Acupuncture outperforms drug therapy for the treatment of Alzheimer’s disease (AD). First Affiliated Hospital of Tianjing University of Traditional Chinese Medicine researchers compared the efficaciousness of acupuncture with donepezil drug therapy for the treatment of Alzheimer’s disease. [1] Acupuncture produced superior patient outcomes compared with the drug therapy. In addition, acupuncture did not produce any serious adverse effects.
Results were determined using the minimum mental state examination (MMSE), activities of daily living scale (ADL), Alzheimer’s disease assessment scale-cognition (ADAS-cog), and digit span (DS) assessments before and after treatments. MMSE is a widely used tool used to assess cognitive impairment. Higher MMSE scores denote a better cognitive function. ADL is used to detect problems in performing independent living activities. Lower ADL scores indicate that an individual has better independent living abilities. ADAS-cog is widely used to measure cognitive changes in AD patients. Lower ADAS-cog scores denote better cognitive performance. Digit span (DS) is a test used to measure immediate verbal memory. Higher DS scores denote better immediate verbal memory.
After treatment, MMSE and DS scores in both groups were increased compared with those before treatment (P<0.05), and ADL and ADAS-cog scores were reduced compared with those before treatment (P<0.05). Acupuncture yielded better treatment results regarding all parameters compared with the drug therapy and there was a significant difference between the two groups (P<0.05).
While donepezil is effective, the downside is that the medication caused one case of stomach discomfort and eight cases of low appetite, nausea, diarrhea, and insomnia. The medication is contraindicated for patients with epilepsy, asthma, or chronic obstructive pulmonary disease. It also increases the risk of developing gastric ulcers. [2] The researchers conclude, “Acupuncture is applicable to the vast majority of patients and has very limited side effects.”
Design
Researchers (Gu et al.) used the following study design. A total of 160 patients were treated and evaluated in this study. All patients were diagnosed with AD. They were randomly divided into an acupuncture treatment group and a control group, with 80 patients in each group. During the study eight patients dropped out from the acupuncture group and eleven patients dropped out from the drug control group.
The treatment group received acupuncture. For control group patients, donepezil was administered. Donepezil is a selective acetylcholinesterase inhibitor and is used for the treatment of AD.
The statistical breakdown for each randomized group was as follows. The acupuncture treatment group was comprised of 22 males and 50 females. The average age in the acupuncture treatment group was 75 ±7 years. The average course of disease in the treatment group was 15.2 ±3.8 years. The drug control group was comprised of 20 males and 49 females. The average age in the drug control group was 72 ±7 years. The average course of disease in the drug control group was 16.1 ±2.9 years. For both groups, there were no significant differences in terms of their gender, age, and course of disease relevant to patient outcome measures at the onset of the investigation.
Drug and Acupuncture Treatment
For the donepezil group, patients initially received 5 mg doses of donepezil tablets, orally administered, before going to bed for four consecutive weeks as one treatment course. Next, the dosage was increased to 10 mg for another three treatment courses. The drug treatment lasted for a total of four treatment courses. The acupuncture group received acupuncture at the following acupoints:
- GV24 (Shenting)
- GV20 (Baihui)
- GB20 (Fengchi)
- GB12 (Wangu)
- CV17 (Danzhong)
- CV12 (Zhongwan)
- CV6 (Qihai)
- SP10 (Xuehai)
- ST36 (Zusanli)
Secondary acupuncture points were added based on diagnostic patterns. For heart and liver yin deficiency, the following acupoints were added:
- HE5 (Tongli)
- SP6 (Sanyinjiao)
- KI3 (Taixi)
For heart spleen deficiency, the following acupoints were added:
- HE5 (Tongli)
- SP6 (Sanyinjiao)
- SP9 (Yinlingquan)
For phlegm turbidity obstructing the orifices, the following acupoints were added:
- ST25 (Tianshu)
- ST40 (Fenglong)
- LV3 (Taichong)
Treatment commenced with patients in a supine position. After disinfection of the acupoint sites, a 0.30 mm × 40 mm or 0.30 mm × 50 mm disposable filiform needle was inserted into each acupoint with a high needle entry speed. For Shenting, the needle was inserted transverse-obliquely to a depth of 13–21 mm and applied with the Ping Bu Ping Xie (mild attenuating and tonifying) manipulation technique.
For Baihui, the needle was inserted transverse-obliquely to a depth of 8–13 mm and was applied with the Ping Bu Ping Xie (mild attenuating and tonifying) manipulation technique. For Fengchi, the needle was inserted transverse-obliquely to a depth of 26–34 mm and was applied with the twisting-rotating attenuating technique to obtain a deqi sensation radiating to the opposite side of the head.
For Wangu, the needle was inserted perpendicularly to a depth of 16–32 mm, applied first with the lifting-thrusting tonifying technique and then with the twisting-rotating tonifying technique (120 times per minute). The technique was performed to obtain a deqi sensation radiating to the top of the head.
For Danzhong, the needle was inserted downwardly and transverse-obliquely to a depth of 5–13 mm, and was applied with the high-frequency twisting-rotating tonifying technique for 30 seconds. For Qihai and Zhongwan, the needle was inserted perpendicularly to a depth of 40 mm, and was applied with the high-frequency twisting-rotating tonifying technique.
For Xuehai and Zusanli, the needles were inserted perpendicularly to a depth of 13–26 mm, and was applied with the lifting-thrusting tonifying technique. The rest of the acupoints received regular needle insertion applications. A 30-minute needle retention time was observed. Acupuncture treatments were conducted once per day, six days per week, four weeks as one treatment course, for a total of four treatment courses.
Basis
The researchers provide a brief synopsis of the Traditional Chinese Medicine (TCM) understanding of Alzheimer’s disease. In TCM, Alzheimer’s disease falls under the Chi Dai (mental deficiency), Yu Chi (lack of cognitive ability), Shan Wang (forgetfulness), or Yu Zheng (depression) class of disorders. According to TCM principles, Alzheimer’s disease is related to three major organs: heart, kidney, brain. It is written in the Su Wen (the Plain Questions) that the “heart governs the bright spirit” and that the “brain is the house of the original spirit.” Here, the bright spirit refers to life activities, including both mental and physical activities. The original spirit refers mainly to mental activities, such as learning, reading, and thinking. [3]
In the Ling Shu (Magic Pivot), it is written that the “Kidney stores essence, essence generates marrow, and the brain is the sea of marrow…. deficiency in the sea of marrow can cause mental deficiency and loss of memory.” The treatment principle is to boost qi, move the blood, regulate the spirit, and sharpen cognition.
The researchers also provide a historical context for the protocol used in the study. Baihui and Shenting are located on the du meridian (governing vessel). According to the Nan Jing (Classic of Difficult Issues), the du meridian “finally enters into the brain.” Needling Baihui and Shenting boosts qi, moves the blood, regulates the spirit, and sharpens cognition. Needling Fengchi and Wangu quiets the spirit, wakens the brain, sharpens hearing, and brightens the eyes. Needling Danzhong, Zhongwan, and Qihai courses the liver, resolves depression, boosts qi, and moves the blood. Xuehai is located on the foot taiyin spleen meridian. Zusanli is located on the foot yangming stomach meridian. Needling Xuehai and Zusanli strengthens the spleen and stomach, which also helps to boost qi and move the blood.
Summary
Modern research supports the use of acupuncture for the treatment of AD. Acupuncture improves cognitive functions and living ability for AD patients without causing severe side effects. Given that acupuncture outperforms donepezil, it is worthwhile to test a combination of acupuncture and donepezil in an integrated protocol to determine whether or not the combination is synergistic. The hope is that a comprehensive treatment strategy will yield substantial results in the fight against Alzheimer’s disease.
References
[1] Gu W, Jin XX, Zhang YJ, Li ZJ, Kong Y. Clinical observation of Alzheimer’s disease treated with acupuncture [J]. Chinese Acupuncture and Moxibustion, 2014,34(12):1156-1160.
[2] Kuang BP. Drug science for neurological disease [M]. Beijing: People's Medical Publishing House, 2008: 560-561.
[3] Li SH, Chen BG. Brief discussion on “heart governs the bright spirit” [J]. Tianjin Journal of Traditional Chinese Medicine, ,2009,26(05):396-397.
