an inflammatory response, such as vascular reaction with exudation of leucocytes and enhanced microvascular permeability. This is considered to be a host-defense mechanism.

Orr_PH; Scherer K; Macdonald A; Moffatt ME (1993) Randomized placebo_controlled trials of antibiotics for acute bronchitis: a critical review of the literature [see comments]. J Fam Pract May 36(5):507-512. See Comment in: J Fam Pract Sep 37(3):221. Dept of Community Health Sciences, Univ of Manitoba, Winnipeg, Canada. Acute bronchitis is a common clinical problem that causes considerable morbidity and presents both diagnostic and treatment dilemmas for the physician. An evaluation of all published randomized controlled trials of antibiotics in the treatment of acute bronchitis was conducted to:

1.        quantitatively assess methodologic rigor;
2.        determine if effectiveness of antimicrobial therapy is known and;
3.        analyze strengths and weaknesses of randomized controlled trials in family practice settings.

A scoring system for the evaluation of randomized controlled trials was adapted for this study. Four raters, who were blinded to which journals published the studies and the type of antibiotic used in each study, assessed the six-randomized clinical trials for treatment of bronchitis identified through a literature search. The trials were rated according to criteria that measured internal validity. Scores for internal validity ranged from 65.5-102.5 points with a maximum possible score of 120 points (55-85%). The two trials with the highest scores assessed doxycycline and showed no benefit from use of this antibiotic. Single trials that studied erythromycin and trimethoprim-sulphamethoxazole showed improvement in outcome from use of these drugs; however, of the six trials, these two studies ranked fourth and fifth for internal validity. Low scores resulted from small sample size, possible contamination with other treatment measures, and poor assessment of subjects' compliance with antibiotic regimen. Conclusions: An evaluation of the current literature did not support antibiotic treatment for acute bronchitis. Further studies of this common illness are indicated. It is hoped that this critical review of randomized control trials will prove useful in the planning of future studies, in placing greater emphasis on methodologic rigor, and in giving greater consideration to the practical constraints of research in the family practice setting.

Rogers_PAM; Schoen AM; Limehouse J (1992) AP for immune-mediated disorders: Literature review and clinical applications. Probl Vet Med Mar 4(1):162-193. AP activates the defense systems. It influences specific and nonspecific cellular and humoral immunities; activates cell proliferation, including blood, reticuloendothelial, and traumatized cells; and activates leucocytosis, microbicidal activity, antibodies, globulin, complement, and interferon. It modulates hypothalamic-pituitary control of the ANS and neuroendocrine systems, especially microcirculation, response of smooth and striated muscle, and local and general thermoregulation. Immunostimulant points include LI04, LI11, ST36, GB39, SP06, GV14, BL11, BL20, BL23, BL24, BL25, BL26, BL27, BL28, and CV12. Some, such as BL47, are immunosuppressive. Antifebrile points include GV14 and ST36. Reactive reflex Shu-, Mu- and Ear- points are useful in organic diseases. In immunomediated diseases, some or all of these points can be used with other points, especially local points and points of the major symptoms or points of the affected body part, area, function, or organ. Applications of AP include treatment of inflammation and trauma; stimulation of tissue healing in burns, ulcers, indolent wounds, ischemia, necrosis, and gangrene; infections; postinfection sequelae; fever; autoimmune disease; allergies; anaphylaxis and shock; and treatment or prevention of side effects from cytotoxic chemotherapy and ionizing radiation. AP therapy may inhibit neoplastic cells. Examples are given of AP use in immunomediated conditions in small animals.

Sciesinski_Ka1; Frindt A; Kaleta T (1988) The topography of AP points responsible for the level of cellular immunity in polar foxes. Scientifur 12(2):95-98. Immune AP points GV14, LI04, GB39, SP06 and ST36 were located by a prototype sound-detecting device in 35 arctic fox cubs from 3 litters at 11 and 20 wk of age.

Sciesinski_Ka2 (1988) Immunity stimulation in young polar foxes with the help of AP. Scientifur 12(2):99-104. Inst Anim Breed & Tech Anim Prod, Warsaw Agric Univ (SGGW), ul Przejard 4, 05-840 Brwinow, Poland. EAP (6v, 200 mA, 6 Hz for 5 min) was given at LI04 and LI11 in groups of 12 arctic fox cubs, 6 or 8 wk old. Blood samples were collected before and at 4, 10, 28 and 42 d after stimulation. Leucocyte counts were increased 99 and 65% at 4 d in 6 and 8 wk old cubs, respectively. Counts were still increased by 43 and 34% at 42 d.

Sciesinski_Ka3; Frindt A (1988) Stimulation of cell immunity in young polar foxes by EAP at LI11. Scientifur 12(2):105-108. EAP (12V, 200 mA and 10 Hz for 10 min) was given at LI11 or at a nonspecific point in groups of 12 arctic fox cubs at 7 wk of age. Blood samples were collected before and from 3-56 d after stimulation. Leucocyte counts were increased at 3-42 d compared to controls and were lower than controls at 56 d. Changes in differential leucocyte counts are tabulated. EAP at point LI11 may be used to increase immunity in young foxes.

Sciesinski_Ka4 (1988) Producing immune reaction in adult foxes with the help of AP. Scientifur 12(2):109-114. Inst Anim Breed & Tech Anim Prod, Warsaw Agric Univ (SGGW), ul Przejard 4, 05-840 Brwinow, Poland. EAP (6v, 200 mA, 6 Hz) was given at LI04 and LI11 in adult arctic foxes at 8.5 mo (5 foxes; 10 min) or 6 mo (6 foxes; 5 min) of age. Control groups were stimulated at non-specific points. Blood samples were collected from 24 h to 7 d after stimulation in the older group and up to 73 d after in the younger group. Leucocytosis occurred in both groups from 24 h after AP and persisted for 73 d. Neutrophils were increased while lymphocyte counts decreased from 24 h. At 44 d neutrophils were decreased and lymphocytes were increased. It was concluded that AP can induce a significant immune response in adult arctic foxes.

Sciesinski_Ka5 (1990) The measurements of electrical conductivity of the skin at the AP points affecting the immunity in healthy and diseased polar foxes. Scientifur 14(4):271-273. Inst Anim Breed & Tech Anim Prod, Warsaw Agric Univ (SGGW), ul Przejard 4, 05-840 Brwinow, Poland. Measurements were taken of the electrical conductivity of the Reactive Electric Permeable Points (REPP) LI04, LI11, ST36 and GV14, in 20 mature male polar foxes (Alopex lagopus), 10 with no clinical symptoms and 10 with skin lesions (purulent bite wounds or abscesses). Significant differences in REPP measurements were observed at LI04, LI11 and ST36 (but not at GV14) between diseased and healthy animals. Measurements between the left and right side of the body did not differ significantly. Differences in REPP measurements at LI04, LI11 and ST36 could be of diagnostic value to evaluate the functional state of the immune system of foxes.

Sciesinski_Ka6 (1990) Cellular immunity after AP stimulation at the points GV14, LI04 and ST36 together with prophylactic vaccinations in young polar foxes. Scientifur 14(4):274-278. Inst Anim Breed & Tech Anim Prod, Warsaw Agric Univ (SGGW), ul Przejard 4, 05-840 Brwinow, Poland. 24 polar fox cubs (Alopex lagopus) were assigned at 7-wk-old to 4 groups of 6 (3 from each litter): 1=EAP at non-specific points (Negative Control); 2=EAP at LI04, ST36 and GV14; 3=Vaccine + EAP as in 2 (FH vaccine, against distemper and infectious hepatitis); 4=Vaccine alone. Treatments 2 and 3 increased in the number of leucocytes with initial neutrophilia and lymphocytopenia (11 and 28 d) and subsequent lymphocytes (42 d). Vaccine alone did not influence the leucocyte level. EAP at LI04, ST36 and GV14 increased cellular immunity, increasing the number of and altering the composition of the leucocytes.

Sodipo_J (1993) AP and blood studies in sickle-cell anaemia. Lagos AJCM 21(1):85-89. Clinic AP Centre, Surulere, Nigeria. The author recently treated a case of sickle-cell crisis as an emergency for pain relief using AP because all other conventional therapies failed. The result was so effective, dramatic and encouraging that 4 other cases of genotype SS/SC were also treated. These cases are reported, (though small in number) to bring attention to this easy, simple, cheap and convenient therapy and to stimulate research among practising acupuncturists and clinicians.

Wu_Z (1991) Dr Xu Ruizheng's experience in the treatment of verruca plana (flat wart) with AP. JTCM Dec 11(4):281-283. Nanjing College of TCM, PRC.

Xu_H (1990) [The effect of AP on the regulation of immunity: the discovery of serum lymphocyte transformation inhibitory factor in rats after EAP, determination of biological characteristics and analysis of its mechanism of action]. Sheng Li Ko Hsueh Chin Chan Apr 21(2):158-160.

Xu_Y (1990) Treatment of facial skin diseases with AP: a report of 129 cases. JTCM Mar 10(1):22-25. Dept of Dermatology, Wuhan Municipal Hospital of TCM, PRC.

Yang_SH; Lin JG; Tsai CH; Ma JJ (1993) Protection by moxibustion against experimental hyperbilirubinemia and cholangitis in rats. AJCM 21(3-4):237-242. Graduate Inst of Chinese Med Science, China Med Coll, Taichung, Taiwan, ROC. The effects of moxibustion on experimental hyperbilirubinemia and cholangitis were studied in male rats (n=33). The experimental group were treated with moxibustion, 18, 12 and 6 h before and 6, 12 and 18 h after challenge with oral alpha-naphthyl-isothiocyanate (ANIT, 100 mg/kg). Rats were sacrificed 48 h after challenge. Serum and liver samples were taken for biochemical and histological analysis, respectively. Rats treated with ANIT exhibited elevations in bilirubin, SGOT and SGPT as well as cholangitis. In rats receiving moxibustion and ANIT, biochemical and morphological parameters of liver injury were significantly reduced. Thus, this study shows that moxibustion therapy may be able to prevent ANIT-induced hyperbilirubinemia and cholangitis.

Yuan_D; Fu Z; Li S (1992) [Effect of He-Ne laser-AP on lymph-nodes in rats]. Chen Tzu Yen Chiu 17(1):54-58. Hebei Med Coll, Shijiazhuang, PRC. The lymphocytes and antigen presenting cells in lymph node of rats stimulated by He-Ne laser-AP were observed by using TEM and SEM to investigate the ultrastructural changes of them. There were numerous activated T-cells which showed deeply indented nucleus, abundant small void mitochondria and free ribosomes in the paracortex area. The B-cells were gradually differentiated into large lymphocytes, immature and mature plasmatic cells which with a lot of rough endoplasmic reticulum. They were prominently increased in the pulp area. The macrophages had short processes with numerous folds and microvilli and tended to neighbouring lymphocytes. The nucleus pores were increased. There were a lot of pinocytosomes, phagosomes, lysosomes in various size of macrophages. The bundles (5-6 nm in diameter) of microfilaments of the macrophages were extended from the cytoplasm to the processes. The interdigitating cells which contained the characterized single layer of rER, numerous polysomes, mitochondria and well-developed Golgi-complex were closed to macrophages and lymphocytes. In conclusion the activities of the cellular immunity and humoral immunity were enhanced by laser-AP.

Zhu_Z; Xu R (1990) [Morphometric observation on the mast cells under the AP Channel lines]. Chen Tzu Yen Chiu 15(2):157-158. Inst of Biophysics, Academia Sinica, PRC. Observation of the number, distribution and characteristics of the mast cells under the low impedance AP Channel lines of 19 amputated limbs of patients suffered from osteoblastoma and 21 rats was carried out microscopically after sectioned and toluidine blue stained. The number of the mast cells was more concentrate under the Channel lines in comparison with their control areas. The difference was significant. This experiment reflexed another aspect of the morphological basis of the biophysical nature of the AP Channel.

Zohmann_A (1994) Effects of AP and Neural Therapy on Diseases of the Immunological Defense. Prakt Tierarzt 1 Feb 75(2):93. A Zohmann, Ludwig Boltzmann Inst, Akupunktur Aussenstelle Vet, Rosenegg 61 A, A-6391 Fieberbrunn, Austria. Understanding the mechanisms of self-regulation extends our knowledge of physiology and pathophysiology. Homeostatic mechanisms also form the basis for understanding the effect of forms of therapy which stimulate the immunologic response, in particular AP and neural therapy.

2. FEVERKuang_X; Liang C; Liang Z; Lu C; Zhong G (1992) [The effect of AP on rabbits with fever caused by endotoxin]. Guangzhou Coll of TCM, Guangdong. Chen Tzu Yen Chiu 17(3):212-216. 48 rabbits were used to investigate the effect of AP needling at GV14, LI11 on the level of plasma endotoxin and the change of body temperature. The animals were assigned to groups: 1=Bu manipulation (reinforcing); 2=Xie manipulation (reducing); 3=EAP; 4=Endotoxin-Control; 5=Untreated Control. The different AP techniques had no effect on endotoxin levels or body temperature in endotoxin-induced fever.
Nezhentsev_MV1; Aleksandrov SI (1993) Evaluation of the antipyretic action of psychotropic drugs and their effect on the antipyretic effect of AP therapy. Biull Eksp Biol Med Mar 115(3):262-264. Dept of Pharmacology, Paediatric Med Inst, St. Petersburg, Russia. The effect of psychotropic drugs on antipyretic effect of AP was studied in rabbits with experimental fever. Haloperidol (0.5 mg/kg) and benactyzine (0.1 mg/kg) reduced body temperature in fever; amitriptyline induced no significant changes in fever; all drugs enhanced the antipyretic effect of AP. At 1 mg/kg by a single injection, haloperidol and benactyzine dropped body temperature; diazepam had no influence; at that dose, all drugs reduced the intensity and duration of the antipyretic effect of AP.
Nezhentsev_MV2; Aleksandrov SI (1993) Effect of naloxone on the antipyretic action of AP. Pharmacology May 46(5):289-293. Dept of Pharmacology, Paediatric Med Inst, St. Petersburg, Russia. The effect of the opioid antagonist naloxone on the antipyretic action of AP was studied in rabbits. When given iv before AP, naloxone (0.1-0.2 mg/kg) reduced the intensity and duration of the antipyretic action of AP only in the initial stage. An endogenous opioid system participates in initiation of different responses mediating the antipyretic effect of AP.
Nezhentsev_MVa; Aleksandrov SI (1991) [The influence of aminazine on the antipyretic effect of AP in animals]. Fiziol Zh SSSR Im I M Sechenova Dec 77(12):56-61. AP increased the hypothermic effect of aminazine in rabbits with a fever induced by pyrogenal (2 ug/kg iv). AP points LU11 and LI01 were used. Aminazine (0.5 mg/kg) exerted a little antipyretic effect, but when combined with AP, its effect became potentiated and longer lasting.
Nezhentsev_MVb; Aleksandrov SI (1992) [Febrifugal activity of AP and its strengthening by the effects of anaprilin]. Biull Eksp Biol Med Mar 113(3):288-290. The power and duration of antipyretic actions of AP under single or repeated stimulation of LU11 and LI01 were studied in rabbits. Under conditions of preliminary iv injection of propranolol (1-2 mg/kg), strengthening of AP antipyretic activity was revealed. This effect suggests participation of norepinephrine system in mechanism of febrifugal action of AP.
Nezhentsev_MVc; Aleksandrov SI (1994) [The current concepts of the humoral mechanisms of the analgetic and antipyretic actions of AP (a review of the literature)]. Vrach Delo Mar-Apr (3-4):39-42. Needling triggers adaptive mechanisms, this feature determining a broad range of effects directed towards correction of disturbances in the homeostatic systems of the body. At present peripheral and central levels of response to needling are recognized. In a review of the published literature mechanisms are discussed of analgetic and antipyretic effects of AP based on the latest findings in the field of neurochemistry.
Tan_D (1992) Treatment of fever due to Exopathic Wind-Cold by rapid AP. JTCM Dec 12(4):267-271. Beijing Coll of AP & Orthopaedics, PRC. 57 cases of common cold, influenza, acute tonsillitis and acute bronchitis were treated by rapid needling with filiform needles at GV14, GB20, and LI11. The indices for observation were first determined, and the 19 cases that manifested an axilla temperature drop of over 1oC after treatment and a ratio of <0.3 of the main symptom scores after treatment were regarded as markedly effective; the 27 cases that manifested an axilla temperature drop of 0.5-1.0oC and a symptom score ratio of 0.3-0.6 were regarded as effective, and the 11 cases that manifested an axilla temperature drop of <0.5oC and a symptom score ratio of >0.7 were regarded as failures. The total effective rate was 81%. After AP, body temperature, rate of respiration, pulse, blood pressure and AP point temperature all dropped, with a simultaneous increase in the % of T-lymphocytes. Numbers of peripheral blood leucocytes and lymphocytes did not differ significantly. The immediate effects were especially marked in fevers due to exogenous wind and cold.
Yang_Y; Zhi D (1994) The antifebrile effect of AP and its relationship to changes of AVP levels in the plasma and CSF in rabbits. Chen Tzu Yen Chiu - AP Research 19(2):56-59. Dept of the Physiology and Biochemistry, Lanzhou PLA Military Med Coll, PRC. The study monitored the effects of AP hypothermia and its relationship to the changes of arginine vasopressin (AVP) levels in the plasma and CSF of rabbits. Intermittent EAP clearly inhibited fever induced by endotoxin in rabbits; AVP levels in the plasma and CSF increased markedly in comparison with normal and febrile rabbits; injection of AVP-antiserum into the septal area markedly reduced effects of AP hypothermia. One of the mechanisms of AP hypothermia may be by promoting release of endogenous AVP.
Hu_Ja3 (1991) What are the common AP methods for treating herpes zoster?. JTCM Dec 11(4):302-303. Inst of AP and Moxibustion, China Acad of TCM, Beijing, PRC.
Kasahara_T; Wu YX; Wang Y; Sakurai Y; Oguchi K (1990) Modulation of lipopolysaccharide-induced cytotoxic factor and interferon production by moxibustion in mice. In Vivo Sep-Oct 4(5):289-291. Dept of Pharmacol Sch of Med, Showa Univ, Tokyo, Japan. Pretreatment of mice with moxibustion (Mox) modulated lipopolysaccharide (LPS)-induced endogenous cytotoxic factor (CF) and interferon (IFN) production in serum. CF was measured by the L929 cytotoxicity test and IFN by the cytopathic effect microassay on L929 cells with vesicular stomatitis virus. Significant inhibition of CF activity was observed when Mox and LPS were applied simultaneously.Its potentiation was maximal, circa 9 times the control level, when treatment intervals between Mox and LPS were 24-72 h, and declined thereafter. Mox treatment modified LPS-induced IFN production with a similar biphasic pattern but the onset of modification was delayed. This is the first report of modulation of cytokine production by Mox treatment.
Liao_SJ1; Liao TA (1991) AP treatment for herpes simplex infections: A clinical case report. AETRIJ 16(3-4):135-142. Boston Univ Med Sch, Massachusetts. Herpes simplex is a common skin disorder. There is no effective cure. The recent introduction of drugs, such as acyclovir, is indeed a great advance in its therapeutics. However, these drugs may only modestly reduce the length of an attack, but do not lengthen the remission nor prevent recurrences. Our very limited experience in 2 cases of herpes oral-labialis and 3 cases of herpes genitalis with AP treatment seemed to indicate the possibility of a marked reduction of an episode, a lengthening of the remission, and a prevention of recurrences. We encourage our colleagues to try AP in the clinical management of herpes cases and to study its immunologic effects.
Ma_Z; Wang Y; Fan Q (1992) [The influence of AP on interleukin 2 interferon-natural killer cell regulatory network of Kidney Xu mice]. Chen Tzu Yen Chiu 17(2):139-142. Shaanxi of TCM Coll, Xianyang, PRC. The influence of AP on IL2-IFN-NKC regulatory network was studied in KI Xu (Deficient) mice which received AP at ST36. The interleukin 2 (IL2), natural killer cell (NKC) activity and interferon (IFN) in KI Xu mice were lower than in normal mice. AP increased the levels of all the IL2 and NKC activity, AP promoted Newcastle disease virus (NDV) inducing the IFN of KI Xu mice, but also induced IFN directly. AP made positive adjustment to IL2-IFN-NKC regulatory network. This gives a new theoretical basis for the principles of AP theory on IL2-IFN-NKC regulatory network put forward recently.
Maciocia_G1 (1996) Myalgic encephalomyelitis (ME) and Chronic Fatigue Immune Dysfunction Syndrome (CFIDS): Part 1. Adapted from WWW (Acupuncture.com). [Mr Maciocia developed the East West Treasures line of tablets, which are distributed by Crane Enterprises (1-800-227-4118) on the East Coast and by East West Herbs (USA) Inc (1-800-575-8526) on the West Coast: WebMaster].

Myalgic encephalomyelitis (ME) is becoming more and more widespread in Western countries. ME is the name mainly used in the UK, while in the USA it is now called Chronic Fatigue Immune Dysfunction Syndrome (CFIDS). This Syndrome is also variously called "Chronic Fatigue Syndrome", "Postviral Syndrome", or "Postviral Fatigue Syndrome". I personally make a distinction between "true" ME and "not true" ME which I call "Postviral Fatigue Syndrome", and this distinction (and its significance) will be explained shortly.

Western view
WM generally does not accept or recognize ME as a "disease". The main reasons for this are that ME has no specific diagnostic test and that the same Syndrome may result from many different causative factors (e.g. enteroviruses, Epstein-Barr virus, etc). However, many doctors are researching the aetiology and pathology of ME. In UK, the researchers generally agree that ME is a chronic viral infection. A Coxsackie virus, which belongs to the family of enteroviruses, is thought to implicated. Other researchers think that all of the 72 enteroviruses discovered in the last 30-40 yr are no more than variations of the polio virus, and they believe that ME is nothing but a form of polio. Enteroviruses cause a fever and swollen glands in the acute stage; if not neutralized by the body's immune system, they cause a chest infection and then settle in the intestines where they form a reservoir of infection (hence their name; entero means intestinal). From the intestines, these viruses display a particular tropism towards nerve and muscle cells therefore settling in the muscles and brain: this explains 2 of the major symptoms of ME, e.g. poor memory and concentration, and muscle ache. Muscle biopsy samples of 140 patients with clinical symptoms of ME showed that 24% of subjects were positive for the presence of enterovirus RNA. This may not sound like a high % but it becomes very significant when compared with a control group of 152 subjects, none of whom showed the presence of enterovirus RNA in their muscle biopsies. Statistically, this is a highly significant finding.

CHINESE VIEW.
In TCM, two main Syndromes cause ME: residual pathogens and Latent Heat.

Residual pathogen
Residual pathogen in a common cause of the ME Syndrome. If External Wind invades the body and is not dispelled, or if the person fails to rest during an acute invasion of Wind, the pathogen may remain in the Interior (usually as either Heat, Phlegm-Heat or Damp-Heat). Here, on the one hand, it continues to produce symptoms and signs and, on the other, it predisposes the person to further attacks by External Pathogens because it obstructs the proper diffusing and descending of (causes Stasis of) LU-Qi. It also tends to cause Qi-Xu and/or Yin-Xu, establishing a vicious circle of pathogen and Xu (Weakness).

Apart from Heat itself, Damp-Heat is a very common residual pathogen after febrile disease. There are 2 main reasons:
1.        Febrile disease upsets the ascending and descending movements of SP and ST, and thereby upsets the Jin-Ye. Because ST-Qi cannot descend, Ye (Turbid Fluid) is not transformed, and because SP-Qi cannot ascend, the Jin (Clear Fluid) cannot be transformed: this leads to the formation of Damp.
2.        Heat burns the Jin-Ye, which can then condense into Damp. Once formed, Damp tends to be self-perpetuating. It further impairs the transformation and transportation functions of SP; this causes formation of more Damp, establishing a vicious circle.

Antibiotics are one of the main causes of residual pathogen in our society. Whilst they destroy bacteria, from the viewpoint of TCM they tend to "lock" the pathogenic factor into the Interior and do not release the Exterior in the early stages of External invasion, nor do they Clear Heat or resolve Phlegm in the later stages.

Latent Heat
Symptoms of ME appearing without an acute infection can be explained as a manifestation of Latent Heat. The "Simple Questions" in chapter 3 says: "If Cold enters the body in wintertime, it comes out as Heat in springtime." This means that a pathogen (which may be Wind-Cold or Wind-Heat) sometimes can enter the body without causing immediate symptoms. It then incubates in the Interior and turns into Heat; the Heat emerges later, moving to the Exterior and causing a person to feel a sudden onset of great weariness with dragging limbs and a slight thirst. The patient feels Hot and irritable, does not sleep well and passes dark urine. At this time the pulse feels Fine and slightly Rapid and the tongue is Red. This Syndrome (Latent Heat), is also called Spring Heat, although it can occur in any season, not just in springtime.

Latent Heat, besides causing the above symptoms and signs, also tends to injure Qi and/or Yin, thus establishing a vicious circle of Heat and Xu. In ME, Latent Heat usually takes the form of Damp-Heat. This process ("incubation" of an External pathogen in the Interior to emerge as Heat later) explains many cases of ME. Latent Heat may move outward to emerge on the surface by itself, as described above; alternatively, it may be "pulled" towards the surface by a new invasion of External Wind; there would also be some External symptoms such as shivering, fever, occipital headache, aches and sneezing, plus the above symptoms of Internal Heat. However, the pulse (Fine and Rapid) and tongue (Red), clearly point to Internal Heat. Emotional stress is another factor that may draw Latent Heat towards the surface. This may pull Latent Heat outwards, especially when it affects LV and causes Heat.

Thus Latent Heat occurs when an individual suffers an invasion of External Wind without developing immediate External symptoms; Wind pathogen remains and incubates in the Interior and turns into Heat that emerges out months later. KI-Xu is the usual underlying reason for this. In KI-Xu, due to overwork and excessive sexual activity, the body's Qi is too weak even to respond to the invading External Wind.

If the body condition and KI are good, a person develops symptoms at the time of invasion of External Wind. This is the healthy reaction. TCM taught that if the Jing-Essence is properly guarded and not dissipated, pathogenic factors can not enter the body and Latent Heat can not develop. "Simple Questions" (Chapter 4) says: "Jing-Essence is the root of the body; if it is guarded and stored Latent Heat will not appear in springtime." This concept is very important in practice; it implies that resistance to pathogens depends not only on LU-Qi (which influences Weiqi), but also on KI-Qi and KI-Jing.
Maciocia_G2 (1996) Myalgic encephalomyelitis (ME) and Chronic Fatigue Immune Dysfunction Syndrome (CFIDS): Part 2. Weiqi is spread by LU but it has its root in KI, specifically KI-Yang. Also, in chronic, recurrent infections such as ME, KI-Qi is often Xu, causing a decreased immune response.

Vaccination is another possible cause of Latent Heat. From the perspective of the 4 Levels of TCM, WM immunization consists of injecting a pathogen (albeit attenuated) directly into the Xue. Attenuated or inert forms of pathogens are injected into the body, by-passing the body's first line of resistance. In TCM, it is as if an External pathogen penetrated the body's Interior directly, completely by-passing the External levels. This can cause problems.

Latent Heat also can manifest as the Shaoyang (TH-GB) Syndrome, characterized by alternation of shivers and feeling of Heat, when the pathogen is "trapped" between the Interior and Exterior: for this reason, when it goes towards the Exterior the person feels Cold, when it goes towards the Interior the person feels Hot. This Syndrome is more common in teenagers and young people.

In all the above Syndromes the underlying cause is overexertion and lack of adequate rest as explained above.

To summarize, 3 factors can cause ME:
1.        Residual pathogen (usually Damp-Heat) after invasion by an External pathogen
2.        Latent Heat (usually also as Damp-Heat)
3.        Shaoyang Syndrome (a form of Latent Heat).

The 4 groups of symptoms essential to diagnose ME are:
1.        Chronic fatigue;
2.        Poor memory and inability to concentrate to the point of forgetting words while speaking, a "muzzy" feeling of the brain;
3.        A persistent and intermittent flu-like feeling with shivers, sensations of Heat, sore throat, swollen glands;
4.        Muscle ache and fatigue after the slightest exercise.

I personally consider these to be the essential manifestations of what I call "true" ME, by which I mean one characterized by a persistent, chronic viral infection. If one or more of these 4 groups of symptoms are absent, I call the Syndrome "not true" ME or simply "Postviral Fatigue Syndrome", e.g. a state of fatigue after an acute febrile disease but without a persistent viral infection. Although the aetiology, pathology and treatment of ME and Postviral Fatigue Syndrome are exactly the same, I believe this distinction is important for prognosis as "true" ME is much more difficult to treat and will take longer to respond to treatment.

In TCM, muscle ache is directly related to Damp: the more Damp, the greater the muscle ache, and vice-versa. From a WM perspective, I relate the muscle ache intensity to the viral infection.

Treatment.
Every case of ME has both a Xu (Weakness) of Qi, Yang, or Yin and a Shi (Excess), usually of Damp or Damp-Heat. However, the Xu and Shi are never absolutely equal; one always predominates. One cannot differentiate between a Xu and Shi state on grounds of tiredness alone. Symptomatically, the more muscle ache, the more Shi. Pulse- and tongue- diagnosis are essential to distinguish between Xu and Shi states. Shi predominates if the pulse is Full and Slippery and the tongue has a thick coating; Xu predominates if the pulse is Weak or Fine and the tongue has no thick coating. In Damp (as in other Qi disorders), if Xu predominates, reinforce (nourish, tonify) by Bu method; if Shi predominates, disperse (drain, expel) by Xie method. (In Xu use Bu; in Shi use Xie).

Symptom-, Tongue- and Pulse- Differentiation between Xu and Shi in ME:
Xu         No or little muscle ache, no pronounced flu-like feeling; T: Thin coating, not too Swollen; P: Weak, Choppy or Fine.
Shi         Pronounced muscle ache and flu-like feeling; T: Thick coating, Swollen; P: Full, Slippery or Wiry.
Nam_TC; Chang CH; Park YH; Seo KM (1996) Therapeutic effects of AP in calf respiratory disease. Proc. World Buiatrics Congress, Edinburgh, July. Coll Vet Med, Seoul Nat Univ, Seodun-dong, Kwonson-Gu, Kyung Gi-Do, 441-744, South Korea, Fax: +82-331-293-6403. Traditional AP points used to treat respiratory disease include SanTai, FeiYu, An-fu and SuQi. Clinical, bacteriological, virological and immunological effects of AP were studied in 89 calves with respiratory disease, which were allocated to one of 5 groups for treatment by: 1=Medicine alone; 2=Medicine + AP at SuQi; 3=Medicine + AP at (SanTai + FeiYu + AnFu); 4=AP at SuQi alone; 5=AP at (SanTai + FeiYu + AnFu) alone. In the AP groups, needles were inserted into the points to a depth of 3 cm for 20 minutes daily for three days. Clinical recovery rates (Excellent to Good) were respectively: 1=59%; 2=83%; 3=73%; 4=83% and 5=63%. Virus isolation rate was significantly decreased in calves with viral respiratory diseases after AP. Otherwise, antibody response of calves given AP, especially at SuQi, was increased significantly. The % leucocyte subpopulation expressing MHC class II antigen, CD2, CD4, sIgM and N12 antigens were significantly higher in the calves with respiratory disease treated with AP. AP therapy reduced the clinical signs in calves with respiratory disease and promoted their immune responses. Therapy which combines medicine with AP could be put to practical use in field outbreaks of respiratory disease in calves.
Rothfeld_Gb1 (1996) Chronic Fatigue Syndrome (CFS): Part 1. Glenn Rothfeld MD. Adapted from WWW (http://www1.shore.net/~spectrum/articlesandstories.html).

Alternative view: patterns of disharmony (TCM Syndromes)
According to a recent study in the NEJM, millions of patients are turning to so-called Alternative Medicine to treat their conditions, many times without discussing their plans with their primary physician. The slowness with which orthodox medicine has acknowledged the existence of CFS, and the lack of a coherent pattern of diagnosis and treatment, have set many CFS patients along this course.

This paper will focus on one such alternative approach which is being used by many with CFS. TCM includes AP, Chinese herbal medicine, and Qigong exercises and massage techniques. These treatments are sometimes used separately and sometimes together. All are based on principles of TCM written some 2500 years ago and based on even older concepts.

The ancients studied the natural world, and described events in the human body in terms of those forces of nature. Because they revered their dead, they did not dissect or biopsy for information. Rather, their medicine was based on what they observed in the living patient, what the pattern of symptoms were.

One can see why TCM is an attractive way of approaching CFS. Firstly, TCM starts with the concept of Qi ("energy" or "life force"). For a patient whose primary symptom is Qi Xu (lack of energy), particularly fatigue which is highly variable, disabling, and invisible to the outside world, a system which at least acknowledges the existence of Qi as a concept is refreshing.

Secondly, there is no question of whether this is a "real" illness in TCM. That is to say, ANY combination of symptoms and patient presentation is seen in terms of Qi imbalance and treated as such. There is no division of mind and body (or of "spirit" for that matter: more on that later) in this medicine. An emotion is seen as the non-physical representation of an illness. There is no hierarchy of physical and mental, and no need for a patient to plead for a SPECT scan to prove that they don't need a psychiatrist.

Thirdly, because TCM focuses on Syndromes of presentation and on the interrelationship of body systems rather than on causative factors and discrete organ pathologies, one can easily explain the global effects of an illness such as CFS. The myriad symptoms of the neurologic, psychologic, gastrointestinal, reproductive, respiratory, haematologic, dermatologic, and immunologic systems can confound (and sometimes, cause "turf wars" between) WM specialists. For TCM, they are different hues to paint a more complete picture of imbalance.

Finally, since the forces of nature never change, the Syndromes described in CFS are familiar ones to a practitioner of Oriental Medicine. The diagnosis and treatment is based on the skill of the practitioner and does not change rapidly with advances in immunology and pharmacology.

A full discussion of TCM diagnosis is beyond the scope of this article. But, here are some Syndromes of disharmony commonly seen in CFS. The organ names (KI, SP, etc) are NOT referring to the anatomical organs, but to energetic functions related to the organs, as the Chinese understood them.

Yin-Yang disharmony: All of life involves an interplay of active and passive principles: day/night, summer/winter, hot/cold, exterior/interior, sympathetic/parasympathetic. The Yang part of the Qi is that part of us which is in movement, warms us, is active, external, and lifts us up. The Yin part is interior, replenishes, anchors and nourishes us, creates stillness, and is cool and fluid. Common Yin-Yang disharmony in CFS patients presents mainly as Xu (Deficiency) of Yin or Yang:
Yang Xu: collapsed fatigue, difficulty waking in the morning, cold limbs, sluggish digestion and other body processes, diminished libido; and/or
Yin Xu: restless fatigue and insomnia, hot flushes, stiffness and deep aching pain.

Shaoyin (KI) Disharmony: In TCM, the KI Qi is the deepest energy and holds the reserves and the will. Therefore, any chronic illness will eventually deplete the KI Qi (causing KI Xu), especially the Yin aspect which is like an underground spring: deep, refreshing, and liquid. KI Yin Xu is a common Syndrome in CFS, as it is in AIDS and in other chronic debilitating conditions. (The similarity of some AIDS and CFS symptoms cause confusion and frustration in the research, clinical and political worlds; in TCM they can be seen as different degrees of the same disharmony Syndromes). KI Yin Xu can show up as frequent urination, severe exhaustion, weak legs and knees, dizziness and tinnitus, dry mouth and throat, disturbed, restless sleep which does not relieve the fatigue, night sweats, fearfulness and lack of resolve and willpower. The Shaoyin Channel (HT-KI) also includes HT Qi, which holds the Spirit, or "Shen." This Shen, the spark of liveliness within us, is not really a mental process in TCM, but has to do with our potential to live life fully. I have had patients who have had their "spark" drained by their constant battle with chronic illness, such that they became flat and hopeless. Every so often, they awake feeling some energy, and they put a smile on and fill their day with activity. Yet, these patients are frequently treated as having endogenous depression, and given mood elevators.

Weiqi Disharmony: LU governs Weiqi, or Protective Qi, which prevents our receiving External Pathogens (the adverse climates, outside or foreign influences, viruses, toxins). Weak Weiqi will lead to repeated episodes of viral-like illnesses, scratchy throat, slight fever (especially later in the day), shortness of breath, and a dry cough, as well as exhaustion.

Damp-Heat Syndrome: This frequently comes from an infection (a common precipitant in CFS) or from unhealthy lifestyle patterns. Dampness is the term given to the waste products of metabolism and digestion, which can accumulate in the Qi Channels. This leads to aching and tiredness in the muscles, heaviness of body or head, fatigue after any exertion, bloating and sour digestion, and a lack of concentration and clouded feeling in the brain. With heat (from infection, or Yin Xu (Deficiency)) can come burning on urination, foul gas and vaginal discharge.

Pericardium-Circulation-Sex Syndrome: Five Phase AP, popularized in the West by Prof JR Worsley, includes the concept of PC (the Heart Protector, or Circulation-Sex Channel), which guards HT. Thus, when one's intimacy is breached (by rape, abuse or even "heartbreak") the PC (HT Protector) is adversely affected, so that external factors are allowed in which should not be, and those which should get in are kept out. This can manifest as environmental sensitivity (overreacting to things which should not be threatening), as issues involving intimacy, or as tightness in the chest and as coldness and paraesthesias of the limbs (Qi staying close to the HT).
Rothfeld_Gb2 (1996) Chronic Fatigue Syndrome (CFS): Part 2. Glenn Rothfeld MD.

Therapies
AP: There are approximately 8,000 AP practitioners in the U.S., 25% of whom are MDs. AP involves the placement and manipulation of thin needles in "points" along the Qi Channels. This facilitates the movement of stuck Qi, and helps repair the disharmonies. Points also may be stimulated by moxibustion, by electrical current, magnets, or lasers. A typical course of AP involves treatments 1-2 times/wk. CFS, as a chronic illness, takes a while to treat effectively, but common results after a few weeks of treatment are less heat sensations, less muscle and joint pains, and an increased sense of well-being.

Western perspective: AP was first introduced in the U.S. as an alternative to anaesthesia, and most of the Western research has still focused on this, somewhat peripheral, use. The discovery that AP needles stimulate the type 3 afferent muscle fibres to release endorphins, and that AP releases ACTH and TRH in the central nervous system helps to understand the effects which (unlike TENS machines) last for days after the needles are removed. However, it is the application of electromagnetic field theory and of quantum physics to the neuroendocrine system which is beginning to articulate a basis for understanding how AP works.

CHM: There are hundreds of Chinese herbs, and they are combined into formulas, which are then given in pill, powder or tincture form, or cooked whole until the liquid extracts the resins and is drunk. A course of therapy is usually several weeks, after which the prescription is altered according to response. An herbal prescription usually contains the herbs of main action (e.g. KI tonic herbs for treating KI Xu syndrome), secondary herbs to help correct the imbalances, and herbs to ameliorate any side effects (e.g. herbs to protect ST from irritation). This allows the herbalist to use smaller (and therefore safer) doses of any single herb, and still get a powerful cumulative effect. The current push in psychiatry toward poly-pharmacy, and the "step" approach in antihypertensive therapy use similar principles.

Western perspective: The current interest in the antineoplastic drug Taxol, produced from the Pacific Yew tree, and the investigation of trichosanthes (Chinese cucumber) and various mushrooms have brought Chinese herbal medicine to the attention of Western scientists. When studied, various herbs have antimicrobial (isatis, astragalus), antiparasitic, antineoplastic and antihypertensive effects. There are also resins called terpenes and saponins that are prevalent in herbs such as ginseng, astragalus and licorice, which have what is called an "adaptogenic" effect on the adrenal and other endocrine organs. However, studies of the prescriptions themselves rather than the component herbs, are just beginning to appear in Western journals.

Qigong: The PBS/Bill Moyers special "Healing and the Mind" has brought Qigong to prominence. Qigong literally means "energy exercise" and can include anything from Taiqi (a dance-like series of movements) to Gongfu and other martial arts. A Qigong practitioner will teach a patient exercises to build the Qi, and to encourage it to circulate within the patient's Channels. The exercise form is not stressful, and can be done by patients who are otherwise disabled. Qigong can also involve treatment with a form of massage called acupressure, which the patient can be taught to self-administer.

Western perspective
There is some controversy over the use of exercise in CFS. Qigong is actually similar to yoga in that the mind and the breath are used with gentle movements and postures. Whereas yoga and meditation have been studied some, studies of Qigong await the acceptance in the West that concepts like "energy" and "well-being" are real and tangible to patients.

Conclusion
In the 19th century, Dr Ehrlich began what is known as the search for the Magic Bullet. This paradigm, that there is an infectious cause of a disease and therefore a discrete curative substance which merely awaits discovery, has dominated medicine through the current century. This in turn has led to major medical successes over bacterial and related diseases. But it has also steered us down an increasingly expensive path of capsular protein antigen assays and fourth-generation antibiotics.

CFS, with its wide range of symptoms and of target organs, its insidious onset and variable course, and its focus on the patient's own report of their energy, poses an elusive and complex problem for this model. TCM and its therapies give CFS patients a different perspective of their illness, and offer some the hope of an effective adjunct or primary form of treatment. For more information please contact us by e-mail: [email protected]
Stone_Ae (1996) The Root, Branch and Smell of AIDS. Adapted from WWW: Al Stone e-mail: [email protected]).

Treating AIDS is a symptomatic and systemic problem for the practitioner. But we have to extend the Chinese analogy of Ben and Biao, or Root and Branch to one more part of the tree, and that is "smell." I'm not referring to the smells that give the practitioner diagnostic information, but an ineffable cloud that hangs over a patient's life that the practitioner cannot fail to address, and that is the fear of death.

AIDS has given way to the euphemism "HIV" for 2 reasons.
1.        A class of patients exists with a T-cell count >200 who are HIV positive but asymptomatic (not suffering from AIDS).
2.        We prefer to say HIV instead of AIDS because we have decided, collectively and unconsciously, that HIV is a condition but AIDS is an incurable disease. (The latter need not be so: many methods can help, if not "cure" AIDS-sufferers).

AIDS is as much a medical differentiation as it is a thick dark cloud hanging over the most vulnerable place of the human psyche. Hence, when treating AIDS we have 2 jobs, one is to boost the immune system and provide symptomatic relief for specific manifestations of opportunistic infections, and the other service we provide is to poke a hole in that dark cloud of fear called AIDS. It requires not information found in a book, but confidence and compassion on the part of the practitioner.

We are often in a position to provide hope to those who have none. But hope is not empty words of encouragement. The more real it is within our hearts, the more of it can be provided to the patient. Qigong teaches that the Qi follows the Shen-Spirit (Qi follows our conscious intent). When our Shen-Spirit touches the heart of another, their body receives Qi through this interaction. This is why sincere encouragement of the practitioner will effect the patient. Western science might call this the placebo effect. TCM calls it External Qigong. Some Western religions call it the Power of Love.

The placebo effect is compassion made manifest.
Guan Yin, the Buddha of compassion, is sometimes shown with her hands held in a specific mudra, or meditative posture. This position, which has the tips of the middle (PC, Fire) and ring (TH, Fire) fingers touching the tip of the thumb (LU, Metal), has an energetic effect. The index (LI) and little fingers (HT, SI, Fire) are extended outward. The central energetic purpose of this mudra is that Qi is circulated back toward yourself, and extended out at the same time. In this way, we are reminded that Compassion is loving yourself, and recognizing yourself in another.

This is why, in order to adequately treat the fears of another, we must create an honest and courageous relationship with our own mortality. Clearing away the dark cloud of the fear of death that looms above the AIDS patient must first be cleared away within the mind of the practitioner. We must all die and we must all accept the divine timing inherent within our lives. It is difficult to say who is taken from us too early and who sticks around longer than is necessary. From the Oriental philosophical outlook, we all come at exactly the perfect moment and leave with that same perfection.

AIDS, the dark cloud, is too big for any one of us to treat, not because of its size, but because of its lack of substance. It is added to every time we turn on the television. AIDS is fear. Fear causes the Qi to descend and causes KI-Xu and Weiqi-Xu (weakens KI and immunity). Before AIDS was officially recognised, there were opportunistic infections. We practitioners can fight these with AP and herbs. However, we must also confront the fear that this little retro-virus has spawned.

Pain is inevitable, suffering is optional: pain comes from the physical condition. Suffering comes from fear. The needles and herbs can take away the pain, but it is up to us to remove the suffering (fear); we begin with ourselves.

Tang_Z; Song X; Zhou M; Zhang J; Dong C; Ni D (1992) [Influence of moxibustion on TXA2 and PGI2 in plasma of rat infected epidemic haemorrhagic fever virus (EHFV)]. Chen Tzu Yen Chiu 17(1):45-47, 44. Inst of AP and Channels, Anhui Coll of TCM, Hefei, PRC. Rat were infected with EHFV and the influence of moxibustion on TXA2 and PGI2 in plasma was observed. Plasma TXA2 increased and PGI2 decreased significantly after abdominal inoculation of EHFV. The level of TXA2 decreased and PGI2 increased markedly to normal level in rats infected EHFV after treatment with moxibustion, suggesting that the regulative function of moxibustion on TXA2 and PGI2 is a significant nerve-endocrine-immune regulation in the body. This study provides an important reference for mechanism exploration of moxibustion preventing and treating EHF.
Tang_Z; Song X; Liu B; Zhou M; Dong C; Ni D (1990) [Research on moxibustion in the treatment of EHFV-infected rats]. Chen Tzu Yen Chiu 15(4):302-305. Inst of AP and Channels, Anhui Coll of TCM Hefei, PRC. We studied the effect of moxibustion on the changes of antigens, antibodies, neurotransmitters in blood and tissue in 60 weanling Wistar rats experimentally infected with EHFV by the abdominal cavity. The rats were assigned at random to 3 groups: 1=Normal control (N); 2=EHF control (C) and; 3=EHF + moxibustion (M). Moxibustion was given at BL23 for 30 min/d, for 7 d. On d 14 after EHFV-infection, blood and lungs of the rats were examined. Results: 1. Serum BUN values in groups N, C and M were 15.3+2.50 (n=10), 24.6+7.24 (n=10) and 16.4+4.59 (n=26); the differences between group C and N and M were significant (p <.001), but not between groups N and M (p >.05). 2. EHF specific antibody titres in groups C and M were 1:267+82 (n=8) and ; in group M 1:336+176 (n=10); the difference was significant. Moxibustion enhanced the function of immune system in rats with EHF. 3. EHFV antigens occurred in lungs of groups C and M occurred in 62.5 (n=8) and in 49.4% (n=16); moxibustion may enhance immune function and may eliminate virus from lung lymphocytes.
Zeller_B (1996) AIDS and addiction: A model of long term care. Barbara Zeller MD, Med Director Samaritan HELP Project, 1401 Univ Avenue, Bronx, New York, 10452; Tel: 718-681-8700. The person with AIDS who is chemically dependent has special needs, requiring an integrated model of care. Samaritan HELP Project is a 66-bed long term care facility located in the heart of the HIV epidemic in the Bronx, New York. The program addresses the special needs of the person with AIDS who is chemically dependent, often homeless or incarcerated, and often co-infected with tuberculosis. HELP has developed a model for Primary Care utilizing an interdisciplinary team approach. This program provides primary HIV Med care, with an alternative component of AP and Herbal Med, intensive resident education, 24 h nursing care, a graduated phase substance abuse program within an adaptive therapeutic community, therapeutic activities, and a special activities track for people with HIV-cognitive impairment. The program has filled a special need, providing a higher quality of life, Med stabilization, and, for over half of the residents, a return to independent community living. People with AIDS and chemical dependence can achieve an improved quality of life and recovery from chemical abuse through an integrated care model in a setting of a nursing home/adaptive therapeutic community.

Chen_ZL; Lu J; Wang JG (1989) Discussing the feasibility of AP treatment on AIDS according to clinical symptoms. Shanghai J AP Moxibust 8(3):42-43.
Debata_A (1987) The AIDS peril and the AP clinic: 1. J Jpn AP Moxibust 46(5):107-110.
Denzin_M (1987) AP and AIDS: some guidelines for the prevention of nosocomial disease transmission. AJA 15(4):355-356. As an invasive procedure which exposes personnel to blood and bodily fluids, AP needs special guidelines for prevention of nosocomial spread of AIDS and other blood-borne diseases. Sterilization of needle sand segregation of needles are too subject to human error to be acceptable protocol during a time when the incidence of blood-borne infectious disease is so high.
Dui_J (1990) [Exploratory treatment of AIDS by AP]. Chen Tzu Yen Chiu 15(3):250-251. Dept of AP and Moxibustion, Second Hospital of Tianjin Med College, PRC.
Henry_K (1988) Alternative therapies for AIDS: A physician's guide. Minn Med 71(5):297-299.
Hirose_K; Tajima K; Fujihira N; Hasegawa S; Fujioka M (1995) [AIDS/HIV related knowledge, attitude and behaviour of AP therapists in Aichi Prefecture]. Div of Nippon Koshu Eisei Zasshi Apr 42(4):269-279. Epidemiol, Aichi Cancer Centre Research Inst. To promote AIDS prevention measures in Japan, the actual state of knowledge, attitudes and behaviours (KAB) of workers at risk for HIV infection requires clarification. In the present study, AP therapists in Aichi Prefecture were evaluated for level of their KAB. By using a self-administered questionnaire, the KAB condition of 500 AP therapists was surveyed from September-November in 1993. Responses from 494 (99%) were available for analysis. Knowledge level on general issues regarding HIV epidemics was good. The main sources for information on AIDS/HIV were TV, general lectures, public reports and magazines. >80% of AP therapists sterilize their needles by autoclave or boiling and 60% of them use disposable needles. Also, 97% of the therapists reported utilizing one or the other of these methods. >50% of them have participated in AIDS education programs. While circa 30% of them responded that they are able to accept HIV carriers as clients, 20% of them expressed negative responses. There appears to be a discrepancy between their level of knowledge of HIV transmission routes and their practical attitude towards clients with AIDS and/or HIV carriers. A more appropriate education program based on behavioral science is desirable to lessen discrepancy distance between general knowledge and preferable behaviour regarding AIDS/HIV.
Hou_ST (1988) Current status in AIDS treated with TCM by doctors in US. Beijing JTCM (3):42-47.
James_JSa1 (1995) AP and TCM in the treatment of AIDS: Part 1. AIDS Treatment News, Issue #230, September 1. Interview with Tom Sinclair LAc. Thomas M Sinclair MS LAc, Diplomate Nat Board of AP Orthopaedics, has treated people with HIV for eight years. He is executive director of the Immune Enhancement Project in San Francisco. AIDS TREATMENT NEWS interviewed him August 22, at the IEP office in San Francisco's Castro district. The questions (Q) were asked by James and the answers (A) were given by Sinclair.

(Q): Where do you have most success with TCM?
(S): TCM has been particularly successful in treating peripheral neuropathy, sinusitis, pain-related problems, night sweats, insomnia, dry skin, headache, and low energy, and fatigue. With digestive problems, we do not always get a person functioning back at a normal level. But often AP, together with diet changes or medication, can help to return the digestion to a more normal state.

(Q): Where does TCM not work as well?
(S): The first condition that comes to mind has been Kaposi's sarcoma (KS). We have not had good success in that area. And sometimes in late-stage AIDS it is difficult to make dramatic changes, as the body's energy is so depleted (Qi Xu).

Finding a Practitioner
(Q): How can somebody go about finding a practitioner of TCM across the US. How do regulations differ in different states?
(S): Currently in the US there are 27 states where AP is licensed and regulated. It goes all the way from California, where we function as primary care physicians, to some states, even including Illinois, where AP is illegal at this point. You need to check with the local licensing bodies.
Most importantly, you want to go to somebody who is licensed, if licensing exists within your state; that is your assurance that you will get at least a minimal level of competency. In most states, there is a tendency to regulate only AP, as opposed to herbal medicine. In California, our license covers both herbs and AP. There are a number of ways to choose a practitioner:

Referral through friends, people who have seen a practitioner, is often the best way. You get the most personal insight about the practitioner.

Check with your physician. We have been developing a much better rapport with physicians than in the past. Often physicians will have practitioners they send people to.

Check with local HIV agencies. Often they have listings of practitioners.

Contact programs like the Quan Yin Healing Arts Centre, in San Francisco, which offers an HIV certification; they have a list of practitioners across the country who have taken their HIV training. It's quite a good program -- and an assurance of a standard.

Call the state licensing agency (in California, it is the Department of Consumer Affairs), and ask them to send you a list of licensed practitioners.

Also, there is a National Commission for the Certification of AP Practitioners, NCCA. They have been accepted as the standard in a number of states that do not have their own state licensing exam. You can find out if someone has a national board certification in AP, and also in herbs.

For an individual state listing, send $3 to: NCCA, P.O. Box 97075, Washington, D.C., 20090-7075; or you can order the complete directory for the whole U.S. for $22, (which includes postage). You can also order by phone, 202/232-1404, 9 a.m. through 5 p.m. Monday through Friday, Eastern time.

Probably the most important question I would ask, if I were going to choose an AP practitioner, is how much experience they have treating HIV. Choose a practitioner who has as many years as possible. HIV is a very complex disease; the same underlying problem can look quite different in different people.

Private Practitioner versus Clinic
(Q): What is the difference between seeing a private practitioner, going to a clinic, or going to a teaching- school clinic?
(S): The advantage of a private practitioner is that you get more individualized treatment. A clinic will cost less, but you may be treated in a group setting. It may be a room with as many as ten to twelve tables, or just two or three tables. The quality of care is largely equal; the difference is the amount of time the practitioner can spend with you.

If you go to a teaching school, you will often be seen by students; it's like going to a teaching hospital and being seen by medical students. The care certainly can be excellent; but you need to realize that you are being seen by someone in training, not a seasoned, licensed practitioner, but someone on their way there.

Paying for AP
(Q): In San Francisco, what might people expect to pay for TCM treatment?
(S): To see a private practitioner in the San Francisco area, the average cost is about $55 for an hour appointment. For a clinic, we try to offer low-cost care, by offering package programs. The most common program at our clinic is th e 12-week program of herbs and AP. The $240 cost covers basically all the herbs you need over a three-month period, plus an initial consultation and AP session, and three more AP sessions. If you need additional AP, we charge $25 a session. This is about the going rate for clinics that have sliding scales.

In San Francisco there are other payment options. Medi-Cal can pay for two visits a month. The Immune Enhancement Project, the Bayview-Hunter's Point Foundation, and the American College of TCM, all have a Ryan White (Federally funded) program that provides free herbs and AP to HIV-positive residents of San Francisco with income no more that $1,160 per month.

(Q): Will insurance companies pay for AP and herbal treatments?
(S): That depends on the company, and on local regulation. Call your health-insurance carrier and find out what they will cover. We have had good results with companies like ITT Hartford, and Aetna. Some Blue Cross and/or Blue Shield policies will cover AP, as will some Prudential policies. You need to check about your policy, and find out if they will pay for treatment with both herbs and AP. Often insurance will only pay for AP treatment.

(Q): In that case, can you bill for the AP separately, so the patient can pay for only the other part?

(S)? Yes.

(Q): I have heard that the FDA is about to reclassify AP needles. What is the practical meaning of that?

(S): There were five different applications submitted to the FDA for uses of AP needles. Currently AP needles are classified as an experimental device. So a new classification will make it much easier to get insurance reimbursement, and open a number of possibilities including applying for Medicare reimbursement. Insurance companies do not like to pay for things that are regarded as experimental procedures, and it has been a real drawback that needles were classified this way. I believe the ruling is due out sometime in September, and we are pretty certain that needles will have one classified use. That will improve the whole realm of insurance reimbursement.
James_JSa2 (1995) AP and TCM in the treatment of AIDS: Part 2.

AP, Herbs, Electrostimulation, Moxibustion, Other Treatments
(Q): Should patients usually take AP and herbal treatments together?

(S): When I work with patients, I like to work with both. Often I will work on a more long-term, internal basis using herbs. They come in decoctions (prepared into a drink like a strong tea), or tinctures (herbal extracts in alcohol), or raw compressed tablets. Often they have a slower effect than AP, but act better over a long time. Often I will use the AP treatment for immediate symptom relief. If someone comes in with a headache, or neuropathy, or sinusitis, I will probably use AP to treat those symptoms. But the underlying condition, the HIV infection, we would probably treat more with herbs. This rule has many exceptions, of course, in how I work with people.

I think it's best to use both herbs and AP together. But some people have certain preferences. Some have a fear of needles, or have had bad experiences, or just do not find AP pleasant; there is nothing wrong with just using the herbs. And some people do not like taking herbs; particularly in HIV infection, people are taking so many pills, and one of the problems with the herbs is that you need to take a lot of product to have an effect -- simply because there is a lot of fibre. Look for a practitioner who is flexible, to work with you where you're at.

(Q): Can you describe herbal decoctions?
(S): That is the traditional way of taking herbs in China. They put together a formula by assembling many loose herbs, as roots, barks, seeds, twigs, berries; then that mixture is cooked, and the liquid is reduced, and drunk over a period.

(Q): Is AP painful?
(S): That is a concern for many people. Of course you feel a prick as the needle penetrates the skin. What people sometimes describe as painful is more the AP needling sensation. That sensation is called Deqi ("arrival of Qi" at that point. That can feel like a burning, a tingling, numbness, a grabbing sensation, an electric sensation. This is an appropriate response; it's what we are looking for, it means that your body is responding to the stimulation it is receiving.

Most people find AP sessions very relaxing, whatever we treat. Some patients just have a great sensitivity; usually people are much more sensitive when they first start treatment. As your body becomes more balanced and more adjusted, you will find that the needling sensations are much less painful.

(Q): How often does one receive AP?
(S): What I have observed in eight years of treating persons with HIV with herbs and AP is that those who do the best are those who start early, and those who are very consistent. How often you see a practitioner can depend on your lifestyle, your economic situation, your commitments. The best thing is to be very regular; it may be once a month, twice a month, twice a week -- what is important is to stay with it over a long period of time. I often tell clients I would rather t hey come in once a month for three years than once a week for three months.

Treatment with herbs and AP is a subtle process which can have dramatic changes, but you need to think about the long haul. As Westerners, as members of a pill-popping society, people want to have immediate results. Of course we try to achieve that; but you have to temper this goal with the realization that TCM is a long-term therapy. If you are going to do it, to get the best results, think of the long term.

(Q): Can you explain other procedures, such as moxibustion, or electrical stimulation of AP points, or Qigong?
(S): In California our license covers the use of herbs, AP, and related methods including electric stimulation, the application of cups (basically creating a kind of suction on the body), and the burning of mugwort (which is called moxibustion). Often moxibustion is used extensively with HIV. TCM looks at the influence of environmental factors, such as heat, cold, dampness, wind; often, temperature in the body is very important. In HIV we often see a deficiency, where the body's energy is very low, the tongue might have a white coat, digestion might be poor, there could be diarrhoea. One of the treatments for that is the use of moxibustion, or the burning of mugwort over AP points. The whole idea here is to put energy into the body, feed energy into a weak and deficient system.

Practitioners use moxibustion in different ways. They may put the moxa on an AP needle and burn it. They may burn a stick of moxa over the needling site. There are other methods, such as applying moxa onto a piece of aconite which is placed directly on the body.

(Q): And electrical stimulation?
(S): Often we use that for pain relief; it's a modern development in AP. We get very good results, particularly with conditions like neuropathy, through the use of electrical stimulations.

Chinese and Western Medicine
(Q): How do you integrate Eastern and Western care?
(S): In the last five years we have seen a tremendous change in physician attitudes. It used to go from indifference to outright hostility; now there is more acceptance and, in fact, encouragement of the integration of care. My philosophy on HIV is to use whatever you can get your hands on that is consistent with your belief system. That might not be AP; it might be yoga or spiritual work, or meditation, or strictly pharmaceuticals and drug trials. There is no one right way with HIV, especially given the chronic nature of the disease, and the limitations of Western medicines.

Western medicines often have an impact on opportunistic infections, but in terms of stopping the underlying process, I don't think medical science has achieved that yet. It behooves the individual to bring in many therapies, and TCM is a very useful option. It's important that you have a good working relationship with your physician; and it's even more important that your physician supports your integrating TCM, herbs and AP, into your treatment program. If you a re having trouble with neuropathy, for example, there is no entirely satisfactory Western medication to treat it; doctors have amitriptyline and a few other drugs. The physician could refer you to AP to treat the neuropathy, which may be induced by drugs like d4T or ddI or ddC; that is a valuable synthesis right there. Or if you have digestive upset, you might have parasite cultures, an endoscopy, sigmoidoscopy, standard Western procedures. They may not identify a pathogen; then you may choose to treat with TCM. This is another opportunity to integrate both models.

The question comes up about the use of AZT, 3TC, or other antivirals. Here I come back to the philosophy that you need to use everything you can to stay healthy and stay alive. I used to feel that if one pill is good, ten pills is much better. I'm coming to see that an important principle with HIV is to use the minimum amount of treatment to achieve the maximum effect. I have seen people come into this clinic who are on Neupogen and Procrit because they have poor bone marrow reserves; they are combining ganciclovir, hydroxyurea, multiple nucleosides, and they wonder why they have problems with bone marrow.
James_JSa3 (1995) AP and TCM in the treatment of AIDS: Part 3.

Other Aspects
(Q): What is "Qigong", and how does it relate to "Taiqi", a term more familiar to our readers?
(S): Both are variations of each other. Each is a systematic series of movements that serve to enhance Qi (the body's energy). Qigong tends to be slower; it is less of a martial art. Taiqi can be a defensive martial art, even though it al so is gentle and soothing. Each gives one a profound sense of relaxation. What I hear constantly from our clients who do Qigong or Taiqi is that they have increased energy. It does not take a lot of technology or training to learn the basic form; then it's up to you to practice.

(Q): You mentioned that the practitioner can act as client advocate, can help the client be informed about lifestyle, diet, stress, and alternative/complementary treatments. Can you give some examples?

(S): I look at the relationship between the practitioner of TCM and the client as a prevention strategy. Particularly with a well-trained practitioner, they can recognize early danger signs. For example, in this clinic, we have seen patients come in with a splitting headache, they are sensitive to light, they have a stiff neck -- these are signs of meningitis. A number of times we have referred people immediately to the emergency room. Sometimes we will treat, and then have the patient call their physician, or go into the emergency room to be treated. Patients usually see their AP practitioner much more frequently than they see their Western physician. It is important that you pick a practitioner who is experienced, so he or she can be a sentinel for early danger signs, and knows when to refer you to a Western provider. The relationship that develops is often intimate, informal. It's a good opportunity for the practitioner to talk to you about lifestyle decisions you are making, stress, coffee, activity, exercise, drug use.

AP has an aspect of disease prevention; certainly we see that in the reduction of colds and flu. If we accept the theory that you want to prevent the immune system from being stimulated (to avoid stimulating the growth of HIV), Chinese medicine may have a beneficial effect. HIV can be very overwhelming; it is difficult for people to make a lot of choices. A well-informed practitioner can talk to you about clinical trials, about Western medications, about other alternative therapies, about nutrients and supplements. Certainly at our clinic, everyone is very well trained in these areas.

(Q): You mentioned coffee. Do you think it is best avoided?

(S): My philosophy is that we need to be realistic. Yes, it's probably good to stop coffee, stop staying up late, don't smoke, don't do drugs, avoid stress, get appropriate exercise. But that's not always realistic for the ways people exist in the real world. I much prefer to see people do gradual changes over time, changes they are going to stick with. If someone is drinking ten cups of coffee a day, there is a reason why they are drinking so much, and they need to look at that. But I think one or two cups is fine -- although there are practitioners who will disagree with me. I like to take a realistic approach; I never want to lecture to my patients. Generally people know what they should do. It is not from lack of information (that they don't do it); it is a number of other factors that influence people's decisions.

Research in TCM
(Q): What research are you doing at the Immune Enhancement Project?
(S): We received funding through the National Institutes of Health Office of Alternative Medicine to do a study comparing the use of antibiotics to herbs and AP for treating HIV-related sinusitis. It's an eight-week trial with a four-week washout. We tried to design it to be as objective as possible, so we are looking at objective measures such as nasal resistance, nasal air flow, smell testing; and we are doing paranasal CT scans to show whether the therapy is having an impact. This study is randomized, with 20 people in each arm of the study.

(Q): Is the study full, or are you still recruiting?
(S): We are still actively seeking patients. Recruitment is going much slower than we originally anticipated. Part of the problem is that by the time people have tried all the antibiotics, they are ready to do AP; but what this study offers them is a randomized choice.

(Q): Is there a cost to participate in the study?
(S): There is no cost. And whichever group you are in, you get a lot from it. You will have a complete ENT exam by the physician, Kelvin Lee MD. Also you will get pre- and post-treatment paranasal CT scans, as well as either 8 weeks of herbs and AP, or eight weeks of antibiotic therapy. For more information about volunteering for this trial, see AIDS TREATMENT NEWS # 225, June 16, 1995, or call Tom Sinclair at the Immune Enhancement Project, 415/252-8711.

There is a growing interest in research on TCM within the US. We have a long way to go; but we have come a long way already, in being able to document and show the benefit of these therapies.

Immune Enhancement Project History
(Q): How did the Immune Enhancement Project begin?
(S): The original concept of the Immune Enhancement Project was developed in 1983. IEP was organized at our present location in 1990, and incorporated as a non-profit in July 1992. Our function is to provide low-cost care, to educate t he public about the benefits of TCM, and to conduct research. That is our mission, and that's what we do.

(Q): What are some of the other major centres in San Francisco?
(S): We are very fortunate in San Francisco that there are many options. In teaching clinics, there is the American College of TCM; it has been a leader in the field of HIV treatment. There is also the Meiji School; I don't know if they have an HIV program. In terms of the clinics, there is the Immune Enhancement Project, and also the Quan Yin Healing Arts Centre.

Misha Cohen (the founder of Quan Yin, now in private practice) should also be acknowledged. We all owe her much credit. Over the years she has been a pioneer in treating HIV, in providing education about how to treat HIV, and in providing access t o low-cost care.

Also, in terms of detox, there are treatment programs available at the Haight Ashbury Free Clinic, and Walden House. Also the Bayview-Hunter's Point Foundation has Ryan White funding.

(Q): What newsletters or other info about TCM can you suggest?
(S): The Immune Enhancement Project publishes a quarterly newsletter. We try to appeal to general clients; also, we try to have articles which will be useful to practitioners working with people who are HIV-positive.

[A sample issue of the newsletter is free; a year's subscription (4 issues) costs $12. Send a request for a free issue, or a check or money order for a subscription, to IEP, Newsletter Subscription, 3450 16th St., San Francisco, CA 94114. Or call the Immune Enhancement Project at 415/252-8711.]

There is a growing field of journals of alternative medicine. Some have come out in the last year, and have a number of well-written articles.

Tom Sinclair suggested the following books and journals on TCM. They can be ordered through bookstores, or directly from the publisher. AIDS service organizations which maintain a library could use these to begin a section on Chinese medicine.
James_JSa4 (1995) AP and TCM in the treatment of AIDS: Part 4.

Books
TCM AND HIV, short booklet by Gene London, 1995. $1, Impact AIDS, San Francisco, phone 415/861-3397; also available from the Immune Enhancement Project, where the author is a practitioner.

BETWEEN HEAVEN AND EARTH: A GUIDE TO TCM, by Harriet Beinfield and Efrem Korngold, 1993. $14, Ballantine Books, New York.

TREATING AIDS WITH TCM, by Mary Kay Ryan and Arthur Shattuck, 1994. $29.95, Pacific View Press, Berkeley, California, 510/849-4213.

THE WEB THAT HAS NO WEAVER; UNDERSTANDING TCM, by Ted J. Kaptchuk, 1983. $19.95, Congdon and Weed, New York.

AIDS AND ITS TREATMENT BY TCM, by Huang Bing Shan, 1991. $24.95, Blue Poppy Press, Boulder, Colorado, 303/447-8372 (or place orders at 800/487-9296), 9 a.m. to 2 p.m. Mountain time Monday through Friday.

NINE OUNCES: A NINE-PART PROGRAM FOR THE PREVENTION OF AIDS IN HIV-POSITIVE PERSONS, by Bob Flaws, 1992. $9.95, Blue Poppy Press, Boulder, Colorado (see phone information above).

AIDS AND TCM, by Qingcai Zhang, M.D., 1993. $19.95, Oriental Healing Arts Centre, Long Beach, California, 310/431-3544.

Journals
ALTERNATIVE THERAPIES IN HEALTH AND MEDICINE. Bimonthly, $48 per year. Aliso Viejo, California; phone 800/899-1712.

ALTERNATIVE/COMPLEMENTARY THERAPIES. Bimonthly, $79 per year plus shipping. Mary Ann Liebert Publications; phone 914/834-3100, ask for customer service.

THE AMERICAN JOURNAL OF AP. Quarterly, $60 per year. Capitola, California; phone 408/475-1700.
Lei_Y (1989) A report of 2 cases of type B AIDS treated with AP. JTCM 9(2):95-96. Two cases of type B AIDS (pre-AIDS stage) were treated by AP in Melbourne. Although these two cases of AIDS belonged to type B, their clinical symptoms were different according to the diagnostic criteria of TCM. Case 1 was LV Yin Xu (Deficiency) caused by invasion of External Epidemic Qi; the therapeutic principle was to reinforce Weiqi to eliminate pathogens and nourish LV Yin. Case 2 was injury to SP Yang caused by invasion of External Epidemic Qi; and the therapeutic principle was to reinforce Weiqi to eliminate pathogens and to nourish the SP-Yang; for this purpose moxibustion was also used at some AP points. In these two cases of type B AIDS, AP alleviated most symptoms, including night sweating, fever, diarrhoea, nervousness, loss of body weight, even enlargement of lymph nodes etc. After treatment, these two patients were followed up for >2 yr and both are in good health now.

Lin_YG (1987) Countermeasure to AIDS. Orient Med 15(3):95-97. (Continued). Firstly, BL Channel is effective, because it could prevent the exogenous evil factor from entering the body. Another important Meridian is TH. The Upper Burner recognizes and judges the invading External Evil; the Middle Burner instructs BL and assists BL function; the Lower Burner keeps watch on the Middle Burner and prevents the erroneous attack on BL. The AIDS virus is the evil factor, which has important relation with Upper Burner. Recently Qigong was introduced to Japan, as a method to strengthen the SP, KI, BL and TH Channels. This is effective therapy for the prevention of AIDS.

Matsumoto_M (1987) AIDS and oriental medicine. Orient Med 15(2):94-95. Needles and scissors should be sterilized in order to prevent AIDS. The following parameters have been proposed: >56oC, sterilize for 30 min; 100oC, boil >5 min. Sterilize >10 min. with >25% ethyl-alcohol. Ultraviolet ray irradiates over 1 min. [Rogers comment: Today, use of single-use disposable needles would be regarded as mandatory in most countries].

Murata_T (1985) Disinfection and sterilization in AP: 4: Needles, vectors of AIDS. Orient Med 13(60):94-96.

Rabinowitz_N (1987) AP and the AIDS epidemic: reflections on the treatment of 200 patients in four years. AJA 15(1):35-42. Also: Rabinowitz_N (1987) AP and AIDS. Shanghai J AP Moxibust 6(4):37. 200 people with AIDS and AIDS-Related Complex (ARC) were treated with traditional AP. While not a cure, the treatment seemed to be beneficial on a physical, emotional and spiritual level and had significance as prophylaxis. This paper examines the theory of AIDS from a Western medical and traditional Chinese medical perspective and explores various treatment issues.

Samlert_H (1985) AIDS and how to prevent a transmission through AP. Akupunkturarzt Aurikulotherapeut 12(5):130-. Measures to prevent transmission of AIDS through AP are discussed, especially the importance of using disposable needles to avoid cross-contamination.

Smith_MO; Rabinowitz N (1987) A preliminary report on the AP treatment of AIDS. WFAS 1st Conf (Eng) 114-115. See also: Smith_MO (1984) AP and the immune system: A preliminary report on the treatment of AIDS. Br J AP 7(2):18. Our AP clinic has been treating patients with AIDS since December, 1982. By 1987 we have seen 150 patients on a regular out-patient basis. 50 of these patients have AIDS by the accepted international criteria and many of the others have a clear "prodromal syndrome". The results have been encouraging. Most patients with a Qi Xu (Deficient Syndrome) have a prompt beneficial response during the first 2 wk of treatment. The control of fatigue, sweating, diarrhoea, and weight loss usually continues as long as the patient continues AP. For two patients, with moderate number (8-10) of Kaposi Sarcoma lesions, all of their lesions disappeared during the first two months of AP treatment. These patients were not on any specific chemotherapy or other cancer regimen at the time. A number of our AIDS patients have already survived a significant period of time beyond their life expectancy. Traditional Chinese medical theory emphasizes treatments for the prevention of vulnerability to infections, including the management of night sweats, fatigue and comparable symptoms . Most of our AIDS patients came to us in between period of acute infection. Their primary Chinese diagnosis was Qi Xu (Deficiency) and they were treated accordingly. Symptoms of infection in AIDS are usually of the Cold Xu type (clear phlegm, watery diarrhoea). Warming the Middle Burner and tonification of LU have helped. AIDS patients who have Xue Xu (Blood Deficiency) due to chemotherapy have not responded well to AP.

Takahashi_M (1987) AIDS and the disinfection in AP. Orient Med 15(4):31-36.

Zhu_Q (1986) AP in the treatment and prevention of AIDS. Singapore JTCM 7(1):42-.

3. CANCERChen_HL; Huang XM (1991) Treatment of chemotherapy - induced leucocytopenia with AP and moxibustion. Chung Hsi i Chieh Ho Tsa Chih - Chin J of Modern Developments in Trad Med Jun 11(6):350-352, 325. The effects of AP and moxibustion on WBC counts in 376 cases of chemotherapy-induced leucocytopenia was observed in patients with malignant tumours in the intermediary and advanced stages. In a group treated with AP and moxibustion with warming needle, a positive result (effective + partial) occurred in 88% of cases; in a group treated with moxibustion with ignited moxa cone, some effect occurred in 91% of cases. The difference in effect between the treatments was not significant (p>.05). Total effective rate was 38.2% when compared with the control group on batyl-alcohol and pentoxyl; the difference was significant (p <.01). Regardless of the kind of disease, the chemotherapy regime, and the treatment course used, the effect of AP and moxibustion in raising WBC values depended on the extent of bone marrow inhibition. The effect was better in patients who had higher basic WBC values; the effect was less in those who had lower basic WBC values.
Filshie_J; Redman D (1986) AP and Cancer Research: AP for Malignant Pain Problems. International Med AP Conference, London, UK. May 4-8. Dept. of Anaesthetics, Royal Marsden Hospital, London, UK. The effect of AP was assessed in 183 patients attending the Pain Clinic in a cancer hospital. Early results were promising; 82% of patients got benefit for hours/ds. However, only 52% of patients obtained significant help and multiple treatments were often necessary. AP was most helpful for vascular problems, muscle spasm and dysesthetic problems. AP was significantly helpful for some patients with malignant pain problems.
Halevi_S1 (1996) Can Cancer be Defeated by AP?. Adapted from WWW. Originally published in the CMJ (UK). [Dr Shmuel Halevi is a practitioner of TCM, practising in Israel: WebMaster]. Cancer patients are occasionally seen in the AP clinic, and some of them respond favourably either to AP or herbal treatment. Most cases however, only resort to AP at a late stage in their disease, and usually in despair. Most patients are >50, and, as can be expected, in very bad shape. Partly because of this, cancer patients who benefit from treatment usually experience only symptomatic relief, which, though very significant in some cases, is usually not a complete cure. The following case history concerns a young man, who had come to my clinic only 2 mo after the inception of the disease, and 10 d after diagnosis. Because the disease was in the early stage, and he had not received any chemotherapy or similar treatment, his chances of recovery were significantly higher than those of the average cancer patient.

The patient, Mr E, a 25 yr old army captain, came to my clinic in February 1991. 2 mo before that, after a heavy blow to his face from a basketball, he had started to experience double vision and other visual disturbances. He then gradually lost sensation in his right arm, hand and leg, with marked motor disability of his right hand, and developed dizziness. In the first wk of Feb, Mr E had several bouts of electric-shock-like sensations throughout his entire body, after which he felt completely depleted, and his right side became virtually paralysed. His left eye became fixed in the centre of the orbit, was unable to move at all to the left, and he was only able to see blurred and double shapes. During these 2 mo Mr E had series of urgent Med tests, including an MRI scan of the brain. Radiologists at the Wadassa hospital in Jerusalem and the Assuta hospital in Tel Aviv confirmed the existence of a brain tumour in the medulla pons area, slightly pushing onto the bottom of the 4th cerebral ventricle. He was diagnosed as a brain cancer patient with a rather poor prognosis. Due to the anatomic location of the tumour, surgical procedures were not recommended, nor was any other treatment proposed.

The 3 professors who saw him did not suggest any link between the tumour and the trauma he had suffered earlier.

Clinical manifestations.
Appearance: The patient looked very emaciated, thin and fragile. His right side was obviously feeble and his left eye was fixed in an unblinking, unmoving gaze. He was rather pale and frightened.

The pulse was deep, weak and slow. The middle left (LV) position was thin and very wiry.

The tongue was very swollen, and slightly contracted. He was unable to stick it out at my request. Around the tip there were red points, and the rear portion was covered with dry, thick, yellowish moss.

Palpation: LV was apparently enlarged (circa 1 finger below the ribs), hard and sensitive. LV13 on the left was very tender, as well as points CV14, CV12 and GB20.

Diagnosis: A swollen tongue that was contracted and could not be extended along with a wiry LV pulse, suggested immediately a severe Xue Stasis type of disorder. Both pulse and tongue, along with clear Xue-Stasis symptoms (the tumour, fixed eye etc.), were in agreement with the Western diagnosis of cancer. The slow pulse, along with the obvious emaciation and slight paralysis, suggested an underlying Xu Syndrome of Xue and Qi. His history confirmed a congenital HT problem with a murmur, and bradycardia.

It is my experience that tongue diagnosis of cancer patients is of supreme importance. A swollen, and contracted tongue shows severe damage to the general flow of Xue and Qi. Later, in more advanced stages, it is apt to change into a thin and contracted tongue, and then criss-cross cracks and/or pronounced tooth-marks appear (if they had not existed before). This is a gradual change from a Shi Syndrome into a Xu Syndrome, which reflects the matter-consuming nature of this disease. The patient was therefore still in the Shi stage, although quite quickly deteriorating. I was worried about the impact of this Stasis on his LV. At that time I was afraid of a LV origin to this tumour, in which case the prognosis would have been poorer. Yet he did not have any gastrointestinal complications which LV cancer usually causes, which was a positive sign.

In disagreement with his Western doctors, it was my opinion that the cause of his disease was clearly his basketball accident. The heavy blow to the face tilted his head forcefully backward, causing a sudden and fierce impediment to the flow of Qi-Xue in the occipital region. His underlying Syndrome of Xue Xu due to his congenital HT problem ("HT controls the Xue"), did not allow the trauma focus to recover, and regain its normal free-flow of Qi-Xue. A sudden and heavy pressure of this kind usually generates Heat-Stasis within the skull, which could not expand outwards, thus creating a marked area of Xue-Stasis, possibly culminating in cancer. Also, the pressure of the tumour probably affected the nerves of his left eye, and the Qi-Xue-Stasis in his brain caused his hemiplegic symptoms.

Treatment plan
Being reluctant to act initially directly on the tumour, I aimed first to activate the Qi-Xue in the patient's right limbs. This, plus tonifying his substantial Qi, were intended to assist him in regaining his vital Qi, and to loosen the Stasis focus through the invigoration of the affected regions (e.g. right limbs and left eye). This is similar to treatment procedures used in CVA sequelae.

If this proved successful, the second step would be to act directly on the tumour, using decisive Xue invigoration techniques. This procedure would be carried out, however, only after the patient had regained enough Qi, to enable him to withstand such harsh techniques.

Treatment: Right side: LI04, LI11 and LI15 all with strong, even manipulation. Left side: Qiuhou (Extra) and Z 09 both with even method. Bilaterally: ST36 (strongly reinforced); LV03 (dispersed); SP06 (dispersed); CV04 and CV06 (reinforced). LI04, LI11 and LI15 belong to the hand Yangming Channel which is abundant in Qi-Xue. They are used in TCM as the most potent combination to invigorate the Qi-Xue of the arm and hand. ST36 (also belonging to the Yangming Channel) is probably the most powerful point on the lower limb; it tonifies the circulation in the right leg, and is used as a general tonic also. The combination of ST36 with CV04 and CV06 is renowned for its general tonifying abilities. LV03 and SP06 is also a well known combination, used to tonify LV-Qi, and move Xue. Qiuhou (Extra) and Z 09 were chosen to tonify eye circulation, enhance nervous functioning, and affect the tumour by acting upon its sequelae. Thus, tonifying Qi-Xue in the hand, leg and eye, was supported by a general tonification of LV-Qi and general Qi.

This treatment was given for circa 20 d, sometimes replacing points with others of a similar nature (substituting LI11 for instance, with LI10).
Halevi_S2 (1996) Can Cancer be Defeated by AP?. Originally published in the CMJ (UK).
During these 20 d the patient's condition improved dramatically. His right hand gradually regained its strength, until he was able to write almost as before. His right leg improved even faster and his gait changed to normal after 10 d. The problem in his left eye still remained, even though he was now able to move his eye a little to the left. Though his general energy clearly improved, he still became weak now and then. After 20 d we began the second phase of treatment, and for this 2 sets of points were chosen: Group A: GV20, GV26, GB20, GV16, GV14, LI04 and SI03 (alternated); BL40, BL60 and BL62 (Alternated). Group B: BL43, GV14, BL17 and LI04. Group A was intended to invigorate Qi-Xue in the brain, by acting mainly on the GV Channel. For this purpose points GV20, GV26, GB20 and GV14 were selected near the disease focus. SI03 and BL62 were needled occasionally to open the GV Channel, being the master and coupled points of this Channel. The GV Channel enters the brain and binds all the Yang Channels. Drastic stimulation of the Yang was necessary so as to invigorate the Qi in the brain and eventually dissolve the Xue-Stasis. LI04 and BL60 were chosen for their ability to invigorate Qi-Xue in the head. BL40 and BL60 together have a dramatic impact upon the BL Channel, which also travels through the brain, and eventually terminates in the eye. All these points were manipulated by dispersing method, causing an upward sensation propagating to the head. BL60 was needled with a 4 inch needle, which after the arrival of Qi was directed upwards, causing a distinct sensation through the back to the occiput, and sometimes even to the eyes. After the withdrawal of the needles (and only on days when the patient felt strong enough), olive oil was spread on the back, cups were placed over GV14 and over BL11, and slid up and down the GV and BL Channels several times until the skin reddened. Group B points were used every other day with reinforcing technique. BL43, GV14 and BL17 were also cauterized with moxa on ginger several times, after which the patient would feel very strong for the next few days.

At the end of another mo of almost daily treatments, the patient's left eye could move a fraction farther to the left, his general physical ability became almost normal, his pulse was dramatically regenerated (though still slow), and above all, his tongue could stick out freely, was no longer contracted, was much less swollen, and had lost its thick yellowish fur.

Then the patient received another MRI test in Assuta hospital in Tel Aviv after which it was concluded that "in comparison to the previous inspection there is a reduction in the brain stem expansion. " As a result, Mr E was advised to have radiation therapy. I agreed to this, as he would be receiving AP treatment in parallel with the radiation. Also, the patient received powdered Dang Gui Ji Xue Tang (Tangkuei and Jixuetang Decoction), which is indicated for blood problems (such as leucopenia) which may occur due to radiation therapy.

Apart from a negligible weakness now and then, Mr E withstood radiotherapy in a way that amazed his doctors. However there was no distinguishable change in his condition after the radiation, and I kept treating him as before. Sessions were now given 3 times/wk and directed mainly to his eye problem, with the addition of points either from group A or B, according to his condition. On days when he felt weak, points and techniques of tonification were chosen. On other days group B points and points to affect his eye were utilised. In treating the patient's left eye during this phase, I usually needled points BL01, ST01, Qiuhou (Extra) and Z 09 alternately. All points were punctured deeply (1-2 cun), causing radiating sensations behind the eye ball. Considering that the eye problem was the only symptom he now suffered from, it was hoped that putting full impetus on the eye treatment, along with occasional group A points, would eventually resolve the problem. In 1 yr, during which the frequency of treatment sessions markedly decreased, the patient's eye very slowly improved, until it gained its full orbital movement. Mr E has now resumed his previous job in the army, and comes for AP, in very good health, once/mo.

Conclusion
1. To treat cancer it is very important to assess the patient's condition at the time of each needling session and adjust the approach to treatment accordingly. Cancer patients have notable changes in their Qi (energy level), and the treatment has to be tailored to the state of the patient on the day of the treatment, otherwise deterioration may occur. However, despite this principle, for best results, the treatment plan must address the patient's overall condition and needs. I would call the general treatment plan, which may be composed of several phases, a strategy. By contrast the treatment routine, given daily within the strategy frame, may be called the treatment tactics. The tactics are based on evaluation of the cancer patient's condition before every treatment, and dictate the nature of the treatment for that day. This may include the strength of needle stimulation, the technique (whether needling, cupping, moxa) etc. Confusion between the strategy of the treatment, and its tactics, may cause either a worsening of the condition (which in a cancer patient could be fatal), or a disoriented treatment which can not induce a cure.

2. Many established principles of AP treatment have applications in cancer therapy. Life is at stake and the battle is fierce. When a defined TCM Syndrome is diagnosed, the usual principle is to counteract it: in cases of Heat, Cooling actions are taken, in cases of Shi (Excess), dispersing techniques etc. A cancer-tumour usually involves a Xue-Stasis Syndrome, a situation which calls for techniques to tonify Xue as the main principle of treatment. However, despite the obvious Shi Syndrome, and the basic Xue-Stasis Syndrome, the patient initially received treatments aimed at tonifying the paralysed limbs, and Xue and Qi in general. Only after the Qi was moving normally in his limbs, and his general Qi-Xue level had been raised, as evidenced by his pulse and symptoms, was the Xue-Stasis Syndrome dealt with directly.

Li_QS; Cao SH; Xie GM; Gan YH; Ma HJ; Lu JZ; Zhang ZH (1994) Combined TCM and WM: Relieving effects of Chinese herbs, Ear-AP and epidural morphine on postoperative pain in liver cancer. CMJ (UK) Apr 107(4):289-294. Research Ctr on Pain, Zhong Shan Hospital, Shanghai Med Univ, PRC. 16 male patients with primary liver cancer were observed to evaluate the postoperative relief of pain and abdominal distension induced by Chinese herbs (A), Ear-AP (B) and epidural morphine (C). This study was conducted by means of orthogonal double blind, randomized design. The patients received various treatments according to the display of the orthogonal table L16(2)15 which corresponds to 2 X 2 X 2 factorial design. C+ (morphine 2 mg) was given before the peritoneum was sutured. A+ (orally administered) and B+ were given 24 h after operation. 50-100 mg of pethidine was given when the pain intensity VAS (0-100) exceeded 50-70. The observation parameters included plasma Leu-Enk, postoperative total dosage of narcotics administered for 5 d, VAS for pain and pain reliever, abdominal distension, urinary retention, constipation, etc. Patients who had received A (A+B+C+, A+B+C-, A+B-C-, A+B-C+); C (C+A+B+, C+A+B-, C+A-B+, C+A-B-), or B (B+A+C+, B+A+C-, B+A-C+, B+A-C-) produced better analgesic effects than those who had received placebo. The A, B, and C reduced narcotics 650, 450 and 550 mg respectively when compared with placebo. The effects of A and C were statistically significant (p <.05), while AB, BC, and AC interactions were not found. A and B minimized abdominal distension and urinary retention, while C prolonged them. As compared with the placebo, A and B accelerated restoration of bowel peristalsis (p <.05, ANOVA). Both A and B decreased it for 165 h, while epidural morphine prolonged it for 49 h. (ABSTRACT TRUNCATED AT 250 WORDS).

Sato_A1 (1991) Cancer Chemotherapy with Oriental Med: 2: Clinical Experiments of Oriental Med with Anti-tumour Crude Drugs. International J of Oriental Med 1:34-43. TCM herbs combat the symptoms of chemotherapy and prolong life. They reduce the adverse effects of cytotoxic chemotherapy and radiation therapy:
a. by increasing leucocyte-, erythrocyte- and thrombocyte- counts;
b. by improving digestive functions (especially LV function);
c. by improving KI function;
d. by reducing pain;
e. by enhancing immunofunctions, and especially,
e. by decreasing pain in the terminal stage.

Song_LC; Liu CY; Zhang BP; Wang T; Song YQ; Li YW (1994) Electrochemical therapy (ECT) for thyroid adenoma during APA: analysis of 46 patients. Eur J Surg Suppl 574:79-81. Central District Hospital, Zaozhung, Shandong, PRC. From Feb '89 - Apr '93, 46 patients with thyroid adenoma were treated by electrochemical treatment (ECT) during APA. After a follow up period of 3 mo - 4 yr, the cure rate was 98%. ECT is a new technique which provides simple, effective and safe treatment of thyroid adenoma. Treatment of benign tumours with ECT represents a new application.

Wang_Guan-ting; Xu Jia-yu; Zhang Ai-mei; Wu Xian-yi (1992) Treatment of Postoperative Advanced Gastric Cancer With Chemotherapy and Anticancer Herbs. International J of Oriental Med 4:202-205. Treatment of advanced gastric (ST) cancer with combined chemotherapy and anticancer herbs which "support the righteous Qi" (often translated to Immune System in WM) gave 41 and 30% survival rates at 3 and 5 yr respectively. The survival rates were significantly higher than for those patients receiving chemotherapy only (26 and 15% respectively).

Wu_B1; Zhou RX; Zhou MS (1994) Effect of AP on interleukin-2 level and NK cell immunoactivity of peripheral blood of malignant tumour patients. Chung Kuo Chung Hsi I Chieh Ho Tsa Chih Sep 14(9):537-539. First Affiliated Hospital, Huaxi Med Univ, Chengdu, PRC. This paper deals with the observation of AP therapy affecting interleukin-2 (IL-2) level and natural killer (NK) cell immunoactivity in the peripheral blood of patients with malignant tumours. In this clinical-Lab test research, randomized double blind method was used. The patients were assigned to 2 groups: 1=AP treatment (n=25) and; 2=Control (untreated, n=20). AP was given for 30 min, once/d for 10 d at ST36, LI11, SP06 and symptomatic points bilaterally. IL-2 level and NK cell activity were lower than normal in patients with malignant tumour, but there was a significant (p <.01) increase in the AP group after 10 d of treatment. This increase may be due to the immunoregulatory mechanism of AP. AP therapy enhanced cellular immune function of patients with malignant tumours and helped in anti-cancer treatment.

Wu_B2 (1996) Effect of AP on Immunomodulation in Patients with Malignant Tumours. Wu Bin, First Affiliated Hospital, West China Univ of Med Sci, Chengdu 610041, PRC. Adapted from WWW at http://www.dmu.ac.uk/ln/cmn/[email protected] (Chin Med News, Beijing Cons Bio-Tech (e-mail: [email protected]). A double blind trial of 40 patients with malignant tumour was designed to study the regulatory role of AP on cellular immune function. Patients were assigned at random to two groups: 1=AP (n=20) and; 2=Control (untreated, n=20). Changes of T-cell subsets (CD3+, CD4+, CD8+), soluble IL-2 receptor (SIL-2R) and beta-End in the blood were studied before and after AP. AP enhanced cellular immunity of patients with malignant tumour; it raised the % T-cell subsets CD3+, CD4+, and the CD4+/CD8+ ratio (p<.01) and the level of beta-End; it decreased the level of SIL-2R (p<.01). Beta-End and T lymphocyte subsets correlated positively; beta-End and SIL-2R correlated negatively and T-cell subsets and SIL-2R correlated negatively. The paper discussed the effects of AP on immunomodulation and the possible mechanisms involved in those effects.

Xia_YQ2 et al (1986) Immunity Reflex State in Cancer patients Treated by AP. Chin AP & Moxibustion Apr 6(2):17-19. (In Chinese). 59 cases with cancer (diagnosed through tissue biopsy) were observed; cellular immunity was lower than in normal persons. Radiation treatment had inhibitory functions on body immunity. AP raised body immunity and regulated ERFC close to the normal level; it also controlled the immunosuppression caused by radiation treatments.

Yang_J3; Yu M; Zhao R; Chen G; Li L; Cai L; Zhang Z; Zhang Y; Lu W (1995) [Influence of radiotherapy and chemotherapy on the function of malignant tumour patients and regulation function of AP]. Chen Tzu Yen Chiu 20(1):1-4. Inst of AP and Moxibustion, China Acad of TCM, Beijing, PRC. The observation on the indexes of cortisol, estradiol, estriol and testosterone showed that incretory function of malignant tumour patients had different extent of pathologic changes, after radiotherapy and chemotherapy, making the change strengthened. AP can regularize this disorder of incretory function of patients treated with radiotherapy and chemotherapy to some extent.

Yang_J4; Zhao R; Yuan J; Chen G; Zhang L; Yu M; Lu A; Zhang Z (1994) [The experimental study of prevention and treatment of the side-effects of chemotherapy with AP (comparison among the effect of AP at different AP point)]. Chen Tzu Yen Chiu 19(1):75-78. Inst of AP and Moxibustion, China Acad of TCM, Beijing, PRC. After ip injection of cyclophosphamide in rats, pathologic changes occurred in haemopoietic, immune and visceral function. AP at one of three different points decreased the above mentioned damage as follows: the effect of AP on haemopoietic function: GV14 >/= ST36, ST36 >/= BL23; the effect of AP on immune function: ST36 > GV14, GV14 >/= BL23; the effect of AP on the function of the liver and the kidney: BL23 >/= ST36, ST36 >/= GV14. The effect of AP at the combination of all 3 points (ST36 + GV14 + BL23) was better than that at any single point. There was no obvious effect when AP was given at non-AP points on the tail.

Yuan_J; Zhou R (1993) Effect of AP on T-lymphocyte and its subsets from the peripheral blood of patients with malignant neoplasm. Chen Tzu Yen Chiu - AP Research 18(3):174-177. Sch of Med of WCUMS, PRC. Effect of AP on the T-lymphocyte and its subsets from the peripheral blood of patients with malignant neoplasm was studied. 51 patients were assigned to 2 groups: 1=AP treatment and; 2=Control (untreated). 48 healthy adults were also studied as a normal control group. The % OKT3+, OKT4+, OKT8+ cells in the peripheral blood of the 51 patients were lower than those of the normal adults. After AP treatment, the percentages of OKT3+, OKT4+, OKT8+ cells were higher than before AP; untreated patients showed no significant variation. AP had more effect on OKT4+ cells than on OKT8+ cells. AP can be used as one of many treatments for patients with cancer.

Zhai_D; Chen H; Wang R; Hua X; Ding B; Jiang Y (1994) [Regulation on beta-End in tumour-bearing mice by moxibustion on CV04]. Chen Tzu Yen Chiu 19(1):63-65, 58. Shanghai Research Inst of AP & Channel, PRC. Tumour-bearing mice were assigned to 2 groups: 1=Moxibustion on CV04 and; 2=Untreated control. Results: Moxibustion on CV04 promoted hyperplasia of the pituitary and the adrenal gland which showed atrophy in the control group. Also, moxibustion stimulated the secretion of beta-End from the pituitary and the adrenal gland, increased the level of serum beta-End significantly and kept the level high for a long time. That allowed beta-End to carry out immunomodulation. Moxibustion did not cause instant release, but probably a constant release of beta-End.

Zhang_T; Gao C; Guo Y (1994) [Effects of moxibustion on the function of MDR gene product, P-glycoprotein (P-170)]. Chen Tzu Yen Chiu 19(2):69-71. Inst of AP and Moxibustion, Acad of TCM, Beijing, PRC. The experiments were performed on BABL/c mice with S-180R adriamycin resistant tumour cells. This animal model was used to analyze the drug accumulation in the S-180R cells by flow cytometer. The drug accumulation presents the pump activity of multidrug resistance (MDR) gene product P-glycoprotein (P-170) in the cell membrane, A weak inhibition was found when moxibustion at Guan-Yan point alone. And a very significant inhibition was observed in the presence of low-dosage of verapamil, but not at high dose. This study may develop a new way to research the mechanism of AP and moxibustion at molecular level, and may be useful to overcome the anticancer drug resistance.

Zhang_ZH4 (1986) Curative Effects Seen in 44 Cases of Radioactive Rectitis After Treating Cervical Cancer. Chin AP & Moxibustion Jun 6(3):18-19. (In Chinese). 44 cases of rectitis (inflammation, pain and bleeding of the rectum) caused by radiation therapy for cancer were treated by AP. 72% cases were cured, 9% cases were markedly effective, and 18% cases were improved. AP also produced analgesia and antipyresis, and reduced inflammation.

Zhao_R; Ma C; Tan L; Zhao X; Zhuang D (1994) The effect of AP on the function of macrophages in rats of immunodepression. Chen Tzu Yen Chiu - AP Research 19(2):66-68. Inst of AP and Moxibustion, China Acad of TCM, Beijing, PRC. Rats were immunodepressed by ip injection of cyclophosphamide. Their phagocytic % and phagocytic index of peritoneal macrophages (PM phi) as well as serum lysozyme (LSZ) decreased obviously; After 6 d of AP at ST36 (bilateral), PM phi phagocytic % and phagocytic index increased significantly, Serum LSZ showed no significant change. AP increased the phagocytic function of M phi in immunodepressed rats, but serum LSZ level did not synchronously increase with the phagocytic function of M phi.

4. BLOOD DISEASES
Deadman_P1; Al-Khafaji M (1996) Some AP points Which Treat Disorders of Blood: Part 1. Adapted from WWW (Acupuncture.com). Acupuncturists who study TCM encounter a great array of herbs, prescriptions and protocols which treat disorders of Xue. By comparison, AP may seem inadequate, and some say that there are only 3-4 AP points which are important to treat Xue disorders. However, careful examination of the traditional and modern indications of AP points, traditional commentaries and classical combinations, reveals that many AP points can nourish Xue, dispel Xue Stasis, clear Heat from the Xue or stop bleeding. This article lists the main AP points to treat Xue diseases (LU03,05,09,10; ST29, SP01,06,08,10,21; HT06; BL15,17,40; KI05,08,14; PC04; LV01,08; GV14, CV07). Indications, discussion and classical combinations of the points given here refer only with their actions in Xue diseases; many other important aspects of the use of these points are omitted.

LU03 Tianfu: Relevant indications: Nosebleed, spitting blood, coughing blood, wheezing, dyspnoea, cough, asthma. In the Discourse Into the Origins and Development of Med "LU is the delicate Zang, neither Heat nor Cold is appropriate: too Hot and the Fire will melt the Metal and the Xue will stir". As early as the Spiritual Pivot (Chapter 21: On Hot and Cold Disease) LU03 was indicated for "Severe thirst, internal upsurge, LV and LU struggle against each other, blood pours from the mouth and nose". This is a clear reference to the Syndrome of LV-Fire attacking LU. LV-Fire rushes upwards and scorches LU, injuring the blood vessels and causing reckless pouring of blood from the mouth and nose. At the same time there will be coughing, which manifests as bouts of spasmodic coughing with a red face. Classical combinations: Bleeding from the nose: LU03 and LI04 (Ode to the 100 Syndromes).

LU05 Chize: Relevant indications: Spitting blood, coughing blood, nosebleed, vomiting blood, HT pain, HT agitation. LU05 is the Water, Sedation and He-sea point of LU. Its main action is to clear all forms of Heat (whether shi or xu) from LU. LU-Heat may injure the blood vessels and cause reckless bleeding, manifested as coughing or spitting of blood or nosebleed. LU Channel originates in the Middle Jiao. As well as being indicated for Heat-induced bleeding from LU, due to its secondary action of descending ST-Qi, LU05 may also be used for vomiting blood. The Song of Points for Miscellaneous Diseases uncompromisingly says: "For vomiting of blood, the action of LU05 is without comparison". LU and HT are intimately associated in the Upper Jiao. Yang Zhao Li says "LU and HT are mutually connected; LU-Heat most easily enters HT" and the Spiritual Pivot (Chapter 75) says "If Zongqi does not descend, Xue Stasis will occur in the Vessels". If LU-Heat enters HT, there will be agitation of HT; if LU- and Zongqi- Xu occurs, there will be Xue Stasis, causing HT pain (angina). Classical combinations: Spitting blood, at times Hot and at times Cold: tonify (Bu) LU05 (Water point) and disperse (Xie) LU10 (Fire point) (A Systematic Classic of AP and Moxibustion).

LU09 (Taiyuan, Great Yuan): This is the LU-Earth, Mother and Shu point and Yuan-Source point. LU09, the Hui-Meeting point of the Vessels, is an important point to harmonise the relationship between the Zongqi and Xue. When Zongqi is weak (Xu) and fails to circulate the Xue, it will pool and stagnate in the chest and HT (Xue Stasis), causing oppression and fullness, agitation, HT pain with a choppy pulse, and manic raving in severe cases. LU09 is further indicated for disorders of the blood vessels in general such as vomiting, spitting or coughing of blood and pulseless Syndrome. The Plain Questions says: "LU governs the 100 Vessels", and the Classic of Difficulties (45th Difficulty) says: "The Vessels gather at LU09". The Classic of Categories says: "The flow of the Jingmai (Channels and Vessels) must follow the Qi; the Qi is dominated by LU, therefore it is the Meeting of the 100 Vessels". These statements refer to the important relationship between Qi-Xue, expressed in the saying "Qi is the commander of Xue", and the statement in The Classic of Categories that "The Vessels are the conduits of Xue-Qi; the movement of the Vessels is dependent on Qi". In other words, Xue moves through the blood vessels by virtue of the movement of Qi, and in the chest and HT region especially, the circulation of the Xue depends on Zongqi which is formed from the gu Qi and air inhaled by LU. Classical combinations: Pain of LU and HT: LU09 and LU10 (A Systematic Classic of AP and Moxibustion). Raving speech: LU09, LI05, LI08 and BL60 (The Great Compendium). Relevant indications: Spitting blood, coughing blood, vomiting blood, agitated HT with HT pain and choppy pulse, oppression of the chest, manic raving, pulseless Syndrome.

LU10 Yuji: Relevant indications:Coughing blood, vomiting blood, blood in the urine, genital Damp itching, impotence with abdominal distention. LU10 is the Ying-Spring and Fire point of LU. In the Classic of Difficulties (68th Difficulty), ying-spring points are indicated for "Heat in the body", and LU10 is effective to clear Heat from both LU Channel and LU Zang. Xue-Heat (a form of Yang-Shi (Excess)), may cause excessive and reckless movement, and hence haemorrhage. LU10 is indicated for bleeding disorders affecting all Three Jiao (the entire TH area). LU-Heat may injure the Vessels (including blood vessels) of LU causing coughing of blood, transmit to the origin of LU Channel in the ST causing vomiting of blood, or transmit to HT and thence the SI and BL causing urinary bleeding (which may be accompanied by genital Damp itching or impotence). Classical combinations: Vomiting blood: LU10, PC03 and HT07 (The Great Compendium of AP and Moxibustion). Pain of the penis: LU10, KI03, CV03 and SP06 (The Great Compendium of AP and Moxibustion).

ST29 Guilai: Relevant indications: Amenorrhoea, irregular menstruation, uterine blood Stasis due to Cold. The name of this point, Guilai (Return) refers to its ability to restore the menstruation to normal, and its overriding action is to warm the Lower Jiao, most particularly the uterus in women. The uterus (along with the ST, SP, SI, LI) belongs to that group of the Zang-Fu or Extra-Fu that can suffer from direct attack by External Cold (e.g. without initially causing symptoms and signs of an External Syndrome such as chills and fever, body aches etc). Injury of the uterus by Cold may be due to inadequate clothing or sitting on cold ground, or over-consumption of Cold foods and drinks, especially during menstruation or after childbirth. Plain Questions (Chapter 82: "On Regulating the Channels") says: "Qi-Xue desire warmth and dislike Cold; when Cold is encountered they coagulate; when warmth is encountered they disperse and flow"; the Spiritual Pivot says:
Deadman_P2; Al-Khafaji M (1996) Some AP points Which Treat Disorders of Blood: Part 2. "The Qi-Xue of the human body circulate ceaselessly, in the same way that the stars in the heavens and the rivers in the earth. When Cold pathogens invade the Channels, Xue coagulates; when Xue coagulates the Channels do not move". Pathogenic Cold in the uterus causes Qi-Xue Stasis and disrupts the function of CV and Chong Mai, causing disorders such as amenorrhoea, irregular menstruation and abdominal masses. ST29 is normally treated with warm needling to Warm the uterus and Dispel pathogenic Cold.

SP01 Yinbai: Relevant indications: Uterine bleeding, menorrhagia, vomiting blood, nosebleed, Heat illness with nosebleed, blood in the urine, blood in the stools. In the Supplements to Commentaries "SP gathers the Xue; in SP-Xu, SP is unable to unite the Xue", whilst the Treatise on Disorders of Blood says "In SP-Yang Xu, the Xue is not gathered". SP01 (SP jing-well point) is one of the best AP points to strengthen SP function of holding Xue. This Syndrome, which is usually chronic in nature, may manifest as bleeding in any part of the body, but mainly in the Lower Jiao, whether as uterine bleeding or as bleeding into the urine or stools. In such cases moxibustion at SP01 is often employed, and it is very helpful to instruct the patient in use of moxibustion daily at home. The action of SP01 in stopping bleeding, however, is not confined to SP-Xu, but may also be applied where Shi or Xu Heat attacks Xue, causing reckless bleeding, especially in the upper part of the body (nosebleed, vomiting blood). In these cases, needling is usually employed. Classical combinations: Bloody stools: SP01 and ST36 (Gatherings from Outstanding Acupuncturists). Bloody dysentery: SP01, ST25, ST44, CV06, KI06 and PC06 (The Great Compendium of AP and Moxibustion). Vomiting and nosebleed: SP01, BL20, BL18 and CV13 (The Great Compendium of AP and Moxibustion). Severe and ceaseless nosebleed: SP01 and BL40 (Classic of Supplementing Life with AP and Moxibustion). Hot head and nosebleed: SP01, BL58, BL64, BL60 and BL57 (1000 Ducats).

SP06 Sanyinjiao: Relevant indications: Irregular menstruation, uterine bleeding, uterine bleeding with dizziness, menorrhagia, amenorrhoea, dysmenorrhoea, difficult labour, failure of the lochia to descend, postpartum dizziness, palpitations, blurred vision, insomnia, eczema, urticaria. Along with BL17, SP10 and SP08, SP06 is considered one of the main AP points to nourish, harmonise and cool Xue and to promote and invigorate its circulation. This explains its main application in gynaecological disorders, but extends to other disorders where Xue disharmony plays an important role such as skin diseases. In SP-Qi-Xu or SP-Yang Xu there may be: 1. inadequate formation of blood (palpitations, blurred vision, amenorrhoea, postpartum dizziness, dizziness associated with uterine bleeding etc.), or 2. failure of SP to hold the Xue (uterine bleeding, menorrhagia). SP06 is an essential point to treat these disorders, especially uterine bleeding and menorrhagia, because of its ability to tonify SP-Qi and Yang and the SP ability to hold the Xue. The further ability of SP06 to regulate SP, LV and KI Channels and to treat all disorders of the lower abdomen makes it an important point to treat gynaecological disorders due to Xue Stasis, KI-Xu, Phlegm-Damp or LV-Stasis. Classical combinations: Uterine bleeding: SP06, CV07 and TH04 (The Lyric of Standard Profundities). Ceaseless uterine bleeding: SP06, KI08, KI10 and LV03 (Classic of Supplementing Life with AP and Moxibustion). Menorrhagia: SP06, HT05 and LV02 (The Great Compendium of AP and Moxibustion). Disordered menstruation: SP06, GB41 and CV03 (The Great Compendium).

SP08 Diji: Relevant indications: Irregular menstruation, dysmenorrhoea, abdominal masses in women due to Qi-Xue-Stasis. SP08 is SP Xi-Cleft point. The Xi-Cleft points are where the Qi-Xue, which flow relatively superficially along the Channels from the jing-well points, gather and plunge more deeply. The Xi-Cleft points in general are indicated to treat acute conditions and pain, whilst the Xi-Cleft points of the Yin Channels have an additional action of treating disorders of Xue. SP controls Xue and its Channel enters the lower abdomen, joining with the CV at CV03 and CV04. SP08 has a specific and important action on resolving Xue Stasis in the uterus and lower abdomen, being indicated to treat irregular menstruation, abdominal masses in women and dysmenorrhoea due to this pathology. As the Xi-Cleft point, SP08 is especially suited to treating acute dysmenorrhoea, for which purpose it is often combined clinically with LI04. A specific indication for this point mentioned in the Illustrated Classic of AP points on the Bronze Man is a hot flowing sensation spreading down the inner thigh to the knee when pressure is applied to abdominal masses in women. Classical combinations: Irregular menstruation: SP08 and SP10 (Ode of the 100 Symptoms).

SP10 Xuehai: Xuehai, literally "Blood Sea", reflects its pre-eminent role in treating disorders of the Xue. It has 2 main actions: 1. to invigorate Xue and dispel Stasis, and; 2. to Clear Heat from the Xue. These 2 actions explain its ability to treat a wide range of gynaecological and dermatological disorders due either to Xue-Stasis or Xue-Heat. In gynaecology, normal menstruation depends factors which include the smooth circulation of Xue. Impaired Xue circulation and consequent Stasis may be due to Stasis or Xu of Qi, traumatic injury, haemorrhage, penetration of Cold, Xue Xu, Heat, chronic disease or emotional factors, and may cause many different disorders of menstruation. These include dysmenorrhoea and uterine bleeding manifested as severe fixed pain and the discharge of dark or clotted blood, and amenorrhoea accompanied by pain and distention, a purple coloured tongue and a choppy pulse. By contrast, in Xue-Heat, most often due to Internal Heat from LV or HT, or from overeating of excessively Heating foods, 2 main Syndromes may arise: 1. movement of Xue may become reckless and overflow, leading to uterine bleeding, or, 2. Heat may cause Xue-Dryness, leading to amenorrhoea. Both cases have signs of Heat such as a red dry tongue and a rapid pulse. Both the Xue-cooling and Xue-invigorating properties of SP10 join in its ability to treat uterine bleeding. Xue-Heat is the main Syndrome of uterine bleeding; as well as cooling Xue, treatment must stress resolving Stasis, since any pathological bleeding may lead to pooling and Stasis of extravasated blood. This is expressed in the TCM saying "where there is haemorrhage there is Stasis". Some authorities further attribute Xue nourishing properties to SP10 and incorporate it into prescriptions to treat Xue Xu. In the light of SP10's pre-eminence in invigorating Xue, this action reflects the saying in TCM "if Xue Stasis is not transformed, new Xue cannot be generated".
Deadman_P3; Al-Khafaji M (1996) Some AP points Which Treat Disorders of Blood: Part 3. This refers to situations either where Xue Xu and consequent poor circulation lead to Stasis, or where Xue Stasis prevents the creation of new Xue. Both of these Syndromes are commonly encountered in postpartum Xue-Xu. Xue disharmony also plays a central role in dermatology. The main dermatological Syndromes treated by SP10 are Xue-Heat, manifested as red lesions, and Xue-Stasis manifested as purple lesions. SP10 may also be used for concomitant Xue-Xu and Xue-Stasis seen for example in eczema with thickening of the skin (lichenification) or post-herpetic neuralgia. SP10 may also be used to treat the manifestations of Wind in skin diseases, especially severe itching. This illustrates the TCM saying "to treat Wind first treat the Xue; once Xue moves Wind will be dispelled". Although the action of SP10 on invigorating and cooling Xue is classically confined to the 2 main areas of gynaecology and dermatology, its application may be extended to any disorder in the body with these pathologies. Classical combinations: Irregular menstruation: SP10 and GB26 (Classic of Supplementing Life with AP and Moxibustion). Relevant indications: Irregular menstruation, dysmenorrhoea, amenorrhoea, uterine bleeding, clotted uterine bleeding, sudden uterine bleeding, postpartum Qi-Xue-Xu, urticaria, eczema, erysipelas, herpes zoster, painful Hot sores, ulceration and itching of the scrotum, blood line.

SP21 Dabao: Relevant indications: Pain of the whole body, weakness of the 4 limbs, flaccidity of the limbs. Dabao (Da=great, Bao=to wrap, to envelop). The Spiritual Pivot says: "Dabao is SP Great Luo point". Luo means Collateral, Connection, Reticulum, Net or Web. The Spiritual Pivot says: "Dabao spreads in the chest and flanks; it is like a net embracing the Xue of all the Luo-Collaterals. When it is Shi there is pain of the whole body. When it is Xu the 100 joints are flaccid. Dabao". It also says that one of the functions of all Luo is to assist (via their network) the Channels and Vessels to distribute Qi, and more especially Xue, to all tissues of the body. Since SP controls Xue, Dabao (SP Great Luo) dominates Xue distribution in the body. In Xue-Stasis "there is pain of the whole body"; in Xue-Xu, Xue can not nourish the tissues and "the 100 joints are flaccid".

HT06 Yinxi: Relevant indications: HT pain, fierce stabbing pain of HT, fullness of the chest, palpitations, fright palpitations, sudden turmoil disorder with HT pain (angina), nosebleed, vomiting blood. HT06, HT Xi-Cleft point (see SP08 above) is indicated for HT pain due to Xue Stasis, and bleeding disorders due to Xue-Heat. However, in terms of both these actions, Ximen PC04, PC Xi-Cleft point, is clinically more important. Acute severe pain in Xue-Stasis, which threatens the survival of HT Zang, is thus mainly treated by using points of the PC Channel, the "Protector" of HT. This is reflected in the statement in the Spiritual Pivot (Chapter 71): "HT is the great master of the Five Zang and Six Fu; it houses the Jing-Shen (the Essence of the Spirit). If HT is injured, Shen-Spirit departs; if Shen-Spirit departs, death follows; therefore the Perverse Qi that attacks HT is diverted to reside in PC".

BL15 Xinshu: Relevant indications: HT pain, oppression of the chest with restlessness, chest pain extending to the back, palpitations, irregular pulse, poor memory, anxiety, weeping with grief, insomnia, excessive dreaming, absent-mindedness as if in a trance, delayed speech development, coughing blood, vomiting blood, nosebleed, night sweats. BL15 (HT Back-Shu point) is where HT-Qi emanates from the interior to the body surface. All Shu-Back points, especially those of the Zang (Yin, Solid Organs), strongly regulate and tonify their corresponding Zang at the deepest level. BL15 is used equally to tonify Xu of HT Xue and to resolve Xue Stasis. In the Spiritual Pivot (Chapter 18) "Xue is the Qi of the Shen-Spirit", whilst the Plain Questions (Chapter 8) says "HT is the monarch from which the Shen-Spirit emanates". Since storage is a Yin function, it is mainly HT Xue and Yin that have the function of nourishing HT and providing the material basis for HT to house the Shen-Spirit. Xue and Yin Xu of HT may originate from physical causes such as loss of blood, chronic illness and overwork, or from emotional causes. Fei Bo Xiong (1800-1879) says: "The 7 emotions injure the 5 Yin organs selectively but they all affect HT"; the Plain Questions (Chapter 62) says: "HT stores the Shen-Spirit; in Shen-Shi (Spirit Excess) there is ceaseless laughter; in Shen-Xu (Spirit Weak) there is sadness". When HT-Xue or HT-Yin are Depleted (Xu), the unrooted and unanchored Shen-Spirit loses its harmony and becomes restless and unquiet, resulting in such symptoms as anxiety, poor memory, insomnia and excessive dreaming and weeping with grief. HT controls the pulse; in HT-Qi-Xu, HT is unable to regulate the Xue; there may be palpitations or irregular pulse, especially if HT-Xue is also weak (Xu). In that case, palpitations are more likely to be accompanied by anxiety, in contrast to the palpitations caused purely by Qi-Xu which are usually unrelated to emotional changes. In Essential Readings from TCM, "That which is stored by HT internally is Xue, externally it is emitted as sweat; sweat is the Jin-Fluid of HT". For this reason, BL15 is also indicated for night sweats. References to the relationship between HT, the Xue and its Vessels abound in the classics. The Plain Questions says: "All Xue pertains to HT" (Chapter 10), "HT dominates the blood vessels of the entire body" (Chapter 44), and "HT stores the Qi of the blood vessels" (Chapter 18). The Classic of Categories says: "The Vessels are the conduits of Xue-Qi, the movement of the Vessels is dependent on Qi"; the Spiritual Pivot says: "When the Qi of hand Shaoyin Channel is exhausted, the Vessels will not move, thus the Xue will not flow; when the Xue does not flow the circulation will eventually stop and the Xue will die". The Methods and Rules of Med says: "In chest Bi-Syndrome, pain in HT region is caused by Yang-Xu and invasion of Cold". Treatment Planning According to Syndrome Categories says: "In chest Bi-Syndrome, the Yanqi of the chest does not move; after a long time, Yin takes the place of Yang". All those statements emphasise the close relationship between the circulation of Xue in the chest and the Qi and Yang of HT. In HT Yang Xu and HT cannot circulate the Xue in the chest and HT, there may be consequential HT Xue Stasis causing pain and oppression of the chest. BL15 is important for all kinds of HT and chest pain, whether due to Xu, Stasis of Xue, or Stasis of Qi or Phlegm. The action of BL15 in treating Xue Stasis as well as Xue Xu, reflects its ability to treat both xu and shi Syndromes of HT with equal effect.
Deadman_P4; Al-Khafaji M (1996) Some AP points Which Treat Disorders of Blood: Part 4. In classic texts BL15 is an important point to clear Heat (both Shi and Xu) from HT, whilst the Illustrated Appendices to the Classic of Categories says: "BL15 is indicated for clearing Heat of the Five Zang in combination with the Five Zang Shu-Back points". This reflects the application of Five Phase Theory in which HT pertains to "Sovereign Fire" and plays a role in governing the Fire of the whole body. When HT-Fire injures the blood vessels of LU or ST, therefore, there may be coughing or vomiting of blood. Classical combinations: Weeping with grief: BL15, HT07, ST41 and PC07 (Classic of Supplementing Life with AP and Moxibustion).
Melancholy and trance-like absent-mindedness: BL15, TH10 and GV11 (Classic of Supplementing Life with AP and Moxibustion).
Trance-like mental confusion: BL15, TH10 and CV14 (The Great Compendium of AP and Moxibustion). Mental stupidity and dull-wittedness: BL15, HT07, LU11 and KI01 (The Great Compendium of AP and Moxibustion). Agitated HT: BL15 and CV14 (Classic of Supplementing Life with AP and Moxibustion). Coughing and spitting blood: BL15, BL18, ST12, CV14 and CV15 (Classic of Supplementing Life with AP and Moxibustion).

BL17 Geshu: Relevant indications: All Xue diseases, epigastric pain, fullness of the abdomen and flank, pain of the whole body, pain of the skin, flesh and bone, stabbing pain of HT, HT pain on eating, tidal fever, night sweats, spontaneous sweats, steaming bone Syndrome, fever without sweats, aversion to Cold, mania-depression disorder, coughing blood, vomiting blood, spitting blood, blood in the stool, urticaria, whole-body Bi-Syndrome. BL17 is one of the 8 Hui-Meeting points with a specific action on the Xue. Many classics simply state that this point can be used for "all Xue diseases". Disorders of Xue may be of 3 main kinds: Xue-Stasis, Xue Heat and Xue Xu. Impaired Xue circulation and consequent Xue-Stasis may be due to various causes (see SP10 above). Xue Stasis can cause many symptoms, but the main one is pain. Shi pain may be due either to Stasis of Qi or Stasis of Xue, as reflected in the TCM saying "when there is no movement there is pain". Pain due to Xue Stasis is manifested as its fixed and stabbing nature. Wang Qingren, Qing dynasty author of Correcting the Errors of Med, says: "when there is pain in the abdomen that does not move, it is Xue Stasis". In the Treatise on Disorders of Blood, Tang Rong Chuan says: "When Xue Stasis is between the Jingluo and the Zang-Fu the whole body is in pain; when it is in the Upper Jiao there is stabbing obstinate pain of the arm, chest and diaphragm; when it is in the Middle Jiao there is pain of the abdomen and flanks". BL17 is applicable in all these cases. Note, however, that due to its location, its special action is on the diaphragm/respiration, which intersects the Upper and Middle Jiao. Thus, its main sphere of action is on the Upper and Middle Jiao, and it is less used for Xue Stasis in the Lower Jiao. BL17 is also an important point to treat various kinds of fever due to Xue Stasis. The Treatise on Disorders of Blood says: "in Xue Stasis of the pores, Yingqi and Weiqi are not harmonised and there is fever plus chills; in Xue Stasis half-Internal half-External, there are alternating chills and fever; in Xue Stasis of the muscles and flesh, there is a burning fever; in Xue Stasis in the Jingluo and Zang-Fu there has to be steaming bone consumption fever". BL17 is also indicated for mania-depression disorder. In Correcting the Errors of Med, Wang Qingren says: "In insanity Syndrome of continual crying and laughing, swearing and singing, the Qi-Xue-Stasis is in the brain". An alternative explanation for this manifestation is that Xue Stasis may both transform to Heat and obstruct the blood vessels, preventing nourishment from reaching HT. This combination of Heat and malnourishment may disturb the Shen-Spirit. BL17 is important for many bleeding disorders, mainly due to Xue-Heat or Xue-Stasis. Xue-Heat may be due to many causes, including constitutional Heat, External Heat, overeating of excessively Heating food or drink, or Heat (Shi or Xu) generated by disharmony of the Zang-Fu. When Xue-Heat causes Xue to move recklessly and burst out of the blood vessels, causing haemorrhage that is usually acute and profuse. BL17 can cool the Xue and stop bleeding, mainly from the upper and Middle Jiao (LU and ST). Another important cause of haemorrhage is Xue Stasis. In Xue Stasis (Xue obstruction, failure to move) blood may be forced out of the blood vessels, causing haemorrhage manifested as its intermittent nature, dark purplish colour and presence of clots. At the same time, haemorrhage of any aetiology is itself in an important cause of further Xue Stasis, as blood that is forced out of the blood vessels easily pools and stagnates. This is reflected in the saying "where there is haemorrhage there is Stasis". The close inter-relationship between Xue Heat, Xue Stasis and haemorrhage is further illustrated, in that Xue Heat may condense to Xue-Dryness and Stasis, as stated in the Treatise on Acute Epidemic Febrile Disease by Wu You Ke (1642): "Because Latent Fire-Stasis evaporates the Fluid of Xue, Xue simmers and forms Stasis". The ability of BL17 to nourish Xue and Yin is clearly overshadowed in the classical indications by its ability to resolve Xue Stasis and Heat. Three areas show its nourishing and tonifying properties. 1. BL17 can treat disorders such as night sweats and steaming bone Syndrome due to severe Xu of Xue and Yin. 2. BL17 is used with BL19 in the classical combination of the "4 Flowers", first mentioned by Wang Tao (752 AD) in "Secrets of a Frontier Official". He did not specify the points but described rather a complex location method. [The method of locating these points described in the Secrets of a Frontier Official (752 AD) is as follows: Tie a piece of string around the neck, with a knot level with CV15. When the string is allowed to fall down the back, the knot will then lie on the vertebral column at the crossing point of two diagonal lines the end of each of which leads to one of the four points]. The Classic of Supplementing Life with AP and Moxibustion in the 13th century first defined the "4 Flowers" as BL17 and BL19 and said that they dominated Xue, being indicated (for treatment by moxibustion) for LU tuberculosis (consumption disorder) manifesting as exhaustion with steaming bone Syndrome, night sweats cough, asthma, feebleness and emaciation. 3. BL17 has a special ability to treat Xue Xu allied to Xue Stasis. It has long been understood that after haemorrhage, the consequent Xue Stasis prevents the formation of new Xue. This is reflected in the saying: "if Xue Stasis is not transformed, new Xue cannot be generated", and the statement by Tang Rong Chuan:
Deadman_P5; Al-Khafaji M (1996) Some AP points Which Treat Disorders of Blood: Part 5."In vomiting blood, nosebleeds and blood in the stool, the Xue leaves the Channels; any Xue outside the Channels is isolated, no longer connected with the Xue that nourishes the entire body; isolated Xue is unable to augment with good Xue, thus the transformation of new Xue is hindered". At the same time, by pooling outside the Channels, Xue Stasis may lead directly to Xue Xu as sufficient Xue is no longer available to nourish the body. Thus Xue Stasis may not only be the cause of, but may be the end result of Xue Xu. The action of BL17 on Bi-Syndrome, commonly referred to as Wind-Damp in TCM, which affects the whole body reflects its action of regulating Xue. Prolonged bi Syndrome may give rise either to Xue Stasis or Xue Xu. The importance of treating the Xue in such cases is reflected in the saying: "to treat Wind, first treat Xue; once Xue moves, Wind will be dispelled".

BL40 Weizhong: Relevant indications: Pain and stiffness of the lumbar spine, heaviness of the lumbar region and buttock, nosebleed, clove sore (ding chuang), erysipelas. An alternative classical name for BL40 is Xuexi (Blood Xi-Cleft). In the Neijing, the Taiyang Channel (BL-SI) is abundant in Xue. This explains the powerful effect of bleeding BL40 to move Xue-Stasis in acute lumbar sprain; it also explains its ability to cool the Xue in nosebleeds and many skin disorders, in which case the point may also be bled. In the Neijing, the Jueyin Channel is the only other Channel abundant in Xue; this may help to explain certain similarities between BL40 (BL (Foot Taiyang) He-Sea point and Earth point) and PC03 (PC (Hand Jueyin) He-Sea point and Water point). Both points are bled to Clear Xue-Heat and are used to treat injury by summer-Heat, sudden turmoil disorder with Heat of the 4 limbs, ceaseless thirst, vomiting and diarrhoea. Classical combinations: Severe and incessant nosebleed: BL40 and SP01 (1000 Ducats). Carbuncles on the back: needle BL40 and GB21, and place a slice of garlic on the carbuncle and burn moxa. If there is no pain, then moxa until there is pain; if there is pain, moxa until there is no pain, the more moxa the better (The Great Compendium of AP and Moxibustion).

KI05 Shuiquan: Relevant indications: Amenorrhoea, irregular menstruation, dysmenorrhoea, delayed menstruation with epigastric pain on onset of menstruation, prolapse of the uterus. KI05 is the Xi-Cleft point of KI Channel (see SP08 above). The Plain Questions (Chapter 1) says: "At the age of 14, KI-Qi of the female is strong, the reproductive function matures, the CV flows and the Chong Mai fills, the menses come according to their times, and she can bear offspring". Normal development of the uterus and the CV and Chong Mai, therefore, depend on healthy functioning of KI. At the same time, harmonious menstruation depends on adequate formation of Xue in the body, especially LV-Xue which flows to the CV and Chong Mai to form menstrual blood. The close relationship between Xue of KI-LV was emphasised in Master Zhang's Med Encyclopedia which says: "When the Jing-Essence is not discharged it will return to LV and transform into clear Xue", whilst KI plays an important role in the formation of Xue, stated unequivocally in the Bing Ji Sha Zhuan "The source of Xue is KI". In KI-Xu, the function of the CV and Chong Mai will be disturbed and the formation of Xue inadequate. KI05 (Xi-Cleft point of KI) and thus able to treat disorders of Xue, regulates the Qi-Xue in KI, CV and Chong Mai. It is indicated for many menstrual disorders such as amenorrhoea, irregular menstruation, dysmenorrhoea and delayed menstruation, whether manifested as Xu (of Xue or Qi) or Shi (Stasis of Xue). Classical combinations: Amenorrhoea with much oppression and pain in the lower HT (upper epigastrium): KI05 and KI06 (1000 Ducats). Irregular menstruation: KI05 and ST25 (Ode to the 100 Syndromes).

KI08 Jiaoxin: Relevant indications: Uterine bleeding, irregular menstruation, dysmenorrhoea, amenorrhoea, uterine prolapse. KI08 is the Xi-Cleft point of the Yinqiao Mai on KI Channel. The Xi-Cleft points of the Yin Channels have a special action of treating disorders of Xue, especially resolving Xue Stasis, clearing Heat from the Xue and stopping bleeding. Although the Yinqiao Mai does not enter the uterus, like all the Extraordinary Channels, it has a close relationship with KI and originates at KI06. KI08 is indicated in many menstrual disorders, and most especially uterine bleeding. The Classic of the Central Viscera by the Han Dynasty doctor Huato says: "KI wraps the Xue". In women, KI injury due to excessive early sexual activity, sexual overindulgence, multiple pregnancies etc, either weakens (Xu) KI-Yin or KI-Yang, causing weakness of the CV and Chong Mai and hence uterine bleeding. KI08 is indicated mainly in Xu Syndromes of uterine bleeding, particularly in KI-Xu. However, as a Xi-Cleft point, and due to its secondary action of draining Damp-Heat, it is effective to treat uterine bleeding due to Xue Stasis, reckless movement of Hot Xue and Damp-Heat. Classical combinations: Ceaseless uterine bleeding: KI08, KI10, LV03 and SP06 (Classic of Supplementing Life with AP and Moxibustion). Diminished Qi uterine bleeding: KI08 and BL55 (Ode to the 100 Syndromes).

KI14 (Siman, Four Fullnesses): One interpretation of the meaning of Siman is that it refers to 4 kinds of Stasis: Qi, Water, Food and Xue. Clear indications reflect each of these Syndromes, for example abdominal distention for Qi, abdominal oedema for water, diarrhoea or constipation for food, but overwhelmingly the indications reflect the presence of Xue Stasis, for example painful abdominal masses, cutting pain below the umbilicus, Xue Stasis in the uterus etc. Relevant indications: Abdominal distention, oedema of the abdomen, diarrhoea, constipation, masses below the umbilicus, painful masses, cutting pain below the umbilicus, irregular menstruation, uterine bleeding, Xue Stasis in the uterus, acute pain due to Xue Stasis.

PC04 Ximen: Relevant indications: Chest pain, HT pain, HT pain with vomiting, vomiting blood, coughing blood, nosebleed, furuncle and carbuncle, agitated HT, Shen-Qi-Xu, depression, low spirits, insomnia, melancholy and fear, fear of strangers and . PC04 (Cleft Door) is the Xi-Cleft point of the PC Channel (see SP08 above). Through its dual actions of invigorating Xue and moderating acute Syndromes, PC04 is strongly indicated for Stasis of Xue in the chest and HT, causing pain. Its important role to treat HT pain was both emphasised in the classics and is borne out by modern clinical practice and research. By virtue of its ability to clear Heat from the Xue and stop bleeding, PC04 is also indicated for Hot reckless bleeding in the Upper Jiao causing nosebleed, and vomiting or coughing of blood.
Deadman_P6; Al-Khafaji M (1996) Some AP points Which Treat Disorders of Blood: Part 6. The second main group of indications for PC04 includes many mental and emotional disorders such as agitation of HT, insomnia, melancholy and fear, fear of strangers and epilepsy. The relationship between PC04 and emotional disorders is expressed through its effect on the Xue and HT Qi. HT rules the Xue and houses the Shen-Spirit; there is therefore a reciprocal relationship between Xue and Shen-Spirit disturbance. On the one hand in Xue Stasis, when blood does not flow freely, essential nourishment will not reach HT and Shen-Spirit may be disrupted. On the other hand, emotional disturbance may lead to Xue Stasis. The Spiritual Pivot (chapter "On Original Causes of the 100 Diseases) says: "A person may be injured Internally by worry and anger; when this occurs Qi will rush upwards; when the Qi rushes thus the 6 Shu (points) will not move, the warm Qi will not circulate and the Xue-Stasis (coagulation) occurs internally". By resolving Xue-Stasis PC04 therefore can restore emotional harmony. Xue-Stasis in HT mainly occurs due to Xu of HT Qi and Yang. These Syndromes often cause feelings of fear, melancholy and gloominess, typically seen in patients after a myocardial infarct (MI) (the shock of which may further injure HT Qi). PC04 can regulate HT Qi, as well as the Xue, and is classically indicated for Shen-Qi-Xu (low spirits). Finally in Ying-Heat or Xue-Heat during febrile disease, when Heat rises to disturb the Shen-Spirit, symptoms may include of mental and emotional agitation, as well as haemorrhage. Thus the Treatise on Warm Febrile Diseases stated: "When Ying is invaded by Heat, Xue is consumed, Shen-Spirit is disturbed and there is insomnia". PC04 can calm Shen-Spirit in such cases by clearing Heat from the Ying and Xue. Classical combinations: HT pain: PC04, PC03 and PC07 (1000 Ducats). HT pain with dry heaves and agitation and fullness: PC04 and HT01 (Classic of Supplementing Life with AP and Moxibustion). Coughing blood: PC04 and PC07 (A Systematic Classic of AP and Moxibustion). Fear of people, Shen-Qi-Xu: PC04 and KI04 (1000 Ducats).

LV01 Dadun: Relevant indications: Irregular menstruation, ceaseless uterine bleeding, menorrhagia, metrorrhagia, bloody urine, nosebleed. LV01 is the LV Jing-Well point, Wood point and Hour point. The LV Channel encircles the genitals and enters the lower abdomen. Through its action of regulating Qi in the Lower Jiao, LV01 is indicated for many disorders of both urination and menstruation. LV stores the Xue; in menstrual disorders, if LV-Qi-Stasis transforms to Heat and enters the Xue, Xue-Heat will cause agitation and turbulence, manifesting in such disorders as irregular menstruation, ceaseless uterine bleeding, menorrhagia or metrorrhagia. The Great Compendium of AP and Moxibustion says "urine red like blood, moxa LV01 and CV04". The action of LV01 on stopping excessive uterine bleeding therefore includes urinary bleeding, and, according to Sun Si Miao, even nosebleed, which often is due to rebellious LV-Heat.

LV08 Ququan: Relevant indications: Abdominal masses in women due to Xue Stasis, infertility due to Xue Stasis, amenorrhoea, lower abdominal swelling, pain of the abdomen and flank, umbilical pain. LV stores the Xue and its Qi controls the smooth flow of menstruation. In LV-Qi-Stasis, menstrual blood may also stagnate. LV08 is indicated in various classical sources for Xue Stasis in the uterus causing infertility, abdominal masses and amenorrhoea. From many sources, one specific indication is the presence of abdominal masses which, when pressed, induce a warm sensation which radiates down the thigh as far as the knee. LV08 is an important point to clear Damp-Heat from the Lower Jiao. Clinically the combination of Damp-Heat and Xue Stasis often occurs in gynaecological disorders, and the action of LV08 on both these pathogens renders very useful to treat such dual disharmony.

GV14 Dazhui: Relevant indications: Nosebleed. After ascending to the vertex, the GV descends through the midline of the nose. GV14 is indicated for nosebleed which does not stop, an indication that mirrors the folk practice of placing a key or other piece of cold metal, or a cold sponge, at the back of the neck to stop nosebleed. Classical combinations: Nosebleed: moxa GV14 and GV15 (Secrets of the Master of Cinnabar Creek).

CV07 Yinjiao: Relevant indications: Uterine bleeding, irregular menstruation, amenorrhoea, leucorrhoea, infertility, ceaseless flow of lochia after childbirth. Due to the close relationship of CV07 to the uterus, it may be used to treat such disorders as uterine bleeding, irregular menstruation, amenorrhoea, lochiorrhagia and infertility due to any aetiology. CV is the "Sea of the Yin Channels"; Chong Mai is the "Sea of Xue". Both begin in the uterus. Their maturation depends on the flourishing of KI; thus the Plain Questions says: "At the age of 14, KI-Qi of the female is strong, the reproductive function matures, the CV flows and the Chong Mai fills, the menses come according to their times, and she can bear offspring". CV07 Yinjiao (Yin Meeting) is a meeting point of the CV, KI and Chong Mai, the 3 Channels that have the strongest relationship with the uterus. Disorders of menstruation may be Yin or Yang, Shi or Xu, due to Cold or Heat, External pathogens (Perverse-Qi), or Internal disharmony (emotional imbalance).

References.
We would especially like to mention:
1. Maciocia G (1994) The Practice of Chin Med. Churchill Livingstone.
2. Flaws B (1994) Master Hua's Classic of the Central Viscera: Excerpts from a Translation of Hua Tuo's Zhong Zang Jing. AJA 22(2).
The material presented in this article is taken from the forthcoming textbook A Manual of AP and originally appeared in CMJ (UK).

Westerman_MP (1994) AP and blood studies in sickle-cell anaemia [letter]. AJCM 22(2):190.

Zorich_OI; Orlova MV (1992) Biotics of human blood after applying microcurrents (letter). Biofizika Mar-Apr 37(2):388-390. Microcurrent-Stimulation of human AP points releases biologically active substances into the blood, which may be accompanied by changes in the composition of microelements. Levels of some microelements of the blood were determined before and after EAP. Levels of elements with alternating valency decreased, while those of alkaline elements increased somewhat in the same blood samples of a healthy man. EAP may regulate homeostasis of microelements in the blood.

5. ALLERGIES
Aleksandrova_RA; Zhikharev SS; Mineev VN; Sinitsina TM; Shchemelinina TI; Karpov OI; Pozigun MA; Duvakina AL; Zhikhareva NB; Solodovnikova GM (1991) [AP therapy to treat patients with bronchial asthma]. Klin Med (Mosk) Mar 69(3):69-72. Erythron membrane impairment was investigated using membrane-active drugs (obsidan, delagil, morphium, ethanol) to specify indications to AP in bronchial asthma (BA). Patients were studied during treatment and followed up for 1 yr. Both immediate and long-term results of AP were related to patterns of the membrane impairment. BA patients with a sharp, >1.5 fold diminution of microcyte count upon delagil test should be assigned to repeated courses of AP for 1 yr. To monitor the treatment effect, it is recommended to define osmotic resistance of the red blood cells in obsidan test in addition to clinicofunctional indices.

Aleksandrova_RA; Nemtsov VI; Petrova MA; Lavrova OV; Trofimov VI; Sinitsina TM; Dotsenko EK (1995) Bronchial nonspecific reactivity in patients with bronchial asthma and in the preasthmatic state and its alteration under the influence of AP. Ter-Arkh 67(8):42-45. The development of nonspecific bronchial hypersensitivity and hyperreactivity in bronchial asthma and effectiveness of its correction with AP were studied in 152 patients with asthma and preasthma. 94 of them were subjected to AP. The authors employed a complex of diagnostic methods with determination of 241 parameters processed later with the use of systemic modelling. Bronchial hypersensitivity as indicated by the response to ACh was related to impaired coordination of bronchomotor tone regulating systems: parasympathetic part of the ANS, eosinophilic and monocytic bronchial inflammation, glucocorticoid homeostatic alterations. The corrective role of AP consists in reduction of nonspecific bronchial hyperreactivity, normalization of blood ACh, resensitization of cell beta-adrenergic receptors, elevation of mean levels of 11-OCS and T-lymphocytes.
Aleksandrova_RA; Nemtsov VI; Lan' PL; Sinitsina TM; Verkhovskaia VA; Goncharova VA; Bondarenko VL; Kozlov VG; Zagustina NA (1995) An analysis of the AP treatment results in bronchial asthma patients. Vopr Kurortol Fizioter Lech Fiz Kult May-Jun(3):10-12. Treatment effects reached in 94 patients with bronchial asthma show that neurogenic, humoral and bioenergetic responses to AP proceed according to adaptation laws and result in reduction of bronchial hyperreactivity. Eosinophilic inflammation in the bronchi diminishes AP efficacy.

Andersson_S (1992) [AP for the treatment of asthma]. Nord Med 107(4):115. Physiology Inst, Goteborgs Univ, Sweden.

Gottberg_L (1992) [AP in asthma? A long_term study should decide]. Lakartidningen 10 Jun 89(24):2177. Lung & Allergy Clinic, Huddinge sjukhus, Sweden.

Guan_Z; Zhang J (1995) Effects of AP on immunoglobulins in patients with asthma and rheumatoid arthritis. JTCM Jun 15(2):102-105. Kunming Municipal Hospital of TCM, Yunnan Province. The effects of AP on immunoglobulins in patients with asthma and rheumatoid arthritis were studied. After AP, in 20 patients with asthma, IgG increased (p <.01), IgM and IgE decreased (both p <.01), while IgA did not change markedly (p >.05); in 12 patients with rheumatoid arthritis, after AP IgG, IgA and IgM decreased (p <.05, 0.05, and 0.01, respectively), while IgE did not change evidently. AP modulated immunoglobulins of the human body, and patients with asthma and rheumatoid arthritis responded effectively to AP therapy. The latter may be related to the reinforcement of the immunological function by AP.

Hauswald_B (1995) Current status of diagnosis and therapy of allergic rhinitis. Ther Umsch Nov 52(11):738-743. Klinik und Poliklinik fur Hals-Nasen-Ohren-Heilkunde der Medizinischen Fakultat Carl-Gustav Carus, Technischen Universitat Dresden. A general rise in the occurrence of allergies has led to an increasing number of ENT consultations due to allergic rhinitis. The prevalence of allergic rhinitis amounts to 10-16% in Central Europe with a tendency to increase. Causal factors include an unhealthy lifestyle (stress), dietary habits, exposure to environmental pollutants, and genetic predisposition. The diagnostic work-up consists of a specific history of allergies, a general ENT examination, provocation tests of allergens such as skin reaction tests, and Lab tests. Treatment includes avoidance of allergens, induction of hyposensitivity, symptomatic drug treatment, and AP.

Joshi_YM (1992) AP in bronchial asthma. J Assoc Physicians India May 40(5):327-331. Bhatia General Hospital, Bombay. By now, there is ample clinical experience of treating bronchial asthma with AP. AP has a limited role in treating acute attacks since it is a weak bronchodilator, but it has an excellent prophylactic effect. AP causes modest improvement in objective parameters, with significant subjective improvement in controlled trials. However, all these trials had wide variation in the technique and methodology used. With standardization of the technique by the best guidelines, future trials may be able to quantify the efficacy of AP in bronchial asthma. Also, investigation of the mechanism by which AP works may lead to better understanding of the pathophysiology of asthma.

Kasahara_T; Amemiya M; Wu Y; Oguchi K (1993) Involvement of central opioidergic and nonopioidergic neuroendocrine systems in the suppressive effect of AP on delayed type hypersensitivity in mice. Int J Immunopharmacol May 15(4):501-508. Dept of Pharmacol, Sch of Med, Showa Univ, Tokyo, Japan. The effect of a single treatment of EAP (Acu) at early or late stages of the efferent phase on 2, 4, 6-trinitrochlorobenzene (TNCB)-induced delayed type hypersensitivity (DTH) was studied in intact and hypophysectomized (HPX) mice. Acu (2.5 Hz, 15 min) applied to the AP point equivalent to GV04 at 0, 3, 18 or 21 h after TNCB challenge induced significant suppression (45-73%) of the maximal extent of ear swelling at 24 h after TNCB challenge. An immunosuppressive and antiinflammatory drug, prednisolone 10 mg/kg ip, also suppressed the DTH to the same extent. Pretreatment with icv injection of naloxone hydrochloride (2 ug) significantly blocked the AP-evoked DTH suppression when Acu treatment was done at 0 or 3 h. On the contrary, naloxone did not block the effect of Acu treatment given at 21 h. In order to examine the potential involvement of the pituitary in the suppression of DTH by Acu, the DTH reaction was examined in HPX mice. Acu failed to produce suppressive response in the HPX mice unless given at 0 h. AP at GV04 during the efferent phase of induced DTH suppressed DTH through central opioidergic or nonopioidergic systems. The pituitary is apparently pivotal in this immunosuppression; DTH suppression by AP may be mediated via activation of the neuroendocrine system.

Kleijnen_J; ter Riet G; Knipschild P (1991) AP and asthma: a review of controlled trials. Thorax Nov 46(11):799-802. Dept of Epidemiol and Biostatistics, Univ of Limburg, Maastricht, The Netherlands. Published trials of AP in asthma often involved too few subjects and gave contradictory results. We reviewed 13 controlled trials on the efficacy of AP to treat patients with asthma to see if clearer conclusions could be drawn. These studies were reviewed on the basis of 18 predefined criteria of methodology. A maximum of 100 points for study design could be earned in 3 main categories: A=Adequate study population; B=Adequate intervention and; C=Adequate measurement of effects. Even the 8 better studies were of mediocre quality (>50% of the maximum score) and had highly contradictory results. No study earned >72% of the maximum score. ConclusionS: Claims that AP is effective to treat asthma are not based on the results of well performed clinical trials.

Lai_X (1993) Observation on the curative effect of AP on type I allergic diseases. Chung i tsa chih (JTCM) Dec 13(4):243-248. In a comparative study on treatment of type I allergic diseases, AP and desensitization therapies were performed in 143 cases. AP therapy had an extensive and remarkable action against type I allergic reaction. The curative effect was higher in the AP group than in the desensitization group in allergic asthma, allergic rhinitis and chronic urticaria.

Liao_SJ2; Liao TA (1992) AP treatment for psoriasis: a retrospective case report. AETRIJ Jul-Sep 17(3):195-208. New York Univ Dental Coll, NY. We treated 61 cases of psoriasis with AP, including 25 patients with complications of joint involvement and 2 cases with scleroderma additionally. All of the patients had failed to respond to their prior conventional western medical management. 25 patients were males and 36 were females. Mean age was circa 52 (range 22-84) yr. Mean ages between the sexes were not significantly different. Most of them (circa 61%) had extensive involvement of the body. Mean duration of illness was >16 (range 2-65) yr. They received a mean of circa 9 (range 1-15) sessions of AP. Almost 33% (19) of them had 11-13 sessions. With the AP treatment, circa 50% (30/61) of patients had complete or almost complete clearance of the skin lesions. Circa 25% (14 patients) of them had a clearance of circa 67% of the skin lesions. 8 had a clearance of one third of the skin lesions. 9 patients had minimal or no improvement. AP is an effective therapy for psoriasis, particularly when the western medical management is unsuccessful. Possible involvement of the cutaneous reticuloendothelial system in the clearance of the skin lesions is discussed.

Liu_X7; Sun L; Xiao J; Yin S; Liu C; Li Q; Li H; Jin B (1993) Effect of AP and point-injection treatment on immunologic function in rheumatoid arthritis. Chung i tsa chih (JTCM) Sep 13(3):174-178. General Hospital of PLA, Beijing, PRC. 54 cases of rheumatoid arthritis (RA) were treated by warm needling (WN) and point-injection (PI) with Zhuifengsu (drug). Good clinical results were observed with an effective rate of 100%. Changes in cellular and humoral immunity and other parameters in peripheral blood were noted before and after treatment. The NK activity and IL-2 value in RA patients were found to be lower than those of normal people; both increased after treatment (p <.01). WN and PI with Zhuifengsu exert a regulatory effect on the cellular immunological function.

Lou_B (1990) Personal experience on AP treatment of asthma. JTCM Mar 10(1):13-16. Inst of TCM, Zhejiang Province, PRC.

Lu_S (1993) AP and moxibustion in the treatment of dermatoses. JTCM Mar 13(1):69-75. AP and Moxibustion Dept, Beijing AP-Moxibustion and Traumatology College, PRC.

Medici_TC (1994) [AP and bronchial asthma]. Schweiz Med Wochenschr Suppl 62:39-48. Dept fur Innere Medizin, Universitõtsspital Zurich. Complementary or alternative medicine is gaining popularity. Patients demand such treatment, but practising physicians need to know more about it. Perception that conventional medicine has limited value is the common motive for the interest of both groups. This is obvious in the case of bronchial asthma, whose underlying cause is largely unknown despite decades of research, and whose treatment is symptomatic. Also, asthma mortality is not declining. In these circumstances it is legitimate to look for alternatives. One alternative therapy is AP. Although there are many published studies on AP and asthma, few meet the scientific tests necessary to prove the effectiveness of AP. From these studies it emerges that short term effects of AP are better documented than long term ones. Nor is it possible to predict what proportion of asthmatics will respond to AP. Allergic eosinophilic inflammation of the respiratory tract is foremost among present day hypotheses concerning the pathogenesis and pathophysiology of asthma. It is interesting that there are no known clinical or experimental investigations into the effect of AP on allergic inflammation of the asthmatic's bronchial mucosa. In view of these facts we are conducting a long term controlled study of the acute and chronic effects of AP on both allergic inflammation of the bronchial mucosa and asthmatics' clinical symptoms, bronchial hyperreactivity and consumption of medication. To establish responders and non-responders, lung function tests and measurement of microcirculation and skin temperature are carried out before and after AP treatment. If we can show that AP has an effect on the allergic inflammation, this is not only a new pathophysiologic aspect and a further explanation of how the AP effect on asthma comes about. If it helps the disease, limits the consumption of medication, prevents side effects and lowers drug costs, AP may have far-reaching implications for asthmatics.

Morton_AR; Fazio SM; Miller D (1993) Efficacy of laser-AP in the prevention of exercise-induced asthma. Ann Allergy Apr 70(4):295-298. Dept of Human Movement Studies, Univ of Western Australia, Nedlands, WA. Many asthmatic patients are reluctant to follow the medication schedule prescribed for them and turn to alternative treatment methods. In this trial, laser-AP, did not prevent exercise-induced asthma.

Schwartz_C (1992) Chronic respiratory conditions and AP therapy. Probl Vet Med Mar 4(1):136-143. East-West Animal Care Ctr, Oakland, California 94606. AP effectively enhances the treatment of chronic allergic bronchitis and asthma in the cat and dog. According to TCM, chronic respiratory conditions can arise from LU, SP, LV or KI Xu (Deficiency). Proper diagnosis is made from patient history, as well as examination of tongue and pulse. AP points are chosen according to involved energy pathways (Channels) and classical AP combinations. In most cases, medication can be reduced as the AP takes effect.

Tandon_MK; Soh PF; Wood AT (1991) AP for bronchial asthma? A double-blind crossover study [see comments]. Med J Aust Mar 154(6):409-412. Thoracic Div, Repatriation General Hospital, Hollywood, W Australia. The therapeutic effectiveness of classic Chinese AP was compared with "placebo" AP in 15 patients with stable bronchial asthma. The patients received treatments with real and placebo AP in a randomly ordered, subject and evaluator-blind crossover fashion twice/wk for 5 wk. Both real and placebo treatment periods were preceded by 3 wk periods when no AP was used. 5 patients felt better on real treatment, 5 patients preferred placebo and 5 did not feel any improvement on either of the 2 treatments. Treatment with real AP when compared with no treatment and placebo treatment failed to provide any improvement in daily peak flow rates, asthma symptom scores, number of puffs of beta 2-agonist aerosol use, and pulmonary function results.

Wang_T; Xie S (1990) [Effect of moxibustion on the inflammatory reactions of adjuvant arthritics rats]. Chen Tzu Yen Chiu 15(1):44-47. Dept of Physiol, First Military Med Coll, Guangzhou, PRC. Adjuvant arthritic (AA) rats were used as the experimental model and the thickness of pedal pad, the circumference and the pathological (light microscopic changes of the ankle joint as well as the plasma level of middle sized molecules (MSM) were studied before and at subsequent experimental days after moxibustion (once/d for 6 d, on Shenque). Moxibustion reduced the inflammatory reactions significantly in comparison with that of the control group.

Waters_KC (1992) AP for dermatologic disorders. Probl Vet Med Mar 4(1):194-199. Vet AP is a useful therapeutic modality for treating dermatologic disease. The principles of TCM diagnosis can be applied to the animal patient, and AP points chosen based on the cause and clinical manifestations of the disease.

Williamson_L; Yudkin P; Livingstone R; Prasad K; Fuller A; Lawrence M (1996) Hay Fever Treatment in General Practice: A Randomised Controlled Trial Comparing Standardised Western AP with Sham AP. Adapted from WWW. The effect of standardised, Western AP on hay fever symptoms was studied in a randomised, controlled, single-blind trial in comparison with "sham" AP. 3 general practices, in Oxfordshire (rural), Lincolnshire (semirural), and Peterborough (urban), recruited 102 patients aged 16 or over with long-standing, moderate or severe hay fever symptoms that had required continuous therapy for at least one mo/yr for >/=3 yr. Patients were asked to record in a diary: the amount of medication used daily; a daily symptom score (using a 10-point scale), from which was derived a weekly remission of symptoms score; and their assessment of the effect of AP on the hay fever symptoms. Symptom scores and use of medication were similar in the 2 groups. In the 4-wk period after each patient's first treatment, remission of symptoms was reported by 39% in the active treatment group and 45% in the sham group; mean weekly symptom scores were 18.4 and 17.6 respectively; and mean units of medication used were 4.1 and 5.0 respectively. 16/43 patients in the active treatment group and 14/43 in the sham group felt that the AP gave an excellent or very good effect on their hay fever. The treatments were simple, safe, reproducible and perceived as equally effective. Whether this represented an AP effect, a placebo effect, or natural variation in a fluctuating condition, is not clear.

Xi_D; Han J; Zhang Z; Sun Z (1992) AP treatment of rheumatoid arthritis and exploration of AP manipulations. JTCM Mar 12(1):35-40. Yueyang Hospital, College of TCM, Shanghai, PRC.

Xiao_J2; Liu X; Sun L; Ying S; Zhang Z; Li Q; Li H; Zhang Z; Jin B; Wang S (1992) Experimental study on the influence of AP and moxibustion on interleukin-2 in patients with rheumatoid arthritis. Chen Tzu Yen Chiu - AP Research 17(2):126-128, 132. General Hospital of PLA, Beijing, PRC. Rheumatoid arthritis (RA) is regarded as an autoimmune disease in WM, but the pathogenesis is unclear. TCM regards RA as one of the Bi Syndromes. To study the effects of AP and moxibustion in the treatment of RA and on IL-2, 41 RA patients were assigned at random to 3 groups: 1=Warming needle (n=20 RAs); 2=AP point injection (n=21 RAs) and; 3=Control (n=19 healthy people). IL-2 levels in groups 1 and 2 before treatment were significantly lower (p<.05) than that in the control group. Treatment did not alter the IL-2 level in the control group, but increased it significantly (p<.01) in the considerably in the 2 RA groups. IL-2 is a very important signal to regulate the immune response. The decrease of IL-2 in patients with RA is one of the main causes of disorder of the internal environment. AP and moxibustion act as a form of stress-stimulation which, through the neuroendocrine system, activates the immune system to increase IL-2 production.

Yang_YQ (1993) [Progress on anti-allergy treatment with AP]. Chung Kuo Chung Hsi I Chieh Ho Tsa Chih Mar 13(3):190-192. In Chinese.

Yu_S; Cao J; Yu Z (1993) AP treatment of chronic rhinitis in 75 cases. JTCM Jun 13(2):103-105. Beijing Hospital of TCM, PRC.

Zamotaev_IP; Mamontova LI; Zavolovskaia LI; Rudakova OM (1991) [Effect of (infrared) laser-AP on the pulmonary vascular resistance in patients with obstructive chronic lung diseases]. Klin Med (Mosk) May 69(5):68-71. Clinical pattern of the disease, systolic pressure in the pulmonary artery, external respiration, central haemodynamics were assessed in 111 patients (50 with chronic obstructive bronchitis and 61 with bronchial asthma) to study the effect of laser-AP. The treatment course consisted of 10 sessions performed with application of Uzor apparatus in pulse regimen with 890 nm wave length, 1500 Hz frequency and 2 mW mean radiation rate. IR laser-AP gave a positive response, evident from improved bronchial patency, enhanced bronchial sensitivity to sympathomimetics and reduced systolic pressure in the pulmonary artery. The promise of laser-AP is attributed to its separate broncholytic effect and the ability to lower pulmonary vascular resistance.

Zang_J (1990) Immediate antiasthmatic effect of AP in 192 cases of bronchial asthma. JTCM Jun 10(2):89-93. Dept of AP, 2nd Municipal People's Hospital, Kaifeng City, Henan Province, PRC. AP at LU06 and LU10 was used to treat 192 cases of bronchial asthma. The immediate total effective rate was 99% and the rate of clinical remission plus marked improvement was 76%. The efficacy for patients of varying ages and varying duration of the disease was not significantly different. Effects were best for asthma of the Cold Syndrome according to TCM and of the allergic type according to WM. Cases that responded fastest to treatment had better long-term clinical results. The duration of needle retention also influenced the clinical result. The author deemed that 40 min of needle retention after the treatment took effect was desirable. AP at LU06 and LU10 was very satisfactory in the treaatment of bronchial asthma. It was particularly useful for cases with a history of drug allergy.

Zwolfer_W2; Keznickl Hillebrand W; Spacek A; Cartellieri M; Grubhofer G (1993) Beneficial effect of AP in adults with bronchial asthma. Dept of Anaesthesia and Intensive Care, Univ of Vienna, Austria. AJCM 21(2):113-117. In a retrospective study 17 patients with long-standing history of bronchial asthma were treated with AP at the outpatient unit of the Dept of Anaesthesia and Intensive Care in the Univ Hospital of Vienna. The subjective effectiveness of the treatment was determined using a standard questionnaire, sent to the patients' homes 6 mo after starting AP treatment. >70% of our patients reported significant improvement of their ailments after 10 wk of treatment as well as 6 mo after starting AP.

6. TISSUE REGENERATION
Bibikova_A1; Oron U (1993) Promotion of Muscle Regeneration in the Toad (Bufo Viridis) Gastrocnemius-Muscle by Low-Energy Laser Irradiation. Anat Rec Mar 235(3):374-380. Tel Aviv Univ, George S Wise Fac Life Sci, Dept Zool, IL-69978 Tel Aviv, Israel. Quantitative histology and morphometry were used to study the effect of low-energy laser (He-Ne, 632.8 nm) irradiation on skeletal muscle regeneration after cold injury to the gastrocnemius muscle of the toad (Bufo viridis). Starting on d4 post-injury, the injured zones in the experimental toads were subjected to five direct He-Ne laser irradiations (6.0 mW for 2.3 min) every 2 d. Muscles that were injured as above, and subjected to red-light irradiation, served as a control group. Morphometric analysis was performed on histological sections of injured areas at 9, 14, and 30 d postinjury. At 9 d postinjury, mononucleated cells populated 69+17% of the total area of injury. Thereafter, their volume fraction (% of total injured zone) decreased gradually but more rapidly in the laser-irradiated muscle than in the control. The volume fraction of the myotubes in the laser-irradiated muscles at 9 d of muscle regeneration was significantly higher (7.0+2.2%) than in the control muscle (1.2+0.4%). Young myofibres in the laser-irradiated muscles populated 15.5+7.9% and 65.0+9.5% of the injured area at 9 and 14 d of muscle regeneration respectively, while in control muscles these structures were not evident at 9 d and made up only 5.3+2.9% of the traumatized area at 14d postinjury. The volume fraction of the young myofibres further increased by 30 d of muscle regeneration making up 75.7+13.2% of the traumatized area, while in the laser-irradiated muscles most of the injured zone was filled with mature muscle fibres. He-Ne laser irradiation during the regeneration process markedly promoted muscle maturation in the injured zone after cold injury to the toad gastrocnemius muscle.

Bibikova_A2; Oron U (1995) Regeneration in Denervated Toad (Bufo-Viridis) Gastrocnemius-Muscle and the Promotion of the Process by Low-Energy Laser Irradiation. Anat Rec Jan 241(1):123-128. U Oron, Tel Aviv Univ, George S Wise Fac Life Sci, Dep Zool, IL-69978 Tel Aviv, Israel. Denervated skeletal muscles can regenerate but regenerated myofibres do not mature. Denervation also causes elevation of "invasive" and satellite cells but the role of these cells in the regeneration process after injury to denervated muscle is unknown. LLLT modulates and accelerates physiological processes in cells. We compared regeneration in denervated and innervated amphibian muscle and studied whether LLLT before injury can stimulate regeneration in denervated muscle. On d7 postdenervation, denervated gastrocnemius muscles of toads were irradiated with He-Ne laser (6.0 mW, 31.2 J/cm2). Control muscle received red light irradiation at the same wavelength. On d9 postdenervation, cold injury was performed on the site of irradiation of both groups of muscles. On d14 postinjury, all muscles were removed for histology and histomorphometry of mononucleated cells, myotubes, and young myofibres in the regenerated zone. The volume fraction (% total injured zone) of the various structures in the injured zones on d14 after cold injury in the denervated muscles did not differ from innervated injured muscles at the same time interval postinjury. The mononucleated cells and myotubes in the LLLT-treated muscles comprised 49+4% and 6+1% of the injured area, respectively, which was significantly lower than their volume fraction (67+2% and 11+2%, respectively) in the control muscles. The young myofibres populated 34+4% of the total injured area in the denervated and laser irradiated muscles which was significantly higher than their volume fraction (12+2%) in control denervated muscles. Early regeneration can also take place in skeletal denervated and injured muscles of amphibians. The kinetics of the regeneration process are identical in denervated and innervated muscles. The process of regeneration in denervated muscles can be markedly enhanced if the muscle is irradiated by LLLT before injury, probably by activation (stimulation of proliferation and/or differentiation) cells in the muscles that are "recruited" and participate in the process of regeneration.

Ghamsari_SM; Acorda JA; Taguchi K; Abe N; Yamada H (1996) Evaluation of Wound-Healing of the Teat with and Without Low-Level Laser Therapy in Dairy-Cattle by Laser-Doppler Flowmetry in Comparison with Histopathology, Tensiometry and Hydroxyproline Analysis. BVJ Sep 152(5):583-592. Obihiro Univ Agr & Vet Med, Sch Vet Med, Dept Vet Surg, Inada CHO, Obihiro, Hokkaido, Japan. Perforated teat-wounds in 8 lactating Holstein-Friesian cows were closed by four suture patterns with or without low level laser therapy (LLLT). Wound healing was evaluated by laser Doppler flowmetry (LDF), tensiometry and hydroxyproline analysis, and compared with histopathological examination. The three-layer pattern provided the best healing of the entire tear. Mucosal hyperplasia was observed in Gambee and continuous two- layer pattern while eversion of the skin, presence of suture tracts and a greater amount of granulation tissue were observed with the continuous and interrupted two- layer patterns. The epidermis in LLLT groups more closely resembled the normal epidermis, and collagen fibres were denser, thicker and better arranged in LLLT- than in non- LLLT groups. LDF, tensiometry and hydroxyproline analysis correlated well with histopathological examination. LDF, a more rapid, less invasive and painless procedure, can replace tensile strength measurement or hydroxyproline analysis to assess the progress of teat wound healing.

Gomezvillamandos_RJ; Valenzuela JMS; Calatrava IR; Gomezvillamandos JC; Jurado IA (1995) He-Ne-Laser Therapy by Fibroendoscopy in the Mucosa of the Equine Upper Airway. Laser Surg Med 16(2):184-188. RJ Gomezvillamandos, Univ Cordoba, Fac Vet Med, Dep Vet Clin Pathol, Avda Med Azahara 9, E-14005 Cordoba, Spain. Effects of LLLT on cicatrization of superficial wounds in the pharyngeal mucosa were studied in horses. Duplicate pharyngeal mucosal ulcers were induced in 12 horses by submucosal injection of H2SO4. A fibroendoscope and an He-Ne laser were used to treat one of the ulcers and the second ulcer in each animal was left as an untreated control. Biopsy samples were taken from 2 horses after the 7th LLLT session. Irradiated lesions cicatrized at 10.5 d and nonirradiated lesions cicatrized at 18 d. Differences between the irradiated and control groups were highly significant (p<.0001). Histology of the control samples showed epithelial coagulation necrosis, edema, and microthrombi. However, samples from LLLT-treated lesions showed no inflammatory edema but showed active fibroblasts, connective tissue and intensive epithelial regeneration. LLLT accelerated scar-formation and had beneficial effects on equine pharyngeal ulcerative lesions. 

E. AP Analgesia (APA)

1. GENERAL DATA
Galoic-Krleza_R (1991) AP and neuroleptanalgesia. Lijecnicki Vjesnik Sep-Oct 113(9-10):327-332. In Serbo-Croatian. In search of a way to inhibit responses to surgical stress, we tried a new method of anaesthesia, a combination of neuroleptanalgesia (NLA) and traditional AP. The aim was to increase the level of endogenous opioid peptides, and thus decrease the need for exogenous opiates and limit the body's response to surgical stress. Combined use of NLA and AP was evaluated in the pre-, intra- and post- operative period. 40 metabolically healthy patients were randomly allocated to a control and experimental group. Hyperglycaemia, cortisol and aldosterone response, fentanyl and dehydrobenzperidol (DHBP) requirements, and its postoperative analgesic and antiemetic efficacy were monitored. AP, combined with NLA, significantly reduced requirements for fentanyl and DHBP, significantly suppressed hyperglycaemia and cortisol response to surgical stress, but did not influence aldosterone mechanism. Postoperative vomiting and pain, and requirements for of analgesic medication were significantly less. A combination of AP and neuroleptanalgesia is easy to use in surgery and is recommended to suppress significantly the response to surgical stress (intraoperative hyperglycaemia and hypercortisolism) and postoperative vomiting and pain.

Hashimoto_T; Akita H; Aikawa S (1993) Analgesia induced by manual AP: its potency and implication. Kitasato Arch Exp Med Apr 65 Suppl: 73-82. Dept of Physiology, Sch of Hygienic Sci, Kitasato Univ, Kanagawa, Japan. In urethane-anaesthetized rats, unitary discharges of wide dynamic range (WDR) neurons were extracellularly recorded from the lumber cord. Repetitive electroshocks were given through needle electrodes in the receptive field with sufficient strength to activate C fibres. The number of evoked discharges was compared before manual AP to LI04 or ST36 and after 30 s. The effects of AP were followed up to 5 min after removal of the AP needle. Two different analgesic effects were observed: AP to LI04 gave long-lasting inhibition after insertion of the needles and stimulation of ST36 produced short-term and long-lasting inhibition similar to that seen in AP to LI04.

Janssens_LAA1 (1993) The Role of AP in Analgesia. Tijdschr Diergeneesk Mar 118(Suppl.):S11-S12. Oudestr 37, B-2610 Antwerp, Belgium.

Kitade_T; Odahara Y; Shinohara S; Ikeuchi T; Sakai T; Morikawa K; Minamikawa M; Toyota S; Kawachi A; Hyodo M; et al (1990) Studies on the enhanced effect of APA by DPA (2nd report): schedule of administration and clinical effects in low back pain and tooth extraction. AETRIJ 15(2):121-135. Dept of Oriental Med, Meiji Coll of Oriental Med, Kyoto, Japan. DPA is known to block the activity of carboxypeptidase, an enzyme which degrades enkephalins, endogenous morphine-like substances. Therefore, it is considered that DPA administered as an inhibiting drug of this degrading enzyme might prolong APA. 1) 30 patients suffering from chronic low back pain were treated with AP 30 min after the oral administration of 4 g of DPA. Results: excellent in 7 cases, good in 11, fair in 6 and poor in 6. Cases graded excellent and good were then compared with a placebo group. The effect was increased 26% in the DPA-AP group, which shows no statistically significant difference (p <0.1). 2) In 56 patients, tooth extraction was performed under APA: 18 had received 4 g DPA (oral) 30 min earlier. Results: excellent in 8, good in 6, fair in 3, and poor in 1. The excellent and good cases were compared with 38 placebo cases. The effect in the DPA-APA group was significantly increased by 35% (p <.01). 3) In order to determine the best time to administer DPA, 2 schedules were compared: 1. DPA was given 1 d previously in 3 doses of 0.5 g (26 cases); 2. A single dose of 4 g was given 30 min before treatment (30 cases). In the "excellent", "good" and "fair" cases, a 16% increase in effectiveness occurred when DPA was given 1 d previously. This was not statistically significant (p <0.1), but strongly suggested a tendency to increase. DPA enhances APA in clinical practice.

Klide_AM (1992) AP-produced surgical analgesia: Physiol, indications, techniques, and limitations. Probl Vet Med Mar 4(1):200-206. Dept of Clinical Studies, Sch of Veterinary Med, Univ of Pennsylvania, Philadelphia 19104. Experimentally and clinically, APA sufficient for surgery has been shown to occur in many species. Advantages of APA for surgery: it avoids the need for depressant drugs, which may be especially useful in veterinary practice in very sick patients, geriatric patients, or in patients requiring Cesarean section. Disadvantages: AP-produced surgical analgesia involves an unfamiliar technique, requires special equipment and very good restraint, requires an unpredictable induction-time and has inconsistent analgesic effects.

Klide_AM (1992) AP-Analgesia. Vet Clin N Am Small Anim Mar 22(2):374-379. Univ Penn, Sch Vet Med, Dept Clin Studies Philadelphia, Small Anim Anaesthesia Sect, Philadelphia, PA 19104 USA. AP-produced surgical analgesia has been shown in many species under experimental and clinical circumstances. The main advantage of APA is that no depressant drugs need to be used. The disadvantages are unfamiliarity, the need for special equipment, inconsistent effects, and lack of restraint.

Ouyang_B; Tan S; Tan S (1990) [The relations between APA and changes of level of serum metallic ion]. Chen Tzu Yen Chiu 15(2):143-146. Dept of Anaesthesia, First Affiliated Hospital, Guangzhou Med Coll, PRC. 40 patients treated by thyroidectomy received superficial cervical plexus block or EAP at LI04 and PC06 bilaterally. All patients were assigned at random into 4 anaesthetic groups: A1, A2 and A3=(EAP-analgesia; C=EAP + pethidine iv. Serum level of Na+, K+, Ca++, Cu++, Mg++ and Zn++ were measured before and during anaesthesia or EAP-analgesia, and postoperation. The analgesic effect of 4 groups did not differ significantly (p >.05). Serum Ca++ level fell during EAP-analgesia (p <.05-0.01), with no difference between group A1 and group A2 (p >.05). EAP decreased serum Ca++ reduced. There was no additive effect for the influence of serum Ca++ when EAP stimulated LI04 and PC06 simultaneously with iv Pethidine (1.3 mg/kg). 3. 5% Glucose injection iv during the operation probably disturbed the serum Ca++ level, but had no effect on analgesia. 4. AP significantly changed the level of serum Na+, Cu++, Mg++ and Zn++ but with wide variation. More research is needed on the mechanisms of these changes.

2. HEAD AREA
Chen_W; Wang Y; Wu H; Gu Z (1991) [Analysing the effects of tooth extraction under APA in 825 cases of old patients]. Chen Tzu Yen Chiu 16(1):1-3, 14. Dept of Stomatol of Tong Ji Hospital, Tong Ji Med Univ, PRC. The effects of tooth extraction under APA for old patients generally are said to be good. To verify this, from >4000 cases whose records of APA were available from 1973-1988, we statistically analyzed 825 cases >60 yr (Group A) and a similar number aged 18-40 yr (Group B). 1. There was no significant difference under APA for different sexes. 2. The differences of the excellent rate of APA between Group A and Group B were extremely evident either in the positions of the tooth or the reason of tooth extraction. The former was 89% and the latter 76% (p <.005). 3. Although a low rate in excellence of tooth extraction under simple APA (only 76%), not so good as the effect by EAP-analgesia (circa 88%), simple APA was more common and more easily accepted by patients. 4. Tooth extraction under APA was safe, effective and without any complications. 5. The reasons for the extractions in old people were mainly for broken crowns, or for roots, or for prosthetic restoration. Old people usually have higher pain thresholds and this is important in the good effect and good rate of tooth extraction under APA. Hospitals which can use the APA for tooth extraction use it as the analgesic method of first choice in old patients who agree to it.

Ekblom_A; Hansson P; Thomsson M; Thomas M (1991) Increased postoperative pain and consumption of analgesics after AP. Pain Mar 44(3):241-247. Dept of Physiol II, Karolinska Inst, Stockholm, Sweden. AP was given to patients before (preoperative-AP group, PRE-ACU, n=25) or after (postoperative-AP group, POST-ACU, n=25) operative removal of impacted mandibular third molars. 60 patients did not receive AP and participated as a control group (CG). All patients completed a questionnaire in order to characterize state tension and stress, degrees of neuroticism, extroversion, depression and psychosomatic disorders. We also recorded intraoperative discomfort and pain intensity, postoperative pain intensity and consumption of analgesics for 72 h. The PRE-ACU was significantly more tense after surgery and found the operative procedure more unpleasant than the other 2 groups. The PRE-ACU further rated intraoperative pain intensity higher than the CG and experienced higher pain intensity immediately postoperatively compared with POST-ACU and CG. Of the PRE-ACU patients15/24 needed additional local anaesthesia intraoperatively while none in the POST-ACU or CG requested extra lidocaine. Postoperatively patients in both PRE- and POST-ACU reported a higher total sum of pain scores (pain intensity) and the PRE-ACU consumed more analgesics compared with the CG. A significantly larger number of patients suffering from "dry socket" (a complication during wound healing) was found in both PRE- and POST-ACU compared with the CG. No correlation was found between assessed personality characteristics and reported postoperative pain/consumption of analgesics in any group. Differences observed between the groups could not be explained. The reason for our unexpected "negative" findings is unclear but some hypothetical explanations are discussed.

Nauta_J; Zhang T (1990) Some introductory remarks on AP in dentistry. EDS Mag May 1:33-36. In general 2 different types of AP are used in dentistry, Traditional Chinese AP and AP according to Dr Voll. Both use imaginary lines, called Channels, according to theories of TCM. However fundamental differences between the 2 types of AP exist.

Huang_H (1995) Application of APA combined with drugs during neolarynx reconstruction. Chen Tzu Yen Chiu 20(2):3-6. Ear Nose and Throat Inst, Shanghai Med Univ, PRC. 50 Cases of neolarynx reconstruction under APA combining with drugs were performed from 1992-1995. We used Ear-points "Lung", "Shenmen", "Sympathetic" and body points LI04, TH06, LI18. The patients were given pethidine, rotundine, metoclopramide im 15-25 min before operation. The excellent rate was 98%.

Jiang_C (1992) [Normalization of APA used in neurosurgery]. Chen Tzu Yen Chiu 17(1):1-6. Dept of Neurosurgery, Huashan Hospital, Shanghai Med Univ, PRC. From Mar 1975 to Feb 1982 and from Apr 1987 to Oct 1990, the national cooperative neurosurgical AP research group had already accumulated the clinic data of 5244 cases totally, consisting of 2107 cases in frontal fossa, 1951 cases in the temporo-parieto-occipital region and 1186 in posterior fossa. By the same manipulative procedures and scaling criteria, the indications, choices of AP points, stimulus parameters, adjuvants, preoperative measurements, and physiological and biochemical changes during operations were studied. Practically, the result was not only reliable, but highly repeatable. 95% of the cases in frontal fossa belonged to grade I (success), 91% of the cases in temporo-parieto-occipital region was grade I and 89% of the cases in posterior fossa was grade I. APA should be widely used as one of the usual methods of anaesthesia. The relative specificity of AP points, the mechanism of adjuvants, personal differences and preoperative measurements were discussed. In the meantime, the advantages and the remaining problems of APA in craniocerebral operations were also mentioned.

Kho_HG; van Egmond J; Zhuang CF; Lin GF; Zhang GL (1990) APA: Observations on its use for removal of thyroid adenomata and influence on recovery and morbidity in a Chinese hospital. Anaesthesia Jun 45(6):480-485. Inst for Anaesthesiol, Univ of Nijmegen, The Netherlands. APA, supplemented by small doses of pethidine, was evaluated in 20 patients who had surgery for removal of a thyroid adenoma. There were significant increases in mean arterial pressure and respiratory rate during surgery, but no significant change in heart rate. The mean dose of pethidine given during surgery was 45 mg (SD 8.9). Postoperative recovery was rapid and complication free. APA did not provide complete analgesia, but was safe and preferable to general anaesthesia where there was a shortage of facilities.

Wang_BG2; Wang EZ; Chen XZ (1994) A study on combined AP and enflurane anaesthesia for craniotomy. Chung Kuo Chung Hsi I Chieh Ho Tsa Chih Jan 14(1):10-13, 3. Beijing Tiantan Hospital, PRC. Synergism between enflurane anaesthesia and transcutaneous AP point electric stimulation (TAES) was studied during craniotomy. 110 neurosurgical patients were assigned at random to 3 groups: A=Enflurane anaesthesia (n=40); B=Enflurane anaesthesia + TAES ipsilateral at LI04, Z 06 and GB20 (n=40); C=Enflurane anaesthesia + TAES + scalp infiltration with 0.5% procaine (n=30). Compared with Group A, Groups B and C decreased their minimum alveolar concentration (MAC) of enflurane 38-47% and 42-66% respectively, had more stable haemodynamics during operation, and had faster postoperative recovery. TAES significantly potentiated the anaesthetic effect and decreased the side effects of enflurane during craniotomy. The triple combination of TAES, enflurane and scalp infiltration with procaine was the best method of anaesthesia for craniotomy.

Yan_H1; Jiang C (1990) [Application of APA during craniocerebral operation in temporo-fronto-occipital region]. Chen Tzu Yen Chiu 15(2):92-96. Huashan Hospital, Shanghai Med Univ, PRC. The paper reports 174 cases of brain operations in temporo-fronto-occipital region by using the regime of combined AP and medication. The patients comprised of 122 males and 52 females. The AP points consisted of ear needling and body needling. Adjuvant drugs used were half-dosage Innovar and 0.1% lidocaine for scalp infiltration. According to the documented 2-grade scaling criteria, 97.1% patients belonged to grade I. No obvious discrepancy existed between ear needling group and body needling one. 3 controlled groups were compared: 1) 0.1% lidocaine alone; 2) AP plus normal saline; 3) AP plus 0.1% lidocaine. The differences were highly significant (p <.005); 0.1% lidocaine per se did not give satisfactory analgesia, whereas the efficacy of AP was enhanced greatly by the combination of 0.1% lidocaine and AP. This was an effective way to offset the incomplete analgesia of AP, especially for those who need to use intraoperative surgical method to avoid impairment to functional areas of cerebral cortex; the combination of Ear- and body- point AP, with lidocaine infiltration of the scalp, is undoubtedly superior to general anaesthesia for such purposes.

3. LIMBS
Agarwal_P; Kumar A (1995) Clinicophysiological Effects of EAP Analgesia of Limbs in Dogs. Indian J of Animal Sci Feb 65(2):149-152. RVC Ctr & Sch, Meerut 250401, Uttar Pradesh, India. EAP at GV20, ST40, BL60, GB40, LI04 and SP04 produced complete desensitization of hip joint, lateral aspect of hip, thigh, stifle joint and proximal part of leg of pelvic limb. EAP at GV20, LU10, TH05, PC06, LI11 and Tianping produced complete desensitization of shoulder girdle, elbow joint and arm of thoracic limb. Analgesia began in 20.1+0.45 min and recovery occurred in 12.7+0.22 min after termination of EAP. EAP caused a significant increase in heart rate, nonsignificant increase in respiration and rectal temperature up to 60 min. Mean arterial blood pressure, ECG and acid-base status did not change significantly after EAP.

Bihari_A4; Kumar A (1995) Physiological and Clinical Effects of EAP Analgesia of Limbs in Goats. Indian Vet J May 72(5):485-489. Coll Vet Sci, Dept Surg & Radiol, Pantnagar 263145, Uttar Pradesh, India.

Bihari_A5; Kumar A (1996) Haemocytological and Biochemical Effects of EAP-Analgesia of Limbs in Goats. Indian J Anim Sci Apr 66(4):318-321. Vet Hosp, Udaipur, Rajasthan, India. Total erythrocytes, leucocytes, PCV and neutrophils increased significantly after EAP of PC06, TH08, GB20 and Tianping, plus LU01, LI04, or LU10, LI11 for forelimb AP-analgesia (APA); and GB40, LI04, GV20 and Tianping, plus BL49 and SP06 or BL60 and SP04 for hindlimb APA. EAP of these points caused a significant increase in total protein, globulin and glucose, and decrease in albumin level with no significant change in urea nitrogen, cholesterol, creatinine, Na, K, chloride and enzymes: alanine aminotransferase and aspartate aminotransferase. These significant haemocytological and biochemical parameters returned to pre-stimulation level by 24-48 h. No adverse effect on metabolic profile was seen. No significant changes in haemocytology and biochemistry was seen between various groups of animals after Electro-APA of the fore- and hind- limbs.

Guagliumi_L (1991) [Orthopaedic surgery of the foot under AP hypo-analgesia with electric stimulation: Critical analysis and re-evaluation]. Minerva Anaestesiol Sep 57(9):484-486. Servizio di Anestesia e Rianimazione, Istituto Ortopedico G. Pini, Milano, Italy.

Lin_JG1; Chen XH; Han JS (1992) Antinociception produced by 2 and 5 KHz peripheral stimulation in the rat. Int J Neurosci May-Jun 64(1-4):15-22. AP Research Centre, China Med Coll, Taichung, ROC. Recently a "medium frequency" electric stimulator (LIKON) was marketed, which delivers 2000-5000 Hz square waves and was claimed to induce strong clinical analgesia. The aim of this study was to clarify whether electric stimulation over 1000 Hz would induce any antinociception in the rat. Tail flick latency (TFL) was taken as the nociceptive index. EAP was applied via needles at ST36 and SP06 on both hind legs. TFL increased significantly.

Oda_H; Fujitani Y (1990) Concentric electrodes for producing AP-like anaesthetic effects. Tohoku J Exp Med Mar 160(3):169-175. Dept of Physiol, Tottori Univ Sch of Med, Yonago, Japan. We designed concentric electrodes composed of a centre electrode and an outer ring electrode. Electrostimulation with 2 sets of such electrodes for 15 min as conditioning stimuli was given to the left hand of 35 adult subjects to induce AP-like analgesic effects. The effects immediately after the conditioning were compared between stimulation through a pair of centre electrodes alone at 3 Hz (conditioning 1) and simultaneous stimulation of 3 Hz through a pair of centre electrodes and 100 Hz through a pair of outer ring electrodes (conditioning 2). In conditioning 2, modulating effects of 100 Hz stimuli through a pair of outer ring electrodes made it possible to increase the voltage strength of 3 Hz stimuli through a pair of centre electrodes with maintaining the minimum perception of pricking sensation. Muscle twitching did not accompany either of the conditioning procedures. The respective stimulating current thresholds for faint touch sensation and also for pricking sensation at the right forearm were elevated significantly more by conditioning 2 (1.54 and 1.40 times) than by conditioning 1 (1.20 and 1.14 times).

Rieb_L; Pomeranz B (1992) Alterations in electrical pain thresholds by use of AP-like TENS in pain-free subjects. Phys Ther Sep 72(9):658-667. Dept of Physiol, Univ of Toronto, Ontario, Canada. AP-like TENS (ALTENS) was compared with a placebo treatment in altering acute electrical pain thresholds. 10 pain-free subjects underwent, on different days, an acclimatization session, an ALTENS treatment, and a placebo treatment in a cross-over design. Electrical sensation and pain thresholds were measured from the tip of the index finger bilaterally at 15-min intervals twice before, once during, and 3 times after a 30-min treatment session. The ALTENS treatment was given at 4 Hz at an intensity just below pain threshold delivered to AP points in the hand and wrist. The placebo treatment was similarly delivered, except that the intensity of stimulation was just above sensation threshold. Neither the ALTENS treatment nor the placebo treatment produced a significant change in pain threshold. There was no correlation between initial pain threshold and change in pain threshold. Implications for the modulation of pain are discussed.

4. ABDOMEN
Bihari_A2; Kumar A; Agarwal P (1995) Caprine and Canine Surgery of Abdomen and Limbs Under EAP. Indian Vet J Aug 72(8):849-854. Vas Dept Anim Husb, Udaipur, Rajasthan, India.

Bihari_A3; Kumar A (1995) Physiological and Clinical Effects of EAP Analgesia of Abdominopelvic Regions in Goats. Indian J of Animal Sci Feb 65(2):144-148. Govind Ballabh Pant Univ Agr & Technol, Pantnagar 263145, Uttar Pradesh, India. EAP at LI04, Lv14, GB34, BL30, GV20 and Tianping (group 1); LI11, LV14, GB34, BL30, GV20 and Tianping (group 2); and ST36, SP06, GB34, BL30, GV20 and Tianping (group 3) at a current of 3-5 volts in adjustable wave form and frequency of 130-150 Hz induced complete analgesia and good muscle relaxation at flank, ventrolateral abdominal region, pelvic and perineal regions, medial aspect of thigh, teats and udder in animals of group 3. A moderate degree of analgesia of flank, ventrolateral abdomen, medial aspect of thigh along with pelvic and perineal regions with poor analgesia of teat and udder was observed in other groups, The onset of analgesia occurred in 18.1+0.3 to 19.5+0.45 min. Analgesia persisted for the duration of EAP stimulation. After EAP in various groups of animals, heart rate increased (p<.05, significant) and respiration increased (p>.05, nonsignificant). Changes in rectal temperature, mean arterial blood pressure, central venous pressure, ECG and acid-base status were minor and not significant. No significant changes were seen between these groups of animals. Recovery occurred in 12.45+0.54 min after discontinuation of EAP.

Chen_P; Chen Y (1990) [Clinical approaches to improvement of appendectomy effects under APA]. Chen Tzu Yen Chiu 15(3):167-169. Dahua Hospital, Shanghai, PRC. Appendicitis is frequently encountered in a surgical Dept. Appendectomy under APA is safe and effective, easy and economical. It enhances the patient's recovery without side effects. APA is worth applying and popularizing. Though appendectomy is a minor operation in clinical practice, it has 3 crucial difficulties during surgery: incomplete analgesia, muscular tension and vagal reaction to traction on viscera. These difficulties must be researched and overcome before APA for appendectomy can be recommended with confidence internationally. Since 1970, we have used APA in circa 2000 cases of appendectomy, of which 1622 cases had detailed medical records. The clinical effects were analyzed and summarised from success and failure. The steps we conferred are as follows: 1. strict selection of the cases; 2. point selection and needle manipulation based on differentiation of symptoms and signs of TCM; 3. reasonable utilization of adjuvants; 4. maintenance of best needling sensation; 5. maintenance of relatively fixed groups of surgeons and assistants; and 6. improvement of operative technique. This is a valid way to have operative effect achieved. We have adhered to the 6 aspects mentioned above since 1982 and improved the success rate of appendectomy under APA. The rate of success reached 97% in which the rate of excellent result (Grade I) was 39% and the rate of good result (Grade II) 58%.

Kho_HG; Eijk RJ; Kapteijns WM; van Egmond J (1991) AP and transcutaneous stimulation analgesia in comparison with moderate-dose fentanyl anaesthesia in major surgery: Clinical efficacy and influence on recovery and morbidity [see comments]. Anaesthesia Feb 46(2):129-135. Inst for Anaesthesiol, Univ of Nijmegen, The Netherlands. The efficacy of AP and transcutaneous stimulation analgesia, supplemented by small doses of fentanyl (mean+SD 1.2+1.7 ug/kg) was compared with moderate-dose fentanyl anaesthesia (mean+SD 23+2.8 ug/kg) in 29 patients who underwent surgery for retroperitoneal lymph node dissection. The present study describes the anaesthetic techniques and comparison of haemodynamics, demand for analgesics after surgery, recovery and blood gases, restoration of urinary and bowel functions, convalescence in terms of self-reliance and the postoperative course in respect of fatigue and morbidity. A more rapid return of consciousness, an absence of hypercapnia and a smaller decrease in pH were observed in patients who received AP and transcutaneous stimulation (p <.05). No clinically relevant disadvantages attributable to the method were found.

Kolesnikov_BD; Artemenko LP; Kubikova IuI; Reznikov DB (1991) [The use of AP in the complex anaesthesiologic management of extracorporeal lithotripsy]. Anesteziol Reanimatol Sep-Oct 5:35-36.
Li_CK; Nauck M; Loeser C; Foelsch UR; Creutzfeldt W (1991) [AP to alleviate pain during colonoscopy]. Dtsch Med Wochenschr Mar 116(10):367-370. Abteilung fur Gastroenterologie und Endokrinologie, Universitõt Goettingen. 36 patients, 18 males and 18 females, mean age 51 (21-76) yr, being prepared for colonoscopy were assigned to 3 groups of 12 each: 1=AP at LI04, PC06, ST36 and SP04 bilaterally); 2=Control (no AP); 3=Sham AP at points not expected to induce pain relief. Pain sensitivity was estimated during the examination by means of a visual analog scale. Group 1 patients had mean pain sensitivity (1.4+0.4) significantly (p=.003) lower than in the groups without AP (2.7+0.3) or pretend AP (3.0+0.3). Also, Group 1 patients needed significantly less analgesics and sedatives (1 patient each; p=.005) than Group 2 (analgesics to 5, sedatives to 8 patients) or Group 3 (analgesics to 4, sedatives to 5 patients). Pain can be reduced by giving AP before colonoscopy.

Li_L; Jiang S; Zhong Y (1994) The application of APA in cystoscopy. JTCM Mar 14(1):30-31. People's Hospital, Dayu County, Jiangxi Province, PRC.

Li_L; Jian L; Chen Y; Chen X; Chen P (1992) [Influence of different types of syndrome on the rising of excellent response rate in hernia repair with APA]. Chen Tzu Yen Chiu 17(3):147-150. Shanghai Inst of AP and Channel, PRC. In order to raise the rate of excellent response in repair of hernia with APA, we valued individual difference in the light of basic theory of TCM. 70 cases were typed by symptoms and signs before hernia operation with APA in which 48 cases were Yang Xu type and 22 cases Yin Xu type, besides, 30 cases of peridural anaesthesia were as the controls. 1. AP Group: 1. Low-frequency EAP-needling (1 Hz) was applied to ST36 and SP06, while high-frequency EAP-needling (10 Hz) applied to the incisional edge. 2. The electrowaves and intension of stimulation were changed by regular time to maintain the best needling sensation. 3. Small doses of adjuvants were used together with AP, which shows synergism clearly (fentanyl, 2 ug/kg, fentanyl/droperidol, 1/50, the dose depending on the condition of patients in operation). 2. The Controls: Routine peridural anaesthesia and adjuvants were used. The same observation was given as the AP group. Results: I. the response rate of Yang Xu type was 97.9%, the excellent response rate 75%, while the response rate of Yin Xu type was 90.8% and its excellent response rate 45.4%. The response rate of the groups was no significant difference (p >.05), but the excellent response rate of the 2 differed significantly, the excellent response rate of Yang Xu type was better than that of Yin Xu type (p <.05). II. The total dose of adjuvants in the AP group was small.(ABSTRACT TRUNCATED AT 250 WORDS).

Sun_P; Li L; Si M (1992) [Comparison between AP and epidural anaesthesia in appendectomy]. Chen Tzu Yen Chiu 17(2):87-89. Alashan Meng Hospital, Inner Mongolia Autonomous region, PRC. Clinical effects of APA were compared with those of epidural anaesthesia in appendectomy. 80 patients with appendicitis were assigned randomly to 2 operative anaesthetic groups: 1=epidural anaesthesia (n=40); 2=APA (n=40). Both methods of anaesthesia gave similar surgical success. Compared with epidural anaesthesia however, APA at ST36 + LI04 gave less respiratory depression, hypotension, cardiac arrhythmia and less need for liquid infusion during surgery. Postoperatively, the APA group released intestinal gas earlier, needed less analgesics and antibiotics, and had lower rates of wound infection. These postoperative effects were significantly better than in the epidural group. AP at ST36 + LI04 gave clear-cut surgical analgesia and less interference with vital signs during surgery, and a more rapid and beneficial postoperative recovery. Thus APA is beneficial in appendectomy.

White_SS; Bolton JR; Fraser DM (1985) Use of EAP as an analgesic for laparotomies in two dairy cows. Aust Vet J Feb 62(2):52-54.

5. POSTOPERATIVE CONDITIONS
Chen_SC; Lu SN; Lai CT; Jean JY; Hsiao CL; Hsu PT (1991) Aqueous AP for postoperative pain: a matched controlled trial. Kaohsiung i Hsueh Ko Hsueh Tsa Chih Kaohsiung - J of Med Sci Sep 7(9):466-470. Dept of Int Med, Kaohsiung Med Coll, Taiwan, ROC. The analgesic effects of AP are well-documented. Aqueous AP, or point injection, is a conveniently modified modern AP method. This matched controlled trial was carried out to evaluate the effects of aqueous AP in postoperative pain control. A total of 12 patients were selected as age-, sex- and operative-style-matched controls. In the AP-treatment group when patients had regained consciousness after operative anaesthesia, 2-5 ml of 20% glucose solution was injected into LI04 and GB34. Pain intensity was scored on verbal assessment, sleep disturbance and use of narcotics. Compared with the control group, AP significantly reduced the intensity of postoperative pain, and the amounts and frequency of narcotics used, especially in the first 12 h post-op. Aqueous AP is a convenient and effective way to control postoperative pain.

Faure-Antonietti_F; Antonietti C; Estanove S; Ninet J; Vigneron M; Champsaur G (1991) Treatment using traditional AP of early scapulohumeral pains after heart surgery. Cahiers d' Anaesthesiologie 39(8):537-540. In French. Service de chirurgie thoracique et cardiovasculaire C, Hôpital cardiologique, Lyon. The purpose of this study was to test the efficacy of traditional Chinese AP to treat scapulohumeral pain during the early stage after heart surgery, by simple AP (without needle stimulation) of points not related anatomically or metamerically with the scapulohumeral joint. Reduction of pain and angular gain were almost immediate, durable, measurable and reproducible. This is explained by possible effects of AP on articular sympathetic mechanoreceptors, then suppressing reflex muscular contractions due to intraoperative postural constraints.

Gemma_M; Bricchi-M; Giannini-A; Coffano-B; Grandi-L; Quirico-P (1993) AP accelerates recovery from general anaesthesia [letter]. Can J Anaesth Dec 40(12):1224-1245.

Grabow_L (1994) Controlled study of the analgetic effectivity of AP. Arzneimittelforschung Apr 44(4):554-558. Zentrale Abteilung für Anästhesiologie und Intensivmedizin, Evangelische und Johanniter Krankenanstalten, Duisburg, Germany. 2 methods were used to test the analgesic effectivity of AP: 1. as a method of postoperative pain therapy several analgesic medications were compared with AP; 2. extracorporeal shockwave lithotripsy (ESWL) was used as a clinical algesimeter to test the analgesic effect of analgesic medications and AP to a controlled pain stimulus. In both groups the analgesic effectivity was placebo controlled. Both methods showed equally that the analgesic effect of AP is similar to that of the placebo group. Thus AP is not a generally useful form to treat acute pain. However, in every examined population, a minority is completely satisfied with AP as sole treatment of pain. The secret of AP probably lies in the selection of patients sensitive to AP. Under controlled conditions, postoperative wound pain may be an algesimeter analagous to ESWL. This may be important.

Lewis_SM; Clelland JA; Knowles CJ; Jackson JR; Dimick AR (1990) Effects of Ear-AP-like TENS on pain levels after wound care in patients with burns: a pilot study. J of Burn Care and Rehab Jul-Aug 11(4):322-329. This study tested the hypothesis that Ear-AP-like TENS would significantly reduce the pain experienced by patients with burns immediately after wound debridement, other wound care, and dressing changes. Subjects were 11 inpatients at the Univ of Alabama Hospital Burn Unit. A 2-period crossover design was used; each patient received one experimental treatment consisting of bilateral AP-like TENS to 6 Earpoints and one control treatment consisting of a placebo pill. The Visual Analogue Scale was used to measure pain and was used immediately before and after treatments and at 15, 30, and 60 min after treatment. A 2-factor repeated measures ANOVA indicated significant effects of measurement time (p<.001) and treatment by time (p=0.002). Post hoc analysis showed significant differences (p<.05) between experimental and control conditions at all times after treatment but not at pretreatment baseline. Ear-AP-like TENS was an effective pain management technique in patients with burns.

Moldovan_C1 et al (1986) EAP Treatment Method for Arm Oedema after Surgery for Breast Cancer. International Med AP Conference, London, UK, May 4-8. Inst of Oncology, Bucharest, Romania. Upper limb oedema (bloating from retention of water) occurs after surgery for breast cancer in circa 83% of the cases. Existing means have relatively limited efficiency. This study presents a treatment method with EAP (AP in which weak electrical currents are sent through the needles) on a group of 21 patients with upper limb oedema. Treatment response was based on objective criteria including clinical and thermoelectric measurements. Complete recovery from oedemas was obtained in 33% of the cases, while partial recovery was seen in 43% of the cases. No response was seen in 24%.

Tsibuliak_VN; Alisov AP; Shatrova VP (1995) [APA and analgesic TENS in the early postoperative period]. Anesteziol Reanimatol Mar-Apr 2:93-97. Efficacies of 2 methods of non-drug analgesia: AP- (1000 cases) and TENS- (91 cases) analgesia, as well as of narcotic analgesics omnopon and promedol (229 cases) were compared in the immediate and early postoperative period. In 229 cases AP was used to treat other functional complications of the postoperative period. The efficacies of the methods in question were assessed by formalized verbal estimation scales. Narcotic analgesics provided adequate analgesia in 75-79% of patients, TENS in 61-64%, AP in 50% of patients. AP, though less effective than narcotic analgesics, helped arrest or noticeably alleviate the severity of such postoperative complications as reflex retention of the urine, impairment of the drainage function of the bronchi, intestinal paresis, bronchial asthma, vomiting, nausea, pain or itching in the stoma, chill, hyperthermia in 43-81% of cases. Conclusion: An integrated approach (combined use of drugs and non-drug methods of analgesia) is desirable in the management of postoperative pain.

6. SKIN
Bossut_DFB; Stromberg MW; Malven PV (1986) EAP-analgesia in sheep: measurement of cutaneous pain thresholds and plasma concentrations of prolactin and beta-endorphin immunoreactivity. Am J Vet Res Mar 47(3):669-676.

Brockhaus_A; Elger CE (1990) Hypalgesic efficacy of AP on experimental pain in man: Comparison of laser-AP and needle AP. Pain Nov 43(2):181-185. Universitäts-Nervenklinik, Epileptologie, Bonn, Germany. The analgesic effect of AP on cutaneous heat stimuli of 43oC was evaluated in a controlled study with healthy volunteers. Under double-blind conditions, helium-neon laser-AP was used on 39 probationers. Bilateral LI04 and Jianqian (Extra) were irradiated for 1 min each. 40 probationers were needled at bilateral LI04 under single-blind conditions. Pain threshold was measured as the time (in ms) that the probationers needed to perceive the cutaneous heat stimulus of 43oC. The painful stimulus was generated by a computer-controlled standardized procedure. The Wilcoxon test was used for the statistical evaluation. Laser-AP did not change the pain threshold. Needle AP did, however, increase the pain threshold compared with the initial value (alpha=.1%). The difference compared with the control group, where a placebo point was needled, was also significant (alpha=5%). This controlled experimental study proves the analgesic effect of needle AP on painful heat stimuli. Laser-AP had no effect on pain threshold in this study.

Yang_Q (1993) AP treatment of 139 cases of neurodermatitis. JTCM Mar 13(1):3-4. Tian Men First People's Hospital, Hubei Province, PRC.

F. AP in Pain and Painful Conditions

1. GENERAL
Carlsson_CP; Sjolund BH (1994) AP and subtypes of chronic pain: assessment of long-term results. Clin J Pain Dec 10(4):290-295. Dept of Anaesthesiology, Malmo General Hospital, Sweden. Patients' opinions of pain relief for a longer time were determined after one treatment period of AP for chronic pain. 211 patients had AP treatment for chronic pain at the Pain Clinic of Malmo Univ Hospital during 1983-5. Their mean pre-treatment duration of pain was 10.4 yr. They were treated with needle AP with a combination of local and distal points every 1-2 wk for a mean of 8 times. Both manual AP and EAP stimulation was utilized. In 1988, all patient documents were screened, and the pain conditions were classified as nociceptive, neurogenic, or psychogenic. Initial results were evaluated from the clinic records of 202/211 patients treated. 85 of these patients (42%) had pain relief immediately after the treatment period. These patients were sent a 1-page questionnaire by mail in 1988. Pain relief over defined time periods (yes/no); do more work at home or at workplace (yes/no); analgesic consumption. Only 35 patients (17% of all patients) still had pain relief 6 mo after treatment. Among those with nociceptive pain, 70/142 (49%) had pain relief initially; those with neurogenic or psychogenic pain had relief in only 11/34 and 4/26 cases, respectively. 33/142 patients with nociceptive pain had pain relief for >6 mo, but 2/34 patients with neurogenic pain, and no patient with psychogenic pain had long-lasting pain relief. Only patients with nociceptive pain can be expected to get pain relief for >6 mo after one treatment period of AP, and of these only a small proportion will be helped.

Cummings_TM (1996) A Computerised Audit of AP in Two Populations: Civilians and Armed Forces. Adapted from WWW. This is a retrospective review and comparison of AP in 2 distinct populations over 2 yr: an armed forces general practice and a civilian private practice. A computerised database is used to draw comparisons between the groups and the results of AP within those groups. Computerised graphic representations of the results are shown. AP was most successful in treating myofascial pain with associated tender points.

Eadie_MJ (1990) AP and the relief of pain [editorial]. Med J Aust 20 Aug 153(4):180-181.

Ernst_E (1994) Is AP effective for pain control? [letter]. J Pain Symptom Manage Feb 9(2):72-74.

Harman_JC (1996) Quick Introduction to AP. Equine Pract May 18(5):33-34. Harmany Equine Clin, POB 8, Washington,VA 22747 USA; Also, Harman_JC (1994) The Effects of AP on the Performance of Horses. Proceedings from 12th Meeting of the Equine Practitioners' Assoc: 48-51. JC Harman, Harmanny Equine Clin, Orlean, VA.

Jones_WE (1992) Sports medicine for the race horse. 2nd Ed Wildomar CA: Veterinary Data 307pp.

Kendall_DE (1994) Neurophysiology and Science of AP. Proceedings from 12th Meeting of the Equine Practitioners' Assoc: 76-82

Klide AM (1992) Use of AP for the control of chronic pain and for surgical analgesia. In: Animal pain, Eds Charles E Short & Alan Van Poznak, Churchill Livingstone, New York, pp249-257. Univ of Pennsylvania School of Veterinary Med, Philadelphia, PA.

Medina_Mirapeix F; Brotons Roman J; Manrique Sanchez J (1995) Comparative study on the influence of health education on perceived recurrences after physiotherapy. Aten Primaria Nov 15 16(8):464-468. Departamento de Fisioterapia, Universidad de Murcia. This study compared the repercussion of the inclusion of health education in the physiotherapist's primary care work on requests for follow-up treatment. Two settings (A=Health Centre, B=Hospital) were studied. Patients for study over a 6-mo period were attending two physiotherapy units (A=50 patients; B=97 patients) for therapy of back-ache, cervical pain or a painful shoulder. The groups were homogeneous by age (A=47+13.4; B=45+12.1 yr) and gender (A=64% women; B=69% women). The % of pathologies was also homogeneous with a p>.1 in back-ache and cervical pain and p>.90 for painful shoulders. At A (catchment population 16000) there was a complete intervention plus health education. At B (catchment 73000) individualised therapy (electrotherapy) was used. For both groups, a monitoring period was set up for the next 6 mo to observe the number who requested Physiotherapy for the same pathology. The Chi2 statistical analysis was used to contrast the equality of proportions by analysing contingency tables. During the monitoring period, 5 new treatments in group A (10%) and 29 in B (30%) were requested, which was a significant difference between the two groups. The inclusion of health education seemed to reduce the demand for repeat treatment for the same conditions.

Nissel_H (1993) Pain treatment by means of AP. AETRIJ Jan-Mar 18(1):1-8. Ludwig Boltzmann AP Inst, Vienna. AP has an important part in pain research. Bischko was the first to undertake surgery (tonsillectomy, 1972) using APA in the Western hemisphere. Decisive research has been carried out at the Ludwig Boltzmann AP Inst in Vienna. We now know much more about the importance of the basic system. We know also that the theories on chaos research, and, especially fractals play an important role. Various ways to use AP in pain relief are discussed: e.g. body AP (with or without supportive TENS); treatment via the so-called somatotopies (ear, oral mucous membrane, scalp AP according to Yamamoto etc). In Vienna, the Ludwig Boltzmann AP Inst and the 2nd Dept of Internal Med at the Kaiserin-Elisabeth Hospital showed that AP significantly reduced the quantity of analgesics required by inpatients with many clinical conditions.

Omura_Y1; Losco BM; Omura AK; Takeshige C; Hisamitsu T; Shimotsuura Y; Yamamoto S; Ishikawa H; Muteki T; Nakajima H; et al (1992) Common factors contributing to intractable pain and medical problems with insufficient drug uptake in areas to be treated, and their pathogenesis and treatment: Part 1: Combined use of medication with AP, (+) Qigong energised material, soft laser or electrostimulation. AETRIJ 17(2):107-148. Heart Disease Research Foundation, New York. Most frequently encountered causes of intractable pain and intractable medical problems, including headache, post-herpetic neuralgia, tinnitus with hearing difficulty, brachial essential hypertension, cephalic hypertension and hypotension, arrhythmia, stroke, osteo-arthritis, Minamata disease, Alzheimer's disease and neuromuscular problems, such as Amyotrophic Lateral Sclerosis, and cancer are often found to be due to co-existence of 1) viral or bacterial infection, 2) localized microcirculatory disturbances, 3) localized deposits of heavy metals, such as lead or mercury, in affected areas of the body, 4) with or without additional harmful environmental EM- or electric- fields from household electrical devices in close vicinity, which create microcirculatory disturbances and reduced ACh. The main reason why medications known to be effective prove ineffective with intractable medical problems, the authors found, is that even effective medications often cannot reach these affected areas in sufficient therapeutic doses, even though the medications can reach the normal parts of the body and result in side effects when doses are excessive. These conditions are often difficult to treat or may be considered incurable in both Western and Oriental medicine. As solutions to these problems, the authors found some of the following methods can improve circulation and selectively enhance drug uptake: 1) AP, 2) Low frequency electrostimulation (1-2 Hz), 3) (+) Qigong energy, 4) Soft lasers using Ga-As diode laser or He-Ne gas laser, 5) Certain EMFs or rapidly changing or moving electric or magnetic fields, 6) Heat or moxibustion, 7) Individually selected Calcium Channel Blockers, 8) Individually selected Oriental herb medicines known to reduce or eliminate circulatory disturbances. Each method has advantages and limitations and therefore the individually optimal method has to be selected. Applications of (+) Qigong energised paper or cloth every 4 h, along with effective medications, were often found to be effective, as materials charged with Qigong can often be used repeatedly, as long as they are not exposed to rapidly changing electric, magnetic or EM fields. Application of (+) Qigong energy-stored paper or cloth, soft laser or changing electric field for 30-60 s on the area above the medulla oblongata, vertebral arteries or endocrine representation area at the tail of pancreas reduced or eliminated microcirculatory disturbances and enhanced drug uptake.

Omura_Y2; Beckman SL (1995) Application of intensified (+) Qigong energy, (-) electrical field, (S) magnetic field, electrical pulses (1-2 Hz), strong Shiatsu massage or AP on the accurate organ representation areas of the hands to improve circulation and enhance drug uptake in pathological organs: clinical applications with special emphasis on the "Chlamydia-(Lyme)-uric acid syndrome" and "Chlamydia-(cytomegalovirus)-uric acid syndrome". AETRIJ Jan-Mar 20(1):21-72. Heart Disease Research Foundation, New York, USA. Various methods of improving circulation and enhancing drug uptake which were used in treating some intractable medical problems caused by infections, and 2 syndromes based on the co-existence of Chlamydia trachomatis infection (mixed with either Lyme Borrelia burgdorferi or Cytomegalovirus) with increased Uric acid are described. The principal author's previous studies have indicated that there are 2 opposite types of Qigong energy, positive (+) and negative (-). Positive (+) Qigong energy is used clinically to enhance circulation and drug uptake in diseased areas where there is a micro-circulatory disturbance and drug uptake is markedly diminished. (-) Qigong energy has completely the opposite effect and therefore has not been used although there may be some as yet undiscovered application. Since the late 1980's the senior author has succeeded in storing (+) Qigong energy on a variety of substances, including small sheets of paper. Recently he was able to concentrate this energy as it passed through a cone-shaped, tapered glass or plastic object placed directly on the (+) Qigong energised paper. Application of (+) Qigong energised paper on the cardiovascular representation area of the medulla oblongata at the occipital area of the skull often improved circulation and enhanced drug uptake. If the drug-uptake enhancement was still not sufficient for the drug to reach therapeutic levels in the diseased organ, direct application of (+) Qigong from the practitioner's hand often enhanced the drug uptake more significantly. However, this direct method often results in the practitioner developing intestinal micro-haemorrhage within 24 h which may or may not be noticed as mild intestinal discomfort with soft, slightly tarry stool. A cone is one of the most efficient shapes to intensify (+) Qigong energy; increased power occurs at an optimal height. However, the power decreases when the total mass and the total distance from base to peak is increased beyond an optimal limit. Clinical application of Intensified (+) Qigong stored energy was evaluated in this preliminary study: intensified (+) Qigong energy applied to the heart representation area of the middle finger on the hands markedly improved circulation in the heart, and increased drug uptake and ACh even more effectively than some of the previously used drug enhancement methods (Shiatsu massage of the organ representation areas and/or application of (+) Qigong energised paper to the occipital area above the cardiovascular representation area of the medulla oblongata).

Schoen_AM (1992) AP for musculoskeletal disorders. Probl Vet Med Mar 4(1):88-97. Vet Inst for Therapeutic Alternatives, Sherman, Connecticut. Medical and surgical approaches to canine and feline musculoskeletal disorders are numerous. AP was helpful in cases in which analgesics and anti-inflammatory medications were ineffective or had caused side effects, and in cases in which surgery was not recommended. It appears that AP not only provides long-term analgesia but also increases circulation to the affected areas and decreases inflammation. Techniques and selection of appropriate AP points depend on the condition treated.

Sutherland_EC (1994) AP in the Horse. Proceedings from 12th Meeting of the Equine Practitioners' Assoc: 63-64

ter_Riet_G; Kleijnen J; Knipschild P (1990) AP and chronic pain: a criteria-based meta-analysis. J Clin Epidemiol 43(11):1191-1199. Dept of Epidemiol/Health Care Research, Univ of Limburg, Maastricht, The Netherlands. A literature search revealed 51 controlled clinical studies on the effectiveness of AP in chronic pain. These studies were reviewed using a list of 18 predefined methodological criteria. A maximum of 100 points for study design could be earned in 4 main categories: (a) comparability of prognosis, (b) adequate intervention, (c) adequate effect measurement and (d) data presentation. The quality of even the better studies proved to be mediocre. No study earned >62% of the maximum score. The results from the better studies (>/=50% of the maximum score) are highly contradictory. The efficacy of AP to treat chronic pain remains doubtful.

Thomas_M2; Arner S; Lundeberg T (1992) Is (periosteal) AP an alternative in idiopathic pain disorder?. Acta Anaesthesiol Scand Oct 36(7):637-642. Dept of Physiology, II, Karolinska Inst, Stockholm, Sweden. We studied the analgesic effect of intensive periosteal AP stimulation in 12 patients with idiopathic pain (10 F, 2 M; mean age=54 yr; mean duration of pain=12.6 yr). Each treatment consisted of brief but painful manual stimulation of 3-4 periosteal sites. Each patient had a mean of 7 (range 4-11) sessions over a period of 3-8 mo. Patients continued their previous analgesic medication but no other physical or psychological treatment for their pain was used. All responses were assessed on pain scales maintained daily before and during the entire period of treatments. Periosteal AP gave no response, or only transient responses which were not maintained until the next treatment in 10/12 patients (83%); 17% had long periods of good pain reduction. Periosteal AP did not help most patients with idiopathic pain.

Wollgienhahn_D; Kim K (1996) Practical Experiences with AP for Treatment of Lameness in the Dog: 3 Cases. Prakt Tierarzt 1 Apr 77(4):314. Moorkamp 15, D 29223 Celle, Germany. This is a case report of AP treatment in 3 cases of chronic canine lameness (two racing dogs, one geriatric patient). Allopathic treatment had failed, or the owners had refused the treatment offered. The result showed that Western and Eastern diagnosis and therapy can complement each other.

Wong_TW; Fung KP (1991) AP: from needle to laser. Family Practice Jun 8(2):168-170. Dept of Community and Family Med, Chinese Univ of Hong Kong. AP has been used to treat many illnesses for >2000 yr. The practice of AP is based on theory different from our understanding of human anatomy and physiology. It has developed through experience and observation. Stimulation, by inserting needles in selective AP Channel points, is believed to restore bodily functions by promoting the flow of Qi throughout the system. Other forms of stimulation include heat, electrostimulation, magnetism and laser. Laser AP offers distinct advantages over the traditional method because the procedure is pain-free and non-traumatic. Clinical applications include pain-control in osteoarthritis, lumbago and migraine, and analgesia for certain surgical procedures, as well as other ailments of the cardiovascular, respiratory and nervous systems. The method is easy to learn; sophisticated instruments are not needed. Thus it is very useful in developing countries with limited health resources.

2. TRAUMATIC PAIN
Tkachuk_VN; Medvedev IP; Bachurin EP (1991) Effectiveness of AP-analgesia (APA) to treat chronic post-traumatic pain Syndromes. Ortopediia Travmatologiia i Protezirovanie May (5):33-35. In Russian. This was a study of the value of APA to treat chronic post-traumatic pain Syndrome. It also compared the characteristics of APA with those of electo-analgesia in the treatment of this pathology. Results of treatment of traumatic pain Syndrome of the lower limbs by the IRT method (106 patients) were analyzed and compared with the results of treatment by the above mentioned methods, as well as by APA and electro-analgesia separately. IRT was better than electroanalgesia an APA to treat chronic pain Syndrome. Electroanalgesia contributed more than AP to rapid analgesia and restoration of autonomic and trophic functions.
Wang_YQ (1996) TCM in trauma treatment. Adapted from WWW: Chinese Med News, Free release by BEIJING CONS BIO-TECH E-mail: [email protected] WWW-Site: http://www.dmu.ac.uk/ln/cmn/[email protected]
TCM has made enormous contributions to healing wounds and curing diseases among ordinary people and solders. It still is important to the Army's Health Care Program, complementing the use of modern WM. TCM comes mainly from the Han ethnic group but includes also medicinal knowledge developed by Tibetans, Mongolians, Uygurs, Dais and other ethnic groups in China.

TCM has developed systematically, based on data accumulation, repeated theorizing and constant practice over several millenia. Pattern (Syndrome) recognition is one of its key skills. Daily activities and the occurrence of disease are related not only to intrinsic changes within the human body, but also to changes in the external natural world and social environment. This emphasis on holism and constant change coincides with the bio-psychosocial model of modern WM. TCM doctors understand disease, based on general Med knowledge, and pay attention to the specific responsive features of the individual.

The patient's constitution, psychology, time and place of onset of the disease and other factors all need consideration. With clinical judgment and long experience, the "Four Diagnostic Methods" are applied to the personal, geographical, seasonal and climatic features relevant to the patient. Only then can the doctor of TCM formulate a therapeutic scheme, select the right prescription and decide the right dose of each component.

TCM stresses the self-regulation and interdependence of overall bodily functions, "Internal" and "External" factors, and the control of, or adaptation to internal and external manifestations. Therapeutic methods of TCM are divided into pharmacotherapeutic and non-pharmacotherapeutic.

Pharmacotherapy uses chiefly natural products found in China. A total of 12807 types of Chinese medicine ingredients, including plants, animals and minerals, have been recorded. These natural drugs contain substances which possess a wide range of physiological and pharmacological properties. Some improve metabolic level, others regulate immunological functions, help strengthen the body and delay aging by fighting off disease. Pharmacotherapy usually is given orally. Fumigation, steam baths, external local application, injection, infusion, and many other methods are also used.

Non-pharmacotherapeutic methods consist mainly of AP, moxibustion, bone knitting, massage and cupping. Fangshi (army doctors) were responsible for the treatment acute illnesses and the preparations of Chinese medicine. This is recorded in Chinese military documents from 8th century BC. Doctors and nurses, and records of wounded solders, were all introduced into the Chinese army. War wounds were treated by amputation, massage, bandaging and immobilization. Alcohol was used as an anaesthetic for surgery.

Around AD 190, Huato, an army surgeon, invented one of the world's first general anaesthetics, Ma Fei San, which he used in performing many different operations including excision of tumours in the peritoneal cavity and orthopaedic operations. Reduction of shoulder and hip joint dislocations, splinting of limb and spine fractures, and suspension reduction of spine fracture were all recorded. In sanitation and anti-epidemic work, stress was laid on multiple sanitary measures to prevent diseases and on nutrition.

In the 4th century BC, drugs to prevent frostbite and heatstroke were already in use by Chinese armies. In many books on the art of war, anti-poisoning prescriptions were recorded which could relieve the effects of over 30 kinds of poison originating in minerals, animals and plants.

During the mid-19th century, Western medicine spread in China. But TCM remained the mainstay. It is now widely held that TCM and WM can be mutually complementary. By applying modern science and technology, Chinese experts have solved many problems related to health service, which is guaranteed for peacetime and wartime, leading to further development of TCM in the military field.

The application of TCM in trauma treatment
1.        Treatment of war wounds and trauma: Chinese medicine has succeeded in treating fire-arm wounds, intraocular haemorrhage, gas gangrene and explosion-deafness, and in providing anaesthetics for field surgery. To treat traumatic paraplegia, three courses of EAP on the GV Channel gave a functional recovery rate >50%.

2.        Prevention and treatment of military training injuries: AP, cupping, and other methods of therapy show definite analgesic and anti-inflammatory effects, and are distinguished by instant effect, short duration of treatment and ease of application. AP has been used to treat soft tissue injuries of the hand, shoulder, waist, knee and ankle, with a success rate of 96%.

3.        Prevention and treatment of common infectious diseases: Encephalitis B, leptospirosis, epidemic haemorrhagic fever, and other infectious diseases have not been found in the army for many years and the incidence of hepatitis and dysentery have been reduced to below 0.15% and 1%, respectively. Treatment of chronic severe hepatitis gave a 64% survival rate. Artemisinin (an active compound) and its derivatives were extracted by Chinese scientists from Herba Artemisiae Annuae. These compounds have made a great contribution to the prevention and treatment of malaria throughout the world.

4.        Health guarantee in extreme environments: From the theory of TCM, Chinese army doctors also discovered a new AP point "Gaoyuan Zhitoutong I". At elevations of 5000-5300 meters, field observation has confirmed the marked preventive and therapeutic effects of AP at this point on headache of acute mountain sickness (AMS).

5.        Clinical treatment of diseases in peacetime: Treatment of intestinal obstruction, peptic ulcer and acute pancreatitis with combined TCM and WM cured 70% of patients without surgery. Treatment of malignant tumours by oral use of a TCM drug preparation "PingXiao Pian", combined with Western therapeutic measures, also achieved notable success.

3. HEAD, EYES, EARSAxelsson_A; Andersson S; Gu LD (1994) AP in the management of tinnitus: a placebo-controlled study. Audiology Nov-Dec 33(6):351-360. Dept of Audiology, Sahlgrenska Univ Hospital, Gothenburg, Sweden. 20 patients, randomly selected from a large group with noise-induced tinnitus, were studied in order to assess the effect of AP on their tinnitus. A single-blind cross-over design was used. The patients were assigned to two groups: 1=classical Chinese needle AP for 5 wk and; 2=Placebo. The procedures were reversed after a 2-wk interval. AP was given by a Chinese otolaryngologist at points near the ear, and at distal points on the extremities. Placebo consisted of mock electrostimulation via surface electrodes connected to a stimulator which delivered a weak sound and a light flash at a frequency of 2 Hz but no electric current to the surface electrodes. The effect was evaluated by the use of visual analogue scales. Differences between AP and placebo in annoyance, awareness or loudness of the tinnitus were not significant. Many patients preferred AP due to nonspecific effects (improved sleep, decreased muscle tension and improved blood circulation etc). AP had no specific alleviating effect on noise-induced tinnitus in this short study.
Baischer_W1 (1993) [Psychological aspects as predicting factors for the indication of AP in migraine patients]. Wien Klin Wochenschr 105(7):200-203. Ludwig-Boltzmann-Inst für Akupunktur, Kaiserin-Elisabeth-Spital, Wein. 30 patients with chronic migraine received needle AP after investigation of personality traits, cognitive and social factors. Treatment response was evaluated in 2 different ways (documentation of attacks in a migraine diary and subjective judgment of outcome). From their diaries, the frequency of attacks was halved, with no essential relation to psychological factors. Short duration of illness was the best predictor of a good response to therapy. Patients' subjective judgement showed a mean improvement of 60%. Unlike diary documentation, the subjective response rates were closely related to personality traits. In particular, patients with high scores for extroversion and low scores for neuroticism reported a better response. Age, sex, social status, and expectations of benefit did not show any relation to treatment efficacy.
Baischer_W2 (1995) AP in migraine: long-term outcome and predicting factors. Headache Sep; 35(8):472-474. Ludwig Boltzmann-Inst fur AP, Vienna, Austria. 26 patients (19 women, 7 men), who suffered from chronic migraine according to IHS criteria, underwent AP. In order to evaluate the long-term stability of treatment effects, patients documented frequency, duration, and intensity of attacks as well as analgesic intake in a migraine diary, which was kept for 5-wk periods before treatment, immediately after treatment, and 3 yr later. Posttreatment, 18 patients (69%) had improved >33% and 15 (58%) were improved at 3-yr follow-up. Drug intake was reduced to 50% and did not re-increase until follow-up. Treatment outcome was associated with personality traits, but not depending on demographic data or severity of migraine.
Ballegaard_S; Meyer CN; Trojaborg W (1994) Effects of dry needling of myofascial TPs in the neck region to metoprolol in migraine prophylaxis. J Intern Med May 235(5):451-456. Dept of Int Med P, Rigshospitalet, Univ Hospital of Copenhagen, Denmark. Pain Clinic and Med Dept, Skodsborg Sanatorium, Denmark. This was a randomized, group comparative study; patients, investigator and statistician were blinded as to treatment; the therapist was blinded as to results. Patients were referred by general practitioners or newspaper advertisements to the outpatient pain clinic in N Copenhagen. Included were patients with a history of migraine with or without aura for >2 yr. Excluded were those with contraindications against treatment with beta blockers, chronic pain syndromes, pregnancy or previous experience with AP or beta-blocking agents. A total of 85 patients were included; 77 completed the study. After a 4-wk run-in period, patients were allocated to a 17-wk regimen either with AP and placebo tablets or to placebo stimulation and metoprolol 100 mg daily. Results: Both groups exhibited significant reduction in attack frequency (p <.01). No difference was found between the groups regarding frequency (p >0.20) or duration (p >0.10) of attacks, whereas we found a significant difference in global rating of attacks in favour of metoprolol (p <.05). ConclusionS. Trigger point inactivation by dry needling is a valuable supplement to the list of migraine prophylactic tools, being equipotent to metoprolol in the influence on frequency and duration (but not severity) of attacks, and superior in terms of negative side-effects.
Beppu_S; Sato Y; Amemiya Y; Tode I (1992) Practical application of Channel AP treatment for trigeminal neuralgia. Anaesthesia and Pain Control in Dentistry Spring 1(2):103-108. Tsurumi Univ Sch of Dental Med. This report evaluates the effect of Channel AP treatment on trigeminal neuralgia. 10 patients aged 26-67 yr (mean 55 yr) were studied at the Dental Anaesthesiology outpatient Clinic of Tsurumi Univ Dental Hospital from 1985-1990. 5 had idiopathic and 5 had symptomatic trigeminal neuralgia. The patients had Channel treatment by AP alone or AP combined with moxibustion. The AP method used was mainly by simple needling. Channel AP treatments were repeated from 2-4 times/mo. 5 patients were restored to a pain-free state. The other 5 patients reported less pain, but with some level of pain remaining (significant pain in one patient). Channel AP treatment is useful and can be one therapeutic approach in the management of trigeminal neuralgia.
Biondi_M; Portuesi G (1994) Tension-type headache: psychosomatic clinical assessment and treatment. Psychother Psychosom 61(1-2):41-64. Terza Clinica Psichiatrica, Universita La Sapienza, Roma, Italy. Tension-type headache (TTH) is an ill-defined nosographic entity. The classification of headaches according to the Headache Classification Committee of the International Headache Society is closer to clinical reality with respect to the past classification. From an aetiopathological standpoint, unified hypotheses to explain primary headaches are interesting. Treatment requires a thorough diagnostic framing, which should include its psychosomatic aspects, focusing on the individual patient and the history. Many studies tried to characterise headache from a psychological viewpoint, but they were unable to provide useful generalisations. None of the currently available treatments (drugs, biofeedback, psychotherapy etc) were clearly superior to the others; the choice should involve an intervention targeted on the most important factors in individual cases. Though interesting results are reported, the efficacy of AP and other physical therapies are difficult to assess and should be reserved for particular cases.
Carlsson_J1; Rosenhall U (1990) Oculomotor disturbances in patients with tension headache treated with AP or physiotherapy [see comments]. Cephalalgia Jun 10(3):123-129. Dept of Neurology, Univ of Göteborg, Sweden. 48 female patients with chronic tension headache were randomized into 2 treatment groups: physiotherapy and AP. The patients were examined using oculomotor tests. Intensity of the headache and tenderness of the trapezius muscles were assessed in accordance with graded scales. The mean velocity gain for smooth pursuit eye movements improved for all target velocities both in the physiotherapy group and in the AP group. The latency was reduced for all 3 gaze angles in the physiotherapy group while no improvement occurred in the AP group. There was a reduction of headache intensity in both groups while tenderness of the trapezius muscles was reduced in the physiotherapy group but unchanged in the AP group. A significant correlation was found between the mean velocity gain and tenderness of the trapezius muscles.
Carlsson_J2; Fahlcrantz A; Augustinsson LE (1990) Muscle tenderness in tension headache treated with AP or physiotherapy. Cephalalgia Jun 10(3):131-141. Dept of Neurology, Univ of Göteborg, Sweden. 62 female patients with chronic tension headache were randomized into 2 treatment groups, AP and physiotherapy. The intensity of headache, muscle tenderness and neck mobility was assessed before and after treatment. 30 healthy women were used for comparison. Before treatment it was found that muscle tenderness was increased and neck rotation was reduced in the patient group compared with controls. There was a significant correlation between the intensity of headache and muscle tenderness. After treatment, the intensity of headache and muscle tenderness were reduced in both treatment groups. The headache was more improved in the physiotherapy group, and there was a marked reduction in the intake of analgesics. The tenderness was reduced in all muscles tested in the physiotherapy group but only in some of the muscles after AP. The limitation of neck rotation was not influenced by either treatment.
Carlsson_J3; Augustinsson LE; Blomstrand C; Sullivan M (1990) Health status in patients with tension headache treated with AP or physiotherapy. Headache Sep 30(9):593-599. Dept of Neurology, Sahlgrenska Hospital, Göteborg, Sweden. 62 female patients with chronic tension headache were assigned at random to 2 treatment groups: 1=AP; 2=Physiotherapy. Their overall function (Sickness Impact Profile), and mental well-being (Mood Adjective Check List) and the intensity and frequency of headache were assessed before and after treatment. Before treatment the patients showed significantly more dysfunction and less positive mental well-being than a general population sample. Both treatment groups improved in overall function, the physiotherapy group somewhat more. The mental well-being increased only in the physiotherapy group. The intensity and frequency of headache was significantly reduced in both the physiotherapy group and the AP group. The intensity of headache was significantly more improved in the physiotherapy group. The improvement of headache intensity persisted unchanged 7-12 mo after treatment.
Chen_P (1991) AP at Yangsheng point to treat voice ailments in 110 cases. JTCM Dec 11(4):261-262. Art phoniatrics Laboratory of Shanghai Conservatory of Music, Shanghai College of Music, PRC.
Costantini_D; Tomasello C; Buonopane CE; Sances D; Marandola M; Delogu G (1995) Treatment of trigeminal neuralgia with EAP: Experience with 104 cases. Ann Ital Chir May-Jun 66(3):373-378. Inst di Anestesiologia e Rianimazione, Univ degli Studi di Roma La Sapienza. Essential or secondary trigeminal neuralgia is a very common incapacitating disease. Med or surgical conventional therapies are often inadequate. In this study we evaluated the effects of the AP therapy on 104 patients (mean age 52+13 yr) with idiopathic or secondary trigeminal neuralgia. EAP was used on local and distant points, or on tender points in the secondary form. Each course was 12 sessions. Three parameters (reappearance of the symptomatology, absence of pain in months and preceding treatments) were evaluated on a 4-point scale (very well, well, fair and null). EAP was an effective treatment in all kinds of secondary trigeminal neuralgia; success in the idiopathic form depended on previous medical treatments and the origins of the disease.
Di_Concetto_G; Sotte L (1991) Treatment of headaches by AP and Chinese herbal therapy: conclusive data concerning 1000 patients. JTCM Sep 11(3):174-176. Italian School of Chinese Med, Gruppo di Studio Societa e Salute.
Ge_S; Xu-B; Zhang-Y (1991) Treatment of primary trigeminal neuralgia with AP in 1500 cases. JTCM Mar 11(1):3-6. Dept of AP, Shenyang Hospital, PLA Air Force, PRC.
Halevi_S01 (1996) AP and snail shell moxibustion to treat eye diseases: Part 1. Originally published in the CMJ (UK). [Dr Shmuel Halevi is a practitioner of TCM, practising in Israel: WebMaster]. The 40-yr old man who came to my office at the beginning of June 1994 was desperate. He was a police captain with no previous health problems. His job was very demanding, and for many years he had spent most of his time at work. 2 wk before our appointment, Mr A (the patient) had a terrible quarrel with his superiors, after which he immediately felt intense heat rushing up to his head. Right after this he experienced a flash-like sensation in his left eye, followed by a stabbing pain inside the eye and loss of vision.

Alarmed and in pain he went to see the police physician who referred him to an eye specialist at a nearby hospital. Pictures of the fundus of the eye were taken, and the diagnosis was severe rupture of blood capillaries, causing Internal haemorrhage and Xue-Stasis which prevented vision. The specialist suggested a laser operation in order to repair the ruptured capillaries. This could only be performed after the blood had been reabsorbed, which would probably take at least 6 mo. Thus, seeing only blurs with his left eye, and with such a depressing prognosis, Mr A fell into a state of severe depression, fear and anxiety.

When I examined him on his first visit his pulse was slightly fast (around 6 beats/respiration), the left Inch/Cun position (HT) was slightly elevated, hard and tense, his left Gate/Guan position (LV) was strong and wiry, and the Foot/Chi (KI) position on both wrists was deep and barely palpable. His tongue was pale, lifeless and had a blue-purplish hue. Both inner eyelids had red-purple stains of Xue-Stasis.

Suspecting a tendency to sudden flaring up of LV-Yang based on KI-Yin Xu, I questioned Mr A; he admitted that sometimes, especially when he became irritated, he felt that his entire head heated up and began to perspire. Thus, a fast and wiry pulse in the positions of HT (left Cun-Inch) and LV (left Guan-Gate) indicated LV-Qi-Stasis, resulting in ascending Yang which speeded up HT rate and pushed Xue towards the head. The trauma to his eye happened due to a sudden and intense rage which had set the mechanism described above into motion. This was presumably the "last straw" for already weakened capillaries. This picture is supported by the observation of Xue-Stasis within the inner lid. Most cases of Xue-Stasis have KI-Xu as the basic cause; in this case (KI-Xu), KI was weakened by many strained working hours over many years. Other signs, such as lower back pain, tenderness at left GB25, and a distended lower abdomen all confirmed this observation. If combined with very strenuous working conditions and anger (he was a police-officer), this may put into motion LV-Yang activity that further exhausts KI-Yin, making a vicious circle that is bound to end in a crisis. The reason why this accident had happened in the left eye, rather than in the right, was because in most acute crises, where Yangqi-Shi (excessive Yang movement) is the cause, the left side is more likely to be affected. The classics say: "All the Yangqi goes to the left, while the Yinqi goes to the right". My first treatment aimed to calm the patient, relieve anxiety and relax tension. I assured him that his prognosis in TCM was very good, and that he should refrain from Heating foods (spices, coffee, alcohol, etc), take a 1 mo vacation and come for treatment daily. I then needled the following points: HT07, PC06, left Z 09, GV20, LV03, left GB37, SP06. HT07, PC06 and SP06. This is a fast acting, efficient formula to reduce HT-Fire, calm the Shen-Spirit and relax the nervous system. LV03, GV20 and SP06 is also a renowned formula to sedate LV, subdue LV-Yang, and assist in calming HT. Z 09 and GB37 were chosen to treat the left eye. The combination of those two points, one local and one distal, can reduce Heat, circulate Qi in the eye and brighten the eye. Z 09 + LV03 + GB37 together can resolve Qi-Stasis via LV. The combination of LV03 and GB37 is based on the principle of combining the Yuan point on the main affected Channel with the Luo point of its Phase-Mate (Yin-Yang Paired) Channel. All points were manipulated by the Xie (reducing) method e.g. counter-clockwise rotation, forceful lifting and slow thrusting the needles on the extremities were directed against the direction of flow of Qi in the Channels.

In <10 min Mr A reported that he felt very sleepy and that he had a comfortable feeling in his left eye. The needles were removed after 30 min and he was asked to come back the next day when his pulse rate was only 5 beats/respiratory cycle, and his left cun and guan positions had lost their hard and wiry quality. He reported that he had slept heavily for 10 h that night, and that his mood and overall feeling had radically improved.

Mr A's second treatment began with left GB20, manipulated first by Xie (Dispersing) technique, then immediately followed by the "Dragon Wags its Tail" technique which is effective to move Qi rather forcefully. The handle of the needle is wagged to and fro with one hand while the other hand massages the Channel in the direction chosen to Propagate the Channel Sensation (PCS). Thus, Mr A felt the needle sensation climbing up his skull and ending deep in his left eye. In subsequent treatments, however, there was no need to massage the Channel route. Manipulating the needle at GB20 was enough to cause the same effect. As soon as the needle sensation reached the left eye (usually after 10-15 sec), the patient was asked to lie supine with the GB20 needle in-situ (and with a pillow to support the head). The other points were then punctured in the following order (all on the left side): LI04, LI11, Z 09, Qiuhou (Extra) to be alternated every other treatment with ST01, ST36, LV03 bilaterally. GB37, LI04, LI11, ST01 and ST36 form a chain of points situated on the left Hand and Leg Yangming Channel. This Channel has much Qi-Xue, and is therefore usually used to resolve Qi-Xue Stasis. Also, all of these points have a strong effect on disorders of the head region. Qiuhou (Extra) and/or ST01 brighten and benefit the eye, Dispel Wind and Clear Heat. This point prescription was aimed at forcefully moving Qi-Xue via the Yangming Channel in the left portion of the hand in general, and in the left eye in particular. Also, as the main cause of the disorder, LV-Shi had to be further sedated, utilising points that have an effect both on LV and the eye. After obtaining Deqi, all the points on Yangming Channel were manipulated in the same fashion as GB20. LI04, LI11 and ST36 were very responsive, and always gave rise to a distinct sensation, travelling proximally and terminating around or inside the left eye. While ST36 was manipulated, Mr A could track the flow of sensation across his thigh, abdomen and chest, and usually pointed with his right finger to ST08 as the last station of the travelling sensation. GB37 was manipulated by the same technique. Z 09 was manipulated by simple lifting-thrusting with small amplitude movements, and initially gave a sensation of a deep stabbing sensation inside the eye, which subsequently changed to round waves encircling the inside of the eye. For ST01 and Qiuhou (Extra), the patient was asked to roll his eyeballs upwards and the needles were quickly inserted to a depth of circa 1 cun, until a pressure was felt behind the eye. All points were left in-situ for 30 min each time.

At the end of a course of 10 treatments (12 d), Mr A could read freely, except for very small letters, and could drive his car. He regained his confidence, slept well and enjoyed his enforced vacation.
Halevi_S02 (1996) AP and snail shell moxibustion to treat eye diseases: Part 2. Nevertheless, he could not differentiate colours at this stage. Even though he experienced remarkable Deqi with needling, I decided at this point to apply moxa to his eye in order to disperse Xue and Fluid within the eye more vigorously. I had read of a renowned Chinese physician who used an empty walnut shell, soaked in herbal tea, as a heating device (with moxa) to treat eye I disorders. I devised my own version by using an empty and sterilized snail shell of about the size of a human eye. A snail shell has some unique qualities, which make it superior, in my opinion, to a walnut shell. It conveys heat in a very moderate and tolerable way, is quite resistant to intense heat and does not crack easily. Its conch-like shape allows the heat, stemming from its top, to concentrate and conduct itself through the inner tunnel, until it reaches and penetrates the eye. Another feature of this shell may be an ability to soothe and descend LV-Yang. Even though, as far as I know, snail shell is not a substance used in the Chinese materia medica, it resembles in shape and quality other substances which are. Substances such as Shi Jue Ming (Concha Haliotidis), Zhen Zhu (Margarita) and Mu Li (Concha Ostreae) can subdue LV-Yang, and many of them are used specifically for eye diseases associated with disturbance of LV-Yang. Assuming that substances similar in shape and construction usually bear parallel energetic qualities, it was reasonable to expect promising results. Thus, 10 min after needles were inserted at Z 09 and ST01, I withdrew the needles, and laid the snail shell over the left eye, covering the whole eye region, and pressing gently against the skin. Over the top of the shell I ignited a moxa cone the size of 1 ml, and let it burn to the end. This procedure was repeated 3 times in each session. The outcome of this technique was quite remarkable. Mr A reported an extraordinary feeling and movement engulfing his eye, giving him a relaxed and pleasant sensation that he had never experienced before. Right after the first session his colour differentiation improved, and his eyesight brightened even more. After 2 more sessions with the snail moxibustion he was able to distinguish colours normally. This treatment was continued twice/wk, substituting BL01 for ST01. This was done in order to reduce oedema (enhance fluid absorption) in the eye fundus. BL01, the last point of Yinqiao Mai, can absorb Yin-Shi from around the eye. Thus, it is often used to treat somnolence, excessive lacrimation, glaucoma, etc. Also, and in order to affect this goal even more radically, KI06, being the master and first point of the Yinqiao Mai, was occasionally punctured bilaterally. Mr A was discharged after 20 treatments, and had regained his eyesight almost as it was before the accident.

Other case histories.
In the past year I have treated 5 more patients suffering from the same eye disease, in various degrees of severity. These patients were referred to me either by a "chain reaction" from patient to patient or by eye specialists who had heard of the previous case. The clinical success was excellent in all these 5 cases, ranging from marked improvement to complete cure. Convinced that this snail shell technique is promising, and considering the interest this case has raised, I decided to write a few more lines and elaborate as much as possible on this technique.

It is not in the scope of this article to give a full account of the other patients who were treated in the past year for this illness. Nevertheless here is some general information which has direct link to the understanding of the possible diversities of this disease. The patients, all male were aged from 40-64. The duration of the problem was 3 wk-2 yr. The severity was from a complete blur and undeciphered picture to a broken or twisted image, mostly described as looking through half a glass of water. Number of sessions: 7-24. WM diagnosis: Internal haemorrhage and/or thrombosis. TCM diagnosis: all patients had a primary diagnosis of internal eye haemorrhage. The aetiologies were as follows: 3 patients due to Shi of LV-Yang-Fire causing rupture to the eye capillaries; 1 patient had an underlying KI-Qi-Xu and SP-Yang-Xu as the main cause, and LV-Xue-Xu as a secondary cause; 1 patient had a Damp-Stasis (an obese person), with subsequent watery and puffy eyes.

Clinical considerations: The main objective of the treatment, regardless of the underlying Syndrome (whether Xu or Shi), was to disperse and recirculate the extravasculated blood inside the eye.

Xie (Dispersing) techniques usually are used in Shi Syndromes. This internal eye haemorrhage was absolutely Shi, although it may occur in a basic Xu Syndrome, for example, SP-Yang-Xu making SP unable to hold the Xue in the blood vessels. Xie techniques must be applied mostly to points near the eye, using also secondary points with a strong general ability to move Xue.

The underlying cause (Shi of LV-Yang or Xu of KI-Qi and SP-Qi) must also be addressed, but with less emphasis. This aspect of treatment is given to support the main course which is (as said before) the dispersion of Xue Stasis. If an underlying Xu Syndrome predominates, and the patient is generally very weak, strengthening methods should be applied in the first place and only then the main problem should be addressed.

After an improvement has occurred and the patient can see better, a gradual shifting of the treatment focus towards the underlying imbalance must take place. After the eyesight has been restored to the maximum degree possible, the remains of the underlying imbalance should be eliminated by all means possible (herbs, AP, diet management, etc).

Regardless of the basic imbalance, snail shell moxa can be used in all cases except one, an underlying state of either LV-Fire or HT-Fire. This manifests as symptoms of flushed face, very red inner eye lids, hypertension and unambiguous dislike of Heat. In such cases, snail shell therapy is contraindicated until this inner imbalance is resolved.

Point-selection: Main points: BL01, possibly the most potent point to treat any eye disease. It is suitable for any possible imbalance, whether Yin or Yang Xu in the eye, or Stasis of Wind, Heat, Damp, Xue or Cold. It is the cross point of the Yinqqiao Mai and Yangqiao Mai which greatly influence the eye. ST01 is a very potent point for eye disease. It is situated in the intersection of the CV, ST and Yangqiao Mai. Being a ST point makes it even superior to BL01 to Xue and/or Heat Stasis. Qiuhou is a wonder point in all afflictions of the optic nerve. It is therefore used whenever a marked deterioration of eyesight is a main symptom. Secondary points: GB20, which intersects the Channels of the GB, TH and the Yangwei Mai. All these Channels either begin or end near the eye. GB20 is indicated for all eye diseases, and is especially appropriate for dispersal purposes of Qi, Xue, Wind, Heat etc. LI04 is the best distant point to use for eye afflictions whenever a strong Qi moving effect is desired. This point is used in the contra lateral side of the diseased eye. SP06 has a strong effect on either the quality and/or the state of the Xue in general.

Halevi_S03 (1996) AP and snail shell moxibustion to treat eye diseases: Part 3. SP06 tonifies and circulates Xue systematically and helps in various bleeding disorders. It is thus a perfect distant point to assist the main points. KI06 is used due to its role as the Confluent point of the Yinqiao Mai. It is also the first point of the Yinqiao Mai, while BL01 is the last point. Puncturing the last and the first points of an Extraordinary Vessel may drain its Shi (Excess). So, Shi of Yin or Xue near the eye may be reabsorbed or dispersed via this point. As a KI point, it can deal with Fluids in any case.

Needle technique: As mentioned above the main objective of the treatment is to disperse extravasculated Xue which pooled within the eye depth due to various aetiologies. This disorder is situated in the most delicate anatomical region and it calls for a very skilful needle technique. BL01 and ST01 are inserted slowly and smoothly perpendicularly to a depth of 1.5 Cun, while the other hand is pushing gently the eyeball leftward or upward respectively. The needle is pushed inside until the patient experiences Deqi. The main Qi sensations here are tingling, numbness and pressure which surrounds the eye. Also, Qiuhou (extra) is punctured in the same manner apart from being directed medially rather than perpendicularly. It usually gives the sensation of slight electric shock or a pressure behind the eyeball. After the Qi has been obtained, the needle should be flicked rapidly but gently with the finger nail, so as to strengthen the Qi sensation and enhance the dispersal effect. Other types of manipulations are prohibited. Now and then, in some patients, a haematoma may develop due to micro bleeding due to needle injury. A black-eye is thus not a very rare outcome of the procedure. If this happens, the patient should be calmed and reassured that this is of no consequence, except for a temporary aesthetic inconvenience. The needles around the eye may remain in-situ for at least 20 min.

The manipulation technique of GB20 was described in detail in the first case. In short, the needle sensation should be made to travel across the skull until it reaches the eye. LI04 sensation should travel proximally to reach the affected eye also, if possible.

Snail shell application: In general, the size of the snail shell must be fitting to cover the whole eye, e.g. the upper and lower lids while the eye is closed. The shell is laid over the eye after the surrounding needles have been withdrawn, and either the patient himself or the practitioner supports the edges of the shell with his fingers, and presses it lightly against the skin. Circa 1 cc of moxa cone is laid on its top and ignited. Practitioners who have used indirect moxa (over ginger or garlic) should have no difficulties with this technique. After a few minutes the patient usually experiences the heat penetrating the eye, and some of them even feel the heat reaching as far as the nape of the neck. Most patients find the procedure extremely enjoyable and relaxing. During each session 2 moxa cones should be used, and one snail shell may be used as much as during 3 sessions. The patient must be warned not to open his eyes while the treatment is ongoing, and he would better lie with closed eyes for a few minutes even after the shell have been removed.

Treating the underlying imbalance: As discussed in the beginning of this paper, in many instances there exists an underlying systemic imbalance which is the basic cause of the eye disorder. Here is a brief account of the main Syndromes associated with this disease, and the most significant symptom for each Syndrome.

LV-Yang-Shi or LV-Fire-Shi: The main symptom in this Syndrome is anger and irritability. The main signs are very red inner lids along with a wiry and fast pulse. Suggested prescription for use with the main points: LV02, GB37, Z 09, GB20.

KI-Qi-Xu: The main symptoms are dizziness or vertigo. In this Syndrome the patient usually complains that his sight worsens significantly after exertion. Signs may include a Xu Chi (KI) pulse of both hands and a pale lower segment of the inner lids. Points are: KI03, CV04, BL10.

Yang-Xu of KI and/or SP: Beside other symptoms and signs relevant to this Syndrome, we should note symptoms such as vertigo and possibly pain in the eye region, accompanied with a Cold sensation. A history of bleeding disorders may also exist. Main sign: a pale and wet tongue. Our point-prescription would be: BL23, GV04, GV14, ST36 (the last 3 with direct moxa).

Xue-Stasis: A sharp and stabbing pain in the eye region is a prime symptom, usually with a complete or almost complete sight loss. A main sign is most often a wiry and choppy pulse, and congested purplish veins in the inner eye lids. In order to properly assign a useful prescription to treat this Syndrome, one should differentiate whether the Xue-Stasis is the result of Xue-Xu, or Xue-Heat. Points that may be used for various Xue disorders are: BL17, BL16, SP06, SP10, PC06.

Damp-Stasis: When this Syndrome affects the eyes to the extent that Xue or Fluids extravasate inside the eye, the main symptom is usually very damp and watery eyes. The main sign is a puffy and big tongue with a thick slippery fur. Also, a thin and very wet tongue may be seen. Points: SP06, SP09, BL22, TH23.

Recommendations: Although moxibustion is essential in this treatment, it is very important to use very skilful needle technique also, especially on the points near the eye. These points are very close to the disease focus and have an immediate effect. Being so called "dangerous points" in AP, deters many practitioners from using them, or while used they are poorly dealt with. This is a pity, as these points usually yield excellent results in many eye diseases. The needle used for these points must be fine, 32 g or finer. Its tip must penetrate the skin very rapidly with one short thrust to a depth of 1 mm. When this has been done the needle is pushed further deeper and deeper, "going with the needle" in the desired direction. If an obstacle is felt, or the needle can not advance, it should be lifted slightly, redirected, and reinserted. At circa 1-1.5 Cun deep, a true type Qi sensation is usually felt, and then the needle handle should be gently flicked several times, as mentioned before.

Involving the patient in the process of PCS (propagating the needle sensation from a distant point along the route of the Channel) enhances the effect dramatically. Thus, manipulating the needle with one hand, and massaging its route with the other hand, usually brings a Qi travelling sensation within seconds. Right after this occurs, the patient is requested to concentrate his mind, and pull (or push) the sensation toward the disease focus with his imagination. Sometimes (most often with children) I ask patients to massage their own skin while I manipulate the needle, from the place where they feel that the Qi has arrived toward the desired focus. With this technique, one is astonished to see how often the Qi sensation from KI06 can reach up to BL01.

References.
1.Essentials of Contemporary Chinese Acupuncturists' Clinical Experiences. Foreign Languages Press, Beijing.

Hesse_J; Mogelvang B; Simonsen H (1994) AP versus metoprolol in migraine prophylaxis: a randomized trial of TP inactivation. Pain Clinic and Med Dept, Skodsborg Sanatorium, Denmark. J Intern Med May 235(5):451-456. The effects of dry needling of myofascial TPs in the neck region was compared with metoprolol therapy in migraine prophylaxis in a randomized, double blind, group comparative study. The therapist was blinded as to results. The work was done in an outpatient pain clinic north of Copenhagen. Patients were referred by general practitioners or respondents to newspaper advertisements. The 85 included patients had a history of migraine with or without aura for at least 2 yr. Excluded were those with contraindications against treatment with beta blockers, chronic pain Syndromes, pregnancy or previous experience with AP or beta-blocking agents. After a 4-wk run-in period, patients were allocated to a 17-wk regimen either with AP and placebo tablets or to placebo stimulation and metoprolol 100 mg/d. 77 patients completed the study. Both groups exhibited significant reduction in attack frequency (p<.20) or duration (p<.10) of attacks, whereas we found a significant difference in global rating of attacks in favour of metoprolol.

Heydenreich_A (1990) Hypothetical aspects of the preventive effectiveness of controlled reflex and stimulation therapy (exemplified by AP and PuTENS) in migraine. Psychiatrie, Neurologie und Medizinische Psychologie (Leipzig) Aug 42(8):500-507. Abteilung Neurologie, Universität Rostock, Germany. On the basis of long-term therapeutic and experimental experience, the role of AP, TENS, reflex-therapy and stimulation-therapy in treating migraine is discussed from the viewpoint of modern neurophysiology. AP has analgesic, vascular-, muscular- relaxing and reflex effects. AP reduces trigger mechanisms notably and helps the functions of the ANS. These effects may explain some of its therapeutic role in migraine.
Jia_D (1993) Current applications of AP by otorhinolaryngologists. JTCM Mar 13(1):59-64. Chengdu College of TCM, Sichuan Province, PRC.

Johansson_A1; Wenneberg B; Wagersten C; Haraldson T (1991) AP in treatment of facial muscular pain. Acta Odontologica Scandinavica Jun 49(3):153-158. Dept of Stomatognathic Physiol, Faculty of Odontol, Univ of Gothenberg, Sweden. People with chronic facial pain or headache of muscular origin were assigned at random to 3 groups (n=15/group): 1=AP; 2=Occlusal splint and; 3=Control. Both AP and occlusal splint significantly reduced subjective symptoms and clinical signs of the stomatognathic system. Differences between Groups 1 and 2 were not significant as regards treatment effects. AP is an alternative method to conventional stomatognathic treatment for people with craniomandibular disorders of muscular origin.
Lao_L; Bergman S; Langenberg P; Wong RH; Berman B (1995) Efficacy of Chinese AP on postoperative oral surgery pain. Oral Surg Oral Med Oral Pathol Oral Radiol Endod Apr 79(4):423-428. Univ of Maryland at Baltimore, Dept of Family Med 21201, USA. One of the challenges of AP research is designing appropriate control groups. To address this problem, after surgical third molar extractions 19 patients were randomly assigned to 2 groups: 1=AP (n=11); 2=Placebo-AP (n=8). Standard patient self-report recorded the duration to reach moderate pain and pain intensity after oral surgery. Subjects treated with AP reported longer pain-free duration times (mean, 181 versus 71 min; p </=.046) and less pain intensity than those who received Placebo-AP. This study provides a model for an AP control to examine the placebo effect in clinical AP research.

Li_B; Li Lng L; Chen J; Chen L; Xu W; Gao R; Yang B; Li W; Li W; Wu B; et al (1993) [Observation on the relation between Propagated Channel Sensation and the therapeutic effect of AP on myopia of youngsters]. Chen Tzu Yen Chiu 18(2):154-158. Fujian Provincial Hospital, Fuzhou, PRC. 992 eyes suffering from various degrees of myopia in 536 youngsters were treated with AP. A method of exciting the Propagated Channel Sensation (PCS) and making it travel toward the affected region was employed in treatment. Bilateral LI04 and LV03; and bilateral TH05 and GB37 were punctured at intervals of 2 d. After 1-3 periods of treatment, 868 eyes (87.5%) had improved vision to various degrees; vision completely recovered in 131 eyes (13.31%), and the dioptre decreased -0.75 to -1.00 D.S. in 13 eyes after AP treatment. The therapeutic effect of AP seemed to be reasonably satisfactory and stable at a follow-up at 2 yr. The degree of distinctness of PCS increased markedly with the increase of time of AP. There was a close relation between the extent of distinctness of PCS and effectiveness of AP. The more striking the centripetal PCS, the better was therapeutic effect of AP. The excellent effect was always achieved when PCS arrived at the affected eye. Since PCS arrived at a large number of eyes in the subjects in younger year and so the better therapeutic effect was also achieved.

Li_Y (1991) Treatment of histamine headache with AP on GV14. JTCM Dec 11(4):256-257. Changchun College of TCM, Jilin Province, PRC.

Li_Y; Wang X; Li T (1993) AP therapy for 12 cases of cranial trauma. JTCM Mar 13(1):5-9. Teaching Hospital, Shanxi College of TCM, Taiyuan, PRC.

Lin_B (199.) Treatment of frontal headache with AP on CV12: a report of 110 cases. JTCM Mar 11(1):7-8. Chen Xiuyuan Hospital, Changle County, Fujian Province, PRC.

Lindberg_P; Scott B (1991) [Methodological shortages of the evaluation of AP therapy in tinnitus]. Lakartidningen 13 Mar 88(11):940, 943. Bada vid audiologiska avdelningen, Akad asjukhuset, Uppsala, Sweden.

Lindholm_S; Berg S; Larsson B; Hybbinette JC (1991) [AP is a valuable therapeutic alternative in tinnitus]. Lakartidningen 6 Mar 88(10):847-849. Ear-Nose and Throat Dept, Kalmar Hospital, Sweden.

List_T1 (1992) AP to treat patients with craniomandibular disorders. Comparative, longitudinal and methodological studies. Swed Dent J Suppl 87: 1-159. Dept of Prosthetic Dentistry, Faculty of Odontology, Univ of Goteborg, Sweden. The aim of the thesis was to compare the short- and long-term effects of AP and occlusal splint therapy in patients with craniomandibular disorders (CMD). 110 patients (23 M, 87 F), participated in the study. All had exhibited moderate or severe signs and symptoms of CMD and had had pain for >6 mo. The participants were assigned at random to 3 groups: 1=AP therapy; 2=Occlusal splint therapy and; 3=Control (untreated). 10 different subjective and/or clinical assessment variables were used in the evaluation of the treatment effect. Immediately after treatment, AP and occlusal splint therapy had reduced the symptoms as compared with the control group which remained essentially unchanged. AP gave better subjective results than occlusal splint in the short-term. In the 12-mo long-term follow-up, 57% of the patients who received AP and 68% of the patients who received occlusal splints benefitted subjectively and clinically from the treatment. There were no statistically significant differences between the two groups in any of the assessment variables. Patients who received various additional therapies after AP and/or occlusal splints rarely responded favourably to additional treatment. No serious adverse events or complications were observed. AP seems to have adverse events of a more general nature whereas adverse events of the occlusal splint seem to be more related to the orofacial region. Most patients responded positively to the comfort of both treatment modes. An algometer was evaluated in order to measure tenderness (pressure pain threshold, PPT) more objectively. The algometer was reliable and valid for recording the PPT in the masticatory muscles. Reliability was improved further by connecting a stopwatch to the algometer so that the pressure rate could be kept within acceptable limits. PPT correlated moderately but statistically significantly with clinical and subjective variables. The algometer was sensitive enough to detect pre- and post-treatment changes. Tenderness was reduced significantly immediately after and at the 6-mo follow-up for both treatment modes. AP gave positive results similar to those of occlusal splint therapy in patients with mainly myogenic CMD symptoms over a 1-yr period.

List_T2; Helkimo M; Andersson S; Carlsson GE (1992) AP and occlusal splint therapy to treat craniomandibular disorders. Part I. A comparative study. Swed Dent J 16(4):125-141. Dept of Stomatognathic Physiology, Inst for Postgrad Dent Educ, Jonkoping, Sweden. 110 patients (23 M, 87 F) participated in a comparative study of the effect of AP and occlusal splint therapy. All the patients exhibited signs and symptoms of craniomandibular disorders (CMD) and had had pain for >6 mo. The participants were assigned at random to 3 groups: 1=AP therapy; 2=Occlusal splint therapy and; 3=Control (untreated). The patients were evaluated before and immediately after treatment/control time. 10 different subjective and/or clinical assessment variables were used in the evaluation of the treatment effects. Both AP and occlusal splint therapy reduced the symptoms as compared with the control group in which the symptoms remained essentially unchanged. In this short-term study, AP gave better subjective results (p <.001) than the occlusal splint therapy.

List_T3; Helkimo M (1992) AP and occlusal splint therapy to treat craniomandibular disorders. Part 2. A 1-yr follow-up study. Acta Odontol Scand Dec 50(6):375-385. Dept of Stomatognathic Physiology, Inst for Postgrad Dent Educ, Jonkoping, Sweden. 80 patients (22 M, 58 F) participated in a 1-year follow-up study. All had shown signs and symptoms of craniomandibular disorders (CMD) and had had pain for >6 mo at the start of treatment. The patients were assigned at random to 2 groups: 1=AP therapy and; 2=Occlusal splint therapy. Those patients who did not respond to either of the treatment modes were offered various additional therapies. 57% of the patients who received AP and 68% of the patients treated with occlusal splint therapy benefited subjectively (p <.01) and clinically (p <.001) from the treatment over a period of 12-mo. No statistically significant difference was found between the 2 groups as to the assessment variables. Those patients who received various additional therapies after AP and/or occlusal splint therapy responded favourably to additional treatment in only a few instances. AP gave positive results similar to those of occlusal splint therapy in patients with primarily myogenic CMD symptoms over a 1-year follow-up period.

List_T4; Helkimo M (1992) Adverse events of AP and occlusal splint therapy to treat craniomandibular disorders. Cranio Oct 10(4):318-24; Discussion 324-326. Inst for Postgrad Dent Educ, Jonkoping, Sweden. Occlusal splint therapy and AP gave positive treatment effects some studies. As with other therapies, adverse events may occur. In this paper, adverse event refers to any reaction to a treatment besides the intended treatment effect, irrespective of any correlation between the treatment and the reaction. This reaction can be positive, as well as negative, to the patient. In the present study, 61 patients with craniomandibular dysfunction (CMD) were treated with AP or occlusal splint therapy and the adverse events were carefully recorded. The profile of the adverse events differed between the two treatment modes. AP seemed to have adverse events of a more general nature, e.g. relaxed feeling, improved sleep, temporarily increased pain; whereas, adverse events of occlusal splint therapy seemed to be more locally related to the orofacial region, e.g. increased or decreased salivation and tension in the teeth. No serious adverse event or complication was observed. Most patients responded positively to both treatment modalities. Only in a few cases did the patients consider the treatment uncomfortable.

Lu_DPa1; Lu GP (1993) APA for pain and anxiety control in dental practice: Part 1: Theory and application. Compendium Feb 14(2):182, 183_189. Allentown Hospital, Lehigh Valley Hospital Centre, Pennsylvania.

Lu_DPa2; Lu GP (1993) APA for pain and anxiety control in dental practice: Part 2: Techniques for clinical applications. Compendium Apr 14(4):464-468, 470-2; Quiz 472. Allentown Hospital, Lehigh Valley Hospital Centre Pennsylvania.

Nilsson_S; Axelsson A; Li De G (1992) AP for tinnitus management. Scand Audiol 21(4):245-251. Dept of Audiology, Sahlgrenska Hospital, Gothenburg, Sweden. 56 patients with continuous and severe tinnitus as their major complaint were treated with traditional Chinese AP. After a pre-treatment period with baseline evaluation of tinnitus, 10 treatments were given during a period of 20 d, followed by a post-treatment period in order to obtain indications of prolonged treatment effects. Assessments were made using visual analogue scales (VAS) and a verbal retrospective rating scale. 3 patients reported improvement which lasted for at least 10 d after the last treatment, indicating a possible long-term effect in some cases. 21% of the patients reported transient intensity reductions lasting for hours/ds. Estimated "substantial" improvement rate by VAS, consistent for all 3 parameters involved (intensity, annoyance, awareness), was 20%, while the corresponding deterioration rate was 25%. Statistical analysis of the whole group did not show any significant general treatment effects. Interactions between treatment evaluations by verbal rating and VAS are discussed as well as interactions with psychological components.

Pasmanik_ED; Nizovtseva TR (1993) [The combined treatment of amblyopia by the methods of AP reflexotherapy and traditional pleoptics]. Vestn Oftalmol Jul-Sep 109(4):6-8. 52 children (75 eyes with amblyopia) were treated by AP and traditional pleoptics. This complex of treatment was found more effective as against traditional pleoptics alone (70 children, 118 eyes with amblyopia) on the whole and to treat high amblyopia. The best results were attained in children previously treated by pleoptic methods with special equipment (older children). Of the 17 eyes with amblyopia resistant to common treatment multiple-modality treatment improved 10 (58.8%). The effect of treatment persisted for 3 mo. The first course of such treatment proved to be the most effective to treat high amblyopia; starting from the 2nd course the condition grew resistant to such treatment, this resistance gradually augmenting.

Podoshin_L; Ben-David Y; Fradis M; Gerstel R; Felner H (1991) Idiopathic subjective tinnitus treated by biofeedback, AP and drug therapy. Ear Nose Throat J May 70(5):284-289. Dept of Otolaryngol, Faculty of Med, Technion-Israel Inst of Technol, Haifa, Israel. The effect of 3 treatment modalities of idiopathic-subjective tinnitus (IST): AP (AP), biofeedback (BF) and Cinnarizine (Cin), was investigated in 58 randomly selected subjects. The findings show that at the end of treatment, 50% of the patients in the biofeedback group reported some amelioration in the level of the tinnitus, while 30% of the AP group and only 10% of the group receiving Cinnarizine reported an amelioration of the tinnitus. Treatment by biofeedback caused a significant easing in the degree of discomfort caused by the tinnitus to patients during rest. Within the limitations of the study, the biofeedback method was more effective than AP or Cinnarizine to treat those suffering from tinnitus.

Rasmussen_M (1991) [AP: a treatment method of interest to dentists]. Tandlaegebladet Apr 95(5):212-214. Dental High School, Arhus, DK. In Danish.

Rogvi-Hansen_B; Perrild H; Christensen T; Detmar SE; Siersbaek-Nielsen K; Hansen JE (1991) AP to treat Graves' ophthalmopathy: A blinded randomized study. Acta Endocrinol (Copenhagen) Feb 124(2):143-145. Dept of Int Med and Endocrinol F, Herlev Hospital, Denmark. 17 patients with Graves' ophthalmopathy, all euthyroid for >1 yr, were included in a blinded trial to test the effect of AP twice/wk for 2 mo on the eye disease, assessed by an ophthalmologist and computed tomography of the eye muscle volume. No significant change was found in eye muscle volume, Hertel measure, palpebral aperture, intraocular pressure, Hess chart, nor was there any statistically significant improvement of the irritative conjunctival symptoms.

Salim_M (1993) AP v carbamazepine in trigeminal neuralgia. J Pak Med Assoc Jan 43(1):13. Dept of Anaesthesiology, Military Hospital, Rawalpindi, Pakistan.

Satko_I; Zßlesßk R; Zajko J (1990) [AP in stomatology]. Prakt Zubn Lek Sep 38(7):194-197. Dept of the 2nd Stomatological Clinic, Bratislava. The authors discuss the possible use of AP in stomatology, as used in their Clinic for 13 yr in diseases of polyaetiological nature or where the cause was not well known. AP was successful in diseases such as glossodynia, stomatodynia, primary neuralgia of the trigeminal nerve, contractures of the jaws, dysfunctional syndrome of the facial muscles and disorders of salivary secretion in 178 patients treated at their out-patient Dept.

Schonherr_AK (1990) Suggestibility and success of AP with the example of the treatment of migraine in people. Doctoral Thesis, Justus Liebig Univ, Giessen, Germany. English summary. Bibliographical references (pp99-113).

Stepanchenko_AV; Puzin MN; Vasil'ev VI (1991) [Treatment of trigeminal neuralgia by AP]. Zh Nevropatol Psikhiatr Im S S Korsakova 91(4):44-46. The paper relates the general principles of the treatment of trigeminal neuralgia by AP. The authors' own research data are provided.

Tavola_T; Gala C; Conte G; Invernizzi G (1992) Traditional Chinese AP in tension-type headache: a controlled study. Pain Mar 48(3):325-329. Dept of Psychiatry, Univ of Milan, Italy. 30 patients with tension-type headache were randomly chosen to undergo a trial of traditional Chinese AP and sham AP. 5 measures were used to assess symptom severity and treatment response: intensity, duration and frequency of headache pain episodes, headache index and analgesic intake. The 5 measures were assessed during a 4 wk baseline period, after 4 and 8 wk of treatment, and 1, 6 and 12 mo thereafter. Before the start of the study, each patient returned the MMPI. Split-plot ANOVAs showed that, compared to baseline, at 1 mo after the end of treatment and for the 12 mo follow-up, the frequency of headache episodes, analgesic consumption and the headache index (but not the duration or intensity of headache episodes) significantly decreased over time; however, no difference between AP and placebo treatment was found. No single MMPI scale predicted the response to treatment, but the mean MMPI profile of AP non-responders showed the presence of "Conversion V".

Troshin_OV (1991) [Laser-AP of earpoints of patients with cochleovestibular dysfunction]. Zh Nevropatol Psikhiatr Im S S Korsakova 91(11):64-67. Based on a comprehensive clinico-neurophysiological examination of 80 patients with vertebrobasilar insufficiency and 30 practically healthy subjects, a method of Earpoint laser-AP of patients with cochleovestibular dysfunction was devised. Ear-AP points have a high functional activity and specificity to the cochleovestibular system. Our data supported the appreciable therapeutic efficacy of Laser-AP of Earpoints.

Vincent_CA (1990) The treatment of tension headache by AP: a controlled single case design with time series analysis. J Psychosom Res 34(5):553-561. Dept of Psychol, Univ Coll London, UK. A single case design, with time series analysis, was employed to evaluate the efficacy of AP to treat tension headache. 14 patients were treated once/wk for 8 wk, 4 of true AP and 4 of sham in random order. Mean pain in medication scores were reduced by 52% and 54% respectively at initial follow-up. Reductions in pain scores of over 50% were achieved by half the patients and the significance of these changes confirmed by time series analysis. Most patients maintained their gains at the 4 mo follow-up. True AP was significantly better then sham-AP; it had a specific therapeutic action in 4 patients. Sham-AP had no effect in the other 4 patients. Possible mechanisms for these effects are discussed. AP may be valuable as a treatment for tension headache but further research is needed.

Wang_K (1992) A report of 22 cases of temporomandibular joint dysfunction syndrome treated with AP and laser radiation. JTCM Jun 12(2):116-118. Dept of Acu-physiotherapy, Jiangshan People's Hospital, Zhejiang, PRC.

White_AR; Eddleston C; Hardie R; Resch KL; Ernst E (1996) A Pilot Study of AP for Tension Headache, Using a Novel Placebo. Adapted from WWW. Tension headache is common; AP treatment often is recommended, though evidence of its effectiveness is contradictory. This small, randomised, controlled trial was designed to test procedures in preparation for a multi-centre trial of the effect of AP as a treatment for tension headache. 10 volunteers suffering from episodic, tension-type headache were recruited by local newspaper articles. Patients were assigned at random to two groups: A=brief needling at tender areas or selected AP points; B=Placebo AP. The Placebo was via pressure from a cocktail stick within a guide tube to defined, non-tender and non-AP areas. The patients' view of the treatment sites was obstructed so that they could get no indication as to which form of treatment was being given. Duration, frequency and intensity of headaches were recorded. Mean weekly headache index was calculated throughout the trial. Comparing pre- and post- treatment values, changes in weekly headache index in the 2 groups were not significantly different. However, Group A had a higher number of headache-free weeks than Group B. The credibility of the 2 procedures was tested using a standard credibility questionnaire and a "final verdict". One subject in Group B concluded that she had not received genuine AP, but overall there was no statistical difference between the credibility of treatment in the 2 groups.

Xie_Z (1992) 51 cases of occipital neuralgia treated with AP. JTCM Sep 12(3):180-181. 157th Hospital of PLA, Guangzhou, PRC.

Zhang_S3 (1992) Treatment of tonic headache with AP. Chung i tsa chih (JTCM) Sep 12(3):175-177. Third Teaching Hospital, Beijing Med Univ, PRC. Headache is a common symptom of complicated etiology; treatment is often ineffective when the intrinsic cause of the manifestation is not identified. Tonic headache is very common in Germany and conventional treatments help few patients. AP helped many cases after other types of treatment had failed. The author brings AP to the attention of the Med profession; it is useful to their armoury.

Zhao_P (1992) 47 cases of migraine treated with AP. JTCM Jun 12(2):108-109. Hospital of TCM, Tianjin, PRC.

4. VERTEBRAL, SPINAL AND PARASPINAL
Agasarov_LG; Krasnova LB; Malygina SI; Bragin EO (1993) [The function of the hypophysis gonadal system in lumbar osteochondrosis in men and its changes during AP and EAP]. Vopr Kurortol Fizioter Lech Fiz Kult Jan-Feb 1:61-63.

Amelin_AV; Vasil'ev IuN; Ignatov IuD; Skoromets AA (1991) The combined use of AP and antidepressants to manage spondylogenic lumbosacral pain Syndrome. Farmakologiia i Toksikologiia Sep-Oct 54(5):123. In Russian. The effects of antidepressants amitriptyline and pyrazidol on the analgesic action of AP in patients with lumbosacral radiculitis was studied by the double blind control method. AP combined with antidepressants enhanced the effectiveness of treatment, to increase the duration of analgesia by a mean by 5-6 h within 24 h after each procedure and to reduce the duration of treatment by a mean of 4-5 d. The data indicate the clinical usefulness of AP combined with antidepressants.

Baldry_P (1996) Whiplash Injuries. Paper to the BMAS Spring Scientific Meeting, Bristol, May 1996. Sites from which whiplash injury pain (acute neck sprain) may arise include myofascial TPs (MTrPs), facet joints and the intervertebral discs. Many methods can deactivate MTrPs; that recommended is superficial dry needling. Pain referral patterns from facet joint and MTrP nociceptors are similar, so failure to obtain appreciable pain relief from MTrP deactivation necessitates a diagnostic, fluoroscopically controlled, facet joint block. Disc pain may occur either because of damage to the innervated annulus fibrosus of an intact disc, or because of nerve root pressure when a disc ruptures. Most whiplash patients (75%) become pain free within 3-6 mo. The remainder are said to have the late whiplash Syndrome. This was formerly thought to be due to neuroticism or compensation seeking avarice, but it is currently considered to have a genuine organic basis. Possible causes include overlooked facet joint damage, undetected disc damage and various self perpetuating MTrP pain persisting mechanisms.

Chan_Gunn C (1991) Treating Myofascial Pain. Am Acad of Med AP Review 3(2):4-6. Neuropathic pain invariably affects the musculoskeletal system, causing muscle contracture and shortening: "Myofascial Pain". Spondylosis, the universal outcome of age, wear and tear, is probably the main cause of neuropathic pain. By irritating nerve roots, spondylosis can lead to peripheral neuropathy and muscle shortening. Many myofascial Syndromes (from Achilles Tendonitis to Tennis Elbow) caused by muscle shortening of spondylotic origin are customarily misconstrued as mundane local conditions. The spondylosis and muscle-shortening model can explain many musculoskeletal pain problems for which no alternative clinical diagnosis exists; it also enables these disparate Syndromes to be grouped under one aetiological classification. Im stimulation effectively relieves pain by releasing muscle, which in turn relieves paraspinal muscle shortening and pressure on nerve roots, as well as stimulating the production of platelet-derived growth factor to promote healing.

Cui_S (1992) 100 cases of acute lumbar sprain treated with AP at Zhibian (BL54). JTCM Jun 12(2):119. Dept of AP, Liaoning College of TCM, Shenyang, PRC.

Ernst_E; Fialka V (1993) Conservative therapy of backache. Part 5: TENS, AP, biofeedback, traction, cryotherapy, massage and ultrasound. Fortschr Med Sep 30 111(27):420-422. Klinik fur Physikalische Medizin und Rehab, Univ Wien. The usual therapies in back pain were discussed in earlier sections. As well as these methods, alternative methods, some of which have a solid scientific basis, are used commonly. Subthreshold TENS is not effective in low back pain. Whether this is also true of higher-dose TENS is not yet clear. EAP, however, seems to be effective, but not biofeedback or traction. As controlled trials have not been done, one cannot definitively assess other common treatment modalities, such as cryotherapy, heat, massage or ultrasound.

Fisher_HW (1992) Acute low back pain treated by spinal manipulation and EAP. J Manipulative Physiol Ther Mar-Apr 15(3):199-202.

Galliamov_AG; Valeev RG (1990) [Radon therapy and the use of AP reflexotherapy in patients with cervical and lumbar osteochondrosis]. Vopr Kurortol Fizioter Lech Fiz Kult Nov-Dec 6:50. In Russian.

Harman_JC (1993) Backs, performance, and AP. Proc Ann Conv Am Assoc Equine Pract Lexington, Ky. Meeting held on November 29-December 2, 1992, Orlando, Florida, pp 337-348.

Hu_Ra2 (1993) Treatment of acute lumbar sprain with AP at Fuyang (BL59). JTCM Dec 13(4):264-265. Dept of AP, Fengcheng City People's Hospital, Jiangxi Province, PRC.

Hu_S; Zhong Y (1992) Clinical observations on the treatment of 50 cases of stiff neck by AP. JTCM Mar 12(1):57-58. Hospital of Gymnasium Road, Chong Wen District, Beijing PRC.

Janssens_LAAx1 (1985) The treatment of canine cervical disc disease by AP: a review of thirty-two cases. J Small Anim Pract 26(4):203-212. Oudestraat 37, Wilryk, Belgium.

Janssens_LAAx2; De_Prins EM (1989) Treatment of thoracolumbar disk disease in dogs by means of AP: a comparison of two techniques. J Am Anim Hosp Assoc Mar-Apr 25(2):169-174. Oudestraat 37, Wilryk, Belgium.

Janssens_LAAx3 (1992) AP for the treatment of thoracolumbar and cervical disc disease in the dog. Probl Vet Med Mar 4(1):107-116. Oudestr 37, B-2610 Antwerp, Belgium. Thoracolumbar disc disease (TLDD) and cervical disc disease (CDD) occur regularly in veterinary small animal practice, mainly in chondrodystrophic breeds and mostly around the age of 5-6 yr. CDD is responsible for circa 15% and TLDD for circa 85% of disc herniations. Treatments may consist of surgery or medication or both. AP can also be used as a treatment for TLDD and CDD. With a few exceptions, the results of AP treatment for TLDD and CDD are favourable and comparable to those of surgical treatments. The AP techniques presented here are relatively simple and can be learned in a minimum of time. [See also: Janssens_L (1991) Acupuncture in thoracolumbar disc disease [letter]. J S Afr Vet Assoc Mar 62(1):2].

Ji_X (1990) AP treatment of cervico-omalgia in 62 cases. JTCM Sep 10(3):204-206. Inst of AP, Acad of TCM, PRC.

Kuno_RC; Cerqueira MD (1995) Enhanced bone metabolism induced by AP. J Nucl Med Dec 36(12):2246-2247. Dept of Radiology, Univ of Washington Sch of Med, Seattle, USA. A 29-yr-old man with several years of back pain was referred for a bone scan. High-resolution regional spot images of the skeleton were obtained after iv injection of 20 mCi 99mTc-methylene diphosphonate. Posterior and lateral images of the skull showed focal increased uptake in several regions of the skull. Upon questioning, the patient stated that he had received AP treatment for his back pain several times in the same regions as the increased uptake. The needle placement was confirmed by the patient's acupuncturist. As shown by increased activity on bone scans, AP can cause enhanced bone metabolism.
Marchuk_GS; Gubenko VP; Novikov IuO; Sandomirskii ME (1991) [Automated system of diagnosis of reflex syndromes in patients with lumbar osteochondrosis: manual and AP therapy of these patients]. Vrach Delo Jun 6:84-85. In Russian.

Martin BB_Jr2; Klide AM (1992) AP for the treatment of chronic back pain in 200 horses. Proc Ann Conv Am Assoc Equine Pract Lexington, KY, USA. 37:593-601. New Bolton Centre, Kennett Square, PA.
Martin_BB_Jr1; Klide AM (1987) Use of AP for the treatment of chronic back pain in horses: stimulation of AP points with saline solution injections. JAVMA 1 May 190(9):1177-1180.

Song_Z (1993) Treatment of 1000 cases of lumbar soft tissue injury with AP plus exercise. JTCM Mar 13(1):19-21. Employees' Hospital of Huai Nan Mining Bureau, PLC.

Steiss_JE; White NA; Bowen JM (1989) EAP in the treatment of chronic lameness in horses and ponies: a controlled clinical trial. Can J Vet Res Rev Apr 53(2):239-243.

Still_J (1989) Analgesic effects of AP in thoracolumbar disc disease in dogs. J Small Anim Pract May 30(5):298-301. Med Univ of Southern Africa, Medunsa, Rep of South Africa.

Thomas_M3; Lundberg T (1994) Importance of modes of AP to treat chronic nociceptive low back pain. Acta Anaesthesiologica Scandinavica Jan 38(1):63-69. Dept of Physiol II, Karolinska Inst, Stockholm, Sweden. Patients with clinical chronic low back pain of nociceptive origin cooperated in a controlled study of different modes of AP stimulation. 40 patients were assigned at random to the study. 30 had 3 trial treatments with manual AP-stimulation of needles (MA), low frequency (2 Hz) EAP stimulation (LF), and high-frequency (80 Hz) EAP stimulation (HF). Patients then continued treatment with the mode from which they got most benefit. 10 patients were put on the waiting list for treatment but served as the untreated control group. The results were evaluated after 6 wk and at 6 mo for: activity related to pain; mobility; verbal descriptors of pain and the patient's subjective assessment of his condition. After 6 wk, compared to the untreated controls, treated patients had significant improvement (p <.05 to <.001) on 3/4 measures. After 6 mo a similar significant improvement was seen in patients continuing with low-frequency (LF) AP, but not in those groups continuing with manual stimulation (MS) or high-frequency (HF) AP. EAP at 2 Hz was the mode of choice when using AP to treat chronic nociceptive low back pain.

Tsarev_IuK; Troshina ED (1991) [The combined use of AP and UV irradiation in treating the neurological manifestations of lumbar osteochondrosis]. Vopr Kurortol Fizioter Lech Fiz Kult May-Jun 3:25-29. Erythema field doses of UV radiation according to the segmental-metameric approach were applied in combination with AP to treat lumbar osteochondrosis. Combination of UV and AP gave the best therapeutic response (93%), as compared with AP alone (73%), or UV irradiation alone (68%).

Xie_HS1; Asquith RL; Kivipelto J (1996) A Review of the Use of AP for Treatment of Equine Back Pain. J Equine Vet Sci Jul 16(7):285-290. Univ Florida, Dept Anim Sci, Gainesville, FL 32611 USA. Poor performance due to back pain is common in horses. Alternative modalities using Herbal Med and AP are useful and effective for this condition. This paper summarized 11 AP techniques to treat equine back pain. AP treatment for back muscular atrophy and AP mechanism of pain relief are also discussed.

Zhang_Y; Wang X (1994) 56 cases of disturbance in small articulations of the lumbar vertebrae treated by puncturing the effective points: a new system of AP. JTCM Jun 14: 2, 115-20. Inst of AP and Moxibustion, China Acad of TCM, Beijing, PRC. In this series, the patients with disturbance of small articulations of the lumbar vertebrae were treated by puncturing the effective points and reduction by manual traction with satisfactory results, the cure rate being 39%, the markedly effective rate 29%, with a total effective rate 98%. This method is simple and easy to master, and highly effective. Therefore it is very acceptable to the patients. It is a very excellent therapeutic method for disturbance of small articulations of the lumbar vertebrae, sometimes complicated by acute lumbar sprain and chronic lumbar strain.

5. LIMB
Bonebrake_AR; Fernandez JE; Dahalan JB; Marley RJ (1993) A treatment for carpal tunnel Syndrome: results of a follow-up study. J Manipulative Physiol Ther Mar-Apr 16(3):125-139. National Inst of Clin AP, Wichita, KS 67208. This study was a follow-up evaluation of carpal tunnel Syndrome (CTS) subjects based on objective and subjective measures utilizing a conservative treatment method. It was hypothesized that the CTS individuals would maintain their improvements over the course of a 6-mo period after treatments. The design used was a case-control study in which the improvements of the CTS subjects were compared within themselves and with a matched comparison group. The treatments were performed at a private chiropractic clinic, and the objective and subjective measures were independently taken in an industrial engineering Lab. All CTS subjects were volunteers from a random sample. 43 individuals were evaluated at the pretreatment period and in the 6-mo follow-up. Only 22 subjects returned for reevaluation. The treatment duration was not controlled. CTS subjects had maintained improvements in most objective measures and pain and distress ratings over the pretreatment level.

Bülow_HH; Christensen BV; Wilbek H; Iuhl IU; Dreijer NC; Rasmussen HF (1992) Predictive value of subjective and objective evaluation before AP treatment. AJCM 20(1):17-23. Anaesthes Dept, Central Hospital, Nyk F, Denmark. To evaluate if it is possible to predict the outcome of AP treatment in patients with knee osteoarthrosis, 6 treatments were given during a 3 wk period. Follow-up time was 9-17 wk. 7 parameters were evaluated to examine if they had any influence on the outcome of treatment: Age, duration of disease, pain, range of knee movement, analgesic consumption, knee score (an objective and subjective evaluation of the knees) and x-ray changes. 29 patients were included with a total of 42 osteoarthritic knees waiting for a total knee replacement. The median age was 69.2 yr, and median duration of disease was 4.2 yr. 85% of the participants reported a subjective effect, and in 88% an objective effect was found. Although there were some significant differences when you looked at the 7 parameters above, the pattern was not a consistent one. Follow up results also indicated that those with the best immediate results, not necessarily were the ones with the best long-term effect. AP treatment of osteoarthritic knees has an unpredictable outcome. Immediate results do not indicate long-term results; AP research must include a follow-up period.

Chacon_SC; Huguenin MTC; Lopez HS; Trigos GM; Vila AMB (1996) Dysplasia of the Hip in a Dog: EAP. Point Vet Feb 27(173):8. SC Chacon, Fac Med Vet, Mexico City, DF, Mexico.

Christensen_BV; Juhl IU; Vilbek H; Bulow HH; Dreijer NC; Rasmussen HF (1992) AP treatment of severe knee osteoarthrosis: A long-term study. Acta Anaesthesiologica Scandinavica Aug 36(6):519-525. Dept of Anaesthesiol, Central Hospital, Nykobing-Falster, Denmark. (Also reported in Ugeskr Laeger 6 Dec 1993 155(49):4007-4011). Effects of AP treatment were studied for 49 wk in patients waiting for arthroplastic surgery. 29 patients with osteoarthritic knees (42 knees) were randomized to 2 groups (A=AP treatment; B=untreated control). Analgesic consumption, pain and objective measurements were registered. All objective measures were done by investigators who were "blinded" as to Group A & B. After 9 wk (part 2 of the study), Group B (17 patients), as well as group A, was treated once/mo. Registration of analgesic consumption, pain and objective measurements continued. Compared with group B, AP significantly reduced pain, analgesic consumption and most objective measures in the first 9 weeks. In part 2 of the study (both groups on AP-treatment) both groups reported 80% subjective improvement, and range of movement of the knee increased significantly, especially in the worst knees. Results were significantly better in those who had not been ill for a long time. AP can ease the discomfort while waiting for an operation. Part 2 of the study showed that AP can be maintain the improvements over long periods, and perhaps even serve as an alternative to surgery. 7 patients responded so well that at present they do not want surgery. (9000 US$ saved/operation).

Fargas-Babjak_AM; Pomeranz B; Rooney PJ (1992) AP-like Stimulation with Codetron for rehabilitation of Patients with Chronic Pain Syndrome and Osteoarthritis. AETRIJ 17(2):95-105. AP is one of the oldest healing methods which is used in TCM. In the Mod Med, we are witnessing a renaissance of this ancient treatment applied mainly in the management of chronic pain. Many modern technological changes are being applied to replace, or modify, classical AP. They include a new, non-habituating form of TENS, the CODETRON. This delivers AP-like stimulation in a random order. It had been evaluated clinically in a multidisciplinary pain clinic; that was an uncontrolled trial in patients who came for AP therapy over a period of 2 yr. Here, we present results from a later 6-wk double-blind randomized placebo controlled pilot trial in osteoarthritis of the hip/knee. The beneficial effect confirmed our initial results. Other indications, efficacy and experiences of CODETRON are discussed.

Faure_Antonietti_F; Antonietti C; Estanove S; Ninet J; Vigneron M; Champsaur G (1992) [Treatment of early scapulohumeral pain by traditional Chinese AP after heart surgery (letter)]. Presse Med 27 Jun 21(24):1130. In French.

Haker_E1; Lundeberg T (1990) AP treatment in epicondylalgia: a comparative study of two AP techniques [see comments]. Clin J Pain Sep 6(3):221-226. Dept of Physiol II, Karolinska Inst, Stockholm, Sweden. The purpose of this study was to compare the pain-alleviating effect of classical AP with superficial needle insertion in 82 patients suffering from lateral epicondylalgia. Sessions were 20 min long, 2-3 times/wk with 10 treatments in all. 5 AP points were treated: LI10,11,12, LU05 and TH05. After 10 treatments significant differences were observed between the groups favouring the classical AP technique in relation to subjective and objective outcome. No such difference was observed at follow-ups after 3 mo and 1 yr. Classical "deep" AP was better than shallow needle insertion in short-term symptomatic treatment of lateral epicondylalgia, but not at the 3-mo and 12-mo follow-up.

Haker_E2; Lundeberg T (1990) Laser treatment applied to AP points in lateral humeral epicondylalgia: A double-blind study. Pain Nov 43(2):243-247. Dept of Physiol II, Karolinska Inst, Stockholm, Sweden. 49 patients suffering from lateral humeral epicondylalgia were enrolled in a double-blind study to observe the effects of Ga-As laser applied to AP points. The Mid 1500 IRRADIA laser machine was used, wavelength: 904 nm, mean power output: 12 mW, peak value: 8.3 W; frequency: 70 Hz (pulse train). Localization of points: LI10,11,12, LU05 and TH05. Each point was treated for 30 s, giving a dose of 0.36 J/point. The patients were treated 2-3 times/wk for 10 sessions. Follow-ups were done after 3 mo and 1 yr. No significant differences were observed between the laser and the placebo group in relation to the subjective or objective outcome after 10 treatments or at the follow-ups.

Hauzeur_JP (1995) Role of conservative treatment in impingement Syndromes of the shoulder. Rev Med Brux Jul-Aug 16(4):171-177. Service de Rhumatologie, Hopital Erasme, Bruxelles. The impingement Syndrome of the shoulder is primary when the origin is abnormalities of the coracoacromial arch, or secondary when the problem concerns the tendons, the hyperlaxity of the joint or an imbalance between the different muscles. In all cases, treatment has to be initially conservative, including analgesics, anti-inflammatory drugs and rehabilitation. These therapeutic procedures are reviewed.

Hu_Ja2 (1991) How to treat tennis elbow with AP?. JTCM Dec 11(4):302. Inst of AP and Moxibustion, China Acad of TCM, Beijing, PRC.

Huang_W (1996) Analysis on Therapeutic Effects of 46 Cases of Periarthritis of Shoulder Treated by Needling JianSanZhen (NA15) With Magnetic Pole Needle and Massage. Affiliated Concord Hospital of Tongji Med Univ, 430022, PRC. Adapted from WWW. Experimental Group E (n=46) of periarthritis of shoulder was treated by needling NA15 with magnetic pole needle and massage; cure rate was 93% and effective rate was 100%. AP Control Group 1 (n=23) received needle AP and massage; the effective rate was 91%. Comparison of the therapeutic effects between groups E and 1 showed X23D4.12 p<.05. AP Control Group 2 (n=23) received needle AP at ST38 through BL57; the effective rate was 83%. Comparison of the therapeutic effects between groups E and 2 showed X23D8.492, p<.01. The therapeutic effect in group E was superior to that in control groups 1 and 2. The methods used in control groups 1 and 2 are still amongst the most effective methods treating this disease at present.

Jia_H; Li Q (1993) Treatment of periomarthritis with scalp AP therapy: a report of 210 cases. JTCM Sep 13(3):199-201. People's Hospital, Dongming County, Shandong Province, PRC.

Li_X; Mu-D (1992) Massage and AP in 58 cases of superior clunial neuralgia. JTCM Dec 12(4):288-289. Affiliated Hospital of Changchun College of TCM, Jilin Province, PRC.

Lin_ML3; Huang CT; Lin JG; Tsai SK (1994) A comparison between the pain relief effect of EAP, regional nerve block and EAP plus regional nerve block in frozen shoulder. Acta Anaesthesiol Sin Dec 32(4):237-242. Dept of Anaesthesiology, Taipei Municipal Chung-Hsing Hospital, ROC. Frozen shoulder is a kind of spontaneous, progressive periarthritis over the shoulder joint. The etiology is not yet clear. Traditional treatments for frozen shoulder included conservative Med therapy, physical therapy, nerve block and AP and so on. The purpose of our study is to determine the pain relief effect of EAP, regional nerve block (RNB) and the combination of EAP + RNB for frozen shoulder. 150 patients with fresh frozen shoulder were, assigned at random to 3 groups: 1=RNB with stellate ganglion block and suprascapular nerve block by 10 ml of 1% xylocaine (n=50); 2=EAP at local AP points LI15, GB21, Chien-Nei-Ling, AhShi point (n=50); 3=EAP+RNB, with AP first, followed by the regional nerve block (n=50). 6 vectors of movements were checked in all methods. Bromage score (4 grades) was used to assess pain: 1=no pain; 2=slight pain (e.g. pain on motion); 3=moderate pain (e.g. pain in silence); 4=severe pain (e.g. request analgesics). The range of shoulder joint was recorded also. Patients were offered a second treatment if pain recurred. The onset (time from injection to maximal pain relief), duration (time from injection to grade 3), Bromage score and side effects were recorded. EAP, or RNB, alone gave pain relief in frozen shoulder, but the combination of both methods (EAP + RNB) gave significantly better pain control, longer duration and better range of movement of the shoulder joint.

Marr_CM; Love S; Boyd JS; McKellar Q (1993) Factors Affecting the Clinical Outcome of Injuries to the Superficial Digital Flexor Tendon in National Hunt and Point-to-Point Racehorses. Vet Rec 8 May 132(19):476-479. CM Marr, Univ Cambridge, Dept Clin Vet Med, Madingley Rd, Cambridge CB3 0ES, UK. The severity of injuries to the superficial digital flexor tendon in 73 National Hunt or point-to-point racehorses was defined by ultrasonography and the factors influencing the outcome of the cases were examined. 46% returned to work with a mean time out of training of 13.5 mo. Recurrence rate of the injury was 35%. The severity of the lesions was related to the outcome; 100% of mildly affected horses worked and 63% of them raced in a mean time of 10.2 mo; 50% of moderately affected horses worked and 30% raced with a mean time out of training of 11 mo; 30% of the severely affected horses worked and 23% raced with a mean time out of training of 18 mo. Differences in outcome between unilateral and bilateral injuries within each severity group were not statistically significant. 67% of horses treated with polysulphated glycosaminoglycans worked, compared with 46% of conservatively managed horses and 50% of horses treated with laser therapy but these differences were not statistically significant and the rate of recurrence of the injury in the horses treated with polysulphated glycosaminoglycans was 50% compared with only 31% in the conservatively managed horses. 70% of mares and 47% of geldings were retired from racing.

Molsberger_A; Hille E (1994) The analgesic effect of AP in chronic tennis elbow pain. Brit J of Rheumatol Dec 33(12):1162-1165. Orthopadische Klinik, Universitat Dusseldorf, Germany. The immediate analgesic effect of a single non-segmental AP stimulation treatment on chronic tennis elbow pain was studied with placebo-controlled single-blind trial completed by 48 patients. Before and after treatment, all patients were examined physically by an unbiased independent examiner. 11-point box scales were used for pain measurement. Patients in the true group were treated at non-segmental distal points (homolateral leg) for elbow pain following Chinese AP rules. Patients in the placebo group were treated with placebo AP avoiding penetration of the skin with an AP needle. Overall reduction in the pain score was 56% (S=2.95) in the true group and 15% (S=2.77) in the placebo group. After one treatment 19/24 patients in the true group (79%) reported pain relief of at least 50% (placebo group: 6/24). The mean duration of analgesia after one treatment in the true group was 20.2 h (S=21.5) and in the placebo group 1.4 h (S=3.5). The results were statistically significant (p <.01). Non-segmental AP had intrinsic analgesic effects, which exceeded that of placebo AP, in the treatment of clinical tennis elbow pain.

Takeda_W; Wessel J (1994) AP for the treatment of pain of osteoarthritic knees. Arthritis Care Res Sep 7(3):118-122. The aim was to determine whether AP was more effective than sham AP in the reduction of pain in persons with osteoarthritis (OA) of the knee. 40 subjects (20 men, 20 women) with radiographic evidence of OA of the knee were stratified by gender and assigned at random to two groups: 1=AP therapy and; 2=Sham AP therapy. Subjects were treated 3 times/wk for 3 wk and evaluated at 3 test sessions. Outcome measures were: 1.        the Pain Rating Index of the McGill Pain Questionnaire; 2.        the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index, and 3) pain threshold at 4 sites at the knee. The analyses of variance showed that both real and sham AP significantly reduced pain, stiffness, and physical disability in the OA knee, but that there were no significant differences between groups. AP was not more effective than sham AP to treat OA pain.

Tekeoglu_I; Adak B; Ercan M (1996) Suppression of Experimental Pain by Ear-pressure. Adapted from WWW. In a controlled trial at a Univ Clinic of Physical Therapy and Rehab, healthy student volunteers were given Ear-pressure to study its analgesic effect. There were 2 study groups, each containing 30 volunteers. The first group was given Ear-pressure to the toe somatic point on the ear, with pressure sensitivity being measured on the skin of the toe with an algometer device before and after ear stimulation. The controls had the same measurements with placebo stimulation to the ear. Ear-pressure gave a statistically significant increase in pain threshold; no significant change occurred in the placebo controls. Ear-pressure is a useful method to suppress post-traumatic somatic pain.

Thomas_M1; Eriksson SV; Lundeberg T (1991) A comparative study of diazepam and AP in patients with osteoarthritis pain: a placebo controlled study. AJCM 19(2)95-100. Dept of Physiol II, Karolinska Inst, Stockholm, Sweden. 44 patients with chronic cervical osteoarthritis took part in this study. Patients were treated with AP, sham-AP, diazepam or placebo-diazepam in randomized order. Pain was rated on visual analogue scales before, during, and after treatment. 2 scales were separately used to rate the intensity (sensory component) and the unpleasantness (affective component) of pain. Diazepam, placebo-diazepam, AP and sham-AP have a more pronounced effect on the affective than on the sensory component of pain. AP was significantly more effective than placebo-diazepam (p <.05), but not significantly more effective than diazepam or sham-AP.

Wang_J; Wang W; Wang S (1993) Treatment of periarthritis humeroscapularis with AP and acupoint blocking. JTCM Dec 13(4):262-263. Changchun College of TCM, Jilin Province, PRC.

Wang_W; Yin X; He Y; Wei J; Wang J; Di F (1990) Treatment of periarthritis of the shoulder with AP at the Zuzhongping (L 14) extrapoint in 345 cases. JTCM Sep; 10(3): 209-12. Beijing Garrison Hospital, PRC.

Zhang_F; Miao Y (1990) AP treatment for sprains of the ankle joint in 354 cases. JTCM Sep 10(3):207-208. PLA Hospital of 86515 Troops, PRC.

Zhang_M (1991) Treatment of periomarthritis with AP at GB34. JTCM Mar 11(1):9-10. Dept of AP, Hospital for Mental Diseases Jiangdu County, Jiangsu Province, PRC.

Zhong_J (1991) AP treatment in 96 cases of superior cluneal nerve injury. JTCM Dec 11(4):259-260. Hai'an County Hospital, Jiangsu Province, PRC.

Zwolfer_W1; Grubhofer G; Cartellieri M; Spacek A (1992) AP in gonarthrotic pain: "Bachmann's knee program". AJCM 20(3-4):325-329. Dept of Anaesthesia and Intensive Care, Univ of Vienna, Austria. In a retrospective study 35 patients with gonarthrotic pain were treated with AP at the outpatient unit of the Dept of Anaesthesia and Intensive Care in the Univ of Vienna. The subjective effectiveness of the treatment using a standard method on the knee showed that patients reported an explicit improvement of their ailments. We can unreservedly recommend this program, which was only augmented through additive "locus dolendi" treatment if indicated.

6. MUSCLES
Brossman_RE1 (1996) Jones' Tender Points and Travell's TPs. RE Brossman AB DDS MS, 3 Crossings Mall, Wheeling, West Virginia 26003 USA; Adapted from WWW ([email protected]). Janet Travell referred to "myofascial TPs", because they occurred mainly in muscles and fasciae, and their stimulation by deep palpation or needling elicited referred pain at other specific sites. The TPs could be effectively deactivated as sources of referred pain if she treated them with vapocoolants, or injection of local anaesthetics. LH Jones DO, in a paper "Spontaneous Release by Positioning", and in his later manual "Strain and Counterstrain", concisely explains the differences and similarities between his "tender points" and Travell's earlier description of TPs. Jones also describes how tender points and TPs often are intimately and closely related to the AP points of TCM, while at the same time still managing to be somewhat different. Chapman, cited decades later in a book "An Endocrine Interpretation of Chapman's Reflexes", also studied tenderness at local sites. Obviously, Chapman knew of these points before Travell's first publication in 1947, but I have not managed to locate the original text. Owens noted that Chapman related his sore spots to "visceral function", but anyone is entitled to call his work anything he wants, and visceral function must have had some relevance in 1937. The work of Korr is recommended also, as it goes into important detail on somatic joint dysfunction and gives what is probably the best scientific description of the process of dysfunction and spontaneous release.

Serious students of pain-point literature must find a major difference between Jones' tender points and the AP points of TCM: AP points are generally located close to the body surface, whereas tender points generally are in the deeper layers of the body, and in the fasciae, tendons, muscles and periosteum. AP points are needled by precisely placing the AP needle through the skin and into the underlying AP point, whereupon the needle is rotated several times between the operator's finger tips. The needles are left in-situ for some time and may be twisted several times during the session. Jones's tender points are of similar size, but are located within muscles, at the periosteal layers of bones, or within the tissue mass of tendons and fascial structures. Generally speaking, tender points are usually circa 1 cm across but the most tender (highly reactive) points may only be circa 3 mm.

All 3 techniques (TP therapy, AP and unblockage of tender-points), and probably a few others, are based on a common observation that the AP point, the TP, and the tender point are all manifestations of an organ, muscle, tendon, or joint dysfunction, and that the point where the dysfunction can be monitored by the clinician does not have to have a direct local relationship to the area where the patient perceives the complaint to be. The mechanism by which all 3 systems exist, first as a sign of dysfunction (AP point, TP, or tender point), or the physiologic process by which the therapeutic effect is obtained is not entirely clear. Korr comes closest to explaining counterstrain therapy from a rational scientific basis, and he relieves us of the necessity of learning to think in terms of TCM philosophy and culture, as would be needed to understand and use classical AP. Western culture demands the scientific approach, and the associated need for hard scientific fact. Oriental culture accepts philosophical approximation and the inscrutable.

The anatomy and physiology of the system
The function of much neural tissue in the spinal cord, for example, is to control and monitor normal physiologic processes. As well as their efferent nerve supply, muscles also have afferent nerve endings that allow the muscle to signal its state of contraction to the CNS. This muscular feedback is integrated within the CNS along with information arriving from the tendons, ligaments, and joint capsules to provide an awareness of both positions and rates of movement to the various parts of the body. Proprioception takes up a large portion of this neural function and many of the nerve endings of the sensory portions arise in neuromuscular spindles and Golgi tendon organs. Apart from these structures and their functions, which provide information to the CNS, many other types of free nerve endings exist in fasciae and tendons.

Neuromuscular Spindles
Neuromuscular spindles are basically length registering receptors. Structurally, they vary in length between 3-5 mm, are circa 0.1-0.2 mm in diameter, and are enclosed in a loose and extendible connective tissue capsule. Generally, circa 2-12 very narrow modified muscle fibres are enclosed within the capsule. Because of their structural incorporation within muscle tissue, they stretch when the muscle is stretched, and in doing this they form the basis of a neuromuscular servomechanism that is critical to purposeful and controlled muscular activity. Without some form of information feedback to the individual, a purposeful movement of a finger or an arm would be impossible. Visually observing a movement would even constitute a minimal form of information feedback, but even that control would be impossible in the dark. A sophisticated mechanism for generating information about rate of movement, extent of movement, strength of movement, etc is critical to any meaningful movement. Without that critical information, all movement would cease to have any meaning to the organism and there would not be much sense in having any structure larger than a small bundle of cells.

At the centre of the spindle you can find a few larger fibres that are literally packed with cell nuclei. This area is made up of non-contractile fibres and is called the nuclear bag because of the many nuclei. The other fibres are usually much thinner and are referred to as nuclear chain fibres as their nuclei are lined up like a chain. There may be up to 10 of the nuclear chain fibres within the spindle.

Spindles are enervated by both efferent and afferent nerve fibres. Each nuclear bag fibre receives a large myelinated afferent nerve fibre from 2 sources, one spirals around the nuclear area and is called an annulospiral ending, or primary ending. Another secondary ending attaches outside of the nuclear bag area and are called secondary afferent endings.

Nuclear chain fibres receive afferent enervation from the same primary myelinated fibre supplying the nuclear bag. Secondary nerve fibres terminate in what are termed flower spray endings on each side of the primary afferent endings. Functionally, primary efferent nerve endings (annulospirals) respond with information on degree and rate of muscle stretch, while secondary efferent endings only respond to degree of stretch.

Efferent nerve fibres ending at both static and dynamic efferent plates on the smaller intrarafusal muscle fibres together with those supplying the nuclear bag fibres effectively set up a system that can receive adjustment information from the CNS.
Brossman_RE2 (1996) Jones' Tender Points and Travell's TPs.
Spindles are most numerous in muscles which must have very precise discrimination of position. The masseter is obviously one place where we would expect many spindles, and it has very many. All the masticatory muscles usually have many neuromuscular spindles.

Confused feedback information to, or from, the spindles of the servomechanism is related to the onset and continuance of muscle spasm pain. Relief of muscle spasm pain by the mechanism of spontaneous release through counterstrain positioning is intimately tied into the neuromuscular spindle system. A finite time factor (circa 90 sec) is involved in the manipulative re-setting, or re-balancing of the spindle neural output message to the CNS, although these structures normally generate and receive nerve impulses at much higher rates of information exchange during normal function. The same process occurs in the following structures.

Tendon Organs
Also, referred to as golgi tendon organs, or neurotendinous organs, these structures are found at the junction area between muscles, their associated tendons, and in the aponeuroses on which the muscles attach. They are also encapsulated structures and are generally slightly smaller than neuromuscular spindles. They are usually enervated by a large myelinated afferent fibre that ends in small non-myelinated branches among small tendon fibres. The end fibres are probably stimulated by being compressed and twisted between the collagenous tendon fibres. Functionally, impulses from these organs tends to inhibit the lower motor neurons in the spinal cord. This action may provide a protective inhibition of muscular forces to prevent excessive stress damages to a muscle and its functional attachments.

Joint Receptors
Several types of sensory receptors are associated with synovial joints. Internal and external joint ligaments are supplied with receptor organs that closely resemble the Golgi Tendon Organs. The fibrous connective tissue capsules of joints are also supplied with many free nerve endings intertwined with the collagen fibres. Paciniform corpuscles (mechanoreceptors) and Ruffini type corpuscles are also numerous. Mechanoreceptors are thought to respond to compressive forces associated with joint movement. A lot of similar structures are seen in the periodontal ligament structure suspending the teeth in the alveolar processes, so the sensory information supplied to the CNS via this network must be superlative.

Proprioception is a critical function that allows fine control of all voluntary muscle activity by providing feedback information concerning rate of movement, amount of movement, and strength of movement. The process must first derive information from sensory units within the muscular unit, feed that information to the CNS at various levels, and return the process information from the CNS to the muscle unit in order to achieve any control at all. A motor nerve impulse to a muscle unit would be of little value if the response from the muscle unit was an all-or-none response of simple contraction. Everyone would be moving in uncontrolled jerks, or would all be suited up inside of a single cell membrane so that we could only accomplish the most rudimentary actions. In any organism, increasing complexity implies increasing complexity of process control. However, increased complexity implies increased risk of error in the program for relatively minor control processes.

Could This All Be Due To Adverse Effects in Software?
In the presence of a joint dysfunction one of the contributing factors to the chronicity of the dysfunction is a disturbed, or altered proprioceptive picture. A common finding in muscle units affected by TP pain is a "switched muscle", in which the functional origin and insertion of the muscle are thought to be reversed. The physiologic effect of this switching is first, an abnormal performance as an effector when under normal neurologic motor control; second, an equally abnormal performance as an antagonistic unit while operating under inaccurate proprioceptive influence. TP pain can exist in both muscle units simultaneously, and most often, does.

To the individual suffering from myofascial pain and dysfunction problems it is not enough to inform them that they may have their pain and dysfunction for no other reason than that they have a somewhat screwed up neuromuscular feedback loop. For all practical purposes, their pain does not ever exist to them as a slight error in the control process. They hurt, and they want someone to help them get relief from their symptoms of pain and altered function.

The Fundamental Concept of Strain and Counterstrain Therapy.
Jones offers 2 definitions for strain and counterstrain therapy. 1. Strain and counterstrain: relieving spinal or other joint pain by passively putting the joint into its position of greatest comfort; or 2. strain and counterstrain: relieving pain by reduction and arrest of the continuing inappropriate proprioceptor activity. He said this was accomplished by markedly shortening the muscle that contains the malfunctioning muscle spindle by applying mild strain to its antagonists. In other words, the inappropriate strain reflex is inhibited by application of counterstrain. Jones also stresses one key factor that must be observed during any active therapy: The return from any position of comfort MUST be done very slowly, especially through the first few degrees of arc. Without careful attention to this clinical detail, release of the myofascial spasm may fail to occur.

Muscle Spasm
Muscle makes up a very large portion of the body and generally, musculoskeletal dysfunction is often revealed by the presence of areas of tension and discomfort within muscles and limitation of motion at the articulations. Mechanical restriction of the associated joints (bracing, guarding), causing a reduced range of motion, is an early sign of muscular dysfunction. In the classic view of the dysfunction, the muscle may be thought of as trying to overcome the restraint supplied by the dysfunctional articulation. In the newer viewpoint, the muscle is viewed as the primary cause of the articular dysfunction. What comes first? The articular dysfunction, or the muscle dysfunction?.

In the normal, homeostatic articulation, the musculature is not painful in any normal position. In a situation where the articulation is painful, there may be one muscle unit that is hyperextended (longer than normal) and the opposing, or antagonistic muscle hypershortened. As regards proprioceptive feedback to the CNS, the hyperextended muscle may send greatly increased information back to the CNS, while the hypershortened muscle sends little or no proprioceptive information of value to the process. The net result is proprioceptive confusion, and that alone may cause the onset of pain in the spastic muscles.
Brossman_RE3 (1996) Jones' Tender Points and Travell's TPs.
You may have begun to realize that counterstrain therapy is fairly easy to apply to the muscles, ligaments and fascia of an anatomic part such as an arm, elbow, or shoulder. These parts have a system of muscle relations that make application of the cardinal principle of therapy, shortening of the painful muscle unit, relatively easy. While the principle should equally applicable to a muscle like the masseter, or temporalis, the anatomy of the functional unit, the mandible itself, is harder to fit into any relationship that can shorten these muscles effectively much more that they are already. Short of extracting all the teeth, it is not mechanically possible to shorten the masseter and temporalis much beyond occlusal contact of the teeth.

Microanatomic studies of muscle usually find that muscle spindles are most numerous in the belly of a muscle, while TPs often are mainly associated with the ends of muscle, where the spindles are absent, or much less numerous.

The masseter has a higher numbers of muscle spindles/unit volume than any other muscle, so the masseter is much more sensitive to anything that disturbs proprioception. It is also the main indicator of problems with the dental apparatus.

It is possible to release a spasm in these muscles by firm digital pressure applied from the insertions toward the origins. You don't get much visible shortening, but the underlying muscle mass does get some effective shortening by means of digital pressure when the fingers of both hands are pushing toward the central mass of the muscle.

A rather unusual approach to releasing masseter and pterygoid spasm involves nothing more than gentle massage of the muscle unit between an intraoral finger of one hand versus an extraoral finger of the other hand. Imagine all of those rays of healing Qi flowing out of those fingertips.

Far Out Stuff
Sooner or later, one meets therapies and therapists that seem to defy scientific facts as we presently know or accept them. I do not understand a lot of these techniques, and I will report only a few of them. Students should approach these ideas with an open mind. One thing that I have learned in 20 yr is that there is little new under the sun: not much is new or unique. Therapy in this whole general area seems to undergo cycles where an older idea is rediscovered and possibly greatly enhanced by the application of newer technology that has only become available the second time around.

I always preferred cranial osteopathy, or cranial manipulation. A Brazilian Physical Therapist, Mariano Rocobado, was expert in this area; he gives continuing education courses around the country. Such operators get right in there and TOUCH their patients. That direct physical contact between clinician and patient is greatly downplayed in traditional therapy; it should not be underestimated as an effective therapeutic tool. Chiropractors enjoy occasional success with jaw manipulation, but only occasional success. A lot of that success is basically due to the placebo effect that comes from just touching the patient and establishing a caring mannerism. When it comes to feeling the movement of the cranial bones in response to the circulation of CSF, I must admit I can't feel a thing and have an equally hard time envisioning any physical motion of matured sutures in the cranium. When it comes to applying pressures to re-align the abnormal relation of cranial bones by digital pressures, I just remember how solid that old skull is and chalk that up to salesmanship.

Applied kinesiology, or dental kinesiology is another fringe area that probably will grow. There is something there. George Eversaul linked applied kinesiology with nutritional factors; there may be some interesting associations between somatic problems in general, and faulty nutrition. The key seems to be the personal interests of the clinician in his patients, and that they all enjoyed the luxury of the laying-on of hands. Maybe patients wanted to believe most of all.

If we (dentists and orthodontists) learn the basics and apply them, we have a lot to offer in the area of head pain. Keep an open mind and study different ideas. You will learn to pick out what you are comfortable with after a period of review and apply what you feel most comfortable with in treating your patients.

Deluze_C; Vischer TL (1993) EAP in Fibromyalgia: Reply. BMJ Feb 6 306(6874):393-393. Hop Cantonal Geneva, Dept Phys Med & Rehab, CH 1211 Geneva 4, Switzerland.

Harman_JC (1994) The Effects of AP on the Performance of Horses. Equine Athlete 1993 Nov-Dec 6(6):22-25. C Harman, Harmanny Equine Clin, POB 193, Orlean, VA 22128. High athletic performance is directly related to optimal musculoskeletal function. For optimal performance, horses must be free from neck and back pain. Saddle-induced pain (from poor fit or improper positioning) is a factor in >90% of cases of back pain. Contraction of the "lower ring of muscles" (R. abdominis, Iloipsoas, T. fasciae latae and Quadriceps (all protractor muscles of the hind limbs) raises the back but only if the L. dorsi can relax. For optimal use of the back, the L. dorsi should be free of pain, otherwise it will not relax and the back will be "splinted" (dorsiflexed). AP (1-4 sessions) successfully restored performance in >85% of horses presented with a history of poor performance.

Ivanichev_GA (1991) [Combined treatment of myodystonic pain syndromes by manual therapy and AP]. Zh Nevropatol Psikhiatr Im S S Korsakova 91(4):37-40. Combination of manual therapy (++post-isometric relaxation) and AP to treat myodystonic syndromes is based from the standpoint of realization of the neurophysiological components of the pathogenesis of myofascicular hypertonus. The controlled afferent flow created by ++post-isometric relaxation and AP exerts a varying effect on the structural and functional levels of the nervous system. The therapeutic effect of manual therapy is realized at the special segmental level, that of AP with participation of the suprasegmental systems.

Lewis_PJ (1993) EAP in Fibromyalgia. BMJ Feb 6;306(6874):393-393. On Pk Med Ctr, Carrara, Qld 4211, Australia.

7. HERPES/POSTHERPETIC
Coghlan_CJ (1992) Herpes zoster treated by AP. Central African J of Med Dec 38(12):466-467. Surgical Unit, 7th Avenue, Mutare. EAP was used to treat 4 patients with acute Herpes zoster and 4 with post-herpetic neuralgia. EAP was effective in most cases. This treatment should be instigated as soon as possible. AP, whose side effects are minimal, merits a trial, since treatment of Herpes zoster by drugs is expensive and not routinely successful.

Lefkowitz_M; Marini RA (1994) Management of postherpetic neuralgia. Ann Acad Med Singapore Nov 23(6 Suppl):139-144. Pain Management Service, Long Island Coll Hospital, Brooklyn 11201, USA. Postherpetic neuralgia is a perplexing disorder in which pain develops due to herpes zoster. It is a common cause of neuropathic pain and may render its effects especially on the elderly and immunocompromised. Once established, postherpetic neuralgia is resistant to most treatment modalities and can lead to much despair. Many therapeutic approaches have been tried, most with varying results. This review describes clinical manifestations including allodynia, hyperaesthesia and anaesthesia. It also reviews pharmacologic and non-pharmacologic treatment modalities including a review of anaesthetic nerve blocks, neurostimulation, AP and surgical techniques.

8. CANCER
Brule-Fermand_S (1993) [Treatment of chronic cancer pain: Contribution of AP, Ear-point therapy and mesotherapy]. Soins Jan (568):39-40.

Stocker_S (1994) Conquer chronic pain and more with AP. Prevention (Emmaus, PA) Dec 46:76-79.

G. AP in Detoxification/Withdrawal

1. FROM DRUGS & ALCOHOL
ASAP (1996) AP in a Drug & Alcohol Detoxification & Treatment Program. Adapted from WWW. Contact: Alternative Substance Abuse Program, 612 Colorado Blvd., Suite 115, Santa Monica, CA 90401 USA; Tel: (310) 452-1011. AP has been successful in detoxification in both clinical settings and under controlled experimental conditions. The results of a 1-yr AP detoxification study in Portland, Oregon and a blind study of AP treatment with chronic alcoholics in Hennepin County, Minnesota are: People who received AP detoxification treatment were 2 times more likely to continue in rehabilitation therapy than people who did not receive AP treatment. >70% of people treated with AP successfully completed detoxification, compared with only 50% of hose who did not receive the treatment. For those detoxifying from alcohol, the success rate was 90%. Recidivism (relapse rate) of addicts to alcohol or drugs fell from 20-25% to 5% for patients receiving AP detoxification treatments. In a blind study of chronic alcoholics in Hennepin County, 37% of the treatment group receiving AP completed the program. Only 7% of the control group had a successful completion of the program.

Avants_SK; Margolin A; Chang P; Kosten TR; Birch S (1995) AP for the treatment of cocaine addiction. Investigation of a needle puncture control. J Subst Abuse Treat May-Jun 12(3):195-205. Yale Univ Sch of Med, CMHC/Substance Abuse Centre, New Haven, CT 06519, USA. This was a 6-wk, single-blind study of AP for cocaine dependence in methadone-maintained patients (N=40) to identify an appropriate needle puncture control for use in future large-scale clinical trials. Patients were randomly assigned to 2 groups: 1=AP daily at 3 Earpoints, plus LI04 and; 2=AP at non-AP points <2-3 mm away from the 4 active sites. Overall, both treatments gave a positive response in many drug-related and psychosocial measures. Cocaine use decreased significantly for patients in both groups. The only statistically significant difference between the two groups was on ratings of craving. Subjects rated each type of needle puncture as equally credible and perceived no significant differences on the acute effects of the two types of needle insertions. Power calculations suggested that very large sample sizes would be required to detect treatment differences between active AP points and placebo control points <2-3 mm away from them. Alternative controls are suggested, and the challenges inherent in implementing controlled clinical trials of AP are discussed.

Brewington_V; Smith M; Lipton D (1994) AP as a detoxification treatment: an analysis of controlled research. J Subst Abuse Treat Jul-Aug 11(4):289-307. Lincoln Med and Mental Health Centre, Bronx, New York 10454. The research literature on the use of AP as a substance abuse treatment is reviewed. Recently, many reports have been published on the efficacy of AP in alleviating withdrawal symptoms with substance abusers attempting abstinence. While few experimental design studies have been done in this area, results from controlled studies generally support that AP is effective in assisting active drug and alcohol users to become abstinent. Controlled, experimental research on AP and related techniques used as substance abuse treatments are reviewed. An overview regarding AP and related procedures used as substance abuse treatments is first provided. Animal and human studies on AP's usefulness in alleviating opiate withdrawal symptoms are presented, followed by studies concerning other substance abuse problems (i.e, alcohol, tobacco and cocaine). Possible physiological mechanisms related to AP's effects are reviewed.

Brumbaugh_AG (1993) AP: new perspectives in chemical dependency treatment. J Subst Abuse Treat Jan-Feb 10(1):35-43. Council on Alcoholism and Drug Abuse, Santa Barbara, CA 93102. The use of Ear-AP in treating acute drug withdrawal began in Hong Kong in 1972. Its practical application in the traditional drug treatment setting evolved at New York City's Lincoln Hospital during the 1970s, and over 250 AP programs in diverse treatment settings have since been established world wide, based on the Lincoln protocol. AP treatment offers the client support during acute and postacute withdrawal through relief of classic symptoms. It has also been found useful as an entry point to treatment and/or recovery in such non-treatment settings as jails and shelters, and has particular efficacy to treat resistant clients, and of prepartum and postpartum women. Though chemical-dependent society accepts the validity of AP with reservation, both research and outcome studies indicate that AP holds promise as a complement to traditional modalities used to counter substance abuse.

Johnstone_H; Marcinak J; Luckett M; Scott J (1994) An evaluation of the treatment effectiveness of the Chicago Health Outreach AP Clinic. J Holist Nurs Jun 12(2):171-183. AP is a treatment modality that is particularly applicable for homeless clients because of its low cost and portability as well as because of its effectiveness in treating the symptomatology of pain syndromes, substance abuse, and human immunodeficiency virus infection. A 2-part descriptive study was conducted to determine the response to AP of homeless persons at the Chicago Health Outreach Clinic. Part 1 of the study consisted of a retrospective chart review of 45 patients to assess AP treatment effectiveness. Part 2 of the study consisted of using a numerical rating scale report form to assess treatment effectiveness of 30 patients. Part 1 of the study indicated that 51% had a positive response to treatment, 42% were indeterminate or lacked documentation of response, and 7% had no response to treatment. In Part 2, 97% had a positive response to treatment, with 3% reporting no response to treatment. AP treatment effectively decreased the symptomatology of the homeless clients seen in the Chicago Health Outreach AP Clinic. Further research should involve follow-up of these clients to assess the length of symptom relief to further determine long-range effectiveness and cost of treatment.

Konefal_J; Duncan R; Clemence C (1994) The impact of the addition of an AP treatment program to an existing metro-Dade County outpatient substance abuse treatment facility. J Addict Dis 13(3):71-99. Dept of Psychiatry, Univ of Miami Sch of Med, FL 33136, USA. Several types of treatment facilities and modalities can deal with substance abuse. In this study, the addition of AP treatments to the usual care program at an existing county-based substance abuse treatment clinic was tested. Men and women who voluntarily attended the clinic or who were remanded by the court to attend were randomized to receive usual care, usual care plus frequent urine testing, or usual care plus frequent urine testing and AP treatments. Clients who received AP, in addition to the usual care and frequent urine testing, became clean (as measured by negative urine tests) in 57% of the time required for the frequent urine testing group. Difficulties experienced included low counsellor compliance with the protocol and a high drop-out rate, indicating that further research is necessary. The study shows that AP can be a feasible and effective addition to existing drug treatment programs.

Lipton_DS; Brewington V; Smith M (1994) AP for crack-cocaine detoxification: experimental evaluation of efficacy. J Subst Abuse Treat May-Jun 11(3):205-215. Nat Development and Research Inst Inc., New York, NY, USA. Anecdotal studies have reported AP alleviating the severity of withdrawal symptoms associated with cocaine abuse. The efficacy of Ear-AP in reducing cocaine/crack craving and consumption was examined via a single-blind, placebo experiment. 150 people seeking treatment for cocaine/crack abuse were randomly assigned to two treatment groups to receive either: 1=Experimental AP, or; 2=Placebo AP. Treatments were provided in an outpatient setting for 1 mo. Placebo treatments involved AP at Earpoints not used for drug treatment. Subjects provided urine specimens for drug content analysis after each AP session. Urinalysis results over the 1-mo study period favoured the experimental group. Experimental subjects in treatment over 2 wk had significantly lower cocaine metabolite levels relative to placebo subjects in treatment for a comparable period. Treatment retention with both groups was similar. Relative to pretreatment usage, a significant decrease in cocaine consumption was reported by both groups. Self-report outcomes did not indicate significant between-groups differences.

Margolin_A; Chang P; Avants SK; Kosten TR (1993) Effects of sham and real Ear-needling: implications for trials of AP for cocaine addiction. AJCM 21(2):103-111. Dept of Psychiatry, Yale Univ Sch of Med, New Haven, CT 06519. This was a single-blind study (n=48) to compare subjective evaluation of needling sham and real Ear-AP points. Both ears were needled concurrently, one in sham sites and the other in active points used to treat cocaine addiction. Subjects then completed a questionnaire rating the intensity of 5 sensations in each ear, and also attempted to identify which ear received sham and which ear received real AP. Real points were more painful than sham; there were no other overall differences. Subjects' ability to identify which ear received sham and which ear received real AP did not rise above the level of chance.

McLellan_AT; Grossman DS; Blaine JD; Haverkos HW (1993) AP treatment for drug abuse: a technical review. Pennsylvania VA Centre for Studies of Addiction, Philadelphia. J Subst Abuse Treat Nov-Dec 10(6):569-576. Pennsylvania VA Ctr for Studies of Addiction, Philadelphia, PA. The efficacy of AP for the treatment of substance abuse is controversial. On October 23, 1991, the Nat Inst on Drug Abuse (NIDA) sponsored a technical review to discuss this issue. The purpose of the meeting was to review the current status of research regarding AP treatment for drug abuse and to propose directions for future studies. This report represents a summary of the meeting which consisted of presentations by individuals currently involved in AP treatment and discussions by a panel of experts in the field of substance abuse treatment research.

Miller_J (1996) An Evaluation of an AP Program for Drug Treatment in San Diego County. Adapted from WWW. A recent pilot study was by the City of San Diego aimed to determine whether or not AP helped to curb the drug addictions of patients and/or motivated these parolees to search for a higher quality of life without drugs. The hope was to find if AP will ease the patients through the initial stages of Post Acute Withdrawal Syndrome (emotional, psychological, and physical symptoms of ridding the body of the substance) and to keep them in treatment longer. The Solutions program began AP treatments on September 1, 1993. The focus of this research was to examine the use of AP in an outpatient program for parolees with drug problems.

The outpatient program, funded by the San Diego County Alcohol and Drug Services and operated by the Community Connection Resource Centre receives referrals from the Parolee Partnership Program (PPP). The Pacific Coll of Oriental Med supplies a licensed acupuncturist and required supplies through an agreement with Community Connection. The goal of Community Connection's AP program is to retain outpatient parolee clients in treatment longer than drug-addicted parolees who do not receive AP.
The research procedures included the case tracking of 52 AP clients and a comparison group of 64 individuals in treatment without AP. Information was compiled on the sociodemographic features of the 2 groups: type, level, and history of drug use, and arrests, charges filed, and dispositions during the time in the program. Study results indicate that AP may have an influence on the length of time in treatment and reduce or eliminate drug use. This research may be helpful to treatment providers and policy-makers in determining how best to allocate resources toward populations in treatment and what results can be reasonably expected by using AP. The research suggests areas for future study, such as drug abuse, including criminal behaviour pre- and post- treatment, and cost of treatment compared to the benefits of treatment. The Test Groups: 2 groups were observed: one group received AP treatment and the other group did not, serving as a comparison group. All clients were adult parolees and >80% were male. Both test groups were mainly comprised of Caucasians and African-Americans. Nearly half (46%) of both groups were between the ages of 31 and 40 yr, and roughly a quarter were in the age category of 26 and 30. 2% of each group had a Coll degree while 56% of the AP clients had graduated high school, compared to 47% of the comparison group.

Over one quarter (27%) of the AP clients did not graduate high school compared to 41% of the comparison group. Heroin was cited most often as the primary drug problem by clients in both groups. 36% of the comparison group reported cocaine compared to 23% of the AP group. 56% of the AP clients and 45% of the comparison group stated that injection was their main way to take drugs. 69% for the AP clients and 61% for the comparison group reported no use of their primary drug in the 30 d before treatment admission. Findings: Arrests during the program were few for both groups. Only 4 AP clients were rearrested during their time in treatment; the comparison group had 5 people rearrested. AP clients stayed in treatment nearly twice as long as the comparison group (a mean of 93 d for the AP clients compared to a mean of 48 d for the comparison group.) Also, the AP clients received more individual counselling, group counselling, ancillary services, and employment referrals than the comparison clients.

Clients had a mean of 10 sessions of AP treatment. Successful AP clients spent a mean time in the program almost double that for successful comparison clients (113 d versus 70 d, respectively). 90% of the AP clients, compared to 69% of the comparison group, reported no drug use since the beginning of the treatment program. 33% of the AP clients were employed in the beginning of treatment, and by the end of treatment, 65% were employed. While the comparison group also show an increase in employment upon program completion, the total number of comparison clients employed upon exit was less (43%). Interpretations: The entire outpatient program lasts 180 d, but, in the past, most people only attended between 30 and 60 d. AP clients stayed in treatment nearly twice the amount of the comparison group (a mean of 93 d for the AP clients and mean of 48 d for the comparison group). Therefore, AP clients had greater opportunity to receive additional individual counselling, group counselling, and ancillary services.

Each client received a mean of 10 AP treatment sessions. Based on a mean of 3 mo in treatment, each received almost one AP session/wk. The goal of the AP component of Solutions program was to keep parolees in treatment longer so they could benefit from the services provided. As noted above, the AP clients did spend more time in treatment and, although self-reported, 90% claim they did not use drugs during their treatment. Some of the factors that impede treatment efforts were that many of the parolees who entered the Solutions program either did not volunteer to receive AP treatment or did not complete the treatment program.

According to the Solutions staff, the reactions to treatment and the reservations toward participating included fear of needles, fear of a new dependence on the AP, headaches or fatigue resulting from treatment, or no positive experiences due to AP (e.g. relaxed, attentive at group therapy, less stressed, etc). Most individuals in either group did not stay in treatment for the recommended (180 d) which is an issue that the service provider may wish to address along with the fact that Solutions' clients did not receive as many AP treatments as specified in the program scope of work. Further information: The results of this pilot study have been so well received by the San Diego substance abuse treatment community that plans are currently under-way for inclusion of AP treatment at San Diego's Las Colinas Women's Detention Facility and the Otay Mesa Jail. Acupuncturists interested in working in these facilities should send their resume to Pacific Coll, attention Jack Miller.

Oleson TD (1996) Addictive Behaviours and Drug Detoxification with Ear AP. Adapted from WWW. Terry Oleson PhD.

The points listed on this page represent a small part of a large book called Auriculotherapy Manual: Chinese and Western Systems of Ear AP, 2nd Edition. To locate the points specific to these treatments, please see the following 3 images:

Ear Points (148k).

For images that describe the Ear-therapy points for many other conditions, please see: Auricular Microsystem Points (200k).

Points labelled with the letter "C" belong to the Chinese system of AP point locations.
Points labelled with the letter "F" belong to the French system of AP point locations.
The efficacy of these systems versus the system for point location that Dr Oleson illustrates in his book must be determined by the practitioner and the patient.

PP: means "Primary Points".
SP: means "Secondary Points".

Alcoholism
PP: Alcoholic Point, LV, LU 2, Brain.C, Point Zero, Shenmen, Occiput, Forehead.
SP: Autonomic Point, Endocrine Point, Tranquillizer Point, Master Cerebral, Thirst Point, External Genitals.C, External Genitals.F, Minor Occipital Nerve, Limbic System, Aggressivity, Master Oscillation, Anti-Depressant Point.

Drug Addiction
PP: LU 2, Point Zero, Shenmen, Autonomic Point, LV, KI.C, Brain, Limbic System.
SP: Occiput, Adrenal Gland.C, External Genitals.C, External Genitals.F.

Nervous Drinking
PP: Alcoholic Point, Thirst Point, KI.C, Brain.C, Shenmen, Nervousness.
SP: Point Zero, Endocrine Point, Thalamus Point, Master Cerebral, Master Tranquillizer.

Smoking Withdrawal
PP: Nicotine Point, LU 1, LU 2, Point Zero, Shenmen, Autonomic Point, Brain.C, Limbic.
SP: Mouth, Palate.C, Palate.F, Adrenal Gland.C, Adrenal Gland.F, Aggressivity. (Treat LU 1 and 2 points at 80 Hz for 2 min).

Weight Control
PP: Appetite Control, Mouth, Oesophagus, ST, SI, Shenmen.
SP: Point Zero, Thalamus Point, Master Sensorial, Master Cerebral, Anti-Depressant Point, Endocrine Point, Posterior Hypothalamus, Occiput. (Treat Appetite Control Point at 20 Hz for 2 min.).

Terry Oleson PhD is a lecturer in Ear-therapy. Receiving his PhD in Psychobiology form the Univ of California at Irvine in 1973, he went on to do pioneering research on Ear-diagnosis and Ear-therapy at the UCLA Pain Management Centre in Los Angeles, California. Besides being the author of many scientific articles, Dr Oleson is the Chair of the Dept of Psychology and the Division of Behaviour Med at the California Graduate Inst. Dr Oleson also serves on the faculty of Emperor's Coll of Traditional Oriental Med and as President of the Centre for Oriental Med Res & Educ (COMRE).

His book, Auriculotherapy Manual: Chinese and Western Systems of Ear AP is available through:

Health Care Alternatives.
8033 Sunset Blvd. #2657.
Los Angeles, CA 90046 USA
Phone (213) 656-2084.
Fax: (213) 656-2085
Smith_MO1 (1989) AP Treatment for Drug Addiction: Testimony presented by Michael O Smith MD DAc, to the Select Committee on Narcotics of the US House of Representatives July 25. Adapted from WWW, NADA Home Page.
I am a physician and psychiatrist who has learned AP on the job as Med Director of the Substance Abuse Division, the Dept of Psychiatry of Lincoln Hospital.in the South Bronx. I completed residency at Lincoln and then worked for their outpatient methadone detoxification program beginning in 1972. I was initially sceptical that such an apparently delicate process such as AP could have a real impact on drug addiction. However, 15 yr of large scale clinical experience has persuaded many of us of the popularity and effectiveness of AP treatment. Currently 250 detoxification patients receive AP daily at Lincoln. Our program provides AP treatment in a large community room where most patients seem to be relaxing or meditating. Each day 45-50 women bring infants and small children with them to our clinic. Typically, the young mother will sit with a baby in her lap while receiving AP.

AP is a foundation for psychosocial rehabilitation so that counselling, drug-free contracts, educational and employment referrals, and Narcotics Anonymous are essential parts of the program. AP not only controls withdrawal symptoms and craving, but it also reduces fears and hostilities that usually disturb drug abuse treatment settings. AP has a balancing effect on the ANS and neurotransmitter systems as well as an apparently rejuvenating effect. Drug abuse treatment is accomplished by inserting 3-5 AP needles just under the skin or surface of the external ear. Needles are sterilized by autoclave. The location of ear points and the technique of insertion can be taught easily so that most AP components can be staffed by a wide range of substance abuse clinicians. Chapter 663 of the laws of New York State was passed in 1988 to establish that AP given in a State-Approved Drug Treatment Program will be exempt form normal licensing, provided that proper training and supervision take place.

Alliance with Criminal Justice System
In January, 1987, our clinic population was suddenly transformed by the avalanche of cocaine-based "crack"that continues to threaten our lives. We have all read of the bizarre, intractable nature of crack addiction. In professional meetings we have been told that the craving and fearful cycles of crack have no known treatment. From the beginning our experience at Lincoln has been strikingly different than these reports.

8,000 crack patients have been treated at Lincoln, many more patients than have been seen at any other program. Crack abusers seek treatment earlier in the course of their illness than other addicts. They often have a longer history of prior drug-free status than other abusers.

We have developed a protocol that is specifically intended to serve criminal justice clients rather than merely grafting probation and parole-referred clients onto a treatment structure designed for voluntary walk-in clients. I believe our program has had the highest success ever recorded to treat an unscreened court mandate population seen on an out patient drug-free basis. >50% of these clients have provided negative urine toxicologies for >2 mo. We have received no adverse reports on these individuals. Certainly, the Lincoln hospital AP Program has the best record in New York City to treat court referred crack abusers.

A computerized tracking system was set up with the assistance of Dr Stan Altman of Stony Brook (SUNY) so that any client's urine testing record could be located at a moment's notice. Lincoln tests urines for cocaine and heroin on a daily basis with EMIT system located on the premises. Therefore a probation officer, for instance, can receive a substantial, precise, and up-to-date report on any client with one phone call. This system is much more appropriate than written correspondence for the hectic and often chaotic work pattern in criminal justice service agencies. Staff members from probation, parole and family court often call for status reports. They also visit the Lincoln clinic and may have a joint session with the client and Lincoln counsellor on such an occasion. Our clients exhibit considerable confidence in this system which allows their frequent toxicology reports to speak for them in court.

55 clients referred by the NYC Probation Dept are listed in our 1987-88 records. Most have received probation with a requirement for drug abuse treatment. Some of our most successful clients have been referred to Lincoln during the pre-sentencing probation investigation. The statistical data can be summarized as follows: 11 of the 55 clients (20%) attended Lincoln only once. 30/44 (68%) of the remaining clients responded to treatment and have provided consistently negative urine toxicologies. This group of 30 successful clients has attended Lincoln for a mean of 9 consecutive wk over >4 mo. The pre-sentencing clients were assigned to probation instead of receiving prison time. One man who was facing 30 yr of federal time for drug-related charges has been sentenced to probation because of his 6-mo record of clean urines. This man still attends NA meetings here every Saturday with his 8-yr-old son. The judges involved have been clearly impressed by our clients' long record of clean urines on an outpatient basis. The successful clients have been re-established. After completing the Lincoln Hospital program, clients often continue long-term drug-free recovery programs, including AA and NA.

A joint project by the NYC Probation Dept, the Police Foundation of Washington, DC and ourselves is under way to provide long term evaluation of Lincoln clients. Our plans include a properly matched controlled study with 2-yr-follow-up of many clients.

In a preliminary study we have traced the outcomes of 34 clients referred to Lincoln by NYC Probation in 1978-88. 6/34 clients (17%) attended Lincoln only once. 18/28 remaining clients (64%) have attended >10 visits over a range of 2-15 mo. Only one of these 18 clients has had his probation revoked and has been sent to prison. 5/18 clients have functioned so well on probation that they were given "early discharges"from the probation system. 5 of the clients who attended <10 times were re-arrested and none were given early discharge. Hence frequent attendance at Lincoln correlates with a 5:1 improvement in outcome for this series of clients.

The possibility of diverting people from incarceration is a very high priority in our field because of overcrowding and the lack of revenue. The National Assoc of Criminal Justice Planners has placed a high priority of AP detoxification in many jurisdictions where crack is rampant.
Smith_MO2 (1989) AP Treatment for Drug Addiction.
Nationwide implementation of this criminal justice program
In April, 1987, I was invited to Portland, Oregon by Judge Nely Johnson and a criminal justice advisor to the mayor. A pilot program was established in the public detox unit.In June the county voted to allow $60,000 of their Federal Bureau of Justice Administration funds to create several AP components. Presently 6 new programs have been established by David Eisen of the Hooper Foundation, the county's contract agency for drug and alcohol treatment. The detoxification program now reports that 85% of its patients complete their program. Before AP was used, only 34% completed the program. The 6-mo recidivism rate has dropped from 25% to 6%. The Oregon State Dept of Correction has helped establish a Criminal Bed Reduction Program using AP to treat men charged with drug and alcohol-related offenses up to the level of class C felony. A clinic for runaway youth and a community-based program have also been started.

State funding is earmarked for AIDS intervention IV drug treatment programs in Portland, Salem and Eugene. AIDS outreach workers will be giving out AP coupons as well as condoms and bleach. The State has suggested a Medicaid reimbursement rate of $28/treatment with an allotment of treatment daily for 3 mo and treatment once/wk for 1 yr. All clinicians will be required to be NADA-certified.

An independent evaluation report prepared by Carolyn Lane for Multnomah County stated: "The successful post-detox enrolment rate is somewhat higher for all AP participants and much higher-nearly double, or 43% versus 25% for participants who had 7 or more treatments. The size of the follow-up group, which is circa 33% of all clients discharged/yr from Hooper Centre, and the lengthy follow-up period of >4 mo, make this finding very impressive.

Our patients were asked, as part of their AP Progress Reports, to note their attendance at self-help recovery groups or their enrolment in other post-detox or recovery programs. Of those that did, circa 2/3 attended Alcoholics Anonymous or Narcotics Anonymous meetings, most 1-2 times/wk but some daily.

Without exception, the clients interviewed were enthusiastic about AP. One "needed less medicine to relax, to sleep,"another felt the desire to use substances "just fade away,"and several remarked they were less tense, less fearful, and "able to cope with things a lot better." Another commented that "with AP, you're moving toward something.".

A major advantage of AP is that treatment can begin immediately, while treatment programs require a client assessment, with its associated costs. The first of these is simply the fixed cost of performing a client evaluation. If the client drops out at this point, as often occurs with unstable individuals, the cost of evaluation plus any potential billing for treatment is lost. Also, the loss is a source of endemic low morale among caseworkers and counsellors. AP treatment does not require such an evaluation and can begin at first contract, in many cases thus retaining clients who would not return otherwise.".

In conclusion, AP appears to be a very cost-effective modality in supplementing and supporting a comprehensive detoxification treatment program. Also, it provides an adjunct treatment that can be applied during the entire cycle of detoxification.".

Judge Herbert Klein of Miami-Dade County has spearheaded the development of an AP-based program in the prison stockade and an outpatient facility in Overton. The program focuses on criminal justice clients; it began in May 1989, and sees 100 people/d.

Suggested reasons for the success of this criminal justice program
1.        AP is a popular and effective treatment. Patients learn to have confidence in daily AP visits and the relief that consistently occurs. AP can treat craving and fear, as well as withdrawal symptoms. This modality facilitates constructive, non-antagonistic counselling and breaks down the barriers that usually inhibit group process. The consistently calm atmosphere in the treatment area is a marked contrast to the tense mood of streets and of even the best conventional drug program. AP acts physiologically by enhancing the patient's own balancing mechanisms. Vitality and integrity is renewed and developed from within before external challenges need to be taken up. In this clinical setting passive aggressive dependency and adolescent acting-out are greatly reduced. Staff and patients alike can focus on stability and growth without the interpersonal static that usually limits communication.

2.        We have applied many of the basic principles of chemical dependency which are often neglected in criminal justice related situations. The struggle for sobriety is "one day at a time." By testing urines daily, providing daily AP, and encouraging brief daily counselling sessions, we are functioning in the same rhythm as the patient's struggle for recovery. Testing urines every 2 wk, in contrast, functions as an external judgmental process that clashes with the potential rhythm of recovery. A common principle of AA is "keep is simple.".

3.        Our clinical staff makes a primary alliance with the criminal justice referral agency as well as with the clients. This process of dual alliance with the client and the disciplinary agency is the basis for successful work in Employee Assistance Programs. The process is not at all contradictory as long as the primary focus is on sobriety and increasing the client's integrity which is the common goal of all parties. Unfortunately many treatment agencies see themselves as adversaries to the courts and end up by disguising the results of sobriety testing and making excuses for continued abuse. This pattern is called "enabling" in our field. The Lincoln clients are very accepting of this "dual alliance" strategy. There is a lack of contradictory messages, a lack of excuses, and an abundance of interest in their daily struggle to be drug-free.

4.        The counselling process at Lincoln emphasizes a non-judgmental, non-invasive supportive approach. The firm challenge of sobriety is established, but the treatment relationship is quite flexible and open-ended. On some days patients may want to "ventilate their feelings each day; at other times they may want to just say, "hello"and take the AP treatment. Patients often experience fear and resentment toward intrusive questions and advice. This phenomenon is particularly true with court-mandated clients. These fears often prevent frequent attendance at otherwise helpful programs. The therapy program cannot "hold a grudge"and put increasing pressure on the patient for previous failures to respond to treatment. Pressure and concern must be appropriate to the quality of today's struggle and not reflect the residue of the past. The use of AP makes this non-judgmental process much easier.

5.        Frequent urine testing provides an objective non-personalized measure of success that can be accepted equally by all parties. In this system, the counsellor is the "good cop" and the urine machine is the "bad cop."
Smith_MO3 (1989) AP Treatment for Drug Addiction. The counselling process can be totally separated from the process of judgment and evaluation. In this approach, clients will not feel a need to be friendly to their counsellor in order to gain a positive evaluation. The computer print-out showing a series of drug-free urines is the only documentation they will need to gain a favourable report for the court.

6.        Clinical supervisors at Lincoln have developed an approach that encourages self-sufficiency in their colleagues. A counsellor who perceives that his or her autonomy is respected will be much more able to develop autonomy in individual clients. The treatment field often neglects the principle that autonomy is a major component of health and sobriety. So much effort is focused on referrals to 24-h facilities that this basic and practical reality often fades out of view. No matter how effective 24-h rehabilitation is, the patient will spend 99% of the time in an independent state. The pressing reality of criminal justice is comparable. To help people, we need to help them function well independently of our agencies.

7. The fear and shame associated with impending incarceration or removal of a child is certainly beneficial for a prospective patient to face a fearful concrete reality. The myth of the well-motivated walk-in patient is just that: a myth. Similarly, court-related referrals should always be made with definite requirements. Referrals of the type "why don't you see if this treatment can help you"lead to an unusually low rate of success. In recent trends of budget deficit and court congestion, the threat of incarceration is often more symbolic than real. The response of probation and SSC clients indicate that a temporary, more-or-less symbolic threat may often be quite effective in persuading a client to begin treatment and these clients continue in treatment long after the circumstances suggesting the threat of punishment abated. This type of situation is typical of interventions and contracting in chemical dependency treatment.

8.        "There is no such thing as a hopeless case" is another basic principle. The Lincoln program does not screen out prospective patients as "poorly motivated" or "unsuitable" as is often done in regard to criminal justice referrals. All referrals are accepted: a fact that makes these statistics all the more promising.

Suggestions for the future
In cooperation with the primary referral sources, Lincoln is developing a selection of treatment contracts that can be mandated for criminal justice clients. For example, a parole client might be required: 1.        to attend AP 5 d/wk for a minimum of 3 wk; 2.        to provide drug-free urines on at least 10 of the first 20 d of treatment; 3.        to provide drug-free urine once/wk for a subsequent 6 mo; 4.        to attend Narcotics Anonymous or equivalent programs for 6 mo.

Note that these requirements allow some leeway in the early period of treatment and continue to require sobriety during the early recovery period. Another client might be mandated to give 6 wk of daily urines and up to a 2-yr follow-up period. Such contracts could easily become the basis of revenue saving court diversion and early release program. Unsuccessful clients would face incarceration, but a sizable number would be spared by their commitment to a drug-free life.

At a recent NYC Bar Assoc retreat, I suggested that drug abusers who are identified by the police sometimes be given summons instead of being arrested. The summons might require that the abuser provide some negative urine toxicologies during a specified period of time in order to avoid arrest. The availability of effective and inexpensive AP treatment for crack abuse makes this type of non-institutional management a legitimate possibility to cope with the huge dimensions of our drug abuse epidemic.

Millions of dollars saved each year by treatment of Crack mothers
One of the bittersweet realities of public service is the opportunity to confront major problems of the day as they develop, much as an explorer discovers new territory and learns to cope with new dangers. Often we are overwhelmed or simply lack methods to handle a given situation. One of the worst symptoms of the crack epidemic has been the massive increase in maternal substance abuse and consequent retention of cocaine-positive infants in hospitals as boarder babies. Many of these infants are deprived of love and nurturing until their mothers can receive successful drug abuse treatment. As virtually the only available outpatient program for crack abuse in the city, Lincoln Hospital has received >3000 referrals of drug-abusing mothers in the past 30 mo. We are pleased to report that the Lincoln Hospital AP Program appears to have saved the city >3 million dollars in 1987 by reducing costs of boarder babies and subsequent foster care for infants born of crack-abusing mothers. The hospital and Special Services for Children (SSC) refer nearly all maternal patients to the AP program. Their attendance and urine results are satisfactory enough so that the agency and the courts release custody of the infants in most cases. Most city hospitals are severely overcrowded and drained of resources due to the boarder baby crisis. Millions of dollars are lost unnecessarily; hospital nurseries are prevented from helping infants with Med needs; and many children remain separated from potentially caring parents. The Lincoln AP program is a reliable alternative to much of the suffering and deprivation of maternal substance abuse.

We sent Dr Wendy Chavkin, then Director of Maternal Health for the City Health Dept, the following reports describing 290 postpartum women whose babies were held in the hospital because of a positive cocaine toxicology. 70% of all postpartum referrals interviewed by our staff have attended AP treatment and counselling on a regular basis for at least 2 consecutive wk. 50% of all referrals have provided a mean of 10 or more clean urines on a regular basis. In one series, postpartum clients provided twice as many clean urines after regaining custody of their child as compared to the pre-custody testing period. These women completed a mean of 3 mo of attendance in our program. 50% of them attend NA meetings. The use of AP detoxification gave substantially beneficial results in this large scale clinical trial.

Special challenges for women in treatment
Lincoln Hospital is the only drug abuse program that I know of which has many child-rearing female clients. Usually female clients in drug programs are rather street-oriented and accommodate to the dominant male clients in that manner. Child-rearing for these women is generally a secondary activity. Lincoln works with many of these street-oriented women. However, a large part of our maternal substance abuse caseload consists of women who identify mainly as home-makers and parents. These women sometimes have outside employment but they almost always have a "job" at home raising children and coping with domestic pressures.

Drug abuse activities invade their home life, but once drug-free status is regained, these women have a respectful "job" they can return to.

Smith_MO4 (1989) AP Treatment for Drug Addiction. Consequently, these women have needs that are quite different than the needs of an unemployed person.
Female drug users are often trapped in very destructive and exploitative relationships. Many drug-related relationships involve violence and abandonment. When we ask a mother with small children to stop using drugs, we are usually asking her to leave her home and her relationship as well as the identified addiction. These women are often forced to live in a shelter or welfare hotel if they leave the apartment where their crack-using companion remains in physical control. In a previous session of this subcommittee, we heard that shelters and welfare hotels are hardly safe harbours in the drug abuse war. A woman with small children is uniquely vulnerable to the intimidating and intrusive nature of the crack sub-culture.

Immediate pressures of child care may also hinder a woman's response to treatment. We instruct AP patients to sit quietly in the chair while the needles are in place. This request takes on an entirely different meaning when the maternal patient has a newborn and a 2-yr-old with her. Attendance in Narcotics Anonymous is also more difficult when children tag along. Every day in our clinic 45-50 women bring small children with them during treatment. We appreciate their commitment to parenthood, but also recognize the increased challenge of their regular attendance. Many of our new mothers visit the hospital each day to feed their infant. Others have to make difficult arrangements for child care.

All too often women are said to have greater resistance to treatment than men. Reality-based fear of physical violence may be falsely interpreted as only part of their fear of confronting addiction. Dependence on living in an apartment and a relationship where crack happens to be used will compound the apparent degree of dependence on the drugs.

At Lincoln we have been able to design a program with a relatively high rate of success for women with small children. AP provides convenient relaxation and reduction of fear on a daily basis. Scheduled appointments are not necessary. Frequent supportive sessions are used rather than early stage confrontations that are often typical of drug-free programs.

Let me conclude this discussion by mentioning one principle that is vital to the success of any maternal substance abuse program. The program must work in terms of the women's autonomy and ask her to become drug-free for herself, not "for the sake of her baby." Guilt is not a good medicine. A person who appreciates her own value will be a better parent and also be able to say "no"to drugs and drug-filled relationships.

Enhancements of the maternal substance abuse program
New York City Council President Stein's office designated $181,000 of fiscal 1989 to establish a unique pre-natal substance abuse program at Lincoln Hospital. The pregnant substance abuser is treated initially for addiction as the primary problem. She receives AP, counselling, urine testing, using the regular protocol. Education about pregnancy and delivery, pelvic examination and more stressful testing will be done when the patient is ready to handle these matters. City Controller Harrison Goldin has designated $110000 in the fiscal 1990 budget to develop a parent education program in conjunction with our postpartum program. The Dept of health will help us track long-term follow-up for these patients as well as our whole postpartum case load.

AIDS prevention
As we have indicated, AP detoxification is a popular and safe method of relieving stress and craving in a wide range of substance abusers. >60% of clients are retained in AP treatment, a much higher figure than any other form of outpatient drug-free treatment. No other drug abuse program except for Lincoln has ever been able to accept poly-drug abusers and mentally ill chemical abusers on an unscreened walk-in basis so that 10 new patients/d can receive acceptable treatment on the day of admission. Lincoln Hospital has a long history of being able to reach the unreachable patient, including some homicidal, paranoid and bizarrely psychotic persons who would be rejected in many sites due to the perception of risk of violence. The following patient summaries indicate that an AP program can reach "unreachable" clients. The patient described is typical of the AIDS-patients who will be most difficult to relate to and therefore will be more likely to spread the condition.

HW presented with a narcotic and cocaine habit and an obviously paranoid condition. He had a history of LSD psychosis in 1972 and at least 3 state psychiatric hospitalizations. HW was evidently hearing voices and reported bizarre somatic delusions. HW attended AP 5-6 d/wk for the next 6 mo. After d 1, he said that his voices "went away." Use of heroin and cocaine continued intermittently. HW was so guarded that no individual verbal sessions were attempted until 6 mo later. HW is now readily communicative, working part-time and attends AP once/wk.

Involving the HIV(+) or PWA person in drug abuse treatment can be the first step in the overall Med treatment of AIDS and a necessary step in the development of sexual responsibility which will protect spouses from the epidemic. The Health Commissioner Steven Joseph has strongly supported this point of view in previous testimony before the New York City Council. The statistic that is most often cited as an indication of the danger of heterosexual spread of AIDS is the rate of HIV(+) findings in mothers and their babies. These statistics have been used to advocate programs such as methadone maintenance and syringe exchange; programs which relate mainly to male narcotic addicts. Helping a man use narcotics "safely"will not necessarily help him use sexual precautions with women he is involved with. The use of cocaine and alcohol tends to increase sexual irresponsibility.

Only a program which directly helps young women become drug-free will have a substantial effect on the rate of HIV(+) findings in mothers and children in the special context of widespread infection in New York City. These women can then involve their partners in treatment. One of our patients told me her husband walked with her to the clinic with a baseball bat in case she did anything wrong. From my office window I could see the man standing on the street with a bat. 2 wk later this patient brought her husband into the clinic for treatment, saying "he doesn't use drugs, he just wants treatment for nerves." Our patient had made a tremendous accomplishment, one that could have been sabotaged easily by premature confrontation.

Medical-scientific reaction
We are often asked about the reaction of the Med scientific community to our use of AP. Because of my own initial scepticism, I understand a natural reluctance to consider the possibility that AP could be effective for such a serious condition as cocaine addiction.

Dr Milton Bullock and acupuncturist Patricia Culliton of Hennepin County Med Centre in Minneapolis began to use a placebo protocol to evaluate our Lincoln Hospital AP protocol in 1983.
Smith_MO5 (1989) AP Treatment for Drug Addiction. Their first article was published in the Alcoholism J in June 1987. It showed that 37% of the treatment group responded well to AP as compared to 7% of the placebo group which received non-specific AP points. The Hennepin group has published a more advanced study in Lancet (June 24, 1989), the prestigious journal of the BMA. 21/40 treatment AP patients completed the program compared to 1/40 controls. Significant treatment effects persisted at the end of a 6-mo follow-up. These studies focus on severe recidivist alcoholics who are very rarely engaged in outpatient management.

Dr Mindy Fullilove of the Univ of CA at San Francisco is just completing a controlled placebo study using the Lincoln protocol with IV heroin abusers. Dr Stephen Kendall and his staff at Beth Israel in New York have planned a controlled study using AP to treat addicted babies. A controlled placebo study by Dr Doug Lipton of the Narcotic Drug Res Inst (NDRI), is under way in crack-patients at Lincoln Hospital. In the recent submission of large scale AIDS prevention drug abuse treatment grants, AP was the second main procedure suggested for evaluation.

In a recent legislative meeting in Albany, New York, the chief representative of the Med Society of New York stated that AP was an important part of the health care field and that physicians were seeking more instructive and more active participation in the AP field.

Relations with the Drug Abuse Treatment Field.
I have always supported the position that AP can only be component part of the whole process of drug abuse treatment. Nearly all of the existing AP drug abuse programs were developed within already existing licensed treatment programs. Our enabling legislation in New York State was written by Public Health Commissioner Deborah Prothrow Stith, the state drug abuse agency of Massachusetts has funded 4 AP-based programs during 1989. Many methadone programs have established AP components in order to treat crack abuse and other secondary addictions. In a therapeutic community setting, such as the Phoenix House in London, staff members report that AP helps reduce craving, tension among the clients and that most clients participate in the weekly AP sessions.

A South Bronx Clinic has gained world-wide recognition
The Lincoln Hospital AP program has received a great deal of national and international attention. >60 clinics in the US and another 25 in Europe, Latin America and Asia have been established explicitly on the model of our clinic in the South Bronx. Indeed Lincoln Hospital has become a "mecca" for visitors and journalists. Television networks from Spain, Italy, Brazil, Sweden, UK, Latin America, Hungary and Japan have filmed our AP drug abuse program.

The National AP Detox Assoc (NADA) was founded in 1985 by clinicians who wanted to extend the example of the Lincoln hospital experience into other treatment settings. I am the chairperson of NADA. The organizational name also uses the Spanish connotation of "nada", suggesting a no-nonsense, drug-free approach. NADA has given many training programs for public institutions and communities in undeveloped areas. It has set standards of certification for AP detoxification specialists that are widely accepted in the substance abuse field.

I have just returned from a UN meeting in Spain scheduled to plan community-based treatment programs on a widely diversified basis. In the December 1988 issue of the Bulletin of Narcotics, we described NADA programs on the Sioux reservation, in Katmandu, in La Perla in Puerto Rico, and Lincoln as an example of the effectiveness of this model in difficult socioeconomic settings.

It is easy to be confused by the aggressiveness that many addicts present and to conclude that the main goal should be symptom suppression. The addict himself takes this approach in the extreme by using sedative narcotics. In contrast, we have derived our approach from TCM theory of detoxification. In TCM the lack of calm inner strength is described as Empty-Fire (Xu-huo), because the Heat of aggressiveness burns out of control when the calm inner tone is lost. The hostile paranoid climate of communities vulnerable to drugs is a clear example of Qi-Xu Syndrome with Empty-Fire burning out of control.

Our patients seek greater power and control over their lives. Empty-Fire is the illusion of power, an illusion that leads to more desperate chemical abuse and senseless violence. AP is an effective treatment for Empty-Fire. The patient is empowered, but in a soft, easy and long-lasting manner.
Smith_MO6 (1986) AP Treatment for Alcoholism. Adapted from WWW, NADA Home Page. Michael O Smith MD DAc, Lahary Pittman, CAC, CA, Ana Oliveira, MA, CA.
The Lincoln Hospital Substance Abuse Division, Bronx, NY, has been detoxifying alcoholic clients with AP since 1974. We combine these innovative methods with the conventional modalities of counselling and in-patient detoxification. We see hundreds of detoxification clients daily in an inner city, walk-in clinic. The data reported here for alcoholism treatment are similar to those we have found for drug addiction and other substance use disorders. Specifically, we are doing an extensive urine survey to evaluate our results obtained treating cocaine or "crack" patients on an out-patient basis.

AP detoxification is relatively simple to learn and apply. Small needles are inserted just under the skin at several locations on the external ear. Clients usually begin AP out of curiosity or desperation. They continue to come for treatments as they appreciate the success of the treatment. Clients who come in tremulous often fall asleep during treatment. Clients who come once/d for >7 d find it easier to remain sober and are visibly more relaxed, alert and confident. Some motivated, as well as poorly motivated clients report that daily AP treatment makes it very difficult to keep drinking. Several have told us that they still hang out with their drinking buddies but "don't feel like drinking".

Many people in this field burn themselves out trying to use counselling methods only to cope with chronic tension, craving and insomnia. These symptoms reflect total body imbalance, not only psychosocial imbalance. Nagging physical withdrawal symptoms and debilitating fears of "white-knuckle sobriety"respond quite well to AP and herbology combined with counselling methods. Our treatment methods help the counsellor's efforts to be much more fruitful.

Since AP is inexpensive and non-addicting, we can easily offer AP treatments "on demand." An addict in withdrawal need not be placed on a waiting list and be lost to follow-up. The cost of AP detoxification is much less than alternate protocols. AP treatment can be provided within a general Med setting so that treatment of significant others and concurrent psychiatric and abuse problems can occur simultaneously. Repeat in-patient detoxification is inappropriate for relapsing clients who have not yet built up a substantial habit. By offering treatment "on demand"the AP detoxification protocol minimizes the barriers for the former client to re-enter treatment. Discussions of stressful psychosocial issues can be delayed until after the client has received renewed relief and reassurance by the effectiveness of AP treatment.

Alcoholism clients particularly appreciate a concerned, giving atmosphere. AP allows the staff to help give relief without any physical symptoms because it helps modify the point selection. We have had additional success in treating nerve and liver disease which are secondary to alcoholism. Physical complaints which are a source of nagging irritation in the usual treatment setting thus become a useful communication in the AP detoxification setting.

In our specialty, a disproportionate amount of time and money are spent on in-patient detoxification. Using AP as an adjunct to our patient's alcoholism treatment enables us to serve a much larger group of clients and allows us to invest more time in the interpersonal and spiritual aspects of rehabilitation. Clinical sites using AP find many less problems related to the management of violence and other disruptive behaviours.

Research studies at Lincoln
We were able to apply the breathalyser testing to our alcohol-related clients before almost every AP visit in June, 1985. This extensive testing provides a unique opportunity to evaluate the detoxification and early sobriety status of AP treatment. These clients completed a treatment agreement as part of the one page intake form. They often received social service support and referral from the intake counsellor. However, no long term treatment slots were available so none of the intakes and relatively few of the longer term clients have any access to regular counselling. Only a handful of these clients attend AA. Psychotic clients and clients with secondary substance abuse habits are not screened out and are included in the sample.

50 intakes in June were found to have a primary problem of alcoholism. Most clients are diagnosed by other agencies and give a 10-20 yr drinking history. Clients with >1 breathalyser tests/wk and a total of 8 tests are included in the sample as active clients. 7 intakes entered so late in the month as to have insufficient tests for inclusion. 18/43 remaining (42%) had no positive breathalyser test. This usually means that even on the second day of treatment, they are breathalyser clean. 12/43 (28%) were classified as "oscillating" because they have occasional positive tests but had on the mean 3 times as many negatives as positives. 12 were categorized as "drop-outs, "usually with 13 visits reported. One person continued active drinking. Therefore, 70% of these diagnosed alcoholics show regular attendance and predominant breathalyser sobriety in an AP setting without regular counselling follow-up.

The data for the entire alcohol-related population, June intakes included, are similar for the same period. A total of 215 clients received at least 2 breathalyser tests/wk before AP treatment. We should mention that the clients line up very cooperatively for testing and voice disappointment if testing is not available at a given time.

99/215 subjects (46%) showed no positive test during the month. 17/215 (8%) were classified as "improved"because they gave all negatives after an initial series of positives. 98/215 (46%) were classified as "oscillating, "again with a mean of 3 times as many negative tests as positive ones. One client had consistently positive tests.

A positive breathalyser test was used as a tool of intervention. Clients were required to speak to their intake counsellor or their long term counsellor if an assignment had been made. People who were grossly intoxicated were asked to leave without treatment and return on the next day. Clients with low positives had brief sessions on the importance of daily sobriety. No one was asked to leave the program on a long term basis because of positive tests. A handful of people were referred for hospital detox. No more than 20-30 of these 215 clients were attending a long term alcoholism program.

The data for June indicate that our AP program can function well as an early sobriety phase of alcoholism rehabilitation. Circa 50% of the clients remain sober for several mo with frequent AP treatment, breathalyser monitoring and minimal counselling. These clients are certainly ready for referral to AA and long term outpatient rehabilitation.

The "oscillating" group of clients can maintain frequent sobriety and continuing relationship with a treatment process. These clients would certainly benefit from alcoholism awareness classes and one-to-one counselling that a more properly staffed program would provide.

Smith_MO7 (1986) AP Treatment for Alcoholism.
The Lincoln AP Program is a successful revenue-producing unit which is fully integrated within the hospital system of New York City. It has served as a model for the programs in Brooklyn and Minneapolis described below as well as others in the USA and abroad. The experience of these other programs indicated that our approach can be taught and implemented successfully in a wide range of programs.

AP training program
In the past decade we have trained over 150 people to perform detox AP who were previously counsellors, nurses, social workers, psychologists and physicians in conventional drug and alcohol treatment settings. While adapted to Western attitudes and conditions, the NADA method derives directly from TCM theory of detoxification. Some of these AP detox trainees have continued their study of TCM to become experts in general AP therapy. Other trainees are working in many public and private addiction treatment settings across the USA and in Europe.

National AP Detox Assoc (NADA) was formed to coordinate training and certification of AP Detox Specialists, designated "ADS". NADA was formed so that the field of AP and chemical dependency can be merged properly and that the critical importance of psychosocial rehabilitation not be lost in the enthusiasm for this new modality. As consultants for NADA, we found that many alcoholism staff members can readily learn the additional technique of ear AP detoxification and integrate this modality into their existing protocol of long term rehabilitation. To further improve understanding, NADA distributes an extensive range of approved educational materials, including literature, audiotapes and videotapes.

The following summary of the NADA training program with the Crow tribe and Sioux Nation in the USA has international significance because the Crow and Sioux are very isolated from the mainstream of Western culture and have economic and social problems that are typical of underdeveloped nations.

Native American AP detoxification
NADA has given 2 very successful training programs for Native American alcoholism programs located in the Crow and Sioux reservations. Alcohol abuse among Native Americans is extremely common. All parties agree that existing treatment efforts are failing to make any headway in coping with this genocidal threat. Extremely few detoxification beds are available for Natives who live on the reservation. In spite of the high unemployment, there is an effective social support system that derives from the traditional tribal culture and the dedication of younger educated Natives who remain on the reservations. The most dangerous problem is the lack of detoxification facilities.

NADA's goals were: 1.        to show the usefulness of AP detox in the Native American setting; 2.        to train Native alcoholism staff in the techniques, uses, and limitations of AP detox; 3.        to supervise the development of an AP component in the local treatment programs.

We found a very similar pattern of success in each program. Our training staff gave >150 AP treatments at each site. These treatments laid the basis of trust between the tribal leadership and ourselves. They observed that AP was a potential answer to urgent public health needs on the reservation. Most regular Native alcoholism staff members were able to learn ear AP for detoxification well enough to provide regular treatment and receive NADA certification. 18 native clinicians from 4 different reservations were certified. During the workshop, needles were sterilized at the adjacent Govt hospital. A complete written protocol was set up for the whole treatment process and it was followed carefully and completely by the Native staff.

The programs we visited were demoralized, low census facilities with a high rate of staff burn-out. The Native staff consistently showed concern and involvement with their patients, but they were seriously handicapped by the poor response of the clients to conventional treatment. In each program the census jumped 5-10 fold during the first wk of training. 2 mo later, the Crow Detox Program continues to give 40 AP treatments/wk, a 500% increase in daily treatment volume. Medication for in-patients (e.g. chloral hydrate) was totally discontinued after the 4th day of training at Crow Agency. Many previously uncooperative clients at the Pine Ridge Sioux Reservation became model patients after 1-2 d of AP. They gained a new found calmness, respect for themselves, and thus a growing interest in the counselling components of the program.

Typically disgruntled and toxic alcoholics from the Sioux jail were referred for AP as part of their rehabilitation. The motivation in this group became so positive that they built a sweat lodge facility for the reservation while still serving their brief sentences. Sweat lodges are used by the Indian community as a means of body cleansing and meditation. Many Natives remarked to us that the TCM approach represented by AP is very similar to their own health traditions. The Sioux said that AP was "takus kanskah" in the Lakota language. The translation of this term, "something holy moving" is very similar to the TCM concept of Qi (vital energy) which is the TCM explanation of the AP effect. Both programs were so visibly successful that long graphic stories have appeared in the major dailies of Montana and South Dakota, as well as the Lakota Times and KILI, the Pine Ridge station. The regional board of Indian alcoholism and the Indian Health Service at Aberdeen, South Dakota have shown interest in using AP detoxification in other reservation programs and a planned regional treatment centre.

Clinical examples
AP detoxification clients at Lincoln include abusers of alcohol, heroin, cocaine, methadone, sedatives, stimulants and hallucinogens alone, or in combination. Some of these patients have a primary psychiatric diagnosis, and others have psychotic toxicity resulting from acute and chronic drug use. The following examples illustrate the challenge of treatment that we have accepted.

Difficult intakes
We have many intensely disturbed people who come to our building for help. One 42-yr-old man, AB, had pages of the bible taped to his chest, and had a large knife extending out of his pocket. He was currently sober but had been referred by a local hospital for alcoholism treatment. As we hesitantly spoke to AB in the AP area, he turned his head around and asked, "can I get some of this? " We were surprised at his interest but gave Ear-AP treatment. AB slept for a while and then was quite willing to be accompanied to a hospital emergency room for admission.

Support for other therapy
RR, referred by a family court social worker, had a long record of alcoholism and child abuse. She had been attending therapy sessions weekly for the past yr with no change in her behaviour.
Smith_MO8 (1986) AP Treatment for Alcoholism. RR was labelled a poorly motivated patient. After 1 wk of AP, her children and neighbours came to the clinic and reported a very agreeable change in her behaviour. RR said this time the impulse hadn't been as strong and she "had been able to remember what her therapist had told her". This patient had not been poorly motivated; she had attended weekly sessions even though there had been no progress. She did not have a poor memory; on the contrary she had been distracted from remembering effective suggestions by an impulse disorder and alcohol abuse. RR only took AP for 23 wk, nevertheless the treatment helped her use the therapy sessions more effectively so that the past year's effort was not wasted. The court agency reports RR continued therapy and no longer shows a tendency towards child abuse.

Management of violence between clinic patients
Usually the possibility of violence between patients would paralyse the treatment process. AP has helped us treat clients within their existing environment of social turmoil. It is much too expensive and impractical to institutionalize every troubled violent person in a city such as New York. As a society we must develop community-based methods of coping with widespread substance abuse and violence.

Herbal detoxification
Herbal treatment has been used for alcohol detoxification and nervous relaxation for millennia in may parts of the world. The herb mixture that we rely on contains chamomile, catnip, peppermint, skullcap, hops and yarrow. The herbal mix is prepared exactly as tea is prepared, using honey instead of sugar. The mixture is less expensive than coffee. Our Lincoln "sleep-mix" can be used for relaxation and insomnia in stable persons. The same mixture is effective for alcohol detoxification if taken every hour. These herbs are not habit forming and do not have any risk of overdose or misuse. Our "herbal formulary"included in the NADA-approved literature, audiotapes and videotapes explains the nature and effects of these ingredients more completely.

Staff attitudes and strengths
Clinical staff who work with AP detoxification patients understand the special opportunities and requirements that we have described in this paper. They can foster autonomy and work in a calm atmosphere. Flexibility and tolerance of recently relapsing clients. Skills involving touching and other non-verbal support are also valuable in this setting. Staff members who use relatively authoritarian, judgmental or guilt-producing techniques do not adjust well to the necessarily gentle and permissive atmosphere of an AP detoxification setting. In the large group setting we do not emphasize authority symbols such as desks and signs. The patients can watch the acupuncturists and counsellors work so that they can feel like they are participating in the treatment procedure.

Many substance abuse clients are obsessed with guilt and self-deprecation. They must try to learn not to link every withdrawal symptom and craving with psychological issues. Even though substance use disorder is an overall psychosocial matter, it is not helpful to psychologize every step of the detoxification process. When a detoxing client starts to cry, teach them not to ask or worry about the "cause" of the tears. Clients should expect to face the psychosocial problems gradually as they gain strength and after the basic cleansing and balancing process.

Usually, our patients are unable to tolerate intense one-to-one relationships. We disarm them by coping with their turmoil in a non-attached, gentle manner. This form of interaction protects the patient from their own feeling of inadequacy and allows that the effect of AP is not comparable to the sedative effects of drugs. AP helps the body develop a healthy neutral state similar to that of meditation or yoga. This condition leads to healing and growth, not merely the control of symptoms. In TCM the lack of calm inner tone in a person is described as a Syndrome of Empty-Fire (Xu-huo), because the Heat of aggressiveness burns out of control when the calm inner tone is lost.

It is easy to be confused by the Empty-Fire (Xu-huo) that many alcoholics present and to conclude that the main goal should be sedation of Fire-Excess (Fire-Shi). The addict himself takes this approach in the extreme by use of sedatives. The hostile, paranoid, hustling climate of our inner city communities exemplifies a Qi-Xu Syndrome with Empty-Fire burning out of control.

Our patients seek greater power and control over their lives. The Empty-Fire Syndrome represents the illusion of power. An illusion that leads to more desperate chemical use and senseless violence. AP provides an effective treatment for these Empty-Fire Syndromes. The patient is empowered, but in a soft and easy manner.

Let me conclude by describing the cheerful and cooperative atmosphere that AP detoxification engenders. We are a crowded walk-in clinic in the South Bronx, one of the poorest sections of the city. Our former methadone component was always filled with argumentative and hyperactive behaviour. The AP component had always had a calm and cooperative atmosphere even though it was staffed by precisely the same people in the same confines. As well as clients for detox, we have many clients who receive AP treatment in the same settings for general medical conditions. Visitors to our clinic see middle-aged housewives, young professional people and working class people, all sitting side by side together with many substance abusers in a harmonious atmosphere. Social bonds become re-established because the treatment modality does not further isolate and stigmatize our clients.
Smith_MO9 (1985) Chinese Theory of Detoxification. Adapted from WWW, NADA Home Page. Michael O Smith MD DAc, Lahary Pittman, CAC, CA, Ana Oliveira, MA, CA.
From 1974-1985, out of necessity and by choice, the AP staff of Lincoln hospital has tested many AP methods for chemical dependency. In the past 4 yr, our basic protocol has given consistently impressive results with many different practitioners and a wide range of settings. Thus, we confidently add this theoretical discussion to the body of AP learning.

Implicated in the disorders of alcoholism and drug addiction are a wide range of substances (e.g. alcohol, heroin, methadone, barbiturates, valium, PCP, cocaine, etc). Nevertheless the similarity of AP points that are effective for these apparently different substances indicates that the critical Qi disturbance is similar in most, if not all, cases. Intense and frequent abuse of chemical substances damages the Jing-Essence (sexual Qi). In turn, KI is damaged because it is the organ (Zang) that stores Jing. Usually Yin-Xu exists, so we see many Empty-Fire (Xu-huo) symptoms. Yang-Xu symptoms also are present.

The symptoms of prolonged withdrawal may last up to 6-12 mo and usually take a psychological character. Periodic agitation, fear, lethargy, and poor response to stress are typical. Insomnia, bone pain, sluggish digestion, poor sexual function may be present also. Usually the patients consider these prolonged symptoms as a permanent result of their past activities. They are quite amazed that fresh clear youthful life is still possible.

We use ear AP with great success in treating these problems, both on a crisis and long term rehabilitation basis. The ear is the sense organ most related to KI. We extend this relationship further by saying that points on the external ear relate especially to KI function. The external ear is the part of the body that is most unchanged since birth. It is passive in function and is shaped like a fetus or a KI. In our experience, in contrast to treatments for knee and shoulder pain, Ear-AP treatment is more effective for KI-related locations (foot pain, sciatica). In our protocol the main needling locations are KI-related points and Ear Shenmen (a point that promotes lower abdominal circulation). The added points, LU, LV, etc, are chosen and located by sensitivity reactions and are related to secondary symptoms.

Jing-essence and KI are Yin in nature. When they have been damaged the recovery process is slow and undulating in intensity. Using frequent repetitions of KI-related Ear-AP is very effective in treating even debilitated addicts and alcoholics. Significantly, even those patients with severe paranoia respond well to this protocol. Paranoia involves fear (KI-related emotion) and a hollow aggressive ego structure that certainly is an Empty-Fire (Xu-huo) phenomenon. This often afflicts patients who are perceived by most health care settings as presenting a risk of violence. The routine ear protocol is more effective with more desperate and antagonistic patients, as one might expect. These patients are precisely the ones who have suffered more Jing damage and exhibit more prominent Empty-Fire symptoms. Also, many socially functioning Empty-Fire patients who may or may not be abusers, benefit greatly from these treatments. On the other hand, patients with relatively moderate chemical dependency or who have completed most of their recovery do not respond as well to the Ear-KI protocol and require body AP planned according to the conventional principles of TCM.

This distinction between treatment protocols for moderate and severe abusers is critical. The severe abusers are the group of patients most in need of better health care and most resistant to virtually all forms of intervention. By purifying the Jing-Essence and strengthening KI, we rehabilitate these Xu (Weak) patients so that they can return to function on the every day expected level of Jing function. Our clients need Ear-KI treatments before they can respond to other AP, psychological and spiritual treatment. We cannot overestimate the critical importance of using Ear-KI treatment as the primary form of AP for chemical dependency. Its use opens a world of relief for millions of chemically dependent people and their families.

Our AP treatment is mainly to tonify Yin. Many background aspects of our treatment setting contribute to Yin-tonification. Treating more patients simultaneously in a large sitting room clearly enhances the results. Patients certainly prefer to come when the room is crowded and they are usually more quiet when the room is more crowded. Shared experience is a Yin approach; whereas focused individual therapy is Yang. We take steps to minimize direct, intrusive interchanges whether in the form of clinic rules or verbal therapy. We share the patient care rather than focusing one acupuncturist on a particular patient each day. Before we became aware of it, the patients created a meditation-like atmosphere in the treatment room. This atmosphere is attractive to abusers of stimulants as well as patient's Yin (private, silent) development. American society as a whole is toxic and Yin Xu. Our Yin-tonifying setting is uniquely supportive and popular in providing all types of AP and other health care.

Stellato_Kabat-D (199.) AP detoxification [letter]. Soc-Work. 1994 Sep; 39(5):623-624.
ter_Riet_G; Kleijnen J; Knipschild P (1990) A meta-analysis of studies into the effect of AP on addiction. Br J Gen Pract Sep 40(338):379-382. Dept of Epidemiol and Health Care Research, Univ of Limburg, The Netherlands. A literature search revealed 22 controlled clinical studies on the efficacy of AP in 3 fields of addiction: cigarette smoking (15), heroin (5), and alcohol (2). These studies were reviewed using a list of 18 predefined criteria of good methodology. A maximum of 100 points for study design could be earned, divided over 4 categories: comparability of prognosis; adequate intervention; adequate effect measurement; and good data presentation. The study design was generally poor. No study earned >75 points and 12 studies (55%) earned <50 points. For smoking cessation, the number of studies with negative outcomes exceeded by far the number with positive outcomes. Taking the quality of the studies into account this negative picture becomes even stronger. For heroin and alcohol addiction controlled clinical research is both scarce and of low quality. Claims that AP is efficacious as a therapy for these addictions are thus not supported by results from sound clinical research.

Washburn_AM; Fullilove RE; Fullilove MT; Keenan PA; McGee B; Morris KA; Sorensen JL; Clark WW (1993) AP heroin detoxification: a single-blind clinical trial. J Subst Abuse Treat Jul-Aug 10(4):345-351. Univ of California, San Francisco. The increasing prevalence of HIV infection among injection drug users mandates the development of innovative treatments. While extensive clinical experience suggests that AP detoxification is both acceptable and safe to those in withdrawal, little research has been done to assess its therapeutic efficacy. In this first controlled study of AP heroin detoxification, 100 addicts were assigned randomly, in a single-blind design, to 2 groups: 1=standard Ear-AP treatment used for addiction; 2=Sham-AP treatment that used points that were geographically close to the standard points. Attrition was high for both groups, but subjects assigned to the standard treatment attended the AP clinic more days and stayed in treatment longer than those assigned to the sham condition. Additionally, attendance varied inversely with self-reports of frequency of drug use, suggesting that those with lighter habits found the treatment modality more helpful. Limitations of the study are discussed.

Worner_TM; Zeller B; Schwarz H; Zwas F; Lyon D (1992) AP fails to improve treatment outcome in alcoholics. Drug Alcohol Depend Jun 30(2):169-173. Alcoholism Services, Long Island Coll Hospital, Brooklyn, NY 10201. 56 alcoholics (49 male, 7 female) of lower socioeconomic class attending an outpatient treatment program in Brooklyn, New York were prospectively randomized to one of 3 treatment group: point-specific AP, sham transdermal stimulation or standard care (control). One third of the subjects reported a history of drug use in addition to alcohol. There were no significant differences in attendance at Alcoholics Anonymous meetings, number of outpatients sessions attended, number of wk in either the study or in the outpatient program, number of persons completing treatment or in the number of relapses. In this small racially mixed sample of urban outpatient alcoholics, fixed point-specific standardized AP did not improve outcome. We caution against the routine use of this treatment until more randomized controlled trials show a beneficial effect.

2. WITHDRAWAL FROM SMOKING
Ballal_SG; Khawaji YN (1992) Auricular stimulation and AP as an adjuvant to an anti-smoking programme: analysis of the results of a 1-year experience. Tuber Lung Dis Dec 73(6):396. Dept of Family and Community Med, College of Med and Med Sciences, King Faisal Univ, Dammam, Kingdom of Saudi Arabia.

Friedman_J (1992) Auricular AP for smoking [letter]. AETRIJ 17(2):149-150.

Jiang_A; Cui M (1994) Analysis of therapeutic effects of AP on abstinence from smoking. JTCM Mar 14(1):56-63. Inst of AP & Moxibustion, China Acad of TCM, Beijing. 1. AP has the same problems as other ways to help abstinence from smoking: unpredictable immediate effects, gradual decrease of therapeutic effects as time passes, and relapse. Research without a follow-up study is of little clinical significance. 2. Gilbey V et al noted that abstinence rates of all the methods have been 20-35%, and the effective rates are circa 45%; this is close to the mean long-term effects reported in this paper. 3. Many researchers noted that AP helped many smokers who had failed to quit smoking by other methods. Research also indicated that the therapeutic effects of AP on abstinence from smoking are similar to those of nicotine chewing gum and behaviour therapy, suggesting that AP is neither superior nor inferior to other methods in stopping smoking. These methods can complement each other. 4. Most smokers who wanted to quit found it difficult to accept the methods used in the past; this led to unsatisfactory therapeutic effects. In general, AP is painless, non-traumatic, without untoward reactions. It inhibits withdrawal symptoms (the abstinence syndrome) and is cheap, simple and easily accepted by smokers. AP can be tried when other methods fail.

H. AP and the Cardiovascular System

1. GENERAL
Cheng_L; Wu K; Qie Z (1990) [Role of "Qi" in reaching affected area using AP in "promoting circulation of Xue (Blood) to remove Xue Stasis"]. Chung Hsi I Chieh Ho Tsa Chih Apr 10(4):209-211, 196. Baoding District Hospital of TCM. In the present work, an experimental observation was carried out with the determination method of bioelectric impedance in 78 cases of chronic hepatitis, 58 cases of chronic obstructive pulmonary disease (COPD), 45 of obstructive thromboendarteritis and 65 of CHD, who were diagnosed definitely and possessed the symptoms and signs of Xue (Blood) Stasis and produced change in haemodynamics. GB34 and LV13 on right side were needled and 4 indices of LV Xue circulation were determined for chronic hepatitis. Bilateral LU06 points were needled and 7 indices of LU Xue circulation were detected for chronic obstructive pulmonary disease. Points along the Channel pathway were needled and 6 indices of blood circulation in the extremities were examined for obstructive thromboendarteritis. Bilateral PC06 points were needled and 4 indices of cardiovascular function were detected for CHD. In 95 cases of the above 4 diseases, Qi radiated to affected area (QiRA). 84 cases had propagated Channel sensation (PCS). 67 cases had local sensation. QiRA (Qi radiation to the affected area) produced obvious effects of dredging the Channel, and promoted circulation of Xue (Blood) to remove Xue Stasis.

Dill_SG; Gleed R; Matthews NS; Erb HN; Miller TK (1988) Cardiovascular effects of AP stimulation at GV26 in halothane-anaesthetized ponies. Am J Vet Res Oct 49(10):1708-1712. AP at GV26 is used commonly in the Orient to treat shock in human beings and other species. The cardiovascular effects of stimulation of GV26 were studied in healthy ponies during 2 episodes of halothane anaesthesia. During one anaesthetic episode, EAP was used at GV26; during the other episode, moxibustion was used at GV26. The order of the stimulations was random. A non-AP point was selected for comparable control stimulation during each experiment. Control and AP stimulations were of equal intensity. There were no significant changes in cardiac output, systemic arterial pressure, or heart rate associated with either electrical or heat AP stimulation.

Lee_HS; Song JC; Kim KS (1991) Effects of AP on the plasma atrial natriuretic peptide: Aldosterone and renin activity in man. AETRIJ 16(3-4):111-115. Wonkwang Univ Coll of Oriental Med, Iri City, Jun Buk, Republic of Korea. To investigate the effect of AP on the plasma levels of hormones, we have applied AP in the Channel points. 2 Channel points, BL25 and BL15, were selected for the hand-running AP application. The plasma levels of immunoreactive atrial natriuretic peptide, aldosterone, and renin activity were measured by RIA. AP in the Channel point BL23 decreased plasma levels of immunoreactive atrial natriuretic peptide, while that in the BL15 increased plasma levels of immunoreactive atrial natriuretic peptide. AP in the BL15 decreased plasma levels of aldosterone while that in the BL23 decreased plasma renin activity. AP in the specific Channel points may have site-specific regulatory function for the hormone levels. BL23 and BL15 may control the regulation in the body fluid and electrolytes balance.

Liu_Z8; Sun F; Li J; Shi X; Hu L; Wang Y; Qian Z (1992) Prophylactic and therapeutic effects of AP on simple obesity complicated by cardiovascular diseases. Chung i tsa chih (JTCM) Mar 12(1):21-29. We studied the changes of pathogenetic and hazardous factors and the regulatory function of the ANS on cardiovascular activities, in order to understand the prophylactic-therapeutic effects of AP and moxibustion in 102 cases of simple obesity complicated by cardiovascular diseases. The therapeutic effect of AP and moxibustion was good with a total effective rate of 88%. AP and moxibustion had benign conversion effect on the loin hip ratio (the pathogenetic factor), the arteriosclerotic index (the hazardous factor), and the function of the ANS in regulating the heart and blood vessels (the equilibrium indices of the ANS). AP is a treatment of choice for obesity and an important method to prevent and treat complicating cardiovascular diseases.

Lundeberg_T (1993) Peripheral effects of sensory nerve stimulation (AP) in inflammation and ischemia. Scand J Rehab Med Suppl 29:61-86. Dept of Physiology II, Karolinska Inst, Stockholm, Sweden.

Sugiyama_Y; Xue YX; Mano T (1995) Transient increase in human muscle sympathetic nerve activity during manual AP. Jpn J Physiol 45(2):337-345. Dept of Autonomic and Behavioral Neurosciences, Nagoya Univ, Japan. To clarify the effects of manual AP on the ANS, we measured efferent muscle sympathetic nerve activity (MSNA) from the right peroneal nerve while simultaneously recording blood pressure and heart rate both during the resting period and after manual AP applied to ST36 of the same limb. The needle was rotated intermittently for 30 s at 5-min intervals. MSNA increased transiently with the suppression of heart rate during rotation of the AP needle. No consistent change in blood pressure was found throughout the AP session. After removal of the needle, both the MSNA and heart rate returned to the initial control values, and the mean blood pressure showed an increase over the resting value. MSNA showed a negative correlation with heart rate in 4/5 subjects who received AP. The AP manoeuvre evoked coactivation of cardiac vagal and muscle sympathetic nerves.

Wang_WK; Hsu TL; Chang HC; Wang YY (1995) Effect of AP at ST36 on the pulse spectrum. AJCM 23(2):121-130. Biophysics Lab, Academia Sinica, Nankang, Taipei, Taiwan, ROC. Effect of AP at ST36 was examined by investigating the pulse variation of the radial artery. AP at ST36 had a specific effect on the Fourier components of the pulse. The harmonic proportions were redistributed (C2, C4 decreased, C5, C6, C8 and C9 increased), and the phase angle of the 5th and 8th harmonic waves were decreased (propagating faster). This specific frequency effect was not found when AP needle was applied on a non-AP point. These results can be explained by the resonance theory, which provides a scientific explanation of the AP effect from the haemodynamic view point.

Xi_YA; Zou P; Song T (1993) Effect of EAP at PC06 on sino-atrial conduction in patients without sick sinus Syndrome. Chung Kuo Chung Hsi I Chieh Ho Tsa Chih Nov 13(11):663-664, 644. Lab of Cardiovascular Diseases, Weifang People's Hospital, PRC. Effects of EAP on sino-atrial conduction times (SACT) were studied in 10 patients with normal sinus nodal function. SACT was calculated from sinus node ECGs. PC06 was the main point for EAP, with PC05 as a secondary point. During EAP, and in period of intrinsic heart rate (IHR0), SACT was significantly shorter than in controls (p <.01 and p <.001, respectively). But EAP during IHR0 could not further shorten the SACT (p <.05). EAP at PC06 as a main point can improve sino-atrial conductivity in most patients with normal sinus node function. This effect seems to be mediated by the ANS. The normal value of SACT after autonomic nerve blockade needs to be established.

Yao_T (1993) AP and somatic nerve stimulation: mechanism underlying effects on cardiovascular and renal activities. Scand J Rehab Med Suppl 29: 7-18. Dept of Physiology, Shanghai Med Univ, PRC. AP and AP-like somatic nerve stimulation exert modulatory effects upon cardiovascular and renal activity under different physiological and pathophysiological conditions. AP facilitates the physiological reflexes in response to changes in internal or external environment. Thus, AP can lower high blood pressure in hypertensives, elevate low blood pressure in hypotensives, and promote urinary Na excretion during hyperosmotic challenge, etc. AP effects are thought to be mediated by activation of the small myelinated fibres coming from muscle receptors. Preliminary studies show that different neurotransmitters and neuropeptides are involved in the effects of AP.

Yao_T (1993) AP and somatic nerve stimulation: mechanism underlying effects on cardiovascular and renal activities. Scand J Rehab Med Suppl 29:7-18. Dept of Physiol, Shanghai Med Univ, PRC. AP and AP-like somatic nerve stimulation exert modulatory effects upon cardiovascular and renal activity under different physiological and pathophysiological conditions. It seems that AP facilitates the physiological reflexes in response to changes in internal or external environment. Thus, AP can lower high blood pressure in hypertensives, elevate low blood pressure in hypotensives, and promote urinary sodium excretion during hyperosmotic challenge, etc. AP effects are thought to be mediated by activation of the small myelinated fibres coming from muscle receptors. Preliminary studies show that different neurotransmitters and neuropeptides are involved in the effects of AP.

Zufrin_AM; Il'in SB; Kachan AT; Bogdanov NN; Bogdanova TA (1990) [Dynamics of modulation super-slow waves in EEG and EKG during weak infrared irradiation of the "Heart" AP point of the floor of the auricle]. Fiziol Cheloveka Nov-Dec 16(6):97-102. In Russian.

2. BLOOD PRESSURE
Akhmedov_TI1; Vasil'ev IuM; Romanov DA (1991) [Criteria of the efficacy of AP and psychotherapy in hypertension patients]. Vrach Delo Aug 8:100-101. In Russian.

Akhmedov_TI2; Vasil'ev IuM; Masliaeva LV (1993) The haemodynamic and neurohumoral correlates of the changes in the status of hypertension patients under the influence of AP. Terapevticheskii Arkhiv 65(12):22-24. In Russian. AP with silver needles in Ear and Body zones with additional effects of AP zones in microneedle pressing produced a hypotensive action in 360 patients with initial essential hypertension. This effect, in 82% of patients, was not the only positive response; there was also a fall in hyperkinetic Syndrome with a significant fall in energy consumption, reduction in circadian excretion of adrenaline, inhibition in the activity of plasma renin and normalization of lipid metabolism. The hypotensive effect in most patients persisted for 12 mo. Hyperactivity of plasma renin, hypokinetic and extremely hyperkinetic haemodynamic types set limitations for the method efficacy.

Berus_AV; Gaponiuk PIa; Iotova VG; Shmal' OV; Stolbikov AE (1993) [Regularities of the effect of AP on EEG and haemodynamic parameters as a function of the initial type of circulation in hypertensive patients]. Fiziol Cheloveka May-Jun 19(3):36-46.

Bobkova_AS; Gaponiuk PIa; Korovkina EG; Sherkovina TIu; Leonova MV (1991) [The effect of AP on endocrine regulation in hypertensive patients]. Vopr Kurortol Fizioter Lech Fiz Kult Jan-Feb 1:29-32. Stage I-II essential hypertension subjects (n=35, aged 25-63 yr) were examined after the 1st and 10th session of AP to clarify the effect of a single session and a course of AP treatment on blood ACTH, STH, TTH, beta-End, neurotensin, thyroxine, aldosterone, cortisol and plasma renin activity. The hormonal spectrum was determined by RIA using special kits. The blood was obtained before AP, 5 min after introduction of the needles, immediately and 30 min after their removal. AP-related decline of arterial pressure occurred in participation of pituitary and adrenal hormones as well as polypeptides beta-End and neurotensin.

Feng_GM; Xing DJ; Sun QX (1994) [Effects of AP on blood pressure, SOD, LPO and five kinds of trace elements to stenosis of renal artery caused hypertensionin rats]. Chung Kuo Chung Hsi I Chieh Ho Tsa Chih Dec 14(12):739-741. Third Teaching Hospital, Norman Bethune Univ of Med Sciences, Changchun. Changes of blood pressure, superoxide dismutase (SOD), lipid peroxidation (LPO) and level of 5 kinds of trace elements including Cu, Zn, Fe, Ca, Mg were observed before or after AP treatment in the stenosis of renal artery caused hypertension in rats [correction of mice]. AP at ST36, PC06, SP06 and KI01 in mice reduced blood pressure significantly and influenced the levels of SOD, LPO and 5 kinds of trace elements in the stenosis of renal artery caused hypertension in mice. Possible mechanisms of AP in reducing blood pressure and influencing the changes of SOD, LPO and 5 kinds of trace elements were discussed.

Gao_M; Xu W; Chen W; He L (1994) Involvement of mu opioid receptors of periaqueductal grey (PAG) in AP inhibition of noxious blood pressure response in rabbits. AETRIJ Jun-Sep; 19(2-3):81-88. Dept of Neurobiology, Shanghai Med Univ, PRC. Strong electric shock stimulation of the rabbit front paw elicited a pressor blood pressure response regarded as noxious response. Ligands of mu opioid receptors were microinjected into the PAG to observe their effects on AP inhibition of the pressor response. Ohmefentanyl (OMF), a mu-agonist, significantly attenuated the pressor response. Mu-antagonist TCTAP greatly enhanced the pressor response. EAP significantly inhibited the pressor response, the inhibition being readily reversed by TCTAP. The response after TCTAP was significantly greater than that of the control before EAP. Noxious stimulation activated PAG mu-opioid receptors to modulate the noxious response and EAP enhanced that activation.

Gaponiuk_PIa; Leonova MV; Iotova VG (1991) [The AP stimulation of the hand points in hypertension patients with different types of blood circulation]. Vopr Kurortol Fizioter Lech Fiz Kult Mar-Apr 2:44-46.
Huang_HQ; Liang SZ (1991) Improvement of blood pressure and left cardiac function in patients with hypertension by Ear-AP. Chung Hsi i Chieh Ho Tsa Chih - Chin J of Modern Developments in Trad Med Nov 11(11):654-656, 643-644. Hubei Coll of TCM, Wuhan, PRC. [The same study was published in 1992 also: Huang H; Liang S (1992) AP at Earpoint HT to treat vascular hypertension. Chung i tsa chih (JTCM) Jun, 12(2):133-136]. They observed 30 patients with hypertension, in which blood pressure was lowered by needling of Earpoint HT. The short-term hypotensive effects of needling Earpoint HT, versus Earpoint ST, were compared. Earpoint ST was not effective as an hypotensive point. Earpoint HT had a marked hypotensive effect, whose effect rate was 100% in the short-term and 63% in the longer-term. It had a marked effect of left myocardial function, with stage 2 and 3 of hypertension, which was improved by HT point. The point had no effect on left cardiac function of normal subjects. [Abstract of 1992 text: The immediate, short-term and long-term depressor effects, the immediate effects on cardiac functions in type 2 and 3 vascular hypertension, and the effects on angiotensin 2 in grade 3 vascular hypertension by AP at Earpoint HT were studied in 30 cases of vascular hypertensive patients. The immediate depressor effect of AP at Earpoint ST was also recorded for comparison. AP at Earpoint HT gave marked immediate depressor effect (short-term effective rate 100%; longer-term effective rate 63%), as well as immediate effects on myocardial functional activities in type 2 and 3 hypertension and marked effects on angiotensin 2 in grade 3 hypertension. AP at Earpoint ST had no depressor effect on vascular hypertension].

Jin_YX; Fu Q; Guo XQ (1992) Effects of EAP of ST36 on high blood pressure and blood hyperviscosity in stress rats. J Tongji Med Univ 12(4):209-215. Dept of Physiology, Shanghai Med Univ, PRC. Elevation of blood pressure (BP) and blood viscosity (BV) was induced in unanesthetized Wistar rats by fixing and hanging. EAP of ST36 or icv microinjection of GABA (60 ug/10 uL) lowered the high BP and BV induced by fixed-hanging, which was blocked by a microinjection of GABA receptor antagonist bicuculline (60 ug/10 uL). The depressant effect of EAP on high BP and blood hyperviscosity induced by fixed-hanging may be mediated by the activation of GABA receptors in the brain.

Ku_YH; Zou CJ (1993) Tinggong (SI19), a novel AP point for 2Hz EAP-induced depressor response. AETRIJ Apr-Jun 18(2):89-96. Dept of Physiology, Beijing Med Univ, PRC. In urethane-anaesthetized, tubocurarine-immobilized and artificially ventilated rats, 2 Hz (3 V) EAP at bilateral SI19 + LI11 induced a depressor (hypotensive) response, while 10 Hz-EAP, and 2 Hz-EAP to other sets of AP points (LI04 + LI11, or LV03 + LI11) did not. Pretreatment, with either phentolamine, propranolol or methyl atropine iv, markedly reduced the depressor response, indicating that the sympathetic vasoconstrictor nerve, the cardiac sympathetic nerve and cardiac vagal nerve all are involved in the hypotensive response.

Ku_YH; Zou CJ (1993) Beta-endorphinergic neurons in nucleus arcuatus and nucleus tractus solitarii mediated depressor-bradycardia effect of 2 Hz EAP at "Tinggong" (SI19). Dept of Physiology, Beijing Med Univ, PRC. AETRIJ Jul-Dec 18(3-4):175-184. We found previously that the RVL mediates the depressor bradycardia response (DpB) to the excitation of beta-endorphinergic neurons in AR or NTS. Now, CNS mechanisms underlying the DpB effect of 2 Hz-EAP (EAP-DpB) at SI19 were analyzed: 1.        Brain transection caudal to nucleus arcuatus (AR) or procaine preinjection into bilateral AR blocked the EAP-DpB; 2.        Preinjection of naloxone into bilateral nucleus paraventricularis reversed the EAP-DpB, but beta-End antiserum had no significant effect on the EAP-DpB; 3.        Preinjection of procaine into the nucleus commissuraris (the caudal NTS), also blocked the EAP-DpB; 4.        Preinjection of naloxone or beta-End antiserum into bilateral rostral ventrolateral medulla (RVL) attenuated or reversed the EAP-DpB. EAP-DpB is mediated by the beta-endorphinergic projections from the AR and NTS to RVL; the mechanism underlying the reverse of the EAP-DpB by naloxone injection into nucleus paraventricularis was discussed.

Lee_HS; Kim JY (1994) Effects of AP on blood pressure and plasma renin activity in two-kidney one clip Goldblatt hypertensive rats. AJCM 22(3-4):215-219. Dept of Physiology, Wonkwang Univ, Coll of Oriental Med, Iri city, Korea. Shixuan (A 01) are Strange Extra-Channel Points on the tips of each finger. These AP points have long been used to treat cardiovascular disease. Alterations in the renin-angiotensin system are considered as the pathophysiological basis of the origin and/or maintenance of hypertension. Activation of the plasma or tissue renin-angiotensin system may be one cause of hypertension. This study examined the effects of AP on blood pressure and plasma renin activity. AP was applied at A 01 of two-kidney one clip Goldblatt hypertensive rats. Both systolic blood pressure and plasma renin activity fell significantly after AP at A 01. In the sham-operated and control rats, the procedure influenced the parameters without significant changes. The suppressive haemodynamic effect of AP at A 01 was related to changes in plasma renin activity.

Liu_ZCo1 (1990) [Regulatory effects of AP and moxibustion on simple obesity complicated with hypertension]. Chung Hsi I Chieh Ho Tsa Chih Sep 10(9):522-525, 515. Nanjing Coll of TCM, PRC. AP and moxibustion is one of the important therapies in TCM for treating obesity. The authors have treated 41 simple obese patients complicated with hypertension by AP and moxibustion, with good results. In the treated group, a total effective rate was 88% (36 cases). For the purpose of understanding regulatory effect of AP and moxibustion, the authors have observed the obesity indices, the lipid indices (TC, TG, VLDL-C, TC/HDL-C, HDL-C, LDL-C, LDL-C/HDL-C and AI), the physiological indices (saliva secretion, heart rate, respiratory rate, blood pressure and temperature) and the energy metabolism indices (BMR) in the simple obese complicated with hypertension before and after the AP and moxibustion. The therapeutic effect of AP and moxibustion was good. They helped to regulate overeating, blood pressure, indexes of the ANS, lipid level and energy metabolism.

Ohsawa_H; Okada K; Nishijo K; Sato Y (1995) Neural mechanism of depressor responses of arterial pressure elicited by AP-like stimulation to a hindlimb in anaesthetized rats. J Auton Nerv Syst 20 Jan 51(1):27-35. Lab of Physiology, Tsukuba Coll of Technology, Japan. The effects of AP-like stimulation of a hindlimb on renal sympathetic nerve activity (RNA) as well as mean arterial blood pressure (MAP) were examined in anaesthetized rats. An AP needle (diameter of 160 um) was inserted into the skin of a hindlimb and underlying muscles to a depth of 5 mm and was twisted at circa 1 Hz. Under deep anaesthetic condition, in circa 70% of trials, AP-like stimulation for 60 s induced a decrease in MAP which was accompanied by a decrease in RNA. AP-like stimulation applied to the muscles alone, but not to the skin alone, induced inhibition of RNA and MAP. Transection of sciatic and femoral nerves ipsilateral to the hindlimb stimulation completely abolished the responses of RNA and MAP. The hindlimb stimulation excited the femoral and common peroneal afferent nerves. In spinalized animals, the hindlimb stimulation did not produce any changes in RNA and MAP. The decrease in MAP induced by AP-like stimulation of a hindlimb is a reflex response. The afferent pathway is composed of hindlimb muscle afferents while the efferent pathway is composed of sympathetic vasoconstrictors including the renal nerves. Endogenous opioids may not be involved in the present reflex, because an iv injection of naloxone, an antagonist of the opioid receptors, did not influence the reflex.

Radzievskii_SA; Fisenko LA; Lebedeva OD (1991) The effect of AP on the haemodynamics and tolerance for physical loads in patients with cardiovascular diseases. Voprosy Kurortologii, Fizioterapii i Lechebnoi Fizicheskoi Kultury Mar-Apr(2):303. In Russian. Discontinuation of chemotherapy substituted for a course of AP and EAP in 124 patients with CHD, essential hypertension and neurocirculatory dystonia gave a positive response of cerebral and peripheral haemodynamics, myocardial contractility and diastolic function. Myocardial hypertrophy regressed, exercise tolerance enhanced. Reflex activation of stress-limiting systems arresting excess adrenergic action on circulation probably causes these phenomena.

Williams_T; Mueller K; Cornwall MW (1991) Effect of AP-point stimulation on diastolic blood pressure in hypertensive subjects: a preliminary study. Physical Therapy Jul 71(7):523-529. Havasu Samaritan Regional Hospital, Lake Havasu City, AZ 86403. EAP of 4 specific antihypertensive AP points (LV03, ST36, LI11, and the Groove behind the ear for Lowering Blood Pressure) was examined in order to determine the effect of this stimulation on diastolic blood pressure in 10 subjects with diastolic hypertension. Subjects were assigned at random to 2 groups: 1=EAP at the antihypertensive points; 2=Sham-EAP (electrostimulation of non-AP-point areas). Repeated-measures analysis of variance showed an immediate and significant reduction of diastolic blood pressure for the EAP v Sham-EAP group poststimulation. More research is needed to see if there are other AP points, stimulation characteristics, or modalities that can enhance the hypotensive effect of EAP, and whether that effect can last for a clinically significant time.

Zhou_Y; Chen Q; Hou Z; Chen Y (1993) Experimental research on treatment of hypertension with AP. JTCM Dec 13(4):277-280. Inst of AP and Moxibustion, Anhui Coll of TCM, Hefei, PRC. The effects of AP on blood pressure, microcirculation of bulbar conjunctiva and haemorheology in spontaneous hypertensive rats (SHRs) were observed. The mechanism of AP to lower blood pressure is discussed from the viewpoint of microcirculation and haemorheology. SHRs and Wistar rats of both sexes weighing circa 250g were assigned to 3 groups: 1=Xie AP in SHRs (n=15) at LI11, LV03, LI04 and ST36 twice/d for 15 d, with the needle retained for 15 min and the reducing method used for twisting and twirling; 2=Control SHRs (Untreated, n=10); 3=Control Normal Wistar rats (n=10). All rats in groups 2 and 3 were treated in the same way as in Group 1 except for the AP. The blood microcirculation and morphology of the bulbar conjunctiva in SHRs were obviously abnormal: capillaries with blood flow were reduced in number, the arterioles were spastic and of smaller diameter, the venules were dilated due to blood stasis which had a slow granular blood flow, blood viscosity was increased, haematocrit increased, and the time for RBC electrophoresis prolonged. The blood was in a state of high viscosity, high concentration and high aggregation. AP treatment reduced blood pressure, and remarkably improved the morphology, blood microcirculation and haemorheology of the bulbar conjunctiva of spontaneously hypertensive rats.

3. HEART RHYTHM
Bobrov_VA; Galichanskii IV; Bobrova EV; Mikhalkin IA; Kupnovitskaia IG; Zalesskii VN (1993) The optimization of the anti-arrhythmia effect of kordaron and novocainamide by laser biostimulation therapy in a combined program for treating refractory tachyarrhythmias. Ter Arkh 65(3):62-64. Antiarrhythmic action of He-Ne laser, in combination with novocainamid and kordaron, has been tried in a program on combined treatment of tachyarrhythmia. In refractory patients, He-Ne laser irradiation enhanced the effect of novocainamid, which arrests the paroxysms, and of cordarone, which prevents paroxysms of atrial tachycardia, fibrillation, flutter.

Lovick_TA; Li P; Schenberg LC (1995) Modulation of the cardiovascular defence response by low frequency stimulation of a deep somatic nerve in rats. J Auton Nerv Syst 3 Jan 50(3):347-354. Dept of Physiology, Med Sch, Birmingham, UK. In rats anaesthetised with alphaxalone/alphadolone, electrostimulation in the dorsal part of the PAG produced a pressor response with tachycardia and vasodilatation in the hind limb, a Syndrome known as the "cardiovascular defence reaction" owing to its resemblance to fear-induced haemodynamic changes. After a 20-min period of stimulation of the peroneal nerve at 10 Hz with current intensities sufficient to recruit group II and III fibres the pressor component of the response was significantly reduced compared to control rats. The maximum decrease of the PAG-evoked pressor response was circa 50% (from 32.0+0.7 to 16.6+5.9 mm Hg). The effect lasted for between 60 and 290 min and was not correlated to baseline blood pressure changes observed after the stimulation of the nerve. In contrast, the tachycardia and hind limb vasodilator components of the defence response as well as their baseline values remained unchanged. Resting blood pressure did not change significantly in control rats but showed a small progressive increase in stimulated rats which reached significance 90-100 min after the stimulation. The afferent input from high threshold fibres in a muscle nerve produced a selective and long-lasting depression of the vasoconstrictor components of the midbrain-evoked cardiovascular defence response. This effect is discussed in relation to the long-lasting sympathoinhibitory effects of AP-like stimulation or sustained physical exercise.

4. HAEMORRHAGE/SHOCK
Chen_FP; Hwang SJ; Lee HP; Yang HY; Chung C (1990) Clinical study of syncope during AP treatment. AETRIJ 15(2):107-119. Dept of Med, Veterans General Hospital, Taipei, Taiwan, ROC. From Aug 1988 to Apr 1989, we observed 52 patients who developed so-called "needle fainting" (or what the Chinese call "Yun-Cheng" phenomenon) 55 times among a total sample of 28285 procedures of AP therapy at the Centre for Traditional Med of Veterans General Hospital in Taipei. Of these syncopal patients, 35 were male and 17 were female. Their mean age was 45 (range 11-72) yr. All patients were in an upright position when needle fainting occurred. Their usual manifestations were pallor, cold sweating, nausea, and bradycardia. They all recovered soon after lying down; no one developed a complete loss of consciousness. No mortality was noted. When comparing the patients who experienced syncope during their first visit to our Clinic (Group I, n=27) with the patients who experienced syncope in a follow-up treatment (Group II, n=25; 3 patients had 2 episodes in sequential treatments), we found a significantly higher incidence of needle fainting (p <.0001) in Group I patients (27/2,855 or 0.94%) than in Group II patients (28/25430 or 0.11%). The mean age of Group I patients (39+15.4 yr) was significantly less than that of Group II patients (51.6+18.0 yr) (p <.001). The coexistence of other medical problems was significantly higher in Group II patients (72%) than in Group I patients (18.5%) (p <.0001).

Deng_S (1990) AP treatment of syncope based on differentiation of signs and symptoms. Inst of AP, Sichuan Acad of TCM. JTCM Sep 10(3):182-188. The 3 typical cases reported above were syncopic patients of different types. Case 1 was a Yin Xu (Deficiency Syndrome), case 2 was a Yang Xu (Deficiency Syndrome), and case 3 was a Jue Syndrome due to disturbance between Qi and Xue (Energy and Blood) induced by Qi Xu and Phlegm Stasis. All of the 3 cases were satisfactorily cured with AP and moxibustion though they did not respond to western medicines. The rationale of AP treatment for syncope includes: 1) Regulate Yin and Yang: For Yin Xu (Deficiency Syndrome), Bu (Reinforcing method) is mainly used to nourish Water to promote reproduction of the Body Fluids and replenish Yin to restore Yang; in case of Yang Xu (Deficiency Syndrome), moxibustion and needle-warming methods are mainly used to nourish the depleted Yang to rescue the patient from collapse and restore Yin. 2) Resuscitate the patient by regulating Qi-Xue and dredging the Channels to activate the circulation of Qi-Xue. After a successful resuscitation, the patient should be radically treated with appropriate herbal medicines so as to consolidate the therapeutic efficacy. 3. An emergency treatment for syncopal patients with AP and moxibustion must be based on a conscientious differentiation of the signs and symptoms. The treatment should strictly follow the therapeutic principles: Bu (reinforce) for Xu (Deficiency), Xie (Reduce) for Shi (Excess), Cool the Heat and Warm the Cold.

Hou_Z; Song X; Tang Z (1995) [An observation of protective effect of AP on the cardiac function and anti-haemorrhagic shock]. Chen Tzu Yen Chiu 20(1):44-47. Inst of AP and Channel, Anhui college of TCM, Hefei. This paper reports the study of the effect of the cardiac function and arterial pressure on rabbits with haemorrhagic shock by EAP PC06 point. PEP was shortened, ET was lengthened, SV, CO and Map were raised by needling PC06 and the each index was significantly different (p <.001). AP strengthened myocardial contractile force, protected the cardiac pump function, raised the blood pressure and had a positive role against haemorrhagic shock.

Huang_K; Zhang X; Cai H (1992) [Observations on the changes in plasma pH and K level and the effect of AP on them in rats with haemorrhagic shock]. Chen Tzu Yen Chiu 17(2):133-135. Inst of AP and Moxibustion, Chinese Acad of TCM, Beijing, PRC. The effects of AP at GV26 were studied in rats with haemorrhagic shock in relation to changes of pH and K-level of the blood. Experimental rats were assigned at random to 3 groups: 1=Controls undergoing surgery; 2=Controls in haemorrhagic shock; 3=AP in haemorrhagic shock. Blood pH and K-level did not change significantly in the surgical control group (n=15). Haemorrhagic shock, maintained for 1 h, significantly decreased blood pH (n=30, p <.01) and increased K-level (n=26). As the shock time increased, blood pH decreased continually (n=14) and blood K-level increased significantly (n=12), but pH tended to increase again after AP at GV26 for 15 min (n=16), while K-level continued to increase (n=14, p <.05). AP slightly rectified the acidosis in haemorrhagic shock in rats, possibly via modulating the respiratory function and reducing the acidic metabolites in blood. AP did not significantly correct shock-induced hyperkalaemia.

Kumar_A2; Bihari A (1996) EAP for Resuscitation in Canine. Indian Vet J May 73(5):573-575. Govind Ballabh Pant Univ Agr & Technol, Coll Vet Sci, Dept Surg & Radiol, Pantnagar 263145, Uttar Pradesh, India.

Smith_FW Jr (1992) AP for cardiovascular disorders. Prob in Vet Med Mar 4(1):125-131. Cardiopet, Inc., Floral Park, New York, NY, USA. AP had significant effects on cardiovascular function and was effective therapy for many cardiovascular ailments in experimental studies in animals and clinical studies in humans. In Vet practice, AP should be considered as adjunctive therapy in cases of shock and cardiac arrest. AP may also help as adjunctive or sole therapy in the management of congestive heart failure, arrhythmia and systemic hypertension.

Song_X; Tang Z; Hou Z; Shan H; Chen Y (1990) [The anti-haemorrhagic shock of AP on PC06 and its effect on the cardiac pump function and the blood viscosity]. Chen Tzu Yen Chiu 15(1):30-34. Inst of AP and Channel, Anhui Coll of TCM, Hefei, PRC. The purpose of this paper is to study and analyze the effects of the cardiac pump function and the blood viscosity on rabbits with haemorrhagic shock by puncturing PC06. 30 rabbits were assigned to 2 groups: 1=Experimental haemorrhage + EAP (EA, n=15) and; 2=Experimental haemorrhage Control (untreated, n=15). Cardiac pump function, blood pressure and blood viscosity were recorded pretreatment and during haemorrhagic shock phase. Results: 1. AP at PC06 raised the mean arterial blood pressure (MAP) of rabbits in haemorrhagic shock from 43+8 to 87+15 mm Hg (p <.001). 2. AP at PC06 reinforced cardiac pump function on all indices measured; SV increased from 0.41+0.46 (before EA) to 0.73+0.12 ml (p <.0001). CO, SI, CI and WL all improved to some degree with different statistical significance. In all cases, indices of cardiac pump function were significantly higher in the EAP group than in the control group. 3. AP at PC06 tended to normalise blood viscosity; plasma viscosity increased. Differences between EAP- and control- changes were significant (p <.05). AP at PC06 protected the function of the cardiac pump, raised blood pressure and had a positive role in combatting haemorrhagic shock.

Song_X2; Tang Z; Hou Z; Zhu S (1993) An experimental study on AP anti-haemorrhagic shock. Chung i tsa chih (JTCM) Sep 13(3):207-210. Inst of AP and Channels, Anhui Coll of TCM, Hefei, PRC. The effect of AP at PC06 on regulating haemorrhagic shock was studied in 90 rabbits. AP at PC06 raised blood pressure, protected cardiac pump function, corrected the disturbance of secretion and metabolism of humoral factors and reduced blood adhesion to normal level. These effects provide a scientific basis for the effects of AP at PC06 in countering haemorrhagic shock.

Tang_Z; Song X (1990) [The effect of AP on the changes of ANP and AII in plasma of rabbits with haemorrhagic shock]. Chen Tzu Yen Chiu 15(2):140-142. Inst of AP and Channels, Anhui Coll of TCM Hefei, PRC. RIA was used to measure the changes of atrial natriuretic polypeptide, (ANP) and angiotensin (AII) in plasma of normal and haemorrhagic shock rabbits. The effect of AP on the changes of ANP and AII in plasma of haemorrhagic shock rabbits was noted. ANP and AII levels in plasma increased in haemorrhagic shock extended. AP at PC06 had anti-shock effect by increasing blood pressure and decreasing the ANP and AII in plasma. Shock may promote the secretion and reduce the disintegration of ANP. AP has anti-shock effect by increasing blood pressure and correcting the disturbance of secretion and metabolism of ANP and AII during shock.

Ying_S; Cheng J (1994) [Effects of EAP on EEG during transient global ischemia and reperfusion in gerbils]. Chen Tzu Yen Chiu 19(1):29-32. Dept of Neurobiol, Shanghai Med Univ, PRC. Effects of EAP on total power of EEG at different periods of global ischemia and reperfusion was studied using the gerbil model of acute global ischemia and reperfusion. EAP (7 Hz, 5-6 mA, for 30 min) was used at GV16 and GV08. Recording was made before ischemia and 0 min, 15 min, 30 min, 60 min, 120 min and 240 min after reperfusion respectively. Results: 1. In the control group, after 10 min of ischemia, the amplitude of EEG was severely inhibited, even flat, and the total power of EEG was significantly decreased to 1.4+1.3%. After reperfusion, recovery of total power was very slow. The peak level of recovery occurred at 120 min after reperfusion was 27.4+11.3%. 2. In comparison with the control group, EAP remarkably improved the recovery of EEG after ischemia and reperfusion. The recovery of total power was 71.5+16.5% (p <.01), and 75.3+18.4% (p <.01) at 120 min and 240 min after reperfusion respectively. EAP reduced the EEG inhibition during global ischemia and improved the recovery after reperfusion.

Ying_SX; Cheng JS (1994) Effects of EAP on C-FOS expression in gerbil hippocampus during transient global ischemia. AETRIJ Oct-Dec 19(4):207-213. Dept of Neurobiol, Shanghai Med Univ, PRC. Using experimental acute global ischemia in gerbils, we studied the effects of EAP on C-FOS expression and the histological changes in various regions of the hippocampus. EAP (7 Hz, 6 mA for 30 min) was given at GV16 + GV08. EAP substantially potentiated the induction of C-FOS protein-like immunoreactivity (CFPLI) in neurons of various hippocampal regions after transient global ischemia, especially in the CA1 subfield. It also prevented delayed degeneration after ischemia in most of the CA1 cells. EAP protected hippocampal neurons after cerebral ischemia and C-FOS may be involved in this process.

5. SLEEP DISORDERS
Buguet_A; Sartre M; Le Kerneau J (1995) [Continuous nocturnal automassage of an AP point modifies sleep in healthy subjects]. Neurophysiol Clin 25(2):78-83. Centre de recherches du service de santé des Armées Emile-Pardé, La Tronche, France. To test the somnogenic properties of the automassage of point 7 heart of AP, polygraphic night sleep was studied in 6 healthy volunteers (age: 27.8+1.6 yr) from 23:00 h to 07:00 h. After one night of adaptation, 2 PEBA cones (Polyether Block Amides; Isocones) were fixed bilaterally at both points HT07 (active application, AA) or on the back of hand (placebo application, AP). The alternate application was used 2 wk later, using a randomized, double-blind, and cross-over protocol. Cyclic alternating patterns (CAP) were also analyzed on the electroencephalogram during non-REM sleep. Sleep efficiency increased in AA, due to a decrease in wakefulness, and an increase in total sleep time due to an increase in non-REM sleep. The number of CAP decreased in AA, as did the number of CAP sequences and the ratio of CAP duration to total sleep time (CAP rate) and to the duration of slow-wave sleep. In conclusion, the application of Isocones at HT07 heart during the night induced a decrease in wakefulness and an increase in non-REM sleep during night sleep in healthy subjects.

Montakab_H; Langel G(1994) [The effect of AP to treat insomnia: Clinical study of subjective and objective evaluation]. Schweiz Med Wochenschr Suppl 62:49-54. The sleep-wake cycle is the most important circadian rhythm in man and thus constitutes an excellent indicator of internal equilibrium and of health. Sleep disorders, and particularly insomnia, affect a great % of the population. In daily practice, an inappropriate treatment may transform a bad sleeper into an insomniac dependent on pharmaceuticals for life. It is therefore necessary to give priority to non-chemical treatments in the management of insomnia. AP, which offers a personalized treatment, is particularly indicated for reharmonizing a disturbed sleep-wake cycle. Also, there is an interesting similarity between the 5000-yr-old theoretical basis of Chinese medicine and the recent scientific discoveries about man's internal rhythms. Clinical and statistical studies of the effects of AP on insomnia are rare and evaluate only the subjective appreciation of sleep. Objective analysis of sleep by polysomnography permits evaluation of sleep architecture and visualizes the site and depth of action of the therapeutic method. Such studies have only been conducted in relation to pharmaceutical treatments. No such study has been done for AP. A scientific, objective evaluation by polysomnography of the effects of AP on insomnia is of academic and practical interest. If its efficiency is thus verified, AP may be integrated with other classical therapeutic methods in insomnia.

Xie_L; Xie L; Dong X (1994) 124 cases of dyssomnia treated with AP at Sishencong (Z 01) points. JTCM Sep 14(3):171-173. Wendeng County Orthopaedic Hospital, Shandong Province, PRC.

6. PHYSICAL STAMINA
Ehrlich_D; Haber P (1992) Influence of AP on physical performance capacity and haemodynamic parameters. Int J Sports Med Aug 13(6):486-491. Dept of Sport and Performance Med, Klinik fur Innere Medizin IV, Univ of Vienna. A single blind study examined the effects of AP-needling of specific points on the capacity for physical performance and the regulation of heart rate and blood pressure. Healthy young men were assigned at random to 3 groups (n=12/group): 1=AP; 2=Placebo AP; 3=Control (untreated). Performance was determined by means of a spiro-ergometer test which was carried out pre-trial and after 5 wk of treatment consisting of one session/wk. Overall, compared with the pre-study performance-test, Group 3 (no treatment), deteriorated; Group 2 showed no significant changes; Group 1 improved significantly. AP increased maximum performance capacity and physical performance at the anaerobic threshold, indicating functional improvement in haemodynamic and metabolic mechanisms.

Ehrlich_D; Haber P (1992) Influence of AP on physical performance capacity and haemodynamic parameters. Int J Sports Med Aug 13(6):486-491. Dept of Sport and Performance Med, Klinik für Innere Medizin IV, Univ of Vienna. In a single blind study the question as to whether the needling of specific AP points is able to produce an increase in physical performance capacity and better regulation of heart rate and blood pressure was examined. 36 healthy young men were assigned at random to 3 groups: 1=AP; 2=Placebo-AP; 3=Control (untreated). Patients were treated once/wk for 5 wk. Performance was assessed by a spiro-ergometer test at the beginning and the end of the 5-wk treatment period. The untreated control group showed unfavourable changes in the values obtained compared with the results of the performance test at the start of the study. Overall, the placebo-AP had no noticeable effect. AP (Group 1) significantly increased maximum performance capacity and physical performance at the anaerobic threshold. AP induced functional improvement in haemodynamic and metabolic mechanisms.

Kaada_B (1993) Enhanced Athletic Performance: The Chinese runners' revolution. Tidsskrift for den Norske Laegeforening 10 Dec 113(30):3799-3801. Scientists are discussing possible explanations for the fantastic improvement in physical performance achieved by Chinese female runners in 1993. Additional procedures must have been used as well as intense training. An old study, reported in AETRIJ (1984; 9:65-80), showed a marked increase in physical performance after low-frequency (2 Hz) TENS in athletes competing in swimming, running and cycling events. The Chinese knew of this study, and TENS may have been one of the methods used. As it is impossible to show that athletes have received such treatment, neither TENS nor AP are regarded as doping.

Yu_Q; Chen Y (1990) [Effect of AP on exercise ability in rabbits]. Chung Hsi I Chieh Ho Tsa Chih Jun 10(6):359-360, 326. Chengdu Inst of Physical Education, PRC. 7 male rabbits were exercised to tiredness on the P20 type table. Arterial blood samples were taken before and after exercise. Blood gas was tested by ABL3 acid-bases balance Lab made by Denmark's Radiometer Company. Blood pH and glucose were reduced after exercise, compared with that before exercise (p <.05). AP at bilateral BL23 prolonged their exercise-duration under the same intensity (p <.05), restored blood glucose, and maintained relatively stable blood acid-base balance. The complexity of this mechanism needs further study.

7. CARDIAC ANGINA
Alliluev_IG; Syrkin AL; Pal'tseva IS; Pecherskaia MB; Loshchenov VB; Ignatov AA; Belkina EM; Kramarenko TA; Radzievskii SA; Fisenko VA et al (1990) [Laser-AP in the complex treatment of stenocardia]. Klin Med (Mosk) Jul 68(7):54-56. Laser-AP (helium-neon) was used in 200 anginal patients. Therapeutic results were good: the number of attacks and nitroglycerin intake reduced, exercise tolerance grew, echocardiographic evidence showed a positive trend, haemodynamics improved, Spilberger's test values changed for the better.

Ballegaard_S; Karpatschoff B; Holck JA; Meyer CN; Trojaborg W (1995) AP in angina pectoris: do psychosocial and neurophysiological factors relate to the effect?. AETRIJ Apr-Jul 20(2):101-116. Dept of Int Med P, Rigshospitalet, Denmark. We studied the effect of AP in 49 patients with angina pectoris with focus on its relationship to psychosocial factors and changes in skin temperature, pain thresholds, and pain tolerance thresholds. No significant influence from patient expectation, social stress (strain) or profiles of the Minnesota Multiphasic Personality Inventory (MMPI) was found (all p >0.1). AP slightly increased exercise tolerance (median 7%), the difference in Systolic Blood Pressure-Heart Rate Product between rest and maximal exercise (delta PRP) (median 3%), and the time to onset of pain (median 10%); decreased nitroglycerin consumption (median 58%) and anginal attack rate (median 38%). Improvement in exercise tolerance was significantly correlated to an improvement in delta PRP (r=.7; p <.0001) but not to time of myocardial ischemia (r=.1; p=.1). Compared with 28 patients with a less pronounced anti-anginal effect, the 21 patients with a pronounced effect had a significant increase in local skin temperature, but had no significant change in distant skin temperature and pain thresholds. Due to haemodynamic alterations, AP may have a specific effect on angina pectoris in addition to drug treatments.

Ballegaard_S; Pedersen F; Pietersen A; Nissen VH; Olsen NV (1990) Effects of AP in moderate, stable angina pectoris: a controlled study. J Intern Med Jan 227(1):25-30. Med Dept, Rigshospitalet, Univ of Copenhagen, Denmark. In order to evaluate the effects of AP in moderate, stable angina pectoris, 49 patients were randomized to either genuine or sham AP. In sham AP needles were inserted into points within the same spinal segment as in genuine AP,but outside the Chinese Channel system. The effect was evaluated from exercise tests, anginal attack rate and nitroglycerin consumption. There were no significant differences between the effects of genuine and sham AP either on exercise test variables or on subjective variables. In patients receiving genuine AP there was a significant increase in exercise tolerance (median 9%) and in delay of onset to pain (median 10%). No significant changes were observed in patients receiving sham AP. Within both groups there was a median reduction of 50% in anginal attack rate and nitroglycerin consumption, and there was no significant difference between the results achieved in the 2 groups. The present design failed to show any significant differences between the effect of genuine and sham AP.

Ballegaard_S1; Meyer CN; Trojaborg W (1991) AP in angina pectoris: does AP have a specific effect?. J of Internal Med Apr 229(4):357-362. To overcome the methodological problems of blinding the patients and the acupuncturist in AP trials, 33 patients with stable angina pectoris, who were randomized to either genuine or sham AP, received EAP by another acupuncturist, and the change in skin temperature was recorded. The change in skin temperature correlated significantly with the degree of improvement after both genuine and sham AP. 14 patients with no decrease in skin temperature had a significantly better response to AP than 19 patients who showed a decrease in skin temperature (G II). In the former group, there was a 15% median improvement in exercise tolerance (G II 0%), a 67% improvement in anginal attack rate (G II 38), and an 84% improvement in nitroglycerine consumption (G Ir 50%). The duration of disease and the effect of AP correlated significantly. Both real and sham AP had a specific effect on some angina pectoris patients in addition to the effect of drug-therapy.

Colquhoun-DM (1993) AP and TENS: where east meets west [comment]: Electrical neurostimulation for angina pectoris. Med-J-Aust 5 Apr 158(7):440-442. and 488-489.

Kraemer_ES; Cardoso M de F; Yamamura Y (1991) AP in angina pectoris [letter; see comments]. J Intern Med Apr 229(4):384-385. J Intern Med Apr 229(4):383.

Richter_A; Herlitz J; Hjalmarson A (1991) Effect of AP in patients with angina pectoris. European Heart J Feb 12(2):175-178. Wallenberg Lab for Cardiovascular Research, Sahlgren's Hospital, Univ of Gothenburg, Sweden. 21 patients with stable effort angina pectoris were randomized in a crossover study to 4 wk traditional Chinese AP or placebo tablet treatment. The patients had at least 5 anginal attacks/wk in spite of intensive treatment. AP was given 3 times/wk at main points PC06, HT05, BL15, BL20 and ST36. Previous antianginal treatment remained unchanged during the whole study. Compared with placebo, the number of anginal attacks during the AP period fell from 10.6-6.1/wk (p<.01). The performance before onset of pain during exercise test increased from 82 W to 94 W (p<.05). However, maximal performance did not increase after AP. Intensity of pain at maximal workload decreased from 1.4-0.8 (scale 0-4, p<.01). Further, ST-segment depressions at maximal comparable load decreased from 1.03-0.71 mm after AP (p<.01). A life quality questionnaire confirmed improved feeling of well-being. Thus, AP showed an additional beneficial effect in patients with severe, intensively treated angina pectoris.

You_Z (1992) [Preliminary observation on the relationships between needling sensation of AP at PC06, Propagated Channel Sensation (PCS) and clinical AP effect in angina]. Chen Tzu Yen Chiu 17(1):75-78. Fujian Inst of TCM and Pharmacol, Fujian, PRC. This paper reports the different needling sensations (mainly distension), when AP was given at PC06 by the same doctor with the same manipulation in 300 CHD-patients with angina. Patients who reported a compound sensation (such as sourness-distension and distension-numbness) reported a higher rate of PCS and a better AP effect on angina. The AP effect was poor in all patients who did not report PCS. Other needling sensations gave an intermediate rate of PCS appearance and intermediate effects of AP effect on angina. The kind of needling sensation induced by AP was closely related to the appearance of PCS and the clinical AP effect in angina.

You_Z; Hu X; Wu B; Zhang W; Liang D (1993) [Differences in the time of appearance of AP effects between subjects with and without PCS during AP of PC06]. Chen Tzu Yen Chiu 18(2):149-153, 148. Fujian Inst of TCM Fuzhou, People's Hospital, Fujian Coll of TCM Fuzhou, PRC. Some work showed that AP at PC06 improved markedly the ECG of CHD-patients when Propagated Channel Sensation (PCS) was achieved. In contrast, patients without PCS gave a response to AP which was significantly less. Other work showed that the presence or absence of PCS did not influence significantly the beneficial clinical effects of AP. We found marked ECG changes in patients during AP of PC06, and some patients without PCS had marked changes as the duration of AP was prolonged. Thus, this trial was designed to observe any differences in the development of AP-induced EEG changes between patients with and without PCS. Patients with CHD (total 170; 86 M, 84 F; aged 35-83 yr) were observed. ECG was recorded with polygraph (model SJ-42) before AP. Then the PC06 AP point of the left forearm was punctured by slow twisting for 5 min and the presence or absence of PCS was observed carefully. PCS appeared to a varying degree in 80 patients, but not in the remaining 90. Another ECG was recorded after retaining the needle for 10 min. Retaining needle lasted for 30 min in some patients and the needle was manipulated every 16 min in order to keep the needling sensation. (ABSTRACT TRUNCATED AT 250 WORDS).

Zhou_XP4; Liu JX (1993) Metrological analysis for efficacy of AP on Angina Pectoris. Chung-Kuo Chung Hsi i Chieh Ho Tsa Chih Apr 13(4):212-214. 40 patients with stable angina pectoris got AP once or 7 times in 1 wk at PC06, HT07, HT03 or Earpoints HT, Shenmen. The effect was assessed quantitatively or semi-quantitatively according to the extent, area, frequency, duration of attack, the time of attack during exercise, and the vanishing of suffering after exercise. After just one session of AP, angina was significantly alleviated (p<.05). The time from the end of exercise to the disappearance of angina in the AP group was shorter than that in the other 2 groups.

Zhou_XQ; Liu JX (1993) [Metrological analysis for efficacy of AP on angina pectoris]. Chung Kuo Chung Hsi I Chieh Ho Tsa Chih Apr 13(4):212-214, 196. Human Coll of TCM, Changsha, PRC. AP (AP points: PC06, HT07, HT03 or Ear-points: Heart, Shenmen) was administrated once or 7 times in 1 week on 40 patients with stable type of angina pectoris. The effect was assessed quantitatively or semi-quantitatively according to the extent, area, frequency, duration of attack, the time of attack during exercise, and the vanishing of suffering after exercise. Just after one performance of AP, 15 patients' angina pectoris were significantly alleviated (p <.001) both in degree and area. After 7 times of AP 10 patients' angina pectoris were not only significantly alleviated both in extent and area, but also in frequency and duration of attack. 15 patients were randomized to an AP, non-AP or AP at non-AP points (ANA) in a single blind design. The time from the beginning of exercise to the anginal attack in active AP group was longer than that in non-AP or ANA group (p <.01), but they were similar (p >.05) in both non-AP group and ANA group. The time from the end of exercise to the disappearance of angina pectoris in AP group was shorter than that in the other 2 groups (p <.05).

8. CORONARY HEART DISEASE (CHD)
Li_L; Chen H; Xi Y; Wang X; Han G; Zhou Y; Yang D; Zhao W; Feng Z; Jiao B et al (1994) Comparative observation on effect of electric AP of PC06 at Chen time versus Xu time on left ventricular function in patients with CHD. Chung i tsa chih (JTCM) Dec 14(4):262-265. Shanghai TCM Coll. Paired experimental design was used to compare the effect on left ventricular function in patients with CHD of EAP of PC06 at Chen Time (0700-0900h, the "Full" time for ST) versus Xu Time (1900-2100h, the "Empty" time for ST). As indicated by shortening of PEPI and decrease of PEPI/LVETI ratio, EAP at circa 0800h improved left ventricular function of CHD patients. However, as indicated by prolonged PEPI and raised PEPI/LVETI ratio in CHD patients, EAP at circa 2000h impaired left ventricular function.

Liu_J3; Han Z; Cao Q; Chen S (1994) Influence of thoracic spinal subarachnoid microinjection of phentolamine on the effect of EAP. Chen Tzu Yen Chiu - AP Research 19(2):47-51. Inst of AP & Moxibustion, China Acad of TCM, Beijing, PRC. The influence of thoracic spinal subarachnoid microinjection of Phentolamine (Phen, 200ug/20ul) on the effect of EAP at PC06 was observed in 42 urethan-chloralose anaesthetized rabbits. EAP of PC06 significantly promoted recovery of elevated ST-segments and T-waves of electrocardiogram induced by acute myocardial ischemia (AMI). Subarachnoid microinjection of phentolamine had no marked influence on recovery of ST-segments and T-waves, but impeded recovery of blood pressure of post-AMI. Subarachnoid microinjection of phentolamine significantly weakened or eliminated the effect of EAP of PC06 in accelerating recovery of ST-segments and T-waves of post-AMI. Alpha-receptors of intra-thoracic spinal cord participate in the action of EAP of PC06 in improving AMI, and the upper thoracic spinal cord segment is one of the links connecting PC06 and the heart.
Liu_J4; Han Z; Chen S; Cao Q (1996) Influence of EAP of PC06 on AMI-induced changes in electrical activity of dorsal horn neurons. Inst of AP and Moxibustion, China Acad of TCM, Beijing, PRC. Adapted from WWW. The electrical activity of the dorsal horn (DH) neurons was recorded extracellularly by glass micro-pipettes in urethane-chloralose anaesthetized rabbits to analyze the role of the thoracic segments (T2-T3) of the spinal cord in the integration of information from EAP at PC06 and acute myocardial ischemia (AMI).

Results:
1.        after AMI, of 83 DH neurons, 18 showed a significant excitatory response, 14 an obvious inhibitory reaction and 51 no apparent change;
2.        after EAP at PC06, of 10 neurons with AMI-induced excitatory response, the electrical activity of 9 neurons was suppressed and the other 1 still maintained its excitatory state; of 8 neurons with AMI-induced inhibitory response, 7 were relieved from the suppressed state, the other 1 had no change after EAP;
and 3.        the receptive field and the responsive types to somatic stimulation were examined in 83 DH neurons.

Signals from EAP at PC06 and AMI converge to the DH neurons of T2-T3. DH participates in the integrative course of information from EAP and AMI and thus it is one of the connective links between PC06 and the heart.

Saku_K; Mukaino Y; Ying H; Arakawa K (1993) Characteristics of reactive electropermeable points on the Ears of CHD patients. Clin Cardiol May 16(5):415-419. Dept of Internal Med, Fukuoka Univ Sch of Med, Japan. In TCM/AP, Earpoints relate to every part of the human body by a projection of functional neuroanatomy. Using a neurometer LC-M, we studied reactive electropermeable points (REPP, points on the skin with low electrical resistance), on the Ear of patients with CHD. We found REPP points which correlated positively with special Earpoints found by Chinese workers to relate cardiac functional anatomy. These points were HT-1 (Xin) and HT-2 (Xinzo). Patients with AMI had an extremely high incidence of positive REPP points at Xin and Xinzo; patients with old myocardial infarction (OMI) and angina pectoris also had a significant number of positive REPPs in those areas. The incidence rates of REPP at Xin and Xinzo points between the OMI and angina groups were not significantly different. High incidence of positive REPP points at the LU and HT-3 (Xinshu) points occurred only in the AMI group; this was significantly high when compared with the control group.

Shi X (1996) Effect of AP on Heart Rate Variability in CHD Patients. Shi Xian, Heilongjiang College of TCM, Harbin 150040. PRC. Adapted from WWW at http://www.dmu.ac.uk/ln/cmn/[email protected] (Chin Med News, Beijing Cons Bio-Tech (e-mail: [email protected]). Using frequency domain analysis, heart rate variability (HRV) was measured in 20 CHD patients pre- and post- AP. In two groups of patients, AP at PC06 (by simple needling or by EAP) gave significant changes from pretreatment values for low frequency (LF) HRV-components (p<.05); changes in untreated control patients were not significant (p>.05). Changes in High frequency (HF) HRV-components were not significant in any group. LF/HF change was marked in the EAP group (p<.05); simple needle AP reduced LF to its lowest level in 10 min, without any rebound phenomenon. AP regulated and improved HRV in CHD; as found by many other groups, stimulation of the median nerve has practical applications in cardiology. AP mechanisms relate to CNS regulation and participation of neurotransmitters.

Xie_X2; Zeng Q; Liu X; Zhen Q; Xiao J (1994) Observation on the changes of plasma cardionatrion before and after microwave AP in CHD. Chung i tsa chih (JTCM) Mar 14(1):26-29. Dept of AP, General (301) Hospital of PLA, Beijing, PRC. The therapeutic effect of microwave AP (MWA) and its influence on the plasma level of cardionatrion is reported. 28 cases with CHD were systemically observed and studied. Atrial natriuretic polypeptides (ANP) were determined by RIA. Plasma level of ANP was elevated, the rising rate being 100%. The therapeutic effect of MWA in the 28 cases with CHD was 86%, the ECG improving rate was 82%. Effect of MWA was briefly discussed. The therapeutic effect of MWA to treat CHD was shown. Measurement of plasma ANP level was a useful method and is an objective parameter for further research.

Yin_K; Jia C (1991) Treatment of chronic coronary insufficiency with AP at PC04. JTCM Jun 11(2):99-100. Dept of AP and Moxibustion, Shaanxi College of TCM, PRC.

Zhou_JR1 (1993) Effect of Ear-AP plus needle embedding in HT point on left cardiac, humoral and endocrine function. Chung Kuo Chung Hsi I Chieh Ho Tsa Chih Mar 13(3):153-154, 132. Wuxi First People's Hospital, Jiangsu, PRC. 12 patients with dilating cardiomyopathy complicated heart failure were assigned at random to 2 groups: 1=Ear-AP (n=7) and; 2=Control (untreated, n=5). Left myocardial function and plasma levels of PRA, ALD, EDLS, ANF were measured. Ear-AP decreased CO, CI, ANF, EDLS and ALD (p <.05). Ear-AP plus needle-embedding in Earpoint HT improved left cardiac function in patients with dilating cardiomyopathy complicated heart failure; the function of specific AP points differs distinctly from other points and from non-points.

9. CARDIOVASCULAR ACCIDENT (CHD, APOPLEXY, STROKE)
Bao_XY et al (1996) Relationship Between Stimulating Quantity and Therapeutic Effects in Treatment of Apoplectic Hemiplegia by AP points of the Scalp. Adapted from WWW. The Second Affiliated Hospital, Heilongjiang Coll of TCM, 150001 PRC. 100 cases of apoplectic hemiplegia were assigned at random to 2 groups for treatment: A=Scalp AP twice/d and; B= Scalp AP once/d. One course consisted of 10 d. Therapeutic effects were assessed after two courses. The clinical effect in Group A was better than in Group B; myodynamia and skin pain threshold showed variable improvements, but the effects in Group A were better than that in the Group B. The therapeutic effects of Scalp AP correlated with the amount of stimulus.

Chen_CH; Chou P; Hu HH; Tsuei JJ (1994) Further analysis of a pilot study for planning an extensive clinical trial in traditional medicine, with an example of AP treatment for stroke. AJCM 22(2):127-136. Inst of Statistical Science, Academia Sinica, Taipei, Taiwan, ROC. Statistical methods for evaluating the effects of treatments and prognostic factors in clinical trials are discussed, including exploratory data analysis, nonparametric methods, regression modelling, and regression diagnostics of influential cases. These methods were applied to the analysis of a pilot 'randomized' controlled trial of AP-treatment of acute stroke. The use of this analysis to modify patient eligibility criteria, determine the required sample size and use stratified randomization in a future extensive stroke trial is discussed.

Chen_DZ (1990) [Evaluation of therapeutic effects of AP in treating ischemic cerebrovascular disease]. Chung Hsi I Chieh Ho Tsa Chih Sep 10(9):526-528, 515. Liaoning College of TCM, Shenyang. In this article, the therapeutic effects of AP and routine drugs in treating 20 cases of ischemic cerebrovascular disease, and in comparison with another 20 cases treated with sole routine drugs were studied. Effects of AP were evaluated from the degree of functional nervous damage, EEGs and SEPs. After treatment, mean functional nervous damage in the test group was reduced by 13 points, as compared with only 3.75 points in the control group (p <.001). Mean EEG slow wave in the test v control groups was reduced by 1.7 v 0.05 points (p <.001); theta wave was reduced 1.05 v 0.25 points (p <.001). The diversity of latent period of P45 peak wave value between left limbs and right limbs were reduced evidently in the test group and showed a significant statistical difference (p <.05) as compared with the control group. The therapeutic effects of AP were objective and were based on neurophysiological mechanism.

Chen_Y (1992) Clinical research on treating senile dementia by combining AP with AP point-injection. AETRIJ 17(2):61-73. Acupuncture Dept., Hua Shan Hospital, Shanghai Med Univ, PRC. Combining AP with AP point-injection of aceglutamide was used to treat 38 cases of senile dementia. The therapy was effective for the cases of multi-infarct dementia; total success rate was 86% (excellent 43%, improved 43%). The rating was based on the revised Hasegawa Dementia Scale and the Functional Activity Questionnaire. Also, the high density lipid-cholesterone component increased significantly after treatment.

Chen_YM; Fang YA (1990) 108 cases of hemiplegia caused by stroke: the relationship between CT scan results, clinical findings and the effect of AP treatment. AETRIJ 15(1):9-17. AP Dept., Hua Shan Hospital, Shanghai Med Univ, PRC. The location of the pathological focus on the film of CT scan was related to the degree of paralysis, and to the result of AP in hemiplegia patients. Retrospective analysis of the clinical data revealed interlinking relationships. In general, early AP treatment (in the first 3 wk) produced better results (improvement in 91% of patients treated) than treatment initiated >3 wk after stroke (improvement in 71% of patients treated).

Deng_QS; Fang ZC; Yin Y (1995) Ionic mechanism of AP on improvement of learning and memory in aged mammals. AJCM 23(1):1-9. Inst of Materia Medica, Chinese Acad of Medical Sciences, Beijing. Memory impairment is one of the most frustrating problems for older people. Several AP points were used to treat memory loss in old rats, and the elemental mechanism of AP therapy was studied with Inductively Coupled Plasma Spectroscopy. AP improved learning and memory ability significantly in aged animals when compared with controls. Elevations of 8 essential elements (B, Ca, Cu, Fe, K, Mg, Na, and P) in the brain were the ionic basis for the therapeutic effect of AP. A hypothetical model of the mechanism of AP therapy is described.

Hu_HH; Chung C; Liu TJ; Chen RC; Chen CH; Chou P; Huang WS; Lin JC; Tsuei JJ (1993) A randomized controlled trial on the treatment for acute partial ischemic stroke with AP. Neuroepidemiology 12(2):106-113. Dept of Neurology, Taipei Veterans General Hospital, Taiwan, ROC. The effectiveness of AP in acute stroke remains largely untested. A randomized, controlled trial was done to study the feasibility of AP in combination with conventional supportive treatment for acute stroke. After appropriate screening, 30 patients, aged 46-74, with the onset of symptoms within 36 h were enrolled into the study. All patients gave informed consent. Based on the same supportive treatment, patients were assigned at random to a treatment with or without AP. AP point selection was decided after several meetings of a group of senior AP doctors in Taiwan. AP was applied 3 times/wk for 4 wk. There were no problems with this trial in terms of physician cooperation and patient acceptance and availability. As assessed by neurological outcome on d 28 and d 90, AP helped stroke patients significantly. Neurological improvement was greatest in patients with a poor baseline neurological score. There were no important side effects except for one episode of dizziness related to AP treatment. The data and results of this study will be used as a guideline for planning a full-scale clinical trial, e.g. sample size calculation, method of randomization with stratification of prognostic factors, choosing AP points and technique of AP.

Johansson_K; Lindgren I; Widner H; Johansson B; Wiklund I (1993) [AP therapy in stroke: Patients experience significant improvement]. Lakartidningen 28 Jul 90(30_31):2597-2600. Neurology Clinic, Univ of Lund, Sweden.

Johansson_K2; Lindgren I; Widner H; Wiklund I; Johansson BB (1993) Can sensory stimulation improve the functional outcome in stroke patients? Neurology Nov 43(11):2189-2192. Dept of Neurology, Lund Univ Hospital, Sweden. After obtaining informed consent, we randomized 78 patients with severe hemiparesis of the left or right side within 10 d of stroke onset: 40 to a control group receiving daily physiotherapy and occupational therapy; 38 to a group that were given additional sensory stimulation (AP) twice/wk for 10 wk. Median age of both groups was 76 yr. Motor function, balance, and FROML (Barthel's Index) were assessed before the start of treatment and at 1 and 3 mo after stroke onset; FROML was also assessed after 12 mo. We assessed the quality of life (QL) using the Nottingham Health Profile 3, 6, and 12 mo after stroke onset. Patients given sensory stimulation recovered faster and to a larger extent than the controls, with a significant difference for balance, mobility, FROML, QL, and days spent at hospitals/nursing homes. Whether AP per se causes the differences requires further study.

Lai_FS (1992) Ischemic apoplexy treated with AP using the principle of replenishing Qi and promoting blood circulation. Chung-Kuo Chung Hsi i Chieh Ho Tsa Chih Apr 12(4):216-218, 196. Dept of Xiyuan Hospital, Acad of TCM, Beijing, PRC. 32 cases of ischemic apoplexy were treated by AP using the principle of replenishing Qi and promoting blood circulation. The clinical efficacy and the change of nail-fold microcirculation and haemorheology before and after the treatment were observed. Total effective rate was 94%. Before treatment, the microcirculation of nail-fold was markedly abnormal, and the criteria of haemorheology was abnormally elevated. But after the treatment, together with the recovery of nail-fold microcirculation and haemorheology, the clinical symptom and sign of the patients also improved. Thus it showed that AP method had the function of changing the microcirculation and the hypercoagulability of the patients' blood, further promote the recovery of the function of affected cerebral tissue.

Li_Y; Jin R (1994) Clinical study on the sequelae of cerebral vascular accident treated with temporal-point AP. Chen Tzu Yen Chiu - AP Research 19(2):4-7. Guangzhou Coll of TCM, Guangzhou, PRC. 108 cases of sequelae of CVA were assigned at random to 2 groups: TA=Temple-point AP (n=58 cases); BA=Body-point AP (n=50 cases). After 30 sessions, the therapeutic effects between the 2 groups were significantly different statistically (p <.01). Both AP therapies improved blood rheology but the effect of AP at points on the temple was better than at body points.

Naeser_MA; Alexander MP; Stiassny-Eder D; Galler V; Hobbs J; Bachman D (1994) AP to treat paralysis in chronic and acute stroke patients: improvement correlated with specific CT scan lesion sites. AETRIJ Oct-Dec 19(4):227-249. Boston Univ Sch of Med, MA, USA. A total of 20 stroke patients received AP, including 10 chronic and 10 acute patients. Based on CT scan lesion site data alone, 19/20 patients (95%) were correctly classified regarding a prognosis of a beneficial response to AP, versus poor response. Patients with beneficial response had damage to <50% of the motor pathway areas on CT scan, especially in the periventricular white matter area (PVWM) at the level of the body of the lateral ventricle. Overall, 8/20 patients receiving AP had beneficial response with measurable objective improvement in motor function, including 3/10 chronic patients treated at >3 mo poststroke, and 5/10 acute patients treated at <3 mo poststroke. Among the 8 patients with beneficial response, significant improvements were observed in knee flexion, knee extension, and shoulder abduction. Neither age, nor months poststroke when AP was begun, was significantly correlated with the total number of improved tests, post-AP. 2 chronic patients with beneficial response first began receiving AP at 3 yr and 6 yr poststroke. Most improvements were sustained for >4 mo after the last AP treatment.

Pang_H (1994) 52 cases of apoplexy treated with scalp AP by the slow-rapid Bu-Xie (Reinforcing-Reducing) method. JTCM Sep 14(3):185-188. Inst of AP, China Acad of TCM, Beijing, PRC. 85 cases of apoplexy were treated with scalp AP, including 52 cases by the method of slow-rapid reinforcing-reducing and 33 cases by the method of flat twisting. The total effective rates differed insignificantly between the 2 methods. However, in respects of improving the myodynamia and motile functional disturbances of the limbs, the method of slow-rapid reinforcing-reducing was markedly superior to the method of flat twisting.

Price_TR (1990) Stroke in patients treated with thrombolytic therapy for acute myocardial infarction: The thrombosis in myocardial infarction clinical trial and a review of placebo-controlled trials. Stroke Nov 21(11) Suppl, III8-9. Dept of Neurology, Univ of Maryland Hospital, Baltimore 21201. The frequency of stroke among patients in six recent placebo-controlled trials of thrombolytic therapy for AMI is reviewed. Three trials used streptokinase and three used tissue plasminogen activator as the thrombolytic agent. While thrombolytic therapy greatly reduces the morbidity and mortality of acute myocardial infarction, it increases the rate of intracerebral haemorrhage.

Qie_ZW; Cheng FK; Cheng LH (1991) Blood flow capacity of the vertebral and cervical artery affected by Propagated Channel Sensation due to AP stimulation. Chung Hsi i Chieh Ho Tsa Chih (Chin J of Modern Developments in Trad Med) Jan 11(1):31-33 and 35. A method to measure total blood flow capacity in the head was improved. AP stimulation of the Propagated Channel Sensation (PCS) was induced in 55 cases of cervical vertebra disease [AP points: LI10, BL11, GV12, SI03], and in 66 cases of cerebral ischemia due to insufficiency of the vertebral arterial supply [AP points: LI04, LI11, LI16, TH15]. There was an obvious effect on head-blood flow (p<.05-.01) in the group in which PCS reached the affected area, some effect in the partial PCS group, and little effect in the group which felt a local needle sensation only. AP excitation of PCS relieved vascular and muscle spasm and ease the degree of vascular tension and Stasis (obstruction). Good PCS significantly increased the blood flow capacity of the cervical and vertebral artery; it promoted blood circulation to Clear Xue Stasis and improve tissue nutrition and function of the ANS. An important component in promoting the clinical effect was to induce the AP-excited PCS to reach the affected area.

Sõllstroem_S; Kjendahl A; Osten PE; Stanghelle JK; Borchgrevink CF (1995) [AP therapy in stroke during the subacute phase: A randomized controlled trial]. Tidsskr Nor Laegeforen Sep 115(23):2884-2887. Sunnaas sykehus, Nesoddtangen. The aim of this study was to investigate whether AP treatment, if given to stroke patients in subacute phase in addition to rehabilitation would influence motor function, activity of daily living (ADL) and quality of life. After obtaining informed consent, 45 patients (median age 57 yr) were randomised into a control group (n=21) and an AP group (n=24). Median time from onset of stroke to inclusion in the study was 40 d. The inclusion criterion was hemiparesis after a first-ever stroke. When included and 6 wk later all patients were evaluated by 3 measurement systems: the Motor Assessment Scale for stroke patients, Sunnaas Index of ADL and Nottingham Health Profile. All patients underwent individually adapted rehabilitation therapy. The patients in the treatment group were given classical AP 3-4 times/wk for 6 wk, each session lasting 20-30 min. Both groups improved significantly in motor function and ADL. However, improvement was significantly greater in the AP group than in the controls. Only the AP group rated a significantly improved quality of life. AP gave an added therapeutic benefit when given to stroke patients during their rehabilitation programme in the subacute phase.

Wang_Y; Xu G; Li G; Li D; Fang Y; Li Y; Wu F (1993) Treatment of apoplectic hemiplegia with scalp AP in relation to CT findings. JTCM Sep 13(3):182-184. Third People's Hospital, Datong, Shanxi Province, PRC.

Xiao_J1 (1993) Clinical observation of 50 cases of hemiplegia treated by AP. Chen Tzu Yen Chiu - AP Research 18(3):172-173. Dept of AP, Beijing Railway General Hospital, PRC. 50 cases of hemiplegia were treated by AP-needling of Scalp points. 14% were basically cured, 24% cases markedly effective, 62% cases improved. The total effective rate was 100%.

Yamashiro_H; Shimada M; Fukui S; Fukano T; Gotoh Y (1990) [Treatment of chronic retinal artery obstruction with stellate ganglion block and electric AP]. Masui Oct 39(10):1413-1416. Dept of Anaesthesia, Hamamatsu Med Ctr. A 56-yr-old man (160 cm, 64 kg) having right visual field defect due to obstruction of the central retinal artery for 6 mo was treated with stellate ganglion block and electric AP. His visual field improved slightly immediately after preliminary treatment with stellate ganglion block and electric AP judging from perimeter recording and his complaints. Stellate ganglion block once/d and EAP every 2 d were performed for 10 d and there after these treatments were done twice/wk. 20 d after starting the treatment, his visual field improved on his perimeter examination. We discussed that the cause of improvement was activation of slept cone cells which needed more energy for activation than rod cells by increasing retinal blood flow with stellate ganglion block and electric AP. We recommend vasodilating treatments such as stellate ganglion block and electric AP for visual field defect due to obstruction of central retinal artery even in chronic state.

Yu_YH; Wang HC; Wang ZJ (1995) The effect of AP on spinal motor neuron excitability in stroke patients. Chung Hua I Hsueh Tsa Chih (Taipei) Oct 56(4):258-263. Dept of Physical Med and Rehab, Taipei Municipal Yang-Ming Hospital, Taiwan, R.O.C. BACKGROUND. Spasticity is a common symptom in stroke patients, and its management constitutes a major problem in their rehabilitation. AP has been applied with moderate effect; their has been clinical experience but little objective evidence to support its use. H-reflex recovery time and H recovery curve were quantitative methods applied to measure spinal motor neuron excitability. AP for stroke patients as treatment to spastic hemiparesis was studied to see the AP effect on increased spinal motor neuron excitability in spasticity. METHODS. 16 stroke patients with spastic hemiparesis were collected to evaluate the therapeutic effect of AP on their spinal motor neuron excitability. H-reflex recovery time and H recovery curve were applied as quantitative evaluations of spinal motor neuron excitability. 11 age-matched normal volunteers were used as a control group. Results: The mean H-reflex recovery time of normal controls was 73.3+18.3 ms; that of the sound-side limbs of stroke patients was 67.1+21.5ms. The difference was not significant statistically (p=.2). However, the mean H-reflex recovery time of the paretic limbs of stroke patients was 52.3+16.8 ms, significantly shorter than for the normal controls (p=.003). The mean H-reflex recovery time of the paretic limbs of stroke patients became 57.6+19.9 ms after AP, significantly prolonged as compared with that before AP (p=.03). The H recovery curve of the paretic limbs after AP also was close to that of the normal controls. ConclusionS. This result provides positive evidence of increased spinal motor neuron excitability in paretic limbs of stroke patients and also of the AP effect which decreased that excitability. The study also presents a simple and practical technique for measuring the effects of various types of treatments, including AP, on other types of CNS disorders.

Zhai_Na1; Du Y; Shi X; Xu P (1993) [Morphological study on AP in interfering experimental cerebral infarction in rat: 1: Compensation of cerebral PIA mater artery in cerebral surface]. Chen Tzu Yen Chiu 18(1):8-13. Dept of AP, Coll of TCM, Tianjin. Occluding unilateral middle cerebral artery (MCAo) of rat, the compensatory blood vessels (CBV) within ischemic area in cerebral surface shown by cerebral perfusion and effect of AP were observed dynamically. Perfusing immediately after MCAo, there was no any blood vessel in the ischemic area. In AP group, the CBV had extended a lot from anastomotic network of cerebral pia mater (ACA-MCA, PCA-MCA) located in marginal zone of ischemic area 3 hs after MCAo. 6.24 and 48 hs after MCAo, the CBV increased much more than control group (non-AP) p <.01. The experiment pointed out that there existed a serious vasospasm in the MCA system in initial stage of MCAo, which led up to decompensation in the ischemic area. The AP can remit the vasospasm, and reverse the deteriorated process in early.

Zhai_Na2; Lu X; Shi X; Xu P (1993) [Morphological study on AP in interfering experimental cerebral infarction in rats: 2: Change of ischemic area in cerebral interior]. Chen Tzu Yen Chiu 18(3):209-212. Dept of AP, First Affiliated Hospital, Coll of TCM, Tianjin, PRC. Occluding unilateral middle cerebral artery (MCAO) of rat, the ischemic volume within cerebrum shown by nitroblue tetrazolium (N-BT) histochemistry method and effect of AP were observed dynamically. 18 hs after MCAO, the ischemic area began to extend from cerebral cortex into subcortical area. 36 hs after MCAO, there was a large ischemic area in cortical and subcortical area, whose volume occupied 20.7% of the whole. Whereas the ischemic area in the cortex disappeared in the AP group, the ischemic volume reduced to 6.3% of the whole. The experiment pointed out that the AP is an effective therapeutic procedure for cerebral infarction.

Zhang_D3; Gao H; Wei Z; Wen B (1991) [The thermographic observation of the relationship between the retention of AP needles and the effect of nose temperatures]. Chen Tzu Yen Chiu 16(1):73-75, 60. Inst of AP and Moxibustion, China Acad of TCM, Beijing, PRC. This is an observation of the relationship between the retention of AP needles and its effect on nose temperature in 74 patients with facial nerve paralysis. 100 patients were assigned to 5 groups according to the period of retention of needles: 0, 10, 20, 30 and 40 min (n=20/group). Nose temperature fell immediately after AP; then it rose to a maximum at 20 min after AP, then fell again; for group with retention for 0, 10 and 20 min, nose temperature rose again during 30-40 min after AP; however, this did not happen in groups with retention for 30 or 40 min. There was a general tendency for a greater change of temperature, of shorter duration in the groups of retention for longer time than in the groups of retention for shorter time. Some theories in ancient books about the retention of AP needles are based in scientific fact.

Zhang_S; Luo Y; Bo M (1991) Vertigo treated with scalp AP. JTCM Mar 11(1):26-28. Dept of E.N.T., Hengshui District Hospital, Hebei Province, PRC.

Zhao_C (1990) Treatment of acute cerebrovascular diseases and sequelae with AP. JTCM Mar 10(1):70-73. Inst of AP and Moxibustion, China Acad of TCM.

Zou_X; Wang D (1990) [Comparative study of AP versus Calan tablets to treat cerebral infarction]. Chung Hsi I Chieh Ho Tsa Chih Apr 10(4):199-202, 195. Beijing Coll of AP-Moxibustion and Orthopaedics-Traumatol, PRC. 55/63 patients were diagnosed as cerebral infarction by computer tomography. Diagnosis of 8 cases relied on history, symptoms, signs together with CSF examination. This article compares the curative effects of Calan tablets versus AP on 6 AP points on Yang Channels in treating cerebral infarction. Patients were assigned at random to 2 treatment groups: 1=AP (n=32 cases) and; 2=Calan tablet (n=31 cases). The AP group was needled once/d for 6 wk, mainly at LI15, LI11, LI04 and GB30, GB34, GB37. LV03, GB20, ST25, ST40, ST36, SP06, KI03 were added, depending on the Syndrome differentiation. Needle manipulation was by lifting and thrusting. The needles were retained for 30 min after the patient felt local sourness, distension and heaviness. Group 2 got a 5 mg Calan tablet 3 times/d for 6 weeks also. Result: The total effective rates were 94% and 84% respectively. AP had a much better therapeutic effect than Calan tablets (p <.05). In both groups, most haemorheological indices were much higher than normal for the same age group.

10. LIMBS
Bielski_J; Czepczynski M; Szczesniewski M (1990) [Use of AP to treat hand ischemia caused by vibration]. Przegl Lek 47(9):629-632. Katedry Higieny i Ochrony Pracy AR w Poznaniu oraz Oddzialu Chorób Zawodowych Uzdrowiskowego Osrodka Badawczo-Konsultacyjnego w Kolobrzegu. Hand ischaemia is common in workers occupationally exposed to mechanical vibration. AP has been said to significantly improve, or even normalize, vibration-induced peripheral ischemia of the upper limb as effectively as, or even more effectively than, balneotherapy (mineral salt bath, underwater whirlpool massage). This paper compares of 4 different therapies, applied in the early phase of vascular lesions in vibration-induced peripheral ischemia of the hand: 1=Balneotherapy; 2=AP therapy; 3=Pharmacotherapy (Pridazol, Bametan); 4=Climatotherapy. All treatment groups were forest workers of similar age and with similar vascular lesions. They were treated at the Kolobrzeg city sanatorium. Results: Balneotherapy improved the ischaemia, but AP-therapy gave a longer duration of improvement. Pharmacotherapy or climatotherapy had no effect. AP therapy is cheaper than balneotherapy and may be used by trained industrial physicians as part of outpatient care. However, more research is needed on the detailed conditions, effectiveness and limitations of AP therapy.

Chiu_NT; Wu CC; Yao WJ; Chang KF (1995) Detection of pelvic deep vein thrombosis by sc radionuclide venography utilizing an AP point. Clin Nucl Med Oct 20(10):899-901. Dept of Nuclear Med, Nat Cheng Kung Univ Hospital, Tainan, Taiwan, ROC. The authors present a case of thrombosis involving the right common iliac vein evaluated with sc radionuclide venography (SCRNV) after injection at AP points. SCRNV showed interruption of venous flow to the right common femoral vein and right iliac vein with prominent collateral venous drainage into the contralateral deep veins. This technique, which is technically simple and relatively operator-independent, has the potential to become a screen or follow-up test for deep vein thrombosis.

Fialka_V; Resch KL; Ritterdietrich D; Alacamlioglu Y; Chen O; Leitha T; Kluger R; Ernst E (1993) AP for Reflex Sympathetic Dystrophy. Arch Intern Med 8 Mar 153(5):661, 665.

Solun_MN; Liaifer AI (1991) [AP to treat diabetic angiopathy of the lower extremities]. Probl Endokrinol (Mosk) Jul-Aug 37 (4):20-23. A course method of AP (10 sessions) using body-AP points of general and segmental action and some Ear-points was used for therapy of the functional stage of lower limb diabetic angiopathy in 55 patients with insulin-dependent diabetes mellitus. Rheovasography, thermography and ultrasound dopplerography were carried out over time to confirm the diagnosis of insulin dependent DM and to assess therapeutic efficacy. A direct noticeable clinical effect was obtained in 78% of cases, determined perhaps by improved elastotonic properties of arteries of average calibre, enhanced blood outflow and regulation of lower limb vascular peripheral resistance.

Thomas_D; Collins S; Strauss S (1992) Somatic sympathetic vasomotor changes documented by medical thermographic imaging during APA. Clin Rheumatol Mar 11(1):55-59. Univ of Queensland, Australia. AP is widely used for pain relief in many musculoskeletal disorders, and evidence suggests that modulation of the sympathetic nervous system responses which play an integral part in somatic pain, is an important mechanism of AP action. This prospective study of 20 patients with neck and arm pain measured finger temperature, controlled by somatic sympathetic vasomotor activity before and after needle AP. Responses were correlated with visual analogue scale (VAS) of pain severity. An association was found between pain relief and reduced sympathetic vasomotor activity. In 10 patients with significant reduction in visual analogue scale (VAS) pain (p <.05), the mean change in temperature (delta toC) was 0.55 (SD+0.86) with significant difference in pre to post treatment temperatures (p <.01). In 10 patients without significant pain relief on VAS scoring (p >.05), the mean toC was 0.20 (SD +0.72) without significant difference in pre to post treatment temperatures (p >.05). The relevance of somatic sympathetic influences on musculoskeletal pain and modulation of sympathetic activity by AP will be discussed.

11. SKIN
Ballegaard_S; Muteki T; Harada H; Ueda N; Tsuda H; Tayama F; Ohishi K (1993) Modulatory effect of AP on the cardiovascular system: a cross-over study. AETRIJ Apr-Jun 18(2):103-115. Dept of Anaesthesiol, Kurume Univ, Sch of Med, Fukuoka, Japan. The effect of AP on the cardiovascular system was studied in 23 healthy males in a cross-over design comparing AP and a placebo pill by measuring skin blood flow and the function of the heart. AP was found to have a modulatory effect on skin blood flow (r=-.68; p <.0005) and heart rate (r=-.56; p <.005), as well as Blood-Pressure-Heart-Rate-Product (r=-.70; p <.0002). The combination of rest and a placebo pill had no modulatory effect on skin blood flow, but did have a delayed effect on the heart when compared with AP. AP can enhance the regulatory mechanisms of the cardiovascular system. The possible underlying mechanism is discussed. The findings represent a physiological explanation for the possible utility of AP in maintaining cardiovascular homeostasis in healthy people.

Suter_B; Kistler A (1994) [Does AP modify skin circulation via the ANS?]. Schweiz Med Wochenschr Suppl 62:36-38. F. Hoffmann-La Roche AG, Basel. Previous research indicated that AP modulates the cardiovascular system via the ANS. Blood vessels of the hand skin have sympathetic constrictor nerves only. Therefore, the possible effect of AP on the ANS can be investigated by measurements of microvascular perfusion and thermoregulation of the hands. Knowing the physiological effects of AP may help to improve acceptance of this unconventional medical approach.

I. AP and the Digestive / Gastrointestinal Tract

1. MOUTH
Blom_M; Dawidson I; Angmar-Månsson B (1992) The effect of AP on salivary flow rates in patients with xerostomia. Oral Surg Oral Med Oral Pathol Mar 73(3):293-298. Dept of Cardiol, Sch of Dentistry, Karolinska Inst, Sweden. Of 21 patients with severe xerostomia, 11 were treated with AP and 10 patients received placebo AP. Those patients who received AP treatment showed increased salivary flow rates during and after the AP treatment. The improved salivary values persisted during the observation year, whereas the patients who received placebo AP showed some improvement of salivary flow rates only during the actual treatment. AP may be a useful adjunct for the stimulation of salivary flow in some patients with xerostomia.

Somova_KT; Vezhnin VF; Panfilov DA; Panfilova MV (1993) Reflexotherapy in the combined treatment of xerostomia patients. Stomatologiia Mosk Apr-Jun 72(2):71-72. The authors used local and systemic AP points and manual therapy of biomechanical disorders in the cervical spine to treat patients with xerostomia. The immediate and late results of treatment were "fairly effective".

2. OESOPHAGUS
Hep_A; Prásek J; Dolina J; Ondrousek L; Díte P (1995) [Treatment of oesophageal motility disorders with Ear-AP (preliminary report)]. Vnitr Lek Jul 41(7):473-475. 3rd interní klinika, Brno-Bohunice. Impaired motility of the oesophagus is relatively frequent in patients with functional blocks of the cervical spine. The patient does not always realize oesophageal dysmotility. Ear-AP focused on reflex relations seems to be a useful therapeutic procedure.

3. ABDOMEN
Gu_Y (1992) Treatment of acute abdomen by EAP: a report of 245 cases. JTCM Jun 12(2):110-113. Nanjing Int AP Training Centre, Nanjing College of TCM, PRC.

4. STOMACH/DIAPHRAGM
Chen_Y; Xiao D; Wang F; Cao Y; Ji J; Chen M (1992) [Effects of moxibustion on experimental gastric ulcer in rats]. Chen Tzu Yen Chiu 17(2):113-116. Dept of Physiol, Nantong Med Coll, Jiangsu, PRC. This study was designed to determine whether moxibustion at GV08 plays a role in protecting gastric mucosa in rats. The areas and histological changes of gastric ulcer were examined. Results: 1.        Moxibustion pretreatment within 3 wk significantly prevented the formation of gastric ulcer; 2.        As gastric ulcer had formed, moxibustion did not shorten the period of recovery of gastric ulcer. Moxibustion pretreatment at GV08 had a protective effect on gastric mucosa. After the experimental ulcer had formed, however, the moxibustion had little protective effect on it.

Chen_Y; Cao Y; Xiao D; Ceu C; Chen M (1993) [The relation between protective effect of moxibustion on gastric mucosa and mucus]. Chen Tzu Yen Chiu 18(4):300-304. Zhenjiang Med Coll, Jiangsu, PRC. Our previous works have proved that moxibustion at GV08 plays a role in protecting gastric mucosa in the experimental gastric ulcer model rat. The present studies are designed to determine whether the mechanisms of moxibustion protecting gastric mucosa are mediated by mucus. Results: Either before or after the experimental gastric ulcer model had formed, moxibustion treatment would markedly increase the ratio of PAS positive staining layer to total length of gastric gland (p <.05), and the combined gastric mucus of stomach (p <.05). These results are negatively correlated to gastric ulcer area and suggest that the mechanisms of moxibustion protection on gastric mucosa are mediated by mucus in the experimental gastric ulcer rat model.

Chen_Z (1994) Treatment of chronic gastritis with AP. JTCM Sep 14(3):233-235. Inst of AP, China Acad of TCM, Beijing, PRC.

Cheng_X (1992) [Effect of circadian rhythm on the action of AP to prevent the formation of experimental gastric ulcer]. Chen Tzu Yen Chiu 17(2):117-122. Dept of AP, Beijing Hospital of TCM. Taking rats and mice as subjects, observations were made on the action of AP to protect the gastric mucosa from experimental injury. The pH value (by accurate test paper), gastric acid output (by titration), the secretion of PG in gastric mucosa (by RIA) were observed altogether at 1-3h, 5-7h, 9-11h, 13-15h, 17-19h and 21-23h. All of the above indices were changed along with the alternation of day and night. And the effects of AP on these indices were different when giving AP at different times. The action of AP to prevent experimental gastric ulcer was also different at different times. In general, AP needling at the acro-phase (peak-time) of circadian rhythm has mainly an inhibitory effect, while AP the valley-phase (12 h from peak-time) has mainly an excitatory effect. Thus, choosing the optimum time to use AP, in accord with TCM concepts of the phases of circadian rhythm (the "Qi Clock"), may enhance the curative effect of AP.

Dill_SG (1992) AP for gastrointestinal disorders. Probl Vet Med Mar 4(1):144-154. AP is best known for its application to various musculoskeletal pain-producing diseases. AP is, however, used for a large variety of internal medical diseases in humans and other animals. This chapter reviews some of the published literature on the use of AP in gastrointestinal (GI) diseases, describes AP points useful for a variety of GI diseases, briefly reviews how TCM treats GI disease, and gives some case examples of how AP can be used in GI diseases.

Emel'ianenko-IV1; Serediuk-NN (1991) [AP and pharmacological repair agents in the combined treatment of peptic ulcer patients]. Vrach Delo Jul 7:56-58.

Emel'ianenko_IV2 (1991) The effect of AP on the psychosomatic status of peptic ulcer patients. Vrachebnoe Delo May 5:98-100 (Russian). Psychosomatic effects of AP treatment were studied in patients with peptic ulcers. A course of AP gave psychological rehabilitation of these patients and significantly improved the functional indices of the gastroduodenal system. AP may influence the pathogenesis and mechanisms of ulcer disease, and may normalize the cortico-hypothalamo-visceral relations.
Emel'ianenko_IV3; Orzheshkovskii VV (1992) [The theoretical bases and clinical efficacy of AP in peptic ulcer]. Vrach Delo Jan 1:69-72.

Kokurin_GV (1992) Autonomic disorders in the clinical picture of gastric and duodenal peptic ulcer and their AP reflexotherapy. Zhurnal Nevropatologii i Psikhiatrii Imeni SS Korsakova 92(5-12):9-10. In Russian. Patients with peptic (ST-SI) ulcer show diverse psychoautonomic disorders that complicate the course of the somatic disease. The following Syndromes were distinguished depending on the intensity of psychoautonomic disorders: asthenoneurotic, asthenohypochondriac, asthenodepressive and psychoautonomic with organic microsymptomatology. The use of laser-AP in multimodality therapy of peptic ulcer patients helps to correct autonomic disorders and normalise regenerative processes occurring in the gastroduodenal system.

Kravtsova_TIu; Rybolovlev EV; Kochurov AP (1994) The use of magnetic puncture in patients with duodenal peptic ulcer. Vopr Kurortol Fizioter Lech Fiz Kult Jan-Feb(1):22-24. 66 patients with duodenal ulcer had apparent shifts in psychoautonomic correlations. The patients underwent puncture with alternating magnetic field of active biological points responsible for general adaptation (ST36, LV14, GB20) and gastroduodenal function (ST20, GV09, GV08). The treatment improved emotional, personality and autonomic regulation. The symptoms declined and ulcer healed more rapidly.

Li_X; Yi J; Qi B (1990) Treatment of hiccough with Ear-AP and Ear-pressure: a report of 85 cases. JTCM Dec 10(4):257-259. Dept of TCM, First Teaching Hospital, Bethune Med College, PRC.

Liu_L6; Zhou L; Zhang D; Li J (1994) Effects of AP on antral G cells in patients with gastric disease. Chen Tzu Yen Chiu - AP Research 19(2):75-78. Dept of Physiology, Chin Acad of Med Sci, Beijing, PRC. AP is effective to treat human gastric (ST) disease. We have observed the effect of AP at CV12, PC06, ST36 on fluorohistochemical changes of G cells of antral mucosa in 42 patients with gastric disease. After AP treatment the amount of fluorescent G cells and the fluorescent intensity of gastrin in the G cells were obviously decreased in patients with duodenal ulcer, as compared with that before AP. However, the amount of G cells was increased by AP treatment in patients with chronic atrophic gastritis. AP may regulate G cell from abnormal to normal condition in gastric mucosa of gastric disease.
Lux_G (1994) [AP inhibits secretion of gastric acid: Prospective randomized study series with various AP procedures]. Fortschr Med 20 Nov 112(32):454.

Lux_G; Hagel J; Bõcker P; Bõcker G; Vogl R; Ruppin H; Domschke S; Domschke W (1994) AP inhibits vagal gastric acid secretion stimulated by sham feeding in healthy subjects [see comments]. Gut Aug 35(8):1026-1029. Dept of Med A, Univ of Erlangen-Nuremberg, Germany. In a prospective randomised study, the effect of AP on sham feeding stimulated gastric acid secretion was investigated. In 8 healthy volunteers (5 men, 3 women, mean (SEM) age 26.3 (4.7) yr) various methods of AP were performed. Apart from the sham procedure, the AP was performed at the classic AP points. EAP reduced gastric acid secretion expressed as median (range) significantly during the 1st 30-min period to 1.6 (0-5.2) mmol compared with 3.8 (2.3-14.5) mmol (p <.05) during control period (sham feeding without AP). Inhibition of gastric acid secretion by EAP was also significant during the 2nd 30-min period (0.2 (0-5.6) v 3.6 (0.3-9.1) mmol; p <.05) and for peak acid output (0.8 (0.2-5.1) v 7.6 (3.4-12.1) mmol; p <.05). TENS also significantly reduced of gastric acid secretion during the first 30-min period (1.0 (0-3.6) mmol v 3.8 (2.3-14.5) mmol; p <.05), and peak acid output (3.6 (1.2-12.0) v 7.6 (3.4-12.1) mmol; p <.05). The classic needle AP, laser-AP, and sham AP had no significant effect on gastric acid secretion. Only AP methods using pronounced stimulation (EAP, TENS) significantly reduced gastric acid secretion in healthy volunteers. Only AP at defined points was effective. Mild forms of AP stimulation (classic needle AP, laser-AP) was not effective.

Ma_C1; Liu Z (1994) Regulative effects of EAP on gastric hyperfunction induced by electrostimulation of the lateral hypothalamus area of rabbits. Chen Tzu Yen Chiu - AP Research 19(2):42-46. Inst of AP, Nanjing Coll of TCM. AP is used clinically to inhibit appetite, relieve hunger and reduce body weight in obese people. We studied the action of AP on gastric (ST) hyperactivity induced by the excitation of the lateral hypothalamus area (LHA, the feeding centre). We also researched the mechanism of the AP in inhibiting excessive appetite and reducing hunger in obesity. Gastric hyperactivity was induced by stimulation of LHA; EAP at ST36 or ST44 inhibited that hyperactivity (p<.05). Propranolol (0.3 mg/kg), a beta-blocker, inhibited the effect of EAP at ST36 to restrain hyperactivity of stomach triggered by excitation of the LHA. EAP inhibited for >/= 3 h the gastric hyperfunction caused by LHA-excitation, indicating that humoral factors are involved in the AP-effect. Since EAP at ST36 inhibits gastric hyperfunction caused by LHA-excitation, and that effect is inhibited by a beta-blocker, the anticholinergic effect of EAP is probably via the gastric beta-receptors.

Nam_TC; Cheong CK; Jo CH; Sung JK (1987) Effects of EAP on motility of the rumen and abomasum of goats. Korean J of Vet Research 27(1):127-135; 24 ref. Coll Vet Med, Nat Univ Seoul, Korea. EAP was performed in healthy goats and goats with induced hypocalcaemia using a current of 1 volt and 3 Hz at Tianping (+) and Baihui (-) for 30 min. EAP significantly increased amplitudes of rumen and abomasal motility in healthy goats but had little effect on rates of rumen and abomasal contractions. EAP effects lasted 10-30 min. In hypocalcaemic goats, rates of rumen and abomasal movements were not changed, amplitudes were reduced, but rumen and abomasum motility was not accelerated by EAP. Bethanechol chloride increased amplitudes of rumen motility. Ruminal contractions were not affected by EAP after atropine sulphate treatment.

Pan_C; Jin W; Shen D (1990) [An observation of protective effect of AP on the gastric mucosa of Wistar rats and the relative histochemical changes of the neurotransmitters]. Chen Tzu Yen Chiu 15(1):48-54. Inst of AP and Channels, Anhui Coll of TCM, Hefei, PRC. The histochemistry of cholinesterase and catecholamine was used to study changes of neurotransmitters and the protective effect of AP on gastric mucosa on 30 pairs of Wistar rats. 1. In gastric ulceration induced in rats by water-immersion, EAP had a statistically significant protective effect on gastric mucosa. 2. The protective effect of AP on gastric mucosa involves significant inhibition of both the cholinergic and adrenergic nerves.

Qi_Y (1993) Treatment of hiccough with AP on middle Sifeng (A 09). JTCM Sep 13(3):202. Provincial Inst of AP & Moxibustion, Shanxi Province, PRC.

Shi_T; Xu X; Lu X; Xing W (1994) AP at GB21 for treatment of achalasia of the cardia. JTCM Sep 14(3):174-179. Shanxi College of TCM, Taiyuan, PRC.

Tougas_G; Yuan LY; Radamaker JW; Chiverton SG; Hunt RH (1992) Effect of AP on gastric acid secretion in healthy male volunteers. Dig Dis Sci Oct 37(10):1576-1582. Div of Gastroenterol, McMaster Univ Med Ctr, Hamilton, Ontario, Canada. 6 randomized, placebo controlled studies were performed to investigate the effect of EAP on gastric acid output in 38 healthy males. EAP decreased basal acid output when compared to placebo AP [from 3.50+0.59 mmol/hr to 2.54+0.56 mmol/hr (p <.05)] as well as sham feeding-stimulated acid output [from 18.52+2.25 mmol/hr to 5.38+2.11 mmol/hr (p <.005)], but had no effect on the pentagastrin stimulated acid output. The inhibitory effect of AP on sham feeding-stimulated acid output was not affected by local anaesthesia of the AP point, but was prevented by a prior iv naloxone injection. AP did not alter plasma gastrin levels (20.7+7.6 ug/L, v control 21.2+7.2 ug/L) but naloxone increased it (26.1+14.5 ug/L) (p <.05). We conclude that the antisecretory effects of EAP do not result from decreased gastrin release or decreased parietal cell sensitivity to gastrin, but are mediated through naloxone-sensitive opioid neural pathways and vagal efferent pathways.

Wu_H; Chen X (1990) [Effect of EAP of ST36 on unit discharges in the lateral hypothalamic area induced by stomach distension]. Chen Tzu Yen Chiu 15(3):194-196. Dept of Physiol Guilin Med Coll, Guongxi, PRC. Previous studies in our Lab have shown that some unit discharges of the neurons in Feeding Centre of the lateral hypothalamic area (LHA) may be inhibited by distending stomach. The present study was performed to observe the effect of EAP at ST36 on the discharge-inhibitory reaction induced by distending stomach in rats. Among 52 unit discharges observed, 36 (69%) showed that EAP at ST36 abolished the inhibitory reaction induced by distending stomach. The durations of the effect range from 5-15 min. The somatic input from ST36 may influence the reactivity of Feeding Centre of LHA to the activity of stomach.

Xiang_L; Zhu F; Ma Y; Weng E; Tang G (1993) [Influences of AP on gastroduodenal mucosal lesion and electrical changes induced by stress in rats]. Chen Tzu Yen Chiu 18(1):53-57. Shuguang Hospital of Shanghai TCM Coll, PRC. Experiments were performed in 57 SD rats. The stress was induced by binding plus revolving (5.5 xg, 170 c/min, 10 min) or cold (0-4oC, 30-60 min). Selected AP points were ST36 and BL21. Bipolar Ag-AgCl recording electrodes were respectively implanted on the serous membrane surface of the antrum, duodenum and on the abdominal skin corresponding to above areas. Results: 1.        63.2% of the stress group showed a many bleeding points spreading over the gastroduodenal mucosal membrane. The area density of lesion was 16-28%. Microscopic findings were mucosal blood vessel dilatation and hyperaemia, gland cell swelling, villi broken and peeling off and lymph cell accumulating, etc. 84% showed clear inhibition of gastroduodenal electroactivity including lower amplitude of slow wave, lower frequency, disordered rhythm, reduced fast wave and prolonged IDMEC III cycle. 2.        In the group of AP plus stress, only 16.7% showed bleeding or hyperaemia, and the lesion area density was only 1.7%. The pathohistological changes were obviously decreased. Gastroduodenal electrical changes were hardly seen (27%) or the inhibitory state above were significantly reduced (55%) when compared with the stress group. AP effectively reduced the mucosal lesion and the inhibition of gastric and duodenal electrical activity induced by stress in rats.

Zhang_J (1992) Treatment with AP at ST36 for epigastric pain in the elderly. JTCM Sep 12(3):178-179. Wuhan Hospital of TCM, PRC.

Zhao_J (1991) AP at Huatuojiaji (X 35) points for treatment of acute epigastric pain. JTCM Dec 11(4):258. Hedong Clinic, Qinhuangdao Harbour Hospital, PLC.

5. NAUSEA/VOMITING
Aglietti_L; Roila F; Tonato M; Basurto C; Bracarda S; Picciafuoco M; Ballatori E; Del Favero A (1990) A pilot study of metoclopramide, dexamethasone, diphenhydramine and AP in women treated with cisplatin. Cancer Chemother Pharmacol 26(3):239-240. Med Oncol Div, Ospedale Policlinico, Perugia, Italy. A total of 26 women who submitted to cisplatin chemotherapy received as antiemetic treatment a combination of metoclopramide, dexamethasone and diphenhydramine. AP according to TCM was also carried out. The results were compared with those obtained in a similar group of women with cancer, who were treated in the same setting with the same antiemetic combination but without additional AP. AP was shown to increase complete protection from nausea and to decrease the intensity and duration of nausea and vomiting. However, the difficulties of performing AP routinely in daily practice are a hindrance to its wider use.

Allen_DL; Kitching AJ; Nagle C (1994) PC06 acupressure and nausea and vomiting after gynaecological surgery. Anaesth Intensive Care Dec 22(6):691-693. Dept of Anaesthesia, Northampton General Hospital, UK. We studied the effect of PC06 acupressure on 46 women undergoing laparotomy for major gynaecological surgery who received patient-controlled analgesia. Half the patients received acupressure at the PC06 site, the remainder received acupressure at a "sham" site. There was a reduction in the requests for anti-emetic therapy in the group receiving PC06 acupressure but there was no difference in the incidence of nausea and vomiting. There was no difference in total morphine consumption between the two groups.

Belluomini_J; Litt RC; Lee KA; Katz M (1994) Acupressure for nausea and vomiting of pregnancy: a randomized, blinded study. Obstet Gynecol Aug 84(2):245-248. Dept of Obstetrics and Gynaecology, California Pacific Med Centre, San Francisco. The effectiveness of acupressure in reducing nausea and vomiting of pregnancy was assessed. Symptomatic pregnant women were randomized to one of two acupressure groups: one treatment group using acupressure at PC06 and one sham control group using a placebo point. Subjects were blind to the group assignment. Each evening for 10 consecutive d, the subjects completed an assessment scale describing the severity and frequency of symptoms that occurred. Data from the first 3 d were used as pre-treatment scores. Beginning on the morning of the day 4, each subject used acupressure at her assigned point for 10 min 4 times/d. Data from day 4 were discarded to allow 24 h for the treatment to take effect. Data from d 5-7 were used to measure treatment effect. 60 women completed the study. There were no differences between groups in attrition, parity, fetal number, maternal age, gestational age at entry, or pre-treatment nausea and emesis scores. Analysis of variance indicated that both groups improved significantly over time, but that nausea improved significantly more in the treatment group than in the sham control group (F1,58=10.4, p=.0021). There were no differences in the severity or frequency of emesis between the groups. There was a significant positive correlation (r=.261, p=.044) between maternal age and severity of nausea. Acupressure at the PC06 was effective in reducing symptoms of nausea but not frequency of vomiting in pregnant women.

Dundee_JW (1990) Belfast experience with PC06 AP antiemesis. Ulster Med J Apr 59(1):63-70. In a strictly controlled clinical situation, (postoperative sickness) where variables were reduced to a minimum, it was possible to show an effective prophylactic antiemetic action of AP at PC06. Manual AP- and EAP- stimulation of this point were equally effective. Non-invasive stimulation (TENS or acupressure) was effective in the early postoperative period, but the effect did not last as long as for invasive AP, although it was as good as standard antiemetics. Stimulation of a "dummy" AP point was ineffective, as was AP given after the emetic stimulus (opioid). This effect can be blocked by local anaesthesia at PC06. Acupressure at PC06 is moderately effective in reducing morning sickness, but here there is more of a psychological element as pressure on a "dummy" point gives some alleviation of symptoms. Given in conjunction with standard antiemetics, PC06 AP is a useful adjuvant in reducing sickness after cancer chemotherapy. This effect can be prolonged for 24 h by acupressure.

Dundee_JW1; McMillan CM (1990) Clinical uses of PC06 AP antiemesis. AETRIJ 15(3-4):211-215. We have seen pregnant women pressing PC06 to prevent morning sickness. Though this was effective, the pressure has to be applied for 5 min every 2 h. This probably has a large psychological element. We studied the antiemetic effects of stimulation of PC06 for 5-10 min by invasive (manual or EAP) or non-invasive (TENS or acupressure) AP. Well controlled studies showed that, when given before opioid premedication, AP significantly reduced postoperative sickness for 6-8 h. Non-invasive AP-methods had a shorter duration of effect, with nausea and/or vomiting often occurring after 2 h. Stimulation of a pseudo-point near the elbow was ineffective. To be effective, AP had to be given before the opioid. The antimentic effect of AP at PC06 can be abolished by local anaesthesia of the point. The most rewarding results were with PC06 stimulation used with standard antiemetics before cancer chemotherapy. Here also, invasive AP was more effective than non-invasive AP. Self-use of TENS was studied recently. Using a portable battery-operated square wave stimulator fixed at 10 Hz, TENS was used for 5 min every 2 h via a large EKG surface electrode on the PC06 point. Modern antiemetics can control vomiting, but they are relatively ineffective against nausea. Nausea and vomiting can be controlled effectively by regular use of TENS or AP. The combination of antiemetic drugs with invasive AP gives the best results in severe cases.

Dundee_JW2; Yang J; McMillan C (1991) Non-invasive stimulation of the PC06 antiemetic AP point in cancer chemotherapy. J of the Royal Society of Med Apr 84(4):210-212. As an adjuvant to standard antiemetics, the beneficial effects of TENS of the PC06 antiemetic point was studied in >100 patients in whom antiemetics alone were inadequate to control chemotherapy-induced sickness. Although the results were not quite as good as with invasive AP, >75% patients achieved considerable benefit from what was a non-toxic procedure. The use of large diffuse low impedance electrodes simplifies the technique. Application of Sea Bands every 2 h prolongs the antiemetic action. Best results were obtained from self-use of 5 min of TENS (15 Hz) every 2 h at PC06 to activate a large, easy-to-place surface electrode and increasing the current until Deqi is elicited.

Dundee_JW3; Ghaly G (1991) Local anaesthesia blocks the antiemetic action of AP at PC06. Clinical Pharmacology and Therapeutics Jul 50(1):78-80. The incidence of postoperative illness was monitored for 6 h in 74 women premedicated with 10 mg nalbuphine, and undergoing short gynaecological operations of similar duration under methohexital-nitrous oxide-oxygen anaesthesia. At the time of premedication, each patient received AP for 5 min at PC06. In random order the site of the AP had been previously infiltrated with normal saline solution in half of the patients and 1% lidocaine in the remaining patients. Postoperative emetic sequelae occurred significantly more often in those who received lidocaine compared with the group that received saline solution. Local anaesthesia of the point of stimulation can block the antiemetic action of AP at PC06 in a manner similar to that shown by others for APA.

Gieron_C; Wieland B; von der Laage D; Tolksdorf W (1993) Acupressure in the prevention of postoperative nausea and vomiting. Anaesthesist Apr 42(4):221-226. Klinik fur Anasthesiologie, Medizinische Fakultat, RWTH Aachen. Postoperative nausea and vomiting are still the side-effects most often mentioned even after modern anaesthesia. Acupressure is said to be a method of preventing these effects in minor gynaecological surgery. We studied its effectiveness in patients undergoing gynaecological operations of longer duration (6-8 h) in a real acupressure group compared to a placebo group. Before the main trial, we studied a control group to find out the frequency of emesis. In the worst case of nausea that we encountered, 80% in the 0-6 h postoperative period, the number of random samples for the acupressure and placebo groups was calculated (30 patients/group). The error for alpha was established at 5% and the reduction of nausea was 50%. The female patients were aged 18-65 yr (ASA group I and II). Acupressure at PC06 was via small metal bullets fastened to each forearm by an elastic bandage. The bullets were left there for 24 h. Premedication anaesthesia, postoperative analgesia and antiemetic treatment were standardized. During a 24-h period we studied the incidence of nausea and vomiting. The anthropometric data, the duration of surgery and the amount of postoperative analgesia were comparable between the 3 groups. In comparison with the placebo group, real acupressure gave a statistically significant and relevant reduction in nausea up to 6 h postoperative (p=.03). Nausea was reduced from 53% in the placebo group to 23% in the acupressure group. Acupressure was effective in preventing nausea and vomiting without any side-effects in this group of longer gynaecological surgery patients, as well as in chemotherapy-induced nausea and vomiting. It is a valuable addition to the prevention of postoperative nausea and vomiting. Further studies are needed.

Ho_RT; Jawan B; Fung ST; Cheung HK; Lee JH (1990) EAP and postoperative emesis [see comments]. Anaesthesia Apr 45(4):327-329. Dept of Anaesthesiol, Chang Gung Memorial Hospital, Taiwan, ROC. Unpremedicated female patients (n=100) of ASA grade 1 or 2 who underwent laparoscopy as outpatients were allocated randomly to one of 4 groups. All patients received general anaesthesia with fentanyl, thiopentone, halothane, nitrous oxide and oxygen; suxamethonium was given to facilitate tracheal intubation. In the recovery room, group 1 (control) received no treatment; group 2 received EAP at PC06 on the right side for 15 min, group 3 received TENS at the PC06 point on the right side for 15 min and group 4 received prochlorperazine 5 mg iv. Any act of vomiting, including dry retching, during the first 3 h after surgery was regarded as postoperative emesis. The incidence of postoperative emesis was 11/25 (44%) in group 1, 3/25 (12%, p <.05) in group 2, 9/25 (36%) in group 3, and 3/25 (12%, p <.05) in group 4. EAP was as effective as prochlorperazine, and may be better than TENS, in reducing postoperative emesis.

Hyde_E (1989) Acupressure therapy for morning sickness: a controlled clinical trial. Journal of Nurse Midwifery Jul-Aug 34(4):171-178. A prospective, controlled clinical trial examined the efficacy of acupressure therapy for morning sickness, using a two group, random assignment, crossover design. Subjects in Group 1 (n=8) used acupressure wristbands for five days, followed by five days without therapy. Subjects in Group 2 (n=8) had no therapy for five days, followed by five days use of wristbands. The Multiple Affect Adjective Checklist and Sickness Impact Profile were used, and extent of nausea was assessed at baseline, day five, and day ten. Use of acupressure wristbands relieved morning sickness for 12/16 subjects (x2=5.31 with Yates' correction factor, df=1, p <.025). Acupressure therapy resulted in statistically significant (p <.05) reductions in anxiety, depression, behavioral dysfunction and nausea. Limitations of the study and suggestions for future research are presented.

McConaghy_P; Bland D; Swales H (1996) AP in the Management of Postoperative Nausea and Vomiting in Patients Receiving Morphine via a Patient-Controlled Analgesia System. Adapted from WWW. A single-blind, randomised, controlled trial was done in patients receiving parenteral morphine via a Patient-Controlled Analgesia System (PCAS), to assess the efficacy of AP at the PC06 in the management of PONV (postoperative nausea and vomiting). 80 patients were recruited on the first postoperative day; 30 were treated with AP after developing PONV lasting >10 min. Patients were randomly allocated to receive AP bilaterally at either PC06 or at a pseudo-point near the elbow, with manual stimulation for a total of 4min. Only patients naive to AP antiemesis were studied; each patient was thus unaware of the group to which they were allocated. The mean VAS for nausea improved more in patients treated with AP at PC06.

Yang_LC; Jawan B; Chen CN; Ho RT; Chang KA; Lee JH (1993) Comparison of PC06 AP point injection with 50% glucose in water and iv droperidol for prevention of vomiting after gynaecological laparoscopy. Acta Anaesthesiol Scand Feb 37(2):192-194. Dept of Anaesthesiology, Chang Gung Memorial Hospital, Kaohsiung Hsien, Taiwan, ROC. Postoperative vomiting causes patients distress and delays discharge after outpatient surgery. Although EAP at PC06 is known to have antiemetic effects, its inconvenient instrumentation may limit its clinical applicability. The purpose of this study was to explore a simple and effective alternative method for control of postoperative vomiting in outpatient surgery. We prospectively compared the effect of point injection with 0.2 ml 50% glucose in water (G/W) at PC06 and iv injection of 20 ug/kg droperidol for prevention of vomiting in 120 consecutive outpatients undergoing gynaecological laparoscopy with general anaesthesia. Patients were randomly allocated to receive AP point injection, iv droperidol, or nothing as control group. Both AP point injection and iv droperidol 20 ug/kg had a significant antiemetic effect when compared with the control group. Point injection of 50% glucose solution at PC06 is simple and effective in reducing the incidence of postoperative emesis in outpatient surgery.

Yentis_SM1; Bissonnette B (1991) Oriental concepts of AP: AP at PC06 and postoperative vomiting after tonsillectomy in children [see comments]. Br J Anaesth Dec 67(6):779-780. Dept of Anaesthesia, Hospital for Sick Children, Univ of Toronto, Ontario, Canada. The effect of AP at PC06 on postoperative vomiting in 45 children undergoing tonsillectomy was studied. After induction of anaesthesia and before the start of surgery, 50% of the patients received AP at PC06 for 5 min. There was no difference in the incidence of vomiting between the AP (39%) and non-AP (36%) groups. When given after induction of anaesthesia, AP at PC06 was not effective in reducing vomiting after tonsillectomy in children.

Yentis_SM2; Bissonnette B (1992) Ineffectiveness of AP and droperidol in preventing vomiting after strabismus repair in children. Can J Anaesth Feb 39(2):151-154. Dept of Anaesthesia, Hospital for Sick Children, Toronto, Ontario, Canada. The antiemetic effects and side-effects of P6 AP and droperidol pre-treatment were evaluated in a randomized, patient- and observer-blinded study. 90 unpremedicated children of ASA physical status I or II undergoing outpatient strabismus repair, and aged > 1 yr, were studied. All received iv thiopentone 5 mg/kg, atropine 0.02 mg/kg and succinylcholine 1.5 mg/kg, and the trachea was intubated. Patients then received either iv droperidol 0.075 mg/kg, droperidol plus 5 min' P6 AP, or AP alone. Anaesthesia was maintained with nitrous oxide 66% and halothane 1.5-2.0% in oxygen with spontaneous ventilation. There was no difference in the incidence of vomiting in the droperidol group (17% before discharge from hospital and 41% up to 48 h after discharge), combined treatment group (17% and 34% respectively) and AP group (27% and 45% respectively). Corresponding figures for the incidence of vomiting before discharge were 17%, 17% and 27% respectively; these values were also not different. The incidence of restlessness was significantly greater in children receiving droperidol (63%) or both treatments (67%) than in those receiving AP alone (30%; p=.007). P6 AP and droperidol are equally ineffective in preventing vomiting within 48 h of paediatric strabismus repair. Droperidol is associated with increased incidence of postoperative restlessness.

6. INTESTINES
Anon_ (1990) Personal experience on AP treatment of diarrhoea. JTCM Sep 10(3):163-167 and JTCM Dec 10(4):251-256.
Halevi_S3 (1996) The Astringent Quality of Point GV20: A case history analysis: Part 1. Originally published in the CMJ (UK). Dr Shmuel Halevi is a practitioner of TCM, practising in Israel. Here is a case history of a 38-yr-old woman who had suffered for 4 yr from ulcerative colitis. The use of point GV20, in her case, induced full recovery from all symptoms associated with this disease. It is quite rare in AP therapy to achieve a full recovery, especially from a stubborn and hard-to-cure disease, by the use of a mere point in a prescription. However, in this case I had no doubt (nor did the patient) that the use of this point was the turning point of the treatment.

Case History.
Mrs H, aged 38, was diagnosed 4 yr before her visit to my clinic as having ulcerative colitis. 2 yr before the diagnosis was established, she started suffering from frequent bowel movements accompanied by heavy bleeding, pus and pain. She was sent to Nahariya Hospital where she had several tests, and where, after 2 yr, was given this diagnosis.

Ulcerative colitis is a chronic, non-specific, inflammatory and ulcerative disease of the LI, characterized most often by bloody diarrhoea. The disease usually begins in the rectosigmoid area and may extend proximally, eventually involving the entire colon, or it may attack most of the LI at once. Most often an attack begins insidiously with an increased urgency to defecate, mild lower abdominal cramps, and the appearance of blood and pus in the stools.

In TCM, LI is a Fu (hollow organ) belonging to the digestive system, and its function is mainly to transport the residues of the digested food to the anus for excretion. Its work depends mostly on SP, which is the Zang in control of the Yun Hua activity of the digestive system, e.g. transformation and transportation of solid and fluid food.

LI diseases may be of Internal or External origin. Internal causes include imbalances of the digestive system such as Xu of ST-Qi or SP-Yang, or by "invasion" of LV-Qi interfering with SP function. These diseases may involve many different digestive problems, besides that of LI. External causes of LI diseases must happen because LI is a Fu (Hollow Bowel) in close relation with possible External pathogens e.g. food, water, poison etc. External LI Syndromes have a more sudden onset; usually most main symptoms are related to the pathology of this organ itself. Because of the functional relationship of LI to SP-ST, LI disease of long duration may harm the transportation-transformation activities of SP. It may also involve SP function of "holding the Xue", or even SP function of "holding the organs and tissues" in place. In these cases there might be chronic bleeding, haemorrhoids, rectal prolapse and other diseases.

Among the Mrs H's symptoms were the following: cramps and pain in her lower abdomen, belching and flatulence, heartburn, dry and itchy eyes. She would sometimes feel weak and dizzy, but most of the time she felt energetic and strong. She also suffered, lately, from sacral-region pain. She did not have gynaecological problems, her periods came on time, and each one lasted 5 d. Mrs H had been pregnant 4 times. She had 3 children and one artificial abortion.

Physical examination revealed a slim, energetic woman, somewhat nervous, who spoke quickly. Her pulse was rapid (96 on first examination), deep, thin and soggy. In the right Gate/Guan position it had a wiry quality as well, and felt more elevated. The tongue was basically pale with somewhat redder edges, covered with slippery yellowish moss.

On palpation of the abdomen the descending colon was very tender, as well as the epigastric region. Left GB25 (KI Mu-Front point) was also tender, as well as both LV14 points (LV Mu-Front points).

In accordance with the findings described above, diagnosis was LI invasion by Damp-Heat. The Heat caused bleeding and irritation of the inner mucosa of the colon (LI), which in turn caused frequent peristalsis and diarrhoea. The long duration of bleeding caused a Xu of Xue and Yin which showed itself in the heartburn, dry eyes and dizziness, as well as the pale tongue and thin submerged pulse. The abundance of Damp showed itself by the slippery yellowish tongue-moss.

The treatment was given in 2 phases:
1.        Eliminate the Shi symptoms, e.g. heavy bleeding, Damp and diarrhoea. 2.        Strengthen constitutional weakness, repair internal damage. The points were: LI04, CV12, BL25, ST25, ST37, SP09, ST36, SP06. LI04 is LI Yuan point. Yuan points deal directly with their associated organs. This point was reduced by rotation and lifting and thrusting manipulation. BL25 and ST25 were chosen in accordance with the principle of combining Shu-Back and Mu-Front points: to regulate LI function. ST37 is the LI Lower He-Sea point and was reduced in order to Clear Damp and Heat from that organ. SP09 and SP06 are famous for their mutual ability to clear Damp from the digestive system, and hence treat diarrhoea and pus in the stools. ST36 was tonified to tonify SP, in order to stop the bleeding and help to recreate Yin and Xue. It was the only point which was tonified. CV12 (ST Mu-Front point and Confluent point of all the Fu (Hollow Bowels)) was manipulated evenly. After 12 sessions, given 3-4 times/wk, bowel frequency fell from 15-20 to 3-4 times/d. There was much less gas and pain in the bowels, and there was very little pus. However, there was only a small decrease of bleeding. In order to further arrest the bleeding, the prescription was changed to the following: SP01, BL17, BL20, BL24, CV06, ST25, ST36, SP09. SP01 (SP Jing-Well point and Wood point) tonifies SP and arrest bleeding (by direct moxibustion). BL17 (Hui point of Xue and Shu-Back point of Diaphragm-respiration) was tonified. BL20 (SP Shu-Back point) was tonified to tonify the SP function of retaining Xue. BL24 (Qihai (Qi Sea) Back-Shu point) was treated by warming needle technique; BL24, with CV06, arrests bleeding. ST25 was also treated by warming needle technique. ST36 and SP09 remained intact.

Warm-needle technique were used for 2 reasons: 1.        This technique is renowned for its ability to resolve Damp and create Xue. 2.        Since the patient's Syndrome showed no definite Heat signs at this stage, and the submerged pulse indicated Yangqi-Xu within the Xue, it was decided to strengthen the Yangqi by warming needle, and by this the astringent quality of SP.

This new formula showed itself effective, and after each treatment with moxa, there was a remission of bleeding for one to 3 d. Along with this the other symptoms further improved, the coating of the tongue subsided, and the bleeding was much less massive.

This new treatment pattern was given for circa 15 sessions, by which time the patient had 1-2 bowel movements/d. Most of the previous symptoms were gone except for bleeding in the stools, and slight light-headedness now and then.

At this stage I decided to further change the point prescription, as follows: SP06 (Bu method); CV04 (also, Bu method, to tonify Yuanqi, KI, Xue and constitution); CV06 and ST25 by warm-needling.

This program was carried on twice/wk for several wk, but the bleeding still persisted.
Halevi_S4 (1996) The Astringent Quality of Point GV20: A case history analysis: Part 2. Several attempts were made to give the treatment without moxa on ST25, after which the usual 2-day remission in the bleeding did not occur.

I decided to add GV20 (Baihui, 100 meetings) to the prescription. GV20 is on the most Yang part of the body, the vertex. It is the Hui-Meeting Point of all the Yang Channels; its function is to strengthen Yang and elevate Qi. GV20 also raises the sinking Qi of SP. Thus (and for other qualities not discussed here) GV20 was used mainly for astringent purposes for TCM disorders in which normal Jin-Ye (urine, sweat, blood, tears, semen etc) are discharged abnormally, abnormal fluids (diarrhoea, vomit etc) are discharged, and/or organs (uterus, rectum etc) prolapse from their normal positions. I punctured Baihui GV20 for 1 cun, horizontally and in a posterior direction. The patient reported a strong tingling sensation all over the top of her head, along with local pain and distention. From that treatment on there was no recurrence of bleeding in the stools. The patient came to me thereafter for several mo, once/mo, to receive the same treatment, and her condition remains unchanged.

Conclusion: The cessation of bleeding and restoration of complete normal functioning of LI was indeed dramatic after the application of GV20. The gradual improvement of the patient's Syndrome e.g. elimination of Shi symptoms first, and then restoration of normal LI function, proves that basically both the diagnosis and treatment were applied correctly. However one might wonder whether an earlier use of GV20 would have cured the patient earlier. I concluded: 1.        If ultimate resolution is not achieved, one should never hesitate to reconsider, alter or add other points (or techniques), even though one is sure of the diagnosis and choice of points. 2.        Even with perfect diagnosis and a point-selection to match the diagnosis, sometimes the choice of 1-2 different points within the many options of a given Syndrome, can make the difference between a good treatment and an inspired one.

Hwang_YC; Jenkins EM (1988) Effect of AP on young pigs with induced enteropathogenic Escherichia coli diarrhoea. Am J Vet Res Sep 49(9):1641-1643. 34 preweaning pigs with induced enteropathogenic Escherichia coli diarrhoea were treated with EAP, traditional AP, or neomycin. In the group treated with EAP, points GV01, bilateral ST36, and Baihui were stimulated electrically. In the group treated with traditional AP, points GV01, bilateral ST36, BL20, Timen (Bulb points), bilateral Erken (Ear Tip), and Shangen were used. CV12 and bilateral ST25 also were treated with moxibustion (applying heat generated by a burning herb, Artemisia argyi). Haemoacupuncture also was applied to Shangen, bilateral Ergen, and Timen. Pigs in the third group were given neomycin orally. Five pigs were inoculated with E coli, but were not treated and served as nontreated controls. At d5 postinoculation 60% of control pigs and >80% of pigs in treated groups recovered from diarrhoea. However, at postinoculation day 3, recovery rates for pigs in the control and group treated with EAP were only 20 and 27.3%, respectively, whereas 82 and 71% of pigs treated with AP or neomycin recovered respectively. Seemingly, traditional AP, but not EAP, was effective in controlling induced E coli diarrhoea in pigs at its early stage.

Iwa_M; Sakita M (1994) Effects of AP and moxibustion on intestinal motility in mice. AJCM 22(2):119-125. Dept of Oriental Med, Meiji Coll of Oriental Med, Kyoto, Japan. To study the effects of AP and moxibustion on intestinal motility, the distance of intra-intestinal movement of a carbon solution injected into the stomach of a mouse was evaluated. Intestinal motility was also evaluated using several drugs to accelerate or reduce intestinal motility. Intestinal peristalsis was accelerated significantly by AP at the abdomen, but suppressed by moxibustion. The intestinal peristalsis acceleration by vagostigmin was reduced significantly by both AP and moxibustion, while the reduction of intestinal peristalsis by atropine was accelerated significantly. However, no remarkable changes of intestinal peristalsis were observed with treatment by AP and moxibustion after reduction by epinephrine.

Jiang_R (1990) Analgesic effect of AP on acute intestinal colic in 190 cases. JTCM Mar 10(1):20-21. Benniu People's Hospital, Wujin County, Jiangsu Province, PRC.

Klauser_AG; Rubach A; Bertsche O; Müller-Lissner SA (1993) Body AP: effect on colonic function in chronic constipation. Z Gastroenterol Oct 31(10):605-608. Dept of Gastroenterol, Klinikum Innenstadt, Medizinische Klinik, Univ of Munich, Germany. Though there are no studies to prove it, AP has been claimed to be effective to treat chronic constipation. We therefore studied the effect of body AP on stool frequency and colonic transit time of radiopaque markers in 8 constipated patients (58+6 yr; 5 M, 3 F). Vigorous straining had been necessary for >1 yr to defecate without the use of laxatives; total colonic marker transit time was >60 h. We used a control lead-in period and a treatment period with 6 sessions in 3 wk. EAP (10 Hz, output to individual threshold, 25 min/session) was given at LI04, ST25, LV03 and BL25. 2 patients dropped out during AP because symptoms of constipation worsened. In the other 6 patients, mean stool frequencies and colonic transit times were not significantly different between the control and AP period (0.38+0.09 v 0.40+0.14 defecations/d+sem, 95% confidence interval for the difference (control minus AP)=[-0.34; 0.30], and 97+17 v 108+24h, 95% CI [-50; 27]). Segmental transit times for right and left hemicolon, and rectosigmoid colon did not differ significantly either. AP as performed in this study did not influence objective parameters of colonic function to a clinically relevant degree.

Kopeikin_VN; Belentsova LA (1991) [AP to treat gastroenteric diseases in children]. Vopr Kurortol Fizioter Lech Fiz Kult May-Jun 3:43-45. Individual regimens of AP were used in combination with other therapies to treat 66 children with various gastrointestinal diseases. Adding AP to the combined treatment improved the clinical results 1.4-fold.

Kunze_M; Seidel HJ; Stube G (1990) Comparative studies of the effectiveness of brief psychotherapy, AP and papaverine therapy in patients with irritable bowel Syndrome (IBS). Zeitschrift fur die Gesamte Innere Medizin und Ihre Grenzgebiete 15 Oct 45(20):625-627. Klinik fur Innere Medizin, Bereich Neuropsychiatrie, Bezirkskrankenhauses Suhl. Five forms of therapy were compared in patients with IBS: 1=brief psychotherapy; 2=AP; 3=Pseudo-AP; 4=papaverine therapy; 5=papaverine-placebo therapy. Psychotherapy gave the best results, with symptom-free long-lasting success in 74% of cases. This was highly significantly better than the other methods. Success rates for the other treatments were: AP 31% (significantly better than pseudo-AP (17%)); papaverine 17% (significantly different from papaverine-placebo). Success rates of brief psychotherapy differed markedly between therapists, indicating the role of personality and perfection in mastering the methods with psychotherapeutic procedures. Comparable differences between the examiners were not found in the effects of spasmolytic therapy.

Laio_CC (1990) Studies on the treatment of neonatal diarrhoea in calves by TCM and AP. Proceedings 5th AAAP Animal Science Congress, May 27-June 1, Taipei, Taiwan, ROC. Vol 3:184. Taiwan Sugar Corporation, Chunan, Miaoli, Taiwan, ROC.

Li_Y; Tougas G; Chiverton SG; Hunt RH (1992) The effect of AP on gastrointestinal function and disorders. Am J Gastroenterol Oct 87(10):1372-1381. Div of Gastroenterol, McMaster Univ Med Ctr, Hamilton, Ontario, Canada. AP has recently drawn interest as a method of analgesia. Despite extensive research, the exact mechanisms of its analgesic action are unknown, but are thought to involve endogenous opioid peptides. Recently, studies attempted to evaluate the effect of AP on gastrointestinal function and disease. A review of studies from both the Chinese and Western literature supports the efficacy of AP in the regulation of gastrointestinal motor activity and secretion through opioid and other neural pathways. However, because of the lack of properly randomized controlled trials, one can draw no firm conclusion on the efficacy of AP to treat specific gastrointestinal disorders.

Liu_J; Zhou X; Zeng X; Zhu J (1993) Effects of AP on myoelectric activity of Oddi's sphincter in humans. JTCM Sep 13(3):189-190. Luzhou Med College, Sichuan, PRC.

Liu_JX5; Zhao Q (1991) Effect of AP on postoperative intestinal peristalsis and sero-enzyme activity. Chung Hsi i Chieh Ho Tsa Chih - Chin J of Modern Developments in Trad Med Mar 11(3):156-157, 133-134. Navy General Hospital, Beijing, PRC. Abdominal surgical patients (n=39) were randomly assigned to 2 groups: 1=Needle AP at ST36 and SP06 at 12-24 h after operation and; 2=Control (untreated). Sero-enzyme activity of GPT, GOT and GGT was assayed preoperation and at 1, 3, 5, 7 d postoperation. Time to the first defecation was noted. Time to first post-operative defecation was 57.8+23.9 v 86.1+20.4 h in Groups 1 and 2 respectively; AP shortened the time of postoperative faecal retention by a mean of 28h (p<.001). In both groups, sero-enzyme activity post-surgery was 23 times greater than before; surgical trauma directly or indirectly impaired cells to release enzyme into blood. However, AP significantly decreased the time to recovery of normal sero-enzyme activity. AP significantly improved restoration of intestinal peristalsis and defecation, regulated tissue reactivity to trauma, and promoted the repair of damaged cells.

Liu_N (1995) [Influence of stimulating ST36 with moxibustion of different quality and quantity on gastrointestinal motor function of reserpinized rats]. Chen Tzu Yen Chiu 20(1):48-53. AP and Massage Dept, Nanjing Coll of TCM. This article is focused on the observation of changes in body temperature, body weight, cholinesterase activity in blood, and gastrointestinal motility of reserpinized rats treated by stimulating ST36 with moxibustion of different quality (mugwort floss or pipe tobacco) and quantity (strong stimulation or weak stimulation). Better results were achieved with moxibustion not by burning tobacco; the result of strong stimulation with moxa-sticks was better than that of weak stimulation with the same material. Strong stimulation with moxa-sticks obviously increased the activity of cholinesterase (p <.05), inhibited hyperactive gastrointestinal motility (p <.05), maintained normal body temperature (p <.05), and prevented body weight loss. The therapeutic results of moxibustion were closely related to the quality and quantity of moxibustion.

Panzer_RB2; Merritt AM; Lester GD; Burrow JA (1993) The Effects of EAP at the Guan-Yuan-Shu AP point on Equine Colonic Motility. Proceedings of 11th Annual Vet Med Forum 657-658. RB Panzer, Univ Florida, Coll Vet Med, Gainesville, FL 32611.

Stone_Af (1996) Irritable Bowel Syndrome (IBS). Adapted from WWW (Al Stone e-mail: [email protected] Acupuncture.com). IBS is a disorder effecting the intestine's ability to move its contents. This creates a symptom complex with both upper and lower gastrointestinal symptoms. Main symptoms include variable degrees of abdominal pain, constipation and/or diarrhoea, as well as bloating after eating. The symptoms nearly always occur in the waking state and are usually triggered by stress or the ingestion of food. This Syndrome represents circa 50% of all GI referrals or initial GI complaints in private and institutional care facilities. Women are affected 3 times as often as men. In the Merck Manual, (16th edition) one of WM's most respected and widely used references, no anatomic cause can be found. Emotional factors, diet, drugs, or hormones may precipitate or aggravate a heightened sensitivity to GI motility.

Clinical IBS has two main types: 1.        The "spastic colon type" has variable LI movements. Most patients have pain that originates in the LI with periodic constipation and diarrhoea. Eating commonly triggers symptoms, which include a dull ache in the lower abdomen (either continuous or comes and goes in bouts). It may be relieved by a bowel movement. Nonspecific symptoms such as bloating, flatulence, nausea, headache, fatigue, depression, anxiety and difficulty in concentration are common. 2.        The "painless urgent precipitous diarrhoea type" mainly occurs immediately upon rising or, more typically, during or immediately after food. Incontinence may also occur. Nocturnal diarrhoea is unusual.

IBS is a Western differentiation. In TCM, symptoms are organized differently. Fortunately, symptoms that may seem unrelated in WM make very simple and typical Syndromes in TCM. In TCM, SP is the key organ in charge of digestion. In WM, SP has certain functions that don't necessarily agree with the TCM concept of the organ; that is why SP is capitalized when referring to its TCM functions. In TCM, SP embraces the WM-functions of both SP and pancreas. SP-Xu, a malfunction in which SP is weakened by various factors, is like a car's engine in need of a tune-up. When the workings of the car aren't operating efficiently, many problems arise, for example reduced power and more exhaust smoke. Symptoms of SP-Xu include bloating and flatulence, somewhat like a car's engine pinging, knocking or backfiring. Diarrhoea, which is also the key symptom of IBS, is another key symptom of SP-Xu. ST is the organ with which SP has most association. In any disharmony within SP, ST may respond with nausea and vomiting.

When a car's engine is not tuned well, it doesn't burn fuel well. This can create a greater amount of exhaust fumes and carbon-accumulation in the exhaust system. In SP-Xu, the weak SP cannot metabolize the food efficiently and SP creates "Damp" in the body, the equivalent of excessive exhaust smoke in the car. In SP-Damp, the Damp it can rise to the head and create headaches that have a sensation of dull fullness in the head, the kind of headache described as "a clamp tightened around the head". Other manifestations of Damp rising to the head include a foggy inability to concentrate. Fog is much like Damp. Given time, Damp-Stasis can increase in LI. When this happens, mucus in the stool, another common IBS sign, is the typical symptom.

If SP cannot adequately obtain nutrition from the food, the obvious symptom would also include fatigue. Inability of SP to assimilate the food's nutrition may cause Xue-Xu. In Xue-Xu, specifically if Xue is not sufficient to nourish HT, anxiety follows. In TCM, Xue-Xu comes close to the WM diagnosis of anaemia. There is some overlap but a few symptoms differ, especially as regards Xue's function to nourish the TCM concept of HT, which is associated with maintaining "peace of mind".

In TCM, other symptoms in Irritable Bowel Syndrome (IBS) can be explained by including one other organ (LV) besides SP. LV (Wood) Controls SP (Earth). Going back to the analogy of the car, SP has what mechanics call "companion parts" that can effect SP if they fall out of balance first. If you have a dead car battery, it could be one of 3 things. The battery could be unable to hold a charge. Or, the problem that manifests in the battery could be coming from one of its companion parts such as the voltage regulator or the alternator. If either of these 2 components are faulty, the battery won't have enough charge to start your car. The same thing applies to SP. If one is subject to severe emotional stress, impaired LV functions impact on SP functions. The problem manifests in SP, but is due to LV problems.

In TCM, LV is the organ most sensitive to emotional stress. When LV is involved, additional symptoms will include dull pain that comes and goes along with alternating constipation and diarrhoea. In this case, it is possible that the underlying cause of the IBS is due to emotional factors effecting LV first and SP second. Though it is also possible that the stress associated with the IBS will create additional emotions effecting LV which further aggravates the condition. Either is possible.

The other "companion part" scenario involves KI. In TCM, KI regulates the Yin-Yang in the body. Yin could be described as the hydration function of the body, and Yang is much like the metabolic heat. Some people simply refer to it as the balance between Fire and Water in the body. Fire-Xu, or Yangqi-Xu in the body can cause SP-Cold, impairing SP function. When a car's windows are fogged up, we turn on the defroster and the warm air evaporates and blows away the Damp condensation. In KI-Yang-Xu, SP can't warm up to digest the food in the same way that the engine must warm up before the heater will start blowing out hot air to clear up the windshield.

When KI is the root of a SP-problem, early morning diarrhoea arises as part of the symptomological picture. This is such a typical manifestation of KI-Yang-Xu in TCM that there is a term for this kind of diarrhoea: "Cock's Crow" Diarrhoea. It gets this name because early morning diarrhoea happens when the Cock is crowing in the morning. In TCM, KI controls the lower orifices (sphincters of the bladder/urethra and LI/anus). In KI-Xu, these orifices don't have enough Qi to stay closed, and so incontinence occurs.

So, although WM doesn't yet have a good idea as to what and how IBS occurs, TCM has a very clear and obvious explanation for what is a very typical symptomatic picture.

Depending on the underlying causes of IBS, the specific symptoms and the patient's constitution, the treatment of IBS needs different approaches. If SP alone is involved, AP and herbal treatment would seek to tonify (or strengthen) SP function to make it more efficient, clear and clean the entire digestive tract, and dry the Damp within the body. If LV is involved also, the treatment principle would include therapies to sedate and calm LV, as well as the patient, which will relieve the abdominal pains and allow for the healing of SP functions. If KI is involved in the IBS, treatment would include tonifying KI-Yang to warm SP and make it more efficient as well as tonifying KI to be able to astringe both the diarrhoea and urine in incontinence.

Irritable Bowel Syndrome (IBS) has been treated effectively for millennia through TCM. And if the number of enquiries that come to Acupuncture.com regarding IBS is any indication, TCM will continue to be a source of very welcome relief for those who suffer from IBS.
Su_Z (1992) AP treatment of infantile diarrhoea: a report of 1050 cases. JTCM Jun 12(2):120-121. Dept. of Pediatrics, Ma An Shan People's Hospital, Anhui Province, PRC.

Xu_G (1994) [Regulating effect of EAP on dysrythmia of gastrocolonic electric activity induced by erythromycin in rabbits]. Chen Tzu Yen Chiu 19(1):71-74. Inst of AP and Channel, Anhui Coll of TCM, Hefei, PRC. The myoelectrical activity of the gastrocolon was recorded in 20 rabbits. Gastrocolonic disorder was induced by iv injection of erythromycin (EM, 7 mg/kg). We studied the regulating effect of EAP on gastrocolonic electric activity (GEA). The effect of EAP was studied after vagotomy. In fasting and anaesthetic rabbits, the frequency and amplitude of GEA were 4.47+1.23 cmp, 1.90+0.27 mV at antrum, 8.33+2.61 cpm, 0.51+0.12 mV at ascending colon, 6.74+2.68 cpm, 0.35+0.10 mV at descending colon. After injection of EM, the frequency and amplitude of GEA increased, the latency and duration of EM effect were 36.5+4.5 min and 3.8+1.4 min and a great contraction wave occurred. EAP shortened the duration and latency, decreased the frequency, amplitude and variation coefficient of GEA. Vagotomy abolished the effect of EAP. The vagus nerve is important in regulating effect of EAP on gastrocolonic disorder.

Xu_G1 (1994) Influence of stress on gastroenteric electric activity and modulated effect of AP on it in rats. Chen Tzu Yen Chiu - AP Research 19(2):72-74. Inst of AP and Channels, Anhui Coll of TCM, PRC. 3 pairs of bipolar electrode were implanted surgically on the antrum, ascending and descending colon of SD rats. Stress was induced by restraint immersion for 30-40 min in cold water at 4oC. The modulating effect of AP at ST36 on gastroenteric electric activity was studied. Stress induced significant inhibition of gastrocolon electrical activity (reduced frequency and amplitude of slow wave, rhythmic disorder, increased degree of dispersion, decreased fast wave and prolonged or disturbed IDMEC phase III. AP at ST36 effectively reduced stress-induced inhibition of gastrocolonic electrical activity in rats.

Zhang_J1; Jiang D; Qin J (1992) The segmental distribution of the afferent neurons of ST36 and the caecum in rabbits: a study with the horseradish peroxidase method. Chen-Tzu-Yen-Chiu 17(2):123-125. Dept of Anatomy, Guilin Med Coll. 10 adult rabbits were used in this experiment. A solution of 10-20% HRP (sigma IX, RZ=3.2) was injected into ST36 and the subserosa of the caecum. The uptake and retrograde transmission of HRP in the afferent neurons of both the somatic and visceral nerves were traced to the spinal ganglia. Labelled afferent neurons from the region of ST36 were found in the spinal ganglia T12-S2 with higher numbers in L4-S2. Labelled afferent neurons from the region of the caecum were found in the spinal ganglia T2-S2 with a higher numbers in T12-L2. The ranges of distribution of labelled afferent neurons from the regions overlapped in the segments T12-S2.

7. OBESITY
Asamoto_S; Takeshige C (1992) Activation of the satiety centre by Ear-AP point stimulation. Brain Res Bull Aug 29(2):157-64. Dept of Physiol, Showa Univ Sch of Med, Tokyo, Japan. In rats, stimulation of the zones on the inner surface of the ear that correspond to the human pylorus, lung, trachea, stomach, oesophagus, endocrine, and heart AP points evoked potentials in the hypothalamic ventromedial nucleus (HVM), the satiety centre. Needle implantation into any of these points reduced the body weight to its initial 290 g after the rat had gained circa 410 g in 20 d, and significantly reduced initial 450-g body weights (p <.01, Student's t test) in 14 d. Stimulation of other AP points did not evoke HVM potentials and did not reduce body weight. After the HVM was lesioned, body weight increased and AP point needling had no effect on body weight. Needling of the Ear-AP points evoked no potentials in the lateral hypothalamus (LHA), the feeding centre, and had almost no influence on weight reduction induced by LHA lesion.

Gadzhiev_AA; Mugarab-Samedi VV; Isaev II; Rafieva SK (1993). [AP therapy of constitution-exogenous obesity in children]. Probl Endokrinol (Mosk) May-Jun 39(3):21-24. The authors have studied the efficacy of AP as a method to help in weight-loss and to normalize lipid metabolism in 62 children with constitutional exogenic obesity. EAP had a beneficial effect on various pathogenetic components of this patient population, which was confirmed by cessation of subjective complaints, body mass reduction and decrease of fatty tissue content, increased performance abilities, recovery of cardiovascular function, normalization of blood serum lipids. AP is recommended as part of a comprehensive treatment of children with constitutional exogenic obesity.

Liu_Z (1990) [Effect of AP and moxibustion on the high density lipoprotein cholesterol in simple obesity]. Chen Tzu Yen Chiu 15(3):227-231. Dept of AP & Moxibustion, Nanjing Coll of TCM, PRC. For the purpose of understanding regulatory effect of AP and moxibustion, we have observed the changes of the obese indices and the lipid indices in 196 sample obesities before and after the AP and moxibustion. AP and moxibustion had a good effect on obesity and a benign regulatory effect on lipid metabolism and high density lipoprotein cholesterol.

Liu_ZCo2 (1990) [Effect of AP and moxibustion on hypothalamus-pituitary-adrenal axis suffering from simple obesity]. Chung Hsi I Chieh Ho Tsa Chih Nov 10(11):656-659, 643-4. Dept of AP & Moxibustion, Nanjing Coll of TCM, PRC. In order to understand the effect of AP and moxibustion on hypothalamus-pituitary-adrenal axis in simple obesity, the authors have observed the obese indices, the lipid level, the level of ACTH in plasma and that of salivary cortisol in 39 simple obesity before and after the AP and moxibustion treatment. The markedly effective rate was 38%, the effective rate was 51%, the ineffective rate was 10% and the total effective rate was 90% after treatment. Hypothalamus-pituitary-adrenal axis function in simple obesity was lower than normal. AP and moxibustion treatment not only regulated the lipid level and achieved the antiobesity effect but also enhanced the function of hypothalamus-pituitary-adrenal system. The key factor of AP and moxibustion in obesity was to hypothalamus-pituitary-adrenal function.

Liu_ZCo3; Sun FM; Shen DZ (1991) [Effect of AP and moxibustion on antiobesity in the variation of plasma cyclic nucleotide and the function of ANS]. Chung Hsi I Chieh Ho Tsa Chih Feb 11(2):83-86, 67-8. Dept of AP & Moxibustion, Nanjing Coll of TCM, PRC. The authors observed the changes of the obesity index, lipid index, the equilibrium indices of the ANS (Y value) and the plasma cAMP of 46 cases of simple obese before and after AP. Of 46 cases, 39 were of the LV-Yang Xu (group 1) and 7 of the LV-Yang Shi (group 2). It was found that the sympathetic nervous function of the patients in group 1 was markedly higher than the normal. In both of them, the lipid metabolism was abnormal and the level of cAMP in plasma was significantly lower than the normal. The marked effects were achieved on the cases which received one course of treatment (1 mo) by AP, the total effective rate being 85%. AP induced an antiobesity effect and also biphase changes in blood pressure and Y value. AP raised blood pressure and Y value of the patients in group 1 but reduced the blood pressure and Y value of the patients in group 2. Also, AP brought about good regulation effect on lipid metabolism and plasma cAMP of patients. This suggests that the regulation effect of AP on plasma cAMP of patients with simple obese might be an important link by which antiobesity effect may be achieved.

Liu_ZCo4; Sun FM; Wang YZ (1995) [Good regulation of AP in simple obesity patients with Stomach-Intestine Excessive Heat Syndrome]. Chung Kuo Chung Hsi I Chieh Ho Tsa Chih Mar 15(3):137-140. Nanjing Coll of TCM, PRC. In order to investigate the regulatory effect of AP on obesity patients with the Stomach-Intestine Excessive Heat Type, the pre-AP and post-AP obesity index and biochemical indices of 718 patients with simple obesity was observed. AP gave a marked weight loss, while the biochemical indices improved. AP had a good regulatory effect on the function of nerve, endocrine, digestion and energy metabolism.

Liu_ZCo5 (1996) Good Regulation of AP on Simple Obesity Patients with Stomach-Intestine Excessive Heart Type. Liu Zhicheng, Nanjing College of TCM, Nanjing 210029, PRC. Adapted from WWW at http://www.dmu.ac.uk/ln/cmn/[email protected] (Chin Med News, Beijing Cons Bio-Tech (e-mail: [email protected]). The obesity-and biochemical- indices of 718 patients with simple obesity was observed pre- and post- AP, to study the regulatory effect of AP on simple obesity patients with ST-SI excessive HT type. Patients who received AP had a marked weight loss and the biochemical indices improved. AP had a good regulatory effect on the function of nerve, endocrine, digestion and energy metabolism.

Sun_Q; Xu Y (1993) Simple obesity and obesity hyperlipaemia treated with Ear-AP point pellet pressure and body AP. Chung i tsa chih (JTCM) Mar 13(1):22-26. Dept of TCM, Second Teaching Hospital of Chongqing Med Univ, PRC. 161 cases of simple obesity with or without hyperlipaemia were treated by pellet pressure on Ear-AP points plus body-AP for 3 mo in a single-blind experiment. Patients on Capsulae Olei Oenothera Erythrosepalae were taken as positive controls. Body weight, circumference of chest, abdomen, arms and legs, the appetite, sleep, bowel movement, blood TC, TG and HDL-C were recorded for comparison. Treatment in the Ear- and body- AP point group was superior to treatment in the control group. In the AP point group body weight dropped by a mean of 5 kg in 85% of the patients, who also showed decreased appetite, blood TC and TG.

Tang_X (1993) 75 cases of simple obesity treated with auricular and body AP. JTCM Sep 13(3):194-195. Dept of AP, First Employees' Hospital, Wuhan, PRC.

Zhang_Z (1990) Weight reduction by Ear-AP: a report of 110 cases. JTCM Mar 10(1):17-18. Dept of AP and Moxibustion, Affiliated Hospital of Jiamusi Med College, PRC.

Zhao_Y; Yang C; Liu Z (1992) Effect of AP on carbohydrate metabolism in patients with simple obesity. JTCM Jun 12(2):129-132. Dept of TCM, Qinghai Med College, Xining, PRC.

8. SPLEEN/PANCREAS/DIABETES
(see immunity-blood diseases also)
Bodnar_PN; Peshko AA (1992) [The AP reflexotherapy of diabetes mellitus patients]. Vrach Delo May 5:12-16.
Chen_D; Gong D; Zhai Y (1994) Clinical and experimental studies in treating diabetes mellitus by AP. JTCM Sep 14(3):163-166. Provincial Inst of TCM and Pharmacy, Jilin Province, PRC.
Choate_C1 (1996) Diabetes mellitus from the perspectives of WM and TCM: Part 1. Adapted from WWW (Acupuncture.com). Clinton Choate LAc; e-mail: [email protected].

Western clinical observations
Background
Because of its frequency, diabetes probably is the most important metabolic disease. It affects every cell in the body, and the essential biochemical processes that go on there. Diabetes has been known as a Med problem since antiquity, one which ranks 8th as a cause of death in USA. The name which was originated by Aretaeus (30-90 AD) came from the Greek words meaning "siphon" and "to run through" and in Med signifies the chronic excretion of an excessive volume of urine.

The cause of spontaneous diabetes mellitus, hereafter referred to as DM, is not known. The fundamental cause, however, is a relative or complete lack of insulin, the hormone produced by Beta cells in the pancreatic islets of Langerhans, which is necessary for the metabolism of carbohydrates. Since we know that the ways that the body derives Nutritive Qi (energy from food) (fats, carbohydrates, proteins) are intermingled, any problem in carbohydrate metabolism will necessarily affect the metabolism of protein and fat as well.

Carbohydrate is the active fuel of the body and is ordinarily the main source of energy of the tissue cell. It is utilized chiefly by the body in the form of glucose and is circulated to the tissues by the blood which keeps it in constant supply. The quantity of glucose in the blood seldom exceeds 160 mg/100cc of blood shortly after food sugar has been absorbed nor seldom falls below 60 mg/100cc during fasting.

In the blood, glucose apparently freely enters certain cells such as those of the CNS but requires the help of insulin to enter most cells at a normal rate. Insufficient production of pancreatic insulin for the metabolism of food sugars and starches produces the diabetic condition. In the normal digestion, food sugars and starches (carbohydrates) are changed into glucose. This is stored in the form of glycogen (animal starch) in the liver and muscles for later use as a body fuel, at which time it is reconverted into glucose. Insulin is the essential hormone for both the storage and conversion of glucose. The metabolic failure characteristic of DM may occur because the body produces too little insulin, or because of a faulty chemical reaction, or a combination of both. The result of the disturbed glucose metabolism causes an abnormal accumulation of sugar in the blood stream and the diabetic condition.

Symptomatology
DM is characterized by 3 Syndromes: polydipsia (excessive thirst), polyphagia (excessive hunger) and polyuria (excessive urination). Lab findings reveal high blood sugar and glucose in the urine. Excessive ketone bodies appear in the blood and urine as the metabolic derangement worsens. Their accumulation produces acidosis which, if not counteracted, can cause coma and death.

Much has been written on the possible etiology of diabetes, most of it speculative. Also, knowledge of the etiology is not particularly helpful in the clinical management of the disease and will not be considered in detail here. Most ideas can be classified under one of the following categories: heredity, endocrine imbalance (hyperpituitarism, etc), dietary indiscretion, sequelae of infection and severe and continued psychic stress. A probable genetic tendency towards diabetes would suggest the wisdom of keeping a close check on close relatives.

The other hypothesized etiologies all stem from factors known to aggravate the disease such as infections, obesity, and psychic stress. From a practical point of view, therefore, it is wise for diabetics or potential diabetics to control their weight, to avoid as much psychic stress as possible and to treat any infections promptly, but who shouldn't?.

Presenting symptoms
The clinical manifestations of diabetes in the order in which they usually appear are:
1.        frequent copious urination
2.        excessive thirst
3.        rapid weight loss
4.        excessive hunger
5.        drowsiness, fatigue
6.        itching of genitals and skin
7.        visual disturbances
8.        skin infections.

In juveniles, 50-75% of the earliest symptoms noted are increases urination, thirst and hunger. Physical findings in adults are mostly attributable to complications; the first sign of the disease may be a dermatological, circulatory, neurological or visual complication.

Lab diagnosis
Lab diagnosis of diabetes depends on finding glucose in the urine concurrently with an elevated blood sugar. Appearance of glucose in the urine depends on its level in arterial blood, the rate of glomerular filtration, and the efficiency of tubular resorption in the kidney. Thus, kidney thresholds for glucose vary widely, both in normal persons and in diabetics. Glycosuria may also occur incidental to emotional stress, systemic infection, or due to hyperthyroidism.

In the Second Edition of the Diabetics Guide for the Physician published by the American Diabetes Assoc, the upper limit of normal for venous blood sugar levels is 130 mg/100 ml in the fasting state and 200 after a meal. Normal fasting level in venous plasma is 60-110 mg/ml, increasing by circa 2 mg/100 ml/decade after age 30. In Type I, or juvenile diabetes, insulin secretion is low. Insulin is the message carrier that orders blood sugar to go down. In juvenile diabetes, there isn't any message, so again the blood sugar rises. In Type II (maturity-onset diabetes, NIDDM) insulin secretion is plentiful; many Type II diabetics have too much insulin, but the message is not received and the blood sugar rises. Blood glucose values above normal, in the absence of complicating illness, drugs, or stress, usually indicate diabetes. After meals, values of 250-350 mg/100cc are not unusual in moderately severe DM. Some mild diabetics will have normal fasting blood sugar values and values in the diabetic range only after meals. Occasionally very mild cases will have values within normal at both times and the diabetic tendency will be evident only when these persons are required to handle more than an ordinary amount of carbohydrate. The Glucose Tolerance Test (GTT) was conceived to test such patients by giving a large amount of glucose or food at one time to measure the adequacy of their islet tissue.

Complications or sequelae of diabetes
Sometimes a complication of diabetes may give a clue to the recognition of the disease. The principle complications or sequelae associated with diabetes are retinopathy, neuropathy, nephropathy, and arteriosclerosis. Whether these are the unavoidable consequences of the existence of the diabetic state over a period of time or whether they may be influenced by the degree of control of the diabetes is still a question. Complications do, however, create trouble for the diabetic and may when they are vascular disorders, reduce life expectancy.

Since the discovery of insulin nearly 70 yr ago, the patterns of morbidity from diabetes have changed. The major cause of death were diabetes ketoacidosis and infection, whereas they are now the microvascular and cardiovascular complications of diabetes, kidney failure and MI (myocardial infarction). These complications reduce the life expectancy of a newly diagnosed insulin dependent diabetic by circa 1/3. The basis of managing diabetes in the 80s is an improvement in the life-style of the diabetic and prevention of complications responsible for morbidity and mortality in diabetes.
Choate_C2 (1996) Diabetes mellitus from the perspectives of WM and TCM: Part 2.

Retinopathy
Eye lesions typical of diabetes involve the veins and capillaries of the retina. Cataracts, associated with early diabetes, seem more frequent in young diabetics; senile cataracts are as frequent in non-diabetics. It usually takes between 10-13 yr for diabetic retinopathy to develop and it is present in some degree in most diabetics who have had the disease for 20 yr. However, the diabetics who develop impaired vision, marked impairment affects only circa 50% and only circa 6% go blind.

Neuropathy
Diabetic neuropathy, which includes pain, paraesthesias and myalgias, is largely peripheral neuritis. The femoral nerve is commonly involved, causing symptoms in the legs and feet, although nerves in the arms, abdomen and back may also be affected. Pain is the chief symptom which tends to worsen at night when the patient is at rest and is relieved by activity. It is aggravated by Cold. Paraesthesias are a common accompaniment of the pain. Attendant cramping, tenderness and weakness of the muscle may occur but atrophy is rare.

Involvement of the ANS may cause such signs as reduced or absent perspiration, reduced vasomotor and pilomotor function, dependent edema, sever edema, severe constipation or nocturnal diarrhoea, sexual impotence, urinary and faecal incontinence, bladder atony and paralysis.

DM is probably the single most common disease associated with erectile failure. As an erection involves all levels of the nervous system, from the brain to the peripheral nerves, lesions anywhere along the path may cause erectile failure. It has been estimated that close to 50% of diabetic males have some degree of erectile dysfunction since diabetes is a metabolic disease with vascular and nervous system complications. The diabetic condition may affect the blood and nerve supply to the penis with the consequent neurogenic impotence.

As diabetes is controlled, neuropathies usually improve, but it may take several wk or mo to show maximal benefit in severe or chronic changes. Paradoxically, there may be a transient aggravation of symptoms with regulation of the disease; the reasons for this are unknown. A high protein intake and supplementary vitamin B-complex, including vitamin B12 1000 mg/d, may be helpful.

Arteriosclerosis
The diabetic state is associated with earlier and more severe vascular changes than occur normally at a given age. HT-vascular-KI disease is the leading cause of death among diabetics. The diabetic appears generally subject to arteriosclerotic changes, but the heart, brain and leg arteries are most often affected by occlusive lesions. The incidence of coronary occlusion in patients with clinical diabetes has been estimated at from 8-18%.

Arteriosclerosis obliterans in the lower extremities may produce such sensations as disturbances in sensation, decrease in muscular endurance, intermittent claudication on effort (cramping of calf muscle) and finally gangrene. Diabetic gangrene usually involves the toes, heels or other prominent parts of the feet and is precipitated by trauma, infection or extreme in temperature.

The aetiology of disease of the large vessels is multifactorial in the diabetics as well as in non-diabetics; lipoprotein metabolism, hypertension, physical activity, obesity, cigarette smoking, stress, personality, genetic and racial factors all play a part. As well as these general factors operative in diabetes, attention has been paid to specific metabolic disorders which could theoretically increase the severity or rate of formation of atheroma in diabetes. Epidemiologic data show no increased risk from diabetes independent of hypertension, cigarette smoking and hyperlipaemia. However, it is possible that hyperfibrinogenaemia, decreased fibrinolysis, abnormalities in platelet adhesiveness and platelet dysfunction, changes in prostaglandin metabolism and the vessel wall, may all play a part. Insulin depletion itself may influence the progression of atheroma through synergistic mechanisms involving hyperlipaemia, altered platelet behaviour and abnormalities in the arterial wall.

Nephropathy
Nephropathy is a common and important effect of diabetes, one which takes precedence over heart disease as a cause of illness and death in young diabetics. As with eye changes, kidney damage shows wide variation in type and degree. Nephropathy is less frequent than retinopathy; when it occurs it also is an effect of long-standing diabetes.

In one study, 50% of 200 juvenile diabetics who survived 20 yr after onset had evidence of kidney disease. The typical nodular lesions of the glomeruli did or did not cause clinical symptoms, depending on the number of glomeruli involved. In another study, most patients had hypertension; 2/3 had albuminuria, but the fully developed nephrotic Syndrome of hypertension, proteinuria and edema occurred in <10% and kidney function was impaired in very few of those patients.

Ketoacidosis
One of the by-products of fat metabolism is the formation of chemical compounds called ketones. When ketone bodies are excessive, diabetic acidosis results, leading to possibly fatal diabetic coma. The possibility of ketoacidosis is suggested by: confusion or coma, the patient almost always appearing extremely ill; air hunger, an attempt to compensate for metabolic acidosis; acetone odour (fruity) invariably on the breath; nausea and vomiting almost always present; abdominal tenderness which may mimic viral gastroenteritis; extreme thirst and dry mucous membranes; weight loss; diabetic history, present in circa 90% of cases.

Before the discovery of proper treatment by insulin and other iv injections, acidosis was the chief cause of death among diabetics.

Hypoglycemia
If insulin levels are too high relative to glucose, blood sugar level falls below normal levels, a condition called hypoglycaemia. In severe hypoglycaemia, commonly called insulin shock, the brain is deprived of an essential energy source. The first sign of insulin shock is mild hunger, quickly followed be dizziness, sweats, palpitation, mental confusion and eventual loss of consciousness. Before the condition reaches emergency proportions, most diabetics learn to counteract the symptoms by eating a piece of candy or by drinking a glass of orange juice. In some cases, the only effective measure is an iv injection of glucose.

Drug therapy
Insulin was the first, and remains the best means of treatment for diabetes. It is given by sc injection. This method is necessary since orally-given insulin is destroyed by gastric (ST) secretions. Many diabetics inject insulin only once a day, thus duplicating the normal insulin action of a non-diabetic. Others require 2 or more injections. The usual time for a dose of insulin is before breakfast. The dosage is established initially according to the severity of the condition, but it often has to be reassessed as one or another of the variables in the person's condition changes.

Oral hypoglycaemic agents were developed in the 1950s for controlling milder cases of diabetes that develop in people over 45. They are used to stimulate the release of insulin from the pancreas and foster insulin activity in other ways. None of the oral agents should be used as a substitute, however, for insulin in the ketoacidosis-prone patient since they are not oral forms of insulin.

Choate_C3 (1996) Diabetes mellitus from the perspectives of WM and TCM: Part 3. The biologic half-lives after administration cannot be measured accurately, making the selection of dose and timing of dosing haphazard. Also, use of oral hypoglycaemic drugs has been reported to be associated with increased cardiovascular mortality.

The current use of any of the oral drugs represents to some extent laziness and lack of understanding of the problem at hand with most non-insulin dependent diabetics. Some of the new generation drugs have a specific and beneficial place, if used correctly in patients who are on the appropriate diet and exercise program and are near their optimal weight.

Nutritional therapy
A non-diabetic produces the constantly varying amounts of insulin necessary for obtaining energy from glucose. A diabetic cannot achieve this balance. Apart from the basic need to provide adequate calories and nutrients, the two major groups of diabetics need very different diet strategies. Type I are insulin-dependent non-obese patients (IDDM). Type II are obese patients do not require insulin (NIDDM). In overweight patients, special attention must be given to total caloric consumption; patients who are on insulin therapy must schedule their meals to provide regular caloric intake.

There is no need to disproportionately restrict the intake of carbohydrates in the diet of most diabetic patients. Flexibility in diet design, therefor, helps many patients to adhere to an effective program. Lowering of fat consumption, however, may reduce risk factors of CHD, the main cause of death and debility in the diabetic. 1/3 diabetic patients in clinical surveys has hyperlipidaemia, clearly indicating the need for dietary management. This is reflected in the standard diet and food exchange lists revised in 1976 by the American Diabetes Assoc which restricts the intake of fat to 35% of calories.

In the system of food exchanges the calculation of the proper diet and the selection of foods by the patient are divided into 6 food lists. In each is listed the kind and amount of food with about the same nutritional value in carbohydrate, protein, and fat. The diet exchange method is based on "Exchange Lists for Meal Planning" prepared by and available from the American Diabetes Assoc and the American Diabetic Assoc.

One of the first dietary rules for all diabetics is to avoid all sugar and food containing sugar, such as pastry, candy, and soft drinks. While these refined sugars and other simple carbohydrates like white flour must be carefully watched, most diabetics are encouraged to eat more complex carbohydrates, the same bulky, fibre-rich unprocessed foods that are now recommended for everyone. Vegetables are ideal. For example, a diabetic can eat a large plate of spinach, which contains as much carbohydrate as a tablespoonful of sugar, without suffering any ill effects.

Spinach, asparagus, broccoli, cabbage, string beans, and celery are among the so-called "Food Exchange Group A" vegetables which the American Diabetes Assoc says can be generously included in the diabetic diet. What makes these complex carbohydrates special is their ability to slow down the body's absorption of carbohydrates by helping to delay the emptying of the stomach and thereby smoothing out the absorption of sugars into the blood. Whole grain cereals also have this ability.

Since diabetics are also particularly prone to atherosclerosis with the complicating problems of heart attacks, strokes, and poor circulation to the feet, they must also limit the amount of fat in their diet and to substitute polyunsaturated fats for the saturated type when possible. Fish and poultry are especially recommended instead of fatty cuts of meat. Greasy, fried foods are strongly discouraged.

In diabetics, platelets, the blood elements which are part of the blood clotting mechanism, tend to clump together too quickly. This condition is thought to contribute to vascular complications such as retinal haematoma, coronary thrombosis, and microangiopathy. At least 8 natural substances are known to inhibit abnormal platelet adhesiveness. These include, Vitamins C, E, B6, Linoleic acid, onions, garlic, bromelin, and mackerel- the active ingredient in mackerel being eicosapentaenoic acid. Important tests to measure for platelet aggregation and other conditions which may indicate the progression of atheroma include test for cholesterol, HDL-cholesterol, triglycerides, and a treadmill EKG.

By carefully calculating the proper daily calorie intake for their body weight and activity level, and never exceeding it, overweight diabetics can usually reduce their weight to an optimal level, a level which is 10% less than that recommended by standard height and weight charts.

"The overweight diabetic who successfully brings their weight back to normal usually experiences a dramatic improvement in their condition. Indeed, the symptoms often virtually disappear," says Charles Weller MD, in his book, The New Way To Live With Diabetes (Doubleday, NY rev. 1976). "Weight reduction and control can bring this incurable disease closer to complete remission than any medication.".

Many diabetics eat smaller, more frequent meals, rather that the 2 or 3 big meals most people consume daily. Multiple frequent feedings tend to keep blood cholesterol levels lower, for the diabetic and non-diabetic alike. Since diabetics eat less than most of us, they are advised to make every calorie count.

Generally, a well-balanced diet, rich in vitamins and minerals, is a main factors in the control of diabetes. Some authorities find that the diabetic is unable to convert carotene into vitamin A, while others deny such findings. It is advisable, therefore, for the diabetic to ingest at least the Recommended Dietary Allowance of vitamin A from a non-carotene source, such as fish-liver oil. Diabetics and others on low-fat diets often need supplemental amounts of this fat-soluble nutrient.

A vitamin E supplement (400-1200 IU/d) and a vitamin C supplement (1000-4000 mg/d) is recommended also to help prevent disease of the small-vessels of the extremities. Diabetics, like everyone else, need all the known nutrients, including 12 vitamins and 17 minerals. To be sure of getting the full range of trace elements and other nutrients, diabetics are encouraged to eat the widest possible variety of permitted foods, as well as taking supplements. Certain nutrients (vitamins C, B1, B2, B12, pantothenic acid, protein, and K) along with small frequent meals containing some carbohydrate, can stimulate production of insulin within the body. Supplementary Zn, Cr, and Mn also have been associated with the treatment of diabetes.

Brewer's yeast is another food supplement that is recommended for the diabetic patient. The yeast is a rich source of Cr-containing GTF (glucose tolerance factor), which can potentiate the insulin in our bodies. Both brewer's yeast (9 gm/d) and trivalent Cr (150-1000 ug/d) can significantly improve blood sugar metabolism when taken for several wk to mo. Brewer's yeast and Cr supplementation also lower elevated total cholesterol and total lipids, and significantly raise the levels of HDL-cholesterol- the beneficial or protective fraction of cholesterol. Diabetics who wish to minimize the ill effects of their condition should also eliminate cigarette smoking and alcohol and follow a program of moderate but regular exercise. It is also important to wear shoes which do not cause abrasions of the feet since a small sore that may be a nuisance to most people can lead to gangrene in a diabetic.

Choate_C4 (1996) Diabetes mellitus from the perspectives of WM and TCM: Part 4.

Nutrients that may help to treat diabetes

Vitamin
Vitamin B complex
Inositol
Vitamin B6
Niacin
Vitamin B1
Vitamin B2
Vitamin B12
Vitamin C
Vitamin D
Vitamin E
Unsaturated fat
Lecithin
plus Protein, Panothenic acid, Pangamic acid, Ca, Fe
Cr
Mg
Mn
K
Zn
Vanadyl Sulphate

Amount (when available)

2-6 g
500-1000 mg
up to 100 mg
10 mg
10 mg
>25 mcg
1000-4000 mg
400 IU
400-1200 IU
2 Tbsp
3 Tbsp

150-200 mg
500 mg
up to 50 mg
300 mg
100-150 mg
100-150 mg

Note: Quantities shown are not prescriptive; some are very high and represent therapeutic test dosages. Individual needs and tolerances will vary according to body size, metabolism, age, diet, and ailment.

Herbal Rx.
TCM places great value on blueberry leaves as a natural method of controlling or lowering blood sugar levels when they are slightly elevated. The leaves of the common blueberry plant has an active principle with a remarkable ability to reduce excess sugar in the blood. For those who have moderately elevated blood sugar, steep some leaves in hot water for 30 min and drink a cup of the tea 3x/d. Make the infusion fresh each time.

Diabetes in the year 2001
Except for appropriate dietary and exercise guidelines, research into the causes and control of this disease, no preventative measures can be taken against diabetes at this time. Since the discovery of insulin in the 1920s and the development of oral hypoglycaemic drugs in the 1950s, diabetics can live active and productive lives. The importance of early detection and proper management of this chronic disease cannot, however, be emphasized too strongly.

The therapy of insulin-dependent diabetes change dramatically over the next few decades. One can predict improved strategies for glucose control in established IDDM. This will include widespread use of mechanical devices, which will involve both implantable glucose sensors and implantable insulin infusion systems and successful transplantation of pancreatic islet or beta cells, without the need of immunosuppressive therapy to prevent rejection. The advances will change the face of diabetes as we know it. Moreover, we will see the application of immune intervention strategies at the time of onset of IDDM, with the reversal of the disease process. Ultimately, these strategies will be applied earlier in the sequence during a stage which we do not yet recognize as clinical diabetes. In these individuals otherwise destined to develop IDDM, the disease will be prevented.

Diabetes mellitus in TCM
Two Chinese terms describe diabetes: In TCM, Xiao-ke ("wasting and thirsting"); in modern Chinese: Tang-niao-bing ("sugar urine illness"). Discussion of diabetes by its TCM name appears in all the earliest texts, including the Neijing. In TCM, it is divided into 3 types: Upper, Middle, and Lower. Each type corresponds to a disproportionate emphasis on the 3 main symptoms - thirst, hunger, and excessive urination. Yin Xu is usually associated with all 3 types. Also, a TCM diagnosis of "wasting and thirsting" may include illnesses besides the modern entity of diabetes. And the opposite is true; someone with tang-niao-bing would not necessarily have Xiao-ke.

Here, Diabetes Mellitus will be viewed as it is in TCM, namely Xiao-ke, or "wasting and thirsting disease". It is related to eating fatty or sweet foods in excess, and to emotional factors. Chapter 47 of Simple Questions says "fat causes Internal Heat while sweetness causes Shi of the Middle Jiao; the Qi rises and overflows and the Syndrome changes into that of thirsting and wasting". Chapter 46 of the Spiritual Axis elaborates: "The Five Zang [Yin Solid Organs] are soft and weak and prone to symptoms of Wasting Heat; when there is something soft and weak there must be something hard and strong. Frequent anger is hard and strong and the soft and weak are thereby easily injured".

Wasting Heat Syndrome arises when Heat exhausts the Jin-Ye, which injures Yin. In TCM, Internal Heat is due to imbalanced or immoderate food habits (e.g. over-consumption of fatty, greasy, pungent and sweet food, Hot drinks and alcohol). Long-term Internal Heat may become pathogenic Dryness, consuming Jin-Ye, which then fail to nourish LU and KI. Pathological changes seen in diabetes therefore always include Yin-Xu and Dry Heat. These factors mutually influence each other: Yin-Xu leads to Dry Heat; Dry Heat to Yin-Xu.

Xiao-ke Syndrome may also occur in KI-Yang-Xu whose Jing-Essence can not transform into Qi. Depending on the Syndrome, the disease is classified as Upper, Middle and Lower wasting. These Syndromes are intimately related to LU, SP and KI respectively.

When dry Heat consumes LU-Fluid there is thirst. LU-Fire manifests by great thirst, drinking large quantities of water and a dry mouth. The tongue is red with yellow moss; the pulse floating and rapid.

In Heat of ST and SP there is excessive appetite and constant hunger. ST-Fire is characterized by large appetite and excessive eating, thinness and constipation. The tongue is red with yellow moss; the pulse rapid. If KI is injured by Fire there can be profuse, frequent urination. "KI-Fire" is characterized by frequent, copious urination, cloudy urine (as if greasy), progressive weight loss, dizziness, blurred vision, sore back, skin itching or ulceration, and vaginal itching. The tongue is red with scanty or no coat; the pulse is fine and rapid.

All 3 pathomechanisms involve the mutual exacerbation of Yin-Xu and Dry-Heat scorching KI-Jing (Yin Essence) and the Fluids of LU and ST. Yin-Xu is mainly associated with KI; according to the principle that injury of Yin affects Yang, KI-Yang-Xu invariably occurs in chronic cases also. Treatment Principle: Clear Heat from the TH.

Needling

Main points
M-BW12 (Yishu)
BL13
BL20
BL23
ST36
KI03

Functions
Controls pancreatic function
LU Shu-Back point to drain Heat from Upper Jiao
SP Shu-Back point to drain Heat from Middle Jiao
KI Shu-Back point to drain Heat from Lower Jiao
ST He-Sea, Uniting, Earth and Hour point
KI Yuan point

Supplemental points

Points
LI11
LI10
BL17
N-BW10
BL21
CV12

Functions
Drains Fire from LU
Drains Fire from LU
Hui-Meeting point of Xue. Nourishes Jin-Ye.
(Pirexue)
ST Shu-Back point to drain Heat from Middle Jiao
ST Mu-Front point to drain Heat from Middle Jiao

When Heat in SP-ST causes hunger and emaciation, these points, along with other Shu-Back and Mu-Front points, are used to Calm Shi (drain Excess):

CV04
KI07
KI05

Strengthens Yuanqi in urinary frequency and KI-Yang-Xu
Used together to stabilize KI-Qi
Used together to stabilize KI-Qi

Method.
The main Shu-Back points should be needled with only mild stimulation and without retaining the needles. The remaining points can be needled with moderate stimulation, retaining the needles from 10-15 min. Treat once/2 d; 10 treatments constitute one course.

For excessive thirst, add LI11, LI10 and BL17. For increased appetite accompanied by emaciation of the muscles, add N-BW10, BL21 and CV12. For frequent urination, add CV04, KI07 and KI05.

Choate_C5 (1996) Diabetes mellitus from the perspectives of WM and TCM: Part 5.
Ear AP 

Symptom
Thirst:
Hunger:
Frequent urination:
To increase insulin:

Ear AP points
Endocrine, LU, Thirst
Endocrine, ST
Endocrine, KI, BL
Pancreas

Method
Insert and retain needles for circa 15 min. 10 treatments constitute one course. Cutaneous AP Tap along both sides of the spine, emphasizing the region between T7 through T10. Each session should last circa 5-10 min every 1-2 d.

Moxibustion
For dryness in the mouth, burn 100 cones at BL27. For frequent urination, moxa can be burned at the tips of the little finger and toe (Taiyang Jing-Well points, SI01, BL67), as well as at points along the cervical vertebrae [e.g. GV14].

Other Prescriptions.
Thirst and emaciation: CV24, BL44, TH01, KI02 [Source: PUB]. Use up to 200 cones moxa (cumulative) at CV04 [Source: BBQS]. According to SX differentiation supplement with: SP06, SP08, SP09, ST40, GV20, LI04.

Remarks.
AP is to be used only as a supplementary method for treating this disease, and must be combined with other medication.
Among diabetic patients, the body's resistance to disease is usually very low, rendering it more easily to infection. Therefore, sterilization of the needles must be particularly rigorous.
Normal dietary restrictions for diabetics apply.

The foregoing discussion of point formulas was taken from AP-Comprehensive Text, (Shanghai). The following discussion is taken from a lecture presented by Prof Qui Mao-liang, Vice President of the China National AP Assoc.

Differentiation and Treatment According to the TH

1.        Upper Jiao
Upper Jiao Wasting: injury of Jin-Ye by LU-Heat. Treatment Principle: strengthen LU and tonify Yin.

Points:
BL12
LU05
CV23
ST36

Functions:
strengthen LU, clear LU-Heat
clear LU-Heat
nourish Jin-Ye
assist BL13 in strengthening LU

Treat every 1-2 d. Needles are retained for 30 min. Apply reinforcing method. In cases of severe thirst with very red tongue, apply reducing method.

2.        Middle Jiao
Middle Jiao Wasting: injury of Yin by ST-Dryness. Treatment Principle: Clear ST-Dryness and tonify Yin. Points: BL20, BL21, ST36.

To Clear ST-Dryness: ST44.
To Clear ST-Dryness and Heat: KI03.
To tonify Yin: M-BW12, Pancreas pt. [1.5 cun lat to T8] (indicated for SP-Xu).

Treat every 1-2 d, using the reinforcing method (Bu). If Heat is severe apply reducing method (Xie). Retain needles 30 min.

3.        Lower Jiao
Lower Jiao Wasting: exhaustion of KI-Jing and KI-Yin. Treatment Principle: tonify KI and tonify Jing.

Points:
BL13
CV04
SP06
KI03

Functions:
Tonify KI.
Nourish and stabilize KI.
Benefits KI, SP, LV.
Tonify KI, pacify Empty-Fire.

Apply Xie (reinforcing) method. Treat every other day. Retain needles 30 min.

Discussion.
Patients commonly present with mixed Syndromes. Treatment should be given according to the main clinical manifestations. Where there are clear signs of 2 Shi signs, e.g. thirst and excessive appetite, treat both. Flexibility in treatment is necessary, for example:
1.        If there is thirst, yellow dry tongue coating, overflowing pulse, select points from Yangming Channels.
2.        If there is Yin-Xu and uprising of Yang, with symptoms such as low-grade fever, night sweats, malar flush, deep-red tongue body, Fine and Rapid pulse, select PC05 and GV13 to clear Fire-Xu.
3.        If night-sweating is severe, add SI03.
4.        KI-Yin-Xu can lead to Qi-Xu. Alternatively Heat can consume ST-Yin leading to Qi-Xu. In Qi-Xu Syndromes, such as shortness of breath after exertion, spontaneous sweats, Deep Thready pulse, apply moxibustion to CV06 and CV04.
5.        In KI-Yang-Xu, with Cold limbs, lower limb oedema, copious urination, pale tongue with white coating, Thready Deep, Weak pulse, apply moxibustion to GV04 and CV04.

Chinese system of food cures
Chinese nutrition uniquely differs from modern Western nutrition in that it determines the Qi energies and therapeutic properties of foods instead of analysing the chemical constituents of them, for example:

Spinach: cooling; strengthens all organs, lubricates SI and LI, quenches thirst, promotes urination. Boil tea from spinach and chicken gizzard. Drink 1 cup 3x/d. Or cook spinach with seaweed to cleanse the Xue and Clear Hot skin eruptions and itchy skin.

Also, Chinese nutrition takes into consideration such factors as method of preparation, body type, season, and one's geographical location in determining the appropriate diet. It is used both as a healing system and a disease prevention system. The advantage of Chinese nutrition lies in its flexibility in adapting to every individual's needs in the prevention of disease, and treatment of the whole person.

Diabetes Food Remedies
Sugar in the urine as one of the main signs of diabetes was included in the TCM classic, A Collection of Diseases, by Wang Shou, published in 752. For the first time in Med history, diabetes was listed among the 1100 diseases in the book. He recommended pork pancreas as treatment for the disease, and also used a special method of testing sugar in the urine: The patient passed urine on a wide, flat brick to see if ants gathered to collect the sugar. That method of testing urine was >1000 yr ahead of Richard Thomas Williamson (1862-1937), who invented a test for the same purpose. The Chinese author's treatment using pork pancreas was similar to modern treatment by insulin. In TCM, however, thirst, weight loss, fatigue, and sugar in the urine are considered the key symptoms of diabetes. When a patient recovers from any of these symptoms, the diabetes treatment is considered successful.

Case reports
1. 25 diabetics were treated at the Canton Coll of TCM by dried bitter melon slices; each dosage/d consisted of 250 g dried bitter melon slices boiled in water. The levels of their blood sugar taken 2.5 h after meals, and of their urine sugar taken 24 h after meals, were both statistically very significant; the same method has subsequently been applied on diabetic rats, which also led to a significant decrease in the level of blood sugar. The same report concludes that the effects of dried bitter melon are comparable to those of insulin. Results are said to be better if 100 g fresh clams are boiled in water with the dried bitter melon slices.

2. At the International Symposium on the Effects of Ginseng held in the Soviet Union in 1954, a report indicates that ginseng can lower the level of blood sugar; and from his experiments, a Chinese doctor also noted that ginseng can reduce the level of blood sugar by as much as 40-50 mg/100 ml blood; such effects can continue for >2 wk after the patient stops taking ginseng. Moreover, in some cases, insulin intake can be reduced while the patient is taking ginseng.

3. In TCM Herbal Med, pork pancreas has a neutral energy and a sweet flavour. It was used as an ingredient in a dietary formula to treat diabetes in China that was originally published in 1846 in a Chinese diet classic, New Collected Works of Proven Dietary Recipes; following is the recipe:

Boil a pork, beef, or lamb pancreas in water with 200 g yam; season with some salt. Divide into 4 parts. Eat each part once a day for 4 d. Or cut up a pork pancreas and bake until dry over low heat; grind into powder. Take 3-5 g in warm water each time, 3x/d. Or wash the pork pancreas, remove and discard all the white fat, and cut into thin pieces; boil over low heat in water with 20 g corn silk; season with some salt. Eat daily.
Choate_C6 (1996) Diabetes mellitus from the perspectives of WM and TCM: Part 6.

Vegetable and Grain Remedies for Diabetes
Bamboo Shoots: Cooling. Strengthen ST, resolves mucous, promotes diuresis. Blend bamboo shoots and celery juice, warm up and drink 1 cup 2x/d. Eat plenty of bamboo.

Bok Choy: Cooling. Clears Heat, lubricates SI and LI, quenches thirst. Drink boy choy and cucumber juice.

Celery: Cooling. Tonifies KI, SP and ST, Clears Heat, promotes diuresis, lowers blood pressure. Drink 3 cups lightly boiled celery juice daily. Or combine celery, yam and pumpkin to make vegetable pie.

Corn Silk: Neutral; sweet. Promotes urination; affects LV and GB; lowers blood sugar. Boil corn silk with watermelon peel and small red beans in water. Drink as soup for relief of chronic nephritis with edema and ascites.

Kohlrabi: Neutral; bitter; sweet; pungent. Detoxicates. Crush 10 g kohlrabi seeds into pwdr. Mix with a glass of boiling water. Strain through cheesecloth over a bowl and squeeze out all liquid. Drink the liquid as tea first thing in the morning to induce bowel movements and urination.

Mung Bean: Cold; sweet. Clears Heat; quenches thirst; aids edema in lower limbs. Make soup from mung beans, barley and rice. Or soak 100 mg mung beans overnight; boil in 3 cups water over low heat; drink 2x/d. Or grind mung beans into powder and take 15 g pwdr. dissolved in warm water 2x/d.

Mushroom (Chinese Black or Shitake): Neutral; sweet. Strengthens ST; promotes healing; lowers blood pressure counteracts cholesterol; lowers blood fat levels. Soak, blend with soak water; heat like soup and take on an empty stomach to Clear toxins from SI and LI. Or bake until it appears burned on the surface; eat 10 g 2x/d; or eat fresh.

Pearl Barley: Cooling. Promotes diuresis; str. SP; clears Heat.
Blend barley and water, boil and drink the liquid. Or cook soupy barley and eat like porridge. Pumpkin: Cooling. Dispels Damp; reduces fever; particularly beneficial for diabetes. Eat a slice of pumpkin with every meal or bake pie with pumpkin, yam and potato.

Snow Peas: Cold. Strengthens middle warmer, detoxifies, promotes diuresis, quenches thirst. Cook snow peas, blend juice; take 1/2 cup 2x/d.

Soybeans: Cooling. Clears Heat; detoxifies; eases urination; lubricates LU, SI and LI. Drink plain soy milk or eat tofu to Clear Heat Syndromes.

Soybean Sprouts: Cooling. Promotes diuresis; Clears Heat, esp. in the ST. Boil 4 hrs; drink tea lukewarm. Continue over a period of 1 mo to relieve hypertension.

Spinach: Cooling. Strengthens all organs; lubricates SI and LI, quenches thirst; promotes urination. Boil tea from spinach (incl. roots) and chicken gizzard; drink 1 cup 3x/d. Or cook with seaweed to cleanse the Xue and Clear Hot skin eruptions and itchy skin.

String Bean (Green Bean): Neutral; sweet, tonic for KI and SP. Boil 50 g dried string beans (with the shells) in water. Drink as soup once a day to relieve diabetes, thirst, and frequent urination.

Sweet Potato (Yam): Neutral; sweet. Tonic for SP-ST and Qi; Clears Heat; detoxifies. Cook soup with winter melon. Or mix 50 g yam pwdr with 10 g pwdr American Ginseng. Dissolve 15 g in warm water; drink 3x/d.

Sweet Rice (Glutinous): Warm; sweet. Used to tonify Qi. Affects SP, ST, and LU. Relieves excessive urination, perspiration, and diarrhoea. Cook 50 g sweet rice with 60 g Job's tears and 8 red dates. Eat at meals to relieve various kinds of chronic diseases.

Tomato: Slightly cooling. Promotes Jin-Ye; quenches thirst; strengthens ST; cools Xue; clears Heat; calms LV. Eat at least 1 raw tomato/d on an empty stomach.

Turnip: Cooling. Clears Heat; removes Damp. Boil with tops as a side dish.

Water Chestnut: Cold; sweet. Clears fever and indigestion; promotes urination; affects LU and ST. Boil 5 water chestnuts in water with 1 fresh mandarin orange peel. Drink as tea 3x/d to relieve hypertension. Or Peel 100 g water chestnuts and chew them slowly in the morning and evening; or drink water chestnut juice to cure sore throat, haemorrhoids, and mouth canker.

Winter Melon: Cooling. Clears Heat; detoxifies; quenches thirst; relieves irritability; dispels Damp. Drink the fresh juice or make soup; drink 3x/d.

Wheat Bran: Cool; sweet. Affects the ST.

Clinical report
A treatment of diabetes: steam 60% wheat bran and 40% all-purpose flour; add an adequate amount of vegetable oil, eggs and vegetables. Eat at meals to relieve diabetes. The proportion of wheat bran decreases as conditions improve. No drugs or nutritional supplements are given in this treatment. In 13 diabetics treated, blood sugar dropped to below 140 mg% in 3/13 cases and to 180 mg% in 7/13 cases; after treatment (which lasts from 4 d to 89 d), sugar in the urine changed from ++++ or +++ to negative in 10/13 cases; but in general, sugar in the urine changed to negative within 1 mo, along with the disappearance of neuritis associated with diabetes.

Animal Product Remedies for Diabetes.
Abalone: Neutral; sweet; salty. Detoxicates; sharpens vision. CI for persons with weak digestion. Boil 20-25 g abalone with 250-300 g fresh radish in water. Drink as soup once every other day. Repeat 6-7X as a treatment program. (This is a time-honoured recipe in TCM for diabetes).

Beef: Neutral; sweet. Tonifies SP, ST, Qi-Xue; affects the ST and SP. Boil lean beef with yam to make soup.

Clam (freshwater): Cold; sweet; salty. Detoxicates; sharpens vision; acts on LV and KI. Freshwater clam saliva is especially beneficial for diabetes. Cook clam with chive. Boil 150 g chives with 200 g clam and suitable seasoning. Drink in a day.

Milk: Cow's milk is Neutral; sweet. Pushes downward; tonic for LU and ST; produces Jin-Ye and lubricates SI and LI; affects HT, LU, and ST. Contraindicated with diarrhoea or mucous discharge. Mix equal amounts cow's milk and goat's milk. Drink the milk as a substitute for tea or juice to improve the physical condition of diabetes patients and frequent urination.

Pork: Neutral; sweet; salty. Used to lubricate dryness; affects SP, ST and KI. Cut up 100 g lean pork (red meats) to boil in water with 100 g Job's tears over low heat for 2 hrs. Eat at meals.

Fruit Remedies for Diabetes
Crab Apple: Neutral; sweet and sour. Quenches thirst; obstructive, affects HT, LV, and LU. Boil 10 partially ripe fresh crab apples in an adequate amount of water until the water is reduced by half. Drink the soup and eat the fruit to quench thirst and relieve diarrhoea.

Guava: Warm; sweet. Obstructive and constrictive; stops diarrhoea.
Crush 90 g fresh guavas; squeeze out the juice to drink before meals; 3X/d to alleviate SX of diabetes.

Peach: Very cooling. Clears Heat; aids diabetes. Eat fresh peaches.

Plum: Neutral; sweet; sour. Produces Jin-Ye; promotes urination and digestion; affects LV and KI.

Strawberry: Cooling. Lubricates LU; promotes Jin-Ye; strengthens SP. Drink 1 glass fresh juice 2X/d.

Mulberry: Slightly Cold. Quenches thirst; detoxifies; ton. KI; lubricates LU. relieves constipation; Calms Shen-Spirit; promotes diuresis. Boil mulberries as tea and drink 1/2 cup 2X/d.

Recipes
Winter Melon Soup
3 qt. vegetable broth.
3 cups chopped and peeled winter melon.
2 carrots.
2 celery stalks.
1 onion.
12 Mushrooms (Chinese Black or Shitake), stems removed.
6 oz. tofu noodles or finely sliced baked tofu.

Cook until tender (circa 25 min.) Then season with 1 tsp chives, 1 Tbls. tamari, 1 tsp peanut oil. Serves 4.
Choate_C7 (1996) Diabetes mellitus from the perspectives of WM and TCM: Part 7.

Stuffed Pumpkin
Cut the top off a small pumpkin; clean out the seeds and strings; save the lid. Fill with the following mixture:
3 cups cooked rice or barley.
1 Tbls crushed, toasted sesame seeds.
23 stalks celery, sliced.
1 Tbls parsley.
1 tsp thyme.
1 tsp sage.
1/2 tsp rosemary.
1 Tbls tamari.

Cover with pumpkin lid and bake at 350 degrees for 1.25-1.5 h. (Fork will easily go into pumpkin when done). Serves 4-6.

Azuki Bean and Squash Casserole
1 cup azuki beans, soaked overnight.
2 6-8 inch pieces of kombu.
1 small butternut squash or other winter squash.

Cover beans and kombu with water and simmer circa 1 hr, adding water as needed. Then add the cubed and peeled squash. Cook until tender (circa 1/2 hr) Stir in a pinch of sea salt or 1-2 tsp tamari. Serves 4.

Herbal remedies for diabetes mellitus
While AP is a distinctive feature of TCM, China's Herbal Med has many parallels to, and is a part of the general quest for effective medicines to treat illness. Our ancestors knew their dependence upon nature in both health and sickness. Led by instinct, taste and experience, they used plants, animal parts and minerals that did not belong to their usual diet. Until well into the 20th century, much of the pharmacopoeia of scientific Med was derived from the just this type of herbal lore. Today in the USA, circa 25% of the prescriptions dispensed by pharmacies contain at least one active ingredient derived from plant material.

The 20th century has also seen a revival of the more natural Med as an outcome of the increasing discontentment with conventional Med. By utilizing natural substances together in their whole form in accurate formulations, effectiveness will be maximized and side effects minimized. This is contrary to conventional Med that extracts or synthesizes active chemicals which often, over time, produce drastic side effects due to their partiality.

Xiao-Ke (Wasting and Thirsting) is a Syndrome which manifests as increased intake of both fluids and solids, emaciation, polyuria, and glycosuria; it broadly corresponds with diabetes mellitus. A list of herbs and herbal formulas, whose effectiveness in treating Xiao-Ke has been confirmed through time-tested use and modern pharmacological research, follows.

Individual Herbs
Radix Anemarrhenae Asphodeloidis (Shi Mu): Bitter; Cold. Enters LU, KI, ST. Clears Heat; quells Fire; generates Jin-Ye. Comb w/ Rx Trichosanthis.

Radix Astragali (Huang Qi): Sweet; slightly warm. Enters SP, LU. Tonifies SP and Qi. Comb w/ Rx Dioscorea Oppositae (Shan Yao) and Rx Rehmanniae Glutinosae (Sheng Di Huang).

Tuber Asparagi Cochinchinensis (Tian Men Dong): Sweet; bitter; Cold. Enters LU, KI. Moistens LU and nourishes KI; used for LU and KI-Yin Xu.

Radix Codonopsis Pilosulae (Dang Shen): Sweet; neutral. Enters SP, LU. Tonifies Qi, Jin-Ye and the Middle Jiao. In general the functions of this herb are analogous to Radix Ginseng (Ren Shen), although not as strong. Clinically used to tonify Qi of SP & LU. Dang Shen has a vasodilatory effect on terminal blood vessels.

Herba Dendrobii (Shi Hu): Sweet; slightly salty; bland; Cold. Enters ST, LU, KI. Nourishes ST-Yin Xu. Comb/w Tuber Ophiopogonis Japonici (Mai Men Dong) and Rx Trichosanthis (Tian Hua Fen) for abdominal discomfort associated with ST-Yin Xu.

Radix Dioscoreae Oppositae (Shan Yao): Sweet; neutral. Enters SP, LU, KI. Benefits LU and nourishes KI (Yin & Yang). Comb/w Rx Trichosanthis (Tian Hua Fen) for irritability and thirst associated with injured Jin-Ye.

Radix Ginseng (Ren Shen): Sweet; slightly bitter; slightly warm. Benefits Yin and generates Jin-Ye. Tonifies LU, Qi, SP and ST; benefits HT and Calms the Shen-Spirit. Some patients can lower their insulin by taking this herb.

Radix Glycyrrhizae (Gan Zao): Sweet, neutral (raw); sweet, warm (honey-baked). Enters all 12 Main Channel (mainly ST, SP) Tonifies SP and Qi: commonly used for SP-Xu Syndromes.

Fructus Lycii Chinensis (Gou Qi Zi): Sweet; neutral. Enters LV, KI. Nourishes and tonifies LV & KI: used for Yin and Xue Xu.

Fructus Mori Albae (Sang Shen): Sweet; cool. Enters LV, KI. Nourishes Yin and Xue. Comb w/Rx et Caulis Jixueteng (Ji Xue Tang) for Yin-Xu.

Tuber Ophiopogonis Japonici (Mai Men Dong): Sweet; sl bitter; sl Cold. Enters LU, ST, HT. Nourishes Yin and clears Heat. Experimentally has lowered serum glucose, speeded recovery of islets of Langerhans, and increased glycogen storage levels in rabbits with artificially induced diabetes mellitus.

Poria Cocos (Fu Ling): Sweet; bland, neutral. Enters HT, SP, LU. Strengthens SP and harmonizes the Middle Jiao; transforms Phlegm and eliminates Damp.

Rhizoma Polygonati (Huang Jing): Sweet; neutral. Enters SP, LU. Tonifies SP: used for SP- or ST- Xu and debility after prolonged illness. Also, tonifies Jing-Essence after a chronic wasting disease. Comb w/ Rx Dioscoreae Oppositae (Shao Yao) and Rx Astragali (Huang Qi).

Rhizoma Polygonati Odorati (Yu Shu): Sweet; sl Cold. Enters LU, ST. Nourishes Yin and moistens dryness: used for Dry Heat of LU and ST or Yin Xu Syndromes with cough, dry throat, irritability, thirst and intense hunger, and constipation.

Fructus Pruni Mume (Wu Mei): Sour; warm. Enters LV, SP, LU, LI. Generates Jin-Ye; alleviates thirst: used for thirst from Heat Xu or Xu of Qi and Yin. Comb w/ Rx Trichosanthis (Tian Hua Fen) for thirst and irritability from injured Jin-Ye.

Radix Puerariae (Ge Gen): Sweet; acrid; cool. Enters SP, ST. Nourishes Jin-Yeh; alleviates thirst, esp from ST-Heat. Comb w/ Rx Trichosanthis (Tian Hua Fen) and Tuber Ophiopogonis (Mai Men Dong) for thirst.

Radix Rehmanniae Glutinosae (Shu Di Huang): Sweet; sl warm. Enters LV, KI, HT. Nourishes the Yin: used for KI-Yin Xu. Lowers blood pressure and serum cholesterol.

Fructus Schisandrae Chinensis (Wu Wei Zi): Sour; warm. Enters LU, KI. Restrains Jing-Essence. Used for Xu Syndromes of LU or KI. Calms Shen-Spirit. Recent reports state this herb increases usage of both LV glycogen stores and serum glucose. Comb w/ Radix Codonopsis (Dang Shen) and Ophiopogonis Japonici (Mai Men Dong) for symptoms associated with exhaustion from Qi and Yin.

Scrophulariae Ningpoensis (Xuan Shen): Salty; sl bitter; Cold. Enters LU, ST, KI. Nourishes Yin; Clears True Heat or Internal Heat. Lowers blood sugar, dilates blood vessels.

Radix Trichosanthis (Tian Hua Fen): Bitter; slightly sweet; sour; cool. Enters LU, ST. Quells Heat; promotes Jin-Yeh. Comb w/ Rx Glehniae Littoralis (Sha Shen), Tuber Ophiopogonis Japonici (Mai Men Dong), and Rx Rehmannieae Glutinosae (Sheng Di Huang) for ST-Heat induced injured Yin.

Stylus Zeae Mays (Yu Mi Xu): Sweet; neutral. Enters BL, SI, LV. Promotes urination.

Herb Formulas.
LU- & ST- Heat & Drought: Bai Hu Jia Ren Shen Tang [White Tiger & Ginseng]. Clears Qi-Heat and the Yangming (LI-ST) Channel. Tonify Qi and increase Jin-Ye.

KI-Yin-Xu: Liu Wei Di Huang Wan [Rehmanniae 6 Formula] and Zuo Gui Wan [Replenishing the Yin (left) Pills]. These formulas reinforce LV-Yin and KI-Yin. Tian Wang Bu Xin Dan [King's Mind-Easing Tonic Pills]. Nourishes HT-Yin & KI-Yin-Jing-Essence; sedative.

Yin-Xu & Yang-Xu combined: Jin Gui Shen Qi Wan [Pills to Restore KI-Qi and Ba Wei Di Huang Wan Function of KI]. Replenishes KI-Yang; to warm the lower part of the body.

Yin-Xu and Yang-Xu in the Upper Jiao: Bai Hu Jia Ren Shen Tang [see above].

Yin-Xu and Yang-Xu in the Middle Jiao: Yu Nu Jian [The Fair Maiden Decoction]. Eliminates intense ST-Heat or ST-Fire; replenishes Ying-Essence.
Choate_C8 (1996) Diabetes mellitus from the perspectives of WM and TCM: Part 8.

Yin-Xu and Yang-Xu in the Lower Jiao: Liu Wei Di Huang Wan [see above] Yin Gui Shen Qi Wan [see above] and You Gui Wan [Replenishing the Yang (right) Pills]. Replenishes KI-Yang; treat spermatorrhoea.

Patent Formulas.
Yuechung Pills (also known as Yu Quan Wan [Jade Spring Pills]): Nourish Yin, strengthen KI, LU, & SP; dispel Phlegm-Heat; relieve thirst; circulate fluid; regulate appetite; Calm Shen-Spirit. A classical RX for "sugar urine disease", used for both juvenile and insipid diabetes in mainland China. The United Pharmaceutical Factory, Szechuan, PRC.

Specific Juk Tsyn Wan: Produces saliva, quenching thirst; relieving fever, alleviating mental uneasiness; vitalizing Xue activity, nourishing KI; invigorating the nervous system and improving appetite. Kwangchow United Factory of Chinese Med, PRC.

BIBLIOGRAPHY.
Western Medical Sources.
1.Merck Manual, 14th Edition, Merck & Co. Inc. 1982 2.Bricklin, Mark, The Practical Encyclopedia of Natural Healing, Rodale Press, 1983. 3.Fishbein's Illustrated Med & Health Encyclopedia, H.S. Stuttman Co. Ind, 1978. 4.Biermann, June and Barabara Toohey, The Diabetics Total Health Book, J.P. Tarcher Inc. 1980 5.Whitaker JM Reversing Diabetes, Warner Books, 1987. 6.Turtle JR Diabetes Mellitus: Recent Knowledge on Aetiology, Complications and Treatment, Academic Press, 1984. 7.A Monograph on the Nature, Diagnosis and Treatment of Diabetes Mellitus, The Upjohn Co. 1960. 8.Guyton AC Textbook of Med Terminology, WB Saunders Co. 1976.

TCM Sources.
1.Kaptchuk TJ The Web That Has No Weaver, Conydon & Weed, 1983 2.Chen JF A Haemorrheological Study on the Effect of AP in Treating Diabetes Mellitus, Chung i tsa chih (JTCM) 7(2):95-100, 1987 3.Li CY Fundamentals of Chin Med, East Asian Med Society, Paradigm Pub. 1985 4.O'Connor J AP: A Comprehensive Text, Eastland Press 1981 5.Yeung HC Handbook of Chin Herbs and Formulas Vol II, Inst of Chin Med 1985 6.Ni MS The Tao of Nutrition, Union of Tao & Man, 1987 7.Lu HC Chin System of Food Cures-Prevention and Remedies, Sterling Publishing Co. 1986 8.Fratkin J Chin Herbal Patent Formulas-A Practical Guide, Inst for TCM, 1986 9.Bensky D Chin Herbal Med-Materia Medica, Eastland Press, 1986. 10.Qui ML The Treatment of Diabetes by AP, CMJ (UK) 15:3-5, 1984.

J. AP and Neurology

1. GENERAL MECHANISMS OF AP
Abad-Alegría_F1; Bono Ariño J (1992) [Modulatory capability of the somatosensory afferents through AP reflexotherapy]. Arch Neurobiol (Madr) May-Jun 55(3):99-102. Clinical Neurophysiol Service, Univ Hospital, Zaragoza, Spain. This paper concerns the influence of the AP on the somatic afferent volley. As the main used points in experimental AP, we stimulated LI04 and HT07. AP modulated somaesthetic afference and different points had different modes of action.

Abad-Alegria_F2; Adelantado S; Martinez T (1995) The role of the cerebral cortex in AP modulation of the somaesthetic afferent. AJCM 23(1):11-14. Clinical Neurophysiol Service, Univ Hospital, Zaragoza, Spain. AP stimulation modifies the somaesthetic afferent to different degrees, depending on the AP point studied. In this study, SEPs of 21 healthy volunteers were recorded. AP at LI04 produced noticeable modifications, with a significant increase of latency and decrease of amplitude of the peaks which reflected the primary cortical afferent. These changes were minimal or absent when a non-AP point was stimulated. The effects on SEPs observed depended on the special quality of the AP point stimulated and not on the mere repetitive stimulation on the skin.

Abad-Alegria_F3; Galve JA; Martinez T (1995) Changes of cerebral endogenous evoked potentials by AP stimulation: a P300 study. AJCM 23(2):115-119. Clinical Neurophysiol Service, Univ Hospital, Zaragoza, Spain. The change of cerebral potential P300 in relation to superior cerebral functions by means of AP stimulation was studied immediately after, and within the next 15 min after, AP stimulation at HT07 and LI04, and at a non-AP control point. After stimulation at HT07, P300 amplitude changed significantly and increased with time. Changes were not detected after stimulation of LI04, or of a non-AP point. These findings support a real action of HT07 (Shen Men, Spirit Door) in different psychoneurological processes.

Andersson_S; Lundeberg T (1995) AP: from empiricism to science: functional background to AP effects in pain and disease. Med Hypotheses Sep 45(3):271-81. Dept of Physiol, Univ of Göteborg, Sweden. AP is part of TCM, a system with an empirical basis which has been used to treat and prevent disease for centuries. A lack of scientific studies to prove or disprove its claimed effects led to rejection by many of the western scientific community. Now that the mechanisms can be partly explained in terms of endogenous pain inhibitory systems, the integration of AP with conventional medicine may be possible. Its use for pain relief has been supported by clinical trials and this has facilitated its acceptance in pain clinics in most countries. AP effects must devolve from physiological and/or psychological mechanisms with biological foundations, and needle stimulation may represent the artificial activation of systems obtained by natural biological effects in functional situations. AP and some other forms of sensory stimulation elicit similar effects in man and other mammals, suggesting that they induce fundamental physiological changes. AP excites receptors or nerve fibres in the stimulated tissue which are also physiologically activated by strong muscle contractions and the effects on certain organ functions are similar to those obtained by protracted exercise. Both exercise and AP produce rhythmic discharges in nerve fibres, and cause the release of endogenous opioids and oxytocin essential to the induction of functional changes in different organ systems. Beta-End levels, important in pain control as well as in the regulation of blood pressure and body temperature, rise in the brain tissue of animals after both AP and strong exercise. Experimental and clinical evidence suggest that AP may affect the sympathetic system via mechanisms at the hypothalamic and brainstem levels, and that the hypothalamic beta-endorphinergic system has inhibitory effects on the vasomotor centre, VMC. Poststimulatory sympathetic inhibition, which reaches a maximum after a few hours and can be sustained for >12 h, occurs in both man and animals. Experimental and clinical studies suggest that afferent input in somatic nerve fibres has a significant effect on functions of the ANS. Hypothetically, the physiological counterpart lies in physical exercise, and the effect can be artificially reproduced via various types of electrical- or manual- stimulation of certain nerve fibres.

Anon_(1993) Western Physiological-Basis of AP: Editorial. J Equine Vet Sci Aug 13(8):442.
Bucinskaite_V1; Lundeberg T; Stenfors C; Ekblom A; Dahlin L; Theodorsson E (1994) Effects of EAP and physical exercise on regional levels of neuropeptides in rat brain. Brain Res 12 Dec 666(1):128-132. Dept of Physiology and Pharmacology, Karolinska Inst, Stockholm, Sweden. The effects of single or repeated treatments with manual AP, EAP or physical exercise on neuropeptide Y (NPY), neurokinin A (NKA), Substance-P (SP), galanin (GAL) and vasoactive intestinal peptide (VIP)-like immunoreactivity (-LI) in different regions of the rat brain were studied. Initially the effect of microwave irradiation (MWI) was compared to decapitation on the recovery of neuropeptides, and significantly higher levels of SP-LI, NKA-LI and NPY-LI were found in the hippocampus, occipital cortex, pituitary and striatum after MWI. Repeated EAP treatments significantly increased SP-LI, NKA-LI and NPY-LI in the hippocampus and NPY-LI in the occipital cortex. No changes were found in animals receiving AP or performing physical exercise.

Bucinskaite_V2; Theodorsson E; Crumpton K; Stenfors C; Ekblom A; Lundeberg T (1996) Effects of repeated sensory stimulation (EAP) and physical exercise (running) on open-field behaviour and levels of neuropeptides in the hippocampus in WKY and SHR rats. OUP European Journal of Neuroscience WWW service, 8(2):382-387. OUP Journals WWW Service. Copyright Oxford Univ Press. Dept of Physiol and Pharmacol, Karolinska Inst, Doktorsringen 6A, S-171 77 Stockholm, Sweden. The effects of repeated EAP and physical exercise (running) on open-field behaviour and on hippocampal levels of neuropeptide Y, neurokinin A, Substance-P, galanin and vasoactive intestinal peptide (VIP)-like immunoreactivities were studied in WKY (wistar-Kyoto) and SHR (spontaneously hypertensive) rats. Significantly higher levels of Substance-P-like immunoreactivity, neurokinin A-like immunoreactivity and neuropeptide Y-like immunoreactivity were found in the hippocampus immediately after 3 wk of treatment (EAP and running), but not 1 wk after the last (10th) changes in neuropeptide levels were similar in the 2 rat strains. Open-field behaviour was significantly less during the treatment period in both strains. Negative correlations between behaviour and neuropeptide levels in SHR rats were significant, suggesting interdependency with sympathetic activity. The effects of EAP and physical exercise in rats are related to increases in neuropeptide Y, neurokinin A and Substance-P in the hippocampus.

Cai_W (1992) AP and the nervous system. AJCM 20(3-4):331-337. Dept of Neurol, Stritch Sch of Med, Loyola Univ of Chicago, Maywood, IL 60153. AP is based on neuroanatomy and neurophysiology. At each AP point, there are peripheral nerves and terminals. AP will be useful for further understanding of the nervous system. A conceptual view of the physiology of AP is presented.

de_Carvalho LA (1994) Modelling the thalamocortical loop. Int J Biomed Comput May 35(4):267-296. COPPE, Universidade Federal do Rio de Janeiro, Brazil. This work proposes a mathematical model for the thalamic gateway to the cortex. In this model, the ionic currents considered and the structural details are in accordance with the bioMed experimental data. To validate the model, 3 series of simulations were performed in different levels of complexity. First, some experiments show that the model captures the electrophysiological properties of a single thalamic cell, that is, the relay and burst modes of operation. Second, a complete neural network representing the thalamic gateway to the cortex is assembled and the influences of the cortical projections over the thalamus are analyzed. Data on how the cortex opens and closes the thalamic gate, and the relation of this control with the phenomenon of attention, are shown. A third set of simulations establishes mechanisms of interaction between neighbouring thalamic regions, especially a form of somatosensory competition. The paper also hints at possible theoretical explanations for clinical facts like counterirritation, AP-analgesia (APA) and variations in the sensibility of somatosensory perception. The model may be a novel way to understand thalamocortical interactions.

de_Vernejoul_P; Albarede P; Darras JC (1992) Nuclear medicine and AP message transmission [editorial]. J Nucl Med Mar 33(3):409-412.

Dong_Q; Dong X; Li H; Chen D; Xian M (1993) [The relations between AP manipulations and responsive discharges of deep receptors]. Chen Tzu Yen Chiu 18(1):75-82. Dept of physiology, Inst of Clinical Medicine, Sichuan Acad of TCM, Chengdu. 29 rabbits were used. The spindle, tendon organ, light and heavy pressure receptors in medial gastrocnemius muscle were identified by recording discharges of single afferent fibre in medial gastrocnemius nerve from fine filaments by dissection. The discharge patterns of the receptors responding to the manipulations (lift and thrust, twist and twirl, rotate, scrape flick the needle and finger-pressure) were observed. Data at 85 units were collected totally. Every type of deep receptor can react to any manipulation. The discharge patterns of different receptors were alike when stimulated with same manipulation, but there were different patterns while varying manipulations acting on the same receptor. These are due to the movement forms, the force amount, the time duration of the manipulations. All these facts are nearly the same as in cutaneous receptors. AP effect on deep receptors was not limited to one point but within a certain area, namely distant effect existed. The area size varied from receptor to receptor and from manipulation to manipulation. Because of the distant effect on receptors by AP, and the lose of responsibility in units when receptor destroyed, we suggest that effective AP stimulation is induced mainly due to the receptor deformation, which is caused by the stress from pressure, stretch and vibration of AP. As the needling sensation is closely related to the curative effects, the receptors dealing with needling sensation are analyzed according to this series works and other facts, we further advance the opinion that the receptors of deep pain are the chief material foundation to induce the sensation of hand needling.

Dong_Q; Dong X; Chen D; Li H; Zhang S (1992) [The relation between AP manipulations and responsive discharges of cutaneous receptors]. Chen Tzu Yen Chiu 17(3):221-229. Dept of Physiology, Sichuan Acad of TCM, Chengu. Nine types of mechanoreceptors of hair skin in 46 rabbits were identified by recording discharges of single afferent fibres in posterior femoral cutaneous nerve from fine filaments by dissection. Responsive discharges were studied to 7 different types of stimuli by needle manipulation or pressure to each receptor: lift and thrust, twist and twirl, rotate, serape, flick the needle and finger-pressure. Data were collected for 165 units, of which 89 units were for the relation between manipulation and discharge patterns, and the other 76 units for discharges responding to manipulations at different distances from the receptive field. Nine types of receptors were observed as responsive to any type of AP manipulation. Thus, no special "AP receptor" exists. Different types of receptor had the same type of discharge pattern in response to the same type of AP manipulation, whereas different discharge patterns occurred at the same unit when the manipulation changed. This may be due to the movement form; force amount and time duration of the manipulations. Receptors responding to AP were not limited to one specific point, but involved a field surrounding the needle point. The size of this field varied with the types of receptors and of manipulation. We reported previously that the AP photograph leading from nerve and building on impulses induced by AP and the groups of afferent fibres conducting AP signals changed with different manipulations. This paper discusses the reasons for that by presenting the relationship between the responsive discharges of receptors and the manipulations.
Feely RA (1996) AP: The Basics Richard Feely DO, RHEMA Med Assoc Ltd. Adapted from WWW; email: [email protected].

AP was a part of TCM >5,000 yr ago. TCM science had a very different paradigm/way of thinking than the Western world. It emphasized holistic patterns, relationships, cycles, and processes. In contrast the western paradigm emphasizes linear thinking, causality and reductionist explanations. AP was first introduced into Europe by the French Jesuits in the 17th Century. It was not widely accepted in the West because of the clash of paradigms that is Western linear thinking couldn't understand how a needle inserted into the hand could cure a toothache. APA did not fit into the existing physiological paradigms of WM and was thus dismissed.

Up until 1976, the evidence for APA was mainly anecdotal. There are few controlled scientific experiments. Since then, the situation has changed dramatically in the last few years there has been many scientifically controlled experiments in AP. At least 17 different lines of scientific evidence verify the AP effect upon humans and animals.

Does APA work?.
Research performed in animals and humans shows that specific AP relieved pain while sham AP (needles at non-AP points) had no pain relieving effect. Controlled clinical trials compared real AP to sham AP in chronic pain patients; AP worked better than placebo in many of the studies. More importantly, AP was as effective as conventional treatment in chronic pain, and had fewer side effects.

How does AP work?.
Needling simulates peripheral nerves in the muscles which send messages to the brain to release endorphins (morphine-like peptides in the brain). These neurochemicals then cause analgesia by blocking the transmission of painful messages. 3 main sites for endorphin APA are known:
1.        The pituitary gland releases endorphins into the blood stream. This hormone travels to the 3 parts of the brain and spinal cord to block the transmission of painful messages.
2.        The PAG neurons in the midbrain release endorphins that act as local transmitters to excite the rostral ventromedial medulla.
3.        The rostal ventromedial medulla in turn projects massively and selectively to pain transmitting neurons in the dorsal horn of the spinal cord and the trigeminal nucleus caudalis. Electrostimulation in the PAG and rostral ventromedial medulla (RVM) produces behavioral analgesia and inhibitions of spinal pain transmission. The spinal cord endorphin system, is where the spinal cord neurons release endorphins to block the release of neurotransmitters from afferent fibres carrying painful messages to the cord.

In 1977, research showed that APA inhibited the spinothalamic tract neurons from responding from painful inputs. This AP effect was then blocked by naloxone, an endorphin receptor blocker. Also, behaviour measurements in mice and humans showed that naloxone blocked APA. AP research has progressed since the 1970s to date to have 17 different lines of evidence convergent upon AP endorphin mechanisms verifying and supporting APA.

The 3 known sites of endorphin release (above), and other evidence (below) are convincing proof that APA is a physiological phenomenon that can occur and be manipulated through the use of AP needles and electrostimulation.

17 lines of convergent evidence of endorphin in APA.
1.        naloxone blocked APA.
2.        opiate antagonists block APA.
3.        dextro-naloxone doesn't block APA.
4.        antibodies to endorphins block APA.
5.        micro-injection of naloxone blocks APA.
6.        genetic defects in opiate receptors reduce or prevent APA.
7.        Depletion in endorphins reduce APA.
8.        endorphins rise in CSF and fall in the brain after APA.
9.        APA is enhanced by protecting from enzyme destruction.
10.        cross circulation of APA effects.
11.        reduced pituitary endorphins block APA.
12.        a rise in mRNA for proenkephalin with APA.
13.        C-fos gene protein rises in endorphin areas of brain.
14.        APA shows cross tolerance with morphine addiction.
15.        APA works best for emotional pain like endorphin.
16.        lesions of arcuate nucleus block APA.
17.        lesions of PAG block APA.

Testing the involvement of the pituitary, several experiments were carried out, both surgically removable pituitary and suppression of the pituitary endorphins by chemical manipulations all of the experiment suppressed APA in animals. Since morphine analgesia is mediated largely by this system, experiments to test the involvement of the midbrain in APA were done. Such experiments include direct lesions to the raphe by cutting the output fibres in the dorsal lateral tract, blockade of serotonin receptors in the spinal cord, blockade of serotonin synthesis and direct micro-injection of naloxone into the midbrain. All of these procedures reduced APA.

Enhancement of serotonin synthesis increased APA. An experiment measuring serotonin showed serotonin was released during APA along with noradrenaline.

Does AP work all the time?.
No, AP works in circa 70-80% of humans and animals. Meanwhile, placebo only works 30% of the time. AP does not work all the time in all people for various reasons. People with high levels of cholecystokinin (CCK) are poor responders to APA. Good responders have less CCK. CCK blocks AP tolerance, it acts in the PAG. In animal experiments, poor responders became better responders through the use of a CCK antagonist, and good responders became poor responders by the use of cDNA, CCK gene.

AP is not physiologically addictive. AP is however additive and cumulative in its effects. It is more powerful after 10-15 treatments. Neurologically we know AP works with a small myelinated fibres A delta-type III, and it does not work larger fibres, C-fibres.

Why does TENS not work as well as AP?.
TENS works by using the gate theory of pain and habituation occurs. TENS activates skin, neurons first and A-delta fibres, the key fibres which are in the muscle, are not activated. With the use of needle AP Deqi activates the small myelinated A-delta fibres. Dr Bruce Pomeranz reports that the A-delta fibres and the Deqi activate the stimulation of the endorphin mechanism.

In conclusion, AP has been used for over 5000 yr. A large body of empirical anecdotal evidence indicates its effectiveness. Scientific research indicates several causes and effects of AP. AP is effective for acute and chronic pain, the treatment of addiction and withdrawal from various drugs, gastrointestinal functions, environmental illnesses and cardiovascular illness, along with positively changing with learning/memory, conditioning and immunology.

More and more physicians outside China are using AP to treat many painful conditions. It is estimated that 5000 MDs in Germany, 30000 in France and 60000 in Japan use AP along with drugs, nerve blocks and other approaches to treat patients with chronic pain. Here in the USA >1000 physicians and surgeons are actively in the practice of AP. With increasing research and evidence, more and more physicians in the West will become AP practitioners.

Futaesaku_Y; Zhai N; Ono M; Watanabe M; Zhao J; Zhang C; Li L; Shi X (1995) Brain activity of a rat reflects apparently the stimulation of AP: radioautography using 2-deoxyglucose. Cell Mol Biol Noisy le grand Feb 41(1):161-170. Dept of Histol and Analytical Morphol, Sch of Allied Health Sci, Kitasato Univ, Kanagawa, Japan. To confirm a relationship between the CNS and AP, the response was examined in the rat brain using radioautography with tritiated 2-deoxyglucose, after stimulation of some AP points. 8 groups, of a total of 27 rats were submitted to AP at 6 different AP points (ST36, GV26, ST25, HT07, PC06, KI01) and control, with or without electric pulses or with anaesthesia respectively, before the injection with isotopic deoxyglucose. 120 cryosections were cut from a freshly frozen brain and exposed on single-coated X-ray films. Compared with the control group, AP at ST36, ST25, HT07 and PC06 enhanced neocortical-, limbic cortical- and thalamic nuclear- activity. AP at GV26 and KI01 depressed the activity on the thalamic nuclei and midbrain. Pentobarbital anaesthesia concealed most activity all over the brain, which hardly responded to any AP stimulus. Brain neuronal activity reflected the signals from AP stimuli and activity changed depending upon each AP point.

Gao_W; Peng G (1994) Surface anatomic observation of cerebral precentral and postcentral gyri for scalp AP. Chen Tzu Yen Chiu - AP Research 19(2):17-20. Ghongqing Univ of Med Sci, Sichuan, PRC. Heads of 10 adult corpses were used to investigate the motor and sensory area of scalp AP. AP textbook locations for the surface anatomy of the precentral and postcentral gyrus did not match exactly with the scalp motor- and sensory- area respectively. The locations of the respective gyri were more posterior than in the textbook. The upper precentral and postcentral gyrus points were 0.5 cm behind the motor area and 1 cm behind the sensory area; the lower precentral gyrus point was 1 cm behind the intersection of the eyebrow-occiput line and the anterior border of the natural temporal hairline; the lower postcentral gyrus point was 2.4 cm posterior to the intersecting point above described. In order to better coincide with the precentral and postcentral gyri, the motor and sensory areas of scalp AP should be placed further back than in the textbook. Best locations were: upper point of motor and sensory area: 1 cm and 3 cm posterior to the midpoint of anteroposterior midline, respectively; lower point of motor and sensory area: 1 cm and 2 cm posterior to the intersecting point described above, respectively.

Joseph_R (1992) Neurologic evaluation and its relation to AP: AP for neurologic disorders. Animal Med Centre, New York, New York 10021. Probl Vet Med Mar 4(1):98-106. AP provides companion animal Vets a valid therapeutic alternative to medicine and surgery in a variety of neurologic disorders. The Vet must arrive at a lesion localization in the nervous system and determine a presumptive diagnosis before instituting AP therapy. Signalment, type of neurologic disorder, efficacy of conventional treatments versus AP, financial constraints, and ethical issues are useful patient selection criteria. In general, animals with pain respond faster and more completely to AP than those with neurologic deficits consistent with loss of function. AP offers clients a noninvasive alternative when medications are contraindicated or surgery is not an option. This chapter serves as an introduction to AP for neurologic disorders in pets. It is hoped that the information here will inspire clinical investigations to evaluate more completely patient selection, patient response, and long-term outcome.

Kashiba_H; Nishigori A; Ueda Y (1992) Expression of galanin in rat primary sensory afferents after moxibustion to the skin. AJCM 20(2):103-114. Dept of Physiol, Kansai Coll of AP Med, Osaka, Japan. We examined the effects of moxibustion on primary sensory neurons in the skin of rats using immunocytochemistry combined with a fluorescent retrograde tracer dye, fluoro gold (FG). Galanin-like immunoreactive (IR) fibres were often observed in the dermis of treated skin at 18 h after moxibustion, while such fibres were rarely detected in untreated (control) skin. Moreover, most of galanin-IR fibres also displayed Substance-P (SP)-like immunoreactivity. Circa 20-30% of the dorsal root ganglion (DRG) neurons labelled when FG was injected intradermally into the moxibustion-treated skin showed galanin-like immunoreactivity, while the proportion of FG-labelled neurons with such immunoreactivity was <10% in control DRGs. Moxibustion induced galanin expression by primary sensory neurons containing SP. The possible functions of this peptide are discussed in relation to the effects of moxibustion.

Khramov_RN; Karpuk NI; Vorob'ev VV; Gal'chenko AA; Kosarskii LS (1993) The electrical activity of the hypothalamus in exposure to millimetre-wave radiation at biologically active points. Biull Eksp Biol Med Sep 116(9):263-265. Nonthermal local millimetre wave irradiation (55-76 GHz range) of Earpoint HT (after FG Portnov) of conscious rabbits significantly suppressed hypothalamic electrical activity at 5 and 16 Hz and enhanced at 7-8, 12 and 26 Hz. Radiation of TR20 (?? TH20, the "hypothalamus" point after R Voll) gave similar though less prominent results at 7-8 and 12 Hz. Radiation of ST36 (the "longevity" point) gave minimal EEG changes.

Lee_TN (1994) Thalamic neuron theory: theoretical basis for the role played by the CNS in the causes and cures of all diseases. Med Hypotheses Nov 43(5):285-302. Acad of Pain Research, San Francisco, CA 94132. The Thalamic Neuron Theory (TNT) postulates that the CNS is involved in all disease processes, as the CNS not only processes incoming physical and chemical information from the periphery, it also sends out physiological commands to the periphery in order to maintain homeostasis for the entire body. Inherent in its capacity to learn and adapt (e.g. to habituate) is the ability of the CNS to learn to be sick (pathological habituation) by looking in certain deranged CNS neural circuitries, leading to chronic disease states. Pathologically habituated states can be reversed by dehabituation. To mimic the habituation process, this can be done repetitively by modulation of abnormal neural circuits by physical neuromodulation (like AP), or by chemical neuromodulation (such as homeopathy, TCM, or WM techniques). Chemoneuromodulation can also be achieved by delivery of minute amounts of pharmacological agents to specific sites in the periphery such as the AP loci. It is hypothesized that humoral and neurotrophic factors and cytokines may be very effective neuromodulators. TNT assumes that the blue print for embryological development is embodied in the phylogenetically ancient part of the brain. This primordial Master Plan, organized in the form of a homunculus, possibly encased in a small nucleus, retains control over the subsequently evolved parts of the brain so that the entire CNS functions like a composite homunculus which controls the physiological functions of the entire body. TNT further postulates that the master homunculus takes the shape of a curled up embryo with its large head buried close to its pelvic region, with its large feet and hands crossed over to the contralateral sides. Neuronal clusters along a neuronal chain in the homunculus represent AP points in the periphery. The neuronal chain itself represents a Channel and Qi is nothing more than the phenomenon of neurotransmission. Certain new theoretical concepts such as the principles of Adynamic State and Bilaterality are also presented. TNT now can explain adequately many clinical findings which are difficult to explain in WM, CHM, AP and homeopathy. Based on this model, new therapeutic techniques can be launched to combat a whole host of intractable diseases.

Levashov_MI; Iaroshenko VT; Lytvynova AM; Gapon OI (1992) Hyperventilation Syndrome and reflexologic methods of its correction. Fiziol Zh Sep-Oct 38(5):42-45. AP was used to treat hyperventilation disorders, especially hyperventilation Syndrome (HVS). Diagnosis was based on clinical, Lab and functional methods. AP was carried out using the first (strong) variant of classical inhibitive procedure of AP. AP decreased EEG characters of dysrhythmia and exaltation and paroxysmal activity as well as inter-hemisphere asymmetry in patients with HVS. Parallel with a decrease in the degree of negative subjective sensations, minute respiratory volume, non-informity of regional ventilation decreased and partial oxygen pressure in alveolar air increased. Using no pharmacotherapy, it is possible to correct HVS by AP.

Liao_TJ; Nakanishi H; Nishikawa H (1993) The effect of AP stimulation of the middle latency auditory evoked potential. Tohoku J Exp Med Jun 170(2):103-112. Dept of Oriental Med, Meiji Coll of Oriental Med, Kyoto, Japan. The effects of AP stimulation on the middle latency auditory evoked potentials (MLAEPs) were studied in 19 normal male volunteers. Scalp recordings were made from 21 points (including Cz) and posterior auricular muscle (PAM) electrodes referenced to the linked mastoid. 4 components of MLAEPs (Po, Na, Pa and Nb) and 2 components of PAM reflex (N12 and P17) were statistically analyzed for changes in latency and amplitude. Wave phase of Po and Na reversed to N12 and P17, respectively, and the peak-to-peak amplitude of Po-Na, Na-Pa, Pa-Nb and N12-P17 showed a marked increase during AP to the ipsilateral side whereas no change in latency was detected. Each component's isovoltage topographic maps and dipole locations were calculated to be near both PAM (Po and Na) and temporal positions (Pa and Nb) during AP. AP promoted MLAEPs activity and these signals (Po and Na) may originate from increased activity in N12 and P17 of the PAM reflex, respectively. The auditory cortex of the temporal gyrus is the generator substrate of Pa and Nb.

Meng_Z; Lu GW (1993) The functional linkage among ST36 and the spinal dorsal horn-SN. Sci China B Oct 36(10):1198-1206. Dept of Neurobiology, Capital Inst of Med, Beijing, PRC. EAP of ST36 and the solitary tract nucleus (SN) as well as microelectrode recording from the laminae III-V of the lumbar spinal dorsal horn were used on pentobarbital-anaesthetized rats. We identified 57 spinal neurons responding to the stimulations of both ST36 and SN; 34 responded antidromically to SN; the others responded orthodromically to SN. Among them, low-threshold mechanoreceptive (LTM) neurons and wide-dynamic-range (WDR) neurons were 50% respectively. A single spinal dorsal horn neuron receives somatic afferent input and then conveys it to the visceral sensory nucleus-SN; some spinal dorsal horn neurons receive, in turn, innervation from the SN; convergence and integration between somatic and visceral sensory inputs might occur in the spinal dorsal horn neurons and/or SN. 

Miltiades_K1 (1996) Neuroscience, neurophysiology and AP: Part 1. Adapted from WWW. The Web-Journal of AP, Home Page of Karanikiotes Charisios MD, [email protected] (Karavis Miltiades MD DipAc. 2 Alkmanos str., 11528 Athens, Greece, Tel:+30 1 7220542, Fax:+30 1 7293345).

Abstract
Neuroscience provides an understanding of the organization and physiology of the nervous system. This understanding is based on an appreciation of the structure of the nervous system and on the relationship between his structure and function. The human CNS is extraordinarily complex.The brain is composed of circa 1012 cells (neurones). These cells uniquely possess specialized processes for receiving (dendrites) and transmitting (axons) information. These stimulus - response systems permit our body to be in contact with environmental fluctuations. Several thousand types of nerves, neurotransmitters, receptors and chemical mediators compose this fundamental system. AP, as needling therapy, is a kind of specialized sensory stimulation that is analyzed through sensorineural pathways.

To understand the action of AP we have to analyze the Anatomy, physiology and physiopathology of Nervous System. This effort is helped by the knowledge of contemporary neuroendocrinology and chemoarchitecture of the brain. Many neural theories are developed to explain the mechanisms of action of AP. It is now quite clear that AP reacts in local, regional (spinal cord) and general (brain) levels. Therefore, placing one or more needles on a particular point (or area) of the body activates neural pathways on 3 different levels provoking local, regional, and general reactions: a.The local reaction is a multifactorial phenomenon. The electric injury potential due to the needle, the synthesis of opioid peptides at the place of the injury, the Substance-P, histamine like substances bradykinin, serotonin, proteolytic enzymes all around the needle, occurred during every needling therapy. b.The regional reaction concerns the activation of an largest area (23 dermatomes) through reflex arches. We can analyze the viscerocutaneous, cutaneovisceral, cutaneomuscular and visceromuscular reflexes and also the autonomic, stretch and polysynaptic segmental reflexes. c. The general reaction mainly activates the brain central mechanism of internal homeostasis. Discussing the role of central neurotransmitters we can explain the action of AP in acute and chronic pain Syndromes, in addictions, in psychiatric diseases. More precisely, we shall discuss the modulatory systems that are activated through AP points: a.opioid systems; b. non-opioid systems, and; c.central sympathetic inhibitory mechanisms.

Introduction
AP needling (superficially in the skin or deep in muscular or nervous tissues, ligaments or bones) is a sensory stimulation. The purpose of therapy is activation of innate (self-healing) mechanisms via the stimulation of selective skin points or areas of the body. Stimulation takes place at several points at the same time. Different combinations of points can activate different response-circuits and the type of stimulus is very important for the therapeutic result.

By character of stimulation (or parameter of stimulation) we mean:
a) The depth of stimulation (skin, muscles, periosteum, ganglia).
b) The intensity of stimulation (Deqi, EAP, Laser-AP).
c) The area of stimulation (AP point, dermatome, myotome).
d) The combination of stimulation points.

In the table 1 we can see the importance of stimulation parameters and the possibilities offered by this knowledge for the systematisation of our practice.

When an external or internal stimulus influences it, the nervous system with its sensory peripheral receptors, afferent sensory pathways, central cerebral nuclei, efferent pathways and effector peripheral organs directs the mechanisms of action and reaction of the body. All changes in the external or internal environment are handled in this manner. In AP, the stimulus is external (needle) and activates mostly homoeostatic mechanisms. AP-stimulation concerns mainly the epidermis, dermis and muscle tissue; it may be by simple needle puncture (dry needling), sc injection of pharmaceutical agents (mechanical and chemical stimulation, wet needling) or electrostimulation (sensory block).

According to Pomeranz[1] an injury to the skin activates the sensory receptors of small afferent A-delta and C nerve fibres. Nerve fibres are classified by size and according to whether they originate in skin or muscle: large diameter myelinated nerves Ab (skin) or type I (muscle) carry "touch" and propioception, respectively. Small diameter myelinated A-delta (skin) or types II and III (muscle) carry "pain". The smallest unmyelinated C (skin) and type IV (muscle) also carry "pain". Types II, III, IV and C also carry non-painful messages).

Sensory distribution: MacKenzie's theory.
The skin, muscles, ligaments, joints, bones, bowels and viscera, and the vessels related to them, are controlled functionally by the neurotomes. These are defined segments of the spinal cord. Sensory afferent fibres converge towards the neurotomes coming from the dermatomes, myotomes, viscerotomes and sclerotomes according to their somatomic origin, e.g. according to their embryonic somatic innervation. The formation of these primitive segments or somites reflects the metamerism.

The structure of the nervous system is such that a skin area, a muscle, a group of ligaments, a bowel or organ/viscus, the segment of a bone, are served by one and the same centre called myelotome (MacKenzie's theory, viscerosomatic convergence theory and peripheral nerve-branching theory)[2,3,4,5]. In the course of embryonic life, innervation of the bones, of the muscles of the skin and of the bowels/viscera is symmetrical. But as the organism grows it loses its initial symmetry. Finally, only the intercostal nerves preserve the initial symmetrical correspondence between neurotomes, dermatomes, myotomes and sclerotomes. Knowledge of the topography and anatomy of these zones is indispensable to AP. It has clinical value in localising diseases of the posterior or anterior roots of the spinal nerves and also for the right choice of the AP points (or areas) which have to be stimulated.

Thus, MacKenzie's theory states that sensory cutaneous stimulation (e.g. placement of a needle) will cause functional reflex reactions to the muscles, the muscle vessels and the ligaments that receive sensory or motor innervation from the same myelotome. The reflex muscle contraction, the hyperalgesia, the tenderness and the associated autonomic manifestation (sympathetic and parasympathetic hyperactivity) are localized not to the site of the injury but to an area at a distance and may involve only a small part of a dermatome. The presence of cutaneous hyperalgesia associated with deep somatic or visceral pain disorders had been recognized by many physiologists like Head, Sherrington, Ross, Sturge and others. We believe that AP acts at a spinal or supraspinal level, using similar neural pathways that produce referred pain (antidromic activation of receptors at a distance). Also, depending on the referred visceral pain mechanisms, and the projection-convergence theory of Rusck, the skin, uses its own "language" (painful skin or muscle areas in visceral pain diseases of the heart, gallbladder, stomach etc) to reflect the exact skin area that needs stimulation, in order to eliminate the vicious cycle of pain[2].
Miltiades_K2 (1996) Neuroscience, neurophysiology and AP: Part 2.

For example, consider the placement of a needle (needling) at ST36 at a depth of 3 cm. This point is in the lower limbs, 1 cm outside the front margin of the leg and 3 cm below the tibial convexity (motor point of the anterior tibial muscle). This stimulation will cause:
a.        Local sensory stimulation of the area of the leg that is sensorially innervated by the cutaneous branch of the major saphenous nerve (neurotome L3-L4).
b.        Stimulation of sensory receptors and mechanoreceptors of the anterior tibial muscle (motor innervation by the deep radial nerve, L4, L5, S1 neurotome).
c.        Vasoconstriction or vasodilatation (depending on the stimulation parameters) of the front tibial artery, that supplies arterial blood to the skin and muscles of the area.
d.        Myochalasis, that will influence all groups of muscles that have a common neurotomal distribution in the L5 myelotome and in particular on the long extensor of the big toe (L4, L5, S1), the long and short tibial muscle (L4, L5) and the major gluteal muscle (L5, S1, S2) and finally.
e.        Activation of serotoninergic and endorphinergic pain modulation systems (central action).

For these reasons, ST36 is selected for stimulation in all cases of back pain or sciatica with L4-S1 pain distribution, with or without neurological findings.

Stux and Pomeranz,[6] formulated the hypothesis that 3 centres are activated by AP to release chemical transmitters that block pain messages.
a) The spinal cord that uses enkephalin and dynorphin (low frequency) and perhaps GABA (high frequency).
b) The midbrain uses enkephalin to activate the raphe descending system which inhibits spinal cord pain transmission by a synergic effect of the monoamines, serotonin and norepinephrine.
c) The hypothalamus-pituitary uses endorphin.

Johannes Bischko,[7] analysing the control loop theory (feedback mechanism) states that every AP point displays at least 4 criteria:
1. Local action.
2. Regional action.
3. An action extending beyond a certain region and.
4. General action.

Watkins and Mayer[8,9] proposed the possible activation with AP (and other physical agents) of 6 different endogenous analgesic systems: neural opiate, hormonal opiate, neural non-opiate, hormonal non-opiate, unknown opiate and unknown non-opiate systems.

We could say that by placing a needle on a particular point (or area) of the body, nervous pathways are activated on 3 different levels provoking: 1.Local reactions concerning an small area of 13cm; 2.regional (segmental) reactions concerning an area of 13 dermatomes, and; 3.general reactions concerning a massive response from the CNS. We will analyze the action of AP at these 3 levels: periphery, spinal cord and CNS.

Local action of AP stimulation
This action of AP is localised in a small skin area, is due mainly to the tissue lesion caused by placing the needle on the skin and concerns all AP points without exception (non-specific action of AP points).

Deactivation of superficial painful skin points.
The local reaction is the result of many factors. Initially, the difference in electric potential existing between the needle and the layers of the skin where it is placed, the difference in temperature between the needle and the skin and the quality of the needle, creates a galvanic current of low intensity. That means that the needle is a source of microenergy[10,11].

This electric current can stimulate the cell membrane to increase its permeability and transform the accumulation of Na and K ions in the 2 poles of the membrane (intra and extracellular) leading the cells, the adjacent sensory receptors and the free nervous endings to a state of excitability.

Moreover, cell injuries of the skin (an in particular of the mast cells of the Lewis layer) provoke a secretion of bradykinin, serotonin and proteolytic enzymes, ACTH and also of histamine-like substances all around the needle[12].

Yaksh and Hammond[13] point out that 3 types of local substances participate in peripheral transduction of nociceptive stimuli into nociceptive impulses (pain).
1) Those that activate nociceptive afferent fibres and produce pain (bradykinin, ACh and K).
2) Those that facilitate the pain evoked by chemical and physical stimuli by sensitisation of nociceptors but are ineffective in evoking pain themselves (prostaglandins) and.
3) those that produce extravasation, such as Substance-P. Substance-P (and perhaps other peptides) may have a role in influencing the milieu of the peripheral afferent terminals, and thus in the transduction of nociceptive information. Substance-P, like other peptides, is synthesised in the cell bodies of small cells (type B cells) of spinal ganglia and the gasserian ganglion by the ribosomal synthesis of large precursor prehormones[14]. If the stimulation of AP is a kind of nociceptive stimulation, we can hypothesise the presence of this substances at the site of the needle.

Therefore, it can be said that the main neurotransmitter of pain to the periphery is Substance-P. Substance-P is a peptide transported by the neural fibres till the last nerve terminals of the neural C-fibres. circa 20% of the cell body in the spinal dorsal root ganglia contain Substance-P. These cells have small somas and small unmyelinated and finely myelinated axons. Their peripheral processes occur in the epidermis and in the walls of blood vessels and glands. Their central processes project to the superficial layers of the dorsal horns of the spinal cord. Also, opioid receptors are present on primary afferent neurons (thinly myelinated and unmyelinated cutaneous nerves), on sympathetic postganglionic neurons. Now many findings indicate the presence and synthesis of opioid peptides in different types of inflammatory cells at the site of tissue injury. Because the local reaction is a kind of small inflammatory reaction, the peripheral antinociceptive effect of exogenous or endogenous opioids will be enhanced especially 3-4 d after the AP treatment. Substance-P, together with the above mentioned substances provokes local clinical phenomena of inflammation such as swellings, red spots, itching or burning pain.

After withdrawing the needle, the unequal distribution of electrical potential (because of the high level of K ions) round the edges of the injury creates an electric "flux potential field" which acts as stimulator of the free nerve endings of the skin for 72 h after the application of AP. The nature of the stimulation varies depending on the depth of the injury, the quality of the tissues, the sensitivity of the nervous system of the patient and the type of needle used.

Inactivation of the deep painful muscle points
The quality of the stimulus depends mainly on the depth of entry of the needle and the quality of the tissue in which it is placed (target-tissue). Often, the needle is placed in muscle, in the TPs[15] or in motor points. Motor (Erb) points are specific points where the motor nerve enters the muscle; electrostimulation of these points causes the muscle to contract. TPs are points in muscle which induce referred pain on needling or pressure palpation. They occur in many degenerative disorders of the spinal cord, in all cases of musculoskeletal pain of radiculopathic origin (neuropathic pain) and in local muscle, ligament or joint injuries (especially overuse Syndromes). circa 70% of all AP points coincide with TPs. Melzack, Stillwell and Fox[16] showed "a remarkably high degree of correspondence (71%) between TPs and AP points".
Miltiades_K3 (1996) Neuroscience, neurophysiology and AP: Part 3. Liao also reported that many AP points coincide with the motor points (Erb points) of skeletal muscle.

The simple placement of the needle at these points achieves: a) the inactivation of the TP (reduction of the intensity and discharge rate of pain sensory stimuli from the muscle to the higher sensory centres) and b) the activation of spinal reflexes. The receptor organs of the muscular shaft (proprioceptive sense) and the cells of the anterior horns of the spinal cord participate in this process. This mechanism will be analyzed in detail in the discussion about the regional action of AP.

Regional action of AP stimulation
AP acts at a spinal (segmental or regional) level. Noxious stimuli from the periphery lead to release peptides in the spinal cord level. These peptides (tachykinins, Substance-P, neurokinin A, calcitonin, gene-related peptide, somatostatin etc) modulate the transmission of nociceptive information to the CNS. Using treatment modalities like TENS, AP and EAP, we can block the nociceptive signals, activating descending pain inhibitory systems which act at the level of the specific myelotome. AP and EAP have an inhibitory effect on interneurons of the spinal cord (lamina V) and this inhibition is mediated by opiate pain-relieving system[17]. Also, many laboratories have shown changes in dorsal horn cell activity (gating) during mechanical, chemical and electrostimulation of somatic and visceral fields. TENS of somatic areas decreases the spontaneous and noxiously evoked activity of most dorsal horn neurons (wide-dynamic-range (WDR) cells, High threshold (HT) cells, and high threshold inhibitory (HTi) cells), reducing the perception of pain[18].

This mechanism can be the spinal (regional) action of many analgesic physical methods which we use daily in physiotherapy. Another regional reaction concerns the activation of an area through reflex arches. Those are produced after the stimulation of a peripheral sensory receptor. The stimulus is directed with afferent neural fibres to a sensory or motor nucleus of the spinal cord and a response reaction is produced there.

Viscerocutaneous reflex or splanchnofascial reflex: A functional or organic visceral disease causes pain, hypalgesia, tension or irritation to a particular area of the skin. Usually, in relation to the painful viscera, the skin area to which pain is projected has a common somatomic origin from its embryonic development. Consequently it is innervated sensorially from the same neurotome of the spinal cord. The skin and the related viscera have the same segmental innervation usually by dorsal roots, spinal nerves and nuclei (referred pain resulting from reflex phenomena). The nociceptive impulses from the affected viscera pass to the dorsal horn and then to anterior horn of spinal cord across interneurons. Visceral afferent nociceptors converge on the same pain projection neurons as the afferents from the skin[19,20,21,22]. For example, stimulation of the descending colon with barium chloride creates paleness (shrinking of the melanin cells-melanocytes) in an area or neurotomes[23] of the specific myelotomes (T9-T12). Moreover, injection of adrenaline 10% to the gastric (ST) mucosa, in the GB or in the fascia of the spleen, creates skin "shining" at a specific small area of the dermatomes of those organs[23].

Pain in the GB is projected on the skin of the right hypochondrium and on the top part of the right shoulder, a pain related to stomach ulcers corresponding to the 11th thoracic vertebra. The viscerocutaneous reflex is transmitted via the sympathetic chain. Dissection of the spinal cord does not affect this reflex. It is abolished by the dissection of the sympathetic chain. This reflex is a diagnostic reflex.

Cutaneovisceral reflex: Irritation of a skin point functionally influences the organ to which the cutaneous area is connected via the neurotomes. Experimentally, procaine-injection into cutaneous tender points in the anterior thoracic wall of patients with acute angina pectoris gives fast relief of precordial pain. EAP of LI18 on both sides, provokes APA sufficient for thyroidectomy. LI18 is in the area of innervation of the 3rd dorsal cervical spinal nerve. The fascia of the thyroid gland and the overlying skin area where the specific AP point is found, is innervated from the same cervical myelotome. This reflex does not depend on higher brain centres. It follows a clearly neurotomic distribution. Dissection of the visceral nerves abolishes the reflex. Dissection of the vagus nerve does not influence the healing effect. It looks like the myotatic, monosynaptic reflexes. This is a therapeutic reflex.

Visceromuscular and viscerovisceral or somatoautonomic reflexes are internal reflexes. They interpret the muscular contraction and vasocontraction observed in diseases of the internal organs. Sensory fibres from the muscles, the vessels and the affected organ originate from the same myelotome on neighbouring nuclei which are functionally interconnected[24]. This reflex produces reflex spasm of the skeletal muscle (TPs of m. pectoralis) during myocardial ischemia (MI). Also, through this reflex we interpret muscular pain during the function of the muscle under conditions of limited blood supply[25]. The sensation of needle insertion into somatic nerve endings in the muscle, ascends with afferent impulses to the anterior hypothalamus. Efferent impulses originate from the same reflex centre of hypothalamus, descend to the cholinergic vasodilator nerve and dilate the blood vessels of the muscle. Dissection of the dorsal spinal roots and that of the visceral nerves abolishes this reflex. A viscerovisceral reflex is activated during the direct excitation of a ganglion by placing a needle deeply in the ganglion or all around the ganglion. For example, SI18, a Hui-Meeting point on the head of the 3 Arm Yang Channels, is needled during acute pain of the musculoskeletal system. This point is very important to treat myoskeletal diseases[26]: application of local anaesthetics to the mucosa overlying the sphenopalatine ganglion can block pain and is extremely effective on myoskeletal pain especially of the neck and back. SI18 and the sphenopalatine ganglion coincide. In this area, there exists the largest collection of neurons in the head outside the brain itself. It is intimately connected to the trigeminal nerve and nucleus, and the superior cervical sympathetic ganglion. It seems to be the final switch between the body and the brain.

Somatomotor or cutaneomuscular segmental reflexes. A harmful stimulus to the skin stimulates the axons of sensory fibres of groups III and IV of peripheral nerves. The information of stimulation enters the posterior horns of the spinal cord and is transmitted with the help of intermediate neurons to the motor neurons of the anterior horns. This pathway is polysynaptic and permits on one hand control and on the other deviation of sensory stimulation. Thus, the stimulation of a group of sensory receptors on the muscles, tendons or the skin will cause contraction or relaxation of muscles in the stimulated area (segmental distribution of the reflex). In this manner, by a sensory stimulus (puncture) it is possible to enlist neurons on the same or on the opposite side of the initial stimulation. The usual response to the sensory stimulus is the ipsilateral stimulation of flexors and the inhibition (relaxation) of extensors and the contralateral inhibition of flexors and stimulation of extensors (flexor and cross-extensor reflex)[27,28].
Miltiades_K4 (1996) Neuroscience, neurophysiology and AP: Part 4. Most rehabilitation treatments by electrophysical agents and, of course, AP, use cutaneomuscular reflexes to achieve muscle relaxation and to ameliorate the im blood supply to individual muscles or muscular groups. The selection of the area to be stimulated depends on the target muscle.

Autonomic reflexes are reflexes through the ANS (sympathetic and parasympathetic). Many short and long autonomic reflexes can "close" the nervous circuit in the brain, the spinal cord, in the big nervous ganglia or in smaller peripheral ganglia. Apart from segmental reflexes, many autonomic reflexes are known in medicine, for example the segmental and suprasegmental reflex produced by local biochemical changes and tissue damage in patients with acute myocardial ischemia (AMI). This reflex (Bezold-Jarich reflex, an abnormal vagovagal reflex) produces severe bradycardia, peripheral vasodilation, severe hypotension and atrioventricular block. The reflex involves afferents and efferents of both cardiac vagus nerves and cardiac sympathetic nerves which produce sympathosympathetic reflexes. In the AMI patients exist also suprasegmental reflex responses result from nociceptively induced stimulation of the medullary centres, hypothalamic centres, limbic structures and neuroendocrine function[29].

According to Gunn, some other common condition of autonomic dysfunction that respond well to AP treatment are the vasomotor, sudomotor, glandular hyperactivity and smooth muscle spasm observing in spondylotic radiculopathy. When pain disappears, the autonomic phenomena disappear.

Autonomic reflexes can be activated by: a.local stimuli; b.general stimuli, and; c.regional stimuli. Data from the Univ of Goteborg[30] showed that AP may affect the sympathetic system via mechanism at the hypothalamic and brainstem levels and the poststimulatory sympathetic inhibition that creates, persist for more that 12 h after AP.

Autonomic reflexes are the clearest evidence of the organisms reaction as an open thermodynamic system. We know very little about these reflexes. The major problem is in describing the connections between the human cortex and the peripheral outflow to smooth muscles, cardiac muscles, secreting glands, sensory organs and vessels. Some organs (heart, gut, spleen, kidney) receive both sympathetic and parasympathetic innervation, while other organs (adrenal, medulla, vascular tissue, skin and muscles) gain only a sympathetic supply. Clinically speaking, the ANS is not as autonomous as we believe and it may be more synergic than antagonistic[31,32,33].

Segmental distribution of AP points
Main Channels which cross the frontal thorax and the frontal abdomen include the SP, ST, KI. The CV runs in the ventral midline. Along their course on the abdomen and thorax, these 4 Channels have 66 ipsilateral points (110 bilateral). Independently of the name of the Channel, if we apply AP to the points on the thorax, we influence the thoracic viscera or their functions; when we apply AP, to points on Channels of the frontal abdomen, we influence the abdominal viscera or their functions. Moreover, all the Channels follow a course towards the middle frontal and the middle dorsal line similar to the segmental distribution of the deep pain that Kellgren[34] has put on a chart after injection of NaCl in the interspinal ligaments of the vertebrae. The dermatomal distribution of the sympathetic fibres coincides with the distribution of the points of AP of the second branch of BL Channel.

The BL and GV Channels seem to preserve the same precise neurotomic distribution of the AP points. AP points LU01 and 02, BL13,14,15,41 and GV14, have been used for centuries to treat LU diseases. All these points concern T2-T4 dermatome of LU and they correspond dermatomically to the outlets of the sympathetic chain of the dorsal lung plexus (2nd-4th thoracic sympathetic ganglion). The big bronchial tubes are autonomously innervated by this sympathetic plexus, and also the division of the trachea and all the vessels which transport blood to the bronchial tree. From the same anatomical region start the preganglionic branches of the lower cervical and of the first and the second thoracic ganglion of the sympathetic chain, which are going to form in the depths of the dorsal cervical triangle, the stellar ganglion. The Shu-Mu (Back Association and Front Alarm) point technique (synchronous needling of Shu-Back and Mu-Abdominal points) is a special ancient method that uses the segmental distribution of AP points to treat diseases of internal organs.

General action of AP stimulation
Teams of neurophysiologists and research workers on the effect of AP, of EAP, of electrotherapy and other methods of physical agents have studied the possible mechanisms and the ways of analysing of the peripheral stimulation from the CNS and also the way of answering of the CNS to these stimuli. Effective application of AP requires integrity of the peripheral nervous system and the spinal cord. AP points are "silent" in paraplegic limbs (individuals with complete sensory-motor paraplegia) or in experimental animals in which surgical resection of the spinal cord has been effected[35].

A peripheral stimulus, depending on its quality, may stimulate specific nuclei of the CNS and provoke secretion or qualitative modification of neurotransmitters in the blood and the CSF. Besides, each combination of AP points may activates different nerve circuits. This view was based on 2 experimental results from the Univ of Peking[36].

After arterial anastomosis of rabbits (cross circulation technique), APA occurs not only in the rabbit on which AP is applied but also in the rabbit to which the blood of the former is circulated through the anastomosis. Also, a CSF transfusion from a cat-donor to which APA had been applied to another cat-recipient causes analgesia to the recipient after 10 min. Since then, the existence (after AP) of analgesic neurotransmitters in the CSF and peripheral blood has been confirmed repeatedly; this clearly shows activation of central pain control systems (and others) by AP points. Reference to these points is related on one hand to the topographical paradox of the points and on the other to their important therapeutic action. Their effects have been established by studies (on experimental animals) and clinically (on patients); randomly selected sham AP points have an analgesic effect on 28-35% of patients when compared to AP points that have an analgesic effect on 55-85% of patients. Papers published from time to time relate to points LU07, ST36, LI04, SP06, LI10, TH05, LV03 and PC06. The systems activated through these points may be a) opiate endogenous analgesic systems, b) non-opiate systems and c) central sympathetic pain inhibition systems through the reticular formation of the brain.

APA is used to treat acute or chronic pain; it is used less for surgical APA. APA influences the neurochemistry of the descending pain control system. This system consists of 4 parts: a.spinal system (dorsal horn); b.cortical and diencephalic system; c.mesencephalic (PAG & PVG) system and; d.pontine (nucleus raphe magnus) system. Each system uses different types of endogenous opioid peptides[37,38].

Miltiades_K5 (1996) Neuroscience, neurophysiology and AP: Part 5. There is clear evidence of the analgesic action of AP in this field. Of 1500 articles in Medline, 1100 concern the analgesic action of AP. The most important among these articles concern Lab studies on experimental animals and clinical studies in Vet clinics. APA in animals does not exclude stress-induced analgesia, but excludes suggestion (animals are thought to be immune to suggestion), hypnosis and placebo effect (in part).

Pomeranz[6] gives the following evidence in support of the endorphinergic action of APA: 4 different opiate antagonists abolish the analgesic action of AP. Naloxone abolishes the analgesic effect. A microinfusion of naloxone or the infusion of endorphin antibodies (to the CNS) abolish the analgesic effect. Mice with a genetically reduced level of opiate receptors in the CNS have a poor response to AP. Rabbits with endorphin Xu do not respond to the AP stimulus. During EAP, endorphin levels increase in peripheral blood and in CSF, but decrease in the CNS. Inhibition of enzymatic degradation of endorphin greatly extends the duration of APA. APA is transmissible through plasma (cross circulation) and CSF. Inhibition of pituitary endorphin abolishes APA. An increase of messenger RNA for pituitary pro-enkephalin is observed for 24-48 h after AP.circa 60% of patients suffering from myofascial pain of the lumbar portion of the spinal cord are considerably relieved after the application of warm compresses (43-51oC) or ultrasound and the improvement of symptoms lasts from 90 min to 7 d. On the contrary, the application of EAP to general AP points relieves patients for several wk, mo, or up to 3 yr. This was noted (from Price at al) on 58% of the patients with chronic myofascial pain of the lumbar portion of the spinal cord to which AP was applied. Han suggests that the specific, long-term analgesic effect of AP is due to 2 factors: 1.activation of a neurogenous serotonin and Met-Enk circuit in the upper part of the descending pain inhibition system (in the mid diencephalon). This causes continuous inhibition (at the level of the spinal cord) and the non-conduction of harmful stimuli from the spinal cord to the CNS, and therefore the non-perception of pain and 2.the (peripheral) activation of low-threshold muscular mechanoreceptors. This increases the activity of thick-diameter nerve fibres (pain modulating system) and gives long-lasting inhibition of muscular pain. The long-term analgesic effect of AP is the most difficult point of contemporary theories. Han's theory (1987: mesolimbic analgesia system) may explain one of analgesic mechanisms of AP[39]. At least, activation of "Diffuse Noxious Inhibitory Controls" (DNIC) triggered by nociceptive peripheral stimuli that activates A-delta and C fibres (some forms of AP and moxa) can be an other mechanism of central action of AP and involves complex loops from spinal and supraspinal structures[40,41]. These studies showed that neurotransmitters, opioid and non-opioid substances of spinal cord and CNS, are the main coordinators of the "stimulation - analysis - response" phenomenon and they control the generalised internal chemical reactions of the organism after AP treatment.
Electro-AP analgesia
Electro-APA is well proven[42,43,44]. In general, the lower the frequency (Hz) electrostimulation, the lower the time required to reach maximum analgesic effect and the longer the effect remains. The higher the frequency, the shorter the time required to obtain maximum pain threshold, and the effects remain for a shorter time (table 2 and 3). Also, periaqueductal central grey (PAG) stimulation produced analgesia is similar to APA in many respects.

In other studies Xie-Guo-Xi, Han-Ji Sheng (1985) the high frequency of stimulation of the points of AP has above all metameric local action while, on the contrary, low frequency (1-15 HZ) generalized analgesic action. If the spinal cord is disrupted or transected, no frequency is adequate.

EAP at a frequency of 2 HZ provokes APA mainly through Met-Enk, with 100 HZ mainly through A dynorphin, while with 15 HZ both neurotransmitters are detected in almost equal quantities. More recent work (especially on high frequency current) suggests that the stimulation at a frequency >10 Hz increases enzymatic degradation of circulating opiate substances reducing APA[45].

Also, new electrotherapy techniques (MENS, microcurrent electrical neuromuscular stimulation) and EAP with current intensities in the order of 400 ¥Á at 10-60 Volts (low voltage pulsed microamp stimulation) and extremely long pulse duration with total current equal to 5x10-6 coulombs/s, are awaiting the results of the clinical tests to which they are subjected[46,47]. This technique is based to Arndt-Schulz law that microamperage (¥A) currents are better at enhancing cellular physiology processes than are currents of higher amplitude. Several clinical studies have documented the enhancing effects of MENS on wound healing, on tendon repair in animal models, on recovery of injured athletes suffering from ruptured ligaments and tendons. Also, Lab studies shows the ability to MENS device to stimulate cellular physiology and growth (increased ATP by almost 500%, increased membrane transport by 30-40% and increase protein synthesis by up to 73%).

The endogenous opioid peptides such as endorphin, enkephalin and others are not related exclusively to pain. They are directly related to all forms of dependence (drugs, smoking, alcoholism). Low levels of Met-Enk occur in patients suffering from Parkinson's disease. Very high levels have been reported in the dorsal cochlear nucleus and the intermediate geniculate body in patients suffering of schizophrenia. There is also significant evidence as to their role in the regulation of food intake (obesity). In regard to obesity, many "saturation" peptides and "stimulating appetite" peptides occur in the hypothalamic nuclei of the brain and the gastrointestinal tract, functioning as hormone inhibitors or as neurotransmitters.

Clinically, AP acts on the following body systems[48] (table 4). The action on the above mentioned body systems must be attributed to the ability of AP to influence the function of the CNS.

Nobel-winning neuroscientist Gerald Edelman[49] said that the human brain is a most complex functional structure. The most specialized and exciting type of cell is the neuron. The neuron, the structural unit of the brain, is unusual as regards its shape, its electrical and chemical function and the way in which it connects to other neurons forming networks. The cortex has circa 10 billion neurons. Each neuron connects with others through synapses. There are circa one million billion synaptic connections in the cortex. If we started counting them, at a rate of one synapse/s, we would finish counting after 32 million years. One piece of our brain of a size equal to the head of a match contains one billion synapses. If we tried to calculate the many ways in which synapses may be combined, we would have a number consisting of 10 followed by millions of zeros (the number of positive charged particles in the universe is 10 followed by 80 zeroes). The brain connects with the outer world through specialized neurons called sensory neurons that form the sensory organs and supply the brain with input signals, while output signals are transported to the brain through neurons connected to muscles and glands.
Miltiades_K6 (1996) Neuroscience, neurophysiology and AP: Part 6. The largest areas of the brain, however, exchange signals with some other areas of the brain without any intervention from the outside world. Edelman points out that the brain is more in contact with itself and the interior of the body than with anything else. The corpus callosum connecting the right to the left hemisphere contains 200 million fibres. The brain tissue is a complex network that communicates electrochemically both to the outer and to the inner environment. It emits and receives dynamic formations of signals and answers to these signals. The formations of its neurons influence the functionality of the heart, the kidneys, lungs, the muscles, the skin and the glands. The brain regulates breath, digestion, blood circulation and naturally analyses the AP stimulus.

It is very difficult to explain the action of AP. However, it is not difficult to underline the contribution of AP in the balance of the chemistry of the nervous system and of the role of the hundreds of neurotransmitters that regulate in whole or in part our health and disease, emotional behaviour, instincts, desires and the psychic disposition of man.

Depression is related to a disorder of noradrenalin- and serotonin- metabolism. The antidepressant action of amphetamines and the existence of benzodiazepine receptors in the cerebellum and the limbic system is also known. The role of GABA, a neurotransmitter with an inhibitory role in neurotransmission (through the K+, Na+, Cl- pump) and its intense ancholytic action is perhaps more general[50,51,52,53].

AP is used to treat a multitude of functional disorders such as metabolic diseases, endocrine disorders, mental disorders, functional, respiratory and digestive disorders, allergies, neuroautonomic disorders etc. Reference of the neuronic theory of the action of AP on these disorders is based on one hand on the investigation of the unknown homeostatic role of the reticular formation of the brain matter and on the other on the multitude of neurotransmitters that are detected peripherally after treatment with AP (CCK, bombazine, neurotensin, CRH (corticotrophin releasing factor), dynorphin, neuropeptide Y, enkephalins, amines etc.) and in the mode of action, secretion, activation and enzymatic inactivation of the above mentioned substances. It appears that these substances are similar in action to the classical endocrine gland hormones, activating negative and positive feedback mechanisms. The role of AP in these diseases has been only clinically established.

The reticular formation.
The reticular formation consists of groups of neurons and of neural fibres which unite the cerebral nuclei between them and each one separately with subcortical centres, thalamic centres, cerebellum centres, parencephalic centres, medulla oblongata and spinal cord. Functionally, it controls the mechanisms of wakefulness and those of sleep, muscular tonus, level of consciousness, cardiac and respiratory rhythm, vessel tonus, regulating and mediating motor, autonomic and sensory functions.

On the level of the nuclei of the reticular formation is led almost all information concerning sensibility and in a slow rhythm (because of the multiple synapsis) are transformed and analyzed qualitatively and quantitatively. Due to this analysis, the nervous signal coming from the periphery when it reaches the upper centres (brain nuclei) is differentiated from the initial one. That agree with hypothesis that mechanical, thermal and chemical noxious stimuli have effect on neuron activity of medullary and mesencephalic reticular formation especially around nucleus gigantocelularis (NGC). Also, Casey and Melzack[54] suggested that reticular neurons may mediate the affective/motivational dimension of the pain experience and pain-related behaviour, indicating the role of reticular formation in pain perception and modulation.

This descending modulation system brings significant functional alterations to the peripheral organs. Indeed, implantation of electrodes in areas of the reticular formation of the medulla oblongata and above all outside the cerebral nuclei brought big alterations on a cell, tissue, organic and functional level to the guinea pigs such as hydronephrosis, organic dysplasia, bone deformity etc. According to the information it receives from the sensory pathways, the activating system of the reticular formation may regulate the level of wakefulness of the functional nuclei of the CNS. It can make the body thrive, or repress many symptoms of the body and psyche, such as worry, dyspnoea, sweats, insomnia, irritability, change of cardiac and respiratory rhythm, vessel tonus. Interference with the homeostatic mechanisms of the reticular formation can be achieved only through sensory stimulation. AP can very possibly be a kind of similar stimulation. Particular points such as Ear-points Shenmen, Jerome and Master sensorial point, and somatic points such as HT07, HT03, LI03, GB20, ST41, PC06, BL10 act the equilibrating way mainly on the mental diseases and are used on patients with mental disorders intensely somatised.

Conclusion
The restoration of morphological and functional homeostasis and the maintenance of the dynamic equilibrium of the body that is gradually restored after AP treatment may be explained only if we consider the body as an open thermodynamic system that may transform exogenous influences from the environment and modify the function of its systems accordingly. This consideration constitutes the theoretical basis of Cybernetic systems (cybernetics: the field that deals most directly with information processing and feedback).
In this manner one can sketch today the therapeutic action of AP. The main difficulties to be overcome by doctors before understanding, learning and applying AP are: a profound knowledge of AP theory, the mechanism of action and reaction of the normal and pathological organism, the concept of the organism as a unique whole (Hippocrates), the mental tracing of Qi-circulation in the Channels, and the selection of AP points.

For us, western physicians, traditional applications of AP, derived from sources lost in antiquity but verified in everyday practice, are a starting point but also a signpost for concerns of contemporary Med research.

I point out that the rejection of a method is not a scientific position. In the history of science, the motive force of progress was the innate tendency towards interpretation (and investigation) of natural phenomena. No matter how many problems we shall face in the preparation of research protocols to establish the action, indications, counter-indications and side effects of AP. Their solution will always be the target of Med science.

Besides, the physician is not obliged to study TCM Philosophy in order to exercise AP. However it is necessary that he takes in his hands a weapon tested throughout the centuries, enriching his therapeutic armoury, having as his sole criterion the relief of man from pain. Each addition of knowledge is an addition of human power (HORATIO).
Miltiades_K7 (1996) Neuroscience, neurophysiology and AP: Part 7.

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Panzer_RB1 (1993) Introduction to the Western Physiological-Basis of AP. Proceedings of 11th Annual Vet Med Forum 652-656. RB Panzer, Univ Florida, Coll Vet Med, Gainesville, FL 32611.
Raitses_VS; Shliakhovenko AA; Emel'ianenko IV (1991) [The effect of AP on the evoked potentials of the ventromedial hypothalamus during stimulation of the visceral and somatic nerves]. Fiziol Zh SSSR Im I M Sechenova Feb 77(2):17-21. The responses of ventromedial hypothalamus' (VNH) population to stimulation of vagal, splanchnic and radial nerves (AP) were studied in cats. The AP increased the latency and changed the amplitude of EPs, particularly in stimulation of visceral afferents. In these conditions the characteristics of somatovisceral interaction in VMH were changed.
Rothfeld_Ga1 (1995) Scientific mechanisms of AP: Part 1. Talk by Glenn Rothfeld MD, to the Michigan State Med Soc Ann Scientific Meeting, Nov 4. Adapted from WWW (http://www1.shore.net/~spectrum/articlesandstories.html).

Definition of AP
AP can be defined as the process of inducing physiologic changes by inserting needles, usually made of stainless steel, in designated AP points in the body. The needles are placed to a predetermined depth, and are frequently manipulated, heated, or stimulated with electric current. They may be retained, or placed in and out. Recently, laser-AP and transdermal TENS (high frequency, low intensity electric bursts) have been studied as a substitute for needles.

AP points are frequently described as being on two dimensional lines projected on the surface of the body, called "Channels". The choice of points commonly is not related to local phenomena, for instance, a headache might be treated by the insertion of needles in the foot. The effects of an AP "treatment" last beyond the duration of the needle insertion itself, and can be hours, days or even weeks.

Thus, a scientific explanation of AP must include the ability to account for the occurrence of points, of Channels, of non-locality of effect, and of duration of treatment. Although a comprehensive theory of AP has not yet been offered and tested, this presentation will demonstrate the body of scientific work to support such a theory.

AP points
Electrically, AP points have a low skin resistance versus other points on the body, that is, they conduct electrical current better. Dr Janet Travell and others have described trigger points, motor points, etc. with similar characteristics, and in fact maps of AP points frequently overlap with those of trigger points. The resistance changes with disease states, sleep, urination, meals, birth and delivery, physical exercise, and changes in external environment, temperature, season and time of day. Furthermore, this lowered skin resistance is measurable even after death and embalming, suggesting some intrinsic electrophysiological quality to the tissue comprising these AP points.

Biochemically, the AP point has measurable changes in the Na/K level at a depth under the skin, as compared to tissue around the point.

Histologically, AP points are surrounded by structures described as a "neurovascular haemolymphatic complexes". These are networks of arteriovenous capillaries; a rich lymphatic drainage; cutaneous nerves (myelinated and unmyelinated) emerging from deep fascia, from bone foramina, and motor points of neuromuscular attachments.

Anatomically, as mentioned before, point maps correspond to motor points, neurovascular points, and trigger points.
Channels
Electrical current is propagated easier along the Channels than other points, and there is less resistance along these pathways (Becker and others). The current intensity, either passively measured or actively instilled with an electric shock, is greater the further the AP points are from one another on the same Channel (Mussat: "la propagation de charge")

Dr Jean Claude Darras' experiments showing radioisotope movement (Technetium 99) of 4 cm/min, too slow for vascular movement, appeared different from lymphatic flow. The experiments were performed on 250 controls and patients, and the tracers did not appear in the lymph nodes for 1-2 hours. These experiments were repeated by Bratila et al. and not repeatable by Lazorthes et al. in later trials.

Viscerocutaneous reflexes frequently correlate with the internal and external Channel pathways, and there is some, though not complete, dermatomal correlation.

AP Needling
Ionic effects: Organs are bathed in a liquid of ions. The electric properties are such that the outside of the surface of the organ is positive, and the inside is negative. Since a charge is transmitted to the surface (this is why we can take an EKG by measuring on the skin) the charge "projects" onto the surface of the container, in this case the skin. The charge is transmitted along the pathways of least resistance. In the body, these are the fascial planes, the cleavage or dividing planes between muscle groups and tissues. The AP points and Channels lie along these fascial planes.

Electrical effects: Needles are stainless steel or another metal. They frequently have another metal on the shaft, or stainless steel wound in a different configuration around the shaft. Thus, there are four phenomena working on the needle

Calvin Thompson's effect, or the thermocouple effect: In a homogeneous conductor with different temperatures at each end, there will be an electrical potential gradient along the temperature gradient. In most cases, therefore, the tip of the needle is positive with respect to the handle.

Bimetallic effect: Two different metals, or a metal with different configurations (straight and spiralled) will set up a weak current along the needle shaft, since the uniform conductor is reinforced at the point that it is in contact with the second metal or the spiralled filament.

Benedict's effect: A metal handle will oxidize when exposed to air, and the oxidation will set up a transfer of electrons.

Radioelectric effect: A shaft of metal will "receive" and transmit the electromagnetic signals of the environment, much as a radio antenna will.

Manipulation effects: Placing a needle 8 cm long and 0.3 mm diameter in at normal body temperature and room temperature will generate a 2-3 microvolt current, which will reach equilibrium after 10-15 minutes. This is the technique known as DISPERSION. When manipulated, the tip of the needle changes to a negative charge, thereby attracting positive ions. Heating the handle generates a 10-15 microvolt potential which will reach equilibrium after a 60-90 minute period. This is the technique known as TONIFICATION.

Sequential needling effect: Tonifying the needles in sequence will create a sequential flow along the pathway created.

Current of Injury effect: There is a 20-100 millivolt potential across the human skin at rest, and a normal resistance of 2-20 Mohms, which drops to 0.1 Mohms when it is needled. Thus a current (called a current of injury) is set up across the hole, of about 1 microAmp. This current of injury lasts about 48 hours, then equilibrates.

Physiology of AP
Placebo Theory: There are numerous studies which rule out AP as a placebo effect, including the predominance of animal studies, the 70-80% efficacy rates in metanalyses versus about 30% for placebo, and the difference in measurable physiologic responses.

Neurological Theory: In 1975 Melzack and Wall articulated the Gate Control theory of nerve transmission. In this theory, AP could build up the neurologic interference which prevents the pain stimuli from being transmitted. However, this doesn't explain the effects of AP beyond the time of needling, the effects on other illnesses, etc.
Rothfeld_Ga2 (1995) Scientific mechanisms of AP: Part 2.

Neurohumoral Theory: In 1976 endogenous morphine-like substances called endorphins were discovered, that act on the opiate receptor sites and inhibit pain transmission. Dr Bruce Pomeranz first measured endorphins being stimulated by using ear points. He later determined that AP stimulates the type 3 small afferent fibres within the muscle tissue, which are connected to the hypothalamus-pituitary axis, thus acting both locally through the spinal cord, and systemically through the release of beta-End and other neurotransmitters. There is a considerable body of evidence supporting this action, particularly the hypothesis that endorphins mediate APA. For instance, endorphin levels in the blood and CSF change in response to APA, naloxone and other opiate receptor antagonists block APA, and loss of opiate receptors in genetically-altered mice results in resistance to APA.

It has since been discovered that a number of neuropeptides and other substances can be released by stimulating AP points (e.g. ACTH, TSH, gastrin, substance P, calcitonin gene-related peptide [CGRP], ACh, enkephalins), and that different frequency stimulation will result in release of different neuropeptides. In 1980 Omura listed AP-triggered peripheral events, including: increased or decreased WBC; ACTH like effect; decreased cholesterol and triglycerides; glucose and cortisol regulation; serotonin regulation and stimulation; sympathetic vasodilation suggesting a microcirculation effect.

Unification of Neurologic and Neurohumoral Theories: It appears, then, that there are local effects of AP stimulation, perhaps acting on segmental neurons. There are also distal effects, not explainable by local reciprocal inhibition, but active in the midbrain and pituitary- hypothalamus axes, perhaps by releasing messenger RNA which mediates the production of beta endorphins and other neuropeptides.

Bioelectromagnetism Theory: The new field of bioelectromagnetism and biophysics is providing a new understanding of phenomena such as AP. It is now known that there are endogenous electromagnetic (EM) fields which signal physiologic states, biological and circadian rhythms, immune and endocrine function, and other functions, that these fields are very low level, low frequency, that external low-intensity EM fields, both natural and man-made, create specific biological responses, and that applying these EM fields can be used to treat nonunion bone fractures, chronic pain, and psychologic states.

The Shang Hypothesis: Cheng Shang has written about measurable oscillations which precede morphologic change in plant and animal tissue by a matter of days. We know that there are weak electric fields which affect calcium Channels, and that their effects can be blocked by Verapamil. These fields (WEF) can influence fibroblast movement, inhibit or enhance tumour growth depending on the polarity, and are necessary for the regeneration of limb growth in frogs and starfish. WEF are difficult to measure due to the larger EM fields of the earth and surrounding elements, and man-made input such as 60 Hz electricity, etc. However, Becker and others have shown their existence and importance. Becker describes a perineural DC current which is a more primitive but higher level of organism organization which serves to regulate and control the nervous system. Shang hypothesizes that AP works partly by restoring the disrupted oscillatory communication of diseased tissue, or by transmitting signals to adjust physiologic functions toward normal. Shang has described "organizing centres", areas which control the oscillatory response in surrounding tissue, in areas of low electrical resistance, such as bends in body surfaces, etc., precisely the areas that major AP points are found. Thus, stimulation at these points with a comparatively weak stimulus can affect large changes in a system.

Zhang-Popp Hypothesis: A different development of this theory involves the Zhang-Popp Hypothesis. These researchers sought to explain the statistical self-similarity of the conductivity properties of AP points by describing a model of EM waves created by the many naturally charged oscillators in the body. These waves have standing patterns, which are affected at boundary conditions such as skin, bones, fascial planes, and other areas where AP points are found. The wave patterns are stable but not static, which may explain the phenomenon known as "Qi movement", and can be altered by minimal input at the boundary sites. The model may also help explain the microsystems like ear and foot AP, via the principle of self-similarity. Dr Beverly Rubik of the Temple University Centre for Frontier Sciences developed this idea further in a recent article in Alternative Therapies (1995, 1[4]: 41).

Conclusion: AP involves five different vectors, or methods of transmission of effects: 1.electric 2.neurologic 3.humoral 4.lymphatic as a medium for the electro-ionic flow along fascial planes 5.wave propagation. 
Shang_Ca1 (1996) The Mechanism of AP: Part 1. (Adapted from WWW). Charles Shang, Boston Univ Sch of Med, Box 275, 80 E. Concord St., Boston, MA 02118; Tel: 617-825-5812. Understanding AP points and the Channel system in terms of modern science is important to facilitate the study and application of related techniques. The model which relates organizing centres in morphogenesis and growth control to AP points can qualitatively explain much of the research data on the Channels and AP points, such as their distribution, high electric conductance, response to non-specific stimuli and polarity of electric stimulation. As a network of singularities in signal transduction, the Channel system plays an important role in physiological and growth regulation. The change of electric activity is part of signal transduction and can precede anatomical change during morphogenesis and pathogenesis. Small perturbations around singular points can have decisive effects on a system. Therefore, manipulation of AP points, the singular points in the signal transduction system, can be an efficient way to diagnose and treat, particularly at the early stage of signal transduction, before the stage of morphologic change. The model has support also from research in developmental biology and can be tested by available techniques. Converging discoveries in signal transduction and AP are discussed.

Morphogenesis and the Channel system
A modern scientific explanation of AP points and Channels is important to further the study and application of related techniques[1,2]. In the Standard International AP Nomenclature proposed by WHO,[3] the Channel system in AP consists of >400 AP points, 12 Main Channels and 8 Extraordinary Vessels connecting some of the points. Most AP points and Channel points are the high electric conductance points on body surface and vice-versa[4,5]. A model has been proposed[6] that AP points are organizing centres in morphogenesis. Macroscopically, they are singular points (e.g. sinks, sources) in the morphogen gradient, phase gradient and electromagnetic field. Channels are separatrices. The pattern of magnetic field on the human scalp mapped by SQUID (Superconducting QUantum Interference Device)[7] shows that the GV is a major conduit of magnetic flux on the scalp and also a separatrix which divides the scalp into 2 domains of different flow directions. Morphologically, the GV is also a separatrix that divides the body surface into 2 symmetrical parts. The AP point GV20 is a major sink at the surface magnetic field[8]. This pattern is consistent with the pattern of the Channel system, but different from the distribution of any major nerve, lymphatic or blood vessel on the scalp.

Intrinsic electric fields and currents are important factors in growth control, cell migration and morphogenesis: Many cells including neurons, myoblasts and fibroblasts are sensitive to electric fields of physiological strength[9]. Somite fibroblasts translocate to the negative pole in a voltage gradient as small as 7 mV/mm[10]. Asymmetric Ca influx is crucial in the galvanotaxis which can be blocked or even reversed by various Ca Channel blockers and ionophores[11]. In most cases, small continuous, pulsed or focal electric fields enhanced cell growth near the cathode reduced cell growth near the anode[12,13]. Some fast growing tissues, particularly tumours, are electrically negative in polarity. If a current from positive pole is applied over certain tumour, its growth can show significant retardation or even regression[14]. This is consistent with the fact that the fluorescent dye rhodamine 123, which has a delocalized positive charge, binds preferentially to some cancer cells and inhibits the cell growth[15,16].

Flatworm Dugesia tigrina has an intrinsic dipole electric field with anterior negative and posterior positive. During regeneration, its anterior-posterior polarity can be reversed by an external electric field with an opposite polarity[17]. The dorsal-ventral polarity of chick epiblast can also be reversed partially by electric field of physiological strength[18]. Imposed electric field can cause polarization of mouse blastomeres[19].

Change of electric activity correlates with signal transduction and can precede morphologic change[20,21]. For example, in axolotls and frogs, outward current can be detected at the site of future limb bud several days before the first cell growth[22]. This indicates that the electric conductance of the epithelium at the future limb bud, an organizing centre, becomes higher before limb bud formation.

In development, the fate of a larger region is often controlled by a small group of cells, "an organizing centre"[23]. Organizing centres are likely to be the high electric conductance points on body surface: Epithelia display their most active growth and morphogenesis in areas of high conductance[12,22,9]. This is supported by the finding of high density of gap junctions at the sites of organizing centres[24,25,26]. Epithelia usually maintain a 30-100 mV voltage difference across themselves with inside positive and outside negative[27]. Points of local high conductance on skin will also be extreme points of current density, sinks or sources of surface current. These singular points are important in growth control and are likely to be organizing centres. The importance of the electric field generated by epithelium in growth has been indicated in limb regeneration. After limb amputation, salamanders can regenerate their limbs (regenerators), while frogs can not (non-regenerators). The regenerators and non-regenerators have different electric field changes after amputation. By simulating the electric field of regenerators on the limb stumps of non-regenerators, partial regeneration can be induced. Simulating the electric field of non-regenerators on the limb stumps of regenerators can inhibit their regeneration. The optimal current density used in the simulation is within the range of physiological current density[28,10].

Development involves bifurcation of the singular points. The first bifurcation in vertebrate development leads to 2 singular points: the animal pole and the vegetal pole. In immature oocytes of both frogs and fish, a transcellular current enters the animal pole and exits the vegetal pole. This current is present before the development of the pigment asymmetry. Several Ca Channel blockers can rapidly reduce this current and cause maturation[22]. This result supports the notion that the change of electric field usually precedes the change in morphology and correlates with signal transduction. Some singular points are connected by separatrices which serve as major conduits of intrinsic electric currents and divide the body into domains of different electric current directions. Separatrices can be folds in extended sheets, boundaries between different structures or abrupt changes in the slope of a gradient[6,29].

The distribution of organizing centres, AP points and singular points in electric fields are closely related to the morphology of the organism. For example, the ear, which has no major nerves or blood vessels but has the most complex surface morphology, also has the highest density of AP points. In the clock-face model,[30,6] many organizing centres are at the extreme points of curvature on body surface, e.g. the locally most convex points (e.g. apical ectodermal ridge, head of hydra and other growth tips) or concave points (e.g. zone of polarizing activity). The same is true for AP points.
Shang_Ca2 (1996) The Mechanism of AP: Part 2. Most extreme points of the body surface curvature are AP points, e.g. convex points: A 01, Qiduan, ST17, ST42, ST45, SP01, SP10, GV25, Z 03; concave points: LI04, CV17, KI01, SI19, TH21, GB20, GB30, BL40, HT01, SI18, BL01, CV08. Those AP points which are not the extreme points of surface curvature may be vestigial organizing centres or more related to the growth control of internal structures.

Mechanism of Channel system based diagnosis and therapy.
As mentioned above, the conductance of organizing centres varies with morphogenesis. Similarly, the conductance of AP points also varies and correlates with physiological changes[5] and pathogenesis[31]. Change in electric field precedes morphologic change[22] and manipulation of the electric field can affect the change[28]; these facts may shed light on Med diagnosis[32] and treatment of many diseases. In the model[6], the network of organizing centres retain their growth control function after morphogenesis, and communicate with each other (perhaps via gap junctions,[33] nerves, etc.) to maintain proper forms and functions. Therefore, an abnormality inside the network may be detected by measuring the electrical parameters of some points on its surface. Malfunctions of some organs can be preceded by change of electric parameters from normal range and treated by manipulation of the interconnected singular points.

Singularity is a type of discontinuity, often indicates abrupt transition from one state to another. Small perturbations around singular points can have decisive effects on a system. As James Clerk Maxwell observed: Every existence above certain rank has its singular points. At these points, influence whose physical magnitude is too small to be taken account of by a finite being, may produce results of the greatest importance[34]. As a technique of perturbation of singular points, AP can be effective in treating various diseases[35] such as common cold, chronic obstructive pulmonary disease (COPD, LU)[36], asthma[37], myopia, diarrhoea, constipation, diabetes, emesis[38,39], enuresis[40], postmenopausal Syndrome[41], obesity[42], stroke[43], hypertension[44] and cardiac arrest[45].

An "annealing" mechanism may play a role in AP and related techniques: Small perturbations at singular points elicit a "shock" to the system, activates and shakes the biological system out of its abnormal and unstable state. After activation, the system has a better chance to settle at a normal, more stable state. This may explain why there have been few negative side effects[46,47,42] of these techniques when properly used, and the therapeutic effect can be achieved by many stimuli[48] including electricity[38], needling, application of heat or cold stimuli, laser-AP,[49] and acupressure. Similarly, organizing centres can be activated also by nonspecific stimuli[23].

In EAP therapy, a positive pulse stimulation of a point sedates its corresponding function while negative pulse stimulation tonifies the function[50]. This is analogous to the fact that cell growth is enhanced toward cathode and reduced toward anode in a pulsed electric field, in consistence with the model that the mechanism underlying AP is similar to that of growth control.

Ca mediated signal transduction in Channel system and AP?: Ca ion level in Channels and AP points in rabbit was significant higher than that in non-Channel and non-AP points[51]. When Ca is chelated in the PC03 point, the curative effect of puncturing PC06 on arrhythmia is blocked, suggesting that Ca is important in the transmission of the AP-signal, and probably is involved in the activities of Channels[52]. A more informative experiment may be to use various Ca-channel blockers and compare their effects of local administration on AP, nerve conduction, blood and lymphatic circulation. In both excitable cells and nonexcitable cells of almost all the physiological systems, Ca as a second messenger, intercellular messenger and morphogen is involved in galvanotaxis, morphogenesis and various physiological functions[21]. Its electrochemical gradient contributes to the electric potential across cell membranes. It can also affect membrane potential by mediating modification of ion-channels and pumps[53,54]. The same Ca waves can be elicited by electrical or mechanical stimulation, laser-AP, or chemical exposure; these stimuli propagate through gap junctions[55,56]. Similarly, many stimuli including laser-AP, mechano- and electro- stimulation can induce the therapeutic effects of AP[48].

Beyond nerves and blood vessels.
Research on AP, particularly the endorphin effect in APA and its blockage by naloxone, clearly shows that some effect of AP is mediated through nervous system[57]. However, many Channels do not correlate with major nerves or blood vessels. The distribution of GV points on the scalp and the Ear-AP points[32,31,42] has not been explained by any model based on nervous system and/or circulatory system. The model reviewed above readily explains these facts, and accommodates the findings of AP effect on the nervous- and circulatory- systems. The Channel system is a distinct signal transduction system which can be measured by instrument such as SQUID. It overlaps and interacts with other systems but is not simply part of nervous- or circulatory- systems. Many nonexcitable cells have shown electrochemical oscillation, coupling, long range intercellular communication and can participate in the Channel signal transduction[21].

In summary, the model has predicted and been supported by many research results in AP, signal transduction and developmental biology. It can be further tested by mapping the electric field in vertebrate development with available techniques such as SQUID or vibrating probe[22]. The model predicts that organizing centres in vertebrates such as the dorsal lip of the blastopore, zone of polarizing activity and apical ectodermal ridge are major sinks or sources of surface current. These points bifurcate and cause some of the AP points in adult. Current SQUID technology is adequate in detecting physiological electric current in embryo development generated by epithelium[58]. Available data showed that SQUID is sensitive enough to detect the individual difference in current pattern at GV20[8]. With the development of high Tc superconductors, the use of superconducting magnetic shield[59] and multi-Channel SQUID[60,61] in the study of Channel system will yield further insight and circumvent the complications of the skin impedance measurement.

I thank Drs. Magnus Lou, San Wan, Andrew Marino, Frederick Kao, John Kao, Sarah Mei, K.S.Tsai, S.J.Chen, Richard Nuccitelli, Lionel Jaffe, Kenneth Klivington and others for their invaluable help and support.

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Tiaa_L; Yuan S; Ba E; Chen H; Zhou Z (1995) Composite AP treatment of mental retardation in children. Chung i tsa chih (JTCM) 15(1):34-37. 128 children of mental retardation were diagnosed in accordance with the diagnostic standards proposed by WHO in 1985. The patients were treated compositely with AP, Ear-AP point pellet pressure and herbal plasters on AP points. This induced improved mental developments in intelligence quotient (IQ) and social adaptation behaviour (SAB), as evidenced by recognized intelligence tests for children.

Wu_B2; Hu X; Yang B; Xu J; Li W; Li B; Chen J; Chen L (1993) [The influence of pressing the Channel course on electroretinogram during AP]. Chen Tzu Yen Chiu 18(2):132-136. Fujian Provincial Hospital, Fuzhon, PRC. Observation was performed on 23 subjects with marked Propagated Channel Sensation (PCS) and 30 without PCS. The electroretinogram (ERG) was recorded with surface electrode. The b wave of ERG evoked by flash stimulation was positive with a latent period circa 60 ms and amplitude of 22+1.66 muv (n=53). There were 2 types of ERG response during puncturing LI04. The amplitude of ERG b wave increased in 33 subjects and decreased in 20 subjects. However, the AP effect was kept relatively stable in each subject. The spontaneous variation of ERG amplitude was circa 10%. In contrast, it changed by 26.5+2.43% (n=20) when LI04 was needled alone. The amplitude of b wave almost remained unchanged, with in the range of 10.08+2.42% (n=20), as the pressure was applied at LI10 during AP, no matter whether the subjects with or without PCS. However, the variation rate of b wave increased by 24.83+3.74% (n=15) once again, if the pressure was applied on both sides of LI10, it was nearly equal to the value caused by AP at LI04 alone. The contrast between the 2 is striking. The result revealed again that there may be a certain substantial process advancing along the Channel during AP. It is the blockade of this process by mechanical pressure which leads to the decrease of the AP effect.

Wu_DZ (1990) AP and neurophysiology. Clin Neurol Neurosurg 92(1):13-25. Dept of Physiology, Shanghai College of TCM, PRC.

Wu_L3; Li J; Xu J; Li G (1993) The effect of AP on plasticity of spinal Clarke's nucleus synaptic terminals. Hua Hsi I Ko Ta Hsueh Hsueh Pao Jun 24(2):117-121. 10 unilateral spared root cats with sectioned L1-S2 dorsal root ganglia, except L6, were used to explore the effect of AP on plasticity of spinal Clarke's nucleus synaptic terminals. 5 of the cats were needled on the operated hind limb for two courses (10 d/course), and the other 5 were kept for control. Two pairs of AP points located in the innervated area of L6 spinal nerve were used. The number of synaptic terminals/photo in neuropil of L3 Clarke's nucleus was compared directly, because there was no significant change in the area of Clarke's nucleus and its neuropil on the operated side of both groups. The number of 3 types of synaptic terminals between the unoperated sides of the two groups was not significantly different: AP may not influence the contralateral side. In the control group, the number of giant axonal terminals from dorsal root of the operated side decreased to 75% of the unoperated side; however, in the experimental group, it recovered to contralateral or normal level of the operated side and was significantly higher than that of the control group's operated side: AP may promote plasticity, such as collateral sprouting and synaptic reinnervation of coarse myelinated fibres from intact dorsal root, L6 mainly. The number of other two types of terminals from spinal interneurons showed no significant difference between the operated sides of two groups: AP may not enhance plasticity of nondorsal root nerve fibres.

Xu_J; Huang X; Wu B; Hu X (1993) [Influence of mechanical pressure applied on the stomach Channel upon the effectiveness of AP of ST36]. Chen Tzu Yen Chiu 18(2):137-142. Fujian Inst of TCM, Fuzhou, PRC. TCM holds that Channels is the regulative system of the functional activity of the human body. According to the theory of Channels there is a relatively specific connection between the AP point and viscus. Many researchers have studied this phenomenon. We reported previously that mechanical pressure blocked the borborygmi caused by AP at ST36 in subjects with marked Propagated Channel Sensation (PCS). This paper reports on a study to compare the influence of pressure on a Channel point and a non-AP point on the electrogastrogram (EGG) during AP at ST36 in 33 subjects without PCS. AP point ST34 was selected as a compressed point and the points on its either side as controls. EGG was recorded with surface non-polarizable electrode from 2 abdominal points corresponding to the areas of corpus ventriculi and antrum pyloricum. The effect of AP on EGG appeared in two types of response which depended on the amplitude of EGG before AP. The amplitude of EGG increased if it was low before AP. On the contrary, if the amplitude was high, it decreased. The response was bi-directional. Mechanical pressure markedly influenced the AP effect: when pressure was applied on ST34, the AP effect of ST36 decreased markedly, even disappeared; in contrast, when mechanical pressure was applied on both sides of ST34, an influence on the AP effect of EGG could not be found.

2. AP AND THE AUTONOMIC NERVOUS SYSTEM (ANS)
Hardy_SGP (1995) Medullary Projections to the Vagus Nerve and Posterolateral Hypothalamus. Anat Rec Jun 242(2):251-258. SGP Hardy, Univ Mississippi, Med Ctr, Dept Phys Therapy, Jackson, MS 39216 USA. Retrogradely transported tracers were injected into the cervical vagus nerve and/or the posterolateral hypothalamus to map the relative locations of medullovagal and medullohypothalamic neurons. Retrogradely labelled medullary neurons were plotted subsequently. Labelling of the 2 neuronal populations was observed mainly in the ventrolateral and dorsomedial medulla. In the ventrolateral medulla, medullovagal neurons were found in the retrofacial nucleus and nucleus retroambiguus, whereas medullo-hypothalamic neurons were found subjacent to these nuclei. In the dorsomedial medulla, labelling of the 2 neuronal populations was limited mainly to the vagal-solitary complex. Here, medullovagal neurons were found within the dorsal vagal nucleus, whereas medullohypothalamic neurons were confined mainly to the caudal part of the solitary nucleus. Conclusions: Vagal visceromotor reflexes depend on reciprocal neural connections between the medulla and the hypothalamus. Medullovagal and medullohypothalamic neurons lie close together. Functional interrelationships may exist between these 2 neuronal populations. Specifically, the medullohypothalamic neurons identified may support vagal-related functions by providing feedback cues regarding vagal motor neuron activity to the posterolateral hypothalamus.

Liu_Z9; Sun F; Li J; Wang Y; Hu K (1993) Effect of AP on weight loss evaluated by adrenal function. Chung i tsa chih (JTCM) Sep 13(3):169-173. Nanjing Coll of TCM. Indices of obesity, lipid, fasting blood-glucose, noradrenaline, dopamine, adrenalin and cortisol were noted in a study of the relationship between adrenal function and simple obesity and effect of AP on it. Patients with simple obesity had hypofunction of sympathetic-adrenal and hypothalamus-pituitary-adrenal systems. AP treatment not only increased weight loss but also enhanced the function of the two systems. AP enhanced weight-loss in obesity, probably by enhancing the functions of both the sympathetic-adrenal- and hypothalamus-pituitary-adrenal systems.

Sato_A3; Sato Y; Suzuki A; Uchida S (1993) Neural mechanisms of reflex inhibition and excitation of gastric motility elicited by AP-like stimulation in anaesthetized rats. Neurosci Res Oct 18(1):53-62. Dept of ANS, Tokyo Metropolitan Inst of Gerontology, Japan. The effects of AP-like stimulation of the various segmental areas on gastric (ST) motility were examined in anaesthetized rats. An AP needle (diameter 340 um) was inserted into the skin and underlying muscles at a depth of 4-5 mm and was twisted right and left once/s for 60 s. Gastric motility in the pyloric region was measured with the balloon method. Gastric motility was inhibited by AP-like stimulation applied to the abdomen and lower chest region, and was often excited when the limbs were stimulated, in all cases in which stimuli were delivered to the skin and muscles, the skin alone, and the underlying muscles alone. The inhibitory gastric response to abdominal stimulation was accompanied by an increase in the activity of the gastric sympathetic efferent nerve and was abolished by severance of either the sympathetic nerve branches to the stomach or the lower thoracic spinal nerves. The abdominal stimulation enhanced the activity of the lower thoracic spinal afferent nerves. The excitatory gastric response to hindpaw stimulation was accompanied by an increase in the activity of the gastric vagal efferent nerve and was abolished by severance of either the bilateral vagi or the femoral and sciatic nerves. The hindpaw stimulation enhanced the activity of the femoral and sciatic afferent nerves. In the spinalized animals, the inhibitory gastric response elicited by abdominal stimulation was present, and the hindpaw stimulation did not produce any gastric response. We conclude that the inhibitory gastric response elicited by AP-like stimulation of the abdomen is a reflex response. Its afferent nerve pathway is composed of abdominal cutaneous and muscle afferent nerves, the efferent nerve pathway is the gastric sympathetic nerve, and its reflex centre is within the spinal cord. The excitatory gastric response elicited by AP-like stimulation of a hindpaw is also a reflex response. Its afferent nerve pathway is composed of hindpaw cutaneous and muscle afferent nerves, the efferent nerve pathway is the gastric vagal efferent nerve, and its reflex centre requires the presence of the brain. Also, naloxone iv (0.4-4 mg/kg) did not influence the excitatory on inhibitory gastric reflex responses. Endogenous opioids may not be involved in these reflexes.

Shiraishi_T; Onoe M; Kojima T; Sameshima Y; Kageyama T (1995) Effects of Ear-stimulation on feeding-related hypothalamic neuronal activity in normal and obese rats. Brain Res Bull 36(2):141-148. Dept of Neurophysiology, Tokai Univ Sch of Med, Kanagawa, Japan. Ear-therapy occasionally affects dramatic body weight reduction for obese patients, although the physiological and anorexigenic functions are not clear. Effects of Ear-stimulation on feeding-related lateral (LHA) and ventromedial (VMH) hypothalamic neuronal activity in normal and experimental (hypothalamic and dietary) obese rats were studied. The LHA and/or VMH neuronal activity were recorded from feeding-related regions in Wistar SPF/VAF male and experimental (hypothalamic and dietary) obese rats, anaesthetized with urethane-chloralose, under stereotaxic coordination. Recording was through 3 M KCI glass microelectrodes, while stimulating the ipsilateral vagal innervated region of the Ear. This is equivalent to the cavum conchae in the human, and was identified by resistance <10-50 k omega. The stimulating electrode was a stainless steel ear AP needle (0.12 x 2.0 mm). The latency of potentials evoked in the LHA by unilateral stimulation of a specific site in the ear was 28.1+3.3 ms (8-92, n=41). LHA neuronal activity was depressed 46% (n=12).

Uvnas_Moberg K; Lundeberg T; Bruzelius G; Alster P (1992) Vagally mediated release of gastrin and CCK after sensory stimulation. Acta Physiol Scand Nov 146(3):349-356. Dept of Pharmacology, Karolinska Inst, Stockholm, Sweden. Our aim was to study if gastrin, CCK and somatostatin secretion can be influenced by sensory stimulation and if so, whether such effects are mediated via the vagus. Male rats anaesthetized with chloral hydrate were exposed to 3 different stimuli (a) low frequency (2 Hz) EAP to muscles via needles; (b) thermal stimulation at 40oC or (c) vibration at 100 Hz. The two former stimuli activate mainly small and medium sized myelinated fibres from muscles and skin respectively, whereas vibration activates large myelinated fibres from skin, sc tissue and muscles. Experiments were also done on animals that were vagotomized or exposed to prior treatment with atropine (0.5 mg/kg). Blood was collected at various time intervals and plasma levels of gastrin, CCK and somatostatin were measured with RIA. All 3 stimuli, e.g. EAP, vibration and thermal stimulation caused significant elevations of gastrin (103+11-151+16 pM, 105+8-140+12 pM and 105+14-162+4 pM) and CCK (9+0.8-15+2.8 pM, 8+0.5-10+1.5 pM and 8.0+0.5-10.5+1.5). EAP increased somatostatin (10+1-14+3 pM). EAP-activation of sensory afferent nerves, in the skin, sc tissue, and muscle, stimulated the release of gastrin and CCK. Atropinization and vagotomy abolished the release of gastrin and CCK in response to all 3 stimuli. CCK levels were significantly reduced after EAP in atropinized rats.

3. APA AND NEUROLOGY
Bing_Z; Cesselin F; Bourgoin S; Clot AM; Hamon M; Le Bars D (1991) AP-like stimulation induces a heterosegmental release of Met-Enk-like material in the rat spinal cord. Pain Oct 47(1):71-77. INSERM U. 161, Paris, France. Either the lumbar or the cervicotrigeminal area was perfused with artificial CSF (0.1 ml/min) in halothane-anaesthetized rats in order to study the effects induced by AP on the activity of enkephalinergic neurons in the spinal cord. Met-Enk-like material (MELM) was measured in 0.5 ml fractions of the perfusates. The effects of manual AP performed by a traditional Chinese acupuncturist at ST36 on the right hind limb were compared to the effects induced by AP applied at a non-AP point near ST36. The manipulation of needles either at the ST36 point or at the non-AP point had no effect on the release of MELM from the lumbar area but significantly increased the release from the cervicotrigeminal zone. It is concluded that manual AP triggers a heterosegmental activation of enkephalinergic neurones within the spinal cord and that this effect is non-specific in terms of the location of the stimulated point.

Bing_Z; Villanueva L; Le Bars D (1990) AP and diffuse noxious inhibitory controls: naloxone-reversible depression of activities of trigeminal convergent neurons. Neuroscience 37(3):809-818. INSERM, Unité de Recherches de Physiopharmacologie du Système Nerveux, Paris, France. Recordings were made from convergent neurons in trigeminal nucleus caudalis of the rat. These neurons were activated by both innocuous and noxious mechanical stimuli applied to their excitatory receptive fields on the ipsilateral part of the muzzle. Percutaneous application of suprathreshold, 2 ms square-wave electrostimuli to the centre of the excitatory field evoked responses to A- and C-fibres. The effects on these responses of manual AP, given by a traditional Chinese acupuncturist at ST36 on the right hindlimb were compared with the effects induced by AP applied at a non-AP point, near ST36. Also, the effects of AP were compared with the inhibitory effects evoked by noxious thermal stimulation of the left hindlimb on the responses of the same neurons. Earlier, our group has termed the latter type of inhibition "diffuse noxious inhibition". AP, either applied at ST36 or at a non-AP point and noxious thermal stimulation induced similar strong inhibitory effects on the C-fibre-evoked responses of trigeminal convergent neurons (77.9+4.4%; 72.5+4.6% and 78.5+3.6% inhibition, respectively) and these inhibitions were followed by long-lasting aftereffects. Also, both the AP- and noxious thermal stimulation-evoked inhibitions were significantly reduced by systemic naloxone (0.4 mg/kg, iv). Since the antinociceptive effects elicited by AP (i) had a similar magnitude and time-course to those evoked by noxious thermal stimulation, (ii) exhibited a lack of topographical specificity and (iii) involved an opioidergic link, we would suggest that, at least in our experimental conditions, AP manoeuvres trigger the neuronal mechanisms involved in diffuse noxious inhibitory controls.

Bing_Z; Villanueva L; Le Bars D (1991) AP-evoked responses of subnucleus reticularis dorsalis neurons in the rat medulla. Neuroscience 44(3):693-703. INSERM U. 161, France. Recordings were made from neurons in subnucleus reticularis dorsalis of rats. 2 populations of neurons were distinguished: those with total nociceptive convergence which were driven by activating A delta- and C-fibres from any part of the body and those with partial nociceptive convergence which were driven by activating A delta-fibres from any part of the body or C-fibres from some, mainly contralateral, regions. The effects on subnucleus reticularis dorsalis neurons of manual AP, performed by a traditional Chinese acupuncturist at GV26, LI10, GV01, and ST36, and at a non-AP point near ST36, were studied. AP stimulation for 30 s at the AP points or the non-AP point strongly excited all the total nociceptive convergence neurons tested; these neurons responded with a discharge of rapid onset which was often followed by after-discharges lasting for circa 30-60 s. Most but not all of the partial nociceptive convergence neurons responded to 30 s of AP stimulation at the AP points or the non-AP point. This was especially the case when the stimulus was applied to contralateral or midline parts of the body. The potency of AP as a means of activating neurons in the subnucleus reticularis dorsalis varied significantly with the area of the body being stimulated such that: contralateral > midline > ipsilateral areas. The levels of induced activity were of similar magnitude to those evoked by noxious mechanical stimuli applied under identical experimental conditions. No differences were found between the capacities to activate subnucleus reticularis dorsalis neurons of ST36 and the adjacent non-AP point, no matter whether these were stimulated ipsi- or contra- laterally; this suggests a lack of topographical specificity in the activation of these neurons. Since subnucleus reticularis dorsalis neurons are activated exclusively or preferentially by noxious inputs, it is concluded that the signals elicited by manual AP travel through pathways responsible for the transmission of nociceptive information. Since AP, a manoeuvre which is known to elicit widespread extrasegmental antinociceptive effects, activates subnucleus reticularis dorsalis neurons which, anatomically, send dense projections to the dorsal horn at all levels of the spinal cord, we would suggest that this structure may be involved not only in signalling pain but also in modulating pain by means of spino-reticulo-spinal feed-back mechanisms.

Cai_B; Huang X; Wang G; Mo W (1994) Potentiation of EAP-analgesia on visceral pain by metoclopramide and its mechanism. Chen Tzu Yen Chiu - AP Research 19(1):66-70, 74. Dept of Neurobiology, Shanghai Med Univ, PRC. This was a study of the effect of metoclopramide (MCP) on EAP analgesia (EAA) and its mechanism on a rabbit visceral pain model. MCP 8mg/kg iv enhanced EAA and prolonged the analgesic duration. The potentiation effect was attenuated by icv apomorphine (a mixed D1/D2 agonist). The duration of EAA was shortened by icv SKF38393 (a selective D1 agonist) or LY171555 (a selective D2 agonist). Using HPLC-ECD, the HVA level in CSF significantly increased at 20 min after EAP or MCP 8mg/kg iv.

Cao_Q; Liu J; Han Z; Wang H (1992) Influence of AP on the discharge of PHA neurons in the rabbit. Chen Tzu Yen Chiu 17(1):21-25. Inst of AP and Moxibustion, China Acad of TCM, Beijing, PRC. This paper deals with whether the posterior hypothalamus area (PHA) can receive signals from EAP at PC06, and whether a relative specificity exists between AP points or between AP points and non-AP points. Neuronal activity was recorded extracellularly to analyze the influence of EAP at different AP points and non-AP point on the discharge of PHA neurons.

Chen_SZ; Han JS (1994) High frequency EAP-induced changes of IP3 level in rat brain and spinal cord. CMJ (UK) Jun 107(6):440-3. Neuroscience Research Centre, Beijing Med Univ, PRC. In this study, the radioreceptor binding method was used to determine the changes of IP3 level in the brain and dorsal spinal cord of rats with high frequency (100 Hz) EAP analgesia (EAA) and of rats tolerant to EAP. Control levels of IP3 in rat brain (less cortex and cerebellum) and dorsal spinal cord were 6.3+0.78 and 3.4+0.60 pmol/mg protein, respectively. IP3 in brain increased gradually within 45 min after EAA. Meanwhile, IP3 level in the dorsal spinal cord decreased significantly 15 min, 30 min after EAA and recovered to control level 45 min after EAA. Brain IP3 level markedly increased in EAP-tolerant rats a spinal cord IP3 level also increased dramatically within 30 min, but decreased rapidly to control level 45 min after EAA. The IP3 level in brain and spinal cord of EAP-tolerant rats was much higher than that in EAA-rats.

Chen_XH; Geller EB; Adler MW (1996) EAP at traditional peripheral AP sites produces brain opioid-receptor-mediated antinociception in rats. J Pharmacol Exp Ther May 277(2):654-60. Dept of Pharmacol, Temple Univ Sch of Med Philadelphia, Pennsylvania, USA. Previous studies in rats measuring latency to tail flick with radiant heat have shown that the antinociceptive effect induced by EAP at different frequencies at traditional AP sites is mediated via different opioid receptors in the spinal cord. The present study was designed to observe: 1. whether EAP at such sites could produce antinociceptive effects in the cold water tail-flick (CWT) test; 2. whether the antinociceptive effects could be blocked by sc injection of the opioid receptor antagonist naloxone and (3) whether icv injection of selective antagonists for mu (cyclic D-Phe-Cys-Tyr-D-Trp-Arg-Thr-Pen-Thr-NH2, CTAP), delta (naltrindole) or kappa (nor-binaltorphimine) opioid receptors would block the antinociceptive effect produced by EAP stimulation. Sprague-Dawley rats were stimulated by EAP at frequencies of 2, 30 or 100 Hz by needles at ST36 and SP06 for 30 min. Antinociception was assayed in the CWT. As compared with the placebo group, a significant frequency-related increase in threshold in the CWT occurred in all EAP-groups, and the antinociceptive effect lasted circa 30 min poststimulation. Naloxone sc antagonized the antinociceptive effect induced by EAP at 2 Hz, 30 Hz or 100 Hz. Either CTAP or naltrindole icv almost eliminated the antinociceptive effect induced by EAP at 2 Hz or 30 Hz, but was less effective in blocking antinociception induced by EAP at 100 Hz; nor-binaltorphimine (icv) greatly reduced antinociception induced by EAP at 30 Hz or 100 Hz, but not at 2 Hz. Antinociception induced by EAP at 2 Hz is mediated by both mu and delta opioid receptors; that induced by EAP at 100 Hz is mediated primarily by the kappa receptor. The antinociception induced by EAP at 30 Hz is mediated by all 3 opioid receptor types. Thus, as measured by the CWT, the antinociceptive effect induced by peripheral electrostimulation involves opioid receptors in the rat brain.
Chen_XH; Han JS; Huang LT (1994) CCK receptor antagonist L-365,260 potentiated EAP-analgesia in Wistar rats but not in audiogenic epileptic rats. CMJ (UK) Feb 107(2):113-118. Dept of Physiology, Beijing Med Univ, PRC. CCK octapeptide (CCK-8) is a neuropeptide with potent anti-opioid activity. Morphine analgesia is mediated by CCK-B receptor in CNS. Nanogram doses of CCK-8, administered to the CNS, totally abolished morphine analgesia in rats. In the present study CCK-B antagonist L-365,260 was injected icv to Wistar rats to see its effect on the analgesic effect induced by EAP. A marked potentiation of EAA was observed. The degree of potentiation depended on the frequency of EAP used, with a rank order of 100 Hz > 15 Hz = 2-15 Hz >> 2 Hz. In a rat-strain with acoustically evoked epileptic seizure (P77PMC rats), an very powerful analgesic effect was produced in response to 100 Hz EAP, which was similar to that in Wistar rats pre-treated with L-365,260. However, L-365,260 was not effective in potentiating EAA in P77PMC rats. Conclusions: 1. high frequency EAP is more likely to increase the release of CCK-8 in CNS as compared to low frequency EAP; 2.P77PMC rats may have a functional defect of CCK neurons in the CNS, either a low CCK level, or a reduced rate of release of CCK-8.

Chen_Y; Wang Y; Yin Q (1991) [The role of paraventricular nucleus of hypothalamus in APA in rats]. Chen Tzu Yen Chiu 16(1):32-38. Dept of Physiol, Suzhou Med Coll. Recent evidence has indicated that vasopressin (VP) can increase the pain threshold. It is not clear whether the hypothalamic paraventricular nucleus (PVN), one of the main VP-secreting nuclei in the brain, is involved in APA. The present study was designed to examine the role of PVN in APA, using Wistar rats. The tail-stimulation vocalization test was used to measure pain threshold. GV26 and CV24 were selected for EAP. Electrostimulation of PVN significantly increased the pain threshold and enhanced the effect of APA. On the contrary, electrolytic lesion of PVN clearly decreased the effect of APA, which was restored by icv injection of 300 ng of arginine VP. Pretreatment with AVP-antiserum (ICV) attenuated the effect of APA. PVN plays an important role in pain modulation and in the effect of APA. This role may be mediated by VP-containing neurons in PVN.

Chen_Za1; Yan Y; Xu W; Shi T (1990) [Relationship between the precruciate cortex and the ventral lateral posterior nucleus of the thalamus in APA]. Chen Tzu Yen Chiu 15(1):61-65. Inst of AP and Moxibustion, China Acad of TCM, Beijing. The present study was designed to investigate the relationship between the precruciate cortex (PreCtx) and the ventral lateral posterior nucleus (VPL) of the thalamus in the mechanisms of APA. Neuronal responses in the nucleus VPL to noxious electrostimulation of the superficial peroneal nerve were recorded extracellularly. Lidocaine was topically applied at PreCtx 20 min after EAP was given at ST36 and GB30 for 5 min. Nociceptive responses were recorded immediately after cessation of EAP and consecutively recorded at 2 min intervals. Similar procedures were made in the control group, in which 0.9% NaCl was topically applied at PreCtx. It was found that topical application of lidocaine at PreCtx did not influence the nociceptive responses of VPL neurons. After topical application of lidocaine at PreCtx, the nociceptive responses were obviously inhibited 0, 4, 6, 10, and 12 h after cessation of EAP. In the saline control group the remarkable inhibitory effect of EAP was observed 0-8 h after ceasing EAP. The inhibitory effect of EAP in the test group was weaker than that in the control group. However, the difference was not statistically significant. PreCtx may participate in the corticofugal modulation of EAP effects in the nucleus VPL only to small extent.

Chen_Za2; Shi H; Wu G; Zheng X; Xu W (1995) [Influence of SmI lesion on AP-induced analgesia in thalamic Pf neurons and effects of iontophoretic ACh on their nociceptive responses]. Chen Tzu Yen Chiu 20(1):15-19. Inst of AP and Moxibustion, China Acad of TCM, Beijing. This study aimed to investigate the role of ACh in SmI emanating descending modulation of thalamic Pf neurons in APA. Multi-micropipettes were used for both extracellularly recording responses of thalamic Pf neurons to noxious stimulation of the plantar area and drug application in rats. Results: 1. Lesion of SmI obviously attenuated the inhibitory effect of EAP applied at ST36 and GB30 on nociceptive responses in Pf neurons; 2. After lesion of SmI iontophoretic application of ACh markedly suppressed the nociceptive responses of Pf neurons, which was significantly different from the effect of iontophoretic NaCl (as the control) showing no influence on them; 3. The inhibition induced by iontophoretic ACh applied in the rats with lesion of SmI was similar to that produced by EAP applied in those with SmI intact. EAP activated SmI to release ACh to exert descending modulation, in which ACh was involved in SmI originating descending regulation of Pf neurons in APA.

Chen_Zb1; Chen P (1991) [Effects of morphine and EAP on the time-lock and not-time-lock responses of cortical unit discharges evoked by nociceptive stimulation in cats]. Chen Tzu Yen Chiu 16(2):95-99. Dept of Physiol, Sun Yat-Sen Univ of Med Science, Guangzhou, PRC. In order to study the effects of morphine and EAP(EA) on non-time-lock response (N-TLR) and time-lock response (TLR) of nociceptive unit discharges, N-TLR was shown by interspike interval mean function (ISIMF) and TLR by normalized cross-covariance function (NCCVF) reflecting the relationship between stimulation and response. The N-TLR elicited by the noxious stimulation appeared as a decrease of ISIMF, which was depressed obviously by EA and morphine, but the inhibitory effect of EA was more rapid than morphine; both EA and morphine inhibited mainly the late peak of the NCCVF elicited by the noxious stimulation, but inhibitory effect of EA developed more rapidly and recovered more quickly than that of morphine. The inhibitory effect of EA on the early peak was very little. P-ED elicited by the noxious stimulation is inhibited by both EA and morphine, but the degree and the speed of inhibition were different. [Question by Rogers: Are cats not unpredictable responders to morphine ?].

Cui_R; Zhao F; Ma C; Tian Y; Cai H; Zhu L (1992) [Influence of 5,7-dihydroxytryptamine on EAP analgesia and Substance-P level in the CNS of arthralgic rats]. Chen Tzu Yen Chiu 17(3):183-185. Inst of AP and Moxibustion, China Acad of TCM, Beijing. The relation between EAP analgesia and Substance-P (SP) level in the brain stem (BS) and lumbar spinal cord (LSC) of arthralgic rats was investigated. The rats were assigned to 3 groups: 1=EAP + 5,7-7DHT (5,7-dihydroxytryptamine); 2=EAP + V (vehicle); 3=5,7-DHT. To induce joint-pain, Freund's adjuvant was injected into joints of all animals 7 d after icv injection of 5,7-DHT or vehicle. The SP level in the BS and LSC was determined by RIA. Compared to group 3, EAP prolonged tail flick latency by 39.6% in group 2, but not in group 1. The SP level in LSC of group 2 (179.1+11.5 pmol/g) was higher than that in group 1 (135.9+9.3pmol/g) and group 3 (125.8+10.0 pmol/g). EAP and arthralgia both activated the descending 5-HT-ergic inhibitory system, which inhibited the release of SP in LSC. Electro-APA was attenuated when the 5-HT-ergic system was destroyed by 5,7-DHT; the SP level in LSC was lowered due to its decreased release in EAP and arthralgia.

Cui_R; Ma C; Wang X; Tian Y (1990) [The influence of P-chlorophenylalanine (PCPA) on the analgesia of EAP and the level of SP in CNS of rats]. Chen Tzu Yen Chiu 15(2):109-111. Inst of AP and Moxibustion, China Acad of TCM, Beijing. PCPA 250 mg/kg IP, was given to a group of rats. 72 hrs later the EAP analgesia was tested and Substance-P (SP) in the brain stem and the lumbar spinal of the rats was determined by RIA. After PCPA injecting the EAP no longer caused analgesia but lowered the pain threshold. Meanwhile the level of SP in the brain stem and lumbar spinal did not increased but much lowered than the group of vehicle injection combined with EAP. By PCPA depleting the 5-HT in CNS and abating the descending inhibition activated by 5-HT, EAP no longer causes analgesia but promotes the SP transmitted release. Transmission of SP in the lower brain stem and spinal cord was regulated by descending inhibition. Analgesia of EAP activates the 5-HT-ergic descending inhibition and decreases the nociceptive transmission of SP partly.

Cui_Y; Chen G; Zhang Q; Jiang J; Wu G; Xu S (1990) [Effects of promethazine on APA]. Chen Tzu Yen Chiu 15(2):123-125, 122. Dept of Endocrinology, First Affiliated Hospital of Nanjing Med Coll. Promethazine, a histaminergic H1-receptor antagonist, was often used as an adjuvant drug before and during APA in clinics, but its effects on APA were not known clearly. By using K-iontophoretic dolorimetry and stimulating unilateral LI04 and TH05 with EAP in 42 rabbits, we found that Promethazine in small dosages (0.5 mg/kg, 1 mg/kg) decreased the pain threshold, and in relatively large dosages (2 mg/kg, 4 mg/kg) raised the pain threshold. At dosages of 1 or 2 mg/kg, promethazine attenuated the analgesic effect of EAP-analgesia. Promethazine should be used carefully in APA.

Dai_JL1; Xu SF (1991) The attenuation effect of chlorpromazine on EAP-analgesia: involvement of dopamine system. AETRIJ 16(3-4):101-109. Dept of Neurobiol, Shanghai Med Univ, PRC. The effect of chlorpromazine (CPZ) (0.1 or 0.5 mg/kg, iv) on EAP-analgesia (EAA) was examined by using potassium dolorimetry in rabbits. CPZ itself induced hyperanalgesia, whereas it attenuated EAA in terms of maximal increase of pain threshold as well as EAA after-effect. Thus, CPZ is not a good candidate for enhancing EAA in clinics. Monoamines and their metabolites in CSF of the rabbits were detected by HPLC coupled to electrochemical detector (HPLC-ECD) method. CPZ enhanced DOPAC and HVA levels in CSF in both the presence and absence of EAP. CPZ attenuated EAA with elevations of DOPAC and HVA level in CSF. There was a positive correlation between the increases of DOPAC and HVA levels in CSF and attenuation effect of CPZ on EAA. Activation of the dopamine system enhances EAP-analgesia.

Dai_JL2; Xu SF (1993) Chlorpromazine attenuated EAP-analgesia in conscious rabbits. Chung Kuo Yao Li Hsueh Pao Sep 14(5):388-392. Dept of Neurobiology, Sch of Basic Med Sci, Shanghai Med Univ, PRC. By measuring the defense behaviour in response to the noxious stimulation induced by K iontophoresis on ear-lobe skin of conscious rabbit, chlorpromazine (CPZ) (0.5 mg/kg iv) induced hyperalgesia, whereas it significantly attenuated the efficacy of EAA. Monoamines and their metabolites in CSF were measured by high pressure liquid chromatography with electrochemical detector (HPLC-ECD) while the attenuation effect of CPZ on EAA was observed. CPZ markedly enhanced 3,4-dihydroxyphenylacetic acid (DOPAC).
Dan'ko-SG; Bkhattachariia-N; Sharma-KN (1993) [Polyelectro-neurographic study of the dynamics of brain processes during AP in people with chronic pain syndrome]. Fiziol Cheloveka Mar-Apr 19(2):20-28.

Eriksson_SV; Lundeberg T; Lundeberg S (1991) Interaction of diazepam and naloxone on AP induced pain relief. AJCM 19(1):1-7. Dept of Med, Danderyds Hospital, Stockholm, Sweden. We have studied if 2 Hz EAP alleviates chronic nociceptive pain and if so whether the alleviation was related to the release of endogenous opioids. 32 patients suffering from osteoarthritis were subjected to EAP, with or without pretreatment with naloxone or diazepam. The effect of the different experimental procedures was assessed using scales for the intensity (sensory component) and unpleasantness (affective component) of pain. EAP induced a significant alleviation of pain. This alleviation was more significant on the affective scales (p <.01) than on the sensory scales (p <.05). After pretreatment with diazepam or naloxone, the subsequent pain alleviating effect was reduced. APA may partly be mediated through endogenous opioids which are affected by pretreatment with diazepam or naloxone.

Fan_T; Li J; Kong T (1993) [Relationship between APA and neurotransmitters in nucleus raphe magnus]. Chen Tzu Yen Chiu 18(3):168-171. Dept of Anatomy, Henan Med Univ, Zhengzhou. Nucleus Raphe Magnus (NRM) is a complex cell group. 5-HT, SP and ENK neurons in the NRM were identified by immunocytochemistry method. The afferent fibres containing 5-HT, SP, M-ENK, L-ENK, B-EP and SRIF were observed in NRM, the efferent fibres containing 5-HT, SP, ENK and TRH from NRM to spinal cord were studied. 2 neurotransmitters (such as 5-HT with SP, ENK or TRH) were found in same neuron, fibre or vesicle. The neurons and axodendritic synapses of the NRM were analyzed during EAP (EA). The NRM increased their synaptic releases and the neurons were in active functional state during EA of ST36. Studies show that NRM is one of important positions in EA analgesia.

Fang_J (1994) [The influence of AP at ST36 on cyclic nucleotide levels of plasma, different brain regions and spleen in rats]. Chen Tzu Yen Chiu 19(1):42-45. Nuclear medicine Lab, Shanghai Coll of TCM. We observed cyclic nucleotide level of plasma, brain and Spleen tissues when APA was produced by AP at ST36. The restrained group without AP was as blank control and AP at LV03 as AP control. We found that after AP at ST36 the level of cyclic nucleotide in plasma was increased significantly (p <.05) and the cAMP level of spleen had a tendency of enhancement, but the level of cAMP in the cortex had a tendency of decrease. The level of cAMP, cGMP and its ratio cAMP/cGMP was different in cortex and spinal cord between groups given AP at ST36 or LV03. AP at ST36 and LV03 induced different changes of level of cAMP and cGMP.

Fang_JQ; Liu YL; Mo XM (1994) [Clinical and experimental studies on analgesic effects of ipsilateral and contralateral stimulations with EAP]. Chung Kuo Chung Hsi I Chieh Ho Tsa Chih Oct 14(10):579-582. Zhejiang Coll, TCM, Hangzhou. 65 cases of painful diseases were treated with EAP to compare the analgesic effect of contralateral stimulation (CS) and ipsilateral stimulation (IS). IS and CS gave similar degrees of pain-relief, but CS was better in improving motor impairment. The pain threshold of rats was tested and the neuronal activity in the D-PAG was recorded. Neither IS nor CS increased the pain threshold in the unilateral D-PAG lesioned rats, but excited neuronal discharge was recorded in the unilateral D-PAG by stimulating ST36 at each side. IS and CS may share the same high level afferent pathway in APA in CNS.

Fang_ZR; Li YH (1993) [The observation on analgesic effect of moxibustion in rats]. Chen Tzu Yen Chiu 18(4):296-269. Inst of AP & Moxibustion, China Acad of TCM, Beijing. Radiant heat exposure on BL32 was taken as radiant heat moxibustion (RHM). When temperature of surface of point was modulated within the range of 38-39 and 43-44oC, the latency of tail flick threshold (LTH) in rats was increased by 17.8+2.1% and 22.2+2.5% after 5 min. and by 16.1+2.9%, 22.1+3.4% and 21.9+3.2% (50-52oC) after 10 min. respectively. LTH was increased by 19.8+3.1% after 10 min. with AP plus moxibustion. The change of latency after RHM in every group and AP with moxibustion group was significant (p <.05). There was no difference of analgesic effect among all groups (p >.05). The APA effect of RHM on BL32 was more powerful than ST36 and BL67 (p <.05).

Fedoseeva_OV; Kalyuzhnyi LV; Sudakov KV (1990) New peptide mechanism of EAP-analgesia using Earpoints: role of angiotensin II. AETRIJ 15(1):1-8. PK Anokhin Inst of Normal Physiol, USSR Acad of Med Sciences, Moscow. Ear-EAP stimulation at frequencies of 15 and 100 Hz induced analgesia in rabbits, expressed by decrease amplitude of cortical SEPs in response to tooth pulp electrostimulation. Saralasin injection icv abolished or blocked the effect of Ear-EAP at 100 Hz, but not at 15 Hz. Naloxone injection iv abolished the effect of Ear-EAP stimulation at 15 Hz but not at 100 Hz. Methysergide or D,L-p-CPA injection diminished but did not entirely block the effect of Ear-EAP stimulation at 100 Hz. The neuropeptide angiotensin II may be a antinociceptive factor in dental peptide analgesic mechanisms induced by Ear-EAP stimulation at 100 Hz.

Gao_M; Li Q; Zhang J; Liu Y (1990) [Effect of changing the functional state of frontal cortex by GABA on the AP effect of PAG neurons]. Chen Tzu Yen Chiu 15(4):264-268. Dept of Physiol, Research Lab of APA Mechanism, Guangxi Med Coll. This was a study of the corticofugal modulation of nucleus periaqueductal grey (PAG) after EAP by topical application of GABA on the frontal cortex. Rabbits were restrained and immobilized with gallamine. Electrostimulation of the n. suralis was used as the noxious stimulation. Single unit activities of PAG neurons were record with glass microelectrodes extracellularly. Bilateral ST36 and GB30 were stimulated by EAP. GABA was applied topically by means of 3 x 3 mm2 filter paper and placed on the frontal cortex. The responses of most PAG neurons evoked by noxious stimulation were inhibited after simple EAP. On the contrary, the AP effect on PAG neurons was abolished when GABA was applied on the frontal cortex. However, the effect of saline control resembled that of simple AP. Corticofugal modulation from the frontal cortex may play a role in APA.

Guan_X; Liang X; Liu X (1990) [Acetylcholine and the primary input of AP sensation: influence of peripheral ACh on the role of EAP analgesia]. Chen Tzu Yen Chiu 15(2):136-139. Dept of Neurobiol, Tongji Med Univ, Wuhan. In order to investigate the correlation between the peripheral ACh and the primary input of AP sensation, in the paper the cholinesterase inhibitor, Neostigmine and the ACh synthesis blocker, Hemicholine, which are unable to pass through blood brain barrier, and ACh were used as tools to increase or decrease the level of ACh in peripheral nerve system of rats. Results: 1.The effect of EAP analgesia was enhanced in a dose-related way by sc injection of neostigmine. 2. ip injection of Hemicholine markedly inhibited the influence of EAP analgesia. 3. Injection of ACh in combination with neostigmine immediately reversed the suppression of EAP analgesia by hemicholine. But could not reverse by neostigmine alone. The effect of EAP analgesia and the primary input of AP sensation were significantly related to the level and content of peripheral ACh.

Guan_X; Wang C; Yu B; Liang X; Zhang Y; Zeng X; Liu X; Shi J; Ai M (1991) [Research on the relationship between central ACh and APA]. Chen Tzu Yen Chiu 16(2):129-137. Dept of Research on APA & Neurobiol, Tongji Med Univ, Wuhan, China. The article systematically reported our physiological and biochemical work on the relationship between central ACh and APA. AP on AP points produced analgesia. APA increased ACh levels in CSF and brain, increased AChE activities in brain. ChE inhibitor reinforced APA and ACh-synthesis-inhibitors inhibited APA, which inhibition was reversed by injection of ACh and chlorocholine. M-AChR antagonists also inhibited APA. APA increased the turnover rate of ACh in diencephalon, caudate nucleus and spinal dorsal horn. Variation of metabolic dynamics was discussed in relation to published literature.

Guoxi_T (1991) The action of the visceronociceptive neurons in the posterior group of thalamic nuclei: possible mechanism of APA on visceral pain. Kitasato Arch Exp Med Apr 64(1):43-55. Lab of Neurophysiol, China Med Univ, Shenyang. Microelectrode and stereotaxic technique were used to record extracellular potentials of the neuron in posterior group of thalamic nuclei (PO). To study the action of some neural structures in the brain, we also applied the method of conditioning-testing stimulation. We found not only somatic nociceptive but visceronociceptive neurons existed in PO. The features of the unit response (latency,discharges and its noxious properties) were studied. Stimulation of S1, cingulate gyrus, caudate nucleus, accumbens, amygdala, habenula, VPL, PAG and substantia nigra caused inhibition of nociceptive neurons in PO. Owing to emerge and recover, the inhibition can be divided into 3 phases: prompt, continued and delayed. All these inhibitions except VPL, Cad and SN (no observation), were reversed by Naloxone. Both stimulation of somatic peripheral nerve fibres and EAP of ST36 of the cat produce suppression of nociceptive neuron in PO. The mechanism of inhibition from the above neural structures of the brain was also discussed.

Han_Y; Yin Q (1992) [Electrophysiological observation on the role of the hypothalamic paraventricular nucleus in APA]. Chen Tzu Yen Chiu 17(3):161-165. Lab of Neurobiol, Suzhou Med Coll, Jiangsu. PRC. In this experiment, the role of PVN in APA was further investigated with electrophysiological technique. Unit discharges were recorded extracellularly in Wistar rats. Noxious stimulation was applied to the sciatic nerve and EAP was given at ST36 and SP06. Totally 82 units were recorded successfully from PVN. 49 units of them reacted to EAP with excitatory (14), inhibitory (23) or on significant effect (12). Various types of reactions including excitation (12), inhibition (6), excito-inhibition (4) or inhibito-excitation (3) were observed on 43 units during noxious stimulation of sciatic nerve. The remainder 18 units had no significant reaction. After EAP those units reacting with excitatory effect on noxious stimulation decreased their firing rate, and those with inhibitory effect increased their firing rate. The duration of nociceptive reaction was shortened after EAP in both types of units. EAP may influence the activities and decrease the nociceptive reactions of PVN neurons. This is electrophysiological evidence of the involvement of PVN in APA.

Huang_K; Xia-L; Rosenfeld-JP (1990) Effects of AP on activity of nociresponsive trigeminal nucleus caudalis (TNC) and a comparison with the effects of nanoinjecting Met-enkephalin (ENK) into the midbrain periaqueductal grey (PAG) or bulbar nucleus reticularis paragigantocellularis (PGC). Chen Tzu Yen Chiu 15(4):274-279. Inst of AP and Moxibustion, China Acad of TCM, PRC.

Huang_Z; Liu N; Zhong S; Lu J; Zhang N (1991) [The role of nucleus tractus solitarii (NTS) in AP inhibition of visceral-somatic reflex (VSR)]. Chen Tzu Yen Chiu 16(1):43-47. Dept of Physiol, Chongqing Univ of Med Sciences. Experiments were carried out on 164 rabbits. The transmission of abdominal vagal impulses and the mechanism of inhibitory effect by AP systematically were investigated. 1) Electrostimulation (single pulse of 20 V, 0.5 ms) of abdominal vagus nerve (AVN) produced 2 kinds of potential on cervical vagus nerve: the fast wave (10.4-24.4 M/s) and the slow wave (0.9-1.7 M/s), the later was more stable. 2) In dorsal medulla oblongata the 'M' shaped evoked potentials with long duration (100 ms or so) were recorded. Afferents from AVN are mainly transmitted through the small fibres and multi-synaptic connections in Medulla. 3) 281/301 response units (93.6%) concentrated in NTS and adjacent regions. This result was also confirmed by injection of Horseradish Peroxidase (HRP) in the trunk of AVN. 4) On 24 awake rabbits the VSR were elicited by strong stimulation of AVN. EAP (EA) at ST36 inhibited VSR, an effect lasted over 20 min. This inhibitory effect of EA was reversed partly by Naloxone (0.5 mg/kg iv) and was attenuated after lesion (DC 0.5 mA, 1 min.) of NTS. In conclusion, NTS plays an important role in suppression of VSR by EA (p <.01).

Ignatov_IuD; Vasil'ev IuN; Kolchin VV; Amelin AV; Li Ch Kh (1991) [The analgetic activity of antidepressants and their influence on the pain-relieving effect of AP]. Farmakol Toksikol May-Jun 54(3):12-14. The analgesic properties of Soviet-made antidepressants pyrasidol, incazan, tetrindol as compared with amitriptyline and their influence on APA were studied in rat experiments by using increasing intensity of electrostimulation of the tail root. Single and subchronic (6 d) administration of all the studied drugs had analgesic actions. Pyrasidol exerted the most pronounced effect. The antidepressants enhanced the analgesic effect of EAP, in particular during activation of the points of general action (such as LI04, ST36 etc). Pyrasidol medication had the greatest synergistic effect on APA.

Janssens_LAAa2; Rogers PAM; Schoen AM (1988) APA: a review. Vet Rec 9 Apr 122(15):355-358. Oudestraat 37, Wilryk, Belgium.

Jeong_Y; Baik EJ; Nam TS; Paik KS (1995) Effects of iontophoretically applied naloxone, picrotoxin and strychnine on dorsal horn neuron activities treated with high frequency conditioning stimulation in cats. Yonsei Med J Sep 36(4):336-347. Dept of Physiology, Yonsei Univ Coll of Med, Seoul, Korea. TENS, AP-needling, and EAP are useful non-ablative methods in Med practice for relief of pain. These procedures seem to work by causing an increased discharge in afferent nerve fibres which in turn modifies the transmission of impulses in pain pathways. The mechanism of analgesic effect via these procedures varies, depending on the stimulating parameters. For example, the endogenous opioid system is profoundly related to the mechanism when peripheral TENS is applied with parameters of low frequency and high intensity. However, when stimulated with parameters of high frequency and high intensity, the reduced activity of dorsal horn neurons is only slightly reversed by a systemic injection of naloxone, a specific opiate antagonist. Thus, the present study examined the neurotransmitter that concerns the mechanism of peripheral nerve stimulation with parameters of high frequency and high intensity. We used an iontophoretic application of antagonists of possible related neurotransmitters. Via a microelectrode at the lumbosacral spinal cord, dorsal horn neuron activity, evoked by squeezing the peripheral cutaneous receptive field, was recorded as an index of pain. Naloxone, picrotoxin and strychnine were applied at 200nA during a period of conditioning TENS. The effects of these drugs on the change of dorsal horn neuron activities were noted. Spontaneous activity of dorsal horn neurons increased in the presence of glutamate and decreased with GABA. It did not change with naloxone, picrotoxin or strychnine. When naloxone was applied iontophoretically during peripheral TENS, the analgesic effect was not statistically significant less than that of the control group. When picrotoxin was applied iontophoretically during TENS, the analgesic effect was reduced. When strychnine was applied, the analgesic effect was reduced but not significantly. The GABAergic system may have been partially related in the analgesic action of peripheral TENS of high frequency and high intensity.

Jiang_M; Liu X (1994) The lesion of somatosensory area II of cerebral cortex reducing the effects of EAP of ST36 on nucleus raphe magnus in rats. Chen Tzu Yen Chiu - AP Research 19(1):4-7. Inst of AP and Moxibustion, China Acad of TCM Beijing, PRC. This work was to study the influence of lesion of Sm II on effects of EAP upon nucleus raphe magnus (NRM). The experiments were performed on rats. The unit discharges of NRM neurons and their responses to noxious stimulation on tail tip were recorded extracellularly with glass microelectrode. The excitatory neurons of NRM were chosen and assigned to 2 groups: 1=Control, before lesion of bilateral Sm II (n=10) and; 2=After the lesion (n=17); two neurons of this group were also observed before lesion. EAP at ST36T activated the neurons in the control group before the lesion of Sm II. Their increased spontaneous discharge in 0-10 min and at 20 min, and decreased nociceptive response in 0-25 min were statistically significant.

Jun_Y (1992) [Effect of AP on the levels of vasopressin and oxytocin in the rat]. Chen Tzu Yen Chiu 17(3):217-20. Dept of Nuclear Med, Nan Fang Hospital, Guangzhou. This work was to investigate the change of the levels of vasopressin and oxytocin during AP in rats. AP changed arginine vasopressin an oxytocin immunoreactivity in many regions of rat brain. Arginine vasopressin and oxytocin may participate APA through the CNS.

Kaliuzhnyi_LV; Kozlov AIu (1991) [Action of an enkephalinase blocker on the effect of AP in AP sensitive and resistant rabbits]. Biull Eksp Biol Med Dec 112(12):571-573. DPA injection did not change the SEP in response to tooth pulp electrostimulation in unanesthetized AP-sensitive rabbits. However, it prolonged the analgetic effect of Ear-EAP stimulation 15 Hz expressed by decreasing of the amplitude of N1P2 component SEP. In AP-resistant rabbit DPA injection induced analgetic effect which was enhanced and prolonged by Ear-AP stimulation. Recovery of pain sensibility after APA may be determined by enkephalinase's mechanism activation which is activated permanently in AP-resistant rabbits.
Kaliuzhnyi_LV; Fedoseeva OV (1990) [Angiotensin mechanism of Ear-AP dental analgesia]. Biull Eksp Biol Med Jul 110(7):3-5. Ear-EAP stimulation at 15 Hz decreased the amplitude of SEP 2nd component in response to the tooth pulp electrostimulation in unanesthetized rabbits. The effect was blocked by iv injection of naloxone but not by icv injection of saralasin. The same effect of Ear-EAP stimulation at 100 Hz was blocked by saralasin, was increased by angiotensin II, was diminished by methysergide but was not changed by naloxone. An angiotensinergic antinociceptive mechanism of dental pain may be activated by Ear-EAP stimulation at 100 Hz.

Kasahara_T; Wu Y; Sakurai Y; Oguchi K (1992) Suppressive effect of AP on delayed type hypersensitivity to trinitrochlorobenzene and involvement of opiate receptors. Int J Immunopharmacol May 14(4):661-665. Dept of Pharmacol, Sch of Med, Showa Univ, Tokyo, Japan. We reported previously that EAP at GV04 in mice either enhanced or suppressed the delayed type hypersensitivity (DTH) to 2,4,6-trinitrochlorobenzene (TNCB, picryl chloride) depending on the time of treatment. We report here the suppression of the efferent phase of DTH to TNCB by EAP in mice. In male BALB/c, C57BL/6 and ddY mice, 7-9 wk-old, significant suppression of the DTH occurred when EAP had been applied once/d for 3 d consecutively before TNCB challenge. When EAP had been applied once only, significant suppression also occurred. EAP at another point (at a middle area of the femoral muscle) failed to suppress the DTH to TNCB. This EAP-evoked DTH suppression was blocked dose-relatedly by pretreatment by iv naloxone hydrochloride. Opioid receptor-mediated mechanisms may be involved in this immune response.

Kashiba_H; Ueda Y (1991) AP to the skin induces release of Substance-P and calcitonin gene-related peptide from peripheral terminals of primary sensory neurons in the rat. Dept of Physiol, Kansai Coll of AP Med, Osaka, Japan. AJCM 19(3-4):189-197. We examined immunohistochemically the short term effects of EAP to the skin on Substance-P (SP)- and calcitonin gene-related peptide (CGRP) containing- primary sensory neurons in the rat. Immunoreactivity to SP and CGRP in these neurons at the treatment site decreased after 30 min of EAP. EAP induces release of SP and CGRP from peripheral terminals of primary sensory neurons.

Kawashima_Y; Toma S; Nakajima Y (1991) Attenuation of somatosensory evoked potentials by AP and tactile skin stimulation in man. Brain Topogr Fall 4(1):37-46. Dept of Physiol, Sch of Med, Chiba Univ, Japan. The effects of AP and tactile skin stimulation on somatosensory evoked potentials (SEPs), elicited by the median nerve stimulation, were investigated in healthy subjects. AP needles were inserted into either LI04 + LI11, LI04 + TH05, or LI11 ipsilateral to the median nerve stimulation. Tactile skin stimulation was applied to either the ulnar side of the palm, or the dorsal surface of the hand or forearm ipsilaterally to the nerve stimulation. It was found that AP significantly suppressed the amplitude of P22 and P40, and that the tactile skin stimulation of the ulnar side of the palm significantly suppressed the amplitude of P22 and P40, but that the peak latencies were not affected. Dipole tracing analysis showed that the location and vector direction of P22 were unchanged but the vector moment of P22 was changed by both AP and tactile stimulation. The suppressive effect of AP and skin stimulation on P22 may be due to afferent inhibition in the somatosensory cortex. Although the suppressive mechanism of P40 by tactile skin stimulation seemed to be similar to that of P22, the suppression of P40 by AP appeared to include different mechanisms.

Kishioka_S; Miyamoto Y; Fukunaga Y; Nishida S; Yamamoto H (1994) Effects of a mixture of peptidase inhibitors (amastatin, captopril and phosphoramidon) on Met-Enk-, beta-End-, dynorphin-(1-13)- and EAP-induced antinociception in rats. Jpn J Pharmacol Nov 66(3):337-345. Dept of Pharmacology, Wakayama Med Coll, Japan. The effects of a mixture of 3 peptidase inhibitors (PIs), amastatin, captopril and phosphoramidon, on Met-Enk-, beta-End-, dynorphin-(1-13) (Dyn)- and EAP- induced antinociception were compared in rats. EAP was performed by passing electric pulses (3 Hz, 0.1 ms duration, for 45 min) through AP needles inserted into LI04. The antinociceptive effect was estimated by the hind paw pressure test. The antinociceptive effects of Met-enk and beta-End injected icv or i.t. and of Dyn injected i.t. were clearly potentiated by the PIs pretreated by the same routes as used to inject opioid peptides. The antinociceptive effects of Met-Enk, beta-End and Dyn injected icv were also potentiated significantly by i.t.-PIs. PIs injected into the PAG potentiated EAP antinociception. However, the EAP effect was not affected by i.t.-PIs and was rather attenuated by icv-PIs. Met-Enk hydrolysing enzymes were involved in the degradation of not only Met-Enk but also beta-End and Dyn in the rat CNS; Met-Enk and beta-End acted on both supraspinal and spinal sites, while Dyn acted only on the spinal site; EAP antinociception was mediated by supraspinal Met-Enk and/or beta-End; EAP activated an anti-opiate peptide system, susceptible to Met-Enk hydrolysing enzymes.

Kumar_A; Tandon OP; Dam S; Bhattacharya A; Tyagi KK (1994) Brainstem auditory evoked response changes after EAP therapy in chronic pain patients. Anaesthesia May 49(5):387-390. Dept of Anaesthesiol and Critical Care, Univ Coll of Med Sciences, Delhi, India. Brainstem auditory evoked responses were recorded in 17 patients with chronic pain who had been given EAP therapy. The absolute peak latencies of waves I to V, and interpeak latencies and amplitudes of waves I and V were analyzed before EAP and compared with values obtained during EAP and 5 min after its termination after one, 5 and 10 sittings. At these sittings the intensity of pain was recorded with the help of a 100 mm visual analogue scale. Each patient had 10 sessions, at 2 d intervals. The absolute peak latencies of waves I, II, and III were delayed significantly (p <.05) after 5 and 10 sittings and amplitudes of wave V decreased significantly (p <.05) after 5 and 10 sittings. Visual analogue scores also decreased significantly (p <.01) during these sittings. It was established that before and after 10 sittings of EAP, there was a significant positive correlation between visual analogue scores and the amplitude of wave V (p <.01). There was a negative correlation between visual analogue scores and absolute peak latencies of wave III at 1, 5 and 10 sittings, suggesting that there is a definite interaction between the EAP neural mechanism and the generators of brainstem auditory evoked responses in the lower brainstem.

Kumar_A1; Tandon OP; Bhattacharya A; Gupta RK; Dhar D (1995) Somatosensory evoked potential changes after EAP therapy in chronic pain patients. Anaesthesia May 50(5):411-414. Dept of Anaesthesiology and Critical Care and Physiology, Univ Coll of Med Sci, Delhi, India. SEPs were recorded in 20 healthy volunteers and 20 patients with chronic pain undergoing EAP therapy. The values of absolute peak latency and amplitudes of N19 and P22 in the control group were compared with the corresponding baseline values in the study group and after EAP therapy at 3 stages during a 10-treatment cycle. On these occasions the intensity of pain was recorded using a 100 mm visual analogue scale score. Each patient in the study group had 10 treatments given every 2 d. The absolute peak latency of N19 was significantly delayed (p<.05) and reverted completely to control values after the 10th treatment (p>0.05). Visual analogue scores also decreased significantly. The neural mechanisms of EAP involve thalamic generation of SEPs, i.e. N19.

Lagerweij E; Nelis PC; Wiegant VM; van Ree JM (1984) The twitch in horses: a variant of AP. Science 14 Sept 225(4667):1172-1174.

Levin_MF; Hui Chan CW (1993) Conventional and AP-like TENS excite similar afferent fibres. Arch Phys Med Rehab Jan 74(1):54-60. Sch of Physical and Occupational Therapy, Faculty of Med, McGill Univ, Montreal, Quebec, Canada. The purpose of our study was to determine whether similar or different peripheral afferent fibre(s) is(are) activated by "conventional" TENS at low intensity-high frequency, as opposed to "AP-like" TENS at high intensity-low frequency. The electrostimulation was delivered to the median nerve at the wrist of 17 healthy subjects. For conventional TENS, single pulses were applied at an intensity of 3 X T (sensory threshold). Two kinds of AP-like TENS were studied: single pulses at 0.1Hz, and trains of 100Hz pulses at 4Hz, both delivered at an intensity greater than 3 X T. 30 compound action potentials/type of stimulation were recorded over the median nerve in the cubital fossa and averaged. Mean conduction velocities of the afferent fibres excited by conventional TENS, single pulse, and short-train AP-like TENS ranged from 50.3-65.4, 50.0-63.5, and 41.3-54.8m/s, respectively. Thus, conventional and AP-like TENS activated similar fibre types, mainly in the A alpha beta range. The effects of these two types of TENS may be mediated by the activation of similar peripheral afferent fibres.

Li_C; Zhu L; Li W; Ji C (1993) [Relationship between the presynaptic depolarization effect of AP and GABA, opioid peptide and Substance-P]. Chen Tzu Yen Chiu 18(3):178-182. Inst of AP, China Acad of TCM, Beijing, PRC. The present study was performed on 22 cats to explore whether GABA, endogenous opioid peptide and Substance-P (SP) were involved in the regulation of presynaptic inhibition in APA. The size of the antidromic compound C action potentials of the sural nerve evoked by the testing stimulation in spinal cord was measured as an indicator of C-afferent terminal excitability. It was found that EAP at GB30 and GB34 induced significant enlargement of the antidromic C-waves, showing the depolarization of presynaptic terminals of primary C-afferents was enhanced. The depolarization effect of EAP was significantly reduced by bicuculline, naloxone and the antiserum of SP locally applied to the surface of spinal cord respectively. It is supposed that GABA, endogenous opioid peptide and SP may be involved in the regulation of presynaptic inhibition in APA.

Li_KY; Zhu JM; Cao XD (1990) Effects of destruction of preoptic catecholaminergic nerve terminal on APA. Dept of Neurobiol, Shanghai Med Univ, PRC. AETRIJ 15(3-4):179-184. The present work studied the effect of preoptic catecholamine on APA. Catecholaminergic terminals were destroyed by microinjection of 6-hydroxydopamine into the preoptic area and the destruction was checked by fluorescence histochemical method. Destruction of catecholaminergic terminals significantly enhanced APA, suggesting that reduction of catecholamine level in the preoptic area may enhance APA.

Liu_C; Zhao F; Zhu L (1994) [Involvement of purines in analgesia produced by weak EAP]. Chen Tzu Yen Chiu 19(1):59-62, 54. Inst of AP and Moxibustion, China Acad of TCM, Beijing, PRC. In the present investigation the intensity of stimulated EAP (EA) was measured by electrophysiological collision technique. In the behavioral experiments, weak EAP at GB34 and GB39 (50 Hz, 1-1.5mA, not enough to activated A delta afferent fibres), prolonged the latency of nociceptive hind limb withdrawal reflex, but not the ail-flick latency. Both ip theophylline and caffeine (P1-purinergic (adenosine) receptor antagonists) blocked EAP-induced elevation of nociceptive thresholds in a dose-effect related manner, whereas dipyridamole (an inhibitor of adenosine release) shortened the after-effect of EAP in a dose dependent way. Weak EAP may induce analgesia and purines appear to be involved in this process.

Liu_C1; Zhao F; Li W; Zhu L (1994) Role of adenosine in weak EAP-induced depression of nociceptive response of spinal dorsal horn neurons in rats. Chen Tzu Yen Chiu - AP Research 19(2):52-55. Inst of AP and Moxibustion, China Acad of TCM, Beijing, PRC. Extracellular recordings were made from wide dynamic range (WDR) neurons in lumbar segments of the spinal cord in rats transected at the first lumbar segment. The nociceptive discharges of WDR neurons were depressed by weak EAP at GB34 and GB39. The depression was blocked by adenosine receptor antagonists, theophylline and caffeine iv. Depression of the nociceptive response of the WDR neurons induced by weak EAP may be mediated by adenosine within the spinal cord.

Liu_JL; Han XW; Su SN (1990) The role of frontal neurons in pain and APA. Sci China [B] Aug 33(8):938-945. Inst of Space Medico-Engineering, Beijing, PRC. To study the role of frontal neurons in pain and APA, experiments were carried out on 4 monkeys (Macaca mulatta) during performing 2 tasks, the Heat Discrimination Response GO/NO-GO Task (Task I) and the Heat Delayed Discrimination GO/NO-GO Task (Task II). After a criterion of 90% of correct performances over 3 d consecutively had been reached, activity of single neurons was recorded from the frontal cortex. Of 276 Task I-related neurons, 211 responded to noxious and/or innocuous heat stimuli. Of 73 Task II-related neurons, 59 responded to noxious and/or innocuous heat stimuli. During AP, the nociceptive reaction time for lever release to avoid painful stimuli was increased, the % of correct performances was lowered, and the neuronal responses to noxious and/or innocuous stimuli were suppressed. These neurons were mainly located in a circumscribed area medial to the superior ramus of the arcuate sulcus in frontal cortex, including the prefrontal and premotor areas. It is suggested that neurons in this area may be related to the discrimination of noxious and innocuous stimuli. The suppression of the activity of these neurons during AP may be involved in the whole mechanism of AP to facilitate the production of analgesia.

Liu_M; Liu X; Liu B (1991) [The analgesic effect of red nucleus and strengthening effect thereof to the APA]. Chen Tzu Yen Chiu 16(1):48-53. Dept of Physiol, N. Bethune Univ of Med Sciences, Changchun, PRC. The modulation of red nucleus (RN) to pain sense was researched with the latent period of radiant-heat tail flick of rats as the standard of the pain threshold. Bilateral injection of glutamic acid into RN significantly raised the pain threshold of tail flick reflex. Simultaneous injection of glutamic acid into RN and lidocaine into nucleus raphe magnus (NRM) attenuated that effect. The activated RN has analgesic effect and the NRM plays an important role in the descending inhibitory pathway of RN. The discharges of neurons in caudal part of nucleus spinalis tract nervi trigemini (cNST) evoked by stimulating nerve alveolaris inferior (nAI) with strong pulse were recorded with microelectrode. nAI-evoked discharges were inhibited by stimulating contralateral or ipsilateral RN. The RN inhibitory time course on nAI-evoked discharges were shortened after injecting lidocaine into NRM. The inhibitory effect of RN on neurons in cNST is mediated by NRM. EAP at ST06 inhibited the pain-evoked discharges of neurons in cNST. The time of EAP analgesia was prolonged by stimulating the RN. Activation of the RN enhances APA.

Liu_W; Song C; Yang J; Lin B; Wang C (1990) [Involvement of oxytocin in spinal cord in APA]. Chen Tzu Yen Chiu 15(1):24-29. Dept of Neurobiol, 2nd Military Coll, Shanghai, PRC. The influence of i.t. injection of oxytocin (OT), anti-OT serum (AOTS) and naloxone on pain threshold and EAP (EA) analgesia in rats was investigated. The tail-flick induced by potassium iontophoresis was used to measure the pain threshold. The increase in pain threshold was observed within 70 min after OT injection (100 ng), and it was much more effective than that of the ACSF injection (p <.001). OT administration enhanced EAP analgesia. This effect was dose-related. Although injection of AOTS did not affect the pain threshold, it diminished EAP analgesia. Also, injection of naloxone did not influence the action of OT on EAP analgesia. OT in the spinal cord is important in EAP analgesia, and its effects are independent of endogenous opiate peptides.

Lou_Z; Sun W; Liu Y; Tong Z (1992) [Effect of EAP on cortical and hippocampal EEG in adjuvant arthritis rats]. Chen Tzu Yen Chiu 17(2):129-132. Dept of Physiolgy, First Military Med Univ, Guangzhou. Adjuvant arthritis (AA) rats were used as the chronic pain model. Cortical and hippocampal (HPC) EEGs were recorded. Behaviour and local inflammatory reaction were observed. Desynchronization of the ECoG and HPC EEG in the AA rats induced an arousal response; beta waves increased and delta waves decreased significantly. However, the effect of desynchronization was inhibited by EAP on bilateral ST36 points and morphine. The cortex and hippocampus participate in the modulating action of chronic pain, and EAP has an analgesic action.

Lu_Z; Cao W; Dong X; Deng Y; Zhang T (1990) [Relation of capsaicin-sensitive neurones to the effect of EAP analgesia]. Chen Tzu Yen Chiu 15(3):213-216. Inst of AP and Moxibustion, China Acad of TCM, Beijing, PRC. Rats treated with capsaicin (50 mg/kg) sc on d 2 of life were used 12 wk after injection. The levels of Substance-P (SP) in sciatic nerves and dorsal spinal cords were measured with RIA to evaluate the extent of C-afferent fibres damaged by capsaicin. Results: Mean levels of SP in the sciatic nerve and dorsal spinal cord were decreased by 69 and 62% respectively, suggesting massive degeneration of the primary C-afferent fibres. Compared with controls, mean basal tail-flick latency (on immersion in 50oC water) was prolonged 105%. After EAP, mean tail-flick latency of capsaicin-treated rats was increased by 81%, while that of the vehicle-treated rats increased by 54%. C-afferent fibres substantially mediate transmission of noxious thermal stimuli, but are not essential for the transmission of AP-signals to induce APA.

Luo_M; Wang P; Yang Y (1991) [Effect of APA on synapses of paraventricular nucleus observed with transmission electron microscope]. Chen Tzu Yen Chiu 16(2):100-102. Inst of AP, China Acad of TCM, Beijing, PRC. In order to study the ultrastructural change of the paraventricular nucleus of hypothalamus during EAP, 13 healthy and adult rats were assigned to 2 groups: 1=Control (untreated) and; 2=EAP-treated. Paraventricular nucleus synapses belong mainly to the axodendricular asymmetrical synapses and contain many clear synaptic vesicles. Compared with the control, EAP very significantly (p <.01) decreased the number of vesicles. The paraventricular nucleus is involved in the EAP analgesia.

Mo_Q; Gong B; Fang J; Li J; Huang J; Chen K; Kuang X; Wang J (1994) [Influence of AP at ST36 on function of 5-HT and muscarine (M) receptor in rat's brain and spleen]. Chen Tzu Yen Chiu - AP Research 19(1):33-36. Shanghai Univ of TCM, PRC. Three groups of rats were studied: groups needled at ST36 (test group), or LV03, or not needled (control groups). Using receptor radioligand binding assay (RLBA), 5-HT and M receptors total binding capacities (Rt) were determined in different brain areas and spleen after needling. Compared with the control group, needling at ST36 gave clear APA and significantly decreased 5-HT and M receptors Rt in the cerebral cortex, hippocampus, striatum, spinal cord and spleen. 5-HT Rt was obviously decreased in brain stem and medulla oblongata but not in the thalamus. M receptor Rt value fell significantly in the thalamus but not in the brain stem and medulla oblongata. Different AP points had different effects on various Channels; AP at ST36 gave results different from those of LV03.

Moret_V; Forster A; Laverriere MC; Lambert H; Gaillard RC; Bourgeois P; Haynal A; Gemperle M; Buchser E (1991) Mechanism of analgesia induced by hypnosis and AP: is there a difference?. Pain May 45(2):135-140. Dept of Anaesthesiol, Hospital Cantonal Univ of Geneva, Switzerland. Hypnosis and AP can alleviate experimentally induced pain but the mechanism of analgesia remains unclear for both techniques. Experimental pain was induced by cold pressor test (CPT) in 8 male volunteers. Analgesic effect of hypnosis (HA) and AP (AA) was assessed before and after double-blind administration of placebo or naloxone, in a prospective, cross-over study. Pain intensity was significantly lower with HA as compared with AA, both with naloxone (p <.001) and placebo (p <.001). Within HA or AA groups, pain scores did not differ significantly when naloxone or placebo was administered. During AA, however, pain scores were similar to control values when naloxone was given (p=.05) but decreased significantly with placebo (p <.002). Analog scales for pain intensity and pain relief showed a good correlation (r=.94). Plasma levels of beta-End did not change significantly in any combination. Heart rate, peripheral arterial blood pressure and skin conductance were very insensitive indices to assess pain intensity or relief, as well as intensity of AP stimulation or depth of hypnotic trance. Conclusions: 1. HA and AA can significantly reduce pain from Cold Pressor Test, and HA is more effective than AA; 2. HA and AA are not primarily mediated by the opiate endorphin system; and 3. Plasma levels of beta-End are not significantly affected by either HA or AA nor by naloxone or placebo administration.

Nezhentsev_MV; Aleksandrov SI (1991) [The effect of psychotropic agents on the efficacy of AP reflexotherapy]. Vrach Delo Sep 9:19-24.

Omana_I; Olvera V; Santos P; Calderon JL (1994) Naloxone prevents reduction of pain responses evoked by AP in neuropathic rats. Proc West Pharmacol Soc 37:135-136. Dept Neurophysiol, Inst Mexicano de Psiquiatria, Mexico.

Pain_YZ; Wang LH; Tang YH; Yin XM; Wang S (1992) Reversal by gallamine triethiodide of the antagonistic effect of Ca2+ injection into habenula on EAP-analgesia. Sheng-Li-Hsueh-Pao Aug 44(4):326-332. Dept of Physiology, Norman Bethune Univ of Med Sci, Changchun. Bilateral intracranial cannulae were used for ic injection of 1 mol/L CaCl2 0.5 uL, 0.06 mol/L ACh 0.5 uL, 5.4 x 10-3 mol/L gallamine triethiodide (cholinergic nicotinic receptor blocker) 0.5 uL and 14.4 x 10-3 mol/L atropine (cholinergic muscarinic receptor blocker) 0.5 uL in the habenula of rats. Pain threshold before and after ic injection was measured by the latency of the tail-flick reflex, elicited by exposure to radiant heat. CaCl2 significantly reduced the basic pain threshold and weakened the effect of AP-analgesia (APA). ACh antagonized the effect of APA. Gallamine triethiodide raised the pain threshold almost to the raised level attained by APA; atropine only weakly and briefly strengthened the APA-effect on pain threshold. The antagonistic effect of Ca2+ on APA may be mediated via ACh in habenula.

Raevskaia_OS (1992) Nociceptive sensitivity of rabbits in varying localization of pain stimuli and naloxone administration. Patol Fiziol Eksp Ter Sep-Dec(5-6):7-9. Study of the dynamics of changes of evoked potential (EP) amplitude in electrodental and electrocutaneous stimulation (EDS and ECS, respectively) as an index of the perceptual component of the nociceptive reaction showed that 0.2 mg/kg and 0.5 mg/kg doses of naloxone produce both a hyper- and an analgesic effect in rabbits. The effect of naloxone depended on the individual properties of the rabbits, while its degree was determined by the localization of the nociceptive stimulus. The animals' individual properties were manifested by the presence or absence of an analgesic effect of Ear-EAP-sensitive (ES) or EAP-resistant (ER) rabbits. Naloxone injection caused a dose-dependent hyperalgesic effect in AS animals and an analgesic effect in ER rabbits in EDS. Similar effects were recorded in ECS, but their degree differed: hyperalgesia in ES rabbits occurred more clearly than analgesia in ER animals.

Rogvi-Hansen_B; Bach FW (1990) [APA: Neurochemical and neurophysiologic aspects]. Ugeskr Laeger Dec 152(49):3684-3687. Rigshospitalet, Kobenhavn, neuromedicinsk afdeling. AP has been used as an analgesic method for millenia without its mechanism of action being understood. In the past 2 decades, evidence has accumulated that AP activates an intrinsic neural network which monitors and modifies the activity of pain-transmitting neurons. Pain-suppression is partly mediated by endogenous opioid peptides and monoamines. The pain-inhibition system is organized at 3 levels of the neuroaxis: spinal cord, medulla and the midbrain. The raphe magnus nucleus and the spinal cord constitute a fundamental circuit while the PAG funnels the influences from the more rostral structures and collects signals from the spinal cord. PAG initiates descending and ascending inhibition resulting in pain reduction. The endogenous pain-control system may be elicited by other physiological stimuli and the effect of AP is unlikely to be specific.

Sato_T; Takeshige C; Shimizu S (1991) Morphine analgesia mediated by activation of the AP-analgesia-producing system. AETRIJ 16(1-2):13-26. Dept of Physiol, Sch of Med, Showa Univ, Tokyo, Japan. Analgesia caused by 0.5 mg/kg morphine ip (MA) in rats is equivalent to APA caused by low frequency stimulation of the tibial muscle (ST36). Analgesia equivalent to both APA and MA was produced by i.t. application of 0.05 ug morphine. This analgesia shows individual variation in effectiveness which is parallel to those of both APA and MA, and disappears after 250 mg DPA/kg ip. Analgesia that persisted after termination of AP stimulation was not affected, maximally developed MA and APA were both partially antagonized, and the initial development of APA and MA were completely antagonized by i.t. application of 0.2 ug naloxone. Analgesia caused by i.t. 0.05 ug morphine was abolished by bilateral lesion of the anterolateral tract (ALT) of the spinal cord and that caused by AP stimulation was abolished by contra-lateral lesion. Analgesia caused by larger doses (0.1-0.2 ug) of i.t. morphine was not abolished, but persisted after ALT lesion, unilateral lesion of the dorsal periaqueductal central grey (D-PAG), or hypophysectomy. Potentials were evoked by AP stimulation in the bilateral D-PAG. Analgesia produced by D-PAG stimulation was not affected by ALT lesion nor by i.t. naloxone, but was abolished by lesion of the dorsolateral funiculus. These results imply 2 types of morphine action in the spinal cord to produce analgesia: activation of the ascending APA pathway; and direct inhibition of pain message in the spinal cord. They also show that the APA producing pathway ascends contralaterally in the ALT and then bilaterally in the D-PAG.

Scherder_EJ; Bouma A (1993) Possible role of the nucleus raphe dorsalis in analgesia by peripheral stimulation: theoretical considerations. AETRIJ Jul-Dec 18(3-4):195-205. Inst of Physiotherapy and AP, Free Univ, Amsterdam, The Netherlands. Direct stimulation of the Nucleus Raphe Dorsalis (NRD) is very effective for obtaining analgesia. However, the possible role of the NRD in analgesia by peripheral stimulation, e.g. EAP or TENS, has received less attention. Most studies show that in particular the nucleus reticularis gigantocellularis, the nucleus raphe magnus, the nucleus reticularis magnocellularis, the locus coeruleus, and the PAG may participate in the supraspinal mechanism for the antinociceptive effect of peripheral stimulation. This paper presents theoretical considerations of the role of the NRD in analgesia by peripheral stimulation. Little direct evidence suggests that the NRD-serotonergic system might contribute to this type of analgesia. The analgesic role of specifically the serotonergic neurons of the NRD in peripheral stimulation was supported by indirect evidence. From studies of direct stimulation of the NRD, two other mechanisms by which peripheral stimulation might exert antinociceptive effects through the NRD have been hypothesized. Stimulation-parameters affecting the effectiveness of peripheral NRD stimulation will be discussed.

Shatskaia_NN; Komleva LM; Tarasova LA (1992) [Role of neuropeptides in the pathogenesis of pain syndrome in autonomic and sensory polyneuropathy of occupational etiology and their role in the therapeutic action of laser-AP]. Gig Tr Prof Zabol (1):25-27. Biochemical studies of opiate system in patients with occupational diseases showed the role of the central pain regulating system inducing the pain syndrome in autonomic and sensory polyneuropathy caused by occupational factors. Increased production of the pain-reducing endogenic neuropeptides such as endorphin and Leu-Enk was one of the means by which He-Ne laser-AP restores human adaptation to pain. A repeated course of laser-AP therapy would normalize the level of both neuropeptides. Blood levels of neuropeptides may serve to evaluate pain syndromes and estimate effects of laser-AP therapy.

Shen_X; Zhang W; Yu W (1993) [The influences of AP on the cortical evoked potentials in rabbits]. Chen Tzu Yen Chiu 18(1):24-28. Shanghai Coll of TCM, PRC. The effects of AP on visual, auditory, somatosensory evoked cortical potentials as well as raw EEGs were observed in 31 rabbits either anaesthetized with urethane or conscious. Results: 1. AP significantly depressed the main components of the evoked potentials; 2. AP desynchronized raw EEGs, while the animals appeared to be slightly activated; 3. AP decreased both the integral values of raw EEGs and the powers of lower frequency waves (1-3.99 Hz); these positively correlated well with the amplitudes of the main components of the evoked potentials. Conclusion: The effects of AP on evoked potentials may be secondary to the changes of EEGs; the inhibition of evoked potentials during AP does not necessarily mean that the cerebral cortex is inhibited.

Shu_J; Li KY; Huang DK (1994) The central effect of EAP analgesia on visceral pain of rats: a study using the [3H] 2-deoxyglucose method. AETRIJ Jun-Sep 19(2-3):107-117. Dept of Neurobiol, Shanghai Med Univ, PRC. This study had the objective to understand the central effect of EAP analgesia (EAA) on visceral pain of rats. We used the method of Sokoloff's 2-deoxyglucose (2-DG) auto-radiographic quantitative analysis to observe the changes of local cerebral metabolic rate of glucose (LCMRG) in rats given electrostimulation of greater splanchnic nerve (GSN) followed by EAP. The LCMRG had a significant difference between EAA group and pain group at some structures, such as the spinal thoracic and lumbar dorsal horns (segments T6-T8, L1-L3), locus coeruleus (lc), nucleus raphe magnus (rm), nucleus reticular gigantocellularis (rgi), periaqueductal grey (PAG) and habenulae lateralis (hl) of the thalamus. The results, combined with reports by other workers, suggest that these local cerebral structures may be the key nuclei in EAP-analgesia on visceral pain.

Shu_J; Li KY; Huang DK (1994) The central effect of EAP-analgesia on visceral pain of rats: a study using the 3H-2-deoxyglucose method. AETRIJ Jun-Sep 19(2-3):107-117. Dept of Neurobiology, Shanghai Med Univ, PRC. This study had the objective to understand the effect of EAP-analgesia (EAA) in the CNS on visceral pain of rats. We used the method of Sokoloff's 2-deoxyglucose (2-DG) auto-radiographic quantitative analysis to observe changes of local cerebral metabolic rate of glucose (LCMRG) in rats given electrostimulation of greater splanchnic nerve (GSN) after EAP. LCMRG was significantly different between EAA group and pain group at some structures, such as the spinal thoracic and lumbar dorsal horns (segments T6-T8, L1-L3), locus coeruleus (lc), nucleus raphe magnus (rm), nucleus reticular gigantocellularis (rgi), PAG and thalamic habenulae lateralis (hl). These local cerebral structures may be the key nuclei in the mechanism of EAA on visceral pain.

Simmons_MS; Oleson TD (1993) Ear-electrical stimulation and dental pain threshold. Anaesth Prog 40(1):14-19. Dept of Orofacial Pain and Occlusion, UCLA Sch of Dentistry. A modified double-blind study of naloxone reversibility of dental EAP-analgesia produced by Ear-Electrostimulation (EES) was examined in 40 subjects assigned at random to 4 groups: ES=EES followed by saline; EN=EES followed by naloxone; PS=Placebo EES followed by saline and; PN=Placebo EES followed by naloxone. Dental pain threshold was tested using a hand-held dental pulp tester. A second investigator used an electrostimulator to give the true or placebo EES. A third investigator injected saline or naloxone iv. The subjects and investigators 1 and 3 were blind to all treatment conditions. A repeated measures analysis of variance showed a significant difference among the 4 groups. EES gave a statistically significant 18% elevation of pain threshold, whereas PS and PN (placebos) remained essentially unchanged. ES increased mean pain threshold to >23% but EN (naloxone) decreased pain threshold to <12%. A small but significant elevation of pain threshold by EES is partially blocked by naloxone. An endogenous opioid system is one mechanism for EAP-analgesia.

Song_CY1; Liu WY; Gu XY; Lin BC (1993) Effect of anti-opioid peptide sera on oxytocin-induced enhancement of EAP-analgesia (EAA). Sheng Li Hsueh Pao Jun 45(3):231-236. Dept of Neurobiology, Second Military Med Univ, Shanghai, PRC. Effects of icv injection of anti-opioid peptide sera on oxytocin-induced enhancement of EAA were observed in this study. Injection of anti-beta-End serum (AEPS) alone attenuated EAA in rats. Injection of AEPS before icv injection of oxytocin did not block the enhancement of EAA by oxytocin. The antidynorphin A1-13 serum (FROMYNS) alone also reduced EAA, whereas injection of FROMYNS before injection of oxytocin potentiated the enhancement of EAA by oxytocin. However, neither anti-Met-Enk serum nor anti-Leu-Enk had any effect on the enhancement of EAA by oxytocin. EAA was attenuated by dynorphin but enhanced by oxytocin, but Beta-End and enkephalin did not affect this role of oxytocin. Enhancement of EAA by oxytocin is not dependent upon the endogenous opioid peptides in brain.

Takakura_N1; Kanamaru A; Sibuya M; Homma I (1992) Effect of AP at right LI04 point on the bilateral vibration-induced finger flexion reflex in man. AJCM 20(2):115-126. Japan Central AP and Moxibustion Coll, Tokyo, Japan. Vibration applied to the volar side of the finger tip induces a finger flexion reflex. AP is reported to inhibit this vibration-induced finger flexion reflex (VFR) in the ipsilateral hand. This study aimed to assess the effect of unilateral AP at one hand on the VFR in both hands. A systematic study of the relationship between VFR and the force of voluntary contraction with no vibration (Initial Force: IF) has not been reported previously. Hence, this relationship was studied before the present study on AP. VFR was induced by mechanical vibration on the volar side of the middle finger tip with an IF of 10-500 g. VFR was induced consistently with an IF of circa 300 g. Thus, an IF of circa 300 g was applied for VFR induction to study the effect of AP on VFR. A stainless steel needle was inserted into the right LI04 point and remained inserted (in-situ technique) for 10 min. AP at the right LI04 significantly decreased VFR in both hands (% control force of VFR: right, 68%; left, 75%). Unilateral-hand AP influences the bilateral reflex arc of VFR.

Takakura_N2; Ogawa H; Iijima S; Nishimura K; Kanamaru A; Sibuya M; Homma I (1993) Effect of AP at right LI04 on bilateral vibration-induced finger flexion reflex in man: comparison between in-situ and Sparrow Pecking technique. AJCM 21(3-4):213-219. Hanada Coll-Japan Sch of AP, Moxibustion and Physiotherapy, Tokyo. This study compared in 30 healthy adults effect of the Pecking Sparrow (PS) with that of the in-situ (IS) technique of AP on the vibration-induced finger flexion reflex (VFR). Flexion movement of the vibrated finger (VFR), was induced by vibrating the volar side of the middle finger tip. The AP point was LI04 (right side). Both techniques of AP inhibited VFR in the ipsilateral and contralateral sides, but inhibition with PS was significantly more than that with IS (% control force of VFR, mean+SD: with SP right, 62.1+24.6%, left, 60.6+27.9%, with IS right, 74.9+26.6%, left, 78.1+29.5%, p <.0005). SP suppresses facilitation of VFR in the reflex arcs more than IS.

Takakura_N3; Ogawa H; Iijima S; Nishimura K; Kanamaru A; Sibuya M; Homma I (1995) Effect of AP at LI04 on vibration-induced finger flexion reflex in man: comparison between press needle technique, EAP, and in-situ technique. AJCM 23(3-4):313-318. Hanada Coll-Japan Sch of AP, Moxibustion and Physiotherapy, Tokyo, Japan. Effects of press needle technique (PN), EAP, or in-situ technique (IS) on vibration-induced finger flexion reflex (VFR) were examined in 31 healthy adults. VFR, which is tonic finger flexion evoked by vibration applied to the finger tip, was induced by vibrating the volar side of the middle finger tip before and after AP. AP was given at bilateral LI04. The 3 techniques, each studied on separate days, inhibited VFR and there was no significant difference in VFR inhibition among the 3 techniques (% of pre-AP VFR was 72+SE 2.2% after PN, 73+SE 2.4% after EAP, and 76+SE 2.8% after IS). Afferent signals from muscles contracting due to electrostimulation had no significant effect on the reflex arcs of VFR. The intradermal stimulation by AP played a significant role in VFR inhibition.

Takeshige_C1; Luo CP; Hishida F; Igarashi O (1990) Differentiation of AP and non-AP points by difference of associated opioids in the spinal cord in production of analgesia by AP and non-AP point stimulation, and relations between Na and those opioids. AETRIJ 15(3-4):193-209. Dept of Physiol, Showa Univ Sch of Med, Tokyo, Japan. Met-Enk antiserum i.t. abolished APA caused by low frequency stimulation of an AP point (ST36) of rats, but antisera of Leu-Enk and dynorphin (Dyn) did not. Dyn antiserum i.t. abolished analgesia (NAA) produced by stimulation of a non-AP point (NAPS) which was revealed by lesion in the analgesia inhibitory system (AIS), whereas antisera of Met-Enk and Leu-Enk did not. NAA was antagonized by the kappa-receptor antagonist, Mr2266, and analgesia was produced by the kappa-agonist, U50-488H, in the AIS lesioned rats. Potentials in the dorsal periaqueductal central grey (D-PAG) evoked by AP stimulation were antagonized by naloxone and antiserum of Met-Enk, and those in the lateral PAG (L-PAG) evoked by NAPS were antagonized by Mr2266 and antiserum of Dyn. After adrenalectomy, APA, potentials in the D-PAG, and analgesia caused by stimulation (SPA) of the D-PAG were abolished 12 h; and NAA, potentials in the L-PAG, and SPA of the L-PAG were abolished in 24 h. All were then restored 1 h after iv application of 1 ml of 5% NaCl solution. APA and NAA which were augmented for several hours before their abolition after adrenalectomy were not antagonized by naloxone nor M 2266, respectively. However naloxone and Mr2266 did antagonize APA and NAA, respectively, 1 h after treatment with 1 ml of 5% NaCl solution.

Takeshige_C2; Zhao WH; Guo SY (1991) Convergence from the preoptic area and arcuate nucleus to the median eminence in AP and non-AP point stimulation analgesia. Brain Res Bull May 26(5):771-778. Dept of Physiol, Showa Univ Sch of Med, Tokyo, Japan. Lesion of the preoptic area (POA) or medial arcuate nucleus (M-HARN) abolished APA. Potentials in the median eminence (ME) evoked by stimulation of the AP point were not affected by lesion of either the POA or M-HARN alone, but were abolished by concurrent lesion of both. No analgesia was produced by stimulation of the POA. Analgesia produced by stimulation of the M-HARN was abolished by lesion of the POA, and the abolished analgesia was restored by concurrent stimulation of the POA and M-HARN, hence POA and M-HARN outputs might converge in the ME to produce APA. Similar convergence from the anterior arcuate nucleus (A-HARN) and POA to the ME was observed in analgesia (NAA) produced by stimulation of a non-AP point (NAP). 2 pathways diverged from the lateral hypothalamus in the APA afferent pathway and 2 from the lateral periaqueductal central grey (L-PAG) in the NAA afferent pathway. POA potentials evoked by stimulation of the AP point were reversed by naloxone, and those evoked by stimulation of the point were reversed by dexamethasone. ACTH sensitive sites were found in both the L-PAG and the anterior hypothalamus.

Takeshige_C3; Tsuchiya M; Guo SY; Sato T (1991) Dopaminergic transmission in the hypothalamic arcuate nucleus to produce APA in correlation with the pituitary gland. Brain Res Bull Jan 26(1):113-122. Dept of Physiol, Showa Univ Sch of Med, Tokyo, Japan. APA caused by low frequency stimulation of the AP point was abolished by hypophysectomy and adrenalectomy. Termination of APA producing pathway from the AP point to the pituitary was in the medial hypothalamic arcuate nucleus (M-HARN). The origin of the descending pain inhibitory system associated with APA was in the posterior HARN (P-HARN). During AP stimulation, microinjection of 0.5 mg/kg morphine ip, or 0.1 ug beta-End into the P-HARN, restored APA in hypophysectomized rats, and enhanced neuronal activity in the P-HARN that were abolished during AP stimulation. Of the analgesia produced by dopamine or beta-End injected into the P-HARN, that caused by beta-End disappeared after denervation of the M-HARN. The P-HARN neurons that responded to AP stimulation also responded to iontophoretic dopamine, but not to iontophoretic morphine nor ultramicroinjected beta-End. The transmission between the M-HARN and P-HARN may be dopaminergic, and beta-End might presynaptically modulate this transmission. Reduction of sodium ions may have been the reason for abolition of AA after adrenalectomy.

Takeshige_C4; Nakamura A; Asamoto S; Arai T (1992) Positive feedback action of pituitary beta-End on APA afferent pathway. Brain Res Bull Jul 29(1):37-44. Dept of Physiol, Showa Univ Sch of Med, Tokyo, Japan. Potentials in the final sector of the afferent pathway from the AP point were enhanced by 0.5 mg/kg morphine ip without changing the threshold of AP stimulation and greatly decreased by hypophysectomy. The decreased potentials were restored to the control level by morphine (0.5 mg/kg, ip). Potentials evoked in the final sector of the afferent pathway from the non-AP point (NAP) by NAP stimulation after lesion of the analgesia inhibitory system were greatly enhanced by corticotropin (ACTH) (0.25 mg/kg, ip) and greatly decreased by hypophysectomy. Diminished potentials were restored to the control level by ACTH (0.25 mg/kg, ip). Both morphine (0.5 mg/kg, IP) and ACTH (0.25 mg/kg, ip) produced analgesia, but morphine did not affect APA and ACTH did not affect non-AP point stimulation-produced analgesia (NAA). All analgesia, that due to 0.5 mg/kg morphine or 0.25 mg/kg ACTH, APA, and NAA were abolished by hypophysectomy. The abolished APA and NAA were restored by 0.5 mg/kg morphine and 0.25 mg/kg ACTH, respectively. Hence, beta-E and ACTH released from the pituitary by stimulation of an AP point and NAP may act as positive feedback on the APA and NAA afferent pathways, respectively.

Takeshige_C5; Sato T; Mera T; Hisamitsu T; Fang J (1992) Descending pain inhibitory system involved in AP-analgesia (APA). Brain Res Bull Nov 29(5):617-634. Dept of Physiology, Showa Univ Sch of Med, Tokyo, Japan. The descending pain inhibitory system (DPIS) associated with APA, caused by low frequency EAP of an AP point, was identified by the results of lesioning and stimulation procedures previously used to differentiate afferent and efferent paths in rats. The DPIS starts in the posterior arcuate nucleus and descends to the hypothalamic ventromedian nucleus (HVM) from whence it divides into two pathways: one path (serotonin-mediated) descends through the ventral periaqueductal central grey (V-PAG) and then to the raphe magnus (RM). The other (noradrenergic) path descends through the reticuloparagigantocellular nucleus (NRPG) and part of the reticulogigantocellular nucleus (NRGC). The afferent and efferent paths are both present in the RM and NRGC. They were identified separately by means of stimulation-produced analgesia (SPA), produced by stimulation of the separate regions in APA-responders and APA-non-responders, because SPA of these regions in non-responders produced only efferent pathway mediated analgesia. [N.B. Stimulation of the CNS sites produced SPA in both APA-responders and APA-non-responders, indicating that the afferent paths were missing in the non-responders].

Takeshige_C6; Oka K; Mizuno T; Hisamitsu T ; Luo CP; Kobori M; Mera H; Fang TQ (1993) The AP point and its connecting central pathway for producing AP-analgesia (APA). Brain Res Bull 30(1-2):53-67. Dept of Physiology, Sch of Med Showa Univ, Tokyo, Japan. Characteristics of the AP point in producing APA were examined by the inhibition of noxious responses in the brain stem reticular formation, potentials, and neuronal activity in the dorsal periaqueductal central grey (D-PAG), and Electro-APA caused by low frequency stimulation of the AP point. Stimulation of the muscle beneath the AP point was effective in producing APA. APA measured by tail flick, vocalization, and writhing tests was abolished by hypophysectomy, and by icv injection of beta-End antiserum into the 3rd ventricle. The pathway from the D-PAG to the anterior hypothalamus (AA-AH) in the APA afferent pathway from the AP point to the pituitary gland was determined. The lateral hypothalamus, lateral septum, cingulate bundle, dorsal-hippocampus, and habenulo-interpeduncular tract were found, as well as regions previously found, to belong to the APA afferent pathway. A network of divergence and convergence in their rostral and caudal relations was observed. The APA afferent pathway diverges from the D-PAG, converges to the HP, and then projects to the AA-AH.

Wang_H4; Jiang J; Can X (1996) Changes of norepinephrine release in rat nucleus reticularis paragigantocellularis lateralis in AP-analgesia (APA). Inst of AP Research, Shanghai Med Univ, PRC. Adapted from WWW. Norepinephrine (NE) of the nucleus reticularis paragigantocellularis lateralis (RPGL) plays an important role in APA. The aim of this experiment was to study the role of NE in RPGL during APA at presynaptic level by using push-pull perfusion, high performance liquid chromatography with electrochemical detection (HPLC-ECD) techniques. Pain threshold increased significantly after 20 min of EAP, while the level of NE and its metabolite MHPG in the perfusate from the RPGL was markedly decreased. A negative correlation existed between the changes of pain threshold and the release of NE and MHPG. EAP inhibited the release of NE from the RPGL during APA.

Wang_HH2a; Xu SF (1993) Effect of D1 and D2 dopamine receptor antagonists on AP-analgesia (APA). Sheng Li Hsueh Pao Feb 45(1):61-68. Dept of Neurobiology, Shanghai Med Univ, PRC. Highly selective D1 or D2 receptor antagonists were tested in a rabbit skin pain model to study the effect of the subtypes of dopamine receptor on APA. D2 receptor antagonists haloperidol and clozapine iv, potentiated APA. D2 receptor antagonists domperidone and sulpiride and D1 receptor antagonist SCH23390 icv also enhanced APA markedly. The effect of D1 and D2 receptor on APA was discussed.

Wang_HH2b; Zhu YH; Xu SF (1994) [The potentiation effect of haloperidol on the binding of etorphine to brain membranes in APA]. Sheng Li Hsueh Pao Aug 46(4):313-319. Dept of Neurobiol, Shanghai Med Univ, PRC. [3H]-etorphine was used in receptor binding studies on membrane preparation from rabbit brain. Scatchard analysis revealed that rabbit brain had 2 different affinity binding sites. In the high affinity site, the dissociation constant (Kd1) of the control group was 2.57+0.33 nmol/L. When analgesia was induced by haloperidol or AP, the Kd1 values decreased respectively (p <.05) to 1.44+0.03 nmol/L and 1.53+0.05 nmol/L. These Kd1 values further decreased to 1.25+0.03 nmol/L when APA was potentiated by combined action of AP and iv haloperidol (p <.01). Autoradiographic analysis of brain slices showed that the density of opioid receptors in many brain regions, such as N. Caudatus, preoptic lateral area, N. Paraventricularis, N. Centromedianus, Periaqueductal grey, showed significant increase. The upregulation of opioid receptors in rabbit brain may be one of the mechanisms in the potentiating action of haloperidol on APA.

Wang_J6; Cheng ZF (1993) The action of medullary tail-flick related neurons in EAP-analgesia. Sheng Li Hsueh Pao Jun 45(3):299-304. Dept of Physiology, Xi'an Med Univ, PRC. 3 types of cells (off-neurons, on-neurons and neutral neurons) were recorded in the rostral ventromedial medulla (RVM) in lightly anaesthetized rats. Just before the occurrence of tail flick elicited by noxious heat, the on-cells showed a burst of activity while the off-cells exhibited a cessation of discharge. No change of neutral cell activity related to tail flick was observed. EAP at the two BL32 points inhibited tail-flick reflex. This EAP-analgesia affected the spontaneous activity of off- and on-cells in a different way: the discharge of most off-cells was increased significantly (p<.05). Tail-flick-related responses of the both cells were inhibited. The off-cells may be the main efferent neurons in RVM involving in EAP-analgesia.

Xia_Y1; Zhang L (1994) The components of somatosensory evoked potentials P250-N350 induced by nervi tibialis posterior stimulation. Chen Tzu Yen Chiu - AP Research 19(2):63-65. Dept of AP, Beijing Univ of TCM. The pain components of SEPs induced by stimulation of the posterior tibial nerves were studied by blocking the bloodflow of the leg in 10 normal adults. SEPs after the painful stimuli (0.1 ms square wave pulse) of the right ankle were recorded from the parietal median (C'Z) and the reference electrode at the Earlobe. A pressure of 80 mm Hg above arterial pressure was given to the right calf by sphygmomanometer. The P250-N350 components (latency 244.2+10.1 ms and 344.2+14.9 ms) of the SEPs persisted and the others disappeared when tactile sensation disappeared but pain existed. The P250-N350 were the pain potentials of nervi tibialis posterior SEPs.

Xiong_K; Zheng P (1990) [The effect of the septal area in APA]. Chen Tzu Yen Chiu 15(1):1-5, 12. Dept of Anatomy, Wannan Med Coll Wuhu, Anhui, PRC. This review summarized some articles on the effect of the septal area in APA. Animal-pain thresholds increased when the septal area was stimulated by EAP, and direct electrostimulation of the septal area markedly inhibited the pain discharges of cells in parafascicular nucleus of thalamus, lateral habenular nucleus, PAG and dorsal raphe nucleus. The septal area plays an important role in APA. Most cholinergic neurons in the septal area are located in nucleus of the vertical limb of the diagonal band (VDB); GABA of the septal area is mainly found in the diagonal band nucleus(td); Dopamine is present in high levels in td and lateral septal nucleus(S1) of septal area; The S1 contain high densities enkephalin-containing neuronal cell bodies and terminals; Also, Substance-P and norepinephrine are also high levels in the septal area. These substance above-mentioned have a relations with APA of septal area. A large number of serotonin-containing neurons are found in the raphe nuclei. The serotonin play an important role in APA. The serotonin-containing neurons in dorsal raphe nucleus project to S1. The fibre connections of the raphe nuclei with the td are reciprocation. The periaqueductal grey is a important structure on pain modulation. It projects to septal area and receives the fibres from S1. A number of adrenergic neurons are located within the locus coeruleus. The locus coeruleus participate pain modulation and APA. The locus coeruleus projects to the septal area.

Xu_R; Guan X; Wang C (1993) [Influence of capsaicin treating sciatic nerve on the pain threshold and the effect of APA of rats]. Chen Tzu Yen Chiu 18(4):280-284. Dept of Neurobiol, Tongji Med Univ, Wuhan, PRC. The model of local application of 1.5% Capsaicin (Cap) on the right sciatic nerve and control of Vehicle (Veh) on the left were used. The influence of Cap on pain threshold, EAP (EA) analgesia and Fluoride-resistant acid phosphatase (FRAP) activity in the dorsal horn of spinal cord were observed. The pain threshold of Cap treatment side rose significantly compared with the control side, FRAP in dorsal horn of spinal cord vanished, and the analgesic effect of EA at GB30 of the Cap treatment side markedly decreased, compared with not only that EA at the control side but also that EA before Cap treatment. The C fibres of the primary afferent participate in the input of pain and EAP analgesic information.

Xu_X; Shibasaki H; Shindo K (1993) Effects of AP on somatosensory evoked potentials: a review. J Clin Neurophysiol Jul 10(3):370-377. Dept of Brain Pathophysiol, Kyoto Univ Faculty of Med, Japan. Although AP has a long history of analgesic effects, the mechanisms underlying its effects are still unclear. Somatosensory evoked potentials (SEPs) were adopted in AP research since the 1970s. Research on the effects of AP on the conventional SEP has given variable results; 2 different opinions concerning the presence or absence of AP effects on the conventional SEP are discussed. Since the conventional SEP is mediated mainly by fast conducting sensory nerve fibres, the conventional SEP methods, especially those for recording short-latency SEP, may be inadequate for studying AP mechanisms. In the case of the long-latency cortical SEP, too few data are available to judge the effects of APA. In studies on the effects of APA on pain-SEPs, APA suppressed the amplitude of pain SEPs (and affected latency also in some trials) in both animals and humans, accompanied by an increased pain threshold. Thus, AP seems to have analgesic effects that are probably related to activation of the antinociceptive system, and application of the pain SEP methods to the study of mechanisms of APA may be promising.

Xu_Z1a; Xu W; Chen Z (1990) [Changes in responses of parafascicular nuclei during adjuvant-induced acute arthritis and effect of AP in the rat]. Chen Tzu Yen Chiu 15(1):77-81, 29. Inst of AP and Moxibustion, China Acad of TCM, Beijing, PRC. We showed earlier that during acute arthritis induced in rats by local intraplanter adjuvant, dramatic alterations in the behavioral responses to noxious stimulation occur. This study observed the responses of parafascicular nuclei (Pf) neurons during acute arthritis and the effect of EAP in rats. Results: 1.        Differences between arthritic and normal rats for the whole population of somatosensory neurons were not significant (p >.05); however, nociceptive neurons activated exclusively by noxious stimulation were less in arthritic rats (21/60) than in normal rats (35/46) (p <.01) and nociceptive-non-nociceptive neurons activated by both noxious and non-noxious stimulation were more in the arthritic rat (30/60) than in the normal rat (9/46) (p <.01) and differences in the numbers of non-nociceptive neurons between the 2 groups were not significant. 2. Nociceptive responses of Pf neurons (n=16) in acute arthritic rats were inhibited markedly by EAP at GB39 and BL60. In particular, the inhibitory effect was of great significance (p <.01) during 0-10 and 20-35 min after cessation of EAP. The rats were hyperalgesic during adjuvant-induced acute arthritis and EAP induced a good analgesic effect in acute arthritis. Adjuvant-induced acute arthritis in rats is a good model for research in pain and analgesia.

Xu_Z1b; Xu W; Chen Z (1994) Iontophoretic atropine attenuates the inhibitory effect of stimulating SmI on nociceptive responses of pf neurons. Chen Tzu Yen Chiu - AP Research 19(1):16-19. Inst of AP, China Acad of TCM, Beijing, PRC. Using the techniques of multimicropipette and iontophoresis, we observed whether ACh was involved in the cortical descending modulation of Pf neurons in rats. Inhibition elicited by stimulation of the sensorimotor area (SmI) was attenuated after microiontophoretic atropine; the nociceptive responses of Pf neurons were obviously reduced by microiontophoretic ACh. ACh may be considered as one of the neurotransmitters involved in the descending modulation of pain.

Yang_J1; Song CY; Lin BC; Zhu HN (1992) [Effects of stimulation and cauterization of hypothalamic paraventricular nucleus on APA]. Sheng Li Hsueh Pao Oct 44(5):455-460. Dept of Neurobiol, 2nd Military Med Coll, Shanghai, PRC. The role of hypothalamic paraventricular nucleus (PVH) in APA was investigated by local brain stimulation and cauterization. Electro-, or L-glutamate sodium- stimulation of PVH enhanced the APA-effect of ST36, both in a dose dependent manner. Electrical cauterization of PVH decreased the effect of APA; removal of pituitary had no effect on the enhancing effect by injection of L-glutamate sodium.

Yang_J2; Lin BC (1992) Hypothalamic paraventricular nucleus plays a role in APA through the CNS in the rat. AETRIJ Jul-Sep 17(3):209-220. Dept of Nuclear Med, Nan Fang Hospital, Guangzhao, PRC. This work investigates the effect of hypothalamic paraventricular nucleus (PVN) on APA in the rat. Electrostimulation of PVN or injection of L-glutamate sodium into PVN enhanced the APA effect induced by AP at ST36; electrical cauterization of PVN decreased the effect; Removal of the pituitary did not influence the effect of enhancing APA induced by the injection of L-glutamate sodium into PVN. The PVN may play an important role in APA through the CNS.

Yaun_B; Liu X (1992) [Effect of EAP on the nociceptive responses of SI cortical neurons in the rat]. Chen Tzu Yen Chiu 17(2):90-95. Research Lab of Neurophysiol, Xi'an Med Univ, Shaaxi, PRC. 1. The effect of EAP (EA) on the responses of single SI cortical nociceptive neurons to peripheral natural stimuli were observed in unanesthetized and paralysed rats. 2. After EA, the responses to noxious mechanical and/or thermal stimulation reduced markedly in 14/20 (70%) of neurons tested, and slightly increased or unchanged in the remaining 6 neurons, as compared to the responses before EA. 3. In contrast to the variation of nociceptive responses, the responses to innocuous mechanical stimulation increased in 9 neurons and unchanged in other 9 neurons, while deceased in only 2 neurons. 4. A small portion of the neurons were activated by EA stimulation, while their responses to noxious stimulation were inhibited. 5. It is considered that the selective inhibition of the nociceptive responses of SI cortical neurons might be a part of the mechanisms of APA.

Yonehara_N; Sawada T; Matsuura H; Inoki R (1992) Influence of EAP on the release of Substance-P and the potential evoked by tooth pulp stimulation in the trigeminal nucleus caudalis of the rabbit. Neurosci Lett Aug 142(1):53-56. Dept of Pharmacol, Faculty of Dentistry, Osaka Univ, Japan. The effects of EAP (EAP) on the release of Substance-P (SP) and the responses evoked by tooth pulp stimulation (ST) in superficial layers of the trigeminal nucleus caudalis (Vc-I,II) were studied in rabbits. ST evoked increase in release of immunoreactive SP (iSP). This increase was inhibited by EAP in 9 of 13 animals. The potentials evoked by ST were composed of 2 main components with latency times of ca 4.3 ms and circa 9.4 ms. The latter component, reflecting the excitation of A delta fibres, was significantly inhibited by CP-96,345 (3 mg/kg, iv), an SP antagonist. EAP also inhibited the latter component in 8/11 animals. One of the mechanisms of analgesia induced by EAP is inhibition of stimulus-evoked SP release in the Vc-I,II.

Yuan_B; Pang T; Liu X (1991) [Response properties of SI cortical neurons to EAP and manual AP in the rat]. Chen Tzu Yen Chiu 16(2):79-86. Research Lab of Neurophysiol, Xi'an Med Univ, PRC. Single SI cortical neurons were recorded extracellularly with glass micropipettes, and their response properties to EAP (EA) of contralateral ST36 and ST40, or to manual AP (MA) of ST36 were observed in unanesthetized and paralysed rats. In 46 rats, a total of 474 neurons were isolated in the hindlimb representation area of SI cortex. Among these neurons, 228 responded to peripheral mechanical stimulation, and were classified as cutaneous neurons, deep neurons and cutaneous-deep convergent neurons. 35 of them were identified as nociceptive neurons. Neurons of various sensory neurons and with receptive fields (RFs) located in the contralateral hindlimb responded to EA. Significant difference (p <.01) existed between the stimulation thresholds of cutaneous neurons (2.39+0.27V) and those of deep neurons (4.12+0.48V). There was no significant difference between the thresholds of nociceptive and non-nociceptive neurons. The typical response of SI neurons to single EA stimulation consisted of early discharges with a latency of 11.57+0.39 ms and late train discharges with a latency of 54.79+4.07 ms. A period of inhibition frequently intervened between the 2 groups of discharges. In a small portion of neurons, only a period of inhibition was produced. The responsiveness of neurons decreased markedly when the frequency of repeated EA stimulation was increased from 1 Hz to 50 Hz. Neurons of various sensory modalities responded to MA as well. Judging by RF distribution of the responsive neurons, however, the extent of action of MA was smaller than that of EA.

Zhang_LS; Tang YZ; Zhang ZX (1984) Antagonistic effect of Ca and Mg ions in amygdala on Electro-APA and morphine analgesia in the rabbit. Acta Zool Sin Peking 30(1):32-43.

Zhang_Z; Tu Z; Zhu Z (1990) [Effect of icv injection of thyrotropin releasing hormone on EAP analgesia and the level of cerebral cAMP in rats]. Chen Tzu Yen Chiu 15(2):112-116. Dept Physiol, Fac of Basic Med Sciences, Tongji Med Univ, Wuhan, PRC. Experiments were performed on 42 female albino rats weighing from 180-250 g. The pain threshold (PT) was determined by radiant heat induced tail-flick method. The cAMP levels in various regions of brain were measured by radio-immunoassay. EAP (EA) at bilateral ST36 and SP06 in rats significantly elevated PT, increased the level of cAMP in the hypophysis, while decreased that of septal nucleus. No effects were found in the basal PT and the cAMP levels of the hypophysis and septal nuclei after icv injection of TRH. However, after TRH icv, EA did not elevate PT, but still increased hypophysial cAMP with a decrease in the level of cAMP in the septal nucleus. cAMP may be related to EAP-analgesia in some brain regions, and TRH injected into cerebral ventricles can antagonize EAP-analgesia, but this effect seemed to have no relation to the levels of cAMP of hypophysis, septal nucleus, caudatum, hypothalamus and thalamus.

Zheng_P; Xiong K (1990) [The efferent pathway of the septal nuclei on participation in APA]. Chen Tzu Yen Chiu 15(3):177-180. Dept of Anatomy, Wannan Med Coll Wuhu, Anhui, PRC. The efferent projections of septal nuclei from the brain areas relating to pain in the rat were studied with WGA-HRP and HRP methods. Results: The septal areas project widely to some brain areas relating to pain, for instance, locus coeruleus, raphe nuclei, periaqueductal grey, thalamus, hypothalamus, habenular, amygdaloid complex, cingulate cortex and hippocampus ets, but the projections of medial septal nucleus, lateral septal nucleus and diagonal band nucleus are different. It is possible that these fibre projections are one of the morphological basis of septal nuclei for regulating pain.

Zheng_X1; Xu W; Chen Z (1992) [Corticofugal modulation of somatosensory area II on AP effect in nucleus ventralis posterolateralis of the thalamus]. Chen Tzu Yen Chiu 17(3):156-160. Inst of AP and Moxibustion, China Acad of TCM, Beijing, PRC. In order to explore whether cortical somatosensory area 11 (SII) was involved in descending modulation of the effect of EAP (EA) on nucleus ventralis posterolateralis (VPL), the present study was designed to investigate the influence of topical application of lidocaine at SII on the EA effects in VPL nucleus. Experiments were performed on 23 adult cats anaesthetized with pentobarbital sodium (35-40 mg/kg ip) and immobilized with gallamine triethiodide. The single unit activities of VPL neurons were extracellularly recorded using glass microelectrodes. Results: 1. The nociceptive responses of VPL were obviously attenuated after EA at GB30 and GB34. The difference was statistically significant at 0-10 min after cessation of EA (n=13, p <.001 or p <.05), then it was gradually recovered. EA inhibited the nociceptive responses of VPL neurons. 2. The inhibitory effect of AP on nociceptive responses were reduced or abolished after topical application of lidocaine (n=14, p >.05). However, it exerted marked inhibition at 0-10 min after cessation of EA in the saline control group (n=14, p <.05). There was a statistical difference between these 2 groups (p <.05). SII was involved in descending modulation of AP effect in VPL nucleus.

Zheng_X2; Chen Z; Xu W; Shi H (1994) Involvement of glutamate in corticofugal modulation of intralaminar nuclei from SII via motor cortex in AP-analgesia (APA). Chen Tzu Yen Chiu - AP Research 19(1):11-15. Inst of AP, China Acad of TCM, Beijing, PRC. This was a study of the effect of glutamate on cortical somatosensory area II (S II) producing descending modulation of intralaminar nuclei (ILN) via the motor cortex (MCtx) in APA. The glutamate antagonist glutamate diethylester (GDEE) or saline was applied topically at MCtx in 17 cats. Single unit activities of ILN neurons were recorded extracellularly. Nociceptive responses of ILN neurons were attenuated by stimulating S II after topical application of saline at MCtx. However, the inhibitory effect of stimulating S II in the same neurons was reduced after application of GDEE. There was a significant difference at 0-1 h after the stimulation between the two groups (n=10, p <.05). The inhibitory effect of EAP on nociceptive responses was reduced after topical application of GDEE, while marked inhibition was shown at 0-10 h after cessation of EAP in the saline control group (n=11, p <.05). The results, and the finding that EA activated most S II neurons, showed that glutamate released from S II to MCtx may be involved in corticofugal modulation of ILN from S II via MCtx in APA.

Zhou_L2a; Tian Q; Jiang J; Wu G; Cao X (1991) [Effect of electro-stimulation and lesion of N reticularis paragigantocellularis lateralis on APA in rats]. Chen Tzu Yen Chiu 16(2):103-107. Dept of Neurobiol, Shanghai Med Univ, PRC. This study aimed to investigate the role of the reticularis paragigantocellularis lateralis (RPGL) in APA. Tail-flick response to electrostimulation of the tail skin was taken as index of pain response. The first part of the study consisted of 4 groups: 1=surgical control, n=14; 2=EAP, n=14; 3=electrostimulation of RPGL, n=14; 4=EAP + simultaneous stimulation of RPGL, n=8). The pain threshold in group 1 was stable during the experiments, but increased significantly after EAP (p <.001) and/or brain stimulation (p <.01; p <.001). Mean pain threshold of group 4 increased much more than that of groups 2 and 3 (p <.001, p <.01). In part 2, a unilateral electrical lesion of the RPGL (n=12, p <.01) significantly reduced the effect of EAP. Electrical stimulation of RPGL enhances EAP-analgesia, but an RPGL-lesion reduces it. The RPGL plays a role in APA.

Zhou_L2b; Jiang JW; Wu GC; Cao XD (1993) [Changes of endogenous opioid peptides level in RPGL during AP-analgesia (APA)]. Sheng Li Hsueh Pao Feb 45(1):36-43. Dept of Neurobiology, Shanghai Med Univ, PRC. Assessed by push-pull perfusion technique and RIA of neuropeptides, release of Leu-Enk from the RPGL was significantly higher after EAP for 20 min, than in the control group (p<.05) but no significant changes were found in the EAP group that had poor analgesia. Changes of release of Leu-Enk or beta-End correlated positively with increase of pain threshold. The release of DynA1-13 was barely significant (p >.05). APA increased the release of Leu-Enk and beta-End in the RPGL.

Zhou_L2c; Wu GC; Cao XD (1995) Role of opioid peptides of rat's nucleus reticularis paragigantocellularis lateralis (RPGL) in AP-analgesia (APA). AETRIJ Apr-Jul 20(2):89-100. Dept of Neurobiology, Shanghai Med Univ, PRC. We studied the role of the RPGL and its endogenous opioid peptides in APA using techniques of brain stimulation and lesion, microinjection, push-pull perfusion and RIA. Electrostimulation of the RPGL increased pain threshold and enhanced the effect of Electro-APA; lesion of the RPGL reduced the effect of APA. Microinjection of naloxone (5 ug/0.5ul/2min) into the RPGL partially reversed the effect of APA and the reversal effect of naloxone was dose-dependent. Release of Leu-Enk and B-endorphin (B-EP) from the RPGL in the APA group was significantly higher than that in the control group (p <.05). Correlations between the changes of release of Leu-Enk, B-EP, and the increase of pain threshold, were positive. The RPGL may play an important role in APA. Activation of the RPGL and the endogenous opioid peptides within it enhance the effect of APA.

Zhou_Y4; Sun YH; Shen JM; Han JS (1993) Increased release of immunoreactive CCK-8 by EAP and enhancement of EAP-analgesia by CCK-B antagonist in rat spinal cord. Neuropeptides Mar 24(3):139-144. Neuroscience Research Centre, Beijing Med Univ, PRC. In the CNS, CCK octapeptide (CCK-8) acts as a potent anti-opioid neuropeptide. It hinders opioid analgesia and facilitates opioid tolerance. EAP markedly increased CCK-8 immunoreactivity (ir) in the perfusate of the rat spinal cord. The increase of CCK-8-ir was most marked in response to EAP of 100 Hz and 15 Hz, and less marked in response to EAP of 2 Hz. Since CCK-8 possesses potent anti-opioid activity at the spinal level, blockade of the spinal CCK effect would be expected to potentiate EAP-analgesia, which is known to be opioid-mediated. Intrathecal (i.t.) injection of CCK-8 antagonist L-365260 per se did not affect tail flick latency (TFL) significantly, yet it potentiated EAP-analgesia in a dose- and frequency- dependent manner. The potentiation was most marked at a dose range of 2.5-5.0 ng (i.t.) and at a frequency rank order of 100 Hz > 15 Hz > 2 Hz. Increased release of CCK-8 after EAP may limit the effect of opioid peptides; CCK-8 receptor mediates the anti-opioid effect of CCK-8 in rat spinal cord.

Zhu_CB; Li XY; Zhu YH; Xu SF (1995) Binding sites of mu receptor increased when APA was enhanced by droperidol: an autoradiographic study. Chung Kuo Yao Li Hsueh Pao Jul 16(4):311-314. Dept of Neurobiol, Shanghai Med Univ, PRC. AIM: To study if mu receptor participates in the process of potentiation of droperidol (Dro) on APA. METHODS: Autoradiographic technic was used. Ohmefentanyl, a highly selective ligand of mu receptors, was used in radio-receptor binding assay in Sprague-Dawley rat brain sections. Results: The binding sites of [beta-3H, p-benzoyl-3H]ohmefentanyl were increased greatly in many nuclei of rat brain after APA, and were further increased when APA was enhanced by Dro. Higher increase was seen in caudate nucleus, accumbens, PAG, interpeduncular nucleus, amygdala (p <.01 v rats treated with EAP alone); moderate increase was noted in thalamus, lateral area of hypothalamus, spinal dorsal horn (p <.01 or 0.05); slight increase appeared in septum, preoptic area, hippocampus, substantia nigra (p <.05). Conclusion: Mu opioid receptors mediated the Dro-induced enhancement of APA.

Zhu_J; Xia Y; Cao X (1990) [Effects of noradrenaline and dopamine in preoptic area on APA]. Chen Tzu Yen Chiu 15(2):117-122. Dept of Neurobiol, Shanghai Med Univ, PRC. Previous work has shown that activation of catecholamine in the preoptic area is to the disadvantage of APA. In this work microinjection and push-pull perfusion as well as HPLC-ECD were used to observe the effect of noradrenaline and dopamine in this area on APA. Results: Microinjection of noradrenaline (0.5 ug unilaterally) into the preoptic area attenuated APA; dopamine (2 ug unilaterally) had no effect on APA. During APA, the levels of noradrenaline and MHPG in the perfusate from the preoptic area decreased markedly but dopamine did not change significantly. Activating noradrenaline, but not dopamine, had antagonistic effect on APA.

Zhu_JM; He XP; Cao XD (1990) [Changes of releases of beta-End-like immunoreactive substances and noradrenaline in rabbit's preoptic area during APA]. Sheng Li Hsueh Pao Apr 42(2):188-193. Dept of Neurobiol, Shanghai Med Univ, PRC. RIA and HPLC-ECD were used respectively to detect beta-End-like immunoreactive substances (beta-EPIS), noradrenaline and 3-methoxy-4-hydroxyphenyloglycol (MHPG), a noradrenaline metabolite, in the perfusate from the rabbit's preoptic area before and after 10 min of EAP (EA). It was found that, the level of beta-EPIS in the perfusate increased during APA, while those of noradrenaline and MHPG decreased. A negative correlation (r=-.831; p <.05) was shown between the changes of beta-EPIS and MHPG levels during APA, indicating that beta-End may be related to the inhibition of noradrenaline release during APA.

Zhu_JM; Li KY; Cao XD (1990) [Effects of destruction of preoptic catecholaminergic nerve terminals on APA]. Sheng Li Hsueh Pao Apr 42(2):135-140. Dept of Neurobiol, Shanghai Med Univ, PRC. The effect of microinjection of 6-hydroxydopamine into the preoptic area was studied to observe the effect of destruction of catecholaminergic terminals in the preoptic area on APA. It was shown that the analgesic effect of AP was significantly enhanced in 6-hydroxydopamine treated group on d 2 and d 4 after injection as compared with those before injection or those in control group. The fluorescence of catecholamine terminals in the preoptic area disappeared almost completely on d 4 after injection, and did not restore on d 10. Reduction of catecholamine level in the preoptic area may enhance APA.

Zhu_L; Li C; Yang B; Ji C; Li W (1990) The effect of neonatal capsaicin on APA: to evaluate the role of C fibres in APA. Chen Tzu Yen Chiu 15(4):285-291. Inst of AP, China Acad of TCM, Beijing, PRC.

Zhu_L; Li C; Ji C; Li W (1993) [The role of OLS in peripheral APA in arthritic rats]. Chen Tzu Yen Chiu 18(3):214-218. Inst of AP and moxibustion, China Acad of TCM, Beijing, PRC. We showed previously that opiate-like substance (OLS) is involved in the central mechanism of APA in arthritic rats. In this paper, the role of OLS in peripheral mechanism of APA is studied further. 24 h after sc injection of Freund's adjuvant into the right ankles, acute arthritis with typical symptoms developed in all rats. After AP needling at GB30 for 10 min, the pain threshold (PT) rose by 42.3% (p <.05) in the inflamed ankles and by 5.6% in the non-inflamed ones. A dose of 250 and 100 ug naloxone (Nx) iv completely and partially (49.6%) blocked AA, respectively. Nx by local (icv ?) injection (100 ug, even 20 ug) completely antagonized APA. After morphine iv (10, 5.0, 2.5, 1.25 mg/kg), PT rise was dose-related, and PT was raised by 86.5+22.7% in the affected ankles and by 32.9+14.9% in the normal ankles at a dose of 5 mg/kg. Opiate receptors in the inflamed area seem to be sensitized and activation of the endogenous opiate system may be involved in APA. AP may enhance the release of peripheral OLS, which can act at the sensitized opiate receptors, leading to more potent analgesic effect in the inflamed area.

Zhu_LX; Zhao FY; Cui RL (1991) Effect of AP on release of substance P. Ann NY Acad Sci 632:488-489. Dept of Physiology, China Acad of TCM, Beijing, PRC.

Zhu_LX; Li CY; Ji CF; Yang B; Li WM (1993) [The role of Substance-P and somatostatin in AP and moxibustion-induced postsynaptic inhibition]. Chen Tzu Yen Chiu 18(4):290-295. Inst of AP and moxibustion, China Acad of TCM, Beijing, PRC. Our previous work indicated that AP and moxibustion (heating AP points with a special lamp) could inhibit the tail flick reflex and the nociceptive response of dorsal horn neurons. In the present study the role of somatostatin (SS) and Substance-P (SP) in AP and moxibustion-induced postsynaptic inhibition was studied further. The experiments were performed on male adult Wistar rats. The antidromic action potential (AAP) induced by cervical cord stimulation was recorded extracellularly at lumbar cord (L3-4). AAP latency was used to represent the excitability of postsynaptic projecting neurons. The effects of AP (0.5 ms, 3.3 Hz, 2 mA) for 5 min or moxibustion (the temperature up to 45-46oC) for 6 min at GB30 points on the latency of AAP were observed. And then the effects of topical administration of SS or SP antiserum on either AP or moxibustion-induced postsynaptic inhibition were observed. Results: AAP latency was markedly prolonged by AP and moxibustion. The maximal prolongation was 0.196+0.071 ms (n=12, p <.02) and 0.176+0.062 ms (n=11, p <.02) respectively. After topical administration of SS antiserum (1:40, 10 uL), AAP latency was prolonged slightly by either AP or moxibustion. The maximal prolongation (0.041+0.029 ms and 0.016+0.020 ms) was significantly reduced by SS antiserum (p <.05). While pretreated with SP antiserum, the latency was still prolonged by moxibustion (0.142+0.067 ms), but not by AP (-0.003+0.046 ms). Postsynaptic inhibition may be involved in both APA and moxibustion analgesia. The former is predominately mediated by SP and partially by SS, while the latter mainly by SS but not by SP.

Zhu_S; Shi F; Liu Z; Jiang J (1990) [Autoradiographic visualization on the role of central 3H-5-HT in APA]. Chen Tzu Yen Chiu 15(4):269-273. Suzhou Med Coll, PRC. The role played by central 5-hydroxytryptamine (5-HT) in EAP analgesia has been studied in rats by means of autoradiography with isotopic tracers 3H-5-HT. The purpose of the present study is to determine the localization of 3H-5-HT in the midbrain raphe nuclei and in the mesencephalon aqueduct as well as periaqueductal grey matter. Parallel experiments were studied by freezing microautoradiographic method and histo-fixative microautoradiographic method. The analgesia effect of AP can be enhanced or lowered by the increment or the decrement of the 5-HT level in the midbrain raphe nuclei and in the mesencephalon aqueduct as well as periaqueductal grey matter. When the rats were subjected to EAP analgesia, the microautoradiographic intensities of 3H-5-HT both in the midbrain raphe nuclei and in the areas of mesencephalon aqueduct were significantly increased. The release of 5-HT in these regions of the brain was accelerated during APA. Midbrain raphe nuclei and the mesencephalon aqueduct as well as the periaqueductal grey matter are closely related to APA. 5-HT in these areas may be one of the most important neurochemical agents mediating APA.

Zou_T; Liu X (1993) [The influence of pyramidal tract pathway of sensorimotor cortex on the effects of APA on NRM neurons]. Chen Tzu Yen Chiu 18(1):29-32, 36. Inst of AP and Moxibustion, China Acad of TCM, Beijing, PRC. The experiment was to study whether the effects of EAP (EA) on neurons in nucleus raphe magnus (NRM) were influenced after lesion of bilateral pyramidal tracts (PT) in the rats. Unit discharges of NRM were recorded extracellularly with glass microelectrodes and their nociceptive responses were induced by trains of electrostimuli to the tail. Only neurons excited by noxious stimulation of the tail were researched. 1. The effects of EA at bilateral ST36 points on 31 NRM neurons were observed in control group. EA had a tendency to activate NRM neurons, but inhibited obviously nociceptive response of the neurons at 0-30 min (p <.01). The effects of EA of PT control group (PT exposed and kept intact) were recorded on 8 units in NRM. EA had a tendency to activate the neurons, but inhibited obviously nociceptive response of the neurons and decreased nociceptive response rate 25.3+8.7% at 0 minute (n=8, p <.05) 3. EA after the PT lesion, it obviously inhibited nociceptive response of the neurons in NRM at 0-20 min (n=9, p <.01-0.05). It inhibited nociceptive response of all the neurons and decreased nociceptive response rate 57.8+11.6% at 0 minute (p <.01). The effect was larger than the effect of EA of PT control group and increased 32.5% at 0 minute (p <.05) than this. It also increased the effect of EA activating the neurons than PT control group. SM may influence the effect of EA analgesia, which involves in both PT and extrapyramidal system (EPS).

4. AP AND FOS-NEURONS
He_L; Wang M; Gao M; Zhou J (1992) Expression of c-fos protein in serotonergic neurons of rat brainstem after EAP. AETRIJ Oct-Dec 17(4):243-248. Dept of Neurobiology, Shanghai Med Univ, PRC. The c-fos proto-oncogene encodes a nuclear phosphoprotein, Fos which has been proposed to be a "third messenger" coupling short term extracellular signals to long term alteration in cell function. Using double labelling immunocytochemistry, the present work showed the co-localization of Fos protein and serotonin in the nucleus raphe dorsalis, nucleus raphe centralis superior and rostral ventromedial medulla. The possible relation of Fos protein to the biosynthesis of serotonin, awaits further investigation.

Ji_RR; Wang XM; Han JS (1992) Induction of Fos-like protein in the rat spinal cord after EAP stimulation. Sheng-Li-Hsueh-Pao Aug 44(4):394-400. Dept of Physiology, Beijing Med Univ, PRC. The expression of the c-fos proto-oncogene has been regarded as a marker for noxious stimulation. We now report that EAP stimulation (100 Hz, 0.3 ms, 1-2-3 mA, 30 min) at SP06 also induced c-fos expression in the rat spinal cord, as shown immunohistochemically by using antibody against the c-fos protein product Fos. In rats receiving EAP, many cells with Fos-like immunoreactivity (FLI) were observed in both dorsal and ventral horn of the spinal cord with dense labelling in laminae III and IV of the ipsilateral side. Only scattered FLI cells were found in laminae I and II. In contrast, FLI evoked by noxious stimulation (5% formalin injected sc at the hindfoot) occurred mainly in laminae I and II, rather than in III and IV. The c-fos expression was very low in control animals receiving neither formalin nor EAP. The site specificity of the c-fos expression induced by EAP is different from that evoked by noxious stimulation. The possibility that EAP-induced Fos protein might participate in AP-analgesia is currently under investigation.

Lee_JH; Beitz AJ (1993) The distribution of brain-stem and spinal cord nuclei associated with different frequencies of EAP-analgesia. Pain Jan 52(1):11-28. Dept of Vet Biology, Univ of Minnesota, St. Paul 55108. Immunocytochemical localization of the c-fos primary gene protein, Fos, was used to identify spinal cord and brain-stem sites activated by either 4-Hz or 100-Hz EAP applied to the ST36 points of both hind limbs in lightly anaesthetized Sprague-Dawley rats. The number and distribution of Fos-immunoreactive neurons in the brain stem and spinal cord of 4-Hz and 100-Hz EAP-treated rats were compared with these in anaesthesia and room control rats. Compared to non-stimulated control rats or rats in which EAP was applied to a non-AP point, both 4-Hz and 100-Hz EAP-treated groups exhibited a significantly more Fos-labelled neurons in the dorsal horn of the L2 spinal cord segment, lateral parabrachial nucleus, substantia nigra, nucleus raphe pallidus, dorsal raphe, locus coeruleus, posterior pretectal nucleus, and the lateroventral PAG. In the 4-Hz-treated group, significant increases in Fos labelling were also observed in the cuneiform nucleus, dorsal and laterodorsal subdivisions of the PAG, habenular nucleus, arcuate hypothalamic nucleus, and the lateroventral and lateral hypothalamic nuclei as compared to non-stimulated controls. The only brain-stem nucleus that exhibited significantly increased Fos-immunoreactive neurons in 100-Hz but not 4-Hz EAP was the rostolateroventral nucleus of the medulla. Many brain-stem regions are activated by both 4-Hz and 100-Hz EAP but additional brain-stem regions are selectively activated by 4-Hz EAP which may relate to the opiate sensitivity of 4-Hz EAP. The data identify several distinct brain-stem nuclei that may play a role in AP-analgesia.

Ma_QP2; Zhou Y; Han JS (1993) EAP accelerated the expression of c-Fos protooncogene in dopaminergic neurons in the ventral tegmental area of the rat. Int J Neurosci Jun 70(3-4):217-222. Dept of Physiology, Beijing Med Univ, PRC. The mesolimbic dopaminergic system has been implicated in mediating morphine and EAP-analgesia. In the present study, Fos immunoreactivity was used as a marker of neuronal activity to study if EAP could activate the dopaminergic neurons in the midbrain. EAP significantly increased the number of Fos-positive dopaminergic neurons in the ventral tegmental area (VTA), whereas no significant c-fos expression in the dopaminergic neurons was observed in the substantia nigra (SN). VTA rather than the SN may play a role in mediating EAP-analgesia.

Pan_B; Castro Lopes JM; Coimbra A (1994) C-fos expression in the hypothalamo-pituitary system induced by EAP or noxious stimulation. Neuroreport 15 Aug 5(13):1649-1652. Inst of Histology and Embryology, Fac of Med, Univ of Oporto, Porto, Portugal. In the anaesthetized rat, low frequency electrostimulation of ST36 or noxious thermal stimulation caused by immersing the footpad in water at 52oC caused marked expression of c-fos in the anterior lobe of the pituitary gland, as well as in the arcuate and some nearby hypothalamic nuclei. A similar anterior lobe response was caused by immobilization stress in awake rats but in this case Fos-immunoreactive cells extended into the intermediate lobe and were very abundant in the paraventricular nucleus. The anterior pituitary cells that respond to stress are also activated by AP or painful stimuli. However, mechanisms of activation of pituitary cells by AP are distinct from those activated by stress, as different hypothalamic nuclei are involved.

K. AP and Spinal Trauma, Paralysis, Polio, Epilepsy, Spasm

1. SPINAL TRAUMA, SPASTICITY, PARALYSIS
Han_JS; Chen XH; Yuan Y; Yan SC (1994) TENS for treatment of spinal spasticity. CMJ (UK) Jan 107(1):6-11. Neuroscience Research Centre, Beijing Med Univ, PRC. 32 patients with spinally originated muscle spasticity were treated with TENS, the Han's AP stimulator (HANS) via skin electrodes placed over the AP points on the hand and leg. High frequency (100 Hz), but not the low frequency (2 Hz), TENS was effective in relieving muscle spasticity. The therapeutic effect lasted for only 10 min in the first treatment, but it became consolidated after treatment once/d for 3 mo. The anti-spastic effect induced by high frequency TENS can be partially reversed by a high dose of naloxone. The anti-spastic effect elicited by peripheral TENS is mediated in the CNS, at least in part, by the endogenous opioid ligand interacting with the kappa opiate receptors, most probably dynorphin.

Jin_ZG (1996) Experimental Spinal Cord Traumatic Injury of the Cat Treated With EAP. Inst of AP and Moxibustion, China Acad of TCM, Beijing 100700, PRC. Adapted from WWW. 44 cats were used in this experiment. The spinal cords of 40 animals were injured at circa L1 level by using Allen's method (400g/cm) and assigned at random to 2 groups: A=EAP treatment (n=20); B=Control (n=20). At 2 wk after spinal cord injury, survival rates in groups A and B (80 and 45% respectively) differed significantly (p<.05). Motor-evoked potentials at 2 wk after spinal cord injury in groups A and B differed significantly in short latency peak 15.6+5.0 and 21.7+5.02 mS (p<.05) and in amplitude (10.6+0.59 and 0.56+0.32 mV; p<.05). Anti-NF-H (neurofilament) was determined at 2 and 4 wk respectively after spinal cord injury. Group A had significantly more (p<.01) NF-H positive labelling fibres than Group B. After traumatic injury to the spinal cord, EAP significantly improved survival rate and regeneration of the spinal cord.

Lopez_HS; Trigos GM; Titievsky JB (1993) Homeopathy, EAP and Laser Therapy in a Successful Treatment of a Complicated Wobbler Syndrome in a Dog: Case-Report. Vet Mexico Oct-Dec 24(4):339-341. HS Lopez, Natl Autonomous Univ Mexico, Fac Med Vet & Zootecn, Dept Fisiol & Farmacol, Mexico City 04510, DF, Mexico. We report successful treatment of a complicated case of wobbler Syndrome using homeopathy, EAP and laser-AP therapy. Cervical vertebral instability was associated with bilateral hip dysplasia and partial muscular atrophy of the hind limbs. This latter problem was treated 1 yr earlier with bilateral removal of the femoral heads followed by physiotherapy which enabled the dog to perform basic manoeuvres. EAP was given once/d for 10 d, then every 2 d for 2 mo. Then, laser-AP at the AP points was given once/d for 10 d and a further 30 d of treatment with simultaneous EAP and laser-AP were given every 2 d. Homeopathy was given during the whole treatment period. Although full recovery was not achieved, the patient showed outstanding control of movement. Independent strolling, self-feeding and full sphincter control made his life possible within the family surroundings.

Politis_MJ; Korchinski MA (1990) Beneficial effects of AP treatment after experimental spinal cord injury: a behavioral, morphological, and biochemical study. AETRIJ 15(1):37-49. Dept of Surgery, Univ of Saskatchewan, Saskatoon, Canada. The uses and limitations of "first aid" AP treatment were assessed after spinal cord injury in rats. Spinal cords were exposed to a standardized contusion lesion at T8, followed by EAP stimulation of 3 points: BL60 (within the depression dorsal to the lateral malleolus), BL40 (popliteal space) and GV03 (intervertebral space between L4-L5). AP was given at either 15 min or 24 hrs after surgery. Control rats received spinal cord injury without AP treatment. Animals were assessed at 3 d post-operatively. Results showed improved function (as assessed by a combined behavioral score) in rats which had been treated with AP 15 min after injury relative to those that received no AP treatment. This was accompanied by minimization of post-traumatic cord shrinkage in AP-treated animals and a marked (3 fold) sparing of ventral horn neurons. Plasma cortisol levels rose over 3-fold within 2 h post-operatively in non-AP-treated rats, where these levels rose <2-fold in AP treated animals. None of the above beneficial effects occurred in rats given AP treatment 24 hrs after spinal cord injury. AP was useful as an adjunct treatment during early stages after spinal cord injury.

Qu_H; Ren L; Guo Y (1991) Combined application of scalp and body AP in the treatment of pseudobulbar paralysis. JTCM Sep 11(3):170-173. Hospital of TCM, Hexi District, Tianjin, PRC.

Yu_Y4 (1993) TENS at AP points to treat spinal spasticity: effects and mechanism. Chung Hua I Hsueh Tsa Chih Oct 73(10):593-595, 637. Dept of Orthopaedic Surgery, First Teaching Hospital, Beijing Med Univ, PRC. To study the effect and mechanism of electrostimulation in treating spinal spasticity, we used EAP on the surface of 2 couples of AP points. The short term application (30 min) of high-frequency EAP (100 Hz) produced an immediate antispastic effect in contrast to the low-frequency EAP (2 Hz). After application of high-frequency EAP (2 times/d, 30 min/time) for 3 mo, antispastic effect was stable. To keep this antispastic effect, the high-frequency EAP must be used permanently. Recent experimental results showed that low and high frequency EAP release MEK and dynorphin respectively from the spinal cord in humans. We infer that by enhancing the production of dynorphin in CSF, high-frequency EAP decrease the excitability of the motor neurons in the anterior horns through the kappa opiate receptors, thus ameliorating the muscle spasticity of spinal origin.

2. POLIO, POST-POLIO SYNDROME
H'Doubler FT Jr (1996) The Treatment of Post-Polio Syndrome (PPS) with AP. Adapted from WWW. Dr FT H'Doubler Jr MD, 1900 South National, Suite 2950, Springfield, Missouri 65804-2240, FAX (417) 882-3210, Voice (417) 882-3066, EMail:[email protected]

Poliomyelitis.
Polio is one of the oldest diseases of mankind. Polio came into prominence in the USA in the dreaded summers of the 1930s, 40s, and 50s when we had such horrible epidemics. Fortunately in 1955, the Salk Vaccine became available and this brought the dreaded disease under control in the USA.

In those days, we were not aware that many polio survivors would develop new symptoms 15-40 yr later. These symptoms were severe fatigue, pain, and muscle weakness. Many of these patients also experienced cold intolerance, insomnia, depression, anxiety, respiratory problems, short attention span, etc.

The usual scenario was that the patient would consult with his or her family doctor regarding these symptoms, had a Med evaluation and possibly a neurological examination, and finally be advised to see a psychiatrist.

The late effects of Polio began gaining wide spread recognition in the early 1980s and the term Post-Polio Syndrome (PPS), was coined at about the time of the First International Post-Polio Conference at Warm Springs, Georgia in May 1984.

The Med community is not well aware of PPS, so it is up to the patient to advise his or her doctor that they have had polio and give literature about PPS to the physician.

Unfortunately, polio has no specific diagnostic test, so it has to be diagnosed by exclusion.

Other PPS therapies
There are circa 650000 Polio survivors in the USA, circa 350000 of whom have PPS symptoms. We have had no definitive therapy to offer these patients.

We advise them in regards to weight control and good nutrition, obtaining more rest and avoiding stress, using improved equipment such as lighter canes, braces, wheelchairs, ventilators, etc, and also to exercise and become active in the PPS Support Groups. Also, they might consider receiving flu and/or pneumonia vaccinations.

Results of this new treatment
We present our experience of treating our first 50 PPS patients and the results. Marked improvement was noted in 45 patients (90%) and 36 (72%) stated that their condition had returned to the pre-PPS state. Usually 4-5 treatments on consecutive d is all that is needed. Several patients returned 6-18 mo later for one additional treatment. Each of these patients had been diagnosed elsewhere as having had Polio in the past.

In our study we did not make changes in the Med management, lifestyle, exercise programs, medications, etc. They were all advised to continue with the present program and to continue being seen by their local doctor. This gave us an opportunity to evaluate more carefully this modality as part of our armoury.

The modality used was Ear-therapy, using a protocol designed for PPS. The entire treatment lasts <1 h and the treatments are now given once/d for 4-5 d for better and quicker results.

It is very, very important that the treatment points be treated very precisely. Also, there are obstacles to treatment which prevent the most favourable response. The main hinderance is stress. Vertebral blockage, especially of the 1st rib is the 2nd most common. These and other hindrances are treated as indicated.

Conclusion
PPS patients are Polio survivors who have stabilized with their acute disease many years ago and then 15-40 yr later notice excess fatigue, pain, weakness, and maybe other symptoms such as cold intolerance, insomnia, dysphagia, respiratory problems, short memory span, etc. There are circa 350000 PPS patients in the US alone who would benefit from this treatment. This breakthrough, using a definitive treatment, has drastically improved the lifestyle of many PPS patients.
H'Doubler_FT_Jr1 (1996) A Clinical Report: The Treatment of Post-Polio Syndrome (PPS) with electrostimulation of Ear-AP points: An evaluation of 12 Patients: Part 1. Adapted from WWW. Dr FT H'Doubler Jr MD, 1900 South National, Suite 2950, Springfield, Missouri 65804-2240, FAX (417) 882-3210, Voice (417) 882-3066, EMail:[email protected]

Abstract.
The objective of this study was to evaluate the effectiveness of Ear-EAP (using a non-invasive Electro-Acuscope) to treat confirmed post-polio Syndrome (PPS) patients. Short and Long term responses in 12 study subjects were measured. Good or excellent results were obtained in all patients; 67% reported a return to their pre-existing levels of health. In our experience, Ear-EAP is effective as a permanent, relatively simple and inexpensive form of therapy for many cases of PPS. This seems to be the first effective therapy available for the >75000 PPS patients in the USA alone.

Introduction.
Ear-EAP therapy does not seem to have been reported before as a modality in the management of PPS patients. This study presents our experience in treating 12 such patients and the evaluation of their response over a 2-yr period. Our results were very encouraging.

Polio is one of the oldest diseases known. In North America, acute polio is essentially nonexistent today. However in many countries polio is still present in epidemic proportions.

In 1985, Rotary International accepted the challenge to eradicate our planet of polio. Hopefully, this can be accomplished by the year 2005, the 100th anniversary of the founding of Rotary. The WHO and other groups have joined in a courageous battle which is being won. However, conservatively >75000 patients are afflicted with PPS in the USA alone(1).

Only in the last few years has PPS become recognized. It presents as new symptoms 20-45 yr after the acute stage of the disease in circa 25% of polio survivors(2). Since the last epidemic in the USA occurred in the early 1950s, we can surmise that some of those survivors will experience sequelae of this dreaded disease.

Diagnosis and Differential Diagnosis.
The symptoms mainly seen with PPS include unaccustomed fatigue, joint and/or muscle pain, muscle weakness and loss of muscle use, respiratory problems, and depression. The criteria used in this study includes the following:
1.        Confirmed case history of paralytic polio.
2.        Electromyographic changes consistent with prior polio.
3.        A period of recovery & stability between onset of polio and onset of new problems.
4.        Gradual or abrupt onset of disuse weakness in affected and/or unaffected muscles which may be accompanied by excessive fatigue, depression, muscle and/or joint pain, decreased endurance and/or function, and muscle atrophy.
5.        Exclusion of other conditions that might cause the problems cited above.

The following diagnosis must include the following:
1.        Amyotrophic lateral sclerosis (ALS)
2.        Multiple Sclerosis (MS)
3.        Poliomytositis
4.        Chronic fatigue Syndrome
5.        Candidiasis
6.        Muscular Dystrophy
7.        Spinal cord injuries
8.        Spinal cord atrophy
9.        Gullian-Barre' Syndrome
10.        Peripheral neuropathy
11.        Coxsackievirus.

Most physicians practising today have not seen acute poliomyelitis and, therefore, are not acquainted with the disease. Unfortunately, some of these patients have been sent to psychiatric wards or to pain clinics because PPS was never considered in the differential diagnosis. Others have been dismissed as having depression or neurosis. To date, no Lab tests help in the diagnosis of this disease.

Until now, there was little to offer patients with PPS. One could advise them regarding weight control and good nutrition, obtaining more rest and avoiding stress, the use of canes, braces, wheelchairs, physio-therapy, surgery, ventilators, and of becoming active in PPS support groups. Also they probably should receive flu and pneumonia vaccinations.

Materials and Methods.
The patients in this study consisted of 12 people from the PPS support group in Springfield, Missouri. Each diagnosis had been made elsewhere and was confirmed in our clinic.

In this study, we did not make changes in their Med management, lifestyle, exercise programs, etc. The were all advised to continue with their present program and to been seen by their local doctor. This gave us an opportunity to evaluate more carefully this modality as part of our armoury.

EAP-therapy of Ear- and odonton- points was done in all cases, using the feedback-controlled Electo-Acuscope [Electrical-Med Inc (EMI), Fountain Valley, CA]. It was used to both locate each Ear-point (search mode) and to stimulate each point (treatment mode).

We used the point protocol for PPS provided by EMI (figure 1). Each of the ear points (see figure 2) was stimulated bilaterally using the Ear-treatment probe. Both ears were treated at the same point before going on to the next point in the order specified protocol. The intensity was set at 25 µA. The frequencies used were varied from point to point and ranged from 2.5-10 Hz. The duration of EAP also varied from point to point, as shown in the PPS protocol.

Also, 2 Voll odonton points 3 (figure 1) were stimulated with a dental probe (from EMI) designed for treating this microsystem. These 2 points were stimulated at an intensity of 200 µA at 10Hz. The duration of electrostimulation also varied (Figure 1).

If the patient reported pain in the hip, shoulder, elbow, etc, Earpoints for these areas were stimulated with the Ear-probe also.

Each patient also received transcranial stimulation performed with electrode clips attached at the earlobes. The settings on the Electo-Acuscope were 200 µA at 8 Hz for 20 min. (The objective of this procedure is to create homeostasis in the ANS. The patient immediately becomes very relaxed and quite often falls asleep. After this treatment, the patient will often feel increased energy and general well-being.).

Most cases had a decrease in fatigue and weakness after the first or second sessions. We added body AP treatment in non-responding cases, and in those in which there was an imbalance of the 3 tissue layers in the ear based on the principles of Nogier(4). Specifically, we treated CV05, CV12 and CV17. Silver needles were inserted into these 3 points after carefully verifying their locations with the device. The needles were left in place for 10 min.

The entire treatment, including the paralysis protocol and body AP, lasts <1 h and the treatments are given every 3-7 d.

All patients were followed up either in the office or by phone for a 2-yr period.

Results
Overall, 67% (8/12) of the study subjects reported 100% relief from their symptoms, 17% (2/12) had 75% improvement and 17% (2/12) reported 20-40% improvement.

Table 1: Results in 12 study subjects treated with the PPS protocol.

1
100
75
40
20
Total

2
5
2
-
-
7

3
3
-
1
1
5

4
8
2
1
1
12

5
66.7
16.7
8.3
8.3
100.0

1 % Improvement
2 No. subjects w/polio onset at age <10 yr
3 No. subjects w/polio onset at age >10 yr
4 No. subjects in total
5 % in each category
H'Doubler_FT_Jr2 (1996) A Clinical Report: The Treatment of Post-Polio Syndrome (PPS) electrostimulation of Ear-AP points: An evaluation of 12 Patients: Part 2.

Polio onset at age <10 yr: In our evaluation of the therapy of the 12 patients treated, 7 were <10 yr of age at the onset of polio. 4/7 of these patients stated that after treatment in our clinic, they rapidly returned to their former state of health (pre-PPS) and had maintained this level of function for 2 yr after therapy.

Of the other 3 patients in this group, one was very pleased and returned to her previous state of health (pre-PPS) except that she still had chronic depression which pre-dated the onset of PPS symptoms. A male patient also had been diagnosed elsewhere with depression 3 yr before being seen in our clinic. When first seen, he complained of extreme fatigue and stated that previously he had always been energetic. He reported that he was in the process of losing his job because he had become so unproductive; thus, he was stressed and would occasionally hyperventilate. Overall, after Ear-therapy, he stated that he had regained 75% of his pre-PPS function.

A third patient in this group, a markedly obese male, stated that he, too, had regained 75% of his pre-PPS function. He reported that the severe pain in the shoulders and elbows was completely gone, but he had noted the return of fatigue and muscle weakness and requires respiratory support during the night. At the present time, he is being managed elsewhere for his recently acquired diabetes.

Polio onset at age >10 Yr: Of the 5 patients who were >10 yr of age when they developed polio, 3 stated that the PPS symptoms had ceased after treatment at our clinic. However, one of these patients has to be retreated every year to maintain pre-PPS health.

Of the other 2, one was a 69-yr old male with Parkinson's disease. After 8 treatments, he stated that his weakness and fatigue was 40% decreased and that he was pain-free except after overexertion. He estimated that his foot-drop had also improved by 40%.

The fifth patient in this group was a 48-yr-old female with severe fatigue of 5-yr duration. She had previously been diagnosed with fibromyalgia. After 4 treatments she stated that the fatigue had decreased by 20% and the shoulder pain was 70% decreased.

All subjects in this group had other Med problems. The 3 patients who had 100% response required 4-8 treatments. The 2 subjects with less favourable responses were treated 8-14 times.

Discussion.
Occasionally a patient may begin to experience a return of symptoms after 6-18 mo. In the few instances we have observed, when given "booster," or repeat treatment, they were quickly returned to their pre-PPS state of health.

The treatment protocol provided by the manufacturer of the Electro-Acuscope is the result of their independent research. They stress the importance of following the point treatment order, much of which is based on the principles of Reinhold Voll(3).

A method that I highly recommend when a patient has painful areas-one that was not used in this study- is as follows: The patient identifies the area of pain. By palpation with firm pressure the most active TPs can be located. These points are then treated with the Electro-Acuscope until the TP is eliminated. This usually takes <2 min/visit.

Also, the Electro-Acuscope seems to be the only self-regulating electro-therapeutic device on the market, e.g. the tissue impedance continuously controls and adjusts the waveform. This instrument is used also for many kinds of acceleration of tissue repair and pain management(5).

It is not within the scope of this report to present a controlled study of the benefits of this modality. Our purpose is to bring it to the attention of:
1.        Primary physicians who may be seeing these patients, and
2.        Med centres with PPS clinics and the resources to conduct in-depth studies and to implement refinements in this technique.

Conclusion.
In patients with PPS, Ear- and odonton- point therapy using the Acuscope was non-invasive, simple and inexpensive. It needed treatment of relatively short-duration, improved the symptoms rapidly and apparently gave long-lasting benefit in most cases. The PPS patients who had other existing Med problems did not respond as well as those without such problems and were the only ones who did not experience excellent results. However, all the subjects reported being "very pleased" with their improvement. Non-invasive EAP shows promise of being a successful and definitive therapy for patients with Post-Polio Syndrome.

3. CEREBRAL PALSY, EPILEPSY, SPASM
Chu_NSa1; Wu CL; Tseng TS; Kuo LL (1991) Sphenoidal EEG recording using AP needle electrode in complex partial seizure. Electroencephalogr Clin Neurophysiol Aug 79(2):119-126. Dept of Neurol, Chang Gung Med Coll and Memorial Hospital, Taipei, Taiwan, ROC. Sphenoidal EEG recording using an uninsulated AP needle electrode were performed in 41 patients with or suspected of complex partial seizures of temporal lobe origin. The anterior temporal spikes were detected by the routine EEG in 17 patients (41%) and by the AP sphenoidal needle in 29 patients (70%). The anterior temporal spikes recorded by the AP needle were almost identical in configuration, amplitude and distribution to those recorded by conventional wire or insulated needle sphenoidal electrodes. The sequence in the frequency of spike detection by these 3 types of sphenoidal electrode were SP1-2, T1-2, F7-8 and A1-2 locations. The spikes of maximal amplitude were most frequently recorded by the SP electrode followed by the T1-2 electrode. The placement of the disposable AP needle was simple and safe. Patients experienced minimal discomfort or pain that lasted at most 0.5 h. No complications occurred. The records were generally free of artifacts. It is concluded that the AP needle can be used as sphenoidal electrode in outpatient EEG recording for the diagnosis of complex partial seizures of anterior temporal-origin.

Chu_NSa2 (1992) A simultaneous comparison of AP needle and insulated needle sphenoidal electrodes for detection of anterior temporal spikes. Dept of Neurol, Chang Gung Med Coll and Memorial Hospital, Taipei, Taiwan, ROC. Clin Electroencephalogr Jan 23(1):47-51. Uninsulated AP needles have been used as sphenoidal electrodes, but the issue of insulation has not been addressed adequately. In this report, AP needles and insulated needle sphenoidal electrodes were used simultaneously to compare the rate of spike detection, spike amplitude and distribution of maximal spikes from 8 spike foci in 7 patients with temporal lobe epilepsy. When compared to the insulated needle electrode, the AP needle electrode was equally effective in spike detection, but spike amplitudes tended to be smaller and maximal spikes were less frequently encountered. Thus, insulation has an influence on the spikes recorded by the AP needle sphenoidal electrode. However, the overall effect appears to be not sufficiently different from the insulated needle electrode for the purpose of detecting anterior temporal spikes in outpatient EEG recordings for the diagnosis of temporal lobe epilepsy.

Janssens_LAA2 (1993) Ear AP for Treatment of Epilepsy in the Dog. Prog Vet Neurol FAL 4(3):89-94. Oudestr 37, B-2610 Antwerp, Belgium. 11 dogs (mean age 5.8 yr; mean bodyweight 26 kg) with chronic epilepsy were treated by ear AP; 7 were on high doses of anti-epileptic drugs (of which 4 showed no decrease of seizures, 2 had temporary reduction of seizures and 1 complete control of seizures). A human stay ear AP needle was implanted in one point in both ears. The needles stayed in place for between 4 d and 4 mo (mean 2 wk). The needles were replaced (mean 4 times) on a 3-9 wk basis. After treatment, 4 were seizure-free, 2 had fewer seizures and 4 showed no amelioration. Of the seven dogs that received medication before AP treatment, one was seizure-free and without medication, one was kept on half-dose drugs and was much improved, and three were maintained on much lower drug doses (-33/-50%) with no clinical deterioration. Two dogs that still had attacks were reported to have shorter or absent prodromal and postictal periods. In conclusion, results from 5/11 dogs tested showed that ear AP may afford partial or complete seizure remission.

Lai_XP (1996) AP Therapy and Point-injection of Med for Treatment of 32 Cases of Infantile Cerebral Palsy. Dept of AP and Moxibustion, Fuyang Textile Mill Hospital, Anhui, 236089 PRC. Adapted from WWW. 32 cases of infantile cerebral palsy were treated with AP and point-injection. 15/32 cases were cured basically, 7/32 markedly effective, 9/32 improved and 2/32 failed; the total effective rate was 94%. AP both could improve the microcirculation of the brain tissues in favour of recovery of cerebral functions.

Lu_W (1994) Prompt pressure applied to Strange points to treat spasmodic infantile cerebral palsy: a report of 318 cases. Chung i tsa chih (JTCM) Sep 14(3):180-184. Infantile cerebral palsy is a nonprogressive CNS motor disturbance of varied etiology. The spasmodic type, its main form, accounts for 50-60% of afflicted infants. The causal factors include many conditions arising during parturition and in the pre- and post- natal periods. No specific treatment for the disease exists. We applied prompt pressure to Strange AP points in treating it, with satisfactory results. Infantile Strange points are points peculiar to infants, mostly located in the head and extremities. They are an important part of the treasure-house of TCM. 318 patients were treated by prompt pressure at the Strange points, combined with appropriate orthopaedic manipulations. Good to excellent therapeutic effect occurred in 73%. Follow-up exam was done in 52 cases; 21/53 were assessed as stable; 31/52 cases were improved. The method is simple and convenient, causes little pain but gave a marked therapeutic effect. It can be regarded as a new way to treat infantile cerebral palsy.

Panzer_RB3; Chrisman CL (1994) An Ear-AP Treatment for Idiopathic Canine Epilepsy: A Preliminary-Report. AJCM 22(1):11-17. RB Panzer, NW Inst AP & Oriental Med, Seattle, WA 98103. A new canine Ear-AP point for the treatment for epilepsy is introduced. The new point was used with a previously reported canine Ear-point (van Neikerk and Eckersley, 1988) to treat epilepsy in 5 dogs. The method is worthy of scientific investigation. Only testimonial evidence currently supports its application, yet this innocuous treatment is recommended for use in all cases of canine epilepsy. The TCM explanation for the treatment is described, and hypothetical Western physiology is presented.

Shaitor_IN; Bogdanov OV; Shaitor VM (1990) [The combined use of functional biocontrol and AP reflexotherapy in children with the spastic forms of infantile cerebral palsy]. Vopr Kurortol Fizioter Lech Fiz Kult Nov-Dec (6):38-42. An optimal method of rehabilitation is outlined for children with movement disorders due to spastic cerebral paralysis. It combines the use of functional biocontrol and AP. In drug intolerance the treatment acquires special significance. The effectiveness of these 2 modalities comes from mutual potentiation effect on central regulation of motor functions as shown by electrophysiological findings. Marked positive shifts in clinical and electrophysiological patterns develop within 15 training procedures with the external feedback in addition to 11 sessions of AP.

Shi_B; Bu H; Lin L (1992) A clinical study on AP treatment of paediatric cerebral palsy. JTCM Mar 12(1):45-51. Children's Hospital, Shanghai Med Univ, PRC.

van_Niekerk_J; Eckersley N (1988) The use of AP in canine epilepsy. J South Afr Vet Assoc 59(1):5.

Wang_BE1; Yang R; Cheng JS (1994) Effect of EAP on the level of preproenkephalin mRNA in rat during penicillin-induced epilepsy. AETRIJ Jun-Sep 19(2-3):129-140. Inst of AP Research, PRC. In our previous studies, seizure induced by injecting penicillin (0.24 mg/2 uL) into hippocampus was inhibited by EAP, probably via decreasing enkephalin level in hippocampus. To determine whether this change reflected the peptide synthesis, preproenkephalin (PPE) mRNA was detected in hippocampus and some other limbic structures during seizure and after EAP treatment by in-situ hybridization. 4 h after injecting penicillin into hippocampus, PPE mRNA levels were significantly increased by 10-fold in entorhinal cortex, subiculum, CA1 area of hippocampus, amygdaloid nucleus and piriform cortex, whereas EAP treatment apparently attenuated the seizure-induced increase of PPE mRNA in the areas mentioned above. EAP may regulate the biosynthesis of PPE in hippocampus during seizure by an alteration in gene transcription.
White_SS; Christie MP (1985) AP used as an adjunct in the treatment of a horse with tetanus. Aust Vet J Jan 62(1):25-26.

Wu_D (1992) Mechanism of AP in suppressing epileptic seizures. JTCM Sep 12(3):187-192. Dept of Physiology, Shanghai College of TCM, PRC.

Wu_Y; Shen Q; Zhang Q (1992) [The effect of AP on high oxygen pressure-induced convulsion and its relationship to the brain GABA level in mice]. Chen Tzu Yen Chiu 17(2):104-109. Inst of Navigation Med, Nantong Med Coll, Jiangsu. This paper reports the effect of AP at GV26 and CV24 on OHP-induced convulsion in mice. Results: 1. Convulsion induced by 6 ATA OHP were accompanied with a decrease in the brain GABA level. 2. When EAP was applied for 15 min before exposure to hyperoxic chamber, the latency of convulsions was lengthened and the symptoms of seizures were alleviated. Besides, the brain GABA level was also elevated remarkably. 3. Administration of vitamin B6 enhanced the effect of AP on convulsions and increased brain GABA level. 4. The latency of convulsions was well correlated with the GABA level of the brain (r=.9867). AP may elevate endogenous GABA levels in the brain and prevent the hyperbaric-oxygen-induced the decrease in the brain GABA level. Therefore, AP protects effect against oxygen convulsions. Vitamin B6 may facilitate the effect of AP by improving the GABA metabolism in the brain. In short, the effect of AP against oxygen convulsions may be closely related to the increase in the brain GABA levels.
Yang_J (1990) Treatment of status epilepticus with AP. JTCM Jun 10(2):101-102. Dept of AP, Hospital for Mental Diseases, Fuyang District, Anhui Province, PRC.

Yoshida_T; Tanaka C; Umeda M; Higuchi T; Fukunaga M; Naruse S (1995) Non-invasive measurement of brain activity using functional MRI: toward the study of brain response to AP stimulation. AJCM 23(3-4):319-325. Dept of Neurosurgery, Meiji Coll of Oriental Med, Kyoto, Japan. We studied functional MRI in 15 male and 13 female normal volunteers on a clinical MRI system using gradient echo sequence. During the experiments, brain activation was induced by grasping the unilateral hand 1-2 times/s for motor tasks. A localized increase of MRI signal in the contralateral motor cortex was observed in 17/21 cases (81%) under right hand motor task and 11/21 cases (52%) under left hand motor task. The application of this method may be useful to evaluate brain response to AP.

Zhang_Z; Yu Z; Zhang H (1992) [Inhibitory effect of EAP on penicillin-induced amygdala epileptiform discharges]. Chen Tzu Yen Chiu 17(2):96-98. Shanghai Coll of TCM, PRC. Epileptiform discharge induced by microinjection of penicillin in the rat's amygdala was attenuated after AP of certain AP points, as shown by reduced frequency and amplitude. The effect of AP was reversed by ip microinjection of naloxone or 3M-P, thus suggesting the participation of endorphin and GABA in antiepileptic action of AP.

Zhou_XJ; Chen T; Chen JT (1993) [75 infantile palsy children treated with AP, acupressure and functional training]. Chung Kuo Chung Hsi I Chieh Ho Tsa Chih Apr 13(4):220-222, 197. Children's Hospital, Zhejiang Med Univ, Hangzhou, PRC. In treating infantile cerebral palsy (CP), 75 CP children were treated with a comprehensive Channel therapy including scalp and body AP, AP point injection and Ear-point stimulation, supplemented with acupressure and massage, and functional training. Treatment was repeated from a minimum of 10 times in 20 d to a maximum of 3 times/wk for 1 yr. The effect of the treatment was evaluated by appraising the children's performance of physical exercise and their social adaptability. The intelligence quotient (IQ) of 30 sick children that had been treated for 60 times (6 courses) was compared before and after treatment. AP treatment gave a very positive improvement in the children's physical capability and an increase of their intelligence.

4. PERIPHERAL PARALYSIS, FACIAL PARALYSIS
Cui_Y (1992) Treatment of peripheral facial paralysis by scalp AP: a report of 100 cases. JTCM Jun 12(2):106-107. Tangshan Hospital of TCM, Hebei Province, PRC.

Hao_J; Zhao C; Cao S; Yang S (1995) Electric AP treatment of peripheral nerve injury. JTCM Jun 15(2):114-117. Luoyang Bone-Setting Hospital, Henan Province. 54 cases of peripheral nerve injury were treated by EAP and compared with 54 control cases treated with supportive medication. The changes after treatment were observed chiefly by electromyography while sensory and motor improvement were also recorded as auxiliary indicators. Results: In the AP group, 5 cases were cured, 26 markedly effective, 19 improved, and 4 cases failed, a total effective rate of 93% in contrast to the 56% for the controls. Therapeutic results in the AP group were significantly better than in the control group. Nerve injuries should be treated as early as possible. The radial nerve and the common peroneal nerve recovered faster than others. Cases not surgically explored recovered faster than those that were. Patients with prompt propagation of the needling sensation (PCS) recovered significantly faster than those with slow PCS.

Jin_WC (1991) [Clinical and experimental studies on the treatment of severe facial paralysis with compressing drug, AP and infrared rays]. Chung Hsi I Chieh Ho Tsa Chih Jun 11(6):337-339, 324. General Military Hospital of Guangzhou. In 160 patients with severe facial paralysis detected by the strength-duration curve, partial or complete reaction of degeneration of the facial nerve and its related muscles occurred in 158 patients and no reaction of degeneration in 2 patients. All patients were assigned at random to 2 groups: 1=Mianmasan (drug) + AP (n=62); 2=Mianmasan (drug) + AP + red light (n=98). Mianmasan was applied by dusting the drug over the scarified skin corresponding to the selected AP points and motor points, then covering the dusted points by adhesive plaster. The clinical experiment was carried out by using double contrast method (autogenous and allogenic contrasts with ear pulse wave and skin temperature records). The affected side of the face had chronic tissue ischemia, which returned to normal after treatment. Among 160 treated patients, 70 (44%) were cured, 46 (29%) markedly improved, 43 (27%) improved and 1 (0.6%) unchanged. Group 2 had a better cure rate than Group 1 (p <.01), and the effective rate in the patients with partial nerve degeneration was higher than that in those with complete degeneration (p <.05).

Kozlov_VI; Samoilov NG (1990) [Morphology of skeletal muscles after long-term hypokinesia and laser-AP]. Arkh Anat Gistol Embriol Nov 99(11):50-4. By restraint of Wistar male rats in special boxes, hypokinesia lasting for 150 d was induced. After restraint for 10, 20, 50, 100 and 150 d, their limb muscles were studied by stereological methods. Hypokinesia, especially for 50 d, inhibited morphogenesis of ultrastructures and development of certain pathological processes in the muscles, mainly in red fibres. Laser-AP stimulated formation of the ultrastructures responsible for contraction and energy supply and sharply decreased the development of the destructive processes in muscle fibres. Laser-AP is a good method to minimise the muscular effects of hypokinesia.

Liu_C; Wang Y (1993) 81 cases of paralytic strabismus treated with AP. JTCM Jun 13(2):101-102. Dept of AP, Liaoning Provincial Hospital, Shenyang, PRC.

Liu_H; Liu Y (1991) Treatment of peripheral facial paralysis with pick-prick and connecting-AP. JTCM Mar 11(1):31-33. Dept of AP Provincial College of TCM, Henan Province, PRC.

Liu_J2; Jiang D; Yu M; Yang J (1992) Observation on 63 cases of facial paralysis treated with AP. Chen Tzu Yen Chiu - AP Research 17(2):85-86, 89. Inst of AP and Moxibustion, China Acad of TCM, Beijing, PRC. 63 cases with facial paralysis were treated mainly by AP combining with point injection. The main points selected were; GB14, BL01, ST02, LI20, ST04, ST06, ST18 and Qianzheng. The points were used alternatively. Auxiliary points: for Qi-Xue-Xu, ST36, and SP06 were added: for Ying-Wei Disharmony, GB20 and LI04 were added; for Qi-Xue-Stasis, TH05 and LV03 were added; for Wind-Heat-Stasis in Collaterals, TH17 and GB34 were added. 10/60 cases had poor results after 2 courses; then vitamins B1 and B12 were injected at facial points combined with LI04 on the opposite side. Overall results: 31 cases (49%) were cured, 15 (24%) improved markedly, 16 (25%) improved and 1 (2%) failed.

Nanjing College of TCM (1990) Personal experience on AP treatment of peripheral facial paralysis. JTCM Sep 10(3):176-181.

Ren_X (1994) A survey of AP treatment for peripheral facial paralysis. JTCM Jun 14(2):139-146. AP Inst of China Acad of TCM, Beijing, PRC.

Samoilov_NG (1991) [Structure of skeletal muscles in combined conditions of denervation, physical load and laser-AP]. Arkh Anat Gistol Embriol Apr 100(4):81-85. The structure of experimentally denervated skeletal muscles was studied in 77 Wistar male rats by histology, electron microscopy and morphometry. After denervation, rats treated by laser-AP, or the combination of laser-AP with physical load, had essentially less disturbance of muscular structure after denervation than untreated denerved controls. Combination of laser-AP and physical load ensures activation of regeneration and reinnervation processes of the skeletal muscles.

Wei_Q; Gao J (1992) Treatment of optic atrophy with AP. JTCM Jun 12(2):142-146. Inst of Ophthalmology, China Acad of TCM, Beijing, PRC.

Wei_Y; Shi H; Wan X (1991) [Effect of AP on neuronal loss induced by axotomy in the rat hypoglossal nuclei]. Chen Tzu Yen Chiu 16(2):112-114. Peking Union Med Coll, Beijing, PRC. It was reported previously that AP promotes regeneration of rat's peripheral nerve. In order to study the effect of AP on recovery of motoneuronal lesion and regeneration of CNS, we studied the effect of AP on neuronal loss induced by axotomy in the rat hypoglossal nuclei. 6 pairs of rats (one given AP and one control in each pair) were used. Each pair was from the same litter and sex. After the right hypoglossal nerves were severed, rats were reared for 14 d. In this period, one rat in each pair was given AP. After killing and perfusion, serial paraffin sections of the rat-brain-stems were cut and stained with cresyl violet. Serial sections were used to count the perikaryon of the hypoglossal nuclei. The % of neuronal population remaining after axotomy was calculated. Neuronal loss (% of neuronal population lost) was significantly less severe in rats which had been given AP. AP increased survival of lesioned neurons, and thus AP may be helpful to the recovery of neuronal lesion. The detailed mechanism is going to be explored.

Xing_W1; Yang S; Guo X (1994) [Treating old facial nerve paralysis of 260 cases with the AP treatment skill of pause and regress in 6 parts]. Chen Tzu Yen Chiu - AP Research 19(2):8-10. AP Dept of Datong Med Coll, Shanxi Province, PRC. Two methods of manual AP were compared in treating facial paralysis: Method 1="Pause and Regress in 6 Parts" (n=260 cases); Method 2="Even Bu-Xie (reinforcing-reducing)", (n=50 cases). Method 1 is a new form of AP-needling, developed from the Xie (reducing) method of the traditional reinforcing-reducing method of lifting and thrusting the needle and 9:6 reinforcing-reducing method. The AP points were chosen in the area of the main distribution of the facial nerve. Method 1 was significantly more effective than Method 2 (p <.01). Skilled AP is an effective way to treat old facial paralysis.
Xing_W2; Yang S; Guo X (1994) Treating old facial nerve paralysis of 260 cases with the AP treatment skill of pause and regress in 6 parts. Che Tzu Yen Chiu - AP Research 19(2):8-10. With the AP treatment skill of pause and regress in 6 parts, we have treated facial paralysis of 260 cases. The other 50 cases were treated with the uniform Xie-Bu method as control. The result shows that the effectiveness of the former is better than the latter. The AP treatment skill of pause and regress in 6 parts is a new way developed from the traditional Xie-Bu method of lifting and thrusting the needle and nine-six Xie-Bu method. Also, the AP points were chosen in the area of the main distribution of the facial nerves. Through the clinical practice, the AP treatment skill is an effective way for treating old facial paralysis.

Zhang_D2; Wei Z; Wen B; Gao H; Peng Y; Wang F (1991) Clinical observations on AP treatment of peripheral facial paralysis aided by infra-red thermography: a preliminary report. JTCM Jun 11(2):139-145. Inst of AP and Moxibustion, China Acad of TCM, Beijing, PRC. We compared the clinical results of two forms of AP therapy in patients with peripheral facial paralysis. The 2 groups of patients were treated by: A=Thermogram-aided AP (n=34 cases), or B=Conventional AP only (n=97 cases). In group A, the AP points were selected on the basis of facial a thermogram and temperature. Results: The cure rates in Group A v B were 68 v 46%, with marked improvement in 26 v 30% and total effect rates of 94 v 76% respectively; the difference in therapeutic efficacy between the 2 groups was significant (p <.02). Mean duration of AP therapy for Groups A v B was 6 v 24 wk respectively; this difference was significant (p <.01). The total number of AP sessions for Groups A v B were 25 v 79 respectively, a very significant difference (p <.001). To treat facial paralysis with AP, thermography-aided selection of AP points gave better results in a shorter time and with less AP sessions than selection by conventional methods of AP. Clinicians should know of these results, which also are significant in that they provide a way to standardise AP therapy and make it more objective to scientific researchers.

Zhang_MD2; Wei Z; Wen B; Gao H; Peng Y; Wang F (1991) Clinical observations on AP treatment of peripheral facial paralysis aided by infra-red thermography: a preliminary report. Chung i tsa chih (JTCM) Jun 11(2):139-145. We clinically observed 34 patients with peripheral facial paralysis treated by AP therapy, as directed by to findings of a facial thermogram and temperature (Group TA-AP). A second group of 97 patients received conventional AP therapy only (Group C-AP). TA-AP gave a cure rate of 68%, and a marked improvement in 26%; C-AP gave a cure rate of 46%, and a marked improvement in 30% (the difference in therapeutic efficacy between the 2 groups was significant at p<.02). Mean duration of AP therapy in TA-AP v C-AP was 6 v 24 wk (difference significant at p<.01). Total mean numbers of treatment sessions/patient in TA-AP v C-AP were 25 v 79 (difference very significant, p<.001). TA-AP had advantages over conventional AP: it enhanced the cure rate, shortened the duration of treatment and reduced the number of sessions needed. TA-AP merits publicity in clinical practice. It has great significance in making AP therapy more standardised and scientifically objective.

Zhang_Y; Wang X (1994) Experience in the treatment of peripheral facial paralysis by puncturing effective points: a new system of AP. JTCM Mar 14(1):19-25. Inst of AP and Moxibustion, China Acad of TCM, Beijing, PRC.

Zhang_Z; Zhao C (1990) Comparative observations on the curative results of the treatment of central aphasia by puncturing the Yumen point versus conventional AP methods. JTCM Dec 10(4):260-263. 266th PLA Hospital, PRC.[Rogers' comment: Typing error in the title ?: the point used was probably Yamen (Mutism Door, GV15), not Yumen (Hell/Dark Gate; its name also means "pylorus", KI21), as written. Yamen (dorsal midline, 1 cun below the skull, 0.5 cun inside the natural hairline of the neck) has powerful effects on the tongue and speech; Yumen (on the abdomen, 1.5 cun lateral to CV14) has powerful effects on the ST, especially the cardia].

L. AP and the Psyche

1. SHEN, PSYCHOSOMATIC DISORDERS, MENTAL RETARDATION
Eichelberger_B01 (1996) The Five Phases of personal evolution: Part 1. Adapted from WWW (Acupuncture.com). [Bruce Eichelberger MTOM OMD (China), LAc DiplAc (NCCA) has been practicing Qigong and Taoist healing arts for >25 yr. He also teaches classes in Personal Evolution, healing arts and Qigong, including "The 5 Movements of Personal Evolution," and "Dancing with Chaos" (c) 1995 Bruce Eichelberger All rights reserved: WebMaster].

No species or idea survives for long unless it is fundamentally sound and able to adapt to its ever-changing environment. The 5000 yr-old TCM concepts of the Wu-Xing (Five Phases) continue their usefulness to this day. The Five Phases of Personal Evolution is a model for human evolution based the structure and processes of the ancient Elemental Five Phases. It combines with these concepts aspects of the Native American Warrior's Path, NLP (Neuro-Linguistic Programming) and Qigong energy cultivation movements. This synthesis, originally refined during a 3-yr period through an advanced Taoist Nei Gong exercise called the 5 Dragons, represents a further evolution of the classical Five Phases.

Below is a skeletal representation of the Five Phase Personal Evolution Model. Each phase as well as each interaction in this model matches major aspects of the traditional Five Phases.

Phase Correspondences.
Each phase correspondence can be understood in positive, process- oriented terms reflecting the "ideal" attributes of each. These ideal states are guidelines or objectives for balanced and integrated functioning. They also reflect the relationships and interactions between phases.

Fire (HT and Shen-Spirit): Fire corresponds with Opening: unconditional giving, responding to events with spontaneous resiliency and adaptability. Our ability to show compassion, experience joy, and share with others resides here, as does the aliveness in our eyes. Fire pathology shows as being too open-hearted (to the point of self-detriment), little or no sense of limits or boundaries in interpersonal relations, inability to give emotionally or to be spontaneous.

Earth (SP and Yi-Mind): Earth is associated with Connecting: patience, being in the moment, focusing thoughtful attention and making useful mental associations. It is also the ability to be clearly in the moment. Patience, stability, home, service and tasting Life belong here. Earth pathology manifests as obsessiveness, inability to be in the moment, acting in a scattered or distracted way (not present), lack of awareness of surroundings, or difficulty moving (feeling and being "stuck").

Metal (LU and P'o-Corporeal Soul): Metal reflects Releasing: stepping back from an experience to evaluate and sort it out, refining goals and directions and the ability to let go of excessive emotional attachments to people and events. Inspiration, acknowledging self and others and refining one's character all show up here. Metal pathology is characterized by, chronic grieving & sadness, aloofness, obsessiveness, living in the past or extreme attachments.

Water (KI and Zhi-Will): Water relates to Aligning: setting foundations, maintaining integrity & balance, gathering energies, and storing reserves. It is the ability to keep rooted even in the face of chaos. It may be thought of as a rudder in the flow of life. Sometimes we must enter the Unknown and must allow Life to guide us without preconceptions, judgements or panic; Aligning is our optimal response. Water pathology might show up as lack of direction, not completing things, extremism, fear, or fixation on only one way of doing things.

Wood (LV and Hun-Heavenly Soul): Wood is expressed in Trusting. Specifically this means trusting in God, Universal Flow, Great Spirit etc. Focusing intent, doing your best and transcending limitations, both inwardly and outwardly, all correspond to this phase. This is where we reach out into new territory, express creativity and focus our intention. Wood pathology might show up as timidness, depression, being overly cautious, lack of focus, "running on empty," impulsiveness, etc.

The process interactions.
Five Phase Sheng (Nourishing) and Ko (Control) interactions are summarised as:

Opening (Fire): is supported by Trusting (Wood); is controlled by (excess is prevented by) Aligning (Water); controls (limits detachment of) Releasing (Metal) and supports Connecting (Earth).

Connecting (Earth): is supported by Opening (Fire); is controlled by (excess is prevented by) Trusting (Wood); controls (prevents Stasis of) Aligning (Water) and supports Releasing (being present to release past) (Metal).

Releasing (Metal): is supported by Connecting (Earth) (releasing the past); is controlled by Opening (Fire); controls (tempers impulsiveness by) Trusting (Wood) and supports (with Will) Aligning (Water).

Aligning (Water): is supported by Releasing (Metal); is controlled by (keeps it current) Connecting (Earth); controls (keeps balance of) Opening (Fire) and supports (is foundation for further growth of) Trusting (Wood).

Trusting (Wood): is supported by (is founded on) Aligning (Water); is controlled by (allows for focus of) Releasing (Metal); controls (contains) Connecting (Earth) and supports Opening (Fire).

Applications of the Five Phases.
Any comprehensive, self-contained, homeostatic system has so many possible permutations that it is difficult to fully describe them. Here are three examples of these ideas:
Eichelberger_B02 (1996) The Five Phases of personal evolution: Part 2.

Example 1: An aspect of Releasing is the quality of detachment. Healthy detachment is prevented from becoming excessive by keeping a sense of openness and adaptability (Releasing controlled by Opening). Similarly, since attachments are typically a function of past/future associations, a healthy releasing of such attachments is supported by being in the present (Connecting).

Example 2: Aligning is also to a large extent the act of balancing and harmonizing all aspects of a situation. Since life is a flow of Qi (energy), a static balance is not healthy. Therefore balance must be an on-going process and is prevented from Stasis by:
1. Providing the basis for new expansion (Aligning supports Trusting) and;
2. Staying in the ever-changing flow of the present moment (Aligning controlled by Connecting).

Example 3: Each Phase is healthiest when supporting its Son Phase in the Sheng (Nourishing) Cycle and simultaneously when exerting control (applying limits) on its Grand-Son Phase in the Ko (Controlling) Cycle. Trusting, as aspect of which is going beyond limitations, functions best when it can temper the tendency of Connecting to stay exclusively in the moment. Planning (another aspect of Trusting, e.g. going beyond the limited perception of the immediate here and now), when done appropriately, tempers any tendency for imbalanced indulgence by Connecting to be only in the here & now, and stimulates Qi to move-on to Releasing where it can evaluate what is most important in the experience.

Effective use.
The important question is, "How can this information be put to effective use?" Most essentially it is a tool for self-examination and personal evolution. The concepts are exceptional as a basis for meditation or incorporation into other yogic, meditative and/or affirmation practices. Qigong exercises, which accompany these concepts, integrate them at a deep cellular-energy level, aiding in fuller understanding.

Working with others the Five Phases may be used as a basis for evaluating personality traits and tendencies and, in the context of a complete holistic treatment, appropriate counterbalancing and supporting affirmations might be assigned, or suggestions given to the patient to enhance, at the level of the patient's beliefs, the idea of total balance, thus contributing to the overall effectiveness of treatment.

In the world at large these concepts have historically been used for everything from planting crops and family interactions to running Govts and businesses. Embodying the Five Phases as a tool for personal evolution is limited only by your imagination.

Rakovic_D (1991) Neural networks, brainwaves, and ionic structures: AP v altered states of consciousness. AETRIJ 16(3-4):89-99. Faculty of Electrical Engineering, Univ of Belgrade, Yugoslavia.It is shown that neural networks with embedded "brainwaves" can cross the gap between the fast parallel unconscious mode of neuroscience and the slow serial conscious mode of psychol. The electromagnetic (EM) component of ultra low frequency (ULF) "brainwaves" appears to enable perfect fitting with narrowed limits of conscious capacity in normal awake states and very extended limits in altered states of consciousness - due to the biophysical relativistic mechanism of dilated subjective time base. An additional complex low-dielectric (epsilon r circa 1) structure is also necessary in these processes. This structure can be related to a displaced (from the body) part of AP ionic system which can conduct ULF brainwave currents circa 10(-7) A, inside the conductive Channels of the initial ionic concentration circa 10(-15) cm-3, with a tendency of deterioration during a period of circa 1 h. It provides an extraordinary biophysical basis for traditional psychology, including transpersonal experiences down to the ultimate state of thoughtless consciousness. Notions, such as "Qi", "subtle body", and "causal body", are physically inevitably associated with ions, displaced (from the body) part of AP ionic structure, and in it embedded an EM component of ULF brainwaves, respectively.

Rampes_H; Davidson JR (1996) EAP: A novel treatment for anxiety disorder. Adapted from WWW. Copyright Psychiatry On-Line 1996 (15.09.96, Version 1.00). Hagen Rampes, Senior Registrar, Barnet Psychiatric Unit, Barnet General Hospital, Wellhouse Lane, Barnet, Herts, EN5 3DJ, UK; Jonathan R T Davidson, Professor, Dept of Psychiatry & Behavioural Sci, Duke Univ Med Centre, Durham, North Carolina 27710, USA. Form and CGI Copyright 1996 Priory Lodge Education Ltd. Summary: A 33-yr old female who suffered from a generalised anxiety disorder was treated successfully with EAP. This is the first report of the use of EAP to treat anxiety. The mechanism of action of EAP may be via modulation of neurotransmitters. Key words: Anxiety; EAP; case report. Introduction: Anxiety disorders are common and cause considerable morbidity. Contemporary treatment approaches involves psychological and biological methods. Pharmacological treatments mainly involve the use of benzodiazepines, azaspirones and antidepressants. The use of these drugs is not without problems: unpleasant adverse reactions and more importantly dependence and abuse. Moreover some pharmacological interventions may be expensive. Comp Med is becoming more popular with the public and professionals. A 1990 survey(1) revealed that Americans made an estimated 425 million visits to providers of unconventional treatments. Among all the Med conditions studied in the survey, anxiety disorders were the second most common. AP was one of 18 therapies listed in the survey. Med AP involves inserting needles either into AP points or tender points in the skin. These points can be further stimulated by manipulation of the needle, applying heat to the needles (moxibustion) or by applying current to a pair of needles (EAP). The indexed literature has no previous reports of the use of EAP to treat anxiety. We report a case of generalised anxiety disorder which was successfully treated by EAP. Case report: A 33-yr-old woman was referred to the outpatient clinic with a history of worsening anxiety. These episodes of anxiety would come on gradually and last for several h. The patient had these episodes intermittently over the last 9 yr. She had used lorazepam with success in the past to alleviate her anxiety. However she did not wish to take medication on this occasion. There was no family history of psychiatric illness. Her childhood was an unhappy one due to parental marital disharmony. She left school aged 16 with mean qualifications. She had worked with a major company as an engineer since the age of 18. Her first marriage lasted 7 yr. Her most recent relationship lasted 2 yr and ended 2 mo before being seen. She has 2 young children from her first marriage. She lives in her own home and has financial debts incurred by her last boyfriend. She has never abused any illicit substances. Mental state examination revealed a tall, blond, young, white female who was casually and appropriately dressed. She had appropriate eye contact but sat uncomfortably and was restless during the interview. Her mood was anxious. There was no evidence of a depressive illness. Her speech was coherent and spontaneous. There were no obsessional phenomena present. Her cognitive functions were intact and insight was present. A diagnosis of generalised anxiety disorder was made. Treatment options were discussed with her and a course of EAP offered and accepted by the patient. Method: Sterile disposable AP needles (0.5" length and 0.22mm diameter) were inserted at the following AP points: Bilaterally at LV03, SP06, ST36, LI04 and TH16. A needle was also inserted at CV13. The names of the points refer to supposed Channels and the numbers refer to the location on the Channel. These AP points are regarded as "nervous tension points" and used as standard treatment. EAP (square wave, frequency of 50 Hertz) was applied bilaterally to the needles at LI04. The intensity of the current was slowly increased until the patient felt either a tingling or warm sensation at the needle site. Treatment duration was for 30 min once/wk for 6 wk. The treatment was carried out with the patient reclining in a comfortable chair. Conversation with the acupuncturist (HR) was minimal during the treatment sessions as is standard practice for this form of treatment. The 30 item General Health Questionnaire(2) and the Zung Self Rating Anxiety Scale(3) were used at baseline, 8 wk, 3 mo and 6 mo. Results: The General Health Questionnaire and Zung Self Rating Anxiety Scale scores both reduced substantially after the treatment intervention (Table 1). Table 1 Scores of General Health Questionnaire (GHQ30) and Zung Self Rating Anxiety Scale (SAS).
GHQ        SAS

Baseline
8 Wk
3 Mo
6 Mo

25
8
14
0

55
31
26
21

The patient was followed up at 3 and 6 mo from the original referral and continued to improve without any further EAP. There was initial improvement in the severity and frequency of her anxiety attacks. After the third AP treatment there was transient deterioration in her symptoms. There were no external factors to account for her deterioration. After the 4th AP treatment she was much improved and at the end of the course of treatment she was almost symptom free. She remained well at 3 mo and was discharged from the clinic. Discussion: Anxiety disorders do of course wax and wane and a spontaneous resolution may be a possible explanation for the improvement in the above patient's mental state. The novel treatment, which includes needles being inserted and being wired up to an electronic machine may of course constitute a powerful way of eliciting the placebo response. Finally the act of simply sitting quietly for 30 min once/wk for 6 wk may have been akin to a form of meditation and may be a contributing factor. Although non-specific factors contributed to the treatment, EAP as described above had a specific therapeutic benefit. The patient reported no adverse reactions to treatment. EAP should not be used in patients with a pacemaker; malfunction of the pacemaker is a theoretical risk(4). Research on animals and humans has shown that EAP modulates neurotransmitters(5). The type and proportion of substances modulated depends on the frequency of the current. Low frequency (4 Hz) releases endorphins and enkephalins. High frequency modulates 5-HT, dopamine and noradrenaline. EAP should be further researched. Its role in psychiatry looks promising if indeed it modulates 5-HT.

Acknowledgement: We thank Dr A Sanderson, Consultant Psychiatrist, South Bedfordshire Community Health Care Trust, UK, for permission to publish.

References:
1. Eisenberg DM; Kessler RC; Foster C; Norlock FE; Calkins DR; DelBanco TL (1993) Unconventional Med in the USA: Prevalence, costs and patterns of use. NEJM 328:246-252.
2. Goldberg DP (1972) The detection of psychiatric illness by questionnaire. Oxford Univ Press.
3. Zung WWK (1971) A rating instrument for anxiety disorders. Psychosomatics 12:371-379.
4. Rampes H; James RC (1995) Complications of AP. AP in Med 13:26-33.
5. Han JS (1986) EAP: an alternative to antidepressants for treating affective diseases?. Int J Neurosci 29:79-92.

Romoli_M1; Giommi A (1993) Ear AP in psychosomatic Med: the importance of the Sanjiao (triple Heater) area. AETRIJ Jul-Dec 18(3-4):185-194. SIRAA (Societa Italiana di Riflessoterapia, AP, Auricoloterapia), Prato, Italy. 50 patients with possible psychosomatic disorders of the cardiovascular, respiratory and digestive systems were treated with Ear-AP. Together with a control group of 20 symptomless volunteers, they were treated once/wk for 4 wk and a final check of the therapy was made after 6 wk. All subjects were examined with the MMPI test, Paykel's scale for stressful life events, and with the SRT scale (Symptom Rating Test) for measuring at each treatment the variations of anxiety, depression and somatisation levels. Both groups responded similarly to AP but the response was significantly better in the stress group for the reduction of the SRT score and the number of Ear-AP points. The outer ear was sensitized by stress response in certain recurrent areas, especially of the cavum conchae. The TH (Sanjiao) area had the highest relative density of Ear-AP points.

Romoli_M2; Giommi A (1994) Ear AP and psychosomatic medicine: right-left asymmetry of AP points and lateral preferences: Part 2. AETRIJ Jan-Mar 19(1)11-17. SIRAA (Societo Italiana di Riflessoterapia, Agopunctura, Auricoloterapia), Prato, Italy. A group of 50 patients with possible psychosomatic disorders was examined with 5 right-left preference tests: Oldfield's Handedness Inventory, and Coren and Porac's preference tests for hand, foot, eye and ear. The patients were sorted into "complete right" (consistent answers) and "incomplete right" (having answered "left" to at least one question) groups for each of these different tests. The sensitization of the left ear, particularly of the TH (Sanjiao) area, is higher in the complete right than in the incomplete right group. The side to treat with AP is important for diagnosis and therapy.

Tian_L; Yuan S; Ba E; Chen H; Zhou Z (1995) Composite AP treatment of mental retardation in children. JTCM Mar 15(1):34-37. Inst of AP, China Acad of TCM, Beijing, PRC. 128 children of mental retardation were diagnosed in accordance with the 1985 diagnostic standards proposed by WHO. The patients were treated compositely with AP, Ear-AP by pellet pressure, and herbal plasters on AP points. The effects were assessed by recognized intelligence tests for children. AP treatment improved mental development (as assessed by IQ) and social adaptation behaviour (SAB).

Wanning_T (1993) Healing and the mind/body arts: massage, AP, yoga, Taiqi, and Feldenkrais. AAOHN J Jul 41(7):349-351. The health practitioner may encounter clients who are faced with problems that do not seem to respond to traditional health care. One way that some choose to confront these systemic complaints is to employ some of the health traditions of other cultures and to view the body and mind as a balanced whole. 3. Massage, AP and acupressure, Taiqi, and Feldenkrais focus on the mind/body connection to facilitate healing through relaxation, pressure points, and movement.

2. MENTAL DISORDER , SCHIZOPHRENIA
Chen_A (1992) An introduction to sequential electric AP (SEAP) to treat stress-related physical and mental disorders. AETRIJ Oct-Dec 17(4):273-283. Dept of Anaesthesiology, Wayne County General Hospital, Westland, Michigan. A method of SEAP to certain AP loci was effective to treat stress-related physical and mental disorders. Cerebral serotonin has anti-depressant and analgesic effects and AP stimulation of certain points can release cerebral serotonin. Omura reported that the stimulation of ST36 and GB20 increased intracephalic blood flow. Increasing intracephalic blood flow may indirectly increase the quantity of serotonin released. The release of serotonin can be enhanced further by sequential stimulation of these AP loci. SEAP markedly improved mental relaxation in this study of 85 clinical cases of chronic physical disorders, e.g. intractable pain, headache, with most disorders complicated by reactive depression. Some of the cases were psychosomatic disorders. The % improvement from slight to remarkable between mental disorders (79%) and physical disorders (77%) was similar. The method of treatment and schematic of the SEAP device were discussed.

Yang_X; Liu X; Luo H; Jia Y (1994) Clinical observation on needling Extra-Channel points in treating mental depression. Chung i tsa chih (JTCM) Mar 14(1):14-18. Inst of AP and Moxibustion, China Acad of TCM, Beijing, PRC. 20 cases of mental depression were treated by AP at Extra-Channel points with an effective rate of 90%; comparison of these cases with 21 controls treated with amitriptyline, showed no significant difference in effect (p>.05). Measured with Hamilton's scale, factors of anxiety somatization, cognitive disturbance, retardation, sleep disturbance and feeling of despair in both the needling and control groups showed obvious decrease in the mean value, and the change in anxiety somatization was markedly significant in the needling group as compared with that in the controls.

Zhang_B (1991) [A controlled study of clinical therapeutic effects of laser-AP for schizophrenia]. Chung Hua Shen Ching Ching Shen Ko Tsa Chih Apr 24(2):81-83, 124. Psychiatric hospital of Kai Luan Mine Bureau, Tangshan. A controlled study of clinical therapeutic effects of laser-AP was made for 33 patients suffering from schizophrenia. As evaluated by BPRS, CGI, a rating scale for extramidal side-effects and Chinese clinical assessments for therapeutic effects. Our clinical practise suggests that laser-AP was as effective as chlorpromazine to treat schizophrenia.

Zhuge_DY; Chen JK (1993) Comparison between EAP with chlorpromazine and chlorpromazine alone in 60 schizophrenic patients. Chung Kuo Chung Hsi I Chieh Ho Tsa Chih Jul 13(7):408-409, 388. Yangzhou 2nd People's Hospital, PRC. 60 schizophrenics (30 in each group) were treated with EAP and chlorpromazine in comparison with chlorpromazine therapy alone. Curative effects were evaluated according to the brief psychiatric rating scale (BPRS). The total curative effects of the two groups were similar. However, the marked effects appeared earlier in combined therapy than that of using chlorpromazine alone, less chlorpromazine was needed, hence displayed fewer side-effects.

3. STUTTERING
Craig_AR; Kearns M (1995) Results of a traditional AP intervention for stuttering. J Speech Hear Res Jun 38(3):572-578. Dept of Health Services, UTS New South Wales, Australia. It is important that researchers investigate alternative strategies for treating stuttering, as contemporary treatments are not entirely successful in reducing stuttering with all people. Also, many "successfully treated" cases suffer from high relapse rates in the long term. AP seems to be a promising treatment for several disorders, so a pilot investigation into its effectiveness for stuttering was considered worthwhile. This study investigated traditional AP-based treatments for 2 adult males who had stuttered since childhood. A single-case experimental ABAB multiple baseline design was employed to test for treatment effectiveness. Subjects were followed up for a further 12 wk to evaluate maintenance (C phase) of possible improvement. No significant ABAB reversal effects were observed, and stuttering frequency through the treatment phases remained at baseline levels for the 2 subjects. Speech rate also remained at baseline levels throughout the treatment phases, as did naturalness of speech and anxiety levels. This research is important as claims that AP may successfully reduce stuttering need to be tested, and the scope and usefulness of treatments like AP for a wide variety of problems needs to be determined. However, the low subject numbers involved suggest caution in concluding AP is not a successful intervention for stuttering. Perhaps alternative AP points need to be evaluated and a wider variety of persons who stutter need to be involved in any future research.

M. AP and the Urogenital / Adrenal System

1. GYNAECOLOGY (ANIMAL AND HUMAN)Alieva_EA; Fanchenko ND; Parshutin NP; Gasparov AS; Pshenichnikova TIa (1993) The effect of a decrease in body weight in patients with the polycystic ovary Syndrome. Akush Ginekol Mosk (3):33-36. 80 patients with polycystic ovary Syndrome and excessive weight were examined. In 60 patients weight reduction resulted from diets and in 20 it occurred over the course of AP. Such treatment led to pregnancy in 21 (34%) patients. Diets and AP for weight reduction are recommended as the first stage of treatment for patients with polycystic ovaries combined with obesity.

Anon_New Scientist (1995) Electric blankets and birth defects. New Scientist 2 Aug, p11. This is a report of the first study showing a link between exposure to EMFs (electromagnetic fields) and birth defects. The study looked at 486 women who had been trying to conceive for more than 12 months. They found that those who slept with their electric blanket switched on were 7 times more likely to have babies with urinary tract defects than those who turned their blankets off.

Bahr_FR (1994) [AP in gynaecology and obstetrics]. Gynakologe Dec 27(6):369-374. In German.

Chen_BY; Yu J (1991) Relationship between blood radioimmunoreactive beta-End and hand skin temperature during the EAP induction of ovulation. AETRIJ 16(1-2):1-5. Inst of AP Research, Shanghai Med Univ, PRC. 13 cycles of anovulation menstruation in 11 cases were treated with EAP to induce ovulation. In 6 of these cycles which showed ovulation, the hand skin temperature (HST) of these patients was increased after EAP. In the other 7 cycles ovulation was not induced. There were no regular changes in HST of 5 normal subjects. The level of radioimmunoreactive beta-End (r beta-E) fluctuated, and returned to the pre-AP level by 30 min after withdrawal of needles in normal subjects. After EAP, the level of blood r beta-E in cycles with ovulation declined or maintained the range of normal subjects. But the level of blood r beta-E in cycles in which the induction failed to cause ovulation was kept higher than normal (p <.05). There was a negative correlation in the decrease of blood r beta-E and increase of HST after EA (r=.677, p <.01). EA can regulate the function of the hypothalamic-pituitary-ovarian axis. Since a good response is usually accompanied with the increase of HST, monitoring HST may provide a rough but simple method to predict the curative effect of EA. The role of r beta-E in the mechanism of EA ovulation induction was discussed.

Chien_CH; Li SH; Shen CL (1991) The ovarian innervation in the dog: a preliminary study for the base for EAP. J Auton Nerv Syst Sep 35(3):185-92. Dept of Anatomy, Coll Med, Nat Cheng-Kung Univ, Tainan, Taiwan, ROC. The origin of the canine ovarian sensory and sympathetic nerves was studied by applying horseradish peroxidase (HRP) or wheat germ agglutinin conjugated to HRP (WGA-HRP) to the ovarian stroma and into the ovarian bursa. HRP/WGA-HRP positive neurons were found bilaterally in the dorsal root ganglia of segments T10-L4, with most located in T13-L2. In sympathetic paravertebral ganglia, labelled neurons were distributed bilaterally in ganglia from T11-L4 with the majorities located in segments T13-L2. Both distributions show ipsilateral predominance. Labelled prevertebral neurons were mainly located in the aorticorenal ganglion, ovarian ganglia and caudal mesenteric ganglion. No labelled neurons were found in the dorsal motor nucleus of vagus, nodose ganglia or sacral segment from S1-S3. This study provides the possible morphological basis of EAP concerning the somatovisceral reflex of the ovary.

Gerhard_I et al (1993) Ear-AP in the treatment of female infertility. Gynaecol Endocrinol 6(3):171. In a German study of 90 infertile women, half were treated with auricular AP (in the ear and half with hormone treatment. There was a fractionally higher birth rate in the group treated with AP (22/45) than in the group treated with hormones (20/45). The researchers noted that the AP group experienced additional health benefits and no adverse side effects. They concluded that "auricular AP seems to offer a valuable alternative therapy for female infertility due to hormone disorders", being more effective and with no side effects. [Alan: I also know that nutrition can help a lot with infertility].

Gerhard_I; Postneek F (1992) Ear-AP to treat female infertility. Gynecol Endocrinol Sep 6(3):171-181. Dept for Gynecological Endocrinology and Reproduction, Women's Hospital, Univ of Heidelberg, Germany. 45 infertile women suffering from oligoamenorrhoea (n=27) or luteal insufficiency (n=18) were treated with Ear-AP after a full gynaecologic-endocrinologic workup. Results were compared to those of 45 women who received hormone treatment. Both groups were matched for age, duration of infertility, body mass index, previous pregnancies, menstrual cycle and tubal patency. Women treated with AP had 22 pregnancies, 11 after AP, 4 spontaneously, and 7 after appropriate medication. Women treated with hormones had 20 pregnancies, 5 spontaneously, and 15 in response to therapy. 4 women of each group had abortions. 35-38% of women of each group who failed to become pregnant after therapy developed endometriosis, with normal menstrual cycles. Only 4% of the women who responded to AP or hormone treatment with a pregnancy had endometriosis, and 7% had normal cycles. Also, women who remained infertile after hormone therapy had higher body mass indices and testosterone values than responders from this group. Women who became pregnant after AP suffered more often from menstrual abnormalities and luteal insufficiency with lower estragon, thyrotropin (TSH) and dehydro-epiandrosterone sulphate (DHEAS) levels than the women who achieved pregnancy after hormone treatment. Although the pregnancy rate was similar for both groups, eumenorrhoeic women treated with AP had adnexitis, endometriosis, out-of-phase endometria and reduced postcoital tests more often than those receiving hormones. 12/27 women (44%) with menstrual irregularities remained infertile after therapy with AP compared to 15/27 controls (56%) treated with hormones, even though hormone disorders were more pronounced in the AP group. Side-effects were observed only during hormone treatment. Various disorders of the ANS normalized during AP. Ear-AP offers a valuable alternative therapy for female infertility due to hormone disorders.

Gong_D; Liang C; Lai X; Lai X (1993) [Effects of different AP manipulation on plasma estradiol, testosterone and cortisol in patients with KI Xu]. Chen Tzu Yen Chiu 18(4):253-256. Dept of AP and Moxibustion, Guangzhou Coll of TCM. Observation was made on the effect of different AP manipulation on plasma estradiol (E2), testosterone (T), E2/T and cortisol (C) in 78 patients with KI Xu (Deficiency). The level of E2 and T in women was lowered by both reinforcing manipulation (RFM) and reducing manipulation (RDM). E2/T index was lowered by RDM but not by RFM, and there was significance (p <.05) between the RDM group and RDM group in E2/T, but no significance between the men's groups. The level of C was decreased by RDM but not by RFM. The different manipulation effects are different on the level of sex hormones in women and the C level in patients with KI Xu.

Hao_LC (1987) EAP therapy trial for treating infertility in mares. Theriogenology Sept 28(3):301-305.

Hasenpusch_E (1988) Treatment of non_cyclic young postpartum cows with EAP or Abbovestrol-spiral. Inaugural-Dissertation, Tierarztliche Hochschule Hannover (No 41), 99pp. Summary in: English.

Hirsh_RC1 (1996) Chin Med and Assisted Reproductive Technology for the Modern Couple: Part 1. Adapted from WWW. [Roger C Hirsh, OMD LAc BAc (UK), Dipl NCCA (email: [email protected]) has been working for the last 7 yr to specialize in reproductive health care within the TCM model and to integrate the diverse traditions of TCM and WM in his work with fertility. An Honours graduate of the International Coll of Oriental Med (London, 1976) he received his Doctorate in Oriental Med (1984) with a specialty in Constitutional Med. After a 3000 h Postgrad internship with Master Sehan Kim OMD and Ms Kyo Ok Kim MD PhD, he joined the Centre for Orthomolecular Med in Palo Alto, where he practised AP and Herbal Med for several years as a member of a 6 physician team. Dr Hirsh has served as an adjunct faculty member of the Am Coll of TCM, the California AP Coll and Emperor's Coll of TCM and is one of the founders and is currently chairman of the board of directors of China International Med Univ. He is currently in private practice in Beverly Hills, California, specializing in work with couples who have simple to complex fertility concerns or are preparing to have a family: WebMaster].

AP and Herbal Therapy are ancient methods used to treat and prevent disease in TCM. These systems are as ancient and effective as any other Med techniques used in the world today. They have been practised consistently for the past 5000 yr in the Orient. Circa 17.5% of the world's population uses AP and herbs as their main form of health care. Although AP has been used in England, France, and Germany for several centuries, only in the past 2 decades have AP and TCM been recognized in the USA. The benefits of AP and TCM in treatment for the infertile couple can be found in early TCM literature. Not only do these techniques assist in regulating the menstrual cycle and invigorating the sperm, but they also serve to enhance the function of the whole body. This "whole body" health approach, in turn, provides a key to unlock unlimited potential in healing. This is especially appropriate for the over 40 couple as it stimulates overall health to effect reproductive health and a reduction of biological age.

PMS, amenorrhoea, endometriosis, blocked fallopian tubes, immune system incongruities, and infertility related hormonal problems yield to many of these old world (traditional) procedures. Also, herbal formulas that tonify KI-Qi (KI- and adrenal- function), and KI-Jing-Essence are especially useful in raising sperm count and motility. The highly technical and expensive methods used in WM are supported by complimentary TCM procedures and Herbal Med. Complete treatment programs also include a series of Qigong healing energy exercises to enhance Qi-flow in specific Channels, as well as the use of AP, TCM and Herbal Med. These exercises, developed by Chinese Taoists (metaphysicians) >3000 yr ago, stimulate the flow of intrinsic Qi in the body which, in turn, enhance health and benefit organ function. The meditative dance-like movements coordinate with specific visualizations and exercise; they oxygenate the blood and simultaneously enhance one's artistic nature. Oriental sexological literature lists specific sexual positions that enhance a man's sperm count and motility as well as regulating a woman's cycle. Currently, studies focused on understanding the effects of these techniques are under way in the USA and Europe. Longevity and regaining a persons youthfulness are key topics. As a way to heighten a couple's fertility, TCM has several advantages.

Advantages of using TCM:
1. TCM sees the person as an integral Mind/body organism, thereby does not treat just symptoms/diseases. TCM ventures to stimulate the bodies natural healing potential by treating root causes rather than just symptoms.
2. TCM, used to treat infertility, minimizes undesired side effects and accumulated toxicity from invasive procedures and drug therapies, known and unknown.
3. TCM may be used to strengthen and balance one's general health so that IVF, GIFT, ZIFT, ICSI, AHT and TET procedures are more effective. Patients of TCM derive general health benefits and endocrine system balancing from specific AP and Herbal Med. Pregnancy becomes easier to achieve and postpartum recuperation happens faster. Med studies have been done in China to verify this type of whole body health enhancement.
4. Widespread use of TCM suggests that it is a complete health care system and can be used with or without integration with WM. The integration of WM, as we know it in America, began in the Orient <100 yr ago. It is called integral TCM (ITCM). TCM techniques (AP and herbs) seem to work best when combined with WM.

Unexplained infertility / LV-Qi Stasis: Irritability, depression, frustration are keywords to LV-Qi-Stasis. Whenever an organ is mentioned in TCM, it implies the related Channel and its TCM functions. A Channel is a conduit along which Qi (vital energy) flows. The psychological aspect of LV is said to assist in planning easily and wisely. The person who suffers from LV-Qi-Stasis may be found in a job that they don't enjoy, working late hours, and with a history of taking birth control pills. There often exists an inner psychological frustration about having and raising children. Dysfunctional family factors play a major role in LV-upset, as the condition may have existed for years.

Physical symptoms of irregular periods, PMS, dark coloured blood with small clots, breast pain with distention, worry and frequent sighing and headaches often accompany the psychological symptoms. Pulse diagnostic palpation at the radial artery usually reveals a wiry and small quality pulse in the person with a LV imbalance. Pulse Diagnosis at the radial artery is an extremely sensitive and skilled art that takes years to perfect. It is like a Lab blood test. Each wrist has >12 different pulse positions and 28 pulse qualities can related to each one of these positions. The readings yield a multitude of relationships when integrated and compared with the patients' signs, symptoms and tongue characteristics. The different pulses can confirm a diagnosis and be used to monitor a patient's progress. Both pregnancy and the sex of a child can be diagnosed from the pulses by a skilled practitioner.

Infertility due to LV-Qi-Stasis manifests mostly in women and is a common cause of unexplained infertility. This is because this type of LV-Stasis effects the blood flow in the pelvic cavity. AP at the right time in the menstrual cycle, in conjunction with an herbal formula and some counselling, very likely can clear the Stasis in several mo. The resulting pregnancy is more than welcome along with the emotional clarity that arrives when LV is less toxic (less LV-Stasis). Couples must realize, however, that the prevalence of LV-Qi-Stasis in modern society is not something simple that can be relieved overnight. It may take 9 mo or more to release the stress, trauma, and toxin in the system, if it is at all possible. Some cases resolved in <1 mo.

Miscarriage in TCM: Since the Western Han Dynasty (206BC-24AD), Chinese people have been using TCM to effectively treat both male and female infertility.
Hirsh_RC2 (1996) Chin Med and Assisted Reproductive Technology for the Modern Couple: Part 2. Many texts have been published in the Med literature focusing on these problems that have so recently come to the forefront in western society. TCM for threatened miscarriage includes AP, herbs, diet and an a different approach to exercise. Treating infertility and miscarriage by any method is complicated and involved. The Med that helps the patient attain a healthy vital energy (Qi, Tian kuei) can greatly aid the woman who has had miscarriages due to hormonal imbalance. For women >40 there are herbs to nourish the deeper vitality necessary to ovulate healthy ova. Currently, both in China and America, TCM is used with WM techniques and testing to design an effective course of treatment for the couple wishing to achieve not only pregnancy, but a healthy baby delivered at full term. 60% of all spontaneous abortions occur in the first half of the first trimester of pregnancy. Genetics play a key role in habitual miscarriages. To presume that TCM alters genetic structure without triple blind studies etc., would be a stretch of the imagination for most people. However, TCM is very effective in strengthening a persons' constitution. If a woman has miscarried, it is important to build and conserve her Qi and build her Xue. This usually means building and conserving KI-Qi, as within KI both Yin (Xue) and Yang (Qi) are generated. In TCM, KI means the whole psychophysical interrelated matrix and visceral relationship of KI function and its Channel conduits, not just the ear-shaped organs guarded by the ribs just above the lower back.

In TCM, all chronic imbalances effect KI; if a person has a weak constitution (e.g. is pale, feels cold is undernourished, etc), then this is a result of either prenatal (genetic) influences (Yuanqi-Xu) and/or life-habits and illnesses which weaken or obstruct KI-Qi. The way to change these conditions, if possible, is to change them through treating KI with tools of AP, herbs, diet, and exercise. KI means bone and bone marrow, and Xue is made from the marrow. Xue nourishes Qi and the cycle regenerates and builds. In TCM, the Xue nourishes, the Qi protects, and KI-Qi holds the fetus. KI is injured by Cold, therefore dietary considerations are generally applicable for this patient. Recent studies have also shown that good dental hygiene and dental work of high quality can increase fertility.

A very famous formula, that builds Qi-Xue, is used to strengthen the body and prepare a woman for conception. This is especially useful if she has a history of miscarriage. The formula should be given for 3-6 mo before conception is attempted. It is called "The Rock on Tai Mountain Decoction." This somewhat poetic name refers to a great mountain that many Chinese religiously pilgrimage to, hoping to get their prayers answered. It is an extremely demanding climb of 1000, just as pregnancy is demanding of the modern mother. Just giving this herbal decoction does not guarantee that conception will take place and the next baby delivered to full term. Seeing the patient as a whole person and thereby considering their total health picture helps the TCM physician decide how to choose and change a formula to be specific to the patient.

Sex during pregnancy: Oriental culture has a very direct and honest attitude toward sexuality. As sex is seen as a natural function, as natural as "clouds and rain", nothing sexual is considered to be "dirty". In training, a TCM practitioner is taught that it is not the job of the physician to be judgemental about an individual's sexual practices; it is more important to discuss the consequences of these practices. Therefore it is easy for the doctor to indicate that intercourse during the first trimester is contraindicated, especially for the woman that has a history of miscarriage, as the placenta is not yet fully formed. Many men have a problem with this recommendation (but the "problem" can be solved without risk to the female). Usually, TCM practitioners go one step further and indicate that it is probably best for all couples to abstain from intercourse for the whole 9 mo of pregnancy. Modern couples usually have no problem with this idea especially when they consider the investment they have made. For the couple, where the woman is over 40, intercourse is not recommended for the entire pregnancy even by western physicians.

Raising fertility quotient with TCM
1.        Timing and consistency of treatment, whether having AP or just taking herbs, is of primary importance. Consistency of treatment is most important for men, as to raise sperm count and motility with herbs starts to take effect in mo 4 of treatment. It takes 70 d to generate new sperm. Timing and consistency is also important for women, as specific hormonal adjustments can be made at each week of the cycle. Missing 1 wk of treatment may lose an important chance to heal a particular segment of the 4 phase menstrual cycle. It takes a minimum of 3 consecutive cycles (12 treatments) to do the foundation work of regulation regardless of biological age. Most women can benefit from this type of concentrated foundational treatment every 2 yr, even if they aren't trying to conceive. This should be started before a woman reaches 28 yr old or earlier if birth control pills have been taken.

2.        Course of 6-9 mo: If a woman is nearing 40-yr old and has had either many fertility drugs (over 3 cycles), birth control pills, PMS, ART procedures, elevated FSH, polycystic ovaries, endometriosis, sperm antibodies, or a history of drug, alcohol, or smoking abuse, then it usually takes longer to balance her reproductive system. Likewise, if a man has a history of STDs, history of drug, alcohol, smoking, or sexual abuse, urinary tract infections, burning urination, chronic lower back pain, prostatitis, difficulty passing urine, or other urological health issues it takes longer to rejuvenate the reproductive function. The extent of rejuvenation is relative to the effort and inherent constitution of the individual. Daily training sessions with the right exercises usually provide tangible results when combined with weekly treatment, meditation and a reasonable diet. The couple must expect to focus 6-9 mo before expecting to evaluate results. There is no quick path to conception, full term pregnancy and recovery after delivery.

3.        Re-evaluation: In TCM, it is appropriate to evaluate between the 6th-9th mo of consistent treatment if a woman is in a high state of wellness (warm hands and feet and no PMS are good indicators), and has a "normal" active and a relatively low-stress, energy-abundant lifestyle.

4.        Biological v chronological age: The 2000-yr old TCM classic (Neijing Suwen Lingshu) states precepts of health and aging that remain very important today. Accordingly, the normal life span for humans is over 100 yr. Some monks have lived in good health to >150 yr old. In the Neijing dialogue between the Yellow Emperor and his old Taoist teacher (Qi-po), Huangdi asks: "Why does medicine exist?". Qi-Po answers: "because people have severed themselves from their roots (Tao)".
Hirsh_RC3 (1996) Chin Med and Assisted Reproductive Technology for the Modern Couple: Part 3. The reconnection between the individual and their "roots" (spirituality) is a very important aspect in the maintaining of youthfulness and is thereby inherent in the basic foundation of TCM. Modern science supports this in the focus on the emerging stem cell technologies and the possible cures for major life threatening diseases. The umbilical cord is abundant in stem cells, which suggests a deep-rooted connection between Jingqi (Source-Essential-Ancestral Qi) and the umbilicus. The umbilicus contains CV08 (Shenque, Spirit Palace, also called Qishe (Qi Residence), and is also the essential physical connection to the mother's uterus and the route of the mothers Qi to the foetus). Understanding the root cause and quality of one's own longevity can slow the aging process and rejuvenate the body as thoughts can create reality. Knowing with certainty that we are an ageless body is the basis for creating high level wellness in the modern world. Longevity however is more than just belief.

5.        Correct dietary and exercise habits are just as important for the preconceptive mother as for the father. Eating salads (Cold nature food) for a year is not the best diet for a person who has generally a low basal body temperature (BBT). Sometimes eating meat such as lamb (warming food) can help tonify a "Cold" barren uterus. In cases of unexplained infertility, or male factors, couples can do specific physical and mental exercises to generate the right environment necessary for creativity and conception.

6.        Combining WM reproductive technologies with TCM (AP and Herbal Med) demands good communication between team members which includes the patient as captain. Communication between the patient, the acupuncturist and the reproductive specialist is a delicate process. It is important for the physician to know the procedures of the acupuncturist or herbalist and vice-versa. Lack of knowledge of a patient's herbal program can affect the results of an ART procedure. It even can be detrimental, as alternative therapies effectively change a person's body. Also, it is important that the patient tell the acupuncturist about any herbs or vitamins (other than standard prenatal vitamins) that are being taken while undergoing treatment. Over-the-counter herbal remedies may sometimes be effective, but may not be indicated for a particular cycle. It could be like having carpet delivered for the baby's room before the concrete foundation was poured for the house.

TCMs and AP work quite differently than WMs. They are gentle and deep acting rather than flashy and bright. Expect to feel a growing subtle influence that permeates your life like the smell of star jasmine on a summers night.

7.        Previous AP treatment? When selecting an acupuncturist or any healer it is important to know that they are suitably qualified to do fertility work. Communication, experience and skill are important. Having a state AP license means that acupuncturists have passed a course of study that qualifies them as entry level practitioners. Usually this training lasts circa 3000 h. Though some programs for physicians are only 300 h, more and more doctors who integrate the reproductive techniques of TCM with WM have more than entry level experience of treating couples. These physicians are to be sought out, as treating infertile couples demands not just general practice but also a specialty skill. General practice skills help remove pre-existing conditions. If these conditions are the cause of infertility then the couples fecundity quotient will increase. However, if either reproductive function or biological age of the endocrine system is the primary contributory factor then specialty skills and experience is necessary.

Bibliography.
1.The Infertility Book, A Comprehensive Med and Emotional Guide, Harkness, Carla, 2nd edition 1992, Celestial Arts, P.O. Box 7327 Berkeley, California. (510) 845-8414.
2.Infertility: A guide for the Childless Couple, Menning, Barbara Eck, New York, Prentice Hall rev. 1988.
3.You Can Have A Baby, Everything you need to Know about Fertility, Bellina, Joseph H., M.D., Ph.D., Wilson, Josleen New York, Crown Publishers Inc., 1985.
4.Adoption, Is It For You?, Dywarsuk, Collette T. New York: Harper & Row, 1973.
5.Endometriosis & Infertility and TCM, Flaws, Bob, CO, Blue Poppy Press, 1989.
6.Endometriosis as Treated by TCM, Cao Ling-xian & Tang Ji-fu (1983). Trans. CS Cheung, MD & Carolyn Atkinson) J Am Coll of TCM. SF, CA, 1(1):54-57.
7.A Woman's guide to Endometriosis, Older, Julia, Charles Scribner's Sons, NY,1984.
8.Handbook of Chin Herbs and Formulas, Vol 1 & 2, Him-che Yeung, Los Angeles, 1985.
9.Chin Herbal Patent Formulas, A Practical Guide, Jake Fratkin, Shya Publications, 1986.
10.Chin Tonic Herbs, Ron Teeguarden, Japan Publications, Inc. 1985.
11.Wise Woman Herbal For the Childbearing Year, Weed, Susun, New York, Ash Tree Publishing, PO Box 64, Woodstock, NY 12498, 1986.
12.Consumer Protection Issues Involving IVF Clinics (stock number 552-070-06387-1 US Govt Printing Office, $31) 202-2753030.

Korematsu_K; Takagi E; Kawabe T; Nakao T; Moriyoshi M; Kawata K (1993) Therapeutic Effects of Moxibustion on Delayed Uterine Involution in Postpartum Dairy-Cows. J Vet Med Sci Aug 55(4):613-616. Dept of Vet Obstetrics and Gynecol, Rakuno Gakuen Univ, Hokkaido, Japan. 48 cows with delayed uterine involution, diagnosed on rectal palpation and vaginoscopic examination 21-35 d after parturition, were allocated to 3 groups. Moxibustion was applied to 12 points in 16 cows once/d for 3 d. 17 cows were injected im with 25 mg PGF2-alpha and 15 cows were infused in utero with 500 mg ampicillin. Uterine involution after treatment was monitored by rectal palpation and vaginoscopic examination. As a monitor of ovarian function, milk progesterone was assayed 3 times/wk. No significant difference occurred in uterine involution among the groups treated with moxibustion, PGF2-alpha or ampicillin. In the 4 wk after treatment, the % cows with abnormal cervical mucus and bacterial isolation from cervical swab decreased remarkably in all groups. Inactive ovaries were diagnosed in 46% of cows with delayed uterine involution. After moxibustion, 67% of cows ovulated and formed corpora lutea. This was a slightly better result than for cows treated with PGF2alpha or ampicillin. Reproductive performance after moxibustion was comparable to those after PGF2-alpha or ampicillin treatment. Moxibustion can be used as an alternative to PGF2-alpha and antibiotics to treat delayed uterine involution in cows. (Note: PGF2-alpha is indicated after postpartum cyclicity is established, not before!).
Li_RQ; Qin DY (1984) Application of AP in treatment of animal infertility [Cattle, horses]. Sheep_Goat-Handb, Westview Press, Boulder, CO. Vol 4:293-302.
Lin_ JH; Panzer R (1990) To face some female animal reproductive problems with acupuncture. Proceedings 5th AAAP Animal Science Congress, May 27-June 1, Taipei, Taiwan, ROC. Vol 2:305-322. Dept Anim Husb, Nat Taiwan Univ, Taipei, Taiwan, ROC.
Lin_JH; Liu S; Chan W; Wu L; Pi W (1988) Effects of EAP and GnRH treatments on hormonal changes in anestrous sows. AJCM 16(3-4):117-126. Dept Anim Husb, Nat Taiwan Univ, Taipei, Taiwan, ROC. Anestrous sows with luteal ovaries were allocated to three groups: 1=EAP at Baihui and Weiken (n=4 sows); 2=EAP at Chiangfeng and Choushu (n=3 sows); 3=GnRH 50 ug iv (n=4 sows). Return to estrus was monitored during 14 d after treatment. At that time, the number of animals returned to estrus were 3, 1 and 1 in groups 1, 2 and 3, respectively. Only treatment 1 seemed to have therapeutic effects in inducing estrus. Changes of serum sex hormone levels support this conclusion. Serum LH levels fell for about 2 h after EAP both in groups 1 and 2, whereas those in group 3 rose sharply at 10 min, reached a peak at 20 min and returned gradually to basal level between 4-6 h after GnRH. Serum progesterone levels rose between 4-6 h after treatment in groups 1 and 3 but not in group 2. In total, 5 sows came in estrus and showed a low progesterone level 2 d after treatments; the other six anestrous sows did not show this change. Estradiol levels changed little during the blood sampling period of 5-7 d in these 3 groups. Cortisol levels rose in 15 min after EAP in groups 1 and 2. However, the EAP-induced increase in cortisol was less than that induced by the first bleeding, indicating that the therapeutic action of EAP in group 1 was not due to adrenal stimulation per se. EAP treatment and GnRH injection altered the release of LH from the pituitary in different ways but only EAP at Baihui and Weiken had a specific action on the ovary and a significant therapeutic effect. Therapeutic effects of EAP on reproductive disturbance may involve a synergistic reflex between the points (somatic) and the ovary and uterus, mediated by the CNS and endocrine system (the hypothalamo-pituitary-ovary axis).
Lin_JH2; Panzer R (1992) AP for reproductive disorders. Prob in Vet Med Mar 4(1):155-161. Dept of Animal Husbandry, Nat Taiwan Univ, Taipei, ROC. AP can give excellent results in reproductive disorders. Two physiologic mechanisms may explain its effects on the reproductive system:
1. an endorphin-mediated mechanism affecting the hypothalamic-pituitary-gonadal endocrine axis, and 2.
a direct effect on gonadal paracrine and autocrine control of steroidogenesis.
This chapter discusses reproductive disorders from the perspectives of both WM and TCM, and details the use of AP to treat eight specific categories of reproductive dysfunction
Milchev_N; Krutov G; Piperkov T (1992) [The use of low-energy lasers via action on the AP points in inflammatory processes in the female adnexa]. Akush Ginekol (Sofia) 31(2):25-27. This is a report of the clinical effect of low-energy laser-AP in female adnexitis. 60 women with subacute and chronic adnexitis were assigned to 2 treatment groups (n=30/group): 1=Laser-AP, via irradiation of biologically active points and; 2=Conventional therapy. Patients treated by laser-AP spent 3 d less in hospital than the other patients, and their pain symptoms disappeared quickly. Laser-AP at biologically active points for subacute and chronic adnexitis has a role in gynaecological practice.
Miljkovic_V; Pavlovic V; Petrujkic T; Mrvos G (1993) Neurotherapy of Infertility in Cows Caused by Uterine Adnexitis. Acta Vet Beograd 43(2-3):113-119. V Miljkovic, Fac Vet Med, Belgrade, Yugoslavia. Chronic adnexitis often is due to dystocia, uterine trauma and placental retention (RFM). It has a long duration and is difficult to diagnose because of its subclinical form, unless adhesions of the ovaries, cornua and peritoneum develop. It produces long-lasting sterility manifested in constant abortions. From 1989-1991 we treated 208 black and white Holstein-Friesian cows or Simmentals on dairy farms in Vojvodina and Kosovo & Metohia for infertility, using neurotherapy (pharmaco-AP) with paracervical injections of Impletol. The cause of infertility was chronic subclinical or clinical adnexitis, diagnosed by subsequent rectovaginal examinations and anamnesis (para and perimetritis), utero-peritoneal adhesions paracervical abscesses, constantly repeated estruses. The cows had been infertile for 120-265 d postpartum; most calvings had been difficult and complicated, accompanied by RFM, puerperal infections and intoxications, purulent endometritis or paracervical abscesses. Most had been treated unsuccessfully for long periods by intrauterine infusions of Lotagen and Lugol, accompanied by parenteral antibiotics, Catosal, vitamins A, D3, E, PGF2-a, GnRh hormones etc. Overall herd mean milk yield was 4500-7000 l/yr. Neurotherapy (pharmaco-AP using paracervical injections of Impletol) was given immediately after establishing correct diagnoses, and was repeated after 15 d. Paracervical Impletol has a dual effect: neurotherapy and pharmaco-AP. Impletol consists of 40 ml of 5% procaine hydrochloride and 3 ml of 50% caffeine Na benzoate with redistilled water made up to 100 ml. Impletol was applied using a 50 cm long needle, 3-5 cm deep, just beside the os cervicis on both sides. After therapy 47% of cows became pregnant and calved normally. The good results of pharmaco-AP using Impletol recommend it for wider use in chronic adnexitis patients.
Mo_X; Li D; Pu Y; Xi G; Le X; Fu Z (1993) Clinical studies on the mechanism for AP stimulation of ovulation. JTCM Jun 13(2):115-119. Zhejiang Coll of TCM, Hangzhou, PRC. Ovulatory dysfunction is commonly seen in gynecol clinic. It may cause infertility, amenorrhoea, functional uterine bleeding and a variety of complications. This research according to TCM theory records treating with AP 34 patients suffering from ovulatory dysfunction. Changes in clinical symptoms and some relative targets are reported, plus findings in animal experiments. The effect of AP in improving ovulation and the rationale are discussed. According to TCM theory concerning the generative and physiologic axis of women, this research involved the following points: BL18, BL23, CV04, CV03 and SP06. The reinforcement and reduction of AP enables it to strengthen LV and KI. Through the Chong Mai and CV Channels it nourishes uterus to adjust the patient's axis function and recover ovulation. Treated circa 30 times, the patients' symptoms improved to varying degrees; 35% were markedly improved and the total effective rate was 82%. BBT, VS, CMS, and B ultrasonic picture all improved to some degree. AP may adjust FSH, LH, and E2 in 2 directions and raise the progesterone level, bringing them to normal. The animal experiments confirmed this result. AP may adjust endocrine function of the generative and physiologic axis of women, thus stimulating ovulation. The results provide some scientific basis for treating and further studying this disorder.
Nuske_S (1996) Investigations on the Change of Skin Temperature in the Area of AP points Correlated with the Female Genital System of Dairy-Cows. Wien Tierarztl Monatsschr 83(2):51-59. S Nuske, Hubertusstr 12, D-85764 Oberschleissheim, Germany. In 56 German Simmental and Holstein Friesian cows non-contact skin temperature measurements with infrared thermometry have been taken in the area of AP points correlated to the female genital system. Skin temperature in the area of AP points is markedly different to the temperature of non-AP points in the same area. The positive or negative deviation and the range of temperature differences to non-AP points do not allow any significant diagnostic interpretation.
Parshutin_NP; Korsakov SG (1990) [Comparative analysis of the data of AP electrodiagnosis and hormonal status of women with oligomenorrhoea]. Akush Ginekol (Mosk) Jun 6:26-29. This study, in oligomenorrhoeic women, compared AP electrodiagnostic and hormonal data of before and after an AP regimen. Patients were assigned to 3 groups according to pretreatment hormonal status: 1=Ovarian hypofunction; 2=Ovarian hypofunction + hyperandrogenism; 3=Ovarian hypofunction + functional hyperprolactinemia. AP treatment normalized the hormonal status in all 3 groups. The hormonal status of oligomenorrhoeic patients correlated with conductivity of the skin at biologically active AP points.
Petrov_VA; Osetrov AA; Kharenko NI; Shul'ga VA (1991) EAP in treatment of endometritis in cows. Veterinariya Moskva 7:54-55.
Stener-Victorin_E; Waldenstrom U; Andersson SA; Wikland M (1996) Reduction of blood flow impedance in the uterine arteries of infertile women with EAP. Adapted from the OUP Human Reproduction WWW service. Part of the OUP Journals WWW Service 11(6):1314-1317. Copyright Oxford Univ Press. Dept of Obst and Gyn, Fertility Centre Scandinavia, Kvinnokliniken, Sahlgrenska Sjukhuset, S-413 45 Gothenburg, Sweden. To assess whether EAP can reduce the impedance of a high uterine artery blood flow, 10 infertile but otherwise healthy women with a pulsatility index (PI) >/= 3 in the uterine arteries were treated with EAP in a prospective, non-randomized study. To exclude any fluctuating endogenous hormone effects on PI, the women were down-regulated with gonadotrophin-releasing hormone analogue (GnRHa) before inclusion, and throughout the entire study period. Baseline PI was measured when the serum estradiol was </= 0.1 nmol/l; thereafter the women were given EAP twice/wk for 4 wk. PI was measured again closely after the eighth treatment, and once more 10-14 d after the EAP period. Skin temperature on the forehead (STFH) and in the lumbosacral area (STLS) was measured during the EAP treatments 1, 5 and 8. Compared to baseline PI, the mean PI was significantly reduced both shortly after EAP treatment 8 (p<.0001) and 10-14 d after the EAP period (p<.0001). STFH increased significantly during EAP treatments. Both of these effects are due to central inhibition of sympathetic activity.
Stone_A2 (1996) Chinese Med's Treatments for Women: Menopause, Pre-Menstrual Syndrome, Dysmenorrhoea, Menorrhagia or Metrorrhagia. Adapted from WWW (Acupuncture.com). TCM has been treating women for millenia. If you've been suffering for years, you owe it to yourself to research your alternatives. You have options; suffering need not be one of them.

TCM (AP, Herbal Med and other therapies) is rapidly growing in acceptance in the West simply because it works. It's strongest feature is probably its ability to treat chronic Syndromes for which conventional Med has no answers, no treatments and no relief other than harsh chemicals with potentially unpleasant side effects. TCM treats women's health very differently from conventional WM. This article describes some typical problems that woman have treated with TCM.

TCM is based on the law of Yin-Yang. This law teaches that health only comes from a balance between these 2 fundamental principles. In the same way as American culture is struggling to find equality between the sexes, for millenia, Chinese culture has understood that health depends on having a balance and harmony of the masculine (Yang) and feminine (Yin) principles within ourselves. Applying the law of Yin-Yang socially is the basis for mens' and womens' groups in our culture. TCM seeks to insure health through this same concept as applied to one's bodily functions.

Menopause: TCM approaches Menopause as many Syndromes. All the Syndromes have been treated successfully by AP and Herbal Med. The most typical cause of symptoms associated with menopause is the slowing of the flow of Yin. When applied to the body, this is the TCM concept of the hydration or the cooling system within the body. Typical symptoms of this Yin-Xu include hot flashes, night sweats, mood swings, insomnia and HT palpitations. Sometimes, instead of a weak Yin (Yin-Xu), Yang becomes weak (Yang-Xu). Yang represents the warming function of the cells, their metabolism and other active processes. In Yang-Xu, symptoms include: water retention, edema, weight gain, indigestion, hypertension, and a raised cholesterol level. Left untreated, Yin-Xu or Yang-Xu can lead to Qi-Xu. Qi is the TCM term for vital internal energies. Symptoms of a Qi-Xu can include: feeling "run-down," fatigue, decreased sex drive, dry vagina, cold extremities, lower back pain, weak knees and incontinence. In China, maturity and the wisdom of age is revered highly; perhaps that is why they call the time after menopause to be a women's "second spring." This reverence for the elders has led to the evolution of TCM Herbal Med to its current beneficial status. Menopause can be made much smoother through TCM herbal therapy.

Prognosis: Very good. Although the symptoms associated with "the change" are obviously transitory, TCM has helped women for millenia to enjoy their second spring without any the growing pains of the first. Many women, after menopause, because of the slowing of the flow of "Yin," discover their Yang principle and go on to achieve, for the first time in their lives, success in business and other areas which have been traditionally dominated by men and their prominent "Yang" principle. In the same way, men, after the age of 50 or so, often find the time to discover their "Yin" or feminine principle and develop a more refined sense of compassion and nurturing in life.

Pre-menstrual Syndrome: Emotional and/or physical discomfort occurring before or after the period. In TCM, menstruation is regulated mainly by LV and SP. In TCM, LV and SP are very different from the organs described in WM. LV starts the menstrual cycle and SP follows through. In disharmony in LV, symptoms include the emotional swings often associated with PMS, such as: depression, sadness, irritability, crying and outbursts of anger. When the problem comes from SP, a woman will likely experience clumsiness, distention of the abdomen and breasts, and insomnia. In TCM, emotional strain, overwork, too much sexual activity, and dietary problems are regarded as the causes of PMS. Diet from the Chinese perspective doesn't talk about a lack of nutrients, but rather, excessive amounts of foods that aggravate the body's systems. Foods that are the most likely to lead to PMS include an excessive intake of dairy products and greasy or fried foods.

Prognosis: Both AP and herbs give excellent results for PMS. As with all menstrual problems, it will take a minimum of 3 menstrual periods to regulate the cycle completely, although some improvement can often be seen even after 1 mo.

Dysmenorrhoea: Pain occurring before, during or after menstruation. This pain often occurs in the lower abdomen or lower back. Related conditions in WM include; endometriosis, uterine fibroids, myoma and mittelschmerz (middle-pain). In TCM, these arise either from Xue-Xu (like anaemia in WM, though it has other meanings as well), or from Qi-Xue-Stasis. Qi- or Xue- Stasis can both effect and be effected by emotion. Stasis makes one emotional, and emotions cause Stasis. TCM seeks to unblock the Qi-Xue-Stasis, Nourish and increase the amount of Xue in circulation, remove the pain and ease the emotions. Left untreated, Qi-Stasis leads to Xue-Stasis. This causes intermittent sharp pains in the abdomen, or what the West calls mittelschmerz. If the Xue-Stasis is allowed to slow the circulation of Qi or Xue for a long time, a soft nodule can appear in the area. This is one way of describing endometriosis. Again, should the soft nodule go untreated and the Stasis in the body remain, in time it can become a harder nodule like a uterine fibroid. Should that nodule begin to grow more rapidly, it can become what the West calls myoma, or cancer. In TCM, pain tends to come from Qi- or Xue- Stasis. At that stage it is a simple matter to get that Qi or Xue moving again to remove the monthly pain. However, left untreated, complications can appear. It isn't the intent of this article to frighten anyone with the discomfort associated with menstruation, but it is a reminder that pain is nature's way of reminding us to be aware of our body's needs. Often times pain is simply a first alert to a problem that can be solved as by something as simple as expressing your emotions or feeling better understood.

Menorrhagia or Metrorrhagia: Excessive menstrual flow or spotting. In TCM, the reasons for these Syndromes are many. They include Qi-Stasis due to emotional strain, and Qi-Xu due to many situations including overwork, too much sexual activity, chronic illness, or childbirth. Another cause could be Xue-Heat which would probably be associated with restlessness, fever and constipation. One could even spot-bleed after the period because of SP-Xu (SP weakness). Symptoms associated with SP-Xu might include a poor appetite, shortness of breath and a pale complexion. In cases of excessive post-menstrual flow or spotting, treatment could range from wearing "shields" (where spotting falls within normal limits) to an aggressive treatment plan to rebalance all of the various organ systems involved with this Syndrome.
Stone_Ab1 (1996) "High winds don't last all morning": a look at PMS from the Oriental Med perspective: Part 1. Adapted from WWW (Acupuncture.com).

For millenia, TCM has been treating the symptoms of pre-menstrual Syndrome. In the modern world, many women have found, especially in the area of gynaecology, that conventional modern WM offers few answers, little relief and no treatments other than harsh chemicals with potentially unpleasant side effects.

PMS is a reasonably simple Syndrome to treat with TCM. However, left untreated, this little problem can become a big one. In TCM, PMS is a precursor to lumps, cysts, lesions, and cancerous tumours in the breasts and uterus.

AP and herbs can provide enormous relief for the symptoms of PMS, however the underlying cause of PMS is often times due to one's lifestyle and the way in which one relates with the world. Methods such as meditation, relaxation techniques and exercises that require mental focus, are better to treat the root causes of PMS.

Symptoms of PMS
In TCM, LV and SP are the two main organs that control (regulate) menstruation. In TCM, LV and SP are very different from the two organs described in WM. That is why they are capitalized in this article, because we're talking about LV and SP from the viewpoint of TCM.

LV starts the menstrual cycle and SP controls the creation of Xue in the body. In LV disharmony, symptoms include the mood swings that we often associate with PMS which include periods of depression, sadness, irritability, crying, and anger. When the problem arises from SP, a woman will likely experience symptoms such as a foggy sense of clumsiness, dull pain of the abdomen and/or breasts, or insomnia.

Other symptoms possible with PMS include cravings (especially for sweets), water retention, fatigue, diarrhoea, and/or constipation, frequent colds (during premenstrual period) abdominal bloating, breast tenderness with possible lumps, migraines, sore throat, nausea, and dysmenorrhoea (any problem with the menstrual flow from scanty amounts to excessive flow).

PMS occurs when LV function fails to work right. In TCM, all of the body's functions are regulated and energized by Qi. It could translate to anything from bioelectric energy to cellular metabolism. For our purposes, calling it simply Qi (energy) is probably best.

In TCM, one of the functions of LV in the body, is to maintain the free flow of Qi. When this happens, we feel flexible, flowing and graceful within our bodies as well as within life. In a LV problem, its function of circulating Qi is compromised; one result of LV-Qi-Stasis is PMS.

Where PMS comes from: In TCM, LV is associated with the Wood Phase. Wood likes to grow, but when hampered, LV "becomes angry". Our culture is heavily influenced by the desire to move forward, to achieve something, to be someone. When something stands in one's way, one feels like a tree that cannot grow; thus, LV reacts.

TCM is based on Taoism, (pronounced DOW-ism) a Chinese philosophy that dates back 8,000 yr. This philosophy says that health comes from a balance between the masculine and feminine principles within everything. For instance, the LV-Yang is very aggressively moving forward, but this must be balanced with LV-Yin which represents the ability to move backwards, to be flexible, and to respond to conditions in new and spontaneous ways.

The Wood-Qi of LV is like a sapling that wants to grow. When a shoot begins to grow out of a seed it may hit a rock and not be able to grow upwards anymore. It doesn't get angry or frustrated, but it seeks to find a way around the rock so it can continue its upward climb to the light of the above ground world. This is the perfect blend of LV-Yin and LV-Yang.

When we encounter barriers to what we want, obstacles to our future, or any shortcoming to our expectations in life, LV reacts. We become angry and the free flow of Qi ceases to flow smoothly.

PMS is what a woman feels when the Qi's free flow is compromised. Disharmonies of LV will have 2 effects on the menstrual cycle. One is the compromised free flow of Qi which causes moodiness and unexpectedly intense emotions. The other problem that comes from LV disharmony is what happens after we become angry. It is said that anger makes the Qi rise to the head. That's why our eyes get red, we get headaches, dizziness, and even nosebleeds when we're very angry. The problem with this is that for the menstrual flow to begin and move easily the Qi must be descending. Without the free descending flow of Qi at the onset of the menses, there is pain.

Many other symptoms may occur in PMS along with moodiness and pain. Sometimes, LV gets so angry that it "attacks" SP. This causes SP functions to be compromised. Symptoms associated with this portion of PMS include: cravings (especially for sweets), water retention, fatigue, frequent colds (during PMS period) abdominal bloating, breast tenderness with possible lumps, and of course, dysmenorrhoea, especially toward the end of the period.

On a mental or emotional level, a LV (Wood) "attack" (Overacting) on SP (Earth) manifests as obsession. SP controls the digestive system, but it also controls the digestion of our life-experiences. SP-Qi "digests" (mulls over, processes the implications) our old relationships, traumas, or losses in our lives. So, when LV "attacks" SP, not only do we feel angry, but we can't get it out of our heads. We obsessively think about the object of our desire all the time. Nothing is ever fully processed, or digested in our minds. With all this SP-Qi being used in the mental realm, the physical digestive system suffers, leading to further aggravation of the symptoms mentioned earlier.

Complications of PMS
When LV is angry, Qi stops flowing smoothly. Qi-Stasis is like a freeway tie-up due to another car's break-down on the freeway's shoulder. There isn't anything in the middle of the freeway to back things up, but the flow of cars slows down. PMS is essentially Qi-Stasis. It is relatively easy to treat this. However, Qi-Stasis can lead to other things much worse. The slowed traffic can lead to a little fender-bender if the drivers aren't watching carefully and this will back things up even further. Given time, there can be a larger accident involving a gasoline tanker or worse. In the same way, Qi-Stasis can lead to Xue Stasis which can lead to lumps, cysts, lesions, and even cancerous tumours in the breasts and uterus.

Treatments for PMS
AP will gently break free the Stasis of the Qi in the body. This has the effect of easing the emotions and softening the pain associated with menstruation. As with all menstrual problems, it may take a few menstrual periods to regulate the cycle completely, although some improvement can often be seen even after 1 mo.

A TCM herbal formula (Xiao Yao Wan, or Hsiao Yao Wan, pronounced "shao yao wan") is often used for PMS. This is ironic, since it translates to "Free and Easy Pill." Individual herbs, such as Dang Gui, are effective for women, but this herb is rarely used alone.
Stone_Ab2 (1996) "High winds don't last all morning": a look at PMS from the Oriental Med perspective: Part 2. TCM herbal formulas are created with balance and harmony in mind. Xiao Yao Wan has Dang Gui as well as other ingredients to Clear Qi-Stasis, nourish the Xue, strengthen SP, and relieve pain. They all support each other to increase their various functions. Xiao Yao Wan is widely available at stores that carry Chinese herbs.

Exercise can help too. Aerobic exercise helps to:
1.        Vent off nervous energy;
2.        Stimulate LU functions, which help to control LV. In the same way that LV can lower SP-Qi, so it is that LU can sedate LV.

Taiqi or Qigong (breathing exercises to amplify and invigorate Qi) helps at the root of the problem. Even meditation will have this same effect. Pulling the consciousness into "The Now" makes LV less attached to preplanned goals. With this added flexibility, we can become more able to accept obstacles in life which allows us to find more appropriate solutions than emotional reactions. Taiqi, Qigong and Meditations have many benefits to health well beyond the control of PMS; the latter is but one manifestation of the many problems that result from the many possible disharmonies of LV.

Changes in lifestyle can be incorporated into one's life to help control PMS at its root: Taoism says that one live in accordance with nature. Many say that this includes a vegetarian diet, living off the land, going to bed with the stars, and getting up with the sun, but in the middle of the city in the 20th century, this is very difficult. Instead, it would be wise to become sensitive to the nature within. If one is doing something which makes one feel uncomfortable, one can stop doing it. If one wants to be a mother instead of an advertising executive, one can make the change and watch one's health improve. If one must work to survive, one can find a job that allows for more expression of one's creative or nurturing side. This sort of change in one's life is not easy, nor is it something that can be adequately addressed in an article about PMS, but it is amazing how health issues clear up when the internal issues are resolved.

From the Buddhist standpoint, the calming of LV might include seeing things as they are, without any additional meaning. Things that make us mad do so because we attach to them a great deal of significance which may or may not even be valid. Buddhism teaches detachment. With detachment comes the ability to see things as they are, not as one would like them to be, nor as one fears they might become. TCM says that LV is attached to the eyes. Seeing life clearly with complete acceptance and a lack of interpretation provides LV with the freedom to attack life or retreat from it as is appropriate to the moment. With this balance, the free flow of Qi is restored, anger and frustration are calmed.

Islam, Christianity and Judaism all have methods to calm the LV as well. In surrendering one's will to Allah, in living one's life only to love God, or in offering up one's sins to Jesus, one is freed from the past and one is also freed from the future. An unhealthy obsession with goals in life increases the likelihood of LV reacting with anger or LV-Qi-Stasis when something stands in our way. Having a direction in life is good, having no flexibility nor acceptance of the midcourse corrections that God makes in one's life is another way to describe the root cause of LV-Qi-Stasis.

The 20th century brings with it levels of stress and pain that have never been encountered in the past. However, because of the unique multi-cultural interactions available within US society, we can also benefit from ancient treatments such as TCM for these contemporary disorders. Today, we have options; when it comes to PMS, suffering need not be one of them.

Sun_YL (1996) Clinical Observation on 48 Cases with Dysmenorrhoea Treated by Nerve Stimulation Therapy. The Dept of Gynaecology and Obstetrics, Red Cross Hospital of Shenzhen, 518000 PRC. Adapted from WWW. 48 cases with dysmenorrhoea were treated by nerve stimulation therapy. Of these 32 cases (67%) were clinically cured, 3 (17%) remarkably improved, 5 (9%) improved, the total effective rate was 94%.
Titova_NG; Khashukoeva AZ; Korneev BM (1991) AP therapy in the comprehensive treatment of salpingo-oophoritis. Akusherstvo i Ginekologiia Jun (6):44-47. In Russian. Therapy and follow-up of 136 patients showed that, as compared to traditional therapeutic modalities, AP was effective as part of a combined therapeutic approach to treat nonspecific salpingo-oophoritis. AP therapy shortens in-hospital therapy, normalises the immunobiologic defense and of the ANS, and reduces the incidence of recurrence of the condition.

Tsenov_D (1993) AP therapy to treat reflex diencephalic Syndrome in gynaecology. Akush Ginekol Sofia 32(3):34-36. Obstetricians must know the reflex diencephalic Syndrome because the diseases of genital organ can provoke it. Moreover its treatment is often difficult. The most efficient is earlier, complete and adequate treatment. Treatment usually is symptomatic. The author presents 3 cases of reflex diencephalic Syndrome after gynaecology diseases treating with AP and EAP: LV01,07, CV01,03,06, SP06,15. The effect was very good.

Wyon_Y; Lindgren R; Hammar M; Lundeberg T (1994) AP in climacteric disorders: Fewer symptoms after menopause. Lakartidningen 8 Jun 91(23):2318-2322. Halsouniversitetet, Linkoping. Vasomotor symptoms are common in perimenopausal women, but also in castrated men. Their cause is not the low steroid levels per se, but probably changes in neuropeptide activity in the CNS. 24 healthy women with natural menopause, suffering from hot flushes, were studied. They were randomly assigned to one of two groups: 1=EAP; 2=SNP (AP by shallow needle position. Treatment was for a total of 8 wk (twice/wk for 2 wk; then once/wk for the remaining 6 wk). From the participants' logbooks, the frequency of flushes decreased significantly by >50% in both groups. It remained decreased in the EAP group, but it increased slightly again over the 3 mo post-treatment in the SNP group. Kupperman Index values decreased in both groups during treatment; changes were still evident at 3-mo follow-up, whereas self-rated general climacteric symptoms (VAS) decreased significantly only in the EAP group. The PGWB (Psychological General Well-Being) index did not change significantly in either group during treatment.

Yan_H2; Wang J (1994) The clinical study on hysteromyoma treated with AP. Chen Tzu Yen Chiu - AP Research 19(2):14-16. Jin Hai An (Golden Coast) Central Hospital of Zhuhai City, Guangdong, PRC. Hysteromyoma is a very common female disease; there is no specific therapy except for surgery. We used AP to treat it and we used TCM and WM treatments as a control at the same time. AP treatment was better than medical treatment. The total effective rate was 98% and cure rate 73%.

Yu_J3; Yang SP; He LF (1996) Studies on Inducing Ovulation with AP. Biol Reprod 54:379-379. Shanghai Med Univ, Shanghai 200011, PRC.

2. OBSTETRICS (ANIMAL AND HUMAN)
Aleksandrina_EV; Zharkin AF; Gavrilova AS (1992) [The AP prevention of anomalies in labour strength in pregnant women of a risk group]. Akush Ginekol (Mosk), 8-12 22-24. AP was carried out for 3-6 d in the course of preparation to labour of 80 pregnant women at risk of developing abnormalities of parturition. Points on the LU, KI, ST and CV Channels, and Ear- points were used. AP enhanced mainly the cholinergic-type activities of the ANS. Women who had received AP before the birth had a more normal course of spontaneous labour and significantly less blood loss than those who had not received AP.

Arkatov_VA; Zverev VV; Volkovinskii KE (1992) [The effect of tramal and APA on labour pain and the psychoemotional status of the parturient]. Anesteziol Reanimatol Mar-Apr 2:31-33. The changes in psychoemotional status, and the intensity and structure of parturition-pain, were studied in 65 women with reference to the use of concomitant correcting therapy during various types of analgesia. 44 women comprised a control group. APA was optimal during delivery without any correcting therapy, while tramal (at a dose of 1.43+0.06 mg/kg) was optimal during "programmed" delivery.

Beal_MW2 (1992) AP and related treatment modalities: 2: Applications to antepartal and intrapartal care. J Nurse Midwifery Jul-Aug 37(4):260-268. Yale Univ Sch of Nursing, New Haven, CT 06536-0740. The application of AP, moxibustion, acupressure, and shiatsu to antepartal and intrapartal care are discussed. Information on therapeutic interventions as described in textbooks is presented and compared with specific treatments evaluated in research studies. Specific clinical indications addressed include nausea during pregnancy, repositioning of the fetus in breech position, stimulation of contractions and true labour, and pain relief in labour. Qualifications for practitioners and recommendations for certified nurse-midwives caring for clients seeking referral for these services are discussed.

Berks_A (1996) AP in Labour and Delivery. Adapted from WWW. [After an uncomplicated delivery, Alex and Denise's son Noah Loren was born on 20 Aug 1996. For information on how to order Bob Flaws' books, please see the Blue Poppy Press page at the Acupuncture.com Book Farm: WebMaster].

The use of TCM in labour and delivery can be understand in many ways. Like all activities of life, labour induces a shift in the directionality of the Qi. This may be more important to understand than simple point prescriptions; once one understands the nature of Qi and the points, it is a simple and creative process to choose effective AP points.

For the pregnancy, mother has been holding the fetus in and up with her SP-Qi. All the other Zang-Fu Qi has had to spread and regulate and consolidate evenly. During labour, the Qi must go down and out. Both psychological and physical factors can slow or block this. Bob Flaws in his book "Path of Pregnancy Vol 1", lists 3 causes of delayed labour: Qi-Xue-Xu, Qi-Xue-Stasis, and Middle Jiao Qi-Xu. All three cause insufficient Qi and/or Xue to move the fetus down and out the birth canal.

The easiest of these to treat is Qi-Xue-Stasis. If the mother-to be can relax and get the uterus to relax labour will not be far behind. This can be done with many different therapeutic activities: stimulate the uterus with belly massage, have an orgasm, relax and visualize the uterus contracting. Bob Flaws quotes Wan Mi-Zhai (p169): "If labour goes on for >1 day, the woman is preoccupied with family and personal affairs and still has an appetite this is due to astringing of the uterus. But if the woman's labour goes on for >1 day, all the woman's affairs are settled and her appetite diminished, this is insufficiency of middle Qi not able to transport the and move the fetus".

Yin Channel Qi rises. Yang Channel Qi descends. Therefore, moxa or acupressure down the Yang Channels will assist downward movement of Qi. This principle is also applied in home remedies to bring on labour such as castor oil, a stimulating purgative and a favourite of Edgar Cayce. See Childbearing Year by Susan Weed (p60).

Specific AP points that descend include: LI04, SP06, GB21. LI04 is LI Yuan point; SP06 is the "3 Yin Crossing" point of the Foot Yin Channels. LI04 and SP06 are important points to circulate Qi-Xue and induce downward movement and labour. GB21 also descends (see Oriental Med J Spring, 1996 p6). These points can be combined with TH06 and LV03. Bob Flaws recommends not to retain the needles.

ST36 (ST He-Sea, Earth, Hour and Uniting point) combines with SP06 invigorates SP and ST, produces Qi-Xue and induces labour. These points can be needled, pressed, or warmed with moxa.

Bob Flaws in "the Path of Pregnancy Vol 1" lists other possible point combinations: LI04, SP06, BL67, Du Yin (Extra point, on the plantar surface of the centre of the proximal phalangeal joint of the second toe). Needle the first tow points and moxa the second 2. Another combination is: LI04, SP06, BL30 and Cuo Chan Xue (Hastening Birth point), an Extra point, 3 cun lateral to CV04. Needle 5 fen in depth. In pronounced back labour pain in the sacrum, needle Ba Liao (BL31-34) transversely. Tape the needles in place flush with the skin and use EAP.

Potential labour problems can be greatly aided by the use of herbs and an appropriate activity before labour to drain (disperse) Shi (Excess) or tonify (nourish) Xu (Weakness). However, AP also can act quickly on Qi-Stasis and Xue Stasis. For further discussion please read Bob Flaws Path of Pregnancy Vol 1.

In my limited experience, having recently witnessed the birth of my son Noah, labour is aided by a clear plan of action, focused breathing, a synchronized supportive set of people at the birth and an emotionally clear labouring woman. Strong physical fitness also helps. The acupressure that I was able to apply to her back, helped a great deal in preventing her use of medication.

The "Bradley Way" is an enjoyable book on Natural childbirth. Though stern in its approach to delivery without Med intervention. It had the best advice to the woman in labour and how the father should approach the situation as a birth coach.

Cardini_F; Basevi V; Valentini A; Martellato A (1991) Moxibustion and breech presentation: preliminary results. AJCM 19(2):105-114. Div of Obstetrics and Gynecol, Zevio Hospital, Verona, Italy. Moxibustion at BL67 is an ancient method of obtaining the version of abnormal presentation of the fetus during the last 3 mo of pregnancy. The authors reviewed the Chinese references on this subject and stressed the importance of parity and gestational age in testing the efficacy of this therapy. Preliminary results are described and compared with those reported in Chinese articles. Success rates in version by moxibustion versus spontaneous version are also compared.

Cardini_F; Marcolongo A (1993) Moxibustion to correct breech presentation: a clinical study with retrospective control. AJCM 21(2):133-138. Dept of Obstetrics and Gynecol, Policlinico Borgo Roma, Verona, Italy. In this study we treated a group of women during pregnancy by moxibustion on point BL67, to obtain inversion of fetuses in breech presentation. Comparison is made with a control group drawn retrospectively from clinical files at a regional hospital. The aim of the study is to identify the ideal population (in terms of parity and gestational age) to be included in a randomized controlled trial.

Donchenko_VS; Kiverov SV; Lants GI; Uramaev FR; Samoilov VA (1991) [Pharmacological stimulation of AP points for analgesia in patients with gynaecologic diseases in the postoperative period]. Akush Ginekol Mosk May 5:69-70.

Engel_K; Gerke-Engel G; Gerhard I; Bastert G (1992) [Fetomaternal macrotransfusion after successful internal version from breech presentation by moxibustion]. Geburtshilfe Frauenheilkd Apr 52(4):241-243. Universitäts-Frauenklinik Heidelberg, Germany. In a primigravida with a fundal/anterior wall placenta, a successful cephalic version was noted at 39 wk after repeated moxibustion of the BL67. Since routine foetal heart rate monitoring showed a sinusoidal pattern with severe decelerations, immediate Caesarean section was performed. Foetomaternal macrotransfusion of circa 300 ml of blood was found. In view of this complication, possible risks of the method are discussed. Moxibustion does not seem to be suitable as self-therapy without close medical follow-up.

Frygner_K (1994) [AP during childbirth]. Jordmorbladet 5:20-21. In Norwegian.

Lyrenõs_S; Lutsch H; Hetta J; Nyberg F; Willdeck-Lundh G; Lindberg B (1990) AP before delivery: effect on pain perception and the need for analgesics. Gynecol Obstet Invest 29(2):118-124. Dept of Obstetrics and Gynecol, Uppsala Univ, Sweden. Pain experience and the amount of analgesics needed during labour were studied in 32 primiparous women who had received repeated treatment with AP (AP) during the month prepartum and in 16 nontreated primiparous women. The women's psychological profiles were evaluated by a psychiatric interview at wk 38 of pregnancy. Treatment with AP did not reduce the need for analgesics in labour. During labour, all women experienced successively rising pain irrespective of whether or not they had been treated with AP before labour or delivered under local anaesthesia. Experience of pain was not reduced in subjective assessments in women treated with AP. There was a strong correlation between assessments of pain made during labour and 6 mo after delivery. In the group that did not receive AP, CSF dynorphin A was significantly lower in parturients who chose epidural anaesthesia.

Ma_H; Jiang E; Zhao X (1992) [The effect of AP on the level of Substance-P in serum of gravida during delivery]. Jinzhou Med Coll, Liaoning. Chen Tzu Yen Chiu 17(1):65-66. We determined the level of Substance-P in the serum of 56 gravida with RIA before and after AP during the active period of the delivery. The result suggested that the AP may be decline the level of Substance-P in the serum of the gravida, so that played role of analgesic effects.

Martensson_L; Lundqvist E (1993) [AP during pregnancy and delivery: a midwife's concern (letter)]. Jordemodern May 106(5):162-163.

Nilsson_M (1993) [AP for analgesia during childbirth]. Jordemodern Jul_Aug 106(7-8):246-267.

Tremeau_ML; Fontanie-Ravier P; Teurnier F; Demouzon J (1992) Protocol of cervical maturation by AP. J de Gynecologie, Obstetrique et Biologie de la Reproduction 21(4):375-380. INSERM, UnitÚ 292, Le Kremlin-BicÛtre, France. 98 patients were assigned to 3 groups: 1=Control; 2=Placebo; 3=AP treatment. It was possible to improve cervical maturation if AP sessions were given at the start of the 9th mo. Bishop-scores in the 3 groups after 10 d interval show that there was a significant progression of 2.61 points in the AP-Group, compared with only 0.89 and 1.08 in the placebo and control groups.

Yelland_S (1995) Using AP in midwifery care. Mod Midwife Jan 5(1):8-11. AP is based on the theories of TCM. These have little in common with the western models of anatomy or the processes of health and disease. However, it appears that in many cases AP is clinically effective (greater than placebo). Many women look to alternative therapies during pregnancy and childbirth. AP is safe, cheap and works clinically. AP is therefore a valuable holistic skill to add to the midwife's repertoire. Both research and a system of training are required if AP is to play its full part in midwifery care.

3. MALE/PROSTATE
Chen_Y (1993) AP treatment of functional non-ejaculation: a report of 70 cases. JTCM Mar 13(1):10-12. Dept of AP, Moxibustion and Massage, Fujian TCM College, Fuzhou, PRC.

Hu_Ja4 (1993) How is impotence treated with AP?. JTCM Sep 13(3):234-235. Inst of AP & Moxibustion, China Acad of TCM, Beijing PRC.

Ikeuchi_T; Iguchi H (1994) [Clinical studies on chronic prostatitis and prostatitis-like syndrome (7): Electric AP therapy for intractable cases of chronic prostatitis-like syndrome]. Hinyokika Kiyo Jul 40(7):587-591. Dept of Urol, Fujigaoka Hospital, Sch of Med, Showa Univ, Japan. 17 men with prostatodynia (chronic prostatitis-like syndrome) refractory to conventional medical treatment were treated with low frequency EAP. All had had a complicated clinical course and pelvic hypertonicity. EAP was given to decongest pelvic circulation, especially around the prostate. The clinical efficacy of long-term treatment was excellent in 30% and moderate in 70% of the patients, with an overall efficacy rate of 100%. Treatment with Chinese medicines and chemical agents were withdrawn completely in 50% of the patients; treatment with chemical agents were withdrawn in 30% of the patients, and the dose of either type of medication was reduced in 20% of the patients. To examine whether the efficacy of EAP was related to the induction of cytokines we also examined the serum levels of INF-gamma, IL-1 beta and IL-6, but, no significant elevations were detected.

Kong_T; Fan T; Chu X (1991) [Studies on the relationship between APA and testosterone or dihydrotestosterone in blood plasma]. Dept of Anatomy, Henan Med Univ, PRC. Chen Tzu Yen Chiu 16(2):138-141. 55 rats (Wistar, Male, 250-350 g) were assigned to 4 groups: 1=BTA (bilateral testectomy + adrenalectomy); 2=BT (bilateral testectomy); 3=BA (bilateral adrenalectomy); 4=SO (sham operation). EAP was given to bilateral ST36 of each animal at 72 h postoperation. K-iontophoretic colorimetry was used to determine the pain threshold of rats; RIA was used to measure the levels of T and DHT in femoral vein blood. T, DHT and the pain threshold of each animal were measured preoperation and at 72 h postoperation and after EAP but for Group SO, the measurement was done once at 72 h after im testosterone phenylacetate. The level of T in BTA and BT groups decreased significantly at 72 h postoperation, but the changes of pain threshold were similar to BA and SO groups. After EAP the level of T in BT and SO groups were raised significantly (p <.01), but in BT group raised slightly (p >.05). In all animals the level of DHT and the pain threshold increased significantly at 45 min after EAP. No effect on pain threshold and EAP-analgesia was observed in group SO after im testosterone phenylacetate. T (from testes and adrenal) and DHT rose markedly after EAP. Increasing T and DHT or decreasing T in plasma had no effect on the pain threshold and EAP-analgesia. T and DHT in plasma may not play a role in EAP-analgesia, but EAP may improve hypogonadal condition.

Yaman_LS; Kilic S; Sarica K; Bayar M; Saygin B (1994) The place of AP in the management of psychogenic impotence. European Urology 26(1):52-55. Dept of Urol, Univ of Ankara, Med Sch Ibn-I Sina Hospital, Turkey. Successful sexual function is complex, involving psychological and social responses as well as neurological, biochemical and vascular processes. Is believed that >50% of sexual dysfunction cases have an organic etiology. Currently, reflecting the controversy over the management of psychogenic impotence, several methods are used clinically. This prospective study aimed to evaluate the curative effects of AP therapy in men with purely psychogenic impotence. 20/29 men treated with AP had successful erections after a varying number of AP sessions. AP may be an effective alternative in the management of purely psychogenic impotence.

4. URINARY/KIDNEY
Darenkov_AF; Balchii-ool AA; Shemetov VD; Troitskii OA; Kuznetsov VM (1993) AP in the combined treatment of pyelonephritis. Urologiia i Nefrofogiia Mar-Apr(2):10-12. Pyelonephritis still causes problems in practical uronephrology; the main clinical treatments aim to enhance the patient's resistance, KI blood flow and urodynamics. As AP was said to meet the above requirements, it was used in a combination treatment of 102 pyelonephritis cases (51 acute and 51 chronic) showing intact KI function. Radionuclide renography showed a positive trend in the secretion and urodynamics of the upper urinary tract in 50% of the patients. Dynamic nephroscintigraphy gave a positive response in 60% of cases versus 25% in those treated without AP. AP promoted earlier recovery or remission, reduced the scope of chemotherapy and gave good short- and long-term response. AP is recommended for application in urological and nephrological practice.
Lee_YH; Lee WC; Chen MT; Huang JK; Chung C; Chang LS (1992) AP to treat renal colic. J of Urology Jan 147(1):16-18. Dept of Surgery (Urol) and AP, Nat Yang-Ming Med Coll, Taiwan, ROC. A prospective randomized study was performed to compare the effect of AP and im Avafortan injection to treat KI colic. Our results showed that AP is as effective in relieving KI colic as Avafortan but it had a more rapid analgesic onset (3.14+2.88 min versus 15.44+7.55 min, p<.05). Of the patients in the Avafortan group 7 (44%) had side effects, including skin rash in 3, tachycardia in 2, drowsiness in 1 and facial flush in 1. No side effects were noted in the AP group. During 2 h of observation, AP and Avafortan seemed to be ineffective in promoting stone passage. However, patients receiving Avafortan treatment were more likely to have paralytic ileus. AP can be a good alternative to treat KI colic.

Li_W; Liang C; Liang Z; Lin J; Zhong G; Lu C (1993) [Experimental research of AP manipulation of Bu (Reinforcing) and Xie (Reducing) by lifting and thrusting needle on the animal]. Chen Tzu Yen Chiu 18(4):285-289. Dept of AP and Moxibustion, Guangzhou Coll of TCM, PRC. Rabbits were injected with large dosage of Dexamethasone (DXM) for 5 d. Manual AP by Bu (Reinforcing manipulation), Xie (Reducing manipulation), and EAP were respectively used at ST36 points for 5 d to observe the change on temperature, body weight, levels of corticosterone and testosterone, and the amplitude of the plethysmogram. DXM injection induced a Syndrome similar to KI Xu (Deficiency). Body weight increased in the DXM control group, decreased in the Xie group and had no significant influence in the other groups. Body weights between the Bu manipulation and the Xie manipulation groups were not different. The other indices were not significantly affected in the different groups. There was no significant difference on most of observed signs among the Bu group, the Xie group and ES group. AP manipulation needs more research.

Liang_Z; Liang C; Liu I; Lin J (1992) [The influence of different AP manipulations on the plethysmogram of the patient with KI Xu (Kidney Deficiency)]. Chen Tzu Yen Chiu 17(1):61-64. Dept of AP and Moxibustion, Guangzhou Coll of TCM, PRC. In order to prove the specific property between the tonifying manipulation (Bu) and reducing manipulation (Xie), and search further for the key in improving the effect of manipulation, the influence of to on 2 different manipulations. The plethysmogram indicated a syndrome like KI Xu (Deficiency). Bu was by slow-trusting and quick lifting; Xie was the converse movement. Randomized block design, cross-over design and single-blind design were used. Bu increased the amplitude of the plethysmogram obviously, whereas Xie had no significant influence. There was significant difference not only between the Bu group and the control group, but also between the Bu group and Xie group (p <.01 or p <.05). The difference between the Xie group and the control group was not significant (p >.05). "Mind concentration" on AP manipulation is important. There was some evidence for different mechanisms of Bu- and Xie- needle manipulation, but this aspect of AP needs more research.

5. URINARY/BLADDER
Caione_P; Nappo S; Capozza N; Minni B; Ferro F (1994) Primary enuresis in children. Which treatment today? Minerva-Pediatr Oct 46(10):437-443. Dept di Chirurgia, Ospedale Pediatrico Bambino Gesu-Roma. Enuresis is a problem that paediatric urologists are often called to treat. It affects 15-30% of school-age children. In 85% of affected children bedwetting is monosymptomatic, not accompanied by other voiding disorders or daytime incontinence. Treatment of choice is still highly controversial, as the physiopathology is not yet fully understood and the pathogenesis is multifactorial: genetic and psychological factors, sleep disorders, urinary reservoir abnormalities, urine production disorders can all play a part. Behavioural treatments (psychotherapy, bladder training and biofeedback, electric alarm) and pharmacological therapy (tricyclic antidepressants, anticholinergics, DDAVP) have been used with variable results. In our experience (54 enuretic children) DDAVP proved to be effective in reducing the number of wet nights/wk in 79% of cases. AP, which we have been using for many years, also gave good results in 55% of treated patients. Long term success of DDAVP and AP was respectively 50 and 40%. We discuss the probable pathophysiology and present our own results and those reported in the literature. An accurate diagnostic selection of patients and a better understanding of physiopathology are the basis of effective treatment of enuresis.

Capozza_N; Creti C; De Gennaro M; Minni B; Caione P (1991) The treatment of nocturnal enuresis: A comparative study between desmopressin and AP used alone or in combination. Minerva Pediatrica Sep 43(9):577-582. In Italian. From Mar to Sep 1989, 40 children suffering from primary nocturnal enuresis, aged between 5 and 14 yr, were included in a study to assess the comparative therapeutical efficacy of DDAVP and AP. Children were assigned to 4 treatment groups (n=10/group): A=DDAVP; B=AP; C=DDAVP + AP and; D=Placebo (untreated control). The trial design included 3 periods: observation (2 wk), treatment (8 wk) and follow-up (4 wk). 19 children completed the study. When used separately, DDAVP and AP were highly effective treatments, as expressed by % of dry nights. However, the combined treatment of DDAVP + AP was best as regards the % of dry nights at the end of treatment and as regards the stability of results after the end of the study. Detailed analysis of correlations between type of treatment and urinary osmolarity is given.

Chang_PL; Wu CJ; Huang MH (1993) Long-term outcome of AP in women with frequency, urgency and dysuria. AJCM 21(3-4):231-236. Dept of Surgery, Chang Gung Memorial Hospital, Chang Gung Med Coll, Taipei, Taiwan, ROC. Urodynamic measurements including cystometry, anal sphincter electromyography, urethral pressure profilometry and uroflowmetry were carried out on 21 female patients before AP and at 1 and 3 yr during follow-up. Follow-up ranged from 60-72 (mean 66) mo. Differences in urodynamic measurements before AP and at the 1- or 3- yr follow-up were not significant. During follow-up, AP at SP06 was performed in patients who had recurrence of symptoms of frequency, urgency and dysuria. Mean number of AP treatments was 4.8 (range 2-8). 8 patients decreased their AP treatments after 30 mo, but this was not statistically significant. The long-term outcome of AP at SP06 for women with frequency, urgency and dysuria was positive, but that the effect was temporary and repeated AP was necessary to maintain beneficial effects.

Chen_Z; Chen L (1991) The treatment of enuresis with scalp AP. JTCM Mar 11(1):29-30. Linhai City Hospital of TCM, Zhejiang Province, PRC.

Geirsson_G; Wang YH; Lindström S; Fall M (1993) Traditional AP and electrostimulation of the posterior tibial nerve: A trial in chronic interstitial cystitis. Scand J Urol Nephrol 27(1):67-70. Dept of Surgery, Sahlgrenska sjukhuset, Univ of Göteborg, Sweden. A prospective study on the symptomatic effect of traditional Chinese AP treatment and transcutaneous nerve stimulation (TENS) of the tibial nerve in patients with interstitial cystitis is presented. There was no difference in voiding frequency, mean voided volume, maximal voided volume or visual analogue scale symptom scores before or after treatment with either TENS or AP. Only one patient became improved both subjectively and objectively after AP for a short period of time. Even though the present material involves a small group of patients, it seems that the 2 methods, as applied in this study, have a very limited effect in patients with interstitial cystitis.

Huang_X (1991) Treatment of urinary retention with AP and moxibustion. JTCM Sep 11(3):187-188. People's Hospital of Ji'an District, Jiangxi Province, PRC.

Kachan_AT; Trubin MIu; Skoromets AA; Shmushkevich AI (1993) AP reflexotherapy of neurogenic bladder dysfunction in children with enuresis. Zh Nevropatol Psikhiatr Im S S Korsakova 93(5):40-42. Urodynamics of the lower urinary tract were evaluated in 25 children treated for enuresis (16 with unstable bladder). 12 children with detrusor hyperreflexia comprised the largest group. AP helped 17/25 cases. A follow-up showed its detrusor-stabilizing effects in patients with neurogenic bladder dysfunctions. The success of AP depended on the patients' mental and emotional status, concurrent abnormalities and accuracy in observing the practitioner's recommendations. The mechanisms of therapeutic effects of AP are discussed.

Kitakoji_H; Terasaki T; Honjo H; Odahara Y; Ukimura O; Kojima M; Watanabe H (1995) Effect of AP on the overactive bladder. Nippon Hinyokika Gakkai Zasshi Oct 86(10):1514-1519. Dept of Channels and AP points, Mejii Coll of Oriental Med, Japan. We examined the effect of AP for the overactive bladder. 11 patients (9 males, 2 females; aged 51-82 (mean 71 yr)) with the overactive bladder were treated with AP. 9 had urge-incontinence and 2 had urgency. Before AP, all patients had uninhibited contraction. A disposable needle (0.3 mm in diameter, 60 mm in length) was inserted to a depth of 50-60 mm into BL33 bilaterally and was rotated manually for 10 min. Treatment was given 4-12 (mean 7) times. Urge incontinence was controlled completely in 5/9 and partially in 2/9 patients. In 2 patients who complained urgency, complete response was obtained after treatment. Uninhibited contraction disappeared in 6 patients after treatment. AP increased maximum bladder capacity and bladder compliance significantly. AP at BL33 controlled overactive bladder effectively.

Minni_B; Capozza N; Creti G; De Gennaro M; Caione P; Bischko J (1990) BL instability and enuresis treated by AP and electro-therapeutics: early urodynamic observations. AETRIJ 15(1):19-25. Dept of Paediatric Urol, Ospedale Bambino Ges×, Vatican Hospital Rome, Italy. The authors report the results of a study on 20 children suffering from a particular type of enuresis, associated with bladder instability, characterized by uninhibited contractions of the detrusor muscle. The children selected showed symptoms of enuresis, frequency, urinary urgency and a positive urodynamic test. This test was performed on 11 patients before and after AP. In 16/20 children, the authors observed a net increase in the intensity and frequency of uninhibited bladder contractions 30 min after AP. At 60 min the contractions decreased and at 24 h they had practically disappeared. Clinically, enuresis was eliminated gradually in 11 cases and other 7 cases improved. AP suppressed uninhibited bladder contractions, even though the therapeutic mechanism has yet to be clarified.

Morrison_JF; Sato A; Sato Y; Suzuki A (1995) Long-lasting facilitation and depression of periurethral skeletal muscle after AP-like stimulation in anaesthetized rats. Neurosci Res Sep 23(2):159-169. Dept of Physiology, Univ of Leeds, UK. The effects of AP-like stimulation on the tone of the partially filled bladder and on the periurethral electromyogram (EMG) were examined in urethane-anaesthetized rats. AP-like stimuli usually were applied to the skin and underlying muscles (or other structures), either separately or together, for a period of 1 min; the effects were studied in spinal cord intact and in spinalized animals. Maps have been constructed showing the effects of AP-like stimulation at different sites on the body surface and of similar stimulation applied to individual muscles, the urethra and the testis. AP-like stimuli applied to the skin and underlying structures in the rostral half of the body and the hindpaw, testis or urethra, usually excited periurethral EMG activity. Depression of EMG activity was seen mainly during stimulation of structures close to the urethra, but not opposed to it. When AP-like stimuli were applied only to structures beneath the skin, depression of EMG activity usually occurred. AP-like stimulation of the bulbocavernosus, which partly overlies the proximal urethra produced depression of EMG activity in 50% of trials, but the incidence of similar effects from the more distant pubococcygeus, or the dorsal or ventral sacrococcygeal muscles was circa 90-100%. AP-like stimulation for 1 min produced either excitation or depression of periurethral EMG activity lasting circa 5 or 6 min, depending on the site of insertion and rotation of the AP needles. Excitation of short duration (<3 min) was consistently observed from areas of the body distant to the bladder, e.g. the nose, forepaw, forelimb, chest, abdominal wall and hindpaw. Longer lasting excitation of EMG activity was often seen from the penile urethra, perineal area and hindlimb. Depression of EMG activity with a duration of >3 min was consistently seen from the muscles at the base of the tail (sacrococcygeus) and perineal area (pubococcygeus and bulbocavernosus). The bladder was partially filled in these experiments, so that micturition contractions were never seen; AP-like stimulation of the perineal area induced some increase in bladder tone in 40% of trials. In spinalized animals, the pattern of activity induced by AP-like stimulation was similar to that seen in spinal cord intact animals and the durations of the effects were not significantly different in these two groups. The distribution of sites from which AP-like stimuli can influence the activity of the lower urinary tract is discussed.

Roje-Starcevic_M (1990) The treatment of nocturnal enuresis by AP. Neurologija 39(3):179-184. Univ Hospital, Zagreb. The etiology of enuresis is not fully known. It is assumed that it may be a psychosomatic disorder caused by psychological and urological predispositions, combined with unfavourable environmental factors. 37 patients of both sexes (mean age 8 yr), who had not improved after psychotherapy, were treated by AP. Statistical decrease of enuresis was evident (2.9) during the 6-mo observation period after AP treatment. AP offers a new possibility to treat patients with enuresis.

Sato_A2; Sato Y; Suzuki A (1992) Mechanism of reflex inhibition of micturition contractions of the urinary bladder elicited by AP-like stimulation in anaesthetized rats. Neurosci Res Nov 15(3):189-198. Dept of ANS, Tokyo Metropolitan Inst of Gerontology, Japan. The effects of AP-like stimulation of various segmental areas on the rhythmic micturition contractions (RMCs) of the urinary bladder were examined in anaesthetized rats. The urinary bladder was cannulated via the urethra and expanded by infusing saline until the urinary bladder produced micturition contractions rhythmically as a consequence of the rhythmic burst discharges of the vesical pelvic efferent nerves. An AP needle, having a diameter of either 160 or 340 um, was inserted to a depth of circa 4-5 mm into the skin and underlying muscles at various segmental areas, rostrally from the face then caudally to the hindlimb. Once being inserted, the needle was twisted left and right with the fingers circa once/s for 60 s.

1. AP-like stimulation of the perineal area inhibited both the RMCs and the rhythmic burst discharges of vesical pelvic efferent nerves without any significant changes in the hypogastric efferent nerve activity. By contrast, stimulation applied to the face, neck, forelimb, chest, abdomen, back, and hindlimb areas was ineffective.
2. After surgically separating the perineal skin from the underlying muscles with the main cutaneous nerve branches intact, stimulation of either the perineal skin or the perineal muscles inhibited the RMCs. Stimulation of the perineal muscles produced a stronger inhibition of the RMCs than that of the perineal skin.
3. Stimulation of the perineal area increased afferent nerve activity, either recorded from the pudendal nerve branches innervating the perineal skin or underlying muscles, or recorded from the pelvic nerve branches innervating the perineal muscles.
4. Ôhe stimulation-induced inhibition of the RMCs was abolished after surgically severing both pudendal and pelvic nerve branches that innervated the perineal skin and underlying muscles.
5. The inhibition of the RMCs after AP-like stimulation of the perineal area is a reflex response characterized by segmental organization. The afferent arcs of the reflex are both pelvic and pudendal nerve branches innervating the perineal skin and underlying muscles, while the efferent arcs are pelvic nerve branches innervating the urinary bladder.

N. Hormones, Miscellaneous

Cao_W; Wang Y; Lu Z (1990) Effects of AP on pain threshold and plasma corticosterone level at different times of the day. JTCM Jun 10(2):136-140. Inst of AP and Moxibustion, China Acad of TCM, PRC.

Chernilevskii_VE; Gudoshnikov VI; Mirkin AS; Sokolov PP (1992) [Possible interrelationship between the system of AP points and channels and mechanisms of endocrine regulation]. Fiziol Cheloveka Sep-Oct 18(5):171-173.

Kho_HG; Kloppenborg PW; van Egmond J (1993) Effects of AP and TENS analgesia on plasma hormone levels during and after major abdominal surgery. Eur J Anaesthesiol May 10(3):197-208. Inst for Anaesthesiology, Univ of Nijmegen, The Netherlands. The effects of AP and TENS on plasma adrenaline (A) and noradrenaline (NA), ACTH, beta-End, anti-diuretic hormone (FROMH) and cortisol were evaluated during and, for 4 d after surgery in 42 male patients submitted to a standardized major abdominal operation in a comparative study of 3 different anaesthetic techniques. Group 1 received AP and TENS as the main non-pharmacological analgesic during surgery. Group 2 received moderate-dose fentanyl (initial bolus of 10 ug/kg followed by continuous infusion of 5 ug/kg/h for the first h, and then 4 ug/kg/h. Group 3 received a combination of both methods. In all 3 groups analgesia was supplemented, if necessary, by small bolus injections of 50 ug fentanyl. Anaesthesia was induced in all groups with thiopentone 5 mg/kg and vecuronium 0.1 mg/kg and patients were ventilated (N2O:O2=2:1) to achieve normocapnia without the use of a halogenated agent. Pre-operatively AP plus TENS in Groups 1 and 3 led to a rise in beta E without changes of haemodynamics. After intubation beta E did not increase further. Intubation in Group 2 led to an increase of beta E (p <.05) also, and to a rise in pulse rate and blood pressure (p <.05) in all 3 groups. Per-operatively AP plus TENS in Group 1 showed a response of circulating NA and cortisol similar to that in Groups 2 and 3, whereas the responses of the circulating A, ACTH, beta E and ADH in Group 1 were more pronounced (p <.01). Post-operatively no differences in hormonal profiles occurred between the groups with or without AP plus TENS (Group 2 v Group 3) nor between those with or without moderate-dose fentanyl anaesthesia (Group 1 v Group 3). AP and TENS had no effect on the cardiovascular response to laryngoscopy and intubation. They can replace moderate-dose fentanyl anaesthesia in major abdominal surgery at the cost of a more enhanced per-operative neuroendocrine stress response, which does not, however, influence postoperative hormonal profiles nor the rapidity of return to pre-operative values.

Kho_HG; van Egmond J; Zhuang CF; Zhang GL; Lin GF (1990) The patterns of stress response in patients undergoing thyroid surgery under APA in China. Acta Anaesthesiol Scand Oct 34(7):563-571. Inst for Anaesthesiol, Univ of Nijmegen, The Netherlands. The patterns of catecholamines (adrenaline and noradrenaline), peptide hormones (ACTH, antidiuretic hormone, beta-End, growth hormone and prolactin), cortisol and those of immunoglobulins (IgA, IgG and IgM) and total and differential leucocyte counts in the peripheral blood were investigated during and for 6 d after thyroid surgery in 20 patients (F/M: 18/2) performed under APA, supplemented by small doses of pethidine (mean+sd 45+8.9 mg). Throughout surgery the patients remained conscious. During surgery the level of catecholamines and the above-mentioned circulating hormones increased significantly and immunoglobulins decreased, whereas leucocytosis due to lymphocytosis occurred; % eosinophils decreased and % neutrophils decreased remarkably. In the postoperative phase, levels of noradrenaline and beta-End remained elevated, whereas the other circulating hormones gradually returned to normal values. Immunoglobulin levels and eosinophil counts returned to the preinduction values within 24 h, and those of neutrophil and lymphocyte counts within 2 d. Changes in monocyte and basophil numbers were not detected peri- and post- operatively.

Liu_J (1994) Clinical observations on treatment of hyperprolactinemia by AP. JTCM Jun 14(2):121-12. Xuanwu Hospital of TCM, Beijing, PRC.