Philip Niño Tan-Gatue
Acupuncture for Crohn’s Disease
Australia’s Centre for Digestive Diseases (link) defines Crohn’s as:
Crohn’s Disease causes inflammation of the bowel. It most commonly affects the lower small intestine (ileum) and the large intestine (colon), but may involve any part of the digestive tract from the mouth to the anus. The inflammation extends through the entire thickness of the bowel wall. Such inflammation can cause abdominal pain, diarrhoea and a range of other symptoms including fever and weight loss.
Signs and Symptoms include:
The most common symptoms associated with Crohn’s Disease include abdominal pain, often in the right lower quadrant, and diarrhoea. Rectal bleeding, loss of appetite, fever and weight loss may also occur. Bleeding may persist and cause anaemia. Because Crohn’s is a chronic disease, patients will experience periods of aggravation of symptoms and other periods of remission. During periods of active symptoms, patients may experience fatigue, joint pain and skin problems. Some patients may experience symptoms ranging from mild to severe. Children with Crohn’s Disease may suffer delayed development and stunted growth.
It’s a good thing then that acupuncture can help.
image courtesy of cooldesign/freedigitalphotos.com
Acupuncture for Crohn’s Disease
There is this newly published paper (link) is very good proof for acupuncture for crohn’s disease. So how did the study go about?
METHODS: Ninety-two patients were equally and randomly divided into the treatment group and received herb-partitioned moxibustion combined with acupuncture, and the control group received wheat bran-partitioned moxibustion combined with superficial acupuncture. The patients received three treatment sessions per week for 12 wk and were followed up for 24 wk. The main outcome was evaluated using the CD Activity Index (CDAI) score, and the secondary outcomes were evaluated using laboratory indicators such as hemoglobin (HGB), C-reactive protein (CRP), erythrocyte sedimentation rate, quality-of-life, endoscopic ratings, and intestinal histology scores.
What this means was that they took 92 people and effectively flipped a coin to see if they would go to one of two groups. One group is called the treatment group, which got the real acupuncture and moxibustion treatment. The other group is called the control group, which got fake acupuncture and fake moxibustion. As the study says, they got three sessions a week for twelve weeks. They would then be followed up after 24 weeks to see if the treatment took hold.
Incidentally, the evaluation of the experiment was not just a subjective “are you feeling better” questionnaire. In this study, they had an actual, scientifically validated scale in the CDAI score, and laboratory examinations!
Photo courtesy of Ohmega1982 / Freedigitalphotos.net
Acupuncture points used included ST 36, ST 37, SP 4, SP 6, KI 3 and LIV 3, with moxibustion done at CV 6, CV 12 and ST 25. It should be noted that not all points were used in every patient. Chinese Medicine Syndrome Differentiation was used to select the appropriate points for each patient.
So what kind of sham acupuncture was used in this study?
The control group received wheat bran-partitioned moxibustion combined with superficial acupuncture. … The acupoints used in wheat bran-partitioned moxibustion were the same as those used for the treatment group. The procedure of superficial needling at non-acupoints was based on previous studies. Non-meridian and non-acupoint zones located 1-2 cm away from the acupoints of the treatment group were selected for the control group, and an equal number of points were used in each group.
So firstly, they used fake moxibustion with wheat bran. Rich in fiber!
Secondly, they needled very shallowly on non-acupoints. Physiologically, inserting the needle at any part of the body triggers a physiologic reaction. There have been studies that have shown that such needling seems to also trigger a therapeutic effect, and skeptics have pounced on this to try to debunk acupuncture by saying that needling anywhere produces an effect anyway, so why bother with acupoints? What skeptics conveniently ignored was that putting needles was better than not putting needles at all. Also, studies have shown that putting needles in acupoints have produced different effects on a cellular level than putting needles in non-acupoints.
RESULTS: The CDAI scores of both the treatment and control groups were significantly reduced after treatment compared with those measured before treatment. However, the degree of improvement in the treatment group was significantly greater than that of the control group. The improvement in symptoms in patients of the treatment group was sustained at follow-up, whereas that of the control group was not. The overall efficacy of the treatment was significantly greater than that of the control. Both groups demonstrated significant improvements in quality-of-life ratings after treatment, but the improvement was significantly greater in the treatment group than in the control group. In addition, the patients in the treatment group showed significantly increased HGB and significantly decreased CRP levels and histopathological scores at the end of treatment, whereas the control group did not exhibit significant changes.
In plain English, both groups experienced relief. So once again the skeptics will repeat their mantra. However, real scientists already know that there would be some effect just by needling the body, and especially so when needling near the actual acupoints. The significant difference is that the improvement was sustained at follow up whereas the guys with fake treatment had the effects wear off quickly. Also, the laboratory results reinforced the fact that needling in real acupoints is better than needling anywhere.