Wu Yixian, Zheng Daosheng, Yu Guorui, Cheng Baihua, Ye Jiashu, Qian Daihua, Zhou Yuying, Chen Meifang, Wu Jenhong, Wang Mukang, Xu Jingbo (Shanghai 3rd People's Hospital, Shanghai 2nd Medical College)
The authors reported in a previous paper a long-term followup study of rheumatic heart disease showing clinical improvement after acupuncture. For further confirmation of the therapeutic effect and investigation of its mechanism, the authors made a prospective study by selecting 21 patients suffering from this disease, and observed the changes of the symptoms and signs, chest films, EKG, echocardiography, systolic time interval, blood cortisol level and cAMP/cGMP before, during and immediately after a course of acupuncture.
After puncturing the Neiguan to 1.5-3 cm in depth in both forearms, the needles were twisted back and forth at 150-180º with a rate of 80-100 times per minute for about 2 minutes, and then left in place for 15 minutes. Each patient received acupuncture 3 times a week for 4 weeks.
At the time of puncturing, all patients had a feeling of soreness, distention, heaviness or numbness of varying degrees. The needling sensation was felt radiating along the Channel of Pericardium in92% of cases. At the end of 2 weeks of the treatment, 15 of the 21 patients (15/21) had good clinical improvement, and 5/21 excellent. The liver was found to be smaller in 13/19 patients after the treatment. Of the 5 with excellent results, improvement of venous engorgement over the right upper lung was observed. 3 of the 5 patients had Kerley's lines which disappeared in 2 patients after the treatment. 97% of patients showed shortening of the systolic time interval (P<0.001) after a course of treatment, 61.66% of cases showed decrease of internal diameter of left ventricle during diastole, and 75.55% of cases showed improvement on EF slope of anterior mitral valve in echocardiography. These changes suggested an improvement of the myocardial contractibility after the acupuncture. The blood cAMP/cGMP increased after the first and during the course of acupuncture (P<0.05 and P<0.01 respectively). This probably reflects a strenghtening of myocardial contractibility. The blood cortisol level was 10.63±1.13% before the treatment and was 8.3±1.05µg%, 8.51±1.56µg% and 14±0.83µg% immediately after needling, during, and at the end of the course of acupuncture respectively (P<0.05 in all). A normalization of this cortisol level seemed to appear during the course. This might suggest that it may be the cause of the improvement of the cardiocirculatory function in some patients after acupuncture.
All the 21 patients were followed up for 2 months after the acupuncture. Fifteen patients kept on their good cardiac status as during the treatment. However, 6 patients got worse 2 weeks after the last acupuncture, with reappearance of edema and dyspnea. One of them showed edema and enlargement of the liver to the pretreatment level. A second course of acupuncture was then started. Edema subsided after the 3rd, and the liver became smaller after the 6th acupuncture. Clinical improvement persisted up to the end of the 2nd course.
The authors reported in a previous paper a long-term followup study of rheumatic heart disease showing clinical improvement after acupuncture. For further confirmation of the therapeutic effect and investigation of its mechanism, the authors made a prospective study by selecting 21 patients suffering from this disease, and observed the changes of the symptoms and signs, chest films, EKG, echocardiography, systolic time interval, blood cortisol level and cAMP/cGMP before, during and immediately after a course of acupuncture.
After puncturing the Neiguan to 1.5-3 cm in depth in both forearms, the needles were twisted back and forth at 150-180º with a rate of 80-100 times per minute for about 2 minutes, and then left in place for 15 minutes. Each patient received acupuncture 3 times a week for 4 weeks.
At the time of puncturing, all patients had a feeling of soreness, distention, heaviness or numbness of varying degrees. The needling sensation was felt radiating along the Channel of Pericardium in92% of cases. At the end of 2 weeks of the treatment, 15 of the 21 patients (15/21) had good clinical improvement, and 5/21 excellent. The liver was found to be smaller in 13/19 patients after the treatment. Of the 5 with excellent results, improvement of venous engorgement over the right upper lung was observed. 3 of the 5 patients had Kerley's lines which disappeared in 2 patients after the treatment. 97% of patients showed shortening of the systolic time interval (P<0.001) after a course of treatment, 61.66% of cases showed decrease of internal diameter of left ventricle during diastole, and 75.55% of cases showed improvement on EF slope of anterior mitral valve in echocardiography. These changes suggested an improvement of the myocardial contractibility after the acupuncture. The blood cAMP/cGMP increased after the first and during the course of acupuncture (P<0.05 and P<0.01 respectively). This probably reflects a strenghtening of myocardial contractibility. The blood cortisol level was 10.63±1.13% before the treatment and was 8.3±1.05µg%, 8.51±1.56µg% and 14±0.83µg% immediately after needling, during, and at the end of the course of acupuncture respectively (P<0.05 in all). A normalization of this cortisol level seemed to appear during the course. This might suggest that it may be the cause of the improvement of the cardiocirculatory function in some patients after acupuncture.
All the 21 patients were followed up for 2 months after the acupuncture. Fifteen patients kept on their good cardiac status as during the treatment. However, 6 patients got worse 2 weeks after the last acupuncture, with reappearance of edema and dyspnea. One of them showed edema and enlargement of the liver to the pretreatment level. A second course of acupuncture was then started. Edema subsided after the 3rd, and the liver became smaller after the 6th acupuncture. Clinical improvement persisted up to the end of the 2nd course.
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