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Angina: zdravljenje z akupunkturo in kitajsko zeliščno medicino

Akupunktura zmanjšuje pogostost in stopnjo napadov angine[1]. Multi-centralna raziskava je odkrila, da je akupunkturno zdravljenje na bolezensko prizadetih akupunkturnih kanalih učinkovitejše kot zdravljenje na neprizadetih kanalih ali lažna akupunktura.



Rezultati raziskave so bili objavljeni v JAMA Internal Medicine. V raziskavi je skupno sodelovalo 398 pacientov s kronično stabilno angino. Sodelujoče so naključno razporedili v eno izmed štirih skupin za zdravljenje: akupunktura za bolezensko prizadete meridiane, akupunktura na neprizadetih kanalih, lažna akupunktura, čakalna lista kot kontrolna skupina. Kriteriji za vključitev so bili naslednji: starost 35-80 let, trajanje angine >3 mesecev, kjer so napadi vsaj dvakrat tedensko; v osnovi brez znatnih sprememb v pogostosti angine, obsegu, naravi, in inducirajočih/pomirjujočih dejavnikov.


Vsi pacienti so bili 16 tednov deležni standardne protianginske terapije. Ta je vključevala zdravila, kot so beta-blokerji ali blokerji kalcijevih kanalčkov, aspirin ali klopidogrel, statine in ACE inhibitorje. Zdravila so bila pacientu predpisana glede na njegove potrebe. Če so pacienti potrebovali reševalno zdravilo med obdobjem raziskave, so bili upravičeni do nitro-glicerina, nifedipina ali kitajskega zeliščnega zdravila Suxiao Jiuxin Wan (zeliščni ekstrakt, ki vsebuje Chuan Xiong in Bing Pian). Vsi sodelujoči, z izjemo čakalne skupine oz. kontrolne skupine so bili deležni akupunkturnih terapij glede na sledeče protokole.


Rezultati

Vsi sodelujoči so tekom osnovnih ocenjevanj izpolnili dnevnik angine in se udeležili kontrolnega pregleda po 16 tednih. Stanje so ocenjevali v štirih tedenskih intervalih tekom obdobja raziskave. Primarno merilo vrednotenja rezultatov je bila pogostost napadov angine, ki so jih izmerili glede na SD (standardni odklon) v osnovni oceni. V primerjavi z akupunkturo, izvedeno na neprizadetih meridianih (kar pomeni, da uporabljene akupresurne točke po teoriji TKM niso povezane z angino), lažno akupunkturo ali skupino, ki sploh ni bila deležna akupunkture (kontrolna skupina na čakalni listi), je pri odpravljanju angine pokazala nadpovprečne rezultate skupina, ki je bila deležna akupunkture na bolezensko prizadetih meridianih (raba akupresurnih točk, ki so po TKM teoriji povezane z angino) kot obliko dopolnilne terapije k protianginski terapiji.


Protianginska tradicionalna kitajska zeliščna medicina, kombinirana z akupunkturo

Druga podobna raziskava je prav tako dodatno pokazala dokaze o uspešnosti[2]. V tej klinični raziskavi akupunkture za angino je skupina z akupunkturo izkazala 94,23% učinkovitost v primerjavi z 76,92% učinkovitostjo pri kontrolni skupini. Skupno so 104 pacientov, ki imajo kombinirane sindrom motnje srčnega-janga, angino in koronarne srčne bolezni, naključno razporedili v akupunkturno skupino (n=52) ali v kontrolno skupino (n=52).


Zdravljenje

Vsi pacienti so bili deležni standardnih protianginskih zdravil, vključno z beta-blokerji, zdravili proti strjevanju krvi in ACE inhibitorji. Poleg tega so pacienti akupunkturne skupine prejeli tudi Gua Lou Xie Bai Gui Zhi Tang. Akupunkturne iglice so se zabadale poševno na točke Xinshu (BL15) in Geshu (BL17) ter transverzalno na Danzhong (CV17). S tehnikama dvig-prodiranje in navijanje-rotiranje so pri pacientih sprožili deqi odziv, ki so ga zadržali za 30 minut. Zdravljenja so pri obeh skupinah izvajali vsak drug dan v obdobju dveh mesecev.

Rezultati

Primarno merilo za oceno izida raziskave je bila skupna klinična učinkovitost, ki je temeljila na sledečih parametrih. Za paciente, ki so bili na koncu brez simptomov in so imeli normalne EKG izvide, so označili zdravljenje za očitno učinkovita. Za tiste, ki so se jim simptomi znatno izboljšali in so imeli skoraj normalne EKG izvide, so označili zdravljenje za učinkovito. Za tiste, ki pa tekom zdravljenja niso pokazali izboljšanja ali poslabšanja v simptomih, so označili zdravljenje za neučinkovito. V akupunkturni skupini so označili 27 primerov za očitno učinkovite, 22 učinkovite in 3 neučinkovite, kar končno znese 94,23% stopnjo učinkovitosti. V kontrolni skupini so 21 primerov označili za očitno učinkovite, 19 učinkovite in 12 za neučinkovite, kar končno znese 76,92% stopnjo učinkovitosti. Sodelujoči v akupunkturni skupini so izkazali zmanjšanje v pogostosti in trajanju napadov (povprečno 3,16-krat in 2:32 minut) v primerjavi s kontrolno skupino (povprečno 5,62-krat in 4:54 minut).


Rezultati indicirajo, da akupunktura znatno zmanjša pogostost in resnost napadov angine. Prav tako so pokazali, da je akupunktura primerna klinična oblika po integrativnem medicinskem protokolu.


Viri:

[1] Zhao L, Li D, Zheng H, et al. Acupuncture as Adjunctive Therapy for Chronic Stable Angina: A Randomized Clinical Trial. JAMA Intern Med. 2019;179(10):1388–1397. doi:10.1001/jamainternmed.2019.2407.


[2] Cong Hedong (2019) “Clinical Effects of Gualou Xiebai Guizhi Tang Jia Jian Combined with Acupuncture in Treating Angina Pectoris and Coronary Heart Disease Due to Heart-Yang Disorder” Cardiovascular Disease Electronic Journal of Integrated Chinese and Western Medicine Vol.7 (25) pp.155.


prevod: Tanja Topić

vir fotografij: internet



Acupuncture and Chinese medicine for anginaAcupuncture and Chinese medicine for angina


Acupuncture reduces the frequency and severity of angina attacks. [1] A multi-center investigation finds acupuncture treatment on disease-affected acupuncture channels is more effective than treatment on non-affected channels or sham acupuncture.


The results were published in JAMA Internal Medicine. A total of 398 patients with chronic stable angina successfully completed the study. Participants were randomized to one of four treatment groups: disease affected meridian acupuncture, non-affected meridian acupuncture, sham acupuncture, and waitlist control. Inclusion criteria for the study were as follows: ages 35–80, angina duration >3 months with attacks at least twice weekly at baseline, no significant changes in angina frequency, extent, nature, and inducing/alleviating factors at baseline.


All patients received standard anti-angina therapy for 16 weeks. This included medications such as beta-blockers or calcium channel blockers, aspirin or clopidogrel, statins, and ACE inhibitors. Medications were prescribed according to each patient’s individual needs. If patients required rescue medications during the study period, they were permitted nitro-glycerine, nifedipine, or the Chinese herbal medicine Suxiao Jiuxin Wan (an herbal extract that includes Chuan Xiong and Bing Pian). All participants, with the exception of the waitlist control group, also received acupuncture treatment, according to the following protocols.


Results

All participants completed an angina diary between the baseline assessment and the 16-week follow-up appointment. Assessments were conducted at four weekly intervals throughout this period. The primary outcome measure was the frequency of angina attacks, measured by SD (standard deviation) from the baseline assessment. Compared with acupuncture on the non-affected meridian (which means the use of acupoints are not related to angina in TCM theory), sham acupuncture, or no acupuncture (waiting list control), acupuncture on the disease-affected meridian (the use of acupoints related to angina in TCM theory) as adjunctive treatment to antianginal therapy showed superior benefits in alleviating angina.


Traditional Chinese herbal medicine combined with acupuncture for angina

Another similar research also shows supporting evidence.[2] In this clinical trial on acupuncture for angina, the acupuncture group experienced a 94.23% effective rate compared with just 76.92% in the control group. A total of 104 patients with combined heart-yang disorder syndrome, angina, and coronary heart disease were randomized to the acupuncture group (n=54) or the control group (n=54).


Treatment

All patients received standard anti-angina medications, including nitrates, beta-blockers, anti-platelet medications, and ACE inhibitors. Additionally, patients assigned to the acupuncture group received Gua Lou Xie Bai Gui Zhi Tang. Acupuncture was administered obliquely at Xinshu (BL15) and Geshu (BL17) and transversely at Danzhong (CV17). Needles were manipulated using a lifting-thrusting and twisting rotating technique to elicit deqi and were retained for a total of 30 minutes. Treatment was conducted on alternate days and both groups received two months of continuous treatment.


Results

The primary outcome measure for the study was the total clinical effective rate, based on the following parameters. For patients whose symptoms fully resolved and whose ECG readings were normal, the treatment was classified as markedly effective. For those whose symptoms significantly improved and whose ECG readings were almost normal, the treatment was classified as effective. For those who experienced no improvements or worsening of symptoms, the treatment was classified as ineffective. In the acupuncture group, there were 27 markedly effective, 22 effective, and 3 ineffective cases, yielding a total effective rate of 94.23%. In the control group, there were 21 markedly effective, 19 effective, and 12 ineffective cases, yielding a total effective rate of 76.92%. Participants in the acupuncture group had a reduced frequency and duration of attacks (mean 3.16 times and 2.32 minutes, respectively) compared with the control group (mean 5.62 times and 4.54 minutes).


The results indicate that acupuncture significantly reduces the frequency and severity of angina attacks and is an appropriate clinical modality in an integrative medicine protocol.


References:

[1] Zhao L, Li D, Zheng H, et al. Acupuncture as Adjunctive Therapy for Chronic Stable Angina: A Randomized Clinical Trial. JAMA Intern Med. 2019;179(10):1388–1397. doi:10.1001/jamainternmed.2019.2407.


[2] Cong Hedong (2019) “Clinical Effects of Gualou Xiebai Guizhi Tang Jia Jian Combined with Acupuncture in Treating Angina Pectoris and Coronary Heart Disease Due to Heart-Yang Disorder” Cardiovascular Disease Electronic Journal of Integrated Chinese and Western Medicine Vol.7 (25) pp.155.


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