Healthcare professionals

Irritable bowel syndrome (IBS) describes a collection of symptoms, commonly including chronic abdominal pain, bloating, flatulence and altered bowel habits. It is a functional disorder of the intestines, occurring in the absence of visible structural abnormality.

IBS affects up to 22% of people in the UK and is the most common functional digestive disorder seen by GPs. Women are 2-3 times more likely to develop IBS, and often suffer more symptoms during their periods. The condition often begins in adolescence or early adulthood. Predisposing factors may include a low-fibre diet, emotional stress, use of laxatives or a bout of infectious diarrhoea. It is typically a chronic, recurrent disorder, associated with substantial health, social and economic costs. Pain and impairment from IBS can lead to frequent doctor visits, hospitalizations and workplace absenteeism, and can cause depression.

The cause of IBS is unclear, but it appears that sensory nerves in the bowel are hypersensitive in people with IBS and may overreact when the bowel wall stretches. Intestinal muscles can be hypo- or hyperactive, causing pain, cramping, flatulence, sudden bouts of diarrhea, and/or constipation. The symptoms are usually triggered by stress or eating. Systematic reviews of the research literature suggest that conventional medications are of limited benefit in IBS (Akehurst et al, 2001).

How acupuncture can help

Research has shown that acupuncture treatment may benefit IBS symptoms by:

• Providing pain relief (Pomeranz, 1987).

• Regulating the motility of the digestive tract (Chen et al, 2008).

• Raising the sensory threshold of the gut (Xing et al, 2004). A lowered threshold to bowel pain and distention are hallmarks of IBS.

• Increasing parasympathetic tone (Schneider et al, 2007). Stress activates the sympathetic nervous system, which can stimulate colon spasms, resulting in abdominal discomfort. In people with IBS, the colon can be oversensitive to the smallest amount of conflict or stress. Acupuncture activates the opposing parasympathetic nervous system, which initiates the relaxation or ‘rest and digest’ response.

• Reducing anxiety and depression (Samuels et al, 2008). The distress provoked by IBS symptoms can lead to a vicious cycle of anxiety-pain-anxiety, while the embarrassing nature of the condition can lead to feelings of depression. Acupuncture can alter the brain’s mood chemistry, increases production of serotonin (Han et al, 1986) and endorphins (Han, 2004), helping to combat these negative affective states.
Acupuncture can be safely and effectively combined with Western biomedicine, and other treatments such as relaxation exercises, herbal medicine and psychotherapy. In addition to offering acupuncture and related therapies, acupuncturists will often make suggestions as to dietary and other lifestyle changes that may be helpful in combating IBS symptoms. Working with a supportive therapist can also help people suffering from IBS to change their negative health beliefs and improve their coping mechanisms, which can have a positive influence on both mood and symptoms.

Full details of research studies into traditional acupuncture treatment for depression can be found below.

Research	Conclusion
Chen J, Song GQ, Yin J, Koothan T, Chen JD. Electroacupuncture improves impaired gastric motility and slow waves induced by rectal distension in dogs. Am J Physiol Gastrointest Liver Physiol. 2008 Sep;295(3):G614-20.	Experimental trial of effect of electroacupunture on gastric motility in dogs. Found that electroacupuncture restored impaired gastric motility induced by rectal distention, possibly by enhancing vagal nerve activity, mediated via the opioid pathway. Authors conclude electroacupuncture may have therapeutic potential for functional gastrointestinal disorders.
Renolds JA, Bland JM, MacPherson H. Acupuncture for irritable bowel syndrome an exploratory randomised controlled trial. Acupunct Med 2008 Mar; 26(1):8-16.	Pragmatic randomized controlled trial of acupuncture for IBS involving 30 patients. Compared 10 sessions of acupuncture plus usual GP care with usual GP care alone. At 3 months, a statistically and clinically significant difference between groups of 138 points in favour of acupuncture was observed on the IBS Symptom Severity Score.
Trujillo NP. Acupuncture for the treatment of irritable bowel syndrome. Med Acupunct 2008 Mar 20(1):47-49.	Uncontrolled study in which 149 patients with IBS, which had not responded to standard medical care, were treated with two different acupuncture protocols. Found an overall 80% improvement in both acupuncture groups.
Schneider S, Weiland C, Enck P, Joos S, Streitberger K, Gluth C, Zipfel S, Herzog W, Neuroendocrinological effects of acupuncture treatment in patients with irritable bowel syndrome. Complement Ther Med. 2007 Dec;15(4):255-63.	Randomized controlled trial of acupuncture for IBS involving 43 patients. Compared acupuncture with sham acupuncture using a non-penetrating needle. Found quality-of-life improved in both groups, while true acupuncture group showed greater improvement relating to parameters measuring activation of the parasympathetic nervous system. Authors conclude real acupuncture, but not sham acupuncture, improved IBS symptoms via its effects on parasympathetic control of gut sensations and functions.
Schneider A, Streitberger K, Joos S. Acupuncture treatment in gastrointestinal diseases: A systematic review. World J Gastroenterol 2007 July 7; 13(25): 3417-3424.	Systematic review and meta-analysis of acupuncture for gastrointestinal diseases. In 2 trials of acupuncture for IBS identified as being of high methodological quality, quality-of-life improved remarkably after acupuncture, although there was no difference between real and sham/placebo acupuncture.
Tian XY, Bian ZX, Hu XG, Zhang XJ, Liu L, Zhang H. Electro-acupuncture attenuates stress-induced defecation in rats with chronic visceral hypersensitivity via serotonergic pathway. Brain Res. 2006 May 9;1088(1):101-8.	Experimental study of electroacupuncture for IBS in rats. Found acupuncture decreased sensitivity to mechanically induced rectal pain and reduced stress-induced defecation in rats with experimentally induced IBS.
Lim B, Manheimer E, Lao L, Ziea E, Wisniewski J, Liu J, Berman B. Acupuncture for treatment of irritable bowel syndrome. Cochrane Database Syst Rev. 2006 Oct 18;(4):CD005111.	Systematic review and meta-analysis of acupuncture for IBS. Analysed pooled results of 6 trials. Acupuncture treatment and sham acupuncture found to be equally effective. For two studies without a sham control, acupuncture was more effective than control treatment (herbal medicine and psychotherapy) for improvement of symptoms.
Forbes A, Jackson S, Walter C, Quraishi S, Jacyna M, Pitcher M. Acupuncture for irritable bowel syndrome: a blinded placebo-controlled trial. World J Gastroenterol 2005; 11: 4040-4044.	Randomized controlled trial of acupuncture for IBS involving 60 IBS patients. Compared acupuncture with sham acupuncture. Patients in both groups improved, but no real difference was found between the two groups.
Cui KM, Li WM, Gao X, Chung K, Chung JM, Wu GC. Electro-acupuncture relieves chronic visceral hyperalgesia in rats. Neurosci Lett. 2005 Mar 7;376(1):20-3.	Experimental study of electroacupuncture for IBS in rats. Found acupuncture effectively reduced pain induced by mechanical distention of the colon and rectum in rats with experimentally induced IBS.
Xing J, Larive B, Mekhail N, Soffer E. Transcutaneous electrical acustimulation can reduce visceral perception in patients with the irritable bowel syndrome: a pilot study. Altern Ther Health Med. 2004 Jan-Feb;10(1):38-42.	Experimental study of electroacupuncture for IBS involving 7 patients. Patients received either real or sham acupuncture while undergoing rectal distention using an inflatable balloon apparatus. Real acupuncture stimulation, but not sham stimulation, significantly increased the threshold of rectal sensation of gas, desire to defecate and pain, as compared to a control period. Authors conclude that acupuncture can reduce rectal sensitivity in IBS patients.
Lu B, Hu Y, Tenner S. A randomised controlled trial of acupuncture for irritable bowel syndrome. Program and abstracts of the 65^th Annual Scientific Meeting of the American College of Gastroenterology; October 16-18, 2000, New York, NY. Poster 268, p.428	Randomized controlled trial of acupuncture for IBS involving 27 patients. Compared acupuncture with relaxation sessions. Found quality-of-life and gastrointestinal symptom scores improved equally in both groups. A significant reduction in abdominal pain was observed in both groups at the end of the trial, however, only in the acupuncture group did pain reduction persist at 4 weeks post trial. Reduced stress perception was also observed in acupuncture group, but not with relaxation.
Samuels N, Gropp C, Singer SR, Oberbaum M. Acupuncture for psychiatric illness: a literature review. Behav Med. 2008 Summer;34(2):55-64.	Literature review of acupuncture for psychiatric illness. Presents research which has found that acupuncture increases central nervous system hormones including ACTH, beta-endorphins, serotonin, and noradrenaline. Concludes that acupuncture can have positive effects on depression and anxiety.
Han JS. Acupuncture and endorphins. Neurosci Lett. 2004 May 6;361(1-3):258-61.	Literature review of studies relating to the release of endorphins by acupuncture.
Pomeranz B. Scientific basis of acupuncture. In: Stux G, Pomeranz B, eds. Acupuncture Textbook and Atlas. Heidelberg: Springer-Verlag; 1987:1-18.	Needle activation of A delta and C afferent nerve fibres in muscle send signals to spinal cord, where dynorphin and enkephalins are released. Afferent pathways continue to midbrain, triggering excitatory and inhibitory mediators in spinal cord. Ensuing release of neurotransmitters serotonin and norepinephrine onto spinal cord leads to pain transmission being inhibited both pre- and postsynaptically in spinothalamic tract. Finally, these signals reach hypothalamus and pituitary, triggering release of adrenocorticotropic hormones and beta-endorphin.
Akehurst R, Kaltenthaler E. Treatment of irritable bowel syndrome: a review of randomised controlled trials. Gut. 2001 Feb;48(2):272-82.	Systematic review of randomised controlled trials examining the clinical effectiveness of medical interventions for IBS. Concludes that ‘the evidence for efficacy of drug therapies is weak’.
Han JS. Electroacupuncture: An alternative to antidepressants for treating affective diseases? Intl J Neurosci 1986;29:79-92.	Review presenting evidence that acupuncture can accelerate synthesis and release of serotonin and noradrenline in the CNS. As well as clinical data indicating that electroacupuncture is effective in treating depressive patients, and at least as effective and with a higher therapeutic index than tricyclic amitriptyline.

Depression is a common mental health problem that affects people of all genders, ages, and backgrounds. About two thirds of adults will at some time experience depression severe enough to interfere with their normal activities (Mintel/YouGov, 2006, Stewart et al, 2004). Women are twice as likely as men to become depressed (Stewart et al, 2004) partly due to hormone changes occurring pre-menstrually, at menopause, during pregnancy or after childbirth.

Depression is estimated to cost the UK £7.5 billion a year in medication, benefits and lost working days (McCrone et al, 2008). The World Health Organization predicts that by 2020 depression will be second only to chronic heart disease as an international health burden (WHO, 2008).
Although everyone occasionally experiences low mood, these feelings usually pass after a couple of days. When a person has clinical depression, these problems can become chronic or recurrent, interfering with daily life. Depression causes symptoms such as low mood, loss of interest in enjoyable activities, anxiety, irritability low self-esteem, disturbed sleep or appetite, weight change, tiredness, lack of motivation, concentration or libido, physical pain, and suicidal thoughts.

Depression is likely to result from a combination of genetic, biochemical, environmental, and psychological factors. It may be triggered by stressful events, such as bereavement, illness, relationship problems or financial difficulties.

How acupuncture can help

Research has shown that acupuncture treatment can help ameliorate the symptoms of depression. In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional wellbeing.

Studies indicate that acupuncture can have a specific positive effect on depression by altering the brain’s mood chemistry, increasing production of serotonin (Sprott et al, 1998) and endorphins (Han, 1986). Acupuncture may also benefit depression by acting through other neurochemical pathways, including those involving dopamine (Scott et al, 1997), noradrenaline (Han, 1986), cortisol (Han et al, 2004) and neuropeptide Y (Pohl & Nordin, 2002).
Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the ‘analytical’ brain which is responsible for anxiety and worry (Wu et al, 1999).

Some of the most recent research suggests that depression is associated with dysfunction in the way that parts of the resting brain interact with each other (Broyd et al 2008). Acupuncture has been shown to be capable of changing this ‘default mode network’ (Dhond et al, 2007), thus providing another possible mechanism for its beneficial effect on depression.

Acupuncture can be safely combined with conventional medical treatments such as anti-depressants, helping to reduce their side effects and enhance their beneficial effects (Zhang et al, 2007).

Acupuncture treatment can also help resolve physical ailments such as chronic pain (Zhao, 2008), which may be a contributing cause of depression. In addition to offering acupuncture and related therapies, acupuncturists will often make suggestions as to dietary and other lifestyle changes that may be helpful in overcoming depression. Finally, people struggling to cope with depression usually find that coming to see a supportive therapist on a regular basis is helpful in itself.

Full details of research studies into traditional acupuncture treatment for depression can be found below.

Research	Conclusion
Wang H, Qi H, Wang BS, Cui YY, Zhu L, Rong ZX, Chen HZ. Is acupuncture beneficial in depression: A meta-analysis of 8 randomized controlled trials? J Affect Disord. 2008 Dec;111(2-3):125-34.	Meta-analysis which looked at the most recent clinical studies of acupuncture in the treatment of depression. It analysed the pooled results of eight small randomized controlled trials, comprising a total of 477 subjects and concluded; “acupuncture was an effective treatment that could significantly reduce the severity of disease in the patients with depression”.
Broyd SJ, Demanuele C, Debener S, Helps SK, James CJ, Sonuga-Barke EJ. Default-mode brain dysfunction in mental disorders: A systematic review. Neurosci Biobehav Rev. 2008 Sep 9.	Systematic review of the role of the default mode network in the pathophysiology of mental disorders including anxiety and depression.
Dhond RP, Yeh C, Park K, Kettner N, Napadow V. Acupuncture modulates resting state connectivity in default and sensorimotor brain networks. Pain. 2008 Jun;136(3):407-18.	Experimental fMRI study of brain activity before and after acupuncture. Found that verum acupuncture had a persistent effect on the connectivity of different brain areas during its resting-state. Acupuncture increased the extent of regions of the brain active at rest (the ‘default mode network’) to include areas involved with pain, emotion and memory.
Zhao ZQ, Neural mechanism underlying acupuncture analgesia. Prog Neurobiol. 2008 Aug;85(4):355-75.	Review of evidence for neural mechanisms underlying acupuncture analgesia and its ability to treat chronic pain.
Fu WB, Fan L, Zhu XP, He Q, Wang L, Zhuang LX, Liu YS, Tang CZ, Li YW, Meng CR, Zhang HL, Yan J. Acupuncture for treatment of depressive neurosis: a multi-center randomized controlled study. Zhongguo Zhen Jiu. 2008 Jan;28(1):3-6.	Multi-centre randomized controlled study of acupuncture for depression, involving 440 cases. Found the therapeutic effect of acupuncture on depression to be similar to or better than that of Prozac, with fewer side effects.
Zhang GJ, Shi ZY, Liu S, Gong SH, Liu JQ, Liu JS. Clinical observation on treatment of depression by electro-acupuncture combined with Paroxetine. Chin J Integr Med. 2007 Sep;13(3):228-30.	Randomized controlled trial involving 42 patients. Found that acupuncture combined with anti-depressant medication was more effective in treating depression than anti-depressants alone. Patients on the combined treatment also improved more quickly and experienced fewer side effects than those who only took medication.
Leo RJ, Ligot JS Jr. A systematic review of randomized controlled trials of acupuncture in the treatment of depression. J Affect Disord. 2007 Jan;97(1-3):13-22.	Systematic review and meta analysis of acupuncture as a treatment of depression, which analysed the pooled results of nine small randomised controlled trials. Found that; “acupuncture modalities were as effective as antidepressants employed for treatment of depression”.
Manber R, Schnyer RN, Allen JJ, Rush AJ, Blasey CM. Acupuncture: a promising treatment for depression during pregnancy. J Affect Disord. 2004 Nov 15;83(1):89-95.	Randomized controlled study of acupuncture for depression during pregnancy, involving 61 women. Found that eight weeks of acupuncture at points specifically chosen to treat depression was significantly more effective than either non-specific acupuncture or massage in reducing symptoms of depression.
Han C, Li X, Luo H, Zhao X, Li X. Clinical study on electro-acupuncture treatment for 30 cases of mental depression. J Tradit Chin Med. 2004 Sep;24(3):172-6.	Randomized controlled study of electroacupuncture for depression, involving 61 patients. Found that electroacupuncture produced the same therapeutic effect as tetracyclic drug maprotiline with fewer side effects and better symptomatic improvement.
Gallagher SM, Allen JJ, Hitt SK, Schnyer RN, Manber R. Six-month depression relapse rates among women treated with acupuncture. Complement Ther Med. 2001 Dec;9(4):216-8.	Follow-up study of earlier randomized controlled trial by Allen et al (see below). Found that depression relapse rates following depression-specific acupuncture treatment were comparable to those achieved following conventional drug treatments.
Pohl A, Nordin C. Clinical and biochemical observations during treatment of depression with electroacupuncture: a pilot study. Hum Psychopharmacol. 2002 Oct;17(7):345-8.	Pilot study of electroacupuncture for major depression. Found a decrease of neuropeptide in plasma during treatment.
Röschke J, Wolf C, Müller MJ, Wagner P, Mann K, Grözinger M, Bech S. The benefit from whole body acupuncture in major depression. J Affect Disord. 2000 Jan-Mar;57(1-3):73-81.	Randomized controlled study of acupuncture used in conjunction with antidepressants to treat depression, involving 70 patients. Concluded that acupuncture plus antidepressants improved the course of depression more than medication alone.
Eich H, Agelink MW, Lehmann E, Lemmer W, Klieser E. Acupuncture in patients with minor depressive episodes and generalized anxiety. Results of an experimental study. Fortschr Neurol Psychiatr. 2000 Mar;68(3):137-44.	Randomized controlled trial of acupuncture treatment in 43 patients with minor depression. Results indicated that, compared with placebo treatment, acupuncture leads to a significant clinical improvement in depression as well as a marked reduction in anxiety symptoms.
Wu MT, Hsieh JC, Xiong J, Yang CF, Pan HB, Chen YC, Tsai G, Rosen BR, Kwong KK. Central nervous pathway for acupuncture stimulation: localization of processing with functional MR imaging of the brain--preliminary experience. Radiology. 1999 Jul;212(1):133-41.	Experimental study using fMRI to characterize the central nervous system pathway for acupuncture stimulation. Found that acupuncture activates structures of descending antinocioceptive pathway and deactivates areas mediating pain modulation.
Allen JJB, Schnyer RN, Hitt SK. The efficacy of acupuncture in the treatment of major depression in women. Psychological Science 1998:9(5):397-401.	Randomized controlled trial of acupuncture for major depression in 33 women. Eight weeks of depression-specific acupuncture led to a significantly greater reduction in depression than either non-specific acupuncture or being on a waiting list. Following specific acupuncture, 64% of women experienced full remission of depressive symptoms.
Sprott H, Franke S, Kluge H, Hein G. Pain treatment of fibromyalgia by acupuncture. Rheumatol Int 1998;18:35-36.	Experimental study of pain modulation by acupuncture in fibromyalgia patients. Found that acupuncture was associated with decreased subjective pain levels, as well as changes in concentration of pain modulating substances (serotonin and substance P) in serum.
Scott S, Scott WN. A biochemical hypothesis for the effectiveness of acupuncture in the treatment of substance abuse: acupuncture and the reward cascade. Am J Acupunct 1997;25:33–40.	Review exploring physiological basis of acupuncture in the treatment of addiction, in relation to endorphin mechanisms and the reward cascade.
Han JS. Electroacupuncture: An alternative to antidepressants for treating affective diseases? Intl J Neurosci 1986;29:79-92.	Review presenting evidence that acupuncture can accelerate synthesis and release of serotonin and noradrenline in the CNS. As well as linical data indicating that electroacupuncture is effective in treating depressive patients, and at least as effective and with a higher therapeutic index than tricyclic amitriptyline.

Additional references

Mintel/YouGov. Depression poll commissioned by the British Association for Counselling and Psychotherapy. 2006 Apr.

Stewart DE, Gucciardi E, Grace SL; Depression. BMC Women’s Health. 2004 Aug 25;4 Suppl 1:S19.

McCrone P, Dhanasiri S, Patel A, Knapp M, Lawton-Smith S. Paying the Price: The cost of mental health care in England to 2026. The King’s Fund, May 2008, ISBN 978 1 85717 571 4.

World Health Organization. 2008. http://www.who.int/mental_health/management/depression/definition/en/

Type-2 diabetes (adult-onset or non-insulin-dependent diabetes) is a common metabolic disorder in which the body is unable to regulate the amount of glucose in the blood. The condition affects nearly 1.5 million people in the UK (Diabetes UK, 2004), and may be undiagnosed in as many as a million more. It develops when insufficient insulin is produced by the body, or when the body’s cells no longer respond to insulin (insulin resistance).

The four common symptoms of type-2 diabetes are: excessive thirst, passing large amounts of urine, tiredness and weight loss. Over time, the high blood sugar levels caused by type-2 diabetes causes damage to blood vessels. This leads to atheroma, which can cause problems such as poor circulation, angina, heart attacks and stroke. It can result in diabetic complications, including eye disorders, nerve damage, foot problems, kidney disease and impotence.

The cause of type-2 diabetes is complex, involving an interplay of genes and environmental factors. It tends to occur in people over 40 and is strongly associated with being overweight.

How acupuncture can help

Chinese medical texts have recognized diabetes as ‘wasting-thirsting’ for thousands of years, relating it to the consumption of too much rich food. Acupuncture therapy is a common approach to treating diabetes in modern China. Research has shown that traditional acupuncture can help manage diabetic symptoms and prevent and manage complications of the disease by:

• Helping to treat obesity (Cho et al, 2009), which is the primary risk factor for developing type-2 diabetes. Weight loss (plus increased physical activity) is more effective than drug therapy for preventing or delaying the development of type-2 diabetes (Knowler et al, 2002).

• Increasing insulin production (Lin et al, 2004) and improving blood sugar regulation (Cabioğlu & Ergene, 2006).

• Improving insulin sensitivity (Chang et al, 2006).

• Improving blood lipid profile (Cabioğlu & Ergene, 2005). Dyslipidaemia is common in patients with type-2 diabetes and is responsible for the atherosclerosis and ensuing cardiovascular morbidity and mortality associated with the disease (Krentz, 2003).

• Improving blood circulation (Tsuchiya et al 2007), thus helping to slow the onset and progression of diabetic circulatory complications.

• Helping manage the pain of diabetic peripheral neuropathy (Jiang et al, 2006; Abuaisha et al, 1998).

• Reducing the stress response (Sakai et al, 2007). Stress hormones such as cortisol cause blood glucose to rise and promote insulin resistance (Purnell et al, 2009). Stress may play a role in the development of the metabolic syndrome (Rosmond, 2005), which often precedes diabetes, as well as increasing the risk of developing type-2 diabetes itself (Eriksson et al, 2008), and that it can increase the severity of the condition (Oltmans et al, 2006).

• Helping with depression (Wang et al, 2008). Depression is common among people with diabetes and affects their quality of life. It may contribute to developing the condition (Carnethon et al, 2007). People suffering from depression may take less good care of themselves, eat less well, drink more alcohol or exercise less. All of these can make type-2 diabetes worse.

Most people use acupuncture as part of an integrated diabetes treatment plan because they are already using Western medication. Acupuncture can be safely and effectively combined with Western biomedicine and other treatments such as relaxation exercises and herbal medicine. In addition to offering acupuncture and related therapies, acupuncturists will often make suggestions as to dietary and other lifestyle changes that may be beneficial. Eating a healthy balanced diet, taking regular physical exercise, reducing stress and maintaining a healthy body weight can help to prevent or delay the onset of type-2 diabetes and slow the progression of the disease. Working with a supportive therapist can help people commit to these positive lifestyle changes.

Full details of research studies into traditional acupuncture treatment for diabetes can be found below:

Research	Conclusion
Cho SH, Lee JS, Thabane L, Lee J. Acupuncture for obesity: a systematic review and meta-analysis. Int J Obes (Lond). 2009 Feb;33(2):183-96.	Systematic review of studies of acupuncture for treating obesity. Analysed pooled results from 31 studies involving 3013 cases. Concludes that acupuncture is an effective treatment for obesity.
Purnell JQ, Kahn SE, Samuels MH, Brandon D, Loriaux DL, Brunzell JD. Enhanced cortisol production rates, free cortisol, and 11beta-HSD-1 expression correlate with visceral fat and insulin resistance in men: effect of weight loss. Am J Physiol Endocrinol Metab. 2009 Feb;296(2):E351-7.	Cohort study investigating the relationship between cortisol production, visceral obesity and insulin resistance. Quantified cortisol production and clearance rates, abdominal fat deposits, insulin sensitivity, and adipocyte gene expression in a cohort of 24 men. Concluded that increased hypothalamic-pituitary-adrenal activity in men promotes selective visceral fat accumulation and insulin resistance.
Wang H, Qi H, Wang BS, Cui YY, Zhu L, Rong ZX, Chen HZ. Is acupuncture beneficial in depression: A meta-analysis of 8 randomized controlled trials? J Affect Disord. 2008 Dec;111(2-3):125-34.	Meta-analysis which looked at the most recent clinical studies of acupuncture in the treatment of depression. It analysed the pooled results of eight small randomized controlled trials, comprising a total of 477 subjects and concluded; “acupuncture was an effective treatment that could significantly reduce the severity of disease in the patients with depression”.
Eriksson AK, Ekbom A, Granath F, Hilding A, Efendic S, Ostenson CG. Psychological distress and risk of pre-diabetes and Type 2 diabetes in a prospective study of Swedish middle-aged men and women. Diabet Med. 2008 Jul;25(7):834-42.	Cohort study looking at the role of psychological stress in pre-diabetes and type-2 diabetes. Followed 2127 Swedish middle-aged men and 3100 women with baseline normal glucose tolerance for up to 10 years. Found that psychological distress (including symptoms of anxiety, apathy, depression, fatigue and insomnia) doubled the risk of pre-diabetes and type-2 diabetes in men.
Sakai S, Hori E, Umeno K, Kitabayashi N, Ono T, Nishijo H. Specific acupuncture sensation correlates with EEGs and autonomic changes in human subjects. Auton Neurosci. 2007 May 30;133(2):158-69.	Experimental study of the effects of acupuncture on the autonomic nervous system in healthy volunteers. Found that acupuncture inhibited activity of the sympathetic nervous system (responsible for the ‘fight or flight’ stress response).
Carnethon MR, Biggs ML, Barzilay JI, Smith NL, Vaccarino V, Bertoni AG, Arnold A, Siscovick D. Longitudinal association between depressive symptoms and incident type 2 diabetes mellitus in older adults: the cardiovascular health study. Arch Intern Med. 2007 Apr 23;167(8):802-7.	Cohort study looking at the association between depressive symptoms and and type-2 diabetes in older adults. Followed 4681 people for 10 years. Found that older adults who reported higher depressive symptoms were more likely to develop type-2 diabetes.
Tsuchiya M, Sato EF, Inoue M, Asada A. Acupuncture enhances generation of nitric oxide and increases local circulation. Anesth Analg. 2007 Feb;104(2):301-7.	Randomized controlled trial studying the effects of acupuncture on local blood circulation. 20 volunteers underwent a session each of real and sham acupuncture in a single hand and forearm with a 1-wk interval between treatments. Concentration of nitric oxide (NO - a vasodilator) in the plasma from the acupunctured arm was significantly increased. Blood flow in the hand of the acupunctured arm also increased. No changes were observed with sham. Concluded that acupuncture increases the NO level in treated regions and thereby increases local circulation.
Chang SL, Lin KJ, Lin RT, Hung PH, Lin JG, Cheng JT. Enhanced insulin sensitivity using electroacupuncture on bilateral Zusanli acupoints (ST 36) in rats. Life Sci. 2006 Aug 1;79(10):967-71.	Experimental study of the effect of electroacupuncture (EA) on blood glucose and insulin levels in diabetic rats. Found that EA had hypoglycaemic activity and improved glucose tolerance.
Jiang H, Shi K, Li X, Zhou W, Cao Y. Clinical study on the wrist-ankle acupuncture treatment for 30 cases of diabetic peripheral neuritis. J Tradit Chin Med. 2006 Mar;26(1):8-12.	Randomized controlled trial of acupuncture for peripheral diabetic neuropathy. 90 patients were treated with either wrist-ankle acupuncture, whole-body acupuncture, or conventional medical treatment. Both acupuncture groups experienced significantly better results than the conventional medical/control group. Acupuncture was also observed to improve blood sugar and lipid metabolism, and restore the functions of peripheral nerve cells
Oltmanns KM, Dodt B, Schultes B, Raspe HH, Schweiger U, Born J, Fehm HL, Peters A. Cortisol correlates with metabolic disturbances in a population study of type 2 diabetic patients. Eur J Endocrinol. 2006 Feb;154(2):325-31.	Observational study of levels of the stress hormone cortisol in 192 type-2 diabetes patients. Found that the degree of severity of several clinical measures of type-2 diabetes (including blood glucose glycosylated haemoglobin and abdominal mass) correlates with cortisol concentrations.
Cabioğlu MT, Ergene N. Changes in levels of serum insulin, C-Peptide and glucose after electroacupuncture and diet therapy in obese women. Am J Chin Med. 2006;34(3):367-76.	Randomized controlled trial of acupuncture investigating the effects of electroacupuncture (EA) combined with diet on body weight and levels of serum insulin, c-peptide and glucose in obese women. Found that (compared with sham EA+diet), EA+diet was effective in treating obesity and that EA decreased serum glucose levels by increasing serum insulin and c-peptide levels.
Rosmond R. Role of stress in the pathogenesis of the metabolic syndrome. Psychoneuroendocrinology. 2005 Jan;30(1):1-10.	Review discussing how stress and cortisol secretion play a role in the pathogenesis of role in the metabolic syndrome.
Cabioğlu MT, Ergene N. Electroacupuncture therapy for weight loss reduces serum total cholesterol, triglycerides, and LDL cholesterol levels in obese women. Am J Chin Med. 2005;33(4):525-33.	Randomized controlled trial of acupuncture investigating the effects of electroacupuncture (EA) on serum lipid profile in obese women. Found that decreased total cholesterol, triglyceride, and LDL cholesterol levels by increasing the serum beta endorphin level. Concluded that the lipolytic effect of EA may also reduce the morbidity of obesity by mobilizing the energy stores that result in weight reduction.
Lin JG, Chen WC, Hsieh CL, Tsai CC, Cheng YW, Cheng JT, Chang SL. Multiple sources of endogenous opioid peptide involved in the hypoglycemic response to 15 Hz electroacupuncture at the Zhongwan acupoint in rats. Neurosci Lett. 2004 Aug 5;366(1):39-42.	Experimental study investigating the the hypoglycemic response to electroacupuncture (EA) in rats. Concludes that EA causes an increase in beta-endorphin production by the adrenal gland, which enhances the secretion of insulin, thereby reducing plasma glucose levels.
Diabetes UK. Diabetes in the UK 2004. www.diabetes.org.uk/Documents/Reports/in_the_UK_2004.doc	Report providing statistics and other information about the prevalence of diabetes in the United Kingdom in 2004, who is affected and its impact on society.
Krentz AJ. Lipoprotein abnormalities and their consequences for patients with type 2 diabetes. Diabetes Obes Metab. 2003 Nov;5 Suppl 1:S19-27.	Review of lipoprotein abnormalities in patients with type 2 diabetes and their consequences for cardiovascular disease.
Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002 Feb 7;346(6):393-403.	Randomized controlled trial comparing a lifestyle-intervention with the use of metformin to prevent or delay the development of type-2 diabetes. 3234 people were either given the drug metformin (850 mg twice daily), or placed on a a lifestyle-modification program with the goals of at least a 7% weight loss and at least 150 minutes of physical activity per week. The lifestyle intervention was significantly more effective than metformin, reducing the incidence of type-2 diabetes by 58% (compared with by 31% with metformin.
Abuaisha BB, Costanzi JB, Boulton AJ.Acupuncture for the treatment of chronic painful peripheral diabetic neuropathy: a long-term study. Diabetes Res Clin Pract. 1998 Feb;39(2):115-21.	Observational study of acupuncture for peripheral diabetic neuropathy. 46 patients were treated with classical acupuncture over a period of 10 weeks and followed up for up to one year. 77% showed significant improvement in their symptoms with 7 reporting complete elimination of symptoms. 67% of patients who used medications at the start of the study were able to stop or reduce their medications significantly during the follow-up period.

Everyone knows exercise is good for you, but taking part in fitness activities or sports can lead to injury. Sports injuries can be caused by accidents, lack of fitness, poor training practices, improper gear or failure to warm up.

Sports injuries fall into two general types. Acute traumatic injuries occur suddenly and usually involve a single application of force, for example, a hard tackle in football. They include fractures, breaks, bruises, sprains, strains and abrasions. Chronic or overuse injuries, by contrast, happen over a period of time. These injuries are usually the result of training that involves repetitive movements, such as running or serving a ball in tennis. Common types include shin splints and tendonitis. While it may be tempting to ignore overuse injuries as minor, seeking treatment is advised, as, left untreated, chronic injuries tend to get worse.

Injured athletes who receive acupuncture are often able to return to training more quickly than would otherwise be possible, and the treatment is therefore used by top sports people and athletes, including the British Rugby team, many Premiership football teams and the British Olympic team, to treat musculoskeletal problems.

Since keeping the body in balance promotes more efficient training, acupuncture is also increasingly being used to enhance athletic performance.

How acupuncture can help

Acupuncture stimulates the nervous system and causes the release of chemical messenger molecules. The resulting biochemical changes influence the body's self-regulating systems, stimulating its natural healing abilities.

Research has shown that acupuncture treatment can promote resolution of injuries by:

• providing pain relief (Pomeranz, 1987).

• increasing local microcirculation (Komori et al, 2009) which aids dispersal of swelling and bruising.

• suppression of the peripheral inflammatory response (Kim et al, 2008) and other anti-inflammatory mechanisms (Kavoussi & Ross, 2007, Zijlstra et al , 2003).

• breaking down scar tissue – controlled microtrauma causes a local inflammatory response, which initiates reabsorption of inappropriate fibrosis or excessive scar tissue and facilitates a cascade of healing activities resulting in remodeling of affected soft tissue structures.

• promoting faster recovery after training sessions (Pan & Pan, 2007).

Acupuncture can be effectively combined with other treatments such as massage and rehabilitation exercises.

Research	Conclusion
Vrchota KD, Begrade MJ, Johnson RJ, Potts JF. True acupuncture vs. sham acupuncture and conventional sports medicine therapy for plantar fasciitis: a controlled, double-blind study. Int J Clin Acupuncture. 1991;2:247-252.	Randomized controlled trial of acupuncture for plantar fasciitis. Compared real electroacupuncture with sham acupuncture and conventional sports medicine. 43 subjects randomised to the three treatments received 4 weekly treatments. At end of treatment period, and at 3-week follow-up, real acupuncture group experienced significantly greater decrease in pain than sports medicine group, allowing more rapid return to sports activity.
Yang J. 32 cases of femoral adductors syndrome treated by electroacupuncture and moxibustion. J Tradit Chin Med. 1998 Dec;18(4):263-4.	Ramdomized controlled trial of acupuncture for femoral adductors syndrome (FAS) caused by sports injury. 40 subjects, 32 treated with electroacupuncture plus moxibustion and 8 controls who received anti-inflammatory drugs. Both groups received 10 treatments. Acupuncture group performed better than control group with total effective rate of 87.5% vs 75%.
Kleinhenz J, Streitberger K, Windeler J, Güssbacher A, Mavridis G, Martin E. Randomised clinical trial comparing the effects of acupuncture and a newly designed placebo needle in rotator cuff tendinitis. Pain. 1999 Nov;83(2):235-41.	Randomized controlled trial of acupuncture for rotator cuff tendonitis involving 52 sportsmen. Compared real acupuncture with acupuncture using placebo needle. Patents received 8 treatments over 4 weeks. Found shoulder function scores in acupuncture group improved by 19.2 points, vs only 8.4 points in control group, a significant difference.
Jensen R, Gøthesen O, Liseth K, Baerheim A. Acupuncture treatment of patellofemoral pain syndrome. J Altern Complement Med. 1999 Dec;5(6):521-7.	Randomized controlled trial of acupuncture for patellofemoral pain syndrome. 75 patients randomly assigned to receive either semi-individualised acupuncture or no treatment. Patents received 8 treatments over 4 weeks. Over 12-months of trial and follow-up, acupuncture group knee pain and function scores improved by 17.2 points, vs 5.6 points in the controls, a significant superiority. Authors concluded that acupuncture showed a clear and long-lasting effect in reducing pain and improving function.
Callison M (2002) Acupuncture and tibial stress syndrome (shin splints). J Chin Med. 2002:70: 24-7.	Randomized controlled trial of acupuncture for shin splints. 40 athletes with shin splints were divided between three treatment groups, standard sports medicine, acupuncture and a combined group who received both. Participants received a minimum of 2 treatments per week for 3 weeks. Acupuncture and combined groups recorded significantly lower pain levels after treatment than sports medicine group – both during sports and non-sporting activities, and at rest. For overall effectiveness of the treatment on pain, 72.5% of the acupuncture group reported an improvement vs 54.5% of the combined group and 46.5% of the sports group. Self-medication with anti-inflammatories was also significantly lower in the acupuncture and combined groups.
Pan H, Pan H. Impact of Acupuncture Applied to Sanyinjiao on the Movement Ability of Female Athletes. Int J Clin Acupuncture 2007;16(3):157-61.	Observational study of effects of acupuncture on female swimmers. Found that acupuncture improved exercise tolerance, increased haemoglobin and blood glucose concentrations and promoted quick recovery. Authors concluded that acupuncture can delay the appearance of sports fatigue.
Dhillon S. The acute effect of acupuncture on 20-km cycling performance. Clin J Sport Med. 2008 Jan;18(1):76-80.	Prospective single blind crossover design study. 20 male cyclists underwent three tests a week, riding a stationary bike for 20km as fast as possible. Before each test, they received acupuncture, 'sham' acupuncture (shallow needling of known acupoints), and no intervention once each in a random order. Cyclists receiving acupuncture before their ride achieved greater levels of exertion, with faster cycling times and experienced less pain.
Hübscher M, Vogt L, Bernhörster M, Rosenhagen A, Banzer W. Effects of acupuncture on symptoms and muscle function in delayed-onset muscle soreness. J Altern Complement Med. 2008 Oct;14(8):1011-6.	Randomized controlled trial of acupuncture for exercise-induced muscle soreness. 22 healthy adults were randomly assigned to real acupuncture, sham acupuncture (superficial needling at nonacupuncture points) or control (no needling). Soreness of the elbow was induced through eccentric muscle contractions until exhaustion. After 72 hours, pain perception was significantly lower with acupuncture vs sham acupuncture and no treatment. Authors concluded that acupuncture reduced perceived pain arising from exercise-induced muscle soreness.
Pomeranz B. Scientific basis of acupuncture. In: Stux G, Pomeranz B, eds. Acupuncture Textbook and Atlas. Heidelberg: Springer-Verlag; 1987:1-18.	Needle activation of A delta and C afferent nerve fibres in muscle send signals to spinal cord, where dynorphin and enkephalins are released. Afferent pathways continue to midbrain, triggering excitatory and inhibitory mediators in spinal cord. Ensuing release of neurotransmitters serotonin and norepinephrine onto spinal cord leads to pain transmission being inhibited both pre- and postsynaptically in spinothalamic tract. Finally, these signals reach hypothalamus and pituitary, triggering release of adrenocorticotropic hormones and beta-endorphin.
Zijlstra FJ, van den Berg-de Lange I, Huygen FJ, Klein J. Anti-inflammatory actions of acupuncture. Mediators Inflamm. 2003 Apr;12(2):59-69.	Suggests hypothesis for anti-inflammatory action of acupuncture. Insertion of acupuncture needle initially stimulates production of beta-endorphins, CGRP and substance P, leading to further stimulation of cytokines and NO. While high levels of CGRP have been shown to be pro-inflammatory , CGRP in low concentrations exerts potent anti-inflammatory actions , therefore, a frequently applied 'low-dose' treatment of acupuncture could provoke a sustained release of CGRP with anti-inflammatory activity, without stimulation of pro-inflammatory cells.
Kavoussi B, Ross BE. The neuroimmune basis of anti-inflammatory acupuncture. Integr Cancer Ther. 2007 Sep;6(3):251-7.	Review article. Suggests that anti-inflammatory actions of traditional and electro-acupuncture are mediated by efferent vagus nerve activation and inflammatory macrophage deactivation.
Kim HW, Uh DK, Yoon SY, Roh DH, Kwon YB, Han HJ, Lee HJ, Beitz AJ, Lee JH. Low-frequency electroacupuncture suppresses carrageenan-induced paw inflammation in mice via sympathetic post-ganglionic neurons, while high-frequency EA suppression is mediated by the sympathoadrenal medullary axis. Brain Res Bull. 2008 Mar 28;75(5):698-705. Epub 2007 Dec 26.	Experimental study on rats. Results suggest that suppressive effects of low frequency electroacupuncture on carrageenan-induced paw inflammation are mediated by sympathetic post-ganglionic neurons, while suppressive effects of high frequency electroacupuncture are mediated by the sympatho-adrenal medullary axis.
Komori M, Takada K, Tomizawa Y, Nishiyama K, Kondo I, Kawamata M, Ozaki M. Microcirculatory responses to acupuncture stimulation and phototherapy. Anesth Analg. 2009 Feb;108(2):635-40.	Experimental study on rabbits. Acupuncture stimulation was directly observed to increase diameter and blood flow velocity of peripheral arterioles, enhancing local microcirculation.

Healthcare professionals

Traditional acupuncture is growing in popularity as more and more people experience its health benefits for themselves.

The BAcC is keen to bridge the gap between traditional acupuncturists and the western medical community. We believe that combining our strengths can benefit patients as well as reducing costs for the NHS. Systems of integrated medicine are well-established in China, the USA and many other countries.

In the UK some BAcC members already work within the NHS and integrated clinics. More and more studies demonstrate that traditional acupuncture is especially effective when used to complement various aspects of western healthcare.

We can help you make informed decisions about integrating acupuncture into your treatment plans by providing you with:

the latest evidence-based clinical research into the efficacy of traditional acupuncture and the social and economic cost benefits of using acupuncture to treat particular conditions
accurate information about traditional acupuncture for you and your patients
a guarantee that all BAcC members have degree level training and expert practice skills maintained by mandatory continuing professional development
an assurance of best practice as laid down in our Code of Safe Practice and Code of Professional Conduct
details of BAcC registered acupuncturists in your area

If you want to know more about working with traditional acupuncturists and the BAcC please contact Persis Tamboly on 020 8735 1222 This e-mail address is being protected from spambots. You need JavaScript enabled to view it

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How acupuncture can help

Research

Conclusion

How acupuncture can help

Additional references

How acupuncture can help

How acupuncture can help

Research

Conclusion

Healthcare professionals