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Acupuncture and Chinese medicine for angina

Acupuncture reduces the frequency and severity of angina attacks. [1] A multi-center investigation finds acupuncture treatment on disease-affected acupuncture channels is more effective than treatment on non-affected channels or sham acupuncture.

The results were published in JAMA Internal Medicine. A total of 398 patients with chronic stable angina successfully completed the study. Participants were randomized to one of four treatment groups: disease-affected meridian acupuncture, non-affected meridian acupuncture, sham acupuncture, and waitlist control. Inclusion criteria for the study were as follows: ages 35–80, angina duration >3 months with attacks at least twice weekly at baseline, no significant changes in angina frequency, extent, nature, and inducing/alleviating factors at baseline.

All patients received standard anti-angina therapy for 16 weeks. This included medications such as beta-blockers or calcium channel blockers, aspirin or clopidogrel, statins, and ACE inhibitors. Medications were prescribed according to each patient’s individual needs. If patients required rescue medications during the study period, they were permitted nitro-glycerine, nifedipine, or the Chinese herbal medicine Suxiao Jiuxin Wan (an herbal extract that includes Chuan Xiong and Bing Pian). All participants, with the exception of the waitlist control group, also received acupuncture treatment, according to the following protocols.

Results

All participants completed an angina diary between the baseline assessment and the 16-week follow-up appointment. Assessments were conducted at four weekly intervals throughout this period. The primary outcome measure was the frequency of angina attacks, measured by SD (standard deviation) from the baseline assessment.

Compared with acupuncture on the non-affected meridian (which means the use of acupoints are not related to angina in TCM theory), sham acupuncture, or no acupuncture (waiting list control), acupuncture on the disease-affected meridian (the use of acupoints related to angina in TCM theory) as adjunctive treatment to antianginal therapy showed superior benefits in alleviating angina.

Traditional Chinese herbal medicine combined with acupuncture for angina

Another similar research also shows supporting evidence.[2] In this clinical trial on acupuncture for angina, the acupuncture group experienced a 94.23% effective rate compared with just 76.92% in the control group. A total of 104 patients with combined heart-yang disorder syndrome, angina, and coronary heart disease were randomized to the acupuncture group (n=54) or the control group (n=54).

Treatment

All patients received standard anti-angina medications, including nitrates, beta-blockers, anti-platelet medications, and ACE inhibitors. Additionally, patients assigned to the acupuncture group received Gua Lou Xie Bai Gui Zhi Tang.

Acupuncture was administered obliquely at Xinshu (BL15) and Geshu (BL17) and transversely at Danzhong (CV17). Needles were manipulated using a lifting-thrusting and twisting rotating technique to elicit deqi and were retained for a total of 30 minutes. Treatment was conducted on alternate days and both groups received two months of continuous treatment.

Results

The primary outcome measure for the study was the total clinical effective rate, based on the following parameters. For patients whose symptoms fully resolved and whose ECG readings were normal, the treatment was classified as markedly effective. For those whose symptoms significantly improved and whose ECG readings were almost normal, the treatment was classified as effective. For those who experienced no improvements or worsening of symptoms, the treatment was classified as ineffective.

In the acupuncture group, there were 27 markedly effective, 22 effective, and 3 ineffective cases, yielding a total effective rate of 94.23%. In the control group, there were 21 markedly effective, 19 effective, and 12 ineffective cases, yielding a total effective rate of 76.92%. Participants in the acupuncture group had a reduced frequency and duration of attacks (mean 3.16 times and 2.32 minutes, respectively) compared with the control group (mean 5.62 times and 4.54 minutes).

The results indicate that acupuncture significantly reduces the frequency and severity of angina attacks and is an appropriate clinical modality in an integrative medicine protocol.


References:

  1. Zhao L, Li D, Zheng H, et al. Acupuncture as Adjunctive Therapy for Chronic Stable Angina: A Randomized Clinical Trial. JAMA Intern Med. 2019;179(10):1388–1397. doi:10.1001/jamainternmed.2019.2407.

  2. Cong Hedong (2019) “Clinical Effects of Gualou Xiebai Guizhi Tang Jia Jian Combined with Acupuncture in Treating Angina Pectoris and Coronary Heart Disease Due to Heart-Yang Disorder” Cardiovascular Disease Electronic Journal of Integrated Chinese and Western Medicine Vol.7 (25) pp.155.


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