While treatment plans for allergies vary greatly, with results ranging from temporary relief to complete remission, acupuncture and related therapies can often relieve allergy symptoms within a short period of time. The first objective is to reduce the acute allergy symptoms so that an effective strategy can be developed to address the underlying condition. As we are able to develop a holistic program we can effectively work to prevent the disease process from reoccurring in the future.
Allergies usually occur when our immune system is unable to digest or effectively process (i.e. metabolize or protect against) something within our environment. Allergens can vary from pollen, pet dander, mold, various foods, drugs and more. The body tends to react via an inflammatory process as a means of trying to remove the allergen or protect the body from it doing further harm.
When a client presents with allergy symptoms, we’ll need to perform a full intake and make the proper diagnosis. Symptoms may include a stuffy nose, copious mucus, lung/sinus congestion, fatigue, headache, indigestion, irritable bowels, redness, swelling, etc. To develop a holistic program to reduce or eliminate the condition it is important that we consider the whole pattern of symptoms that the client is experiencing. This includes considering dietary habits, energy levels, sleep patterns as well as other lifestyle practices.
Together with your practitioner, you can begin to understand how all those elements of your life may relate to the allergy symptoms you are experiencing. Effective therapy strategies will first focus on the acute symptoms in an effort to reduce them enough to address the underlying condition, then follow-up care for the chronic, remission stage begins. Oftentimes the acute stage is so influential that the chronic symptoms must be address in the opposite season (i.e. fall vs spring, winter vs summer) to make an effective investment in the underlying cause.
Acupuncture as well as chiropractic therapy supported by dietary therapy and herbal therapy will form the main components of most people’s health program for the treatment of allergies. Acupuncture may include the use of point local near the nose/sinuses, on the arms/hands and legs. Dietary changes are likely to be very beneficial in the effort to control the symptoms through the elimination of food and drinks that may cause mucus to form. When our diet is optimized for our constitution and for our presenting condition, clients will experience less mucous, less inflammation, increased energy, better breathing and a greater sense of well-being.
Ernst et al. claimed “acupuncture is neither a safe procedure nor superior to placebo.”
One of the last review articles on acupuncture research from Professor Edzard Ernst, prior to the announcement of his retirement, was met with broad dissatisfaction from the acupuncture research community, with concerns raised that he had presented a biased picture of the state of the science. A summary of the published letters rebutting Professor Ernst’s conclusions is presented below. We urge acupuncture researchers and practitioners to read Professor Ernst’s article in Pain (as well as the full complement of letters to the editor published in a subsequent issue of the journal (Witt et al.; Manheimer and Berman; Karst; Baumler; Usichenko; Henke 2011). For the sake of brevity, we summarize the letters to the editors.
A letter by Witt and colleagues found the article “highly misleading” and criticized the authors’ choice of evidence from different levels within the evidence hierarchy for different parts of the paper. In particular, the writers of the letter criticize the use of case studies to determine the safety of acupuncture and cite several larger-scale studies that had different results.
A letter by Manheimer and colleagues criticized Ernst et al.’s methods of data analysis and evaluation as neither systematic, reproducible, nor transparent and found Ernst et al.’s evaluation criteria for assessing the quality and results of systematic reviews to be poorly defined. The writers of the letter also suggest that Ernst et al. succumbed to presentation bias, presenting data in the Discussion section which were not included in the review.
A letter by Matthias Karst notes that the paper misinterprets one of the cited cases, and suggests that the paper’s other conclusions should be suspect, and also warns of a possible “efficacy paradox” which can lead to false positives when testing complex interventions by means of randomized controlled trials.
A letter by Baumler and colleagues pointed out several inconsistencies and accuses the authors of failing to incorporate basic scientific methodology. Specifically, the writers of the letter find the paper’s aim vague, study eligibility criteria absent, and (like Witt et al.) the choice of case reports in the assessment of acupuncture risk questionable. Like Manheimer et al., the letter-writers found Ernst et al.’s methods of determining the quality and outcome of each review unclear. The letter-writers determine that the paper is “not … based on a careful and scientific analysis of the literature.”
A letter by Usichenko and colleagues, like Witt et al. and Baumler et al., criticized the authors’ use of case studies to determine the adverse effects of acupuncture.
A letter by Christian Henke points out the relatively high instance of drug-related adverse events compared to acupuncture-related adverse events and criticizes Ernst et al.’s choice to include the conclusions of various acupuncture experiments in their discussion, despite the fact that conclusions of papers do not reflect statistical outcomes. The letter-writers also note that some important studies were overlooked.
Finally, a letter by James Mooney criticizes the authors’ addressing of the broad spectrum of acupuncture as little more than a single treatment. The letter-writers note that if only the highest-quality reviews are examined, the results are no longer condemning of acupuncture. Mooney also dismisses the authors’ conclusion that acupuncture should be questioned since it reduces pain in “some conditions while failing to work in many others,” noting that the same can be said about acetaminophen.
The authors’ response ran in the same issue of PAIN: Ernst E. Response from Author. Letters to the Editor / PAIN 152 (2011) 2184–2186. As of Oct 13, it is noted this is withdrawn at authors’ request.
Ernst E, Lee MS, Choi TY. Acupuncture: does it alleviate pain and are there serious risks? A review of reviews. Pain. 2011 Apr;152(4):755-64.
Karst M. Comment on ''Acupuncture: does it alleviate pain and are there serious risks? A review of reviews" Ernst et al. [Pain 2011;152:755-764]. Pain. 2011 Sep;152(9):2181
Bäumler P, Irnich D. Pain. 2011 Sep;152(9):2181-2
Henke C. Pain. 2011 Sep;152(9):2183-4.
Manheimer E, Berman BM. Pain. 2011 Sep;152(9):2179-80Source: Society for Acupuncture Research
Study Suggests Acupuncture Can Improve Recovery, Physical Functioning in Stroke Patients
By Editorial Staff
Nearly five years ago, Emperor's College of Traditional Oriental Medicine received a $40,000 grant from The Center for Integrative Health, Medicine and Research to conduct a pilot study to determine the effectiveness of acupuncture in the rehabilitation of stroke patients.1 The results of that study have been published in the official journal of the American Society of Neurorehabilitation,2 and suggest that acupuncture provides "statistically significant" benefits in physical functioning and recovery when used as an adjunct to conventional stroke rehabilitation measures.
According to the Centers for Disease Control and Prevention, strokes are the third leading cause of death in the United States, and the leading cause of serious, long-term disability in adults. The American Heart Association estimates that between 500,000 and 750,000 strokes occur in the U.S. each year, with approximately 150,000 dying from the stroke itself or from related complications.
The Daniel Freeman Rehabilitation Center was the site of the acupuncture-stroke rehabilitation study.
The object of the pilot study was to address inconsistencies in the published literature with regard to whether acupuncture improves physical and mental abilities of stroke patients when combined with traditional Western rehabilitation procedures. While some trials have suggested that acupuncture provides no additional benefit in the rehabilitation of stroke patients, other studies have reported that stroke patients receiving acupuncture have demonstrated significant improvements in certain aspects, such as recovery of motor skills and overall physical functioning.
The study was conducted at the Daniel Freeman Rehabilitation Center's inpatient stroke rehabilitation unit in Los Angeles. In the trial, 29 patients who had suffered a stroke within the previous 60 days that resulted in hemiparesis (weakness on one side of the body) were randomized to either a control group or an acupuncture group. The control group received conventional stroke rehabilitation care (consisting of three hours of physical, occupational, and/or speech therapy, six days per week) for the duration of the inpatient stay. The acupuncture group received the same care as the control group, along with an additional 30 minutes of acupuncture therapy, seven days per week, for two weeks during the inpatient stay. Acupuncture was provided by eight licensed acupuncturists who had trained at Emperor's College and had a minimum of one year of clinical experience.
To ensure consistency, a standardized treatment protocol was used among all patients in the acupuncture group. Needles were inserted into specific points on the affected limb. Acupuncture points included Du 20, Du 19, Du 21, UB 7, GB 20, Du 14, Ren 6, Ren 12 and St 25.
Supplementary points for the upper limbs (LI 15, LI 11, SJ 5, LI 4, and Lu 7) and lower limbs (GB 31, St 36, GB 34, Sp 6, St 40, St 41, and Liv 3) were selected depending on the patient's condition. Within two weeks of the stroke episode, the acupuncturists added ba feng (an extra acupuncture point), Ren 23 and Ht 5 for aphasia; St 4, SI 18 and St 6 for facial paralysis; and UB 6 and GB 37 for vision problems.
To measure the effects acupuncture might have, the researchers used a tool that assessed aspects of physical performance in a person's upper and lower extremities, along with a functional independence scale that evaluated a person's ability to complete certain activities of daily living without assistance. Patients were evaluated at baseline (within three days of being admitted to the stroke rehabilitation unit) and after being discharged. At baseline and after the completion of the study, evaluations were performed by therapists who were blinded as to the randomization of each patient.
While a general analysis of the data appeared to show no real difference in physical performance scores between patients in the control and acupuncture groups, closer inspection revealed that acupuncture patients experienced "significantly greater" lower extremity motor function compared to the control group. Acupuncture patients also fared slightly better than control patients in terms of lower extremity joint pain.
Other improvements were seen when the researchers compared functional independence scores. While the average score of patients in the control group increased 8.5 points between baseline and discharge, the average score of acupuncture patients increased 11.2 points. In all seven activities of daily living measured on the scale, the average score of patients receiving acupuncture was between .1 and .8 points higher than control patients. The authors noted that "patients who received acupuncture as an adjunct to standard rehabilitation demonstrated significantly greater improvement in tub/shower transfer mobility and a trend for greater improvement in toilet transfer mobility."
In a discussion comparing the results of the pilot study to similar studies, the authors suggested that the reason previous trials of acupuncture and stroke rehabilitation have produced questionable results is because the tests used to measure acupuncture's effects are often not sensitive enough to detect subtle differences. They noted that while many studies used "global measures" of motor and physical function that showed no real benefit groups of control patients and acupuncture patients, "when subscores of these global measures were used, differences between groups were apparent."
Moreover, the authors reasoned that some tests used to measure the effects of acupuncture may be incompatible with acupuncture's physiologic mechanisms. Most studies have used intentionally selected stroke measurements that are recognized internationally. In the opinion of the scientists, however, "these instruments ... are not reasonably associated with the mechanisms that may account for acupuncture effectiveness."
"This pilot study is consistent with previous studies that have examined acupuncture treatment as an adjunct to conventional acupuncture treatment as an adjunct to conventional stroke rehabilitation," the researchers concluded. "When global measures are used, there are no differences in motor recovery or physical function associated with acupuncture. However, when more responsive measures are used, acupuncture effects are evident. Future work that investigates the efficacy and effectiveness of acupuncture treatment poststroke should incorporate levels of measurement that are sensitive to the physiologic mechanisms that may underlie acupuncture effects."
In a statement to Acupuncture Today, the authors elaborated on the results of their research, and outlined ways that future studies that examine the effectiveness of acupuncture in the rehabilitation of stroke patients should be conducted.
"This study provides important insight into the design of future post-stroke acupuncture clinical trials, particularly the selection of appropriate outcome measures," they wrote. "We believe that one of the problems in past investigations of acupuncture effectiveness after stroke is that outcome measures are used that look at gross changes in motor or functional ability that may be too far removed from the underlying mechanisms that may account for acupuncture effectiveness. Recent studies that are trying to understand the mechanisms that could explain how acupuncture works after stroke suggest that acupuncture induces changes in blood flow to the brain or may stimulate the production of growth factors that can help neurons survive. If that is the case, then studies need to use outcome measures that are more sensitive and can detect relevant changes in motor control that may lead to improved function. Our study demonstrated that when more sensitive measures are used these types of motor and functional changes can be detected."3
- Emperor's College receives grant to study acupuncture for stroke rehabilitation. Acupuncture Today, May 2000.
- Alexander DN, Cen S, Sullivan KJ, et al. Effects of acupuncture treatment on poststroke motor recovery and physical function: a pilot study. Neurorehabilitation and Neural Repair 2004;18(4):259-267.
- E-mail from Stanley Azen, PhD, to Acupuncture Today, February 11, 2005.
CAM is a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine. Complementary medicine is used together with conventional medicine, and alternative medicine is used in place of conventional medicine. Integrative medicine combines conventional and CAM treatments for which there is evidence of safety and effectiveness.
Barnes PM, Bloom B, Nahin R. CDC National Health Statistics Report #12 - NCCAM/NIH
Functional medicine focuses on prevention and understanding a person's core clinical imbalances that underlie various disease conditions. Functional medicine seeks prevention as the key component for the cultivation of health especially with regards to chronic disease. By targeting the underlying cause of disease versus focusing on just accommodating symptoms functional medicine seeks to improve outcomes by targeting one objective, the disease, to accomplish multiple benefits, reducing the symptoms. In the cases of chronic disease with the goal of understanding each individual's physiological, environmental, and psychosocial contexts becomes a necessary part of the diagnostic process.
While functional medicine is perspective of more recent terminology the historical systems of healing (e.g. Chinese Medicine, Ayurvedic medicine, Tibetan medicine, etc.) have utilized the holistic view as a means of approaching disease. All of the healing systems mentioned above seek to target the disease to reduce symptoms in concert with constitutional/personal diagnosis all of which Everspring Health embraces and offers as a part of our service offerings.
This question was once addressed by Dr. Bernie Siegel where he mentioned that we may not be able to cure every disease but people can indeed be healed. The concept here is noting a difference in perspective. The discussion surrounding a cure is focused on a disease and the context of specifically eliminating the disease whereas the discussion of healing is in relation to the individual as a whole. When we seek to cure a disease our focus is on the disease and the process of eliminating that disease. Since healing involves improving the quality of life for the individual as a whole, a disease may still be targeted but in concert with the intent to improve the quality of one's daily life.
An example of healing would be the process where a disease is controlled or reduced to a point where a person's quality of life may be such that the disease no longer interferes with their daily productivity. So while an individual may still have diabetes, for example, they may have no signs of the disease and/or the disease no longer hinders the quality of one's experience in daily living. A key benchmark in the process of healing includes liberation from the disease even if the disease may still be present. This liberation is the experience where one's perspective shifts from focusing on, and possibly being dictated by a disease, to being focused on the appreciation of one's life as a whole. This perspective may still include the presence of a disease but more importantly the focus shifts to the many opportunities they have before them.
This definition of healing is why Everspring Health incorporates healing into the functional mission of our cooperative. We are a lifestyle, health and healing cooperative because each of those concepts is at the heart of what we do everyday. Healing is the process of cultivating quality of life and quality of life is our mission.
Integrative medicine is a healthcare resource that combines conventional, complementary and alternative (CAM) treatments for which there is evidence of safety and effectiveness.
In the clinic setting integrated medicine means that all effective medical resources are considered to address the chief complaint, identify the most accessible options to obtain the chief objective and to consider options for preventing concerns that may be predicted to arise in the future. The benefit of integrative medicine where the whole picture is considered we observe and note a more complete picture of one's life thus taking a diagnosis further and extending a healing program as far as possible towards the cultivation of quality of life.
Integrative health is a somewhat evolving terminology with a definition that is equally still evolving. However, Everspring Health suggests that integrative health is a metric that we can use to gain perspective of our health as a whole and in turn use that information for our benefit. The perspective of integrative health requires us to consider all intersecting aspects of an individual's life and lifestyle before a final diagnosis is made and subsequent plan is implemented.
Through the use of integrated protocols (see Integrative Medicine) we make note of a web of symptoms or experiences where the final diagnosis is based on the value of the intersecting points and the relation of all possible factors within one's experience. We finalize this process by asking how do these experiences relate to one's overall quality of life. The diagnosis in relation to one's quality of life becomes our chief objective for developing a plan for integrative health, namely quality of life.
To benefit from this perspective the client needs to find a practitioner who is well trained to determine which intersecting points are valid to the diagnosis and most importantly which are valid to the client's quality of life. Quality of life is our mission and integrative health is the service we strive to provide at Everspring Health.