RM Clemmons, DVM, PhD, CVA, CVFT University of Florida.

SCIENCE OF ACUPUNCTURE

2010RM Clemmons, DVM, PhD, CVA, CVFTUniversity of Florida

J Pain Symptom Manage. 2009 Apr;37(4):709-14. Epub 2008 Sep 11.

Acupuncture: what does the most reliable evidence tell us?Many trials of acupuncture and numerous systematic reviews have recently become available. Their conclusions are far from uniform. In an attempt to find the most reliable type of evidence, this article provides an overview of Cochrane reviews of acupuncture. Such reviews were studied, their details extracted, and they were categorized as: reviews with a negative conclusion (no evidence that acupuncture is effective); reviews that were inconclusive; and reviews with a positive or tentatively positive conclusion. Thirty-two reviews were found, covering a wide range of conditions. Twenty-five of them failed to demonstrate the effectiveness of acupuncture. Five reviews arrived at positive or tentatively positive conclusions and two were inconclusive. The conditions that are most solidly backed up by evidence are chemotherapy-induced nausea/vomiting, postoperative nausea/vomiting, and idiopathic headache. It is concluded that Cochrane reviews of acupuncture do not suggest that this treatment is effective for a wide range of conditions.

What does the literature say? Total 14829

Human 11093 Animal 2761

Scientific Human 2253 Animal 46

390/year

59/year

Cites by species Dog 209 Cat 410 Horse 58 Cow 34 Pig 33 Bird 8 Chicken 3 Rodent 816 Human 11226

Feb-2009 to Feb-2010 Total 990

Human 565 Animal 130

Scientific (Clinical trials, meta-analysis, random control trials) Human 239

English 125 Chinese 110

Science by system (Highlights) GI 3

This study did not find evidence to support the superiority of acupuncture compared with sham acupuncture in the treatment of IBS.

Heart 10 Bladder 4

Our pilot study has provided evidence that acupuncture may be clinically useful for the radical treatment of Diabetic Bladder Dysfunction.

Science by system (Highlights) Blood pressure 6 Brain 13 Hearing 2

Electroacupuncture plus acupoint injection is the best therapy for sudden sensorineural deafness, and the timely intervention of acupuncture, the severity degree of the illness and the patient's age are all related to the prognosis of this disease.

Science by system (Highlights) Reproduction 20 Cancer 10 Pain 83 Arthritis11

Acupuncture relieves symptom, remedies physical function, and improves quality of life in RA patients, but may have no or very limited anti-inflammatory effect systemically. The regional effects of acupuncture are unlikely to be induced through reduction of regional inflammation.

Science by system (Highlights) Incontinence 2 Arrhythmia 1 Disc7

The cured rate and the cured markedly effective rate were 55.8% and 82.7% in the observation group and 33.3% and 54.2% in the control group, respectively, with significant differences between the two groups (P < 0.05, P < 0.01). CONCLUSION: Electroacupuncture combined with blood letting puncture at stagnant collaterals nearby Wei zhong (BL 40) has a significant therapeutic effect on acute lumbar disc herniation.

Science by system (Highlights) Asthma 3

Adjunctive Acu-TENS therapy appears to reduce decline of forced expiratory volume following exercise training in patients with asthma.

Stroke 12 The therapeutic effect of acupuncture for treatment of the

depression in patients of post stroke is superior to other common medicine.

Three weeks of transcutaneous electrical stimulation to lower leg acupuncture points, given 5 times a week within 10 days post-stroke, significantly decreased ankle plantar flexor spasticity, and increased dorsiflexor strength concomitant with a decrease in antagonist co-contraction.

Science by system (Highlights) Stem Cells

The results show that both acupuncture and moxibustion could improve proliferation of neural stem cells, but only moxibustion could induce differentiation of neural stem cells into neurons.

Depression 12 Additionally applied standardized acupuncture to

low-dose fluoxetine for depression is as effective as a recommended dose of fluoxetine treatment. Depressive patients with severe anxious symptoms and/or intolerable side-effects of antidepressants can benefit from it.

Science by system (Highlights) Alzheimer’s

Acupuncture combined with Yizhi Jiannao Granules has a significant therapeutic effect on Alzheimer's disease, which is better than that of Yizhi Jiannao Granules or Aricept.

Paralysis 10 Acupuncture on local points of eye is an effective

therapy for paralytic strabismus. Acute stage is the best opportunity for acupuncture

treatment of peripheral facial paralysis, and the earlier the intervention time, the better the therapeutic effect and the shorter the therapeutic course.

Science by system (Highlights) Nausea 10

Repeated needle acupuncture may be effective in postoperative pain relief and the treatment of nausea and vomiting in the postoperative period. These effects seem not to be due solely to interaction between the acupuncturist and the patient.

P6 acupoint stimulation prevented postoperative nausea and vomiting. There was no differences in risks of postoperative nausea or vomiting after P6 acupoint stimulation compared to antiemetic drugs.

Obesity 5 Our review suggests that acupuncture is an effective treatment

for obesity. However, the amount of evidence is not fully convincing because of the poor methodological quality of trials reviewed. In conclusion, there is an urgent need for well-planned, long-term studies to address the effectiveness of acupuncture for treating obesity.

Animals (Scientific Studies) Analgesia

Bilateral EA produced a shorter latency period, a greater intensity, and longer duration of analgesia than unilateral stimulation, without stimulating a stress response. CLINICAL RELEVANCE: Bilateral EA produces a better analgesic effect than unilateral EA.

The acupuncture points "GV20 and Yintang" were applied for 20 min. Sedation level was assessed before, during, and after acupuncture by spectral edge frequency 95 values and the Ramsay sedation score. The spectral edge frequency 95 values were significantly reduced during acupuncture on GV20 or Yintang point and returned to the baseline values after acupuncture releasing. The Ramsay sedation score (RSS) also showed the acceptable sedation level during acupuncture. It was concluded that an acupuncture application at GV20 or Yintang point used in the present study would be a valuable method to induce the sedation in dogs.


The consciousness was evident and standing position was maintained during EA stimulation in contrast to that of dorsal excellent (1/5, 20.0%), 3 good (3/5, 60.0%) and 1 poor (1/5, 20.0%) in the lumbar acupoint group. Additionally, grades of analgesic effect were 4 excellent (4/8, 50.0%), 3 good (3/8, 37.5%) and 1 poor (1/8, 12.5%). On the other hand, pain was present and analgesia was not accomplished under EA stimulation in control group. In conclusion, analgesia by EA was effective with decreasing order of dorsal acupoint > dorsal-lumbar acupoint > lumbar acupoint among groups. It was considered that dorsal acupoint group might be useful for operation with recumbent position, and lumbar and dorsal-lumbar acupoint groups might be proper for operation with standing position.


Butorphanol produced greater increases in rectal pain threshold, compared with EA (mean +/- SD, 214 +/- 24 vs 174 +/- 35 mm Hg of balloon pressure). Electroacupuncture produced minimal cardiovascular and respiratory changes. Although clinically not important, butorphanol produced moderate significant increases in heart and respiratory rates, arterial blood pressure, and rectal temperature and decreases in arterial oxygen tension. Arterial pH, carbon dioxide tension, bicarbonate concentrations, base excess, Hct, and concentration of total solids were not significantly different from baseline values after EA, butorphanol, and control treatments. CONCLUSIONS AND CLINICAL RELEVANCE: Electroacupuncture and butorphanol (0.1 mg/kg, IV) may provide useful rectal analgesia in horses.


Administration of PAES was more effective than acupuncture for activating the spinal cord to release beta-endorphins into the CSF of horses. Acupuncture and PAES provided cutaneous analgesia in horses without adverse cardiovascular and respiratory effects.

Low Hz EA…Electroacupuncture induced a significant alleviation of pain. This alleviation was more significant on the affective scales (p less than 0.01) than on the sensory scales (p less than 0.05). After pretreatment with diazepam or naloxone, the subsequent pain alleviating effect was reduced. These data indicate that acupuncture induced analgesia may partly be mediated through endogenous opioids which are affected by pretreatment with diazepam or naloxone.

Animals (Scientific Studies) Spinal Cord Injury

Time (mean +/- SD) to recover ambulation in dogs with grade 3 and 4 dysfunction in group 1 (10.10 +/- 6.49 days) was significantly lower than in group 2 (20.83 +/- 11.99 days). Success (able to walk without assistance) rate for dogs with grade 3 and 4 dysfunction in group 1 (10/10 dogs) was significantly higher than that of similarly affected dogs in group 2 (6/9 dogs). Dogs without deep pain perception (grade 5 dysfunction) had a success (recovery of pain sensation) rate of 3 of 6 and 1 of 8 in groups 1 and 2, respectively, but the difference was not significant. Overall success rate (all dysfunction grades) for group 1 (23/26; 88.5%) was significantly higher than for group 2 (14/24; 58.3%). CONCLUSIONS AND CLINICAL RELEVANCE: Electroacupuncture combined with standard Western medical treatment was effective and resulted in shorter time to recover ambulation and deep pain perception than did use of Western treatment alone in dogs with signs of thoracolumbar intervertebral disk disease.


Recovery days of conscious proprioception in groups A, B, AB, and C were 21.2+/-8.5 days, 19.8+/-4.3 days, 8.2+/-2.6 days, and 46.6+/-3.7 days, respectively. Recovery days of extensor postural thrust in group A, group B, group AB, and group C were 12.8+/-6.8 days, 13.8+/-4.8 days, 5.4+/-1.8 days, and 38.2+/-4.2 days, respectively. There were no significant differences between group A and group B. However, recovery days of group AB was significantly shorter than that of other groups and that of group C was significantly delayed (p<0.05). Conduction velocities of each group were significantly decreased after induction of spinal cord injury on SEPs (p<0.05) and they showed a tendency to return to normal when motor functions were recovered. According to these results, it was considered that the combination of corticosteroid and electroacupuncture was the most therapeutically effective for ambulatory paresis due to spinal cord injury in dogs.


Wobblers…Overall per cent success in Group I was only 20%, while in group II the corresponding value was 85%. The number of acupuncture treatments required to achieve full recovery in Group II was dependent upon the severity of the case, as follows: Grade I: 18.5 +/- 2.5; Grade II: 25 +/- 5.4; and Grade III: 34 +/- 6.7 (r = 0.962). No adverse effects were observed with acupuncture. The use of this technique is proposed for large-scale clinical trials.

The above results indicated that EA could promote the recovery of neurological function in acute ischemic stroke patients and SEP on MCAO (middle cerebral artery occlusion) rats.

Animals (Scientific Studies) Eye

After the EA treatment, IOP was significantly decreased in the both eyes (p<0.05). However, there were not significant differences in hemodynamic parameters between those of before and after EA treatment. From these results, the EA treatment at LI-4, LIV-3 and GB-37 would be considered one of the valuable methods for the IOP treatment in dogs.

Animals (Scientific Studies) Depression

The monoamine hypothesis for affective disorders indicates a functional impairment of the monoamine systems in CNS as the causative factor for the development of depression. Pharmacological manipulations of the monoaminergic neuronal system using tricyclics and monoamine oxidase inhibitors produced promising therapeutic effects as well as certain unwanted side effects, which urged the search of a physiological means to activate the central monoamine systems. In the present paper, evidence from animal experiments is presented to show that acupuncture or electroacupuncture (EA) is capable of accelerating the synthesis and release of serotonin (5-HT) and norepinephrine (NE) in the CNS. Clinical data indicate that EA is effective in treating depressive patients, and at least as effective and with a higher therapeutic index than tricyclic amitriptyline.

Animals (Scientific Studies) GI tract

Manual acupuncture was applied at the following acupoints: 7 main points on the Large Intestine Meridian (LI1, LI2, LI3, LI4, LI5, LI6, and LI11), ST25, BL25 or GV1. Acupuncture at the Large Intestine Meridian acupoints, ST25 and BL25 had no significant effects on the proximal colonic motility. However, acupuncture at GV1 depressed the proximal colonic motility by decreasing the total duration and the frequency of contractile states, which may contribute to the therapeutic effects of GV1. This study also revealed that there was no clear correlation between Large Intestine Meridian and the proximal colonic motility in conscious dogs.


Ten among twelve cows with abomasal displacement were recovered by electroacupuncture and moxibustion, but two were treated with paramedian abomasopexy. It is considered that electroacupuncture and moxibustion may be convenient, safe and economical therapeutic alternatives available instead of surgical procedures on abomasal displacement in dairy cattle.


Butorphanol produced greater increases in rectal pain threshold, compared with EA (mean +/- SD, 214 +/- 24 vs 174 +/- 35 mm Hg of balloon pressure). Electroacupuncture produced minimal cardiovascular and respiratory changes. Although clinically not important, butorphanol produced moderate significant increases in heart and respiratory rates, arterial blood pressure, and rectal temperature and decreases in arterial oxygen tension. Arterial pH, carbon dioxide tension, bicarbonate concentrations, base excess, Hct, and concentration of total solids were not significantly different from baseline values after EA, butorphanol, and control treatments. CONCLUSIONS AND CLINICAL RELEVANCE: Electroacupuncture and butorphanol (0.1 mg/kg, IV) may provide useful rectal analgesia in horses.

Animals (Scientific Studies) Reproduction

Percentage of cows that responded with ovulation and corpus luteum formation after moxibustion was 67 percent, slightly higher than those in cows treated with PGF2 alpha or ampicillin. Reproductive performance after the moxibustion was well-comparable to those after PGF2 alpha or ampicillin treatment. Result indicates that the moxibustion could be used as the alternative to PGF2 alpha and antibiotics for treating delayed uterine involution in cows.

Animals (Scientific Studies) Otitis

Otitis interna treatment plus atbs…These results suggest that acupuncture stimulates animal defensive systems increasing the conventional treatment effect, which seems to work mainly against the invading agent while acupuncture seems to act by reinforcing the host's defensive barriers. Combination of both shows a synergistic effect capable of empowering the anti-infectious therapy. A three months follow-up revealed all animals were without symptoms. Further evaluation of both groups after a one year follow up will allow us to establish if relapse incidence is also modified by acupuncture, and the potential usefulness of this complementary treatment on recurrent infectious pathology.

Animals (Scientific Studies) Lung

JSL (Jinshui Liujun decoction) has the effect of resolving phlegm as well as improving animal immunological and pulmonary ventilatory functions.

Skin

Non-healed skin lesions…Following electrostimulation in all patients in both groups healing proceeded in a thoroughly organized manner, almost regardless of the severity of the type of wound or burn treated.

Animals (Scientific Studies) Anesthesia

In control group and nonacupoint electrical stimulation group MAC were not decreased significantly. From these results, electroacupuncture at each acupoints used in the present study would have an advantage in isoflurane anesthesia with reducing its requirement.

Use of EA and TCES decreased MAC of isoflurane in dogs without inducing adverse hemodynamic effects. However, the reduction in isoflurane MAC by EA and TCES treatments was not considered clinically relevant.

Animals (Scientific Studies) Heart

The results showed that femoral arterial pressure of subjects which were needled on the selected points for 3 days dropped. Acupuncture at these two acupoints seemed to improve the condition of hypertension in a short period of time. Significant changes in the femoral arterial pressure were observed in all subjects when they were treated for 6 days. In the two acupoint groups, the LVW/BW and the WHW/BW ratios did not change significantly. Cardiac muscle cells reduced in size in the Yanglingquan (GB. 34) treatment groups. This indicates that the Yanglingquan (GB. 34) points not only can lower blood pressure, but also prevent hypertrophy of cardiac muscle cells in spontaneous hypertensive rats (SHR). Therefore, acupuncture could be a good treatment modality for hypertension and hypertrophy of the heart.

Animals (Scientific Studies) Heart

A clinical study on acupuncture at point Neiguan (PC 6) was conducted on the basis of successful treatment of patients with angina pectoris and acute myocardial infarct. The effective rate (91.3%) was found to be far superior to isosorbide dinitrate and nifedipine (P < 0.01). The experimental studies in animal models demonstrated that electro-acupuncture could decrease the elevated ST segments in ECGs and reduce the infarct areas induced by coronary ligation.

Animals (Scientific Studies) Arthritis

Vet Rec. 2001 Oct 13;149(15):452-6. Double-blind evaluation of implants of gold wire at acupuncture points in the dog

as a treatment for osteoarthritis induced by hip dysplasia.

Thirty-eight dogs with hip dysplasia were studied to evaluate the use of gold wire implants at acupuncture points around the hip joints. They were assigned at random into two groups of 19. In the treated group, gold wire was inserted through hypodermic needles at electrically found acupuncture points around both hips. In the control group, the areas were prepared in the same way but had only the skin pierced at sites which were not acupuncture points, with a needle of the same size as that used in the treated group. Over a period of six months the dogs were studied repeatedly by two veterinarians and by the dogs' owners who were unaware of the treatments the dogs had received; they assessed the dogs' locomotion, hip function and signs of pain. Radiographs were taken at the beginning and end of the study. Although the data collected from both groups by the veterinarians and the owners showed a significant improvement of locomotion and reduction in signs of pain (P=0.036 for the veterinary evaluation and locomotion and P=0.0001 and P=0.0034 for the owners' evaluation of locomotion and pain, respectively), there were no statistically significant differences between the treated and control groups (P=0.19 and P=0.41, P=0.24, respectively).


Vet Rec. 2006 May 27;158(21):722-6. Double-blind, placebo-controlled trial of the pain-relieving effects of the

implantation of gold beads into dogs with hip dysplasia.

Seventy-eight dogs with pain due to hip dysplasia were studied in a controlled, double-blind clinical trial to evaluate gold bead implantation as a pain-relieving treatment. The dogs were randomly assigned to two groups, 36 in the gold implantation group and 42 in the placebo group. Both groups were treated equally regarding anesthesia, hair clipping and penetration of the skin with the same type of needle. The gold implantation group had small pieces of 24 carat gold inserted through needles at five different acupuncture points and the placebo group had the skin penetrated at five non-acupuncture points so as to avoid any possible effect of stimulating the acupuncture points. A certified veterinary acupuncturist marked the points, and two surgeons performed the implantations according to a randomization code made in advance. After 14 days, three months and six months, the owners assessed the overall effect of the treatments by answering a questionnaire, and the same veterinarian examined each dog and evaluated its degree of lameness by examining videotaped footage of it walking and trotting. The treatment was blinded for both the owners and the veterinarian. There were significantly greater improvements in mobility and greater reductions in the signs of pain in the dogs treated with gold implantation than in the placebo group. The veterinarian's and the owners' assessments corresponded well.


Electroacupuncture was used to treat lameness in horses and ponies with chronic laminitis (n = 10) or navicular disease (n = 10). A clinical trial was conducted with random allocation of equal numbers of animals to control and treatment groups. Acupuncture was performed three times per week for four consecutive weeks. The degree of lameness was assessed by 1) a grading scheme, 2) measurement of stride lengths and 3) analysis of weight distribution using a force plate. Although seven out of ten animals with chronic laminitis improved clinically during the trial, there were no statistically significant differences between treatment and control groups. Six out of ten horses with navicular disease improved, but there were no significant differences between treatment and control groups.


Treatment (control, acupuncture, or sham) did not have a significant effect on ground reaction forces for any limb. Owners of 8 of the 9 dogs were able to correctly guess the time period when ESA was delivered. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that ESA did not have any significant effects on severity of lameness, as determined by measurement of ground reaction forces, or severity of pain, as determined by visual analog scale pain scores, in dogs with chronic elbow joint osteoarthritis secondary to elbow joint dysplasia.

RM Clemmons, DVM, PhD, CVA, CVFT University of Florida.

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