The selection of dermatomes for sham (placebo) acupuncture points is relevant for the outcome of acupuncture studies: a systematic review of sham (placebo)-controlled randomized acupuncture trials.

BACKGROUND: Many randomized controlled trials (RCTs) of acupuncture reveal no significant differences between acupuncture and so-called placebo acupuncture. There is a strong tendency to replace the term "placebo" by the term "sham," because any needling stimulates a certain physiological response. However, neither concept accounts for the great diversity of results in RCTs comparing verum acupuncture and sham (placebo) acupuncture. Some trials have shown little or no difference, while other studies have found statistically significant differences. OBJECTIVE: Verum acupuncture and sham (placebo) acupuncture may achieve similar results to the extent that they share active constituents. We identified these common active constituents as dermatomes: the segmental structure of the human body. In our study, we tested the hypothesis that the more verum and sham (placebo) acupuncture share the same dermatomes, the closer the clinical outcomes will be, and vice versa. METHODS: All major databases were searched for RCTs that tested acupuncture versus sham (placebo) acupuncture. The dermatome charts of Hansen and Schliack were used to verify verum and sham (placebo) needling locations. Reported clinical outcomes were assessed in relation to the percentage of overlap between the dermatomes stimulated by acupuncture and sham (placebo) acupuncture. RESULTS: Our literature search yielded a total of 1738 references. Thirty-four studies met the inclusion criteria. The effects of sham (placebo) acupuncture varied according to the dermatomes stimulated: high overlap with those stimulated by verum acupuncture resulted in almost identical efficacy, while low overlap resulted in significant differences in efficacy. Clinical outcomes were similar when verum acupuncture and sham (placebo) acupuncture shared the same dermatomes (p < 0.01). DISCUSSION: The findings of this review confirm our hypothesis. Acupuncture studies that employed verum and sham locations on overlapping dermatomes helped to create a mediocre to negative picture of acupuncture's efficacy. The segmental structure of the body with its interconnected reflex system offers an additional neurophysiological explanation for the effectiveness of acupuncture applied to structures segmentally innervated by the spinal and visceral nervous system. Further comparative acupuncture studies should be based on knowledge of segmental anatomy. In testing verum acupuncture versus sham acupuncture, the chosen sham acupuncture needling locations should be situated on non-overlapping dermatomes.

Dermatitis artefacta: keloids and foreign body granuloma due to overvalued ideation of acupuncture.

Skin is well recognized as an important somatic mirror of one's emotion and a site for the discharge of one's anxieties. We present a case of a 42-year-old female patient presenting with a vague history of generalized body pain and skin lesions in the form of cotton threads buried under the skin, crusted plaque, multiple keloids and rusted pin buried through the skin mostly in the easily accessible areas of the body. Histopathology from the crusted plaque revealed foreign body granuloma. To satisfy her psychological or emotional need, it is the deliberate and conscious production of self-inflicted skin lesions through overvalued ideation of acupuncture on her part.

Testing strategies to reduce diarrhea in persons with HIV using traditional Chinese medicine: acupuncture and moxibustion.

Diarrhea affects more than 60% of persons living with HIV/AIDS. Diarrhea can be caused by pathogens, neoplastic diseases, side effects of medications, malabsorption, and/or enteropathy. Activities of daily living and quality of life are often affected by HIV/AIDS-related diarrhea. Traditional Chinese medical interventions such as acupuncture and moxibustion show promise in the area of gastrointestinal symptom management. The purposes of this study were to (a) determine the influence of acupuncture and moxibustion in reducing the frequency of diarrhea and increasing stool consistency in HIV-infected men with chronic diarrhea (defined as three or more episodes of watery, liquid, or loose stools in a 24-hour period for 3 weeks or more), (b) ascertain the feasibility of the methodology for a future prospective randomized controlled trial, and (c) determine sample size estimate for a prospective randomized controlled trial. Using a time-series design, 15 HIV-positive men with chronic diarrhea received the same acupuncture/moxibustion treatment for six sessions over a 3-week period. Each participant maintained a daily stool frequency/consistency and medication diary. All treatments were administered by a licensed acupuncturist trained in traditional Chinese medicine. Based on the intent to treat analysis comparing the change in stool frequency from baseline (Week 1) to Week 3 and Week 4, stool frequency reduced approximately one episode per day (Week 3: p < .001; Week 4: p < .005). Stool consistency also improved, from baseline to Week 3 and Week 4, by more than 1 point on Hansen's stool consistency scale. Acupuncture and moxibustion are promising modalities for the symptom management of chronic diarrhea in HIV/AIDS. The results of this pilot study also establish the feasibility of a larger study and provide the empirical basis to serve as preliminary data from which to estimate statistical power and sample size for a larger efficacy study, inclusive of women as well as men.

The usefulness of acupuncture in leprosy.

The damage to motor nerves in leprosy causes imbalance at various joints and these postural alterations result in various deformities. Active exercises which can prevent disuse atrophy of muscles, are not possible when the muscles are completely paralyzed. Needleless electroacupuncture produces electric impulses similar to nerve impulses. Electroacupuncture done at the correct acupuncture points can give active exercises to the paralyzed muscles and thus prevent disuse atrophy of the paralyzed muscles. Electroacupuncture can serve as the most effective physical therapy to prevent and treat early deformities such as claw hand, foot drop, trophic ulcer, etc. Acupuncture can give relief from the neuritic pain in leprosy.

Where health is patriotism. Visit of New Zealand medical delegation to China: 20 August-9 September 1974.

PIP: At the invitation of the Chinese government a New Zealand delegation visited the People's Republic of China to observe medical administration and public health. The use of "barefoot doctors" and the integration of western and traditional medicine has led to a revision of the organization of medical care. Acupuncture has been implemented for anesthesia, diagnosis, treatment and drug addiction. Herbal medicine, treatment of fractures and burns and cupping and mixibustion are additional methods of treatment employed with success by the Chinese. The emphasis on preventive medicine has led to education of the people and "barefoot doctors" and to the elimination of various pests such as flies, mosquitoes, rats, bedbugs the semination of a wide range of endemic bacterial and viral diseases such as plague, cholera and leprosy and the elimination of diseases such as malaria, hookworm and venereal diseases. Population control is emphasized in schools (premarital sex is strongly disapproved of) and through the revolutionary philosophy that women can only gain equality when they are freed from endless childbearing. Birth rates have been reduced to 6.5 per 1000 in urban Shanghai. Medical training has been shortened to 3 1/2 years and is taught with the philosophy that it will be used to serve the people.^ieng