I am writing this after reading about medical acupuncture in the treatment of COVID-19 in a very interesting blog by Dr Mike Cummings, Medical Director at the British Medical Acupuncture Society.
Mike reminded me that the influence of acupuncture is in many cases, homeostatic. In other words, acupuncture can help normalise our body's internal physiological milieu which, depending on how far from 'normal' the body was operating, can have quite profound effects. These homeostatic effects can influence pain, sleep, mood, cognitive function and behaviours, usually very positively.
One of the fundamental mechanisms proposed to drive the homeostatic effects of acupuncture is the vagal nerve anti-inflammatory reflex1. My understanding of this mechanism is that it inhibits the release of pro-inflammatory cytokines, chemicals which drive and sustain systemic inflammation, and so facilities as a quicker resolution to the inflammatory response to injury or disease.
The power of this effect was shown in a study where mice, in usually fatal septic shock, were treated with brief electroacupuncture (EA)2. The acupuncture acted as an indirect method of enhancing vagal tone, and thus the anti-inflammatory reflex. Most of the mice receiving the EA survived!
Mike described three further studies which looked at EA in the treatment of humans with sepsis. The treatment groups received treatment which included stimulation at a well known 'central regulatory' point known at ST36.
"The smaller two of these papers (n=60)3 (n=82)4 did not demonstrate a significant impact on mortality, but the larger one (n=331) did5, with a modest reduction in days on mechanical ventilation, days in intensive care (ICU) and a drop in 28-day mortality from 43.3% to 31.5%."
The effect of both direct (and indirect using acupuncture) vagal nerve stimulation has also been compared and combined in a rodent model of colonic inflammatory bowel disease with positive results6.
Finally, the effects of EA on inflammation and lung function in a chronic obstructive pulmonary disease (COPD) have also been studied, with positive results here7.
So what do these studies tell us about the potential role of acupuncture to support the treatment of COVID-19?
COVID-19 triggers significant systemic inflammation as part of the disease process. As such, acupuncture may have a role to play in assisting the resolution of inflammation as the patient hopefully recovers. I would agree with Mike in that acupuncture may be most useful during the recovery phase of COVID-19, after the acute infective phase has passed.
I would anticipate many who are recovering from COVID-19 will require physiotherapy to treat restricted lung function, mobility issues, pain complaints, loss of strength and function. Acupuncture may well play an instrumental role here as part of an integrated treatment plan.
By Simon Coghlan MSc, BSc Physio, DipMedAc
1. Tracey KJ. The inflammatory reflex. Nature 2002;420:853–9. doi:10.1038/nature01321
2. Torres-Rosas R, Yehia G, Peña G, et al. Dopamine mediates vagal modulation of the immune system by electroacupuncture. Nat Med 2014;20:291–5. doi:10.1038/nm.3479
3. Yang G, Hu R, Deng A, et al. Effects of Electro-Acupuncture at Zusanli, Guanyuan for Sepsis Patients and Its Mechanism through Immune Regulation. Chin J Integr Med 2016;22:219–24. doi:10.1007/s11655-016-2462-9
4. Meng J, Jiao Y, Xu X, et al. Electro-acupuncture attenuates inflammatory responses and intraabdominal pressure in septic patients. Medicine (Baltimore) 2018;97:e0555. doi:10.1097/MD.0000000000010555
5. Wang Y, Zhang Y, Jiang R. Early traditional Chinese medicine bundle therapy for the prevention of sepsis acute gastrointestinal injury in elderly patients with severe sepsis. Sci Rep 2017;7:46015. doi:10.1038/srep46015
6. Jin H, Guo J, Liu J, et al. Autonomically mediated anti‐inflammatory effects of electrical stimulation at acupoints in a rodent model of colonic inflammation. Neurogastroenterol Motil 2019;31:e13615. doi:10.1111/nmo.13615
7. Zhang X-F, Xiang S-Y, Geng W-Y, et al. Electro-acupuncture regulates the cholinergic anti-inflammatory pathway in a rat model of chronic obstructive pulmonary disease. J Integr Med 2018;16:418–26. doi:10.1016/j.joim.2018.10.003
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