Acupuncture reduces the frequency and severity of angina attacks. [i] 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 wait list control. Inclusion criteria for the study was 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 wait list control group, also received acupuncture treatment, according to the following protocols.
DAM (disease-affected meridian) Group
Acupuncture was administered at acupoints Neiguan (PC6) and Tongli (HT5), bilaterally. Needles were stimulated using a lifting-thrusting, twisting-rotating technique to elicit deqi. Auxiliary needles were placed 2 mm lateral to each acupoint, to a depth of 2 mm, without manual stimulation. This technique was used to ensure electrical stimulation was working on the local points. A HANS acupoint nerve stimulator was used to stimulate the points at a frequency of 2 Hz at an intensity of 0.1–2 mA, dependent upon each patient’s tolerance levels.
NAM (non-affected meridian) Group
Acupuncture was administered at the acupoints Taiyuan (LU9) and Kongzui (LU6), bilaterally. Needles were manually and electrically stimulated according to the protocol described above.
SA (sham acupuncture) Group
Acupuncture was administered at two fixed points, bilaterally. No manual stimulation was applied to elicit deqi. Electrical stimulation was applied according to the protocol employed in the DAM and NAM acupuncture groups.
All acupuncture treatments lasted 30 minutes and were administered three times each week for four weeks. All patients received a total of 12 treatments, with the exception of the wait list control group. Those patients were instructed to schedule acupuncture treatment after completion of the trial.
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.
In the DAM group, the SD was 5.57 during weeks 1–4 (treatment period), 6.86 during weeks 5–8, 7.32 during weeks 9–12, and 7.96 during weeks 12–16. In the NAM group, the corresponding SDs were 3.14 during weeks 1–4, 3.72 during weeks 5–8, 3.65 during weeks 9–12, and 3.89 during weeks 12–16. In the SA group, the SDs were 2.00 during weeks 1–4, 2.55 during weeks 5–8, 2.67 during weeks 9–12, and 2.78 during weeks 12–16. In the control group, SDs were 0.48 during weeks 1–4, 1.94 during weeks 5–8, 2.38 during weeks 9–12, and 2.33 during weeks 12–16. The frequency of angina attacks were significantly lower in the DAM group at each data point from weeks 4–16.
Secondary outcome measures included angina severity, measured by the VAS (visual analog scale), the SAQ (Seattle Angina Questionnaire), rescue medication intakes, 6-minute walk distance tests, and self-rated scales for anxiety and depression. Heart rate variability, reasons for drop out, and adverse events were also recorded. Both VAS and SAQ scores improved more significantly in the DAM group than the other three groups at each assessment.
There were no intergroup differences in terms of rescue medication use. In the 6-minute walking test at the end of week 4, patients in the DAM group outperformed those in the SA and wait list groups, but not the NAM group. There were no intergroup differences in self-rated anxiety and depression at the end of treatment. However, patients in the DAM group reported lower levels of anxiety and depression during follow-up periods at weeks 5–8 and 13–16 compared with the SA and wait list groups.
The results of this study are supported by similar research conducted at Dengtazhen Hospital (Liaoyuan City Xi’an District). [ii] 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).
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, which was comprised of the following herbs:
- Bai Fu Ling 30g
- Gua Lou 20g
- He Ye 20g
- Bai Shao 20g
- Dan Shen 15g
- Xie Bai 15g
- Chao Bai Zhu 10g
- Gui Zhi 10g
- Ze Xie 10g
- Niu Xi 10g
- Dang Gui 15g
- Cu Xiang Fu 15g
- Yu Jin 15g
- Mu Xiang 8g
- Chen Pi 8g
- Gan Cao 6g
For patients with phlegm obstruction, Jie Geng (6g) was added. For patients lacking vitality, Huang Qi (30g) was added. For patients with blood stasis, Chao Zao Ren (15g), Chuan Xiong (12g), and San Leng (8g) were added. For patients suffering from exhaustion, Dang Shen (15g) and Zhi Huang Qi (20g) were added.
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.
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.
[i] 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.
[ii] 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.