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Archive for the ‘Common Disease’ Category

May
24

Having adopted the American diet, the Chinese now are seeking help from American endocrinologists on ways to manage the negative byproducts of that diet: obesity and diabetes.

A delegation of some two dozen Chinese endocrinologists is here at the annual meeting of the American Association of Clinical Endocrinologists (AACE) to learn tips and tricks on taming the growing metabolic epidemics spreading across their country.

“In 2010, the prevalence of diabetes in China was nearly 10%,” said Guo Xiaohui, MD, from Peking University First Hospital, during a press briefing. “More striking is that 64% of those with diabetes are undiagnosed.”

According to the World Health Organization, the overall percentage of obesity among the Chinese is nearly 6%, but can be as high as 20% in some cities, Xiaohui said.

When asked if the Western diet is partly responsible for the increase in diabetes and obesity, he said, “More specifically, the American diet.”

The Chinese people are eating more food per serving, have more money to buy and eat food — particularly junk food — when they’re not hungry, and engage in less physical activity, Xiaohui said.

He said that many people still eat a traditional Chinese meal, but along with rice and veggies will be more meat, and portions will be bigger as well. In addition, fast-food restaurants such as Kentucky Fried Chicken and McDonald’s are enjoying success at the price of a growing obesity epidemic among children and teens, he said.

One promising initiative is a new network of primary care physicians across the country. These physicians have received training to better deal with diabetes patients. The initiative is mostly focused on rural physicians, whose knowledge of diabetes is lacking.

“The grassroots program trains doctors in the countryside how to diagnose, treat, and manage patients with diabetes,” said Guang Ning, MD, president of the Chinese Society of Endocrinology, at the press conference. “It also teaches them how to properly inject insulin and how to better educate patients to take care of themselves.”

“Perhaps we in the U.S. can also learn from the Chinese,” said Yehuda Handelsman, MD, outgoing president of AACE. “They are to be congratulated for taking a national approach to address this epidemic of diabetes.”

Handelsman and Zachary Bloomgarden, MD, from Mount Sinai School of Medicine in New York City, have been traveling to China the last several years, and it was through their friendship with Ning that the present group of Chinese endocrinologists ended up coming to this meeting to exchange ideas.

A second, related program in China is aimed at educating rural physicians about thyroid disorders, which also are increasing in number, Xiaohui said.

There are six central hospitals in different areas of China where physicians can come for training.

“Unfortunately, the level of knowledge about thyroid disorders among doctors in the countryside is even less than that of diabetes,” Xiaohui said.

“We want to establish a system for fundamental medical care, especially in the countryside, to help improve the health of our country,” he said.

The Chinese delegates are particularly interested in learning about clinical best practices, including guidelines and recommendations for practice.

By Chris Kaiser, Cardiology Editor, MedPage Today

Sep
28

In Western medicine, depression is a symptom that there is an abnormal chemistry in the brain so physicians prescribe pharmaceutical drugs to correct the brain’s chemistry and create a sense of normalcy. In Traditional Chinese Medicine, however, depression is not viewed as a mental problem per se but more of a problem in the chest area.

Certain emotions related to loss or grief, repressed feelings, and stressful circumstances cause tightness in the chest that restricts the flow of Qi and vital fluids to the organs such as the Heart and Liver. So, what TCM refers to as Liver Qi Stagnation is identified as depression in Western medicine. When chest energy is constrained and pent up, it leads to an agitated feeling .

The chest Qi must be moved in order to relieve stagnation of Liver Qi, which manifests as feelings of anxiety. Physically releasing Qi from the chest offers relief and this happens when a person laughs or cries. In the same way, many people report that they feel better after performing upper body exercises such as push-ups or boxing. Breathing exercises and yoga are also known to have similar calming effects.

Chinese herbal medicine is another approach used by TCM practitioners to relieve depression. Naturally, the herbs used are those that will stimulate the release of the Chest Qi such as bupleurum (chai hu). Herbs are combined to enhance their effects. For instance, the combination of bupleurum with mint is one of the best known herbal formulations to ease depression.

Herbs that nourish the heart such as mimosa bark (he huan pi) are also used as well as substances that are said to effectively calm the spirit such as amber and oyster shell. Chinese herbal medicines are very safe and their effects can be felt within a few weeks or even days of taking them. Other TCM approaches that are used to relieve depression are acupressure and acupuncture, which both work to release blocked Qi.

Most people who try Traditional Chinese Medicine to alleviate depression are those who’ve seen disappointing results from anti-depressant drugs or experienced adverse side effects. The TCM approach is also a great alternative to a lifetime of taking drugs. More importantly, TCM doesn’t just deal with specific symptoms of depression but aims to improve the overall quality of life.

Sep
22

In Western medicine, being overweight is viewed as a result of overeating and inadequate exercise. In Traditional Chinese Medicine, these two factors are also considered but, in addition to them, a person’s bodily constitution and mental condition are regarded as contributing factors to obesity. 

TCM does not address excess weight alone but deals with the possible body condition that leads to being overweight. TCM practitioners believe that if there is internal balance, the body’s metabolism should function properly provided that there is balance between food consumption and physical activity.

In particular, TCM believes that fatty tissues are mainly caused by phlegm and dampness pathogens. The spleen is the main organ that corresponds to obesity because it produces phlegm and transports body fluids. Eating too many sweets and not getting adequate exercise damages the spleen, weakening its metabolic function. When wastes are not properly disposed from the body, they become dampness evils that eventually form into phlegm and become fat.

The approach to TCM weight loss treatment will depend on the individual’s body constitution. While there is no single remedy in TCM to promote weight loss, every therapeutic method follows certain guidelines. For instance, one TCM principle for weight loss is to restore harmony in the stomach to help it digest fatty substances. Blood flow must also be activated to lower the blood’s fat or lipid content.

Eliminating phlegm evils from the lungs is also important as well as removing any stagnation in the liver or gallbladder, which aids metabolism. Bowel movement and urine excretion must also be induced to eliminate excess dampness in the body that contributes to being overweight.

The most common modalities used to facilitate weight loss are herbal formulations and nutrition therapy. However, various other TCM techniques which TCM practitioners have used and refined over the centuries may also be used individually or in combination, such as such as acupuncture, massage and Qi-Gong as well lifestyle counseling.

It is important to keep in mind, however, that weight loss and maintaining a healthy weight is only possible with adequate exercise and proper diet. This point is held in both Western and Traditional Chinese Medicine. The advantage of TCM is its holistic approach on the body, providing the answer to maintaining a healthy weight for good.

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Sep
22

Traditional Chinese Medicine considers acne as a skin condition that is mainly associated with the pathogenic effects of Heat on the Fundamental Substances, the meridians and the Zang Fu organs. Excessive heat may result from improper diet, stress, fatigue, genetic condition or a natural increase of Yang energy that is typical in puberty.

Heat may have an effect on the Stomach or Lung Meridians and can travel to the facial skin and the skin of the chest where acne’s characteristic inflammation can occur. If the acne appears on the back, it means the Heat escaped from the Small Intestine and Bladder channel. In the Lung Meridian, the External Pathogen of the Wind aggravates Heat that causes redness while it is exacerbated in the Stomach Meridian by consuming too many spicy and fatty foods.

Heat may also change into Toxic Heat or affect the Blood and cause lesions. Lastly, emotional wellbeing is also a factor in the formation of acne. Very intense emotions of stress, anxiety, sadness, or anger can disrupt the body’s harmony and lead to Qi stagnation, causing Heat to transmit to the surface of the skin and manifest as acne.

TCM acne treatment is a great alternative to conventional methods. The basic approach in Traditional Chinese Medicine in order to treat acne is to remove the underlying pathogenic heat from the related meridian, organ or Fundamental Substance. One TCM method that can be used to relieve acne symptoms is acupuncture but the preferred modality to treat acne is Chinese herbal medication.

To use herbal medicine, a combination of herbs will be prescribed according to the diagnosed type of pathogenic Heat in the body. An individual can take in herbal formulations, which may come in liquid, tablet or powder form, and apply a topical solution to the affected area to reduce inflammation and prevent new acne formation. Herbal medicine also lessens internal dampness and enhances the function of the intestines to prevent toxic buildup that contributes to acne.

Since nutrition plays a significant role in Traditional Chinese Medicine, the TCM physician will also include dietary recommendations in the acne treatment regimen. A low-carbohydrate and high-protein diet is advised while fried and processed foods should be avoided. TCM also stresses lifestyle changes, resulting in not just acne treatment but the restoration of balance in the body.

Feb
16

CAN Western medicine and Traditional Chinese Medicine (TCM) join hands to treat cancer patients?

If you asked Prof Li FuMin, a Singapore-based consultant TCM practitioner who specialises in immunology and oncology, the answer is yes. In fact, an integration of both techniques is more beneficial than using any of them alone, he says, but only if doctors from both sides talked to each other more often.

“Both Western and TCM have their individual strengths and weaknesses. And cancer is a unique disease that neither of them can treat nor cure fully,” Li, 68, explains when met in Kuala Lumpur recently. “That is why integrating the two might be more efficient in treating the disease.”

Although his statement might appeal to conventional logic, barriers to an integrative approach in cancer treatment have thus far prevented it from becoming a widespread reality. The lack of communication and mutual trust between practitioners from both systems are among two of them.

“In China, where Western medicine and TCM are deemed equal, and medical students from both systems are required to have basic knowledge of the other medical system, there is generally greater integration in the approach,” Li said. In other places, where complementary medicine is still regarded with a huge dose of scepticism, patients can find it more difficult to benefit from both systems.

“Sometimes patients are told to completely avoid consuming traditional Chinese medicines when they are on conventional cancer treatment,” Li laments. But on the contrary, TCM can play a supportive role to cancer treatment, he added.

Elaborating on the way Western medicine and TCM are usually integrated in cancer treatment today, Prof Li offered: “Usually, patients will go through the conventional therapies like surgery, radiotherapy, and chemotherapy first before they go for TCM therapies.

“It can act as a complementary therapy that could help alleviate some of the side effects of these cancer treatments, regulate patients’ body systems to improve their quality of life and prevent the recurrence of cancer once the disease is stabilised.”

This is the way Li would suggest his patients go about it too. “After being diagnosed with cancer, many patients will consult many doctors, trained both in Western medicine and TCM. But I would always advise my patients to seize the opportunity to remove the tumour or go for chemotherapy or radiotherapy first.

“After that, TCM can help them with side effects and their recovery. It can also help reduce the chances of recurrence when taken long-term,” he explained.

The reason for this approach is a very practical one, because TCM practitioners could not diagnose cancer.

“The claim that traditional Chinese medicine practitioners could diagnose cancer is a fallacy,” Li emphasised. First of all, many cancers have little or no symptoms until it reaches a late stage, which make diagnosis through the TCM way (observation of external symptoms and enquiries into a patients’ lifestyle) difficult, if not impossible.

Second, as TCM practitioners deduce the presence of a disease or ailments by relating certain groups of external symptoms to unhealthy changes inside the body, it is also difficult to diagnose a highly variable disease like cancer accurately.

“Cancers can manifest in very different ways in individuals, and we now know that external symptoms may sometimes mislead us in our diagnosis,” Li said. “That is why, to diagnose cancer, or other diseases, for that matter, we need to use modern diagnostic facilities,” he added.

Besides leaving the diagnosis to Western medicine, Li also stressed the importance of communication between attending doctors from both systems of medicine, particularly when a patient goes for conventional cancer treatment and TCM at the same time.

“When patients go for both treatments separately without informing their doctors about the other treatment, they may risk being repeatedly treated, over-treated, or mistreated. For instance, if you are about to go for a surgery, a traditional Chinese herb that increases your blood flow may cause you to bleed excessively during the procedure,” he said.

You would also be better off if you consult a TCM doctor who specialises in cancer treatment and understands conventional cancer treatment.

“In cancer treatments, only when the TCM doctor understands his patient’s condition and the procedures his patient had undergone completely will he be able to prescribe the best treatment to suit his patient’s needs,” said Li, who also reads his patients medical records, X-rays and laboratory results when they are referred to him.

“And just like Western Medicine, TCM doctors can specialise in the treatment of certain diseases as well,” Li said.

In Malaysia, although there are efforts in integrating TCM and other traditional complementary medicine systems into public hospitals, the recognition of TCM as a complementary therapy for cancer treatment is still limited.

However, said Malaysian Oncological Society president Datuk Dr Mohd Ibrahim Wahid, many cancer patients undergoing treatment still seek alternative treatment, with or without their oncologists’ consent or knowledge.

“So, even if we strongly oppose it, it doesn’t help the total care of the patient,” he said.

And since his patients are going to go for alternative medicine like TCM anyway, he prefers to know about it. “If (TCM) is used as a complementary therapy, and if it has no unsafe or untoward interactions with the treatments we are giving our patients, then we have no problems with that,” he said.

“We are only concerned when patients rely solely on traditional treatments as an alternative to conventional treatment and delay appropriate treatment. This is because it will jeopardise our chances of curing or treating the cancer,” he added.

So, if cancer patients undergoing treatment are taking alternative medicine, Dr Ibrahim strongly advises them to inform their oncologists.

“Even when we are still not exactly sure how these medicines interact with conventional cancer treatment, we can monitor our patients’ condition with blood tests to ensure that their condition do not worsen as a result,” he says.

The way forward, as Dr Ibrahim sees it, is for oncologists to work together with TCM practitioners for the benefit of cancer patients. “We can’t say that Western medicine can cure every ailment, and we can’t say that Chinese medicine can cure every ailment too.

“Maybe by working together, patients can have the best of both worlds and they can be reassured that we are doing the best we can to give them the best possible care,” he said.

Jan
22

SOME couples struggle to conceive, especially when infertility might be an underlying problem.

And besides undergoing Western fertility treatments, some are turning to traditional Chinese medicine (TCM) for help.

TCM treatments include herbal remedies and acupuncture, which are meant to bring the body into balance and thus facilitate conception.

But those who turn to TCM should know that TCM isn’t a quick fix, said physician Loh Kim Gek, 55.

As with Western medicine, a substantial amount of time and patience may be required before a couple sees a successful result.

With TCM, couples need to undergo at least nine to 12 months of consistent treatment, said Ms Loh, who is one of four physicians at the fertility unit in free clinic Singapore Thong Chai Medical Institution.

Ms Loh, who has more than 20 years of experience, added: “I feel a sense of satisfaction when my patients bring along their babies to meet me. It makes me very happy.”

She has helped about 30 per cent of some 900 couples to conceive.

She said that the success rate could have been as high as 50 per cent if some of those couples had stuck to their treatment without giving up halfway.

Although women are traditionally blamed for fertility problems, Ms Loh said that, in seven out of 10 cases, the problem actually lies with the male.

She will give a talk on Saturday to explain how TCM can help to boost fertility, and how one can improve one’s constitution. my paper gets her to answer some questions from readers.

Why would TCM be better than Western medicine in fertility treatments?

MS JOEY GWEE, 25

Ms Loh: TCM treatment for gynaecological problems has a long history in China, and has proved to be effective.

To me, TCM and Western medicine serve complementary needs. TCM treats the root problem, while Western medicine tackles the symptoms.

For instance, if you have ovulation problems or problems with the quality of your ovaries, TCM treatment – which comprises Chinese medicine as well as acupuncture – can improve the function of the ovaries. TCM can also help strengthen men’s sperm to enable a higher chance of conception.

But if you have problems such as a blockage in your fallopian tube due to ovarian cysts, then I would recommend Western treatment to remove them. My wife and I have been trying to have a baby for two years.

What can we do to improve our chances of conceiving?

MR J. Y. QUEK, 31

Ms Loh: Firstly, you should learn how to be free of worry. When people are anxious, it will affect the quality of a woman’s ovaries and the effectiveness of sperm. In my talk, I will share some simple methods for relieving stress.

Secondly, you need to build up your constitution and prevent development of illnesses. Illnesses during the ovulation period can greatly affect conception.

You can improve your general health by drinking teas, such as chrysanthemum and wolfberry tea, boiled dried longan, American ginseng and red dates, or wolfberry and lily tea with some brown sugar. But do consult your TCM physician to see if these are suitable for your condition, and seek treatment as soon as possible.

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Jan
14

Eczema is a general term for conditions marked by inflammation and dry, red, itchy patches on the skin. The most common form, atopic eczema, is seen in people with a predisposition to allergies, like hay fever or asthma.

    In the new study, German researchers looked at the short-term effects of acupuncture on skin inflammation and itching in 30 people with atopic eczema. They found that the therapy, when done minutes after patients’ skin was exposed to an allergen—either pollen or dust mites—appeared to soothe subjective feelings of itchiness.

     In addition, when patients were exposed to the allergen for a second time shortly after the acupuncture session, they tended to have a less-severe skin reaction, the researchers report in the journal Allergy.

    The findings show that in this “experimental setting,” acupuncture seems to ease the itch of atopic eczema, lead researcher Dr. Florian Pfab, of the Technical University of Munich, told Reuters Health in an e-mail. The study does not, however, answer the question of whether acupuncture as practiced in the real world would have similar benefits.

    For the study, Pfab and his colleagues looked at all 30 patients under three different test conditions. In one, patients had their skin exposed to either pollen or dust-mite allergens, then received true, or “point-specific,” acupuncture, in which needles were placed in traditional acupuncture points that, according to Chinese medicine, are related to itchy skin.

    In another condition, the allergen exposure was followed by “placebo-point” acupuncture, where the needles were inserted into skin areas not used in traditional Chinese medicine. In the third condition, patients received no treatment.

    Overall, Pfab’s team found, patients’ itchiness ratings were lower after they received true acupuncture, compared with both no treatment and placebo acupuncture. Then, when the researchers exposed patients’ skin to the allergens a second time, skin flare-ups tended to be less-severe following the point-specific acupuncture. As for itchiness, however, both the true and placebo therapies had similar benefits compared with no treatment.

    Acupuncture has been used for more than 2,000 years in Chinese medicine to treat a wide variety of ailments. According to traditional medicine, specific acupuncture points on the skin are connected to internal pathways that conduct energy, or qi (“chee”), and stimulating these points with a fine needle promotes the healthy flow of qi.

    Modern research has suggested that acupuncture may help ease pain by altering signals among nerve cells or affecting the release of various chemicals of the central nervous system. Pfab explained that pain and itchiness have similarities in their underlying mechanisms, so acupuncture’s effects on pain mechanisms may also account for the benefits seen in this study. The researcher pointed out, however, that more research is needed to see whether and why acupuncture might be helpful for people with eczema.

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Oct
30

Arthritis is not just 1 disease is a complex disease that includes more than 100 different conditions and can affect people at any stage of life. Two of the most common forms are osteoarthritis and rheumatoid arthritis. During these 2 very different forms of arthritis, causes, risk factors and their effects on the body, often share a symptom persistent joint pain.

Osteoarthritis (OA) is the most common form of arthritis in the United States and is estimated to affect 21 million adults. OA begins with the degradation of articular cartilage, causing pain and stiffness.

)Rheumatoid arthritis (RA can affect many different joints, and some people in other parts of the body, including blood, lungs and heart. Arthritis, diet, such as the synovium, can cause pain, stiffness, swelling, heat and redness. The public may also be affected lose their shape, resulting in the loss of normal movement. RA can last a long time and is a disease of flares (active symptoms) and remissions (few) have no symptoms.

The acupuncture points for treatment of arthritis in the whole body, not only directly affected by the region. During the acupuncture treatment may in small needles for the legs, arms, shoulders, and maybe even a little leg!

There seems little sensitivity to the integration of acupuncture needles. It is so thin that acupuncture needles can go more in the middle of a hypodermic needle. Sometimes there is a brief moment of discomfort when the needle penetrates the skin, but when the needles are there to relax and fall asleep, most people, even during treatment.

The length, number and frequency of treatment may vary. Typical applications last five to 30 minutes, with patients who received one or two times a week. Some signs of relief after the first treatment, while more serious or chronic illnesses require more frequent treatments.
There are many Chinese herbal medicine prescribed for arthritis. Acupuncturist will examine you, take a look at the start of their illness and learn the signs and symptoms to determine what herbs are best for you.

Remove dejection SSI (John Tang BI) – For joint pain increases with the cold and weight and may be accompanied by numbness in the extremities. Cinnamon Twig, Peony, and the dejection Anamerrhena (GUI Zhi Zhi Tang that SHOA mu) – For the swelling and joint pain, hot to the touch and worse at night.
Angelica pubescent and Sangjisheng dejection (Du Huo Ji Sheng Tang), together with – in serious and painful sensations at fixed locations in the middle and lower extremities due to weakness and stiffness.

Several studies have shown that acupuncture can help people with arthritis and autoimmune diseases.

In a Scandinavian study, 25 per cent of patients with rheumatoid arthritis, it canceled plans for the activity of knee surgery after an acupuncture treatment. In the study, researchers compared acupuncture with advice and exercise for the treatment of osteoarthritis of the hip. Thirty-two patients awaiting total hip replacement were divided into 2 groups. One group received 10 minutes and 25 minutes and five sessions of acupuncture and the other group received counseling and hip exercises for 6 weeks.

Patients were evaluated for pain and functional ability: Patients in the acupuncture group showed significant improvement, whereas no significant changes in the group, opinions and exercise therapy have been reported. The results of this study indicate that acupuncture is more effective than exercise and advice on the treatment of osteoarthritis of the hip.

Another study at the University of Maryland showed that the improvement of elderly patients with rheumatoid arthritis with pain in knee arthritis due to significant when acupuncture treatment recorded.

The randomized clinical trial conducted at the University of Maryland School of Medicine, to determine whether acupuncture is clinically safe and effective adjuvant therapy for older patients with knee osteoarthritis.

Acupuncture is added to conventional therapy produced an additional measure of pain relief;
It will be the effect of acupuncture for the past 4 weeks after treatment;
We acupuncture and side effects?

To increase even though no studies to continue the popularity of acupuncture for arthritis, because most people have significant relief of Oriental medicine without adverse side effects have been found by Western medicine.

Your diet plays a key role to prevent or manage arthritis. The first objective of a healthy diet to help lose weight if overweight. Obesity can lead to additional load on the joints.

The second form is a varied and balanced diet can help relieve arthritis pain by providing vitamins and minerals to keep your joints and prevent liquid foods such as dairy products and fatty or spicy foods.

If you have arthritis or knee pain or hip, vitamin C and vitamin D may help prevent bone and cartilage destruction. And a multivitamin can ensure that you always have the nutrition it needs.

Here are some other healthy (and tasty) choices in their diet.

Ginger – A natural anti-inflammatory, as a powder in capsules, extracts, alcohol-based extracts. Follow dosage instructions on the label. A bit of tea or a combination of half a teaspoon of grated ginger with eight ounces of boiling water. Drain cover and let stand for 10 to 15 minutes, and season to taste with honey.
Fresh pineapple – bromelain, an enzyme, pineapple, reduces inflammation. Make sure the pineapple is fresh, not canned or frozen.
Cherries – Recent research has shown that tart cherries are an excellent source of nutrients that can contribute to joint pain and inflammation, reduce the association of arthritis.
Fish – Cold water fish like salmon and mackerel contain omega-3 fatty acids that help healthy joints and reduce pain and swelling. If we consider a value for the fish to your diet with fish oil capsules as a supplement.
Turmeric – Another natural anti-inflammatory. For a piece of turmeric as a whole, the health food store, follow the dosage instructions on the label.

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Oct
30

According to the CDC:
“The symptoms of 2009 H1N1 flu virus in people include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. Some people may have vomiting and diarrhea. People may be infected with the flu, including 2009 H1N1 and have respiratory symptoms without a fever. Severe illnesses and deaths have occurred as a result of illness associated with this virus.”

Longer than that of regular seasonal influenza, the incubation period for swine flu is usually about 1-7 days. Try to seek medical treatment if you have symptoms like the following:

1. Clinical swine flu symptoms
Part of the patients’ condition can rapidly progress, with a sudden high fever of over 39 °C, and even secondary onset to severe pneumonia, acute respiratory distress syndrome, pulmonary hemorrhage, pleural effusion, pancytopenia, renal failure, sepsis, shock and Reye syndrome, respiratory failure and multiple organ damage, leading to death.

2. Swine flu signs
Pulmonary signs often are not so obvious, and some patients can be heard moist rales or present pulmonary consolidation and so on.

3. The prognosis of swine flu
The prognosis of human infection with swine flu subtype virus are favorable; while poor prognosis for those infected with H1N1 virus, case-fatality rate of about 6%.

4. Chest radiograph for swine flu
When combined with pneumonia lung, slice images can be seen. In serious cases, a wide range of slice images can be seen.

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Oct
15

ACUPUNCTURE FOR HIP AND KNEE ARTHRITIS
A large German trial has found that acupuncture is of significant benefit in controlling the pain of osteoarthritis of the hip and knee. Of 3633 patients, 357 were randomised to receive acupuncture (15 treatments over three months), 355 were randomised to a non-acupuncture control group, and 2921 did not accept randomisation and opted for acupuncture treatment. All patients received usual medical care in addition to acupuncture. The randomised acupuncture group showed significant improvement over controls at both three and six months in osteoarthritis severity (WOMAC scale) and quality of life. Improvements were comparable to those in the non randomised acupuncture group. The authors report that ” P h y s i c i a n c h a r a c t e r i s t i c s , s u c h a s t h e l e v e l o f f o r m a l a c u p u n c t u r e t r a i n i n g o r c e r t i f i c a t i o n , d i d n o t i n f l u e n c e t r e a t m e n t o u t c o m e s ” , although only 140 hours of certified training was a minimum requirement of participating physicians. Partly as a result of this trial, the German Ministry of Health is considering a recommendation from a federal committee of doctors and health insurers that acupuncture should be covered by medical insurance. (Acupuncture in patients with osteoarthritis of the knee or hip: A randomized, controlled trial with an additional nonrandomized arm. Arthritis & Rheumatism, 54; 11: 3485 – 3493).

ACUPUNCTURE & RHEUMATOID ARTHRITIS
A small study has demonstrated that acupuncture, and particularly electro-acupuncture, appears to be effective in reducing joint pain, stiffness and swelling in rheumatoid arthritis (RA). 36 patients, average age 58, suffering from RA that was unresponsive to other therapies, were assigned to three groups and received either electro-acupuncture, traditional acupuncture or ‘placebo acupuncture’. All received twenty treatments over ten weeks. The points used in the first two groups were Yangchi SJ-4, Waiguan SJ-5, Yangxi L.I.-5, Wangu SI-4, Dazhui DU-14 and Quchi L.I.-11. A total of 29 patients completed the study and most of the drop-outs (because of inefficacy) were in the placebo group. In both the acupuncture groups the number of tender joints and physician’s global scores were significantly reduced. (Efficacy of Traditional Chinese Acupuncture in the Treatment of Rheumatoid Arthritis (RA): A Double-blind Controlled Pilot Study. American College of Rheumatology Annual Scientific Meeting, November 2006).

ACUPUNCTURE & KNEE OSTEOARTHRITIS
Another German trial has shown a significant benefit for acupuncture treatment (in this case in the treatment of osteoarthritis of the knee), yet with no significant difference between true and sham acupuncture. In this large trial of 1007 patients (treated by 320 different practitioners in 315 primary care practices), who had had chronic pain from knee arthritis for over six months, a minimum 36% improvement was seen at 26 weeks (after ten acupuncture treatments) in 53.1% of true acupuncture patients, 51.0% of sham acupuncture patients and 29.1% for patients receiving conservative therapy (standard physician visits). This batch of German studies raises important questions for acupuncturists. While some attention has been focused on what might be the physiological effects of sham needling (usually very superficial insertion at non-points with no deqi), it is also necessary to examine the true acupuncture, and specifically how effectively practitioners succeeded in obtaining deqi, which was a necessary part of the true acupuncture protocol. (Acupuncture and Knee Osteoarthritis: A Three-Armed Randomized Trial, Annals of Internal Medicine, 4 July 2006).

ACUPUNCTURE EFFECTIVE FOR KNEE ARTHRITIS
In a study of the treatment of chronic arthritis of the knee, 150 patients were assigned to receive ‘true’ acupuncture, 76 to minimal acupuncture (superficial needling at non-acupuncture points) and 76 to a waiting list control. Both acupuncture groups received 12 treatment sessions over 8 weeks at 28 different outpatient centres. Patients completed standard questionnaires at 8, 26 and 52 weeks after onset of treatment. The study found that patients in both acupuncture groups improved compared to a waiting list group, but that those receiving true acupuncture suffered significantly less pain and joint dysfunction at 8 weeks than the sham acupuncture group. The difference was no longer significant, however, at 52 weeks. (The Lancet 2005; 366:136-143).

ACUPUNCTURE & KNEE ARTHRITIS
The longest and largest randomised, controlled phase III clinical trial of acupuncture ever conducted has found that acupuncture can significantly improve the symptoms of arthritis of the knee. The study of 570 patients was carried out at the University of Maryland School of Medicine. The patients were randomly assigned to receive 23 treatments of either true or sham (no actual insertion of needles) acupuncture or a 12-week knee osteoarthritis education course. At the end of the study, the true acupuncture group had the greatest reduction (40%) in knee pain and the greatest improvement (nearly 40%) in knee function. The study was funded by the National Center for Complementary and Alternative Medicine (NCCAM) and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), both components of the US National Institutes of Health. “For the first time, a clinical trial with sufficient rigour, size, and duration has shown that acupuncture reduces the pain and functional impairment of osteoarthritis of the knee,” said Stephen E. Straus, NCCAM Director. “These results also indicate that acupuncture can serve as an effective addition to a standard regimen of care and improve quality of life for knee osteoarthritis sufferers. (Ann Intern Med, Dec 2004; 141: 901-910.)

ACUPUNCTURE & KNEE ARTHRITIS
In a separate Spanish study of the potential benefits of acupuncture in the treatment of knee osteoarthritis, 97 patients were randomly assigned to receive either acupuncture plus diclofenac, or placebo acupuncture plus diclofenac. The true acupuncture consisted of needling (followed by electroacupuncture at the local points) at Yanglingquan GB-34, Yinlingquan SP-9, Xiyan (MN-LE-16), Zusanli ST-36, Taixi KID-3, Sanyinjiao SP-6, Hegu L.I.-4 and Fenglong ST-40 (all with deqi). The placebo acupuncture was administered using retractable needles (with adhesive cylinders) at the same points, and sham electroacupuncture was also given. Both groups received twelve weekly treatments. At the end of the study, the true acupuncture group had a greater reduction in pain and stiffness, improved physical functioning, and an improved quality of life. (BMJ 2004;329:1216).ACUPUNCTURE FOR NECK PAIN
This very large German study compared the effects of fifteen acupuncture treatments over three months with no acupuncture in the treatment of chronic neck pain (longer than six months). 1753 patients were randomly allocated to receive acupuncture and 1698 to the non-acupuncture control group, and a further 10,395 patients rejected randomisation and elected to receive acupuncture. At the end of the three-month treatment period, chronic pain and disability scores and quality of life scores improved significantly in both acupuncture groups compared to controls, with no significant differences between the randomised and non-randomised acupuncture groups. (11th Annual Symposium on Complementary Health Care 2004).

ACUPUNCTURE FOR OSTEOARTHRITIS OF THE KNEE
30 patients with osteoarthritis of the knee were randomised to one of three groups: 1. acupuncture alone at Hegu L.I.-4, Xuehai SP-10, Xiyan (MN-LE-16), Yinlingquan SP-9, Yanglingquan GB-34, Zusanli ST-36, Taichong LIV-3, Weizhong BL-40 and Chengshan BL-57 (twice weekly treatment, obtaining of deqi, 10 treatments in total, using electro-acupuncture at most points); 2. identical acupuncture plus continuation of their symptomatic Western medication; 3. symptomatic medication alone for five weeks, followed by a course of acupuncture as above. Outcome measures (visual analogue pain scale/VAS and Western Ontario McMaster questionnaire/WOMAC) were administered by a blinded observer. Highly significant improvements in both measures were observed in the first two groups, and there was no change in the third group until they received acupuncture, when significant changes were observed. The benefits were maintained one month after the end of the course of acupuncture. (Acupuncture in Medicine 2004;22(1):14-22). In another study, 563 patients with arthritis of the knee (54% of 5-10 year duration; 23% more than 10 years) were treated with acupuncture for a maximum of 15 sessions, with treatment cessation if no improvement was noted after three treatments (these patients were included in the study results). Of the 85% of patients who completed treatment (standard points and additional points according to TCM pattern, with deqi, average 8.9 sessions per patient), 75% experienced a greater than 45% relief in pain scores. There was a significant difference in quantity of analgesics taken at completion of treatment (most of the 45% pain-relief responders ceased medication entirely). Cost analysis showed a reduction from a mean of .91 euros a day before treatment, to .18 euros a day after treatment, representing a daily saving of 349.50 euros a day for the 478 patients who stayed in the study. (Acupuncture in Medicine 2004;22(1):23-28).

LEI GONG TENG & RA
A root extract of Lei Gong Teng (Tripterygium Wilfordii Hook) has been shown to safely and effectively reduce pain and inflammation in a randomised, double-blind, placebo-controlled trial of a small group of people with treatment-resistant rheumatoid arthritis (RA). In the 20-week clinical trial, 21 RA patients were randomly assigned to one of three treatment groups: placebo, low-dose extract, or high-dose extract. After four weeks, 80% of patients in the high-dose group and 40% in the low-dose group showed rapid improvement in symptoms compared with no improvement in the placebo group. Side effects were minor for all three treatment groups. According to the researchers Lei Gong Teng is unique, because it slows down the overactive immune system, reduces inflammation by turning off inflammatory genes such as tumour necrosis factor alpha, and reduces the activity of B and T cells. It has the potential to treat other immune diseases such as lupus, and further studies are planned. The extraction process used in the trial transforms the otherwise toxic Lei Gong Teng. (Arthritis & Rheumatism 2002;46(7):1735-43). Meanwhile Fujisawa Pharmaceutical, the Japanese company who manufacture Prograf, a prescription medicine used to prevent the immune system from rejecting transplants, has entered into collaboration with Pharmagenesis, the US company which develops pharmaceuticals derived from Chinese herbal medicines, to explore triptolide derivatives, novel and potent immunosuppressants created by Pharmagenesis from Lei Gong Teng. Triptolide and its derivatives inhibit cytokine production in T cells through a different mechanism of action from Prograf and are expected to be effective in prevention of acute and chronic rejection for patients undergoing organ transplants.

ACUPUNCTURE & KNEE OSTEOARTHRITIS
60 patients on a waiting list for total knee replacement were randomly divided into two groups. 30 received “medical acupuncture” using one inch needles inserted “deeply” at Yinlingquan SP-9, Xuehai SP-10, Liangqiu ST 34, Zusanli ST-36 and Hegu L.I.-4. The needles were manipulated manually 4 times during a 15 minute retention and patients received a total of 6 weekly treatments. The 30 patients in the control group received no treatment. At a 2-month follow up, scores for the time to walk 50 metres and the time to climb 20 steps fell significantly in the acupuncture group compared to the control, as did pain scores, whilst HSS knee scores – which gives marks for pain, functional ability, range of motion, muscle strength, flexion deformity and knee stability – improved significantly in the acupuncture group. Scores for all measures deteriorated in the non-treatment group. 3 patients in the acupuncture group requested suspension from the waiting list due to the improvement in their symptoms. (Acupunct Med 2002; 20(1): 19-21).

ACUPUNCTURE & OSTEOARTHRITIS OF THE KNEE
44 patents with advanced osteoarthritis of the knee who were awaiting total knee joint replacements were given acupuncture either on the most affected knee only, or on both knees. Points needled were Yinlingquan SP-9, Xuehai SP-10, Liangqiu ST-34, Zusanli ST-36 and Hegu L.I.-4. Results showed a significant reduction in symptoms in both groups with no signficant dfference between the two groups, suggesting hat unilateral acupuncture is as effective as bilateral acupuncture for this condition. (Acupuncture in Medicine 2001;19(1):15-18).

OSTEOARTHRITIC HYPEROSTOSIS
It is estimated that the majority of the over-50’s in the USA have osteoarthritic bony hypertrophy (osteophytes), with the disease present in 90% of 80-year olds. In a study carried out at Guangzhou Hospital of TCM, 183 patients were treated by warm needling (Shenshu BL-23, Pangguangshu BL-28, Yaoyangguan DU-3 plus Weizhong BL-40 for cold-damp type and Taixi KID-3 for Kidney deficient type) followed by cupping to the lumbo-sacral area. After treatment, although x-rays showed no change to the degree of bony malformation, the symptoms of 48% of patients were cured and 50% were improved (American Journal of Acupuncture Vol.24, No.1).

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