Five of our articles find different ways of ‘touching a nerve’.

Nerve conduction velocity was the objective way that by Schroeder et al measured the effect of acupuncture on patients with peripheral neuropathy due to chemotherapy. The results look exciting, though readers will be cautious about drawing conclusions since the control patients were self-selected (unable to get to clinics for treatment) and were less severely affected, leaving less scope for change. That said, the cumulative evidence now published suggests that it is time for a rigorous sham-controlled study.

Some readers may share the Editor's ignorance of the word ‘mitempfindung’. It is the phenomenon where touching a nerve at one site produces the sensation of itch at a remote site. Silberstein noted in himself, went on to explore it systematically, and combined his findings with some previously published reports. All this careful work suggests that mitempfindung could be the origin...

I was intrigued by the strange postures adopted by the Ming Dynasty models to illustrate acupuncture meridians, as in the first image. My bathroom has one electric light bulb hanging from the ceiling, and while I was in the bath reaching for soap, I observed a single line of reflected light going up my wet forearm in a direction that depended on the position of my arm. Such a ‘line’ of reflected light can be seen in the model, covered in oil, shown in the second image. Provided the model poses in a similar way to a Ming Dynasty drawing, the pathway of that particular channel can be seen.

(Reproduced from MIMS Magazine Oct (1977) 67–83 with kind permission of the publishers).

Image and text provided by Alex Macdonald

Do you have any interesting images relating to any aspect of acupuncture that...

I have thought for a long time that the phenomenon of referred itch (mitempfindung) might have relevance to acupuncture so I was delighted to see this paper. Silberstein has shown convincingly, albeit on a small number of cases, that the distribution of remote sensations in referred itch is remarkably similar to the location of certain paired channels in the traditional system.1 So what does this tell us?

First, it reinforces what we already knew: the existence of this curious phenomenon must indicate the presence of connections in the nervous system, peripheral or central (or both), that are at present unknown. Whether or not this is directly relevant to acupuncture, it lends plausibility to the claim that inserting needles in various sites may have wide-ranging effects on distant body areas or organs.

Second, it tends to show that the traditional grouping of the channels may not be fanciful...

Chemotherapy-induced peripheral neuropathy (CIPN) can produce severe neurological deficits and neuropathic pain and is a potential reason for terminating or suspending chemotherapy treatments. Specific and effective curative treatments are lacking.

A pilot study was conducted to evaluate the therapeutic effect of acupuncture on CIPN as measured by changes in nerve conduction studies (NCS) in six patients treated with acupuncture for 10 weeks in addition to best medical care and five control patients who received the best medical care but no specific treatment for CIPN.

In five of the six patients treated with acupuncture, NCS improved after treatment. In the control group, three of five patients did not show any difference in NCS, one patient improved and one showed impaired NCS.

The data suggest that acupuncture has a positive effect on CIPN. The encouraging results of this pilot study justify a randomised controlled trial of acupuncture in CIPN on the basis of NCS.

Pruritus is a debilitating aspect of atopic dermatitis (AD). Acupuncture has been reported to diminish pruritus, but self-administered acupressure has not been previously evaluated.

To evaluate the effectiveness of acupressure on the severity of eczema in a pilot trial.

Adult patients with AD were randomised to an intervention group (acupressure with standard of care) or a control group (standard of care alone). Subjects in the intervention group performed acupressure using a 1.2 mm acupellet at the LI11 point, applying pressure for 3 min three times per week for 4 weeks. The severity of itching and AD at baseline and at 4 weeks were measured on a visual analogue scale (VAS), the Investigator's Global Assessment (IGA) and the Eczema Area and Severity Index (EASI).

Fifteen subjects were enrolled, 12 of whom completed the study between November 2009 and May 2011. There was no significant change between baseline and follow-up survey scores within the control group. In the investigation group there was a decrease in the VAS score (p=0.05) and EASI lichenification (p=0.03), although without significant change in the overall EASI score. Comparison of the scores between groups showed a greater decrease in VAS in the experimental group than in the control group (p=0.04), and a decrease in the IGA (p=0.03) and EASI lichenification score (p=0.03). The overall EASI scores were unchanged.

Subjects using acupressure at LI11 for 4 weeks had improvement in pruritus and lichenification. Acupressure may prove to be an easily administered alternative treatment, but larger-scale studies are needed to confirm these preliminary findings.

Acupuncture is rooted in traditional Chinese medicine (TCM) and emphasises individualised treatment according to TCM patterns. Eight TCM patterns are regarded as typical for female infertility. There are no empirical data comparing these patterns in fertile and infertile women.

To identify and compare the TCM patterns and recommended acupuncture points in infertile and fertile women. The hypothesis that infertile and fertile women should differ in occurrence of TCM patterns described as typical for infertility was examined.

A cross-sectional study examined the distribution of TCM patterns and acupuncture points among 24 infertile and 24 fertile women. TCM patterns and points proposed by two acupuncturists were analysed. The odds ratio was used as the effect measure.

Three patterns were found in more than 92% of the women. Five patterns occurred more frequently among infertile (p≤0.03), and four among fertile (p≤0.02) women. Only three of the eight patterns assumed typical for infertile women were more common among infertile women. Two of the eight patterns were more common among fertile women. Acupuncture points KI3, LI3 and SP6 were chosen for almost all women, whereas CV4, CV3 and ST29 were chosen more often for infertile women (p<0.03), and SP3 more often for fertile women (p<0.001).

The data indicate that the presence of some, and the absence of other, TCM patterns are associated with infertility. These results are not consistent with the assumed associations between eight specific patterns and infertility, as maintained by TCM textbooks.

To describe the relationship between referred itch (mitempfindung) stimulus and referral points and acupuncture meridians, noting that the neuroanatomical mechanism of mitempfindung has never previously been satisfactorily explained.

Analysis of clinical findings in the author as well as subjects in four previously described studies, comparing proportions in each of five groups.

Ninety-two per cent (range 85–94%) of mitempfindung point pairs (stimulus and referral) aligned to a recognised acupuncture meridian with no statistical difference (p<0.05) between the five data sources.

While previous authors have speculated on an association between mitempfindung and acupuncture, this is the first description of a relationship between stimulus and referral points and acupuncture meridians. The author suggests that the transmission of mitempfindung along acupuncture meridians may involve a series of C-fibre–Merkel cell relays, with the final referred itch sensation caused by substance P release triggering mast cell degranulation.

The hypoalgesic effect of electroacupuncture (EA) was directly compared with the analgesic effect of pharmacological interventions using the submaximum effort tourniquet technique (SETT).

125 healthy subjects (mean age 24.44±4.46 years; 62.4% female, 37.6% male) performed SETT at baseline and under one of five experimental conditions (n=25 per group): EA (2 Hz with burst pulses in alternating one-phase-square wave pulses; burst length 180 μs, burst frequency 80 Hz, stimulation time/pulse width 3 s), tramadol (50 mg), ibuprofen (400 mg), placebo pill or non-treatment control. EA was performed at LI4 and LI10 contralaterally with stimulation beginning 20 min before SETT and lasting throughout SETT. The pharmacological interventions were given in a double-blind design 1 h before the SETT assessment.

Subjects showed a hypoalgesic effect of the opiate and of the EA for subjective pain rating (EA p=0.0051; tramadol p=0.0299), and pain tolerance index (time/rating) (EA p=0.043; tramadol p=0.047) analysed using analysis of covariance. More subjects reached the strict time limit of 30 min (analysed by logistic regression and adjusted OR as a post-hoc analysis) under EA compared with most other experimental conditions. Only EA and tramadol were not significantly different (95% Wald confidence limits: non-treatment control vs EA 0.011 to 0.542; placebo pill vs EA 0.009 to 0.438; ibuprofen vs EA 0.021 to 0.766; tramadol vs EA 0.065 to 1.436).

In a laboratory setting, an EA procedure was as effective as a single dose of an orally administered opiate in reducing experimentally induced ischaemic pain.

To determine whether any difference exists in responses to indirect moxibustion relative to thermal stimulation sites.

Twenty one healthy men of mean±SD age 22.5±6.1 years were randomly divided into two groups, one receiving a single moxibustion stimulation in three locations (the three-point stimulation group, n=10 participants) and the other receiving three stimulations in one location (the one-point stimulation group, n=11 participants). The thermal stimulation sites were GV14, GV9 and GV4 acupuncture points. A thermograph was used to obtain the skin temperature on the posterior trunks of the participants. To analyse skin temperature, four arbitrary frames (the scapular, interscapular, lumbar and vertebral regions) were made on the posterior trunk.

An increase in skin temperature on the posterior trunk was observed following both one- and three-point moxibustion administrations. The skin temperature of the lumbar region showed a significant increase after three-point stimulation compared with single-point stimulation (p=0.011). There was also a significant increase in skin temperature of the spinal region after three-point stimulation compared with one-point stimulation (p=0.046).

Administration of single moxibustion doses on the GV14, GV9 and GV4 points produces greater changes in skin temperature than three applications of moxibustion to the GV14 point only.

To determine the current perception thresholds (CPTs) for arm and mental foramen areas to enable a quantitative evaluation of the effectiveness of acupuncture treatment.

Ninety-eight volunteers enrolled as participants and were randomly assigned to one of three groups: an acupuncture group (34 subjects); a sham acupuncture group (32 subjects) and a waiting group (32 subjects). CPTs for the arm and mental foramen areas were determined before and after acupuncture at LI4 Hegu of the left hand. A Neurometer CPT was used to evaluate the perception threshold at the homolateral mental foramen and arm. For further exploration, thresholds of homolateral and contralateral mental foramina were determined before and after acupuncture in a subgroup of 13 participants in the acupuncture group.

Acupuncture at LI4 increased the perception thresholds of the left mental foramen in the acupuncture group significantly (p<0.01). The increases were significantly greater than in the control group for all frequencies, and significantly greater than sham acupuncture for 250 Hz and 5 Hz. In the subgroup, only the CPTs at 5 Hz increased significantly for the contralateral mental foramen.

Acupuncture at LI4 increases the perception threshold in the mandibular area, but not in the arm. This finding is probably related to the analgesic effect of acupuncture.

Electroacupuncture (EA) treatment has been shown to increase bone mineral density (BMD) in ovariectomised (OVX) rats; however, the underlying mechanisms remain unclear.

To systematically evaluate the effects of EA on OVX rats and the Wnt/β-catenin signalling pathway.

Three-month-old female Sprague–Dawley rats were randomly divided into three different groups (n=10 each): sham operated control (sham operated), ovariectomy (OVX) and ovariectomy with EA treatment (OVX+EA). Rats in the OVX+EA group received 12-week EA treatments.

Serum bone-specific alkaline phosphatase level (p<0.01), BMD of the proximal femoral metaphysis and the fifth lumbar (L5) vertebral body (both, p<0.05) and maximum load and energy to failure of L5 vertebral body (both p<0.01) were significantly higher in the OVX+EA group than in the OVX group. Trabecular area, trabecular width and trabecular number were significantly higher in the OVX+EA group by 66.9%, 29.2% and 30.3%, respectively, than in the OVX group (all, p<0.01). Trabecular separation was 31.9% lower in the OVX+EA group than in the OVX group (p<0.01). Quantitative real-time reverse transcription polymerised chain reaction indicated that the expressions of mRNAs for low-density lipoprotein receptor-related protein 5 and β-catenin were significantly increased in the OVX+EA group, as compared with the OVX group (p<0.01 and p<0.05, respectively).

This study demonstrates that EA can prevent OVX-induced bone loss and deterioration of bone architecture and strength by stimulating the Wnt/β-catenin signalling pathway. These findings suggest that EA may bet a promising adjunct method for inhibiting OVX-induced osteoporosis in clinical settings.

The anatomical structures vulnerable to acupuncture around the PC6 acupuncture point were investigated. Needles were inserted in PC6 of eight wrists from four cadavers to a depth of 2 cm, the forearms were dissected and the adjacent structures around the path of the needles were observed. The needles passed between the tendons of the palmaris longus and flexor carpi radialis muscles and then penetrated the flexor digitorum superficialis, flexor digitorum profundus and pronator quadratus muscles. The inserted needles were located adjacent to the median nerve. To minimise the risk of unintended injury by acupuncture, it is recommended that needles should not be inserted deeply at the PC6 acupuncture point. An understanding of the anatomical variations of the median nerve and the persistent median artery in the forearm is of clinical importance when performing acupuncture procedures.

PC6 is a classic acupuncture point in traditional Chinese medicine. It is considered to be effective when treating cardiovascular disorders. In the present review the authors have focused on the neurophysiological bases of the effects of PC6 stimulation on cardiovascular mechanisms. Experimental studies have shown that the hypothalamic rostral ventrolateral medulla, arcuate nucleus and ventrolateral periaqueductal gray are involved in acupuncture attenuation of sympathoexcitatory cardiovascular reflex responses. This long-loop pathway also appears to contribute to the long-lasting, acupuncture-mediated attenuation of sympathetic premotor outflow and excitatory cardiovascular reflex responses. Acupuncture of PC6 modulates the activity in the cardiovascular system, an effect that may be attributed to attenuation of sympathoexcitatory cardiovascular reflex responses.

Malaise and fainting are unpleasant acupuncture adverse effects. This paper shows how the use of thermography might identify subjects before the systematic responses become clinically significant.

Central neuropathic pain is a common debilitating symptom in patients with multiple sclerosis. Side effects of analgesics often limit reaching therapeutic dosages. In this case report, a 61-year-old woman with chronic central neuropathic pain due to multiple sclerosis is described. Acupuncture could only partly and temporarily reduce the pain. However, after adding the natural compound palmitoylethanolamide, a glial modulator and peroxisome proliferator-activated receptor-α agonist, pain reduction was more pronounced and the interval between acupuncture sessions could be increased. A multimodal stepped care approach is demonstrated, with acupuncture and palmitoylethanolamide both influencing non-neuronal cells, such as activated glial cells, which are key factors in the development and maintenance of neuropathic pain.

A case of recurrent sudden sensorineural hearing loss in the right ear is presented. The patient was a 58-year-old Chinese woman with profound hearing loss, a feeling of fullness in the ear, vomiting and severe dizziness for 2 months. A head scan and MRI of the brain and neck showed no cause for the symptoms. The ear, nose and throat specialist diagnosed a microcirculatory dysfunction, rejecting the diagnosis of Meniere's disease. The patient did not respond to medical treatment and after 2 months attended for acupuncture. It was suspected that the severe dizziness was associated with her neck and back pain. Daily electroacupuncture treatments to her ear, back and neck were given. After 1 month the dizziness was significantly reduced and the hearing loss recovered to a good level. The patient's symptoms recurred after exposure to cold and strong wind and again recovered with acupuncture. She later suffered a third recurrence of severe dizziness which again responded to acupuncture.

Acupuncture is believed to have a positive effect on wound healing. A case is presented in which the healing of a leg ulcer which proved to be difficult to treat coincided with the added treatment modality of needling healthy tissue surrounding the lesion. It raises questions about the potential effect of local dry needling on tissue regeneration.

Deering BM, Fullen B, Egan C, et al. Acupuncture as an adjunct to pulmonary rehabilitation. J Cardiopulm Rehabil Prev 2011;31:392–9.

A three-arm study (n=60) of acupuncture as an adjunct to an intensive pulmonary rehabilitation programme.

A randomised controlled trial (RCT) in participants who fulfilled the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria for severe chronic obstructive pulmonary disease (COPD). Nineteen controls had no specific intervention; 25 underwent physical rehabilitation (PR) alone and 16 had both acupuncture and PR. Intensive PR consisted of twice weekly attendances for exercise and education over 2 h, plus inspiratory muscle training and unsupervised home exercise on 3 days each week. Additional acupuncture consisted of seven once a week sessions (immediately after a PR class), using points LI11, LI10, TE10, TE6, LU5 and LU7. Stimulation details are not reported. The control group duration...

Beginning to practice acupuncture may at times be overwhelming with so many points to remember. The anatomical positions of over 380 classical acupuncture points would be challenging for a fair few of us to keep at the forefront of our memory, especially those which are used less frequently. How helpful to have such a book available to provide an aide memoire!

Christopher Norris is obviously an experienced practitioner given his role as approved tutor for the Acupuncture Association of Chartered Physiotherapists, and his position on the British Acupuncture Council. He has written a book, now in its second edition, to provide a handy reference for other practitioners.

Although slightly larger than the average pocket, this is a neat, portable light weight book which is helpful for those requiring a little help with remembering specific point locations during busy clinics. It is written...

In an earlier article,1 I proposed a theory and described the supporting evidence for the pathways for the possible influence of tumour necrosis factor α (TNFα) on maternal breast milk and its influence on the pathophysiology of infantile colic. I emphasised how the increased TNF levels of a breastfeeding mother affect TNF, melatonin and serotonin levels of a colicky baby, and examined evidence for the direct and indirect regulatory effects of acupuncture over TNFα, serotonin and melatonin levels, and thereby infantile colic.

In a commentary on my paper,2 Reinthal et al stated that ‘Even if TNFα does play a role, this does not explain why children who are formula-fed may suffer from colic.’ However, it has been demonstrated that, compared with human milk-fed infants at 2 weeks, formula-fed infants produced (statistically significantly) more TNFα.3 Moreover, if the formula contains long-chain polyunsaturates, the levels...