Journal of Integrative Medicine

Distribution of licensed acupuncturists and educational institutions in the United States in early 2015

Arthur Yin Fan, Sarah Faggert

Journal of Integrative Medicine. 2018, 16(1): 1-5. doi:10.1016/j.joim.2017.12.003

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In recent decades, acupuncture has been used more widely and extensively in the United States (U.S.). However, there have been no national surveys or analyses reported in academic journals on the number of practicing or licensed acupuncturists. This study was conducted to identify the approximate number of licensed acupuncturists active in 2015. The Board of Acupuncture or Board of Medicine in each state or U.S. territory was contacted to collect data. Online license information searching was also performed in order to get accurate numbers of licensed acupuncturists for those states in which a board was unable to be contacted. The study found that the number of licensed acupuncturists in 2015 in the U.S. was 34,481. Of this, more than 50% were licensed in three states alone: California (32.39%), New York (11.89%) and Florida (7.06%). The number of licensed acupuncturists increased 23.30% and 52.09%, compared to the year 2009 (n?=?27,965) and 2004 (n?=?22,671), respectively; increasing about 1,266 per year. There were 62 and 10 accredited acupuncture institutions providing master and doctoral degrees, respectively. The West Coast comprised 51.39% of degree granting programs, while the East Coast comprised 29.17%; together the coastal states housed more than 80% of all programs, with the remainder sprinkled across the southern (9.72%), northern (8.33%), and the middle/central states (1.39%). Forty-four states and the District of Columbia regulated acupuncture practice by law at the time of data collection. Acupuncture continues to be a quickly growing profession in the U.S.

Research methods in complementary and alternative medicine: An integrative review

Fabiana de Almeida Andrade, Caio Fabio Schlechta Portella

Journal of Integrative Medicine. 2018, 16(1): 6-13. doi:10.1016/j.joim.2017.12.001

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The scientific literature presents a modest amount of evidence in the use of complementary and alternative medicine (CAM). On the other hand, in practice, relevant results are common. The debates among CAM practitioners about the quality and execution of scientific research are important. Therefore, the aim of this review is to gather, synthesize and describe the differentiated methodological models that encompass the complexity of therapeutic interventions. The process of bringing evidence-based medicine into clinical practice in CAM is essential for the growth and strengthening of complementary medicines worldwide.

The benefits of yoga in children

Chandra Nanthakumar

Journal of Integrative Medicine. 2018, 16(1): 14-19. doi:10.1016/j.joim.2017.12.008

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The number of children suffering from stress and anxiety in Malaysia is on the rise. Evidence shows that mind–body therapies such as mindfulness therapy, meditation and yoga have been practiced in many other countries to reduce and/or manage the psychological effects of stress and anxiety. This review article looks at the intervention of yoga as a meditative movement practice in helping school children manage stress and anxiety. Articles were retrieved using a combination of databases including PubMed/MEDLINE, and PsycINFO. Not only peer-reviewed articles, but also those written in English language were included in this review. All studies reviewed had incorporated some form of meditative movement exercise. The intervention encompassed asanas (postures), pranayama (expansion of life force), dharana (concentration) and dhyana (meditation), which are the different paths in yoga. A total of eight articles met the inclusion criteria and were reviewed. The findings of this review reveal that the practice of yoga has brought about, among other things, improvement in managing and reducing stress and anxiety. Despite the limitations in most, if not all of the studies reviewed, in terms of heterogeneity and sample size, yoga appears to be an effective modality for helping children cope with stress and anxiety. It appears that if schools in Malaysia can incorporate yoga as part of the physical education curriculum, it will definitely benefit the students.

Management of acute cough by Zataria multiflora Boiss as an alternative treatment

Mohaddese Mahboubi

Journal of Integrative Medicine. 2018, 16(1): 20-25. doi:10.1016/j.joim.2017.12.006

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Cough, as a defensive reflux mechanism, removes foreign objects and secretions from bronchi and bronchioles of airways. Zataria multiflora is a popular plant for treatment of cough in Iranian traditional medicine. The aim of this review was to evaluate the potency of Z. multiflora as an alternative treatment in management of acute cough and its possible mechanisms of action. Here the authors compiled information about Z. multiflora in the treatment of cough from all accessible resources and books. The results of this investigation showed that there were five clinical studies that evaluated the efficacy of Z. multiflora essential oil or extract alone (n?=?1), in combination with Althaea officinalis(n?=?2) or Foeniculum vulgare essential oil (n?=?1), in the form of syrup (n?=?3), oral drop (n?=?1) and soft capsule (n?=?1), for the treatment of acute cough in comparison with placebo or synthetic drugs (bromhexine, dextromethorphan and clobutinol). All clinical studies confirmed the efficacy of Z. multiflora in the amelioration of acute cough in pediatric (n?=?1) and adult patients (n?=?4) without any adverse effects. Different mechanisms, such as anti-inflammatory, analgesic, antimicrobial, relaxant and immune-enhancement, may be responsible for the efficacy of Z. multiflora in cough relief. Other clinical trials can be performed with Z. multiflora in combination with ivy leaf extract or primrose root extract on patients with cough.

Brain functional connectivity network studies of acupuncture: A systematic review on resting-state fMRI

Rong-lin Cai, Guo-ming Shen, Hao Wang, Yuan-yuan Guan

Journal of Integrative Medicine. 2018, 16(1): 26-33. doi:10.1016/j.joim.2017.12.002

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Background

Functional magnetic resonance imaging (fMRI) is a novel method for studying the changes of brain networks due to acupuncture treatment. In recent years, more and more studies have focused on the brain functional connectivity network of acupuncture stimulation.

Objective

To offer an overview of the different influences of acupuncture on the brain functional connectivity network from studies using resting-state fMRI.

Search strategy

The authors performed a systematic search according to PRISMA guidelines. The database PubMed was searched from January 1, 2006 to December 31, 2016 with restriction to human studies in English language.

Inclusion criteria
Electronic searches were conducted in PubMed using the keywords “acupuncture” and “neuroimaging” or “resting-state fMRI” or “functional connectivity”.

Data extraction and analysis

Selection of included articles, data extraction and methodological quality assessments were respectively conducted by two review authors.

Results

Forty-four resting-state fMRI studies were included in this systematic review according to inclusion criteria. Thirteen studies applied manual acupuncture vs. sham, four studies applied electro-acupuncture vs. sham, two studies also compared transcutaneous electrical acupoint stimulation vs. sham, and nine applied sham acupoint as control. Nineteen studies with a total number of 574 healthy subjects selected to perform fMRI only considered healthy adult volunteers. The brain functional connectivity of the patients had varying degrees of change. Compared with sham acupuncture, verum acupuncture could increase default mode network and sensorimotor network connectivity with pain-, affective- and memory-related brain areas. It has significantly greater connectivity of genuine acupuncture between the periaqueductal gray, anterior cingulate cortex, left posterior cingulate cortex, right anterior insula, limbic/paralimbic and precuneus compared with sham acupuncture. Some research had also shown that acupuncture could adjust the limbic-paralimbic-neocortical network, brainstem, cerebellum, subcortical and hippocampus brain areas.

Conclusion

It can be presumed that the functional connectivity network is closely related to the mechanism of acupuncture, and central integration plays a critical role in the acupuncture mechanism.

Determination of symptoms associated with hiesho among young females using hie rating surveys

Hidetoshi Mori, Hiroshi Kuge, Shunji Sakaguchi, Tim Hideaki Tanaka, Junji Miyazaki

Journal of Integrative Medicine. 2018, 16(1): 34-38. doi:10.1016/j.joim.2017.12.005

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Objective
Hie (cold sensation) is one of the most well-known health complaints in Japan and elsewhere in East Asia. Those who suffer from severe hie are considered to have hiesho (cold disorder). This study was conducted to determine symptoms associated with hie in young females using a survey consisting of the hie scale and hie diary.

Methods

Two hundred and seventy-one participants were included for the analysis. Survey forms were distributed to the participants. Diagnosis of hiesho was determined by using the hie scale. A discriminant score of over ?0.38 was considered hiesho. The Short Form-8 Health Survey Standard Version (SF-8) was used to measure health-related quality of life (QOL). The participants were also asked to respond to the questionnaire evaluating 14 physical and emotional symptoms, utilizing a six-level Likert scale item.

Results

The 1st factor (hie factor) was correlated with hie (r?=?0.546), dry mouth (r?=?0.332), lower-extremity edema (r?=?0.450), headrushes (r?=?0.470), shoulder stiffness (r?=?0.311), headrushes with chills (r?=?0.726), and fatigue (r?=?0.359). Cronbach’s α of the 1st factor was 0.748, which indicated reliability between the items. When hie factor was the dependent variable, standardized partial regression coefficient was β?=??0.387 for physical component score (P?<?0.001) and β?=??0.243 for mental component score (P?<?0.001).
Conclusion
This study indicated that hiesho symptoms among young female adults were associated with bodily pain and general health perceptions of the SF-8 QOL survey.

Efficacy and safety of herbal steam bath in allergic rhinitis: A randomized controlled trial

Parunkul Tungsukruthai, Preecha Nootim, Wiwan Worakunphanich, Nareerat Tabtong

Journal of Integrative Medicine. 2018, 16(1): 39-44. doi:10.1016/j.joim.2017.12.010

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Background
Allergic rhinitis is a nasal mucosa inflammatory disorder that is induced by exposure to an allergen which results in four major symptoms, including anterior or posterior rhinorrhea, sneezing, nasal itching and nasal congestion. Allergic rhinitis may result in sleep disturbance, fatigue, depression of mood-cognitive function and quality of life impairment.

Objective

This study examined the efficacy and safety of herbal steam bath used for the reduction of allergic rhinitis symptoms, and evaluated treatment satisfaction and improvements in quality of life among participating patients with allergic rhinitis.

Design, setting, participants and intervention

A single-blind randomized controlled trial was conducted at Thai Traditional and Alternative Medicine Hospital between June and December 2016, using 64 subjects, equally divided into two groups. The treatment group received herbal steam bath and the control group received steam bath without herbs for 30?min 3 times a week for 4 consecutive weeks.

Main outcome measures

Allergic rhinitis symptoms, such as itchy nose, runny nose, sneezing, nasal congestion and watery eyes, were measured using the visual analog scale at weeks 0, 1, 2, 3 and 4. Quality of life was assessed at week 0 and week 4.

Results

The characteristics (sex, age, marital status, education, allergic rhinitis symptoms and frequency of symptoms) at the baseline were not statistically different (P?>?0.05) between the two test groups. Anterior or posterior rhinorrhea symptoms, including sneezing, nasal itching and nasal congestion, were statistically reduced over the course of the treatment, but reductions were not significantly different between the control and treatment groups. The treatment group, however, was shown to be significantly more satisfied with the treatment than the control group (P?<?0.05).

Conclusion

Both treatments appear to be able to significantly reduce the symptoms of allergic rhinitis. However, there was no difference in the effectiveness of steam bath with herbs and steam bath without herbs.

Trial registration

This trial was registered in the Thai Clinical Trial Registry with the identifier TCTR20170712002.

Rhus coriaria L. increases serum apolipoprotein-A1 and high-density lipoprotein cholesterol levels: A double-blind placebo-controlled randomized clinical trial

Zahra Hajmohammadi, Mojtaba Heydari, Majid Nimrouzi, Pouya Faridi, Mohammad Javad Zibaeenezhad, Gholamhossein Ranjbar Omrani, Mesbah Shams

Journal of Integrative Medicine. 2018, 16(1): 45-50. doi:10.1016/j.joim.2017.12.007

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Background
Lipid-lowering effect of Rhus coriaria L. (Rhus) has been investigated in multiple animal studies with promising results. Nonetheless, its clinical efficacy has not been adequately examined.

Objective

The aim of this study was to evaluate the lipid-lowering effects of Rhus among patients with hyperlipidemia.

Design, setting, participants and interventions

The study was designed as a two-arm, double-blind placebo-controlled randomized clinical trial, using a parallel design. Eighty patients with primary hyperlipidemia were randomly assigned to receive Rhus capsules or placebo for 6?weeks.

Main outcome measures

The serum lipid levels, apolipoprotein-A1 (Apo-A1) and apolipoprotein-B (Apo-B) were measured.

Results

Mean serum high-density lipoprotein cholesterol (HDL-C) and Apo-A1 levels were significantly increased in the Rhus group, compared with the placebo group, after 6?weeks of intervention (P?=?0.001). The analysis of covariance test including age, gender, body mass index (BMI), and smoking as co-variables revealed that the increase in HDL-C and Apo-A1 levels remained significant, and increases in HDL-C were dependent on the increase in Apo-A1 levels. No significant difference was observed between Rhus and placebo groups in terms of mean reductions in total cholesterol, low-density lipoprotein cholesterol and triglyceride levels; however, more significant improvement was observed among obese patients (BMI?≥?30?kg/m²).

Conclusion

The study showed significant increases in HDL-C and Apo-A1 levels in response to Rhus supplementation in patients with hyperlipidemia.

Trial registration

ClinicalTrials.gov ID: NCT02295293.

Effects of aqueous leaf extract of Tridax procumbens on contractile activity of corpus cavernosum in N-nitro-L-arginine methyl ester-induced hypertensive male rats

Shakiru Ademola Salami, Hussein Mofomosara Salahdeen, Evangelshane Chukwudubem Ugbebor, Babatunde Adekunle Murtala, Yinusa Raji

Journal of Integrative Medicine. 2018, 16(1): 51-56. doi:10.1016/j.joim.2017.11.001

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Objective
This study investigated the effects of aqueous leaf extract of Tridax procumbens (ALETP) on contractile activity of corpus cavernosum in N-nitro-L-arginine methyl ester (L-NAME)-induced hypertensive male rats.

Methods

Twenty normal, adult male rats (130–150?g) were divided into four groups of five rats each. Group I (control) was given normal saline (0.6?mL/kg) and group II was given L-NAME (40?mg/kg) for 6?weeks. Groups III and IV also received L-NAME (40?mg/kg) for 6?weeks but were further co-treated with 100 and 200?mg/kg of ALETP, respectively, from week 4 to week 6. All treatments were given orally. Strips of corpus cavernosum from each of the four groups were exposed to increasing concentrations of acetylcholine (ACh) and sodium nitroprusside (SNP) (10^?9–10^?5 mol/L) after contraction with phenylephrine (10^?7?mol/L) to test for a dose–response effect. Response to potassium and calcium was also measured after cumulatively adding potassium and calcium (10–50?mmol/L) to potassium- and calcium-free organ chamber. Isometric contractions were recorded through an Ugo Basile data capsule acquisition system.

Results

Mean arterial blood pressure was significantly reduced in the ALETP co-treated group compared to the control and L-NAME-only groups (P?<?0.05). Cavernosa strips from ALETP co-treated rats exhibited significant inhibition of contraction in response to phenylephrine, potassium chloride, and calcium chloride (P?<?0.05). Relaxation in response to Ach and SNP was also significantly impaired in cavernosa strips from the L-NAME-only treated group (P?<?0.05), while ALETP co-treated groups showed enhanced percentage relaxation.

Conclusion

ALETP treatment of L-NAME-induced hypertensive rats promotes a relaxant effect on isolated cavernosa strips. ALETP shows potential in correcting erectile dysfunction in hypertension.

Cytotoxic activity of the chemical constituents of Clerodendrum indicum and Clerodendrum villosum roots

Pathom Somwong, Rutt Suttisri

Journal of Integrative Medicine. 2018, 16(1): 57-61. doi:10.1016/j.joim.2017.12.004

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Objective
The roots of two Thai medicinal plants, Clerodendrum indicum and Clerodendrum villosum are found in traditional medicine practices. The aim of this research was to preliminarily study the cytotoxicity of extracts of their roots, and the parts that possessed cytotoxic activity were separated on a chromatograph to identify their active compounds.

Methods

The extracts of both plants were screened for cytotoxicity on the SW620 cell line and the compounds isolated from the active extracts were further evaluated for their cytotoxic activity against five human cancer cell lines, including SW620, ChaGo-K-1, HepG2, KATO-III and BT-474 using the 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-H-tetrazolium bromide (MTT) assay.

Results

Dichloromethane extracts of C. indicum and C. villosum were active against the SW620 cell line. Triterpenoids were mostly obtained from the extracts of these plants (0.28% and 1.02%, respectively) and exhibited varying degrees of cytotoxicity and specificity against the tested cell lines. Two triterpenoids, oleanolic acid 3-acetate and betulinic acid, displayed moderate to strong cytotoxicity toward all cancer cell lines, with 50% inhibitory concentration (IC₅₀) values of 1.66–20.49?μmol/L, whereas 3β-hydroxy-D:B-friedo-olean-5-ene and taraxerol were cytotoxic to only the SW620 cell line (IC₅₀?=?23.39 and 2.09?μmol/L, respectively). Triterpenoid, lupeol, showed potent cytotoxicity on both SW620 (IC₅₀?=?1.99?μmol/L) and KATO-III cell lines (IC₅₀?=?1.95?μmol/L), while a flavonoid, pectolinarigenin, displayed moderate cytotoxicity against these cells (IC₅₀?=?13.05 and 24.31?μmol/L, respectively). Although the widely distributed steroid, stigmasterol, was effective against the SW620 cell line (IC₅₀?=?2.79?μmol/L) and β-sitosterol was also active against SW620 (IC₅₀?=?11.26?μmol/L), BT-474 (IC₅₀?=?14.11?μmol/L) and HepG2 cancer cells (IC₅₀?=?20.47?μmol/L), none of the characteristic 24β-ethylsteroids of either Clerodendrum species were shown to be cytotoxic.

Conclusion

This study is the first report on the presence of cytotoxic triterpenoids from the roots of these medicinal plants, which have been used in herbal formulas as an antipyretic. Our findings support further in-depth study of this pharmacological activity as an anticancer agent.

Anti-inflammatory and bronchodilatory constituents of leaf extracts of Anacardium occidentale L. in animal models

Oluwakemi Josephine Awakan, Sylvia Omonirume Malomo, Abdullahi Adeyinka Adejare, Adedoyin Igunnu, Olubunmi Atolani, Abiodun Humphrey Adebayo, Bamidele Victor Owoyele

Journal of Integrative Medicine. 2018, 16(1): 62-70. doi:10.1016/j.joim.2017.12.009

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Objective

Anacardium occidentale L. leaf is useful in the treatment of inflammation and asthma, but the bioactive constituents responsible for these activities have not been characterized. Therefore, this study was aimed at identifying the bioactive constituent(s) of A. occidentale ethanolic leaf extract (AOEL) and its solvent-soluble portions, and evaluating their effects on histamine-induced paw edema and bronchoconstriction.

Methods

The bronchodilatory effect was determined by measuring the percentage protection provided by plant extracts in the histamine-induced bronchoconstriction model in guinea pigs. The anti-inflammatory effect of the extracts on histamine-induced paw edema in rats was determined by measuring the increase in paw diameter, after which the percent edema inhibition was calculated. The extracts were analyzed using gas chromatography-mass spectrometry to identify the bioactive constituents. Column chromatography and Fourier transform infrared spectroscopy were used respectively to isolate and characterize the constituents. The bronchodilatory and anti-inflammatory activities of the isolated bioactive constituent were evaluated.

Results

Histamine induced bronchoconstriction in the guinea pigs and edema in the rat paw. AOEL, hexane-soluble portion of AOEL, ethyl acetate-soluble portion of AOEL, and chloroform-soluble portion of AOEL significantly increased bronchodilatory and anti-inflammatory activities (P < 0.05). Oleamide (9-octadecenamide) was identified as the most abundant compound in the extracts and was isolated. Oleamide significantly increased bronchodilatory and anti-inflammatory activities by 32.97% and 98.41%, respectively (P < 0.05).

Conclusion

These results indicate that oleamide is one of the bioactive constituents responsible for the bronchodilatory and anti-inflammatory activity of A. occidentale leaf, and can therefore be employed in the management of bronchoconstriction and inflammation.

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