l’acupuncture comme support - onkologiepflege.ch · altern ther health med. 2004 jan-feb;10(1)...
TRANSCRIPT
LrsquoACUPUNCTURE COMME SUPPORT DANS LES TRAITEMENTS
ONCOLOGIQUES
Dr Hongguang DONG 5e Journeacutee romande de formation continue ndash Soins en Oncologie Vaud-Valais
Sion 05 Sept 2014
42 of Americans receive care from CAM instead of
allopathic medicine and this figure is increasing (Eisenberg
et al N Engl J Med 1993 Jan 28328(4)246-52)
46 Medical doctors in Swiss Romande use CAM for
themselves (Domenighetti et al Med Hyg 2000 58570-2)
80 of American women (age 45-60) use CAM for
menopausal symptoms (Kang et alInt J Gynaecol Obstet 2002
Dec 79(3)195-207)
Prevalent use of Complementary
and Alternative Medicine (CAM)
Complementary and alternative medicine use by women after
completion of allopathic treatment for breast cancer
Telephone interviews were conducted with 551 females in the
Portland Oregon metropolitan area who had been diagnosed
with breast cancer an average of 35 years earlier
Two-thirds (66) of the women used at least one CAM
therapy during the previous 12 months and the majority of
them perceived that their CAM use was without the
recommendation of their doctor Relaxationmeditation herbs
spiritual healing and megavitamins were used most often
Significant predictors of CAM use included younger age
higher education and private insurance The majority of the
CAM therapies were perceived by their users to be at least
moderately important in remaining free of cancer
Altern Ther Health Med 2004 Jan-Feb10(1)52-7
Use of complementary and alternative medicine by
chinese women with breast cancer
1065 breast cancer women were analyzed in urban
Shanghai Patients average age at diagnosis was 481 years
and the median time from the initial diagnosis to the
follow-up survey was 43 years
Overall 98 of patients had used at least one form of
CAM therapy after diagnosis of breast cancer The most
popular CAM modality was traditional Chinese medicine
(867) followed by the use of supplements (848)
physical exercises (655) and support group attendance
(166) CHM was used by 864 of patients while
acupuncture was used only by 49 of patients
Breast Cancer Res Treat 2004 Jun85(3)263
Chinese Medicine
an overview
Unique theory system
Concept of Wholism
Individual Treatment based
on syndrome
Variety of treatment methods
based on nature
天人合一mdash整体观
Unity of Heaven and Man--Holism
bull 人与自然是一个整体
bull Human beings and nature are taken as a whole
bull 人与社会是一个整体
bull Human beings and society are taken as a whole
bull 人本身各系统之间是一个整体
bull The various systems in the human body are inter connected as a whole
bull 天地人相参
bull Heaven earth and human beings interact and correspond with each
other
Fundamentals of TCM
bull The material basis of the human body
Qi Blood Jing Jing-ye
bull The concept of Yin and Yang
bull The theory of f ive elements Wood Fire Earth Metal Water
bull The theory of Zang-Fu
bull The pathways of the human body Meridians
Five Elements Theory
Types of Qi and their origins
Zong Qi
Gathering
Qi
Lungs
process
air
Spleen
process
food
Kong Qi
Air Qi
Gu Qi
Grain Qi
Yuan Qi
Original
Qi
Zheng Qi
Normal
Qi
Ying Qi
Nutritive
Qi
Wei Qi
Defensive
Qi
Zang Fu
Zhi Qi
Organ Qi
Human body
Heart ruler of all organs in charge of blood circulation and mental activity
Cardiovacular and certain parts of higher nervous systerm
Liver laquoa viscus of temperamentraquo stores blood secretes bile and controls muscles
Centrals nervous and autonomous nervous systems
Spleen transforms and transports nutrients and water nourishing the muscles and limbs
and determining the bodyrsquos constitution protects the body against pathogen
Digestive and immune systemsas well as the functional system in charge of energy and water metabolism
Lung respiration cotrols vital energy and superficial body resistance regulates circulation of body fluid
Respiratory system part of immune system also related to water metablism
Kidney works to secrete urine store essence of life either inborn or acquired in charge of reproduction growth and development replenishing the brain nourishing the bones and producing marrow helps the lung inhale air
Related to the urogenital systemendocrine system (particularly the pituitary-adrenal and pituitary and gonadal axes) a part of immune system and higher nervous system
The causes of the diseases
Endogenous pathogenic factors
Seven emotions joy anger worry anxiety sorrow
terror and fright (Colegravere Joie Soucis Affliction et
Chagrin Angoisse Effroi)
Exogenous pathogenic factors
Six Excesses (Climatic changes) wind cold summer
heat dampness dryness fire
Epidemiques Trauma Inadequate diet
ETIOLOGIE EN MTC
CANCER EN MTC
bull Les tumeurs reacutesultent dun deacuteseacutequilibre dans le corps ou entre le corps et lenvironnement exteacuterieur
bull Les tumeurs sont dues agrave des changements qualitatifs et irreacuteversibles dans la structure ou la fonction de Zang Fu Qi et du Sang ou de LO
bull Si il y a carence les facteurs pathogegravenes envahissent profondeacutement le corps et si elle persiste la lutte entre le Froid et la Chaleur peut endommager la chair
bull Si les facteurs pathogegravenes ne peuvent pas ecirctre dissipeacutes ceci conduira agrave la formation de tumeurs
LES ELEMENTS CLES DANS LE DEVELOPPEMENT DE TUMEUR DANS MTC
bull 1- stagnation de Qi et la stase du Sang
bull 2- accumulation des Toxines lieacutees agrave la Chaleur
bull 3- deacuteficience de Qi Vital
bull 4- toutes les maladies proviennent des Glaires la plupart des masses qui se produisent dans le corps sont dues aux Glaires
Clinical Guide
bull Principle of diagnosis Diagnosis of disease
Syndrome differentiation
(individulized treatment)
bull Methods
Inspection Auscultation and Olfaction Interrogation Palpation
bull Intervention modalities
Chinese medication Acupuncture Qigong Tuina Dietary
(nutrition)
Treatment
The goal of treatment is to adjust and harmonize Yin and Yang
This is achieved by regulating the Qi Moisture and Blood in the Organ Networksweak organs are tonified congested channels are opened
excess is dispersed tightness is softened agitation is calmed heat is cooled cold is warmed dryness is moistened and dampness is drained
Preventive treatment of Progression of
Disease
《难经middot七十七难》ldquo所谓治未病者见肝之病则知肝当传之于脾 故先实其脾气无令得受肝之邪故曰治未病焉rdquo
重视疾病的传变规律ldquo先安未受邪之地rdquo 痰毒瘀结是肿瘤转移的关键流窜经络脏腑是其特点对于肿瘤的转移预防比治疗更有现实意义
laquo Classique des Problegravemes meacutedicaux raquo chap77 rdquoSi le Foie est malade il peut attaquer la Rate Par conseacutequent la Rate doit ecirctre fortifieacutee avant qursquoelle ne soit elle-mecircme affecteacutee raquo
Acupuncture
Bronze Model for the Meridians and
Acupuncture Points
(Qing Dynasty 1744)
An insight into acupuncture
Concept of Yin Yang
Holism
Five element theory
Human body
About Qi Formation of Qi
Function of Qi
Disharmony of Qi
Meridians - the pathways of the body
Techniques and methods
Meridian pathways of the Body
bullComponents bull 12 regular meridians
12 Collaterals
8 extraordinary meridians
Functions Connect and coordinate
creating an integral whole
Transporting functions
Spleen Meridian
Techniques and methods
Manual (Classic) Acupuncture
Electric-Acupuncture
Acupuncture and Moxibustion
Laser Acupuncture
Ultrasound Acupuncture
Acupuncture and the Moxibustion
Cupping Therapy
Indications
In 1979 WHO named 43 different diseases that can be
treated by Acupuncture
Upper Respiratory Tract
Acute sinusitis
Acute rhinitis
Common cold
Acute tonsillitis
Respiratory System
Acute Bronchitis
Bronchial asthma
Disorders of the Eye Acute conjunctivitis
Central retinitis
Myopia (in children)
Cataract (without
complications)
Disorders of the Mouth Toothache
Post-extraction pain
Gingivitis
Acute and chronic pharyngitis
Journal of World Health Organisation Dec1979
Known biological effects of
acupuncture
bullAcupuncture multiple biological responses
bullOccur locally or at a distance mediated by sensor neurons to many structures of the central nervous system -- leads to activation of pathways affecting various physiology systems in the brain as well as periphery Attention has been focused on the role of endogenous opioids in analgesia and anesthesia
bullActivate the hypothalamus and pituitary resulting in a broad spectrum of systemic effects
bullAlteration in secretion of neurotransmitters and neurohormones that causes changes in the regulation of blood flow both centrally and peripherally
bullEvidence of alteration of immune functions NIH Consensus Statement Online 1997 Nov 3-5 month day] 15(5)1-34
LES TRAITEMENTS
bull 1-la stagnation de Qi et la stase du Sang
bull dynamiser le sang et transformer la stase du sang
bull 2- accumulation des Toxines lieacutees agrave la Chaleur
bull clarifier la chaleur et deacutegager la Toxiciteacute
bull 3- deacuteficience de Qi Vital
bull soutenir le Qi Vital et cultiver la racine
bull 4- toutes les maladies proviennent des Glaires la plupart des masses qui se produisent dans le corps sont dues aux Glaires
bull transformer les Glaires et ramollir la dureteacute
Dans le diagnostic et le traitement des tumeurs la MTC considegravere leacutetat geacuteneacuteral du patient plutocirct que de se focaliser sur le cancer lui-mecircme ou les symptocircmes particuliers
Soutien psychologique
bull angoisse devant lrsquoinconnu
bull angoisse devant la douleur
bull angoisse devant le deacuteveloppement de la maladie et la perte de controcircle sur son propre corps
bull angoisse devant les effets secondaires dus aux divers traitements
bull angoisse devant les complications tardives dues aux divers traitements
bull angoisse devant le regard social porteacute sur le malade
bull angoisse devant la mort
Soutien psychologique
Ces informations reacutesonnent agrave lrsquointeacuterieur du patient ougrave elle
provoquent des dysfonctionnements qui
peuvent se manifester par
bull des maux de ventre
bull des palpitations
bull des troubles du sommeil
bull des difficulteacutes respiratoires
bull des douleurs diverses etc
Nauseacutees et vomissements
RAPPEL LrsquoEstomac
bull YANG
bull Controcircle le mucircrissement amp pourrissement de la nourriture
bull Controcircle le transport des essences de la nourriture Gouverne la descente du Qi fait descendre la nourriture transformeacutee vers lrsquoIntestin Grecircle
bull Si le mouvement de descente est perturbeacute par les pervers si il y a un mouvement ascendant de QI de lrsquoEstomac (agrave contre-sens- NI) il y a des VOMISSEMENTS
Nauseacutees et vomissements
LES VOMISSEMENTS SE MANIFESTENT QUAND LE QI DE LrsquoESTOMAC MONTE A LA PLACE DE DESCENDRE
Neuropathie
Avastine Xeloda Gemzar Cysplatine Taxol Fludara Alimta Procarbazine
points GI2 3 4 IG 2 3 C7 MC6 8 P7 9 F2 3 V60 VB41
traitement
preacutevention
LA DOULEUR DUE AU CANCER
bull Etiologie et physiopathologie
bull Lrsquoinvasion des pervers Externes - tout pervers srsquoil persiste peut provoquer le blocage des meacuteridiens et par la suite une stagnation de Qi et de Sg ou des troubles de Zang-Fu
bull Le deacuteregraveglement des eacutemotions
bull Le deacuteseacutequilibre de lrsquoalimentation
bull Une faiblesse de constitution
DIFFEacuteRENCIATION DE LA DOULEUR
SELON LA LOCALISATION bull dans le cancer du poumon souvent une sensibiliteacute au
P1 et V13 accompagneacutee de toux et de souffle court bull dans le cancer de lrsquoœsophage ou de lrsquoestomac une
sensibiliteacute au E34 et E42 accompagneacutee de nauseacutees dysphagie inappeacutetence
SELON LE VIDE ET LA PLEacuteNITUDE bull Vide douleurs souvent leacutegegraveres intermittentes
sourdes bull Pleacutenitude douleurs tensives lancinantes coliques
aigues
LA FATIGUE
XU LAO = fatigue par Vide = lrsquoeacutepuisement En Occident crsquoest le symptocircme le plus souvent invoqueacute et pas toujours ducirc au Vide
LA FATIGUE - eacutetiologie
bull La faiblesse constitutionnelle
bull Le surmenage
bull Lrsquoexcegraves drsquoactiviteacute physique
bull Lrsquoalimentation
bull Les maladies graves
bull Lrsquoexcegraves drsquoactiviteacute sexuelle
bull Lrsquoaccouchement
bull La consommation de drogues
LA FATIGUE - pathologie
bull Vide
bull Combinaison de Vide et de Pleacutenitude
bull Pleacutenitude
Contre-indications agrave lrsquoacupuncture
bull Des risques de laquo gros bras raquo apregraves curage axillaire
bull Des opeacuterations selon Halsted ou Patey
bull Des drainages lymphatiques
bull Pas drsquoaiguille du cocircteacute opeacutereacute
TCM in cancer treatments
bull Used mostly as adjuvant therapy before or during or
after surgery radiotherapy and chemotherapy
bull Remit the side-effects and toxicity of other treatments
bull Symptom control
bull Activate and strengthen immune system
bull For advanced cancer patients mainly palliative but it
can also prolong life in some cases
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 15 Number 7 2009
Acupuncture for Chemotherapy-Induced Neutropenia in Patients with GynecologiMalignancies A Pilot Randomized Sham-Controlled Clinical Trial
Weidong Lu MB MPH LicAc1ndash3 Ursula A Matulonis MD4 Anne Doherty-Gilman MPH1 Hang ScD3
Peter M Wayne PhD23 David S Rosenthal MD14 and Richard T Penson MD6
bull Abstract bull Objectives The objective of this study was to investigate the effect of acupuncture administered during mye-
losuppressive chemotherapy on white blood cell (WBC) count and absolute neutrophil count (ANC) in patients with ovarian cancer
bull Design This study is a pilot randomized sham-controlled clinical trial Patients received active acupuncture versus sham acupuncture while undergoing chemotherapy A standardized acupuncture protocol was em- ployed with manual and electrostimulation The frequency of treatment was 2ndash3 times per week for a total of 10 sessions starting 1 week before the second cycle of chemotherapy
bull Setting The setting was two outpatient academic centers for patients with cancer bull Subjects Twenty-one (21) newly diagnosed and recurrent ovarian cancer patients were the subjects bull Outcome measures WBC count ANC and plasma granulocyte colony-stimulating factor (G-CSF ) were assessed
weekly bull Results The median leukocyte value in the acupuncture arm at the first day of the third cycle of chemotherapy
was significantly higher than in the control arm after adjusting for baseline value (8600 cells=mL range 4800ndash 12000 versus 4400 cell=mL range 2300ndash10000) ( p frac14 0046) The incidence of grade 2ndash4 leukopenia was less in the acupuncture arm than in the sham arm (30 versus 90 p frac14 002) However the median leukocyte nadir neutrophil nadir and recovering ANC were all higher but not statistically significantly different ( p frac14 0116ndash016) after adjusting for baseline differences There were no statistically significant differences in plasma G-CSF between the two groups
bull Conclusions We observed clinically relevant trends of higher WBC values during one cycle of chemotherapy in patients with ovarian cancer which suggests a potential myeloprotective effect of acupuncture A larger trial is warranted to more definitively determine the efficacy of acupuncture on clinically important outcomes of chemotherapy-induced neutropenia
Acupuncture for the alleviation of hot flashes in men treated with androgen
ablation therapy Ashamalla H1 Jiang ML Guirguis A Peluso F Ashamalla M
bull Abstract bull PURPOSE bull Hot flashes are common side effect due to androgen ablation therapy (AAT) The utility of acupuncture for hot flashes in
men has not been thoroughly studied We prospectively studied the effect of acupuncture in men with hot flashes bull METHODS AND MATERIALS bull The study was approved by internal review board Seventeen men with hot flashes and history of AAT for prostate cancer
were enrolled Three men declined participation before receiving any treatment A hot flash score (HFS) was used to measure daily hot flashes The composite daily score was calculated as the product of frequency times severity The baseline daily scores were compared with scores taken at 2 and 6 weeks and at 8-month average follow-up
bull RESULTS bull No side effects were encountered during immediately after treatment or at 8 months The mean initial HFS was 283 it
dropped to 103 (p = 00001) at 2 weeks posttreatment 75 (p = 00001) at 6 weeks and 70 (p = 0001) at 8 months Clinical improvement for each patient is defined as the percent decrease in the mean HFS at each time point The mean improvement at Weeks 2 and 6 was 684 (mean HFS decreased from 37409 to 11836 p = 0001) and 892 (mean HFS decreased from 37409 to 405 p = 00078) respectively The improvement at 8 months was 803 (mean HFS decreased from 37409 to 7385 p = 0002)
bull CONCLUSIONS bull Acupuncture provides excellent control of hot flashes in men with a history of AAT The absence of side effects and the
durable response at 8 months are likely to be appealing to patients Prospective randomized study is warranted to further evaluate this modality against medical therapy
bull Copyright copy 2011 Elsevier Inc All rights reserved
bull Int J Radiat Oncol Biol Phys 2011 Apr 179(5)1358-63 doi 101016jijrobp201001025 Epub 2010 Jun 3
bull J Clin Oncol 2010 Mar 128(7)1154-60 doi 101200JCO2009234708 Epub 2010 Jan 25 bull Randomized blinded sham-controlled trial of acupuncture for the management of aromatase
inhibitor-associated joint symptoms in women with early-stage breast cancer bull Crew KD1 Capodice JL Greenlee H Brafman L Fuentes D Awad D Yann Tsai W Hershman DL bull Author information
bull Abstract bull PURPOSE Women with breast cancer (BC) treated with aromatase inhibitors (AIs) may experience
joint symptoms that can lead to discontinuation of effective therapy We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC METHODS We conducted a randomized controlled blinded study comparing true acupuncture (TA) versus sham acupuncture (SA) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs TA included full bodyauricular acupuncture and joint-specific point prescriptions whereas SA involved superficial needle insertion at nonacupoint locations Outcome measures included the Brief Pain Inventory-Short Form (BPI-SF) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH) obtained at baseline and at 3 and 6 weeks Results Of 51 women enrolled 43 women were randomly assigned and 38 were evaluable Baseline characteristics were comparable between the two groups Our primary end point was the difference in mean BPI-SF worst pain scores at 6 weeks which was lower for TA compared with SA (30 v 55 P lt 001) We also found differences between TA and SA in pain severity (26 v 45 P = 003) and pain-related interference (25 v 45 P = 002) at 6 weeks Similar findings were seen for the WOMAC and M-SACRAH scores The acupuncture intervention was well-tolerated CONCLUSION Women with AI-induced arthralgias treated with TA had significant improvement of joint pain and stiffness which was not seen with SA Acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect
42 of Americans receive care from CAM instead of
allopathic medicine and this figure is increasing (Eisenberg
et al N Engl J Med 1993 Jan 28328(4)246-52)
46 Medical doctors in Swiss Romande use CAM for
themselves (Domenighetti et al Med Hyg 2000 58570-2)
80 of American women (age 45-60) use CAM for
menopausal symptoms (Kang et alInt J Gynaecol Obstet 2002
Dec 79(3)195-207)
Prevalent use of Complementary
and Alternative Medicine (CAM)
Complementary and alternative medicine use by women after
completion of allopathic treatment for breast cancer
Telephone interviews were conducted with 551 females in the
Portland Oregon metropolitan area who had been diagnosed
with breast cancer an average of 35 years earlier
Two-thirds (66) of the women used at least one CAM
therapy during the previous 12 months and the majority of
them perceived that their CAM use was without the
recommendation of their doctor Relaxationmeditation herbs
spiritual healing and megavitamins were used most often
Significant predictors of CAM use included younger age
higher education and private insurance The majority of the
CAM therapies were perceived by their users to be at least
moderately important in remaining free of cancer
Altern Ther Health Med 2004 Jan-Feb10(1)52-7
Use of complementary and alternative medicine by
chinese women with breast cancer
1065 breast cancer women were analyzed in urban
Shanghai Patients average age at diagnosis was 481 years
and the median time from the initial diagnosis to the
follow-up survey was 43 years
Overall 98 of patients had used at least one form of
CAM therapy after diagnosis of breast cancer The most
popular CAM modality was traditional Chinese medicine
(867) followed by the use of supplements (848)
physical exercises (655) and support group attendance
(166) CHM was used by 864 of patients while
acupuncture was used only by 49 of patients
Breast Cancer Res Treat 2004 Jun85(3)263
Chinese Medicine
an overview
Unique theory system
Concept of Wholism
Individual Treatment based
on syndrome
Variety of treatment methods
based on nature
天人合一mdash整体观
Unity of Heaven and Man--Holism
bull 人与自然是一个整体
bull Human beings and nature are taken as a whole
bull 人与社会是一个整体
bull Human beings and society are taken as a whole
bull 人本身各系统之间是一个整体
bull The various systems in the human body are inter connected as a whole
bull 天地人相参
bull Heaven earth and human beings interact and correspond with each
other
Fundamentals of TCM
bull The material basis of the human body
Qi Blood Jing Jing-ye
bull The concept of Yin and Yang
bull The theory of f ive elements Wood Fire Earth Metal Water
bull The theory of Zang-Fu
bull The pathways of the human body Meridians
Five Elements Theory
Types of Qi and their origins
Zong Qi
Gathering
Qi
Lungs
process
air
Spleen
process
food
Kong Qi
Air Qi
Gu Qi
Grain Qi
Yuan Qi
Original
Qi
Zheng Qi
Normal
Qi
Ying Qi
Nutritive
Qi
Wei Qi
Defensive
Qi
Zang Fu
Zhi Qi
Organ Qi
Human body
Heart ruler of all organs in charge of blood circulation and mental activity
Cardiovacular and certain parts of higher nervous systerm
Liver laquoa viscus of temperamentraquo stores blood secretes bile and controls muscles
Centrals nervous and autonomous nervous systems
Spleen transforms and transports nutrients and water nourishing the muscles and limbs
and determining the bodyrsquos constitution protects the body against pathogen
Digestive and immune systemsas well as the functional system in charge of energy and water metabolism
Lung respiration cotrols vital energy and superficial body resistance regulates circulation of body fluid
Respiratory system part of immune system also related to water metablism
Kidney works to secrete urine store essence of life either inborn or acquired in charge of reproduction growth and development replenishing the brain nourishing the bones and producing marrow helps the lung inhale air
Related to the urogenital systemendocrine system (particularly the pituitary-adrenal and pituitary and gonadal axes) a part of immune system and higher nervous system
The causes of the diseases
Endogenous pathogenic factors
Seven emotions joy anger worry anxiety sorrow
terror and fright (Colegravere Joie Soucis Affliction et
Chagrin Angoisse Effroi)
Exogenous pathogenic factors
Six Excesses (Climatic changes) wind cold summer
heat dampness dryness fire
Epidemiques Trauma Inadequate diet
ETIOLOGIE EN MTC
CANCER EN MTC
bull Les tumeurs reacutesultent dun deacuteseacutequilibre dans le corps ou entre le corps et lenvironnement exteacuterieur
bull Les tumeurs sont dues agrave des changements qualitatifs et irreacuteversibles dans la structure ou la fonction de Zang Fu Qi et du Sang ou de LO
bull Si il y a carence les facteurs pathogegravenes envahissent profondeacutement le corps et si elle persiste la lutte entre le Froid et la Chaleur peut endommager la chair
bull Si les facteurs pathogegravenes ne peuvent pas ecirctre dissipeacutes ceci conduira agrave la formation de tumeurs
LES ELEMENTS CLES DANS LE DEVELOPPEMENT DE TUMEUR DANS MTC
bull 1- stagnation de Qi et la stase du Sang
bull 2- accumulation des Toxines lieacutees agrave la Chaleur
bull 3- deacuteficience de Qi Vital
bull 4- toutes les maladies proviennent des Glaires la plupart des masses qui se produisent dans le corps sont dues aux Glaires
Clinical Guide
bull Principle of diagnosis Diagnosis of disease
Syndrome differentiation
(individulized treatment)
bull Methods
Inspection Auscultation and Olfaction Interrogation Palpation
bull Intervention modalities
Chinese medication Acupuncture Qigong Tuina Dietary
(nutrition)
Treatment
The goal of treatment is to adjust and harmonize Yin and Yang
This is achieved by regulating the Qi Moisture and Blood in the Organ Networksweak organs are tonified congested channels are opened
excess is dispersed tightness is softened agitation is calmed heat is cooled cold is warmed dryness is moistened and dampness is drained
Preventive treatment of Progression of
Disease
《难经middot七十七难》ldquo所谓治未病者见肝之病则知肝当传之于脾 故先实其脾气无令得受肝之邪故曰治未病焉rdquo
重视疾病的传变规律ldquo先安未受邪之地rdquo 痰毒瘀结是肿瘤转移的关键流窜经络脏腑是其特点对于肿瘤的转移预防比治疗更有现实意义
laquo Classique des Problegravemes meacutedicaux raquo chap77 rdquoSi le Foie est malade il peut attaquer la Rate Par conseacutequent la Rate doit ecirctre fortifieacutee avant qursquoelle ne soit elle-mecircme affecteacutee raquo
Acupuncture
Bronze Model for the Meridians and
Acupuncture Points
(Qing Dynasty 1744)
An insight into acupuncture
Concept of Yin Yang
Holism
Five element theory
Human body
About Qi Formation of Qi
Function of Qi
Disharmony of Qi
Meridians - the pathways of the body
Techniques and methods
Meridian pathways of the Body
bullComponents bull 12 regular meridians
12 Collaterals
8 extraordinary meridians
Functions Connect and coordinate
creating an integral whole
Transporting functions
Spleen Meridian
Techniques and methods
Manual (Classic) Acupuncture
Electric-Acupuncture
Acupuncture and Moxibustion
Laser Acupuncture
Ultrasound Acupuncture
Acupuncture and the Moxibustion
Cupping Therapy
Indications
In 1979 WHO named 43 different diseases that can be
treated by Acupuncture
Upper Respiratory Tract
Acute sinusitis
Acute rhinitis
Common cold
Acute tonsillitis
Respiratory System
Acute Bronchitis
Bronchial asthma
Disorders of the Eye Acute conjunctivitis
Central retinitis
Myopia (in children)
Cataract (without
complications)
Disorders of the Mouth Toothache
Post-extraction pain
Gingivitis
Acute and chronic pharyngitis
Journal of World Health Organisation Dec1979
Known biological effects of
acupuncture
bullAcupuncture multiple biological responses
bullOccur locally or at a distance mediated by sensor neurons to many structures of the central nervous system -- leads to activation of pathways affecting various physiology systems in the brain as well as periphery Attention has been focused on the role of endogenous opioids in analgesia and anesthesia
bullActivate the hypothalamus and pituitary resulting in a broad spectrum of systemic effects
bullAlteration in secretion of neurotransmitters and neurohormones that causes changes in the regulation of blood flow both centrally and peripherally
bullEvidence of alteration of immune functions NIH Consensus Statement Online 1997 Nov 3-5 month day] 15(5)1-34
LES TRAITEMENTS
bull 1-la stagnation de Qi et la stase du Sang
bull dynamiser le sang et transformer la stase du sang
bull 2- accumulation des Toxines lieacutees agrave la Chaleur
bull clarifier la chaleur et deacutegager la Toxiciteacute
bull 3- deacuteficience de Qi Vital
bull soutenir le Qi Vital et cultiver la racine
bull 4- toutes les maladies proviennent des Glaires la plupart des masses qui se produisent dans le corps sont dues aux Glaires
bull transformer les Glaires et ramollir la dureteacute
Dans le diagnostic et le traitement des tumeurs la MTC considegravere leacutetat geacuteneacuteral du patient plutocirct que de se focaliser sur le cancer lui-mecircme ou les symptocircmes particuliers
Soutien psychologique
bull angoisse devant lrsquoinconnu
bull angoisse devant la douleur
bull angoisse devant le deacuteveloppement de la maladie et la perte de controcircle sur son propre corps
bull angoisse devant les effets secondaires dus aux divers traitements
bull angoisse devant les complications tardives dues aux divers traitements
bull angoisse devant le regard social porteacute sur le malade
bull angoisse devant la mort
Soutien psychologique
Ces informations reacutesonnent agrave lrsquointeacuterieur du patient ougrave elle
provoquent des dysfonctionnements qui
peuvent se manifester par
bull des maux de ventre
bull des palpitations
bull des troubles du sommeil
bull des difficulteacutes respiratoires
bull des douleurs diverses etc
Nauseacutees et vomissements
RAPPEL LrsquoEstomac
bull YANG
bull Controcircle le mucircrissement amp pourrissement de la nourriture
bull Controcircle le transport des essences de la nourriture Gouverne la descente du Qi fait descendre la nourriture transformeacutee vers lrsquoIntestin Grecircle
bull Si le mouvement de descente est perturbeacute par les pervers si il y a un mouvement ascendant de QI de lrsquoEstomac (agrave contre-sens- NI) il y a des VOMISSEMENTS
Nauseacutees et vomissements
LES VOMISSEMENTS SE MANIFESTENT QUAND LE QI DE LrsquoESTOMAC MONTE A LA PLACE DE DESCENDRE
Neuropathie
Avastine Xeloda Gemzar Cysplatine Taxol Fludara Alimta Procarbazine
points GI2 3 4 IG 2 3 C7 MC6 8 P7 9 F2 3 V60 VB41
traitement
preacutevention
LA DOULEUR DUE AU CANCER
bull Etiologie et physiopathologie
bull Lrsquoinvasion des pervers Externes - tout pervers srsquoil persiste peut provoquer le blocage des meacuteridiens et par la suite une stagnation de Qi et de Sg ou des troubles de Zang-Fu
bull Le deacuteregraveglement des eacutemotions
bull Le deacuteseacutequilibre de lrsquoalimentation
bull Une faiblesse de constitution
DIFFEacuteRENCIATION DE LA DOULEUR
SELON LA LOCALISATION bull dans le cancer du poumon souvent une sensibiliteacute au
P1 et V13 accompagneacutee de toux et de souffle court bull dans le cancer de lrsquoœsophage ou de lrsquoestomac une
sensibiliteacute au E34 et E42 accompagneacutee de nauseacutees dysphagie inappeacutetence
SELON LE VIDE ET LA PLEacuteNITUDE bull Vide douleurs souvent leacutegegraveres intermittentes
sourdes bull Pleacutenitude douleurs tensives lancinantes coliques
aigues
LA FATIGUE
XU LAO = fatigue par Vide = lrsquoeacutepuisement En Occident crsquoest le symptocircme le plus souvent invoqueacute et pas toujours ducirc au Vide
LA FATIGUE - eacutetiologie
bull La faiblesse constitutionnelle
bull Le surmenage
bull Lrsquoexcegraves drsquoactiviteacute physique
bull Lrsquoalimentation
bull Les maladies graves
bull Lrsquoexcegraves drsquoactiviteacute sexuelle
bull Lrsquoaccouchement
bull La consommation de drogues
LA FATIGUE - pathologie
bull Vide
bull Combinaison de Vide et de Pleacutenitude
bull Pleacutenitude
Contre-indications agrave lrsquoacupuncture
bull Des risques de laquo gros bras raquo apregraves curage axillaire
bull Des opeacuterations selon Halsted ou Patey
bull Des drainages lymphatiques
bull Pas drsquoaiguille du cocircteacute opeacutereacute
TCM in cancer treatments
bull Used mostly as adjuvant therapy before or during or
after surgery radiotherapy and chemotherapy
bull Remit the side-effects and toxicity of other treatments
bull Symptom control
bull Activate and strengthen immune system
bull For advanced cancer patients mainly palliative but it
can also prolong life in some cases
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 15 Number 7 2009
Acupuncture for Chemotherapy-Induced Neutropenia in Patients with GynecologiMalignancies A Pilot Randomized Sham-Controlled Clinical Trial
Weidong Lu MB MPH LicAc1ndash3 Ursula A Matulonis MD4 Anne Doherty-Gilman MPH1 Hang ScD3
Peter M Wayne PhD23 David S Rosenthal MD14 and Richard T Penson MD6
bull Abstract bull Objectives The objective of this study was to investigate the effect of acupuncture administered during mye-
losuppressive chemotherapy on white blood cell (WBC) count and absolute neutrophil count (ANC) in patients with ovarian cancer
bull Design This study is a pilot randomized sham-controlled clinical trial Patients received active acupuncture versus sham acupuncture while undergoing chemotherapy A standardized acupuncture protocol was em- ployed with manual and electrostimulation The frequency of treatment was 2ndash3 times per week for a total of 10 sessions starting 1 week before the second cycle of chemotherapy
bull Setting The setting was two outpatient academic centers for patients with cancer bull Subjects Twenty-one (21) newly diagnosed and recurrent ovarian cancer patients were the subjects bull Outcome measures WBC count ANC and plasma granulocyte colony-stimulating factor (G-CSF ) were assessed
weekly bull Results The median leukocyte value in the acupuncture arm at the first day of the third cycle of chemotherapy
was significantly higher than in the control arm after adjusting for baseline value (8600 cells=mL range 4800ndash 12000 versus 4400 cell=mL range 2300ndash10000) ( p frac14 0046) The incidence of grade 2ndash4 leukopenia was less in the acupuncture arm than in the sham arm (30 versus 90 p frac14 002) However the median leukocyte nadir neutrophil nadir and recovering ANC were all higher but not statistically significantly different ( p frac14 0116ndash016) after adjusting for baseline differences There were no statistically significant differences in plasma G-CSF between the two groups
bull Conclusions We observed clinically relevant trends of higher WBC values during one cycle of chemotherapy in patients with ovarian cancer which suggests a potential myeloprotective effect of acupuncture A larger trial is warranted to more definitively determine the efficacy of acupuncture on clinically important outcomes of chemotherapy-induced neutropenia
Acupuncture for the alleviation of hot flashes in men treated with androgen
ablation therapy Ashamalla H1 Jiang ML Guirguis A Peluso F Ashamalla M
bull Abstract bull PURPOSE bull Hot flashes are common side effect due to androgen ablation therapy (AAT) The utility of acupuncture for hot flashes in
men has not been thoroughly studied We prospectively studied the effect of acupuncture in men with hot flashes bull METHODS AND MATERIALS bull The study was approved by internal review board Seventeen men with hot flashes and history of AAT for prostate cancer
were enrolled Three men declined participation before receiving any treatment A hot flash score (HFS) was used to measure daily hot flashes The composite daily score was calculated as the product of frequency times severity The baseline daily scores were compared with scores taken at 2 and 6 weeks and at 8-month average follow-up
bull RESULTS bull No side effects were encountered during immediately after treatment or at 8 months The mean initial HFS was 283 it
dropped to 103 (p = 00001) at 2 weeks posttreatment 75 (p = 00001) at 6 weeks and 70 (p = 0001) at 8 months Clinical improvement for each patient is defined as the percent decrease in the mean HFS at each time point The mean improvement at Weeks 2 and 6 was 684 (mean HFS decreased from 37409 to 11836 p = 0001) and 892 (mean HFS decreased from 37409 to 405 p = 00078) respectively The improvement at 8 months was 803 (mean HFS decreased from 37409 to 7385 p = 0002)
bull CONCLUSIONS bull Acupuncture provides excellent control of hot flashes in men with a history of AAT The absence of side effects and the
durable response at 8 months are likely to be appealing to patients Prospective randomized study is warranted to further evaluate this modality against medical therapy
bull Copyright copy 2011 Elsevier Inc All rights reserved
bull Int J Radiat Oncol Biol Phys 2011 Apr 179(5)1358-63 doi 101016jijrobp201001025 Epub 2010 Jun 3
bull J Clin Oncol 2010 Mar 128(7)1154-60 doi 101200JCO2009234708 Epub 2010 Jan 25 bull Randomized blinded sham-controlled trial of acupuncture for the management of aromatase
inhibitor-associated joint symptoms in women with early-stage breast cancer bull Crew KD1 Capodice JL Greenlee H Brafman L Fuentes D Awad D Yann Tsai W Hershman DL bull Author information
bull Abstract bull PURPOSE Women with breast cancer (BC) treated with aromatase inhibitors (AIs) may experience
joint symptoms that can lead to discontinuation of effective therapy We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC METHODS We conducted a randomized controlled blinded study comparing true acupuncture (TA) versus sham acupuncture (SA) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs TA included full bodyauricular acupuncture and joint-specific point prescriptions whereas SA involved superficial needle insertion at nonacupoint locations Outcome measures included the Brief Pain Inventory-Short Form (BPI-SF) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH) obtained at baseline and at 3 and 6 weeks Results Of 51 women enrolled 43 women were randomly assigned and 38 were evaluable Baseline characteristics were comparable between the two groups Our primary end point was the difference in mean BPI-SF worst pain scores at 6 weeks which was lower for TA compared with SA (30 v 55 P lt 001) We also found differences between TA and SA in pain severity (26 v 45 P = 003) and pain-related interference (25 v 45 P = 002) at 6 weeks Similar findings were seen for the WOMAC and M-SACRAH scores The acupuncture intervention was well-tolerated CONCLUSION Women with AI-induced arthralgias treated with TA had significant improvement of joint pain and stiffness which was not seen with SA Acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect
Complementary and alternative medicine use by women after
completion of allopathic treatment for breast cancer
Telephone interviews were conducted with 551 females in the
Portland Oregon metropolitan area who had been diagnosed
with breast cancer an average of 35 years earlier
Two-thirds (66) of the women used at least one CAM
therapy during the previous 12 months and the majority of
them perceived that their CAM use was without the
recommendation of their doctor Relaxationmeditation herbs
spiritual healing and megavitamins were used most often
Significant predictors of CAM use included younger age
higher education and private insurance The majority of the
CAM therapies were perceived by their users to be at least
moderately important in remaining free of cancer
Altern Ther Health Med 2004 Jan-Feb10(1)52-7
Use of complementary and alternative medicine by
chinese women with breast cancer
1065 breast cancer women were analyzed in urban
Shanghai Patients average age at diagnosis was 481 years
and the median time from the initial diagnosis to the
follow-up survey was 43 years
Overall 98 of patients had used at least one form of
CAM therapy after diagnosis of breast cancer The most
popular CAM modality was traditional Chinese medicine
(867) followed by the use of supplements (848)
physical exercises (655) and support group attendance
(166) CHM was used by 864 of patients while
acupuncture was used only by 49 of patients
Breast Cancer Res Treat 2004 Jun85(3)263
Chinese Medicine
an overview
Unique theory system
Concept of Wholism
Individual Treatment based
on syndrome
Variety of treatment methods
based on nature
天人合一mdash整体观
Unity of Heaven and Man--Holism
bull 人与自然是一个整体
bull Human beings and nature are taken as a whole
bull 人与社会是一个整体
bull Human beings and society are taken as a whole
bull 人本身各系统之间是一个整体
bull The various systems in the human body are inter connected as a whole
bull 天地人相参
bull Heaven earth and human beings interact and correspond with each
other
Fundamentals of TCM
bull The material basis of the human body
Qi Blood Jing Jing-ye
bull The concept of Yin and Yang
bull The theory of f ive elements Wood Fire Earth Metal Water
bull The theory of Zang-Fu
bull The pathways of the human body Meridians
Five Elements Theory
Types of Qi and their origins
Zong Qi
Gathering
Qi
Lungs
process
air
Spleen
process
food
Kong Qi
Air Qi
Gu Qi
Grain Qi
Yuan Qi
Original
Qi
Zheng Qi
Normal
Qi
Ying Qi
Nutritive
Qi
Wei Qi
Defensive
Qi
Zang Fu
Zhi Qi
Organ Qi
Human body
Heart ruler of all organs in charge of blood circulation and mental activity
Cardiovacular and certain parts of higher nervous systerm
Liver laquoa viscus of temperamentraquo stores blood secretes bile and controls muscles
Centrals nervous and autonomous nervous systems
Spleen transforms and transports nutrients and water nourishing the muscles and limbs
and determining the bodyrsquos constitution protects the body against pathogen
Digestive and immune systemsas well as the functional system in charge of energy and water metabolism
Lung respiration cotrols vital energy and superficial body resistance regulates circulation of body fluid
Respiratory system part of immune system also related to water metablism
Kidney works to secrete urine store essence of life either inborn or acquired in charge of reproduction growth and development replenishing the brain nourishing the bones and producing marrow helps the lung inhale air
Related to the urogenital systemendocrine system (particularly the pituitary-adrenal and pituitary and gonadal axes) a part of immune system and higher nervous system
The causes of the diseases
Endogenous pathogenic factors
Seven emotions joy anger worry anxiety sorrow
terror and fright (Colegravere Joie Soucis Affliction et
Chagrin Angoisse Effroi)
Exogenous pathogenic factors
Six Excesses (Climatic changes) wind cold summer
heat dampness dryness fire
Epidemiques Trauma Inadequate diet
ETIOLOGIE EN MTC
CANCER EN MTC
bull Les tumeurs reacutesultent dun deacuteseacutequilibre dans le corps ou entre le corps et lenvironnement exteacuterieur
bull Les tumeurs sont dues agrave des changements qualitatifs et irreacuteversibles dans la structure ou la fonction de Zang Fu Qi et du Sang ou de LO
bull Si il y a carence les facteurs pathogegravenes envahissent profondeacutement le corps et si elle persiste la lutte entre le Froid et la Chaleur peut endommager la chair
bull Si les facteurs pathogegravenes ne peuvent pas ecirctre dissipeacutes ceci conduira agrave la formation de tumeurs
LES ELEMENTS CLES DANS LE DEVELOPPEMENT DE TUMEUR DANS MTC
bull 1- stagnation de Qi et la stase du Sang
bull 2- accumulation des Toxines lieacutees agrave la Chaleur
bull 3- deacuteficience de Qi Vital
bull 4- toutes les maladies proviennent des Glaires la plupart des masses qui se produisent dans le corps sont dues aux Glaires
Clinical Guide
bull Principle of diagnosis Diagnosis of disease
Syndrome differentiation
(individulized treatment)
bull Methods
Inspection Auscultation and Olfaction Interrogation Palpation
bull Intervention modalities
Chinese medication Acupuncture Qigong Tuina Dietary
(nutrition)
Treatment
The goal of treatment is to adjust and harmonize Yin and Yang
This is achieved by regulating the Qi Moisture and Blood in the Organ Networksweak organs are tonified congested channels are opened
excess is dispersed tightness is softened agitation is calmed heat is cooled cold is warmed dryness is moistened and dampness is drained
Preventive treatment of Progression of
Disease
《难经middot七十七难》ldquo所谓治未病者见肝之病则知肝当传之于脾 故先实其脾气无令得受肝之邪故曰治未病焉rdquo
重视疾病的传变规律ldquo先安未受邪之地rdquo 痰毒瘀结是肿瘤转移的关键流窜经络脏腑是其特点对于肿瘤的转移预防比治疗更有现实意义
laquo Classique des Problegravemes meacutedicaux raquo chap77 rdquoSi le Foie est malade il peut attaquer la Rate Par conseacutequent la Rate doit ecirctre fortifieacutee avant qursquoelle ne soit elle-mecircme affecteacutee raquo
Acupuncture
Bronze Model for the Meridians and
Acupuncture Points
(Qing Dynasty 1744)
An insight into acupuncture
Concept of Yin Yang
Holism
Five element theory
Human body
About Qi Formation of Qi
Function of Qi
Disharmony of Qi
Meridians - the pathways of the body
Techniques and methods
Meridian pathways of the Body
bullComponents bull 12 regular meridians
12 Collaterals
8 extraordinary meridians
Functions Connect and coordinate
creating an integral whole
Transporting functions
Spleen Meridian
Techniques and methods
Manual (Classic) Acupuncture
Electric-Acupuncture
Acupuncture and Moxibustion
Laser Acupuncture
Ultrasound Acupuncture
Acupuncture and the Moxibustion
Cupping Therapy
Indications
In 1979 WHO named 43 different diseases that can be
treated by Acupuncture
Upper Respiratory Tract
Acute sinusitis
Acute rhinitis
Common cold
Acute tonsillitis
Respiratory System
Acute Bronchitis
Bronchial asthma
Disorders of the Eye Acute conjunctivitis
Central retinitis
Myopia (in children)
Cataract (without
complications)
Disorders of the Mouth Toothache
Post-extraction pain
Gingivitis
Acute and chronic pharyngitis
Journal of World Health Organisation Dec1979
Known biological effects of
acupuncture
bullAcupuncture multiple biological responses
bullOccur locally or at a distance mediated by sensor neurons to many structures of the central nervous system -- leads to activation of pathways affecting various physiology systems in the brain as well as periphery Attention has been focused on the role of endogenous opioids in analgesia and anesthesia
bullActivate the hypothalamus and pituitary resulting in a broad spectrum of systemic effects
bullAlteration in secretion of neurotransmitters and neurohormones that causes changes in the regulation of blood flow both centrally and peripherally
bullEvidence of alteration of immune functions NIH Consensus Statement Online 1997 Nov 3-5 month day] 15(5)1-34
LES TRAITEMENTS
bull 1-la stagnation de Qi et la stase du Sang
bull dynamiser le sang et transformer la stase du sang
bull 2- accumulation des Toxines lieacutees agrave la Chaleur
bull clarifier la chaleur et deacutegager la Toxiciteacute
bull 3- deacuteficience de Qi Vital
bull soutenir le Qi Vital et cultiver la racine
bull 4- toutes les maladies proviennent des Glaires la plupart des masses qui se produisent dans le corps sont dues aux Glaires
bull transformer les Glaires et ramollir la dureteacute
Dans le diagnostic et le traitement des tumeurs la MTC considegravere leacutetat geacuteneacuteral du patient plutocirct que de se focaliser sur le cancer lui-mecircme ou les symptocircmes particuliers
Soutien psychologique
bull angoisse devant lrsquoinconnu
bull angoisse devant la douleur
bull angoisse devant le deacuteveloppement de la maladie et la perte de controcircle sur son propre corps
bull angoisse devant les effets secondaires dus aux divers traitements
bull angoisse devant les complications tardives dues aux divers traitements
bull angoisse devant le regard social porteacute sur le malade
bull angoisse devant la mort
Soutien psychologique
Ces informations reacutesonnent agrave lrsquointeacuterieur du patient ougrave elle
provoquent des dysfonctionnements qui
peuvent se manifester par
bull des maux de ventre
bull des palpitations
bull des troubles du sommeil
bull des difficulteacutes respiratoires
bull des douleurs diverses etc
Nauseacutees et vomissements
RAPPEL LrsquoEstomac
bull YANG
bull Controcircle le mucircrissement amp pourrissement de la nourriture
bull Controcircle le transport des essences de la nourriture Gouverne la descente du Qi fait descendre la nourriture transformeacutee vers lrsquoIntestin Grecircle
bull Si le mouvement de descente est perturbeacute par les pervers si il y a un mouvement ascendant de QI de lrsquoEstomac (agrave contre-sens- NI) il y a des VOMISSEMENTS
Nauseacutees et vomissements
LES VOMISSEMENTS SE MANIFESTENT QUAND LE QI DE LrsquoESTOMAC MONTE A LA PLACE DE DESCENDRE
Neuropathie
Avastine Xeloda Gemzar Cysplatine Taxol Fludara Alimta Procarbazine
points GI2 3 4 IG 2 3 C7 MC6 8 P7 9 F2 3 V60 VB41
traitement
preacutevention
LA DOULEUR DUE AU CANCER
bull Etiologie et physiopathologie
bull Lrsquoinvasion des pervers Externes - tout pervers srsquoil persiste peut provoquer le blocage des meacuteridiens et par la suite une stagnation de Qi et de Sg ou des troubles de Zang-Fu
bull Le deacuteregraveglement des eacutemotions
bull Le deacuteseacutequilibre de lrsquoalimentation
bull Une faiblesse de constitution
DIFFEacuteRENCIATION DE LA DOULEUR
SELON LA LOCALISATION bull dans le cancer du poumon souvent une sensibiliteacute au
P1 et V13 accompagneacutee de toux et de souffle court bull dans le cancer de lrsquoœsophage ou de lrsquoestomac une
sensibiliteacute au E34 et E42 accompagneacutee de nauseacutees dysphagie inappeacutetence
SELON LE VIDE ET LA PLEacuteNITUDE bull Vide douleurs souvent leacutegegraveres intermittentes
sourdes bull Pleacutenitude douleurs tensives lancinantes coliques
aigues
LA FATIGUE
XU LAO = fatigue par Vide = lrsquoeacutepuisement En Occident crsquoest le symptocircme le plus souvent invoqueacute et pas toujours ducirc au Vide
LA FATIGUE - eacutetiologie
bull La faiblesse constitutionnelle
bull Le surmenage
bull Lrsquoexcegraves drsquoactiviteacute physique
bull Lrsquoalimentation
bull Les maladies graves
bull Lrsquoexcegraves drsquoactiviteacute sexuelle
bull Lrsquoaccouchement
bull La consommation de drogues
LA FATIGUE - pathologie
bull Vide
bull Combinaison de Vide et de Pleacutenitude
bull Pleacutenitude
Contre-indications agrave lrsquoacupuncture
bull Des risques de laquo gros bras raquo apregraves curage axillaire
bull Des opeacuterations selon Halsted ou Patey
bull Des drainages lymphatiques
bull Pas drsquoaiguille du cocircteacute opeacutereacute
TCM in cancer treatments
bull Used mostly as adjuvant therapy before or during or
after surgery radiotherapy and chemotherapy
bull Remit the side-effects and toxicity of other treatments
bull Symptom control
bull Activate and strengthen immune system
bull For advanced cancer patients mainly palliative but it
can also prolong life in some cases
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 15 Number 7 2009
Acupuncture for Chemotherapy-Induced Neutropenia in Patients with GynecologiMalignancies A Pilot Randomized Sham-Controlled Clinical Trial
Weidong Lu MB MPH LicAc1ndash3 Ursula A Matulonis MD4 Anne Doherty-Gilman MPH1 Hang ScD3
Peter M Wayne PhD23 David S Rosenthal MD14 and Richard T Penson MD6
bull Abstract bull Objectives The objective of this study was to investigate the effect of acupuncture administered during mye-
losuppressive chemotherapy on white blood cell (WBC) count and absolute neutrophil count (ANC) in patients with ovarian cancer
bull Design This study is a pilot randomized sham-controlled clinical trial Patients received active acupuncture versus sham acupuncture while undergoing chemotherapy A standardized acupuncture protocol was em- ployed with manual and electrostimulation The frequency of treatment was 2ndash3 times per week for a total of 10 sessions starting 1 week before the second cycle of chemotherapy
bull Setting The setting was two outpatient academic centers for patients with cancer bull Subjects Twenty-one (21) newly diagnosed and recurrent ovarian cancer patients were the subjects bull Outcome measures WBC count ANC and plasma granulocyte colony-stimulating factor (G-CSF ) were assessed
weekly bull Results The median leukocyte value in the acupuncture arm at the first day of the third cycle of chemotherapy
was significantly higher than in the control arm after adjusting for baseline value (8600 cells=mL range 4800ndash 12000 versus 4400 cell=mL range 2300ndash10000) ( p frac14 0046) The incidence of grade 2ndash4 leukopenia was less in the acupuncture arm than in the sham arm (30 versus 90 p frac14 002) However the median leukocyte nadir neutrophil nadir and recovering ANC were all higher but not statistically significantly different ( p frac14 0116ndash016) after adjusting for baseline differences There were no statistically significant differences in plasma G-CSF between the two groups
bull Conclusions We observed clinically relevant trends of higher WBC values during one cycle of chemotherapy in patients with ovarian cancer which suggests a potential myeloprotective effect of acupuncture A larger trial is warranted to more definitively determine the efficacy of acupuncture on clinically important outcomes of chemotherapy-induced neutropenia
Acupuncture for the alleviation of hot flashes in men treated with androgen
ablation therapy Ashamalla H1 Jiang ML Guirguis A Peluso F Ashamalla M
bull Abstract bull PURPOSE bull Hot flashes are common side effect due to androgen ablation therapy (AAT) The utility of acupuncture for hot flashes in
men has not been thoroughly studied We prospectively studied the effect of acupuncture in men with hot flashes bull METHODS AND MATERIALS bull The study was approved by internal review board Seventeen men with hot flashes and history of AAT for prostate cancer
were enrolled Three men declined participation before receiving any treatment A hot flash score (HFS) was used to measure daily hot flashes The composite daily score was calculated as the product of frequency times severity The baseline daily scores were compared with scores taken at 2 and 6 weeks and at 8-month average follow-up
bull RESULTS bull No side effects were encountered during immediately after treatment or at 8 months The mean initial HFS was 283 it
dropped to 103 (p = 00001) at 2 weeks posttreatment 75 (p = 00001) at 6 weeks and 70 (p = 0001) at 8 months Clinical improvement for each patient is defined as the percent decrease in the mean HFS at each time point The mean improvement at Weeks 2 and 6 was 684 (mean HFS decreased from 37409 to 11836 p = 0001) and 892 (mean HFS decreased from 37409 to 405 p = 00078) respectively The improvement at 8 months was 803 (mean HFS decreased from 37409 to 7385 p = 0002)
bull CONCLUSIONS bull Acupuncture provides excellent control of hot flashes in men with a history of AAT The absence of side effects and the
durable response at 8 months are likely to be appealing to patients Prospective randomized study is warranted to further evaluate this modality against medical therapy
bull Copyright copy 2011 Elsevier Inc All rights reserved
bull Int J Radiat Oncol Biol Phys 2011 Apr 179(5)1358-63 doi 101016jijrobp201001025 Epub 2010 Jun 3
bull J Clin Oncol 2010 Mar 128(7)1154-60 doi 101200JCO2009234708 Epub 2010 Jan 25 bull Randomized blinded sham-controlled trial of acupuncture for the management of aromatase
inhibitor-associated joint symptoms in women with early-stage breast cancer bull Crew KD1 Capodice JL Greenlee H Brafman L Fuentes D Awad D Yann Tsai W Hershman DL bull Author information
bull Abstract bull PURPOSE Women with breast cancer (BC) treated with aromatase inhibitors (AIs) may experience
joint symptoms that can lead to discontinuation of effective therapy We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC METHODS We conducted a randomized controlled blinded study comparing true acupuncture (TA) versus sham acupuncture (SA) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs TA included full bodyauricular acupuncture and joint-specific point prescriptions whereas SA involved superficial needle insertion at nonacupoint locations Outcome measures included the Brief Pain Inventory-Short Form (BPI-SF) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH) obtained at baseline and at 3 and 6 weeks Results Of 51 women enrolled 43 women were randomly assigned and 38 were evaluable Baseline characteristics were comparable between the two groups Our primary end point was the difference in mean BPI-SF worst pain scores at 6 weeks which was lower for TA compared with SA (30 v 55 P lt 001) We also found differences between TA and SA in pain severity (26 v 45 P = 003) and pain-related interference (25 v 45 P = 002) at 6 weeks Similar findings were seen for the WOMAC and M-SACRAH scores The acupuncture intervention was well-tolerated CONCLUSION Women with AI-induced arthralgias treated with TA had significant improvement of joint pain and stiffness which was not seen with SA Acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect
Use of complementary and alternative medicine by
chinese women with breast cancer
1065 breast cancer women were analyzed in urban
Shanghai Patients average age at diagnosis was 481 years
and the median time from the initial diagnosis to the
follow-up survey was 43 years
Overall 98 of patients had used at least one form of
CAM therapy after diagnosis of breast cancer The most
popular CAM modality was traditional Chinese medicine
(867) followed by the use of supplements (848)
physical exercises (655) and support group attendance
(166) CHM was used by 864 of patients while
acupuncture was used only by 49 of patients
Breast Cancer Res Treat 2004 Jun85(3)263
Chinese Medicine
an overview
Unique theory system
Concept of Wholism
Individual Treatment based
on syndrome
Variety of treatment methods
based on nature
天人合一mdash整体观
Unity of Heaven and Man--Holism
bull 人与自然是一个整体
bull Human beings and nature are taken as a whole
bull 人与社会是一个整体
bull Human beings and society are taken as a whole
bull 人本身各系统之间是一个整体
bull The various systems in the human body are inter connected as a whole
bull 天地人相参
bull Heaven earth and human beings interact and correspond with each
other
Fundamentals of TCM
bull The material basis of the human body
Qi Blood Jing Jing-ye
bull The concept of Yin and Yang
bull The theory of f ive elements Wood Fire Earth Metal Water
bull The theory of Zang-Fu
bull The pathways of the human body Meridians
Five Elements Theory
Types of Qi and their origins
Zong Qi
Gathering
Qi
Lungs
process
air
Spleen
process
food
Kong Qi
Air Qi
Gu Qi
Grain Qi
Yuan Qi
Original
Qi
Zheng Qi
Normal
Qi
Ying Qi
Nutritive
Qi
Wei Qi
Defensive
Qi
Zang Fu
Zhi Qi
Organ Qi
Human body
Heart ruler of all organs in charge of blood circulation and mental activity
Cardiovacular and certain parts of higher nervous systerm
Liver laquoa viscus of temperamentraquo stores blood secretes bile and controls muscles
Centrals nervous and autonomous nervous systems
Spleen transforms and transports nutrients and water nourishing the muscles and limbs
and determining the bodyrsquos constitution protects the body against pathogen
Digestive and immune systemsas well as the functional system in charge of energy and water metabolism
Lung respiration cotrols vital energy and superficial body resistance regulates circulation of body fluid
Respiratory system part of immune system also related to water metablism
Kidney works to secrete urine store essence of life either inborn or acquired in charge of reproduction growth and development replenishing the brain nourishing the bones and producing marrow helps the lung inhale air
Related to the urogenital systemendocrine system (particularly the pituitary-adrenal and pituitary and gonadal axes) a part of immune system and higher nervous system
The causes of the diseases
Endogenous pathogenic factors
Seven emotions joy anger worry anxiety sorrow
terror and fright (Colegravere Joie Soucis Affliction et
Chagrin Angoisse Effroi)
Exogenous pathogenic factors
Six Excesses (Climatic changes) wind cold summer
heat dampness dryness fire
Epidemiques Trauma Inadequate diet
ETIOLOGIE EN MTC
CANCER EN MTC
bull Les tumeurs reacutesultent dun deacuteseacutequilibre dans le corps ou entre le corps et lenvironnement exteacuterieur
bull Les tumeurs sont dues agrave des changements qualitatifs et irreacuteversibles dans la structure ou la fonction de Zang Fu Qi et du Sang ou de LO
bull Si il y a carence les facteurs pathogegravenes envahissent profondeacutement le corps et si elle persiste la lutte entre le Froid et la Chaleur peut endommager la chair
bull Si les facteurs pathogegravenes ne peuvent pas ecirctre dissipeacutes ceci conduira agrave la formation de tumeurs
LES ELEMENTS CLES DANS LE DEVELOPPEMENT DE TUMEUR DANS MTC
bull 1- stagnation de Qi et la stase du Sang
bull 2- accumulation des Toxines lieacutees agrave la Chaleur
bull 3- deacuteficience de Qi Vital
bull 4- toutes les maladies proviennent des Glaires la plupart des masses qui se produisent dans le corps sont dues aux Glaires
Clinical Guide
bull Principle of diagnosis Diagnosis of disease
Syndrome differentiation
(individulized treatment)
bull Methods
Inspection Auscultation and Olfaction Interrogation Palpation
bull Intervention modalities
Chinese medication Acupuncture Qigong Tuina Dietary
(nutrition)
Treatment
The goal of treatment is to adjust and harmonize Yin and Yang
This is achieved by regulating the Qi Moisture and Blood in the Organ Networksweak organs are tonified congested channels are opened
excess is dispersed tightness is softened agitation is calmed heat is cooled cold is warmed dryness is moistened and dampness is drained
Preventive treatment of Progression of
Disease
《难经middot七十七难》ldquo所谓治未病者见肝之病则知肝当传之于脾 故先实其脾气无令得受肝之邪故曰治未病焉rdquo
重视疾病的传变规律ldquo先安未受邪之地rdquo 痰毒瘀结是肿瘤转移的关键流窜经络脏腑是其特点对于肿瘤的转移预防比治疗更有现实意义
laquo Classique des Problegravemes meacutedicaux raquo chap77 rdquoSi le Foie est malade il peut attaquer la Rate Par conseacutequent la Rate doit ecirctre fortifieacutee avant qursquoelle ne soit elle-mecircme affecteacutee raquo
Acupuncture
Bronze Model for the Meridians and
Acupuncture Points
(Qing Dynasty 1744)
An insight into acupuncture
Concept of Yin Yang
Holism
Five element theory
Human body
About Qi Formation of Qi
Function of Qi
Disharmony of Qi
Meridians - the pathways of the body
Techniques and methods
Meridian pathways of the Body
bullComponents bull 12 regular meridians
12 Collaterals
8 extraordinary meridians
Functions Connect and coordinate
creating an integral whole
Transporting functions
Spleen Meridian
Techniques and methods
Manual (Classic) Acupuncture
Electric-Acupuncture
Acupuncture and Moxibustion
Laser Acupuncture
Ultrasound Acupuncture
Acupuncture and the Moxibustion
Cupping Therapy
Indications
In 1979 WHO named 43 different diseases that can be
treated by Acupuncture
Upper Respiratory Tract
Acute sinusitis
Acute rhinitis
Common cold
Acute tonsillitis
Respiratory System
Acute Bronchitis
Bronchial asthma
Disorders of the Eye Acute conjunctivitis
Central retinitis
Myopia (in children)
Cataract (without
complications)
Disorders of the Mouth Toothache
Post-extraction pain
Gingivitis
Acute and chronic pharyngitis
Journal of World Health Organisation Dec1979
Known biological effects of
acupuncture
bullAcupuncture multiple biological responses
bullOccur locally or at a distance mediated by sensor neurons to many structures of the central nervous system -- leads to activation of pathways affecting various physiology systems in the brain as well as periphery Attention has been focused on the role of endogenous opioids in analgesia and anesthesia
bullActivate the hypothalamus and pituitary resulting in a broad spectrum of systemic effects
bullAlteration in secretion of neurotransmitters and neurohormones that causes changes in the regulation of blood flow both centrally and peripherally
bullEvidence of alteration of immune functions NIH Consensus Statement Online 1997 Nov 3-5 month day] 15(5)1-34
LES TRAITEMENTS
bull 1-la stagnation de Qi et la stase du Sang
bull dynamiser le sang et transformer la stase du sang
bull 2- accumulation des Toxines lieacutees agrave la Chaleur
bull clarifier la chaleur et deacutegager la Toxiciteacute
bull 3- deacuteficience de Qi Vital
bull soutenir le Qi Vital et cultiver la racine
bull 4- toutes les maladies proviennent des Glaires la plupart des masses qui se produisent dans le corps sont dues aux Glaires
bull transformer les Glaires et ramollir la dureteacute
Dans le diagnostic et le traitement des tumeurs la MTC considegravere leacutetat geacuteneacuteral du patient plutocirct que de se focaliser sur le cancer lui-mecircme ou les symptocircmes particuliers
Soutien psychologique
bull angoisse devant lrsquoinconnu
bull angoisse devant la douleur
bull angoisse devant le deacuteveloppement de la maladie et la perte de controcircle sur son propre corps
bull angoisse devant les effets secondaires dus aux divers traitements
bull angoisse devant les complications tardives dues aux divers traitements
bull angoisse devant le regard social porteacute sur le malade
bull angoisse devant la mort
Soutien psychologique
Ces informations reacutesonnent agrave lrsquointeacuterieur du patient ougrave elle
provoquent des dysfonctionnements qui
peuvent se manifester par
bull des maux de ventre
bull des palpitations
bull des troubles du sommeil
bull des difficulteacutes respiratoires
bull des douleurs diverses etc
Nauseacutees et vomissements
RAPPEL LrsquoEstomac
bull YANG
bull Controcircle le mucircrissement amp pourrissement de la nourriture
bull Controcircle le transport des essences de la nourriture Gouverne la descente du Qi fait descendre la nourriture transformeacutee vers lrsquoIntestin Grecircle
bull Si le mouvement de descente est perturbeacute par les pervers si il y a un mouvement ascendant de QI de lrsquoEstomac (agrave contre-sens- NI) il y a des VOMISSEMENTS
Nauseacutees et vomissements
LES VOMISSEMENTS SE MANIFESTENT QUAND LE QI DE LrsquoESTOMAC MONTE A LA PLACE DE DESCENDRE
Neuropathie
Avastine Xeloda Gemzar Cysplatine Taxol Fludara Alimta Procarbazine
points GI2 3 4 IG 2 3 C7 MC6 8 P7 9 F2 3 V60 VB41
traitement
preacutevention
LA DOULEUR DUE AU CANCER
bull Etiologie et physiopathologie
bull Lrsquoinvasion des pervers Externes - tout pervers srsquoil persiste peut provoquer le blocage des meacuteridiens et par la suite une stagnation de Qi et de Sg ou des troubles de Zang-Fu
bull Le deacuteregraveglement des eacutemotions
bull Le deacuteseacutequilibre de lrsquoalimentation
bull Une faiblesse de constitution
DIFFEacuteRENCIATION DE LA DOULEUR
SELON LA LOCALISATION bull dans le cancer du poumon souvent une sensibiliteacute au
P1 et V13 accompagneacutee de toux et de souffle court bull dans le cancer de lrsquoœsophage ou de lrsquoestomac une
sensibiliteacute au E34 et E42 accompagneacutee de nauseacutees dysphagie inappeacutetence
SELON LE VIDE ET LA PLEacuteNITUDE bull Vide douleurs souvent leacutegegraveres intermittentes
sourdes bull Pleacutenitude douleurs tensives lancinantes coliques
aigues
LA FATIGUE
XU LAO = fatigue par Vide = lrsquoeacutepuisement En Occident crsquoest le symptocircme le plus souvent invoqueacute et pas toujours ducirc au Vide
LA FATIGUE - eacutetiologie
bull La faiblesse constitutionnelle
bull Le surmenage
bull Lrsquoexcegraves drsquoactiviteacute physique
bull Lrsquoalimentation
bull Les maladies graves
bull Lrsquoexcegraves drsquoactiviteacute sexuelle
bull Lrsquoaccouchement
bull La consommation de drogues
LA FATIGUE - pathologie
bull Vide
bull Combinaison de Vide et de Pleacutenitude
bull Pleacutenitude
Contre-indications agrave lrsquoacupuncture
bull Des risques de laquo gros bras raquo apregraves curage axillaire
bull Des opeacuterations selon Halsted ou Patey
bull Des drainages lymphatiques
bull Pas drsquoaiguille du cocircteacute opeacutereacute
TCM in cancer treatments
bull Used mostly as adjuvant therapy before or during or
after surgery radiotherapy and chemotherapy
bull Remit the side-effects and toxicity of other treatments
bull Symptom control
bull Activate and strengthen immune system
bull For advanced cancer patients mainly palliative but it
can also prolong life in some cases
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 15 Number 7 2009
Acupuncture for Chemotherapy-Induced Neutropenia in Patients with GynecologiMalignancies A Pilot Randomized Sham-Controlled Clinical Trial
Weidong Lu MB MPH LicAc1ndash3 Ursula A Matulonis MD4 Anne Doherty-Gilman MPH1 Hang ScD3
Peter M Wayne PhD23 David S Rosenthal MD14 and Richard T Penson MD6
bull Abstract bull Objectives The objective of this study was to investigate the effect of acupuncture administered during mye-
losuppressive chemotherapy on white blood cell (WBC) count and absolute neutrophil count (ANC) in patients with ovarian cancer
bull Design This study is a pilot randomized sham-controlled clinical trial Patients received active acupuncture versus sham acupuncture while undergoing chemotherapy A standardized acupuncture protocol was em- ployed with manual and electrostimulation The frequency of treatment was 2ndash3 times per week for a total of 10 sessions starting 1 week before the second cycle of chemotherapy
bull Setting The setting was two outpatient academic centers for patients with cancer bull Subjects Twenty-one (21) newly diagnosed and recurrent ovarian cancer patients were the subjects bull Outcome measures WBC count ANC and plasma granulocyte colony-stimulating factor (G-CSF ) were assessed
weekly bull Results The median leukocyte value in the acupuncture arm at the first day of the third cycle of chemotherapy
was significantly higher than in the control arm after adjusting for baseline value (8600 cells=mL range 4800ndash 12000 versus 4400 cell=mL range 2300ndash10000) ( p frac14 0046) The incidence of grade 2ndash4 leukopenia was less in the acupuncture arm than in the sham arm (30 versus 90 p frac14 002) However the median leukocyte nadir neutrophil nadir and recovering ANC were all higher but not statistically significantly different ( p frac14 0116ndash016) after adjusting for baseline differences There were no statistically significant differences in plasma G-CSF between the two groups
bull Conclusions We observed clinically relevant trends of higher WBC values during one cycle of chemotherapy in patients with ovarian cancer which suggests a potential myeloprotective effect of acupuncture A larger trial is warranted to more definitively determine the efficacy of acupuncture on clinically important outcomes of chemotherapy-induced neutropenia
Acupuncture for the alleviation of hot flashes in men treated with androgen
ablation therapy Ashamalla H1 Jiang ML Guirguis A Peluso F Ashamalla M
bull Abstract bull PURPOSE bull Hot flashes are common side effect due to androgen ablation therapy (AAT) The utility of acupuncture for hot flashes in
men has not been thoroughly studied We prospectively studied the effect of acupuncture in men with hot flashes bull METHODS AND MATERIALS bull The study was approved by internal review board Seventeen men with hot flashes and history of AAT for prostate cancer
were enrolled Three men declined participation before receiving any treatment A hot flash score (HFS) was used to measure daily hot flashes The composite daily score was calculated as the product of frequency times severity The baseline daily scores were compared with scores taken at 2 and 6 weeks and at 8-month average follow-up
bull RESULTS bull No side effects were encountered during immediately after treatment or at 8 months The mean initial HFS was 283 it
dropped to 103 (p = 00001) at 2 weeks posttreatment 75 (p = 00001) at 6 weeks and 70 (p = 0001) at 8 months Clinical improvement for each patient is defined as the percent decrease in the mean HFS at each time point The mean improvement at Weeks 2 and 6 was 684 (mean HFS decreased from 37409 to 11836 p = 0001) and 892 (mean HFS decreased from 37409 to 405 p = 00078) respectively The improvement at 8 months was 803 (mean HFS decreased from 37409 to 7385 p = 0002)
bull CONCLUSIONS bull Acupuncture provides excellent control of hot flashes in men with a history of AAT The absence of side effects and the
durable response at 8 months are likely to be appealing to patients Prospective randomized study is warranted to further evaluate this modality against medical therapy
bull Copyright copy 2011 Elsevier Inc All rights reserved
bull Int J Radiat Oncol Biol Phys 2011 Apr 179(5)1358-63 doi 101016jijrobp201001025 Epub 2010 Jun 3
bull J Clin Oncol 2010 Mar 128(7)1154-60 doi 101200JCO2009234708 Epub 2010 Jan 25 bull Randomized blinded sham-controlled trial of acupuncture for the management of aromatase
inhibitor-associated joint symptoms in women with early-stage breast cancer bull Crew KD1 Capodice JL Greenlee H Brafman L Fuentes D Awad D Yann Tsai W Hershman DL bull Author information
bull Abstract bull PURPOSE Women with breast cancer (BC) treated with aromatase inhibitors (AIs) may experience
joint symptoms that can lead to discontinuation of effective therapy We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC METHODS We conducted a randomized controlled blinded study comparing true acupuncture (TA) versus sham acupuncture (SA) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs TA included full bodyauricular acupuncture and joint-specific point prescriptions whereas SA involved superficial needle insertion at nonacupoint locations Outcome measures included the Brief Pain Inventory-Short Form (BPI-SF) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH) obtained at baseline and at 3 and 6 weeks Results Of 51 women enrolled 43 women were randomly assigned and 38 were evaluable Baseline characteristics were comparable between the two groups Our primary end point was the difference in mean BPI-SF worst pain scores at 6 weeks which was lower for TA compared with SA (30 v 55 P lt 001) We also found differences between TA and SA in pain severity (26 v 45 P = 003) and pain-related interference (25 v 45 P = 002) at 6 weeks Similar findings were seen for the WOMAC and M-SACRAH scores The acupuncture intervention was well-tolerated CONCLUSION Women with AI-induced arthralgias treated with TA had significant improvement of joint pain and stiffness which was not seen with SA Acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect
Chinese Medicine
an overview
Unique theory system
Concept of Wholism
Individual Treatment based
on syndrome
Variety of treatment methods
based on nature
天人合一mdash整体观
Unity of Heaven and Man--Holism
bull 人与自然是一个整体
bull Human beings and nature are taken as a whole
bull 人与社会是一个整体
bull Human beings and society are taken as a whole
bull 人本身各系统之间是一个整体
bull The various systems in the human body are inter connected as a whole
bull 天地人相参
bull Heaven earth and human beings interact and correspond with each
other
Fundamentals of TCM
bull The material basis of the human body
Qi Blood Jing Jing-ye
bull The concept of Yin and Yang
bull The theory of f ive elements Wood Fire Earth Metal Water
bull The theory of Zang-Fu
bull The pathways of the human body Meridians
Five Elements Theory
Types of Qi and their origins
Zong Qi
Gathering
Qi
Lungs
process
air
Spleen
process
food
Kong Qi
Air Qi
Gu Qi
Grain Qi
Yuan Qi
Original
Qi
Zheng Qi
Normal
Qi
Ying Qi
Nutritive
Qi
Wei Qi
Defensive
Qi
Zang Fu
Zhi Qi
Organ Qi
Human body
Heart ruler of all organs in charge of blood circulation and mental activity
Cardiovacular and certain parts of higher nervous systerm
Liver laquoa viscus of temperamentraquo stores blood secretes bile and controls muscles
Centrals nervous and autonomous nervous systems
Spleen transforms and transports nutrients and water nourishing the muscles and limbs
and determining the bodyrsquos constitution protects the body against pathogen
Digestive and immune systemsas well as the functional system in charge of energy and water metabolism
Lung respiration cotrols vital energy and superficial body resistance regulates circulation of body fluid
Respiratory system part of immune system also related to water metablism
Kidney works to secrete urine store essence of life either inborn or acquired in charge of reproduction growth and development replenishing the brain nourishing the bones and producing marrow helps the lung inhale air
Related to the urogenital systemendocrine system (particularly the pituitary-adrenal and pituitary and gonadal axes) a part of immune system and higher nervous system
The causes of the diseases
Endogenous pathogenic factors
Seven emotions joy anger worry anxiety sorrow
terror and fright (Colegravere Joie Soucis Affliction et
Chagrin Angoisse Effroi)
Exogenous pathogenic factors
Six Excesses (Climatic changes) wind cold summer
heat dampness dryness fire
Epidemiques Trauma Inadequate diet
ETIOLOGIE EN MTC
CANCER EN MTC
bull Les tumeurs reacutesultent dun deacuteseacutequilibre dans le corps ou entre le corps et lenvironnement exteacuterieur
bull Les tumeurs sont dues agrave des changements qualitatifs et irreacuteversibles dans la structure ou la fonction de Zang Fu Qi et du Sang ou de LO
bull Si il y a carence les facteurs pathogegravenes envahissent profondeacutement le corps et si elle persiste la lutte entre le Froid et la Chaleur peut endommager la chair
bull Si les facteurs pathogegravenes ne peuvent pas ecirctre dissipeacutes ceci conduira agrave la formation de tumeurs
LES ELEMENTS CLES DANS LE DEVELOPPEMENT DE TUMEUR DANS MTC
bull 1- stagnation de Qi et la stase du Sang
bull 2- accumulation des Toxines lieacutees agrave la Chaleur
bull 3- deacuteficience de Qi Vital
bull 4- toutes les maladies proviennent des Glaires la plupart des masses qui se produisent dans le corps sont dues aux Glaires
Clinical Guide
bull Principle of diagnosis Diagnosis of disease
Syndrome differentiation
(individulized treatment)
bull Methods
Inspection Auscultation and Olfaction Interrogation Palpation
bull Intervention modalities
Chinese medication Acupuncture Qigong Tuina Dietary
(nutrition)
Treatment
The goal of treatment is to adjust and harmonize Yin and Yang
This is achieved by regulating the Qi Moisture and Blood in the Organ Networksweak organs are tonified congested channels are opened
excess is dispersed tightness is softened agitation is calmed heat is cooled cold is warmed dryness is moistened and dampness is drained
Preventive treatment of Progression of
Disease
《难经middot七十七难》ldquo所谓治未病者见肝之病则知肝当传之于脾 故先实其脾气无令得受肝之邪故曰治未病焉rdquo
重视疾病的传变规律ldquo先安未受邪之地rdquo 痰毒瘀结是肿瘤转移的关键流窜经络脏腑是其特点对于肿瘤的转移预防比治疗更有现实意义
laquo Classique des Problegravemes meacutedicaux raquo chap77 rdquoSi le Foie est malade il peut attaquer la Rate Par conseacutequent la Rate doit ecirctre fortifieacutee avant qursquoelle ne soit elle-mecircme affecteacutee raquo
Acupuncture
Bronze Model for the Meridians and
Acupuncture Points
(Qing Dynasty 1744)
An insight into acupuncture
Concept of Yin Yang
Holism
Five element theory
Human body
About Qi Formation of Qi
Function of Qi
Disharmony of Qi
Meridians - the pathways of the body
Techniques and methods
Meridian pathways of the Body
bullComponents bull 12 regular meridians
12 Collaterals
8 extraordinary meridians
Functions Connect and coordinate
creating an integral whole
Transporting functions
Spleen Meridian
Techniques and methods
Manual (Classic) Acupuncture
Electric-Acupuncture
Acupuncture and Moxibustion
Laser Acupuncture
Ultrasound Acupuncture
Acupuncture and the Moxibustion
Cupping Therapy
Indications
In 1979 WHO named 43 different diseases that can be
treated by Acupuncture
Upper Respiratory Tract
Acute sinusitis
Acute rhinitis
Common cold
Acute tonsillitis
Respiratory System
Acute Bronchitis
Bronchial asthma
Disorders of the Eye Acute conjunctivitis
Central retinitis
Myopia (in children)
Cataract (without
complications)
Disorders of the Mouth Toothache
Post-extraction pain
Gingivitis
Acute and chronic pharyngitis
Journal of World Health Organisation Dec1979
Known biological effects of
acupuncture
bullAcupuncture multiple biological responses
bullOccur locally or at a distance mediated by sensor neurons to many structures of the central nervous system -- leads to activation of pathways affecting various physiology systems in the brain as well as periphery Attention has been focused on the role of endogenous opioids in analgesia and anesthesia
bullActivate the hypothalamus and pituitary resulting in a broad spectrum of systemic effects
bullAlteration in secretion of neurotransmitters and neurohormones that causes changes in the regulation of blood flow both centrally and peripherally
bullEvidence of alteration of immune functions NIH Consensus Statement Online 1997 Nov 3-5 month day] 15(5)1-34
LES TRAITEMENTS
bull 1-la stagnation de Qi et la stase du Sang
bull dynamiser le sang et transformer la stase du sang
bull 2- accumulation des Toxines lieacutees agrave la Chaleur
bull clarifier la chaleur et deacutegager la Toxiciteacute
bull 3- deacuteficience de Qi Vital
bull soutenir le Qi Vital et cultiver la racine
bull 4- toutes les maladies proviennent des Glaires la plupart des masses qui se produisent dans le corps sont dues aux Glaires
bull transformer les Glaires et ramollir la dureteacute
Dans le diagnostic et le traitement des tumeurs la MTC considegravere leacutetat geacuteneacuteral du patient plutocirct que de se focaliser sur le cancer lui-mecircme ou les symptocircmes particuliers
Soutien psychologique
bull angoisse devant lrsquoinconnu
bull angoisse devant la douleur
bull angoisse devant le deacuteveloppement de la maladie et la perte de controcircle sur son propre corps
bull angoisse devant les effets secondaires dus aux divers traitements
bull angoisse devant les complications tardives dues aux divers traitements
bull angoisse devant le regard social porteacute sur le malade
bull angoisse devant la mort
Soutien psychologique
Ces informations reacutesonnent agrave lrsquointeacuterieur du patient ougrave elle
provoquent des dysfonctionnements qui
peuvent se manifester par
bull des maux de ventre
bull des palpitations
bull des troubles du sommeil
bull des difficulteacutes respiratoires
bull des douleurs diverses etc
Nauseacutees et vomissements
RAPPEL LrsquoEstomac
bull YANG
bull Controcircle le mucircrissement amp pourrissement de la nourriture
bull Controcircle le transport des essences de la nourriture Gouverne la descente du Qi fait descendre la nourriture transformeacutee vers lrsquoIntestin Grecircle
bull Si le mouvement de descente est perturbeacute par les pervers si il y a un mouvement ascendant de QI de lrsquoEstomac (agrave contre-sens- NI) il y a des VOMISSEMENTS
Nauseacutees et vomissements
LES VOMISSEMENTS SE MANIFESTENT QUAND LE QI DE LrsquoESTOMAC MONTE A LA PLACE DE DESCENDRE
Neuropathie
Avastine Xeloda Gemzar Cysplatine Taxol Fludara Alimta Procarbazine
points GI2 3 4 IG 2 3 C7 MC6 8 P7 9 F2 3 V60 VB41
traitement
preacutevention
LA DOULEUR DUE AU CANCER
bull Etiologie et physiopathologie
bull Lrsquoinvasion des pervers Externes - tout pervers srsquoil persiste peut provoquer le blocage des meacuteridiens et par la suite une stagnation de Qi et de Sg ou des troubles de Zang-Fu
bull Le deacuteregraveglement des eacutemotions
bull Le deacuteseacutequilibre de lrsquoalimentation
bull Une faiblesse de constitution
DIFFEacuteRENCIATION DE LA DOULEUR
SELON LA LOCALISATION bull dans le cancer du poumon souvent une sensibiliteacute au
P1 et V13 accompagneacutee de toux et de souffle court bull dans le cancer de lrsquoœsophage ou de lrsquoestomac une
sensibiliteacute au E34 et E42 accompagneacutee de nauseacutees dysphagie inappeacutetence
SELON LE VIDE ET LA PLEacuteNITUDE bull Vide douleurs souvent leacutegegraveres intermittentes
sourdes bull Pleacutenitude douleurs tensives lancinantes coliques
aigues
LA FATIGUE
XU LAO = fatigue par Vide = lrsquoeacutepuisement En Occident crsquoest le symptocircme le plus souvent invoqueacute et pas toujours ducirc au Vide
LA FATIGUE - eacutetiologie
bull La faiblesse constitutionnelle
bull Le surmenage
bull Lrsquoexcegraves drsquoactiviteacute physique
bull Lrsquoalimentation
bull Les maladies graves
bull Lrsquoexcegraves drsquoactiviteacute sexuelle
bull Lrsquoaccouchement
bull La consommation de drogues
LA FATIGUE - pathologie
bull Vide
bull Combinaison de Vide et de Pleacutenitude
bull Pleacutenitude
Contre-indications agrave lrsquoacupuncture
bull Des risques de laquo gros bras raquo apregraves curage axillaire
bull Des opeacuterations selon Halsted ou Patey
bull Des drainages lymphatiques
bull Pas drsquoaiguille du cocircteacute opeacutereacute
TCM in cancer treatments
bull Used mostly as adjuvant therapy before or during or
after surgery radiotherapy and chemotherapy
bull Remit the side-effects and toxicity of other treatments
bull Symptom control
bull Activate and strengthen immune system
bull For advanced cancer patients mainly palliative but it
can also prolong life in some cases
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 15 Number 7 2009
Acupuncture for Chemotherapy-Induced Neutropenia in Patients with GynecologiMalignancies A Pilot Randomized Sham-Controlled Clinical Trial
Weidong Lu MB MPH LicAc1ndash3 Ursula A Matulonis MD4 Anne Doherty-Gilman MPH1 Hang ScD3
Peter M Wayne PhD23 David S Rosenthal MD14 and Richard T Penson MD6
bull Abstract bull Objectives The objective of this study was to investigate the effect of acupuncture administered during mye-
losuppressive chemotherapy on white blood cell (WBC) count and absolute neutrophil count (ANC) in patients with ovarian cancer
bull Design This study is a pilot randomized sham-controlled clinical trial Patients received active acupuncture versus sham acupuncture while undergoing chemotherapy A standardized acupuncture protocol was em- ployed with manual and electrostimulation The frequency of treatment was 2ndash3 times per week for a total of 10 sessions starting 1 week before the second cycle of chemotherapy
bull Setting The setting was two outpatient academic centers for patients with cancer bull Subjects Twenty-one (21) newly diagnosed and recurrent ovarian cancer patients were the subjects bull Outcome measures WBC count ANC and plasma granulocyte colony-stimulating factor (G-CSF ) were assessed
weekly bull Results The median leukocyte value in the acupuncture arm at the first day of the third cycle of chemotherapy
was significantly higher than in the control arm after adjusting for baseline value (8600 cells=mL range 4800ndash 12000 versus 4400 cell=mL range 2300ndash10000) ( p frac14 0046) The incidence of grade 2ndash4 leukopenia was less in the acupuncture arm than in the sham arm (30 versus 90 p frac14 002) However the median leukocyte nadir neutrophil nadir and recovering ANC were all higher but not statistically significantly different ( p frac14 0116ndash016) after adjusting for baseline differences There were no statistically significant differences in plasma G-CSF between the two groups
bull Conclusions We observed clinically relevant trends of higher WBC values during one cycle of chemotherapy in patients with ovarian cancer which suggests a potential myeloprotective effect of acupuncture A larger trial is warranted to more definitively determine the efficacy of acupuncture on clinically important outcomes of chemotherapy-induced neutropenia
Acupuncture for the alleviation of hot flashes in men treated with androgen
ablation therapy Ashamalla H1 Jiang ML Guirguis A Peluso F Ashamalla M
bull Abstract bull PURPOSE bull Hot flashes are common side effect due to androgen ablation therapy (AAT) The utility of acupuncture for hot flashes in
men has not been thoroughly studied We prospectively studied the effect of acupuncture in men with hot flashes bull METHODS AND MATERIALS bull The study was approved by internal review board Seventeen men with hot flashes and history of AAT for prostate cancer
were enrolled Three men declined participation before receiving any treatment A hot flash score (HFS) was used to measure daily hot flashes The composite daily score was calculated as the product of frequency times severity The baseline daily scores were compared with scores taken at 2 and 6 weeks and at 8-month average follow-up
bull RESULTS bull No side effects were encountered during immediately after treatment or at 8 months The mean initial HFS was 283 it
dropped to 103 (p = 00001) at 2 weeks posttreatment 75 (p = 00001) at 6 weeks and 70 (p = 0001) at 8 months Clinical improvement for each patient is defined as the percent decrease in the mean HFS at each time point The mean improvement at Weeks 2 and 6 was 684 (mean HFS decreased from 37409 to 11836 p = 0001) and 892 (mean HFS decreased from 37409 to 405 p = 00078) respectively The improvement at 8 months was 803 (mean HFS decreased from 37409 to 7385 p = 0002)
bull CONCLUSIONS bull Acupuncture provides excellent control of hot flashes in men with a history of AAT The absence of side effects and the
durable response at 8 months are likely to be appealing to patients Prospective randomized study is warranted to further evaluate this modality against medical therapy
bull Copyright copy 2011 Elsevier Inc All rights reserved
bull Int J Radiat Oncol Biol Phys 2011 Apr 179(5)1358-63 doi 101016jijrobp201001025 Epub 2010 Jun 3
bull J Clin Oncol 2010 Mar 128(7)1154-60 doi 101200JCO2009234708 Epub 2010 Jan 25 bull Randomized blinded sham-controlled trial of acupuncture for the management of aromatase
inhibitor-associated joint symptoms in women with early-stage breast cancer bull Crew KD1 Capodice JL Greenlee H Brafman L Fuentes D Awad D Yann Tsai W Hershman DL bull Author information
bull Abstract bull PURPOSE Women with breast cancer (BC) treated with aromatase inhibitors (AIs) may experience
joint symptoms that can lead to discontinuation of effective therapy We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC METHODS We conducted a randomized controlled blinded study comparing true acupuncture (TA) versus sham acupuncture (SA) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs TA included full bodyauricular acupuncture and joint-specific point prescriptions whereas SA involved superficial needle insertion at nonacupoint locations Outcome measures included the Brief Pain Inventory-Short Form (BPI-SF) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH) obtained at baseline and at 3 and 6 weeks Results Of 51 women enrolled 43 women were randomly assigned and 38 were evaluable Baseline characteristics were comparable between the two groups Our primary end point was the difference in mean BPI-SF worst pain scores at 6 weeks which was lower for TA compared with SA (30 v 55 P lt 001) We also found differences between TA and SA in pain severity (26 v 45 P = 003) and pain-related interference (25 v 45 P = 002) at 6 weeks Similar findings were seen for the WOMAC and M-SACRAH scores The acupuncture intervention was well-tolerated CONCLUSION Women with AI-induced arthralgias treated with TA had significant improvement of joint pain and stiffness which was not seen with SA Acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect
Unique theory system
Concept of Wholism
Individual Treatment based
on syndrome
Variety of treatment methods
based on nature
天人合一mdash整体观
Unity of Heaven and Man--Holism
bull 人与自然是一个整体
bull Human beings and nature are taken as a whole
bull 人与社会是一个整体
bull Human beings and society are taken as a whole
bull 人本身各系统之间是一个整体
bull The various systems in the human body are inter connected as a whole
bull 天地人相参
bull Heaven earth and human beings interact and correspond with each
other
Fundamentals of TCM
bull The material basis of the human body
Qi Blood Jing Jing-ye
bull The concept of Yin and Yang
bull The theory of f ive elements Wood Fire Earth Metal Water
bull The theory of Zang-Fu
bull The pathways of the human body Meridians
Five Elements Theory
Types of Qi and their origins
Zong Qi
Gathering
Qi
Lungs
process
air
Spleen
process
food
Kong Qi
Air Qi
Gu Qi
Grain Qi
Yuan Qi
Original
Qi
Zheng Qi
Normal
Qi
Ying Qi
Nutritive
Qi
Wei Qi
Defensive
Qi
Zang Fu
Zhi Qi
Organ Qi
Human body
Heart ruler of all organs in charge of blood circulation and mental activity
Cardiovacular and certain parts of higher nervous systerm
Liver laquoa viscus of temperamentraquo stores blood secretes bile and controls muscles
Centrals nervous and autonomous nervous systems
Spleen transforms and transports nutrients and water nourishing the muscles and limbs
and determining the bodyrsquos constitution protects the body against pathogen
Digestive and immune systemsas well as the functional system in charge of energy and water metabolism
Lung respiration cotrols vital energy and superficial body resistance regulates circulation of body fluid
Respiratory system part of immune system also related to water metablism
Kidney works to secrete urine store essence of life either inborn or acquired in charge of reproduction growth and development replenishing the brain nourishing the bones and producing marrow helps the lung inhale air
Related to the urogenital systemendocrine system (particularly the pituitary-adrenal and pituitary and gonadal axes) a part of immune system and higher nervous system
The causes of the diseases
Endogenous pathogenic factors
Seven emotions joy anger worry anxiety sorrow
terror and fright (Colegravere Joie Soucis Affliction et
Chagrin Angoisse Effroi)
Exogenous pathogenic factors
Six Excesses (Climatic changes) wind cold summer
heat dampness dryness fire
Epidemiques Trauma Inadequate diet
ETIOLOGIE EN MTC
CANCER EN MTC
bull Les tumeurs reacutesultent dun deacuteseacutequilibre dans le corps ou entre le corps et lenvironnement exteacuterieur
bull Les tumeurs sont dues agrave des changements qualitatifs et irreacuteversibles dans la structure ou la fonction de Zang Fu Qi et du Sang ou de LO
bull Si il y a carence les facteurs pathogegravenes envahissent profondeacutement le corps et si elle persiste la lutte entre le Froid et la Chaleur peut endommager la chair
bull Si les facteurs pathogegravenes ne peuvent pas ecirctre dissipeacutes ceci conduira agrave la formation de tumeurs
LES ELEMENTS CLES DANS LE DEVELOPPEMENT DE TUMEUR DANS MTC
bull 1- stagnation de Qi et la stase du Sang
bull 2- accumulation des Toxines lieacutees agrave la Chaleur
bull 3- deacuteficience de Qi Vital
bull 4- toutes les maladies proviennent des Glaires la plupart des masses qui se produisent dans le corps sont dues aux Glaires
Clinical Guide
bull Principle of diagnosis Diagnosis of disease
Syndrome differentiation
(individulized treatment)
bull Methods
Inspection Auscultation and Olfaction Interrogation Palpation
bull Intervention modalities
Chinese medication Acupuncture Qigong Tuina Dietary
(nutrition)
Treatment
The goal of treatment is to adjust and harmonize Yin and Yang
This is achieved by regulating the Qi Moisture and Blood in the Organ Networksweak organs are tonified congested channels are opened
excess is dispersed tightness is softened agitation is calmed heat is cooled cold is warmed dryness is moistened and dampness is drained
Preventive treatment of Progression of
Disease
《难经middot七十七难》ldquo所谓治未病者见肝之病则知肝当传之于脾 故先实其脾气无令得受肝之邪故曰治未病焉rdquo
重视疾病的传变规律ldquo先安未受邪之地rdquo 痰毒瘀结是肿瘤转移的关键流窜经络脏腑是其特点对于肿瘤的转移预防比治疗更有现实意义
laquo Classique des Problegravemes meacutedicaux raquo chap77 rdquoSi le Foie est malade il peut attaquer la Rate Par conseacutequent la Rate doit ecirctre fortifieacutee avant qursquoelle ne soit elle-mecircme affecteacutee raquo
Acupuncture
Bronze Model for the Meridians and
Acupuncture Points
(Qing Dynasty 1744)
An insight into acupuncture
Concept of Yin Yang
Holism
Five element theory
Human body
About Qi Formation of Qi
Function of Qi
Disharmony of Qi
Meridians - the pathways of the body
Techniques and methods
Meridian pathways of the Body
bullComponents bull 12 regular meridians
12 Collaterals
8 extraordinary meridians
Functions Connect and coordinate
creating an integral whole
Transporting functions
Spleen Meridian
Techniques and methods
Manual (Classic) Acupuncture
Electric-Acupuncture
Acupuncture and Moxibustion
Laser Acupuncture
Ultrasound Acupuncture
Acupuncture and the Moxibustion
Cupping Therapy
Indications
In 1979 WHO named 43 different diseases that can be
treated by Acupuncture
Upper Respiratory Tract
Acute sinusitis
Acute rhinitis
Common cold
Acute tonsillitis
Respiratory System
Acute Bronchitis
Bronchial asthma
Disorders of the Eye Acute conjunctivitis
Central retinitis
Myopia (in children)
Cataract (without
complications)
Disorders of the Mouth Toothache
Post-extraction pain
Gingivitis
Acute and chronic pharyngitis
Journal of World Health Organisation Dec1979
Known biological effects of
acupuncture
bullAcupuncture multiple biological responses
bullOccur locally or at a distance mediated by sensor neurons to many structures of the central nervous system -- leads to activation of pathways affecting various physiology systems in the brain as well as periphery Attention has been focused on the role of endogenous opioids in analgesia and anesthesia
bullActivate the hypothalamus and pituitary resulting in a broad spectrum of systemic effects
bullAlteration in secretion of neurotransmitters and neurohormones that causes changes in the regulation of blood flow both centrally and peripherally
bullEvidence of alteration of immune functions NIH Consensus Statement Online 1997 Nov 3-5 month day] 15(5)1-34
LES TRAITEMENTS
bull 1-la stagnation de Qi et la stase du Sang
bull dynamiser le sang et transformer la stase du sang
bull 2- accumulation des Toxines lieacutees agrave la Chaleur
bull clarifier la chaleur et deacutegager la Toxiciteacute
bull 3- deacuteficience de Qi Vital
bull soutenir le Qi Vital et cultiver la racine
bull 4- toutes les maladies proviennent des Glaires la plupart des masses qui se produisent dans le corps sont dues aux Glaires
bull transformer les Glaires et ramollir la dureteacute
Dans le diagnostic et le traitement des tumeurs la MTC considegravere leacutetat geacuteneacuteral du patient plutocirct que de se focaliser sur le cancer lui-mecircme ou les symptocircmes particuliers
Soutien psychologique
bull angoisse devant lrsquoinconnu
bull angoisse devant la douleur
bull angoisse devant le deacuteveloppement de la maladie et la perte de controcircle sur son propre corps
bull angoisse devant les effets secondaires dus aux divers traitements
bull angoisse devant les complications tardives dues aux divers traitements
bull angoisse devant le regard social porteacute sur le malade
bull angoisse devant la mort
Soutien psychologique
Ces informations reacutesonnent agrave lrsquointeacuterieur du patient ougrave elle
provoquent des dysfonctionnements qui
peuvent se manifester par
bull des maux de ventre
bull des palpitations
bull des troubles du sommeil
bull des difficulteacutes respiratoires
bull des douleurs diverses etc
Nauseacutees et vomissements
RAPPEL LrsquoEstomac
bull YANG
bull Controcircle le mucircrissement amp pourrissement de la nourriture
bull Controcircle le transport des essences de la nourriture Gouverne la descente du Qi fait descendre la nourriture transformeacutee vers lrsquoIntestin Grecircle
bull Si le mouvement de descente est perturbeacute par les pervers si il y a un mouvement ascendant de QI de lrsquoEstomac (agrave contre-sens- NI) il y a des VOMISSEMENTS
Nauseacutees et vomissements
LES VOMISSEMENTS SE MANIFESTENT QUAND LE QI DE LrsquoESTOMAC MONTE A LA PLACE DE DESCENDRE
Neuropathie
Avastine Xeloda Gemzar Cysplatine Taxol Fludara Alimta Procarbazine
points GI2 3 4 IG 2 3 C7 MC6 8 P7 9 F2 3 V60 VB41
traitement
preacutevention
LA DOULEUR DUE AU CANCER
bull Etiologie et physiopathologie
bull Lrsquoinvasion des pervers Externes - tout pervers srsquoil persiste peut provoquer le blocage des meacuteridiens et par la suite une stagnation de Qi et de Sg ou des troubles de Zang-Fu
bull Le deacuteregraveglement des eacutemotions
bull Le deacuteseacutequilibre de lrsquoalimentation
bull Une faiblesse de constitution
DIFFEacuteRENCIATION DE LA DOULEUR
SELON LA LOCALISATION bull dans le cancer du poumon souvent une sensibiliteacute au
P1 et V13 accompagneacutee de toux et de souffle court bull dans le cancer de lrsquoœsophage ou de lrsquoestomac une
sensibiliteacute au E34 et E42 accompagneacutee de nauseacutees dysphagie inappeacutetence
SELON LE VIDE ET LA PLEacuteNITUDE bull Vide douleurs souvent leacutegegraveres intermittentes
sourdes bull Pleacutenitude douleurs tensives lancinantes coliques
aigues
LA FATIGUE
XU LAO = fatigue par Vide = lrsquoeacutepuisement En Occident crsquoest le symptocircme le plus souvent invoqueacute et pas toujours ducirc au Vide
LA FATIGUE - eacutetiologie
bull La faiblesse constitutionnelle
bull Le surmenage
bull Lrsquoexcegraves drsquoactiviteacute physique
bull Lrsquoalimentation
bull Les maladies graves
bull Lrsquoexcegraves drsquoactiviteacute sexuelle
bull Lrsquoaccouchement
bull La consommation de drogues
LA FATIGUE - pathologie
bull Vide
bull Combinaison de Vide et de Pleacutenitude
bull Pleacutenitude
Contre-indications agrave lrsquoacupuncture
bull Des risques de laquo gros bras raquo apregraves curage axillaire
bull Des opeacuterations selon Halsted ou Patey
bull Des drainages lymphatiques
bull Pas drsquoaiguille du cocircteacute opeacutereacute
TCM in cancer treatments
bull Used mostly as adjuvant therapy before or during or
after surgery radiotherapy and chemotherapy
bull Remit the side-effects and toxicity of other treatments
bull Symptom control
bull Activate and strengthen immune system
bull For advanced cancer patients mainly palliative but it
can also prolong life in some cases
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 15 Number 7 2009
Acupuncture for Chemotherapy-Induced Neutropenia in Patients with GynecologiMalignancies A Pilot Randomized Sham-Controlled Clinical Trial
Weidong Lu MB MPH LicAc1ndash3 Ursula A Matulonis MD4 Anne Doherty-Gilman MPH1 Hang ScD3
Peter M Wayne PhD23 David S Rosenthal MD14 and Richard T Penson MD6
bull Abstract bull Objectives The objective of this study was to investigate the effect of acupuncture administered during mye-
losuppressive chemotherapy on white blood cell (WBC) count and absolute neutrophil count (ANC) in patients with ovarian cancer
bull Design This study is a pilot randomized sham-controlled clinical trial Patients received active acupuncture versus sham acupuncture while undergoing chemotherapy A standardized acupuncture protocol was em- ployed with manual and electrostimulation The frequency of treatment was 2ndash3 times per week for a total of 10 sessions starting 1 week before the second cycle of chemotherapy
bull Setting The setting was two outpatient academic centers for patients with cancer bull Subjects Twenty-one (21) newly diagnosed and recurrent ovarian cancer patients were the subjects bull Outcome measures WBC count ANC and plasma granulocyte colony-stimulating factor (G-CSF ) were assessed
weekly bull Results The median leukocyte value in the acupuncture arm at the first day of the third cycle of chemotherapy
was significantly higher than in the control arm after adjusting for baseline value (8600 cells=mL range 4800ndash 12000 versus 4400 cell=mL range 2300ndash10000) ( p frac14 0046) The incidence of grade 2ndash4 leukopenia was less in the acupuncture arm than in the sham arm (30 versus 90 p frac14 002) However the median leukocyte nadir neutrophil nadir and recovering ANC were all higher but not statistically significantly different ( p frac14 0116ndash016) after adjusting for baseline differences There were no statistically significant differences in plasma G-CSF between the two groups
bull Conclusions We observed clinically relevant trends of higher WBC values during one cycle of chemotherapy in patients with ovarian cancer which suggests a potential myeloprotective effect of acupuncture A larger trial is warranted to more definitively determine the efficacy of acupuncture on clinically important outcomes of chemotherapy-induced neutropenia
Acupuncture for the alleviation of hot flashes in men treated with androgen
ablation therapy Ashamalla H1 Jiang ML Guirguis A Peluso F Ashamalla M
bull Abstract bull PURPOSE bull Hot flashes are common side effect due to androgen ablation therapy (AAT) The utility of acupuncture for hot flashes in
men has not been thoroughly studied We prospectively studied the effect of acupuncture in men with hot flashes bull METHODS AND MATERIALS bull The study was approved by internal review board Seventeen men with hot flashes and history of AAT for prostate cancer
were enrolled Three men declined participation before receiving any treatment A hot flash score (HFS) was used to measure daily hot flashes The composite daily score was calculated as the product of frequency times severity The baseline daily scores were compared with scores taken at 2 and 6 weeks and at 8-month average follow-up
bull RESULTS bull No side effects were encountered during immediately after treatment or at 8 months The mean initial HFS was 283 it
dropped to 103 (p = 00001) at 2 weeks posttreatment 75 (p = 00001) at 6 weeks and 70 (p = 0001) at 8 months Clinical improvement for each patient is defined as the percent decrease in the mean HFS at each time point The mean improvement at Weeks 2 and 6 was 684 (mean HFS decreased from 37409 to 11836 p = 0001) and 892 (mean HFS decreased from 37409 to 405 p = 00078) respectively The improvement at 8 months was 803 (mean HFS decreased from 37409 to 7385 p = 0002)
bull CONCLUSIONS bull Acupuncture provides excellent control of hot flashes in men with a history of AAT The absence of side effects and the
durable response at 8 months are likely to be appealing to patients Prospective randomized study is warranted to further evaluate this modality against medical therapy
bull Copyright copy 2011 Elsevier Inc All rights reserved
bull Int J Radiat Oncol Biol Phys 2011 Apr 179(5)1358-63 doi 101016jijrobp201001025 Epub 2010 Jun 3
bull J Clin Oncol 2010 Mar 128(7)1154-60 doi 101200JCO2009234708 Epub 2010 Jan 25 bull Randomized blinded sham-controlled trial of acupuncture for the management of aromatase
inhibitor-associated joint symptoms in women with early-stage breast cancer bull Crew KD1 Capodice JL Greenlee H Brafman L Fuentes D Awad D Yann Tsai W Hershman DL bull Author information
bull Abstract bull PURPOSE Women with breast cancer (BC) treated with aromatase inhibitors (AIs) may experience
joint symptoms that can lead to discontinuation of effective therapy We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC METHODS We conducted a randomized controlled blinded study comparing true acupuncture (TA) versus sham acupuncture (SA) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs TA included full bodyauricular acupuncture and joint-specific point prescriptions whereas SA involved superficial needle insertion at nonacupoint locations Outcome measures included the Brief Pain Inventory-Short Form (BPI-SF) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH) obtained at baseline and at 3 and 6 weeks Results Of 51 women enrolled 43 women were randomly assigned and 38 were evaluable Baseline characteristics were comparable between the two groups Our primary end point was the difference in mean BPI-SF worst pain scores at 6 weeks which was lower for TA compared with SA (30 v 55 P lt 001) We also found differences between TA and SA in pain severity (26 v 45 P = 003) and pain-related interference (25 v 45 P = 002) at 6 weeks Similar findings were seen for the WOMAC and M-SACRAH scores The acupuncture intervention was well-tolerated CONCLUSION Women with AI-induced arthralgias treated with TA had significant improvement of joint pain and stiffness which was not seen with SA Acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect
天人合一mdash整体观
Unity of Heaven and Man--Holism
bull 人与自然是一个整体
bull Human beings and nature are taken as a whole
bull 人与社会是一个整体
bull Human beings and society are taken as a whole
bull 人本身各系统之间是一个整体
bull The various systems in the human body are inter connected as a whole
bull 天地人相参
bull Heaven earth and human beings interact and correspond with each
other
Fundamentals of TCM
bull The material basis of the human body
Qi Blood Jing Jing-ye
bull The concept of Yin and Yang
bull The theory of f ive elements Wood Fire Earth Metal Water
bull The theory of Zang-Fu
bull The pathways of the human body Meridians
Five Elements Theory
Types of Qi and their origins
Zong Qi
Gathering
Qi
Lungs
process
air
Spleen
process
food
Kong Qi
Air Qi
Gu Qi
Grain Qi
Yuan Qi
Original
Qi
Zheng Qi
Normal
Qi
Ying Qi
Nutritive
Qi
Wei Qi
Defensive
Qi
Zang Fu
Zhi Qi
Organ Qi
Human body
Heart ruler of all organs in charge of blood circulation and mental activity
Cardiovacular and certain parts of higher nervous systerm
Liver laquoa viscus of temperamentraquo stores blood secretes bile and controls muscles
Centrals nervous and autonomous nervous systems
Spleen transforms and transports nutrients and water nourishing the muscles and limbs
and determining the bodyrsquos constitution protects the body against pathogen
Digestive and immune systemsas well as the functional system in charge of energy and water metabolism
Lung respiration cotrols vital energy and superficial body resistance regulates circulation of body fluid
Respiratory system part of immune system also related to water metablism
Kidney works to secrete urine store essence of life either inborn or acquired in charge of reproduction growth and development replenishing the brain nourishing the bones and producing marrow helps the lung inhale air
Related to the urogenital systemendocrine system (particularly the pituitary-adrenal and pituitary and gonadal axes) a part of immune system and higher nervous system
The causes of the diseases
Endogenous pathogenic factors
Seven emotions joy anger worry anxiety sorrow
terror and fright (Colegravere Joie Soucis Affliction et
Chagrin Angoisse Effroi)
Exogenous pathogenic factors
Six Excesses (Climatic changes) wind cold summer
heat dampness dryness fire
Epidemiques Trauma Inadequate diet
ETIOLOGIE EN MTC
CANCER EN MTC
bull Les tumeurs reacutesultent dun deacuteseacutequilibre dans le corps ou entre le corps et lenvironnement exteacuterieur
bull Les tumeurs sont dues agrave des changements qualitatifs et irreacuteversibles dans la structure ou la fonction de Zang Fu Qi et du Sang ou de LO
bull Si il y a carence les facteurs pathogegravenes envahissent profondeacutement le corps et si elle persiste la lutte entre le Froid et la Chaleur peut endommager la chair
bull Si les facteurs pathogegravenes ne peuvent pas ecirctre dissipeacutes ceci conduira agrave la formation de tumeurs
LES ELEMENTS CLES DANS LE DEVELOPPEMENT DE TUMEUR DANS MTC
bull 1- stagnation de Qi et la stase du Sang
bull 2- accumulation des Toxines lieacutees agrave la Chaleur
bull 3- deacuteficience de Qi Vital
bull 4- toutes les maladies proviennent des Glaires la plupart des masses qui se produisent dans le corps sont dues aux Glaires
Clinical Guide
bull Principle of diagnosis Diagnosis of disease
Syndrome differentiation
(individulized treatment)
bull Methods
Inspection Auscultation and Olfaction Interrogation Palpation
bull Intervention modalities
Chinese medication Acupuncture Qigong Tuina Dietary
(nutrition)
Treatment
The goal of treatment is to adjust and harmonize Yin and Yang
This is achieved by regulating the Qi Moisture and Blood in the Organ Networksweak organs are tonified congested channels are opened
excess is dispersed tightness is softened agitation is calmed heat is cooled cold is warmed dryness is moistened and dampness is drained
Preventive treatment of Progression of
Disease
《难经middot七十七难》ldquo所谓治未病者见肝之病则知肝当传之于脾 故先实其脾气无令得受肝之邪故曰治未病焉rdquo
重视疾病的传变规律ldquo先安未受邪之地rdquo 痰毒瘀结是肿瘤转移的关键流窜经络脏腑是其特点对于肿瘤的转移预防比治疗更有现实意义
laquo Classique des Problegravemes meacutedicaux raquo chap77 rdquoSi le Foie est malade il peut attaquer la Rate Par conseacutequent la Rate doit ecirctre fortifieacutee avant qursquoelle ne soit elle-mecircme affecteacutee raquo
Acupuncture
Bronze Model for the Meridians and
Acupuncture Points
(Qing Dynasty 1744)
An insight into acupuncture
Concept of Yin Yang
Holism
Five element theory
Human body
About Qi Formation of Qi
Function of Qi
Disharmony of Qi
Meridians - the pathways of the body
Techniques and methods
Meridian pathways of the Body
bullComponents bull 12 regular meridians
12 Collaterals
8 extraordinary meridians
Functions Connect and coordinate
creating an integral whole
Transporting functions
Spleen Meridian
Techniques and methods
Manual (Classic) Acupuncture
Electric-Acupuncture
Acupuncture and Moxibustion
Laser Acupuncture
Ultrasound Acupuncture
Acupuncture and the Moxibustion
Cupping Therapy
Indications
In 1979 WHO named 43 different diseases that can be
treated by Acupuncture
Upper Respiratory Tract
Acute sinusitis
Acute rhinitis
Common cold
Acute tonsillitis
Respiratory System
Acute Bronchitis
Bronchial asthma
Disorders of the Eye Acute conjunctivitis
Central retinitis
Myopia (in children)
Cataract (without
complications)
Disorders of the Mouth Toothache
Post-extraction pain
Gingivitis
Acute and chronic pharyngitis
Journal of World Health Organisation Dec1979
Known biological effects of
acupuncture
bullAcupuncture multiple biological responses
bullOccur locally or at a distance mediated by sensor neurons to many structures of the central nervous system -- leads to activation of pathways affecting various physiology systems in the brain as well as periphery Attention has been focused on the role of endogenous opioids in analgesia and anesthesia
bullActivate the hypothalamus and pituitary resulting in a broad spectrum of systemic effects
bullAlteration in secretion of neurotransmitters and neurohormones that causes changes in the regulation of blood flow both centrally and peripherally
bullEvidence of alteration of immune functions NIH Consensus Statement Online 1997 Nov 3-5 month day] 15(5)1-34
LES TRAITEMENTS
bull 1-la stagnation de Qi et la stase du Sang
bull dynamiser le sang et transformer la stase du sang
bull 2- accumulation des Toxines lieacutees agrave la Chaleur
bull clarifier la chaleur et deacutegager la Toxiciteacute
bull 3- deacuteficience de Qi Vital
bull soutenir le Qi Vital et cultiver la racine
bull 4- toutes les maladies proviennent des Glaires la plupart des masses qui se produisent dans le corps sont dues aux Glaires
bull transformer les Glaires et ramollir la dureteacute
Dans le diagnostic et le traitement des tumeurs la MTC considegravere leacutetat geacuteneacuteral du patient plutocirct que de se focaliser sur le cancer lui-mecircme ou les symptocircmes particuliers
Soutien psychologique
bull angoisse devant lrsquoinconnu
bull angoisse devant la douleur
bull angoisse devant le deacuteveloppement de la maladie et la perte de controcircle sur son propre corps
bull angoisse devant les effets secondaires dus aux divers traitements
bull angoisse devant les complications tardives dues aux divers traitements
bull angoisse devant le regard social porteacute sur le malade
bull angoisse devant la mort
Soutien psychologique
Ces informations reacutesonnent agrave lrsquointeacuterieur du patient ougrave elle
provoquent des dysfonctionnements qui
peuvent se manifester par
bull des maux de ventre
bull des palpitations
bull des troubles du sommeil
bull des difficulteacutes respiratoires
bull des douleurs diverses etc
Nauseacutees et vomissements
RAPPEL LrsquoEstomac
bull YANG
bull Controcircle le mucircrissement amp pourrissement de la nourriture
bull Controcircle le transport des essences de la nourriture Gouverne la descente du Qi fait descendre la nourriture transformeacutee vers lrsquoIntestin Grecircle
bull Si le mouvement de descente est perturbeacute par les pervers si il y a un mouvement ascendant de QI de lrsquoEstomac (agrave contre-sens- NI) il y a des VOMISSEMENTS
Nauseacutees et vomissements
LES VOMISSEMENTS SE MANIFESTENT QUAND LE QI DE LrsquoESTOMAC MONTE A LA PLACE DE DESCENDRE
Neuropathie
Avastine Xeloda Gemzar Cysplatine Taxol Fludara Alimta Procarbazine
points GI2 3 4 IG 2 3 C7 MC6 8 P7 9 F2 3 V60 VB41
traitement
preacutevention
LA DOULEUR DUE AU CANCER
bull Etiologie et physiopathologie
bull Lrsquoinvasion des pervers Externes - tout pervers srsquoil persiste peut provoquer le blocage des meacuteridiens et par la suite une stagnation de Qi et de Sg ou des troubles de Zang-Fu
bull Le deacuteregraveglement des eacutemotions
bull Le deacuteseacutequilibre de lrsquoalimentation
bull Une faiblesse de constitution
DIFFEacuteRENCIATION DE LA DOULEUR
SELON LA LOCALISATION bull dans le cancer du poumon souvent une sensibiliteacute au
P1 et V13 accompagneacutee de toux et de souffle court bull dans le cancer de lrsquoœsophage ou de lrsquoestomac une
sensibiliteacute au E34 et E42 accompagneacutee de nauseacutees dysphagie inappeacutetence
SELON LE VIDE ET LA PLEacuteNITUDE bull Vide douleurs souvent leacutegegraveres intermittentes
sourdes bull Pleacutenitude douleurs tensives lancinantes coliques
aigues
LA FATIGUE
XU LAO = fatigue par Vide = lrsquoeacutepuisement En Occident crsquoest le symptocircme le plus souvent invoqueacute et pas toujours ducirc au Vide
LA FATIGUE - eacutetiologie
bull La faiblesse constitutionnelle
bull Le surmenage
bull Lrsquoexcegraves drsquoactiviteacute physique
bull Lrsquoalimentation
bull Les maladies graves
bull Lrsquoexcegraves drsquoactiviteacute sexuelle
bull Lrsquoaccouchement
bull La consommation de drogues
LA FATIGUE - pathologie
bull Vide
bull Combinaison de Vide et de Pleacutenitude
bull Pleacutenitude
Contre-indications agrave lrsquoacupuncture
bull Des risques de laquo gros bras raquo apregraves curage axillaire
bull Des opeacuterations selon Halsted ou Patey
bull Des drainages lymphatiques
bull Pas drsquoaiguille du cocircteacute opeacutereacute
TCM in cancer treatments
bull Used mostly as adjuvant therapy before or during or
after surgery radiotherapy and chemotherapy
bull Remit the side-effects and toxicity of other treatments
bull Symptom control
bull Activate and strengthen immune system
bull For advanced cancer patients mainly palliative but it
can also prolong life in some cases
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 15 Number 7 2009
Acupuncture for Chemotherapy-Induced Neutropenia in Patients with GynecologiMalignancies A Pilot Randomized Sham-Controlled Clinical Trial
Weidong Lu MB MPH LicAc1ndash3 Ursula A Matulonis MD4 Anne Doherty-Gilman MPH1 Hang ScD3
Peter M Wayne PhD23 David S Rosenthal MD14 and Richard T Penson MD6
bull Abstract bull Objectives The objective of this study was to investigate the effect of acupuncture administered during mye-
losuppressive chemotherapy on white blood cell (WBC) count and absolute neutrophil count (ANC) in patients with ovarian cancer
bull Design This study is a pilot randomized sham-controlled clinical trial Patients received active acupuncture versus sham acupuncture while undergoing chemotherapy A standardized acupuncture protocol was em- ployed with manual and electrostimulation The frequency of treatment was 2ndash3 times per week for a total of 10 sessions starting 1 week before the second cycle of chemotherapy
bull Setting The setting was two outpatient academic centers for patients with cancer bull Subjects Twenty-one (21) newly diagnosed and recurrent ovarian cancer patients were the subjects bull Outcome measures WBC count ANC and plasma granulocyte colony-stimulating factor (G-CSF ) were assessed
weekly bull Results The median leukocyte value in the acupuncture arm at the first day of the third cycle of chemotherapy
was significantly higher than in the control arm after adjusting for baseline value (8600 cells=mL range 4800ndash 12000 versus 4400 cell=mL range 2300ndash10000) ( p frac14 0046) The incidence of grade 2ndash4 leukopenia was less in the acupuncture arm than in the sham arm (30 versus 90 p frac14 002) However the median leukocyte nadir neutrophil nadir and recovering ANC were all higher but not statistically significantly different ( p frac14 0116ndash016) after adjusting for baseline differences There were no statistically significant differences in plasma G-CSF between the two groups
bull Conclusions We observed clinically relevant trends of higher WBC values during one cycle of chemotherapy in patients with ovarian cancer which suggests a potential myeloprotective effect of acupuncture A larger trial is warranted to more definitively determine the efficacy of acupuncture on clinically important outcomes of chemotherapy-induced neutropenia
Acupuncture for the alleviation of hot flashes in men treated with androgen
ablation therapy Ashamalla H1 Jiang ML Guirguis A Peluso F Ashamalla M
bull Abstract bull PURPOSE bull Hot flashes are common side effect due to androgen ablation therapy (AAT) The utility of acupuncture for hot flashes in
men has not been thoroughly studied We prospectively studied the effect of acupuncture in men with hot flashes bull METHODS AND MATERIALS bull The study was approved by internal review board Seventeen men with hot flashes and history of AAT for prostate cancer
were enrolled Three men declined participation before receiving any treatment A hot flash score (HFS) was used to measure daily hot flashes The composite daily score was calculated as the product of frequency times severity The baseline daily scores were compared with scores taken at 2 and 6 weeks and at 8-month average follow-up
bull RESULTS bull No side effects were encountered during immediately after treatment or at 8 months The mean initial HFS was 283 it
dropped to 103 (p = 00001) at 2 weeks posttreatment 75 (p = 00001) at 6 weeks and 70 (p = 0001) at 8 months Clinical improvement for each patient is defined as the percent decrease in the mean HFS at each time point The mean improvement at Weeks 2 and 6 was 684 (mean HFS decreased from 37409 to 11836 p = 0001) and 892 (mean HFS decreased from 37409 to 405 p = 00078) respectively The improvement at 8 months was 803 (mean HFS decreased from 37409 to 7385 p = 0002)
bull CONCLUSIONS bull Acupuncture provides excellent control of hot flashes in men with a history of AAT The absence of side effects and the
durable response at 8 months are likely to be appealing to patients Prospective randomized study is warranted to further evaluate this modality against medical therapy
bull Copyright copy 2011 Elsevier Inc All rights reserved
bull Int J Radiat Oncol Biol Phys 2011 Apr 179(5)1358-63 doi 101016jijrobp201001025 Epub 2010 Jun 3
bull J Clin Oncol 2010 Mar 128(7)1154-60 doi 101200JCO2009234708 Epub 2010 Jan 25 bull Randomized blinded sham-controlled trial of acupuncture for the management of aromatase
inhibitor-associated joint symptoms in women with early-stage breast cancer bull Crew KD1 Capodice JL Greenlee H Brafman L Fuentes D Awad D Yann Tsai W Hershman DL bull Author information
bull Abstract bull PURPOSE Women with breast cancer (BC) treated with aromatase inhibitors (AIs) may experience
joint symptoms that can lead to discontinuation of effective therapy We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC METHODS We conducted a randomized controlled blinded study comparing true acupuncture (TA) versus sham acupuncture (SA) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs TA included full bodyauricular acupuncture and joint-specific point prescriptions whereas SA involved superficial needle insertion at nonacupoint locations Outcome measures included the Brief Pain Inventory-Short Form (BPI-SF) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH) obtained at baseline and at 3 and 6 weeks Results Of 51 women enrolled 43 women were randomly assigned and 38 were evaluable Baseline characteristics were comparable between the two groups Our primary end point was the difference in mean BPI-SF worst pain scores at 6 weeks which was lower for TA compared with SA (30 v 55 P lt 001) We also found differences between TA and SA in pain severity (26 v 45 P = 003) and pain-related interference (25 v 45 P = 002) at 6 weeks Similar findings were seen for the WOMAC and M-SACRAH scores The acupuncture intervention was well-tolerated CONCLUSION Women with AI-induced arthralgias treated with TA had significant improvement of joint pain and stiffness which was not seen with SA Acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect
Fundamentals of TCM
bull The material basis of the human body
Qi Blood Jing Jing-ye
bull The concept of Yin and Yang
bull The theory of f ive elements Wood Fire Earth Metal Water
bull The theory of Zang-Fu
bull The pathways of the human body Meridians
Five Elements Theory
Types of Qi and their origins
Zong Qi
Gathering
Qi
Lungs
process
air
Spleen
process
food
Kong Qi
Air Qi
Gu Qi
Grain Qi
Yuan Qi
Original
Qi
Zheng Qi
Normal
Qi
Ying Qi
Nutritive
Qi
Wei Qi
Defensive
Qi
Zang Fu
Zhi Qi
Organ Qi
Human body
Heart ruler of all organs in charge of blood circulation and mental activity
Cardiovacular and certain parts of higher nervous systerm
Liver laquoa viscus of temperamentraquo stores blood secretes bile and controls muscles
Centrals nervous and autonomous nervous systems
Spleen transforms and transports nutrients and water nourishing the muscles and limbs
and determining the bodyrsquos constitution protects the body against pathogen
Digestive and immune systemsas well as the functional system in charge of energy and water metabolism
Lung respiration cotrols vital energy and superficial body resistance regulates circulation of body fluid
Respiratory system part of immune system also related to water metablism
Kidney works to secrete urine store essence of life either inborn or acquired in charge of reproduction growth and development replenishing the brain nourishing the bones and producing marrow helps the lung inhale air
Related to the urogenital systemendocrine system (particularly the pituitary-adrenal and pituitary and gonadal axes) a part of immune system and higher nervous system
The causes of the diseases
Endogenous pathogenic factors
Seven emotions joy anger worry anxiety sorrow
terror and fright (Colegravere Joie Soucis Affliction et
Chagrin Angoisse Effroi)
Exogenous pathogenic factors
Six Excesses (Climatic changes) wind cold summer
heat dampness dryness fire
Epidemiques Trauma Inadequate diet
ETIOLOGIE EN MTC
CANCER EN MTC
bull Les tumeurs reacutesultent dun deacuteseacutequilibre dans le corps ou entre le corps et lenvironnement exteacuterieur
bull Les tumeurs sont dues agrave des changements qualitatifs et irreacuteversibles dans la structure ou la fonction de Zang Fu Qi et du Sang ou de LO
bull Si il y a carence les facteurs pathogegravenes envahissent profondeacutement le corps et si elle persiste la lutte entre le Froid et la Chaleur peut endommager la chair
bull Si les facteurs pathogegravenes ne peuvent pas ecirctre dissipeacutes ceci conduira agrave la formation de tumeurs
LES ELEMENTS CLES DANS LE DEVELOPPEMENT DE TUMEUR DANS MTC
bull 1- stagnation de Qi et la stase du Sang
bull 2- accumulation des Toxines lieacutees agrave la Chaleur
bull 3- deacuteficience de Qi Vital
bull 4- toutes les maladies proviennent des Glaires la plupart des masses qui se produisent dans le corps sont dues aux Glaires
Clinical Guide
bull Principle of diagnosis Diagnosis of disease
Syndrome differentiation
(individulized treatment)
bull Methods
Inspection Auscultation and Olfaction Interrogation Palpation
bull Intervention modalities
Chinese medication Acupuncture Qigong Tuina Dietary
(nutrition)
Treatment
The goal of treatment is to adjust and harmonize Yin and Yang
This is achieved by regulating the Qi Moisture and Blood in the Organ Networksweak organs are tonified congested channels are opened
excess is dispersed tightness is softened agitation is calmed heat is cooled cold is warmed dryness is moistened and dampness is drained
Preventive treatment of Progression of
Disease
《难经middot七十七难》ldquo所谓治未病者见肝之病则知肝当传之于脾 故先实其脾气无令得受肝之邪故曰治未病焉rdquo
重视疾病的传变规律ldquo先安未受邪之地rdquo 痰毒瘀结是肿瘤转移的关键流窜经络脏腑是其特点对于肿瘤的转移预防比治疗更有现实意义
laquo Classique des Problegravemes meacutedicaux raquo chap77 rdquoSi le Foie est malade il peut attaquer la Rate Par conseacutequent la Rate doit ecirctre fortifieacutee avant qursquoelle ne soit elle-mecircme affecteacutee raquo
Acupuncture
Bronze Model for the Meridians and
Acupuncture Points
(Qing Dynasty 1744)
An insight into acupuncture
Concept of Yin Yang
Holism
Five element theory
Human body
About Qi Formation of Qi
Function of Qi
Disharmony of Qi
Meridians - the pathways of the body
Techniques and methods
Meridian pathways of the Body
bullComponents bull 12 regular meridians
12 Collaterals
8 extraordinary meridians
Functions Connect and coordinate
creating an integral whole
Transporting functions
Spleen Meridian
Techniques and methods
Manual (Classic) Acupuncture
Electric-Acupuncture
Acupuncture and Moxibustion
Laser Acupuncture
Ultrasound Acupuncture
Acupuncture and the Moxibustion
Cupping Therapy
Indications
In 1979 WHO named 43 different diseases that can be
treated by Acupuncture
Upper Respiratory Tract
Acute sinusitis
Acute rhinitis
Common cold
Acute tonsillitis
Respiratory System
Acute Bronchitis
Bronchial asthma
Disorders of the Eye Acute conjunctivitis
Central retinitis
Myopia (in children)
Cataract (without
complications)
Disorders of the Mouth Toothache
Post-extraction pain
Gingivitis
Acute and chronic pharyngitis
Journal of World Health Organisation Dec1979
Known biological effects of
acupuncture
bullAcupuncture multiple biological responses
bullOccur locally or at a distance mediated by sensor neurons to many structures of the central nervous system -- leads to activation of pathways affecting various physiology systems in the brain as well as periphery Attention has been focused on the role of endogenous opioids in analgesia and anesthesia
bullActivate the hypothalamus and pituitary resulting in a broad spectrum of systemic effects
bullAlteration in secretion of neurotransmitters and neurohormones that causes changes in the regulation of blood flow both centrally and peripherally
bullEvidence of alteration of immune functions NIH Consensus Statement Online 1997 Nov 3-5 month day] 15(5)1-34
LES TRAITEMENTS
bull 1-la stagnation de Qi et la stase du Sang
bull dynamiser le sang et transformer la stase du sang
bull 2- accumulation des Toxines lieacutees agrave la Chaleur
bull clarifier la chaleur et deacutegager la Toxiciteacute
bull 3- deacuteficience de Qi Vital
bull soutenir le Qi Vital et cultiver la racine
bull 4- toutes les maladies proviennent des Glaires la plupart des masses qui se produisent dans le corps sont dues aux Glaires
bull transformer les Glaires et ramollir la dureteacute
Dans le diagnostic et le traitement des tumeurs la MTC considegravere leacutetat geacuteneacuteral du patient plutocirct que de se focaliser sur le cancer lui-mecircme ou les symptocircmes particuliers
Soutien psychologique
bull angoisse devant lrsquoinconnu
bull angoisse devant la douleur
bull angoisse devant le deacuteveloppement de la maladie et la perte de controcircle sur son propre corps
bull angoisse devant les effets secondaires dus aux divers traitements
bull angoisse devant les complications tardives dues aux divers traitements
bull angoisse devant le regard social porteacute sur le malade
bull angoisse devant la mort
Soutien psychologique
Ces informations reacutesonnent agrave lrsquointeacuterieur du patient ougrave elle
provoquent des dysfonctionnements qui
peuvent se manifester par
bull des maux de ventre
bull des palpitations
bull des troubles du sommeil
bull des difficulteacutes respiratoires
bull des douleurs diverses etc
Nauseacutees et vomissements
RAPPEL LrsquoEstomac
bull YANG
bull Controcircle le mucircrissement amp pourrissement de la nourriture
bull Controcircle le transport des essences de la nourriture Gouverne la descente du Qi fait descendre la nourriture transformeacutee vers lrsquoIntestin Grecircle
bull Si le mouvement de descente est perturbeacute par les pervers si il y a un mouvement ascendant de QI de lrsquoEstomac (agrave contre-sens- NI) il y a des VOMISSEMENTS
Nauseacutees et vomissements
LES VOMISSEMENTS SE MANIFESTENT QUAND LE QI DE LrsquoESTOMAC MONTE A LA PLACE DE DESCENDRE
Neuropathie
Avastine Xeloda Gemzar Cysplatine Taxol Fludara Alimta Procarbazine
points GI2 3 4 IG 2 3 C7 MC6 8 P7 9 F2 3 V60 VB41
traitement
preacutevention
LA DOULEUR DUE AU CANCER
bull Etiologie et physiopathologie
bull Lrsquoinvasion des pervers Externes - tout pervers srsquoil persiste peut provoquer le blocage des meacuteridiens et par la suite une stagnation de Qi et de Sg ou des troubles de Zang-Fu
bull Le deacuteregraveglement des eacutemotions
bull Le deacuteseacutequilibre de lrsquoalimentation
bull Une faiblesse de constitution
DIFFEacuteRENCIATION DE LA DOULEUR
SELON LA LOCALISATION bull dans le cancer du poumon souvent une sensibiliteacute au
P1 et V13 accompagneacutee de toux et de souffle court bull dans le cancer de lrsquoœsophage ou de lrsquoestomac une
sensibiliteacute au E34 et E42 accompagneacutee de nauseacutees dysphagie inappeacutetence
SELON LE VIDE ET LA PLEacuteNITUDE bull Vide douleurs souvent leacutegegraveres intermittentes
sourdes bull Pleacutenitude douleurs tensives lancinantes coliques
aigues
LA FATIGUE
XU LAO = fatigue par Vide = lrsquoeacutepuisement En Occident crsquoest le symptocircme le plus souvent invoqueacute et pas toujours ducirc au Vide
LA FATIGUE - eacutetiologie
bull La faiblesse constitutionnelle
bull Le surmenage
bull Lrsquoexcegraves drsquoactiviteacute physique
bull Lrsquoalimentation
bull Les maladies graves
bull Lrsquoexcegraves drsquoactiviteacute sexuelle
bull Lrsquoaccouchement
bull La consommation de drogues
LA FATIGUE - pathologie
bull Vide
bull Combinaison de Vide et de Pleacutenitude
bull Pleacutenitude
Contre-indications agrave lrsquoacupuncture
bull Des risques de laquo gros bras raquo apregraves curage axillaire
bull Des opeacuterations selon Halsted ou Patey
bull Des drainages lymphatiques
bull Pas drsquoaiguille du cocircteacute opeacutereacute
TCM in cancer treatments
bull Used mostly as adjuvant therapy before or during or
after surgery radiotherapy and chemotherapy
bull Remit the side-effects and toxicity of other treatments
bull Symptom control
bull Activate and strengthen immune system
bull For advanced cancer patients mainly palliative but it
can also prolong life in some cases
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 15 Number 7 2009
Acupuncture for Chemotherapy-Induced Neutropenia in Patients with GynecologiMalignancies A Pilot Randomized Sham-Controlled Clinical Trial
Weidong Lu MB MPH LicAc1ndash3 Ursula A Matulonis MD4 Anne Doherty-Gilman MPH1 Hang ScD3
Peter M Wayne PhD23 David S Rosenthal MD14 and Richard T Penson MD6
bull Abstract bull Objectives The objective of this study was to investigate the effect of acupuncture administered during mye-
losuppressive chemotherapy on white blood cell (WBC) count and absolute neutrophil count (ANC) in patients with ovarian cancer
bull Design This study is a pilot randomized sham-controlled clinical trial Patients received active acupuncture versus sham acupuncture while undergoing chemotherapy A standardized acupuncture protocol was em- ployed with manual and electrostimulation The frequency of treatment was 2ndash3 times per week for a total of 10 sessions starting 1 week before the second cycle of chemotherapy
bull Setting The setting was two outpatient academic centers for patients with cancer bull Subjects Twenty-one (21) newly diagnosed and recurrent ovarian cancer patients were the subjects bull Outcome measures WBC count ANC and plasma granulocyte colony-stimulating factor (G-CSF ) were assessed
weekly bull Results The median leukocyte value in the acupuncture arm at the first day of the third cycle of chemotherapy
was significantly higher than in the control arm after adjusting for baseline value (8600 cells=mL range 4800ndash 12000 versus 4400 cell=mL range 2300ndash10000) ( p frac14 0046) The incidence of grade 2ndash4 leukopenia was less in the acupuncture arm than in the sham arm (30 versus 90 p frac14 002) However the median leukocyte nadir neutrophil nadir and recovering ANC were all higher but not statistically significantly different ( p frac14 0116ndash016) after adjusting for baseline differences There were no statistically significant differences in plasma G-CSF between the two groups
bull Conclusions We observed clinically relevant trends of higher WBC values during one cycle of chemotherapy in patients with ovarian cancer which suggests a potential myeloprotective effect of acupuncture A larger trial is warranted to more definitively determine the efficacy of acupuncture on clinically important outcomes of chemotherapy-induced neutropenia
Acupuncture for the alleviation of hot flashes in men treated with androgen
ablation therapy Ashamalla H1 Jiang ML Guirguis A Peluso F Ashamalla M
bull Abstract bull PURPOSE bull Hot flashes are common side effect due to androgen ablation therapy (AAT) The utility of acupuncture for hot flashes in
men has not been thoroughly studied We prospectively studied the effect of acupuncture in men with hot flashes bull METHODS AND MATERIALS bull The study was approved by internal review board Seventeen men with hot flashes and history of AAT for prostate cancer
were enrolled Three men declined participation before receiving any treatment A hot flash score (HFS) was used to measure daily hot flashes The composite daily score was calculated as the product of frequency times severity The baseline daily scores were compared with scores taken at 2 and 6 weeks and at 8-month average follow-up
bull RESULTS bull No side effects were encountered during immediately after treatment or at 8 months The mean initial HFS was 283 it
dropped to 103 (p = 00001) at 2 weeks posttreatment 75 (p = 00001) at 6 weeks and 70 (p = 0001) at 8 months Clinical improvement for each patient is defined as the percent decrease in the mean HFS at each time point The mean improvement at Weeks 2 and 6 was 684 (mean HFS decreased from 37409 to 11836 p = 0001) and 892 (mean HFS decreased from 37409 to 405 p = 00078) respectively The improvement at 8 months was 803 (mean HFS decreased from 37409 to 7385 p = 0002)
bull CONCLUSIONS bull Acupuncture provides excellent control of hot flashes in men with a history of AAT The absence of side effects and the
durable response at 8 months are likely to be appealing to patients Prospective randomized study is warranted to further evaluate this modality against medical therapy
bull Copyright copy 2011 Elsevier Inc All rights reserved
bull Int J Radiat Oncol Biol Phys 2011 Apr 179(5)1358-63 doi 101016jijrobp201001025 Epub 2010 Jun 3
bull J Clin Oncol 2010 Mar 128(7)1154-60 doi 101200JCO2009234708 Epub 2010 Jan 25 bull Randomized blinded sham-controlled trial of acupuncture for the management of aromatase
inhibitor-associated joint symptoms in women with early-stage breast cancer bull Crew KD1 Capodice JL Greenlee H Brafman L Fuentes D Awad D Yann Tsai W Hershman DL bull Author information
bull Abstract bull PURPOSE Women with breast cancer (BC) treated with aromatase inhibitors (AIs) may experience
joint symptoms that can lead to discontinuation of effective therapy We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC METHODS We conducted a randomized controlled blinded study comparing true acupuncture (TA) versus sham acupuncture (SA) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs TA included full bodyauricular acupuncture and joint-specific point prescriptions whereas SA involved superficial needle insertion at nonacupoint locations Outcome measures included the Brief Pain Inventory-Short Form (BPI-SF) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH) obtained at baseline and at 3 and 6 weeks Results Of 51 women enrolled 43 women were randomly assigned and 38 were evaluable Baseline characteristics were comparable between the two groups Our primary end point was the difference in mean BPI-SF worst pain scores at 6 weeks which was lower for TA compared with SA (30 v 55 P lt 001) We also found differences between TA and SA in pain severity (26 v 45 P = 003) and pain-related interference (25 v 45 P = 002) at 6 weeks Similar findings were seen for the WOMAC and M-SACRAH scores The acupuncture intervention was well-tolerated CONCLUSION Women with AI-induced arthralgias treated with TA had significant improvement of joint pain and stiffness which was not seen with SA Acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect
Five Elements Theory
Types of Qi and their origins
Zong Qi
Gathering
Qi
Lungs
process
air
Spleen
process
food
Kong Qi
Air Qi
Gu Qi
Grain Qi
Yuan Qi
Original
Qi
Zheng Qi
Normal
Qi
Ying Qi
Nutritive
Qi
Wei Qi
Defensive
Qi
Zang Fu
Zhi Qi
Organ Qi
Human body
Heart ruler of all organs in charge of blood circulation and mental activity
Cardiovacular and certain parts of higher nervous systerm
Liver laquoa viscus of temperamentraquo stores blood secretes bile and controls muscles
Centrals nervous and autonomous nervous systems
Spleen transforms and transports nutrients and water nourishing the muscles and limbs
and determining the bodyrsquos constitution protects the body against pathogen
Digestive and immune systemsas well as the functional system in charge of energy and water metabolism
Lung respiration cotrols vital energy and superficial body resistance regulates circulation of body fluid
Respiratory system part of immune system also related to water metablism
Kidney works to secrete urine store essence of life either inborn or acquired in charge of reproduction growth and development replenishing the brain nourishing the bones and producing marrow helps the lung inhale air
Related to the urogenital systemendocrine system (particularly the pituitary-adrenal and pituitary and gonadal axes) a part of immune system and higher nervous system
The causes of the diseases
Endogenous pathogenic factors
Seven emotions joy anger worry anxiety sorrow
terror and fright (Colegravere Joie Soucis Affliction et
Chagrin Angoisse Effroi)
Exogenous pathogenic factors
Six Excesses (Climatic changes) wind cold summer
heat dampness dryness fire
Epidemiques Trauma Inadequate diet
ETIOLOGIE EN MTC
CANCER EN MTC
bull Les tumeurs reacutesultent dun deacuteseacutequilibre dans le corps ou entre le corps et lenvironnement exteacuterieur
bull Les tumeurs sont dues agrave des changements qualitatifs et irreacuteversibles dans la structure ou la fonction de Zang Fu Qi et du Sang ou de LO
bull Si il y a carence les facteurs pathogegravenes envahissent profondeacutement le corps et si elle persiste la lutte entre le Froid et la Chaleur peut endommager la chair
bull Si les facteurs pathogegravenes ne peuvent pas ecirctre dissipeacutes ceci conduira agrave la formation de tumeurs
LES ELEMENTS CLES DANS LE DEVELOPPEMENT DE TUMEUR DANS MTC
bull 1- stagnation de Qi et la stase du Sang
bull 2- accumulation des Toxines lieacutees agrave la Chaleur
bull 3- deacuteficience de Qi Vital
bull 4- toutes les maladies proviennent des Glaires la plupart des masses qui se produisent dans le corps sont dues aux Glaires
Clinical Guide
bull Principle of diagnosis Diagnosis of disease
Syndrome differentiation
(individulized treatment)
bull Methods
Inspection Auscultation and Olfaction Interrogation Palpation
bull Intervention modalities
Chinese medication Acupuncture Qigong Tuina Dietary
(nutrition)
Treatment
The goal of treatment is to adjust and harmonize Yin and Yang
This is achieved by regulating the Qi Moisture and Blood in the Organ Networksweak organs are tonified congested channels are opened
excess is dispersed tightness is softened agitation is calmed heat is cooled cold is warmed dryness is moistened and dampness is drained
Preventive treatment of Progression of
Disease
《难经middot七十七难》ldquo所谓治未病者见肝之病则知肝当传之于脾 故先实其脾气无令得受肝之邪故曰治未病焉rdquo
重视疾病的传变规律ldquo先安未受邪之地rdquo 痰毒瘀结是肿瘤转移的关键流窜经络脏腑是其特点对于肿瘤的转移预防比治疗更有现实意义
laquo Classique des Problegravemes meacutedicaux raquo chap77 rdquoSi le Foie est malade il peut attaquer la Rate Par conseacutequent la Rate doit ecirctre fortifieacutee avant qursquoelle ne soit elle-mecircme affecteacutee raquo
Acupuncture
Bronze Model for the Meridians and
Acupuncture Points
(Qing Dynasty 1744)
An insight into acupuncture
Concept of Yin Yang
Holism
Five element theory
Human body
About Qi Formation of Qi
Function of Qi
Disharmony of Qi
Meridians - the pathways of the body
Techniques and methods
Meridian pathways of the Body
bullComponents bull 12 regular meridians
12 Collaterals
8 extraordinary meridians
Functions Connect and coordinate
creating an integral whole
Transporting functions
Spleen Meridian
Techniques and methods
Manual (Classic) Acupuncture
Electric-Acupuncture
Acupuncture and Moxibustion
Laser Acupuncture
Ultrasound Acupuncture
Acupuncture and the Moxibustion
Cupping Therapy
Indications
In 1979 WHO named 43 different diseases that can be
treated by Acupuncture
Upper Respiratory Tract
Acute sinusitis
Acute rhinitis
Common cold
Acute tonsillitis
Respiratory System
Acute Bronchitis
Bronchial asthma
Disorders of the Eye Acute conjunctivitis
Central retinitis
Myopia (in children)
Cataract (without
complications)
Disorders of the Mouth Toothache
Post-extraction pain
Gingivitis
Acute and chronic pharyngitis
Journal of World Health Organisation Dec1979
Known biological effects of
acupuncture
bullAcupuncture multiple biological responses
bullOccur locally or at a distance mediated by sensor neurons to many structures of the central nervous system -- leads to activation of pathways affecting various physiology systems in the brain as well as periphery Attention has been focused on the role of endogenous opioids in analgesia and anesthesia
bullActivate the hypothalamus and pituitary resulting in a broad spectrum of systemic effects
bullAlteration in secretion of neurotransmitters and neurohormones that causes changes in the regulation of blood flow both centrally and peripherally
bullEvidence of alteration of immune functions NIH Consensus Statement Online 1997 Nov 3-5 month day] 15(5)1-34
LES TRAITEMENTS
bull 1-la stagnation de Qi et la stase du Sang
bull dynamiser le sang et transformer la stase du sang
bull 2- accumulation des Toxines lieacutees agrave la Chaleur
bull clarifier la chaleur et deacutegager la Toxiciteacute
bull 3- deacuteficience de Qi Vital
bull soutenir le Qi Vital et cultiver la racine
bull 4- toutes les maladies proviennent des Glaires la plupart des masses qui se produisent dans le corps sont dues aux Glaires
bull transformer les Glaires et ramollir la dureteacute
Dans le diagnostic et le traitement des tumeurs la MTC considegravere leacutetat geacuteneacuteral du patient plutocirct que de se focaliser sur le cancer lui-mecircme ou les symptocircmes particuliers
Soutien psychologique
bull angoisse devant lrsquoinconnu
bull angoisse devant la douleur
bull angoisse devant le deacuteveloppement de la maladie et la perte de controcircle sur son propre corps
bull angoisse devant les effets secondaires dus aux divers traitements
bull angoisse devant les complications tardives dues aux divers traitements
bull angoisse devant le regard social porteacute sur le malade
bull angoisse devant la mort
Soutien psychologique
Ces informations reacutesonnent agrave lrsquointeacuterieur du patient ougrave elle
provoquent des dysfonctionnements qui
peuvent se manifester par
bull des maux de ventre
bull des palpitations
bull des troubles du sommeil
bull des difficulteacutes respiratoires
bull des douleurs diverses etc
Nauseacutees et vomissements
RAPPEL LrsquoEstomac
bull YANG
bull Controcircle le mucircrissement amp pourrissement de la nourriture
bull Controcircle le transport des essences de la nourriture Gouverne la descente du Qi fait descendre la nourriture transformeacutee vers lrsquoIntestin Grecircle
bull Si le mouvement de descente est perturbeacute par les pervers si il y a un mouvement ascendant de QI de lrsquoEstomac (agrave contre-sens- NI) il y a des VOMISSEMENTS
Nauseacutees et vomissements
LES VOMISSEMENTS SE MANIFESTENT QUAND LE QI DE LrsquoESTOMAC MONTE A LA PLACE DE DESCENDRE
Neuropathie
Avastine Xeloda Gemzar Cysplatine Taxol Fludara Alimta Procarbazine
points GI2 3 4 IG 2 3 C7 MC6 8 P7 9 F2 3 V60 VB41
traitement
preacutevention
LA DOULEUR DUE AU CANCER
bull Etiologie et physiopathologie
bull Lrsquoinvasion des pervers Externes - tout pervers srsquoil persiste peut provoquer le blocage des meacuteridiens et par la suite une stagnation de Qi et de Sg ou des troubles de Zang-Fu
bull Le deacuteregraveglement des eacutemotions
bull Le deacuteseacutequilibre de lrsquoalimentation
bull Une faiblesse de constitution
DIFFEacuteRENCIATION DE LA DOULEUR
SELON LA LOCALISATION bull dans le cancer du poumon souvent une sensibiliteacute au
P1 et V13 accompagneacutee de toux et de souffle court bull dans le cancer de lrsquoœsophage ou de lrsquoestomac une
sensibiliteacute au E34 et E42 accompagneacutee de nauseacutees dysphagie inappeacutetence
SELON LE VIDE ET LA PLEacuteNITUDE bull Vide douleurs souvent leacutegegraveres intermittentes
sourdes bull Pleacutenitude douleurs tensives lancinantes coliques
aigues
LA FATIGUE
XU LAO = fatigue par Vide = lrsquoeacutepuisement En Occident crsquoest le symptocircme le plus souvent invoqueacute et pas toujours ducirc au Vide
LA FATIGUE - eacutetiologie
bull La faiblesse constitutionnelle
bull Le surmenage
bull Lrsquoexcegraves drsquoactiviteacute physique
bull Lrsquoalimentation
bull Les maladies graves
bull Lrsquoexcegraves drsquoactiviteacute sexuelle
bull Lrsquoaccouchement
bull La consommation de drogues
LA FATIGUE - pathologie
bull Vide
bull Combinaison de Vide et de Pleacutenitude
bull Pleacutenitude
Contre-indications agrave lrsquoacupuncture
bull Des risques de laquo gros bras raquo apregraves curage axillaire
bull Des opeacuterations selon Halsted ou Patey
bull Des drainages lymphatiques
bull Pas drsquoaiguille du cocircteacute opeacutereacute
TCM in cancer treatments
bull Used mostly as adjuvant therapy before or during or
after surgery radiotherapy and chemotherapy
bull Remit the side-effects and toxicity of other treatments
bull Symptom control
bull Activate and strengthen immune system
bull For advanced cancer patients mainly palliative but it
can also prolong life in some cases
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 15 Number 7 2009
Acupuncture for Chemotherapy-Induced Neutropenia in Patients with GynecologiMalignancies A Pilot Randomized Sham-Controlled Clinical Trial
Weidong Lu MB MPH LicAc1ndash3 Ursula A Matulonis MD4 Anne Doherty-Gilman MPH1 Hang ScD3
Peter M Wayne PhD23 David S Rosenthal MD14 and Richard T Penson MD6
bull Abstract bull Objectives The objective of this study was to investigate the effect of acupuncture administered during mye-
losuppressive chemotherapy on white blood cell (WBC) count and absolute neutrophil count (ANC) in patients with ovarian cancer
bull Design This study is a pilot randomized sham-controlled clinical trial Patients received active acupuncture versus sham acupuncture while undergoing chemotherapy A standardized acupuncture protocol was em- ployed with manual and electrostimulation The frequency of treatment was 2ndash3 times per week for a total of 10 sessions starting 1 week before the second cycle of chemotherapy
bull Setting The setting was two outpatient academic centers for patients with cancer bull Subjects Twenty-one (21) newly diagnosed and recurrent ovarian cancer patients were the subjects bull Outcome measures WBC count ANC and plasma granulocyte colony-stimulating factor (G-CSF ) were assessed
weekly bull Results The median leukocyte value in the acupuncture arm at the first day of the third cycle of chemotherapy
was significantly higher than in the control arm after adjusting for baseline value (8600 cells=mL range 4800ndash 12000 versus 4400 cell=mL range 2300ndash10000) ( p frac14 0046) The incidence of grade 2ndash4 leukopenia was less in the acupuncture arm than in the sham arm (30 versus 90 p frac14 002) However the median leukocyte nadir neutrophil nadir and recovering ANC were all higher but not statistically significantly different ( p frac14 0116ndash016) after adjusting for baseline differences There were no statistically significant differences in plasma G-CSF between the two groups
bull Conclusions We observed clinically relevant trends of higher WBC values during one cycle of chemotherapy in patients with ovarian cancer which suggests a potential myeloprotective effect of acupuncture A larger trial is warranted to more definitively determine the efficacy of acupuncture on clinically important outcomes of chemotherapy-induced neutropenia
Acupuncture for the alleviation of hot flashes in men treated with androgen
ablation therapy Ashamalla H1 Jiang ML Guirguis A Peluso F Ashamalla M
bull Abstract bull PURPOSE bull Hot flashes are common side effect due to androgen ablation therapy (AAT) The utility of acupuncture for hot flashes in
men has not been thoroughly studied We prospectively studied the effect of acupuncture in men with hot flashes bull METHODS AND MATERIALS bull The study was approved by internal review board Seventeen men with hot flashes and history of AAT for prostate cancer
were enrolled Three men declined participation before receiving any treatment A hot flash score (HFS) was used to measure daily hot flashes The composite daily score was calculated as the product of frequency times severity The baseline daily scores were compared with scores taken at 2 and 6 weeks and at 8-month average follow-up
bull RESULTS bull No side effects were encountered during immediately after treatment or at 8 months The mean initial HFS was 283 it
dropped to 103 (p = 00001) at 2 weeks posttreatment 75 (p = 00001) at 6 weeks and 70 (p = 0001) at 8 months Clinical improvement for each patient is defined as the percent decrease in the mean HFS at each time point The mean improvement at Weeks 2 and 6 was 684 (mean HFS decreased from 37409 to 11836 p = 0001) and 892 (mean HFS decreased from 37409 to 405 p = 00078) respectively The improvement at 8 months was 803 (mean HFS decreased from 37409 to 7385 p = 0002)
bull CONCLUSIONS bull Acupuncture provides excellent control of hot flashes in men with a history of AAT The absence of side effects and the
durable response at 8 months are likely to be appealing to patients Prospective randomized study is warranted to further evaluate this modality against medical therapy
bull Copyright copy 2011 Elsevier Inc All rights reserved
bull Int J Radiat Oncol Biol Phys 2011 Apr 179(5)1358-63 doi 101016jijrobp201001025 Epub 2010 Jun 3
bull J Clin Oncol 2010 Mar 128(7)1154-60 doi 101200JCO2009234708 Epub 2010 Jan 25 bull Randomized blinded sham-controlled trial of acupuncture for the management of aromatase
inhibitor-associated joint symptoms in women with early-stage breast cancer bull Crew KD1 Capodice JL Greenlee H Brafman L Fuentes D Awad D Yann Tsai W Hershman DL bull Author information
bull Abstract bull PURPOSE Women with breast cancer (BC) treated with aromatase inhibitors (AIs) may experience
joint symptoms that can lead to discontinuation of effective therapy We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC METHODS We conducted a randomized controlled blinded study comparing true acupuncture (TA) versus sham acupuncture (SA) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs TA included full bodyauricular acupuncture and joint-specific point prescriptions whereas SA involved superficial needle insertion at nonacupoint locations Outcome measures included the Brief Pain Inventory-Short Form (BPI-SF) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH) obtained at baseline and at 3 and 6 weeks Results Of 51 women enrolled 43 women were randomly assigned and 38 were evaluable Baseline characteristics were comparable between the two groups Our primary end point was the difference in mean BPI-SF worst pain scores at 6 weeks which was lower for TA compared with SA (30 v 55 P lt 001) We also found differences between TA and SA in pain severity (26 v 45 P = 003) and pain-related interference (25 v 45 P = 002) at 6 weeks Similar findings were seen for the WOMAC and M-SACRAH scores The acupuncture intervention was well-tolerated CONCLUSION Women with AI-induced arthralgias treated with TA had significant improvement of joint pain and stiffness which was not seen with SA Acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect
Types of Qi and their origins
Zong Qi
Gathering
Qi
Lungs
process
air
Spleen
process
food
Kong Qi
Air Qi
Gu Qi
Grain Qi
Yuan Qi
Original
Qi
Zheng Qi
Normal
Qi
Ying Qi
Nutritive
Qi
Wei Qi
Defensive
Qi
Zang Fu
Zhi Qi
Organ Qi
Human body
Heart ruler of all organs in charge of blood circulation and mental activity
Cardiovacular and certain parts of higher nervous systerm
Liver laquoa viscus of temperamentraquo stores blood secretes bile and controls muscles
Centrals nervous and autonomous nervous systems
Spleen transforms and transports nutrients and water nourishing the muscles and limbs
and determining the bodyrsquos constitution protects the body against pathogen
Digestive and immune systemsas well as the functional system in charge of energy and water metabolism
Lung respiration cotrols vital energy and superficial body resistance regulates circulation of body fluid
Respiratory system part of immune system also related to water metablism
Kidney works to secrete urine store essence of life either inborn or acquired in charge of reproduction growth and development replenishing the brain nourishing the bones and producing marrow helps the lung inhale air
Related to the urogenital systemendocrine system (particularly the pituitary-adrenal and pituitary and gonadal axes) a part of immune system and higher nervous system
The causes of the diseases
Endogenous pathogenic factors
Seven emotions joy anger worry anxiety sorrow
terror and fright (Colegravere Joie Soucis Affliction et
Chagrin Angoisse Effroi)
Exogenous pathogenic factors
Six Excesses (Climatic changes) wind cold summer
heat dampness dryness fire
Epidemiques Trauma Inadequate diet
ETIOLOGIE EN MTC
CANCER EN MTC
bull Les tumeurs reacutesultent dun deacuteseacutequilibre dans le corps ou entre le corps et lenvironnement exteacuterieur
bull Les tumeurs sont dues agrave des changements qualitatifs et irreacuteversibles dans la structure ou la fonction de Zang Fu Qi et du Sang ou de LO
bull Si il y a carence les facteurs pathogegravenes envahissent profondeacutement le corps et si elle persiste la lutte entre le Froid et la Chaleur peut endommager la chair
bull Si les facteurs pathogegravenes ne peuvent pas ecirctre dissipeacutes ceci conduira agrave la formation de tumeurs
LES ELEMENTS CLES DANS LE DEVELOPPEMENT DE TUMEUR DANS MTC
bull 1- stagnation de Qi et la stase du Sang
bull 2- accumulation des Toxines lieacutees agrave la Chaleur
bull 3- deacuteficience de Qi Vital
bull 4- toutes les maladies proviennent des Glaires la plupart des masses qui se produisent dans le corps sont dues aux Glaires
Clinical Guide
bull Principle of diagnosis Diagnosis of disease
Syndrome differentiation
(individulized treatment)
bull Methods
Inspection Auscultation and Olfaction Interrogation Palpation
bull Intervention modalities
Chinese medication Acupuncture Qigong Tuina Dietary
(nutrition)
Treatment
The goal of treatment is to adjust and harmonize Yin and Yang
This is achieved by regulating the Qi Moisture and Blood in the Organ Networksweak organs are tonified congested channels are opened
excess is dispersed tightness is softened agitation is calmed heat is cooled cold is warmed dryness is moistened and dampness is drained
Preventive treatment of Progression of
Disease
《难经middot七十七难》ldquo所谓治未病者见肝之病则知肝当传之于脾 故先实其脾气无令得受肝之邪故曰治未病焉rdquo
重视疾病的传变规律ldquo先安未受邪之地rdquo 痰毒瘀结是肿瘤转移的关键流窜经络脏腑是其特点对于肿瘤的转移预防比治疗更有现实意义
laquo Classique des Problegravemes meacutedicaux raquo chap77 rdquoSi le Foie est malade il peut attaquer la Rate Par conseacutequent la Rate doit ecirctre fortifieacutee avant qursquoelle ne soit elle-mecircme affecteacutee raquo
Acupuncture
Bronze Model for the Meridians and
Acupuncture Points
(Qing Dynasty 1744)
An insight into acupuncture
Concept of Yin Yang
Holism
Five element theory
Human body
About Qi Formation of Qi
Function of Qi
Disharmony of Qi
Meridians - the pathways of the body
Techniques and methods
Meridian pathways of the Body
bullComponents bull 12 regular meridians
12 Collaterals
8 extraordinary meridians
Functions Connect and coordinate
creating an integral whole
Transporting functions
Spleen Meridian
Techniques and methods
Manual (Classic) Acupuncture
Electric-Acupuncture
Acupuncture and Moxibustion
Laser Acupuncture
Ultrasound Acupuncture
Acupuncture and the Moxibustion
Cupping Therapy
Indications
In 1979 WHO named 43 different diseases that can be
treated by Acupuncture
Upper Respiratory Tract
Acute sinusitis
Acute rhinitis
Common cold
Acute tonsillitis
Respiratory System
Acute Bronchitis
Bronchial asthma
Disorders of the Eye Acute conjunctivitis
Central retinitis
Myopia (in children)
Cataract (without
complications)
Disorders of the Mouth Toothache
Post-extraction pain
Gingivitis
Acute and chronic pharyngitis
Journal of World Health Organisation Dec1979
Known biological effects of
acupuncture
bullAcupuncture multiple biological responses
bullOccur locally or at a distance mediated by sensor neurons to many structures of the central nervous system -- leads to activation of pathways affecting various physiology systems in the brain as well as periphery Attention has been focused on the role of endogenous opioids in analgesia and anesthesia
bullActivate the hypothalamus and pituitary resulting in a broad spectrum of systemic effects
bullAlteration in secretion of neurotransmitters and neurohormones that causes changes in the regulation of blood flow both centrally and peripherally
bullEvidence of alteration of immune functions NIH Consensus Statement Online 1997 Nov 3-5 month day] 15(5)1-34
LES TRAITEMENTS
bull 1-la stagnation de Qi et la stase du Sang
bull dynamiser le sang et transformer la stase du sang
bull 2- accumulation des Toxines lieacutees agrave la Chaleur
bull clarifier la chaleur et deacutegager la Toxiciteacute
bull 3- deacuteficience de Qi Vital
bull soutenir le Qi Vital et cultiver la racine
bull 4- toutes les maladies proviennent des Glaires la plupart des masses qui se produisent dans le corps sont dues aux Glaires
bull transformer les Glaires et ramollir la dureteacute
Dans le diagnostic et le traitement des tumeurs la MTC considegravere leacutetat geacuteneacuteral du patient plutocirct que de se focaliser sur le cancer lui-mecircme ou les symptocircmes particuliers
Soutien psychologique
bull angoisse devant lrsquoinconnu
bull angoisse devant la douleur
bull angoisse devant le deacuteveloppement de la maladie et la perte de controcircle sur son propre corps
bull angoisse devant les effets secondaires dus aux divers traitements
bull angoisse devant les complications tardives dues aux divers traitements
bull angoisse devant le regard social porteacute sur le malade
bull angoisse devant la mort
Soutien psychologique
Ces informations reacutesonnent agrave lrsquointeacuterieur du patient ougrave elle
provoquent des dysfonctionnements qui
peuvent se manifester par
bull des maux de ventre
bull des palpitations
bull des troubles du sommeil
bull des difficulteacutes respiratoires
bull des douleurs diverses etc
Nauseacutees et vomissements
RAPPEL LrsquoEstomac
bull YANG
bull Controcircle le mucircrissement amp pourrissement de la nourriture
bull Controcircle le transport des essences de la nourriture Gouverne la descente du Qi fait descendre la nourriture transformeacutee vers lrsquoIntestin Grecircle
bull Si le mouvement de descente est perturbeacute par les pervers si il y a un mouvement ascendant de QI de lrsquoEstomac (agrave contre-sens- NI) il y a des VOMISSEMENTS
Nauseacutees et vomissements
LES VOMISSEMENTS SE MANIFESTENT QUAND LE QI DE LrsquoESTOMAC MONTE A LA PLACE DE DESCENDRE
Neuropathie
Avastine Xeloda Gemzar Cysplatine Taxol Fludara Alimta Procarbazine
points GI2 3 4 IG 2 3 C7 MC6 8 P7 9 F2 3 V60 VB41
traitement
preacutevention
LA DOULEUR DUE AU CANCER
bull Etiologie et physiopathologie
bull Lrsquoinvasion des pervers Externes - tout pervers srsquoil persiste peut provoquer le blocage des meacuteridiens et par la suite une stagnation de Qi et de Sg ou des troubles de Zang-Fu
bull Le deacuteregraveglement des eacutemotions
bull Le deacuteseacutequilibre de lrsquoalimentation
bull Une faiblesse de constitution
DIFFEacuteRENCIATION DE LA DOULEUR
SELON LA LOCALISATION bull dans le cancer du poumon souvent une sensibiliteacute au
P1 et V13 accompagneacutee de toux et de souffle court bull dans le cancer de lrsquoœsophage ou de lrsquoestomac une
sensibiliteacute au E34 et E42 accompagneacutee de nauseacutees dysphagie inappeacutetence
SELON LE VIDE ET LA PLEacuteNITUDE bull Vide douleurs souvent leacutegegraveres intermittentes
sourdes bull Pleacutenitude douleurs tensives lancinantes coliques
aigues
LA FATIGUE
XU LAO = fatigue par Vide = lrsquoeacutepuisement En Occident crsquoest le symptocircme le plus souvent invoqueacute et pas toujours ducirc au Vide
LA FATIGUE - eacutetiologie
bull La faiblesse constitutionnelle
bull Le surmenage
bull Lrsquoexcegraves drsquoactiviteacute physique
bull Lrsquoalimentation
bull Les maladies graves
bull Lrsquoexcegraves drsquoactiviteacute sexuelle
bull Lrsquoaccouchement
bull La consommation de drogues
LA FATIGUE - pathologie
bull Vide
bull Combinaison de Vide et de Pleacutenitude
bull Pleacutenitude
Contre-indications agrave lrsquoacupuncture
bull Des risques de laquo gros bras raquo apregraves curage axillaire
bull Des opeacuterations selon Halsted ou Patey
bull Des drainages lymphatiques
bull Pas drsquoaiguille du cocircteacute opeacutereacute
TCM in cancer treatments
bull Used mostly as adjuvant therapy before or during or
after surgery radiotherapy and chemotherapy
bull Remit the side-effects and toxicity of other treatments
bull Symptom control
bull Activate and strengthen immune system
bull For advanced cancer patients mainly palliative but it
can also prolong life in some cases
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 15 Number 7 2009
Acupuncture for Chemotherapy-Induced Neutropenia in Patients with GynecologiMalignancies A Pilot Randomized Sham-Controlled Clinical Trial
Weidong Lu MB MPH LicAc1ndash3 Ursula A Matulonis MD4 Anne Doherty-Gilman MPH1 Hang ScD3
Peter M Wayne PhD23 David S Rosenthal MD14 and Richard T Penson MD6
bull Abstract bull Objectives The objective of this study was to investigate the effect of acupuncture administered during mye-
losuppressive chemotherapy on white blood cell (WBC) count and absolute neutrophil count (ANC) in patients with ovarian cancer
bull Design This study is a pilot randomized sham-controlled clinical trial Patients received active acupuncture versus sham acupuncture while undergoing chemotherapy A standardized acupuncture protocol was em- ployed with manual and electrostimulation The frequency of treatment was 2ndash3 times per week for a total of 10 sessions starting 1 week before the second cycle of chemotherapy
bull Setting The setting was two outpatient academic centers for patients with cancer bull Subjects Twenty-one (21) newly diagnosed and recurrent ovarian cancer patients were the subjects bull Outcome measures WBC count ANC and plasma granulocyte colony-stimulating factor (G-CSF ) were assessed
weekly bull Results The median leukocyte value in the acupuncture arm at the first day of the third cycle of chemotherapy
was significantly higher than in the control arm after adjusting for baseline value (8600 cells=mL range 4800ndash 12000 versus 4400 cell=mL range 2300ndash10000) ( p frac14 0046) The incidence of grade 2ndash4 leukopenia was less in the acupuncture arm than in the sham arm (30 versus 90 p frac14 002) However the median leukocyte nadir neutrophil nadir and recovering ANC were all higher but not statistically significantly different ( p frac14 0116ndash016) after adjusting for baseline differences There were no statistically significant differences in plasma G-CSF between the two groups
bull Conclusions We observed clinically relevant trends of higher WBC values during one cycle of chemotherapy in patients with ovarian cancer which suggests a potential myeloprotective effect of acupuncture A larger trial is warranted to more definitively determine the efficacy of acupuncture on clinically important outcomes of chemotherapy-induced neutropenia
Acupuncture for the alleviation of hot flashes in men treated with androgen
ablation therapy Ashamalla H1 Jiang ML Guirguis A Peluso F Ashamalla M
bull Abstract bull PURPOSE bull Hot flashes are common side effect due to androgen ablation therapy (AAT) The utility of acupuncture for hot flashes in
men has not been thoroughly studied We prospectively studied the effect of acupuncture in men with hot flashes bull METHODS AND MATERIALS bull The study was approved by internal review board Seventeen men with hot flashes and history of AAT for prostate cancer
were enrolled Three men declined participation before receiving any treatment A hot flash score (HFS) was used to measure daily hot flashes The composite daily score was calculated as the product of frequency times severity The baseline daily scores were compared with scores taken at 2 and 6 weeks and at 8-month average follow-up
bull RESULTS bull No side effects were encountered during immediately after treatment or at 8 months The mean initial HFS was 283 it
dropped to 103 (p = 00001) at 2 weeks posttreatment 75 (p = 00001) at 6 weeks and 70 (p = 0001) at 8 months Clinical improvement for each patient is defined as the percent decrease in the mean HFS at each time point The mean improvement at Weeks 2 and 6 was 684 (mean HFS decreased from 37409 to 11836 p = 0001) and 892 (mean HFS decreased from 37409 to 405 p = 00078) respectively The improvement at 8 months was 803 (mean HFS decreased from 37409 to 7385 p = 0002)
bull CONCLUSIONS bull Acupuncture provides excellent control of hot flashes in men with a history of AAT The absence of side effects and the
durable response at 8 months are likely to be appealing to patients Prospective randomized study is warranted to further evaluate this modality against medical therapy
bull Copyright copy 2011 Elsevier Inc All rights reserved
bull Int J Radiat Oncol Biol Phys 2011 Apr 179(5)1358-63 doi 101016jijrobp201001025 Epub 2010 Jun 3
bull J Clin Oncol 2010 Mar 128(7)1154-60 doi 101200JCO2009234708 Epub 2010 Jan 25 bull Randomized blinded sham-controlled trial of acupuncture for the management of aromatase
inhibitor-associated joint symptoms in women with early-stage breast cancer bull Crew KD1 Capodice JL Greenlee H Brafman L Fuentes D Awad D Yann Tsai W Hershman DL bull Author information
bull Abstract bull PURPOSE Women with breast cancer (BC) treated with aromatase inhibitors (AIs) may experience
joint symptoms that can lead to discontinuation of effective therapy We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC METHODS We conducted a randomized controlled blinded study comparing true acupuncture (TA) versus sham acupuncture (SA) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs TA included full bodyauricular acupuncture and joint-specific point prescriptions whereas SA involved superficial needle insertion at nonacupoint locations Outcome measures included the Brief Pain Inventory-Short Form (BPI-SF) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH) obtained at baseline and at 3 and 6 weeks Results Of 51 women enrolled 43 women were randomly assigned and 38 were evaluable Baseline characteristics were comparable between the two groups Our primary end point was the difference in mean BPI-SF worst pain scores at 6 weeks which was lower for TA compared with SA (30 v 55 P lt 001) We also found differences between TA and SA in pain severity (26 v 45 P = 003) and pain-related interference (25 v 45 P = 002) at 6 weeks Similar findings were seen for the WOMAC and M-SACRAH scores The acupuncture intervention was well-tolerated CONCLUSION Women with AI-induced arthralgias treated with TA had significant improvement of joint pain and stiffness which was not seen with SA Acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect
Human body
Heart ruler of all organs in charge of blood circulation and mental activity
Cardiovacular and certain parts of higher nervous systerm
Liver laquoa viscus of temperamentraquo stores blood secretes bile and controls muscles
Centrals nervous and autonomous nervous systems
Spleen transforms and transports nutrients and water nourishing the muscles and limbs
and determining the bodyrsquos constitution protects the body against pathogen
Digestive and immune systemsas well as the functional system in charge of energy and water metabolism
Lung respiration cotrols vital energy and superficial body resistance regulates circulation of body fluid
Respiratory system part of immune system also related to water metablism
Kidney works to secrete urine store essence of life either inborn or acquired in charge of reproduction growth and development replenishing the brain nourishing the bones and producing marrow helps the lung inhale air
Related to the urogenital systemendocrine system (particularly the pituitary-adrenal and pituitary and gonadal axes) a part of immune system and higher nervous system
The causes of the diseases
Endogenous pathogenic factors
Seven emotions joy anger worry anxiety sorrow
terror and fright (Colegravere Joie Soucis Affliction et
Chagrin Angoisse Effroi)
Exogenous pathogenic factors
Six Excesses (Climatic changes) wind cold summer
heat dampness dryness fire
Epidemiques Trauma Inadequate diet
ETIOLOGIE EN MTC
CANCER EN MTC
bull Les tumeurs reacutesultent dun deacuteseacutequilibre dans le corps ou entre le corps et lenvironnement exteacuterieur
bull Les tumeurs sont dues agrave des changements qualitatifs et irreacuteversibles dans la structure ou la fonction de Zang Fu Qi et du Sang ou de LO
bull Si il y a carence les facteurs pathogegravenes envahissent profondeacutement le corps et si elle persiste la lutte entre le Froid et la Chaleur peut endommager la chair
bull Si les facteurs pathogegravenes ne peuvent pas ecirctre dissipeacutes ceci conduira agrave la formation de tumeurs
LES ELEMENTS CLES DANS LE DEVELOPPEMENT DE TUMEUR DANS MTC
bull 1- stagnation de Qi et la stase du Sang
bull 2- accumulation des Toxines lieacutees agrave la Chaleur
bull 3- deacuteficience de Qi Vital
bull 4- toutes les maladies proviennent des Glaires la plupart des masses qui se produisent dans le corps sont dues aux Glaires
Clinical Guide
bull Principle of diagnosis Diagnosis of disease
Syndrome differentiation
(individulized treatment)
bull Methods
Inspection Auscultation and Olfaction Interrogation Palpation
bull Intervention modalities
Chinese medication Acupuncture Qigong Tuina Dietary
(nutrition)
Treatment
The goal of treatment is to adjust and harmonize Yin and Yang
This is achieved by regulating the Qi Moisture and Blood in the Organ Networksweak organs are tonified congested channels are opened
excess is dispersed tightness is softened agitation is calmed heat is cooled cold is warmed dryness is moistened and dampness is drained
Preventive treatment of Progression of
Disease
《难经middot七十七难》ldquo所谓治未病者见肝之病则知肝当传之于脾 故先实其脾气无令得受肝之邪故曰治未病焉rdquo
重视疾病的传变规律ldquo先安未受邪之地rdquo 痰毒瘀结是肿瘤转移的关键流窜经络脏腑是其特点对于肿瘤的转移预防比治疗更有现实意义
laquo Classique des Problegravemes meacutedicaux raquo chap77 rdquoSi le Foie est malade il peut attaquer la Rate Par conseacutequent la Rate doit ecirctre fortifieacutee avant qursquoelle ne soit elle-mecircme affecteacutee raquo
Acupuncture
Bronze Model for the Meridians and
Acupuncture Points
(Qing Dynasty 1744)
An insight into acupuncture
Concept of Yin Yang
Holism
Five element theory
Human body
About Qi Formation of Qi
Function of Qi
Disharmony of Qi
Meridians - the pathways of the body
Techniques and methods
Meridian pathways of the Body
bullComponents bull 12 regular meridians
12 Collaterals
8 extraordinary meridians
Functions Connect and coordinate
creating an integral whole
Transporting functions
Spleen Meridian
Techniques and methods
Manual (Classic) Acupuncture
Electric-Acupuncture
Acupuncture and Moxibustion
Laser Acupuncture
Ultrasound Acupuncture
Acupuncture and the Moxibustion
Cupping Therapy
Indications
In 1979 WHO named 43 different diseases that can be
treated by Acupuncture
Upper Respiratory Tract
Acute sinusitis
Acute rhinitis
Common cold
Acute tonsillitis
Respiratory System
Acute Bronchitis
Bronchial asthma
Disorders of the Eye Acute conjunctivitis
Central retinitis
Myopia (in children)
Cataract (without
complications)
Disorders of the Mouth Toothache
Post-extraction pain
Gingivitis
Acute and chronic pharyngitis
Journal of World Health Organisation Dec1979
Known biological effects of
acupuncture
bullAcupuncture multiple biological responses
bullOccur locally or at a distance mediated by sensor neurons to many structures of the central nervous system -- leads to activation of pathways affecting various physiology systems in the brain as well as periphery Attention has been focused on the role of endogenous opioids in analgesia and anesthesia
bullActivate the hypothalamus and pituitary resulting in a broad spectrum of systemic effects
bullAlteration in secretion of neurotransmitters and neurohormones that causes changes in the regulation of blood flow both centrally and peripherally
bullEvidence of alteration of immune functions NIH Consensus Statement Online 1997 Nov 3-5 month day] 15(5)1-34
LES TRAITEMENTS
bull 1-la stagnation de Qi et la stase du Sang
bull dynamiser le sang et transformer la stase du sang
bull 2- accumulation des Toxines lieacutees agrave la Chaleur
bull clarifier la chaleur et deacutegager la Toxiciteacute
bull 3- deacuteficience de Qi Vital
bull soutenir le Qi Vital et cultiver la racine
bull 4- toutes les maladies proviennent des Glaires la plupart des masses qui se produisent dans le corps sont dues aux Glaires
bull transformer les Glaires et ramollir la dureteacute
Dans le diagnostic et le traitement des tumeurs la MTC considegravere leacutetat geacuteneacuteral du patient plutocirct que de se focaliser sur le cancer lui-mecircme ou les symptocircmes particuliers
Soutien psychologique
bull angoisse devant lrsquoinconnu
bull angoisse devant la douleur
bull angoisse devant le deacuteveloppement de la maladie et la perte de controcircle sur son propre corps
bull angoisse devant les effets secondaires dus aux divers traitements
bull angoisse devant les complications tardives dues aux divers traitements
bull angoisse devant le regard social porteacute sur le malade
bull angoisse devant la mort
Soutien psychologique
Ces informations reacutesonnent agrave lrsquointeacuterieur du patient ougrave elle
provoquent des dysfonctionnements qui
peuvent se manifester par
bull des maux de ventre
bull des palpitations
bull des troubles du sommeil
bull des difficulteacutes respiratoires
bull des douleurs diverses etc
Nauseacutees et vomissements
RAPPEL LrsquoEstomac
bull YANG
bull Controcircle le mucircrissement amp pourrissement de la nourriture
bull Controcircle le transport des essences de la nourriture Gouverne la descente du Qi fait descendre la nourriture transformeacutee vers lrsquoIntestin Grecircle
bull Si le mouvement de descente est perturbeacute par les pervers si il y a un mouvement ascendant de QI de lrsquoEstomac (agrave contre-sens- NI) il y a des VOMISSEMENTS
Nauseacutees et vomissements
LES VOMISSEMENTS SE MANIFESTENT QUAND LE QI DE LrsquoESTOMAC MONTE A LA PLACE DE DESCENDRE
Neuropathie
Avastine Xeloda Gemzar Cysplatine Taxol Fludara Alimta Procarbazine
points GI2 3 4 IG 2 3 C7 MC6 8 P7 9 F2 3 V60 VB41
traitement
preacutevention
LA DOULEUR DUE AU CANCER
bull Etiologie et physiopathologie
bull Lrsquoinvasion des pervers Externes - tout pervers srsquoil persiste peut provoquer le blocage des meacuteridiens et par la suite une stagnation de Qi et de Sg ou des troubles de Zang-Fu
bull Le deacuteregraveglement des eacutemotions
bull Le deacuteseacutequilibre de lrsquoalimentation
bull Une faiblesse de constitution
DIFFEacuteRENCIATION DE LA DOULEUR
SELON LA LOCALISATION bull dans le cancer du poumon souvent une sensibiliteacute au
P1 et V13 accompagneacutee de toux et de souffle court bull dans le cancer de lrsquoœsophage ou de lrsquoestomac une
sensibiliteacute au E34 et E42 accompagneacutee de nauseacutees dysphagie inappeacutetence
SELON LE VIDE ET LA PLEacuteNITUDE bull Vide douleurs souvent leacutegegraveres intermittentes
sourdes bull Pleacutenitude douleurs tensives lancinantes coliques
aigues
LA FATIGUE
XU LAO = fatigue par Vide = lrsquoeacutepuisement En Occident crsquoest le symptocircme le plus souvent invoqueacute et pas toujours ducirc au Vide
LA FATIGUE - eacutetiologie
bull La faiblesse constitutionnelle
bull Le surmenage
bull Lrsquoexcegraves drsquoactiviteacute physique
bull Lrsquoalimentation
bull Les maladies graves
bull Lrsquoexcegraves drsquoactiviteacute sexuelle
bull Lrsquoaccouchement
bull La consommation de drogues
LA FATIGUE - pathologie
bull Vide
bull Combinaison de Vide et de Pleacutenitude
bull Pleacutenitude
Contre-indications agrave lrsquoacupuncture
bull Des risques de laquo gros bras raquo apregraves curage axillaire
bull Des opeacuterations selon Halsted ou Patey
bull Des drainages lymphatiques
bull Pas drsquoaiguille du cocircteacute opeacutereacute
TCM in cancer treatments
bull Used mostly as adjuvant therapy before or during or
after surgery radiotherapy and chemotherapy
bull Remit the side-effects and toxicity of other treatments
bull Symptom control
bull Activate and strengthen immune system
bull For advanced cancer patients mainly palliative but it
can also prolong life in some cases
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 15 Number 7 2009
Acupuncture for Chemotherapy-Induced Neutropenia in Patients with GynecologiMalignancies A Pilot Randomized Sham-Controlled Clinical Trial
Weidong Lu MB MPH LicAc1ndash3 Ursula A Matulonis MD4 Anne Doherty-Gilman MPH1 Hang ScD3
Peter M Wayne PhD23 David S Rosenthal MD14 and Richard T Penson MD6
bull Abstract bull Objectives The objective of this study was to investigate the effect of acupuncture administered during mye-
losuppressive chemotherapy on white blood cell (WBC) count and absolute neutrophil count (ANC) in patients with ovarian cancer
bull Design This study is a pilot randomized sham-controlled clinical trial Patients received active acupuncture versus sham acupuncture while undergoing chemotherapy A standardized acupuncture protocol was em- ployed with manual and electrostimulation The frequency of treatment was 2ndash3 times per week for a total of 10 sessions starting 1 week before the second cycle of chemotherapy
bull Setting The setting was two outpatient academic centers for patients with cancer bull Subjects Twenty-one (21) newly diagnosed and recurrent ovarian cancer patients were the subjects bull Outcome measures WBC count ANC and plasma granulocyte colony-stimulating factor (G-CSF ) were assessed
weekly bull Results The median leukocyte value in the acupuncture arm at the first day of the third cycle of chemotherapy
was significantly higher than in the control arm after adjusting for baseline value (8600 cells=mL range 4800ndash 12000 versus 4400 cell=mL range 2300ndash10000) ( p frac14 0046) The incidence of grade 2ndash4 leukopenia was less in the acupuncture arm than in the sham arm (30 versus 90 p frac14 002) However the median leukocyte nadir neutrophil nadir and recovering ANC were all higher but not statistically significantly different ( p frac14 0116ndash016) after adjusting for baseline differences There were no statistically significant differences in plasma G-CSF between the two groups
bull Conclusions We observed clinically relevant trends of higher WBC values during one cycle of chemotherapy in patients with ovarian cancer which suggests a potential myeloprotective effect of acupuncture A larger trial is warranted to more definitively determine the efficacy of acupuncture on clinically important outcomes of chemotherapy-induced neutropenia
Acupuncture for the alleviation of hot flashes in men treated with androgen
ablation therapy Ashamalla H1 Jiang ML Guirguis A Peluso F Ashamalla M
bull Abstract bull PURPOSE bull Hot flashes are common side effect due to androgen ablation therapy (AAT) The utility of acupuncture for hot flashes in
men has not been thoroughly studied We prospectively studied the effect of acupuncture in men with hot flashes bull METHODS AND MATERIALS bull The study was approved by internal review board Seventeen men with hot flashes and history of AAT for prostate cancer
were enrolled Three men declined participation before receiving any treatment A hot flash score (HFS) was used to measure daily hot flashes The composite daily score was calculated as the product of frequency times severity The baseline daily scores were compared with scores taken at 2 and 6 weeks and at 8-month average follow-up
bull RESULTS bull No side effects were encountered during immediately after treatment or at 8 months The mean initial HFS was 283 it
dropped to 103 (p = 00001) at 2 weeks posttreatment 75 (p = 00001) at 6 weeks and 70 (p = 0001) at 8 months Clinical improvement for each patient is defined as the percent decrease in the mean HFS at each time point The mean improvement at Weeks 2 and 6 was 684 (mean HFS decreased from 37409 to 11836 p = 0001) and 892 (mean HFS decreased from 37409 to 405 p = 00078) respectively The improvement at 8 months was 803 (mean HFS decreased from 37409 to 7385 p = 0002)
bull CONCLUSIONS bull Acupuncture provides excellent control of hot flashes in men with a history of AAT The absence of side effects and the
durable response at 8 months are likely to be appealing to patients Prospective randomized study is warranted to further evaluate this modality against medical therapy
bull Copyright copy 2011 Elsevier Inc All rights reserved
bull Int J Radiat Oncol Biol Phys 2011 Apr 179(5)1358-63 doi 101016jijrobp201001025 Epub 2010 Jun 3
bull J Clin Oncol 2010 Mar 128(7)1154-60 doi 101200JCO2009234708 Epub 2010 Jan 25 bull Randomized blinded sham-controlled trial of acupuncture for the management of aromatase
inhibitor-associated joint symptoms in women with early-stage breast cancer bull Crew KD1 Capodice JL Greenlee H Brafman L Fuentes D Awad D Yann Tsai W Hershman DL bull Author information
bull Abstract bull PURPOSE Women with breast cancer (BC) treated with aromatase inhibitors (AIs) may experience
joint symptoms that can lead to discontinuation of effective therapy We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC METHODS We conducted a randomized controlled blinded study comparing true acupuncture (TA) versus sham acupuncture (SA) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs TA included full bodyauricular acupuncture and joint-specific point prescriptions whereas SA involved superficial needle insertion at nonacupoint locations Outcome measures included the Brief Pain Inventory-Short Form (BPI-SF) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH) obtained at baseline and at 3 and 6 weeks Results Of 51 women enrolled 43 women were randomly assigned and 38 were evaluable Baseline characteristics were comparable between the two groups Our primary end point was the difference in mean BPI-SF worst pain scores at 6 weeks which was lower for TA compared with SA (30 v 55 P lt 001) We also found differences between TA and SA in pain severity (26 v 45 P = 003) and pain-related interference (25 v 45 P = 002) at 6 weeks Similar findings were seen for the WOMAC and M-SACRAH scores The acupuncture intervention was well-tolerated CONCLUSION Women with AI-induced arthralgias treated with TA had significant improvement of joint pain and stiffness which was not seen with SA Acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect
The causes of the diseases
Endogenous pathogenic factors
Seven emotions joy anger worry anxiety sorrow
terror and fright (Colegravere Joie Soucis Affliction et
Chagrin Angoisse Effroi)
Exogenous pathogenic factors
Six Excesses (Climatic changes) wind cold summer
heat dampness dryness fire
Epidemiques Trauma Inadequate diet
ETIOLOGIE EN MTC
CANCER EN MTC
bull Les tumeurs reacutesultent dun deacuteseacutequilibre dans le corps ou entre le corps et lenvironnement exteacuterieur
bull Les tumeurs sont dues agrave des changements qualitatifs et irreacuteversibles dans la structure ou la fonction de Zang Fu Qi et du Sang ou de LO
bull Si il y a carence les facteurs pathogegravenes envahissent profondeacutement le corps et si elle persiste la lutte entre le Froid et la Chaleur peut endommager la chair
bull Si les facteurs pathogegravenes ne peuvent pas ecirctre dissipeacutes ceci conduira agrave la formation de tumeurs
LES ELEMENTS CLES DANS LE DEVELOPPEMENT DE TUMEUR DANS MTC
bull 1- stagnation de Qi et la stase du Sang
bull 2- accumulation des Toxines lieacutees agrave la Chaleur
bull 3- deacuteficience de Qi Vital
bull 4- toutes les maladies proviennent des Glaires la plupart des masses qui se produisent dans le corps sont dues aux Glaires
Clinical Guide
bull Principle of diagnosis Diagnosis of disease
Syndrome differentiation
(individulized treatment)
bull Methods
Inspection Auscultation and Olfaction Interrogation Palpation
bull Intervention modalities
Chinese medication Acupuncture Qigong Tuina Dietary
(nutrition)
Treatment
The goal of treatment is to adjust and harmonize Yin and Yang
This is achieved by regulating the Qi Moisture and Blood in the Organ Networksweak organs are tonified congested channels are opened
excess is dispersed tightness is softened agitation is calmed heat is cooled cold is warmed dryness is moistened and dampness is drained
Preventive treatment of Progression of
Disease
《难经middot七十七难》ldquo所谓治未病者见肝之病则知肝当传之于脾 故先实其脾气无令得受肝之邪故曰治未病焉rdquo
重视疾病的传变规律ldquo先安未受邪之地rdquo 痰毒瘀结是肿瘤转移的关键流窜经络脏腑是其特点对于肿瘤的转移预防比治疗更有现实意义
laquo Classique des Problegravemes meacutedicaux raquo chap77 rdquoSi le Foie est malade il peut attaquer la Rate Par conseacutequent la Rate doit ecirctre fortifieacutee avant qursquoelle ne soit elle-mecircme affecteacutee raquo
Acupuncture
Bronze Model for the Meridians and
Acupuncture Points
(Qing Dynasty 1744)
An insight into acupuncture
Concept of Yin Yang
Holism
Five element theory
Human body
About Qi Formation of Qi
Function of Qi
Disharmony of Qi
Meridians - the pathways of the body
Techniques and methods
Meridian pathways of the Body
bullComponents bull 12 regular meridians
12 Collaterals
8 extraordinary meridians
Functions Connect and coordinate
creating an integral whole
Transporting functions
Spleen Meridian
Techniques and methods
Manual (Classic) Acupuncture
Electric-Acupuncture
Acupuncture and Moxibustion
Laser Acupuncture
Ultrasound Acupuncture
Acupuncture and the Moxibustion
Cupping Therapy
Indications
In 1979 WHO named 43 different diseases that can be
treated by Acupuncture
Upper Respiratory Tract
Acute sinusitis
Acute rhinitis
Common cold
Acute tonsillitis
Respiratory System
Acute Bronchitis
Bronchial asthma
Disorders of the Eye Acute conjunctivitis
Central retinitis
Myopia (in children)
Cataract (without
complications)
Disorders of the Mouth Toothache
Post-extraction pain
Gingivitis
Acute and chronic pharyngitis
Journal of World Health Organisation Dec1979
Known biological effects of
acupuncture
bullAcupuncture multiple biological responses
bullOccur locally or at a distance mediated by sensor neurons to many structures of the central nervous system -- leads to activation of pathways affecting various physiology systems in the brain as well as periphery Attention has been focused on the role of endogenous opioids in analgesia and anesthesia
bullActivate the hypothalamus and pituitary resulting in a broad spectrum of systemic effects
bullAlteration in secretion of neurotransmitters and neurohormones that causes changes in the regulation of blood flow both centrally and peripherally
bullEvidence of alteration of immune functions NIH Consensus Statement Online 1997 Nov 3-5 month day] 15(5)1-34
LES TRAITEMENTS
bull 1-la stagnation de Qi et la stase du Sang
bull dynamiser le sang et transformer la stase du sang
bull 2- accumulation des Toxines lieacutees agrave la Chaleur
bull clarifier la chaleur et deacutegager la Toxiciteacute
bull 3- deacuteficience de Qi Vital
bull soutenir le Qi Vital et cultiver la racine
bull 4- toutes les maladies proviennent des Glaires la plupart des masses qui se produisent dans le corps sont dues aux Glaires
bull transformer les Glaires et ramollir la dureteacute
Dans le diagnostic et le traitement des tumeurs la MTC considegravere leacutetat geacuteneacuteral du patient plutocirct que de se focaliser sur le cancer lui-mecircme ou les symptocircmes particuliers
Soutien psychologique
bull angoisse devant lrsquoinconnu
bull angoisse devant la douleur
bull angoisse devant le deacuteveloppement de la maladie et la perte de controcircle sur son propre corps
bull angoisse devant les effets secondaires dus aux divers traitements
bull angoisse devant les complications tardives dues aux divers traitements
bull angoisse devant le regard social porteacute sur le malade
bull angoisse devant la mort
Soutien psychologique
Ces informations reacutesonnent agrave lrsquointeacuterieur du patient ougrave elle
provoquent des dysfonctionnements qui
peuvent se manifester par
bull des maux de ventre
bull des palpitations
bull des troubles du sommeil
bull des difficulteacutes respiratoires
bull des douleurs diverses etc
Nauseacutees et vomissements
RAPPEL LrsquoEstomac
bull YANG
bull Controcircle le mucircrissement amp pourrissement de la nourriture
bull Controcircle le transport des essences de la nourriture Gouverne la descente du Qi fait descendre la nourriture transformeacutee vers lrsquoIntestin Grecircle
bull Si le mouvement de descente est perturbeacute par les pervers si il y a un mouvement ascendant de QI de lrsquoEstomac (agrave contre-sens- NI) il y a des VOMISSEMENTS
Nauseacutees et vomissements
LES VOMISSEMENTS SE MANIFESTENT QUAND LE QI DE LrsquoESTOMAC MONTE A LA PLACE DE DESCENDRE
Neuropathie
Avastine Xeloda Gemzar Cysplatine Taxol Fludara Alimta Procarbazine
points GI2 3 4 IG 2 3 C7 MC6 8 P7 9 F2 3 V60 VB41
traitement
preacutevention
LA DOULEUR DUE AU CANCER
bull Etiologie et physiopathologie
bull Lrsquoinvasion des pervers Externes - tout pervers srsquoil persiste peut provoquer le blocage des meacuteridiens et par la suite une stagnation de Qi et de Sg ou des troubles de Zang-Fu
bull Le deacuteregraveglement des eacutemotions
bull Le deacuteseacutequilibre de lrsquoalimentation
bull Une faiblesse de constitution
DIFFEacuteRENCIATION DE LA DOULEUR
SELON LA LOCALISATION bull dans le cancer du poumon souvent une sensibiliteacute au
P1 et V13 accompagneacutee de toux et de souffle court bull dans le cancer de lrsquoœsophage ou de lrsquoestomac une
sensibiliteacute au E34 et E42 accompagneacutee de nauseacutees dysphagie inappeacutetence
SELON LE VIDE ET LA PLEacuteNITUDE bull Vide douleurs souvent leacutegegraveres intermittentes
sourdes bull Pleacutenitude douleurs tensives lancinantes coliques
aigues
LA FATIGUE
XU LAO = fatigue par Vide = lrsquoeacutepuisement En Occident crsquoest le symptocircme le plus souvent invoqueacute et pas toujours ducirc au Vide
LA FATIGUE - eacutetiologie
bull La faiblesse constitutionnelle
bull Le surmenage
bull Lrsquoexcegraves drsquoactiviteacute physique
bull Lrsquoalimentation
bull Les maladies graves
bull Lrsquoexcegraves drsquoactiviteacute sexuelle
bull Lrsquoaccouchement
bull La consommation de drogues
LA FATIGUE - pathologie
bull Vide
bull Combinaison de Vide et de Pleacutenitude
bull Pleacutenitude
Contre-indications agrave lrsquoacupuncture
bull Des risques de laquo gros bras raquo apregraves curage axillaire
bull Des opeacuterations selon Halsted ou Patey
bull Des drainages lymphatiques
bull Pas drsquoaiguille du cocircteacute opeacutereacute
TCM in cancer treatments
bull Used mostly as adjuvant therapy before or during or
after surgery radiotherapy and chemotherapy
bull Remit the side-effects and toxicity of other treatments
bull Symptom control
bull Activate and strengthen immune system
bull For advanced cancer patients mainly palliative but it
can also prolong life in some cases
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 15 Number 7 2009
Acupuncture for Chemotherapy-Induced Neutropenia in Patients with GynecologiMalignancies A Pilot Randomized Sham-Controlled Clinical Trial
Weidong Lu MB MPH LicAc1ndash3 Ursula A Matulonis MD4 Anne Doherty-Gilman MPH1 Hang ScD3
Peter M Wayne PhD23 David S Rosenthal MD14 and Richard T Penson MD6
bull Abstract bull Objectives The objective of this study was to investigate the effect of acupuncture administered during mye-
losuppressive chemotherapy on white blood cell (WBC) count and absolute neutrophil count (ANC) in patients with ovarian cancer
bull Design This study is a pilot randomized sham-controlled clinical trial Patients received active acupuncture versus sham acupuncture while undergoing chemotherapy A standardized acupuncture protocol was em- ployed with manual and electrostimulation The frequency of treatment was 2ndash3 times per week for a total of 10 sessions starting 1 week before the second cycle of chemotherapy
bull Setting The setting was two outpatient academic centers for patients with cancer bull Subjects Twenty-one (21) newly diagnosed and recurrent ovarian cancer patients were the subjects bull Outcome measures WBC count ANC and plasma granulocyte colony-stimulating factor (G-CSF ) were assessed
weekly bull Results The median leukocyte value in the acupuncture arm at the first day of the third cycle of chemotherapy
was significantly higher than in the control arm after adjusting for baseline value (8600 cells=mL range 4800ndash 12000 versus 4400 cell=mL range 2300ndash10000) ( p frac14 0046) The incidence of grade 2ndash4 leukopenia was less in the acupuncture arm than in the sham arm (30 versus 90 p frac14 002) However the median leukocyte nadir neutrophil nadir and recovering ANC were all higher but not statistically significantly different ( p frac14 0116ndash016) after adjusting for baseline differences There were no statistically significant differences in plasma G-CSF between the two groups
bull Conclusions We observed clinically relevant trends of higher WBC values during one cycle of chemotherapy in patients with ovarian cancer which suggests a potential myeloprotective effect of acupuncture A larger trial is warranted to more definitively determine the efficacy of acupuncture on clinically important outcomes of chemotherapy-induced neutropenia
Acupuncture for the alleviation of hot flashes in men treated with androgen
ablation therapy Ashamalla H1 Jiang ML Guirguis A Peluso F Ashamalla M
bull Abstract bull PURPOSE bull Hot flashes are common side effect due to androgen ablation therapy (AAT) The utility of acupuncture for hot flashes in
men has not been thoroughly studied We prospectively studied the effect of acupuncture in men with hot flashes bull METHODS AND MATERIALS bull The study was approved by internal review board Seventeen men with hot flashes and history of AAT for prostate cancer
were enrolled Three men declined participation before receiving any treatment A hot flash score (HFS) was used to measure daily hot flashes The composite daily score was calculated as the product of frequency times severity The baseline daily scores were compared with scores taken at 2 and 6 weeks and at 8-month average follow-up
bull RESULTS bull No side effects were encountered during immediately after treatment or at 8 months The mean initial HFS was 283 it
dropped to 103 (p = 00001) at 2 weeks posttreatment 75 (p = 00001) at 6 weeks and 70 (p = 0001) at 8 months Clinical improvement for each patient is defined as the percent decrease in the mean HFS at each time point The mean improvement at Weeks 2 and 6 was 684 (mean HFS decreased from 37409 to 11836 p = 0001) and 892 (mean HFS decreased from 37409 to 405 p = 00078) respectively The improvement at 8 months was 803 (mean HFS decreased from 37409 to 7385 p = 0002)
bull CONCLUSIONS bull Acupuncture provides excellent control of hot flashes in men with a history of AAT The absence of side effects and the
durable response at 8 months are likely to be appealing to patients Prospective randomized study is warranted to further evaluate this modality against medical therapy
bull Copyright copy 2011 Elsevier Inc All rights reserved
bull Int J Radiat Oncol Biol Phys 2011 Apr 179(5)1358-63 doi 101016jijrobp201001025 Epub 2010 Jun 3
bull J Clin Oncol 2010 Mar 128(7)1154-60 doi 101200JCO2009234708 Epub 2010 Jan 25 bull Randomized blinded sham-controlled trial of acupuncture for the management of aromatase
inhibitor-associated joint symptoms in women with early-stage breast cancer bull Crew KD1 Capodice JL Greenlee H Brafman L Fuentes D Awad D Yann Tsai W Hershman DL bull Author information
bull Abstract bull PURPOSE Women with breast cancer (BC) treated with aromatase inhibitors (AIs) may experience
joint symptoms that can lead to discontinuation of effective therapy We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC METHODS We conducted a randomized controlled blinded study comparing true acupuncture (TA) versus sham acupuncture (SA) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs TA included full bodyauricular acupuncture and joint-specific point prescriptions whereas SA involved superficial needle insertion at nonacupoint locations Outcome measures included the Brief Pain Inventory-Short Form (BPI-SF) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH) obtained at baseline and at 3 and 6 weeks Results Of 51 women enrolled 43 women were randomly assigned and 38 were evaluable Baseline characteristics were comparable between the two groups Our primary end point was the difference in mean BPI-SF worst pain scores at 6 weeks which was lower for TA compared with SA (30 v 55 P lt 001) We also found differences between TA and SA in pain severity (26 v 45 P = 003) and pain-related interference (25 v 45 P = 002) at 6 weeks Similar findings were seen for the WOMAC and M-SACRAH scores The acupuncture intervention was well-tolerated CONCLUSION Women with AI-induced arthralgias treated with TA had significant improvement of joint pain and stiffness which was not seen with SA Acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect
ETIOLOGIE EN MTC
CANCER EN MTC
bull Les tumeurs reacutesultent dun deacuteseacutequilibre dans le corps ou entre le corps et lenvironnement exteacuterieur
bull Les tumeurs sont dues agrave des changements qualitatifs et irreacuteversibles dans la structure ou la fonction de Zang Fu Qi et du Sang ou de LO
bull Si il y a carence les facteurs pathogegravenes envahissent profondeacutement le corps et si elle persiste la lutte entre le Froid et la Chaleur peut endommager la chair
bull Si les facteurs pathogegravenes ne peuvent pas ecirctre dissipeacutes ceci conduira agrave la formation de tumeurs
LES ELEMENTS CLES DANS LE DEVELOPPEMENT DE TUMEUR DANS MTC
bull 1- stagnation de Qi et la stase du Sang
bull 2- accumulation des Toxines lieacutees agrave la Chaleur
bull 3- deacuteficience de Qi Vital
bull 4- toutes les maladies proviennent des Glaires la plupart des masses qui se produisent dans le corps sont dues aux Glaires
Clinical Guide
bull Principle of diagnosis Diagnosis of disease
Syndrome differentiation
(individulized treatment)
bull Methods
Inspection Auscultation and Olfaction Interrogation Palpation
bull Intervention modalities
Chinese medication Acupuncture Qigong Tuina Dietary
(nutrition)
Treatment
The goal of treatment is to adjust and harmonize Yin and Yang
This is achieved by regulating the Qi Moisture and Blood in the Organ Networksweak organs are tonified congested channels are opened
excess is dispersed tightness is softened agitation is calmed heat is cooled cold is warmed dryness is moistened and dampness is drained
Preventive treatment of Progression of
Disease
《难经middot七十七难》ldquo所谓治未病者见肝之病则知肝当传之于脾 故先实其脾气无令得受肝之邪故曰治未病焉rdquo
重视疾病的传变规律ldquo先安未受邪之地rdquo 痰毒瘀结是肿瘤转移的关键流窜经络脏腑是其特点对于肿瘤的转移预防比治疗更有现实意义
laquo Classique des Problegravemes meacutedicaux raquo chap77 rdquoSi le Foie est malade il peut attaquer la Rate Par conseacutequent la Rate doit ecirctre fortifieacutee avant qursquoelle ne soit elle-mecircme affecteacutee raquo
Acupuncture
Bronze Model for the Meridians and
Acupuncture Points
(Qing Dynasty 1744)
An insight into acupuncture
Concept of Yin Yang
Holism
Five element theory
Human body
About Qi Formation of Qi
Function of Qi
Disharmony of Qi
Meridians - the pathways of the body
Techniques and methods
Meridian pathways of the Body
bullComponents bull 12 regular meridians
12 Collaterals
8 extraordinary meridians
Functions Connect and coordinate
creating an integral whole
Transporting functions
Spleen Meridian
Techniques and methods
Manual (Classic) Acupuncture
Electric-Acupuncture
Acupuncture and Moxibustion
Laser Acupuncture
Ultrasound Acupuncture
Acupuncture and the Moxibustion
Cupping Therapy
Indications
In 1979 WHO named 43 different diseases that can be
treated by Acupuncture
Upper Respiratory Tract
Acute sinusitis
Acute rhinitis
Common cold
Acute tonsillitis
Respiratory System
Acute Bronchitis
Bronchial asthma
Disorders of the Eye Acute conjunctivitis
Central retinitis
Myopia (in children)
Cataract (without
complications)
Disorders of the Mouth Toothache
Post-extraction pain
Gingivitis
Acute and chronic pharyngitis
Journal of World Health Organisation Dec1979
Known biological effects of
acupuncture
bullAcupuncture multiple biological responses
bullOccur locally or at a distance mediated by sensor neurons to many structures of the central nervous system -- leads to activation of pathways affecting various physiology systems in the brain as well as periphery Attention has been focused on the role of endogenous opioids in analgesia and anesthesia
bullActivate the hypothalamus and pituitary resulting in a broad spectrum of systemic effects
bullAlteration in secretion of neurotransmitters and neurohormones that causes changes in the regulation of blood flow both centrally and peripherally
bullEvidence of alteration of immune functions NIH Consensus Statement Online 1997 Nov 3-5 month day] 15(5)1-34
LES TRAITEMENTS
bull 1-la stagnation de Qi et la stase du Sang
bull dynamiser le sang et transformer la stase du sang
bull 2- accumulation des Toxines lieacutees agrave la Chaleur
bull clarifier la chaleur et deacutegager la Toxiciteacute
bull 3- deacuteficience de Qi Vital
bull soutenir le Qi Vital et cultiver la racine
bull 4- toutes les maladies proviennent des Glaires la plupart des masses qui se produisent dans le corps sont dues aux Glaires
bull transformer les Glaires et ramollir la dureteacute
Dans le diagnostic et le traitement des tumeurs la MTC considegravere leacutetat geacuteneacuteral du patient plutocirct que de se focaliser sur le cancer lui-mecircme ou les symptocircmes particuliers
Soutien psychologique
bull angoisse devant lrsquoinconnu
bull angoisse devant la douleur
bull angoisse devant le deacuteveloppement de la maladie et la perte de controcircle sur son propre corps
bull angoisse devant les effets secondaires dus aux divers traitements
bull angoisse devant les complications tardives dues aux divers traitements
bull angoisse devant le regard social porteacute sur le malade
bull angoisse devant la mort
Soutien psychologique
Ces informations reacutesonnent agrave lrsquointeacuterieur du patient ougrave elle
provoquent des dysfonctionnements qui
peuvent se manifester par
bull des maux de ventre
bull des palpitations
bull des troubles du sommeil
bull des difficulteacutes respiratoires
bull des douleurs diverses etc
Nauseacutees et vomissements
RAPPEL LrsquoEstomac
bull YANG
bull Controcircle le mucircrissement amp pourrissement de la nourriture
bull Controcircle le transport des essences de la nourriture Gouverne la descente du Qi fait descendre la nourriture transformeacutee vers lrsquoIntestin Grecircle
bull Si le mouvement de descente est perturbeacute par les pervers si il y a un mouvement ascendant de QI de lrsquoEstomac (agrave contre-sens- NI) il y a des VOMISSEMENTS
Nauseacutees et vomissements
LES VOMISSEMENTS SE MANIFESTENT QUAND LE QI DE LrsquoESTOMAC MONTE A LA PLACE DE DESCENDRE
Neuropathie
Avastine Xeloda Gemzar Cysplatine Taxol Fludara Alimta Procarbazine
points GI2 3 4 IG 2 3 C7 MC6 8 P7 9 F2 3 V60 VB41
traitement
preacutevention
LA DOULEUR DUE AU CANCER
bull Etiologie et physiopathologie
bull Lrsquoinvasion des pervers Externes - tout pervers srsquoil persiste peut provoquer le blocage des meacuteridiens et par la suite une stagnation de Qi et de Sg ou des troubles de Zang-Fu
bull Le deacuteregraveglement des eacutemotions
bull Le deacuteseacutequilibre de lrsquoalimentation
bull Une faiblesse de constitution
DIFFEacuteRENCIATION DE LA DOULEUR
SELON LA LOCALISATION bull dans le cancer du poumon souvent une sensibiliteacute au
P1 et V13 accompagneacutee de toux et de souffle court bull dans le cancer de lrsquoœsophage ou de lrsquoestomac une
sensibiliteacute au E34 et E42 accompagneacutee de nauseacutees dysphagie inappeacutetence
SELON LE VIDE ET LA PLEacuteNITUDE bull Vide douleurs souvent leacutegegraveres intermittentes
sourdes bull Pleacutenitude douleurs tensives lancinantes coliques
aigues
LA FATIGUE
XU LAO = fatigue par Vide = lrsquoeacutepuisement En Occident crsquoest le symptocircme le plus souvent invoqueacute et pas toujours ducirc au Vide
LA FATIGUE - eacutetiologie
bull La faiblesse constitutionnelle
bull Le surmenage
bull Lrsquoexcegraves drsquoactiviteacute physique
bull Lrsquoalimentation
bull Les maladies graves
bull Lrsquoexcegraves drsquoactiviteacute sexuelle
bull Lrsquoaccouchement
bull La consommation de drogues
LA FATIGUE - pathologie
bull Vide
bull Combinaison de Vide et de Pleacutenitude
bull Pleacutenitude
Contre-indications agrave lrsquoacupuncture
bull Des risques de laquo gros bras raquo apregraves curage axillaire
bull Des opeacuterations selon Halsted ou Patey
bull Des drainages lymphatiques
bull Pas drsquoaiguille du cocircteacute opeacutereacute
TCM in cancer treatments
bull Used mostly as adjuvant therapy before or during or
after surgery radiotherapy and chemotherapy
bull Remit the side-effects and toxicity of other treatments
bull Symptom control
bull Activate and strengthen immune system
bull For advanced cancer patients mainly palliative but it
can also prolong life in some cases
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 15 Number 7 2009
Acupuncture for Chemotherapy-Induced Neutropenia in Patients with GynecologiMalignancies A Pilot Randomized Sham-Controlled Clinical Trial
Weidong Lu MB MPH LicAc1ndash3 Ursula A Matulonis MD4 Anne Doherty-Gilman MPH1 Hang ScD3
Peter M Wayne PhD23 David S Rosenthal MD14 and Richard T Penson MD6
bull Abstract bull Objectives The objective of this study was to investigate the effect of acupuncture administered during mye-
losuppressive chemotherapy on white blood cell (WBC) count and absolute neutrophil count (ANC) in patients with ovarian cancer
bull Design This study is a pilot randomized sham-controlled clinical trial Patients received active acupuncture versus sham acupuncture while undergoing chemotherapy A standardized acupuncture protocol was em- ployed with manual and electrostimulation The frequency of treatment was 2ndash3 times per week for a total of 10 sessions starting 1 week before the second cycle of chemotherapy
bull Setting The setting was two outpatient academic centers for patients with cancer bull Subjects Twenty-one (21) newly diagnosed and recurrent ovarian cancer patients were the subjects bull Outcome measures WBC count ANC and plasma granulocyte colony-stimulating factor (G-CSF ) were assessed
weekly bull Results The median leukocyte value in the acupuncture arm at the first day of the third cycle of chemotherapy
was significantly higher than in the control arm after adjusting for baseline value (8600 cells=mL range 4800ndash 12000 versus 4400 cell=mL range 2300ndash10000) ( p frac14 0046) The incidence of grade 2ndash4 leukopenia was less in the acupuncture arm than in the sham arm (30 versus 90 p frac14 002) However the median leukocyte nadir neutrophil nadir and recovering ANC were all higher but not statistically significantly different ( p frac14 0116ndash016) after adjusting for baseline differences There were no statistically significant differences in plasma G-CSF between the two groups
bull Conclusions We observed clinically relevant trends of higher WBC values during one cycle of chemotherapy in patients with ovarian cancer which suggests a potential myeloprotective effect of acupuncture A larger trial is warranted to more definitively determine the efficacy of acupuncture on clinically important outcomes of chemotherapy-induced neutropenia
Acupuncture for the alleviation of hot flashes in men treated with androgen
ablation therapy Ashamalla H1 Jiang ML Guirguis A Peluso F Ashamalla M
bull Abstract bull PURPOSE bull Hot flashes are common side effect due to androgen ablation therapy (AAT) The utility of acupuncture for hot flashes in
men has not been thoroughly studied We prospectively studied the effect of acupuncture in men with hot flashes bull METHODS AND MATERIALS bull The study was approved by internal review board Seventeen men with hot flashes and history of AAT for prostate cancer
were enrolled Three men declined participation before receiving any treatment A hot flash score (HFS) was used to measure daily hot flashes The composite daily score was calculated as the product of frequency times severity The baseline daily scores were compared with scores taken at 2 and 6 weeks and at 8-month average follow-up
bull RESULTS bull No side effects were encountered during immediately after treatment or at 8 months The mean initial HFS was 283 it
dropped to 103 (p = 00001) at 2 weeks posttreatment 75 (p = 00001) at 6 weeks and 70 (p = 0001) at 8 months Clinical improvement for each patient is defined as the percent decrease in the mean HFS at each time point The mean improvement at Weeks 2 and 6 was 684 (mean HFS decreased from 37409 to 11836 p = 0001) and 892 (mean HFS decreased from 37409 to 405 p = 00078) respectively The improvement at 8 months was 803 (mean HFS decreased from 37409 to 7385 p = 0002)
bull CONCLUSIONS bull Acupuncture provides excellent control of hot flashes in men with a history of AAT The absence of side effects and the
durable response at 8 months are likely to be appealing to patients Prospective randomized study is warranted to further evaluate this modality against medical therapy
bull Copyright copy 2011 Elsevier Inc All rights reserved
bull Int J Radiat Oncol Biol Phys 2011 Apr 179(5)1358-63 doi 101016jijrobp201001025 Epub 2010 Jun 3
bull J Clin Oncol 2010 Mar 128(7)1154-60 doi 101200JCO2009234708 Epub 2010 Jan 25 bull Randomized blinded sham-controlled trial of acupuncture for the management of aromatase
inhibitor-associated joint symptoms in women with early-stage breast cancer bull Crew KD1 Capodice JL Greenlee H Brafman L Fuentes D Awad D Yann Tsai W Hershman DL bull Author information
bull Abstract bull PURPOSE Women with breast cancer (BC) treated with aromatase inhibitors (AIs) may experience
joint symptoms that can lead to discontinuation of effective therapy We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC METHODS We conducted a randomized controlled blinded study comparing true acupuncture (TA) versus sham acupuncture (SA) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs TA included full bodyauricular acupuncture and joint-specific point prescriptions whereas SA involved superficial needle insertion at nonacupoint locations Outcome measures included the Brief Pain Inventory-Short Form (BPI-SF) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH) obtained at baseline and at 3 and 6 weeks Results Of 51 women enrolled 43 women were randomly assigned and 38 were evaluable Baseline characteristics were comparable between the two groups Our primary end point was the difference in mean BPI-SF worst pain scores at 6 weeks which was lower for TA compared with SA (30 v 55 P lt 001) We also found differences between TA and SA in pain severity (26 v 45 P = 003) and pain-related interference (25 v 45 P = 002) at 6 weeks Similar findings were seen for the WOMAC and M-SACRAH scores The acupuncture intervention was well-tolerated CONCLUSION Women with AI-induced arthralgias treated with TA had significant improvement of joint pain and stiffness which was not seen with SA Acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect
CANCER EN MTC
bull Les tumeurs reacutesultent dun deacuteseacutequilibre dans le corps ou entre le corps et lenvironnement exteacuterieur
bull Les tumeurs sont dues agrave des changements qualitatifs et irreacuteversibles dans la structure ou la fonction de Zang Fu Qi et du Sang ou de LO
bull Si il y a carence les facteurs pathogegravenes envahissent profondeacutement le corps et si elle persiste la lutte entre le Froid et la Chaleur peut endommager la chair
bull Si les facteurs pathogegravenes ne peuvent pas ecirctre dissipeacutes ceci conduira agrave la formation de tumeurs
LES ELEMENTS CLES DANS LE DEVELOPPEMENT DE TUMEUR DANS MTC
bull 1- stagnation de Qi et la stase du Sang
bull 2- accumulation des Toxines lieacutees agrave la Chaleur
bull 3- deacuteficience de Qi Vital
bull 4- toutes les maladies proviennent des Glaires la plupart des masses qui se produisent dans le corps sont dues aux Glaires
Clinical Guide
bull Principle of diagnosis Diagnosis of disease
Syndrome differentiation
(individulized treatment)
bull Methods
Inspection Auscultation and Olfaction Interrogation Palpation
bull Intervention modalities
Chinese medication Acupuncture Qigong Tuina Dietary
(nutrition)
Treatment
The goal of treatment is to adjust and harmonize Yin and Yang
This is achieved by regulating the Qi Moisture and Blood in the Organ Networksweak organs are tonified congested channels are opened
excess is dispersed tightness is softened agitation is calmed heat is cooled cold is warmed dryness is moistened and dampness is drained
Preventive treatment of Progression of
Disease
《难经middot七十七难》ldquo所谓治未病者见肝之病则知肝当传之于脾 故先实其脾气无令得受肝之邪故曰治未病焉rdquo
重视疾病的传变规律ldquo先安未受邪之地rdquo 痰毒瘀结是肿瘤转移的关键流窜经络脏腑是其特点对于肿瘤的转移预防比治疗更有现实意义
laquo Classique des Problegravemes meacutedicaux raquo chap77 rdquoSi le Foie est malade il peut attaquer la Rate Par conseacutequent la Rate doit ecirctre fortifieacutee avant qursquoelle ne soit elle-mecircme affecteacutee raquo
Acupuncture
Bronze Model for the Meridians and
Acupuncture Points
(Qing Dynasty 1744)
An insight into acupuncture
Concept of Yin Yang
Holism
Five element theory
Human body
About Qi Formation of Qi
Function of Qi
Disharmony of Qi
Meridians - the pathways of the body
Techniques and methods
Meridian pathways of the Body
bullComponents bull 12 regular meridians
12 Collaterals
8 extraordinary meridians
Functions Connect and coordinate
creating an integral whole
Transporting functions
Spleen Meridian
Techniques and methods
Manual (Classic) Acupuncture
Electric-Acupuncture
Acupuncture and Moxibustion
Laser Acupuncture
Ultrasound Acupuncture
Acupuncture and the Moxibustion
Cupping Therapy
Indications
In 1979 WHO named 43 different diseases that can be
treated by Acupuncture
Upper Respiratory Tract
Acute sinusitis
Acute rhinitis
Common cold
Acute tonsillitis
Respiratory System
Acute Bronchitis
Bronchial asthma
Disorders of the Eye Acute conjunctivitis
Central retinitis
Myopia (in children)
Cataract (without
complications)
Disorders of the Mouth Toothache
Post-extraction pain
Gingivitis
Acute and chronic pharyngitis
Journal of World Health Organisation Dec1979
Known biological effects of
acupuncture
bullAcupuncture multiple biological responses
bullOccur locally or at a distance mediated by sensor neurons to many structures of the central nervous system -- leads to activation of pathways affecting various physiology systems in the brain as well as periphery Attention has been focused on the role of endogenous opioids in analgesia and anesthesia
bullActivate the hypothalamus and pituitary resulting in a broad spectrum of systemic effects
bullAlteration in secretion of neurotransmitters and neurohormones that causes changes in the regulation of blood flow both centrally and peripherally
bullEvidence of alteration of immune functions NIH Consensus Statement Online 1997 Nov 3-5 month day] 15(5)1-34
LES TRAITEMENTS
bull 1-la stagnation de Qi et la stase du Sang
bull dynamiser le sang et transformer la stase du sang
bull 2- accumulation des Toxines lieacutees agrave la Chaleur
bull clarifier la chaleur et deacutegager la Toxiciteacute
bull 3- deacuteficience de Qi Vital
bull soutenir le Qi Vital et cultiver la racine
bull 4- toutes les maladies proviennent des Glaires la plupart des masses qui se produisent dans le corps sont dues aux Glaires
bull transformer les Glaires et ramollir la dureteacute
Dans le diagnostic et le traitement des tumeurs la MTC considegravere leacutetat geacuteneacuteral du patient plutocirct que de se focaliser sur le cancer lui-mecircme ou les symptocircmes particuliers
Soutien psychologique
bull angoisse devant lrsquoinconnu
bull angoisse devant la douleur
bull angoisse devant le deacuteveloppement de la maladie et la perte de controcircle sur son propre corps
bull angoisse devant les effets secondaires dus aux divers traitements
bull angoisse devant les complications tardives dues aux divers traitements
bull angoisse devant le regard social porteacute sur le malade
bull angoisse devant la mort
Soutien psychologique
Ces informations reacutesonnent agrave lrsquointeacuterieur du patient ougrave elle
provoquent des dysfonctionnements qui
peuvent se manifester par
bull des maux de ventre
bull des palpitations
bull des troubles du sommeil
bull des difficulteacutes respiratoires
bull des douleurs diverses etc
Nauseacutees et vomissements
RAPPEL LrsquoEstomac
bull YANG
bull Controcircle le mucircrissement amp pourrissement de la nourriture
bull Controcircle le transport des essences de la nourriture Gouverne la descente du Qi fait descendre la nourriture transformeacutee vers lrsquoIntestin Grecircle
bull Si le mouvement de descente est perturbeacute par les pervers si il y a un mouvement ascendant de QI de lrsquoEstomac (agrave contre-sens- NI) il y a des VOMISSEMENTS
Nauseacutees et vomissements
LES VOMISSEMENTS SE MANIFESTENT QUAND LE QI DE LrsquoESTOMAC MONTE A LA PLACE DE DESCENDRE
Neuropathie
Avastine Xeloda Gemzar Cysplatine Taxol Fludara Alimta Procarbazine
points GI2 3 4 IG 2 3 C7 MC6 8 P7 9 F2 3 V60 VB41
traitement
preacutevention
LA DOULEUR DUE AU CANCER
bull Etiologie et physiopathologie
bull Lrsquoinvasion des pervers Externes - tout pervers srsquoil persiste peut provoquer le blocage des meacuteridiens et par la suite une stagnation de Qi et de Sg ou des troubles de Zang-Fu
bull Le deacuteregraveglement des eacutemotions
bull Le deacuteseacutequilibre de lrsquoalimentation
bull Une faiblesse de constitution
DIFFEacuteRENCIATION DE LA DOULEUR
SELON LA LOCALISATION bull dans le cancer du poumon souvent une sensibiliteacute au
P1 et V13 accompagneacutee de toux et de souffle court bull dans le cancer de lrsquoœsophage ou de lrsquoestomac une
sensibiliteacute au E34 et E42 accompagneacutee de nauseacutees dysphagie inappeacutetence
SELON LE VIDE ET LA PLEacuteNITUDE bull Vide douleurs souvent leacutegegraveres intermittentes
sourdes bull Pleacutenitude douleurs tensives lancinantes coliques
aigues
LA FATIGUE
XU LAO = fatigue par Vide = lrsquoeacutepuisement En Occident crsquoest le symptocircme le plus souvent invoqueacute et pas toujours ducirc au Vide
LA FATIGUE - eacutetiologie
bull La faiblesse constitutionnelle
bull Le surmenage
bull Lrsquoexcegraves drsquoactiviteacute physique
bull Lrsquoalimentation
bull Les maladies graves
bull Lrsquoexcegraves drsquoactiviteacute sexuelle
bull Lrsquoaccouchement
bull La consommation de drogues
LA FATIGUE - pathologie
bull Vide
bull Combinaison de Vide et de Pleacutenitude
bull Pleacutenitude
Contre-indications agrave lrsquoacupuncture
bull Des risques de laquo gros bras raquo apregraves curage axillaire
bull Des opeacuterations selon Halsted ou Patey
bull Des drainages lymphatiques
bull Pas drsquoaiguille du cocircteacute opeacutereacute
TCM in cancer treatments
bull Used mostly as adjuvant therapy before or during or
after surgery radiotherapy and chemotherapy
bull Remit the side-effects and toxicity of other treatments
bull Symptom control
bull Activate and strengthen immune system
bull For advanced cancer patients mainly palliative but it
can also prolong life in some cases
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 15 Number 7 2009
Acupuncture for Chemotherapy-Induced Neutropenia in Patients with GynecologiMalignancies A Pilot Randomized Sham-Controlled Clinical Trial
Weidong Lu MB MPH LicAc1ndash3 Ursula A Matulonis MD4 Anne Doherty-Gilman MPH1 Hang ScD3
Peter M Wayne PhD23 David S Rosenthal MD14 and Richard T Penson MD6
bull Abstract bull Objectives The objective of this study was to investigate the effect of acupuncture administered during mye-
losuppressive chemotherapy on white blood cell (WBC) count and absolute neutrophil count (ANC) in patients with ovarian cancer
bull Design This study is a pilot randomized sham-controlled clinical trial Patients received active acupuncture versus sham acupuncture while undergoing chemotherapy A standardized acupuncture protocol was em- ployed with manual and electrostimulation The frequency of treatment was 2ndash3 times per week for a total of 10 sessions starting 1 week before the second cycle of chemotherapy
bull Setting The setting was two outpatient academic centers for patients with cancer bull Subjects Twenty-one (21) newly diagnosed and recurrent ovarian cancer patients were the subjects bull Outcome measures WBC count ANC and plasma granulocyte colony-stimulating factor (G-CSF ) were assessed
weekly bull Results The median leukocyte value in the acupuncture arm at the first day of the third cycle of chemotherapy
was significantly higher than in the control arm after adjusting for baseline value (8600 cells=mL range 4800ndash 12000 versus 4400 cell=mL range 2300ndash10000) ( p frac14 0046) The incidence of grade 2ndash4 leukopenia was less in the acupuncture arm than in the sham arm (30 versus 90 p frac14 002) However the median leukocyte nadir neutrophil nadir and recovering ANC were all higher but not statistically significantly different ( p frac14 0116ndash016) after adjusting for baseline differences There were no statistically significant differences in plasma G-CSF between the two groups
bull Conclusions We observed clinically relevant trends of higher WBC values during one cycle of chemotherapy in patients with ovarian cancer which suggests a potential myeloprotective effect of acupuncture A larger trial is warranted to more definitively determine the efficacy of acupuncture on clinically important outcomes of chemotherapy-induced neutropenia
Acupuncture for the alleviation of hot flashes in men treated with androgen
ablation therapy Ashamalla H1 Jiang ML Guirguis A Peluso F Ashamalla M
bull Abstract bull PURPOSE bull Hot flashes are common side effect due to androgen ablation therapy (AAT) The utility of acupuncture for hot flashes in
men has not been thoroughly studied We prospectively studied the effect of acupuncture in men with hot flashes bull METHODS AND MATERIALS bull The study was approved by internal review board Seventeen men with hot flashes and history of AAT for prostate cancer
were enrolled Three men declined participation before receiving any treatment A hot flash score (HFS) was used to measure daily hot flashes The composite daily score was calculated as the product of frequency times severity The baseline daily scores were compared with scores taken at 2 and 6 weeks and at 8-month average follow-up
bull RESULTS bull No side effects were encountered during immediately after treatment or at 8 months The mean initial HFS was 283 it
dropped to 103 (p = 00001) at 2 weeks posttreatment 75 (p = 00001) at 6 weeks and 70 (p = 0001) at 8 months Clinical improvement for each patient is defined as the percent decrease in the mean HFS at each time point The mean improvement at Weeks 2 and 6 was 684 (mean HFS decreased from 37409 to 11836 p = 0001) and 892 (mean HFS decreased from 37409 to 405 p = 00078) respectively The improvement at 8 months was 803 (mean HFS decreased from 37409 to 7385 p = 0002)
bull CONCLUSIONS bull Acupuncture provides excellent control of hot flashes in men with a history of AAT The absence of side effects and the
durable response at 8 months are likely to be appealing to patients Prospective randomized study is warranted to further evaluate this modality against medical therapy
bull Copyright copy 2011 Elsevier Inc All rights reserved
bull Int J Radiat Oncol Biol Phys 2011 Apr 179(5)1358-63 doi 101016jijrobp201001025 Epub 2010 Jun 3
bull J Clin Oncol 2010 Mar 128(7)1154-60 doi 101200JCO2009234708 Epub 2010 Jan 25 bull Randomized blinded sham-controlled trial of acupuncture for the management of aromatase
inhibitor-associated joint symptoms in women with early-stage breast cancer bull Crew KD1 Capodice JL Greenlee H Brafman L Fuentes D Awad D Yann Tsai W Hershman DL bull Author information
bull Abstract bull PURPOSE Women with breast cancer (BC) treated with aromatase inhibitors (AIs) may experience
joint symptoms that can lead to discontinuation of effective therapy We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC METHODS We conducted a randomized controlled blinded study comparing true acupuncture (TA) versus sham acupuncture (SA) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs TA included full bodyauricular acupuncture and joint-specific point prescriptions whereas SA involved superficial needle insertion at nonacupoint locations Outcome measures included the Brief Pain Inventory-Short Form (BPI-SF) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH) obtained at baseline and at 3 and 6 weeks Results Of 51 women enrolled 43 women were randomly assigned and 38 were evaluable Baseline characteristics were comparable between the two groups Our primary end point was the difference in mean BPI-SF worst pain scores at 6 weeks which was lower for TA compared with SA (30 v 55 P lt 001) We also found differences between TA and SA in pain severity (26 v 45 P = 003) and pain-related interference (25 v 45 P = 002) at 6 weeks Similar findings were seen for the WOMAC and M-SACRAH scores The acupuncture intervention was well-tolerated CONCLUSION Women with AI-induced arthralgias treated with TA had significant improvement of joint pain and stiffness which was not seen with SA Acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect
LES ELEMENTS CLES DANS LE DEVELOPPEMENT DE TUMEUR DANS MTC
bull 1- stagnation de Qi et la stase du Sang
bull 2- accumulation des Toxines lieacutees agrave la Chaleur
bull 3- deacuteficience de Qi Vital
bull 4- toutes les maladies proviennent des Glaires la plupart des masses qui se produisent dans le corps sont dues aux Glaires
Clinical Guide
bull Principle of diagnosis Diagnosis of disease
Syndrome differentiation
(individulized treatment)
bull Methods
Inspection Auscultation and Olfaction Interrogation Palpation
bull Intervention modalities
Chinese medication Acupuncture Qigong Tuina Dietary
(nutrition)
Treatment
The goal of treatment is to adjust and harmonize Yin and Yang
This is achieved by regulating the Qi Moisture and Blood in the Organ Networksweak organs are tonified congested channels are opened
excess is dispersed tightness is softened agitation is calmed heat is cooled cold is warmed dryness is moistened and dampness is drained
Preventive treatment of Progression of
Disease
《难经middot七十七难》ldquo所谓治未病者见肝之病则知肝当传之于脾 故先实其脾气无令得受肝之邪故曰治未病焉rdquo
重视疾病的传变规律ldquo先安未受邪之地rdquo 痰毒瘀结是肿瘤转移的关键流窜经络脏腑是其特点对于肿瘤的转移预防比治疗更有现实意义
laquo Classique des Problegravemes meacutedicaux raquo chap77 rdquoSi le Foie est malade il peut attaquer la Rate Par conseacutequent la Rate doit ecirctre fortifieacutee avant qursquoelle ne soit elle-mecircme affecteacutee raquo
Acupuncture
Bronze Model for the Meridians and
Acupuncture Points
(Qing Dynasty 1744)
An insight into acupuncture
Concept of Yin Yang
Holism
Five element theory
Human body
About Qi Formation of Qi
Function of Qi
Disharmony of Qi
Meridians - the pathways of the body
Techniques and methods
Meridian pathways of the Body
bullComponents bull 12 regular meridians
12 Collaterals
8 extraordinary meridians
Functions Connect and coordinate
creating an integral whole
Transporting functions
Spleen Meridian
Techniques and methods
Manual (Classic) Acupuncture
Electric-Acupuncture
Acupuncture and Moxibustion
Laser Acupuncture
Ultrasound Acupuncture
Acupuncture and the Moxibustion
Cupping Therapy
Indications
In 1979 WHO named 43 different diseases that can be
treated by Acupuncture
Upper Respiratory Tract
Acute sinusitis
Acute rhinitis
Common cold
Acute tonsillitis
Respiratory System
Acute Bronchitis
Bronchial asthma
Disorders of the Eye Acute conjunctivitis
Central retinitis
Myopia (in children)
Cataract (without
complications)
Disorders of the Mouth Toothache
Post-extraction pain
Gingivitis
Acute and chronic pharyngitis
Journal of World Health Organisation Dec1979
Known biological effects of
acupuncture
bullAcupuncture multiple biological responses
bullOccur locally or at a distance mediated by sensor neurons to many structures of the central nervous system -- leads to activation of pathways affecting various physiology systems in the brain as well as periphery Attention has been focused on the role of endogenous opioids in analgesia and anesthesia
bullActivate the hypothalamus and pituitary resulting in a broad spectrum of systemic effects
bullAlteration in secretion of neurotransmitters and neurohormones that causes changes in the regulation of blood flow both centrally and peripherally
bullEvidence of alteration of immune functions NIH Consensus Statement Online 1997 Nov 3-5 month day] 15(5)1-34
LES TRAITEMENTS
bull 1-la stagnation de Qi et la stase du Sang
bull dynamiser le sang et transformer la stase du sang
bull 2- accumulation des Toxines lieacutees agrave la Chaleur
bull clarifier la chaleur et deacutegager la Toxiciteacute
bull 3- deacuteficience de Qi Vital
bull soutenir le Qi Vital et cultiver la racine
bull 4- toutes les maladies proviennent des Glaires la plupart des masses qui se produisent dans le corps sont dues aux Glaires
bull transformer les Glaires et ramollir la dureteacute
Dans le diagnostic et le traitement des tumeurs la MTC considegravere leacutetat geacuteneacuteral du patient plutocirct que de se focaliser sur le cancer lui-mecircme ou les symptocircmes particuliers
Soutien psychologique
bull angoisse devant lrsquoinconnu
bull angoisse devant la douleur
bull angoisse devant le deacuteveloppement de la maladie et la perte de controcircle sur son propre corps
bull angoisse devant les effets secondaires dus aux divers traitements
bull angoisse devant les complications tardives dues aux divers traitements
bull angoisse devant le regard social porteacute sur le malade
bull angoisse devant la mort
Soutien psychologique
Ces informations reacutesonnent agrave lrsquointeacuterieur du patient ougrave elle
provoquent des dysfonctionnements qui
peuvent se manifester par
bull des maux de ventre
bull des palpitations
bull des troubles du sommeil
bull des difficulteacutes respiratoires
bull des douleurs diverses etc
Nauseacutees et vomissements
RAPPEL LrsquoEstomac
bull YANG
bull Controcircle le mucircrissement amp pourrissement de la nourriture
bull Controcircle le transport des essences de la nourriture Gouverne la descente du Qi fait descendre la nourriture transformeacutee vers lrsquoIntestin Grecircle
bull Si le mouvement de descente est perturbeacute par les pervers si il y a un mouvement ascendant de QI de lrsquoEstomac (agrave contre-sens- NI) il y a des VOMISSEMENTS
Nauseacutees et vomissements
LES VOMISSEMENTS SE MANIFESTENT QUAND LE QI DE LrsquoESTOMAC MONTE A LA PLACE DE DESCENDRE
Neuropathie
Avastine Xeloda Gemzar Cysplatine Taxol Fludara Alimta Procarbazine
points GI2 3 4 IG 2 3 C7 MC6 8 P7 9 F2 3 V60 VB41
traitement
preacutevention
LA DOULEUR DUE AU CANCER
bull Etiologie et physiopathologie
bull Lrsquoinvasion des pervers Externes - tout pervers srsquoil persiste peut provoquer le blocage des meacuteridiens et par la suite une stagnation de Qi et de Sg ou des troubles de Zang-Fu
bull Le deacuteregraveglement des eacutemotions
bull Le deacuteseacutequilibre de lrsquoalimentation
bull Une faiblesse de constitution
DIFFEacuteRENCIATION DE LA DOULEUR
SELON LA LOCALISATION bull dans le cancer du poumon souvent une sensibiliteacute au
P1 et V13 accompagneacutee de toux et de souffle court bull dans le cancer de lrsquoœsophage ou de lrsquoestomac une
sensibiliteacute au E34 et E42 accompagneacutee de nauseacutees dysphagie inappeacutetence
SELON LE VIDE ET LA PLEacuteNITUDE bull Vide douleurs souvent leacutegegraveres intermittentes
sourdes bull Pleacutenitude douleurs tensives lancinantes coliques
aigues
LA FATIGUE
XU LAO = fatigue par Vide = lrsquoeacutepuisement En Occident crsquoest le symptocircme le plus souvent invoqueacute et pas toujours ducirc au Vide
LA FATIGUE - eacutetiologie
bull La faiblesse constitutionnelle
bull Le surmenage
bull Lrsquoexcegraves drsquoactiviteacute physique
bull Lrsquoalimentation
bull Les maladies graves
bull Lrsquoexcegraves drsquoactiviteacute sexuelle
bull Lrsquoaccouchement
bull La consommation de drogues
LA FATIGUE - pathologie
bull Vide
bull Combinaison de Vide et de Pleacutenitude
bull Pleacutenitude
Contre-indications agrave lrsquoacupuncture
bull Des risques de laquo gros bras raquo apregraves curage axillaire
bull Des opeacuterations selon Halsted ou Patey
bull Des drainages lymphatiques
bull Pas drsquoaiguille du cocircteacute opeacutereacute
TCM in cancer treatments
bull Used mostly as adjuvant therapy before or during or
after surgery radiotherapy and chemotherapy
bull Remit the side-effects and toxicity of other treatments
bull Symptom control
bull Activate and strengthen immune system
bull For advanced cancer patients mainly palliative but it
can also prolong life in some cases
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 15 Number 7 2009
Acupuncture for Chemotherapy-Induced Neutropenia in Patients with GynecologiMalignancies A Pilot Randomized Sham-Controlled Clinical Trial
Weidong Lu MB MPH LicAc1ndash3 Ursula A Matulonis MD4 Anne Doherty-Gilman MPH1 Hang ScD3
Peter M Wayne PhD23 David S Rosenthal MD14 and Richard T Penson MD6
bull Abstract bull Objectives The objective of this study was to investigate the effect of acupuncture administered during mye-
losuppressive chemotherapy on white blood cell (WBC) count and absolute neutrophil count (ANC) in patients with ovarian cancer
bull Design This study is a pilot randomized sham-controlled clinical trial Patients received active acupuncture versus sham acupuncture while undergoing chemotherapy A standardized acupuncture protocol was em- ployed with manual and electrostimulation The frequency of treatment was 2ndash3 times per week for a total of 10 sessions starting 1 week before the second cycle of chemotherapy
bull Setting The setting was two outpatient academic centers for patients with cancer bull Subjects Twenty-one (21) newly diagnosed and recurrent ovarian cancer patients were the subjects bull Outcome measures WBC count ANC and plasma granulocyte colony-stimulating factor (G-CSF ) were assessed
weekly bull Results The median leukocyte value in the acupuncture arm at the first day of the third cycle of chemotherapy
was significantly higher than in the control arm after adjusting for baseline value (8600 cells=mL range 4800ndash 12000 versus 4400 cell=mL range 2300ndash10000) ( p frac14 0046) The incidence of grade 2ndash4 leukopenia was less in the acupuncture arm than in the sham arm (30 versus 90 p frac14 002) However the median leukocyte nadir neutrophil nadir and recovering ANC were all higher but not statistically significantly different ( p frac14 0116ndash016) after adjusting for baseline differences There were no statistically significant differences in plasma G-CSF between the two groups
bull Conclusions We observed clinically relevant trends of higher WBC values during one cycle of chemotherapy in patients with ovarian cancer which suggests a potential myeloprotective effect of acupuncture A larger trial is warranted to more definitively determine the efficacy of acupuncture on clinically important outcomes of chemotherapy-induced neutropenia
Acupuncture for the alleviation of hot flashes in men treated with androgen
ablation therapy Ashamalla H1 Jiang ML Guirguis A Peluso F Ashamalla M
bull Abstract bull PURPOSE bull Hot flashes are common side effect due to androgen ablation therapy (AAT) The utility of acupuncture for hot flashes in
men has not been thoroughly studied We prospectively studied the effect of acupuncture in men with hot flashes bull METHODS AND MATERIALS bull The study was approved by internal review board Seventeen men with hot flashes and history of AAT for prostate cancer
were enrolled Three men declined participation before receiving any treatment A hot flash score (HFS) was used to measure daily hot flashes The composite daily score was calculated as the product of frequency times severity The baseline daily scores were compared with scores taken at 2 and 6 weeks and at 8-month average follow-up
bull RESULTS bull No side effects were encountered during immediately after treatment or at 8 months The mean initial HFS was 283 it
dropped to 103 (p = 00001) at 2 weeks posttreatment 75 (p = 00001) at 6 weeks and 70 (p = 0001) at 8 months Clinical improvement for each patient is defined as the percent decrease in the mean HFS at each time point The mean improvement at Weeks 2 and 6 was 684 (mean HFS decreased from 37409 to 11836 p = 0001) and 892 (mean HFS decreased from 37409 to 405 p = 00078) respectively The improvement at 8 months was 803 (mean HFS decreased from 37409 to 7385 p = 0002)
bull CONCLUSIONS bull Acupuncture provides excellent control of hot flashes in men with a history of AAT The absence of side effects and the
durable response at 8 months are likely to be appealing to patients Prospective randomized study is warranted to further evaluate this modality against medical therapy
bull Copyright copy 2011 Elsevier Inc All rights reserved
bull Int J Radiat Oncol Biol Phys 2011 Apr 179(5)1358-63 doi 101016jijrobp201001025 Epub 2010 Jun 3
bull J Clin Oncol 2010 Mar 128(7)1154-60 doi 101200JCO2009234708 Epub 2010 Jan 25 bull Randomized blinded sham-controlled trial of acupuncture for the management of aromatase
inhibitor-associated joint symptoms in women with early-stage breast cancer bull Crew KD1 Capodice JL Greenlee H Brafman L Fuentes D Awad D Yann Tsai W Hershman DL bull Author information
bull Abstract bull PURPOSE Women with breast cancer (BC) treated with aromatase inhibitors (AIs) may experience
joint symptoms that can lead to discontinuation of effective therapy We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC METHODS We conducted a randomized controlled blinded study comparing true acupuncture (TA) versus sham acupuncture (SA) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs TA included full bodyauricular acupuncture and joint-specific point prescriptions whereas SA involved superficial needle insertion at nonacupoint locations Outcome measures included the Brief Pain Inventory-Short Form (BPI-SF) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH) obtained at baseline and at 3 and 6 weeks Results Of 51 women enrolled 43 women were randomly assigned and 38 were evaluable Baseline characteristics were comparable between the two groups Our primary end point was the difference in mean BPI-SF worst pain scores at 6 weeks which was lower for TA compared with SA (30 v 55 P lt 001) We also found differences between TA and SA in pain severity (26 v 45 P = 003) and pain-related interference (25 v 45 P = 002) at 6 weeks Similar findings were seen for the WOMAC and M-SACRAH scores The acupuncture intervention was well-tolerated CONCLUSION Women with AI-induced arthralgias treated with TA had significant improvement of joint pain and stiffness which was not seen with SA Acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect
Clinical Guide
bull Principle of diagnosis Diagnosis of disease
Syndrome differentiation
(individulized treatment)
bull Methods
Inspection Auscultation and Olfaction Interrogation Palpation
bull Intervention modalities
Chinese medication Acupuncture Qigong Tuina Dietary
(nutrition)
Treatment
The goal of treatment is to adjust and harmonize Yin and Yang
This is achieved by regulating the Qi Moisture and Blood in the Organ Networksweak organs are tonified congested channels are opened
excess is dispersed tightness is softened agitation is calmed heat is cooled cold is warmed dryness is moistened and dampness is drained
Preventive treatment of Progression of
Disease
《难经middot七十七难》ldquo所谓治未病者见肝之病则知肝当传之于脾 故先实其脾气无令得受肝之邪故曰治未病焉rdquo
重视疾病的传变规律ldquo先安未受邪之地rdquo 痰毒瘀结是肿瘤转移的关键流窜经络脏腑是其特点对于肿瘤的转移预防比治疗更有现实意义
laquo Classique des Problegravemes meacutedicaux raquo chap77 rdquoSi le Foie est malade il peut attaquer la Rate Par conseacutequent la Rate doit ecirctre fortifieacutee avant qursquoelle ne soit elle-mecircme affecteacutee raquo
Acupuncture
Bronze Model for the Meridians and
Acupuncture Points
(Qing Dynasty 1744)
An insight into acupuncture
Concept of Yin Yang
Holism
Five element theory
Human body
About Qi Formation of Qi
Function of Qi
Disharmony of Qi
Meridians - the pathways of the body
Techniques and methods
Meridian pathways of the Body
bullComponents bull 12 regular meridians
12 Collaterals
8 extraordinary meridians
Functions Connect and coordinate
creating an integral whole
Transporting functions
Spleen Meridian
Techniques and methods
Manual (Classic) Acupuncture
Electric-Acupuncture
Acupuncture and Moxibustion
Laser Acupuncture
Ultrasound Acupuncture
Acupuncture and the Moxibustion
Cupping Therapy
Indications
In 1979 WHO named 43 different diseases that can be
treated by Acupuncture
Upper Respiratory Tract
Acute sinusitis
Acute rhinitis
Common cold
Acute tonsillitis
Respiratory System
Acute Bronchitis
Bronchial asthma
Disorders of the Eye Acute conjunctivitis
Central retinitis
Myopia (in children)
Cataract (without
complications)
Disorders of the Mouth Toothache
Post-extraction pain
Gingivitis
Acute and chronic pharyngitis
Journal of World Health Organisation Dec1979
Known biological effects of
acupuncture
bullAcupuncture multiple biological responses
bullOccur locally or at a distance mediated by sensor neurons to many structures of the central nervous system -- leads to activation of pathways affecting various physiology systems in the brain as well as periphery Attention has been focused on the role of endogenous opioids in analgesia and anesthesia
bullActivate the hypothalamus and pituitary resulting in a broad spectrum of systemic effects
bullAlteration in secretion of neurotransmitters and neurohormones that causes changes in the regulation of blood flow both centrally and peripherally
bullEvidence of alteration of immune functions NIH Consensus Statement Online 1997 Nov 3-5 month day] 15(5)1-34
LES TRAITEMENTS
bull 1-la stagnation de Qi et la stase du Sang
bull dynamiser le sang et transformer la stase du sang
bull 2- accumulation des Toxines lieacutees agrave la Chaleur
bull clarifier la chaleur et deacutegager la Toxiciteacute
bull 3- deacuteficience de Qi Vital
bull soutenir le Qi Vital et cultiver la racine
bull 4- toutes les maladies proviennent des Glaires la plupart des masses qui se produisent dans le corps sont dues aux Glaires
bull transformer les Glaires et ramollir la dureteacute
Dans le diagnostic et le traitement des tumeurs la MTC considegravere leacutetat geacuteneacuteral du patient plutocirct que de se focaliser sur le cancer lui-mecircme ou les symptocircmes particuliers
Soutien psychologique
bull angoisse devant lrsquoinconnu
bull angoisse devant la douleur
bull angoisse devant le deacuteveloppement de la maladie et la perte de controcircle sur son propre corps
bull angoisse devant les effets secondaires dus aux divers traitements
bull angoisse devant les complications tardives dues aux divers traitements
bull angoisse devant le regard social porteacute sur le malade
bull angoisse devant la mort
Soutien psychologique
Ces informations reacutesonnent agrave lrsquointeacuterieur du patient ougrave elle
provoquent des dysfonctionnements qui
peuvent se manifester par
bull des maux de ventre
bull des palpitations
bull des troubles du sommeil
bull des difficulteacutes respiratoires
bull des douleurs diverses etc
Nauseacutees et vomissements
RAPPEL LrsquoEstomac
bull YANG
bull Controcircle le mucircrissement amp pourrissement de la nourriture
bull Controcircle le transport des essences de la nourriture Gouverne la descente du Qi fait descendre la nourriture transformeacutee vers lrsquoIntestin Grecircle
bull Si le mouvement de descente est perturbeacute par les pervers si il y a un mouvement ascendant de QI de lrsquoEstomac (agrave contre-sens- NI) il y a des VOMISSEMENTS
Nauseacutees et vomissements
LES VOMISSEMENTS SE MANIFESTENT QUAND LE QI DE LrsquoESTOMAC MONTE A LA PLACE DE DESCENDRE
Neuropathie
Avastine Xeloda Gemzar Cysplatine Taxol Fludara Alimta Procarbazine
points GI2 3 4 IG 2 3 C7 MC6 8 P7 9 F2 3 V60 VB41
traitement
preacutevention
LA DOULEUR DUE AU CANCER
bull Etiologie et physiopathologie
bull Lrsquoinvasion des pervers Externes - tout pervers srsquoil persiste peut provoquer le blocage des meacuteridiens et par la suite une stagnation de Qi et de Sg ou des troubles de Zang-Fu
bull Le deacuteregraveglement des eacutemotions
bull Le deacuteseacutequilibre de lrsquoalimentation
bull Une faiblesse de constitution
DIFFEacuteRENCIATION DE LA DOULEUR
SELON LA LOCALISATION bull dans le cancer du poumon souvent une sensibiliteacute au
P1 et V13 accompagneacutee de toux et de souffle court bull dans le cancer de lrsquoœsophage ou de lrsquoestomac une
sensibiliteacute au E34 et E42 accompagneacutee de nauseacutees dysphagie inappeacutetence
SELON LE VIDE ET LA PLEacuteNITUDE bull Vide douleurs souvent leacutegegraveres intermittentes
sourdes bull Pleacutenitude douleurs tensives lancinantes coliques
aigues
LA FATIGUE
XU LAO = fatigue par Vide = lrsquoeacutepuisement En Occident crsquoest le symptocircme le plus souvent invoqueacute et pas toujours ducirc au Vide
LA FATIGUE - eacutetiologie
bull La faiblesse constitutionnelle
bull Le surmenage
bull Lrsquoexcegraves drsquoactiviteacute physique
bull Lrsquoalimentation
bull Les maladies graves
bull Lrsquoexcegraves drsquoactiviteacute sexuelle
bull Lrsquoaccouchement
bull La consommation de drogues
LA FATIGUE - pathologie
bull Vide
bull Combinaison de Vide et de Pleacutenitude
bull Pleacutenitude
Contre-indications agrave lrsquoacupuncture
bull Des risques de laquo gros bras raquo apregraves curage axillaire
bull Des opeacuterations selon Halsted ou Patey
bull Des drainages lymphatiques
bull Pas drsquoaiguille du cocircteacute opeacutereacute
TCM in cancer treatments
bull Used mostly as adjuvant therapy before or during or
after surgery radiotherapy and chemotherapy
bull Remit the side-effects and toxicity of other treatments
bull Symptom control
bull Activate and strengthen immune system
bull For advanced cancer patients mainly palliative but it
can also prolong life in some cases
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 15 Number 7 2009
Acupuncture for Chemotherapy-Induced Neutropenia in Patients with GynecologiMalignancies A Pilot Randomized Sham-Controlled Clinical Trial
Weidong Lu MB MPH LicAc1ndash3 Ursula A Matulonis MD4 Anne Doherty-Gilman MPH1 Hang ScD3
Peter M Wayne PhD23 David S Rosenthal MD14 and Richard T Penson MD6
bull Abstract bull Objectives The objective of this study was to investigate the effect of acupuncture administered during mye-
losuppressive chemotherapy on white blood cell (WBC) count and absolute neutrophil count (ANC) in patients with ovarian cancer
bull Design This study is a pilot randomized sham-controlled clinical trial Patients received active acupuncture versus sham acupuncture while undergoing chemotherapy A standardized acupuncture protocol was em- ployed with manual and electrostimulation The frequency of treatment was 2ndash3 times per week for a total of 10 sessions starting 1 week before the second cycle of chemotherapy
bull Setting The setting was two outpatient academic centers for patients with cancer bull Subjects Twenty-one (21) newly diagnosed and recurrent ovarian cancer patients were the subjects bull Outcome measures WBC count ANC and plasma granulocyte colony-stimulating factor (G-CSF ) were assessed
weekly bull Results The median leukocyte value in the acupuncture arm at the first day of the third cycle of chemotherapy
was significantly higher than in the control arm after adjusting for baseline value (8600 cells=mL range 4800ndash 12000 versus 4400 cell=mL range 2300ndash10000) ( p frac14 0046) The incidence of grade 2ndash4 leukopenia was less in the acupuncture arm than in the sham arm (30 versus 90 p frac14 002) However the median leukocyte nadir neutrophil nadir and recovering ANC were all higher but not statistically significantly different ( p frac14 0116ndash016) after adjusting for baseline differences There were no statistically significant differences in plasma G-CSF between the two groups
bull Conclusions We observed clinically relevant trends of higher WBC values during one cycle of chemotherapy in patients with ovarian cancer which suggests a potential myeloprotective effect of acupuncture A larger trial is warranted to more definitively determine the efficacy of acupuncture on clinically important outcomes of chemotherapy-induced neutropenia
Acupuncture for the alleviation of hot flashes in men treated with androgen
ablation therapy Ashamalla H1 Jiang ML Guirguis A Peluso F Ashamalla M
bull Abstract bull PURPOSE bull Hot flashes are common side effect due to androgen ablation therapy (AAT) The utility of acupuncture for hot flashes in
men has not been thoroughly studied We prospectively studied the effect of acupuncture in men with hot flashes bull METHODS AND MATERIALS bull The study was approved by internal review board Seventeen men with hot flashes and history of AAT for prostate cancer
were enrolled Three men declined participation before receiving any treatment A hot flash score (HFS) was used to measure daily hot flashes The composite daily score was calculated as the product of frequency times severity The baseline daily scores were compared with scores taken at 2 and 6 weeks and at 8-month average follow-up
bull RESULTS bull No side effects were encountered during immediately after treatment or at 8 months The mean initial HFS was 283 it
dropped to 103 (p = 00001) at 2 weeks posttreatment 75 (p = 00001) at 6 weeks and 70 (p = 0001) at 8 months Clinical improvement for each patient is defined as the percent decrease in the mean HFS at each time point The mean improvement at Weeks 2 and 6 was 684 (mean HFS decreased from 37409 to 11836 p = 0001) and 892 (mean HFS decreased from 37409 to 405 p = 00078) respectively The improvement at 8 months was 803 (mean HFS decreased from 37409 to 7385 p = 0002)
bull CONCLUSIONS bull Acupuncture provides excellent control of hot flashes in men with a history of AAT The absence of side effects and the
durable response at 8 months are likely to be appealing to patients Prospective randomized study is warranted to further evaluate this modality against medical therapy
bull Copyright copy 2011 Elsevier Inc All rights reserved
bull Int J Radiat Oncol Biol Phys 2011 Apr 179(5)1358-63 doi 101016jijrobp201001025 Epub 2010 Jun 3
bull J Clin Oncol 2010 Mar 128(7)1154-60 doi 101200JCO2009234708 Epub 2010 Jan 25 bull Randomized blinded sham-controlled trial of acupuncture for the management of aromatase
inhibitor-associated joint symptoms in women with early-stage breast cancer bull Crew KD1 Capodice JL Greenlee H Brafman L Fuentes D Awad D Yann Tsai W Hershman DL bull Author information
bull Abstract bull PURPOSE Women with breast cancer (BC) treated with aromatase inhibitors (AIs) may experience
joint symptoms that can lead to discontinuation of effective therapy We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC METHODS We conducted a randomized controlled blinded study comparing true acupuncture (TA) versus sham acupuncture (SA) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs TA included full bodyauricular acupuncture and joint-specific point prescriptions whereas SA involved superficial needle insertion at nonacupoint locations Outcome measures included the Brief Pain Inventory-Short Form (BPI-SF) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH) obtained at baseline and at 3 and 6 weeks Results Of 51 women enrolled 43 women were randomly assigned and 38 were evaluable Baseline characteristics were comparable between the two groups Our primary end point was the difference in mean BPI-SF worst pain scores at 6 weeks which was lower for TA compared with SA (30 v 55 P lt 001) We also found differences between TA and SA in pain severity (26 v 45 P = 003) and pain-related interference (25 v 45 P = 002) at 6 weeks Similar findings were seen for the WOMAC and M-SACRAH scores The acupuncture intervention was well-tolerated CONCLUSION Women with AI-induced arthralgias treated with TA had significant improvement of joint pain and stiffness which was not seen with SA Acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect
Treatment
The goal of treatment is to adjust and harmonize Yin and Yang
This is achieved by regulating the Qi Moisture and Blood in the Organ Networksweak organs are tonified congested channels are opened
excess is dispersed tightness is softened agitation is calmed heat is cooled cold is warmed dryness is moistened and dampness is drained
Preventive treatment of Progression of
Disease
《难经middot七十七难》ldquo所谓治未病者见肝之病则知肝当传之于脾 故先实其脾气无令得受肝之邪故曰治未病焉rdquo
重视疾病的传变规律ldquo先安未受邪之地rdquo 痰毒瘀结是肿瘤转移的关键流窜经络脏腑是其特点对于肿瘤的转移预防比治疗更有现实意义
laquo Classique des Problegravemes meacutedicaux raquo chap77 rdquoSi le Foie est malade il peut attaquer la Rate Par conseacutequent la Rate doit ecirctre fortifieacutee avant qursquoelle ne soit elle-mecircme affecteacutee raquo
Acupuncture
Bronze Model for the Meridians and
Acupuncture Points
(Qing Dynasty 1744)
An insight into acupuncture
Concept of Yin Yang
Holism
Five element theory
Human body
About Qi Formation of Qi
Function of Qi
Disharmony of Qi
Meridians - the pathways of the body
Techniques and methods
Meridian pathways of the Body
bullComponents bull 12 regular meridians
12 Collaterals
8 extraordinary meridians
Functions Connect and coordinate
creating an integral whole
Transporting functions
Spleen Meridian
Techniques and methods
Manual (Classic) Acupuncture
Electric-Acupuncture
Acupuncture and Moxibustion
Laser Acupuncture
Ultrasound Acupuncture
Acupuncture and the Moxibustion
Cupping Therapy
Indications
In 1979 WHO named 43 different diseases that can be
treated by Acupuncture
Upper Respiratory Tract
Acute sinusitis
Acute rhinitis
Common cold
Acute tonsillitis
Respiratory System
Acute Bronchitis
Bronchial asthma
Disorders of the Eye Acute conjunctivitis
Central retinitis
Myopia (in children)
Cataract (without
complications)
Disorders of the Mouth Toothache
Post-extraction pain
Gingivitis
Acute and chronic pharyngitis
Journal of World Health Organisation Dec1979
Known biological effects of
acupuncture
bullAcupuncture multiple biological responses
bullOccur locally or at a distance mediated by sensor neurons to many structures of the central nervous system -- leads to activation of pathways affecting various physiology systems in the brain as well as periphery Attention has been focused on the role of endogenous opioids in analgesia and anesthesia
bullActivate the hypothalamus and pituitary resulting in a broad spectrum of systemic effects
bullAlteration in secretion of neurotransmitters and neurohormones that causes changes in the regulation of blood flow both centrally and peripherally
bullEvidence of alteration of immune functions NIH Consensus Statement Online 1997 Nov 3-5 month day] 15(5)1-34
LES TRAITEMENTS
bull 1-la stagnation de Qi et la stase du Sang
bull dynamiser le sang et transformer la stase du sang
bull 2- accumulation des Toxines lieacutees agrave la Chaleur
bull clarifier la chaleur et deacutegager la Toxiciteacute
bull 3- deacuteficience de Qi Vital
bull soutenir le Qi Vital et cultiver la racine
bull 4- toutes les maladies proviennent des Glaires la plupart des masses qui se produisent dans le corps sont dues aux Glaires
bull transformer les Glaires et ramollir la dureteacute
Dans le diagnostic et le traitement des tumeurs la MTC considegravere leacutetat geacuteneacuteral du patient plutocirct que de se focaliser sur le cancer lui-mecircme ou les symptocircmes particuliers
Soutien psychologique
bull angoisse devant lrsquoinconnu
bull angoisse devant la douleur
bull angoisse devant le deacuteveloppement de la maladie et la perte de controcircle sur son propre corps
bull angoisse devant les effets secondaires dus aux divers traitements
bull angoisse devant les complications tardives dues aux divers traitements
bull angoisse devant le regard social porteacute sur le malade
bull angoisse devant la mort
Soutien psychologique
Ces informations reacutesonnent agrave lrsquointeacuterieur du patient ougrave elle
provoquent des dysfonctionnements qui
peuvent se manifester par
bull des maux de ventre
bull des palpitations
bull des troubles du sommeil
bull des difficulteacutes respiratoires
bull des douleurs diverses etc
Nauseacutees et vomissements
RAPPEL LrsquoEstomac
bull YANG
bull Controcircle le mucircrissement amp pourrissement de la nourriture
bull Controcircle le transport des essences de la nourriture Gouverne la descente du Qi fait descendre la nourriture transformeacutee vers lrsquoIntestin Grecircle
bull Si le mouvement de descente est perturbeacute par les pervers si il y a un mouvement ascendant de QI de lrsquoEstomac (agrave contre-sens- NI) il y a des VOMISSEMENTS
Nauseacutees et vomissements
LES VOMISSEMENTS SE MANIFESTENT QUAND LE QI DE LrsquoESTOMAC MONTE A LA PLACE DE DESCENDRE
Neuropathie
Avastine Xeloda Gemzar Cysplatine Taxol Fludara Alimta Procarbazine
points GI2 3 4 IG 2 3 C7 MC6 8 P7 9 F2 3 V60 VB41
traitement
preacutevention
LA DOULEUR DUE AU CANCER
bull Etiologie et physiopathologie
bull Lrsquoinvasion des pervers Externes - tout pervers srsquoil persiste peut provoquer le blocage des meacuteridiens et par la suite une stagnation de Qi et de Sg ou des troubles de Zang-Fu
bull Le deacuteregraveglement des eacutemotions
bull Le deacuteseacutequilibre de lrsquoalimentation
bull Une faiblesse de constitution
DIFFEacuteRENCIATION DE LA DOULEUR
SELON LA LOCALISATION bull dans le cancer du poumon souvent une sensibiliteacute au
P1 et V13 accompagneacutee de toux et de souffle court bull dans le cancer de lrsquoœsophage ou de lrsquoestomac une
sensibiliteacute au E34 et E42 accompagneacutee de nauseacutees dysphagie inappeacutetence
SELON LE VIDE ET LA PLEacuteNITUDE bull Vide douleurs souvent leacutegegraveres intermittentes
sourdes bull Pleacutenitude douleurs tensives lancinantes coliques
aigues
LA FATIGUE
XU LAO = fatigue par Vide = lrsquoeacutepuisement En Occident crsquoest le symptocircme le plus souvent invoqueacute et pas toujours ducirc au Vide
LA FATIGUE - eacutetiologie
bull La faiblesse constitutionnelle
bull Le surmenage
bull Lrsquoexcegraves drsquoactiviteacute physique
bull Lrsquoalimentation
bull Les maladies graves
bull Lrsquoexcegraves drsquoactiviteacute sexuelle
bull Lrsquoaccouchement
bull La consommation de drogues
LA FATIGUE - pathologie
bull Vide
bull Combinaison de Vide et de Pleacutenitude
bull Pleacutenitude
Contre-indications agrave lrsquoacupuncture
bull Des risques de laquo gros bras raquo apregraves curage axillaire
bull Des opeacuterations selon Halsted ou Patey
bull Des drainages lymphatiques
bull Pas drsquoaiguille du cocircteacute opeacutereacute
TCM in cancer treatments
bull Used mostly as adjuvant therapy before or during or
after surgery radiotherapy and chemotherapy
bull Remit the side-effects and toxicity of other treatments
bull Symptom control
bull Activate and strengthen immune system
bull For advanced cancer patients mainly palliative but it
can also prolong life in some cases
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 15 Number 7 2009
Acupuncture for Chemotherapy-Induced Neutropenia in Patients with GynecologiMalignancies A Pilot Randomized Sham-Controlled Clinical Trial
Weidong Lu MB MPH LicAc1ndash3 Ursula A Matulonis MD4 Anne Doherty-Gilman MPH1 Hang ScD3
Peter M Wayne PhD23 David S Rosenthal MD14 and Richard T Penson MD6
bull Abstract bull Objectives The objective of this study was to investigate the effect of acupuncture administered during mye-
losuppressive chemotherapy on white blood cell (WBC) count and absolute neutrophil count (ANC) in patients with ovarian cancer
bull Design This study is a pilot randomized sham-controlled clinical trial Patients received active acupuncture versus sham acupuncture while undergoing chemotherapy A standardized acupuncture protocol was em- ployed with manual and electrostimulation The frequency of treatment was 2ndash3 times per week for a total of 10 sessions starting 1 week before the second cycle of chemotherapy
bull Setting The setting was two outpatient academic centers for patients with cancer bull Subjects Twenty-one (21) newly diagnosed and recurrent ovarian cancer patients were the subjects bull Outcome measures WBC count ANC and plasma granulocyte colony-stimulating factor (G-CSF ) were assessed
weekly bull Results The median leukocyte value in the acupuncture arm at the first day of the third cycle of chemotherapy
was significantly higher than in the control arm after adjusting for baseline value (8600 cells=mL range 4800ndash 12000 versus 4400 cell=mL range 2300ndash10000) ( p frac14 0046) The incidence of grade 2ndash4 leukopenia was less in the acupuncture arm than in the sham arm (30 versus 90 p frac14 002) However the median leukocyte nadir neutrophil nadir and recovering ANC were all higher but not statistically significantly different ( p frac14 0116ndash016) after adjusting for baseline differences There were no statistically significant differences in plasma G-CSF between the two groups
bull Conclusions We observed clinically relevant trends of higher WBC values during one cycle of chemotherapy in patients with ovarian cancer which suggests a potential myeloprotective effect of acupuncture A larger trial is warranted to more definitively determine the efficacy of acupuncture on clinically important outcomes of chemotherapy-induced neutropenia
Acupuncture for the alleviation of hot flashes in men treated with androgen
ablation therapy Ashamalla H1 Jiang ML Guirguis A Peluso F Ashamalla M
bull Abstract bull PURPOSE bull Hot flashes are common side effect due to androgen ablation therapy (AAT) The utility of acupuncture for hot flashes in
men has not been thoroughly studied We prospectively studied the effect of acupuncture in men with hot flashes bull METHODS AND MATERIALS bull The study was approved by internal review board Seventeen men with hot flashes and history of AAT for prostate cancer
were enrolled Three men declined participation before receiving any treatment A hot flash score (HFS) was used to measure daily hot flashes The composite daily score was calculated as the product of frequency times severity The baseline daily scores were compared with scores taken at 2 and 6 weeks and at 8-month average follow-up
bull RESULTS bull No side effects were encountered during immediately after treatment or at 8 months The mean initial HFS was 283 it
dropped to 103 (p = 00001) at 2 weeks posttreatment 75 (p = 00001) at 6 weeks and 70 (p = 0001) at 8 months Clinical improvement for each patient is defined as the percent decrease in the mean HFS at each time point The mean improvement at Weeks 2 and 6 was 684 (mean HFS decreased from 37409 to 11836 p = 0001) and 892 (mean HFS decreased from 37409 to 405 p = 00078) respectively The improvement at 8 months was 803 (mean HFS decreased from 37409 to 7385 p = 0002)
bull CONCLUSIONS bull Acupuncture provides excellent control of hot flashes in men with a history of AAT The absence of side effects and the
durable response at 8 months are likely to be appealing to patients Prospective randomized study is warranted to further evaluate this modality against medical therapy
bull Copyright copy 2011 Elsevier Inc All rights reserved
bull Int J Radiat Oncol Biol Phys 2011 Apr 179(5)1358-63 doi 101016jijrobp201001025 Epub 2010 Jun 3
bull J Clin Oncol 2010 Mar 128(7)1154-60 doi 101200JCO2009234708 Epub 2010 Jan 25 bull Randomized blinded sham-controlled trial of acupuncture for the management of aromatase
inhibitor-associated joint symptoms in women with early-stage breast cancer bull Crew KD1 Capodice JL Greenlee H Brafman L Fuentes D Awad D Yann Tsai W Hershman DL bull Author information
bull Abstract bull PURPOSE Women with breast cancer (BC) treated with aromatase inhibitors (AIs) may experience
joint symptoms that can lead to discontinuation of effective therapy We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC METHODS We conducted a randomized controlled blinded study comparing true acupuncture (TA) versus sham acupuncture (SA) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs TA included full bodyauricular acupuncture and joint-specific point prescriptions whereas SA involved superficial needle insertion at nonacupoint locations Outcome measures included the Brief Pain Inventory-Short Form (BPI-SF) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH) obtained at baseline and at 3 and 6 weeks Results Of 51 women enrolled 43 women were randomly assigned and 38 were evaluable Baseline characteristics were comparable between the two groups Our primary end point was the difference in mean BPI-SF worst pain scores at 6 weeks which was lower for TA compared with SA (30 v 55 P lt 001) We also found differences between TA and SA in pain severity (26 v 45 P = 003) and pain-related interference (25 v 45 P = 002) at 6 weeks Similar findings were seen for the WOMAC and M-SACRAH scores The acupuncture intervention was well-tolerated CONCLUSION Women with AI-induced arthralgias treated with TA had significant improvement of joint pain and stiffness which was not seen with SA Acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect
Preventive treatment of Progression of
Disease
《难经middot七十七难》ldquo所谓治未病者见肝之病则知肝当传之于脾 故先实其脾气无令得受肝之邪故曰治未病焉rdquo
重视疾病的传变规律ldquo先安未受邪之地rdquo 痰毒瘀结是肿瘤转移的关键流窜经络脏腑是其特点对于肿瘤的转移预防比治疗更有现实意义
laquo Classique des Problegravemes meacutedicaux raquo chap77 rdquoSi le Foie est malade il peut attaquer la Rate Par conseacutequent la Rate doit ecirctre fortifieacutee avant qursquoelle ne soit elle-mecircme affecteacutee raquo
Acupuncture
Bronze Model for the Meridians and
Acupuncture Points
(Qing Dynasty 1744)
An insight into acupuncture
Concept of Yin Yang
Holism
Five element theory
Human body
About Qi Formation of Qi
Function of Qi
Disharmony of Qi
Meridians - the pathways of the body
Techniques and methods
Meridian pathways of the Body
bullComponents bull 12 regular meridians
12 Collaterals
8 extraordinary meridians
Functions Connect and coordinate
creating an integral whole
Transporting functions
Spleen Meridian
Techniques and methods
Manual (Classic) Acupuncture
Electric-Acupuncture
Acupuncture and Moxibustion
Laser Acupuncture
Ultrasound Acupuncture
Acupuncture and the Moxibustion
Cupping Therapy
Indications
In 1979 WHO named 43 different diseases that can be
treated by Acupuncture
Upper Respiratory Tract
Acute sinusitis
Acute rhinitis
Common cold
Acute tonsillitis
Respiratory System
Acute Bronchitis
Bronchial asthma
Disorders of the Eye Acute conjunctivitis
Central retinitis
Myopia (in children)
Cataract (without
complications)
Disorders of the Mouth Toothache
Post-extraction pain
Gingivitis
Acute and chronic pharyngitis
Journal of World Health Organisation Dec1979
Known biological effects of
acupuncture
bullAcupuncture multiple biological responses
bullOccur locally or at a distance mediated by sensor neurons to many structures of the central nervous system -- leads to activation of pathways affecting various physiology systems in the brain as well as periphery Attention has been focused on the role of endogenous opioids in analgesia and anesthesia
bullActivate the hypothalamus and pituitary resulting in a broad spectrum of systemic effects
bullAlteration in secretion of neurotransmitters and neurohormones that causes changes in the regulation of blood flow both centrally and peripherally
bullEvidence of alteration of immune functions NIH Consensus Statement Online 1997 Nov 3-5 month day] 15(5)1-34
LES TRAITEMENTS
bull 1-la stagnation de Qi et la stase du Sang
bull dynamiser le sang et transformer la stase du sang
bull 2- accumulation des Toxines lieacutees agrave la Chaleur
bull clarifier la chaleur et deacutegager la Toxiciteacute
bull 3- deacuteficience de Qi Vital
bull soutenir le Qi Vital et cultiver la racine
bull 4- toutes les maladies proviennent des Glaires la plupart des masses qui se produisent dans le corps sont dues aux Glaires
bull transformer les Glaires et ramollir la dureteacute
Dans le diagnostic et le traitement des tumeurs la MTC considegravere leacutetat geacuteneacuteral du patient plutocirct que de se focaliser sur le cancer lui-mecircme ou les symptocircmes particuliers
Soutien psychologique
bull angoisse devant lrsquoinconnu
bull angoisse devant la douleur
bull angoisse devant le deacuteveloppement de la maladie et la perte de controcircle sur son propre corps
bull angoisse devant les effets secondaires dus aux divers traitements
bull angoisse devant les complications tardives dues aux divers traitements
bull angoisse devant le regard social porteacute sur le malade
bull angoisse devant la mort
Soutien psychologique
Ces informations reacutesonnent agrave lrsquointeacuterieur du patient ougrave elle
provoquent des dysfonctionnements qui
peuvent se manifester par
bull des maux de ventre
bull des palpitations
bull des troubles du sommeil
bull des difficulteacutes respiratoires
bull des douleurs diverses etc
Nauseacutees et vomissements
RAPPEL LrsquoEstomac
bull YANG
bull Controcircle le mucircrissement amp pourrissement de la nourriture
bull Controcircle le transport des essences de la nourriture Gouverne la descente du Qi fait descendre la nourriture transformeacutee vers lrsquoIntestin Grecircle
bull Si le mouvement de descente est perturbeacute par les pervers si il y a un mouvement ascendant de QI de lrsquoEstomac (agrave contre-sens- NI) il y a des VOMISSEMENTS
Nauseacutees et vomissements
LES VOMISSEMENTS SE MANIFESTENT QUAND LE QI DE LrsquoESTOMAC MONTE A LA PLACE DE DESCENDRE
Neuropathie
Avastine Xeloda Gemzar Cysplatine Taxol Fludara Alimta Procarbazine
points GI2 3 4 IG 2 3 C7 MC6 8 P7 9 F2 3 V60 VB41
traitement
preacutevention
LA DOULEUR DUE AU CANCER
bull Etiologie et physiopathologie
bull Lrsquoinvasion des pervers Externes - tout pervers srsquoil persiste peut provoquer le blocage des meacuteridiens et par la suite une stagnation de Qi et de Sg ou des troubles de Zang-Fu
bull Le deacuteregraveglement des eacutemotions
bull Le deacuteseacutequilibre de lrsquoalimentation
bull Une faiblesse de constitution
DIFFEacuteRENCIATION DE LA DOULEUR
SELON LA LOCALISATION bull dans le cancer du poumon souvent une sensibiliteacute au
P1 et V13 accompagneacutee de toux et de souffle court bull dans le cancer de lrsquoœsophage ou de lrsquoestomac une
sensibiliteacute au E34 et E42 accompagneacutee de nauseacutees dysphagie inappeacutetence
SELON LE VIDE ET LA PLEacuteNITUDE bull Vide douleurs souvent leacutegegraveres intermittentes
sourdes bull Pleacutenitude douleurs tensives lancinantes coliques
aigues
LA FATIGUE
XU LAO = fatigue par Vide = lrsquoeacutepuisement En Occident crsquoest le symptocircme le plus souvent invoqueacute et pas toujours ducirc au Vide
LA FATIGUE - eacutetiologie
bull La faiblesse constitutionnelle
bull Le surmenage
bull Lrsquoexcegraves drsquoactiviteacute physique
bull Lrsquoalimentation
bull Les maladies graves
bull Lrsquoexcegraves drsquoactiviteacute sexuelle
bull Lrsquoaccouchement
bull La consommation de drogues
LA FATIGUE - pathologie
bull Vide
bull Combinaison de Vide et de Pleacutenitude
bull Pleacutenitude
Contre-indications agrave lrsquoacupuncture
bull Des risques de laquo gros bras raquo apregraves curage axillaire
bull Des opeacuterations selon Halsted ou Patey
bull Des drainages lymphatiques
bull Pas drsquoaiguille du cocircteacute opeacutereacute
TCM in cancer treatments
bull Used mostly as adjuvant therapy before or during or
after surgery radiotherapy and chemotherapy
bull Remit the side-effects and toxicity of other treatments
bull Symptom control
bull Activate and strengthen immune system
bull For advanced cancer patients mainly palliative but it
can also prolong life in some cases
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 15 Number 7 2009
Acupuncture for Chemotherapy-Induced Neutropenia in Patients with GynecologiMalignancies A Pilot Randomized Sham-Controlled Clinical Trial
Weidong Lu MB MPH LicAc1ndash3 Ursula A Matulonis MD4 Anne Doherty-Gilman MPH1 Hang ScD3
Peter M Wayne PhD23 David S Rosenthal MD14 and Richard T Penson MD6
bull Abstract bull Objectives The objective of this study was to investigate the effect of acupuncture administered during mye-
losuppressive chemotherapy on white blood cell (WBC) count and absolute neutrophil count (ANC) in patients with ovarian cancer
bull Design This study is a pilot randomized sham-controlled clinical trial Patients received active acupuncture versus sham acupuncture while undergoing chemotherapy A standardized acupuncture protocol was em- ployed with manual and electrostimulation The frequency of treatment was 2ndash3 times per week for a total of 10 sessions starting 1 week before the second cycle of chemotherapy
bull Setting The setting was two outpatient academic centers for patients with cancer bull Subjects Twenty-one (21) newly diagnosed and recurrent ovarian cancer patients were the subjects bull Outcome measures WBC count ANC and plasma granulocyte colony-stimulating factor (G-CSF ) were assessed
weekly bull Results The median leukocyte value in the acupuncture arm at the first day of the third cycle of chemotherapy
was significantly higher than in the control arm after adjusting for baseline value (8600 cells=mL range 4800ndash 12000 versus 4400 cell=mL range 2300ndash10000) ( p frac14 0046) The incidence of grade 2ndash4 leukopenia was less in the acupuncture arm than in the sham arm (30 versus 90 p frac14 002) However the median leukocyte nadir neutrophil nadir and recovering ANC were all higher but not statistically significantly different ( p frac14 0116ndash016) after adjusting for baseline differences There were no statistically significant differences in plasma G-CSF between the two groups
bull Conclusions We observed clinically relevant trends of higher WBC values during one cycle of chemotherapy in patients with ovarian cancer which suggests a potential myeloprotective effect of acupuncture A larger trial is warranted to more definitively determine the efficacy of acupuncture on clinically important outcomes of chemotherapy-induced neutropenia
Acupuncture for the alleviation of hot flashes in men treated with androgen
ablation therapy Ashamalla H1 Jiang ML Guirguis A Peluso F Ashamalla M
bull Abstract bull PURPOSE bull Hot flashes are common side effect due to androgen ablation therapy (AAT) The utility of acupuncture for hot flashes in
men has not been thoroughly studied We prospectively studied the effect of acupuncture in men with hot flashes bull METHODS AND MATERIALS bull The study was approved by internal review board Seventeen men with hot flashes and history of AAT for prostate cancer
were enrolled Three men declined participation before receiving any treatment A hot flash score (HFS) was used to measure daily hot flashes The composite daily score was calculated as the product of frequency times severity The baseline daily scores were compared with scores taken at 2 and 6 weeks and at 8-month average follow-up
bull RESULTS bull No side effects were encountered during immediately after treatment or at 8 months The mean initial HFS was 283 it
dropped to 103 (p = 00001) at 2 weeks posttreatment 75 (p = 00001) at 6 weeks and 70 (p = 0001) at 8 months Clinical improvement for each patient is defined as the percent decrease in the mean HFS at each time point The mean improvement at Weeks 2 and 6 was 684 (mean HFS decreased from 37409 to 11836 p = 0001) and 892 (mean HFS decreased from 37409 to 405 p = 00078) respectively The improvement at 8 months was 803 (mean HFS decreased from 37409 to 7385 p = 0002)
bull CONCLUSIONS bull Acupuncture provides excellent control of hot flashes in men with a history of AAT The absence of side effects and the
durable response at 8 months are likely to be appealing to patients Prospective randomized study is warranted to further evaluate this modality against medical therapy
bull Copyright copy 2011 Elsevier Inc All rights reserved
bull Int J Radiat Oncol Biol Phys 2011 Apr 179(5)1358-63 doi 101016jijrobp201001025 Epub 2010 Jun 3
bull J Clin Oncol 2010 Mar 128(7)1154-60 doi 101200JCO2009234708 Epub 2010 Jan 25 bull Randomized blinded sham-controlled trial of acupuncture for the management of aromatase
inhibitor-associated joint symptoms in women with early-stage breast cancer bull Crew KD1 Capodice JL Greenlee H Brafman L Fuentes D Awad D Yann Tsai W Hershman DL bull Author information
bull Abstract bull PURPOSE Women with breast cancer (BC) treated with aromatase inhibitors (AIs) may experience
joint symptoms that can lead to discontinuation of effective therapy We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC METHODS We conducted a randomized controlled blinded study comparing true acupuncture (TA) versus sham acupuncture (SA) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs TA included full bodyauricular acupuncture and joint-specific point prescriptions whereas SA involved superficial needle insertion at nonacupoint locations Outcome measures included the Brief Pain Inventory-Short Form (BPI-SF) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH) obtained at baseline and at 3 and 6 weeks Results Of 51 women enrolled 43 women were randomly assigned and 38 were evaluable Baseline characteristics were comparable between the two groups Our primary end point was the difference in mean BPI-SF worst pain scores at 6 weeks which was lower for TA compared with SA (30 v 55 P lt 001) We also found differences between TA and SA in pain severity (26 v 45 P = 003) and pain-related interference (25 v 45 P = 002) at 6 weeks Similar findings were seen for the WOMAC and M-SACRAH scores The acupuncture intervention was well-tolerated CONCLUSION Women with AI-induced arthralgias treated with TA had significant improvement of joint pain and stiffness which was not seen with SA Acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect
Acupuncture
Bronze Model for the Meridians and
Acupuncture Points
(Qing Dynasty 1744)
An insight into acupuncture
Concept of Yin Yang
Holism
Five element theory
Human body
About Qi Formation of Qi
Function of Qi
Disharmony of Qi
Meridians - the pathways of the body
Techniques and methods
Meridian pathways of the Body
bullComponents bull 12 regular meridians
12 Collaterals
8 extraordinary meridians
Functions Connect and coordinate
creating an integral whole
Transporting functions
Spleen Meridian
Techniques and methods
Manual (Classic) Acupuncture
Electric-Acupuncture
Acupuncture and Moxibustion
Laser Acupuncture
Ultrasound Acupuncture
Acupuncture and the Moxibustion
Cupping Therapy
Indications
In 1979 WHO named 43 different diseases that can be
treated by Acupuncture
Upper Respiratory Tract
Acute sinusitis
Acute rhinitis
Common cold
Acute tonsillitis
Respiratory System
Acute Bronchitis
Bronchial asthma
Disorders of the Eye Acute conjunctivitis
Central retinitis
Myopia (in children)
Cataract (without
complications)
Disorders of the Mouth Toothache
Post-extraction pain
Gingivitis
Acute and chronic pharyngitis
Journal of World Health Organisation Dec1979
Known biological effects of
acupuncture
bullAcupuncture multiple biological responses
bullOccur locally or at a distance mediated by sensor neurons to many structures of the central nervous system -- leads to activation of pathways affecting various physiology systems in the brain as well as periphery Attention has been focused on the role of endogenous opioids in analgesia and anesthesia
bullActivate the hypothalamus and pituitary resulting in a broad spectrum of systemic effects
bullAlteration in secretion of neurotransmitters and neurohormones that causes changes in the regulation of blood flow both centrally and peripherally
bullEvidence of alteration of immune functions NIH Consensus Statement Online 1997 Nov 3-5 month day] 15(5)1-34
LES TRAITEMENTS
bull 1-la stagnation de Qi et la stase du Sang
bull dynamiser le sang et transformer la stase du sang
bull 2- accumulation des Toxines lieacutees agrave la Chaleur
bull clarifier la chaleur et deacutegager la Toxiciteacute
bull 3- deacuteficience de Qi Vital
bull soutenir le Qi Vital et cultiver la racine
bull 4- toutes les maladies proviennent des Glaires la plupart des masses qui se produisent dans le corps sont dues aux Glaires
bull transformer les Glaires et ramollir la dureteacute
Dans le diagnostic et le traitement des tumeurs la MTC considegravere leacutetat geacuteneacuteral du patient plutocirct que de se focaliser sur le cancer lui-mecircme ou les symptocircmes particuliers
Soutien psychologique
bull angoisse devant lrsquoinconnu
bull angoisse devant la douleur
bull angoisse devant le deacuteveloppement de la maladie et la perte de controcircle sur son propre corps
bull angoisse devant les effets secondaires dus aux divers traitements
bull angoisse devant les complications tardives dues aux divers traitements
bull angoisse devant le regard social porteacute sur le malade
bull angoisse devant la mort
Soutien psychologique
Ces informations reacutesonnent agrave lrsquointeacuterieur du patient ougrave elle
provoquent des dysfonctionnements qui
peuvent se manifester par
bull des maux de ventre
bull des palpitations
bull des troubles du sommeil
bull des difficulteacutes respiratoires
bull des douleurs diverses etc
Nauseacutees et vomissements
RAPPEL LrsquoEstomac
bull YANG
bull Controcircle le mucircrissement amp pourrissement de la nourriture
bull Controcircle le transport des essences de la nourriture Gouverne la descente du Qi fait descendre la nourriture transformeacutee vers lrsquoIntestin Grecircle
bull Si le mouvement de descente est perturbeacute par les pervers si il y a un mouvement ascendant de QI de lrsquoEstomac (agrave contre-sens- NI) il y a des VOMISSEMENTS
Nauseacutees et vomissements
LES VOMISSEMENTS SE MANIFESTENT QUAND LE QI DE LrsquoESTOMAC MONTE A LA PLACE DE DESCENDRE
Neuropathie
Avastine Xeloda Gemzar Cysplatine Taxol Fludara Alimta Procarbazine
points GI2 3 4 IG 2 3 C7 MC6 8 P7 9 F2 3 V60 VB41
traitement
preacutevention
LA DOULEUR DUE AU CANCER
bull Etiologie et physiopathologie
bull Lrsquoinvasion des pervers Externes - tout pervers srsquoil persiste peut provoquer le blocage des meacuteridiens et par la suite une stagnation de Qi et de Sg ou des troubles de Zang-Fu
bull Le deacuteregraveglement des eacutemotions
bull Le deacuteseacutequilibre de lrsquoalimentation
bull Une faiblesse de constitution
DIFFEacuteRENCIATION DE LA DOULEUR
SELON LA LOCALISATION bull dans le cancer du poumon souvent une sensibiliteacute au
P1 et V13 accompagneacutee de toux et de souffle court bull dans le cancer de lrsquoœsophage ou de lrsquoestomac une
sensibiliteacute au E34 et E42 accompagneacutee de nauseacutees dysphagie inappeacutetence
SELON LE VIDE ET LA PLEacuteNITUDE bull Vide douleurs souvent leacutegegraveres intermittentes
sourdes bull Pleacutenitude douleurs tensives lancinantes coliques
aigues
LA FATIGUE
XU LAO = fatigue par Vide = lrsquoeacutepuisement En Occident crsquoest le symptocircme le plus souvent invoqueacute et pas toujours ducirc au Vide
LA FATIGUE - eacutetiologie
bull La faiblesse constitutionnelle
bull Le surmenage
bull Lrsquoexcegraves drsquoactiviteacute physique
bull Lrsquoalimentation
bull Les maladies graves
bull Lrsquoexcegraves drsquoactiviteacute sexuelle
bull Lrsquoaccouchement
bull La consommation de drogues
LA FATIGUE - pathologie
bull Vide
bull Combinaison de Vide et de Pleacutenitude
bull Pleacutenitude
Contre-indications agrave lrsquoacupuncture
bull Des risques de laquo gros bras raquo apregraves curage axillaire
bull Des opeacuterations selon Halsted ou Patey
bull Des drainages lymphatiques
bull Pas drsquoaiguille du cocircteacute opeacutereacute
TCM in cancer treatments
bull Used mostly as adjuvant therapy before or during or
after surgery radiotherapy and chemotherapy
bull Remit the side-effects and toxicity of other treatments
bull Symptom control
bull Activate and strengthen immune system
bull For advanced cancer patients mainly palliative but it
can also prolong life in some cases
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 15 Number 7 2009
Acupuncture for Chemotherapy-Induced Neutropenia in Patients with GynecologiMalignancies A Pilot Randomized Sham-Controlled Clinical Trial
Weidong Lu MB MPH LicAc1ndash3 Ursula A Matulonis MD4 Anne Doherty-Gilman MPH1 Hang ScD3
Peter M Wayne PhD23 David S Rosenthal MD14 and Richard T Penson MD6
bull Abstract bull Objectives The objective of this study was to investigate the effect of acupuncture administered during mye-
losuppressive chemotherapy on white blood cell (WBC) count and absolute neutrophil count (ANC) in patients with ovarian cancer
bull Design This study is a pilot randomized sham-controlled clinical trial Patients received active acupuncture versus sham acupuncture while undergoing chemotherapy A standardized acupuncture protocol was em- ployed with manual and electrostimulation The frequency of treatment was 2ndash3 times per week for a total of 10 sessions starting 1 week before the second cycle of chemotherapy
bull Setting The setting was two outpatient academic centers for patients with cancer bull Subjects Twenty-one (21) newly diagnosed and recurrent ovarian cancer patients were the subjects bull Outcome measures WBC count ANC and plasma granulocyte colony-stimulating factor (G-CSF ) were assessed
weekly bull Results The median leukocyte value in the acupuncture arm at the first day of the third cycle of chemotherapy
was significantly higher than in the control arm after adjusting for baseline value (8600 cells=mL range 4800ndash 12000 versus 4400 cell=mL range 2300ndash10000) ( p frac14 0046) The incidence of grade 2ndash4 leukopenia was less in the acupuncture arm than in the sham arm (30 versus 90 p frac14 002) However the median leukocyte nadir neutrophil nadir and recovering ANC were all higher but not statistically significantly different ( p frac14 0116ndash016) after adjusting for baseline differences There were no statistically significant differences in plasma G-CSF between the two groups
bull Conclusions We observed clinically relevant trends of higher WBC values during one cycle of chemotherapy in patients with ovarian cancer which suggests a potential myeloprotective effect of acupuncture A larger trial is warranted to more definitively determine the efficacy of acupuncture on clinically important outcomes of chemotherapy-induced neutropenia
Acupuncture for the alleviation of hot flashes in men treated with androgen
ablation therapy Ashamalla H1 Jiang ML Guirguis A Peluso F Ashamalla M
bull Abstract bull PURPOSE bull Hot flashes are common side effect due to androgen ablation therapy (AAT) The utility of acupuncture for hot flashes in
men has not been thoroughly studied We prospectively studied the effect of acupuncture in men with hot flashes bull METHODS AND MATERIALS bull The study was approved by internal review board Seventeen men with hot flashes and history of AAT for prostate cancer
were enrolled Three men declined participation before receiving any treatment A hot flash score (HFS) was used to measure daily hot flashes The composite daily score was calculated as the product of frequency times severity The baseline daily scores were compared with scores taken at 2 and 6 weeks and at 8-month average follow-up
bull RESULTS bull No side effects were encountered during immediately after treatment or at 8 months The mean initial HFS was 283 it
dropped to 103 (p = 00001) at 2 weeks posttreatment 75 (p = 00001) at 6 weeks and 70 (p = 0001) at 8 months Clinical improvement for each patient is defined as the percent decrease in the mean HFS at each time point The mean improvement at Weeks 2 and 6 was 684 (mean HFS decreased from 37409 to 11836 p = 0001) and 892 (mean HFS decreased from 37409 to 405 p = 00078) respectively The improvement at 8 months was 803 (mean HFS decreased from 37409 to 7385 p = 0002)
bull CONCLUSIONS bull Acupuncture provides excellent control of hot flashes in men with a history of AAT The absence of side effects and the
durable response at 8 months are likely to be appealing to patients Prospective randomized study is warranted to further evaluate this modality against medical therapy
bull Copyright copy 2011 Elsevier Inc All rights reserved
bull Int J Radiat Oncol Biol Phys 2011 Apr 179(5)1358-63 doi 101016jijrobp201001025 Epub 2010 Jun 3
bull J Clin Oncol 2010 Mar 128(7)1154-60 doi 101200JCO2009234708 Epub 2010 Jan 25 bull Randomized blinded sham-controlled trial of acupuncture for the management of aromatase
inhibitor-associated joint symptoms in women with early-stage breast cancer bull Crew KD1 Capodice JL Greenlee H Brafman L Fuentes D Awad D Yann Tsai W Hershman DL bull Author information
bull Abstract bull PURPOSE Women with breast cancer (BC) treated with aromatase inhibitors (AIs) may experience
joint symptoms that can lead to discontinuation of effective therapy We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC METHODS We conducted a randomized controlled blinded study comparing true acupuncture (TA) versus sham acupuncture (SA) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs TA included full bodyauricular acupuncture and joint-specific point prescriptions whereas SA involved superficial needle insertion at nonacupoint locations Outcome measures included the Brief Pain Inventory-Short Form (BPI-SF) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH) obtained at baseline and at 3 and 6 weeks Results Of 51 women enrolled 43 women were randomly assigned and 38 were evaluable Baseline characteristics were comparable between the two groups Our primary end point was the difference in mean BPI-SF worst pain scores at 6 weeks which was lower for TA compared with SA (30 v 55 P lt 001) We also found differences between TA and SA in pain severity (26 v 45 P = 003) and pain-related interference (25 v 45 P = 002) at 6 weeks Similar findings were seen for the WOMAC and M-SACRAH scores The acupuncture intervention was well-tolerated CONCLUSION Women with AI-induced arthralgias treated with TA had significant improvement of joint pain and stiffness which was not seen with SA Acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect
An insight into acupuncture
Concept of Yin Yang
Holism
Five element theory
Human body
About Qi Formation of Qi
Function of Qi
Disharmony of Qi
Meridians - the pathways of the body
Techniques and methods
Meridian pathways of the Body
bullComponents bull 12 regular meridians
12 Collaterals
8 extraordinary meridians
Functions Connect and coordinate
creating an integral whole
Transporting functions
Spleen Meridian
Techniques and methods
Manual (Classic) Acupuncture
Electric-Acupuncture
Acupuncture and Moxibustion
Laser Acupuncture
Ultrasound Acupuncture
Acupuncture and the Moxibustion
Cupping Therapy
Indications
In 1979 WHO named 43 different diseases that can be
treated by Acupuncture
Upper Respiratory Tract
Acute sinusitis
Acute rhinitis
Common cold
Acute tonsillitis
Respiratory System
Acute Bronchitis
Bronchial asthma
Disorders of the Eye Acute conjunctivitis
Central retinitis
Myopia (in children)
Cataract (without
complications)
Disorders of the Mouth Toothache
Post-extraction pain
Gingivitis
Acute and chronic pharyngitis
Journal of World Health Organisation Dec1979
Known biological effects of
acupuncture
bullAcupuncture multiple biological responses
bullOccur locally or at a distance mediated by sensor neurons to many structures of the central nervous system -- leads to activation of pathways affecting various physiology systems in the brain as well as periphery Attention has been focused on the role of endogenous opioids in analgesia and anesthesia
bullActivate the hypothalamus and pituitary resulting in a broad spectrum of systemic effects
bullAlteration in secretion of neurotransmitters and neurohormones that causes changes in the regulation of blood flow both centrally and peripherally
bullEvidence of alteration of immune functions NIH Consensus Statement Online 1997 Nov 3-5 month day] 15(5)1-34
LES TRAITEMENTS
bull 1-la stagnation de Qi et la stase du Sang
bull dynamiser le sang et transformer la stase du sang
bull 2- accumulation des Toxines lieacutees agrave la Chaleur
bull clarifier la chaleur et deacutegager la Toxiciteacute
bull 3- deacuteficience de Qi Vital
bull soutenir le Qi Vital et cultiver la racine
bull 4- toutes les maladies proviennent des Glaires la plupart des masses qui se produisent dans le corps sont dues aux Glaires
bull transformer les Glaires et ramollir la dureteacute
Dans le diagnostic et le traitement des tumeurs la MTC considegravere leacutetat geacuteneacuteral du patient plutocirct que de se focaliser sur le cancer lui-mecircme ou les symptocircmes particuliers
Soutien psychologique
bull angoisse devant lrsquoinconnu
bull angoisse devant la douleur
bull angoisse devant le deacuteveloppement de la maladie et la perte de controcircle sur son propre corps
bull angoisse devant les effets secondaires dus aux divers traitements
bull angoisse devant les complications tardives dues aux divers traitements
bull angoisse devant le regard social porteacute sur le malade
bull angoisse devant la mort
Soutien psychologique
Ces informations reacutesonnent agrave lrsquointeacuterieur du patient ougrave elle
provoquent des dysfonctionnements qui
peuvent se manifester par
bull des maux de ventre
bull des palpitations
bull des troubles du sommeil
bull des difficulteacutes respiratoires
bull des douleurs diverses etc
Nauseacutees et vomissements
RAPPEL LrsquoEstomac
bull YANG
bull Controcircle le mucircrissement amp pourrissement de la nourriture
bull Controcircle le transport des essences de la nourriture Gouverne la descente du Qi fait descendre la nourriture transformeacutee vers lrsquoIntestin Grecircle
bull Si le mouvement de descente est perturbeacute par les pervers si il y a un mouvement ascendant de QI de lrsquoEstomac (agrave contre-sens- NI) il y a des VOMISSEMENTS
Nauseacutees et vomissements
LES VOMISSEMENTS SE MANIFESTENT QUAND LE QI DE LrsquoESTOMAC MONTE A LA PLACE DE DESCENDRE
Neuropathie
Avastine Xeloda Gemzar Cysplatine Taxol Fludara Alimta Procarbazine
points GI2 3 4 IG 2 3 C7 MC6 8 P7 9 F2 3 V60 VB41
traitement
preacutevention
LA DOULEUR DUE AU CANCER
bull Etiologie et physiopathologie
bull Lrsquoinvasion des pervers Externes - tout pervers srsquoil persiste peut provoquer le blocage des meacuteridiens et par la suite une stagnation de Qi et de Sg ou des troubles de Zang-Fu
bull Le deacuteregraveglement des eacutemotions
bull Le deacuteseacutequilibre de lrsquoalimentation
bull Une faiblesse de constitution
DIFFEacuteRENCIATION DE LA DOULEUR
SELON LA LOCALISATION bull dans le cancer du poumon souvent une sensibiliteacute au
P1 et V13 accompagneacutee de toux et de souffle court bull dans le cancer de lrsquoœsophage ou de lrsquoestomac une
sensibiliteacute au E34 et E42 accompagneacutee de nauseacutees dysphagie inappeacutetence
SELON LE VIDE ET LA PLEacuteNITUDE bull Vide douleurs souvent leacutegegraveres intermittentes
sourdes bull Pleacutenitude douleurs tensives lancinantes coliques
aigues
LA FATIGUE
XU LAO = fatigue par Vide = lrsquoeacutepuisement En Occident crsquoest le symptocircme le plus souvent invoqueacute et pas toujours ducirc au Vide
LA FATIGUE - eacutetiologie
bull La faiblesse constitutionnelle
bull Le surmenage
bull Lrsquoexcegraves drsquoactiviteacute physique
bull Lrsquoalimentation
bull Les maladies graves
bull Lrsquoexcegraves drsquoactiviteacute sexuelle
bull Lrsquoaccouchement
bull La consommation de drogues
LA FATIGUE - pathologie
bull Vide
bull Combinaison de Vide et de Pleacutenitude
bull Pleacutenitude
Contre-indications agrave lrsquoacupuncture
bull Des risques de laquo gros bras raquo apregraves curage axillaire
bull Des opeacuterations selon Halsted ou Patey
bull Des drainages lymphatiques
bull Pas drsquoaiguille du cocircteacute opeacutereacute
TCM in cancer treatments
bull Used mostly as adjuvant therapy before or during or
after surgery radiotherapy and chemotherapy
bull Remit the side-effects and toxicity of other treatments
bull Symptom control
bull Activate and strengthen immune system
bull For advanced cancer patients mainly palliative but it
can also prolong life in some cases
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 15 Number 7 2009
Acupuncture for Chemotherapy-Induced Neutropenia in Patients with GynecologiMalignancies A Pilot Randomized Sham-Controlled Clinical Trial
Weidong Lu MB MPH LicAc1ndash3 Ursula A Matulonis MD4 Anne Doherty-Gilman MPH1 Hang ScD3
Peter M Wayne PhD23 David S Rosenthal MD14 and Richard T Penson MD6
bull Abstract bull Objectives The objective of this study was to investigate the effect of acupuncture administered during mye-
losuppressive chemotherapy on white blood cell (WBC) count and absolute neutrophil count (ANC) in patients with ovarian cancer
bull Design This study is a pilot randomized sham-controlled clinical trial Patients received active acupuncture versus sham acupuncture while undergoing chemotherapy A standardized acupuncture protocol was em- ployed with manual and electrostimulation The frequency of treatment was 2ndash3 times per week for a total of 10 sessions starting 1 week before the second cycle of chemotherapy
bull Setting The setting was two outpatient academic centers for patients with cancer bull Subjects Twenty-one (21) newly diagnosed and recurrent ovarian cancer patients were the subjects bull Outcome measures WBC count ANC and plasma granulocyte colony-stimulating factor (G-CSF ) were assessed
weekly bull Results The median leukocyte value in the acupuncture arm at the first day of the third cycle of chemotherapy
was significantly higher than in the control arm after adjusting for baseline value (8600 cells=mL range 4800ndash 12000 versus 4400 cell=mL range 2300ndash10000) ( p frac14 0046) The incidence of grade 2ndash4 leukopenia was less in the acupuncture arm than in the sham arm (30 versus 90 p frac14 002) However the median leukocyte nadir neutrophil nadir and recovering ANC were all higher but not statistically significantly different ( p frac14 0116ndash016) after adjusting for baseline differences There were no statistically significant differences in plasma G-CSF between the two groups
bull Conclusions We observed clinically relevant trends of higher WBC values during one cycle of chemotherapy in patients with ovarian cancer which suggests a potential myeloprotective effect of acupuncture A larger trial is warranted to more definitively determine the efficacy of acupuncture on clinically important outcomes of chemotherapy-induced neutropenia
Acupuncture for the alleviation of hot flashes in men treated with androgen
ablation therapy Ashamalla H1 Jiang ML Guirguis A Peluso F Ashamalla M
bull Abstract bull PURPOSE bull Hot flashes are common side effect due to androgen ablation therapy (AAT) The utility of acupuncture for hot flashes in
men has not been thoroughly studied We prospectively studied the effect of acupuncture in men with hot flashes bull METHODS AND MATERIALS bull The study was approved by internal review board Seventeen men with hot flashes and history of AAT for prostate cancer
were enrolled Three men declined participation before receiving any treatment A hot flash score (HFS) was used to measure daily hot flashes The composite daily score was calculated as the product of frequency times severity The baseline daily scores were compared with scores taken at 2 and 6 weeks and at 8-month average follow-up
bull RESULTS bull No side effects were encountered during immediately after treatment or at 8 months The mean initial HFS was 283 it
dropped to 103 (p = 00001) at 2 weeks posttreatment 75 (p = 00001) at 6 weeks and 70 (p = 0001) at 8 months Clinical improvement for each patient is defined as the percent decrease in the mean HFS at each time point The mean improvement at Weeks 2 and 6 was 684 (mean HFS decreased from 37409 to 11836 p = 0001) and 892 (mean HFS decreased from 37409 to 405 p = 00078) respectively The improvement at 8 months was 803 (mean HFS decreased from 37409 to 7385 p = 0002)
bull CONCLUSIONS bull Acupuncture provides excellent control of hot flashes in men with a history of AAT The absence of side effects and the
durable response at 8 months are likely to be appealing to patients Prospective randomized study is warranted to further evaluate this modality against medical therapy
bull Copyright copy 2011 Elsevier Inc All rights reserved
bull Int J Radiat Oncol Biol Phys 2011 Apr 179(5)1358-63 doi 101016jijrobp201001025 Epub 2010 Jun 3
bull J Clin Oncol 2010 Mar 128(7)1154-60 doi 101200JCO2009234708 Epub 2010 Jan 25 bull Randomized blinded sham-controlled trial of acupuncture for the management of aromatase
inhibitor-associated joint symptoms in women with early-stage breast cancer bull Crew KD1 Capodice JL Greenlee H Brafman L Fuentes D Awad D Yann Tsai W Hershman DL bull Author information
bull Abstract bull PURPOSE Women with breast cancer (BC) treated with aromatase inhibitors (AIs) may experience
joint symptoms that can lead to discontinuation of effective therapy We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC METHODS We conducted a randomized controlled blinded study comparing true acupuncture (TA) versus sham acupuncture (SA) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs TA included full bodyauricular acupuncture and joint-specific point prescriptions whereas SA involved superficial needle insertion at nonacupoint locations Outcome measures included the Brief Pain Inventory-Short Form (BPI-SF) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH) obtained at baseline and at 3 and 6 weeks Results Of 51 women enrolled 43 women were randomly assigned and 38 were evaluable Baseline characteristics were comparable between the two groups Our primary end point was the difference in mean BPI-SF worst pain scores at 6 weeks which was lower for TA compared with SA (30 v 55 P lt 001) We also found differences between TA and SA in pain severity (26 v 45 P = 003) and pain-related interference (25 v 45 P = 002) at 6 weeks Similar findings were seen for the WOMAC and M-SACRAH scores The acupuncture intervention was well-tolerated CONCLUSION Women with AI-induced arthralgias treated with TA had significant improvement of joint pain and stiffness which was not seen with SA Acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect
Meridian pathways of the Body
bullComponents bull 12 regular meridians
12 Collaterals
8 extraordinary meridians
Functions Connect and coordinate
creating an integral whole
Transporting functions
Spleen Meridian
Techniques and methods
Manual (Classic) Acupuncture
Electric-Acupuncture
Acupuncture and Moxibustion
Laser Acupuncture
Ultrasound Acupuncture
Acupuncture and the Moxibustion
Cupping Therapy
Indications
In 1979 WHO named 43 different diseases that can be
treated by Acupuncture
Upper Respiratory Tract
Acute sinusitis
Acute rhinitis
Common cold
Acute tonsillitis
Respiratory System
Acute Bronchitis
Bronchial asthma
Disorders of the Eye Acute conjunctivitis
Central retinitis
Myopia (in children)
Cataract (without
complications)
Disorders of the Mouth Toothache
Post-extraction pain
Gingivitis
Acute and chronic pharyngitis
Journal of World Health Organisation Dec1979
Known biological effects of
acupuncture
bullAcupuncture multiple biological responses
bullOccur locally or at a distance mediated by sensor neurons to many structures of the central nervous system -- leads to activation of pathways affecting various physiology systems in the brain as well as periphery Attention has been focused on the role of endogenous opioids in analgesia and anesthesia
bullActivate the hypothalamus and pituitary resulting in a broad spectrum of systemic effects
bullAlteration in secretion of neurotransmitters and neurohormones that causes changes in the regulation of blood flow both centrally and peripherally
bullEvidence of alteration of immune functions NIH Consensus Statement Online 1997 Nov 3-5 month day] 15(5)1-34
LES TRAITEMENTS
bull 1-la stagnation de Qi et la stase du Sang
bull dynamiser le sang et transformer la stase du sang
bull 2- accumulation des Toxines lieacutees agrave la Chaleur
bull clarifier la chaleur et deacutegager la Toxiciteacute
bull 3- deacuteficience de Qi Vital
bull soutenir le Qi Vital et cultiver la racine
bull 4- toutes les maladies proviennent des Glaires la plupart des masses qui se produisent dans le corps sont dues aux Glaires
bull transformer les Glaires et ramollir la dureteacute
Dans le diagnostic et le traitement des tumeurs la MTC considegravere leacutetat geacuteneacuteral du patient plutocirct que de se focaliser sur le cancer lui-mecircme ou les symptocircmes particuliers
Soutien psychologique
bull angoisse devant lrsquoinconnu
bull angoisse devant la douleur
bull angoisse devant le deacuteveloppement de la maladie et la perte de controcircle sur son propre corps
bull angoisse devant les effets secondaires dus aux divers traitements
bull angoisse devant les complications tardives dues aux divers traitements
bull angoisse devant le regard social porteacute sur le malade
bull angoisse devant la mort
Soutien psychologique
Ces informations reacutesonnent agrave lrsquointeacuterieur du patient ougrave elle
provoquent des dysfonctionnements qui
peuvent se manifester par
bull des maux de ventre
bull des palpitations
bull des troubles du sommeil
bull des difficulteacutes respiratoires
bull des douleurs diverses etc
Nauseacutees et vomissements
RAPPEL LrsquoEstomac
bull YANG
bull Controcircle le mucircrissement amp pourrissement de la nourriture
bull Controcircle le transport des essences de la nourriture Gouverne la descente du Qi fait descendre la nourriture transformeacutee vers lrsquoIntestin Grecircle
bull Si le mouvement de descente est perturbeacute par les pervers si il y a un mouvement ascendant de QI de lrsquoEstomac (agrave contre-sens- NI) il y a des VOMISSEMENTS
Nauseacutees et vomissements
LES VOMISSEMENTS SE MANIFESTENT QUAND LE QI DE LrsquoESTOMAC MONTE A LA PLACE DE DESCENDRE
Neuropathie
Avastine Xeloda Gemzar Cysplatine Taxol Fludara Alimta Procarbazine
points GI2 3 4 IG 2 3 C7 MC6 8 P7 9 F2 3 V60 VB41
traitement
preacutevention
LA DOULEUR DUE AU CANCER
bull Etiologie et physiopathologie
bull Lrsquoinvasion des pervers Externes - tout pervers srsquoil persiste peut provoquer le blocage des meacuteridiens et par la suite une stagnation de Qi et de Sg ou des troubles de Zang-Fu
bull Le deacuteregraveglement des eacutemotions
bull Le deacuteseacutequilibre de lrsquoalimentation
bull Une faiblesse de constitution
DIFFEacuteRENCIATION DE LA DOULEUR
SELON LA LOCALISATION bull dans le cancer du poumon souvent une sensibiliteacute au
P1 et V13 accompagneacutee de toux et de souffle court bull dans le cancer de lrsquoœsophage ou de lrsquoestomac une
sensibiliteacute au E34 et E42 accompagneacutee de nauseacutees dysphagie inappeacutetence
SELON LE VIDE ET LA PLEacuteNITUDE bull Vide douleurs souvent leacutegegraveres intermittentes
sourdes bull Pleacutenitude douleurs tensives lancinantes coliques
aigues
LA FATIGUE
XU LAO = fatigue par Vide = lrsquoeacutepuisement En Occident crsquoest le symptocircme le plus souvent invoqueacute et pas toujours ducirc au Vide
LA FATIGUE - eacutetiologie
bull La faiblesse constitutionnelle
bull Le surmenage
bull Lrsquoexcegraves drsquoactiviteacute physique
bull Lrsquoalimentation
bull Les maladies graves
bull Lrsquoexcegraves drsquoactiviteacute sexuelle
bull Lrsquoaccouchement
bull La consommation de drogues
LA FATIGUE - pathologie
bull Vide
bull Combinaison de Vide et de Pleacutenitude
bull Pleacutenitude
Contre-indications agrave lrsquoacupuncture
bull Des risques de laquo gros bras raquo apregraves curage axillaire
bull Des opeacuterations selon Halsted ou Patey
bull Des drainages lymphatiques
bull Pas drsquoaiguille du cocircteacute opeacutereacute
TCM in cancer treatments
bull Used mostly as adjuvant therapy before or during or
after surgery radiotherapy and chemotherapy
bull Remit the side-effects and toxicity of other treatments
bull Symptom control
bull Activate and strengthen immune system
bull For advanced cancer patients mainly palliative but it
can also prolong life in some cases
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 15 Number 7 2009
Acupuncture for Chemotherapy-Induced Neutropenia in Patients with GynecologiMalignancies A Pilot Randomized Sham-Controlled Clinical Trial
Weidong Lu MB MPH LicAc1ndash3 Ursula A Matulonis MD4 Anne Doherty-Gilman MPH1 Hang ScD3
Peter M Wayne PhD23 David S Rosenthal MD14 and Richard T Penson MD6
bull Abstract bull Objectives The objective of this study was to investigate the effect of acupuncture administered during mye-
losuppressive chemotherapy on white blood cell (WBC) count and absolute neutrophil count (ANC) in patients with ovarian cancer
bull Design This study is a pilot randomized sham-controlled clinical trial Patients received active acupuncture versus sham acupuncture while undergoing chemotherapy A standardized acupuncture protocol was em- ployed with manual and electrostimulation The frequency of treatment was 2ndash3 times per week for a total of 10 sessions starting 1 week before the second cycle of chemotherapy
bull Setting The setting was two outpatient academic centers for patients with cancer bull Subjects Twenty-one (21) newly diagnosed and recurrent ovarian cancer patients were the subjects bull Outcome measures WBC count ANC and plasma granulocyte colony-stimulating factor (G-CSF ) were assessed
weekly bull Results The median leukocyte value in the acupuncture arm at the first day of the third cycle of chemotherapy
was significantly higher than in the control arm after adjusting for baseline value (8600 cells=mL range 4800ndash 12000 versus 4400 cell=mL range 2300ndash10000) ( p frac14 0046) The incidence of grade 2ndash4 leukopenia was less in the acupuncture arm than in the sham arm (30 versus 90 p frac14 002) However the median leukocyte nadir neutrophil nadir and recovering ANC were all higher but not statistically significantly different ( p frac14 0116ndash016) after adjusting for baseline differences There were no statistically significant differences in plasma G-CSF between the two groups
bull Conclusions We observed clinically relevant trends of higher WBC values during one cycle of chemotherapy in patients with ovarian cancer which suggests a potential myeloprotective effect of acupuncture A larger trial is warranted to more definitively determine the efficacy of acupuncture on clinically important outcomes of chemotherapy-induced neutropenia
Acupuncture for the alleviation of hot flashes in men treated with androgen
ablation therapy Ashamalla H1 Jiang ML Guirguis A Peluso F Ashamalla M
bull Abstract bull PURPOSE bull Hot flashes are common side effect due to androgen ablation therapy (AAT) The utility of acupuncture for hot flashes in
men has not been thoroughly studied We prospectively studied the effect of acupuncture in men with hot flashes bull METHODS AND MATERIALS bull The study was approved by internal review board Seventeen men with hot flashes and history of AAT for prostate cancer
were enrolled Three men declined participation before receiving any treatment A hot flash score (HFS) was used to measure daily hot flashes The composite daily score was calculated as the product of frequency times severity The baseline daily scores were compared with scores taken at 2 and 6 weeks and at 8-month average follow-up
bull RESULTS bull No side effects were encountered during immediately after treatment or at 8 months The mean initial HFS was 283 it
dropped to 103 (p = 00001) at 2 weeks posttreatment 75 (p = 00001) at 6 weeks and 70 (p = 0001) at 8 months Clinical improvement for each patient is defined as the percent decrease in the mean HFS at each time point The mean improvement at Weeks 2 and 6 was 684 (mean HFS decreased from 37409 to 11836 p = 0001) and 892 (mean HFS decreased from 37409 to 405 p = 00078) respectively The improvement at 8 months was 803 (mean HFS decreased from 37409 to 7385 p = 0002)
bull CONCLUSIONS bull Acupuncture provides excellent control of hot flashes in men with a history of AAT The absence of side effects and the
durable response at 8 months are likely to be appealing to patients Prospective randomized study is warranted to further evaluate this modality against medical therapy
bull Copyright copy 2011 Elsevier Inc All rights reserved
bull Int J Radiat Oncol Biol Phys 2011 Apr 179(5)1358-63 doi 101016jijrobp201001025 Epub 2010 Jun 3
bull J Clin Oncol 2010 Mar 128(7)1154-60 doi 101200JCO2009234708 Epub 2010 Jan 25 bull Randomized blinded sham-controlled trial of acupuncture for the management of aromatase
inhibitor-associated joint symptoms in women with early-stage breast cancer bull Crew KD1 Capodice JL Greenlee H Brafman L Fuentes D Awad D Yann Tsai W Hershman DL bull Author information
bull Abstract bull PURPOSE Women with breast cancer (BC) treated with aromatase inhibitors (AIs) may experience
joint symptoms that can lead to discontinuation of effective therapy We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC METHODS We conducted a randomized controlled blinded study comparing true acupuncture (TA) versus sham acupuncture (SA) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs TA included full bodyauricular acupuncture and joint-specific point prescriptions whereas SA involved superficial needle insertion at nonacupoint locations Outcome measures included the Brief Pain Inventory-Short Form (BPI-SF) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH) obtained at baseline and at 3 and 6 weeks Results Of 51 women enrolled 43 women were randomly assigned and 38 were evaluable Baseline characteristics were comparable between the two groups Our primary end point was the difference in mean BPI-SF worst pain scores at 6 weeks which was lower for TA compared with SA (30 v 55 P lt 001) We also found differences between TA and SA in pain severity (26 v 45 P = 003) and pain-related interference (25 v 45 P = 002) at 6 weeks Similar findings were seen for the WOMAC and M-SACRAH scores The acupuncture intervention was well-tolerated CONCLUSION Women with AI-induced arthralgias treated with TA had significant improvement of joint pain and stiffness which was not seen with SA Acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect
Spleen Meridian
Techniques and methods
Manual (Classic) Acupuncture
Electric-Acupuncture
Acupuncture and Moxibustion
Laser Acupuncture
Ultrasound Acupuncture
Acupuncture and the Moxibustion
Cupping Therapy
Indications
In 1979 WHO named 43 different diseases that can be
treated by Acupuncture
Upper Respiratory Tract
Acute sinusitis
Acute rhinitis
Common cold
Acute tonsillitis
Respiratory System
Acute Bronchitis
Bronchial asthma
Disorders of the Eye Acute conjunctivitis
Central retinitis
Myopia (in children)
Cataract (without
complications)
Disorders of the Mouth Toothache
Post-extraction pain
Gingivitis
Acute and chronic pharyngitis
Journal of World Health Organisation Dec1979
Known biological effects of
acupuncture
bullAcupuncture multiple biological responses
bullOccur locally or at a distance mediated by sensor neurons to many structures of the central nervous system -- leads to activation of pathways affecting various physiology systems in the brain as well as periphery Attention has been focused on the role of endogenous opioids in analgesia and anesthesia
bullActivate the hypothalamus and pituitary resulting in a broad spectrum of systemic effects
bullAlteration in secretion of neurotransmitters and neurohormones that causes changes in the regulation of blood flow both centrally and peripherally
bullEvidence of alteration of immune functions NIH Consensus Statement Online 1997 Nov 3-5 month day] 15(5)1-34
LES TRAITEMENTS
bull 1-la stagnation de Qi et la stase du Sang
bull dynamiser le sang et transformer la stase du sang
bull 2- accumulation des Toxines lieacutees agrave la Chaleur
bull clarifier la chaleur et deacutegager la Toxiciteacute
bull 3- deacuteficience de Qi Vital
bull soutenir le Qi Vital et cultiver la racine
bull 4- toutes les maladies proviennent des Glaires la plupart des masses qui se produisent dans le corps sont dues aux Glaires
bull transformer les Glaires et ramollir la dureteacute
Dans le diagnostic et le traitement des tumeurs la MTC considegravere leacutetat geacuteneacuteral du patient plutocirct que de se focaliser sur le cancer lui-mecircme ou les symptocircmes particuliers
Soutien psychologique
bull angoisse devant lrsquoinconnu
bull angoisse devant la douleur
bull angoisse devant le deacuteveloppement de la maladie et la perte de controcircle sur son propre corps
bull angoisse devant les effets secondaires dus aux divers traitements
bull angoisse devant les complications tardives dues aux divers traitements
bull angoisse devant le regard social porteacute sur le malade
bull angoisse devant la mort
Soutien psychologique
Ces informations reacutesonnent agrave lrsquointeacuterieur du patient ougrave elle
provoquent des dysfonctionnements qui
peuvent se manifester par
bull des maux de ventre
bull des palpitations
bull des troubles du sommeil
bull des difficulteacutes respiratoires
bull des douleurs diverses etc
Nauseacutees et vomissements
RAPPEL LrsquoEstomac
bull YANG
bull Controcircle le mucircrissement amp pourrissement de la nourriture
bull Controcircle le transport des essences de la nourriture Gouverne la descente du Qi fait descendre la nourriture transformeacutee vers lrsquoIntestin Grecircle
bull Si le mouvement de descente est perturbeacute par les pervers si il y a un mouvement ascendant de QI de lrsquoEstomac (agrave contre-sens- NI) il y a des VOMISSEMENTS
Nauseacutees et vomissements
LES VOMISSEMENTS SE MANIFESTENT QUAND LE QI DE LrsquoESTOMAC MONTE A LA PLACE DE DESCENDRE
Neuropathie
Avastine Xeloda Gemzar Cysplatine Taxol Fludara Alimta Procarbazine
points GI2 3 4 IG 2 3 C7 MC6 8 P7 9 F2 3 V60 VB41
traitement
preacutevention
LA DOULEUR DUE AU CANCER
bull Etiologie et physiopathologie
bull Lrsquoinvasion des pervers Externes - tout pervers srsquoil persiste peut provoquer le blocage des meacuteridiens et par la suite une stagnation de Qi et de Sg ou des troubles de Zang-Fu
bull Le deacuteregraveglement des eacutemotions
bull Le deacuteseacutequilibre de lrsquoalimentation
bull Une faiblesse de constitution
DIFFEacuteRENCIATION DE LA DOULEUR
SELON LA LOCALISATION bull dans le cancer du poumon souvent une sensibiliteacute au
P1 et V13 accompagneacutee de toux et de souffle court bull dans le cancer de lrsquoœsophage ou de lrsquoestomac une
sensibiliteacute au E34 et E42 accompagneacutee de nauseacutees dysphagie inappeacutetence
SELON LE VIDE ET LA PLEacuteNITUDE bull Vide douleurs souvent leacutegegraveres intermittentes
sourdes bull Pleacutenitude douleurs tensives lancinantes coliques
aigues
LA FATIGUE
XU LAO = fatigue par Vide = lrsquoeacutepuisement En Occident crsquoest le symptocircme le plus souvent invoqueacute et pas toujours ducirc au Vide
LA FATIGUE - eacutetiologie
bull La faiblesse constitutionnelle
bull Le surmenage
bull Lrsquoexcegraves drsquoactiviteacute physique
bull Lrsquoalimentation
bull Les maladies graves
bull Lrsquoexcegraves drsquoactiviteacute sexuelle
bull Lrsquoaccouchement
bull La consommation de drogues
LA FATIGUE - pathologie
bull Vide
bull Combinaison de Vide et de Pleacutenitude
bull Pleacutenitude
Contre-indications agrave lrsquoacupuncture
bull Des risques de laquo gros bras raquo apregraves curage axillaire
bull Des opeacuterations selon Halsted ou Patey
bull Des drainages lymphatiques
bull Pas drsquoaiguille du cocircteacute opeacutereacute
TCM in cancer treatments
bull Used mostly as adjuvant therapy before or during or
after surgery radiotherapy and chemotherapy
bull Remit the side-effects and toxicity of other treatments
bull Symptom control
bull Activate and strengthen immune system
bull For advanced cancer patients mainly palliative but it
can also prolong life in some cases
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 15 Number 7 2009
Acupuncture for Chemotherapy-Induced Neutropenia in Patients with GynecologiMalignancies A Pilot Randomized Sham-Controlled Clinical Trial
Weidong Lu MB MPH LicAc1ndash3 Ursula A Matulonis MD4 Anne Doherty-Gilman MPH1 Hang ScD3
Peter M Wayne PhD23 David S Rosenthal MD14 and Richard T Penson MD6
bull Abstract bull Objectives The objective of this study was to investigate the effect of acupuncture administered during mye-
losuppressive chemotherapy on white blood cell (WBC) count and absolute neutrophil count (ANC) in patients with ovarian cancer
bull Design This study is a pilot randomized sham-controlled clinical trial Patients received active acupuncture versus sham acupuncture while undergoing chemotherapy A standardized acupuncture protocol was em- ployed with manual and electrostimulation The frequency of treatment was 2ndash3 times per week for a total of 10 sessions starting 1 week before the second cycle of chemotherapy
bull Setting The setting was two outpatient academic centers for patients with cancer bull Subjects Twenty-one (21) newly diagnosed and recurrent ovarian cancer patients were the subjects bull Outcome measures WBC count ANC and plasma granulocyte colony-stimulating factor (G-CSF ) were assessed
weekly bull Results The median leukocyte value in the acupuncture arm at the first day of the third cycle of chemotherapy
was significantly higher than in the control arm after adjusting for baseline value (8600 cells=mL range 4800ndash 12000 versus 4400 cell=mL range 2300ndash10000) ( p frac14 0046) The incidence of grade 2ndash4 leukopenia was less in the acupuncture arm than in the sham arm (30 versus 90 p frac14 002) However the median leukocyte nadir neutrophil nadir and recovering ANC were all higher but not statistically significantly different ( p frac14 0116ndash016) after adjusting for baseline differences There were no statistically significant differences in plasma G-CSF between the two groups
bull Conclusions We observed clinically relevant trends of higher WBC values during one cycle of chemotherapy in patients with ovarian cancer which suggests a potential myeloprotective effect of acupuncture A larger trial is warranted to more definitively determine the efficacy of acupuncture on clinically important outcomes of chemotherapy-induced neutropenia
Acupuncture for the alleviation of hot flashes in men treated with androgen
ablation therapy Ashamalla H1 Jiang ML Guirguis A Peluso F Ashamalla M
bull Abstract bull PURPOSE bull Hot flashes are common side effect due to androgen ablation therapy (AAT) The utility of acupuncture for hot flashes in
men has not been thoroughly studied We prospectively studied the effect of acupuncture in men with hot flashes bull METHODS AND MATERIALS bull The study was approved by internal review board Seventeen men with hot flashes and history of AAT for prostate cancer
were enrolled Three men declined participation before receiving any treatment A hot flash score (HFS) was used to measure daily hot flashes The composite daily score was calculated as the product of frequency times severity The baseline daily scores were compared with scores taken at 2 and 6 weeks and at 8-month average follow-up
bull RESULTS bull No side effects were encountered during immediately after treatment or at 8 months The mean initial HFS was 283 it
dropped to 103 (p = 00001) at 2 weeks posttreatment 75 (p = 00001) at 6 weeks and 70 (p = 0001) at 8 months Clinical improvement for each patient is defined as the percent decrease in the mean HFS at each time point The mean improvement at Weeks 2 and 6 was 684 (mean HFS decreased from 37409 to 11836 p = 0001) and 892 (mean HFS decreased from 37409 to 405 p = 00078) respectively The improvement at 8 months was 803 (mean HFS decreased from 37409 to 7385 p = 0002)
bull CONCLUSIONS bull Acupuncture provides excellent control of hot flashes in men with a history of AAT The absence of side effects and the
durable response at 8 months are likely to be appealing to patients Prospective randomized study is warranted to further evaluate this modality against medical therapy
bull Copyright copy 2011 Elsevier Inc All rights reserved
bull Int J Radiat Oncol Biol Phys 2011 Apr 179(5)1358-63 doi 101016jijrobp201001025 Epub 2010 Jun 3
bull J Clin Oncol 2010 Mar 128(7)1154-60 doi 101200JCO2009234708 Epub 2010 Jan 25 bull Randomized blinded sham-controlled trial of acupuncture for the management of aromatase
inhibitor-associated joint symptoms in women with early-stage breast cancer bull Crew KD1 Capodice JL Greenlee H Brafman L Fuentes D Awad D Yann Tsai W Hershman DL bull Author information
bull Abstract bull PURPOSE Women with breast cancer (BC) treated with aromatase inhibitors (AIs) may experience
joint symptoms that can lead to discontinuation of effective therapy We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC METHODS We conducted a randomized controlled blinded study comparing true acupuncture (TA) versus sham acupuncture (SA) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs TA included full bodyauricular acupuncture and joint-specific point prescriptions whereas SA involved superficial needle insertion at nonacupoint locations Outcome measures included the Brief Pain Inventory-Short Form (BPI-SF) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH) obtained at baseline and at 3 and 6 weeks Results Of 51 women enrolled 43 women were randomly assigned and 38 were evaluable Baseline characteristics were comparable between the two groups Our primary end point was the difference in mean BPI-SF worst pain scores at 6 weeks which was lower for TA compared with SA (30 v 55 P lt 001) We also found differences between TA and SA in pain severity (26 v 45 P = 003) and pain-related interference (25 v 45 P = 002) at 6 weeks Similar findings were seen for the WOMAC and M-SACRAH scores The acupuncture intervention was well-tolerated CONCLUSION Women with AI-induced arthralgias treated with TA had significant improvement of joint pain and stiffness which was not seen with SA Acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect
Techniques and methods
Manual (Classic) Acupuncture
Electric-Acupuncture
Acupuncture and Moxibustion
Laser Acupuncture
Ultrasound Acupuncture
Acupuncture and the Moxibustion
Cupping Therapy
Indications
In 1979 WHO named 43 different diseases that can be
treated by Acupuncture
Upper Respiratory Tract
Acute sinusitis
Acute rhinitis
Common cold
Acute tonsillitis
Respiratory System
Acute Bronchitis
Bronchial asthma
Disorders of the Eye Acute conjunctivitis
Central retinitis
Myopia (in children)
Cataract (without
complications)
Disorders of the Mouth Toothache
Post-extraction pain
Gingivitis
Acute and chronic pharyngitis
Journal of World Health Organisation Dec1979
Known biological effects of
acupuncture
bullAcupuncture multiple biological responses
bullOccur locally or at a distance mediated by sensor neurons to many structures of the central nervous system -- leads to activation of pathways affecting various physiology systems in the brain as well as periphery Attention has been focused on the role of endogenous opioids in analgesia and anesthesia
bullActivate the hypothalamus and pituitary resulting in a broad spectrum of systemic effects
bullAlteration in secretion of neurotransmitters and neurohormones that causes changes in the regulation of blood flow both centrally and peripherally
bullEvidence of alteration of immune functions NIH Consensus Statement Online 1997 Nov 3-5 month day] 15(5)1-34
LES TRAITEMENTS
bull 1-la stagnation de Qi et la stase du Sang
bull dynamiser le sang et transformer la stase du sang
bull 2- accumulation des Toxines lieacutees agrave la Chaleur
bull clarifier la chaleur et deacutegager la Toxiciteacute
bull 3- deacuteficience de Qi Vital
bull soutenir le Qi Vital et cultiver la racine
bull 4- toutes les maladies proviennent des Glaires la plupart des masses qui se produisent dans le corps sont dues aux Glaires
bull transformer les Glaires et ramollir la dureteacute
Dans le diagnostic et le traitement des tumeurs la MTC considegravere leacutetat geacuteneacuteral du patient plutocirct que de se focaliser sur le cancer lui-mecircme ou les symptocircmes particuliers
Soutien psychologique
bull angoisse devant lrsquoinconnu
bull angoisse devant la douleur
bull angoisse devant le deacuteveloppement de la maladie et la perte de controcircle sur son propre corps
bull angoisse devant les effets secondaires dus aux divers traitements
bull angoisse devant les complications tardives dues aux divers traitements
bull angoisse devant le regard social porteacute sur le malade
bull angoisse devant la mort
Soutien psychologique
Ces informations reacutesonnent agrave lrsquointeacuterieur du patient ougrave elle
provoquent des dysfonctionnements qui
peuvent se manifester par
bull des maux de ventre
bull des palpitations
bull des troubles du sommeil
bull des difficulteacutes respiratoires
bull des douleurs diverses etc
Nauseacutees et vomissements
RAPPEL LrsquoEstomac
bull YANG
bull Controcircle le mucircrissement amp pourrissement de la nourriture
bull Controcircle le transport des essences de la nourriture Gouverne la descente du Qi fait descendre la nourriture transformeacutee vers lrsquoIntestin Grecircle
bull Si le mouvement de descente est perturbeacute par les pervers si il y a un mouvement ascendant de QI de lrsquoEstomac (agrave contre-sens- NI) il y a des VOMISSEMENTS
Nauseacutees et vomissements
LES VOMISSEMENTS SE MANIFESTENT QUAND LE QI DE LrsquoESTOMAC MONTE A LA PLACE DE DESCENDRE
Neuropathie
Avastine Xeloda Gemzar Cysplatine Taxol Fludara Alimta Procarbazine
points GI2 3 4 IG 2 3 C7 MC6 8 P7 9 F2 3 V60 VB41
traitement
preacutevention
LA DOULEUR DUE AU CANCER
bull Etiologie et physiopathologie
bull Lrsquoinvasion des pervers Externes - tout pervers srsquoil persiste peut provoquer le blocage des meacuteridiens et par la suite une stagnation de Qi et de Sg ou des troubles de Zang-Fu
bull Le deacuteregraveglement des eacutemotions
bull Le deacuteseacutequilibre de lrsquoalimentation
bull Une faiblesse de constitution
DIFFEacuteRENCIATION DE LA DOULEUR
SELON LA LOCALISATION bull dans le cancer du poumon souvent une sensibiliteacute au
P1 et V13 accompagneacutee de toux et de souffle court bull dans le cancer de lrsquoœsophage ou de lrsquoestomac une
sensibiliteacute au E34 et E42 accompagneacutee de nauseacutees dysphagie inappeacutetence
SELON LE VIDE ET LA PLEacuteNITUDE bull Vide douleurs souvent leacutegegraveres intermittentes
sourdes bull Pleacutenitude douleurs tensives lancinantes coliques
aigues
LA FATIGUE
XU LAO = fatigue par Vide = lrsquoeacutepuisement En Occident crsquoest le symptocircme le plus souvent invoqueacute et pas toujours ducirc au Vide
LA FATIGUE - eacutetiologie
bull La faiblesse constitutionnelle
bull Le surmenage
bull Lrsquoexcegraves drsquoactiviteacute physique
bull Lrsquoalimentation
bull Les maladies graves
bull Lrsquoexcegraves drsquoactiviteacute sexuelle
bull Lrsquoaccouchement
bull La consommation de drogues
LA FATIGUE - pathologie
bull Vide
bull Combinaison de Vide et de Pleacutenitude
bull Pleacutenitude
Contre-indications agrave lrsquoacupuncture
bull Des risques de laquo gros bras raquo apregraves curage axillaire
bull Des opeacuterations selon Halsted ou Patey
bull Des drainages lymphatiques
bull Pas drsquoaiguille du cocircteacute opeacutereacute
TCM in cancer treatments
bull Used mostly as adjuvant therapy before or during or
after surgery radiotherapy and chemotherapy
bull Remit the side-effects and toxicity of other treatments
bull Symptom control
bull Activate and strengthen immune system
bull For advanced cancer patients mainly palliative but it
can also prolong life in some cases
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 15 Number 7 2009
Acupuncture for Chemotherapy-Induced Neutropenia in Patients with GynecologiMalignancies A Pilot Randomized Sham-Controlled Clinical Trial
Weidong Lu MB MPH LicAc1ndash3 Ursula A Matulonis MD4 Anne Doherty-Gilman MPH1 Hang ScD3
Peter M Wayne PhD23 David S Rosenthal MD14 and Richard T Penson MD6
bull Abstract bull Objectives The objective of this study was to investigate the effect of acupuncture administered during mye-
losuppressive chemotherapy on white blood cell (WBC) count and absolute neutrophil count (ANC) in patients with ovarian cancer
bull Design This study is a pilot randomized sham-controlled clinical trial Patients received active acupuncture versus sham acupuncture while undergoing chemotherapy A standardized acupuncture protocol was em- ployed with manual and electrostimulation The frequency of treatment was 2ndash3 times per week for a total of 10 sessions starting 1 week before the second cycle of chemotherapy
bull Setting The setting was two outpatient academic centers for patients with cancer bull Subjects Twenty-one (21) newly diagnosed and recurrent ovarian cancer patients were the subjects bull Outcome measures WBC count ANC and plasma granulocyte colony-stimulating factor (G-CSF ) were assessed
weekly bull Results The median leukocyte value in the acupuncture arm at the first day of the third cycle of chemotherapy
was significantly higher than in the control arm after adjusting for baseline value (8600 cells=mL range 4800ndash 12000 versus 4400 cell=mL range 2300ndash10000) ( p frac14 0046) The incidence of grade 2ndash4 leukopenia was less in the acupuncture arm than in the sham arm (30 versus 90 p frac14 002) However the median leukocyte nadir neutrophil nadir and recovering ANC were all higher but not statistically significantly different ( p frac14 0116ndash016) after adjusting for baseline differences There were no statistically significant differences in plasma G-CSF between the two groups
bull Conclusions We observed clinically relevant trends of higher WBC values during one cycle of chemotherapy in patients with ovarian cancer which suggests a potential myeloprotective effect of acupuncture A larger trial is warranted to more definitively determine the efficacy of acupuncture on clinically important outcomes of chemotherapy-induced neutropenia
Acupuncture for the alleviation of hot flashes in men treated with androgen
ablation therapy Ashamalla H1 Jiang ML Guirguis A Peluso F Ashamalla M
bull Abstract bull PURPOSE bull Hot flashes are common side effect due to androgen ablation therapy (AAT) The utility of acupuncture for hot flashes in
men has not been thoroughly studied We prospectively studied the effect of acupuncture in men with hot flashes bull METHODS AND MATERIALS bull The study was approved by internal review board Seventeen men with hot flashes and history of AAT for prostate cancer
were enrolled Three men declined participation before receiving any treatment A hot flash score (HFS) was used to measure daily hot flashes The composite daily score was calculated as the product of frequency times severity The baseline daily scores were compared with scores taken at 2 and 6 weeks and at 8-month average follow-up
bull RESULTS bull No side effects were encountered during immediately after treatment or at 8 months The mean initial HFS was 283 it
dropped to 103 (p = 00001) at 2 weeks posttreatment 75 (p = 00001) at 6 weeks and 70 (p = 0001) at 8 months Clinical improvement for each patient is defined as the percent decrease in the mean HFS at each time point The mean improvement at Weeks 2 and 6 was 684 (mean HFS decreased from 37409 to 11836 p = 0001) and 892 (mean HFS decreased from 37409 to 405 p = 00078) respectively The improvement at 8 months was 803 (mean HFS decreased from 37409 to 7385 p = 0002)
bull CONCLUSIONS bull Acupuncture provides excellent control of hot flashes in men with a history of AAT The absence of side effects and the
durable response at 8 months are likely to be appealing to patients Prospective randomized study is warranted to further evaluate this modality against medical therapy
bull Copyright copy 2011 Elsevier Inc All rights reserved
bull Int J Radiat Oncol Biol Phys 2011 Apr 179(5)1358-63 doi 101016jijrobp201001025 Epub 2010 Jun 3
bull J Clin Oncol 2010 Mar 128(7)1154-60 doi 101200JCO2009234708 Epub 2010 Jan 25 bull Randomized blinded sham-controlled trial of acupuncture for the management of aromatase
inhibitor-associated joint symptoms in women with early-stage breast cancer bull Crew KD1 Capodice JL Greenlee H Brafman L Fuentes D Awad D Yann Tsai W Hershman DL bull Author information
bull Abstract bull PURPOSE Women with breast cancer (BC) treated with aromatase inhibitors (AIs) may experience
joint symptoms that can lead to discontinuation of effective therapy We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC METHODS We conducted a randomized controlled blinded study comparing true acupuncture (TA) versus sham acupuncture (SA) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs TA included full bodyauricular acupuncture and joint-specific point prescriptions whereas SA involved superficial needle insertion at nonacupoint locations Outcome measures included the Brief Pain Inventory-Short Form (BPI-SF) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH) obtained at baseline and at 3 and 6 weeks Results Of 51 women enrolled 43 women were randomly assigned and 38 were evaluable Baseline characteristics were comparable between the two groups Our primary end point was the difference in mean BPI-SF worst pain scores at 6 weeks which was lower for TA compared with SA (30 v 55 P lt 001) We also found differences between TA and SA in pain severity (26 v 45 P = 003) and pain-related interference (25 v 45 P = 002) at 6 weeks Similar findings were seen for the WOMAC and M-SACRAH scores The acupuncture intervention was well-tolerated CONCLUSION Women with AI-induced arthralgias treated with TA had significant improvement of joint pain and stiffness which was not seen with SA Acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect
Acupuncture and the Moxibustion
Cupping Therapy
Indications
In 1979 WHO named 43 different diseases that can be
treated by Acupuncture
Upper Respiratory Tract
Acute sinusitis
Acute rhinitis
Common cold
Acute tonsillitis
Respiratory System
Acute Bronchitis
Bronchial asthma
Disorders of the Eye Acute conjunctivitis
Central retinitis
Myopia (in children)
Cataract (without
complications)
Disorders of the Mouth Toothache
Post-extraction pain
Gingivitis
Acute and chronic pharyngitis
Journal of World Health Organisation Dec1979
Known biological effects of
acupuncture
bullAcupuncture multiple biological responses
bullOccur locally or at a distance mediated by sensor neurons to many structures of the central nervous system -- leads to activation of pathways affecting various physiology systems in the brain as well as periphery Attention has been focused on the role of endogenous opioids in analgesia and anesthesia
bullActivate the hypothalamus and pituitary resulting in a broad spectrum of systemic effects
bullAlteration in secretion of neurotransmitters and neurohormones that causes changes in the regulation of blood flow both centrally and peripherally
bullEvidence of alteration of immune functions NIH Consensus Statement Online 1997 Nov 3-5 month day] 15(5)1-34
LES TRAITEMENTS
bull 1-la stagnation de Qi et la stase du Sang
bull dynamiser le sang et transformer la stase du sang
bull 2- accumulation des Toxines lieacutees agrave la Chaleur
bull clarifier la chaleur et deacutegager la Toxiciteacute
bull 3- deacuteficience de Qi Vital
bull soutenir le Qi Vital et cultiver la racine
bull 4- toutes les maladies proviennent des Glaires la plupart des masses qui se produisent dans le corps sont dues aux Glaires
bull transformer les Glaires et ramollir la dureteacute
Dans le diagnostic et le traitement des tumeurs la MTC considegravere leacutetat geacuteneacuteral du patient plutocirct que de se focaliser sur le cancer lui-mecircme ou les symptocircmes particuliers
Soutien psychologique
bull angoisse devant lrsquoinconnu
bull angoisse devant la douleur
bull angoisse devant le deacuteveloppement de la maladie et la perte de controcircle sur son propre corps
bull angoisse devant les effets secondaires dus aux divers traitements
bull angoisse devant les complications tardives dues aux divers traitements
bull angoisse devant le regard social porteacute sur le malade
bull angoisse devant la mort
Soutien psychologique
Ces informations reacutesonnent agrave lrsquointeacuterieur du patient ougrave elle
provoquent des dysfonctionnements qui
peuvent se manifester par
bull des maux de ventre
bull des palpitations
bull des troubles du sommeil
bull des difficulteacutes respiratoires
bull des douleurs diverses etc
Nauseacutees et vomissements
RAPPEL LrsquoEstomac
bull YANG
bull Controcircle le mucircrissement amp pourrissement de la nourriture
bull Controcircle le transport des essences de la nourriture Gouverne la descente du Qi fait descendre la nourriture transformeacutee vers lrsquoIntestin Grecircle
bull Si le mouvement de descente est perturbeacute par les pervers si il y a un mouvement ascendant de QI de lrsquoEstomac (agrave contre-sens- NI) il y a des VOMISSEMENTS
Nauseacutees et vomissements
LES VOMISSEMENTS SE MANIFESTENT QUAND LE QI DE LrsquoESTOMAC MONTE A LA PLACE DE DESCENDRE
Neuropathie
Avastine Xeloda Gemzar Cysplatine Taxol Fludara Alimta Procarbazine
points GI2 3 4 IG 2 3 C7 MC6 8 P7 9 F2 3 V60 VB41
traitement
preacutevention
LA DOULEUR DUE AU CANCER
bull Etiologie et physiopathologie
bull Lrsquoinvasion des pervers Externes - tout pervers srsquoil persiste peut provoquer le blocage des meacuteridiens et par la suite une stagnation de Qi et de Sg ou des troubles de Zang-Fu
bull Le deacuteregraveglement des eacutemotions
bull Le deacuteseacutequilibre de lrsquoalimentation
bull Une faiblesse de constitution
DIFFEacuteRENCIATION DE LA DOULEUR
SELON LA LOCALISATION bull dans le cancer du poumon souvent une sensibiliteacute au
P1 et V13 accompagneacutee de toux et de souffle court bull dans le cancer de lrsquoœsophage ou de lrsquoestomac une
sensibiliteacute au E34 et E42 accompagneacutee de nauseacutees dysphagie inappeacutetence
SELON LE VIDE ET LA PLEacuteNITUDE bull Vide douleurs souvent leacutegegraveres intermittentes
sourdes bull Pleacutenitude douleurs tensives lancinantes coliques
aigues
LA FATIGUE
XU LAO = fatigue par Vide = lrsquoeacutepuisement En Occident crsquoest le symptocircme le plus souvent invoqueacute et pas toujours ducirc au Vide
LA FATIGUE - eacutetiologie
bull La faiblesse constitutionnelle
bull Le surmenage
bull Lrsquoexcegraves drsquoactiviteacute physique
bull Lrsquoalimentation
bull Les maladies graves
bull Lrsquoexcegraves drsquoactiviteacute sexuelle
bull Lrsquoaccouchement
bull La consommation de drogues
LA FATIGUE - pathologie
bull Vide
bull Combinaison de Vide et de Pleacutenitude
bull Pleacutenitude
Contre-indications agrave lrsquoacupuncture
bull Des risques de laquo gros bras raquo apregraves curage axillaire
bull Des opeacuterations selon Halsted ou Patey
bull Des drainages lymphatiques
bull Pas drsquoaiguille du cocircteacute opeacutereacute
TCM in cancer treatments
bull Used mostly as adjuvant therapy before or during or
after surgery radiotherapy and chemotherapy
bull Remit the side-effects and toxicity of other treatments
bull Symptom control
bull Activate and strengthen immune system
bull For advanced cancer patients mainly palliative but it
can also prolong life in some cases
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 15 Number 7 2009
Acupuncture for Chemotherapy-Induced Neutropenia in Patients with GynecologiMalignancies A Pilot Randomized Sham-Controlled Clinical Trial
Weidong Lu MB MPH LicAc1ndash3 Ursula A Matulonis MD4 Anne Doherty-Gilman MPH1 Hang ScD3
Peter M Wayne PhD23 David S Rosenthal MD14 and Richard T Penson MD6
bull Abstract bull Objectives The objective of this study was to investigate the effect of acupuncture administered during mye-
losuppressive chemotherapy on white blood cell (WBC) count and absolute neutrophil count (ANC) in patients with ovarian cancer
bull Design This study is a pilot randomized sham-controlled clinical trial Patients received active acupuncture versus sham acupuncture while undergoing chemotherapy A standardized acupuncture protocol was em- ployed with manual and electrostimulation The frequency of treatment was 2ndash3 times per week for a total of 10 sessions starting 1 week before the second cycle of chemotherapy
bull Setting The setting was two outpatient academic centers for patients with cancer bull Subjects Twenty-one (21) newly diagnosed and recurrent ovarian cancer patients were the subjects bull Outcome measures WBC count ANC and plasma granulocyte colony-stimulating factor (G-CSF ) were assessed
weekly bull Results The median leukocyte value in the acupuncture arm at the first day of the third cycle of chemotherapy
was significantly higher than in the control arm after adjusting for baseline value (8600 cells=mL range 4800ndash 12000 versus 4400 cell=mL range 2300ndash10000) ( p frac14 0046) The incidence of grade 2ndash4 leukopenia was less in the acupuncture arm than in the sham arm (30 versus 90 p frac14 002) However the median leukocyte nadir neutrophil nadir and recovering ANC were all higher but not statistically significantly different ( p frac14 0116ndash016) after adjusting for baseline differences There were no statistically significant differences in plasma G-CSF between the two groups
bull Conclusions We observed clinically relevant trends of higher WBC values during one cycle of chemotherapy in patients with ovarian cancer which suggests a potential myeloprotective effect of acupuncture A larger trial is warranted to more definitively determine the efficacy of acupuncture on clinically important outcomes of chemotherapy-induced neutropenia
Acupuncture for the alleviation of hot flashes in men treated with androgen
ablation therapy Ashamalla H1 Jiang ML Guirguis A Peluso F Ashamalla M
bull Abstract bull PURPOSE bull Hot flashes are common side effect due to androgen ablation therapy (AAT) The utility of acupuncture for hot flashes in
men has not been thoroughly studied We prospectively studied the effect of acupuncture in men with hot flashes bull METHODS AND MATERIALS bull The study was approved by internal review board Seventeen men with hot flashes and history of AAT for prostate cancer
were enrolled Three men declined participation before receiving any treatment A hot flash score (HFS) was used to measure daily hot flashes The composite daily score was calculated as the product of frequency times severity The baseline daily scores were compared with scores taken at 2 and 6 weeks and at 8-month average follow-up
bull RESULTS bull No side effects were encountered during immediately after treatment or at 8 months The mean initial HFS was 283 it
dropped to 103 (p = 00001) at 2 weeks posttreatment 75 (p = 00001) at 6 weeks and 70 (p = 0001) at 8 months Clinical improvement for each patient is defined as the percent decrease in the mean HFS at each time point The mean improvement at Weeks 2 and 6 was 684 (mean HFS decreased from 37409 to 11836 p = 0001) and 892 (mean HFS decreased from 37409 to 405 p = 00078) respectively The improvement at 8 months was 803 (mean HFS decreased from 37409 to 7385 p = 0002)
bull CONCLUSIONS bull Acupuncture provides excellent control of hot flashes in men with a history of AAT The absence of side effects and the
durable response at 8 months are likely to be appealing to patients Prospective randomized study is warranted to further evaluate this modality against medical therapy
bull Copyright copy 2011 Elsevier Inc All rights reserved
bull Int J Radiat Oncol Biol Phys 2011 Apr 179(5)1358-63 doi 101016jijrobp201001025 Epub 2010 Jun 3
bull J Clin Oncol 2010 Mar 128(7)1154-60 doi 101200JCO2009234708 Epub 2010 Jan 25 bull Randomized blinded sham-controlled trial of acupuncture for the management of aromatase
inhibitor-associated joint symptoms in women with early-stage breast cancer bull Crew KD1 Capodice JL Greenlee H Brafman L Fuentes D Awad D Yann Tsai W Hershman DL bull Author information
bull Abstract bull PURPOSE Women with breast cancer (BC) treated with aromatase inhibitors (AIs) may experience
joint symptoms that can lead to discontinuation of effective therapy We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC METHODS We conducted a randomized controlled blinded study comparing true acupuncture (TA) versus sham acupuncture (SA) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs TA included full bodyauricular acupuncture and joint-specific point prescriptions whereas SA involved superficial needle insertion at nonacupoint locations Outcome measures included the Brief Pain Inventory-Short Form (BPI-SF) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH) obtained at baseline and at 3 and 6 weeks Results Of 51 women enrolled 43 women were randomly assigned and 38 were evaluable Baseline characteristics were comparable between the two groups Our primary end point was the difference in mean BPI-SF worst pain scores at 6 weeks which was lower for TA compared with SA (30 v 55 P lt 001) We also found differences between TA and SA in pain severity (26 v 45 P = 003) and pain-related interference (25 v 45 P = 002) at 6 weeks Similar findings were seen for the WOMAC and M-SACRAH scores The acupuncture intervention was well-tolerated CONCLUSION Women with AI-induced arthralgias treated with TA had significant improvement of joint pain and stiffness which was not seen with SA Acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect
Cupping Therapy
Indications
In 1979 WHO named 43 different diseases that can be
treated by Acupuncture
Upper Respiratory Tract
Acute sinusitis
Acute rhinitis
Common cold
Acute tonsillitis
Respiratory System
Acute Bronchitis
Bronchial asthma
Disorders of the Eye Acute conjunctivitis
Central retinitis
Myopia (in children)
Cataract (without
complications)
Disorders of the Mouth Toothache
Post-extraction pain
Gingivitis
Acute and chronic pharyngitis
Journal of World Health Organisation Dec1979
Known biological effects of
acupuncture
bullAcupuncture multiple biological responses
bullOccur locally or at a distance mediated by sensor neurons to many structures of the central nervous system -- leads to activation of pathways affecting various physiology systems in the brain as well as periphery Attention has been focused on the role of endogenous opioids in analgesia and anesthesia
bullActivate the hypothalamus and pituitary resulting in a broad spectrum of systemic effects
bullAlteration in secretion of neurotransmitters and neurohormones that causes changes in the regulation of blood flow both centrally and peripherally
bullEvidence of alteration of immune functions NIH Consensus Statement Online 1997 Nov 3-5 month day] 15(5)1-34
LES TRAITEMENTS
bull 1-la stagnation de Qi et la stase du Sang
bull dynamiser le sang et transformer la stase du sang
bull 2- accumulation des Toxines lieacutees agrave la Chaleur
bull clarifier la chaleur et deacutegager la Toxiciteacute
bull 3- deacuteficience de Qi Vital
bull soutenir le Qi Vital et cultiver la racine
bull 4- toutes les maladies proviennent des Glaires la plupart des masses qui se produisent dans le corps sont dues aux Glaires
bull transformer les Glaires et ramollir la dureteacute
Dans le diagnostic et le traitement des tumeurs la MTC considegravere leacutetat geacuteneacuteral du patient plutocirct que de se focaliser sur le cancer lui-mecircme ou les symptocircmes particuliers
Soutien psychologique
bull angoisse devant lrsquoinconnu
bull angoisse devant la douleur
bull angoisse devant le deacuteveloppement de la maladie et la perte de controcircle sur son propre corps
bull angoisse devant les effets secondaires dus aux divers traitements
bull angoisse devant les complications tardives dues aux divers traitements
bull angoisse devant le regard social porteacute sur le malade
bull angoisse devant la mort
Soutien psychologique
Ces informations reacutesonnent agrave lrsquointeacuterieur du patient ougrave elle
provoquent des dysfonctionnements qui
peuvent se manifester par
bull des maux de ventre
bull des palpitations
bull des troubles du sommeil
bull des difficulteacutes respiratoires
bull des douleurs diverses etc
Nauseacutees et vomissements
RAPPEL LrsquoEstomac
bull YANG
bull Controcircle le mucircrissement amp pourrissement de la nourriture
bull Controcircle le transport des essences de la nourriture Gouverne la descente du Qi fait descendre la nourriture transformeacutee vers lrsquoIntestin Grecircle
bull Si le mouvement de descente est perturbeacute par les pervers si il y a un mouvement ascendant de QI de lrsquoEstomac (agrave contre-sens- NI) il y a des VOMISSEMENTS
Nauseacutees et vomissements
LES VOMISSEMENTS SE MANIFESTENT QUAND LE QI DE LrsquoESTOMAC MONTE A LA PLACE DE DESCENDRE
Neuropathie
Avastine Xeloda Gemzar Cysplatine Taxol Fludara Alimta Procarbazine
points GI2 3 4 IG 2 3 C7 MC6 8 P7 9 F2 3 V60 VB41
traitement
preacutevention
LA DOULEUR DUE AU CANCER
bull Etiologie et physiopathologie
bull Lrsquoinvasion des pervers Externes - tout pervers srsquoil persiste peut provoquer le blocage des meacuteridiens et par la suite une stagnation de Qi et de Sg ou des troubles de Zang-Fu
bull Le deacuteregraveglement des eacutemotions
bull Le deacuteseacutequilibre de lrsquoalimentation
bull Une faiblesse de constitution
DIFFEacuteRENCIATION DE LA DOULEUR
SELON LA LOCALISATION bull dans le cancer du poumon souvent une sensibiliteacute au
P1 et V13 accompagneacutee de toux et de souffle court bull dans le cancer de lrsquoœsophage ou de lrsquoestomac une
sensibiliteacute au E34 et E42 accompagneacutee de nauseacutees dysphagie inappeacutetence
SELON LE VIDE ET LA PLEacuteNITUDE bull Vide douleurs souvent leacutegegraveres intermittentes
sourdes bull Pleacutenitude douleurs tensives lancinantes coliques
aigues
LA FATIGUE
XU LAO = fatigue par Vide = lrsquoeacutepuisement En Occident crsquoest le symptocircme le plus souvent invoqueacute et pas toujours ducirc au Vide
LA FATIGUE - eacutetiologie
bull La faiblesse constitutionnelle
bull Le surmenage
bull Lrsquoexcegraves drsquoactiviteacute physique
bull Lrsquoalimentation
bull Les maladies graves
bull Lrsquoexcegraves drsquoactiviteacute sexuelle
bull Lrsquoaccouchement
bull La consommation de drogues
LA FATIGUE - pathologie
bull Vide
bull Combinaison de Vide et de Pleacutenitude
bull Pleacutenitude
Contre-indications agrave lrsquoacupuncture
bull Des risques de laquo gros bras raquo apregraves curage axillaire
bull Des opeacuterations selon Halsted ou Patey
bull Des drainages lymphatiques
bull Pas drsquoaiguille du cocircteacute opeacutereacute
TCM in cancer treatments
bull Used mostly as adjuvant therapy before or during or
after surgery radiotherapy and chemotherapy
bull Remit the side-effects and toxicity of other treatments
bull Symptom control
bull Activate and strengthen immune system
bull For advanced cancer patients mainly palliative but it
can also prolong life in some cases
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 15 Number 7 2009
Acupuncture for Chemotherapy-Induced Neutropenia in Patients with GynecologiMalignancies A Pilot Randomized Sham-Controlled Clinical Trial
Weidong Lu MB MPH LicAc1ndash3 Ursula A Matulonis MD4 Anne Doherty-Gilman MPH1 Hang ScD3
Peter M Wayne PhD23 David S Rosenthal MD14 and Richard T Penson MD6
bull Abstract bull Objectives The objective of this study was to investigate the effect of acupuncture administered during mye-
losuppressive chemotherapy on white blood cell (WBC) count and absolute neutrophil count (ANC) in patients with ovarian cancer
bull Design This study is a pilot randomized sham-controlled clinical trial Patients received active acupuncture versus sham acupuncture while undergoing chemotherapy A standardized acupuncture protocol was em- ployed with manual and electrostimulation The frequency of treatment was 2ndash3 times per week for a total of 10 sessions starting 1 week before the second cycle of chemotherapy
bull Setting The setting was two outpatient academic centers for patients with cancer bull Subjects Twenty-one (21) newly diagnosed and recurrent ovarian cancer patients were the subjects bull Outcome measures WBC count ANC and plasma granulocyte colony-stimulating factor (G-CSF ) were assessed
weekly bull Results The median leukocyte value in the acupuncture arm at the first day of the third cycle of chemotherapy
was significantly higher than in the control arm after adjusting for baseline value (8600 cells=mL range 4800ndash 12000 versus 4400 cell=mL range 2300ndash10000) ( p frac14 0046) The incidence of grade 2ndash4 leukopenia was less in the acupuncture arm than in the sham arm (30 versus 90 p frac14 002) However the median leukocyte nadir neutrophil nadir and recovering ANC were all higher but not statistically significantly different ( p frac14 0116ndash016) after adjusting for baseline differences There were no statistically significant differences in plasma G-CSF between the two groups
bull Conclusions We observed clinically relevant trends of higher WBC values during one cycle of chemotherapy in patients with ovarian cancer which suggests a potential myeloprotective effect of acupuncture A larger trial is warranted to more definitively determine the efficacy of acupuncture on clinically important outcomes of chemotherapy-induced neutropenia
Acupuncture for the alleviation of hot flashes in men treated with androgen
ablation therapy Ashamalla H1 Jiang ML Guirguis A Peluso F Ashamalla M
bull Abstract bull PURPOSE bull Hot flashes are common side effect due to androgen ablation therapy (AAT) The utility of acupuncture for hot flashes in
men has not been thoroughly studied We prospectively studied the effect of acupuncture in men with hot flashes bull METHODS AND MATERIALS bull The study was approved by internal review board Seventeen men with hot flashes and history of AAT for prostate cancer
were enrolled Three men declined participation before receiving any treatment A hot flash score (HFS) was used to measure daily hot flashes The composite daily score was calculated as the product of frequency times severity The baseline daily scores were compared with scores taken at 2 and 6 weeks and at 8-month average follow-up
bull RESULTS bull No side effects were encountered during immediately after treatment or at 8 months The mean initial HFS was 283 it
dropped to 103 (p = 00001) at 2 weeks posttreatment 75 (p = 00001) at 6 weeks and 70 (p = 0001) at 8 months Clinical improvement for each patient is defined as the percent decrease in the mean HFS at each time point The mean improvement at Weeks 2 and 6 was 684 (mean HFS decreased from 37409 to 11836 p = 0001) and 892 (mean HFS decreased from 37409 to 405 p = 00078) respectively The improvement at 8 months was 803 (mean HFS decreased from 37409 to 7385 p = 0002)
bull CONCLUSIONS bull Acupuncture provides excellent control of hot flashes in men with a history of AAT The absence of side effects and the
durable response at 8 months are likely to be appealing to patients Prospective randomized study is warranted to further evaluate this modality against medical therapy
bull Copyright copy 2011 Elsevier Inc All rights reserved
bull Int J Radiat Oncol Biol Phys 2011 Apr 179(5)1358-63 doi 101016jijrobp201001025 Epub 2010 Jun 3
bull J Clin Oncol 2010 Mar 128(7)1154-60 doi 101200JCO2009234708 Epub 2010 Jan 25 bull Randomized blinded sham-controlled trial of acupuncture for the management of aromatase
inhibitor-associated joint symptoms in women with early-stage breast cancer bull Crew KD1 Capodice JL Greenlee H Brafman L Fuentes D Awad D Yann Tsai W Hershman DL bull Author information
bull Abstract bull PURPOSE Women with breast cancer (BC) treated with aromatase inhibitors (AIs) may experience
joint symptoms that can lead to discontinuation of effective therapy We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC METHODS We conducted a randomized controlled blinded study comparing true acupuncture (TA) versus sham acupuncture (SA) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs TA included full bodyauricular acupuncture and joint-specific point prescriptions whereas SA involved superficial needle insertion at nonacupoint locations Outcome measures included the Brief Pain Inventory-Short Form (BPI-SF) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH) obtained at baseline and at 3 and 6 weeks Results Of 51 women enrolled 43 women were randomly assigned and 38 were evaluable Baseline characteristics were comparable between the two groups Our primary end point was the difference in mean BPI-SF worst pain scores at 6 weeks which was lower for TA compared with SA (30 v 55 P lt 001) We also found differences between TA and SA in pain severity (26 v 45 P = 003) and pain-related interference (25 v 45 P = 002) at 6 weeks Similar findings were seen for the WOMAC and M-SACRAH scores The acupuncture intervention was well-tolerated CONCLUSION Women with AI-induced arthralgias treated with TA had significant improvement of joint pain and stiffness which was not seen with SA Acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect
Indications
In 1979 WHO named 43 different diseases that can be
treated by Acupuncture
Upper Respiratory Tract
Acute sinusitis
Acute rhinitis
Common cold
Acute tonsillitis
Respiratory System
Acute Bronchitis
Bronchial asthma
Disorders of the Eye Acute conjunctivitis
Central retinitis
Myopia (in children)
Cataract (without
complications)
Disorders of the Mouth Toothache
Post-extraction pain
Gingivitis
Acute and chronic pharyngitis
Journal of World Health Organisation Dec1979
Known biological effects of
acupuncture
bullAcupuncture multiple biological responses
bullOccur locally or at a distance mediated by sensor neurons to many structures of the central nervous system -- leads to activation of pathways affecting various physiology systems in the brain as well as periphery Attention has been focused on the role of endogenous opioids in analgesia and anesthesia
bullActivate the hypothalamus and pituitary resulting in a broad spectrum of systemic effects
bullAlteration in secretion of neurotransmitters and neurohormones that causes changes in the regulation of blood flow both centrally and peripherally
bullEvidence of alteration of immune functions NIH Consensus Statement Online 1997 Nov 3-5 month day] 15(5)1-34
LES TRAITEMENTS
bull 1-la stagnation de Qi et la stase du Sang
bull dynamiser le sang et transformer la stase du sang
bull 2- accumulation des Toxines lieacutees agrave la Chaleur
bull clarifier la chaleur et deacutegager la Toxiciteacute
bull 3- deacuteficience de Qi Vital
bull soutenir le Qi Vital et cultiver la racine
bull 4- toutes les maladies proviennent des Glaires la plupart des masses qui se produisent dans le corps sont dues aux Glaires
bull transformer les Glaires et ramollir la dureteacute
Dans le diagnostic et le traitement des tumeurs la MTC considegravere leacutetat geacuteneacuteral du patient plutocirct que de se focaliser sur le cancer lui-mecircme ou les symptocircmes particuliers
Soutien psychologique
bull angoisse devant lrsquoinconnu
bull angoisse devant la douleur
bull angoisse devant le deacuteveloppement de la maladie et la perte de controcircle sur son propre corps
bull angoisse devant les effets secondaires dus aux divers traitements
bull angoisse devant les complications tardives dues aux divers traitements
bull angoisse devant le regard social porteacute sur le malade
bull angoisse devant la mort
Soutien psychologique
Ces informations reacutesonnent agrave lrsquointeacuterieur du patient ougrave elle
provoquent des dysfonctionnements qui
peuvent se manifester par
bull des maux de ventre
bull des palpitations
bull des troubles du sommeil
bull des difficulteacutes respiratoires
bull des douleurs diverses etc
Nauseacutees et vomissements
RAPPEL LrsquoEstomac
bull YANG
bull Controcircle le mucircrissement amp pourrissement de la nourriture
bull Controcircle le transport des essences de la nourriture Gouverne la descente du Qi fait descendre la nourriture transformeacutee vers lrsquoIntestin Grecircle
bull Si le mouvement de descente est perturbeacute par les pervers si il y a un mouvement ascendant de QI de lrsquoEstomac (agrave contre-sens- NI) il y a des VOMISSEMENTS
Nauseacutees et vomissements
LES VOMISSEMENTS SE MANIFESTENT QUAND LE QI DE LrsquoESTOMAC MONTE A LA PLACE DE DESCENDRE
Neuropathie
Avastine Xeloda Gemzar Cysplatine Taxol Fludara Alimta Procarbazine
points GI2 3 4 IG 2 3 C7 MC6 8 P7 9 F2 3 V60 VB41
traitement
preacutevention
LA DOULEUR DUE AU CANCER
bull Etiologie et physiopathologie
bull Lrsquoinvasion des pervers Externes - tout pervers srsquoil persiste peut provoquer le blocage des meacuteridiens et par la suite une stagnation de Qi et de Sg ou des troubles de Zang-Fu
bull Le deacuteregraveglement des eacutemotions
bull Le deacuteseacutequilibre de lrsquoalimentation
bull Une faiblesse de constitution
DIFFEacuteRENCIATION DE LA DOULEUR
SELON LA LOCALISATION bull dans le cancer du poumon souvent une sensibiliteacute au
P1 et V13 accompagneacutee de toux et de souffle court bull dans le cancer de lrsquoœsophage ou de lrsquoestomac une
sensibiliteacute au E34 et E42 accompagneacutee de nauseacutees dysphagie inappeacutetence
SELON LE VIDE ET LA PLEacuteNITUDE bull Vide douleurs souvent leacutegegraveres intermittentes
sourdes bull Pleacutenitude douleurs tensives lancinantes coliques
aigues
LA FATIGUE
XU LAO = fatigue par Vide = lrsquoeacutepuisement En Occident crsquoest le symptocircme le plus souvent invoqueacute et pas toujours ducirc au Vide
LA FATIGUE - eacutetiologie
bull La faiblesse constitutionnelle
bull Le surmenage
bull Lrsquoexcegraves drsquoactiviteacute physique
bull Lrsquoalimentation
bull Les maladies graves
bull Lrsquoexcegraves drsquoactiviteacute sexuelle
bull Lrsquoaccouchement
bull La consommation de drogues
LA FATIGUE - pathologie
bull Vide
bull Combinaison de Vide et de Pleacutenitude
bull Pleacutenitude
Contre-indications agrave lrsquoacupuncture
bull Des risques de laquo gros bras raquo apregraves curage axillaire
bull Des opeacuterations selon Halsted ou Patey
bull Des drainages lymphatiques
bull Pas drsquoaiguille du cocircteacute opeacutereacute
TCM in cancer treatments
bull Used mostly as adjuvant therapy before or during or
after surgery radiotherapy and chemotherapy
bull Remit the side-effects and toxicity of other treatments
bull Symptom control
bull Activate and strengthen immune system
bull For advanced cancer patients mainly palliative but it
can also prolong life in some cases
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 15 Number 7 2009
Acupuncture for Chemotherapy-Induced Neutropenia in Patients with GynecologiMalignancies A Pilot Randomized Sham-Controlled Clinical Trial
Weidong Lu MB MPH LicAc1ndash3 Ursula A Matulonis MD4 Anne Doherty-Gilman MPH1 Hang ScD3
Peter M Wayne PhD23 David S Rosenthal MD14 and Richard T Penson MD6
bull Abstract bull Objectives The objective of this study was to investigate the effect of acupuncture administered during mye-
losuppressive chemotherapy on white blood cell (WBC) count and absolute neutrophil count (ANC) in patients with ovarian cancer
bull Design This study is a pilot randomized sham-controlled clinical trial Patients received active acupuncture versus sham acupuncture while undergoing chemotherapy A standardized acupuncture protocol was em- ployed with manual and electrostimulation The frequency of treatment was 2ndash3 times per week for a total of 10 sessions starting 1 week before the second cycle of chemotherapy
bull Setting The setting was two outpatient academic centers for patients with cancer bull Subjects Twenty-one (21) newly diagnosed and recurrent ovarian cancer patients were the subjects bull Outcome measures WBC count ANC and plasma granulocyte colony-stimulating factor (G-CSF ) were assessed
weekly bull Results The median leukocyte value in the acupuncture arm at the first day of the third cycle of chemotherapy
was significantly higher than in the control arm after adjusting for baseline value (8600 cells=mL range 4800ndash 12000 versus 4400 cell=mL range 2300ndash10000) ( p frac14 0046) The incidence of grade 2ndash4 leukopenia was less in the acupuncture arm than in the sham arm (30 versus 90 p frac14 002) However the median leukocyte nadir neutrophil nadir and recovering ANC were all higher but not statistically significantly different ( p frac14 0116ndash016) after adjusting for baseline differences There were no statistically significant differences in plasma G-CSF between the two groups
bull Conclusions We observed clinically relevant trends of higher WBC values during one cycle of chemotherapy in patients with ovarian cancer which suggests a potential myeloprotective effect of acupuncture A larger trial is warranted to more definitively determine the efficacy of acupuncture on clinically important outcomes of chemotherapy-induced neutropenia
Acupuncture for the alleviation of hot flashes in men treated with androgen
ablation therapy Ashamalla H1 Jiang ML Guirguis A Peluso F Ashamalla M
bull Abstract bull PURPOSE bull Hot flashes are common side effect due to androgen ablation therapy (AAT) The utility of acupuncture for hot flashes in
men has not been thoroughly studied We prospectively studied the effect of acupuncture in men with hot flashes bull METHODS AND MATERIALS bull The study was approved by internal review board Seventeen men with hot flashes and history of AAT for prostate cancer
were enrolled Three men declined participation before receiving any treatment A hot flash score (HFS) was used to measure daily hot flashes The composite daily score was calculated as the product of frequency times severity The baseline daily scores were compared with scores taken at 2 and 6 weeks and at 8-month average follow-up
bull RESULTS bull No side effects were encountered during immediately after treatment or at 8 months The mean initial HFS was 283 it
dropped to 103 (p = 00001) at 2 weeks posttreatment 75 (p = 00001) at 6 weeks and 70 (p = 0001) at 8 months Clinical improvement for each patient is defined as the percent decrease in the mean HFS at each time point The mean improvement at Weeks 2 and 6 was 684 (mean HFS decreased from 37409 to 11836 p = 0001) and 892 (mean HFS decreased from 37409 to 405 p = 00078) respectively The improvement at 8 months was 803 (mean HFS decreased from 37409 to 7385 p = 0002)
bull CONCLUSIONS bull Acupuncture provides excellent control of hot flashes in men with a history of AAT The absence of side effects and the
durable response at 8 months are likely to be appealing to patients Prospective randomized study is warranted to further evaluate this modality against medical therapy
bull Copyright copy 2011 Elsevier Inc All rights reserved
bull Int J Radiat Oncol Biol Phys 2011 Apr 179(5)1358-63 doi 101016jijrobp201001025 Epub 2010 Jun 3
bull J Clin Oncol 2010 Mar 128(7)1154-60 doi 101200JCO2009234708 Epub 2010 Jan 25 bull Randomized blinded sham-controlled trial of acupuncture for the management of aromatase
inhibitor-associated joint symptoms in women with early-stage breast cancer bull Crew KD1 Capodice JL Greenlee H Brafman L Fuentes D Awad D Yann Tsai W Hershman DL bull Author information
bull Abstract bull PURPOSE Women with breast cancer (BC) treated with aromatase inhibitors (AIs) may experience
joint symptoms that can lead to discontinuation of effective therapy We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC METHODS We conducted a randomized controlled blinded study comparing true acupuncture (TA) versus sham acupuncture (SA) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs TA included full bodyauricular acupuncture and joint-specific point prescriptions whereas SA involved superficial needle insertion at nonacupoint locations Outcome measures included the Brief Pain Inventory-Short Form (BPI-SF) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH) obtained at baseline and at 3 and 6 weeks Results Of 51 women enrolled 43 women were randomly assigned and 38 were evaluable Baseline characteristics were comparable between the two groups Our primary end point was the difference in mean BPI-SF worst pain scores at 6 weeks which was lower for TA compared with SA (30 v 55 P lt 001) We also found differences between TA and SA in pain severity (26 v 45 P = 003) and pain-related interference (25 v 45 P = 002) at 6 weeks Similar findings were seen for the WOMAC and M-SACRAH scores The acupuncture intervention was well-tolerated CONCLUSION Women with AI-induced arthralgias treated with TA had significant improvement of joint pain and stiffness which was not seen with SA Acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect
Known biological effects of
acupuncture
bullAcupuncture multiple biological responses
bullOccur locally or at a distance mediated by sensor neurons to many structures of the central nervous system -- leads to activation of pathways affecting various physiology systems in the brain as well as periphery Attention has been focused on the role of endogenous opioids in analgesia and anesthesia
bullActivate the hypothalamus and pituitary resulting in a broad spectrum of systemic effects
bullAlteration in secretion of neurotransmitters and neurohormones that causes changes in the regulation of blood flow both centrally and peripherally
bullEvidence of alteration of immune functions NIH Consensus Statement Online 1997 Nov 3-5 month day] 15(5)1-34
LES TRAITEMENTS
bull 1-la stagnation de Qi et la stase du Sang
bull dynamiser le sang et transformer la stase du sang
bull 2- accumulation des Toxines lieacutees agrave la Chaleur
bull clarifier la chaleur et deacutegager la Toxiciteacute
bull 3- deacuteficience de Qi Vital
bull soutenir le Qi Vital et cultiver la racine
bull 4- toutes les maladies proviennent des Glaires la plupart des masses qui se produisent dans le corps sont dues aux Glaires
bull transformer les Glaires et ramollir la dureteacute
Dans le diagnostic et le traitement des tumeurs la MTC considegravere leacutetat geacuteneacuteral du patient plutocirct que de se focaliser sur le cancer lui-mecircme ou les symptocircmes particuliers
Soutien psychologique
bull angoisse devant lrsquoinconnu
bull angoisse devant la douleur
bull angoisse devant le deacuteveloppement de la maladie et la perte de controcircle sur son propre corps
bull angoisse devant les effets secondaires dus aux divers traitements
bull angoisse devant les complications tardives dues aux divers traitements
bull angoisse devant le regard social porteacute sur le malade
bull angoisse devant la mort
Soutien psychologique
Ces informations reacutesonnent agrave lrsquointeacuterieur du patient ougrave elle
provoquent des dysfonctionnements qui
peuvent se manifester par
bull des maux de ventre
bull des palpitations
bull des troubles du sommeil
bull des difficulteacutes respiratoires
bull des douleurs diverses etc
Nauseacutees et vomissements
RAPPEL LrsquoEstomac
bull YANG
bull Controcircle le mucircrissement amp pourrissement de la nourriture
bull Controcircle le transport des essences de la nourriture Gouverne la descente du Qi fait descendre la nourriture transformeacutee vers lrsquoIntestin Grecircle
bull Si le mouvement de descente est perturbeacute par les pervers si il y a un mouvement ascendant de QI de lrsquoEstomac (agrave contre-sens- NI) il y a des VOMISSEMENTS
Nauseacutees et vomissements
LES VOMISSEMENTS SE MANIFESTENT QUAND LE QI DE LrsquoESTOMAC MONTE A LA PLACE DE DESCENDRE
Neuropathie
Avastine Xeloda Gemzar Cysplatine Taxol Fludara Alimta Procarbazine
points GI2 3 4 IG 2 3 C7 MC6 8 P7 9 F2 3 V60 VB41
traitement
preacutevention
LA DOULEUR DUE AU CANCER
bull Etiologie et physiopathologie
bull Lrsquoinvasion des pervers Externes - tout pervers srsquoil persiste peut provoquer le blocage des meacuteridiens et par la suite une stagnation de Qi et de Sg ou des troubles de Zang-Fu
bull Le deacuteregraveglement des eacutemotions
bull Le deacuteseacutequilibre de lrsquoalimentation
bull Une faiblesse de constitution
DIFFEacuteRENCIATION DE LA DOULEUR
SELON LA LOCALISATION bull dans le cancer du poumon souvent une sensibiliteacute au
P1 et V13 accompagneacutee de toux et de souffle court bull dans le cancer de lrsquoœsophage ou de lrsquoestomac une
sensibiliteacute au E34 et E42 accompagneacutee de nauseacutees dysphagie inappeacutetence
SELON LE VIDE ET LA PLEacuteNITUDE bull Vide douleurs souvent leacutegegraveres intermittentes
sourdes bull Pleacutenitude douleurs tensives lancinantes coliques
aigues
LA FATIGUE
XU LAO = fatigue par Vide = lrsquoeacutepuisement En Occident crsquoest le symptocircme le plus souvent invoqueacute et pas toujours ducirc au Vide
LA FATIGUE - eacutetiologie
bull La faiblesse constitutionnelle
bull Le surmenage
bull Lrsquoexcegraves drsquoactiviteacute physique
bull Lrsquoalimentation
bull Les maladies graves
bull Lrsquoexcegraves drsquoactiviteacute sexuelle
bull Lrsquoaccouchement
bull La consommation de drogues
LA FATIGUE - pathologie
bull Vide
bull Combinaison de Vide et de Pleacutenitude
bull Pleacutenitude
Contre-indications agrave lrsquoacupuncture
bull Des risques de laquo gros bras raquo apregraves curage axillaire
bull Des opeacuterations selon Halsted ou Patey
bull Des drainages lymphatiques
bull Pas drsquoaiguille du cocircteacute opeacutereacute
TCM in cancer treatments
bull Used mostly as adjuvant therapy before or during or
after surgery radiotherapy and chemotherapy
bull Remit the side-effects and toxicity of other treatments
bull Symptom control
bull Activate and strengthen immune system
bull For advanced cancer patients mainly palliative but it
can also prolong life in some cases
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 15 Number 7 2009
Acupuncture for Chemotherapy-Induced Neutropenia in Patients with GynecologiMalignancies A Pilot Randomized Sham-Controlled Clinical Trial
Weidong Lu MB MPH LicAc1ndash3 Ursula A Matulonis MD4 Anne Doherty-Gilman MPH1 Hang ScD3
Peter M Wayne PhD23 David S Rosenthal MD14 and Richard T Penson MD6
bull Abstract bull Objectives The objective of this study was to investigate the effect of acupuncture administered during mye-
losuppressive chemotherapy on white blood cell (WBC) count and absolute neutrophil count (ANC) in patients with ovarian cancer
bull Design This study is a pilot randomized sham-controlled clinical trial Patients received active acupuncture versus sham acupuncture while undergoing chemotherapy A standardized acupuncture protocol was em- ployed with manual and electrostimulation The frequency of treatment was 2ndash3 times per week for a total of 10 sessions starting 1 week before the second cycle of chemotherapy
bull Setting The setting was two outpatient academic centers for patients with cancer bull Subjects Twenty-one (21) newly diagnosed and recurrent ovarian cancer patients were the subjects bull Outcome measures WBC count ANC and plasma granulocyte colony-stimulating factor (G-CSF ) were assessed
weekly bull Results The median leukocyte value in the acupuncture arm at the first day of the third cycle of chemotherapy
was significantly higher than in the control arm after adjusting for baseline value (8600 cells=mL range 4800ndash 12000 versus 4400 cell=mL range 2300ndash10000) ( p frac14 0046) The incidence of grade 2ndash4 leukopenia was less in the acupuncture arm than in the sham arm (30 versus 90 p frac14 002) However the median leukocyte nadir neutrophil nadir and recovering ANC were all higher but not statistically significantly different ( p frac14 0116ndash016) after adjusting for baseline differences There were no statistically significant differences in plasma G-CSF between the two groups
bull Conclusions We observed clinically relevant trends of higher WBC values during one cycle of chemotherapy in patients with ovarian cancer which suggests a potential myeloprotective effect of acupuncture A larger trial is warranted to more definitively determine the efficacy of acupuncture on clinically important outcomes of chemotherapy-induced neutropenia
Acupuncture for the alleviation of hot flashes in men treated with androgen
ablation therapy Ashamalla H1 Jiang ML Guirguis A Peluso F Ashamalla M
bull Abstract bull PURPOSE bull Hot flashes are common side effect due to androgen ablation therapy (AAT) The utility of acupuncture for hot flashes in
men has not been thoroughly studied We prospectively studied the effect of acupuncture in men with hot flashes bull METHODS AND MATERIALS bull The study was approved by internal review board Seventeen men with hot flashes and history of AAT for prostate cancer
were enrolled Three men declined participation before receiving any treatment A hot flash score (HFS) was used to measure daily hot flashes The composite daily score was calculated as the product of frequency times severity The baseline daily scores were compared with scores taken at 2 and 6 weeks and at 8-month average follow-up
bull RESULTS bull No side effects were encountered during immediately after treatment or at 8 months The mean initial HFS was 283 it
dropped to 103 (p = 00001) at 2 weeks posttreatment 75 (p = 00001) at 6 weeks and 70 (p = 0001) at 8 months Clinical improvement for each patient is defined as the percent decrease in the mean HFS at each time point The mean improvement at Weeks 2 and 6 was 684 (mean HFS decreased from 37409 to 11836 p = 0001) and 892 (mean HFS decreased from 37409 to 405 p = 00078) respectively The improvement at 8 months was 803 (mean HFS decreased from 37409 to 7385 p = 0002)
bull CONCLUSIONS bull Acupuncture provides excellent control of hot flashes in men with a history of AAT The absence of side effects and the
durable response at 8 months are likely to be appealing to patients Prospective randomized study is warranted to further evaluate this modality against medical therapy
bull Copyright copy 2011 Elsevier Inc All rights reserved
bull Int J Radiat Oncol Biol Phys 2011 Apr 179(5)1358-63 doi 101016jijrobp201001025 Epub 2010 Jun 3
bull J Clin Oncol 2010 Mar 128(7)1154-60 doi 101200JCO2009234708 Epub 2010 Jan 25 bull Randomized blinded sham-controlled trial of acupuncture for the management of aromatase
inhibitor-associated joint symptoms in women with early-stage breast cancer bull Crew KD1 Capodice JL Greenlee H Brafman L Fuentes D Awad D Yann Tsai W Hershman DL bull Author information
bull Abstract bull PURPOSE Women with breast cancer (BC) treated with aromatase inhibitors (AIs) may experience
joint symptoms that can lead to discontinuation of effective therapy We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC METHODS We conducted a randomized controlled blinded study comparing true acupuncture (TA) versus sham acupuncture (SA) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs TA included full bodyauricular acupuncture and joint-specific point prescriptions whereas SA involved superficial needle insertion at nonacupoint locations Outcome measures included the Brief Pain Inventory-Short Form (BPI-SF) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH) obtained at baseline and at 3 and 6 weeks Results Of 51 women enrolled 43 women were randomly assigned and 38 were evaluable Baseline characteristics were comparable between the two groups Our primary end point was the difference in mean BPI-SF worst pain scores at 6 weeks which was lower for TA compared with SA (30 v 55 P lt 001) We also found differences between TA and SA in pain severity (26 v 45 P = 003) and pain-related interference (25 v 45 P = 002) at 6 weeks Similar findings were seen for the WOMAC and M-SACRAH scores The acupuncture intervention was well-tolerated CONCLUSION Women with AI-induced arthralgias treated with TA had significant improvement of joint pain and stiffness which was not seen with SA Acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect
LES TRAITEMENTS
bull 1-la stagnation de Qi et la stase du Sang
bull dynamiser le sang et transformer la stase du sang
bull 2- accumulation des Toxines lieacutees agrave la Chaleur
bull clarifier la chaleur et deacutegager la Toxiciteacute
bull 3- deacuteficience de Qi Vital
bull soutenir le Qi Vital et cultiver la racine
bull 4- toutes les maladies proviennent des Glaires la plupart des masses qui se produisent dans le corps sont dues aux Glaires
bull transformer les Glaires et ramollir la dureteacute
Dans le diagnostic et le traitement des tumeurs la MTC considegravere leacutetat geacuteneacuteral du patient plutocirct que de se focaliser sur le cancer lui-mecircme ou les symptocircmes particuliers
Soutien psychologique
bull angoisse devant lrsquoinconnu
bull angoisse devant la douleur
bull angoisse devant le deacuteveloppement de la maladie et la perte de controcircle sur son propre corps
bull angoisse devant les effets secondaires dus aux divers traitements
bull angoisse devant les complications tardives dues aux divers traitements
bull angoisse devant le regard social porteacute sur le malade
bull angoisse devant la mort
Soutien psychologique
Ces informations reacutesonnent agrave lrsquointeacuterieur du patient ougrave elle
provoquent des dysfonctionnements qui
peuvent se manifester par
bull des maux de ventre
bull des palpitations
bull des troubles du sommeil
bull des difficulteacutes respiratoires
bull des douleurs diverses etc
Nauseacutees et vomissements
RAPPEL LrsquoEstomac
bull YANG
bull Controcircle le mucircrissement amp pourrissement de la nourriture
bull Controcircle le transport des essences de la nourriture Gouverne la descente du Qi fait descendre la nourriture transformeacutee vers lrsquoIntestin Grecircle
bull Si le mouvement de descente est perturbeacute par les pervers si il y a un mouvement ascendant de QI de lrsquoEstomac (agrave contre-sens- NI) il y a des VOMISSEMENTS
Nauseacutees et vomissements
LES VOMISSEMENTS SE MANIFESTENT QUAND LE QI DE LrsquoESTOMAC MONTE A LA PLACE DE DESCENDRE
Neuropathie
Avastine Xeloda Gemzar Cysplatine Taxol Fludara Alimta Procarbazine
points GI2 3 4 IG 2 3 C7 MC6 8 P7 9 F2 3 V60 VB41
traitement
preacutevention
LA DOULEUR DUE AU CANCER
bull Etiologie et physiopathologie
bull Lrsquoinvasion des pervers Externes - tout pervers srsquoil persiste peut provoquer le blocage des meacuteridiens et par la suite une stagnation de Qi et de Sg ou des troubles de Zang-Fu
bull Le deacuteregraveglement des eacutemotions
bull Le deacuteseacutequilibre de lrsquoalimentation
bull Une faiblesse de constitution
DIFFEacuteRENCIATION DE LA DOULEUR
SELON LA LOCALISATION bull dans le cancer du poumon souvent une sensibiliteacute au
P1 et V13 accompagneacutee de toux et de souffle court bull dans le cancer de lrsquoœsophage ou de lrsquoestomac une
sensibiliteacute au E34 et E42 accompagneacutee de nauseacutees dysphagie inappeacutetence
SELON LE VIDE ET LA PLEacuteNITUDE bull Vide douleurs souvent leacutegegraveres intermittentes
sourdes bull Pleacutenitude douleurs tensives lancinantes coliques
aigues
LA FATIGUE
XU LAO = fatigue par Vide = lrsquoeacutepuisement En Occident crsquoest le symptocircme le plus souvent invoqueacute et pas toujours ducirc au Vide
LA FATIGUE - eacutetiologie
bull La faiblesse constitutionnelle
bull Le surmenage
bull Lrsquoexcegraves drsquoactiviteacute physique
bull Lrsquoalimentation
bull Les maladies graves
bull Lrsquoexcegraves drsquoactiviteacute sexuelle
bull Lrsquoaccouchement
bull La consommation de drogues
LA FATIGUE - pathologie
bull Vide
bull Combinaison de Vide et de Pleacutenitude
bull Pleacutenitude
Contre-indications agrave lrsquoacupuncture
bull Des risques de laquo gros bras raquo apregraves curage axillaire
bull Des opeacuterations selon Halsted ou Patey
bull Des drainages lymphatiques
bull Pas drsquoaiguille du cocircteacute opeacutereacute
TCM in cancer treatments
bull Used mostly as adjuvant therapy before or during or
after surgery radiotherapy and chemotherapy
bull Remit the side-effects and toxicity of other treatments
bull Symptom control
bull Activate and strengthen immune system
bull For advanced cancer patients mainly palliative but it
can also prolong life in some cases
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 15 Number 7 2009
Acupuncture for Chemotherapy-Induced Neutropenia in Patients with GynecologiMalignancies A Pilot Randomized Sham-Controlled Clinical Trial
Weidong Lu MB MPH LicAc1ndash3 Ursula A Matulonis MD4 Anne Doherty-Gilman MPH1 Hang ScD3
Peter M Wayne PhD23 David S Rosenthal MD14 and Richard T Penson MD6
bull Abstract bull Objectives The objective of this study was to investigate the effect of acupuncture administered during mye-
losuppressive chemotherapy on white blood cell (WBC) count and absolute neutrophil count (ANC) in patients with ovarian cancer
bull Design This study is a pilot randomized sham-controlled clinical trial Patients received active acupuncture versus sham acupuncture while undergoing chemotherapy A standardized acupuncture protocol was em- ployed with manual and electrostimulation The frequency of treatment was 2ndash3 times per week for a total of 10 sessions starting 1 week before the second cycle of chemotherapy
bull Setting The setting was two outpatient academic centers for patients with cancer bull Subjects Twenty-one (21) newly diagnosed and recurrent ovarian cancer patients were the subjects bull Outcome measures WBC count ANC and plasma granulocyte colony-stimulating factor (G-CSF ) were assessed
weekly bull Results The median leukocyte value in the acupuncture arm at the first day of the third cycle of chemotherapy
was significantly higher than in the control arm after adjusting for baseline value (8600 cells=mL range 4800ndash 12000 versus 4400 cell=mL range 2300ndash10000) ( p frac14 0046) The incidence of grade 2ndash4 leukopenia was less in the acupuncture arm than in the sham arm (30 versus 90 p frac14 002) However the median leukocyte nadir neutrophil nadir and recovering ANC were all higher but not statistically significantly different ( p frac14 0116ndash016) after adjusting for baseline differences There were no statistically significant differences in plasma G-CSF between the two groups
bull Conclusions We observed clinically relevant trends of higher WBC values during one cycle of chemotherapy in patients with ovarian cancer which suggests a potential myeloprotective effect of acupuncture A larger trial is warranted to more definitively determine the efficacy of acupuncture on clinically important outcomes of chemotherapy-induced neutropenia
Acupuncture for the alleviation of hot flashes in men treated with androgen
ablation therapy Ashamalla H1 Jiang ML Guirguis A Peluso F Ashamalla M
bull Abstract bull PURPOSE bull Hot flashes are common side effect due to androgen ablation therapy (AAT) The utility of acupuncture for hot flashes in
men has not been thoroughly studied We prospectively studied the effect of acupuncture in men with hot flashes bull METHODS AND MATERIALS bull The study was approved by internal review board Seventeen men with hot flashes and history of AAT for prostate cancer
were enrolled Three men declined participation before receiving any treatment A hot flash score (HFS) was used to measure daily hot flashes The composite daily score was calculated as the product of frequency times severity The baseline daily scores were compared with scores taken at 2 and 6 weeks and at 8-month average follow-up
bull RESULTS bull No side effects were encountered during immediately after treatment or at 8 months The mean initial HFS was 283 it
dropped to 103 (p = 00001) at 2 weeks posttreatment 75 (p = 00001) at 6 weeks and 70 (p = 0001) at 8 months Clinical improvement for each patient is defined as the percent decrease in the mean HFS at each time point The mean improvement at Weeks 2 and 6 was 684 (mean HFS decreased from 37409 to 11836 p = 0001) and 892 (mean HFS decreased from 37409 to 405 p = 00078) respectively The improvement at 8 months was 803 (mean HFS decreased from 37409 to 7385 p = 0002)
bull CONCLUSIONS bull Acupuncture provides excellent control of hot flashes in men with a history of AAT The absence of side effects and the
durable response at 8 months are likely to be appealing to patients Prospective randomized study is warranted to further evaluate this modality against medical therapy
bull Copyright copy 2011 Elsevier Inc All rights reserved
bull Int J Radiat Oncol Biol Phys 2011 Apr 179(5)1358-63 doi 101016jijrobp201001025 Epub 2010 Jun 3
bull J Clin Oncol 2010 Mar 128(7)1154-60 doi 101200JCO2009234708 Epub 2010 Jan 25 bull Randomized blinded sham-controlled trial of acupuncture for the management of aromatase
inhibitor-associated joint symptoms in women with early-stage breast cancer bull Crew KD1 Capodice JL Greenlee H Brafman L Fuentes D Awad D Yann Tsai W Hershman DL bull Author information
bull Abstract bull PURPOSE Women with breast cancer (BC) treated with aromatase inhibitors (AIs) may experience
joint symptoms that can lead to discontinuation of effective therapy We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC METHODS We conducted a randomized controlled blinded study comparing true acupuncture (TA) versus sham acupuncture (SA) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs TA included full bodyauricular acupuncture and joint-specific point prescriptions whereas SA involved superficial needle insertion at nonacupoint locations Outcome measures included the Brief Pain Inventory-Short Form (BPI-SF) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH) obtained at baseline and at 3 and 6 weeks Results Of 51 women enrolled 43 women were randomly assigned and 38 were evaluable Baseline characteristics were comparable between the two groups Our primary end point was the difference in mean BPI-SF worst pain scores at 6 weeks which was lower for TA compared with SA (30 v 55 P lt 001) We also found differences between TA and SA in pain severity (26 v 45 P = 003) and pain-related interference (25 v 45 P = 002) at 6 weeks Similar findings were seen for the WOMAC and M-SACRAH scores The acupuncture intervention was well-tolerated CONCLUSION Women with AI-induced arthralgias treated with TA had significant improvement of joint pain and stiffness which was not seen with SA Acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect
Dans le diagnostic et le traitement des tumeurs la MTC considegravere leacutetat geacuteneacuteral du patient plutocirct que de se focaliser sur le cancer lui-mecircme ou les symptocircmes particuliers
Soutien psychologique
bull angoisse devant lrsquoinconnu
bull angoisse devant la douleur
bull angoisse devant le deacuteveloppement de la maladie et la perte de controcircle sur son propre corps
bull angoisse devant les effets secondaires dus aux divers traitements
bull angoisse devant les complications tardives dues aux divers traitements
bull angoisse devant le regard social porteacute sur le malade
bull angoisse devant la mort
Soutien psychologique
Ces informations reacutesonnent agrave lrsquointeacuterieur du patient ougrave elle
provoquent des dysfonctionnements qui
peuvent se manifester par
bull des maux de ventre
bull des palpitations
bull des troubles du sommeil
bull des difficulteacutes respiratoires
bull des douleurs diverses etc
Nauseacutees et vomissements
RAPPEL LrsquoEstomac
bull YANG
bull Controcircle le mucircrissement amp pourrissement de la nourriture
bull Controcircle le transport des essences de la nourriture Gouverne la descente du Qi fait descendre la nourriture transformeacutee vers lrsquoIntestin Grecircle
bull Si le mouvement de descente est perturbeacute par les pervers si il y a un mouvement ascendant de QI de lrsquoEstomac (agrave contre-sens- NI) il y a des VOMISSEMENTS
Nauseacutees et vomissements
LES VOMISSEMENTS SE MANIFESTENT QUAND LE QI DE LrsquoESTOMAC MONTE A LA PLACE DE DESCENDRE
Neuropathie
Avastine Xeloda Gemzar Cysplatine Taxol Fludara Alimta Procarbazine
points GI2 3 4 IG 2 3 C7 MC6 8 P7 9 F2 3 V60 VB41
traitement
preacutevention
LA DOULEUR DUE AU CANCER
bull Etiologie et physiopathologie
bull Lrsquoinvasion des pervers Externes - tout pervers srsquoil persiste peut provoquer le blocage des meacuteridiens et par la suite une stagnation de Qi et de Sg ou des troubles de Zang-Fu
bull Le deacuteregraveglement des eacutemotions
bull Le deacuteseacutequilibre de lrsquoalimentation
bull Une faiblesse de constitution
DIFFEacuteRENCIATION DE LA DOULEUR
SELON LA LOCALISATION bull dans le cancer du poumon souvent une sensibiliteacute au
P1 et V13 accompagneacutee de toux et de souffle court bull dans le cancer de lrsquoœsophage ou de lrsquoestomac une
sensibiliteacute au E34 et E42 accompagneacutee de nauseacutees dysphagie inappeacutetence
SELON LE VIDE ET LA PLEacuteNITUDE bull Vide douleurs souvent leacutegegraveres intermittentes
sourdes bull Pleacutenitude douleurs tensives lancinantes coliques
aigues
LA FATIGUE
XU LAO = fatigue par Vide = lrsquoeacutepuisement En Occident crsquoest le symptocircme le plus souvent invoqueacute et pas toujours ducirc au Vide
LA FATIGUE - eacutetiologie
bull La faiblesse constitutionnelle
bull Le surmenage
bull Lrsquoexcegraves drsquoactiviteacute physique
bull Lrsquoalimentation
bull Les maladies graves
bull Lrsquoexcegraves drsquoactiviteacute sexuelle
bull Lrsquoaccouchement
bull La consommation de drogues
LA FATIGUE - pathologie
bull Vide
bull Combinaison de Vide et de Pleacutenitude
bull Pleacutenitude
Contre-indications agrave lrsquoacupuncture
bull Des risques de laquo gros bras raquo apregraves curage axillaire
bull Des opeacuterations selon Halsted ou Patey
bull Des drainages lymphatiques
bull Pas drsquoaiguille du cocircteacute opeacutereacute
TCM in cancer treatments
bull Used mostly as adjuvant therapy before or during or
after surgery radiotherapy and chemotherapy
bull Remit the side-effects and toxicity of other treatments
bull Symptom control
bull Activate and strengthen immune system
bull For advanced cancer patients mainly palliative but it
can also prolong life in some cases
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 15 Number 7 2009
Acupuncture for Chemotherapy-Induced Neutropenia in Patients with GynecologiMalignancies A Pilot Randomized Sham-Controlled Clinical Trial
Weidong Lu MB MPH LicAc1ndash3 Ursula A Matulonis MD4 Anne Doherty-Gilman MPH1 Hang ScD3
Peter M Wayne PhD23 David S Rosenthal MD14 and Richard T Penson MD6
bull Abstract bull Objectives The objective of this study was to investigate the effect of acupuncture administered during mye-
losuppressive chemotherapy on white blood cell (WBC) count and absolute neutrophil count (ANC) in patients with ovarian cancer
bull Design This study is a pilot randomized sham-controlled clinical trial Patients received active acupuncture versus sham acupuncture while undergoing chemotherapy A standardized acupuncture protocol was em- ployed with manual and electrostimulation The frequency of treatment was 2ndash3 times per week for a total of 10 sessions starting 1 week before the second cycle of chemotherapy
bull Setting The setting was two outpatient academic centers for patients with cancer bull Subjects Twenty-one (21) newly diagnosed and recurrent ovarian cancer patients were the subjects bull Outcome measures WBC count ANC and plasma granulocyte colony-stimulating factor (G-CSF ) were assessed
weekly bull Results The median leukocyte value in the acupuncture arm at the first day of the third cycle of chemotherapy
was significantly higher than in the control arm after adjusting for baseline value (8600 cells=mL range 4800ndash 12000 versus 4400 cell=mL range 2300ndash10000) ( p frac14 0046) The incidence of grade 2ndash4 leukopenia was less in the acupuncture arm than in the sham arm (30 versus 90 p frac14 002) However the median leukocyte nadir neutrophil nadir and recovering ANC were all higher but not statistically significantly different ( p frac14 0116ndash016) after adjusting for baseline differences There were no statistically significant differences in plasma G-CSF between the two groups
bull Conclusions We observed clinically relevant trends of higher WBC values during one cycle of chemotherapy in patients with ovarian cancer which suggests a potential myeloprotective effect of acupuncture A larger trial is warranted to more definitively determine the efficacy of acupuncture on clinically important outcomes of chemotherapy-induced neutropenia
Acupuncture for the alleviation of hot flashes in men treated with androgen
ablation therapy Ashamalla H1 Jiang ML Guirguis A Peluso F Ashamalla M
bull Abstract bull PURPOSE bull Hot flashes are common side effect due to androgen ablation therapy (AAT) The utility of acupuncture for hot flashes in
men has not been thoroughly studied We prospectively studied the effect of acupuncture in men with hot flashes bull METHODS AND MATERIALS bull The study was approved by internal review board Seventeen men with hot flashes and history of AAT for prostate cancer
were enrolled Three men declined participation before receiving any treatment A hot flash score (HFS) was used to measure daily hot flashes The composite daily score was calculated as the product of frequency times severity The baseline daily scores were compared with scores taken at 2 and 6 weeks and at 8-month average follow-up
bull RESULTS bull No side effects were encountered during immediately after treatment or at 8 months The mean initial HFS was 283 it
dropped to 103 (p = 00001) at 2 weeks posttreatment 75 (p = 00001) at 6 weeks and 70 (p = 0001) at 8 months Clinical improvement for each patient is defined as the percent decrease in the mean HFS at each time point The mean improvement at Weeks 2 and 6 was 684 (mean HFS decreased from 37409 to 11836 p = 0001) and 892 (mean HFS decreased from 37409 to 405 p = 00078) respectively The improvement at 8 months was 803 (mean HFS decreased from 37409 to 7385 p = 0002)
bull CONCLUSIONS bull Acupuncture provides excellent control of hot flashes in men with a history of AAT The absence of side effects and the
durable response at 8 months are likely to be appealing to patients Prospective randomized study is warranted to further evaluate this modality against medical therapy
bull Copyright copy 2011 Elsevier Inc All rights reserved
bull Int J Radiat Oncol Biol Phys 2011 Apr 179(5)1358-63 doi 101016jijrobp201001025 Epub 2010 Jun 3
bull J Clin Oncol 2010 Mar 128(7)1154-60 doi 101200JCO2009234708 Epub 2010 Jan 25 bull Randomized blinded sham-controlled trial of acupuncture for the management of aromatase
inhibitor-associated joint symptoms in women with early-stage breast cancer bull Crew KD1 Capodice JL Greenlee H Brafman L Fuentes D Awad D Yann Tsai W Hershman DL bull Author information
bull Abstract bull PURPOSE Women with breast cancer (BC) treated with aromatase inhibitors (AIs) may experience
joint symptoms that can lead to discontinuation of effective therapy We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC METHODS We conducted a randomized controlled blinded study comparing true acupuncture (TA) versus sham acupuncture (SA) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs TA included full bodyauricular acupuncture and joint-specific point prescriptions whereas SA involved superficial needle insertion at nonacupoint locations Outcome measures included the Brief Pain Inventory-Short Form (BPI-SF) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH) obtained at baseline and at 3 and 6 weeks Results Of 51 women enrolled 43 women were randomly assigned and 38 were evaluable Baseline characteristics were comparable between the two groups Our primary end point was the difference in mean BPI-SF worst pain scores at 6 weeks which was lower for TA compared with SA (30 v 55 P lt 001) We also found differences between TA and SA in pain severity (26 v 45 P = 003) and pain-related interference (25 v 45 P = 002) at 6 weeks Similar findings were seen for the WOMAC and M-SACRAH scores The acupuncture intervention was well-tolerated CONCLUSION Women with AI-induced arthralgias treated with TA had significant improvement of joint pain and stiffness which was not seen with SA Acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect
Soutien psychologique
bull angoisse devant lrsquoinconnu
bull angoisse devant la douleur
bull angoisse devant le deacuteveloppement de la maladie et la perte de controcircle sur son propre corps
bull angoisse devant les effets secondaires dus aux divers traitements
bull angoisse devant les complications tardives dues aux divers traitements
bull angoisse devant le regard social porteacute sur le malade
bull angoisse devant la mort
Soutien psychologique
Ces informations reacutesonnent agrave lrsquointeacuterieur du patient ougrave elle
provoquent des dysfonctionnements qui
peuvent se manifester par
bull des maux de ventre
bull des palpitations
bull des troubles du sommeil
bull des difficulteacutes respiratoires
bull des douleurs diverses etc
Nauseacutees et vomissements
RAPPEL LrsquoEstomac
bull YANG
bull Controcircle le mucircrissement amp pourrissement de la nourriture
bull Controcircle le transport des essences de la nourriture Gouverne la descente du Qi fait descendre la nourriture transformeacutee vers lrsquoIntestin Grecircle
bull Si le mouvement de descente est perturbeacute par les pervers si il y a un mouvement ascendant de QI de lrsquoEstomac (agrave contre-sens- NI) il y a des VOMISSEMENTS
Nauseacutees et vomissements
LES VOMISSEMENTS SE MANIFESTENT QUAND LE QI DE LrsquoESTOMAC MONTE A LA PLACE DE DESCENDRE
Neuropathie
Avastine Xeloda Gemzar Cysplatine Taxol Fludara Alimta Procarbazine
points GI2 3 4 IG 2 3 C7 MC6 8 P7 9 F2 3 V60 VB41
traitement
preacutevention
LA DOULEUR DUE AU CANCER
bull Etiologie et physiopathologie
bull Lrsquoinvasion des pervers Externes - tout pervers srsquoil persiste peut provoquer le blocage des meacuteridiens et par la suite une stagnation de Qi et de Sg ou des troubles de Zang-Fu
bull Le deacuteregraveglement des eacutemotions
bull Le deacuteseacutequilibre de lrsquoalimentation
bull Une faiblesse de constitution
DIFFEacuteRENCIATION DE LA DOULEUR
SELON LA LOCALISATION bull dans le cancer du poumon souvent une sensibiliteacute au
P1 et V13 accompagneacutee de toux et de souffle court bull dans le cancer de lrsquoœsophage ou de lrsquoestomac une
sensibiliteacute au E34 et E42 accompagneacutee de nauseacutees dysphagie inappeacutetence
SELON LE VIDE ET LA PLEacuteNITUDE bull Vide douleurs souvent leacutegegraveres intermittentes
sourdes bull Pleacutenitude douleurs tensives lancinantes coliques
aigues
LA FATIGUE
XU LAO = fatigue par Vide = lrsquoeacutepuisement En Occident crsquoest le symptocircme le plus souvent invoqueacute et pas toujours ducirc au Vide
LA FATIGUE - eacutetiologie
bull La faiblesse constitutionnelle
bull Le surmenage
bull Lrsquoexcegraves drsquoactiviteacute physique
bull Lrsquoalimentation
bull Les maladies graves
bull Lrsquoexcegraves drsquoactiviteacute sexuelle
bull Lrsquoaccouchement
bull La consommation de drogues
LA FATIGUE - pathologie
bull Vide
bull Combinaison de Vide et de Pleacutenitude
bull Pleacutenitude
Contre-indications agrave lrsquoacupuncture
bull Des risques de laquo gros bras raquo apregraves curage axillaire
bull Des opeacuterations selon Halsted ou Patey
bull Des drainages lymphatiques
bull Pas drsquoaiguille du cocircteacute opeacutereacute
TCM in cancer treatments
bull Used mostly as adjuvant therapy before or during or
after surgery radiotherapy and chemotherapy
bull Remit the side-effects and toxicity of other treatments
bull Symptom control
bull Activate and strengthen immune system
bull For advanced cancer patients mainly palliative but it
can also prolong life in some cases
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 15 Number 7 2009
Acupuncture for Chemotherapy-Induced Neutropenia in Patients with GynecologiMalignancies A Pilot Randomized Sham-Controlled Clinical Trial
Weidong Lu MB MPH LicAc1ndash3 Ursula A Matulonis MD4 Anne Doherty-Gilman MPH1 Hang ScD3
Peter M Wayne PhD23 David S Rosenthal MD14 and Richard T Penson MD6
bull Abstract bull Objectives The objective of this study was to investigate the effect of acupuncture administered during mye-
losuppressive chemotherapy on white blood cell (WBC) count and absolute neutrophil count (ANC) in patients with ovarian cancer
bull Design This study is a pilot randomized sham-controlled clinical trial Patients received active acupuncture versus sham acupuncture while undergoing chemotherapy A standardized acupuncture protocol was em- ployed with manual and electrostimulation The frequency of treatment was 2ndash3 times per week for a total of 10 sessions starting 1 week before the second cycle of chemotherapy
bull Setting The setting was two outpatient academic centers for patients with cancer bull Subjects Twenty-one (21) newly diagnosed and recurrent ovarian cancer patients were the subjects bull Outcome measures WBC count ANC and plasma granulocyte colony-stimulating factor (G-CSF ) were assessed
weekly bull Results The median leukocyte value in the acupuncture arm at the first day of the third cycle of chemotherapy
was significantly higher than in the control arm after adjusting for baseline value (8600 cells=mL range 4800ndash 12000 versus 4400 cell=mL range 2300ndash10000) ( p frac14 0046) The incidence of grade 2ndash4 leukopenia was less in the acupuncture arm than in the sham arm (30 versus 90 p frac14 002) However the median leukocyte nadir neutrophil nadir and recovering ANC were all higher but not statistically significantly different ( p frac14 0116ndash016) after adjusting for baseline differences There were no statistically significant differences in plasma G-CSF between the two groups
bull Conclusions We observed clinically relevant trends of higher WBC values during one cycle of chemotherapy in patients with ovarian cancer which suggests a potential myeloprotective effect of acupuncture A larger trial is warranted to more definitively determine the efficacy of acupuncture on clinically important outcomes of chemotherapy-induced neutropenia
Acupuncture for the alleviation of hot flashes in men treated with androgen
ablation therapy Ashamalla H1 Jiang ML Guirguis A Peluso F Ashamalla M
bull Abstract bull PURPOSE bull Hot flashes are common side effect due to androgen ablation therapy (AAT) The utility of acupuncture for hot flashes in
men has not been thoroughly studied We prospectively studied the effect of acupuncture in men with hot flashes bull METHODS AND MATERIALS bull The study was approved by internal review board Seventeen men with hot flashes and history of AAT for prostate cancer
were enrolled Three men declined participation before receiving any treatment A hot flash score (HFS) was used to measure daily hot flashes The composite daily score was calculated as the product of frequency times severity The baseline daily scores were compared with scores taken at 2 and 6 weeks and at 8-month average follow-up
bull RESULTS bull No side effects were encountered during immediately after treatment or at 8 months The mean initial HFS was 283 it
dropped to 103 (p = 00001) at 2 weeks posttreatment 75 (p = 00001) at 6 weeks and 70 (p = 0001) at 8 months Clinical improvement for each patient is defined as the percent decrease in the mean HFS at each time point The mean improvement at Weeks 2 and 6 was 684 (mean HFS decreased from 37409 to 11836 p = 0001) and 892 (mean HFS decreased from 37409 to 405 p = 00078) respectively The improvement at 8 months was 803 (mean HFS decreased from 37409 to 7385 p = 0002)
bull CONCLUSIONS bull Acupuncture provides excellent control of hot flashes in men with a history of AAT The absence of side effects and the
durable response at 8 months are likely to be appealing to patients Prospective randomized study is warranted to further evaluate this modality against medical therapy
bull Copyright copy 2011 Elsevier Inc All rights reserved
bull Int J Radiat Oncol Biol Phys 2011 Apr 179(5)1358-63 doi 101016jijrobp201001025 Epub 2010 Jun 3
bull J Clin Oncol 2010 Mar 128(7)1154-60 doi 101200JCO2009234708 Epub 2010 Jan 25 bull Randomized blinded sham-controlled trial of acupuncture for the management of aromatase
inhibitor-associated joint symptoms in women with early-stage breast cancer bull Crew KD1 Capodice JL Greenlee H Brafman L Fuentes D Awad D Yann Tsai W Hershman DL bull Author information
bull Abstract bull PURPOSE Women with breast cancer (BC) treated with aromatase inhibitors (AIs) may experience
joint symptoms that can lead to discontinuation of effective therapy We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC METHODS We conducted a randomized controlled blinded study comparing true acupuncture (TA) versus sham acupuncture (SA) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs TA included full bodyauricular acupuncture and joint-specific point prescriptions whereas SA involved superficial needle insertion at nonacupoint locations Outcome measures included the Brief Pain Inventory-Short Form (BPI-SF) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH) obtained at baseline and at 3 and 6 weeks Results Of 51 women enrolled 43 women were randomly assigned and 38 were evaluable Baseline characteristics were comparable between the two groups Our primary end point was the difference in mean BPI-SF worst pain scores at 6 weeks which was lower for TA compared with SA (30 v 55 P lt 001) We also found differences between TA and SA in pain severity (26 v 45 P = 003) and pain-related interference (25 v 45 P = 002) at 6 weeks Similar findings were seen for the WOMAC and M-SACRAH scores The acupuncture intervention was well-tolerated CONCLUSION Women with AI-induced arthralgias treated with TA had significant improvement of joint pain and stiffness which was not seen with SA Acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect
Soutien psychologique
Ces informations reacutesonnent agrave lrsquointeacuterieur du patient ougrave elle
provoquent des dysfonctionnements qui
peuvent se manifester par
bull des maux de ventre
bull des palpitations
bull des troubles du sommeil
bull des difficulteacutes respiratoires
bull des douleurs diverses etc
Nauseacutees et vomissements
RAPPEL LrsquoEstomac
bull YANG
bull Controcircle le mucircrissement amp pourrissement de la nourriture
bull Controcircle le transport des essences de la nourriture Gouverne la descente du Qi fait descendre la nourriture transformeacutee vers lrsquoIntestin Grecircle
bull Si le mouvement de descente est perturbeacute par les pervers si il y a un mouvement ascendant de QI de lrsquoEstomac (agrave contre-sens- NI) il y a des VOMISSEMENTS
Nauseacutees et vomissements
LES VOMISSEMENTS SE MANIFESTENT QUAND LE QI DE LrsquoESTOMAC MONTE A LA PLACE DE DESCENDRE
Neuropathie
Avastine Xeloda Gemzar Cysplatine Taxol Fludara Alimta Procarbazine
points GI2 3 4 IG 2 3 C7 MC6 8 P7 9 F2 3 V60 VB41
traitement
preacutevention
LA DOULEUR DUE AU CANCER
bull Etiologie et physiopathologie
bull Lrsquoinvasion des pervers Externes - tout pervers srsquoil persiste peut provoquer le blocage des meacuteridiens et par la suite une stagnation de Qi et de Sg ou des troubles de Zang-Fu
bull Le deacuteregraveglement des eacutemotions
bull Le deacuteseacutequilibre de lrsquoalimentation
bull Une faiblesse de constitution
DIFFEacuteRENCIATION DE LA DOULEUR
SELON LA LOCALISATION bull dans le cancer du poumon souvent une sensibiliteacute au
P1 et V13 accompagneacutee de toux et de souffle court bull dans le cancer de lrsquoœsophage ou de lrsquoestomac une
sensibiliteacute au E34 et E42 accompagneacutee de nauseacutees dysphagie inappeacutetence
SELON LE VIDE ET LA PLEacuteNITUDE bull Vide douleurs souvent leacutegegraveres intermittentes
sourdes bull Pleacutenitude douleurs tensives lancinantes coliques
aigues
LA FATIGUE
XU LAO = fatigue par Vide = lrsquoeacutepuisement En Occident crsquoest le symptocircme le plus souvent invoqueacute et pas toujours ducirc au Vide
LA FATIGUE - eacutetiologie
bull La faiblesse constitutionnelle
bull Le surmenage
bull Lrsquoexcegraves drsquoactiviteacute physique
bull Lrsquoalimentation
bull Les maladies graves
bull Lrsquoexcegraves drsquoactiviteacute sexuelle
bull Lrsquoaccouchement
bull La consommation de drogues
LA FATIGUE - pathologie
bull Vide
bull Combinaison de Vide et de Pleacutenitude
bull Pleacutenitude
Contre-indications agrave lrsquoacupuncture
bull Des risques de laquo gros bras raquo apregraves curage axillaire
bull Des opeacuterations selon Halsted ou Patey
bull Des drainages lymphatiques
bull Pas drsquoaiguille du cocircteacute opeacutereacute
TCM in cancer treatments
bull Used mostly as adjuvant therapy before or during or
after surgery radiotherapy and chemotherapy
bull Remit the side-effects and toxicity of other treatments
bull Symptom control
bull Activate and strengthen immune system
bull For advanced cancer patients mainly palliative but it
can also prolong life in some cases
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 15 Number 7 2009
Acupuncture for Chemotherapy-Induced Neutropenia in Patients with GynecologiMalignancies A Pilot Randomized Sham-Controlled Clinical Trial
Weidong Lu MB MPH LicAc1ndash3 Ursula A Matulonis MD4 Anne Doherty-Gilman MPH1 Hang ScD3
Peter M Wayne PhD23 David S Rosenthal MD14 and Richard T Penson MD6
bull Abstract bull Objectives The objective of this study was to investigate the effect of acupuncture administered during mye-
losuppressive chemotherapy on white blood cell (WBC) count and absolute neutrophil count (ANC) in patients with ovarian cancer
bull Design This study is a pilot randomized sham-controlled clinical trial Patients received active acupuncture versus sham acupuncture while undergoing chemotherapy A standardized acupuncture protocol was em- ployed with manual and electrostimulation The frequency of treatment was 2ndash3 times per week for a total of 10 sessions starting 1 week before the second cycle of chemotherapy
bull Setting The setting was two outpatient academic centers for patients with cancer bull Subjects Twenty-one (21) newly diagnosed and recurrent ovarian cancer patients were the subjects bull Outcome measures WBC count ANC and plasma granulocyte colony-stimulating factor (G-CSF ) were assessed
weekly bull Results The median leukocyte value in the acupuncture arm at the first day of the third cycle of chemotherapy
was significantly higher than in the control arm after adjusting for baseline value (8600 cells=mL range 4800ndash 12000 versus 4400 cell=mL range 2300ndash10000) ( p frac14 0046) The incidence of grade 2ndash4 leukopenia was less in the acupuncture arm than in the sham arm (30 versus 90 p frac14 002) However the median leukocyte nadir neutrophil nadir and recovering ANC were all higher but not statistically significantly different ( p frac14 0116ndash016) after adjusting for baseline differences There were no statistically significant differences in plasma G-CSF between the two groups
bull Conclusions We observed clinically relevant trends of higher WBC values during one cycle of chemotherapy in patients with ovarian cancer which suggests a potential myeloprotective effect of acupuncture A larger trial is warranted to more definitively determine the efficacy of acupuncture on clinically important outcomes of chemotherapy-induced neutropenia
Acupuncture for the alleviation of hot flashes in men treated with androgen
ablation therapy Ashamalla H1 Jiang ML Guirguis A Peluso F Ashamalla M
bull Abstract bull PURPOSE bull Hot flashes are common side effect due to androgen ablation therapy (AAT) The utility of acupuncture for hot flashes in
men has not been thoroughly studied We prospectively studied the effect of acupuncture in men with hot flashes bull METHODS AND MATERIALS bull The study was approved by internal review board Seventeen men with hot flashes and history of AAT for prostate cancer
were enrolled Three men declined participation before receiving any treatment A hot flash score (HFS) was used to measure daily hot flashes The composite daily score was calculated as the product of frequency times severity The baseline daily scores were compared with scores taken at 2 and 6 weeks and at 8-month average follow-up
bull RESULTS bull No side effects were encountered during immediately after treatment or at 8 months The mean initial HFS was 283 it
dropped to 103 (p = 00001) at 2 weeks posttreatment 75 (p = 00001) at 6 weeks and 70 (p = 0001) at 8 months Clinical improvement for each patient is defined as the percent decrease in the mean HFS at each time point The mean improvement at Weeks 2 and 6 was 684 (mean HFS decreased from 37409 to 11836 p = 0001) and 892 (mean HFS decreased from 37409 to 405 p = 00078) respectively The improvement at 8 months was 803 (mean HFS decreased from 37409 to 7385 p = 0002)
bull CONCLUSIONS bull Acupuncture provides excellent control of hot flashes in men with a history of AAT The absence of side effects and the
durable response at 8 months are likely to be appealing to patients Prospective randomized study is warranted to further evaluate this modality against medical therapy
bull Copyright copy 2011 Elsevier Inc All rights reserved
bull Int J Radiat Oncol Biol Phys 2011 Apr 179(5)1358-63 doi 101016jijrobp201001025 Epub 2010 Jun 3
bull J Clin Oncol 2010 Mar 128(7)1154-60 doi 101200JCO2009234708 Epub 2010 Jan 25 bull Randomized blinded sham-controlled trial of acupuncture for the management of aromatase
inhibitor-associated joint symptoms in women with early-stage breast cancer bull Crew KD1 Capodice JL Greenlee H Brafman L Fuentes D Awad D Yann Tsai W Hershman DL bull Author information
bull Abstract bull PURPOSE Women with breast cancer (BC) treated with aromatase inhibitors (AIs) may experience
joint symptoms that can lead to discontinuation of effective therapy We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC METHODS We conducted a randomized controlled blinded study comparing true acupuncture (TA) versus sham acupuncture (SA) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs TA included full bodyauricular acupuncture and joint-specific point prescriptions whereas SA involved superficial needle insertion at nonacupoint locations Outcome measures included the Brief Pain Inventory-Short Form (BPI-SF) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH) obtained at baseline and at 3 and 6 weeks Results Of 51 women enrolled 43 women were randomly assigned and 38 were evaluable Baseline characteristics were comparable between the two groups Our primary end point was the difference in mean BPI-SF worst pain scores at 6 weeks which was lower for TA compared with SA (30 v 55 P lt 001) We also found differences between TA and SA in pain severity (26 v 45 P = 003) and pain-related interference (25 v 45 P = 002) at 6 weeks Similar findings were seen for the WOMAC and M-SACRAH scores The acupuncture intervention was well-tolerated CONCLUSION Women with AI-induced arthralgias treated with TA had significant improvement of joint pain and stiffness which was not seen with SA Acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect
Nauseacutees et vomissements
RAPPEL LrsquoEstomac
bull YANG
bull Controcircle le mucircrissement amp pourrissement de la nourriture
bull Controcircle le transport des essences de la nourriture Gouverne la descente du Qi fait descendre la nourriture transformeacutee vers lrsquoIntestin Grecircle
bull Si le mouvement de descente est perturbeacute par les pervers si il y a un mouvement ascendant de QI de lrsquoEstomac (agrave contre-sens- NI) il y a des VOMISSEMENTS
Nauseacutees et vomissements
LES VOMISSEMENTS SE MANIFESTENT QUAND LE QI DE LrsquoESTOMAC MONTE A LA PLACE DE DESCENDRE
Neuropathie
Avastine Xeloda Gemzar Cysplatine Taxol Fludara Alimta Procarbazine
points GI2 3 4 IG 2 3 C7 MC6 8 P7 9 F2 3 V60 VB41
traitement
preacutevention
LA DOULEUR DUE AU CANCER
bull Etiologie et physiopathologie
bull Lrsquoinvasion des pervers Externes - tout pervers srsquoil persiste peut provoquer le blocage des meacuteridiens et par la suite une stagnation de Qi et de Sg ou des troubles de Zang-Fu
bull Le deacuteregraveglement des eacutemotions
bull Le deacuteseacutequilibre de lrsquoalimentation
bull Une faiblesse de constitution
DIFFEacuteRENCIATION DE LA DOULEUR
SELON LA LOCALISATION bull dans le cancer du poumon souvent une sensibiliteacute au
P1 et V13 accompagneacutee de toux et de souffle court bull dans le cancer de lrsquoœsophage ou de lrsquoestomac une
sensibiliteacute au E34 et E42 accompagneacutee de nauseacutees dysphagie inappeacutetence
SELON LE VIDE ET LA PLEacuteNITUDE bull Vide douleurs souvent leacutegegraveres intermittentes
sourdes bull Pleacutenitude douleurs tensives lancinantes coliques
aigues
LA FATIGUE
XU LAO = fatigue par Vide = lrsquoeacutepuisement En Occident crsquoest le symptocircme le plus souvent invoqueacute et pas toujours ducirc au Vide
LA FATIGUE - eacutetiologie
bull La faiblesse constitutionnelle
bull Le surmenage
bull Lrsquoexcegraves drsquoactiviteacute physique
bull Lrsquoalimentation
bull Les maladies graves
bull Lrsquoexcegraves drsquoactiviteacute sexuelle
bull Lrsquoaccouchement
bull La consommation de drogues
LA FATIGUE - pathologie
bull Vide
bull Combinaison de Vide et de Pleacutenitude
bull Pleacutenitude
Contre-indications agrave lrsquoacupuncture
bull Des risques de laquo gros bras raquo apregraves curage axillaire
bull Des opeacuterations selon Halsted ou Patey
bull Des drainages lymphatiques
bull Pas drsquoaiguille du cocircteacute opeacutereacute
TCM in cancer treatments
bull Used mostly as adjuvant therapy before or during or
after surgery radiotherapy and chemotherapy
bull Remit the side-effects and toxicity of other treatments
bull Symptom control
bull Activate and strengthen immune system
bull For advanced cancer patients mainly palliative but it
can also prolong life in some cases
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 15 Number 7 2009
Acupuncture for Chemotherapy-Induced Neutropenia in Patients with GynecologiMalignancies A Pilot Randomized Sham-Controlled Clinical Trial
Weidong Lu MB MPH LicAc1ndash3 Ursula A Matulonis MD4 Anne Doherty-Gilman MPH1 Hang ScD3
Peter M Wayne PhD23 David S Rosenthal MD14 and Richard T Penson MD6
bull Abstract bull Objectives The objective of this study was to investigate the effect of acupuncture administered during mye-
losuppressive chemotherapy on white blood cell (WBC) count and absolute neutrophil count (ANC) in patients with ovarian cancer
bull Design This study is a pilot randomized sham-controlled clinical trial Patients received active acupuncture versus sham acupuncture while undergoing chemotherapy A standardized acupuncture protocol was em- ployed with manual and electrostimulation The frequency of treatment was 2ndash3 times per week for a total of 10 sessions starting 1 week before the second cycle of chemotherapy
bull Setting The setting was two outpatient academic centers for patients with cancer bull Subjects Twenty-one (21) newly diagnosed and recurrent ovarian cancer patients were the subjects bull Outcome measures WBC count ANC and plasma granulocyte colony-stimulating factor (G-CSF ) were assessed
weekly bull Results The median leukocyte value in the acupuncture arm at the first day of the third cycle of chemotherapy
was significantly higher than in the control arm after adjusting for baseline value (8600 cells=mL range 4800ndash 12000 versus 4400 cell=mL range 2300ndash10000) ( p frac14 0046) The incidence of grade 2ndash4 leukopenia was less in the acupuncture arm than in the sham arm (30 versus 90 p frac14 002) However the median leukocyte nadir neutrophil nadir and recovering ANC were all higher but not statistically significantly different ( p frac14 0116ndash016) after adjusting for baseline differences There were no statistically significant differences in plasma G-CSF between the two groups
bull Conclusions We observed clinically relevant trends of higher WBC values during one cycle of chemotherapy in patients with ovarian cancer which suggests a potential myeloprotective effect of acupuncture A larger trial is warranted to more definitively determine the efficacy of acupuncture on clinically important outcomes of chemotherapy-induced neutropenia
Acupuncture for the alleviation of hot flashes in men treated with androgen
ablation therapy Ashamalla H1 Jiang ML Guirguis A Peluso F Ashamalla M
bull Abstract bull PURPOSE bull Hot flashes are common side effect due to androgen ablation therapy (AAT) The utility of acupuncture for hot flashes in
men has not been thoroughly studied We prospectively studied the effect of acupuncture in men with hot flashes bull METHODS AND MATERIALS bull The study was approved by internal review board Seventeen men with hot flashes and history of AAT for prostate cancer
were enrolled Three men declined participation before receiving any treatment A hot flash score (HFS) was used to measure daily hot flashes The composite daily score was calculated as the product of frequency times severity The baseline daily scores were compared with scores taken at 2 and 6 weeks and at 8-month average follow-up
bull RESULTS bull No side effects were encountered during immediately after treatment or at 8 months The mean initial HFS was 283 it
dropped to 103 (p = 00001) at 2 weeks posttreatment 75 (p = 00001) at 6 weeks and 70 (p = 0001) at 8 months Clinical improvement for each patient is defined as the percent decrease in the mean HFS at each time point The mean improvement at Weeks 2 and 6 was 684 (mean HFS decreased from 37409 to 11836 p = 0001) and 892 (mean HFS decreased from 37409 to 405 p = 00078) respectively The improvement at 8 months was 803 (mean HFS decreased from 37409 to 7385 p = 0002)
bull CONCLUSIONS bull Acupuncture provides excellent control of hot flashes in men with a history of AAT The absence of side effects and the
durable response at 8 months are likely to be appealing to patients Prospective randomized study is warranted to further evaluate this modality against medical therapy
bull Copyright copy 2011 Elsevier Inc All rights reserved
bull Int J Radiat Oncol Biol Phys 2011 Apr 179(5)1358-63 doi 101016jijrobp201001025 Epub 2010 Jun 3
bull J Clin Oncol 2010 Mar 128(7)1154-60 doi 101200JCO2009234708 Epub 2010 Jan 25 bull Randomized blinded sham-controlled trial of acupuncture for the management of aromatase
inhibitor-associated joint symptoms in women with early-stage breast cancer bull Crew KD1 Capodice JL Greenlee H Brafman L Fuentes D Awad D Yann Tsai W Hershman DL bull Author information
bull Abstract bull PURPOSE Women with breast cancer (BC) treated with aromatase inhibitors (AIs) may experience
joint symptoms that can lead to discontinuation of effective therapy We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC METHODS We conducted a randomized controlled blinded study comparing true acupuncture (TA) versus sham acupuncture (SA) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs TA included full bodyauricular acupuncture and joint-specific point prescriptions whereas SA involved superficial needle insertion at nonacupoint locations Outcome measures included the Brief Pain Inventory-Short Form (BPI-SF) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH) obtained at baseline and at 3 and 6 weeks Results Of 51 women enrolled 43 women were randomly assigned and 38 were evaluable Baseline characteristics were comparable between the two groups Our primary end point was the difference in mean BPI-SF worst pain scores at 6 weeks which was lower for TA compared with SA (30 v 55 P lt 001) We also found differences between TA and SA in pain severity (26 v 45 P = 003) and pain-related interference (25 v 45 P = 002) at 6 weeks Similar findings were seen for the WOMAC and M-SACRAH scores The acupuncture intervention was well-tolerated CONCLUSION Women with AI-induced arthralgias treated with TA had significant improvement of joint pain and stiffness which was not seen with SA Acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect
Nauseacutees et vomissements
LES VOMISSEMENTS SE MANIFESTENT QUAND LE QI DE LrsquoESTOMAC MONTE A LA PLACE DE DESCENDRE
Neuropathie
Avastine Xeloda Gemzar Cysplatine Taxol Fludara Alimta Procarbazine
points GI2 3 4 IG 2 3 C7 MC6 8 P7 9 F2 3 V60 VB41
traitement
preacutevention
LA DOULEUR DUE AU CANCER
bull Etiologie et physiopathologie
bull Lrsquoinvasion des pervers Externes - tout pervers srsquoil persiste peut provoquer le blocage des meacuteridiens et par la suite une stagnation de Qi et de Sg ou des troubles de Zang-Fu
bull Le deacuteregraveglement des eacutemotions
bull Le deacuteseacutequilibre de lrsquoalimentation
bull Une faiblesse de constitution
DIFFEacuteRENCIATION DE LA DOULEUR
SELON LA LOCALISATION bull dans le cancer du poumon souvent une sensibiliteacute au
P1 et V13 accompagneacutee de toux et de souffle court bull dans le cancer de lrsquoœsophage ou de lrsquoestomac une
sensibiliteacute au E34 et E42 accompagneacutee de nauseacutees dysphagie inappeacutetence
SELON LE VIDE ET LA PLEacuteNITUDE bull Vide douleurs souvent leacutegegraveres intermittentes
sourdes bull Pleacutenitude douleurs tensives lancinantes coliques
aigues
LA FATIGUE
XU LAO = fatigue par Vide = lrsquoeacutepuisement En Occident crsquoest le symptocircme le plus souvent invoqueacute et pas toujours ducirc au Vide
LA FATIGUE - eacutetiologie
bull La faiblesse constitutionnelle
bull Le surmenage
bull Lrsquoexcegraves drsquoactiviteacute physique
bull Lrsquoalimentation
bull Les maladies graves
bull Lrsquoexcegraves drsquoactiviteacute sexuelle
bull Lrsquoaccouchement
bull La consommation de drogues
LA FATIGUE - pathologie
bull Vide
bull Combinaison de Vide et de Pleacutenitude
bull Pleacutenitude
Contre-indications agrave lrsquoacupuncture
bull Des risques de laquo gros bras raquo apregraves curage axillaire
bull Des opeacuterations selon Halsted ou Patey
bull Des drainages lymphatiques
bull Pas drsquoaiguille du cocircteacute opeacutereacute
TCM in cancer treatments
bull Used mostly as adjuvant therapy before or during or
after surgery radiotherapy and chemotherapy
bull Remit the side-effects and toxicity of other treatments
bull Symptom control
bull Activate and strengthen immune system
bull For advanced cancer patients mainly palliative but it
can also prolong life in some cases
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 15 Number 7 2009
Acupuncture for Chemotherapy-Induced Neutropenia in Patients with GynecologiMalignancies A Pilot Randomized Sham-Controlled Clinical Trial
Weidong Lu MB MPH LicAc1ndash3 Ursula A Matulonis MD4 Anne Doherty-Gilman MPH1 Hang ScD3
Peter M Wayne PhD23 David S Rosenthal MD14 and Richard T Penson MD6
bull Abstract bull Objectives The objective of this study was to investigate the effect of acupuncture administered during mye-
losuppressive chemotherapy on white blood cell (WBC) count and absolute neutrophil count (ANC) in patients with ovarian cancer
bull Design This study is a pilot randomized sham-controlled clinical trial Patients received active acupuncture versus sham acupuncture while undergoing chemotherapy A standardized acupuncture protocol was em- ployed with manual and electrostimulation The frequency of treatment was 2ndash3 times per week for a total of 10 sessions starting 1 week before the second cycle of chemotherapy
bull Setting The setting was two outpatient academic centers for patients with cancer bull Subjects Twenty-one (21) newly diagnosed and recurrent ovarian cancer patients were the subjects bull Outcome measures WBC count ANC and plasma granulocyte colony-stimulating factor (G-CSF ) were assessed
weekly bull Results The median leukocyte value in the acupuncture arm at the first day of the third cycle of chemotherapy
was significantly higher than in the control arm after adjusting for baseline value (8600 cells=mL range 4800ndash 12000 versus 4400 cell=mL range 2300ndash10000) ( p frac14 0046) The incidence of grade 2ndash4 leukopenia was less in the acupuncture arm than in the sham arm (30 versus 90 p frac14 002) However the median leukocyte nadir neutrophil nadir and recovering ANC were all higher but not statistically significantly different ( p frac14 0116ndash016) after adjusting for baseline differences There were no statistically significant differences in plasma G-CSF between the two groups
bull Conclusions We observed clinically relevant trends of higher WBC values during one cycle of chemotherapy in patients with ovarian cancer which suggests a potential myeloprotective effect of acupuncture A larger trial is warranted to more definitively determine the efficacy of acupuncture on clinically important outcomes of chemotherapy-induced neutropenia
Acupuncture for the alleviation of hot flashes in men treated with androgen
ablation therapy Ashamalla H1 Jiang ML Guirguis A Peluso F Ashamalla M
bull Abstract bull PURPOSE bull Hot flashes are common side effect due to androgen ablation therapy (AAT) The utility of acupuncture for hot flashes in
men has not been thoroughly studied We prospectively studied the effect of acupuncture in men with hot flashes bull METHODS AND MATERIALS bull The study was approved by internal review board Seventeen men with hot flashes and history of AAT for prostate cancer
were enrolled Three men declined participation before receiving any treatment A hot flash score (HFS) was used to measure daily hot flashes The composite daily score was calculated as the product of frequency times severity The baseline daily scores were compared with scores taken at 2 and 6 weeks and at 8-month average follow-up
bull RESULTS bull No side effects were encountered during immediately after treatment or at 8 months The mean initial HFS was 283 it
dropped to 103 (p = 00001) at 2 weeks posttreatment 75 (p = 00001) at 6 weeks and 70 (p = 0001) at 8 months Clinical improvement for each patient is defined as the percent decrease in the mean HFS at each time point The mean improvement at Weeks 2 and 6 was 684 (mean HFS decreased from 37409 to 11836 p = 0001) and 892 (mean HFS decreased from 37409 to 405 p = 00078) respectively The improvement at 8 months was 803 (mean HFS decreased from 37409 to 7385 p = 0002)
bull CONCLUSIONS bull Acupuncture provides excellent control of hot flashes in men with a history of AAT The absence of side effects and the
durable response at 8 months are likely to be appealing to patients Prospective randomized study is warranted to further evaluate this modality against medical therapy
bull Copyright copy 2011 Elsevier Inc All rights reserved
bull Int J Radiat Oncol Biol Phys 2011 Apr 179(5)1358-63 doi 101016jijrobp201001025 Epub 2010 Jun 3
bull J Clin Oncol 2010 Mar 128(7)1154-60 doi 101200JCO2009234708 Epub 2010 Jan 25 bull Randomized blinded sham-controlled trial of acupuncture for the management of aromatase
inhibitor-associated joint symptoms in women with early-stage breast cancer bull Crew KD1 Capodice JL Greenlee H Brafman L Fuentes D Awad D Yann Tsai W Hershman DL bull Author information
bull Abstract bull PURPOSE Women with breast cancer (BC) treated with aromatase inhibitors (AIs) may experience
joint symptoms that can lead to discontinuation of effective therapy We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC METHODS We conducted a randomized controlled blinded study comparing true acupuncture (TA) versus sham acupuncture (SA) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs TA included full bodyauricular acupuncture and joint-specific point prescriptions whereas SA involved superficial needle insertion at nonacupoint locations Outcome measures included the Brief Pain Inventory-Short Form (BPI-SF) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH) obtained at baseline and at 3 and 6 weeks Results Of 51 women enrolled 43 women were randomly assigned and 38 were evaluable Baseline characteristics were comparable between the two groups Our primary end point was the difference in mean BPI-SF worst pain scores at 6 weeks which was lower for TA compared with SA (30 v 55 P lt 001) We also found differences between TA and SA in pain severity (26 v 45 P = 003) and pain-related interference (25 v 45 P = 002) at 6 weeks Similar findings were seen for the WOMAC and M-SACRAH scores The acupuncture intervention was well-tolerated CONCLUSION Women with AI-induced arthralgias treated with TA had significant improvement of joint pain and stiffness which was not seen with SA Acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect
Neuropathie
Avastine Xeloda Gemzar Cysplatine Taxol Fludara Alimta Procarbazine
points GI2 3 4 IG 2 3 C7 MC6 8 P7 9 F2 3 V60 VB41
traitement
preacutevention
LA DOULEUR DUE AU CANCER
bull Etiologie et physiopathologie
bull Lrsquoinvasion des pervers Externes - tout pervers srsquoil persiste peut provoquer le blocage des meacuteridiens et par la suite une stagnation de Qi et de Sg ou des troubles de Zang-Fu
bull Le deacuteregraveglement des eacutemotions
bull Le deacuteseacutequilibre de lrsquoalimentation
bull Une faiblesse de constitution
DIFFEacuteRENCIATION DE LA DOULEUR
SELON LA LOCALISATION bull dans le cancer du poumon souvent une sensibiliteacute au
P1 et V13 accompagneacutee de toux et de souffle court bull dans le cancer de lrsquoœsophage ou de lrsquoestomac une
sensibiliteacute au E34 et E42 accompagneacutee de nauseacutees dysphagie inappeacutetence
SELON LE VIDE ET LA PLEacuteNITUDE bull Vide douleurs souvent leacutegegraveres intermittentes
sourdes bull Pleacutenitude douleurs tensives lancinantes coliques
aigues
LA FATIGUE
XU LAO = fatigue par Vide = lrsquoeacutepuisement En Occident crsquoest le symptocircme le plus souvent invoqueacute et pas toujours ducirc au Vide
LA FATIGUE - eacutetiologie
bull La faiblesse constitutionnelle
bull Le surmenage
bull Lrsquoexcegraves drsquoactiviteacute physique
bull Lrsquoalimentation
bull Les maladies graves
bull Lrsquoexcegraves drsquoactiviteacute sexuelle
bull Lrsquoaccouchement
bull La consommation de drogues
LA FATIGUE - pathologie
bull Vide
bull Combinaison de Vide et de Pleacutenitude
bull Pleacutenitude
Contre-indications agrave lrsquoacupuncture
bull Des risques de laquo gros bras raquo apregraves curage axillaire
bull Des opeacuterations selon Halsted ou Patey
bull Des drainages lymphatiques
bull Pas drsquoaiguille du cocircteacute opeacutereacute
TCM in cancer treatments
bull Used mostly as adjuvant therapy before or during or
after surgery radiotherapy and chemotherapy
bull Remit the side-effects and toxicity of other treatments
bull Symptom control
bull Activate and strengthen immune system
bull For advanced cancer patients mainly palliative but it
can also prolong life in some cases
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 15 Number 7 2009
Acupuncture for Chemotherapy-Induced Neutropenia in Patients with GynecologiMalignancies A Pilot Randomized Sham-Controlled Clinical Trial
Weidong Lu MB MPH LicAc1ndash3 Ursula A Matulonis MD4 Anne Doherty-Gilman MPH1 Hang ScD3
Peter M Wayne PhD23 David S Rosenthal MD14 and Richard T Penson MD6
bull Abstract bull Objectives The objective of this study was to investigate the effect of acupuncture administered during mye-
losuppressive chemotherapy on white blood cell (WBC) count and absolute neutrophil count (ANC) in patients with ovarian cancer
bull Design This study is a pilot randomized sham-controlled clinical trial Patients received active acupuncture versus sham acupuncture while undergoing chemotherapy A standardized acupuncture protocol was em- ployed with manual and electrostimulation The frequency of treatment was 2ndash3 times per week for a total of 10 sessions starting 1 week before the second cycle of chemotherapy
bull Setting The setting was two outpatient academic centers for patients with cancer bull Subjects Twenty-one (21) newly diagnosed and recurrent ovarian cancer patients were the subjects bull Outcome measures WBC count ANC and plasma granulocyte colony-stimulating factor (G-CSF ) were assessed
weekly bull Results The median leukocyte value in the acupuncture arm at the first day of the third cycle of chemotherapy
was significantly higher than in the control arm after adjusting for baseline value (8600 cells=mL range 4800ndash 12000 versus 4400 cell=mL range 2300ndash10000) ( p frac14 0046) The incidence of grade 2ndash4 leukopenia was less in the acupuncture arm than in the sham arm (30 versus 90 p frac14 002) However the median leukocyte nadir neutrophil nadir and recovering ANC were all higher but not statistically significantly different ( p frac14 0116ndash016) after adjusting for baseline differences There were no statistically significant differences in plasma G-CSF between the two groups
bull Conclusions We observed clinically relevant trends of higher WBC values during one cycle of chemotherapy in patients with ovarian cancer which suggests a potential myeloprotective effect of acupuncture A larger trial is warranted to more definitively determine the efficacy of acupuncture on clinically important outcomes of chemotherapy-induced neutropenia
Acupuncture for the alleviation of hot flashes in men treated with androgen
ablation therapy Ashamalla H1 Jiang ML Guirguis A Peluso F Ashamalla M
bull Abstract bull PURPOSE bull Hot flashes are common side effect due to androgen ablation therapy (AAT) The utility of acupuncture for hot flashes in
men has not been thoroughly studied We prospectively studied the effect of acupuncture in men with hot flashes bull METHODS AND MATERIALS bull The study was approved by internal review board Seventeen men with hot flashes and history of AAT for prostate cancer
were enrolled Three men declined participation before receiving any treatment A hot flash score (HFS) was used to measure daily hot flashes The composite daily score was calculated as the product of frequency times severity The baseline daily scores were compared with scores taken at 2 and 6 weeks and at 8-month average follow-up
bull RESULTS bull No side effects were encountered during immediately after treatment or at 8 months The mean initial HFS was 283 it
dropped to 103 (p = 00001) at 2 weeks posttreatment 75 (p = 00001) at 6 weeks and 70 (p = 0001) at 8 months Clinical improvement for each patient is defined as the percent decrease in the mean HFS at each time point The mean improvement at Weeks 2 and 6 was 684 (mean HFS decreased from 37409 to 11836 p = 0001) and 892 (mean HFS decreased from 37409 to 405 p = 00078) respectively The improvement at 8 months was 803 (mean HFS decreased from 37409 to 7385 p = 0002)
bull CONCLUSIONS bull Acupuncture provides excellent control of hot flashes in men with a history of AAT The absence of side effects and the
durable response at 8 months are likely to be appealing to patients Prospective randomized study is warranted to further evaluate this modality against medical therapy
bull Copyright copy 2011 Elsevier Inc All rights reserved
bull Int J Radiat Oncol Biol Phys 2011 Apr 179(5)1358-63 doi 101016jijrobp201001025 Epub 2010 Jun 3
bull J Clin Oncol 2010 Mar 128(7)1154-60 doi 101200JCO2009234708 Epub 2010 Jan 25 bull Randomized blinded sham-controlled trial of acupuncture for the management of aromatase
inhibitor-associated joint symptoms in women with early-stage breast cancer bull Crew KD1 Capodice JL Greenlee H Brafman L Fuentes D Awad D Yann Tsai W Hershman DL bull Author information
bull Abstract bull PURPOSE Women with breast cancer (BC) treated with aromatase inhibitors (AIs) may experience
joint symptoms that can lead to discontinuation of effective therapy We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC METHODS We conducted a randomized controlled blinded study comparing true acupuncture (TA) versus sham acupuncture (SA) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs TA included full bodyauricular acupuncture and joint-specific point prescriptions whereas SA involved superficial needle insertion at nonacupoint locations Outcome measures included the Brief Pain Inventory-Short Form (BPI-SF) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH) obtained at baseline and at 3 and 6 weeks Results Of 51 women enrolled 43 women were randomly assigned and 38 were evaluable Baseline characteristics were comparable between the two groups Our primary end point was the difference in mean BPI-SF worst pain scores at 6 weeks which was lower for TA compared with SA (30 v 55 P lt 001) We also found differences between TA and SA in pain severity (26 v 45 P = 003) and pain-related interference (25 v 45 P = 002) at 6 weeks Similar findings were seen for the WOMAC and M-SACRAH scores The acupuncture intervention was well-tolerated CONCLUSION Women with AI-induced arthralgias treated with TA had significant improvement of joint pain and stiffness which was not seen with SA Acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect
LA DOULEUR DUE AU CANCER
bull Etiologie et physiopathologie
bull Lrsquoinvasion des pervers Externes - tout pervers srsquoil persiste peut provoquer le blocage des meacuteridiens et par la suite une stagnation de Qi et de Sg ou des troubles de Zang-Fu
bull Le deacuteregraveglement des eacutemotions
bull Le deacuteseacutequilibre de lrsquoalimentation
bull Une faiblesse de constitution
DIFFEacuteRENCIATION DE LA DOULEUR
SELON LA LOCALISATION bull dans le cancer du poumon souvent une sensibiliteacute au
P1 et V13 accompagneacutee de toux et de souffle court bull dans le cancer de lrsquoœsophage ou de lrsquoestomac une
sensibiliteacute au E34 et E42 accompagneacutee de nauseacutees dysphagie inappeacutetence
SELON LE VIDE ET LA PLEacuteNITUDE bull Vide douleurs souvent leacutegegraveres intermittentes
sourdes bull Pleacutenitude douleurs tensives lancinantes coliques
aigues
LA FATIGUE
XU LAO = fatigue par Vide = lrsquoeacutepuisement En Occident crsquoest le symptocircme le plus souvent invoqueacute et pas toujours ducirc au Vide
LA FATIGUE - eacutetiologie
bull La faiblesse constitutionnelle
bull Le surmenage
bull Lrsquoexcegraves drsquoactiviteacute physique
bull Lrsquoalimentation
bull Les maladies graves
bull Lrsquoexcegraves drsquoactiviteacute sexuelle
bull Lrsquoaccouchement
bull La consommation de drogues
LA FATIGUE - pathologie
bull Vide
bull Combinaison de Vide et de Pleacutenitude
bull Pleacutenitude
Contre-indications agrave lrsquoacupuncture
bull Des risques de laquo gros bras raquo apregraves curage axillaire
bull Des opeacuterations selon Halsted ou Patey
bull Des drainages lymphatiques
bull Pas drsquoaiguille du cocircteacute opeacutereacute
TCM in cancer treatments
bull Used mostly as adjuvant therapy before or during or
after surgery radiotherapy and chemotherapy
bull Remit the side-effects and toxicity of other treatments
bull Symptom control
bull Activate and strengthen immune system
bull For advanced cancer patients mainly palliative but it
can also prolong life in some cases
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 15 Number 7 2009
Acupuncture for Chemotherapy-Induced Neutropenia in Patients with GynecologiMalignancies A Pilot Randomized Sham-Controlled Clinical Trial
Weidong Lu MB MPH LicAc1ndash3 Ursula A Matulonis MD4 Anne Doherty-Gilman MPH1 Hang ScD3
Peter M Wayne PhD23 David S Rosenthal MD14 and Richard T Penson MD6
bull Abstract bull Objectives The objective of this study was to investigate the effect of acupuncture administered during mye-
losuppressive chemotherapy on white blood cell (WBC) count and absolute neutrophil count (ANC) in patients with ovarian cancer
bull Design This study is a pilot randomized sham-controlled clinical trial Patients received active acupuncture versus sham acupuncture while undergoing chemotherapy A standardized acupuncture protocol was em- ployed with manual and electrostimulation The frequency of treatment was 2ndash3 times per week for a total of 10 sessions starting 1 week before the second cycle of chemotherapy
bull Setting The setting was two outpatient academic centers for patients with cancer bull Subjects Twenty-one (21) newly diagnosed and recurrent ovarian cancer patients were the subjects bull Outcome measures WBC count ANC and plasma granulocyte colony-stimulating factor (G-CSF ) were assessed
weekly bull Results The median leukocyte value in the acupuncture arm at the first day of the third cycle of chemotherapy
was significantly higher than in the control arm after adjusting for baseline value (8600 cells=mL range 4800ndash 12000 versus 4400 cell=mL range 2300ndash10000) ( p frac14 0046) The incidence of grade 2ndash4 leukopenia was less in the acupuncture arm than in the sham arm (30 versus 90 p frac14 002) However the median leukocyte nadir neutrophil nadir and recovering ANC were all higher but not statistically significantly different ( p frac14 0116ndash016) after adjusting for baseline differences There were no statistically significant differences in plasma G-CSF between the two groups
bull Conclusions We observed clinically relevant trends of higher WBC values during one cycle of chemotherapy in patients with ovarian cancer which suggests a potential myeloprotective effect of acupuncture A larger trial is warranted to more definitively determine the efficacy of acupuncture on clinically important outcomes of chemotherapy-induced neutropenia
Acupuncture for the alleviation of hot flashes in men treated with androgen
ablation therapy Ashamalla H1 Jiang ML Guirguis A Peluso F Ashamalla M
bull Abstract bull PURPOSE bull Hot flashes are common side effect due to androgen ablation therapy (AAT) The utility of acupuncture for hot flashes in
men has not been thoroughly studied We prospectively studied the effect of acupuncture in men with hot flashes bull METHODS AND MATERIALS bull The study was approved by internal review board Seventeen men with hot flashes and history of AAT for prostate cancer
were enrolled Three men declined participation before receiving any treatment A hot flash score (HFS) was used to measure daily hot flashes The composite daily score was calculated as the product of frequency times severity The baseline daily scores were compared with scores taken at 2 and 6 weeks and at 8-month average follow-up
bull RESULTS bull No side effects were encountered during immediately after treatment or at 8 months The mean initial HFS was 283 it
dropped to 103 (p = 00001) at 2 weeks posttreatment 75 (p = 00001) at 6 weeks and 70 (p = 0001) at 8 months Clinical improvement for each patient is defined as the percent decrease in the mean HFS at each time point The mean improvement at Weeks 2 and 6 was 684 (mean HFS decreased from 37409 to 11836 p = 0001) and 892 (mean HFS decreased from 37409 to 405 p = 00078) respectively The improvement at 8 months was 803 (mean HFS decreased from 37409 to 7385 p = 0002)
bull CONCLUSIONS bull Acupuncture provides excellent control of hot flashes in men with a history of AAT The absence of side effects and the
durable response at 8 months are likely to be appealing to patients Prospective randomized study is warranted to further evaluate this modality against medical therapy
bull Copyright copy 2011 Elsevier Inc All rights reserved
bull Int J Radiat Oncol Biol Phys 2011 Apr 179(5)1358-63 doi 101016jijrobp201001025 Epub 2010 Jun 3
bull J Clin Oncol 2010 Mar 128(7)1154-60 doi 101200JCO2009234708 Epub 2010 Jan 25 bull Randomized blinded sham-controlled trial of acupuncture for the management of aromatase
inhibitor-associated joint symptoms in women with early-stage breast cancer bull Crew KD1 Capodice JL Greenlee H Brafman L Fuentes D Awad D Yann Tsai W Hershman DL bull Author information
bull Abstract bull PURPOSE Women with breast cancer (BC) treated with aromatase inhibitors (AIs) may experience
joint symptoms that can lead to discontinuation of effective therapy We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC METHODS We conducted a randomized controlled blinded study comparing true acupuncture (TA) versus sham acupuncture (SA) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs TA included full bodyauricular acupuncture and joint-specific point prescriptions whereas SA involved superficial needle insertion at nonacupoint locations Outcome measures included the Brief Pain Inventory-Short Form (BPI-SF) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH) obtained at baseline and at 3 and 6 weeks Results Of 51 women enrolled 43 women were randomly assigned and 38 were evaluable Baseline characteristics were comparable between the two groups Our primary end point was the difference in mean BPI-SF worst pain scores at 6 weeks which was lower for TA compared with SA (30 v 55 P lt 001) We also found differences between TA and SA in pain severity (26 v 45 P = 003) and pain-related interference (25 v 45 P = 002) at 6 weeks Similar findings were seen for the WOMAC and M-SACRAH scores The acupuncture intervention was well-tolerated CONCLUSION Women with AI-induced arthralgias treated with TA had significant improvement of joint pain and stiffness which was not seen with SA Acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect
DIFFEacuteRENCIATION DE LA DOULEUR
SELON LA LOCALISATION bull dans le cancer du poumon souvent une sensibiliteacute au
P1 et V13 accompagneacutee de toux et de souffle court bull dans le cancer de lrsquoœsophage ou de lrsquoestomac une
sensibiliteacute au E34 et E42 accompagneacutee de nauseacutees dysphagie inappeacutetence
SELON LE VIDE ET LA PLEacuteNITUDE bull Vide douleurs souvent leacutegegraveres intermittentes
sourdes bull Pleacutenitude douleurs tensives lancinantes coliques
aigues
LA FATIGUE
XU LAO = fatigue par Vide = lrsquoeacutepuisement En Occident crsquoest le symptocircme le plus souvent invoqueacute et pas toujours ducirc au Vide
LA FATIGUE - eacutetiologie
bull La faiblesse constitutionnelle
bull Le surmenage
bull Lrsquoexcegraves drsquoactiviteacute physique
bull Lrsquoalimentation
bull Les maladies graves
bull Lrsquoexcegraves drsquoactiviteacute sexuelle
bull Lrsquoaccouchement
bull La consommation de drogues
LA FATIGUE - pathologie
bull Vide
bull Combinaison de Vide et de Pleacutenitude
bull Pleacutenitude
Contre-indications agrave lrsquoacupuncture
bull Des risques de laquo gros bras raquo apregraves curage axillaire
bull Des opeacuterations selon Halsted ou Patey
bull Des drainages lymphatiques
bull Pas drsquoaiguille du cocircteacute opeacutereacute
TCM in cancer treatments
bull Used mostly as adjuvant therapy before or during or
after surgery radiotherapy and chemotherapy
bull Remit the side-effects and toxicity of other treatments
bull Symptom control
bull Activate and strengthen immune system
bull For advanced cancer patients mainly palliative but it
can also prolong life in some cases
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 15 Number 7 2009
Acupuncture for Chemotherapy-Induced Neutropenia in Patients with GynecologiMalignancies A Pilot Randomized Sham-Controlled Clinical Trial
Weidong Lu MB MPH LicAc1ndash3 Ursula A Matulonis MD4 Anne Doherty-Gilman MPH1 Hang ScD3
Peter M Wayne PhD23 David S Rosenthal MD14 and Richard T Penson MD6
bull Abstract bull Objectives The objective of this study was to investigate the effect of acupuncture administered during mye-
losuppressive chemotherapy on white blood cell (WBC) count and absolute neutrophil count (ANC) in patients with ovarian cancer
bull Design This study is a pilot randomized sham-controlled clinical trial Patients received active acupuncture versus sham acupuncture while undergoing chemotherapy A standardized acupuncture protocol was em- ployed with manual and electrostimulation The frequency of treatment was 2ndash3 times per week for a total of 10 sessions starting 1 week before the second cycle of chemotherapy
bull Setting The setting was two outpatient academic centers for patients with cancer bull Subjects Twenty-one (21) newly diagnosed and recurrent ovarian cancer patients were the subjects bull Outcome measures WBC count ANC and plasma granulocyte colony-stimulating factor (G-CSF ) were assessed
weekly bull Results The median leukocyte value in the acupuncture arm at the first day of the third cycle of chemotherapy
was significantly higher than in the control arm after adjusting for baseline value (8600 cells=mL range 4800ndash 12000 versus 4400 cell=mL range 2300ndash10000) ( p frac14 0046) The incidence of grade 2ndash4 leukopenia was less in the acupuncture arm than in the sham arm (30 versus 90 p frac14 002) However the median leukocyte nadir neutrophil nadir and recovering ANC were all higher but not statistically significantly different ( p frac14 0116ndash016) after adjusting for baseline differences There were no statistically significant differences in plasma G-CSF between the two groups
bull Conclusions We observed clinically relevant trends of higher WBC values during one cycle of chemotherapy in patients with ovarian cancer which suggests a potential myeloprotective effect of acupuncture A larger trial is warranted to more definitively determine the efficacy of acupuncture on clinically important outcomes of chemotherapy-induced neutropenia
Acupuncture for the alleviation of hot flashes in men treated with androgen
ablation therapy Ashamalla H1 Jiang ML Guirguis A Peluso F Ashamalla M
bull Abstract bull PURPOSE bull Hot flashes are common side effect due to androgen ablation therapy (AAT) The utility of acupuncture for hot flashes in
men has not been thoroughly studied We prospectively studied the effect of acupuncture in men with hot flashes bull METHODS AND MATERIALS bull The study was approved by internal review board Seventeen men with hot flashes and history of AAT for prostate cancer
were enrolled Three men declined participation before receiving any treatment A hot flash score (HFS) was used to measure daily hot flashes The composite daily score was calculated as the product of frequency times severity The baseline daily scores were compared with scores taken at 2 and 6 weeks and at 8-month average follow-up
bull RESULTS bull No side effects were encountered during immediately after treatment or at 8 months The mean initial HFS was 283 it
dropped to 103 (p = 00001) at 2 weeks posttreatment 75 (p = 00001) at 6 weeks and 70 (p = 0001) at 8 months Clinical improvement for each patient is defined as the percent decrease in the mean HFS at each time point The mean improvement at Weeks 2 and 6 was 684 (mean HFS decreased from 37409 to 11836 p = 0001) and 892 (mean HFS decreased from 37409 to 405 p = 00078) respectively The improvement at 8 months was 803 (mean HFS decreased from 37409 to 7385 p = 0002)
bull CONCLUSIONS bull Acupuncture provides excellent control of hot flashes in men with a history of AAT The absence of side effects and the
durable response at 8 months are likely to be appealing to patients Prospective randomized study is warranted to further evaluate this modality against medical therapy
bull Copyright copy 2011 Elsevier Inc All rights reserved
bull Int J Radiat Oncol Biol Phys 2011 Apr 179(5)1358-63 doi 101016jijrobp201001025 Epub 2010 Jun 3
bull J Clin Oncol 2010 Mar 128(7)1154-60 doi 101200JCO2009234708 Epub 2010 Jan 25 bull Randomized blinded sham-controlled trial of acupuncture for the management of aromatase
inhibitor-associated joint symptoms in women with early-stage breast cancer bull Crew KD1 Capodice JL Greenlee H Brafman L Fuentes D Awad D Yann Tsai W Hershman DL bull Author information
bull Abstract bull PURPOSE Women with breast cancer (BC) treated with aromatase inhibitors (AIs) may experience
joint symptoms that can lead to discontinuation of effective therapy We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC METHODS We conducted a randomized controlled blinded study comparing true acupuncture (TA) versus sham acupuncture (SA) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs TA included full bodyauricular acupuncture and joint-specific point prescriptions whereas SA involved superficial needle insertion at nonacupoint locations Outcome measures included the Brief Pain Inventory-Short Form (BPI-SF) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH) obtained at baseline and at 3 and 6 weeks Results Of 51 women enrolled 43 women were randomly assigned and 38 were evaluable Baseline characteristics were comparable between the two groups Our primary end point was the difference in mean BPI-SF worst pain scores at 6 weeks which was lower for TA compared with SA (30 v 55 P lt 001) We also found differences between TA and SA in pain severity (26 v 45 P = 003) and pain-related interference (25 v 45 P = 002) at 6 weeks Similar findings were seen for the WOMAC and M-SACRAH scores The acupuncture intervention was well-tolerated CONCLUSION Women with AI-induced arthralgias treated with TA had significant improvement of joint pain and stiffness which was not seen with SA Acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect
LA FATIGUE
XU LAO = fatigue par Vide = lrsquoeacutepuisement En Occident crsquoest le symptocircme le plus souvent invoqueacute et pas toujours ducirc au Vide
LA FATIGUE - eacutetiologie
bull La faiblesse constitutionnelle
bull Le surmenage
bull Lrsquoexcegraves drsquoactiviteacute physique
bull Lrsquoalimentation
bull Les maladies graves
bull Lrsquoexcegraves drsquoactiviteacute sexuelle
bull Lrsquoaccouchement
bull La consommation de drogues
LA FATIGUE - pathologie
bull Vide
bull Combinaison de Vide et de Pleacutenitude
bull Pleacutenitude
Contre-indications agrave lrsquoacupuncture
bull Des risques de laquo gros bras raquo apregraves curage axillaire
bull Des opeacuterations selon Halsted ou Patey
bull Des drainages lymphatiques
bull Pas drsquoaiguille du cocircteacute opeacutereacute
TCM in cancer treatments
bull Used mostly as adjuvant therapy before or during or
after surgery radiotherapy and chemotherapy
bull Remit the side-effects and toxicity of other treatments
bull Symptom control
bull Activate and strengthen immune system
bull For advanced cancer patients mainly palliative but it
can also prolong life in some cases
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 15 Number 7 2009
Acupuncture for Chemotherapy-Induced Neutropenia in Patients with GynecologiMalignancies A Pilot Randomized Sham-Controlled Clinical Trial
Weidong Lu MB MPH LicAc1ndash3 Ursula A Matulonis MD4 Anne Doherty-Gilman MPH1 Hang ScD3
Peter M Wayne PhD23 David S Rosenthal MD14 and Richard T Penson MD6
bull Abstract bull Objectives The objective of this study was to investigate the effect of acupuncture administered during mye-
losuppressive chemotherapy on white blood cell (WBC) count and absolute neutrophil count (ANC) in patients with ovarian cancer
bull Design This study is a pilot randomized sham-controlled clinical trial Patients received active acupuncture versus sham acupuncture while undergoing chemotherapy A standardized acupuncture protocol was em- ployed with manual and electrostimulation The frequency of treatment was 2ndash3 times per week for a total of 10 sessions starting 1 week before the second cycle of chemotherapy
bull Setting The setting was two outpatient academic centers for patients with cancer bull Subjects Twenty-one (21) newly diagnosed and recurrent ovarian cancer patients were the subjects bull Outcome measures WBC count ANC and plasma granulocyte colony-stimulating factor (G-CSF ) were assessed
weekly bull Results The median leukocyte value in the acupuncture arm at the first day of the third cycle of chemotherapy
was significantly higher than in the control arm after adjusting for baseline value (8600 cells=mL range 4800ndash 12000 versus 4400 cell=mL range 2300ndash10000) ( p frac14 0046) The incidence of grade 2ndash4 leukopenia was less in the acupuncture arm than in the sham arm (30 versus 90 p frac14 002) However the median leukocyte nadir neutrophil nadir and recovering ANC were all higher but not statistically significantly different ( p frac14 0116ndash016) after adjusting for baseline differences There were no statistically significant differences in plasma G-CSF between the two groups
bull Conclusions We observed clinically relevant trends of higher WBC values during one cycle of chemotherapy in patients with ovarian cancer which suggests a potential myeloprotective effect of acupuncture A larger trial is warranted to more definitively determine the efficacy of acupuncture on clinically important outcomes of chemotherapy-induced neutropenia
Acupuncture for the alleviation of hot flashes in men treated with androgen
ablation therapy Ashamalla H1 Jiang ML Guirguis A Peluso F Ashamalla M
bull Abstract bull PURPOSE bull Hot flashes are common side effect due to androgen ablation therapy (AAT) The utility of acupuncture for hot flashes in
men has not been thoroughly studied We prospectively studied the effect of acupuncture in men with hot flashes bull METHODS AND MATERIALS bull The study was approved by internal review board Seventeen men with hot flashes and history of AAT for prostate cancer
were enrolled Three men declined participation before receiving any treatment A hot flash score (HFS) was used to measure daily hot flashes The composite daily score was calculated as the product of frequency times severity The baseline daily scores were compared with scores taken at 2 and 6 weeks and at 8-month average follow-up
bull RESULTS bull No side effects were encountered during immediately after treatment or at 8 months The mean initial HFS was 283 it
dropped to 103 (p = 00001) at 2 weeks posttreatment 75 (p = 00001) at 6 weeks and 70 (p = 0001) at 8 months Clinical improvement for each patient is defined as the percent decrease in the mean HFS at each time point The mean improvement at Weeks 2 and 6 was 684 (mean HFS decreased from 37409 to 11836 p = 0001) and 892 (mean HFS decreased from 37409 to 405 p = 00078) respectively The improvement at 8 months was 803 (mean HFS decreased from 37409 to 7385 p = 0002)
bull CONCLUSIONS bull Acupuncture provides excellent control of hot flashes in men with a history of AAT The absence of side effects and the
durable response at 8 months are likely to be appealing to patients Prospective randomized study is warranted to further evaluate this modality against medical therapy
bull Copyright copy 2011 Elsevier Inc All rights reserved
bull Int J Radiat Oncol Biol Phys 2011 Apr 179(5)1358-63 doi 101016jijrobp201001025 Epub 2010 Jun 3
bull J Clin Oncol 2010 Mar 128(7)1154-60 doi 101200JCO2009234708 Epub 2010 Jan 25 bull Randomized blinded sham-controlled trial of acupuncture for the management of aromatase
inhibitor-associated joint symptoms in women with early-stage breast cancer bull Crew KD1 Capodice JL Greenlee H Brafman L Fuentes D Awad D Yann Tsai W Hershman DL bull Author information
bull Abstract bull PURPOSE Women with breast cancer (BC) treated with aromatase inhibitors (AIs) may experience
joint symptoms that can lead to discontinuation of effective therapy We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC METHODS We conducted a randomized controlled blinded study comparing true acupuncture (TA) versus sham acupuncture (SA) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs TA included full bodyauricular acupuncture and joint-specific point prescriptions whereas SA involved superficial needle insertion at nonacupoint locations Outcome measures included the Brief Pain Inventory-Short Form (BPI-SF) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH) obtained at baseline and at 3 and 6 weeks Results Of 51 women enrolled 43 women were randomly assigned and 38 were evaluable Baseline characteristics were comparable between the two groups Our primary end point was the difference in mean BPI-SF worst pain scores at 6 weeks which was lower for TA compared with SA (30 v 55 P lt 001) We also found differences between TA and SA in pain severity (26 v 45 P = 003) and pain-related interference (25 v 45 P = 002) at 6 weeks Similar findings were seen for the WOMAC and M-SACRAH scores The acupuncture intervention was well-tolerated CONCLUSION Women with AI-induced arthralgias treated with TA had significant improvement of joint pain and stiffness which was not seen with SA Acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect
LA FATIGUE - eacutetiologie
bull La faiblesse constitutionnelle
bull Le surmenage
bull Lrsquoexcegraves drsquoactiviteacute physique
bull Lrsquoalimentation
bull Les maladies graves
bull Lrsquoexcegraves drsquoactiviteacute sexuelle
bull Lrsquoaccouchement
bull La consommation de drogues
LA FATIGUE - pathologie
bull Vide
bull Combinaison de Vide et de Pleacutenitude
bull Pleacutenitude
Contre-indications agrave lrsquoacupuncture
bull Des risques de laquo gros bras raquo apregraves curage axillaire
bull Des opeacuterations selon Halsted ou Patey
bull Des drainages lymphatiques
bull Pas drsquoaiguille du cocircteacute opeacutereacute
TCM in cancer treatments
bull Used mostly as adjuvant therapy before or during or
after surgery radiotherapy and chemotherapy
bull Remit the side-effects and toxicity of other treatments
bull Symptom control
bull Activate and strengthen immune system
bull For advanced cancer patients mainly palliative but it
can also prolong life in some cases
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 15 Number 7 2009
Acupuncture for Chemotherapy-Induced Neutropenia in Patients with GynecologiMalignancies A Pilot Randomized Sham-Controlled Clinical Trial
Weidong Lu MB MPH LicAc1ndash3 Ursula A Matulonis MD4 Anne Doherty-Gilman MPH1 Hang ScD3
Peter M Wayne PhD23 David S Rosenthal MD14 and Richard T Penson MD6
bull Abstract bull Objectives The objective of this study was to investigate the effect of acupuncture administered during mye-
losuppressive chemotherapy on white blood cell (WBC) count and absolute neutrophil count (ANC) in patients with ovarian cancer
bull Design This study is a pilot randomized sham-controlled clinical trial Patients received active acupuncture versus sham acupuncture while undergoing chemotherapy A standardized acupuncture protocol was em- ployed with manual and electrostimulation The frequency of treatment was 2ndash3 times per week for a total of 10 sessions starting 1 week before the second cycle of chemotherapy
bull Setting The setting was two outpatient academic centers for patients with cancer bull Subjects Twenty-one (21) newly diagnosed and recurrent ovarian cancer patients were the subjects bull Outcome measures WBC count ANC and plasma granulocyte colony-stimulating factor (G-CSF ) were assessed
weekly bull Results The median leukocyte value in the acupuncture arm at the first day of the third cycle of chemotherapy
was significantly higher than in the control arm after adjusting for baseline value (8600 cells=mL range 4800ndash 12000 versus 4400 cell=mL range 2300ndash10000) ( p frac14 0046) The incidence of grade 2ndash4 leukopenia was less in the acupuncture arm than in the sham arm (30 versus 90 p frac14 002) However the median leukocyte nadir neutrophil nadir and recovering ANC were all higher but not statistically significantly different ( p frac14 0116ndash016) after adjusting for baseline differences There were no statistically significant differences in plasma G-CSF between the two groups
bull Conclusions We observed clinically relevant trends of higher WBC values during one cycle of chemotherapy in patients with ovarian cancer which suggests a potential myeloprotective effect of acupuncture A larger trial is warranted to more definitively determine the efficacy of acupuncture on clinically important outcomes of chemotherapy-induced neutropenia
Acupuncture for the alleviation of hot flashes in men treated with androgen
ablation therapy Ashamalla H1 Jiang ML Guirguis A Peluso F Ashamalla M
bull Abstract bull PURPOSE bull Hot flashes are common side effect due to androgen ablation therapy (AAT) The utility of acupuncture for hot flashes in
men has not been thoroughly studied We prospectively studied the effect of acupuncture in men with hot flashes bull METHODS AND MATERIALS bull The study was approved by internal review board Seventeen men with hot flashes and history of AAT for prostate cancer
were enrolled Three men declined participation before receiving any treatment A hot flash score (HFS) was used to measure daily hot flashes The composite daily score was calculated as the product of frequency times severity The baseline daily scores were compared with scores taken at 2 and 6 weeks and at 8-month average follow-up
bull RESULTS bull No side effects were encountered during immediately after treatment or at 8 months The mean initial HFS was 283 it
dropped to 103 (p = 00001) at 2 weeks posttreatment 75 (p = 00001) at 6 weeks and 70 (p = 0001) at 8 months Clinical improvement for each patient is defined as the percent decrease in the mean HFS at each time point The mean improvement at Weeks 2 and 6 was 684 (mean HFS decreased from 37409 to 11836 p = 0001) and 892 (mean HFS decreased from 37409 to 405 p = 00078) respectively The improvement at 8 months was 803 (mean HFS decreased from 37409 to 7385 p = 0002)
bull CONCLUSIONS bull Acupuncture provides excellent control of hot flashes in men with a history of AAT The absence of side effects and the
durable response at 8 months are likely to be appealing to patients Prospective randomized study is warranted to further evaluate this modality against medical therapy
bull Copyright copy 2011 Elsevier Inc All rights reserved
bull Int J Radiat Oncol Biol Phys 2011 Apr 179(5)1358-63 doi 101016jijrobp201001025 Epub 2010 Jun 3
bull J Clin Oncol 2010 Mar 128(7)1154-60 doi 101200JCO2009234708 Epub 2010 Jan 25 bull Randomized blinded sham-controlled trial of acupuncture for the management of aromatase
inhibitor-associated joint symptoms in women with early-stage breast cancer bull Crew KD1 Capodice JL Greenlee H Brafman L Fuentes D Awad D Yann Tsai W Hershman DL bull Author information
bull Abstract bull PURPOSE Women with breast cancer (BC) treated with aromatase inhibitors (AIs) may experience
joint symptoms that can lead to discontinuation of effective therapy We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC METHODS We conducted a randomized controlled blinded study comparing true acupuncture (TA) versus sham acupuncture (SA) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs TA included full bodyauricular acupuncture and joint-specific point prescriptions whereas SA involved superficial needle insertion at nonacupoint locations Outcome measures included the Brief Pain Inventory-Short Form (BPI-SF) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH) obtained at baseline and at 3 and 6 weeks Results Of 51 women enrolled 43 women were randomly assigned and 38 were evaluable Baseline characteristics were comparable between the two groups Our primary end point was the difference in mean BPI-SF worst pain scores at 6 weeks which was lower for TA compared with SA (30 v 55 P lt 001) We also found differences between TA and SA in pain severity (26 v 45 P = 003) and pain-related interference (25 v 45 P = 002) at 6 weeks Similar findings were seen for the WOMAC and M-SACRAH scores The acupuncture intervention was well-tolerated CONCLUSION Women with AI-induced arthralgias treated with TA had significant improvement of joint pain and stiffness which was not seen with SA Acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect
LA FATIGUE - pathologie
bull Vide
bull Combinaison de Vide et de Pleacutenitude
bull Pleacutenitude
Contre-indications agrave lrsquoacupuncture
bull Des risques de laquo gros bras raquo apregraves curage axillaire
bull Des opeacuterations selon Halsted ou Patey
bull Des drainages lymphatiques
bull Pas drsquoaiguille du cocircteacute opeacutereacute
TCM in cancer treatments
bull Used mostly as adjuvant therapy before or during or
after surgery radiotherapy and chemotherapy
bull Remit the side-effects and toxicity of other treatments
bull Symptom control
bull Activate and strengthen immune system
bull For advanced cancer patients mainly palliative but it
can also prolong life in some cases
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 15 Number 7 2009
Acupuncture for Chemotherapy-Induced Neutropenia in Patients with GynecologiMalignancies A Pilot Randomized Sham-Controlled Clinical Trial
Weidong Lu MB MPH LicAc1ndash3 Ursula A Matulonis MD4 Anne Doherty-Gilman MPH1 Hang ScD3
Peter M Wayne PhD23 David S Rosenthal MD14 and Richard T Penson MD6
bull Abstract bull Objectives The objective of this study was to investigate the effect of acupuncture administered during mye-
losuppressive chemotherapy on white blood cell (WBC) count and absolute neutrophil count (ANC) in patients with ovarian cancer
bull Design This study is a pilot randomized sham-controlled clinical trial Patients received active acupuncture versus sham acupuncture while undergoing chemotherapy A standardized acupuncture protocol was em- ployed with manual and electrostimulation The frequency of treatment was 2ndash3 times per week for a total of 10 sessions starting 1 week before the second cycle of chemotherapy
bull Setting The setting was two outpatient academic centers for patients with cancer bull Subjects Twenty-one (21) newly diagnosed and recurrent ovarian cancer patients were the subjects bull Outcome measures WBC count ANC and plasma granulocyte colony-stimulating factor (G-CSF ) were assessed
weekly bull Results The median leukocyte value in the acupuncture arm at the first day of the third cycle of chemotherapy
was significantly higher than in the control arm after adjusting for baseline value (8600 cells=mL range 4800ndash 12000 versus 4400 cell=mL range 2300ndash10000) ( p frac14 0046) The incidence of grade 2ndash4 leukopenia was less in the acupuncture arm than in the sham arm (30 versus 90 p frac14 002) However the median leukocyte nadir neutrophil nadir and recovering ANC were all higher but not statistically significantly different ( p frac14 0116ndash016) after adjusting for baseline differences There were no statistically significant differences in plasma G-CSF between the two groups
bull Conclusions We observed clinically relevant trends of higher WBC values during one cycle of chemotherapy in patients with ovarian cancer which suggests a potential myeloprotective effect of acupuncture A larger trial is warranted to more definitively determine the efficacy of acupuncture on clinically important outcomes of chemotherapy-induced neutropenia
Acupuncture for the alleviation of hot flashes in men treated with androgen
ablation therapy Ashamalla H1 Jiang ML Guirguis A Peluso F Ashamalla M
bull Abstract bull PURPOSE bull Hot flashes are common side effect due to androgen ablation therapy (AAT) The utility of acupuncture for hot flashes in
men has not been thoroughly studied We prospectively studied the effect of acupuncture in men with hot flashes bull METHODS AND MATERIALS bull The study was approved by internal review board Seventeen men with hot flashes and history of AAT for prostate cancer
were enrolled Three men declined participation before receiving any treatment A hot flash score (HFS) was used to measure daily hot flashes The composite daily score was calculated as the product of frequency times severity The baseline daily scores were compared with scores taken at 2 and 6 weeks and at 8-month average follow-up
bull RESULTS bull No side effects were encountered during immediately after treatment or at 8 months The mean initial HFS was 283 it
dropped to 103 (p = 00001) at 2 weeks posttreatment 75 (p = 00001) at 6 weeks and 70 (p = 0001) at 8 months Clinical improvement for each patient is defined as the percent decrease in the mean HFS at each time point The mean improvement at Weeks 2 and 6 was 684 (mean HFS decreased from 37409 to 11836 p = 0001) and 892 (mean HFS decreased from 37409 to 405 p = 00078) respectively The improvement at 8 months was 803 (mean HFS decreased from 37409 to 7385 p = 0002)
bull CONCLUSIONS bull Acupuncture provides excellent control of hot flashes in men with a history of AAT The absence of side effects and the
durable response at 8 months are likely to be appealing to patients Prospective randomized study is warranted to further evaluate this modality against medical therapy
bull Copyright copy 2011 Elsevier Inc All rights reserved
bull Int J Radiat Oncol Biol Phys 2011 Apr 179(5)1358-63 doi 101016jijrobp201001025 Epub 2010 Jun 3
bull J Clin Oncol 2010 Mar 128(7)1154-60 doi 101200JCO2009234708 Epub 2010 Jan 25 bull Randomized blinded sham-controlled trial of acupuncture for the management of aromatase
inhibitor-associated joint symptoms in women with early-stage breast cancer bull Crew KD1 Capodice JL Greenlee H Brafman L Fuentes D Awad D Yann Tsai W Hershman DL bull Author information
bull Abstract bull PURPOSE Women with breast cancer (BC) treated with aromatase inhibitors (AIs) may experience
joint symptoms that can lead to discontinuation of effective therapy We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC METHODS We conducted a randomized controlled blinded study comparing true acupuncture (TA) versus sham acupuncture (SA) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs TA included full bodyauricular acupuncture and joint-specific point prescriptions whereas SA involved superficial needle insertion at nonacupoint locations Outcome measures included the Brief Pain Inventory-Short Form (BPI-SF) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH) obtained at baseline and at 3 and 6 weeks Results Of 51 women enrolled 43 women were randomly assigned and 38 were evaluable Baseline characteristics were comparable between the two groups Our primary end point was the difference in mean BPI-SF worst pain scores at 6 weeks which was lower for TA compared with SA (30 v 55 P lt 001) We also found differences between TA and SA in pain severity (26 v 45 P = 003) and pain-related interference (25 v 45 P = 002) at 6 weeks Similar findings were seen for the WOMAC and M-SACRAH scores The acupuncture intervention was well-tolerated CONCLUSION Women with AI-induced arthralgias treated with TA had significant improvement of joint pain and stiffness which was not seen with SA Acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect
Contre-indications agrave lrsquoacupuncture
bull Des risques de laquo gros bras raquo apregraves curage axillaire
bull Des opeacuterations selon Halsted ou Patey
bull Des drainages lymphatiques
bull Pas drsquoaiguille du cocircteacute opeacutereacute
TCM in cancer treatments
bull Used mostly as adjuvant therapy before or during or
after surgery radiotherapy and chemotherapy
bull Remit the side-effects and toxicity of other treatments
bull Symptom control
bull Activate and strengthen immune system
bull For advanced cancer patients mainly palliative but it
can also prolong life in some cases
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 15 Number 7 2009
Acupuncture for Chemotherapy-Induced Neutropenia in Patients with GynecologiMalignancies A Pilot Randomized Sham-Controlled Clinical Trial
Weidong Lu MB MPH LicAc1ndash3 Ursula A Matulonis MD4 Anne Doherty-Gilman MPH1 Hang ScD3
Peter M Wayne PhD23 David S Rosenthal MD14 and Richard T Penson MD6
bull Abstract bull Objectives The objective of this study was to investigate the effect of acupuncture administered during mye-
losuppressive chemotherapy on white blood cell (WBC) count and absolute neutrophil count (ANC) in patients with ovarian cancer
bull Design This study is a pilot randomized sham-controlled clinical trial Patients received active acupuncture versus sham acupuncture while undergoing chemotherapy A standardized acupuncture protocol was em- ployed with manual and electrostimulation The frequency of treatment was 2ndash3 times per week for a total of 10 sessions starting 1 week before the second cycle of chemotherapy
bull Setting The setting was two outpatient academic centers for patients with cancer bull Subjects Twenty-one (21) newly diagnosed and recurrent ovarian cancer patients were the subjects bull Outcome measures WBC count ANC and plasma granulocyte colony-stimulating factor (G-CSF ) were assessed
weekly bull Results The median leukocyte value in the acupuncture arm at the first day of the third cycle of chemotherapy
was significantly higher than in the control arm after adjusting for baseline value (8600 cells=mL range 4800ndash 12000 versus 4400 cell=mL range 2300ndash10000) ( p frac14 0046) The incidence of grade 2ndash4 leukopenia was less in the acupuncture arm than in the sham arm (30 versus 90 p frac14 002) However the median leukocyte nadir neutrophil nadir and recovering ANC were all higher but not statistically significantly different ( p frac14 0116ndash016) after adjusting for baseline differences There were no statistically significant differences in plasma G-CSF between the two groups
bull Conclusions We observed clinically relevant trends of higher WBC values during one cycle of chemotherapy in patients with ovarian cancer which suggests a potential myeloprotective effect of acupuncture A larger trial is warranted to more definitively determine the efficacy of acupuncture on clinically important outcomes of chemotherapy-induced neutropenia
Acupuncture for the alleviation of hot flashes in men treated with androgen
ablation therapy Ashamalla H1 Jiang ML Guirguis A Peluso F Ashamalla M
bull Abstract bull PURPOSE bull Hot flashes are common side effect due to androgen ablation therapy (AAT) The utility of acupuncture for hot flashes in
men has not been thoroughly studied We prospectively studied the effect of acupuncture in men with hot flashes bull METHODS AND MATERIALS bull The study was approved by internal review board Seventeen men with hot flashes and history of AAT for prostate cancer
were enrolled Three men declined participation before receiving any treatment A hot flash score (HFS) was used to measure daily hot flashes The composite daily score was calculated as the product of frequency times severity The baseline daily scores were compared with scores taken at 2 and 6 weeks and at 8-month average follow-up
bull RESULTS bull No side effects were encountered during immediately after treatment or at 8 months The mean initial HFS was 283 it
dropped to 103 (p = 00001) at 2 weeks posttreatment 75 (p = 00001) at 6 weeks and 70 (p = 0001) at 8 months Clinical improvement for each patient is defined as the percent decrease in the mean HFS at each time point The mean improvement at Weeks 2 and 6 was 684 (mean HFS decreased from 37409 to 11836 p = 0001) and 892 (mean HFS decreased from 37409 to 405 p = 00078) respectively The improvement at 8 months was 803 (mean HFS decreased from 37409 to 7385 p = 0002)
bull CONCLUSIONS bull Acupuncture provides excellent control of hot flashes in men with a history of AAT The absence of side effects and the
durable response at 8 months are likely to be appealing to patients Prospective randomized study is warranted to further evaluate this modality against medical therapy
bull Copyright copy 2011 Elsevier Inc All rights reserved
bull Int J Radiat Oncol Biol Phys 2011 Apr 179(5)1358-63 doi 101016jijrobp201001025 Epub 2010 Jun 3
bull J Clin Oncol 2010 Mar 128(7)1154-60 doi 101200JCO2009234708 Epub 2010 Jan 25 bull Randomized blinded sham-controlled trial of acupuncture for the management of aromatase
inhibitor-associated joint symptoms in women with early-stage breast cancer bull Crew KD1 Capodice JL Greenlee H Brafman L Fuentes D Awad D Yann Tsai W Hershman DL bull Author information
bull Abstract bull PURPOSE Women with breast cancer (BC) treated with aromatase inhibitors (AIs) may experience
joint symptoms that can lead to discontinuation of effective therapy We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC METHODS We conducted a randomized controlled blinded study comparing true acupuncture (TA) versus sham acupuncture (SA) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs TA included full bodyauricular acupuncture and joint-specific point prescriptions whereas SA involved superficial needle insertion at nonacupoint locations Outcome measures included the Brief Pain Inventory-Short Form (BPI-SF) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH) obtained at baseline and at 3 and 6 weeks Results Of 51 women enrolled 43 women were randomly assigned and 38 were evaluable Baseline characteristics were comparable between the two groups Our primary end point was the difference in mean BPI-SF worst pain scores at 6 weeks which was lower for TA compared with SA (30 v 55 P lt 001) We also found differences between TA and SA in pain severity (26 v 45 P = 003) and pain-related interference (25 v 45 P = 002) at 6 weeks Similar findings were seen for the WOMAC and M-SACRAH scores The acupuncture intervention was well-tolerated CONCLUSION Women with AI-induced arthralgias treated with TA had significant improvement of joint pain and stiffness which was not seen with SA Acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect
TCM in cancer treatments
bull Used mostly as adjuvant therapy before or during or
after surgery radiotherapy and chemotherapy
bull Remit the side-effects and toxicity of other treatments
bull Symptom control
bull Activate and strengthen immune system
bull For advanced cancer patients mainly palliative but it
can also prolong life in some cases
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 15 Number 7 2009
Acupuncture for Chemotherapy-Induced Neutropenia in Patients with GynecologiMalignancies A Pilot Randomized Sham-Controlled Clinical Trial
Weidong Lu MB MPH LicAc1ndash3 Ursula A Matulonis MD4 Anne Doherty-Gilman MPH1 Hang ScD3
Peter M Wayne PhD23 David S Rosenthal MD14 and Richard T Penson MD6
bull Abstract bull Objectives The objective of this study was to investigate the effect of acupuncture administered during mye-
losuppressive chemotherapy on white blood cell (WBC) count and absolute neutrophil count (ANC) in patients with ovarian cancer
bull Design This study is a pilot randomized sham-controlled clinical trial Patients received active acupuncture versus sham acupuncture while undergoing chemotherapy A standardized acupuncture protocol was em- ployed with manual and electrostimulation The frequency of treatment was 2ndash3 times per week for a total of 10 sessions starting 1 week before the second cycle of chemotherapy
bull Setting The setting was two outpatient academic centers for patients with cancer bull Subjects Twenty-one (21) newly diagnosed and recurrent ovarian cancer patients were the subjects bull Outcome measures WBC count ANC and plasma granulocyte colony-stimulating factor (G-CSF ) were assessed
weekly bull Results The median leukocyte value in the acupuncture arm at the first day of the third cycle of chemotherapy
was significantly higher than in the control arm after adjusting for baseline value (8600 cells=mL range 4800ndash 12000 versus 4400 cell=mL range 2300ndash10000) ( p frac14 0046) The incidence of grade 2ndash4 leukopenia was less in the acupuncture arm than in the sham arm (30 versus 90 p frac14 002) However the median leukocyte nadir neutrophil nadir and recovering ANC were all higher but not statistically significantly different ( p frac14 0116ndash016) after adjusting for baseline differences There were no statistically significant differences in plasma G-CSF between the two groups
bull Conclusions We observed clinically relevant trends of higher WBC values during one cycle of chemotherapy in patients with ovarian cancer which suggests a potential myeloprotective effect of acupuncture A larger trial is warranted to more definitively determine the efficacy of acupuncture on clinically important outcomes of chemotherapy-induced neutropenia
Acupuncture for the alleviation of hot flashes in men treated with androgen
ablation therapy Ashamalla H1 Jiang ML Guirguis A Peluso F Ashamalla M
bull Abstract bull PURPOSE bull Hot flashes are common side effect due to androgen ablation therapy (AAT) The utility of acupuncture for hot flashes in
men has not been thoroughly studied We prospectively studied the effect of acupuncture in men with hot flashes bull METHODS AND MATERIALS bull The study was approved by internal review board Seventeen men with hot flashes and history of AAT for prostate cancer
were enrolled Three men declined participation before receiving any treatment A hot flash score (HFS) was used to measure daily hot flashes The composite daily score was calculated as the product of frequency times severity The baseline daily scores were compared with scores taken at 2 and 6 weeks and at 8-month average follow-up
bull RESULTS bull No side effects were encountered during immediately after treatment or at 8 months The mean initial HFS was 283 it
dropped to 103 (p = 00001) at 2 weeks posttreatment 75 (p = 00001) at 6 weeks and 70 (p = 0001) at 8 months Clinical improvement for each patient is defined as the percent decrease in the mean HFS at each time point The mean improvement at Weeks 2 and 6 was 684 (mean HFS decreased from 37409 to 11836 p = 0001) and 892 (mean HFS decreased from 37409 to 405 p = 00078) respectively The improvement at 8 months was 803 (mean HFS decreased from 37409 to 7385 p = 0002)
bull CONCLUSIONS bull Acupuncture provides excellent control of hot flashes in men with a history of AAT The absence of side effects and the
durable response at 8 months are likely to be appealing to patients Prospective randomized study is warranted to further evaluate this modality against medical therapy
bull Copyright copy 2011 Elsevier Inc All rights reserved
bull Int J Radiat Oncol Biol Phys 2011 Apr 179(5)1358-63 doi 101016jijrobp201001025 Epub 2010 Jun 3
bull J Clin Oncol 2010 Mar 128(7)1154-60 doi 101200JCO2009234708 Epub 2010 Jan 25 bull Randomized blinded sham-controlled trial of acupuncture for the management of aromatase
inhibitor-associated joint symptoms in women with early-stage breast cancer bull Crew KD1 Capodice JL Greenlee H Brafman L Fuentes D Awad D Yann Tsai W Hershman DL bull Author information
bull Abstract bull PURPOSE Women with breast cancer (BC) treated with aromatase inhibitors (AIs) may experience
joint symptoms that can lead to discontinuation of effective therapy We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC METHODS We conducted a randomized controlled blinded study comparing true acupuncture (TA) versus sham acupuncture (SA) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs TA included full bodyauricular acupuncture and joint-specific point prescriptions whereas SA involved superficial needle insertion at nonacupoint locations Outcome measures included the Brief Pain Inventory-Short Form (BPI-SF) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH) obtained at baseline and at 3 and 6 weeks Results Of 51 women enrolled 43 women were randomly assigned and 38 were evaluable Baseline characteristics were comparable between the two groups Our primary end point was the difference in mean BPI-SF worst pain scores at 6 weeks which was lower for TA compared with SA (30 v 55 P lt 001) We also found differences between TA and SA in pain severity (26 v 45 P = 003) and pain-related interference (25 v 45 P = 002) at 6 weeks Similar findings were seen for the WOMAC and M-SACRAH scores The acupuncture intervention was well-tolerated CONCLUSION Women with AI-induced arthralgias treated with TA had significant improvement of joint pain and stiffness which was not seen with SA Acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 15 Number 7 2009
Acupuncture for Chemotherapy-Induced Neutropenia in Patients with GynecologiMalignancies A Pilot Randomized Sham-Controlled Clinical Trial
Weidong Lu MB MPH LicAc1ndash3 Ursula A Matulonis MD4 Anne Doherty-Gilman MPH1 Hang ScD3
Peter M Wayne PhD23 David S Rosenthal MD14 and Richard T Penson MD6
bull Abstract bull Objectives The objective of this study was to investigate the effect of acupuncture administered during mye-
losuppressive chemotherapy on white blood cell (WBC) count and absolute neutrophil count (ANC) in patients with ovarian cancer
bull Design This study is a pilot randomized sham-controlled clinical trial Patients received active acupuncture versus sham acupuncture while undergoing chemotherapy A standardized acupuncture protocol was em- ployed with manual and electrostimulation The frequency of treatment was 2ndash3 times per week for a total of 10 sessions starting 1 week before the second cycle of chemotherapy
bull Setting The setting was two outpatient academic centers for patients with cancer bull Subjects Twenty-one (21) newly diagnosed and recurrent ovarian cancer patients were the subjects bull Outcome measures WBC count ANC and plasma granulocyte colony-stimulating factor (G-CSF ) were assessed
weekly bull Results The median leukocyte value in the acupuncture arm at the first day of the third cycle of chemotherapy
was significantly higher than in the control arm after adjusting for baseline value (8600 cells=mL range 4800ndash 12000 versus 4400 cell=mL range 2300ndash10000) ( p frac14 0046) The incidence of grade 2ndash4 leukopenia was less in the acupuncture arm than in the sham arm (30 versus 90 p frac14 002) However the median leukocyte nadir neutrophil nadir and recovering ANC were all higher but not statistically significantly different ( p frac14 0116ndash016) after adjusting for baseline differences There were no statistically significant differences in plasma G-CSF between the two groups
bull Conclusions We observed clinically relevant trends of higher WBC values during one cycle of chemotherapy in patients with ovarian cancer which suggests a potential myeloprotective effect of acupuncture A larger trial is warranted to more definitively determine the efficacy of acupuncture on clinically important outcomes of chemotherapy-induced neutropenia
Acupuncture for the alleviation of hot flashes in men treated with androgen
ablation therapy Ashamalla H1 Jiang ML Guirguis A Peluso F Ashamalla M
bull Abstract bull PURPOSE bull Hot flashes are common side effect due to androgen ablation therapy (AAT) The utility of acupuncture for hot flashes in
men has not been thoroughly studied We prospectively studied the effect of acupuncture in men with hot flashes bull METHODS AND MATERIALS bull The study was approved by internal review board Seventeen men with hot flashes and history of AAT for prostate cancer
were enrolled Three men declined participation before receiving any treatment A hot flash score (HFS) was used to measure daily hot flashes The composite daily score was calculated as the product of frequency times severity The baseline daily scores were compared with scores taken at 2 and 6 weeks and at 8-month average follow-up
bull RESULTS bull No side effects were encountered during immediately after treatment or at 8 months The mean initial HFS was 283 it
dropped to 103 (p = 00001) at 2 weeks posttreatment 75 (p = 00001) at 6 weeks and 70 (p = 0001) at 8 months Clinical improvement for each patient is defined as the percent decrease in the mean HFS at each time point The mean improvement at Weeks 2 and 6 was 684 (mean HFS decreased from 37409 to 11836 p = 0001) and 892 (mean HFS decreased from 37409 to 405 p = 00078) respectively The improvement at 8 months was 803 (mean HFS decreased from 37409 to 7385 p = 0002)
bull CONCLUSIONS bull Acupuncture provides excellent control of hot flashes in men with a history of AAT The absence of side effects and the
durable response at 8 months are likely to be appealing to patients Prospective randomized study is warranted to further evaluate this modality against medical therapy
bull Copyright copy 2011 Elsevier Inc All rights reserved
bull Int J Radiat Oncol Biol Phys 2011 Apr 179(5)1358-63 doi 101016jijrobp201001025 Epub 2010 Jun 3
bull J Clin Oncol 2010 Mar 128(7)1154-60 doi 101200JCO2009234708 Epub 2010 Jan 25 bull Randomized blinded sham-controlled trial of acupuncture for the management of aromatase
inhibitor-associated joint symptoms in women with early-stage breast cancer bull Crew KD1 Capodice JL Greenlee H Brafman L Fuentes D Awad D Yann Tsai W Hershman DL bull Author information
bull Abstract bull PURPOSE Women with breast cancer (BC) treated with aromatase inhibitors (AIs) may experience
joint symptoms that can lead to discontinuation of effective therapy We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC METHODS We conducted a randomized controlled blinded study comparing true acupuncture (TA) versus sham acupuncture (SA) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs TA included full bodyauricular acupuncture and joint-specific point prescriptions whereas SA involved superficial needle insertion at nonacupoint locations Outcome measures included the Brief Pain Inventory-Short Form (BPI-SF) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH) obtained at baseline and at 3 and 6 weeks Results Of 51 women enrolled 43 women were randomly assigned and 38 were evaluable Baseline characteristics were comparable between the two groups Our primary end point was the difference in mean BPI-SF worst pain scores at 6 weeks which was lower for TA compared with SA (30 v 55 P lt 001) We also found differences between TA and SA in pain severity (26 v 45 P = 003) and pain-related interference (25 v 45 P = 002) at 6 weeks Similar findings were seen for the WOMAC and M-SACRAH scores The acupuncture intervention was well-tolerated CONCLUSION Women with AI-induced arthralgias treated with TA had significant improvement of joint pain and stiffness which was not seen with SA Acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect
Acupuncture for the alleviation of hot flashes in men treated with androgen
ablation therapy Ashamalla H1 Jiang ML Guirguis A Peluso F Ashamalla M
bull Abstract bull PURPOSE bull Hot flashes are common side effect due to androgen ablation therapy (AAT) The utility of acupuncture for hot flashes in
men has not been thoroughly studied We prospectively studied the effect of acupuncture in men with hot flashes bull METHODS AND MATERIALS bull The study was approved by internal review board Seventeen men with hot flashes and history of AAT for prostate cancer
were enrolled Three men declined participation before receiving any treatment A hot flash score (HFS) was used to measure daily hot flashes The composite daily score was calculated as the product of frequency times severity The baseline daily scores were compared with scores taken at 2 and 6 weeks and at 8-month average follow-up
bull RESULTS bull No side effects were encountered during immediately after treatment or at 8 months The mean initial HFS was 283 it
dropped to 103 (p = 00001) at 2 weeks posttreatment 75 (p = 00001) at 6 weeks and 70 (p = 0001) at 8 months Clinical improvement for each patient is defined as the percent decrease in the mean HFS at each time point The mean improvement at Weeks 2 and 6 was 684 (mean HFS decreased from 37409 to 11836 p = 0001) and 892 (mean HFS decreased from 37409 to 405 p = 00078) respectively The improvement at 8 months was 803 (mean HFS decreased from 37409 to 7385 p = 0002)
bull CONCLUSIONS bull Acupuncture provides excellent control of hot flashes in men with a history of AAT The absence of side effects and the
durable response at 8 months are likely to be appealing to patients Prospective randomized study is warranted to further evaluate this modality against medical therapy
bull Copyright copy 2011 Elsevier Inc All rights reserved
bull Int J Radiat Oncol Biol Phys 2011 Apr 179(5)1358-63 doi 101016jijrobp201001025 Epub 2010 Jun 3
bull J Clin Oncol 2010 Mar 128(7)1154-60 doi 101200JCO2009234708 Epub 2010 Jan 25 bull Randomized blinded sham-controlled trial of acupuncture for the management of aromatase
inhibitor-associated joint symptoms in women with early-stage breast cancer bull Crew KD1 Capodice JL Greenlee H Brafman L Fuentes D Awad D Yann Tsai W Hershman DL bull Author information
bull Abstract bull PURPOSE Women with breast cancer (BC) treated with aromatase inhibitors (AIs) may experience
joint symptoms that can lead to discontinuation of effective therapy We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC METHODS We conducted a randomized controlled blinded study comparing true acupuncture (TA) versus sham acupuncture (SA) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs TA included full bodyauricular acupuncture and joint-specific point prescriptions whereas SA involved superficial needle insertion at nonacupoint locations Outcome measures included the Brief Pain Inventory-Short Form (BPI-SF) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH) obtained at baseline and at 3 and 6 weeks Results Of 51 women enrolled 43 women were randomly assigned and 38 were evaluable Baseline characteristics were comparable between the two groups Our primary end point was the difference in mean BPI-SF worst pain scores at 6 weeks which was lower for TA compared with SA (30 v 55 P lt 001) We also found differences between TA and SA in pain severity (26 v 45 P = 003) and pain-related interference (25 v 45 P = 002) at 6 weeks Similar findings were seen for the WOMAC and M-SACRAH scores The acupuncture intervention was well-tolerated CONCLUSION Women with AI-induced arthralgias treated with TA had significant improvement of joint pain and stiffness which was not seen with SA Acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect
bull J Clin Oncol 2010 Mar 128(7)1154-60 doi 101200JCO2009234708 Epub 2010 Jan 25 bull Randomized blinded sham-controlled trial of acupuncture for the management of aromatase
inhibitor-associated joint symptoms in women with early-stage breast cancer bull Crew KD1 Capodice JL Greenlee H Brafman L Fuentes D Awad D Yann Tsai W Hershman DL bull Author information
bull Abstract bull PURPOSE Women with breast cancer (BC) treated with aromatase inhibitors (AIs) may experience
joint symptoms that can lead to discontinuation of effective therapy We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC METHODS We conducted a randomized controlled blinded study comparing true acupuncture (TA) versus sham acupuncture (SA) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs TA included full bodyauricular acupuncture and joint-specific point prescriptions whereas SA involved superficial needle insertion at nonacupoint locations Outcome measures included the Brief Pain Inventory-Short Form (BPI-SF) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH) obtained at baseline and at 3 and 6 weeks Results Of 51 women enrolled 43 women were randomly assigned and 38 were evaluable Baseline characteristics were comparable between the two groups Our primary end point was the difference in mean BPI-SF worst pain scores at 6 weeks which was lower for TA compared with SA (30 v 55 P lt 001) We also found differences between TA and SA in pain severity (26 v 45 P = 003) and pain-related interference (25 v 45 P = 002) at 6 weeks Similar findings were seen for the WOMAC and M-SACRAH scores The acupuncture intervention was well-tolerated CONCLUSION Women with AI-induced arthralgias treated with TA had significant improvement of joint pain and stiffness which was not seen with SA Acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect