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Cedars-Sinai Medical Center Outsmarting Brain Tumors May 14, 2011. Acupuncture and Integrative Medicine as a Support System for Brain Tumor Treatment. Lucy Postolov, L.Ac. Master of Traditional Oriental Medicine Diplomate in Acupuncture (NCCAOM)

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acupuncture and integrative medicine as a support system for brain tumor treatment

Cedars-Sinai Medical Center

Outsmarting Brain Tumors

May 14, 2011

Acupuncture and Integrative Medicine as a Support System for Brain Tumor Treatment

Lucy Postolov, L.Ac.

Master of Traditional Oriental Medicine

Diplomate in Acupuncture (NCCAOM)

Allied Health Professional / Cedars-Sinai Medical CenterBoard Certified in Integrative Medicine

integrative medicine is a part of modern medicine
Integrative Medicine is a part of Modern Medicine
  • Mainstream Medicine
    • Allopathic Medicine
  • CAM
    • Complimentary and Alternative Medicine
nccam groups cam modalities into five major domains
NCCAM Groups CAM ModalitiesInto Five Major Domains
  • Alternative Medical Systems
    • Traditional Oriental Medicine and Homeopathy
  • Mind-Body Intervention
    • Meditation, Imagery, Relaxation
  • Biologically-Based Treatments
    • Herbals, High-Dose Vitamin Therapy, Enzyme Therapy
  • Manipulative and Body-Based Approaches
    • Massage, Yoga, Chiropractic
  • Energy Therapy
    • Qi Gong, Reiki,Therapeutic Touch
an increasing number of cancer patients are turning to complimentary and alternative medicine cam
An Increasing Number of Cancer Patients are Turning to Complimentary and Alternative Medicine (CAM)

CAM use among cancer patients is diverse and varies by region

  • National Center for CAM estimates
    • 7-54% of cancer patients use CAM
    • 48-88% of cancer patients used CAM while being treated in comprehensive cancer centers in the USA
how acupuncture works

How Acupuncture Works

The Eastern Philosophical Point of View

how acupuncture works1

How Acupuncture Works

These are several consecutive transaxial slices from single-photon emission computed tomography scans of patient 2 with baseline scan (top row) showing initial thalamic (thick arrow) and basal ganglia (thin arrow) asymmetry with the right activity greater than the left. The post acupuncture scan (bottom row) shows normalization of the thalamic and basal ganglia asymmetry, with the both right and left having relatively equal activity.

“Acupuncture Modulates the Limbic System and Subcortical Gray Structures of the Human Brain: Evidence From fMRI Studies in Normal Subjects”, Massachusetts, 2000

Kathleen K.S.Hui, Jing Liu, Niko Makris, Randy L. Gollub, Anthony J.W. Chen, Christopher I. Moore, David N. Kennedy, Bruce R.Rosen, and Kenneth K. Kwong.

how acupuncture works2

How Acupuncture Works

Bilateral fMRI signal increases in somatosensory cortices and signal decreases in deep structures: acupuncture needle manipulation of the left LI 4 versus tactile stimulation in a single subject. Pseudocolor KS statistical maps of signal increases (left column, a, b) and signal decreases (right column, c, d) overlaid on high-resolution scans in gray scale at the indicated slice plane relative to the anterior commissure. Both tactile stimulation and acupuncture needle manipulation elicited signal increases in the primary and secondary somatosensory cortices (SI, SII), but the changes were more marked during tactile stimulation (a) than during acupuncture b). Acupuncture needle manipulation elicited signal decreases in the parahippocampus/fusiform gyrus (PH/FusG) and insula (Ins) (d), whereas tactile stimulation did not (c). Also shown are acupuncture needle manipulation associated signal decreases in the middle temporal gyrus (TGm) and precentral gyrus (PrCG). Color bar shows significance, same color if signal increased or decreased.

“Cerebral Blood Flow Effects of Pain and Acupuncture: A preliminary Single-Photon Emission Computed Tomography Imagining Study.” American Society of Neuroimaging. 2004

Andrew B . Newberg MD, Patrick J. LaRiccia, MD Brunde Y. Lee, MD, John T. Farrar, MD, Lorna Lee, MA, Abass Alavi, MD.

how acupuncture works3

How Acupuncture Works

The Western Medical Point of View

From “Neuro-Acupuncture”, Cho ZH et al, Q-puncture, Inc. 2001

how acupuncture works western theory stimulation of neurotransmitters
How Acupuncture Works:Western TheoryStimulation of Neurotransmitters

Dopamine Norepinephrine Endorphins

Complimentary & Alternative Medicine

Freeman Lawlis, 2001

nih consensus development panel on acupuncture
NIH Consensus Development Panel on Acupuncture
  • Promising results have emerged, for example, showing efficacy of acupuncture in adult postoperative and chemotherapy nausea and vomiting and in postoperative dental pain. There are other situations, such as addiction, strokerehabilitation, headache, menstrual cramps, tenniselbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome, and asthma, in which acupuncture may be useful as adjunct treatment or an acceptable alternative or be included in a comprehensive management program. Further research is likely to uncover additional areas where acupuncture interventions will be useful.

JAMA. 1998;280:1518-1524

clinical applications of acupuncture for patients with cancers
Clinical Applications of Acupuncture for Patients with Cancers

Chemotherapy Related Side Effects

  • Myelo-suppression: with leucopenia, thrombocytopenia,

anemia

  • Nausea
  • Vomiting
  • Mucositis

(mucus membrane ulceration)

Radiotherapy Induced Symptoms

  • Xerostomia

(Dry mouth condition caused by radiation)

Symptom Management

  • Cancer Pain
other symptoms as a result of chemotherapy toxicity
Other Symptoms as a Result of Chemotherapy Toxicity

Other Symptoms

CNS Toxicity

  • Insomnia
  • Fatigue
  • Mood Disorder
  • Feeling a Loss of Control

Loss of Appetite

Weakened Immune System

Alopecia

other clinical issues
Other Clinical Issues
  • Cancer Treatment Induced Early Menopause
  • Chemotherapy-Induced Diarrhea or Constipation
  • Post-Operative Pain
  • Neuropathy
  • Skin Reaction
  • Liver Toxicity
  • End of Life Care
risk of harm associated with non conventional approaches to cancer management
Risk of Harm Associated with Non-Conventional Approaches to Cancer Management
  • Symptom control of nausea and vomiting should be initiated after underlying causes have been identified
  • Claims to “cure” cancer with natural and non-toxic treatment
  • Herb-drug interactions
  • Side effects associated with unsafe and unregulated non-conventional interventions
requirements for acupuncturists working with oncology patients
Requirements for Acupuncturists Working with Oncology patients
  • Acupuncture License
    • National (optional)
    • State (required)
  • General Medical Training Background
  • Hospital System Experience
  • Good Communication Skills
  • Experience Treating Oncology Patients
chinese herbal medicine to support patients going through chemo and radiation
Chinese Herbal Medicine to Support Patients Going Through Chemo and Radiation

Bu Zhong Yi Qi Tang

Ren Shen Ginseng Rx.

Bai Zhu Atractylodis Alba Rz

Huang Qi Astragali Rx

Dang Gui Angelicae Sinensis Rx

Dao Zao Jujubae Fr.

Chen Pi Citri Reticulatae Pc.

Chai Hu Bupleuri Rx.

Zhi Gan Cao Glycyrrhizae Rx. Preparata

Sheng Jiang Zingiberis Recens Rz

Sheng Ma Cimicifugae Rz..

Chemo-Support

Huang Qi Radix Astragali Ren Shen Radix Ginseng Ling Zhi Ganoderma Xi Yang Shen Radix Panacis quinquefolii Mu Dan Pi Cortex Moutan Zhi Mu Radix Anemarrhenae Fu Ling Poria Chen Pi Pericarpium Citri reticulatae Mai Men Dong Radix Ophiopogonis Dang Gui Radix Angelicae sinensis Ban Xia Rhizoma Pinelliae Preparatum Lu Gen Rhizoma Phragmitis Nu Zhen Zi Fructus Ligustri lucidi Sha Ren Fructus Amomi Huang Jing Rhizoma Polygonati Gan Cao Radix Glycyrrhizae uralensis

Radio Support

Huang Qi

Radix Astragali Dang Gui Radix Angelicae sinsis Hong Hua Flos Carthami tinctorii Dan Shen Radix Salviae miltiorrhizae Shou Wu Radix Polygoni multiflori preparata Gou Qi Zi Fructus Lycii chinensis Wu Wei Zi Fructus Schisandrae Nu Zhen Zi Fructus Ligustri lucidi Zhi Mu Radix Anemarrhenae Mu Dan Pi Cortex Moutan Gan Cao Radix Glycyrrhizae uralensis Sheng Di Huang Radix Rehmanniae Chen Pi Pericarpium Citri reticulatae Yu Zhu Rhizoma Polygonati odorati

analysis of individual herbs in chemo support pharmacology of chemo support ingredients
Analysis of Individual Herbsin Chemo SupportPharmacology of Chemo Support Ingredients

Huang Qi - Radix Astragali Membranacei

  • Enhancement of Immune Function

The decoction given to mice increases the phagocytic activity of the reticuloendothelial system.

  • Antibacterial Effect

In vitro was effective against Shigella Shigae, Bacillum anthracis, Streptococcus hemolyticus, and Staphyloccus aureus.

  • Effect on endurance

Decoction of Huang Qi given to mice significantly increase the endurance in swimming tests.

analysis of individual herbs in chemo support
Dang Shen - Radix Codonopsis pilosulae

Promotion of Phagocytosis

Daily administration of decoction enhanced reticuloendothelial phagocytosis

Hematologic effect

Oral and intravenous use of Dang Shen in normal rabbits caused an increase in red blood cell count and hemoglobin.

Immunologic effect

Dang Shen inhibited the febrile reaction to toxins such as turpentine in mice and rats.

Anti-ulcerative effect

Pre-treatment with the decoction of the herb reduced the incidence of ulcers in rats due to stress of pylorus ligation.

Analysis of Individual Herbsin Chemo Support
analysis of individual herbs in chemo support1
Analysis of Individual Herbsin Chemo Support

Ling Zhi - Fructificatio Ganodermae lucidi

  • Antimicrobial Action

The decoction of the root showed strong antibacterial action in vitro against, Bacillus subtilis, Escherichia coli, Salmonella typhi, Staphylococcus aureus, Streptococcus hemolytic

Fu Ling - Scierotium Poriae Cocus

  • Antineoplastic effect

Produces an inhibition rate of 96.88% against sarcoma in rats.

  • Effect on Immune Function

Oral administration increased phytohemagglutinin-induced lymphocyte transformation rate and increased serum IgG.

analysis of individual herbs in chemo support2
Analysis of Individual Herbsin Chemo Support

Chen Pi- Pericarpium Citri reticulatae

  • Actions on gastro-intestinal smooth muscles

The herb decoction inhibited the motility of isolated small intestines of mice and rabbits.

Dang Gui- Radix Angelicae sinesis

  • Effect on platelet aggregation

Inhibited rat platelet aggregation and serotonin release

Ban Xia- Rhizoma Pinelliae ternatae

  • Anti-emetic action

Prevents early vomiting caused by deslanoside as well as emesis caused by orally-administered copper sulfate.

current research on alternative therapies

Current Research on Alternative Therapies

Cohen, Lorenze and Markman, Maurie. Integrative Oncology. p 126. Huston, TX. 2008 Humana Press.

bibliography
Bibliography
  • Maciocia, Giovanni, The Three Treasures Newsletters

Autumn, 1999

  • Perry M, Anderson C, Dorr V, Wilkes J, The Chemotherapy Sourcebook, Williams & Wilkins, Baltimore, Maryland, 1999.
  • Skeel R, Handbook of Cancer Chemotherapy, Williams & Wilkins, Baltimore, Maryland, 1999
  • Zhu YP, Chinese Materia Medica, Harwood Academic Publishers, Amsterdam, 1998.
  • Bensky D and Gamble A, Chinese Herbal Medicine Materia Medica, Eastland Press, Seattle, 1993.
  • Chang H.M. and But P.P. Hay, Pharmacology and Applications of Chinese Materia Medica, World Scientific, Hong Kong, Vol. I, 1986., World Scientific, Hong Kong, Vol. I, 1986.
  • Dorsher PT, “The Neuroanatomic Basis of the Acupuncture Principal Meridians”, Mayo Foundation for Medical Education and Research 2009
  • Harris RE et al.“Traditional Chinese acupuncture and placebo (sham) acupuncture are differentiated by their effects on µ-opiod receptors (MORs)”, Elsevier Inc. 2009
  • Cohen, Lorenze and Markman, Maurie. Integrative Oncology. p126. Huston, TX. 2008 Humana Press.
  • Kathleen K.S.Hui, Jing Liu, Niko Makris, Randy L. Gollub, Anthony J.W. Chen, Christopher I. Moore, David N. Kennedy, Bruce R.Rosen, and Kenneth K. Kwong. “Acupuncture Modulates the Limbic System and Subcortical Gray Structures of the Human Brain: Evidence From fMRI Studies in Normal Subjects”, Massachusetts, 2000
  • Andrew B . Newberg MD, Patrick J. LaRiccia, MD Brunde Y. Lee, MD, John T. Farrar, MD, Lorna Lee, MA, Abass Alavi, MD. “Cerebral Blood Flow Effects of Pain and Acupuncture: A preliminary Single-Photon Emission Computed Tomography Imagining Study.” American Society of Neuroimaging. 2004
slide27

Medicine today is science, and business, and law (perhaps not in that order) but not so much art as it seemed to be even when I started. I know why we are counting, why it is important, essential even.

Despite years of study and numbering, after all, we still haven’t settled the role of vitamins, hydrochlorothiazide, mammograms, aspirin, diabetes control, or almost any other topic in medicine including statistical analysis itself. But medicine as its fundamental is still about suffering, healing, and comforting; it is about individuals; it is about relationships, and trust; it is about stories.

Michael H. Monroe, MD.Drawer on the Right. Charlotte, North Carolina, March 23/30, 2011 JAMA