Acupuncture relief for congestive heart failure

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Acupuncture increases the effectiveness of drugs for the treatment of congestive heart failure (CHF), with results confirmed by color Doppler echocardiography, changes in blood urea nitrogen and creatinine levels, and tolerance testing to effort. Researchers from Yanbian University Affiliated Hospital (Yanji, China) compared two groups: control and acupuncture. One received standard pharmacological medication and Sheng Mai San herbal injections and the other received the same treatment regimen plus the addition of acupuncture treatments. The group that did not receive acupuncture had a total effective rate of 86.7%. The group receiving acupuncture had a total effective rate of 93.3%. [1] Based on the results, the researchers conclude that adding acupuncture to treatment protocols merits clinical promotion.

A total of 60 patients with stage 2 to 4 CHF were recruited for the study after admission to hospital. The acupuncture group consisted of 18 men and 12 women with an average age of 72.5 years. The control group consisted of 17 men and 13 women with an average age of 71.9 years. There were no statistically significant differences in baseline characteristics between the two groups.

Medication
Both groups were treated with a combination of drugs and Chinese herbal medicine. Digitalis, diuretics and vasodilators were prescribed to patients according to individual needs. All patients in both groups received Sheng Mai intravenous fluid, consisting of Sheng Mai San in a dextrose solution. The treatment was given once a day, the 14 days constituting a cycle of care. Patients assigned to the acupuncture observation group were also treated with acupuncture administered at the following acupuncture points:

  • Neiguan (PC6)
  • Gongsun (SP4)
  • Shenmen (HT7)
  • Zusanli (ST36)
  • Sanyinjiao (SP6)
  • Little finger: Heart, Sympathetic, Shenmen
  • For patients with a diagnosis of mucus obstruction: Fenglong (ST40)
  • For blood stasis patients: Xuehai (SP10)
  • For patients with Qi stagnation: Taichong (LV3)

After standard insertion, the needles were stimulated using a balanced reinforcement-reduction method and retained for 20 minutes. The treatment was carried out once a day or twice a day for severe cases. Ear points were treated with recessed needles that were changed daily, using alternate ears. A treatment cycle lasted 10-14 days.

Results
Study outcome measures included heart and kidney function, as well as total effective treatment rate for each group. Cardiac function was assessed by color Doppler echocardiography, including EF (ejection fraction) and FS (fractional shortening). These measurements indicate how efficiently the ventricles pump blood with each contraction, with higher scores indicating better heart function.

Mean EF scores before treatment were 38.9 in the control group and 39.3 in the acupuncture group. After treatment, the scores increased to 40.3 and 48.6 respectively. Although both groups saw improvements, these were significantly greater in the acupuncture group (p

Mean FS scores before treatment were 21.8 in the control group and 21.6 in the acupuncture group. After treatment, the scores increased to 24.7 and 27.3 respectively. Patients in the acupuncture group experienced significantly greater improvements (p

Kidney function was assessed by measuring blood urea nitrogen (BUN) and creatinine. Levels of these markers tend to be higher in the blood of patients with CHF due to reduced kidney function. Potassium and sodium levels were also taken into consideration.

Mean urea levels before treatment were 8.12 in the control group and 8.37 in the acupuncture group. After treatment, these numbers decreased to 7.38 and 7.35 respectively. The difference between the groups was modest but statistically significant, with greater improvements in the acupuncture group (p

Mean creatine levels before treatment were 175.67 in the control group and 163.3 in the acupuncture group. After treatment, the scores decreased to 152.39 and 121.86 respectively. Significantly greater improvements were seen in the acupuncture group (p

The total effective treatment rate was calculated using a 6-minute walk test for exercise tolerance and overall symptom improvement. For patients whose CHF improved by two or more stages, treatment was rated as clearly effective. For patients whose CHF improved by one stage, treatment was rated as effective. For patients with no change or deterioration in condition, treatment was classified as ineffective.

In the control group, there were 26 effective cases and 4 ineffective cases, giving a total effective rate of 86.7%. In the acupuncture observation group, there were 28 effective cases and 2 ineffective cases, an effective rate of 93.3%. The intergroup difference was considered statistically significant by the research team (p

The results of the study indicate that acupuncture is a useful adjunct to the treatment of congestive heart failure. It has the potential to improve heart and kidney function, while improving patients’ exercise tolerance.

About Sheng Mai Intravenous Injection
Sheng Mai Injection (SMI) is a form of Shengmai San, a traditional Chinese herbal formula. Sheng Mai injection “is widely used in various cardiovascular diseases, and at least three systematic reviews have been conducted to date to assess the effectiveness of SMI on heart failure, acute heart infarction mortality rate, myocardium and hypotension after acute myocardial infarction”. [2] Research indicates that this injection form of the herbal formula improves heart function, alleviates myocardial hypertrophy, improves contractility, and protects myocardial cells. [3]

The references:
1. Lei Yan-na, Piao Long, Lu Yan, Liu Long, Wan Xue-wen, Liu Dong-na, Jin Hai, Zhang Hong-jia (2010) “Effect of medicine in combination with acupuncture on 30 deficiencies chronic congestive heart patients” Tropical Chinese Medicine, vol 10(3) pp.349, 351.
2. Chen, Chao-yang, Ling-yan Lu, Peng Chen, Kang-ting Ji, Jia-feng Lin, Peng-lin Yang, Ji-fei Tang and Yan Wang. “Injection of Shengmai, a traditional Chinese patent medicine, for intradialytic hypotension: a systematic review and meta-analysis.” Evidence-Based Complementary and Alternative Medicine 2013 (2013).
3. Xu, SH and SY Liu. “Progress on the pharmacological effect of shengmai injection.” Chinese Pharmaceutical Affairs 24, no. 4 (2010): 405-407.

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