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   Jan 13

Acupuncture Found Antiinflammatory, Herbs Relieve Osteomyelitis

Acupuncture reduces systemic inflammation due to infections and prevents sepsis. Researchers at the Rutgers New Jersey Medical School (Department of Surgery) find electroacupuncture effective for the treatment of infections, including polymicrobial peritonitis. In additional research, Qi et al. find Chinese herbal medicine effective for the treatment of osteomyelitis. We will look at both the acupuncture and herbal medicine findings

The Rutgers New Jersey Medical School researchers completed a sham-controlled laboratory investigation. Electroacupuncture successfully regulated cytokine levels and achieved potent antiinflammatory effects that prevented sepsis and death of laboratory animals. In addition, electroacupuncture was shown to significantly boost dopamine levels.

Researchers find acupuncture and traditional Chinese herbal medicine effective treatment modalities for patients with chronic infectious diseases. Next, we examine the evidence demonstrating the beneficial effects of Chinese herbal medicine for patients with chronic osteomyelitis. Clinical research demonstrates Traditional Chinese Medicine (TCM) significantly benefits patients with chronic osteomyelitis. In a trial of 121 patients with osteomyelitis (Qi et al.), it was demonstrated that Traditional Chinese Medicine, as a standalone therapy, had a total treatment effective rate of 66.7%. Conventional Western biomedicine, in the same study, had a 54.8% total treatment effective rate. More importantly, when biomedicine and TCM were combined, the total treatment effective rate increased to 88.9%.

Qi et al. conclude that an integrated approach to patient care produces superior patient outcomes. Total treatment effective rates increase and hospitalization times decrease when Chinese herbs and antibiotics are combined into a formal treatment protocol. The study notes that Chinese herbal medicine is used both topically and orally (for internal intake).

Chronic osteomyelitis is a pernicious infectious disease that involves bacterial infections in the bones (Qi et al., Lazaro-Martınez et al.). There are a multitude of bacteria involved in this condition (e.g. staphylococcus, streptococcus, E. coli). Infections may infiltrate any bone, often at the site of a wound or trauma. The cause and spreading of osteomyelitis may be from trauma or transmission through the bloodstream. Open wounds, infected soft tissues or prosthetics, or infected growth plates may lead to osteomyelitis. If left untreated or treated improperly, the infection may lead to hyperplasia.

Complications include recurrent abscesses, necrotic tissues and bones, and tracts through soft tissues that precipitate infection. In cases of chronic osteomyelitis, the quality of life for the patient can suffer dramatically. In extreme cases, amputation is used to prevent sepsis. Standard biomedical interventions include large doses of antibiotics and surgery (Tlougan et al.). Long-term use of antibiotics may lead to drug resistance. When the blood supply to affected areas is restricted, systemic use of antibiotics may not be adequate to control the disease.

Integrative therapy proves itself valuable for the treatment of osteomyelitis. Qi et al. reveal a significant reduction in hospitalization times when biomedicine and Chinese medicine interventions are combined. Using only biomedicine, the average hospitalization time is 74 days. Using only Chinese medicine, the average hospitalization time is 59 days. However, when biomedicine is combined with Chinese medicine, the hospitalization time drops to 43 days.

Qi et al. find integrative therapy an optimal treatment protocol to increase effective rates. Using only biomedicine, the treatment effective rate is 54.8%. Using only Chinese medicine, the treatment effective rate is 66.7%. Using both biomedicine and Chinese medicine, the treatment effective rate climbs to 88.9%. The limitation of this result is that total treatment efficacy rates represent all tiers of significant improvements and do not reflect total recovery rates.

Qi et al. randomly divided 121 patients with osteomyelitis into three separate groups. Etiologies were heterogeneous. All three groups were hospital in-patients. One group was treated exclusively with Western biomedicine, one group exclusively with Traditional Chinese Medicine, and a third group received a combination therapy of both forms of medicine. Nutritional counseling was provided in all groups because dietetics is important in both biomedicine and TCM. Wound cleaning and dressing was also included in both TCM and biomedical protocols. The Western biomedicine group differed from the TCM group with the inclusion of antibiotics, surgeries to remove necrotic or inflammatory tissues, cavities, and tracts, and bone flap transplantations. Saline washes were combined with antibiotic administration for the Western biomedicine group.

The TCM treatment group included the oral intake formula Shenqi Fuzheng Tang, which is a combination of Radix Astragali (Huang Qi) and Radix Codonopsis (Dang Shen). External application involved a poultice or herbal perfusion wash applied to a cleaned wound made of Guju Yixiao San. The primary herbs in Guju Yixiao San are Cortex Phellodendri (Huang Bai), Hoelen (Fu Ling), Glycyrrhizae (Gan Cao), and Dandelion (Pu Gong Ying). The TCM treatment principle was to clear pathogens, move the blood, strengthen overall health, and detoxify cellular debris. The herbal formulas demonstrated efficacy in tissue repair and resolving intractable infections. The researchers note that the perfusion wash was especially successful as it provided sterilization and mechanical cleaning, which helped wash away tissue debris, blood clots, and bacteria. The researchers suggest that the perfusion wash enhanced the efficacy of antibiotics by allowing them to penetrate more effectively into tissues.

The researchers provided details of the herbal Guju Yixiao San perfusion wash. The herbal liquid was percolated with six-layer sterile gauze. The percolate was kept at 0°C for 48 hours. The supernatant was processed with a filter to obtain the washing solution. The wound was washed with a combination of 500 ml saline and 400 ml of the herbal liquid. Each day, a total of 3000 ml was dripped through a wound. The perfusion was continued for 2 – 3 weeks until there was no inflammatory reactions present in the wound, the drainage fluid was clear, and pathogen tests came up negative for three consecutive times. Following this intensive approach to wound cleaning, additional washes were applied to ensure long-term efficacy.

The researchers cite an extensive history of successful TCM treatments for osteomyelitis. They add that the combination of biomedicine with TCM provides optimal patient outcomes. Given the difficulty of treatment combined with the pain and suffering associated with osteomyelitis, the researchers suggest that implementing TCM into a regimen of care is paramount. Moreover, the researchers note there is a successful track record of TCM treatments for osteomyelitis patients with compromised immune systems.

Torres-Rosas, Rafael, Ghassan Yehia, Geber Peña, Priya Mishra, Maria del Rocio Thompson-Bonilla, Mario Adán Moreno-Eutimio, Lourdes Andrea Arriaga-Pizano, Armando Isibasi, and Luis Ulloa. “Dopamine mediates vagal modulation of the immune system by electroacupuncture.” Nature medicine 20, no. 3 (2014): 291-295. Laboratory of Anti-inflammatory Signaling, Department of Surgery, Rutgers University New Jersey Medical School, Newark, New Jersey, USA.

Qi, Chang, Huang Tao, and Huang Changlin. “Clinical effect of chronic osteomyelitis treated by integrated Chinese-Western therapy.” International Journal of Medicine and Medical Sciences 3, no. 15 (2011): 403-408.

Lazaro-Martinez, J., Aragon-Sanchez, J., Garcia-Morales, E. 2014. Antibiotics Versus Conservative Surgery for Treating Diabetic Foot Osteomyelitis: A Randomized Comparative Trial. Diabetes Care. Vol 37: 789-795.

Assmann, G., Kureck, O., Kirchhoff, T., Rosenthal, H., Voswinkel, J., Pfreundschuh, M., Zeidler, H., Wagner, AD. 2009. Efficacy of antibiotic therapy for SAPHO syndrome is lost after its discontinuation: an interventional study. Arthritis Res. Ther. 11:140.

Tlougan, BE., Podjasek, JO., O’Haver, J., Cordova, KB., Nguyen, XH., Tee, R., Pinckard-Hansen, KC., Hansen. RC. 2009. Chronic recurrent multifocal osteomyelitis (CRMO) and synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome with associated neutrophilic dermatoses: a report of seven cases and review of the literature. Pediatr. Dermatol., 26: 497-505

Source: Health CMI

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