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

A total of 60 patients with stage 2–4 CHF were recruited for the study after admission to the hospital. The acupuncture group was comprised of 18 male and 12 female patients with a mean age of 72.5 years. The control group was comprised of 17 male and 13 female patients with a mean age of 71.9 years. There were no statistically significant differences in baseline characteristics between the two groups.

 

Medicine
Both groups were treated with a combination of medications and Chinese herbal medicine. Patients were prescribed digitalis, diuretics, and vasodilators dependent upon individual needs. All patients in both groups received Sheng Mai intravenous fluid, comprised of Sheng Mai San in a dextrose solution. Treatment was administered once daily, with 14 days constituting one course of care. Patients assigned to the acupuncture observation group were also treated with acupuncture administered at the following acupoints:

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

Following standard insertion, needles were stimulated using a balanced reinforcing-reducing method and were retained for 20 minutes. Treatment was conducted once daily or twice a day for severe cases. Auricular points were treated with embedded needles which were changed daily, utilizing alternate ears. One course of treatment lasted 10–14 days.

 

Results
Outcome measures for the study included cardiac and renal function, as well as the treatment total effective rate for each group. Cardiac function was assessed by color doppler echocardiography, including EF (ejection fraction) and FS (fractional shortening). These measures indicate how effectively the ventricles are pumping blood with each contraction, with higher scores indicative of better cardiac function.

Mean pre-treatment EF scores were 38.9 in the control group and 39.3 in the acupuncture group. Following treatment, scores increased to 40.3 and 48.6 respectively. Although both groups saw improvements, these were significantly greater in the acupuncture group (p<0.01).

Mean pre-treatment FS scores were 21.8 in the control group and 21.6 in the acupuncture group. Following treatment, scores increased to 24.7 and 27.3 respectively. Patients in the acupuncture group experienced significantly greater improvements (p<0.05).

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

Mean pre-treatment BUN levels were 8.12 in the control group and 8.37 in the acupuncture group. Following treatment, these figures decreased to 7.38 and 7.35 respectively. The intergroup difference was modest but statistically significant, with greater improvements in the acupuncture group (p<0.05).

Mean pre-treatment creatine levels were 175.67 in the control group and 163.3 in the acupuncture group. Following treatment, scores decreased to 152.39 and 121.86 respectively. Significantly greater improvements were seen in the acupuncture group (p<0.01). No statistically significant differences were found between pre and post-treatment potassium or sodium levels in either group.

The treatment total effective rate was calculated using a 6 minute walking test for exercise tolerance and overall improvement in symptoms. For patients whose CHF improved by two or more stages, the treatment was classified as markedly effective. For patients whose CHF improved by one stage, the treatment was classified as effective. For patients showing no change or a deterioration in condition, the treatment was classified as ineffective.

In the control group, there were 26 effective and 4 ineffective cases, giving a total effective rate of 86.7%. In the acupuncture observation group, there were 28 effective and 2 ineffective cases, giving an effective rate of 93.3%. The intergroup difference was considered statistically significant by the research team (p<0.01).

The results of the study indicates that acupuncture provides a useful adjunct to the treatment of congestive heart failure. It has the potential to improve cardiac and renal function, while enhancing patients’ tolerance for exercise.

 

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

 

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

 

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