The Burris Report

Sunday, March 03, 2013

Acupuncture Treats Fibromyalgia - New Research

New research concludes that acupuncture reduces pain sensitivity for patients suffering from fibromyalgia syndrome (FMS). The study also showed that patients receiving acupuncture had significant reductions in anxiety and depression. Further, the overall quality of life score improved for FMS patients receiving acupuncture therapy.

Acupuncture reduces pain in patients with FMS. The treatment method was the application of five acupuncture points at a rate of once per week. The points were located in areas of discomfort near the occipital bone, rhomboid and trapezius muscles and in the region of the upper chest and lateral epicondyle. The results were published in the Journal of Acupuncture and Meridian Studies.

Fibromyalgia is a pain syndrome affecting the soft tissues and often involves sleep disturbances, tenderness at specific points, muscle pain, fatigue and depression. A literal translation of the term is pain of the muscles and fibrous tissues. Fibromyalgia is distinguished from most other forms of pain because it is non-nociceptive. Nociceptive pain involves inflammation and is triggered by pain receptors in the skin, muscles, joints and other tissues. FMS and other non-nociceptive types of pain conditions do not inherently involve inflammation and is a result of a disruption in central processing. Examples of non-nociceptive pain include irritable bowel syndrome, migraine headaches and FMS. It is estimated that FMS affects up to approximately 4% of the US population. In Chinese Medicine, FMS is due to Liver Qi stagnation, Bi syndrome, dampness with Wei Qi obstruction, Qi deficiency and Yin deficiency. Acupuncture and herbal medicine are commonly used to treat FMS. Biomedical treatments for FMS include anti-depressants, serotonin reuptake inhibitors, sleep drugs, pain medications and nutritional supplements.

More Research

Another recent study published in Clinical Rheumatology concludes that acupuncture is effective for the treatment of fibromyalgia syndrome. The researchers concluded that acupuncture demonstrates definitive “beneficial effects” in the treatment of fibromyalgia. Researchers from the University of Maryland School of Medicine in Baltimore also conclude that acupuncture is significantly effective in the treatment of fibromyalgia syndrome in their new research. Other research performed at the prestigious Mayo Clinic College of Medicine in Rochester concluded that acupuncture is effective in treating fibromyalgia and showed specific efficaciousness in its ability to reduce pain, fatigue and anxiety.

The mounting evidence suggests that acupuncture is a primary treatment for FMS. Emerging integrative medical clinics within the hospital and general medical system are helping in the delivery of acupuncture services to patients. However, most acupuncturists have individual or family group style medical practices in the US.

Acupuncture Numbers

Currently, there are slightly over 20,000 licensed acupuncturists in the USA. California has the most acupuncturists with a total of 6,682. New York has 1,909 licensed acupuncturists followed by Florida with a total of 1,719. Those numbers are up from 2009 when California had 6,578 acupuncturists, New York had 854 licensed acupuncturists and Florida had only 2,027 licensed acupuncturists. Massachusetts comes in fourth place with a total of 1,048 licensed acupuncturists. Colorado has 893 acupuncturists, Oregon has 830 acupuncturists, Texas has 796 acupuncturists and Washington has 753 acupuncturists. The numbers begin to drop-off at this point with Maryland having 667 acupuncturists, Illinois with 587 and New Jersey with 567 acupuncturists. Many states have under 100 acupuncturists and 6 states do not even have acupuncture licensing laws at all. Acupuncture has been proven to be an important and effective method for the treatment of fibromyalgia syndrome but access to care remains an issue.

- See more at: http://www.healthcmi.com/acupuncturist-news-online/713-acupuncturefmsresearch#sthash.G3S1FYOZ.dpuf

Wednesday, February 27, 2013

Acupuncture for Drug & Alcohol Withdrawal - New Study

New research concludes that ear acupuncture helps reduce anxiety and other symptoms caused by drug and alcohol withdrawal. The new study published in the Journal of Psychiatric And Mental Health Nursing notes that the patients experienced increased relaxation and well-being. Anxiety reduction and reduced drug and alcohol consumption were directly related to the use of the ear acupuncture therapy.

Ear acupuncture, also known as auricular acupuncture, is the placement of needles on the tissue of the outer ear. The acupuncture protocols used in the study followed those created by NADA (National Acupuncture Detoxification Association). The study noted that no negative side-effects were reported and the study notes that the ear acupuncture had an overall positive physical impact on the patients. Given the success of acupuncture therapy for the treatment of drug and alcohol addiction in this study, the investigators suggest continued research into the use of the NADA acupuncture techniques for addiction withdrawal.

Another recent study finds acupuncture effective for the treatment of withdrawal symptoms and anxiety associated with heroin addiction. In this controlled study, the use of two acupuncture points located on the arm, HT7 and P6, were investigated. The research concluded that both acupuncture points were successful in the treatment of heroin withdrawal symptoms.

The use of acupuncture point HT7 is widely used for the treatment of anxiety. Also known as Shenmen, Spirit’s Gate, HT7 is valued by licensed acupuncturists for its ability to induce sustained relaxation and benefiting sleep. Another recent study found HT7 had a “markedly reduced reinstatement of cocaine-seeking” in lab rats. The inhibition rate exceeded 85%. In yet another study of human subjects conducted at Yale University it was discovered that acupuncture is significantly effective in the treatment of cocaine addiction. The subjects were much less likely to return to cocaine use if they had received acupuncture treatments.

References: Bergdahl, Lena, A. H. Berman, and Kristina Haglund. "Patients’ experience of auricular acupuncture during protracted withdrawal." Journal of psychiatric and mental health nursing (2013). Journal of Acupuncture and Tuina Science. Volume 10, Number 3 (2012), 155-159. Therapeutic efficacy observation on acupuncture for post-withdrawal syndrome of heroin dependence. Yan Liang, Lei Zong, Yu Li, Bo Cheng, Jing Xu and Yue-lai Chen. Psychopharmacology. Effects of acupuncture on stress-induced relapse to cocaine-seeking in rats. Seong Shoon Yoon, Eun Jin Yang, Bong Hyo Lee, Eun Young Jang, Hee Young Kim, Sun-Mi Choi, Scott C. Steffensen and Chae Ha Yang.   Arch Intern Med. 2000;160(15):2305-2312. Randomized Controlled Trial of Auricular Acupuncture for Cocaine Dependence. S. Kelly Avants, PhD; Arthur Margolin, PhD; Theodore R. Holford, PhD; Thomas R. Kosten, MD. Yale University School of Medicine and Department of Psychiatry. New Haven, Connecticut. - See more at: http://www.healthcmi.com/acupuncturist-news-online/705-acupuncturedrugalcoho-withdrawal#sthash.8ExP8jpH.dpuf

Monday, February 11, 2013

Scalp Acupuncture Helps Multiple Sclerosis Into Remission

A new scalp acupuncture clinical case study concludes that acupuncture benefits patients with multiple sclerosis. The study finds that acupuncture relieves the symptoms of multiple sclerosis, increases the patient’s quality of life, slows the progression of physical disability and reduces the frequency of relapses.

Acupuncture benefits MS patients. Acupuncture for MS Scalp acupuncture was applied to several standard scalp zones: motor, sensory, foot motor and sensory, balance, hearing, dizziness, tremor. Acupuncture was applied once a week for the first ten weeks followed by once a month for the next six treatments. The patient in the study had multiple sclerosis (MS) for 20 years.

After the application of 16 acupuncture treatments, standing and walking improved significantly. There was also a marked reduction in numbness and tingling in the limbs. Overall, the patient showed increased energy levels and reported less dizziness. The patient’s condition went into remission after the acupuncture treatments. At the time the research was published, the patient had been in remission for 26 months.

Monday, January 28, 2013

Immediate effect of acupuncture on the sleep pattern of patients with obstructive sleep apnoea

The pathogenesis of obstructive sleep apnoea (OSA) is complex but it is probably due to a combination of an anatomically small pharyngeal airway1 in conjunction with a sleeprelated decline in upper airway dilator muscle activity.2 Control of upper airway muscle activity is complex. Factors that may affect upper airway muscle activity include direct input from the brainstem respiratory central pattern generator,3 chemoreceptive inputs,4 vagal input due to changes in lung volume5 and a tonic wakefulness drive that is present in the respiratory system.6 During wakefulness, patients with OSA have augmented activity of upper airway muscle such as the genioglossus muscle and tensor palatine.7 This increased activity is thought to represent a neuromuscular compensatory mechanism for an anatomically small and more collapsible pharyngeal airway. At sleep onset, this augmented upper airway dilator muscle activity is diminished or lost in association with pharyngeal collapse.

We have recently demonstrated that acupuncture is more effective than placebo treatment (sham acupuncture)-providing significant changes in the respiratory events assessed by polysomnography, and improving the quality of life of patients with OSA.9 Manual acupuncture (MA) has been practised for thousands of years in China for the treatment of various diseases.10 Only in the past century has its potent alternative, electroacupuncture (EA), been used with increasing frequency in clinical and basic research,11 and several studies suggest that the results of EA and MA differ.12 EA causes the release of â-endorphin and adrenocorticotrophic hormone into plasma, whereas MA releases only â-endorphin.13 In addition to possible differences between EA and MA, a number of studies have suggested that EA at different frequencies causes different types of responses.13 14 Further evaluation showed that low-frequency (2 Hz) EA activated many more somatic afferents than high-frequency stimulation such as 10 and 20 Hz.15 These findings suggest that the central nervous system might have a frequency-specific response to peripheral electric stimulation.16

In our previous study the most prominent finding was the reduction in the Apnoea- Hypopnoea Index (AHI) after 10 sessions of MA. This result encouraged us to continue investigating the effects of acupuncture, which can be an affordable treatment for OSA. It is known that treatment with acupuncture requires time and several sessions are recommended for adequate results. However, we decided to test the immediate effect of only one session of acupuncture owing to the instant relief related the patients and also to compare the two techniques (EA and MA) in an acute model.

Between January 2007 and August 2008, we screened individuals for inclusion in this research. Eligible patients had a signifi cant symptomatic OSA confirmed by a full polysomnographic (PSG) study with an AHI >15/h and <30/h (moderate OSA), were aged 30-70 years and were all acupuncture naïve. Patients with a high alcohol intake (>80 g/day), morbid obesity, signifi cant lung disease, neurological disease, intellectual defi cit, problems in the skeletal facial framework, central apnoea, insomnia, who had already undergone oropharyngeal operations, who had been treated with continuous positive airway pressure or oral devices and were taking any hypnotic drugs were excluded.

A total of 40 patients were eligible for the study and were submitted to a new PSG at the start of the study. They were randomly allocated by a blinded independent researcher to the following four groups: MA group, EA 10 Hz group, EA 2 Hz group and control group (n=10 each group). After randomisation, study procedures remained blind except for the researcher who applied MA/EA. All patients signed an informed consent form after receiving details of the possible risks of acupuncture such as infection, fainting, haematoma and life-threatening risks if the needle was inappropriately handled. The ethical committee of the Universidade Federal de São Paulo approved the study protocol (number 0503/06). The study was conducted according to a strict protocol.

We used single-use, sterile, cooper-handle, prepacked needles with guide tubes, 40×0.25 mm (Dongbang Acupunture; Boryeong City, South Korea). Before insertion of the needles all the points were sterilised with ethanol. The location and depth of insertions were as described in traditional texts.17 The points used were as follows: LU6, LU7, LI4, LI20, GV20, CV23, ST36, ST40, SP6, KI6. An extra point is located between the hyoid bone and the menton symphysis (Shanglianquan).

For EA the electrodes were placed in the points of the neck (deep enough to reach the genioglossus muscle -CV23 and Shanglianquan) (figure 1) and also along the body in LI4 and ST36. The electrodes were connected to LI4 and ST36 at both sides. The EA stimulation, consisting of 0.45 ms2 wave pulses at 2 or 10 Hz, was delivered by a constant current EA machine (Plexus AP 585 electrostimulator; Accurate Pulse/Biotherapy, Lautz, Brazil) to produce a moderate muscle twitch. The intensity of stimulation was typically 0.6-0.8 mA.

The choice of acupoints was based on their specifi c characteristics, as already described.9 In the MA group the needles were inserted and manually stimulated until the deqi sensation of heaviness and numbness was elicited.18 All acupuncture procedures were done by an experienced doctor, specialist in acupuncture, according to traditional Chinese medicine acupuncture methods.18 Body needles were left in situ for 30 min in the ventral part of the body. Immediately after the acupuncture or electroacupuncture stimulation the subjects were prepared for the PSG recordings.

Every subject went to bed, in the laboratory, at their usual bedtime, and had a minimum of 7 h of PSG recordings. The following sleep variables were collected and stored using amplifi ers and preamplifi ers (Meditron) and a computerised 32-channel sleep system (Sonolab; Meditron, São Paulo, Brazil). A total of four electroencephalograph leads, two electro-oculogram channels, two electromyogram channels (chin and both legs) and one electrocardiogram channel were recorded. Respiration was monitored as follows: (1) nasal cannula with fl ow measured using a pressure transducer; (2) mouth thermocouple to monitor mouth fl ow; (3) two channels for chest and abdominal efforts with calibrated inductive respiratory plethysmography; and pulse oximetry was obtained using a Nellcor oximeter.

Sleep recordings were scored according to the criteria of Rechtshaffen and Kales19 and respiratory events were considered according to the criteria published by the American Academy of Sleep Medicine in 1999.20 Two blinded experienced doctors assessed all the results.

Baseline characteristics of the patients were recorded as the median and compared between groups by the Kruskal- Wallis test. The results among groups were compared before and after the procedures by the Kruskal-Wallis test. The differences between the groups before and after the procedures were compared using a Mann-Whitney test.21 The level of statistical signifi cance was set at 0.05. All data were computer-analysed using Statview software.

Forty patients who entered the study, were randomly assigned to the MA group, EA 10 Hz group, EA 2 Hz group or control group (n=10 each group). Baseline characteristics of the three groups were similar (table 1).

Table 2 shows the PSG parameters before and after procedures for each group. It also shows the statistical differences between the groups before and after treatment. The MA and the EA 10 Hz groups showed a marked signifi cant improvement, in respiratory parameters. However, the control group and the EA 2 Hz group had no signifi cant differences.

Comparison of the results between the groups after treatment showed that the MA group and the EA 10 Hz group signifi cantly differed from both the EA 2 Hz and control groups in all the respiratory parameters, specifi cally in the primary outcome the AHI (figure 2). Those differences were supported by signifi cant changes in other outcomes. The EA 10 Hz group differed from the control group and EA 2 Hz in the respiratory events (p=0.006; p=0.025, respectively). The MA was signifi cant different only from the control group (p=0.015). Nevertheless, in the Hypopnoea Index the MA differed from the control group and EA 2 Hz (p=0.010; p=0.034, respectively) and the EA 10 Hz group only differed from the control group (p=0.019). No adverse events occurred during the trial.

The results of our study demonstrate that median frequency EA 10 Hz and MA exerts better immediate effects than low frequency EA 2 Hz in reducing the AHI as well as the number of nocturnal respiratory events of patients presenting with moderate OSA. In a previous study our group showed that MA was effective in providing significant changes in polysomnographic evaluations as well as in the quality of life of patients with OSA after 10 weekly sessions of acupuncture.9 The speculative hypothesis for this improvement was the involvement of serotonergic pathways22 23 in the responses mediated by acupuncture as well as its anti-inflammatory effect.24

Electrical acupoint stimulation has been widely used as a substitute for classical acupuncture. Nevertheless, the studies dealing with electroacupuncture mainly consider its analgesic effect.25 It has been shown that acupuncture analgesia can be induced by either low-frequency stimulation such as 2 Hz or high-frequency stimulation such as 100 Hz.26 In our study pain was not the focus, but rather a lack of motor competence due to an inflammatory condition or to a central mechanism underlying reduction of activity of the airway dilator muscles.3 We observed that a low and medium frequency (2 and 10 Hz) showed divergent results in promoting acute relief of the apnoea symptoms. This led us to speculate about the differences that exist between other different frequencies and not only frequencies such as 2 and 100 Hz. Perhaps between two near frequencies, such as 2 and 10 Hz, or 15 and 20 Hz, particular properties exist that exert specifi c effects.

The significance of frequency-specific EA stimulation on analgesia and the human brain has been recognised in several studies. One observation is that the release of neurotransmitters may differ between the stimuli of high (100 Hz) and low (2 Hz) frequencies.26 This finding is compatible with an aspect of traditional Chinese medicine theory strongly emphasised by Chinese doctors-namely, the importance of needle manipulation during insertion. While EA has the advantage of objective settings of stimulation parameters, it is certainly possible that EA and MA elicit different brain reactions.27 Our study demonstrated clear evidence of a difference in the acute effect of low-frequency EA and MA. The reason why two similar frequencies elicit different results is not known. We speculate that EA 10 Hz promotes a greater muscle toning effect than EA 2 Hz. Or perhaps the EA 2 Hz low frequency inhibits the effect of acupuncture?

The relation between EA and the muscular system has been little studied. One study by Yang et al (written in Chinese) observed that EA signifi cantly increased an athlete's performance, improving the biomechanical indexes, and thus enhancing the athlete's strength.28 However, for cardiovascular diseases and also pain, both EA and MA have positive therapeutic effects. Zhou et al29 observed that stimulation of low-frequency EA of superfi cial (ie, cutaneous) somatic nerves exerted either a prolonged or no attenuation of the refl ex sympatho excitatory cardiovascular responses. On the other hand, the inhibitory influence of EA on the pressor refl exes was observed in the stimulation of acupoints overlying deep somatic nerves (ie, ST36 acupoint). The stimulation of the ST36 acupoint overlying the deep peroneal nerve reduces the visceral pressor refl ex response, as well as stimulating LI4, an acupoint located in the hand. In our work we used both acupoints, ST36 and LI4, obtaining stimulation of the deep somatic nerves. These data may have direct clinical implications for the practice of EA. We speculate that local EA or MA as well as distant-point EA or MA may have promoted a cascade of reactions ameliorating the nocturnal apnoeas. In our previous work the PSG examination was carried out 2 weeks after the last treatment, and in this recent work we have shown that just one application produces a positive result.

The central mechanism underlying reduction of activity of airway dilator muscles with sleep is related to the projection of caudal raphe serotonergic neurons to upper airway moto neurons. Schwartz et al30 showed that stimulation of the lingual muscles can increase or decrease airfl ow, depending on the specifi c muscles stimulated, without arousing patients from sleep. In this work, specifi cally, we used mainly a muscle whose action protrudes the tongue (genioglossus) for MA and EA stimulation (we should also consider the mylohyoid, but the main stimulation was in the genioglossus, because the needles were deeply inserted). The influence of this lingual muscle on airflow dynamics in the upper airway is well known and we speculate that the effect on this muscle was one of mechanisms underlying the improvement of symptoms. Measuring the electric activity of this muscle was not the reason for our trial, but a study of this aspect may help to elucidate the mechanisms of acupuncture.

Another point to be considered is that we used EA both locally and systemically in two acupoints. Thus, further investigations are currently underway to investigate (1) the improvement of those patients after 10 sessions of EA and MA; (2) the effect of these treatments 3 months after the last treatment session. As we know, acupuncture treatment must be repeated weekly and for sustained effects should be carried out over a long period of time in chronic diseases- for example, once a month after the main protocol, if necessary; (3) the involvement of 5-hydroxytryptamine and anti-inflammatory substances in this effect; (4) the difference between acupuncture treatment and the current 'gold standard' treatment for OSA-namely, continuous positive airway pressure.

Although we concluded that a single session of both MA and EA 10 Hz had an acute effect in reducing the AHI of patients presenting with moderate OSA, larger studies are needed to validate the possible clinical signifi cance of these findings.

Wednesday, January 23, 2013

Acupuncture ‘promising’ way to boost exercise response, recovery

By Helen Albert, Senior medwireNews Reporter

Results from a systematic review suggest that acupuncture may improve exercise performance and postexercise recovery.

Birinder Singh Cheema (University of Western Sydney, Campbelltown, Australia) and colleagues evaluated the results of four studies on the effects of acupuncture on the performance of and/or recovery from aerobic exercise. The studies were all small, involving 10-30 participants per trial with 84 participants overall. Three used a randomized crossover method and one a parallel group design.

Two of the studies focused on professional athletes and the other two did not specify level of fitness of participants-just that they were "apparently healthy." Fourteen acupuncture sites -DU 20, LI 15, LI 13, PC 6, ST 36, SP 6, PC 5, LU 7, LI 4, GB 37, GB 39, GB 34, and LI 11, and LR 3 - were used across the four studies.

One study observed significant improvements in peak power output, rate pressure product, and blood pressure in individuals who had electroacupuncture stimulation of PC 5 and PC 6 or LU 7 and LI 4 versus controls. However, two other studies showed no improvement in performance after acupuncture, using point combinations of the sites DU 20, LI 15, LI 13, PC 6, ST 36, and SP 6 or DU 20, ST 36, GB 34, LI 11, and LR 3.

The study that assessed recovery from aerobic exercise found significant improvements in blood lactate levels, consumption of oxygen, and heart rate following acupuncture at the sites PC 6 and ST 36 versus controls at 30 or 60 minutes after exercise completion.

Despite somewhat promising results, the authors highlight the limitations of the studies such as a failure to control for confounding interventions, and a failure to report on adverse events that might be associated with acupuncture.

While they note that they found "only preliminary evidence that acupuncture methods may enhance exercise performance and postexercise recovery," Cheema et al conclude in The Journal of Alternative and Complementary Medicine that "further investigations involving more-rigorous study designs and methods of reporting are required."

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Wednesday, January 16, 2013

Scientific Discovery - Better Sleep With Acupuncture

Electrical engineers in a medical research team discovered how acupuncture benefits sleep. They did it by measuring brain activity with EEG (electroencephalography) before, during and after an acupuncture treatment. Results were conclusive, acupuncture significantly increases slow wave activity of the brain relative to fast wave activity in both the frontal and central lobes. This phenomena is known to benefit the quality and duration of sleep.

The acupuncture point used in this study increases the delta band power density, a known sleep related brain wave band. In addition, acupuncture at this point downregulates alpha and beta band activity relative to delta band activity. The decreases in these bands also enhances sleep quality.

The researchers applied manual acupuncture to humans at acupoint ST36. It was found that this acupoint significantly increases the power ratio index of slow waves to fast waves following an acupuncture treatment. Stainless steel 0.2 mm diameter acupuncture needles were applied to the subjects. The needles were applied and retained for an initial two minutes followed by manual rotation of the needles applied for another two minutes. Measurements were taken throughout the brain of the delta (0 - 4 Hz), theta (4 - 8 Hz), alpha (8 - 13 Hz) and beta (13 - 30 Hz) bands. Notably, there were increases in the delta band power in five major brain areas during and after acupuncture.

The researchers note that “acupuncture at ST36 can induce obvious changes in different EEG rhythms in healthy subjects.” They also note that acupuncture modulations of brain activity resulting from acupuncture point stimulation show “that the brain plays a key role in acupuncture research.” They also suggest that “cortical electrical activities may be an important mechanism by which acupuncture exerts its complex multisystem effects.”

Tony Burris, L.Ac., is a 17-year practitioner of Traditional Chinese Medicine (TCM) and is an expert in safe and effective acupuncture therapy and herbal remedies. He is the only practitioner in the United States that offers a “Painless Acupuncture- Or Your Money Back!” Guarantee. Tony helps frustrated and injured athletes and chronic pain sufferers discover a unique therapy system that often provides long-lasting or even permanent pain relief. His patients include members of the San Diego Chargers, Washington Redskins, Denver Broncos, Chicago Bears and Detroit Lions. Tony also treats members of the Seattle Mariners, Olympic medalists, mixed martial artists and NCAA competitors. Contact Tony @ tony@eagleacupuncture.com
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Wednesday, January 09, 2013

Traditional Chinese Medicine: Business Blockbuster or False Fad? Read More at http://knowledge.ckgsb.edu.cn/2013/01/08/china/traditional-chinese-medicine-business-blockbuster-or-false-fad/, Written by David Friesen, Copyright © CKGSB Knowledge

by David Friesen

Tong Ren Tang is a household name in China. The pharmacy specializing in traditional Chinese medicine (TCM) has been around since 1669. Legend has it that Tong Ren Tang was set up as the royal pharmacy for the palace of the Qing Dynasty. The dynasty came and went, but Tong Ren Tang withstood the test of time. In fact, today it has spread its wings beyond China to places like the United Arab Emirates, Vietnam, the Philippines, Malaysia and Australia. By 2015, it aims to open over 100 overseas stores in countries as diverse as the US and Japan.

From the claims of healing herbs to pain-reducing acupuncture, TCM is steeped in historical terminology and philosophical musings. Taking a so-called holistic approach to health and wellness, TCM has long been practised in China. Today, as many companies like Tong Ren Tang are discovering, it is also big business, both in China and many Western countries. According to a 2012 report by market research organization IBISWorld, government support and increasing demand in China has driven TCM to expected revenues of $25.7 billion in 2012, up 14.8% from 2011. The industry has grown by 20% each year on average since 2007, and profitability has continued to rise as well.

So what accounts for this sudden spurt in TCM’s popularity, and is it sustainable in the long run?

There is no doubt that TCM within China is a hugely profitable business with growing industrial output. According to China’s National Bureau of Statistics, in 2011 the value of the industrial output of TCM reached RMB 418 billion, recording a year-on-year growth of 37.9%.

The surprising fact, however, is that TCM is growing at a faster clip in other countries. The National Bureau of Statistics also points out that TCM exports rose in 2011, with exports to the US alone jumping by 66.3% year-on-year.

It is not just Western countries that are seeing growth. Africa is now China’s largest market for the export of medical products, both TCM and otherwise, thanks to low cost. In fact, in 2011 TCM was formally introduced into South Africa’s healthcare system.

Many of the large Chinese TCM companies have expanded outside of China. Apart from Tong Ren Tang, others like China Health Resource, Inc. have seen record results this year thanks to increased sales of premium TCM herbs such as its Tian Ma brand in Western countries, as well as a growth of low-cost TCM options in Africa and Asia.

Much of the success of TCM in Western countries is because it is associated with wellness. It offers an alternative to supposed Western modes of thinking about treating the symptoms of disease as opposed to seeing the human body holistically. This is pushing TCM from the fringes to the mainstream in terms of demand and acceptance.

Australians, for example, are spending over AUS$4 billion per year in the complementary and alternative medicine industry, some of which is on TCM. In July this year, the Chinese Medicine National Registration Board began to officially register Chinese Medicine practitioners nationwide in Australia.

In fact, TCM marketing has become a business in itself, with a number of companies now dedicated to providing marketing solutions for individual TCM practitioners and TCM companies.

“There is potential in all areas of Chinese medicine, from the herbs and acupuncture to health preservation and wellness. The ideas of Chinese medicine can be used as a format for understanding the human body to design wellness plans and treatments,” says Alex Tan, a qualified TCM practitioner and educator from Australia who founded the Straight Bamboo TCM Clinic in Beijing.

Tan thinks that aside from his firm belief that TCM really can improve health and wellness, TCM has appeal because of its cost-effectiveness. “TCM (is a) low-technology, low-cost approach. Most of the developing world cannot afford Western medicine purely because of the cost. These countries can use the methodology of Chinese medicine to diagnose and then use local herbs or acupuncture pins which are cheap to treat patients,” says Tan.

This is not always the case in developed countries, however. “Due to the National Health Service in the UK, TCM does not enjoy any economic advantage and is seen as quite expensive. A typical consultation with a Chinese doctor in the UK can cost up to £50 before any charges for medicine are added,” says Mike Bastin, Visiting Academic at Tsinghua University and researcher at Nottingham University’s School of Contemporary Chinese Studies.

The potential economic benefits of TCM are also attracting large pharmaceutical companies, as they begin to research ways of using TCM. Britain’s biggest drug maker, GlaxoSmithKline, has set up a number of research labs in China that are looking at ways of developing TCM. The company has created a Discovery Performance Unit that will integrate traditional Chinese medicine with modern drug discovery.

Despite the economic success of TCM in recent years,TCM also has its share of problems. Although qualifications and regulations are growing and advocates strongly recommend that those offering such services be fully qualified and appropriately registered, the industry is still fragmented in terms of regulation and quality.

For example, the USFDA has struggled to regulate herbal medicines, as it has often seen herbs as ‘not drugs’, thereby leaving them almost completely unregulated. Herbs are classified as dietary supplements, leaving the FDA with no power under federal law to regulate these products in the same way as drugs.

This is not to say that the FDA could not approve certain TCM products. In fact, the Dantonic pill by TCM manufacturer Tasly, used to treat angina and heart disease and approved by drug watchdogs in Canada, Russia, the Republic of Korea, Vietnam, Singapore and some African countries, is currently in Phase III trials to become the first USFDA-approved TCM product in the US.

Of course, such legitimacy is not always sought, given the lack of regulation of herbal products. However, the European Union (EU) has been stricter. In May 2011, all unauthorized TCM products were pulled from shelves in the EU. This followed a directive in 2004 that gave a seven-year grace period to manufacturers of herbal medicines to register their brands. No Chinese TCM producers were able to obtain a license due to high costs and difficulties meeting the EU’s stringent criteria.

This has changed recently however, with SU BioMedicine BV successfully registering the Diao Xin Xue Kang capsules, the first Chinese medicine in the Netherlands this year.

Whilst it is clear that herbal TCM has some promise because many herbs do, in fact, have active ingredients, the products approved are so far the exceptions in terms of regulation and stringent testing. Although most practitioners seemingly welcome further research, this belies the fact that extensive research in many areas has already been carried out. Also, in areas where further research is needed to potentially prove efficacy and mechanisms of action for treatments such as herbs or acupuncture, treatment still continues. This is generally a reversal of the usual methodology of science-based medicine, where efficacy and significant understanding is needed before treatment is prescribed.

Take acupuncture, for example. The well regarded website Science-Based Medicine gives an excellent overview of the efficacy of acupuncture. In summary, there appears to be no plausible mechanism for acupuncture, and most of the evidence supporting acupuncture, of which there is, in fact, very little if any, is generally not scientifically rigorous. A large majority of acupuncture studies showing any sort of positive effect have come out of China and have not been properly peer-reviewed or shown to be scientifically rigorous.

And although major manufacturers do at least have quality controls in place, outside of this there is a worrying lack of quality control and regulation. For example, an Australian-led group of scientists found traces of endangered species, as well as potential toxins and allergens in traditional Chinese medicines that were confiscated from overseas travellers. They performed ‘second generation DNA sequencing’ on 15 samples, and found traces of animals including Asiatic black bear and the saiga antelope.

“There’s absolutely no honesty in the labelling of these products. What they declare is completely at odds with what’s in there,” says Mike Bunce, a geneticist at Murdoch University near Perth, Australia, who led the study, in a comment to the journal Nature.

These concerns do not appear to be harming the TCM business as of yet though. Marketing that plays to today’s consumers regarding health and wellness, as well as the logical fallacy that just because something is ancient and has a long history means it must work, will continue to attract people to TCM. Combined with consumers’ frustration with what they see as the problems of Western medicine, the rise of TCM is likely to continue.

However, without addressing many of these concerns and really putting money into rigorous research, the economics of TCM will surely be overtaken by the weight of evidence in the long-term.

Monday, January 07, 2013

Acupuncture Beats Drugs for Irritable Bowel Syndrome

Acupuncture combined with moxibustion is more effective than conventional ‘western’ medicine for the treatment of irritable bowel syndrome (IBS). A new meta-analysis of 11 research investigations with a sample size of over 950 patients shows that acupuncture with moxibustion leads to better clinical outcomes than conventional pharmaceutical drug therapy. In addition, the study shows that acupuncture combined with moxibustion is not only effective but is also safe. The researchers conclude, “Acupuncture-moxibustion for irritable bowel syndrome is better than the conventional western medication treatment.”

Acupuncture at Yintang for relation. Acupoint Relaxation This is not the first time Chinese medicine has been shown effective for the treatment of irritable bowel syndrome. The Journal of the American Medical Association made an impact in the western world with its ground breaking publication of findings showing that Chinese herbal medicine “offer(s) improvements in symptoms for some patients with IBS.” This early study used the modern standards of investigation now commonly employed in acupuncture and herbal medicine studies. It was a randomized, double-blind, placebo-controlled trial. Gastroenterologists worked in combination with herbalists but both groups were blinded to the treatment group. The study discovered that Chinese herbal medicine improved patients’ health with irritable bowel syndrome including significant improvements documented 14 weeks after completion of the herbal medicine treatments.

One effective herbal formula used for the treatment of irritable bowel syndrome is Shu Gan Wan. Often referred to as soothe the liver pills, this formula is known for its ability to prevent Liver Qi stagnation from attacking the Spleen and Stomach. This syndrome is indicated by abdominal discomfort and gas, bloating, hiccups, belching, abdominal pain, erratic stools and poor digestion. In some cases, hypoglycemia or ulcerative gastritis develops. This syndrome is common when emotional, physical and dietary stresses cause stomach and digestive upset. Irritability and anger during or after eating is a common example of when Liver Qi stagnation attacks the Stomach and Spleen. This is why Chinese medicine doctors often recommend not reading the newspaper during meals or eating in rush or under pressure.

One effective acupuncture point for the treatment of irritable bowel syndrome is LV13 (Zhangmen, Completion Gate). LV13 is the Front Mu point of the Spleen, the Influential point of the Zang organs and is the meeting point of the Liver and Gallbladder channels. This point harmonizes the Liver and Spleen and regulates both the middle and lower burners (jiao). Located anterior and inferior to the free end of the 11th rib, this point is never needled deeply and has many benefits to the digestive system. Indications for the use of this point include pain in the hypochondrium, diarrhea, indigestion, vomiting and abdominal distention.

Thursday, January 03, 2013

Acupuncture Depresses Hypertension - New Findings

Investigators now confirm that acupuncture immediately lowers high blood pressure and has long-term anti-hypertensive effects. High blood pressure, hypertension, affects approximately 1 billion people. Seventy patients with hypertension were given acupuncture five times per week over a three month period. An important pattern emerged. Immediately after acupuncture treatments, the blood pressure reduced significantly. More importantly, the overall blood pressure readings began to decrease over time. Before and after each successive acupuncture treatment, both the systolic and diastolic blood pressure readings showed a gradual decrease over time. The researchers concluded that acupuncture decreases blood pressure both immediately and in the long-term.

Acupuncture for HBPAcupuncture for ther HeartAcupuncture points used in the study were: ST9 (Renying), LI4 (Hegu), LV3 (Taichong), LI11 (Quchi) and ST36 (Zusanli). ST9 (Renying, Man’s Welcome), located on the neck, is classified as a window of sky point, a sea of Qi point and a meeting point of the Stomach and Gallbladder channels. This point regulates Qi and Blood. ST9 alleviates pain and benefits the throat and neck. ST9 strongly settles uprising rebellious Qi and is therefore effective for the treatment of headaches, hypertension, wheezing and vomiting. The bilateral application of acupuncture points LI4 and LV3 is known as the “four gates.” The pain reducing properties of the four gates is well known. The four gates stimulate the free flow of Qi and Blood circulation. LI11 (Quchi, Pool at the Crook) is a He-Sea and earth point. This anti-inflammatory acupoint may be combined with ST36, an important yangming point often used to nourish the body. This combined pair is often used for the treatment of hypertension when applying a reducing technique to the needles.

In another recent study, researchers from University of California, Los Angeles and University of California, Irvine discovered how acupuncture lowers blood pressure. Acupuncture reduces hypertension by stimulating brain neurons, electrically excitable cells that transmit information. Acupuncture downregulates neural activity of the rostral ventrolateral medulla of the brain (rVLM) thereby reducing sympathetic nervous system overstimulation and reducing blood pressure. The researchers “have shown that electroacupuncture stimulation activates neurons in the arcuate nucleus, ventrolateral gray, and nucleus raphe to inhibit the neural activity in the rVLM in a model of visceral reflex stimulation-induced hypertension.” In this study, electro-acupuncture at acupoints P5, P6, LI10 and LI11 were shown to reduce hypertension.

Another recent study shows that acupuncture improves HRV (heart rate variability). HRV measures that body’s flexibility in controlling the heart rate in stressful circumstances. The HRV research notes that acupuncture synchronizes the sympathetic and parasympathetic nervous systems thereby enhancing HRV. This research suggests that acupuncture is an important consideration in the treatment of cardiovascular health.

Tuesday, December 18, 2012

Acupuncture Helps with Neck Pain - New Findings

New acupuncture research shows that acupuncture is effective for the treatment of neck spondylosis, a type of degenerative osteoarthritis. This condition often causes pain, numbness and weakness of the limbs. The researchers compared to approaches to treatment.

Group 1 consisted of 55 subjects who received acupuncture at acupoints Bailao (Ex-HN15), Ht7 (Shenmen), and SI4 (Wangu). Next, Group 1 received moxibustion treatment at GV14 (Dazhui), UB15 (Xinshu) and UB23 (Shenshu). In the third stage of care, group 1 received intradermal needling at Bailao (Ex-HN15), UB15 and UB23. Group 2 consisted of 56 subjects who received acupuncture at acupoints Bailao and TB3 (Zhongzhu). Next, group 2 subjects received intradermal needling at Bailao and SI15.

Both groups improved significantly in a before and after treatment comparison. When the groups were analyzed for statistical differences between age groups, group 1 showed significantly better results for subjects over 45 years of age. The researchers concluded that the group 1 treatment program demonstrates clinically superior efficaciousness for patients that are 45 years or older with chronic cervical spondylosis.

Monday, December 17, 2012

Acupuncture Reverses Plantar Fasciitis - New Research

New research concludes that acupuncture is effective for treating plantar fasciitis, a painful inflammatory foot condition. Plantar fasciitis typically presents with pain on the underside of the foot and heel. The pain is often most severe when first stepping out of bed onto the floor in the morning. Another telltale sign of plantar fasciitis is pain upon dorsiflexion, lifting the foot towards the shin.

In this controlled clinical investigation, the acupuncture group demonstrated a significant reduction in foot pain while the control group showed only minimal changes. The control group received five weeks of analgesic medications, stretching exercises and shoe modifications. The acupuncture group received the same therapies plus electro-acupuncture treatments. The researchers concluded that, “Electro-acupuncture coupled with conventional treatments provided a success rate of 80% in chronic planar fasciitis which was more effective than conventional treatments alone.”

Another recent study demonstrates that acupuncture is effective for the treatment of plantar heel pain. The researchers note that acupuncture has more significant improvements in both pain relief and the restoration of function than a standard regime of care that includes non-steroidal anti-inflammatory medications. Based on these findings, the researchers formally recommend acupuncture for the treatment of plantar heel pain.

In yet another study, investigators concluded that acupuncture at acupoint P7 (Daling, “Big Tomb”) relieves the pain of plantar fasciitis. P7 is located in the middle of the transverse crease of the wrist. P7 is a Shu-Stream point and Yuan (Primary) acupuncture point that is known for the treatment of Heart and Spirit related issues including myocarditis, palpitations, insomnia, mental illness, irritability, and cardiac pain. P7 is also used for Stomach related conditions, however, nearby point P6 is a more common point for the treatment of Stomach issues such as stomachache, nausea, and vomiting.

According to Chinese medicine and acupuncture theory, Shu-Stream points treat a heavy sensation of the of the body and painful joints. P7 is therefore a common point for the treatment of wrist pain because it is a Shu-Stream point located at the wrist . However, the researchers have chosen P7 for the wrist’s distal relationship to the ankle and heel region. At a six month follow-up examination, the P7 acupuncture group showed a significant improvement over the control group. Plantar fasciitis affects approximately 2 million US citizens annually. These findings demonstrate that acupuncture is an important treatment modality for inflammation of the connective tissue on the bottom of the foot. Advantages to acupuncture treatment are that it is both safe, acupuncture is nontoxic and is nonsurgical, and effective.

Thursday, December 13, 2012

Ancient Chinese Cures Seen Helping Drugmaker Pipelines

The world’s biggest drugmakers are turning to ancient Chinese remedies to boost product pipelines.

GlaxoSmithKline Plc is testing botanicals -- compounds extracted from plants -- for immune disorders, Sanofi plans to turn traditional Chinese medicines into alternative diabetes and cancer therapies, and Nestle SA (NESN) teamed last month with billionaire Li Ka-Shing to develop a drug derived from ancient Chinese approaches to cure inflammatory bowel disease.

The confluence of China’s growing middle class and pharmaceutical companies’ need to find new revenue have combined to give Western drugmakers an increasingly open mind about a 2,500 year-old form of medicine they once scoffed at.

“You have 1.3 billion people, many of whom cannot afford Western medicines and who believe that traditional Chinese medicines are good enough,” said Bloomberg Industries analyst Sam Fazeli. “If they can manufacture it on a meaningful scale, and do it with the stamp of a Glaxo or a Sanofi on it, perhaps the consumer will be more interested in buying it than something that’s boiled up in a vat somewhere.”

China’s market for traditional drugs, excluding raw herbs and highly purified compounds extracted from herbs, was $13 billion in 2011 and could grow 14 percent annually over the next five years, according to consultancy McKinsey & Co. Of last year’s total, $6 billion came from medicines sold over the counter, accounting for almost half of China’s market for non- prescription drugs, the consultancy said. Ancient Recipes

Less stringent U.S. rules for approving plant-based treatments may give drugmakers a quicker path to creating medicines, with more than 500 applications to test treatments lodged with the Food & Drug Administration. Previous attempts to break down herbal medicines into single ingredients failed to yield major breakthroughs so Western drugmakers now target mixtures inspired by ancient recipes to sell globally and in China, where many are raised to trust traditional methods.

Combining Western science with traditional cures is an approach that already extends to Glaxo’s research center in Shanghai. Sick workers can tap an alternative Chinese therapy using suction cups made of glass, as well as the pharmaceuticals that generate most of the Brentford, U.K.-based company’s $44 billion of annual sales. Botanical Treatments

“Traditional medicine has been practiced for thousands of years but it has always been based on clinical experience and not so much on clinical evidence like Western medicine,” said Zang Jingwu, Glaxo’s head of China research and development. “Our strategy is to integrate existing traditional knowledge of diseases with modern drug discovery technology.”

The U.S. FDA introduced new guidelines for botanical treatments in 2004, applying less strict conditions to those imposed on chemical and biological drugs seeking approval. That opened up a new avenue for producers to replenish their medical research pipelines and replace expiring patents.

It’s no longer essential to identify the active constituents of botanical drugs, while products legally used as dietary supplements in the U.S. with no known safety issues may provide “markedly reduced” information on their toxicology, according to the U.S. regulator.

“Almost all botanicals are complex natural mixtures that are difficult to have full chemical characterization and will need flexibility in regulatory approaches,” said Shaw Chen, who leads the FDA’s botanical review team. The guidelines are “intended to facilitate more development of new treatments, especially for unmet medical needs,” he said. Scaly Skin

The agency has received more than 500 applications to test drugs under the guidelines, most of which were approved for human trials, Chen said in an e-mailed response to questions. Many are in phase three trials, typically the last hurdle to qualify for approval, with a handful soon to make the final application to become an allowed drug, he said, declining to be more precise.

Glaxo’s herbal drugs efforts will focus initially on immune disorders such as psoriasis, a chronic disease that causes scaly skin, and drugs that treat inflammation of the digestive system, according to Zhang Xun, Shanghai-based head of research and development for the company’s global natural products unit.

“We want to get quickly into the clinical development stage by collaborating with domestic companies,” said Zhang, adding that the company will “soon” have a product in development with a Chinese partner without being more specific. ‘Good Baby’

Sanofi (SAN), France’s largest drugmaker, is in talks with the Hong Kong University of Science and Technology to come up with “modernized” versions of traditional medicines. These could be used to treat chronic diseases such as diabetes and cancer, said Frank Jiang, the company’s head of Asia Pacific research and development.

The Paris-based company wants to first register new drugs in China to target local patients before aiming for the global market through approvals in the U.S.

Wednesday, December 12, 2012

Acupuncture for Cerebral Vasospasm After Subarachnoid Hemorrhage: A Retrospective Case-Control Study

Source: http://www.ncbi.nlm.nih.gov/pubmed/23176375 Abstract

Abstract Objectives: To examine the possibility of acupuncture as a new promising treatment to prevent delayed cerebral vasospasm, retrospective comparison was done of patient outcomes in patients with subarachnoid hemorrhage (SAH) treated with and without acupuncture. Materials and methods: Twenty (20) patients with SAH were treated after their ruptured aneurysms had been secured. Acupuncture treatments were applied to the bilateral Zusanli (ST36) and Neiguan (PC6) once a day for 2 weeks, starting within 3 days of the aneurysm rupture. The incidence of angiographic vasospasm and delayed ischemic neurological deficit (DIND), the patient's functional status at discharge, and mortality rate were analyzed. Patient outcomes were compared with those of an age- and severity-matched comparison group composed of patients treated in the hospital without acupuncture. Results: None of the patients who received acupuncture died. Angiographic vasospasms occurred in 5 patients (25.0%) and DIND in 2 (10%). In terms of functional impairment, the modified Rankin score at discharge was ≤2 in 7 patients (35%). In the control group, angiographic vasospasms occurred in 10 patients (55.6%) and DIND in 7 (38.9%), similar to the reported incidence in conventionally treated patients. Conclusions: Patients with SAH who received acupuncture had a significantly lower incidence of DIND and significantly improved function at discharge, suggesting that acupuncture is effective in preventing cerebral vasospasm. In light of these promising results, a randomized controlled trial is warranted to determine the efficacy of acupuncture in a clinical setting.

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Tuesday, December 11, 2012

Nestle in Chinese medicine deal with Li Ka-Shing's firm

Nestle, the world's biggest food group, has agreed a deal to develop treatments based on traditional Chinese medicines.
It will set up a joint venture with Hutchison China MediTech, controlled by Hong Kong billionaire Li Ka-Shing.

The deal will give Nestle access to more than 50,000 extracts used in the manufacture of Chinese medicines.

The deal comes as the global market for Chinese medicines expands. It is valued at more than $83bn by the World Health Organization.

In China alone, the industry produced almost $48bn worth of such medicines in 2010.
That was up almost 30% from the year before.

"We believe traditional Chinese medicine has a real potential to become part of innovative solutions," Luis Cantarell, chief executive of Nestle Health Science, was quoted as saying on a conference call by the Financial Times and the Bloomberg News agency.

The joint venture, called Nutrition Science Partners Limited (NSP), will develop and manufacture nutritional and medicinal products.

It will initially focus on developing gastro-intestinal products, but may "may in the future expand into the metabolic disease and brain health areas", Nestle said in a statement.7BUJ5NQZFRJ5

Thursday, December 06, 2012

Interest Groups Push to Fill Margins of Health Coverage

Monica Almeida/The New York Times

The chiropractors were out in force, lobbying for months to get their services included in every state’s package of essential health benefits that will be guaranteed under the new health care law.

“We’ve been in constant contact with our state chapters, just telling them, ‘Look, you’ve got to get in the room,’ ” said John Falardeau, senior vice president of government relations at the American Chiropractic Association.

The acupuncturists were modest by comparison, ultimately focusing on a few states, like California, where they had the best odds of being included.

“Our profession really didn’t have a million dollars to spend on a lobbyist,” said Jeannie Kang, the immediate past president of the American Association of Acupuncture and Oriental Medicine. Instead, they mobilized 20,000 acupuncturists and their patients in a letter-writing campaign.

Both efforts seem to have shown results. Most of the roughly two dozen states that have chosen their essential benefits — services that insurance will have to cover under the law — have decided to include chiropractic care in their package. Four states — California, Maryland, New Mexico and Washington — included acupuncture for treating pain, nausea and other ailments. It is also likely to be an essential benefit in Alaska and Nevada, according to the Department of Health and Human Services.

“To me, six is huge,” said Ms. Kang, an acupuncturist in Los Angeles, who helped coordinate the lobbying effort.

The main goal of the health care law has always been to guarantee medical coverage to nearly all Americans, but as states finalize their benefits packages, it is becoming clear that what is received will depend partly on location.

According to proposals that the states have submitted to the Department of Health and Human Services, insurance plans will have to cover weight-loss surgery in New York and California, for example, but not in Minnesota or Connecticut. Infertility treatment will be a required benefit in Massachusetts, but not in Arizona.

Over all, the law requires that essential health benefits cover 10 broad categories, including emergency services, maternity and newborn care, hospitalization, preventive care and prescription drugs. But there is room for variation in those categories. Whether insurance will pay for hearing aids, foot care, speech therapy and various medications will vary significantly by state.

The Obama administration originally planned to impose a single set of essential benefits nationwide, so groups like Ms. Kang’s lobbied federal officials at first. But last year, amid accusations that the health care law was too rigid, it decided to allow each state to choose its own guaranteed benefits within the 10 broad categories.

The law stipulates that starting in January 2014, the essential benefits will have to be covered by insurance plans offered in individual and small-group markets. These are the plans that people will shop for to comply with the law’s mandate that almost everyone have health coverage or pay a penalty. They will be available through health insurance exchanges, online markets where the uninsured can shop for coverage, often with federal subsidies to help pay for it.

The essential benefits will not be guaranteed to people who get coverage through large employers, but such plans already tend to be relatively generous. In comparison, many plans currently sold on the individual market do not cover maternity care, for example, or mental health services.

For the most part, states are defining their essential benefits as those provided by the largest health plan in their small-group insurance market. In Washington State, for example, that plan covers 12 acupuncture visits and 10 chiropractic visits per year. It does not cover in vitro fertilization, weight-loss programs or routine foot care for anyone except diabetics.

“Everybody really was conscious of the cost impact that the plan was going to have,” said Stephanie Marquis, a spokeswoman for the state’s insurance commissioner. “That’s something we’re working very hard at keeping an eye on and making sure we’re not adding benefits unnecessarily.”

Alan Weil, executive director of the National Academy for State Health Policy, said that while the essential benefit packages vary at the margins, they are similar over all. Every state’s package will cover visits to primary care doctors and specialists, for example, and diagnostic tests like X-rays and blood work.

“To people who care about particular diseases or conditions or provider groups, these don’t feel like the margins,” Mr. Weil said. “But at the end of the day, the core benefits are very standardized, and the differences are at the periphery.”

Some states have declined to choose an essential benefits package, saying that the law does not give them enough latitude. In those states, the default will be the largest plan available in their small-group insurance market, according to the Department of Health and Human Services.

Gov. Dave Heineman, Republican of Nebraska, chose an insurance plan with a high deductible as his state’s benchmark, reasoning that such lower-cost plans were popular in the state. But the Obama administration recently informed him that the plan did not meet the requirements of the law, he said.

“The point we were trying to make is that the minimum coverage should not be above what people need,” Mr. Heineman said. “The overriding concern is that the cost will be too great.”

Other states delayed choosing a benchmark plan on the grounds that the Obama administration had not provided enough guidance. Last month, the administration published a proposed rule that sought to answer outstanding questions.

The rule makes clear, for example, that insurers can substitute one covered service for another as long as they are in the same broad category and “substantially equal.” It clarifies that pediatric services, one of the 10 required categories, must be provided to everyone 18 and under.

States can still change or choose a benchmark plan, but they are running out of time. They generally have until Dec. 26, when the comment period for the proposed rule will end. So far, 23 states and the District of Columbia have chosen plans, according to Avalere Health, a consulting company.

Interest groups that did not succeed in getting a particular service covered may have another chance to do so. States will most likely be able to change their benchmark plans after 2015. So groups like the Obesity Action Coalition will keep making their case.

“There’s going to be a great deal more effort on this issue,” said Chris Gallagher, a policy consultant for the coalition. “At a minimum, if plans are going to try to exclude obesity treatment services, there must be some kind of exception for medically necessary treatment. It’s a serious medical condition that affects one in three Americans.”

Likewise, Ms. Kang’s group will keep presenting state decision makers with patient testimonials and research studies on the benefits of acupuncture. Its next targets are New York and Florida, which have more licensed acupuncturists than any state except California.

The chiropractors, meanwhile, are focused on California, where the essential benefits package that Gov. Jerry Brown signed into law in September does not include chiropractic services. Mr. Falardeau said the American Chiropractic Association was still hoping for a change.

“We’re ready, if we have to, to go to war on it,” he said.

This article has been revised to reflect the following correction:

Correction: December 6, 2012

An earlier version of this article, using information supplied by the Department of Health and Human Services, misstated the state where infertility treatment would be a required benefit under proposals submitted by states for the new health care law. It is Massachusetts, not New Hampshire.

Wednesday, December 05, 2012

Try tai chi to improve balance, avoid falls

Compared to the pumping intensity of spin or Zumba, a tai chi class looks like it’s being performed in slow motion. Watching the gentle, graceful movements of this ancient Chinese practice, it’s hard to imagine that tai chi can burn off a single calorie or strengthen muscles. But this exercise program is far more dynamic than it looks.

“The slowness that you see from the outside can be deceptive,” says Dr. Peter Wayne, research director of the Osher Center for Integrative Medicine at Brigham and Women’s Hospital and Harvard Medical School. As an aerobic workout, tai chi is roughly the equivalent of a brisk walk (depending on the intensity at which you perform it). And as a resistance training routine, some studies have found it similar to more vigorous forms of weight training, says Dr. Wayne, who is also founder and director of the Tree of Life Tai Chi Center in Somerville, Massachusetts and co-author of The Harvard Medical School Guide to Tai Chi (due out next spring).

Tai chi and balance

With its integrative approach that strengthens the body while focusing the mind, tai chi addresses a range of physical and mental health issues—including bone strength, joint stability, cardiovascular health, immunity, and emotional well-being. Tai chi is especially useful for improving balance and preventing falls—a major concern for older adults.

Studies have shown tai chi to reduce falls in seniors by up to 45%, Dr. Wayne says. It can also improve balance in people with neurological problems. A recent study in The New England Journal of Medicine found the program particularly effective for balance in people with Parkinson’s disease.

Tai chi helps improve balance because it targets all the physical components needed to stay upright—leg strength, flexibility, range of motion, and reflexes—all of which tend to decline with age.

Interestingly, one of tai chi’s biggest benefits to stability isn’t physical—but emotional.

“Anyone who’s had a fall or who has instability has what we call a ‘fear of falling,’” says Dr. Wayne. “Ironically, a fear of falling is one of the biggest predictors of a fall.” By making you firmer on your feet, tai chi takes away that fear, he says. Tai chi also makes you more aware of both your internal body and the external world, giving you a better sense of your position in space, so you won’t be as likely to trip and fall if you try to simultaneously talk to a friend and navigate a busy sidewalk.

Getting started in a tai chi program

One of the best things about tai chi is its adaptability to every age and fitness level. “I’ve had students in their late 80s,” says Jeffrey Shih-chung Matrician, who teaches tai chi at the Harvard University Center for Wellness. Because tai chi has “zero impact,” it doesn’t put too much strain on aging bones and joints, he adds. “But it’s not by any means something that’s only for the elderly, and it can be quite demanding for the young,” adds Shih-chung Matrician.

“You can start tai chi at most levels of health, and you can ramp up your activities to be appropriate to your level of fitness and function,” adds Dr. Wayne. He’s had students who’ve started out sitting in a chair—or even a wheelchair. Over time, they’ve worked their way into a standing position. Tai chi is also incredibly safe—even for people who are older and have chronic diseases. Dr. Wayne has conducted studies on tai chi that included participants who were awaiting a heart transplant.

To get started, “do a little research,” Dr. Wayne suggests. “Look for classes in your community, and then visit some classes that are convenient for you.”

Get a feel for the way the class is taught, and see if it matches your learning style. “There are quite a few styles and approaches to tai chi, and you can shop around to find one that suits you,” adds Shih-chung Matrician.

Once you’ve tried a tai chi class, you’ll see how this combination of slow, gentle movements adds up to one invigorating workout.

Monday, December 03, 2012

The Tai Chi Treatment for Fibromyalgia Pain

December 2, 2012 By Nate Ladin

If you’re a fan of alternative medicine and even if you’re not this is something you may want to think about if you’re living with fibromyalgia. Tai Chi has been shown to be a beneficial exercise for people suffering with fibromyalgia. This isn’t a brand spanking new study, having been published in the New England Journal of Medicine in 2010 revealed positive results when participants in the study, living with fibromyalgia, began a regimen of tai chi exercises.

Tai Chi is a meditative form of martial arts that emphasizes flexibility, focused breathing techniques, and mental clarity. It is seen as both a hard and soft form of martial arts, meaning it can be either a low impact or a high impact form of exercise.

You might be thinking that if this is old news then why is it being shared? As a fitness trainer my friends often come to me for some help to lose weight from exercising or dieting advice. Recently one of my friends asked me for help in dealing with the pain of his fibromyalgia and I had to admit that I knew a good place to start but wondered if there was something that could be better for him than stretching, which I know has been shown to effectively alleviate pain in some cases.

One of the problems my friend told me about relating to fibromyalgia was the variety of opinions that doctors could have on treating it and in the worst case scenarios, disregard it as a real condition. And sometimes new and interesting news can become forgotten about. The New England Journal of Medicine study found that participants suffering from fibromyalgia that participated in the tai chi fitness program experienced a significant reduction in pain.

Let me say this right now, I’m not a doctor. I can’t prescribe a treatment for you or my friend for that matter. I can tell you about things I’ve heard in the fitness world but you should always check with your personal physician first to make sure that it’s something that will work for you. It is one of the bad parts about the fitness world; people often take on something that they heard about only to discover that it was too much for them to handle or it was very wrong for them to do it. Sometimes it can even lead to injury.

My friend however did feel that Tai Chi was a good fit for him, after checking with his doctor, and has enjoyed the benefit it has been to him in dealing with his pain. If this is something you’re thinking about doing make sure to check with your doctor to make sure that it will work for you. Also make sure to take your time to do some research on the tai chi class that you are looking at. Find out if the instructor is aware of students with conditions such as fibromyalgia.

If something can help people it shouldn’t be forgotten about. My friend was glad that I brought up some old news, and maybe it can help some other people out too. Research on Tai Chi for the Treatment of Fibromyalgia:

“There was strong evidence that multicomponent treatment had beneficial short-term effects on the key symptoms of fibromyalgia syndrome, including pain, fatigue and depressive mood, and of improved self-efficacy and physical fitness post-treatment. Strategies to maintain the benefits of multicomponent treatment in the long term need to be developed.” - Centre for Reviews and Dissemination “Tai chi may be a useful treatment for fibromyalgia and merits long-term study in larger study populations.”