ACUPUNCTURE FOR IMMUNE-MEDIATED DISORDERS

Part 1
Philip A.M. Rogers MRCVS
e-mail : progers@grange.teagasc.ie
Postgraduate Course in Veterinary AP, Dublin, 1996
Updated 1993, 1995

See also the earlier review "Acupuncture effects on the body's defence systems and conditions responsive to acupuncture" (Rogers 1980)

SUMMARY

Acupuncture (AP) activates the defence systems . It influences specific and nonspecific cellular and humoral immunity; activates cell division, including blood-, reticulo-endothelial- and traumatised- cells; activates leucocytosis, microbicidal activity, antibodies, globulin, complement and interferon. It modulates hypothalamic-pituitary control of the autonomic and neuroendocrine systems, especially microcirculation, response of smooth and striated muscle and local and general thermoregulation.

Applications of AP include inflammation; trauma; tissue healing; burns; ulcers; indolent wounds; ischaemia; necrosis; gangrene; infections; post-infection sequelae; fever; auto-immune disease; allergy; anaphylaxis and shock; treatment or prevention of side effects from or sequelae to cerebrovascular disease (CVD), coronary heart disease (CHD), general anaesthetics, parturition, surgery, cytotoxic chemotherapy and ionizing radiation. AP may inhibit neoplastic cells.

Immunostimulant points include LI04,11; ST36; GB39; SP06; GV14; BL11,20,23-28; CV12. Some, such as BL52 are immunosuppressive. Antifebrile points include GV14 and ST36. Reactive reflex SHU, MU and Earpoints are useful in organic diseases. In immunomediated diseases, some or all of those points can be used with other points, especially local points and points for the major symptoms and/or points for the affected body part, area, function or organ.

INTRODUCTION

"Control of infectious diseases has depended on the use of vaccines and antibiotics, isolation and embargo, test and slaughter programmes. These strategies have failed to eradicate the major infectious diseases of livestock" (1). "Bacterial infections of the mare's uterus have the same incidence as they had before penicillin was discovered and the economic importance of endometritis is increasing with the increase in value of horses" (2).

Micro-organisms and other pests preceded the evolution of higher species and will exist long after their extinction. For optimum chance of survival, higher forms must learn to co-exist with lower. Adaptation is the key.

Acupuncture (AP) has antiinflammatory, antibacterial, antiviral effects. It enhances humoral and cellular immunity and has antiallergic effects. Earlier papers on the effects of AP on immunity were reviewed (3-9). Trelles et al (10) reviewed low power laser therapy (LLLT). The stimulus elicited analgesia, vasodilation, antiinflammatory and antioedematous effects, biostimulatory effects, cell proliferation, cicatrisation and tissue regeneration (wounds, burns, ulcers of skin and portio uteri, herpes lesions, urethritis, haemorrhoids, sinusitis, bone fractures and osteomyelitis, arthritis, muscle injury, neuralgia, alopecia areata) and local immune responses.

This Chapter summarises papers published mainly since 1980. The papers were published in medical journals, or in journals not usually read by orthodox health professionals. Most of the abstracts are from the American Journal of AP and the Scandinavian Journal of AP and Electrotherapy. Most of the reviews listed above are excluded. Readers are referred to those reviews.

EFFECTS OF AP ON THE IMMUNE SYSTEM AND CLINICAL USES

AP, Electro-AP (EAP) or moxa enhanced the recovery of red and white cell counts (RCC and WCC) to normal or near-normal values in many conditions (11), including experimental radiation sickness (13-17), experimental Vibrio cholerae sensitivity (18). AP post-op in humans enhanced WCC, neutrophil phagocytosis, lymphocyte counts, and bactericidal activity (19). Low Level Laser Therapy (LLLT) increased phagocytosis in chronic wounds in horses (20), improved immune functions and remedied anaemia in children (21). Homoeostatic effects of AP are more obvious when abnormalities exist first (14). AP in patients on long-term cortisone therapy for spastic bronchitis, restored granulocyte migration to almost normal values (22). LLLT decreased the numbers and caused marked degranulation of mast cells in irradiated tissues (23). EAP or moxa enhanced the activity of the reticulo-endothelial system (24,25) but if used too often, adaptation reduced the effect (26-28).

Narcotic medication inhibits local immune response (29). AP or moxa enhanced cellular immunity (29-31), increased lymphocyte proliferation/count (30,32), lymphocyte transformation (LT) (31,33-35), T-cell numbers (36), serum globulins (34), T-cell staining by alpha naphthyl acetate esterase (ANAE) (37,38) and E-rosette formation (29,31,38). AP increased Natural Killer (NK) -cell activity (32). AP increased suppressor/cytotoxic T-cells, E-rosette positive T-cells and Leu 7+NK cells. Leu 11+NK cells decreased (39).

SPECIFIC AND NON-SPECIFIC ANTIBODIES, GLOBULIN, COMPLEMENT, INTERFERON
Globulins and antibodies: AP, LLLT or moxa increased SIgA in the small intestine in mice sensitised against Vibrio cholerae (18), Igs, specific antibodies and faecal IgA in bacillary dysentery (40), plasma IgM in chronic pelvic inflammation (41), beta and gamma globulins and A/G ratio in dogs with g/i helminthiasis (42) and antibody formation in wounded horses (20). AP improved non-specific immunity and regulated hyperactivity of the non-specific immune system in asthmatic and normal subjects (43). AP, LLLT and moxa improved immune parameters in systemic lupus erythematosus (44). Plasma cAMP was low in early malaria, indicating that metabolites of Plasmodia inhibit immune responses. As AP may cure malaria, its actions are thought to involve activation of the immune system and its symptomatic effects (45). AP or moxa increased complement in acute bacillary dysentery (40) and in scleroderma and asthma (46). Moxa increased complement in rabbits (47). AP increased circulating interferon in humans. Stimulation of interferon production may have clinical uses in viral infections and in other diseases (48).

PRE-, PER- AND POST- OPERATIVE INDICATIONS FOR AP: General anaesthesia suppresses antibody response (49) and other immune functions. It markedly reduces lymphocyte blastogenesis, which is not influenced by AP analgesia (50). Reflex analgesia by AP, EAP or TENS enhances immune response (see above) and leaves autonomic functions, including those of the foetus, intact (51,52). Effective methods of pre-, per- and post- op management, if they have immunostimulant effects, would be in the best interests of the patient and would reduce the need for potent drugs (opiates, barbiturates, diazepam, epidurals, gastric sedatives etc) and depress vital functions less (53,54).

Shock, anxiety, anorexia, nausea, vomiting etc are common pre-op. Some patients are hypersensitive to drugs. Pain, shock, abdominal spasm, anxiety, anorexia, wound infection, adhesions, scar TPs, intestinal adhesion, ileus, nausea, vomiting, apnoea, dyspnoea, retention of sputum, laryngitis, decreased renal filtration rate, urinary retention, peripheral ischaemia, pressure ischaemia etc are common post-op. AP pre- and/or post- op can prevent or treat most of those complications. Combination of per- and post-op EAP reduces the demand for post-op analgesic drugs and patients become self-caring more quickly (55,56). In particular, Patterson (53) cited data which showed that the incidence of post-op sepsis was 3% in patients under AP analgesia or electro-analgesia, as compared with 17% under general anaesthetics.

AP, EAP or acupressure at PC06 was more effective in preventing pre- or post- op nausea and vomiting than cyclazine and metoclopramide in patients undergoing surgery (57-59). When given during operation under drug anaesthesia, EAP (5 minutes at 10 Hz) was not effective (60). Nausea and vomiting due to passing a laryngoscope can be prevented in 80% of patients by heavy acupressure on LI04 (61,62). Atropine or conventional anticholinergic agents produce side effects, including dry mouth, blurred vision, dizziness and tachycardia. AP can replace anticholinergics, with few or no side effects, to facilitate gastroscopy or a barium meal (63-67).

AP, EAP or LLLT are useful per-operative analgesics in: high-risk patients (68); coordination of uterine contraction in labour (69,70); Caesarian section (71); gynaecological operations (31) and in hysterectomy. Post-op analgesia persists for 3-4 hours (54).

EAP combined with epidural (55), local or general anaesthesia for surgery reduces the amount of anaesthetic drugs needed (71) and confers neurovegetative protection from the effects of surgical trauma (72). Post-op recovery of spontaneous breathing, consciousness (56), and autonomic function is faster and the immune system is less depressed after combined anaesthesia than after drug anaesthesia without AP (68,73,74).

Similar analgesic and neurovegetative effects occur with post-op use of EAP and TENS (75). AP or EAP post-op stimulates fast recovery of liver function (69) and reduces hallucinations on emerging from ketamine anaesthesia (76). EAP and TENS post-op gave better analgesia than i/v meperidine but EAP analgesia lasted longer than TENS analgesia and increased with repetition of treatment (77). EAP post-op halved the use of pethidine (78). In post-op wound infection, blood vessels near the HuatoJiaJi points become engorged, usually in the scapular or inter-scapular area in the case of infected wounds of the upper limbs or face and in the lumbar area in the case of the lower limbs. One paravertebral needling, to release a few drops of blood from engorged vessels on the back, cured most cases (79).

AP was better than laser-AP or narcotic management of post-op infected wounds as regards analgesia, speed of healing and hospital stay (29). EAP reduced post-op intestinal adhesions (80). EAP or AP rapidly cured urinary retention post-op and in paraparetic cases (81-83) or retention postpartum or post-obstetrical surgery (84). AP restored urinary function in 100% of cases of retention or incontinence due to laceration and spondylosis of sacral vertebrae (85).

AP was effective in 96% of ileus/obstipation cases. Most cases emptied the bowel within 1 hour (86).

TRAUMA, TISSUE HEALING, BURNS, ULCERS, FISTULAS, INDOLENT WOUNDS: The success and use of plastic surgery, tissue replantation can be improved by increasing local blood circulation, phagocytosis and inflammatory reaction and/or preventing arterial spasm, thrombosis, blood sludging or clotting. Topical leeches (87), nitroglycerin, AP, EAP and LLLT enhance flap/graft survival (88-90).

Time to obtain pain relief and to resolve swelling in bone fracture and time to eliminate other symptoms and to heal the fracture was less than usual with EAP (91). EAP, Electrostimulation (ES) or LLLT greatly enhanced the rate of healing and strength of repair of wounds (92-94) and infected wounds and burns (95) and local antibiotics did not improve the success (96). Brown et al (11) stated that AP stimulation gave a longer rise in ipsilateral skin temperature (vasodilation) than stimulation of "non-points". AP or EAP via needles around the edge of trophic ulcers, including post-phlebitis ulcers, cured 100% (97). AP cured thromboangitis obliterans (98). AP, with anticoagulant therapy (heparin), cured thrombophlebitis (99). LLLT cured chronic wounds in horses (20). TENS or LLLT cured wounds, fistulas and peripheral circulatory disorders including ischaemia, ulcers, gangrene (10,100-103); chronic leprous ulcers (104). The healing rate was the same as in TENS treatment of other types of ulcer (neuropathy, atherosclerosis, varicose veins, thrombophlebitis, decubitus etc). Marked, prolonged vasodilation follows non-segmental TENS, probably due to release of vasoactive intestinal polypeptide (VIP), endorphin and serotonin (104). AP cured 92% of anal fissures. Pain and bleeding improved or stopped after the first session in 82% (105). Moxa needle (warming effect) was better than EAP or simple AP in re-establishing peripheral circulation in frostbite of the fingers (106).

INFLAMMATION, LOCALISED AND ORGANIC INFECTION: EAP inhibited experimental inflammation. EAP into the site gave the greatest antiinflammatory effect (107-109). AP suppressed histamine-mediated increase in vascular permeability and reduced exudation in burns (110).

AP or LLLT cured and prevented acute conjunctivitis (111), cured maxillary sinusitis (112,113). The results were better than with antibiotics. EAP is a first-choice method of preventing repeated attacks of chronic tonsillitis with fever (114). Earpoint AP was effective in treating tracheitis in infants (115) and was as good as medication in pyogenic otitis media (116). LLLT cured most acute cases (117). Fire needling, with a medicinal fuse, cured 100% of tubercular cervical lymphadenitis (118). AP cured 80% of Tinea capitis cases (119). EAP cured 46% and improved 42% of Tinea pedis cases. Fungal culture from the site was negative after AP (120). AP cured or markedly improved 46% and improved 50% of Scrofula cases (121). AP needling to bleed viral warts cured 97% within 3 months (122).

GASTROINTESTINAL DISORDERS: Stomach: AP at ST36 increased gastric motility (123) and amplitude, decreased the frequency of gastric contraction (124), increased serum gastrin (125) and decreased basal and vagally-mediated gastric acid secretion (126,127). EAP at BL20 increased the frequency and amplitude of contraction. Naloxone did not abolish the effect but vagotomy or atropine did (128). AP or EAP at ST36, BL21, PC06 increased gastric secretion of bicarbonate and sodium in dogs. Gastric acidity decreased (129,130). The AP effect was blocked by local anaesthesia of the AP points or by use of atropine. The AP effect is mediated by somatovisceral reflexes, via blockade of histamine H2- or cholinergic- receptors in gastric mucosa (126,128-130). AP-injection at BL18, BL21, ST36 was effective in atrophic gastritis (131). AP or EAP was effective in treating experimental gastric ulcer in rats (132,133), peptic ulceration in foals (134) and in clinical gastroduodenal ulcer in humans (126,135,136), even those which had relapsed after completion of conventional therapies (137). AP, moxa, magnetic-, electro-magnetic- or laser-AP were effective in 1-3 days in infantile enteritis, often in cases which had failed to respond to medication (138-142) and AP was effective in diarrhoea in diabetic neuropathy (143). AP was as good as antibiotic therapy in treating piglet diarrhoea usually associated with E. coli and coronavirus (144-146). LLLT at GV01 was effective in lamb dysentery (403). AP or AP + moxa was effective in dysentery (34,147), which had not responded to medication (37), increased intestinal microcirculation in 15 minutes and reduced hyperperistalsis and borborygmus after 15-30 minutes (148). AP or LLLT was effective in acute appendicitis (149,150). AP at GV01, BL35, BL57, GV20 cured 100 % of types 1 and 2 and 77 % of type 3 prolapsed rectum in children (151). AP, EAP, moxa and herbs are effective in curing hepatopathy (152) and hepatitis, including acute viral icteric hepatitis (153,154,155,156,157,158,159). AP and EAP aided normalisation of the pathological increase of 5-HT metabolism and decrease of DA content of the brain in CCl4 toxicity (160) and helped to prevent and cure pathology in CCl4 toxicity. The AP effect was mediated by endogenous opiates (161,162). AP at GB-related points increases intra-GB pressure up to 26 times. This helps expulsion of stones or ascarides from the bile duct (163). AP, EAP, acupressure are effective in cholecystitis, cholelithiasis and biliary ascariasis (136,163-176).

REPRODUCTIVE DISORDERS: AP-type stimuli influence reproductive organs and functions, including release of LH, FSH, progesterone and oestradiol (177-179). It can activate or inhibit uterine and cervical contraction in humans and animals and can increase local microcirculation and immunity. AP can be used to prevent threatened abortion (180); to correct foetal malposition (181,182); to induce labour in women; to cure morning sickness (183,184); vaginitis/leucorrhea (185); dysmenorrhoea (186-190). AP cured vulvar ulceration (191), vulvar leukoplakia (192) and hysteromyoma without the need for surgery (193). It cured female infertility/sterility (amenorrhoea, anovulation, polycystic ovarian disease (POCD), functional metrorrhagia) (178,179,194,195); pelvic inflammatory disease (PID) (41,196-198). The results were better than in similar cases treated by antibiotics (199).

Endometritis always follows mating in mares but healthy mares clear the uterus within 48-72 hours. Poor contractility, imbalance of lymphatic/ circulatory/uterine secretion (build-up of secretions) and inability to clear the debris through the cervix are important in the aetiology uterine infection (200). AP was effective in repeat-breeder mares (201). Laser on the clitoris was effective in anoestrus in cows (404). Others claim success with AP in treating infertility (anoestrus, cystic ovary, and repeat breeder) in other species (cows, bitches, sows).

AP can treat impotence, poor libido, infertility and prostatitis in men (143,202-209). Similar claims are made for stud animals.

MAMMARY DISORDERS: AP, moxa, point bleeding and massage was effective within a few days in acute mastitis, breast abscess and breast carbuncle in women (210-214). AP cured mammary fibrocystic disease in women within 3 weeks and can be used in the differential diagnosis of fibrocystic disease from mammary carcinoma (215). AP was effective in mammary hyperplasia (216-217); proliferative mastosis (painful breast tumour, not specified if inflammatory or neoplastic) (218); primary agalactia and hypogalactia (219-221). There are claims that AP is effective in mastitis and agalactia in animals. Because of different anatomy/nerve supply, points for mammary disorders in animals are different to those in women.

URINARY DISORDERS: AP is effective in nephritis, cystitis, urethritis, urolithiasis and disorders of diuresis and micturition. BL23, GB25 and KI01 are especially effective for kidney function. AP at KI01 in dogs reduced diuresis (KI function). AP at BL23 blocks the effect of KI01 and adjusts diuresis (222). AP at BL23 markedly increased diuresis (urine, Na and Cl excretion) in men (223). AP was effective in limiting proteinuria and curing nephritis in HgCl2 toxicity in mice (162). AP was effective in renal colic, urolithiasis. Pain is controlled in minutes and stones are often passed in hours or days (136,224-229). The effects of AP on renal function and ureteral peristalsis can be seen with intravenous pyelography (230). BL28,32; CV03 and SP06 are very effective for bladder function and irritable bladder. The effects of AP on bladder function involve supra-spinal reflexes (83,231,232). AP is effective in cystitis, dysuria, urgency, frequency (233). In monkeys with unstable bladder, AP at SP06 had similar effects to atropine - it reduced or eliminated inappropriate bladder contractions but left normal voiding sequences intact. AP gave fast relief of unstable bladder and function normalised after repeated sessions (234). AP cured "neurogenic" bladder, (incontinence/retention) as in distal symmetrical polyneuropathy (143,235) and in enuresis (21,236,237).

SYSTEMIC OR GENERALISED INFECTIONS: AP activates immune reactions and controls the main symptoms in viral, protozoal, bacterial and fungal infectious diseases in humans and animals. It has a role in these conditions, if only as a support-therapy. AP cures the main signs and symptoms of viral diseases and has antiviral effects via the immune responses. Chronic Epstein-Barr Virus (CEBV) syndrome, also called Chronic Fatigue Syndrome (CFS), is caused by a herpes-type virus that causes an infectious mononucleosis. There is no effective medical treatment but AP at the immunostimulant points plus points for the main symptoms is helpful. AP cured mumps within 1-5 sessions (238); early cases of Herpes Zoster (shingles) within 2-7 days, with no post-herpetic sequelae (30,239). Pain eased within minutes of the first session. In chronic cases (more than 3 months old), the dorsal root ganglia may be scarred and prognosis to AP is poor. The most effective points are SI03 and the "Loo Point" (between BL62 and GB40 (240). AP cured or nearly cured 78% of infantile acute infectious multiple radiculitis. There were no deaths and no sequelae. The results were better than in cases treated without AP (241). AP improved 53% of infectious multiple neuritis, classified as a flaccidity syndrome in TCM (242). Saline injection twice/ day for 7 days at BL13 cured 90% of cases of lobar pneumonia, as compared with an 84% cure rate by penicillin and streptomycin (243). LLLT at Earpoint Lung in mice infected with influenza virus completely inhibited virus replication in lung cells but Earpoint Hypothalamus had no effect (244). Very good results were obtained by AP in AIDS and ARC victims in treating fatigue, depression, general malaise, dyspnoea, sinusitis, night sweat, diarrhoea, lymphadenitis, neurological disorders and pain, as in Kaposi's sarcoma. AP may prevent development of opportunistic infection but it was not successful in treating severe anaemia, which required blood transfusions if the PCV fell <22%, nor did AP prevent the appearance of new Kaposi's sarcoma lesions (245). Results improve when Chinese herbs are used (246).

AP treated and prevented symptoms of malaria if given 2 hours before the expected attack (45,247) and was far better therapy than decocted Herba Artemisiae Chinghao (Chinese herb with antidysenteric effect) but was less effective than nitroquine (248). AP cured 90% of cases of thrombocythaemia following splenectomy in schistosomiasis (249).

AP in gastroenteritis, dysentery, cholera etc has been discussed. EAP at PC06 and LU06 in lung TB cured or improved the haemoptysis (250). Local ES via saline-soa-ked gauze wrapped around the digits and tibia, plus naproxin cured infectious polyarthrosis in parrots which had failed to respond to medication (251).

POST-INFECTION SEQUELAE: The prognosis for successful AP treatment of post-herpetic neuralgia was good in younger patients, with more recent pain of lower intensity, but was bad in older patients with severe pain of long duration (252). Carbamacepine or carbamacepine plus AP-injection was used in Post-Distemper Epileptiform Seizures (PDES) and Idiopathic Epilepsy (IE) in dogs. AP cured early IE and enhanced the curative effects of carbamacepine in IE. Neither was effective in PDES, probably because of irreversible brain damage in PDES (253). AP was very effective in 63-89% of post-polio paralysis (254-257).

THERMOREGULATION, FEVER: Fever points include GV13,14,20; LI04,11; ST36 and Earpoints ShenMen, JiaoGuan, Lung, Ear Apex (258-260).

ALLERGY, HYPERSENSITIVITY: AP was successful in allergies, including cardiovascular (migraine), respiratory (asthma, rhinitis, hayfever), digestive (colitis, enteritis, ulceration) and cutaneous (eczema, itch).

SKIN ALLERGY: Bilaterality of signs or symptoms indicates brain or spinal mediation. SI03 and the "Loo Point", alone or combined with Source and GV Points, can help in such cases (Herpes Zoster, neurodermatitis, eczema, psoriasis, pityriasis rosea, dyshidrosis of hands and feet, diffuse granuloma annulare) (240,261). Segmental AP inhibited histamine-induced pruritus. Extra-segmental AP had no effect. The results suggested that AP could be effective in pruritic conditions (262-263). Uraemic pruritus is difficult to treat medically but EAP or laser-AP was successful (264). AP was much better than herbs and western drug therapy in treating acne (265). AP, L-phenylalanine or DPA enhanced immune response, as assessed by enhanced delayed type hypersensitivity to di-nitrofluorobenzene in mice (266). AP was effective in pruritus vulvae (267). Scleroderma is very difficult to cure by conventional methods. AP of the lesion and AP point injection with herbal extracts improved 97% of cases (33). AP and EAP are preferable to conventional methods of treating focal scleroderma (268).

RESPIRATORY ALLERGY: More than 60 papers on AP in chronic obstructive pulmonary disease (COPD) in the previous 10 years were reviewed (269). 70-97% of >18,400 cases were cured or improved. AP and moxa increased immunity to infections, decreased allergic reaction and regulated the ANS. AP (270-272), EAP (273), injection-AP (274), plum-blossom AP and cupping (275), laser-AP (276), moxa followed by application of a mixture of Ginseng, gentian violet and white mustard powder (277) and catgut embedding (278) improved 53-90 of COPD cases. Best results were in mild cases of bronchitis and bronchial asthma. Steroid dependent cases improved less. Success was associated with shorter hospitalisation, improved subjective symptoms, general well-being, improved respiratory function, oxygen cost, ease of breathing and walking distance, increased sputum secretion, normalised serum immunoglobulins and cessation of medication or decreased use of some or all previously required drugs (steroids, mucolytics, antibiotics, amino-xanthines, beta-agonists, sedatives, aerosols and nebulisers) except in attacks of dyspnoea or lung infections. AP (187, 279-283), thermal-AP (284), AP + moxa + cupping (285), Earpoint-AP (283), LLLT (286), "Festering" or scarring moxa (moxa over garlic- or ginger- juice) (287-289) improved 65-100% of bronchial asthmatics. AP with warming moxa was more effective than AP with cupping (290). The therapeutic effect of AP in asthma may be by reflex and humoral effects (279). Others also confirmed that AP was beneficial in asthma (291,292). In children with exercise-induced asthma, AP and sham-AP attenuated exercise-induced asthma but real AP was more effective (293,294). Salbutamol spray was less effective after real AP, as there was less bronchoconstriction at the end of challenge (293). AP, EAP or cesium chloride plasters were effective in resistant allergic rhinitis (283,295-298).

AUTO-IMMUNE DISEASE: AP and moxa decreased steroid use and improved the symptoms and signs of Systemic Lupus Erythematosus (44,299). Symptoms and signs of rheumatoid arthritis were alleviated by AP (300), AP plus cupping (301), semi-permanent needle, point injection, gold beads or magnets (302-304), festering moxa (305,306) and dietary change. The lesions and pruritus of psoriasis were helped by AP, catgut embedding (307) and dietary change.

Signs and symptoms of multiple sclerosis can be controlled by AP, EAP (308-311) and dietary change, especially removal of wheat products.

Signs and symptoms (exophthalmos, palpitations, nervousness etc) in auto-immune hyperthyroidism (Hashimoto's thyroiditis) can be helped by AP (312-314), point injection (315), moxa (316) and LLLT (286,317,318).

EMERGENCIES, ANAPHYLAXIS, SHOCK: Emergencies include shock (traumatic-, haemorrhagic-, endotoxic-, toxic- and anaphylactic-); convulsions, coma, unconsciousness or collapse from many other causes; CVD, CHD, heatstroke, drowning, poisoning etc. Points for revival include GV26 and KI01. GV26 (or KI01) with PC06 is useful in coma or unconsciousness with cardiac failure. AP, EAP and LLLT was effective in anaphylactic shock (319-321); in experimental haemorrhagic shock (322-324) and protected against damage to myocardial cells (325). The antishock effect of AP, EAP, TENS, moxa or electrocautery at GV26 is via sympathicomimetic cardiovascular responses (326-330). AP at GV26 reversed anaesthetic shock and apnoea within 10-30 seconds (331-336). In circulatory collapse with cardiac arrest, the success rate was 43% but stimulation had to be continued for up to 10 minutes (331). In histamine-induced shock, moxa at CV04 increased cardiac output, peripheral resistance, mean BP, renal plasma flow, glomerular filtration rate, urine flow and excretion of Na, Cl and K ions (337). AP at PC06 and the Four Pass points was successful in treating convulsions (187).

CVD, CEREBRAL PALSY, PARALYSIS: In the acute stage of CVD, AP can help to save life and to reduce sequelae. Points include GV26, whose stimulation causes an immediate and marked increase in brain and cerebral pia mater perfusion (322), similar to that following increase of carbon dioxide, but greater than that following 100% oxygen, in the inspired air (338). EAP at ST09 (over the carotid plexus) or AP at GB34, LI04,11 had similar effects to GV26 (338-340).

Signs and symptoms of acute or recent CVD were cured or improved in 50-95% of cases by AP (341-348), AP plus point injection (349) or EAP (350). Early AP treatment gave better results.

CVD sequelae: Loss of motor or sensory power after CVD may be due to clot persistence, oedema and vasospasm. After the vascular rupture has sealed and BP has stabilised, great improvement may be obtained by methods which (a) increase cerebral oxygenation (local vasodilation and removal of oedema) and (b) increase fibrinolysis. AP can give both of these effects.

When the patient is stabilised, to prevent or treat sequelae, points include Scalp points (351), Meridian points and New Points. Points are chosen according to the signs and symptoms and can be combined with distant points, such as SI03 and the "Loo point" (midway between BL62 and GB40) and points on the affected nerve trunk (261). Points are often used on the "good" limb or on the diagonal of the affected limb. The SHU points of the main channels are useful.

Improving cerebral oxygenation post-CVD: AP relieves spasm in cerebral vessels and increases circulation by improving the elasticity of vessels, improving cardiac pumping capacity and promoting formation of collateral circulation (341). AP or EAP is 56-96% effective, even in cases 6-12 months old (308,328,352-356). Best results were in cases less than 3-6 months old. AP plus moxa is used in weak or fatigued patients (355).

Improving fibrinolysis post-CVD: Blood clotting time is reduced in many cerebral thrombosis cases. AP, EAP, LLLT and moxa reduced blood viscosity, decreased fibrinogen and increased clotting time and cerebral arterial flow (357-360).

CVD due to cerebral-arteriosclerosis, infarct: Clinical signs and symptoms in such cases are often reversible. Many such cases have kidney or bladder problems. When these are treated successfully, cerebral functions improve. (Kidney and bladder problems may be the cause of the cerebral signs and symptoms). Headaches may be caused by pelvic, gonadal, vesical or renal problems. Somatic pathology may cause spinal and central signs which resemble arteriosclerosis (361). AP is 60-98% effective in improving organ function in patients diagnosed as infarcted or arteriosclerotic (362-364).

As part of a multiple-modality treatment in cerebral trauma, concussion, AP helped to normalise vegetovascular function (365) and improved 72% of cases (366).

Sequelae of cerebral birth injury include blindness, deafness, paralysis and muscle spasms. AP at BL01,02; ST02; LV03; LI04; GB20,37 cured 100% of children with cortical blindness (367). Brain-damaged children were helped by acupressure (368) and Scalp EAP helped 94% of cerebral palsy cases (356).

Points for spinal disorders (disc disease, spondylitis, paralysis from oedema or bleeding in the cord etc) include Trigger Points (TPs), local points, key points such as: BL40 and GB34 for lumbar spine (369); GV14, BL40 for thoracic spine; SI03, ST38 for cervical spine. SI03 and the "Loo Point" alone or with other points (especially GV points and Source points) has been up to 90% successful for diseases of all parts of the spinal cord, including pain; paraesthesia; tremors; paralysis in polio or trauma (261).

ONCOLOGY, CANCER THERAPY, CHEMOTHERAPY AND RADIATION SICKNESS: Immunocompetence is decreased in cancer (370-372). Chemo- and radio- therapy may depress it still further (373). Therapy which enhances local or general immune response or influence local microclimate may influence metabolism in neoplastic tissue. Direct application of heat, cold, ionizing radiation or chemicals to cancerous tissue changes its micro-environment. Electrothermal needling of transplantable carcinoma in mice cured 50-88% and 70-90% of tumours regressed (374). Direct current applied to cancerous tissue shows promise (375). Aberrant cells are killed selectively (cytotoxic effect) or replication is halted. Local lysis, change of local ionic composition, peripheral micro-thrombosis, reduced fuel- or blood- supply to the cancer and activation of humoral and local cellular immune responses (chemotaxis, phagocytosis etc) may be involved. AP, LLLT, moxa and herbs have a role as a primary or secondary therapy in cancer (376-379). AP increased immune responses (370,372,376,380,381), normalised ERFC and counteracted the immunosuppressive effect of radiotherapy (372,373). Laser-AP promoted immune responses and gave direct and indirect results in cancer therapy (382). Microwave-AP was more effective that chemotherapy. It had marked therapeutic effect on leucopenia resulting from radio-therapy (381). AP helps differential diagnosis of cancer (383). AP, EAP, point injection, TENS etc can give analgesia in patients with cancer pain (384-389), even when physiotherapy, conventional analgesia, radiation- and chemo-therapy give little or no relief (390,391) or when narcotic analgesia causes undesirable side effects (386,387,391,392). They can also control secondary symptoms (384,392). AP analgesia was used successfully to facilitate radiosurgical therapy of cancer (insertion of radium needles in neoplasms of the oral cavity). Post-op analgesia lasted 24-48 hours. Local tissue healing was enhanced (393). Side-effects of cancer therapy (oncosurgery, cytotoxic anticancer drugs, radio-sensitizing drugs and ionizing radiation) may be so severe as to hinder the patient's treatment (394). The side-effects can be treated or prevented by AP, EAP, moxa or LLLT therapy (31,246,394-399). Radiation sickness can be treated or prevented successfully by AP, EAP and moxa (12-16,400, 401).

The following is an example of new claims from Chinese sources: 2% cesium chloride cream was applied to the AP points. The plaster was renewed every 2-3 days. The method was used in >2500 cases, including pain, trauma, chronic rhinitis, asthmatic bronchitis, enuresis and primary hypertension. It gave results similar to those of AP and therapeutic effects usually appeared in 15-30 minutes when the correct points were treated (296). Similar success was reported in 70 cases of pain and skin diseases when lithium chloride cream was applied to AP points or to the lesion, or when cream with 20% urea was applied to painful areas or skin lesions and in 80 cases of anal fissures or colic due to intestinal fissure when suppositories containing 100 mg urea were used (188). Oral or rectal lithium was effective in meno-metrorrhagia, acute dysentery, rectitis, colitis, anal fissure, haemorrhoids, constipation, mild precordial pain, colic due to intestinal adhesion, bipolar affective disorders, granulopenia, shoulder pain but had no effect in backpain and acute cystitis. Lithium, cesium and urea are acetyl choline esterase (AChE) activators. Their clinical effects may be mediated by the biphasic AChE-activation system. AP Channels and Points may be an interconnecting network of tissue rich in AChE isoenzymes and receptors and clinical effects of AP are mediated by that system (188, 402).

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