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به نام خداوند بخشنده مهربان. Integrative Medicine, (Acupuncture, Iranian Traditional Medicine, Homeopathy) an introduction Majid Avijgan MD, Isfahan University.

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Presentation on theme: "به نام خداوند بخشنده مهربان. Integrative Medicine, (Acupuncture, Iranian Traditional Medicine, Homeopathy) an introduction Majid Avijgan MD, Isfahan University."— Presentation transcript:

1 به نام خداوند بخشنده مهربان

2 Integrative Medicine, (Acupuncture, Iranian Traditional Medicine, Homeopathy) an introduction Majid Avijgan MD, Isfahan University of Medical Sciences January

3 جزييات در سايت :

4 Integrative Medicine مسير راه : 1- ابتدا توافق بر رایگان بودن دوره بود. 2- با هدف بارش افکار و انتخاب افراد 3- از بین علاقه مندان به طب سنتی و مكمل 4- موضوع امتیاز دوره همه را جذب میکرد 5- لذا هزینه مختصری را بر گزیدیم تا که افراد علاقه مند هم بتوانند استفاده ای ببرند.

5 Integrative Medicine در هر حال احتمالا در این جمع دو گروه یا سه گروه افراد هستند. 1- افراد علاقه مند به مباحث طب سنتی 2- افراد علاقه مند به دریافت امتیاز دوره و نیز طب سنتی 3- افراد مستمع آزاد

6 Integrative Medicine هدف و سعی بر اين است كه دردوره مقدماتی : 1- افرادی که علاقه مند هستند بتوانند تا راهی برای ادامه کسب دانش در طب سنتی را پیدا کنند. 2- افرادی که مستع آزاد هستند بتوانند که علاقه مند شوند. 3- افرادی هم که با هدف امتیاز آمده اند نیز بتوانند که به هدفشان برسند.

7 Integrative Medicine هدف و سعی بر اين است كه دردوره مقدماتی : رسيدن به تدوين و آموزش برنامه كوتاه مدت حرفه اي براي پزشكان عمومي و حتی متخصص است. تا كه : 1- به كسب دانش و علم بپردازند. 2- به مدركي براي آموزش اين دوره برسند. 3- بتوانند كه به استفاده از اين روشها براي درمان دست يابند.

8 Integrative Medicine بنابراین از همه حاضرین در جلسه دعوت میکنم که به ما کمک کنند تا که ما هم بتوانیم به هدفمان برسیم. 1- برای افراد در انتهای دوره یک امتحان چند گزینه ای برگزار میگردد. 2- این امتحان فقط از افراد حاضر تا آخر جلسه گرفته خواهد شد. ( این افرادی شانس ادامه در دورهای بعدی برگزاری دورهها را دارند.) 3- از بین افراد شرکت کننده در امتحان, افرادی با بالاترین نمره برای دورههای بعدی دعوت به عمل خواهد آمد. 4- از افراد در مورد محتواي دوره كوتاه مدت نظر سنجي مي شود. 5- نتیجه آزمون فوق در سایت در بخش اخبار اعلام میگردد.www.imerc.ir

9 Integrative Medicine بنابراین لطفا افراد شرکت کننده در امتحان این موارد را مرقوم فرمایند. 1- نام کامل 2- تلفن دائمی موبایل ومطب و یا هر تلفن تماسي ديگر 3- آدرس قابل پیگیری پستی 4- ایمیل و یا وب سایت شخصی 5- هر گونه راه تماس دیگری که می توانید ارائه دهید.

10 Integrative Medicine این دوره فقط آشنایی با طب سنتی و مکمل بوده و برای بارش افکار برگزار میکردد. انتخاب افراد برای دورههای بعدی فقط از طریق و بر اساس امتحان برگزار شده و نمره کسب شده خواهد بود.

11 Integrative Medicine افراد انتخاب شده در امتحان می توانند که دوره کوتاه مدت حرفه ای طب سنتی و مکمل ( شامل طب سوزنی, طب سنتی ایرانی, طب هومیوپاتی ؛.....) یکی یا همه را در یک بسته آموزشی رسمی که از طرف دانشگاه برگزار میگردد و مدرک رسمی آموزش ارائه داده خواهد, را کسب کنند.

12 Integrative Medicine در این دوره تمرکز اصلی بر روی بیماریهای تایید شده از طرف سازمان بهداشت جهانی و قابل درمان با طب های سنتی و مکمل خواهد بود : درد ها ناراحتی های گوارشی ( یبوست و گاستریت ها.....) ناراحتی های زنان و زایمان ( دیسمنوره و.....) بیماریهای دستگاه تنفس ( برونشیت وسینوزیت وآلرژی.....) بیماریهای عفونی ( زخم بستر و دردونوریت پس از زونا ) و

13 Integrative Medicine این دورهها شامل : 1- دوره مقدماتي ( مباني و علوم پايه ) 2- دوره پیشرفته ( بيماريها و درمانها ) با حدود ششصد ساعت در کل وحدود 300 ساعت برای هر بخش و هر روز با 6-8 ساعت و در هر پنجشنبه و جمعه برگزار میگردد. که هر بخش در شش ماه فصلی برگزار می گردد.

14 Integrative Medicine با تمکیل این دورهها افراد مدرک رسمی فراگیری دوره را دارند و در حدود و محدوده قوانین نظام پزشکی امکان درمان را دارند.

15 Integrative Medicine افرادی جذب درمان خواهند شد. افرادی نیز باز علاقه مند به ادامه هستند. برای این گونه افراد راههای آینده روشن و ادامه دار است.

16 Integrative Medicine باز آموزیهای برخی بیمارهای اختصاصی و مقطعی تشکیل یک تیم آموزشی از بین افراد نخبه آموزش دیده تشکیل تیمهای پژوهشی برای انجام کارهای تحقیقاتی تشکیل انجمن یا گروهی منسجم در آینده برای اهداف بزرگتر

17 Integrative Medicine تشکیل یک گروه موسسه و یا شرکت ثبت شده برای کار های آینده و اهداف بین المللی الگوی آلبیون استریت در سیدنی

18 Integrative Medicine نوشتم آنچه را که می دانستم ؛ تا در آینده توسط آیندگان تکمیل گردد.

19

20 Traditional Chinese Medicine Introduction to TCM and Traditional Medicine

21 Background Over its 2500 years of development, a wealth of experience has accumulated in the practice of acupuncture, attesting to the wide range of diseases and conditions that can be effectively treated with this approach. Unlike many other traditional methods of treatment, which tend to be specific to their national or cultural context, acupuncture has been used throughout the world, particularly since the 1970s. In recognition of the increasing worldwide interest in the subject, the World Health Organization (WHO) conducted a symposium on acupuncture in June 1979 in Beijing, China. Physicians practising acupuncture in different countries were invited to identify the conditions that might benefit from this therapy. The participants drew up a list of 43 suitable diseases. However, this list of indications was not based on formal clinical trials conducted in a rigorous scientific manner, and its credibility has been questioned.

22 Background In 1991, a progress report on traditional medicine and modern health care was submitted by the Director-General of WHO to the Forty-fourth World Health Assembly 1. The report pointed out that in countries where acupuncture forms part of the cultural heritage, its use in an integrated approach to modern and traditional medicine presents no difficulty. However, in countries where modern Western medicine is the foundation of health care, the ethical use of acupuncture requires objective evidence of its efficacy under controlled clinical conditions. 1 Traditional medicine and modern health care. Progress report by the Director-General. Geneva, World Health Organization, 1991

23 1.1. Definition Acupuncture literally means to puncture with a needle. However, the application of needles is often used in combination with moxibustion-the burning on or over the skin of selected herbs-and may also involve the application of other kinds of stimulation to certain points. In this publication the term “acupuncture” is used in its broad sense to include traditional body needling, moxibustion, electric acupuncture (electro- acupuncture), laser acupuncture (photo-acupuncture), microsystem acupuncture such as ear (auricular), face, hand and scalp acupuncture, and acupressure (the application of pressure at selected sites).

24 Need for evaluation Although acupuncture was introduced to Europe as long ago as the early seventeenth century, scepticism about its effectiveness continues to exist in countries where modern Western medicine is the foundation of health care, especially in those where acupuncture has not yet been widely practised. People question whether acupuncture has a true therapeutic effect, or whether it works merely through the placebo effect, the power of suggestion, or the enthusiasm with which patients wish for a cure. There is therefore a need for scientific studies that evaluate the effectiveness of acupuncture under controlled clinical conditions.

25 Need for evaluation For example, the proportion of chronic pain relieved by acupuncture is generally in the range 55-85%, which compares favourably with that of potent drugs (morphine helps in 70% of cases) and far outweighs the placebo effect (30-35%) (1-3).

26 Need for evaluation A more practical way to evaluate the therapeutic effect of acupuncture is to compare it with the effect of conventional therapy through randomized controlled trials or group studies, provided that the disease conditions before treatment are comparable across the groups, with outcome studies developed for all patients.

27 Need for evaluation Because of the difficulty of ruling out the placebo effect, a comparative study with no treatment as the control may not be convincing in the evaluation of acupuncture practice. Retrospective surveys, in which the effect of acupuncture therapy is compared with past treatments, may not be of significance either, particularly if they have not been well designed. Non-comparative studies are certainly of little significance, particularly when acupuncture is used for the treatment of a self-limited disease. However, if rapid improvement can be achieved in the treatment of a long-standing, chronic disease, or if there is definite improvement in a disease that is generally recognized as intractable to conventional treatment, the effect of acupuncture should be viewed in a more favourable light, even when a well-designed, controlled study has not been carried out.

28 Safety Generally speaking, acupuncture treatment is safe if it is performed properly by a well-trained practitioner. Unlike many drugs, it is non-toxic, and adverse reactions are minimal. This is probably one of the chief reasons why acupuncture is so popular in the treatment of chronic pain in many countries. As mentioned previously, acupuncture is comparable with morphine preparations in its effectiveness against chronic pain, but without the adverse effects of morphine, such as dependency.

29 Safety and Cost Benefit For example, there are reports of controlled clinical trials showing that acupuncture is effective in the treatment of rheumatoid arthritis (4-6), although not as potent as corticosteroids. Because, unlike corticosteroids, acupuncture treatment, does not cause serious side-effects, it seems reasonable to use acupuncture for treating this condition, despite the difference in effectiveness.

30 Availability and practicability The availability and practicability of acupuncture are also important factors to consider. The advantages of acupuncture are that it is simple, convenient and has few contraindications. Although the success rate of acupuncture therapy in treating kidney stones, for example, is confirmed by comparative studies with other therapies (7), it is by no means as high as that of surgical intervention. However, acupuncture treatment of kidney stones is still worth recommending because of its simplicity, which makes it more acceptable to patients. There are also instances where acupuncture is not more practicable than conventional therapy. For example, the effectiveness of acupuncture treatment of acute bacillary dysentery has been shown to be comparable with that of furazolidone (8-10), but this is of rather academic significance because oral administration of furazolidone or other antidysenteric drugs is more convenient.

31 Developing and developed countries In developing countries, where medical personnel and medicines are still lacking, the need for acupuncture may be considerable and urgent; proper use of this simple and economic therapy could benefit a large number of patients. On the other hand, in developed countries, where the health system is well established, with sophisticated technology, adequate personnel and a well-equipped infrastructure, acupuncture might be considered to be of great value in only a limited number of conditions. It could still serve as a valuable alternative treatment for many diseases or conditions for which modern conventional treatments are unsuccessful. It is also valuable in situations where the patient is frightened of the potential risks or adverse effects of modern conventional treatments. In fact, in some developed countries, the diseases for which patients seek help from acupuncturists tend to be beyond the scope of orthodox medicine.

32 Studies on therapeutic mechanisms To date, modern scientific research studies have revealed the following actions of acupuncture: inducing analgesia protecting the body against infections regulating various physiological functions.

33 Studies on therapeutic mechanisms In reality, the first two actions can also be attributed to the regulation of physiological functions. The therapeutic effects of acupuncture are thus brought about through its regulatory actions on various systems, so that it can be regarded as a nonspecific therapy with a broad spectrum of indications, particularly helpful in functional disorders. Although it is often used as a symptomatic treatment (for pain, for instance), in many cases it actually acts on one of the pathogenic links of a disease.

34 Studies on therapeutic mechanisms Although different acupuncture points and manipulations may have an effect through different actions, the most important factor that influences the direction of action is the condition of the patient. Numerous examples reveal that the regulatory action of acupuncture is bi-directional. Acupuncture lowers the blood pressure in patients with hypertension and elevates it in patients with hypotension; increases gastric secretion in patients with hypoacidity, and decreases it in patients with hyperacidity; and normalizes intestinal motility under X-ray observation in patients with either spastic colitis or intestinal hypotonia (11).

35 Diseases Pain Head and face Locomotor system Gout Biliary and renal colic Traumatic or postoperative pain Dentistry Childbirth Surgery

36 Diseases Infections Neurological disorders Respiratory disorders Digestive disorders Blood disorders Urogenital disorders Gynaecological and obstetric disorders Cardiovascular disorders Psychiatric disorders and mental disturbances Paediatric disorders Disorders of the sense organs Skin diseases Cancers

37 Pain As mentioned previously, acupuncture analgesia works better than a placebo for most kinds of pain, and its effective rate in the treatment of chronic pain is comparable with that of morphine. Because of the side-effects of long-term drug therapy for pain and the risks of dependence, acupuncture analgesia can be regarded as the method of choice for treating many chronically painful conditions. The analgesic effect of acupuncture has also been reported for the relief of eye pain due to subconjunctival injection (14), local pain after extubation in children (15), and pain in thromboangiitis obliterans (16).

38 Head and face For tension headache, migraine and other kinds of headache due to a variety of causes, acupuncture has performed favourably in trials comparing it with standard therapy, sham acupuncture, or mock transcutaneous electrical nerve stimulation (TENS) (17-27). Chronic facial pain, including craniomandibular disorders of muscular origin, also responds well to acupuncture treatments (28-31).

39 Locomotor system The conditions concerned include cervical spondylitis or neck pain due to other causes (33-37), periarthritis of the shoulder (38, 39) fibromyalgia (40), fasciitis (41), epicondylitis (tennis elbow) (42-44), low back pain (45-49), sciatica (50-53), osteoarthritis with knee pain (54-56), and radicular and pseudoradicular pain syndromes (57).

40 Locomotor system Rheumatoid arthritis is a systemic disease with extra- articular manifestations in most patients. In this disease, dysfunction of the immune system plays a major role, which explains the extra-articular and articular features. Acupuncture is beneficial in the treatment of rheumatoid arthritis (4-6). While acupuncture may not improve the damage that has been done to the joints, successful pain relief has been verified in the majority of controlled studies (58).

41 Gout In a randomized controlled trial, blood-pricking acupuncture was compared with conventional medication (allopurinol). The acupuncture group showed greater improvement than the allopurinol group. In addition, a similar reduction of uric acid levels in the blood and urine of both groups was noted (60). Plum-blossom needling (acupuncture using plum- blossom needles), together with cupping (the application to the skin of cups which are then depressurized), has been recommended for treating gouty arthritis (61).

42 Biliary and renal colic Acupuncture is suitable for treating acute pain, provided the relief of pain will not mask the correct diagnosis, for which other treatments may be needed. Biliary and renal colic are two conditions for which acupuncture can be used not only as an analgesic but also as an antispasmodic. In controlled studies on biliary colic (62-64) and renal colic (7, 65, 66), acupuncture appears to have advantages over conventional drug treatments (such as intramuscular injection of atropine, pethidine, anisodamine (a Chinese medicine structurally related to atropine, isolated from Anisodus tanguticus), bucinnazine (also known as bucinperazine) or a metamizole-camylofin combination).

43 Infections Acupuncture has been reported to be effective for treating acute bacillary dysentery (8-10). Its effect is comparable with that of conventional medicines such as furazolidone, but the use of acupuncture in the first line of defence against this disease is not practicable-daily The results of research on the effects of acupuncture treatments that stimulate the immune system suggest that acupuncture may be of use in conjunction with other medical therapies for treating infections (84). The effect of acupuncture on the immune system has been tested in hepatitis B virus carriers. In a comparative study, acupuncture- moxibustion is apparently superior to herbal medications in producing hepatitis B e core antibodies and reducing hepatitis B surface antigen (85). For epidemic haemorrhagic fever, compared with steroid and supportive treatments, moxibustion shortened the period of oliguria and promoted the reduction of kidney swelling (86).

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48 1. Diseases, symptoms or conditions for which acupuncture has been proved-through controlled trials-to be an effective treatment: Adverse reactions to radiotherapy and/or chemotherapy Allergic rhinitis (including hay fever) Biliary colic Depression (including depressive neurosis and depression following stroke) Dysentery, acute bacillary Dysmenorrhoea, Primary Epigastralgia, acute (in peptic ulcer, acute and chronic gastritis, and gastrospasm)

49 1. Diseases, symptoms or conditions for which acupuncture has been proved-through controlled trials-to be an effective treatment: Facial pain (including craniomandibular disorders) Headache Hypertension, essential Hypotension, primary Induction of labour Knee pain Leukopenia Low back pain Malposition of fetus, correction of Morning sickness

50 1. Diseases, symptoms or conditions for which acupuncture has been proved-through controlled trials-to be an effective treatment: Nausea and vomiting Neck pain Pain in dentistry (including dental pain and temporomandibular dysfunction) Periarthritis of shoulder Postoperative pain Renal colic Rheumatoid arthritis Sciatica Sprain Stroke Tennis elbow

51 2. Diseases, symptoms or conditions for which the therapeutic effect of acupuncture has been shown but for which further proof is needed: Abdominal pain (in acute gastroenteritis or due to gastrointestinal spasm) Acne vulgaris Alcohol dependence and detoxification Bell’s palsy Bronchial asthma Cancer pain Cardiac neurosis Cholecystitis, chronic, with acute exacerbation Cholelithiasis

52 2. Diseases, symptoms or conditions for which the therapeutic effect of acupuncture has been shown but for which further proof is needed: Competition stress syndrome Craniocerebral injury, closed Diabetes mellitus, non-insulin-dependent Earache Epidemic haemorrhagic fever Epistaxis, simple (without generalized or local disease) Eye pain due to subconjunctival injection Female infertility Facial spasm

53 2. Diseases, symptoms or conditions for which the therapeutic effect of acupuncture has been shown but for which further proof is needed: Female urethral syndrome Fibromyalgia and fasciitis Gastrokinetic disturbance Gouty arthritis Hepatitis B virus carrier status Herpes zoster (human (alpha) herpesvirus 3) Hyperlipaemia Hypo-ovarianism Insomnia Labour pain

54 2. Diseases, symptoms or conditions for which the therapeutic effect of acupuncture has been shown but for which further proof is needed: Lactation, deficiency Male sexual dysfunction, non-organic Ménière disease Neuralgia, post-herpetic Neurodermatitis Obesity Opium, cocaine and heroin dependence Osteoarthritis

55 2. Diseases, symptoms or conditions for which the therapeutic effect of acupuncture has been shown but for which further proof is needed: Pain due to endoscopic examination Pain in thromboangiitis obliterans Polycystic ovary syndrome (Stein-Leventhal syndrome) Postextubation in children Postoperative convalescence Premenstrual syndrome Prostatitis, chronic Pruritus

56 2. Diseases, symptoms or conditions for which the therapeutic effect of acupuncture has been shown but for which further proof is needed: Radicular and pseudoradicular pain syndrome Raynaud syndrome, primary Recurrent lower urinary-tract infection Reflex sympathetic dystrophy Retention of urine, traumatic Schizophrenia Sialism, drug-induced Sjögren syndrome Sore throat (including tonsillitis)

57 2. Diseases, symptoms or conditions for which the therapeutic effect of acupuncture has been shown but for which further proof is needed: Spine pain, acute Stiff neck Temporomandibular joint dysfunction Tietze syndrome Tobacco dependence Tourette syndrome Ulcerative colitis, chronic Urolithiasis Vascular dementia Whooping cough (pertussis)

58 3. Diseases, symptoms or conditions for which there are only individual controlled trials reporting some therapeutic effects, but for which acupuncture is worth trying because treatment by conventional and other therapies is difficult: Chloasma Choroidopathy, central serous Colour blindness Deafness Hypophrenia Irritable colon syndrome Neuropathic bladder in spinal cord injury Pulmonary heart disease, chronic Small airway obstruction

59 4. Diseases, symptoms or conditions for which acupuncture may be tried provided the practitioner has special modern medical knowledge and adequate monitoring equipment: Breathlessness in chronic obstructive pulmonary disease Coma Convulsions in infants Coronary heart disease (angina pectoris) Diarrhoea in infants and young children Encephalitis, viral, in children, late stage Paralysis, progressive bulbar and pseudobulbar

60 Acne vulgaris Li et al., 1998 (228) 42:42 Randomized controlled trial Body acupunctu re (manual) Herbal medication After 30 days of treatment, a cure was observed in: 42.8% of the test group 19.0% of the control group. Wang et al., 1997 (229) 32:20Group comparison Auricular acupunctu re Medication (oral vitamin B 6 and antibiotics, local benzoyl peroxide ointment) Acne disappeared after 10 days of treatment in: 19/32 (59%) in the test group. 7/20 (35%) in the control group.

61 Bronchial asthma Yu et al., 1976 (123)20 Randomized cross- over Acupuncture Isoprenaline or sham acupuncture Isoprenaline was more effective than real acupuncture. Both were more effective than sham acupuncture. Tashkin et al., 1977 (121) (methacholine- induced) 12 Randomized cross- over AcupunctureIsoprenaline or placebo Isoprenaline was more effective than acupuncture. Both were more effective than placebo. Fung et al., 1986 (119) (exercise-induced) 19 Randomized single-blind crossover AcupunctureSham acupuncture Real acupuncture provided better protection against exercise-induced asthma than did sham acupuncture. Tandon et al., 1989 (125) (histamine- induced) 16 Double-blind cross- over Acupuncture Acupuncture at irrelevant points Treatment with real or placebo acupuncture failed to modulate the bronchial hyperreactivity to histamine, suggesting that a single treatment is unlikely to provide improvement in the management of acute bronchial asthma. He et al., 1994 (120)48:48 Randomized group comparison Laser acupuncture Moxibustion at same points as laser acupuncture Pulmonary ventilation indices improved in: 33 of the test group 20 of the control group. Xie et al., 1996 (122)100Randomized controlled trial with partial crossover Electric acupuncture at fèishû (BL13) (n = 30) Electric acupuncture at shàoshâng (LU11) (n =24) yújì (LU10) (n = 24), tàiyuân (LU9) (n = 30), jîngqú (LU8) (n = 28), lièquç (LU7) (n = 28) or qiûxû (GB40) (n = 24) An anti-asthmatic effect was observed in: 28/30 of the test group (BL13); best immediate effect 20/24 LU11, 22/24 LU10, 24/30 LU9, 24/28 LU8, 21/28 LU7; good effect 4/24 GB40; least effe

62 Chloasma Luan et al., 1996 (224) 60:30Randomized controlled trial Auricular acupuncture plus acupressure Vitamins C and E After 3 months of treatment cure was achieved in: 53.3% of the test group 13.3% of the control group. The treatment was effective in: 95.0% of the treatment group 43.3% of the control group

63 Diabetes mellitus, non-insulin-dependent Latief, 1987 (241)20:20 Randomized controlled trial Acupuncture at sânyînjiâo (SP6) Acupuncture at 1 Chinese inch (cun) superiolateral to SP6 There was a reduction in fasting blood sugar of: 19.2% in the test group 4.9% in the control group. Kang et al., 1995 (240) 12:15: 13:10Randomized controlled trial Untimed acupuncture or acupuncture at insulin secretion climax (ISCA) or acupuncture at insulin secretion valley (ICSV) Conventional Western medication (tolbutamide) Improvement in fasting blood glucose, 2-h glucose, postprandial blood glucose, 24-h urine glucose, and glucosylated haemoglobin was: marked in the ISCA group superior in the ISCA group to that in the untimed acupuncture and ISVA groups similar in the ISCA group to that of the tolbutamide group.

64 Hepatitis B virus carrier Wang et al., 1991 (85) 70:42Group comparison Acupuncture plus moxibustion Herbal medication (Herba Cymbopogonis) After 3 months of treatment, carrier status became negative in: 30% of the test group 2.4% of the control group. Antibodies to hepatitis B e core antigen were produced in: 50% of the test group 6.25% of the control group.

65 Insomnia Zhang, 1993 (110) 60 per group Group comparison Auricular acupressure Medication (diazepam plus chlorohydrate) After 1 month of treatment, sleep was restored to normal or markedly improved in: 59/60 in the test group 20/60 in the control group. Luo et al., 1993 (109) 60 per groupRandomized controlled trial Auricular acupressure Medication (phenobarbital, methaqualone or meprobamate) After the course of treatment, sleep improved in: 96.7% of the test group 35.0% of the control group.

66 Leukopenia Chen et al., 1991 (141) (chemotherapy- induced) 121:117: 34 Randomized controlled trial Acupuncture or moxibustion Medication (batilol plus cysteine phenylacetate) Effective rates after 9 days of treatment were: 88.4% in the acupuncture group 91.5% in the moxibustion group 38.2% in the medication group. Chen et al., 1990 (140) (chemotherapy- induced) 57:34 Randomized controlled trial Moxibustion Medication (batilol plus cysteine- phenylacetate) Effective rates after 9 days of treatment were: 89.5% in the test group 38.2% in the control group. Yin et al., 1990 (143) (benzene- induced) 30:27 Randomized controlled trial Acupuncture Medication (cysteine- phenylacetate) Effective rates after 6 weeks of treatment were: 83.3% in the test group 53.4% in the control group. Yin et al., 1992 (144) (benzene- induced) 30:25 Randomized controlled trial Acupuncture Medication (rubidate) Acupuncture was superior to rubidate in improving symptoms and increasing leukocyte count; effective rates were: 91% in the test group 68% in the control group. Wang, 1997 (142) (chemotherapy- induced) 49:34Randomized controlled trial MoxibustionMedication (batilol plus cysteine- phenylacetate) Effective rates were: 82% in the test group 50% in the control group.

67 Male sexual dysfunction, non-organic (see also Defective ejaculation) Aydin et al., 1997 (147) 15:16:29Randomized controlled trial AcupunctureHypnosis or placebo Success rates were: 60% in the acupuncture group 75% in the group treated with hypnotic suggestion 43-47% in the placebo group.

68 Neuralgia, post-herpetic Lewith et al., 1983 (103) 30:32 Random ized controll ed trial Auricular plus body acupuncture Placebo (mock TENS) There were no differences in the pain recorded in the two groups during or after treatment. There was a significant improvement in pain at the end of treatment in 7 patients of the placebo group and 7 patients of the acupuncture group. Sukanda r et al., 1995 (104) 7:7Random ized controll ed trial Acupuncture at jiáj? (EX-B2) on affected side plus amitriptyline- trifluoperazine combo (amitriptyline 5 mg + trifluoperazine 0.5 mg per tablet), one tablet twice a day Acupuncture at jiáj? (EX- B2) on contralateral side plus an amitriptyline- trifluoperazin e combination There was a significant difference in analgesia between the test and control groups. Analgesia was excellent in: all patients in the test group after 6 sessions none of the patients in the control group

69 Obesity (see also Simple obesity in children) Richards et al., 1998 (238) 60Randomized controlled trial Auricular acupuncture Sham acupun cture Suppression of appetite was noticed in: 95% of the test group 0% of the control group.

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[Clinical observation of electro-acupuncture on 133 patients with depression in comparison with tricyclic amytriptyline.] Chinese Journal of Integrated Traditional and Western Medicine, 1988, 8(2):77-80 [in Chinese] Yang X. Clinical observation of needling extrameridian points in treating mental depression. Journal of Traditional Chinese Medicine, 1994, 14: Zhang B et al. A control study of clinical therapeutic effects of laser-acupuncture on depressive neurosis. World Journal of Acupuncture-Moxibustion, 1996, 6(2): Jia YK et al. [Treatment of schizophrenia with helium-neon laser irradiation at acupoints.] Chinese Acupuncture and Moxibustion, 1986, 6(1):19-21 [in Chinese] Que YT et al. [Observation of 111 cases of competition stress syndrome treated with auriculo-pressure therapy.] Chinese Acupuncture and Moxibustion, 1986, 6(2):57 [in Chinese] Wen HL et al. Treatment of drug addiction by acupuncture and electrical stimulation. Asian Journal of Medicine, 1993, 9: Culliton RD et al. Overview of substance abuse acupuncture treatment research. Journal of Alternative and Complementary Medicine, 1996, 2(1): Bullock ML et al. Auricular acupuncture in the treatment of cocaine abuse: a study of efficacy and dosing. Journal of Substance Abuse Treatment, 1999, 16(1): Cai Z et al. [Acupuncture treatment in the late stage of addiction abstinence.] Jiangsu Journal of Traditional Chinese Medicine, 1998, 19(12):35 [in Chinese].

75 201. Margolin A et al. Acupuncture for the treatment of cocaine dependence in methadone-maintained patients. American Journal of Addiction, 1993, 2(3): Washburn AM et al. Acupuncture heroin detoxification: a single-blind clinical trial. Journal of Substance Abuse Treatment, 1993, 10: Clavel F et al. [A study of various smoking cessation programs based on close to 1000 volunteers recruited from the general population: 1-month results.] Revue Epidemiologique de Santé Publique, 1990, 38(2): [in French] Fang YA. [Clinical study on giving up smoking with acupuncture.] Shanghai Journal of Acupuncture and Moxibustion, 1983, 2(2):30-31 [in Chinese] He D et al. Effects of acupuncture on smoking cessation or reduction for motivated smokers. Preventive Medicine, 1997, 26(2): Waite NR et al. A single-blind, placebo-controlled trial of a simple acupuncture treatment in the cessation of smoking. British Journal off General Practice, 1998, 48(433): White AR et al. Randomized trial of acupuncture for nicotine withdrawal symptoms. Archives of Internal Medicine, 1998, 158(20): White AR et al. [Smoking cessation with acupuncture? A ‘best evidence synthesis’]. Forschende Komplimentarmedizin, 1997, 4(2): [in German] Bullock ML et al. Controlled trial of acupuncture for severe recidivist alcoholism. Lancet, 1990, 335: Bullock ML et al. Acupuncture treatment of alcoholic recidivism: a pilot study. American Journal of Acupuncture, 1987, 15(4): Bullock ML et al. Controlled trial of acupuncture for severe recidivist alcoholism. Lancet, 1989, 1: Thorer H et al. Acupuncture after alcohol consumption: a sham controlled assessment. Acupuncture-Medicine, 1996, 14(2): Li YQ et al. Swift needling of zusanli and changqiang in treating infantile diarrhea. International Journal of Clinical Acupuncture, 1997, 8(2): Yang ZW. [Treatment of 100 cases of infantile diarrhoea by acupuncture.] Shanghai Journal of Acupuncture and Moxibustion, 1998, 17(6):11. [in Chinese] He JX et al. [Therapeutic effect of acupuncture at LI 4 in the treatment of infantile convulsion due to high fever.] Zhong Xi Yi Jiehe Shiyong Linchuang Jijiu [Clinical Emergency by Integrated Chinese and Western Medicine], 1997, 4(8): [in Chinese] Jin MZ. [Acupuncture plus auricular acupressure treatment of 30 cases of Gilles de la Tourette’s syndrome.] Guangming Traditional Chinese Medicine, 1998, 78(5):23-24 [in Chinese] Tian LD et al. [Observation of therapeutic effects of 68 cases of Gilles de la Tourette’s syndrome in children treated with acupuncture.] Chinese Acupuncture and Moxibustion, 1996, 16(9): [in Chinese] Wang CH et al. [Clinical study on acupuncture treatment of sudden deafness.] Acupuncture Research, 1998, 23(1):5-7 [in Chinese] Zhang ZF et al. [Clinical study on acupuncture treatment of acute attack of Ménière’s syndrome.] Shanghai Journal of Acupuncture and Moxibustion, 1983, 2(4):28 [in Chinese] Jin XQ et al. [Clinical observation of 35 cases of subjective tinnitus treated with acupuncture.] Zhejiang Journal of Traditional Chinese Medicine, 1998, 33(3):118 [in Chinese] Vilholm OJ et al. Effect of traditional Chinese acupuncture on severe tinnitus: a double-blind, placebo-controlled clinical investigation with open therapeutic control. British Journal of Audiology, 1998, 32(3): Mekhamer A et al. Experience with unexplained otalgia. Pain, 1987, (Suppl.): Lang BX et al. [Clinical observation of the therapeutic effect of ear acupuncture in treating simple epistaxis.] Chinese Acupuncture and Moxibustion, 1995, 15(2):76-77 [in Chinese] Luan YH et al. [Clinical observation of 60 cases of chloasma treated with auricular acupuncture and acupressure.] Chinese Acupuncture and Moxibustion, 1996, 16(9): [in Chinese] Chen BZ et al. Comparative observation of the curative effects of herpes zoster treated by type JI He-Ne laser and polyinosinic acid. World Journal of Acupuncture-Moxibustion, 1994, 4(2): Lunderberg T et al. Effect of acupuncture on experimentally induced itch. British Journal of Dermatology, 1987, 17: Huang BS et al. [Treatment of 60 cases of neurodermatitis with three-step seven-star needling therapy.] Journal of Guiyang Chinese Medical College, 1998, 20(2):35-36 [in Chinese] Li HQ et al. [Acupuncture treatment in 42 cases of acne vulgaris.] Chinese Acupuncture and Moxibustion, 1998, 18(3):166 [in Chinese] Wang J et al. [Auriculo-acupuncture treatment of 32 cases of facial acne vulgaris.] Shanghai Journal of Acupuncture and Moxibustion, 1997, 16(3):25 [in Chinese] Dang W et al. [Clinical study on acupuncture treatment of pain caused by stomach cancer.] Journal of Traditional Chinese Medicine, 1995, 36(5): [in Chinese] Dan Y et al. [Clinical study on analgesic effect of acupuncture on carcinomatous pain.] Chinese Acupuncture and Moxibustion, 1998, 18(1):17-18 [in Chinese] Chen GP et al. [Observation of therapeutic effects of acupuncture in 44 cases with gastrointestinal reaction induced by radiotherapy and chemotherapy.] Chinese Acupuncture and Moxibustion, 1996, 16(7): [in Chinese] Dundee JW et al. Acupuncture to prevent cisplatin-associated vomiting. Lancet, 1987, 1: Li H et al. Clinical study on acupuncture treatment of side reactions of radiotherapy and chemotherapy for malignant tumour. World Journal of Acupuncture-Moxibustion, 1998, 8(2): Liu A et al. [Clinical research on attenuating chemotherapeutic toxicity by acupoint stimulation therapy.] Shanghai Journal of Acupuncture and Moxibustion, 1998, 17(6):8-9 [in Chinese] Wang SZ et al. [Clinical study on acupuncture control of gastrointestinal reactions to chemotherapy.] Chinese Acupuncture and Moxibustion, 1997, 17(1):17-18 [in Chinese] Xia YQ et al. [Acupuncture treatment of reactions due to radiotherapy in patients with malignant tumour.] Chinese Acupuncture and Moxibustion, 1984, 4(6):6-8 [in Chinese] Richards D et al. Stimulation of auricular acupuncture points in weight loss. Australian Family Physician, 1998, 27(S2):S Wang H. Clinical analysis on treatment of 40 cases of hyperlipemia with point-injection of radix salviae miltiorrhizae injection. World Journal of Acupuncture-Moxibustion, 1998, 8(4): Kang SY et al. [Clinical investigation of the treatment of diabetes mellitus with timing acupuncture.] Chinese Acupuncture and Moxibustion, 1995, 15(1):6-8 [in Chinese].

76 241. Latief R. The effect of san yin ciao point on hyperglycemia of non-insulin-dependent diabetes mellitus. Cermin Dumia Kedokteran, 1987, (44):20-23 [in Indonesian] Xiong DZ et al. [Observation of the therapeutic effect of acupuncture in the treatment of drug-induced sialorrhea.] Chinese Acupuncture and Moxibustion, 1993, 13(3): [in Chinese] List T et al. The effect of acupuncture in the treatment of patients with primary Sjögren’s syndrome: a controlled study. Acta Odontologica Scandinavica, 1998, 56(2): Appiah R et al. Treatment of primary Raynaud’s syndrome with traditional Chinese acupuncture. Journal of Internal Medicine, 1997, 241(2): Ma RH et al. [Clinical observation of acupuncture treatment in polycystic ovary syndrome.] Chinese Acupuncture and Moxibustion, 1996, 16(11): [in Chinese] Yang XT. [Observation of 108 cases of Tietze’s syndrome treated with short needling plus cupping.] Chinese Acupuncture and Moxibustion, 1997, 17(7): [in Chinese] Wolkenstein E, Horak F. A statistical evaluation of the protective effect of acupuncture against allergen-provoked rhinitis. Deutsche Zeitschrift für Akupunktur, 1993, 36(6): Biernacki W et al. Acupuncture in treatment of stable asthma. Respiratory Medicine, 1998, 92(9): Ding ZS. [Observation of therapeutic effect of 120 cases of bulbar paralysis treated with acupuncture.] Chinese Acupuncture and Moxibustion, 1996, 16(3): [in Chinese] Cai ZM. [The effect of acupuncture and auricular acupressure on colour discrimination.] Chinese Acupuncture and Moxibustion, 1998, 18(9): [in Chinese] Ma RZ et al. Clinical observation and study of mechanisms of acupuncture treatment of coronary heart disease. World Journal of Acupuncture-Moxibustion, 1997, 7(1): Ding J et al. Comparative observation of curative effects of postoperative symptoms of the closed craniocerebral injury treated by acupuncture. World Journal of Acupuncture-Moxibustion, 1997, 7(3): Clavel F et al. Helping people to stop smoking: randomized comparison of groups being treated with acupuncture and nicotine gum with control group. British Medical Journal, 1985, 291: Luo H et al. Clinical research on the therapeutic effect of the electroacupuncture treatment in patients with depression. Psychiatry and Clinical Neurosciences, 1998, 52 (Suppl.): S338-S Liu ZS et al. [Clinical study on acupuncture treatment of dysphagia in pseudobulbar paralysis.] New Traditional Chinese Medicine, 1998, 30(3): [in Chinese] Ma RH et al. [Clinical observation of 56 cases of hypo-ovarianism treated with acupuncture.] Chinese Acupuncture and Moxibustion, 1997, 17(7): [in Chinese] Tian LT et al. [Clinical observation of 100 children of hypophrenia treated mainly with acupuncture.] Chinese Acupuncture and Moxibustion, 1996, 16(6): [in Chinese] De Aloysio D, Penacchioni P. Morning sickness control in early pregnancy by eiguan point acupressure. Obstetrics and Gynecology, (5): Bayreuther J, Lewith GT, Pickering R. A double-blind cross-over study to evaluate the effectiveness of acupressure at pericardium 6 (P6) in the treatment of early morning sickness (EMS). Complementary Therapies in Medicine, 1994, 2: Dundee JW et al. Traditional Chinese acupuncture: a potentially useful antiemetic? British Medical Journal, 1986, 293: Ghaly RG et al. A comparison of manual needling with electrical stimulation and commonly used antiemetics. Anaesthesia, 1987, 45: Weightman WM et al. Traditional Chinese acupuncture as an antiemetic. British Medical Journal, 1987, 295(6610): Dundee JW et al. Acupuncture prophylaxis of cancer chemotherapy-induced sickness. Journal of the Royal Society of Medicine, 1989, 82: Barsoum G et al. Postoperative nausea is relieved by acupressure. Journal of the Royal Society of Medicine, 1990, 83(2): Ho RT et al. Electro-acupuncture and postoperative emesis. Anaesthesia, 1990, 45: Ho CM et al. Effect of PC 6 acupressure on prevention of nausea and vomiting after epidural morphine for post-cesarean section pain relief. Acta Anaesthesiologica Scandinavica, 1996, 40(3): Andrzejowski J et al. Semi-permanent acupuncture needles in the prevention of postoperative nausea and vomiting. Acupuncture-Medicine, 1996, 14(2): McConaghy P et al. Acupuncture in the management of postoperative nausea and vomiting in patients receiving morphine via a patient-controlled analgesia system. Acupuncture-Medicine, 1996, 14(1): Schwager KL et al. Acupuncture and postoperative vomiting in day-stay paediatric patients. Anaesthesia and Intensive Care, 1996, 24(6): Liu SX et al. Magnetotherapy of neiguan in preventing vomiting induced by cisplatin. International Journal of Clinical Acupuncture, 1997, 8(1): Al-Sadi M et al. Acupuncture in the prevention of postoperative nausea and vomiting. Anaesthesia, 1997, 52(7): Stein DJ et al. Acupressure versus intravenous metoclopramide to prevent nausea and vomiting during spinal anesthesia for cesarean section. Anesthesia and Analgesia, 1997, 84(2): Schlager A et al. Laser stimulation of acupuncture point P6 reduces postoperative vomiting in children undergoing strabismus surgery. British Journal of Anaesthesia, 1998, 8(4): Chu YC et al. Effect of BL10 (tianzhu), BL11 (dazhu) and GB34 (yanglingquan) acuplaster for prevention of vomiting after strabismus surgery in children. Acta Anaesthesiologica Sinica, 1998, 36(1): Alkaissi A et al. Effect and placebo effect of acupressure (P6) on nausea and vomiting after outpatient gynaecological surgery. Acta Anaesthesiologica Scandinavica, 1999, 43(3): Shenkman Z et al. Acupressure-acupuncture antiemetic prophylaxis in children undergoing tonsillectomy. Anesthesiology, 1999, 90(5): Cheng PT et al. A therapeutic trial of acupuncture in neurogenic bladder of spinal cord injured patients-a preliminary report. Spinal Cord, 1998, 36(7): Felhendler D et al. Pressure on acupoints decreases postoperative pain. Clinical Journal of Pain, 1996, 12(4): Zou M et al. [Observation of therapeutic effects of combined treatment of ginger moxibustion and acupoint-injection in 30 cases of chronic pulmonary heart disease.] Chinese Acupuncture and Moxibustion, 1998, 18(7): [in Chinese] Kho KH. The impact of acupuncture on pain in patients with reflex sympathetic dystrophy. Pain-Clinic, 1995, 8(1): Yu DF et al. [Acupuncture treatment in 86 cases of central serous retinopathy.] Chinese Acupuncture and Moxibustion, 1997, 17(5): [in Chinese] Zhang B et al. [Controlled study of clinical effect of computer controlled electro-acupuncture in the treatment of schizophrenia.] Chinese Acupuncture and Moxibustion, 1994, 14(1):17-20 [in Chinese] Yu CQ et al. [Treatment of simple obesity in children with photo-acupuncture.] Chinese Journal of Integrated Traditional and Western Medicine, 1998, 18(6): [in Chinese] Chen Y et al. Observation of the time-effect of acupuncture in improving small airway function. World Journal of Acupuncture-Moxibustion, 1997, 7(2): Santiesteban AJ. Comparison of electro-acupuncture and selected physical therapy for acute spine pain. American Journal of Acupuncture, 1984, 12(3): Wu QF. 100 cases of stiff neck treated by contralateral acupuncture. International Journal of Clinical Acupuncture, 1997, 8(4): Zou XC et al. [Comparative study of cerebral infarction with acupuncture on six acupoints of yang meridian and calan tablets.] Chinese Journal of Integrated Traditional and Western Medicine, 1990, 10(4): [in Chinese] Raustia AM et al. Acupuncture compared with stomatognathic treatment for temporomandibular joint dysfunction. Journal of Prosthetic Dentistry, 1986, 56(5): Ma S et al. [Observation of combined acupuncture and moxibustion treatment of 60 cases of ulcerative colitis.] Chinese Acupuncture and Moxibustion, 1997, 17(5): [in Chinese] Lai XS. [Therapeutic effect of acupuncture in the treatment of senile vascular dementia.] Chinese Acupuncture and Moxibustion, 1997, 17(4): [in Chinese] Liu J et al. [Clinical study on treatment of vascular dementia by electroacupuncture of scalp acupoints.] Chinese Acupuncture and Moxibustion, 1998, 18(4): [in Chinese] Jiang GH et al. [Controlled observation of electro-acupuncture treatment of vascular dementia.] Bulletin of Gaungzhou Traditional Chinese Medicine University, 1998, 15(2): [in Chinese] Wang LQ. [A comparative study on acupuncture treatment of viral encephalitis in children.] Chinese Acupuncture and Moxibustion, 1998, 18(7): [in Chinese].

77 برای درخواست دورههای آموزشی؛ برای درخواست همکاریهای پژوهشی؛ برای درخواست های درمانی ؛ لطفا به سایت : مراجعه فرمایید.

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79 Acupuncture Mechanism or function Thus, we can understand the coherence of biophotons, and the regulation mechanism of the body as a whole.

80 Art of Acupuncture: 369KB80 Diagnosing  Assess ãtongue, skin, complexion, smells, pulse, body build demeanor, mental and emotional state.  Pulse Diagnosis ãThe condition of all the organ networks and the flow of chi through the twelve major meridians is assessed via the pulses. ãThe pulse is felt at various positions on the wrist. ãThere are six basic locations & three depths on each wrist.

81 Art of Acupuncture: 369KB81 Diagnosis Palpation is one of the most important: variations in temp, hardness or softness of tissues, dryness, dampness, discoloration, lumps and bumps, sensations of tenderness or pain Abdominal palpation for tenderness and radial pulse reveals amount, strength, smoothness, and flow of Qi and blood in various parts of the body Visual examination of complexion, emotional affect, body language; tongue looking at shape, coat, color reveals state of Qi in the body Questioning includes: sleep quality, mood, urination, dietary preferences, functioning of senses, digestion and elimination, condition of skin and hair, energy level, exercise and work habits, and menstrual cycle and childbearing history for women

82 Art of Acupuncture: 369KB82 Treatment  Each session is based on symptoms, pulse diagnosis and goals of treatment.  Usually several different points are needled at each session.  The needles may be inserted for a few seconds, or they may be left in for as long as 45 minutes.  Pulses are checked again after the treatment.

83 Arrival of Qi (Deqi) A term in acupuncture, seen in Neijing also named needling sensation or needling reaction. It refers to the tense and heavy feeling of the doctor 's hand after the needle is inserted and manipulated, meanwhile, the patient has a sensation of soreness, numbness, heaviness and distention at the acupoints. Satisfactory therapeutic effects can be obtained only by applying suitable reinforcing-reducing manipulations on the basis of the arrival of qi.

84 Reinforcing and Reducing Manipulation in Acupuncture Therapy Twisting slight and press (reinforcement) Open or press Exhalation-Inspiration (reinforcement) Inspiration-Exhalation (reduction) Deep and deqi (reinforcement) Clockwise and counterclockwise Lifting and thrusting

85 Retention of the Needle A term of needling technique. The needle will be placed in the acupoint for an appropriate period of time after it is inserted. Retention of the needle is on the purpose of strengthening the effect of needle. The patient's condition and needling characteristics decide the duration of retaining the needle. Intermittent manipulation can be given when the needle is retained, or warming needle and electroacupuncture can be applied.

86 عوارض جانبي طب سوزني نسبتاً عوارض جانبي اندكي دارد. رايج ترين عارضه ي طب سوزني ، ‌ احساس سستي عميق و حس افزايش يافته ي تندرستي است. بعضي اوقات ، ممكن است به ازاي هر سوراخ ، ‌ بي رنگي خفيفي د رمحلي كه طب سوزني انجام گرفته است ، ‌ پديد آيد. اين موضوع گذراست و خطرناك نمي باشد. يك گزارش منتشر شده ، ‌ بي خطر بودن طب سوزني را حتي در صورت انجام گرفتن در مورد افرادي كه ضد انعقاد وارفارين دريافت مي كنند ، اثبات مي كند. اگرچه در صورتي كه طب سوزني به صورت نابه جا انجام شود ، ‌ عوارض جانبي ممكن است پديد آيد ، فقط ده مورد آسيب در نتيجه ي انجام طب سوزني در ايالات متحده در سال هاي گزارش شده است.

87 Fainting during acupucnture In severe cases, on the basis of the above- mentioned treatments, press hard with the finger-nails or needles Shuigou (GV 26), Zhongcong (LR 3), Neiguan (PC 6), Hegu (LI 4), etc., or apply moxibustion to Baihui (GV 20), Qihai (CV 6), Guanyuan (CV 4).

88 Art of Acupuncture: 369KB88 Holistic view Acupuncture and Chinese Medicine is a balanced and holistic approach toward achieving good health and wellbeing Adopting and Acupuncture lifestyle can be supported by incorporating other tools into your life that can contribute to the holistic effects this ancient medicine has to offer Exercise: Yoga, tai chi, cardio, and weights A balanced, healthy diet Nature, Religion, Spirtuality Herbs, Vitamins, and Minerals

89 Art of Acupuncture: 369KB89 Quality of the Pulses  The pulses can have 28 different qualities.  The quality of a pulse is determined by:  Strength of each pulsation  Its length  How it trails off  Activity between pulsations

90 Art of Acupuncture: 369KB90 Treatment Methods Number, depth and technique of needle insertion depends on disease condition and state of health of patient; Non-insertion method can be used esp. for pediatric cases Needles retained for seconds, 20, 40 minutes or sometimes longer Other modalities: moxibustion, cupping, gua sha, mild electrical stimulation, dietary/nutritional therapy, exercise, trigger point therapy, sotai (Japanese style PT), and tuina (acupressure) The number of treatments varies on condition, chronicity of the problem, current health of patient; One treatment for simple problems and up to scores (20+) for very complex cases

91 Art of Acupuncture: 369KB91 Acupuncture Use and Safety Acupuncture has been adapted in several countries including Japan, Korea, France, Germany, and the United Kingdom Many university teaching hospitals now offer acupuncture services for patients e.g. UPMC, AGH, Harvard Medical, 425 million visits to providers of unconventional therapy vs. 388 million visits to PCP’s. (Eisenberg et al. NEJM 1990) 2 major prospective studies looking at the safety of acupuncture were reported in the BMJ in 2001; In those two studies of and treatments no serious adverse events were reported

92 Art of Acupuncture: 369KB92 Conditions treatable with Acupuncture Respiratory Tract Acute sinusitis Acute rhinitis Common cold Acute tonsillitis Broncho-pulmonary Disorders Acute bronchitis Bronchial asthma

93 Art of Acupuncture: 369KB93 Conditions treatable with Acupuncture Disorders of the Eye Acute conjunctivitis Central retinitis Myopia (in children) Cataract (without complications) Disorders of the Mouth Cavity Toothache Pain after tooth extraction Gingivitis Acute and chronic pharyngitis

94 Art of Acupuncture: 369KB94 Conditions treatable with Acupuncture Gastrointestinal Disorders Spasm of the esophagus and cardia Hiccups Gastroptosis Acute and chronic gastritis Gastric hyperacidity Chronic duodenal ulcer Acute and chronic colitis Acute bacterial dysentery Constipation Diarrhea Paralytic ileus

95 Art of Acupuncture: 369KB95 Conditions treatable with Acupuncture Neurologic Disorders Headache Migraine Trigeminal neuralgia Facial paralysis Paralysis after apoplectic fit Paralysis caused by poliomyelitis Meniere’s syndrome Neurogenic bladder dysfunction Nocturnal enuresis Intercostal neuralgia Peripheral neuropathy

96 Art of Acupuncture: 369KB96 Conditions treatable with Acupuncture Orthopedic Disorders Periarthritis humeroscapularis Tennis elbow Sciatica Lumbar pain Rheumatoid arthritis

97 Art of Acupuncture: 369KB97 WHO Endorses Acupuncture Allergic rhinitis/Chronic sinusitis Dysentery, acute bacillary Facial pain Hypotension, primary Leukopenia Morning sickness Pain in dentistry Renal colic Sprain Adverse rxns to radiation and chemotherapy Biliary colic Dysmenorrhea, primary Headache

98 Art of Acupuncture: 369KB98 WHO Endorses Acupuncture Low back pain Nausea and vomitting Periarthritis of shoulder Rheumatoid arthritis Stroke Depression Epigastralgia, acute Hypertension, essential Knee pain Malposition of the fetus Neck pain Postoperative pain Sciatica Tennis elbow (Source:http://www.who.int/medicines/library/trm/acupuncture /acupuncture_trials.pdf )

99 Art of Acupuncture: 369KB99 NIH Consensus Statement on conditions treatable with Acupuncture Addiction Fibromyalgia Menstrual Cramps Post-op dental pain Adult post-op pain Nausea and vomiting from chemotherapy Asthma Headache Myofascial pain Stroke rehab Carpal tunnel syndrome Low back pain Osteoarthritis Tennis elbow

100 Art of Acupuncture: 369KB100 Expectations Acupuncture is not a panacea for all ills for all people; different people respond better or worse to different types of healthcare modalities If there is no change (better or worse) within 4-5 treatments, I refer the patient to another type of practitioner or one with more experience with your specific problem “healing crisis” After treatment, one or combination of the following 1. no change, 2. feel much better or very relaxed; 3. exacerbation of symptoms

101 Art of Acupuncture: 369KB101 Conditions acupuncture is NOT recommended Difficulty breathing, shortness of breath Dizziness Acute chest/upper abdomen pain or pressure Sudden weakness or severe pain Sudden bleeding Falls Suicide attempts Severe infection Heart failure

102 Art of Acupuncture: 369KB102 How to make an appointment for acupuncture therapy 1.Set up a 15 minute consultation 2.Schedule an initial intake and treatment 3.Develop a treatment plan and explain treatment expectations

103 Art of Acupuncture: 369KB103 Chinese medicine has the following uses in pregnancy: – Morning Sickness (Acupuncture, Moxabustion and Herbs) – Threatened Miscarriage (Acupuncture and Herbs) – Analgesia during Child Birth (Acupuncture) – Prenatal Care (Acupuncture, Massage and Herbs) – Post-Partum Syndrome (Acupuncture and Herbs) – Cold in Uterus due to Birth (Acupuncture, Moxabustion and Herbs) – Fetus Overdue (Acupuncture) – Hemorrhoids (Acupuncture and Herbs) – Constipation (Acupuncture and Herbs) – Headaches (Acupuncture and Herbs)

104 برای درخواست دورههای آموزشی؛ برای درخواست همکاریهای پژوهشی؛ برای درخواست های درمانی ؛ لطفا به سایت : مراجعه فرمایید.

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106 The Infrastructure of the Integrative Human Body; Qi/Dameh, Qi Movement/Rouh and Zheng/Mezadj: Scientific Base Authors: Majid Avijgan 1, Mahtab Avijgan 2 International Journal of Integrative Medicine, 2013, Vol 1 Paper 22

107 ROS The oxidative metabolism processes of cells generate reactive oxygen species (ROS) such as H 2O2, OH’ and O2 The products lead to the excitation of cons tituents of cells which gives rise to them emi tting ultraweak light. [1] lack of activity on the part of the antioxidant agents in protecting the cells from ROS. [2]

108 ROS generation induces UPE. The energy (ATP) releasing (or producing) metabolism of mitochondria has an important role to play in producing ROS and in the lack of anti oxidant activity leading to ultraweak photon emission (UPE) through electron transportation. [3]

109 UPE induction One study reported UPE induction by sun light (UVA) may be different in various conditions which depends on spectral composition of UVA, temperature of Skin and O 2 concentration surrounding the skin. the other less important factors, presented as humidity and PH of examined skin area. [6]

110 UPE or light External factors ± Internal Factors ROS + Lack of antioxidant electron Transport chain UPE or light

111 Oxidation-Induced UPE is dominated by proteins and along with oxidized amino acid are as the major source of emitted photons.(5) Based on this finding the same role has been exhibited for flowing granules (DNA) in PVS to be source, storing (storing capacity) and a method for photon emission or movement. [7]

112 UPE or light By considering the PVS network as a source of qi, by needling, moxa, massage, heat, etc, it is possible to produce qi movement via this network and for it to reach the target organs in the body. [7]

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114 Producing Qi By considering PVS network as a source of qi; by needling, moxa, massage, heat and etc, it is possible to produce qi moving via this network and being reached the target organs in the body. [7]

115 viability and aliveness Movement of qi, in Traditional Chinese Medicine (TCM) means the movement and availability of qi in human body and presenting viability and aliveness.

116 ROUH and BOKHAR In other side, in Iranian Traditional Medicine (ITM), there is a term called ROUH and BOKHAR which are responsible for viability and aliveness of human. So that Non-ROUH (in Body) means death.

117 Similarity of ITM and TCM In the best of our knowledge, this is for the first time presenting the similar concepts of qi/Bokhar, Free flow of qi/rouh, qi movement/ROUH and ZHENG/MEZADJ (TCM and ITM viewpoint) in Medicine.

118 meridians network and connective tissue Since 1975 when the theory of meridians networks has been presented, the correlation of meridians network and connective tissue has been posed. [8] most of APs (50%) are presented at connective tissue planes (Intramuscular and Inner- muscular). (13)

119 Extracellular matrix Extracellular matrix in various part of body has a different composition which depends on the area; generally this composition is made of locally secreted proteins and polysaccharides that assembled to make a network. Extracellular matrix in every part of body has a various amounts of proteins and polysaccharides which give rise to variation of extracellular matrix. This variation depends on functional requirements of tissue and can be solid and hard such as bone and teeth or soft and transparent such as cornea. [14, 15]

120 PVS Control How has this kind of adaptation happened? Is this adaptation (diversity) under control? Or is it an accidental phenomenon? The response is the PVS theory presented in our previous report [7], which provides a condition of cell to cell contact. This network is amidst the connective tissue and provides links at the level of cell to cell.

121 photon (qi) emission so acupuncture needling and or laser acupuncture can induce photon (qi) emission from APs. [16, 17] This can be confirmed by observation that thermal stimulation of Moxabustion induces the photon (qi) emission from the point. [18]

122 Qi movement Normal, Excess can be lead to pain Deficiency an be lead to pain and weakness

123 qi Movement and Circadian Cycle an intensity increase on the left (yin) hand starting around 8 PM, and from 12 PM until 5 AM the left hand emits more than the right. Subsequently, the left side emission decreases and right side (yang) increases, being higher between 10 AM and 3 PM [23, 24]”. In practice the more intensity of de qi sensation in right side of patients have been reported by patients in office at afternoon session of acupuncture.

124 (CCD) camera by using a “sensitive charge-coupled-device (CCD) camera [26]” The pictures indicated that the time-dependent changes of photon emission intensity in the face and upper body so that “photon emission being weak in the morning increased in the afternoon and at a peak in the late afternoon [26]”

125 Cortisol concentration change of diurnal (and or seasonal) photon emission rhythm of the human body and cortisol concentration have a clear negative correlation, in order that there is different between morning with higher concentration of cortisol and evening with lowest concentration of cortisol

126 Avicenna; ; Canon of Medicine as Temperament or MEZADJ, of Skin. The Temperament or MEZADJ of palm is more Moderate (ETEDAL) than dorsal side, finding which is similar to finding of “the dorsal emission rate is lower than the palm [26]”.

127 Similarities of ITM and TCM In Traditional Medicines like TCM and ITM, there are some terms like Heat/Native Heat and Innate movement (Harekate Gohari)/Rouh as ITM,S terms and qi as TCM, S term which have No evidence base or objective concepts in western medicine. In translation into western medical meaningful, they are translated into the energy or Spirit.

128 Meaningful of BOKHAR in ITM BOKHAR or Vapor is a kind of gaseous steam, separated from any liquid or solid substance, can be produced by heat and has an ascending property to higher level. exhibits photon/qi rising movement by excited electron to higher level, the movement which is similar to BOKHAR. This similarity poses that photon/qi and BOKHAR have unique or similar properties.

129 qi movement or ROUH In fact the infrastructure like PVS [7] and “oriented nature of collagen liquid crystalline [22]”, can produce or facilitate the movement. This is qi movement or ROUH.

130 ROUH (Sharhe Tavale, e): The ROUH, physically, is BOKHR (gentle and Vapor Steam) which is developed from gentle and vapor part of Humor. (Kholasat al Hekmat): The ROUH is the life or vitality.

131

132 Mizaj or Zheng Finally, Mezadj (changes in the composition) is a new quality of interaction of the basic elements of ITM (Cold/Wet/Heat/Dry) and or TCM (Yin/Blood/Yang/qi). This new quality can be transformed into another new quality which is dependent on age, sex, time, day, hour, week, season, year, location, occupation. This transformation would develop various Mezadj/Zheng/temperaments in a person in comparison with others and even in different parts of the body of the same person, so that the different Mezadj/Zheng/temperaments of the human body can be shown as having a lack of uniformity and homogeneity by CCD. [26] (sensitive charge-coupled-device (CCD) camera)

133 Rouh The free flow of qi/rouh or smallest part of qi movement/ROUH

134 diurnal fluctuation This pattern means no fixed or uniform of pattern. There is a diurnal fluctuation in ROUH/qi movement in various part of body and ROUH/qi movement is not uniform issue. When there is high emission in one part of body there is low emission in other part of body. (Yin-Yang pattern) [26]

135 puzzles of free flow of qi Every puzzle is a small piece of ROUH/qi movement which by cooperation with other puzzles (free flow of qi) makes the total ROUH/qi movement of body.

136 puzzles of free flow of qi Body is made of millions of “free flow of qi”s which produce the picture of body as “ROUH”. In other word, and simplicity every “free flow of qi” is a small of portion of ROUH (similar to a pixel or puzzle of a picture) and combination of millions of “free flow of qi”s produce “ROUH” of body or qi movement or picture of body which can be traced by Sensitive Charge- Coupled-Device ( CCD) Camera. [26]

137 Mizaj or Zheng The previous report presented qi and qi production [7], but this is one small portion of the infrastructure of the integrative human body. The interaction of “multi-level factors [38]” (Cold/Wet/Heat/Dry or Yin/Blood/Yang/qi) gives rise to qi production, storing and emission. The qi/Dameh(Bokhar) emission, similar to the pixels of the picture of a human body, is the free flow of qi in TCM or Harekate Gohari in ITM. The gathered (free flow of qi)s produces Rouh (qi movement) which present different pictures depending on various conditions.

138 Health Normal Yin/Blood/yang  qi /BOKHAR  Free flow of qi/rouh  qi/time pattern or qi Movement/ROUH Abnormal Disease

139 TCM viewpoint ITM viewpoint Western viewpoint YincoldearthCollagen BloodWetnesswaterWater YangHeatheat or fireHeat qiDrynessDehydrationMovement Table 2-Correlation between basic element of TCM and ITM and western viewpoint

140 Mizaj or Zheng The acquired genetic codes make up the structure of “multi-level factors [38]” (Cold/Wet/Heat/Dry or Yin/Blood/Yang/qi) which are specific and different in every person. This is the basis of the definition of Mezadj.

141 Mizaj or Zheng This specific structure has a similar mechanism in qi production/Bokhar, free flow of qi/rouh and qi movement/ROUH, but has a specific listed of signs and symptoms in person which is called ZHENG.

142 Pain is Stasis of qi and blood Qi is mother of blood Blood is mother of Qi Stasis of both of them will cause pain. Pain treatment is qi and blood movment.

143 Ashi Point Referring to acupoint selection in accordance with tenderness point. Acupoints of this kind have neither specific term nor fixed location, but are selected as acupuncture parts according to tenderness points or other reaction points.

144 Practical points Penetrating Needling A needling technique. Inserting the needle in certain direction through to a certain point or part. To the corresponding points on the medial and lateral parts or the anterior and posterior parts of the four limbs, straight penetration can be applied.

145 Finger Acupuncture Namely acupressure, refers to pressing or kneading with a hand instead of a needle.

146 Acupoint Sticking Therapy An external treatment method, referring to treating diseases by sticking Chinese drugs on acupoints. Aromatic herb for inducing resuscitation, and Chinese drugs for clearing and activating the channels and collaterals are commonly used. The effects of hot-natured drug are better. The principle of acupoint selection is same as the principle of acupoint selection in acupuncture and moxbustion according to differentiation of symptoms and signs.

147 Cold Moxibustion A form of moxibustion by applying medicine on certain acupoints without any heat resources, also named moxibustion without heat. it is the opposite of heat moxibustion.

148 Cupping Therapy A therapy seen is referring to expelling the air in the cup by various means to create a negative pressure inside and produce suction of cup to the skin to treat diseases. This therapy causes local hyperemia or passive congestion so as to promote the circulation of blood and the flow of qi, alleviate pain and relieve swelling. Its indications are cough, pneumonia, asthma, headache, pain in chest and hypochondrium, wind-dampness, Bisyndrome, sprain, lumbago.

149 Electro acupuncture Method A method of preventing and treating diseases by combining needling with electric stimulation, i.e., supplying needles retained in the acupoint group concerned (two acupoints make up a group) with pulse current from an electric stimulator. There are a dual - directional pulse current (intermittent oscillatory current), sin wave, square wave, with combinations such as continuous waves, sparse- dense waves, intermittent waves, undulatory waves, sawtooth waves.

150 Electro acupuncture Method The frequency most commonly used is Hz, and over 1000 Hz is used less. Proper intensity of stimulation is marked by a muscular twitch around the acupoint and a comfortable sensation. The therapy can be used for cases requiring long needling stimulations. It's not advisable to connect two electrodes from the same output to the two opposite sides of the body when the therapy is applied to acupoints on the chest and upper extremities. It should be used with great care for patients with severe heart disease, or acupoints near the medulla oblongata and the spinal cord.

151 Electro acupuncture Method Usually, the patient feels comfortable with continuous waves, spares – dense waves do not easily cause electricity adaptation, but the patient often feels local discomfort; intermittent waves do not cause electricity adaptation more and has a stronger stimulating effect; undulatory and sawtooth waves are middle and easy to tolerate.

152 برای درخواست دورههای آموزشی؛ برای درخواست همکاریهای پژوهشی؛ برای درخواست های درمانی ؛ لطفا به سایت : مراجعه فرمایید.

153

154 OBGY and ACUPUNCTURE The major theories of TCM include the Yin- yang, the Five Elements, Qi and Blood, and Zang-fu organ theories. In TCM, the understanding of the human body is based on the holistic understanding of the universe as described in Daoism, and the treatment of illness is based primarily on the diagnosis and differentiation of syndromes.

155 Endometriosis Endometriosis, defined by the presence of viable endometrial tissue outside the uterine cavity, is among the most common gynaecologic disorders affecting women of reproductive age. According to the theory of TCM, the etiology of endometriosis is Blood stasis.

156 Endometriosis the etiology of endometriosis is Blood stasis. Blood stasis causes a Fire syndrome and the accumulation of Damp-heat in the lower part of the body (“Lower Jiao”). As most of the patients with endometriosis suffer from the symptoms of pelvic inflammation, the accumulation of Heat and Blood stasis are the main pathologic changes. Although the pathogenic factors and pathogenesis are complex, the keys are Dampness, Heat, andStasis

157 Endometriosis a Chinese medicinal formula with Radix ec Rhizoma Rhei as the main ingredient was used to treat 76 patients with endometriosis, and the total effective rate was 80.26% (Wang et al., 1991). with removing Blood stasis, resolving Phlegm, softening and resolving the Lump as the therapeutic principles,

158 Endometriosis Decoction, with Radix codonopsitis pilosulae, Radix paeoniae rubra and Rhizoma ligusticum wallichii as the main herbs (ingredients), respectively obtained a curative rate of 81.0%, 75.9% and 58.3% in treating endometriosis patients of I, II, and III stages, all higher than those of the controls (Yu, 1998).

159 Endometriosis including Rhizoma sparganii, Rhizoma curcumae, Hirudo, Eupolyphaga sinensis walker, Squama manitis, Semen cuscutae, Herba epimedii, etc) has also been found to be effective in treating endometriosis by tonifying Kidney and removing Blood stasis (Liu et al., 1998).

160 Endometriosis Radix Astragali, Pollen Typhae, Semen Persicae, Hirude Nipponica Whitman and Herba Epimedii gained a total effective rate of 91.67% in treating 36 patients with endometriosis (Song et al., 2005). A study with the purpose to observe the clinical efficacy of Quyu Jiedu Recipe, which consisted of Caulis sargentodoxae, Flos rosae rugosae, Flos lonicerae, Fructus forsythiae, Radix salviae miltiorrhizae, Radix paeoniae rubra, Cortex moutan, in treating endometriosis, and to explore the changes of the levels of vascular endothelial growth factor (VEGF) and cell proliferative nucleoprotein antigen (Ki-67) before and after treatment,

161 Endometriosis Radix salviae miltiorrhizae, Cortex moutan, Radix paeoniae rubra, Pollen typhae and Semen persicae, Hirudo were used as the main herbs (Zhu, 1998)

162 Infertility infertility can be the result of several types of syndromes. It can be caused by a deficiency in the kidney and liver organs, which disrupts the endocrine system. This creates an imbalance of hormones in the body, making sexual reproduction impossible. Infertility can also be the result of stagnant Qi (energy) and Blood; this lack of circulation stymies sexual reproduction even though hormone levels are normal. Blood stagnation is commonly found in women’s bodies as endometriosis, which can also be treated through the use of acupuncture and CHM. Finally, a Damp-heat syndrome can cause infertility that makes internal systems function improperly. The presence of a Damp-heat syndrome is much like inflammation and it causes blockage that must be relieved for sexual reproduction to be possible.

163 Dysmenorrhea In TCM, the specific details of the menstrual cycle (duration, volume, appearance of flow, etc) are only the surface phenomena. The underlying causes of menstrual disorders are the dysfunction of the internal organs; disharmony of Qi, Blood and Body Fluids; imbalance of the Ren and Du meridians; and the irregularity of Kidney Essence.

164 Dysmenorrhea Radix angelicae sinensis, Radix paeoniae rubra and Radix rehmanniae can function to nourish the blood and regulate the menstrual cycle. Radix angelicae sinensis tops the list for gynaecological problems. The “female ginseng” can tonify the female reproductive system, relieve menstrual pain, regulate the menstrual cycle, reduce premenstrual syndrome and relieve many symptoms of menopause.

165 Disharmony of Liver, Spleen, and Kidneys: This pattern includes irregular periods and dysmenorrhea. Also indicated are potential profuse bleeding and amenorrhea. This pattern is always connected to emotions.

166 Dysmenorrhea bupleuri chinensis, Herba schizonepetae, Radix angelicae sinensis, Radix paeoniae lactiflorae, Rhizoma dioscoreae, Rhizoma smilacis glabrae, Semen cuscutae, Radix rehmanniae preparata. This formula was prescribed by Dr. Fu Qingzhu in his famous book, Fu Qingzhu’s Gynecology, written in This is one of the most important gynaecological textbooks in TCM. His formulas are still the standard in the modern textbooks. In this formula, Radix bupleuri chinensis and Herba schizonepetae soothe the Liver, Rhizoma dioscoreae and Sclerotium poriae cocos strengthen the Spleen, Semen cuscutae and Radix rhmanniae tonify the kiney. All these herbs help Radix angelicae Sinensis and Radix peoniae rubra to “soften and comfort” the Liver, nourish the Blood and regulate the menstruation. It is a well-balanced formula.

167 Excessive Heat Pattern: This pattern includes early periods, heavy menstruation, profuse bleeding, dysmenorrhea with symptoms such as anxiety, feverish feeling, dry mouth, purple clots in menses, breast distention, hypochondriac pain or abdominal distention. Qing Jing Tang is the main prescription for menstrual disorders of Excessive Heat Type.

168 Dysmenorrhea Excessive Cold Pattern: This pattern includes scanty periods (oligomennorrhea), delayed periods, amenorrhea, or dysmenorrhea. Main symptoms include Blood stasis with periods, cold limbs, abdominal pain with periods, and aversion to cold. Wen Jing Tang is the main prescription for menstrual disorders of the Cold Type.

169 Dysmenorrhea If the dysmenorrhea starts from menarche, it is called primary dysmenorrhea (functional dysmenorrhea). The patients who suffered from the primary dysmenorrhea have no pathogenic changes in their genital organs. If the dysmenorrhea emerges after the occurrence of menarche, it is called secondary dysmenorrhea, which are often caused by endometriosis, adenomyosis, chronic pelvic inflammatory disease, pelvic tuberculosis, tumor, cervicitis, among which endometriosis is the most common one. As the patients who suffered from primary dysmenorrhea have no pathogenic changes in their genital organs, they can be cured by CHM and acupuncture.

170 Dysmenorrhea According to TCM, primary dysmenorrhea is usually caused by emotional factors, invasion of six exogenous pathogenic factors and stagnation of Qi and Blood; or by retention of Blood in the Paogong due to Liver depression and Qi Stagnation resulting from emotional upsets; or by Colddampness attacking the Lower Jiao and lodging in the Paogong due to walking in water during menstruation or sitting on damp ground; or by constitutional Deficiency of Qi and Blood, or consumption of Qi and Blood due to serious diseases and prolonged illness.

171 Dysmenorrhea Acupuncture at such acupoints as Taixi(KI-3), Gongsun(SP-4), Zusanli(ST-36), Tianshu(ST-25), Guilai(ST-29), Qichong(ST-30), Guanyuan(CV-4) can be used to treat dysmenorrhea, especially to treat those subjects in whom oral contraceptives are contraindicated or refused (Iorno et al., 2008).

172 Dysmenorrhea Group A were treated by acupuncture at Hegu (LI-4) and Taichong (LR-3) with Qinglong Baiwei method; group B were treated by routine acupuncture with Sanyinjiao (SP-6) and Ciliao (BL-32) as the main acupoints; and group C were treated by oral administration of Yueyueshu Decoction, a Chinese medicinal formula.

173 Dysmenorrhea The results showed that the curative rate and the total effective rate were 75.0% and 100.0% in group A, 60.0% and 95.0% in group B, and 25.0% and 90.0% in group C, respectively, group A and B being significantly better than group C. The analgesic effects within 30 min of treatment in both group A and group B were significantly better than that in group C, and that in group A was significantly better than that in group B. It is then concluded that acupuncture at Siguan points with Qinglong Baiwei method has a significant therapeutic effect on primary dysmenorrhea.

174 Dysmenorrhea acupuncture combined with spinal Tuina has good prospects for treatment of primary dysmenorrhea (Guo and Meng, 2008).

175 Dysmenorrhea A study evaluating the analgesic and therapeutic effects of electrosuperficial- acupuncture of Sanyinjiao (SP-6) for treating primary dysmenorrhea found that the analgesic effects of both electro-superficial-acupuncture and superficial-acupuncture at Sanyinjiao (SP-6) for primary dysmenorrhea patients were significantly better than that of oral administration of Brufen (Zhi, 2007).

176 Dysmenorrhea The central modulating mechanism of acupuncture at Sanyinjiao (SP-6) in treatment of primary dysmenorrhea has been demonstrated in a study (Gong et al. 2006). Vitamin K acupuncture point injection, a dysmenorrhea treatment derived from TCM, has also been a standard treatment in some hospitals in China since the 1980s. A recent research showed that acupuncture point injection with vitamin K can alleviate acute menstrual pain, and the relief extended through the nontreatment follow-up cycles in an uncontrolled pilot study, which was conducted in two countries (Wang et al., 2004).

177 Dysmenorrhea Acupuncture at such acupoints as Baihui (DU-20), Hegu (LI-4), Zhongji (CV-3), Guanyuan (CV-4) and Qihai (CV-6) has also shown satisfactory curative effects in treating primary dysmenorrhea (Habek et al., 2003).

178 Dysmenorrhea As conventional treatment for primary dysmenorrhoea has a failure rate of 20% to 25% and may be contraindicated or not tolerated by some women, besides acupuncture, CHM may be another suitable alternative treatment. Tongjing powder, a Chinese medicinal formula, could improve the state of blood circulation and treat the dysmenorrhea effectively (Wu et al., 1998).

179 Abnormal uterine bleeding Abnormal uterine bleeding is usually caused by weak constitution, insufficiency of Kidney Qi, weakness of Chong and Ren meridians to control menstruation, or excessive sexual intercourse and multiparity that impair Kidney Qi. The syndrome should be differentiated according to the quantity, color and texture changes of the bleeding in light of the tongue and pulse conditions as well as the duration of disease. Besides, age is also an important factor to be taken into consideration. For example, the patients at puberty are usually due to insufficiency of Kidney Qi; the patients of childbearing age are frequently due to Liver Stagnation and Blood Heat, and the patients during perimenopausal period are often due to Deficiency of the Liver and Kidney or Deficiency of Spleen Qi.

180 Abnormal uterine bleeding one hundred and thirty types of symptom were found in 1000 patients with dysfunctional uterine bleeding and the cardinal symptoms with comparative high frequency of occurrence (>35%) were as follows: coagulated blood, long menstruationis (more than 14 days), big menstrual blood volume, dark red blood, dripping-wet blood and bright red blood (Jin and Ma, 2008).

181 Abnormal uterine bleeding The difference between the two groups in menstrual cycle and menstrual period recovery after abortion was also significant. YLAC consisted of Radix angelica sinensis, Rhizoma ligusticum wallichii, Semen persicae, Flos carthami, Radix notoginseng, Colla corii asini, pollen typhae, Radix astragalus, Herba leonuri, Radix rubiae, Radix scutellaria, Radix glycyrrhiza, Rhizoma zingiber and Ophicalcitum.

182 Premenstrual syndrome Premenstrual syndrome (PMS) refers to a collection of cyclical physical and/or psychologic symptoms that appear during the late luteal phase of the menstrual cycle

183 Premenstrual syndrome Liver depression and Qi Stagnation leading to transformation of Fire and disturbing cardiac spirit; or by invasion of Liver Qi into the Spleen and Stomach; or by constitutional Yin asthenia; or by constitutional asthenia of the Spleen and Kidney.

184 Premenstrual syndrome It is clear that this syndrome is mainly caused by dysfunction of the Liver and is related to the Heart, Spleen and Kidney. According to the clinical symptoms, this syndrome pertains to the conceptions of headache during menstruation, fever during menstruation, body pain during menstruation, edema during menstruation, diarrhea during menstruation, dizziness during menstruation, abnormal emotional changes during menstruation and distending pain in breasts during menstruation in TCM, generally known as symptoms before and after menstruation.

185 Premenstrual syndrome In Ye Tianshi’s Gynaecological Records, up to 22 premenstrual symptoms were recorded, such as edema, feverish sensation, pain in the hypochondrium, diarrhea, body aches, abdominal cramps, and reduced appetite.

186 Premenstrual syndrome This syndrome is clinically divided into Excess and Deficiency types. The Deficiency type is marked by Kidney Deficiency and Spleen Deficiency. The Excess syndrome is marked by Qi Stagnation. The viscera involved are the Liver, the Spleen and the Kidney. Since clinical symptoms are complicated, clinical syndrome differentiation should be done in light of the time, location and nature of the symptoms as well as the conditions of the tongue and pulse.

187 Premenstrual syndrome The study showed that after being immured in two consecutive menstrual cycles, the monkeys presented depressive symptoms during the premenstrual phase of three consecutive menstrual cycles. The serum contents of the three kinds of monoamine neurotransmitters in depressive monkeys were significantly higher than the normal ones. The serum levels of progesterone and prolactin increased obviously, and a marked change in the pattern of progesterone secretion could be observed. Moreover, the premenstrual depressive symptoms of model group monkeys could not only be cured by Jingqianshu Granule, but the higher serum levels of prolactin and monoamine neurotransmitters in these monkeys could be reduced by this herbal medicine (Qiao et al.,2007).

188 Premenstrual syndrome one group with Yang Deficiency of the Spleen and the Kidney: Taichong (LR-3), Taixi (KI-3), Qihai (CV-6), Ganshu (BL-18), Tanzhong (CV-17), and Sanyinjiao (SP-6) were used

189 Premenstrual syndrome Stagnation of the Liver Qi. Zusanli (ST-36), Pishu (BL-20), Shenshu (BL-23), Taixi (KI-3), Sanyinjiao (SP-6) and Guanyuan (CV4

190 Premenstrual syndrome Acupuncture in treating edema during menstruation was also reported effective in two studies (Li, 2002, Liu et al., 2002). The first study only used Fuliu (KI-7) as the point, and the second study used Zhongwan (CV-12), Qihai (CV-6), Hegu (LI-4), Zusanli (ST-36), Sanyinjiao (SP-6) as the main points.

191 Premenstrual syndrome Headache during menstruation could also be treated by acupuncture, one study (Zhang and Fu,2001) selected Fengchi (GB-20) as the main acupoint and another study (Sun, 1999) used Baihui (DU-20), Qihai (CV-6), Guanyuan (CV4), Sanyinjiao (SP-6), and Zusanli (ST-36) as the acupoints, in conjunction with Chinese herbs

192 Menopausal syndrome a variety of vasomotor and psychological symptoms such as hot flashes, night sweats, menstrual irregularities, vaginal dryness, depression, nervous tension, palpitations, headaches, insomnia, lack of energy, difficulty concentrating, and dizzy spells.

193 Menopausal syndrome The overall risks of HRT outweigh the benefits, which provide an opportunity for TCM going to the world. A combination of estrogen and progestin frequently prescribed to postmenopausal women in U.S.A. increased the risk of invasive breast cancer, heart disease, stroke, and pulmonary embolism while reduced bone fractures and colorectal cancer.

194 Menopausal syndrome In light of the theory of TCM, menopausal syndrome is usually caused by the decline of Kidney Qi, near exhaustion of Tiangui, Deficiency of the Chong and Ren meridians or the insufficiency of Essence and Blood before and after menopause.

195 Menopausal syndrome The congenital “Tiangui” comes from the parents, while the postnatal Essence and Blood result from the food stuff. When the girl is about 14 years old, the Chong and Ren meridians get ripe and menstruation occurs”. In another classic, Plain Questions on Preservation of Congenital Primary Qi of the Ancient People, it says, “When women are about 49 years old, the Chong meridian is failing in function, and menstruation ceases. At the same time, the constitution may gradually get weaker and the fertility ceases”. That is to say, when a woman is about 50 years in age, the Kidney Qi is insufficient. The Kidney Yin and Kidney Yang fall into an imbalance state and a series of clinical symptoms will appear.

196 Uterine fibroids Uterine fibroids are known by many names, including uterine myoma, leioma, fibroma, fibromyoma, or as hysteromyoma; these are equivalent designations for benign growths of smooth muscle tissue in the uterine wall. Clinically,

197 Uterine fibroids Zheng Xia is defined as “masses in the uterus with a feeling of pain, swelling, or fullness, and with bleeding in severe cases.”

198 Uterine fibroids Three patterns of uterine fibroids are differentiated in TCM: Qi Stagnation and Blood stasis, Yin Deficiency and Empty-Fire Blazing, Liver Qi Stagnation and Spleen Deficiency.

199 Uterine fibroids Isoliquiritigenin (ISL), a calchone flavonoid, has cancer-preventing properties and is often used in TCM. ISL has been found to inhibit cell proliferation by initiating apoptosis in human uterine leiomyoma cells coupled with the increased cell cycle arrest, indicating that ISL could prove to be a promising chemo-preventive and therapeutic agent against human uterine leiomyoma (Kim et al., 2008).

200 Uterine fibroids Herba scutellariae barbatae (Lamiaceae) (SB) is a perennial herb which is natively distributed throughout Korea and southern China. This herb is known in TCM as Ban-Zhi-Lian and traditional Korean medicine as Banjiryun, respectively. SB has been used as an anti-inflammatory and antitumor agent. A study was designed to determine the expression of cell cycle-related signal molecules for growth inhibition after HCG treatment by the herb SB in two different human myometrial smooth muscle cells (SMCs) and leiomyomal SMCs (Lee et al., 2004).

201 Uterine fibroids The growth of uterine fibroids is regulated by the complex feedback loops between sex steroid hormones and growth factors (Langevin et al., 2002) and acupuncture has a regulative effect on the pituitary gland, the thyroid gland system, and the central nervous system, without presenting pharmacological interference or having a long-term effect. It may be legitimate to consider acupuncture as a potential therapy for uterine fibroids. There are many types of acupuncture (body, electro, scalp, elongated needle and fire needling) used to treat uterine fibroids in hospitals in China, with body acupuncture being the most commonly used technique (Lan and Li, 1997).

202 Uterine fibroids The treatment period and the follow-up phase in most of the clinical researches on treating uterine fibroids with TCM are not long enough, which should at least last for three to five years.

203 ART and TCM

204 Chronic pelvic inflammation Most cases of chronic pelvic inflammation result from acute pelvic inflammation which had not been cured thoroughly, but there are some patients without any acute inflammatory medical history.

205 Chronic pelvic inflammation The main clinical manifestations are low fever and lassitude, abdominal pain, irregular menstruation dysmenorrhea and sterility. Examination of gynaecology shows that the uterus is often in a posterior position; its movement is restricted or it adheres to the circumferential tissues, resulting in lump formation; appendixes on both sides are often obviously thickened.

206 Chronic pelvic inflammation The ancient Chinese medical physicians said, “Chong meridian is the sea of twelve meridians, the sea of five Zang and six Fu”; “Stomach is the acquired Essence, the sea of food stuff”, “Kidney is the congenital Essence, the root of primordial Qi”. Therefore Chong meridian is selected to strengthen the functions of five Zang and six Fudredge twelve meridians to further strengthen the Stomach, invigorate the Spleen and tonify the Kidney.

207 Chronic pelvic inflammation Ren meridians can govern Yin meridian-Qi of the whole body, and is the sea of Yin meridians. Therefore the acupoints of Ren meridian are selected to treat abdominal pain and lumbago, irregular menstruation and sterility. Acupuncture combined with moxibustion has the functions of warming and promoting Qi and the Blood, strengthening the body resistance to eliminate pathogenic factors and relieving swelling and dissolving lump, so as to achieve the aim of treating chronic pelvic inflammation.

208 Chronic pelvic inflammation Qi Jie Granule, which consisted of Radix astragali, Resina draconis, Radix angelicae sinensis, Ramulus cinnamomi, Caulis sargentodoxae, Herba patriniae, Radix et rhizoma rhei preparata, Myrrha, Radix paeoniae rubra, Radix glycyrrhizae, has been found to have a satisfactory curative effects in treating chronic pelvic inflammation through improving blood viscosity and regulating T-lymphocytic subgroups (Zhang et al., 2004).

209 Chronic pelvic inflammation Penyanqing Capsule (PYQC, consisting of Radix Salviae Miltiorrhizae, Radix Paeoniae Rubra, Fructus Aurantii Immaturus, Radix Ilicis Pubescentis, etc) in treating pelvic inflammation of Qi-Stagnation with Blood stasis syndrome, the total effective rate in the PYQC group was 83.3%, which was insignificantly different from that in the control group and PYQC could significantly lower the hemorrheologic indexes in patients and showed definite influences on the pathogenetic chlamydia and mycoplasma (Shen et al., 2005).

210 Chronic pelvic inflammation Chronic pelvic inflammation is mainly caused by accumulated Heat in the Liver Channel, Stagnation of the Liver-Qi affecting the Spleen, failure of the Spleen to resolve Dampness and Dampness interweaving with Heat A long-standing illness may lead to the obstructed circulation of Qi and Blood and blockage of Blood vessels to form lumps.

211 Chronic pelvic inflammation the therapeutic effects on chronic pelvic inflammation, in which, reducing method was applied at ZhongJi (CV-3), Guanyuan (CV-4) and Zigong (EX-CA-1), reinforcing method at Zusanli (ST-36)Sanyinjiao (SP-6) and Diji (SP-8) and indirect moxibustion with 3 medicated cakes was performed at Shenque (CV-8) (Jin, 2004). Zhao’s study showed that vitamin K3 acupoint injection at Sanyinjiao(SP-6) is an effective and safe measure for treating patients with primary dysmenorrhea, and it has also some effects in relieving pelvic pain caused by chronic pelvic inflammatory disease and endometriosis (Zhao et al., 2003).

212 PCOS PCOS, with a prevalence of 5%–10%, is the most common endocrinopathy in women of reproductive age, and is characterized by chronic anovulation and hyperandrogenism.

213 PCOS To evaluate whether electro-acupuncture could affect oligo- /anovulation and related endocrine and neuroendocrine parameters in women with PCOS, twenty-four women with PCOS and oligo- /amenorrhoea were included in a non-randomized, longitudinal, prospective study (Stener-Victorin et al., 2000). In the study, the period was defined as the period extending from 3 months before the first electro-acupuncture treatment to 3 months after the last electro- acupuncture treatment (10-14 treatments altogether), a total of 8-9 months. Nine women (38%) experienced a good effect, showing increased rates of regular ovulations. These women also demonstrated significantly lower levels of body-mass index (BMI), serum testosterone concentration, serum testosterone/sex hormone hiding globulin (SHBG) ratio and serum basal insulin concentration and significantly higher levels of serum SHBG than those who did not respond to electroacupuncture.

214 PCOS the decoction of BSHX, which consisted of Semen cuscutae, Radix rehmanniae praeparata, Herba taxilii, Herba epimedii, Fructus psoraleae, Rhizoma polygonati, Spina gleditsiae, Semen persicae, Rhizoma homalomenae, Radix salviae miltiorrhizae, and Radix glycyrrhizae, was given to the observation group one dose every day for 14 days in every menstrual cycle (Liang et al., 2008).

215 Cervicitis and vaginitis Cervicitis caused by ureaplasma urealyticum (Uu) is a clinically concurrent disease. Cervicitis caused by mycoplasma belongs to vaginal itching and leukorrhagia in TCM.

216 Cervicitis and vaginitis In TCM, it is believed that this is due to an unrestrained sex life, exogenous excessive Heat, accumulation of toxin, insufficient Kidney Essence, evil Qi taking advantage of such weakness and intruding into the body and dampness, heat interacting with accumulation of toxin in the Lower Jiao, thus resulting in such symptoms as leukorrhagia, reddish and whitish discharge, swollen and itching vulva.

217 Cervicitis and vaginitis According to TCM, the internal cause of vaginitis is long-term pent-up Liver Qi transforming into Heat, typically complicated by a vacuous Spleen not moving fluids. When body fluids stop flowing, they gather, accumulate and transform into Dampness. Liver Heat and Spleen Dampness become mutually entangled and pour downward, invading and soaking the vagina. With the passing of time, toxic evils are usually engendered internally. The external causes of vaginitis mostly have to do with poor vaginal hygiene and toxic evils. Evil toxins burn and damage the vagina causing inflammation.

218 Cervicitis and vaginitis Modern TCM gynecology texts typically divide vaginitis into three distinct patterns: trichomonas vaginitis, hemophilus vaginitis, and senile vaginitis. CHM has good curative effects in treating the disease (Du et al., 2002).

219 Cervicitis and vaginitis For those who suffered from trichomonas vaginitis, Wu Mei Yin Chen Tang (consisting of Fructus mume, Fructus zanthoxyli, Flos lonicerae, Herba artemisiae scopariae, Herba polygoni avicularis, Sclerotium poriae cocos Rhizoma atractylodis, Cortex phellodendri, Radix gentianae) is advised to be orally administered, and a Chinese medicinal formula composed of Radix sophorae, Fructus cnidii, Radix stemonae, Rhizoma coptidis and Herba euphorbiae helioscopiae was used for external wash (Decoct and use both as a fumigant and a wash. In other words, the patient should squat over the steaming decoction exposing their genitalia to the steam rising off it. After the liquid has cooled to be bearable to the skin, the genitalia should be washed with this decoction. This should be repeated once each morning and night for seven consecutive days) (Du et al., 2002).

220 Cervicitis and vaginitis For those who suffered from hemophilus vaginitis, Long Dan Xie Gan Tang Jia Jian (consisting of Radix gentianae, Radix scutellariae, Cortex phellodendri, Fructus gardeniae, Rhizoma atractylodis, Fructus kochiae, Radix rehmanniae, Caulis akebiae and Semen plantaginis) is advised to be orally administered, and a Chinese medicinal formula composed of Fructus cnidii, Radix sophorae, Cortex phellodendri, Fructus zanthoxyli, Alumen and Cortex dictamni was used for external wash (the usage as above) (Du et al., 2002)..

221 Cervicitis and vaginitis For those who suffered from senile vaginitis, Zhi Bai Di Huang Wan Jia Jian (consisting of Radix rehmanniae, Cortex moutan, Fructus corni, Rhizoma alismatis, Sclerotium poriae Cocos Radix dioscoreae, Rhizoma anemarrhenae, Cortex phlellodendri, Rhizoma smilacis glabrae, Flos lonicerae, and Radix paeoniae rubra) is advised to be orally administered, and a Chinese medicinal formula composed of Radix sophorae, Fructus cnidii, Herba mercurialis leiocarpae, Radix glycyrrhizae, Herba taraxaci, and Radix paeoniae rubra was used for external wash (the usage as above) (Du et al., 2002).

222 برای درخواست دورههای آموزشی؛ برای درخواست همکاریهای پژوهشی؛ برای درخواست های درمانی ؛ لطفا به سایت : مراجعه فرمایید.

223 جزييات در سايت :

224 Art of Acupuncture: 369KB224

225 Thank you for attention


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