Dr. Sanjay Gupta: Why I Changed My Mind on Weed

Dr. Sanjay Gupta

Dr. Sanjay Gupta and is an American neurosurgeon and news reporter who wasn’t always in favor of cannabis . In 2013 he wrote:” We have been terribly and systematically misled for nearly 70 years in the United States. He created a 3 part documentary series #weed, presenting compelling evidence that #marijuana has real #medical value. Gupta’s stance is now in favor of using the #plant as a #medicine. #integrativemedicine #chinesemedicine #pain #headache #lowbackpain #cannapyhealth #womensupportwomen #womenempowerment #health #healing #lucypostolovacupuncture

Over the last year, I have been working on a new documentary called “Weed.” The title “Weed” may sound cavalier, but the content is not.

I traveled around the world to interview medical leaders, experts, growers and patients. I spoke candidly to them, asking tough questions. What I found was stunning.

Long before I began this project, I had steadily reviewed the scientific literature on medical marijuana from the United States and thought it was fairly unimpressive. Reading these papers five years ago, it was hard to make a case for medicinal marijuana. I even wrote about this in a TIME magazine article, back in 2009, titled “Why I would Vote No on Pot.”

Well, I am here to apologize.

I apologize because I didn’t look hard enough, until now. I didn’t look far enough. I didn’t review papers from smaller labs in other countries doing some remarkable research, and I was too dismissive of the loud chorus of legitimate patients whose symptoms improved on cannabis.

Instead, I lumped them with the high-visibility malingerers, just looking to get high. I mistakenly believed the Drug Enforcement Agency listed marijuana as a schedule 1 substance because of sound scientific proof. Surely, they must have quality reasoning as to why marijuana is in the category of the most dangerous drugs that have “no accepted medicinal use and a high potential for abuse.”

They didn’t have the science to support that claim, and I now know that when it comes to marijuana neither of those things are true. It doesn’t have a high potential for abuse, and there are very legitimate medical applications. In fact, sometimes marijuana is the only thing that works. Take the case of Charlotte Figi, who I met in Colorado. She started having seizures soon after birth. By age 3, she was having 300 a week, despite being on seven different medications. Medical marijuana has calmed her brain, limiting her seizures to 2 or 3 per month.

https://www.cannapyhealth.com/

alternative2019-08-21T10:50:51-07:00August 21st, 2019|

Dr. Jasmin Hurd and her stance on CBD

Dr. Yasmin Hurd

Yasmin Hurd is a professor of Neuroscience, Psychiatry, and Pharmacology and Systems Therapeutics at the Icahn School of Medicine at Mount Sinai in New York City, was interviewed by New York Times. “The #brain is about a #symphony and #cbd brings the entire symphony into #harmony “ #healing #neuroscience #mountsinaihospital #mountsina #askdrsuzanne #cannapyhealth #womenempowerment #womensupportwomen #newyorktimes #lucypostolovacupuncture

alternative2019-08-21T10:51:53-07:00August 21st, 2019|

Acupuncture And Herbs Alleviate Diabetic Neuropathy

Courtesy of Health CMI-August 5, 2019

Acupuncture and herbs are effective for the treatment of diabetic peripheral neuropathy. Gansu Hospital of Traditional Chinese Medicine (endocrinology department) researchers conducted a controlled clinical trial comparing drug therapy with acupuncture and herbs. Patients receiving both acupuncture and herbal medicine had a total effective rate of 96.67%. Patients receiving Chinese herbal medicine monotherapy had a 73.33% total effective rate. Drug therapy patients had a 53.33% total effective rate for the alleviation of DPN (diabetic peripheral neuropathy). [1]

All patients were monitored throughout the investigation for adverse effects, including liver and renal function tests. No serious adverse effects were reported in any of the clinical trial groups, indicating a high degree of safety for all three treatment protocols. Outcome measures for the study included nerve conduction tests, TCM (traditional Chinese medicine) syndrome scores, and treatment efficacy rates.

Results
Nerve conduction tests were conducted on the common peroneal nerve (along the lateral aspect of the calf) and the median nerve (medial aspect of the forearm). For the common peroneal nerve, mean pre-treatment scores were 29.91 m/s in the drug monotherapy group, 29.91 m/s in the herbal medicine monotherapy group, and 29.90 m/s in the acupuncture plus herbs group. Following treatment, scores increased to 32.22 m/s, 36.62 m/s, and 39.92 m/s respectively.

For the median nerve, mean pre-treatment scores were 34.60 m/s in the drug monotherapy group, 34.60 m/s in the herbal medicine monotherapy group, and 34.56 m/s in the acupuncture plus herbs group. Following treatment, scores increased to 35.52 m/s, 36.52 m/s, and 39.60 m/s respectively. All groups demonstrated significant improvements. The acupuncture plus herbs group had the greatest improvements (p<0.05).

TCM syndrome scores were calculated by the participants subjectively rating symptoms including dry mouth and thirst, fatigue and lack of strength, shortness of breath and dislike of speaking, sweating, insomnia, limb numbness, and formication (the sensation of insects crawling on the skin). Each symptom was rated on a scale of 0–3, with higher scores indicative of severe symptoms. Mean pre-treatment TCM syndrome scores were 16.78 in the drug monotherapy group, 16.85 in the herbal medicine monotherapy group, and 17.54 in the acupuncture plus herbs group. Following treatment, scores fell to 13.47, 12.74, and 9.68 respectively. Improvements were the greatest in the acupuncture plus herbs group (p<0.05). Treatment efficacy rates were calculated for each group. Patients whose self-rated symptoms had fully resolved and whose reflexes were normal, with nerve conduction test improvements of ≥5 m/s, were classified as recovered. For patients whose self-rated symptoms and reflexes had clearly improved, with nerve conduction test improvements of 2–5 m/s, the treatment was classified as effective. For patients with no clear changes in their condition, the treatment was classified as ineffective. In the drug monotherapy group, there were 2 recovered, 14 effective, and 14 ineffective cases, giving a total effective rate of 53.33%. In the herbal medicine monotherapy group, there were 5 recovered, 17 effective, and 8 ineffective cases, giving a total effective rate of 73.33%. In the acupuncture plus herbs group, there were 11 recovered and 18 effective cases, with 1 ineffective case, yielding a total effective rate of 96.67%. Design A total of 90 DPN patients were recruited for the study and, using a random number table, were assigned to either the drug monotherapy group, the herbal medicine monotherapy group, or the acupuncture plus herbs group. The drug monotherapy group was treated with epalrestat, an aldose reductase inhibitor used in the treatment of DPN. The herbal medicine monotherapy group was treated with Tao Hong Si Wu Tang. The acupuncture plus herbs group was treated with Tao Hong Si Wu Tang in combination with acupuncture. Baseline The drug monotherapy group was comprised of 16 male and 14 female patients, ages 40–74 years (mean age 57.60 years). The participants in this group were diagnosed with diabetes for 5.5–21 years (median duration 9.8 years) and suffered from DPN for 1.2–6.8 years (mean duration 4.3 years). The herbal medicine monotherapy group was comprised of 16 male and 14 female patients, ages 41–72 years (mean age 57.03 years). The participants in this group were diagnosed with diabetes for 5–18 years (median duration 9.6 years) and suffered from DPN for 1.5–7.0 years (mean duration 4.3 years). The acupuncture plus herbs group was comprised of 17 male and 13 female patients, ages 40–75 years (mean age 59.03 years). The participants in this group were diagnosed with diabetes for 5–20 years (mean duration 9.5 years) and suffered from DPN for 2–7 years (mean duration 4.5 years). There were no statistically significant differences in baseline characteristics between the three groups (p>0.05).

Diagnostics
Diagnostic criteria included a previous history of diabetes with signs of DPN present either at the time of (or after) diagnosis, signs and symptoms consistent with a diagnosis of DPN such as pain, numbness, formication (the sensation of insects crawling on the skin), and other abnormal sensations. The participants’ reflexes were tested including the ankle jerk reflex and responses to needle pain, vibration, pressure, and heat. In the absence of clinical symptoms, two of the above reflexes were required to be abnormal for inclusion in the study.

Further inclusion criteria included the age range of 40–70 years with a clinical diagnosis of DPN, fasting blood glucose levels of ≤8.0 mmol/L, postprandial blood glucose levels of ≤10.0 mmol/L, diastolic blood pressure of 60–90 mm Hg, and systolic blood pressure of 90–140 mm Hg. All patients were required to give informed consent to participate in the study. Exclusion criteria included infections, external trauma, chronic alcoholism, malnutrition, drug-induced nerve dysfunction, concurrent cardiovascular, respiratory, digestive, neurological, hematologic, immune, endocrine, or psychological disorders, pregnancy, or simultaneously participating in other clinical trials.

Acupuncture, Herbs, And Drugs
All patients received appropriate dietary, exercise, and health education with the aim of regulating blood glucose levels. Any patients taking medications for blood pressure, cholesterol, or coronary heart disease maintained their original treatment and dosage throughout the study period.

Participants in the drug monotherapy group were treated with epalrestat, an aldose reductase inhibitor drug commonly used in the treatment of DPN. A 50mg dose was prescribed, to be taken three times each day. Participants in the herbal medicine monotherapy group were prescribed Tao Hong Si Wu Tang comprised of the following herbs:

Dang Gui 15g
Bai Shao 15g
Chuan Xiong 10g
Shu Di Huang 15g
Tao Ren 15g
Hong Hua 15g

The herbs were decocted in water daily and were split into three doses to be taken morning, noon, and evening. Participants in the acupuncture plus herbs group were prescribed the above herbal formula and also received acupuncture treatment administered at the following acupoints:

Sihua points: Geshu (BL17), Danshu (BL19)
Feishu (BL13)
Pishu (BL20)
Shenshu (BL23)
Yanglingquan (GB34)
Sanyinjiao (SP6)
Quchi (LI11)
Bafeng (MLE8)
Baxie (MUE22)

Needles were inserted using the standard method and, after the arrival of deqi, were manipulated for 30 seconds using a balanced reinforcing-reducing method comprised of twisting, rotating, lifting, and thrusting. Manipulation was repeated at 10-minute intervals and needles were retained for a total of 30 minutes. Treatment was administered daily.

All three treatment groups received two full courses of treatment, with each course comprising two weeks. During the treatment period, patients were advised to avoid cold temperatures and drafts, emotional stress, and overexertion, while refraining from smoking, drinking alcohol, and eating spicy, fatty, or greasy foods.

The results of this study indicate that acupuncture combined with herbal medicine is a safe and effective treatment for DPN and its associated symptoms. Acupuncture and herbs outperformed epalrestat and all treatment modalities used in the study had a low risk of adverse effects.

Reference:
1. Wu Guannan, Meng Caizhou, Zhang Dinghua (2019) “Randomized controlled study of acupuncture combined with Taohong Siwu Decoction in the treatment of diabetic peripheral neuropathy” Journal of Gansu University of Chinese Medicine Vol. 36 (1) pp. 64-67.

alternative2019-08-21T10:52:23-07:00August 12th, 2019|

How acupuncture could help with your seasonal allergies

Wonderful article by Kelsey Roy:

Spring is here, and for many that means seasonal allergies are too.

There are many ways to handle itchy eyes, runny nose or uncontrollable sneezing of allergies, both natural or with medication.

If you are looking for a natural way to help combat allergies (and aren’t scared of needles), some studies show that acupuncture may be worth a try.

According to the National Center for Complementary and Integrative Health, a 2015 evaluation of 13 studies showed that acupuncture could help with symptoms of allergic rhinitis, or hay fever.

The studies involved almost 2,400 people. The review found that the groups that received acupuncture reported reduced nasal symptoms compared to the groups that didn’t.

That same year, the American Academy of Otolaryngology issued practice guidelines that recommends clinicians to offer or refer acupuncture to patients suffering with allergies that would like an alternative to medicine.

alternative2019-05-13T12:22:49-07:00May 13th, 2019|

Should You Try Acupuncture to Treat Arthritis Pain?

While more research is still needed, some experts point to this as way to relieve joint discomfort.

Wonderful article by Michael O. Schroeder, Staff Writer

More

Should I Try Acupuncture for Arthritis?

About 1 in 4, or more than 54 million, adults in the U.S. have arthritis, according to the Centers for Disease Control and Prevention.

The umbrella term describes various conditions that affect the joints and surrounding tissues. The most common type, osteoarthritis, involves the breakdown of cartilage in joints, such as the hips and knees, and it’s particularly prevalent as people get older.

“Osteoarthritis is a degenerative mechanical condition that causes loss of cartilage resulting often in joint pain and sometimes loss of function,” explains Dr. Charis Meng, a rheumatologist at the Hospital for Special Surgery and Weill Cornell Medicine in New York City. As with many causes of chronic pain, there’s no quick fix.

A Patient’s Guide to Rheumatoid Arthritis

In some cases, surgery such as knee replacement is recommended to treat advanced osteoarthritis. That’s “probably the closest thing we come to a ‘cure’ quote unquote, because you’re replacing the joint,” Meng says.

Still, she and other experts reiterate that right now there’s no therapy to reverse the cartilage loss that happens inside the knee or another joint with OA. And for many surgery isn’t necessary or recommended, even while joint pain from arthritis may limit function and daily activities and undermine quality of life.

See: Osteoarthritis and Activity: Walking It Out. ]

To try to tame that chronic pain and improve function, experts recommend everything from losing weight (to take stress off joints) to exercise to over-the-counter and prescription medication and injections of cortisone in the joints, depending on the individual, to ease discomfort.

In addition, some people turn to acupuncture – a form of traditional Chinese medicine that typically involves practitioners inserting ultra-thin needles into the skin – in an effort to relieve or reduce arthritis pain. “Right now we don’t have a medical cure. So we rely on treatment, and I look at acupuncture as a traditional treatment for osteoarthritis pain,” says Meng, who is certified in acupuncture. “I always make it clear it’s not a cure, because nobody’s replacing the cartilage with acupuncture or anything else for that matter in Western medicine.”

Practitioners say acupuncture may also help to relieve pain from rheumatoid arthritis, in which the body’s immune system “attacks” the joints, causing painful inflammation.

Where many with arthritis use more than one approach to address pain and improve function, Jamie Starkey, manager of the Eastern medicine program and lead acupuncturist at the Cleveland Clinic’s Center for Integrative and Lifestyle Medicine, sees it as complementing other options for treating arthritis. “It really oftentimes does take a multidisciplinary approach to care,” she says.

Along those lines, some research provides support for using acupuncture to treat arthritis. In general, the technique has been shown to reduce inflammation, and relieve various forms of chronic pain. Still, there’s also conflicting data, too.

A research review published last year in Evidence-Based Complementary and Alternative Medicine concluded “acupuncture alone or combined with other treatment modalities is beneficial to the clinical conditions of RA (rheumatoid arthritis) without adverse effects reported and can improve function and quality of life and is worth trying.” Another meta-analysis published in The Journal of Pain in 2018 found acupuncture to be effective for treating osteoarthritis pain, among other types of chronic pain, and that the benefits persist over time and pain relief can’t be explained solely by a placebo effect.

But experts reviewing studies on acupuncture to treat arthritis have bemoaned a dearth of high quality research in that area. Further complicating matters is the heterogeneity of acupuncture itself: That is, various practitioners use different techniques, rather than one uniform type of acupuncture being applied.

A 2010 Cochrane review, including studies of people with osteoarthritis in the peripheral joints (knee, hip and hand), found it conferred a small benefit, but owed that was at least partially related to placebo effect. The findings from a 2014 study published in the Journal of the American Medical Association didn’t support the use of acupuncture to relieve moderate or severe knee pain in individuals over 50 (which is typically the result of osteoarthritis). And a 2018 Cochrane review found: “Acupuncture probably has little or no effect in reducing pain or improving function relative to sham acupuncture in people with hip osteoarthritis.”See: 6 Nonopioid Ways to Ease Postoperative Pain. ]

Despite mixed research results – which have been disputed by some practitioners – acupuncture is widely used to treat chronic pain, and data strongly supports its safety.

Almost anyone can have it done with little risk or discomfort. “If somebody has very limited mobility and has trouble getting onto the table – I have had this happen – maybe acupuncture is not the best thing for them, because they do have to lie still for about 20, 30 minutes,” Meng says. “And some people, if they just have a lot of disabilities and they have trouble doing that, it won’t be a very comfortable experience for them.” One other instance where caution may be advised: “Some people are on blood thinners like warfarin or other anticoagulants, and you do have to be careful with acupuncture,” Meng says. “Because even though the needles are very, very thin, there’s always an increased risk of bleeding when you’re on those type of blood thinners.”

For those who are interested in trying acupuncture to treat arthritis pain, it’s important to seek out a licensed acupuncturist, who is board certified, says Brian Jackson, an acupuncturist in the orthopedics department at the University of Maryland School of Medicine. Experts also advise not only considering the professional’s education not only in acupuncture generally, but inquiring about the practitioner’s experience treating arthritis pain and other chronic pain. “The majority of our patients are sort of neck and lower back pain patients; and we have pretty good success rates with treating those patients,” Jackson says.

A physician referral is a good place to start to find an acupuncturist – but often that’s not possible (your physician may not have any suggestions on this).

National Certification Commission for Acupuncture and Oriental Medicine, or the NCCAOM, provides an online directory to find a certified acupuncturist in your area. As the nonprofit’s website notes, “NCCAOM is the only national organization that validates entry-level competency in the practice of acupuncture and Oriental medicine (AOM) through professional certification.”

alternative2019-03-11T14:56:09-07:00March 11th, 2019|

Acupuncture and related interventions for the treatment of symptoms associated with carpal tunnel syndrome

Thank you to Cochrane library for this wonderful article and: Choi GH, Wieland LS, Lee H, Sim H, Lee MS, Shin BC. Acupuncture and related interventions for the treatment of symptoms associated with carpal tunnel syndrome. Cochrane Database of Systematic Reviews 2018, Issue 12. Art. No.: CD011215. DOI: 10.1002/14651858.CD011215.pub2.

Background:Carpal tunnel syndrome (CTS) is a compressive neuropathic disorder at the level of the wrist. Acupuncture and other methods that stimulate acupuncture points, such as electroacupuncture, auricular acupuncture, laser acupuncture, moxibustion, and acupressure, are used in treating CTS. Acupuncture has been recommended as a potentially useful treatment for CTS, but its effectiveness remains uncertain. We used Cochrane methodology to assess the evidence from randomised and quasi‐randomised trials of acupuncture for symptoms in people with CTS.

Objectives

To assess the benefits and harms of acupuncture and acupuncture‐related interventions compared to sham or active treatments for the management of pain and other symptoms of CTS in adults.

Search methods

On 13 November 2017, we searched the Cochrane Neuromuscular Specialised Register, CENTRAL, MEDLINE, Embase, AMED, CINAHL Plus, DARE, HTA, and NHS EED. In addition, we searched six Korean medical databases, and three Chinese medical databases from inception to 30 April 2018. We also searched clinical trials registries for ongoing trials.

Selection criteria

We included randomised and quasi‐randomised trials examining the effects of acupuncture and related interventions on the symptoms of CTS in adults. Eligible studies specified diagnostic criteria for CTS. We included outcomes measured at least three weeks after randomisation. The included studies compared acupuncture and related interventions to placebo/sham treatments, or to active interventions, such as steroid nerve blocks, oral steroid, splints, non‐steroidal anti‐inflammatory drugs (NSAIDs), surgery and physical therapy.

Data collection and analysis

The review authors followed standard Cochrane methods.

Main results

We included 12 studies with 869 participants. Ten studies reported the primary outcome of overall clinical improvement at short‐term follow‐up (3 months or less) after randomisation. Most studies could not be combined in a meta‐analysis due to heterogeneity, and all had an unclear or high overall risk of bias.

Seven studies provided information on adverse events. Non‐serious adverse events included skin bruising with electroacupuncture and local pain after needle insertion. No serious adverse events were reported.

One study (N = 41) comparing acupuncture to sham/placebo reported change on the Boston Carpal Tunnel Questionnaire (BCTQ) Symptom Severity Scale (SSS) at three months after treatment (mean difference (MD) ‐0.23, 95% confidence interval (CI) ‐0.79 to 0.33) and the BCTQ Functional Status Scale (FSS) (MD ‐0.03, 95% CI ‐0.69 to 0.63), with no clear difference between interventions; the evidence was of low certainty. The only dropout was due to painful acupuncture. Another study of acupuncture versus placebo/sham acupuncture (N = 111) provided no usable data.

Two studies assessed laser acupuncture versus sham laser acupuncture. One study (N = 60), which was at low risk of bias, provided low‐certainty evidence of a better Global Symptom Scale (GSS) score with active treatment at four weeks after treatment (MD 7.46, 95% CI 4.71 to 10.22; range of possible GSS scores is 0 to 50) and a higher response rate (risk ratio (RR) 1.59, 95% CI 1.14 to 2.22). No serious adverse events were reported in either group. The other study (N = 25) did not assess overall symptom improvement.

One trial (N = 77) of conventional acupuncture versus oral corticosteroids provided very low‐certainty evidence of greater improvement in GSS score (scale 0 to 50) at 13 months after treatment with acupuncture (MD 8.25, 95% CI 4.12 to 12.38) and a higher responder rate (RR 1.73, 95% CI 1.22 to 2.45). Change in GSS at two weeks or four weeks after treatment showed no clear difference between groups. Adverse events occurred in 18% of the oral corticosteroid group and 5% of the acupuncture group (RR 0.29, 95% CI 0.06 to 1.32). One study comparing electroacupuncture and oral corticosteroids reported a clinically insignificant difference in change in BCTQ score at four weeks after treatment (MD ‐0.30, 95% CI ‐0.71 to 0.10; N = 52).

Combined data from two studies comparing the responder rate with acupuncture versus vitamin B_12, produced a RR of 1.16 (95% CI 0.99 to 1.36; N = 100, very low‐certainty evidence). No serious adverse events occurred in either group.

One study of conventional acupuncture versus ibuprofen in which all participants wore night splints found very low‐certainty evidence of a lower symptom score on the SSS of the BCTQ with acupuncture (MD ‐5.80, 95% CI ‐7.95 to ‐3.65; N = 50) at one month after treatment. Five people had adverse events with ibuprofen and none with acupuncture.

One study of electroacupuncture versus night splints found no clear difference between the groups on the SSS of the BCTQ (MD 0.14, 95% CI ‐0.15 to 0.43; N = 60; very low‐certainty evidence). Six people had adverse events with electroacupuncture and none with splints. One study of electroacupuncture plus night splints versus night splints alone presented no difference between the groups on the SSS of the BCTQ at 17 weeks (MD ‐0.16, 95% CI ‐0.36 to 0.04; N = 181, low‐certainty evidence). No serious adverse events occurred in either group.

One study comparing acupuncture plus NSAIDs and vitamins versus NSAIDs and vitamins alone showed no clear difference on the BCTQ SSS at four weeks (MD ‐0.20, 95% CI ‐0.86 to 0.46; very low‐certainty evidence). There was no reporting on adverse events.

Authors’ conclusions

Acupuncture and laser acupuncture may have little or no effect in the short term on symptoms of CTS in comparison with placebo or sham acupuncture. It is uncertain whether acupuncture and related interventions are more or less effective in relieving symptoms of CTS than corticosteroid nerve blocks, oral corticosteroids, vitamin B₁₂, ibuprofen, splints, or when added to NSAIDs plus vitamins, as the certainty of any conclusions from the evidence is low or very low and most evidence is short term. The included studies covered diverse interventions, had diverse designs, limited ethnic diversity, and clinical heterogeneity. High‐quality randomised controlled trials (RCTs) are necessary to rigorously assess the effects of acupuncture and related interventions upon symptoms of CTS. Based on moderate to very‐low certainty evidence, acupuncture was associated with no serious adverse events, or reported discomfort, pain, local paraesthesia and temporary skin bruises, but not all studies provided adverse event data.

Plain language summary

Acupuncture and related treatments for symptoms of carpal tunnel syndrome

Review question

Do acupuncture and related treatments improve symptoms of carpal tunnel syndrome in adults?

Background

Carpal tunnel syndrome (CTS) is a condition that may cause pain, numbness, tingling and weakness in the hand. It develops when the median nerve, which stretches from the arm into the hand, is compressed as it passes through a structure called the carpal tunnel in the wrist. A person’s job could be a factor in developing CTS and it can be an additional problem in people with other diseases, such as inflammatory arthritis. CTS can be treated by hand exercises, splinting, pain medicines, and injections. Severe CTS may be treated with surgery. People with CTS sometimes choose acupuncture and related treatments to manage the symptoms of CTS. Acupuncture uses needles to puncture the skin and stimulate acupuncture points on the body. These acupuncture points lie along the meridian, which is thought of as a pathway of energy through the body. Acupuncture‐related treatments use different methods to stimulate the acupuncture points. For example, laser acupuncture uses lasers instead of needles.

Study characteristics

We found 12 studies, which analysed 869 people with CTS. There were 148 men and 579 women (1 study did not specify gender). Participant age ranged from 18 to 85 years. The number of people in each study was between 26 and 181. CTS symptoms had been present for months or years. The studies compared needle acupuncture or laser acupuncture to placebo/sham treatments or active treatments, such as corticosteroid nerve blocks, oral corticosteroids, ibuprofen, night splints, physical therapy, and vitamin B₁₂.

Key results and certainty of the evidence

There may be little or no evidence for any difference between acupuncture or laser acupuncture and placebo or sham for symptoms of CTS. We cannot tell whether acupuncture and related interventions are more or less effective than other methods for the treatment of CTS symptoms. The studies we found were small and there may have been problems in how they were carried out. There was not much information on each comparison. The studies found some side effects from acupuncture, such as pain and bruising. None of the harms were serious. However, not all the studies provided information on side effects. We do not have enough good information from current studies to be sure about the effects of acupuncture and related treatments for CTS. We need larger and better‐quality studies to understand any effects of acupuncture and related interventions on symptoms of CTS.

This review is up‐to‐date to 13 November 2017 for English databases and 30 April 2018 for Chinese and Korean databases.

alternative2019-08-21T10:53:04-07:00December 12th, 2018|

Acupuncture MRI Results After Ischemic Stroke

Thank you to Health CMI for this informative article:

Acupuncture regulates brain regions for ischemic stroke patients. Southern Medical University researchers gathered MRI data in a controlled clinical trial consisting of both healthy subjects and patients suffering from ischemic stroke. In a controlled human clinical trial, Waiguan (TB5) applied unilaterally to the right arm produced significant MRI findings. True acupuncture caused important changes in brain functional connectivity.

The researchers determined that true acupuncture triggers significant negative activation in the default mode network (DMN) and other brain regions specific to the Traditional Chinese Medicine (TCM) indications of Waiguan. The DMN is a network of highly correlated brain regions, which is active under resting-state conditions. In addition, they found that ischemic stroke affects the brain’s overall response to acupuncture. The healthy control group and the ischemic stroke group had different negatively-activated brain regions in the DMN when receiving true acupuncture. [1]

Waiguan (TB5)
The earliest introduction of Waiguan was found in the Huangdi Neijing (The Yellow Emperor’s Classic of Medicine). Waiguan is the luo-connecting point of the hand shaoyang sanjiao meridian as well as one of the eight confluent points. It is the confluent point of the yang linking vessel. Needling Waiguan is indicated for the treatment of the following disorders: upper limb disorders (e.g., upper limb paralysis, pain, numbness, swelling and other motor and sensory dysfunction), head and sensory organ disorders (e.g., migraines, red and swollen eyes, tinnitus, deafness), fever and exogenous diseases (e.g., common cold, febrile illnesses). The researchers found that needling Waiguan raises negative activation in the somatic motor cortex, somatic sensory cortex, visual information processing cortex, and auditory information process cortex.

Results
In the normal control group, the brain regions deactivated by real acupuncture included the left superior parietal lobule, left inferior parietal lobule, left precuneus, left superior frontal gyrus, left precentral gyrus, left postcentral gyrus, left occipital lobe, right precentral gyrus, right postcentral gyrus, right precuneus, and right cuneus. The precentral gyrus and superior frontal gyrus are involved in somatic motor functions. The superior parietal lobule and postcentral gyrus are associated with somatic sensory functions. The occipital lobe interprets visual information. The aforementioned regions are specific to the indications of Waiguan. The inferior parietal lobule, occipital lobe, and precuneus are DMN related regions. On the other hand, the brain regions deactivated by sham acupuncture included the left precentral gyrus, left postcentral gyrus, and right superior frontal gyrus. The results indicate specific brain activation patterns associated with true acupuncture and sham acupuncture respectively.

In the ischemic stroke group, the brain regions deactivated by real acupuncture included the left medial frontal gyrus, left postcentral gyrus, left middle temporal gyrus, right postcentral gyrus, right precentral gyrus, and right medial frontal gyrus. The middle temporal gyrus is associated with interpreting auditory information. It is regarded as a Waiguan indication-specific region along with the precentral gyrus, postcentral gyrus, and middle temporal gyrus. The medial frontal gyrus is a part of DMN regions. By contrast, the brain regions deactivated by sham acupuncture included the left and right precuneus.

Design
The researchers (Zhang et al.) used the following study design. A total of 44 subjects participated in the study and were divided into two groups, with 24 and 20 subjects in each group respectively. The treatment group subjects were selected from the Nanfang Hospital and the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine. The treatment group patients were diagnosed with ischemic stroke. The control group subjects included healthy volunteers.

The statistical breakdown for each group was as follows. The treatment group was comprised of 10 males and 10 females. The mean age of the treatment group was 52.8 years. The mean weight was 50.3 kg. The mean height was 160.3 cm. The mean course of disease was 2.2 months. The control group was comprised of 12 males and 12 females. The mean age of the control group was 24.6±3.4 years. The mean weight was 51.4 kg. The mean height was 163.4 cm. There were no significant differences in terms of their gender, age, height, and weight. Both groups were scanned using fMRIs after receiving true or sham acupuncture intervention.

Real Acupuncture
True acupuncture and sham acupuncture were performed by the same acupuncturist with clinical and research experience. Both procedures employed the use of a tube-guided device that can be attached to the skin (Park Sham Tube, AcuPrime). The Park Sham Tube needle is a research device that mimics true acupuncture; however, the needle never penetrates the skin. Instead, the needle retracts into the handle when tapped, thereby visibly appearing as true acupuncture.

After disinfection of the acupoint site, a 0.30 × 40 mm disposable filiform needle was tapped into the acupoint of each patient with a high needle entry speed, reaching a depth of 10 (±2) mm. Upon a deqi sensation, the Ping Bu Ping Xie (attenuating and tonifying) manipulation technique was applied, with a twisting range of 180 degrees and frequency of 60 times/minute. The manipulation was not employed for the first 30 seconds, it was then initiated for the second 30 seconds, and then stopped again for the third 30 second interval. The whole process was repeated continuously for a total of 180 seconds. The device was placed on the skin until the treatment session was finished.

Sham Acupuncture Treatment Simulation
The sham acupuncture group use needles with a retractable, flattened needle point. The Ping Bu Ping Xie (attenuating and tonifying) manipulation was applied. For the first 30 seconds, the needle was slightly lifted to keep the needle point away from the skin; for the second 30 seconds, the needle was tapped into the tube to make the needle point slightly touch the skin, for the third 30 seconds, the needle was lifted again. The whole process was repeated continuously for a total of 180 seconds. The device was placed on the skin until the treatment session was finished.

Summary
According to the research, true acupuncture at Waiguan regulates DMN brain regions and raises negative activation in indication-specific regions, including the somatic motor cortex, somatic sensory cortex, visual information processing cortex, and auditory information process cortex. The process was verified by repeated applications across multiple subjects and was verified by MRIs. The results indicate that acupuncture produces point-specific effects on brain regions in ischemic stroke patients.

This type of research supports additional findings by other researchers. In another investigation, Yang et al. conclude that acupuncture has the ability to “promote the proliferation and differentiation of neural stem cells in the brain… accelerate angiogenesis and inhibit apoptosis…. prevent and treat neural injuries following cerebral ischemia.” [2] Yang et al. add that GV20 (Baihui) and GV26 (Shuigou) regulate cells which “increase the release of nerve growth factors (NGFs) to make nerve cells survive and axons grow, synthesize neurotransmitters, (and) metabolize toxic substances….” In addition, the researchers note that needling CV24 (Chengjiang), CV4 (Guanyuan), GV26, and GV20 “inhibit excessive proliferation of the hippocampal astrocytes and promote cellular differentiation.”

Yang et al. also note that acupuncture at GV20 and GV14 (Dazhui) affect the contents and expression of signal transducers and activators of transcription (STATs). STATs are active in the Janus kinase STAT pathway and transmit information from chemical signals outside the cell, through the cell membrane, and into gene promoters on the DNA inside the cell nucleus (causing DNA transcription and cellular activity). Yang et al. note that acupuncture’s influence on STATs indicates that it activates self-protection and reduction of “apoptosis of the nerve cells in and around the ischemic focus.” This indicates that acupuncture has a neuroprotective effect for stroke patients.

References
[1] Zhang GF, Huang Y, Tang CS, Lai XS, Chen JQ. Identification of Deactivated Brain Regions by Real and Non-penetrating Sham Acupuncture Stimulation on Waiguan: An fMRI Study in Normal Versus Pathological Conditions [J]. Chinese General Practice, 2017, 20(9):1098-1103.

[2] Zhou-xin Yang, Peng-dian Chen, Hai-bo Yu, Wen-shu Luo, Yong-Gang Wu, Min Pi, Jun-hua Peng, Yong-feng Liu, Shao-yun Zhang, Yan-hua Gou. Research advances in treatment of cerebral ischemic injury by acupuncture of conception and governor vessels to promote nerve regeneration. Journal of Chinese Integrative Medicine, 01-2012. vol. 10, 1. Shenzhen Traditional Chinese Medicine Hospital, Guangzhou University of Chinese Medicine.

alternative2018-12-12T10:41:13-08:00December 12th, 2018|

The Comforting Appeal of Herbs

Wonderful article from the NY Times By Ligaya Misha Nov. 21, 2018

ONCE, HERBS WERE weapons. Five thousand years ago, the Sumerians recorded, in cuneiform, lifesaving prescriptions of myrtle and thyme. The oldest surviving text of Chinese herbal pharmacology, extolling the benefits of ginseng, camphor and cannabis, was set down in the first century A.D. Around the same time, the Greek physician Dioscorides documented the properties of herbs he encountered as a surgeon with Nero’s imperial Roman army; Western doctors consulted his compendium, “De Materia Medica,” for the next 1,500 years. In Renaissance England, chamomile, hyssop, pennyroyal and tansy were strewn on floors to ward off the plague; men and women wielded prophylactic posies of flowers and herbs like swords.

But with the triumphs of science and technology in the 19th century, herbs receded in significance. “These ancestral leaves, these immemorial attendants of man, these servants of his magic and healers of his pain,” as the American naturalist Henry Beston described them in 1935, became workhorses, steadfast and drained of alchemy. They came to be defined by that most prosaic of qualities: usefulness. Even in the kitchen, they were underlings, essential but largely confined to a supporting role. Any prettiness they possessed was incidental to their practical purpose and noted only in passing, en route to the boiling pot.

As the modern world has lost its luster, however, herbs are coming into ascendance once more, reasserting their curative powers and claiming a beauty of their own. A private herb garden has become a status symbol, as chefs flaunt seasonings that have fallen out of favor or are hard to find, like salad burnet, its bite as cleansing as a cucumber’s, or sculpit, which evokes a bashful tarragon. This goes beyond the now mainstream farm-to-table movement, which has roots in the counterculture of the 1960s, to what the Spanish chef Rodrigo de la Calle christened gastrobotánica: the restoration of forgotten plants to the realm of cooking. The British horticulturalist Jekka McVicar, who grows more than 650 varieties of herbs on her farm in South Gloucestershire, England, has been approached by British chefs seeking sweet woodruff, beloved in Germany as an infuser of Jell-O and beer, and baldmoney from the Scottish highlands, its flavor a sidestep from cumin. Farm.One, an underground hydroponic facility in downtown Manhattan, supplies avant-garde restaurants and pizzerias with rarities such as tiny, bright pluto basil and akatade, a Japanese water pepper that imparts a faintly anesthetic heat.

alternative2018-11-27T13:22:17-08:00November 27th, 2018|

Acupuncture for Anxiety

These are trying times indeed and can provoke anxiety. I can help you with
acupuncture and herbs. Please give me a call today!
310-444-6212. This article is from Psychology Today

Different approaches have beneficial effects.

Posted Oct 30, 2018

Animal and human studies suggest that the beneficial effects of acupuncture on health, including mental and emotional functioning, are related to different mechanisms of action, including changes in neurotransmitters involved in emotional regulation such as serotonin, modulation of the autonomic nervous system, and changes in immune function. Some researchers have argued that the placebo effect plays a significant role in clinical response to acupuncture; however, sham-controlled studies do not support this hypothesis.

Research findings support acupuncture as a treatment of anxiety.

Acupuncture and acupressure are widely used to treat anxiety in both Asia and Western countries. Extensive case reports from the Chinese medical literature suggest that different acupuncture protocols reduce the severity of generalized anxiety and panic attacks (Lake & Flaws 2001).

In a small double-blind sham-controlled study, 36 mildly depressed or anxious patients were randomized to either an acupuncture protocol traditionally used by Chinese medical practitioners to treat anxiety or to a sham acupuncture protocol (i.e. acupuncture points believed to have no beneficial effects). All patients received three treatments. Heart rate variability (HRV) and mean heart rate were measured at 5 and 15 minutes following treatment. Resting heart rate was significantly lower in the treatment group but not in the sham group, and changes in HRV measures suggested that acupuncture may have changed autonomic activity resulting in a reduction of overall anxiety. The significance of these findings is limited by the absence of measures of baseline anxiety before and after treatment.

In another double-blind study, 55 adults who had not been diagnosed with an anxiety disorder were randomized to either a sham acupuncture point or a bilateral auricular (involving points on the ears) acupuncture protocol called the “shenmen” point. That protocol is believed to be effective against anxiety. In all subjects, acupuncture needles remained in place for 48 hours. The “relaxation” group was significantly less anxious at 30 minutes, 24 hours, and 48 hours compared to the other two groups, however, there were no significant inter-group differences in blood pressure, heart rate, or electrodermal activity (Wang 2001).

Reviews report mainly positive findings.

An early narrative review of controlled studies, outcomes studies, and published case reports on acupuncture as a treatment of anxiety and depressed mood was published by the British Acupuncture Council. Sham-controlled studies yielded consistent improvements in anxiety using both regular (i.e. body) acupuncture and electro-acupuncture. The authors remarked that significant differences existed between protocols used in both regular and electro-acupuncture, suggesting that acupuncture may have general beneficial effects or possibly placebo effects. Although most controlled studies reviewed reported a general anxiety-reducing effect of acupuncture, the reviewers regarded these findings as inconclusive because of study design problems, including the absence of standardized symptom rating scales in most studies, limited follow-up, and poorly defined differences between protocols used in different studies.

A recently published systematic review (Amorim 2018) compared findings of studies on traditional (body) acupuncture, ear acupuncture (ariculotherapy), and electro-therapy in the treatment of anxiety. Some studies included in the review reported that acupuncture enhances response to prescription anti-anxiety medications and may also reduce medication side effects. The authors found good evidence that different styles of acupuncture reduce symptoms of anxiety in general, and recommended additional sham-controlled studies to help determine whether certain protocols are more beneficial than others.

For more information about complementary and alternative treatments of anxiety, read my e-book “Anxiety: The Integrative Mental Health Solution.”

Few mild adverse effects

Uncommon transient adverse effects associated with acupuncture include bruising, fatigue, and nausea. Very rare cases of pneumothorax (i.e. a potentially life-threatening condition caused when an acupuncture needle results in the collapse of a lung) have been reported.

References

“Anxiety: The Integrative Mental Health Solution” by James Lake MD http://theintegrativementalhealthsolution.com/anxiety-the-integrative-mental-health-soution.html

Acupuncture and electroacupuncture for anxiety disorders: A systematic review of the clinical research, Amorim et al. Comp Therapies Clin Practice, 2018 https://www.ncbi.nlm.nih.gov/pubmed/29705474

Animal and human studies suggest that the beneficial effects of acupuncture on health, including mental and emotional functioning, are related to different mechanisms of action, including changes in neurotransmitters involved in emotional regulation such as serotonin, modulation of the autonomic nervous system, and changes in immune function. Some researchers have argued that the placebo effect plays a significant role in clinical response to acupuncture; however, sham-controlled studies do not support this hypothesis.

Research findings support acupuncture as a treatment of anxiety.

Acupuncture and acupressure are widely used to treat anxiety in both Asia and Western countries. Extensive case reports from the Chinese medical literature suggest that different acupuncture protocols reduce the severity of generalized anxiety and panic attacks (Lake & Flaws 2001).

In a small double-blind sham-controlled study, 36 mildly depressed or anxious patients were randomized to either an acupuncture protocol traditionally used by Chinese medical practitioners to treat anxiety or to a sham acupuncture protocol (i.e. acupuncture points believed to have no beneficial effects). All patients received three treatments. Heart rate variability (HRV) and mean heart rate were measured at 5 and 15 minutes following treatment. Resting heart rate was significantly lower in the treatment group but not in the sham group, and changes in HRV measures suggested that acupuncture may have changed autonomic activity resulting in a reduction of overall anxiety. The significance of these findings is limited by the absence of measures of baseline anxiety before and after treatment.

In another double-blind study, 55 adults who had not been diagnosed with an anxiety disorder were randomized to either a sham acupuncture point or a bilateral auricular (involving points on the ears) acupuncture protocol called the “shenmen” point. That protocol is believed to be effective against anxiety. In all subjects, acupuncture needles remained in place for 48 hours. The “relaxation” group was significantly less anxious at 30 minutes, 24 hours, and 48 hours compared to the other two groups, however, there were no significant inter-group differences in blood pressure, heart rate, or electrodermal activity (Wang 2001).

Reviews report mainly positive findings.

An early narrative review of controlled studies, outcomes studies, and published case reports on acupuncture as a treatment of anxiety and depressed mood was published by the British Acupuncture Council. Sham-controlled studies yielded consistent improvements in anxiety using both regular (i.e. body) acupuncture and electro-acupuncture. The authors remarked that significant differences existed between protocols used in both regular and electro-acupuncture, suggesting that acupuncture may have general beneficial effects or possibly placebo effects. Although most controlled studies reviewed reported a general anxiety-reducing effect of acupuncture, the reviewers regarded these findings as inconclusive because of study design problems, including the absence of standardized symptom rating scales in most studies, limited follow-up, and poorly defined differences between protocols used in different studies.

A recently published systematic review (Amorim 2018) compared findings of studies on traditional (body) acupuncture, ear acupuncture (ariculotherapy), and electro-therapy in the treatment of anxiety. Some studies included in the review reported that acupuncture enhances response to prescription anti-anxiety medications and may also reduce medication side effects. The authors found good evidence that different styles of acupuncture reduce symptoms of anxiety in general, and recommended additional sham-controlled studies to help determine whether certain protocols are more beneficial than others.

alternative2018-11-06T10:35:12-08:00November 6th, 2018|

Acupuncture MRI Discovery For Sciatica Relief

Thank you to HealthCMI for this interesting article.

Acupuncture alleviates sciatica and MRIs reveal that acupuncture causes important pain relief related changes in brain functional connectivity. Affiliated Huashan Hospital of Fudan University researchers gathered objective and subjective data in a controlled clinical trial consisting of patients suffering from sciatica. Visual Analogue Scale (VAS) scores indicate that acupuncture produces significant decreases in both pain intensity levels and frequency of pain. Additionally, MRIs show that acupuncture restores pain-free connectivity related activity in the brain; acupuncture changed the functional state of the brain such that patients had greater resting states.

The researchers determined that acupuncture regulates the default mode network (DMN). In addition, the DMN regulation induced by acupuncture treatment correlates to significant reductions in pain for sciatica patients. The DMN is a complex of interconnected activated and deactivated brain regions and the DMN is at its peak activity level when the brain is at rest. Acupuncture facilitated key changes to the brain to allow for the resting state to return. The research indicates that sciatica-related pain disturbs the normal DMN pattern and that acupuncture restores the pattern.

Using functional magnetic resonance imaging (fMRI), the research team discovered that acupuncture “raises negative activation in the brain’s default mode network (DMN) of chronic sciatica patients, especially in the dorsal medial prefrontal cortex and anterior cingulate cortex.” [1] The cingulate cortex and the frontal cortex are known to be involved in pain-related subjective perception and cognition, memory, emotional responses, and attentional responses. [2]

Prior research confirms that decreased negative activation in the DMN is associated with increased pain. Another fMRI study compared chronic lower back pain patients with healthy volunteers. The results showed that patients with chronic lower back pain had significantly decreased negative activation in the default mode network (DMN) of the brain. [3] Negative activation is a form of functional connectivity found during the brain’s resting state. [4]

Symptoms
In the Affiliated Huashan Hospital of Fudan University sciatica research, Visual Analogue Scale (VAS) scores of the acupuncture treatment and control groups were compared before and after treatments. VAS was implemented as an instrument for assessing the intensity and frequency of pain. The scores in the acupuncture treatment group decreased from 5.6 ±1.3 before treatment to 1.2 ±0.8 after treatment. There was a statistically significant difference before and after treatment and the acupuncture group significantly outperformed the control group. The subjective data demonstrates that acupuncture reduces both pain intensity and frequency for patients with sciatica.

Brain Functional Connectivity
The researchers found that negative activation of the DMN in the healthy control group included the following regions: bilateral posterior cingulate, cuneus, precuneus, inferior parietal lobule, dorsal medial prefrontal cortex, and dorsal lateral prefrontal cortex. Prior to acupuncture, the treatment group showed decreased negative activation in the DMN regions as well, including the dorsal medial prefrontal cortex, dorsal lateral prefrontal cortex, anterior cingulate cortex, and precuneus. After acupuncture treatment, the negative activation in these regions increased. Acupuncture produced significant improvements towards the DMN activity found in the healthy control group; however, a slight decrease in negative activation in the precuneus of chronic sciatic patients persisted.

Design
The Fudan University researchers (Li et al.) used the following study design. A total of 20 subjects participated in the study and were divided into two groups, with 10 subjects in each group. The treatment group subjects were selected from the Department of Integrated Traditional and Western Medicine, the Affiliated Huashan Hospital of Fudan University. All were diagnosed with chronic sciatica. The control group subjects included only healthy volunteers. The following selection criteria were applied for the treatment group subjects:

Consistent with the diagnostic criteria of chronic sciatica: radiating pain in the sciatic nerve distribution area (i.e., buttocks, posterior thigh, posterior lateral lower leg, lateral dorsum of the foot).
Chronic lower extremity pain for more than 3 months.
No sedative or analgesic drugs were taken 24 hours before or during acupuncture treatment.
No acupuncture treatment within 0.5 years before the study.
The visual analogue scale (VAS) score was ≥5 points.
Informed consent was signed for each subject.

The following exclusion criteria were applied:

History of spinal fractures, tumors, and intervertebral disc surgery.
History of nervous and mental disorders.
Contraindications for MRI examination (i.e., claustrophobia).

The statistical breakdown for each group was as follows. The treatment group was comprised of 5 males and 5 females. The mean age of the treatment group was 39.5 ±6.0 years. The control group was comprised of 5 males and 5 females. The mean age of the control group was 37.7 ±5.1 years. Both groups were equivalent in all relevant demographics, setting the basis for a fair comparison of results. Only the treatment group received acupuncture treatment. Both groups were scanned twice using fMRIs, once before acupuncture and once after 10 sessions of acupuncture treatment.

Acupuncture Procedure
The primary acupoints selected for the treatment of chronic sciatica were the following:

BL40 (Weizhong)
GB30 (Huantiao)

Additional secondary acupoints were added based on symptom presentation. For lower back pain, the following acupoints were added:

BL23 (Shenshu)
BL25 (Dachangshu)

For pain radiating to the posterior lower leg, the following acupoint was added:

BL57 (Chengshan)

Manual acupuncture was applied prior to the application of electroacupuncture. After deqi was achieved at the acupoints, the acupuncture needles were connected to an electroacupuncture device (2 Hz，2–4 mA, 10 V). The needles were retained for 30 minutes starting from the initiation of electroacupuncture stimulation. One 30 minute electroacupuncture session was administered twice daily, 3 times weekly, for a grand total of 10 sessions for each participant. To learn more about acupuncture procedures to alleviate sciatica, visit the following online course:

Lower Back Pain and Sciatica >

Summary
Subjective clinical and objective MRI data indicates that acupuncture is effective for the treatment of chronic sciatica. According to the research, common protocols involve the application of acupoints Weizhong (BL40) and Huantiao (GB30) for this condition. Patients interested in learning more about acupuncture are recommended to contact a local licensed acupuncturist.

References:
[1] Li J, Dong JC, Le JJ, et al. Effects of acupuncture on default mode network images of chronic sciatica patients in the resting network state [J]. Chinese Journal of Integrated Traditional and Western Medicine, 2012, 32(12):1624-1627.
[2] Vogt BA, Derbyshire S, Jones AK. Pain processing in four regions of human cingulate cortex localized with co-registered PET and MR imaging [J]. Eur J Neurosci, 1996, 8 (7): 1461 – 1473.
[3] Baliki MN, Geha PY, Apkarian AV, et al. Beyond feeling: chronic pain hurts the brain, disrupting the default mode network dynamics[J]. J Neurosci, 2008, 28 (6) :1398 – 1403.
[4] Raichle ME, MacLeod AM, Snyder AZ, et al. A default mode of brain function[J]. Proc Natl Acad Sci USA, 2001, 98(2): 676 – 682.

alternative2018-10-15T15:50:47-07:00October 15th, 2018|