Application of Acupuncture Therapy in Diabetes mellitus Patients

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N.R.Samdani

N.R.Samdani

Acupuncture literally means 'needle piercing," the practice of inserting very fine needles into the skin to stimulate specific anatomic points in the body (called acupoints or acupuncture points) for therapeutic purposes. Acupuncture involves stimulation.

Along with the usual method of puncturing the skin with the fine needles, the practitioners of acupuncture also use heat, pressure, friction, suction or impulses of electromagnetic energy to stimulate the points. The acupoints (acupuncture points) are stimulated to balance the movement of energy (qi) in the body to restore health1.

In the past 40 years acupuncture has become a well-known, reasonably available treatment in developed and developing countries . Acupuncture is used to regulate or correct the flow of movement of energy to restore health2.

How does acupuncture work?

The goal of acupuncture is to establish healthy body function by restoring the natural circulation of energy or life force known in Chinese medicine as Qi. (This is pronounced as "chee" and is also commonly spelt as ch'i, chi or ki). Qi is a fundamental concept of everyday Chinese culture, most often defined as "air" or "breath" and by extension, "life force" or "spiritual energy" that is part of everything that exists.

The pathways through which this vital energy flows are known as meridians.

According to Chinese medical tradition, there is constant interchange between the Qi of the body and the Qi of the environment: external Qi, which can be good or harmful. Within the body, Qi is said to perform several functions, one of which is protection against harmful Qi. If this protective Qi is strong, it acts as a defense. If it is weak, resistance is lowered and that leads to person become ill.

Along the body’s meridian, there are over 500 acupuncture points. Good Qi is thought to be restored to these areas by stimulation for example with needles, although occasionally massage, herbs or suction cups may be used on these points.

In contrast, the Western explanation of acupuncture incorporates modern concepts of neuroscience. According to the National Institutes of Health (NIH), researchers are studying at least three possible explanations as to how acupuncture works:

Opioid release:

During acupuncture, endorphins that are part of our body's natural pain-control system may be released in to central nervous system — brain and spinal cord. This reduces pain much like taking a pain medication.

Spinal cord stimulation:

Acupuncture may stimulate the nerves in spinal cord to release pain-suppressing neurotransmitters. This has sometimes been called the "gate theory."

Blood flow changes:

Acupuncture needles may increase the amount of blood flow in the area around the needle. The increased blood flow may supply additional nutrients or remove toxic substances or both, promoting healing3.

Mechanism of action for diabetes mellitus

The effects of acupuncture on diabetes have been observed experimentally and clinically. Animal experiments have shown that acupuncture can activate glucose-6- phosphatase (an important enzyme in carbohydrate metabolism) and affect the hypothalamus.  Acupuncture can act on the pancreas to enhance insulin synthesis, increase the number of receptors on target cells, and accelerate the utilization of glucose, resulting in lowering of blood sugar4.

How can acupuncture help diabetic patients5?

Scientific studies and clinical tests in international research centers in the past 10 years have shown that acupuncture can help diabetic patients in the following ways:

  • lower blood glucose content;
  • lower the release of pancreatic glucagons;
  • attenuate symptoms of polyphagia (the urge to eat too much), polydipsia (excessive thirst) and polyuria (excessive passage of urine);
  • prevent slowing of motor nerve conduction;
  • improve microcirculation and myocardial contractility;
  • enhance blood outflow and regulate vascular peripheral resistance;
  • exert antiatherogenic, antioxidant and immunomodulating effects;
  • obliterate antheroscelerosis of the legs;
  • induce secretion of endogenous beta-endorphin;
  • elevate a lowered pain threshold; and
  • increase cell proliferation and neuropeptide Y levels.

What ailments can acupuncture treat?

Many people assume that acupuncture is used as a simple pain control technique. A technique where needles are inserted to interrupt the nerve pathways that send pain messages to the brain. But acupuncture is much more than this. It's designed to treat any malady and works to balance the energy of your entire body.

Based on clinical experience, it's known that acupuncture can treat a variety of respiratory, eye, mouth, gastro-intestinal, neurological and muscular disorders. It's especially effective on headaches, migraine and back pain. Acupuncture is also used to stop smoking, lose weight, lower blood pressure, relive constipation, anxiety, insomnia, allergies, asthma and alleviate skin disorders.

How can it treat all these ailments? It works by 'unblocking' and balancing your energy 'circuits'. And unlike conventional drugs, there are only beneficial side-effects such as sleeping better, more energy, deeper breathing and many other bonuses.

Points use to treat diabetes mellitus6,7,8:

1. Jianjing (GB 21)

Location – Midway between 7th cervical vertebra and the acromion.

Puncture – 1.5 cun perpendicularly.

Jianjing

2. Quchi (LI 11)

Location – At the outer end of elbow crease when elbow is semi flexed.

Puncture - 1 to 1.5 cun perpendicularly.

Quchi

3. Hegu (LI4)

Location – It is situated in the web between the forefinger and thumb on the dorsal aspect of the hand at the top of the Ist dorsal interosseous muscle when thumb is adducted.

Puncture – 0.5 to 1 cun perpendicularly.

Hegu

4. Zusanli (St 36)

Location – 1 finger breadth lateral to lower end of tibia tuberosity.

Puncture – 1 cun perpendicularly.

Zusanli

5. Taibai (Sp 3)

Location - Posterior and inferior to head of 1st metatarsal bone at border of two colon of skin.>

Taibai

6. Sanyinjio (Sp 6)

Location – 3 cun above the medial malleolus, posterior to the border of tibia

Puncture – 1 cun vertical.

Sanyinjio

7. Taichong (Liv 3)

Location – 2 cun proximal to the margin of the web of the 1st and 2nd toes.

Puncture – 1 cun obliquely in a proximal direction.

Taichong

8. Dazhui (Du 14)

Location – On the back midline between the dorsal spines of the 7th cervical and 1st thoracic vertebra.

Puncture – 1.0 cun perpendicularly.

Dazhui

9. Pishu (U.B. 20)

Location – 1.5 cun lateral to spine and 11th thoracic vertebra.

Puncture – Pancreas, Internal secretion, Spleen.

Pishu

10. Jiexi (St 41)

Location- Midway between the malleoli on the anterior ankle crease, between the tendons of extensor digitorum longus and hallusis longus.

Puncture – 0.5 cun perpendicularly.

Jiexi

11. Waigun (TW 5)

Location – 2 cun proximal to the midpoint of the dorsal transverse crease of the wrist between the radius and ulna,

Puncture - 1 cun perpendicularly.

Waigun

Safety compared to other treatments

Commenting on the relative safety of acupuncture compared to other treatments, the NIH consensus panel stated that "(adverse) side effects of acupuncture are extremely low and often lower than conventional treatments." They also stated

The incidence of adverse effects is substantially lower than that of many drugs other accepted medical procedures used for the same condition. For example, musculoskeletal conditions, such as fibromyalgia, myofascial pain and tennis elbow are conditions for which acupuncture may be beneficial. These painful conditions are often treated with, among other things, anti-inflammatory medications (aspirin, ibuprofen, etc.) or with steroid injections. Both medical interventions have a potential for deleterious side effects but are still widely used and are considered acceptable treatments9.

Adverse effect of acupuncture in various disease conditions:

The benefits of any therapy are of clinical importance, but the safety of treatments should be a priority in clinical practice10. Serious adverse effects, including pneumothorax, spinal lesions and hepatitis B transmission, have been reported in the literature, but these are rare and are generally associated with poorly trained, unlicensed acupuncturists9. Although most adverse effects associated with acupuncture are minor and serious complications are rare, practitioners should not overlook them. Some of the common & rare complications of acupuncture therapy are as follows11:

Common Adverse Events

Ø   Fainting during treatment

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Ø   Nausea and vomiting

Ø   Increased pain

Ø   Diarrhea

Ø   Local skin irritation

Ø   Bruising

Ø   Needle site bleeding

Ø   Psychiatric disturbance

Ø   Headaches

Ø   Sweating

Ø   Dizziness

Ø   Aggravation of symptoms

Ø   Needle breakage

Rare Complications

Ø   Pneumothorax

Ø   Spinal cord injury

Ø   Hepatitis B

Ø   Septicemia

Ø   Punctured organs

Ø   Convulsions

Ø   Argyria

Studies related to occurrence of adverse events in acupuncture therapy10:

Two prospective studies in the United Kingdom assessed the occurrence of adverse events. In one study, 48 medical doctors (Members of the British Medical Acupuncture Society) and 30 Physiotherapists (Members of the Acupuncture Association of Chartered Physiotherapists) reported adverse effects of 32,000 acupuncture treatments. 25 Results showed that minor adverse events, defined as “any ill-effect, no matter how small, that is unintended and non-therapeutic, even if not unexpected,” resulted from 6.71% of treatments. Most common minor events were needle site bleeding (3.1%), needle site pain (1.1%), and aggravation of symptoms (0.96%) (70% of symptoms subsequently improved).

In the second study, 574 professional acupuncturists (Members of the British Acupuncture Council) reported adverse effects of 34,000 acupuncture treatments. 26 Minor adverse events occurred in 15% of cases; the most common were aggravation of symptoms (2.8%), bruising (1.7%), needle pain (1.2%), and needle site bleeding (0.4%). Most (86%) aggravated symptoms improved, possibly indicating a “healing crisis,” which is a therapeutic process involving temporary exacerbation of existing symptoms that precedes improvement. These two studies reported no life-threatening events associated with acupuncture. It should be noted, however, that in self-reporting studies, over-reporting and under-reporting are inherently unavoidable.

Another prospective study, done in the Czech Republic, surveyed 1,40,000 acupuncture treatments in the year between 1975–1988; found that 7% of patients felt faint and 0.28% actually fainted. 27 During the 13 years under investigation, two patients’ lungs were punctured, resulting in pneumothorax (incidence of pneumothorax was relatively rare at 1/70 000 treatments).

A systematic review on the safety of acupuncture showed a range of common adverse effects. 8 in nine studies reviewed; the most common adverse events found were needle pain (1 % to 45 %), tiredness (2 % to 41 %), and bleeding (0.03 % to 38 %). Incidence of faintness and syncope ranged from 0 % to 0.3 %. Feelings of relaxation were reported by 86 % of patients. Pneumothorax was rare, occurring only twice in nearly a quarter of a million treatments.

Complications arising from needle breakage and intentionally embedded needles are uncommon but warrant caution. A systematic review of adverse events of acupuncture occurring in the year between 1987-1999 found 25 cases of pneumothorax, 18 cases of spinal cord injury, 11 cases of acute hepatitis B, 10 cases of localized argyria, and two deaths from infection. Needle breakage, including 26 cases of intentionally embedded needles and 16 cases of accidental breakage, caused 48 adverse events. There were also 10 cases of injury from self-treatment.

A case report described two patients with multiple health problems, including long-standing rheumatoid arthritis, who died several months after acupuncture treatment. Both patients were admitted to hospital with acute joint swelling and fever; laboratory tests found positive cultures for hemolytic Staphylococcus aureus. No information was given about the practitioners or the sterilization procedures used. The author implied a direct link between acupuncture and staphylococcal septicemia, but the likelihood of the sepsis being needle-induced is questionable.

Advantages and Disadvantages

As with most medical therapies, acupuncture has both benefits and risks. Some of the benefits are:

Ø   Acupuncture is safe when performed properly

Ø   It has few side effects

Ø   It can be useful as a complement to other treatment methods

Ø   It’s becoming more available in conventional medical settings

Ø   It helps control certain types of pain

Ø   It may be an alternative if you don't respond to or don't want to take pain medications

As for risks, acupuncture shouldn't be used by anyone who has a bleeding disorder or who's taking blood thinners. The most common side effects of acupuncture are soreness, bleeding or bruising at the needle sites. You might feel tired after a session. In rare cases a needle may break or an internal organ might be injured. If needles are reused, infectious diseases may be accidentally transmitted. However, these risks are low in the hands of a competent, fully certified acupuncture practitioner3.

Discussion

In the research conducted by Dr. Futian et al (Ganshu hospital of TCM Lanzou , China) 34 cases of Diabetes were given 4 courses of 10 sittings each. They got 76.4 % success rate. In another research work done by Shen Jianfei (Neuroendocrine group No.1 hospital of Nanchang, Jiangxi province) and Wei Jia (Jiangxi college of TCM, China) they treated 20 diabetics and got 85.71 % success rate. According to their observations the blood viscosity was remarkably improved (P<0.01 or 0.05). Hematocrit, blood sedimentation, fibrinogen and prothrombin were also considerably improved. Fasting blood sugar was averagely lowered from 227.93 + 11.85 before the treatment to 138.86 + 6.82 after the treatment. They have stated that acupuncture can play a role of more intensified dual regulation for the microcirculation disturbance of severe Diabetes Mellitus thereby helping in cases associated with cardio-vascular or cerebro-vascular disorders. In yet another research, Guo Shuichi et al (Gansu Huang Fumi Institute of Acupuncture and Moxibustion, Lanzhou, China) carried out experiment on 24 fasted dogs. Hyperglycaemia was produced by an I.V. injection of 50 % glucose solution (1gm/kg). Acupuncture was given for 30 minutes for group A & for group B, both Acupuncture and Moxibustion were given while group C was control group. They observed that the normal blood sugar level in dogs (99.9 mg%) increased to 300.19 + 50 mg% in group A, 287.98 + 89.45 mg% in group B and 344.19 + 50 mg% in the control group C, 15 minutes after the injection. After 60 minutes, it significantly decreased in all groups; still the one in the control group was much higher. Their experiment proved that stimulation of Acupuncture and Moxibustion enhanced the sensitivity of Insulin receptor of Beta cells to glucose, increased the secretion of insulin and accelerated the usage and the transformation of glucose thereby reducing the elevated glucose levels. They also found that Yin meridian points were more useful than those of Yang meridians.

This discussion is based on clinical trials done in diabetes mellitus patients thereby proving the effective role of acupuncture in the treatment of diabetes mellitus.12

References:

(1) http://www.holisticonline.com/Acupuncture/acp_what_is.htm (Intro)

(2) http://www.acupuncture.com.au/education/about/how.html (Ist para)

(3) http://www.doc4pain.com/acupincture.nxg (how does it )

(4) Dey, Anoja S. Attele, Chun-Su Yuan. Alternative Therapies for Type 2 Diabetes. 2002;7(1):52-53.

(5) Yin lo. Diabetes and Acupuncture Acupuncture Today. November 2003,Vol 04,Issue 11.

(6) http://www.acupuncture.com.au/education/acupoints/points.html (Acu point)

(7)  Dharmananda S, Treatment of Diabetes with Chinese Herbs and Acupuncture. Internet journal of the institute for traditional medicine and preventive health care. Oregon Web Posting Date: January 2003 (Acu point).

(8) Lohiya PB, Lohiya SP. Acupuncture principles and treatment. 1st ed. Aurangabad: Indian academy of acupuncture science; 2002.

(9) http://en.wikipedia.org/wiki/Acupuncture#Safety_and_risks ( Sefty)

(10) Chung A, Luke Bui ND,  Edward Mills MD, Adverse effects of acupuncture, Which are clinically significant?. CME 2003 August (http://www.cfpc.ca/cfp/2003/Aug/_pdf/vol49-aug-cme-1.pdf).

(11) NHS centre for reviews and dissemination, Effective Health Care, November   2001, volume 7, Number 2: Page no 1-12.

(12)  Prof. Sir Dr.Lohiya P.B. Role of Acupuncture in treatment of diabetes mellitus,  Aurangabad.

About Authors:

N.R.Samdani

N.R.Samdani
R.C.Patel College of Pharmacy, Shirpur, Dist – Dhule, (MS).
Department of Clinical Pharmacy, R. C. Patel College of Pharmacy, Shirpur -425405, Dist: Dhule (M.S.), India.
Email- nrsamdani@gmail.com; Phone- +91 9423762161
Fax – 02563- 251808

P.V.Ingle

P.V.Ingle
R.C.Patel College of Pharmacy, Shirpur, Dist – Dhule, (MS).

V.G.Kuchake

V.G.Kuchake
R. C. Patel College of Pharmacy, Shirpur, Dist – Dhule, (MS).

P.H.Patil

P.H.Patil
R.C.Patel College of Pharmacy, Shirpur, Dist – Dhule, (MS).

S.J.Surana

S.J.Surana
R.C.Patel College of Pharmacy, Shirpur, Dist – Dhule, (MS).

M.S.Pardeshi

M.S.Pardeshi
Indira Gandhi Memorial Hospital, Shirpur, Dist – Dhule, (MS).

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Comments

Prof. J. Vijaya Ratna's picture

Dear Authors Your article is very interesting. If we can standardize this type of treatments they can be very useful. If the treatment can be self administered it will be even more useful. Is Qi something like body immunity?
Sailaja Byrisetty's picture

Interesting information to know !