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Acupunctur

e in cancer
Dr Mehran Rezvani pain fellowship anesthesiologist
& acupuncturist

Acupuncture is defined as the application of stimulation


such as needling, moxibustion, cupping, and acupressure
on specific sites of the body known as acupuncture points

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

In China, acupuncture is part of a TCM system of


traditional
medical knowledge and is practiced along with other
treatment modalities such as :
Herbal medicine
Tui na (massage and acupressure)
Mind/body exercise (e.g.,qigong and tai chi)
Dietary therapy
Dr Mehran Rezvani pain fellowship anesthesiologist
& acupuncturist

Acupuncture has been practiced in


China and other Asian countries for
more than 4,000 years

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

The relatively brief history of acupuncture in the United


States
can be traced back about 200 years, when Dr. Franklin
Bache
published a report in the North American Medical and
Surgical
Journal on his use of acupuncture to treat lower back pain

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

The U.S. Food and Drug Administration approved


the acupuncture needle as a medical device in 1996

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

The human body must be perceived and treated as a


whole and
as part of nature; health is the result of harmony among
bodily functions and between the body and nature, and
disease occurs
when this harmony is disrupted

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

Acupuncture is closely associated with Chinese meridian


theory
According to this theory, there are 12 primary meridians,
or
channels, and 8 additional meridians, each following a
particular directional course along the body

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

A vital energy known as qi flows through these meridians


and participates in the homeostatic regulation of various
bodily
functions.
Along the meridians are approximately 360 points that
serve
as both pathognomonic signs of disorder and as loci for
acupuncture treatments

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

When the normal flow of energy over a meridian is


obstructed
(e.g., as a result of tissue injury or a tumor), pain or other
symptoms result
The purpose of acupuncture therapy is to normalize
energy flow, thereby relieving the symptoms by
stimulating specific sites (acupuncture points) on the
meridians
Dr Mehran Rezvani pain fellowship anesthesiologist
& acupuncturist

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

Acupuncture
Mechanisms

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

Acupuncture Mechanisms
Activate the hypothalamus and the pituitary gland
Balance the sympathetic and parasympathetic systems
Anti-inflammatory effects
Endogenous opioid system
Boost animal immune function by enhancing NK cell
and lymphocyte activity

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

Laboratory and animal studies to explore the


mechanisms of acupuncture for cancer treatment have
focused mainly on the
role of acupuncture in the activation of immune
functions, such
as increasing blood cell count and enhancing lymphocyte
and
natural killer cell activity

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

Acupuncture indications in cancer


Manage cancer-related symptoms
Treat side effects induced by chemotherapy or radiation
therapy
Boost blood cell count
Enhance lymphocyte and natural killer (NK) cell activity
Dr Mehran Rezvani pain fellowship anesthesiologist
& acupuncturist

Primary use is symptom


management
Cancer pain
Chemotherapy-induced nausea and vomiting

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

The positive results of the studies on chemotherapyinduced N/V, which benefit from scientifically sound
research designs, are the most convincing

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

Other indications
Weight loss
Anxiety
Depression
Insomnia
Poor appetite
Xerostomia
Hot flashes
Peripheral neuropathy
Gastrointestinal symptoms (constipation and diarrhea)
Dr Mehran Rezvani pain fellowship anesthesiologist
& acupuncturist

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

Laboratory &
Animal
Preclinical Studies
Dr Mehran Rezvani pain fellowship anesthesiologist
& acupuncturist

At least seven animal studies


investigating the effects of acupuncture
in cancer or cancer-related conditions
have been reported in the scientific
literature

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

Four ex vivo studies suggested that


acupuncture is useful in anticancer therapy
either by actively stimulating immune
activity or by preventing chemotherapy
suppression of immune activity

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

In a study involving normal rats, electroacupuncture


applied at the point Tsu-Sanli (St36) for 2 hours daily on 3
consecutive days enhanced the cytotoxicity of splenic
natural killer (NK) cells compared with a stimulation of a
non acupuncture control point in the
abdominal muscle

Sato T, Yu Y, Guo SY, et al.: Acupuncture stimulation enhances splenic natural killer cell cytotoxicity
in rats. Jpn J Physiol 46 (2): 131-6, 1996

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

Another study found that NK cell activity and Tlymphocyte transformation rate were increased in a
mouse model of transplanted mammary cancer
compared with a control after eight sessions of
acupuncture and moxibustion

Liu LJ, Guo CJ, Jiao XM: [Effect of acupuncture on immunologic function and histopathology of
transplanted mammary cancer in mice] Zhongguo Zhong Xi Yi Jie He Za Zhi 15 (10): 615-7, 1995.

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

A study using moxibustion to warm the acupuncture


point Guanyuan (CV4) once a day for 10 days found
significantly increased production of erythrocytes,
compared with a nontreatment control

Wu P, Cao Y, Wu J: Effects of moxa-cone moxibustion at Guanyuan on erythrocytic immunity and its


regulative function in tumor-bearing mice. J Tradit Chin Med 21 (1): 68-71, 2001
Dr Mehran Rezvani pain fellowship anesthesiologist
& acupuncturist

Repeated EA treatments (12 treatments administered


over 30 days) in
PCO rats significantly lowered the concentrations of NGF
in the ovaries, compared with untreated PCO rats
Stener-Victorin E, Lundeberg T, Waldenstrm U, et al.: Effects of electro-acupuncture on nerve growth
factor and ovarian morphology in rats with experimentally induced polycystic ovaries. Biol Reprod 63 (5): 1497503, 2000

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

A study of cyclophosphamide -induced emesis in a ferret


behavioral model used acupuncture as an adjunct
therapy in treating the emetic side effects of
chemotherapy significantly reduced the total number of
emetic episodes by % 36-73

Lao L, Zhang G, Wong RH, et al.: The effect of electroacupuncture as an adjunct on


cyclophosphamide induced emesis in ferrets. Pharmacol Biochem Behav 74 (3): 691-9, 2003

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

The findings of these studies suggest that


acupuncture may be effective in treating
cancer-related symptoms and cancer
treatmentrelated disorders and that
acupuncture may be able to activate
immune functions and regulate the
autonomic nervous system
Dr Mehran Rezvani pain fellowship anesthesiologist
& acupuncturist

Only one study reported a decrease in tumor volume in


animals treated with acupuncture compared with control
animals (Limited scientific value)

Liu LJ, Guo CJ, Jiao XM: [Effect of acupuncture on immunologic function and
histopathology of transplanted mammary cancer in mice] Zhongguo Zhong Xi Yi Jie He Za
Zhi 15 (10): 615-7, 1995

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

Human/Clinical
Studies
Dr Mehran Rezvani pain fellowship anesthesiologist
& acupuncturist

Effect of Acupuncture on
Immune Function

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

At least seven human studies have evaluated the effect


of acupuncture on immune system function in patients
(all in china)
Acupuncture
enhanced or
Four randomized controlled trials regulated
One nonrandomized clinical study immune
function

Two case series

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

The first randomized controlled trial


immune

Acupuncture treatment enhanced platelet


count and prevented leukocyte decrease
after radiation therapy or chemotherapy
Xia YQ, Zhang D, Yang CX, et al.: An approach to the effect on
tumors of acupuncture in combination with radiotherapy or
chemotherapy. J Tradit Chin Med 6 (1): 23-6, 1986

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

Second study
immune

Leukocyte phagocytosis was enhanced in the


treated group, compared with the baseline measurement
(P < .01)
Zhou RX, Huang FL, Jiang SR, et al.: The effect of acupuncture on the phagocytic
activity of human leukocytes. J Tradit Chin Med 8 (2): 83-4, 1988.

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

Third study
immune

The data showed that IL-2 level and NK cell activity were
significantly increased in the acupuncture group,
compared with the control group (P < .01)

Wu B, Zhou RX, Zhou MS: [Effect of acupuncture on interleukin-2 level and NK cell immunoactivity
of peripheral blood of malignant tumor patients] Zhongguo Zhong Xi Yi Jie He Za Zhi 14 (9): 537-9,
1994

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

Fourth study
immune

The data showed that acupuncture treatment increased the


proportion of the CD3+ and CD4+ T-lymphocyte subsets,
the CD4+/CD8+ ratio (P < .01), and the level of beta-EP
The investigators suggested that the anticancer effect of
acupuncture may be mediated via the mechanism of
immunomodulation

Wu B, Zhou RX, Zhou MS: [Effect of acupuncture on immunomodulation in patients with


malignant tumors] Zhongguo Zhong Xi Yi Jie He Za Zhi 16 (3): 139-41, 1996
Dr Mehran Rezvani pain fellowship anesthesiologist
& acupuncturist

Fifth study
immune

Electroacupuncture in patients undergoing chemotherapy


experienced no declines in T cells (CD3+, CD4+, CD8+)
or in NK cell activity, both of which are usually
suppressed by chemotherapy

Ye F, Chen S, Liu W: Effects of electro-acupuncture on immune function after chemotherapy in 28


cases.
J Tradit Chin Med 22 (1): 21-3, 2002
Dr Mehran Rezvani pain fellowship anesthesiologist
& acupuncturist

Sixth study
immune

48 patients with leukopenia including two cancer


patientswho were treated with manual acupuncture
experienced improvements in leukocyte count, and
immunoglobulin (IgG, IgA, and IgM) levels after 14 daily
acupuncture treatments, compared with their
pretreatment levels

Wei Z: Clinical observation on therapeutic effect of acupuncture at zusanli for


leukopenia.
J Tradit Chin Med 18 (2): 94-5,
1998
Dr Mehran
Rezvani pain fellowship anesthesiologist
& acupuncturist

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

Effect of Acupuncture
on Cancer Pain
Dr Mehran Rezvani pain fellowship anesthesiologist
& acupuncturist

First study
pain

Randomized trial compared two type acupuncture and


conventional analgesic treatment in patients with gastric
cancer pain
There was equivalent analgesic effect among the three
groups observed after 2 months of treatment; however, the
conventionally treated group experienced significantly
superior analgesia in first 10 days of treatment
Dang W, Yang J: Clinical study on acupuncture treatment of stomach carcinoma pain. J Tradit Chin
Med 18 (1): 31-8, 1998
Dr Mehran Rezvani pain fellowship anesthesiologist
& acupuncturist

Second study
pain

In study evaluated the effect of auricular acupuncture in 20


cancer patients who were still experiencing pain after
treatment with analgesics While patients continued their
analgesic medication, auricular acupuncture needles were
embedded in ear acupuncture points.
pain intensity decreased or remained stable after auricular
acupuncture in all patients, with a significant average pain
intensity decrease of 33 mm (P < .001)

Alimi D, Rubino C, Leandri EP, et al.: Analgesic effects of auricular acupuncture for cancer pain. J Pain Symptom Manage
19 (2): 81-2, 2000
Dr Mehran Rezvani pain fellowship anesthesiologist
& acupuncturist

Third study
Pain

In a case series involving 183 cancer patients who were


treated with acupuncture for cancer-related pain, 52%
were significantly helped (P value not stated

Filshie J, Redman D: Acupuncture and malignant pain problems. Eur J Surg Oncol 11 (4): 389-94,
1985
Dr Mehran Rezvani pain fellowship anesthesiologist
& acupuncturist

Forth study
pain

case series, 29 patients with malignant tumors who


developed pain received EA treatment . All experienced
various degrees of pain relief, and 25 out of 29 were able
to either reduce or eliminate their
analgesic requirements following multiple EA treatments

Wen HL: Cancer pain treated with acupuncture and electrical stimulation. Mod Med Asia 13 (2): 126, 1977
Dr Mehran Rezvani pain fellowship anesthesiologist
& acupuncturist

Most of these studies were positive but the findings have


limited significance because of methodologic weaknesses
such as :
Small sample sizes
An absence of patient blinding to treatment in most
cases
Varying acupuncture treatment regimens
A lack of standard outcome measurements
Absence of adequate randomization
Dr Mehran Rezvani pain fellowship anesthesiologist
& acupuncturist

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

Effect of Acupuncture on
Cancer Treatmentrelated
Side Effects

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

Pain due to cancer treatment -1


A RCT evaluated the effect of various combinations of auricular
acupuncture, Chinese herbs, and epidural morphine to relieve
postoperative pain in 16 patients with liver cancer
All of the combination treatment groups experienced better
analgesia than did the placebo -treated control group

Li QS, Cao SH, Xie GM, et al.: Combined traditional Chinese medicine and Western medicine. Relieving effects of Chinese
herbs, ear-acupuncture and epidural morphine on postoperative pain in liver cancer Chin Med J (Engl) 107 (4): 289-94, 1994

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

Pain due to cancer treatment -2


The effect of acupuncture in postoperative pain
management and arm movement in breast cancer patients
after surgical excision of the cancer and axillary lymph node:
The acupuncture group had significant pain relief during arm
movement on the fifth and seventh days following surgery
and at the time of discharge. The range of arm motion also
increased significantly in the treatment group, (P < .001)

He JP, Friedrich M, Ertan AK, et al.: Pain-relief and movement improvement by acupuncture after ablation and axillary
lymphadenectomy in patients with mammary cancer. Clin Exp Obstet Gynecol 26 (2): 81-4, 1999
Dr Mehran Rezvani pain fellowship anesthesiologist
& acupuncturist

Pain due to cancer treatment -3


A small retrospective case review of acupuncture for
chemotherapy-induced peripheral neuropathy in 18
patients showed benefit with reduced symptoms in 82%

Donald GK, Tobin I, Stringer J: Evaluation of acupuncture in the management of chemotherapyinduced peripheral
neuropathy. Acupunct Med 29 (3): 230-3, 2011
Dr Mehran Rezvani pain fellowship anesthesiologist
& acupuncturist

Arthralgias and myalgias from


aromatase inhibitors
True acupuncture was significantly more effective than sham
acupuncture, as measured by Brief Pain Inventory-Short Form
scores in relieving joint symptoms

Crew KD, Capodice JL, Greenlee H, et al.: Randomized, blinded, sham-controlled trial of acupuncture for the management of
aromatase inhibitor-associated joint symptoms in women with early-stage breast cancer. J Clin Oncol 28 (7): 1154-60, 2010.
Dr Mehran Rezvani pain fellowship anesthesiologist
& acupuncturist

Chemotherapy-induced nausea and


vomiting
The positive effect of acupuncture on chemotherapyinduced nausea and vomiting (N/V) is the most
convincing, as demonstrated by the consistency of the
results of a variety of clinical study types

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

Chemotherapy-induced nausea and


vomiting
A systematic review of the effect of acupuncture on N/V
describes five clinical trials of chemotherapy-induced
N/V, conducted by different investigators on different
groups of patients and using different forms of
acupuncture point stimulation
All five trials yielded positive results

Dr Mehran
Rezvani
pain fellowship
anesthesiologist
Vickers AJ: Can acupuncture have
specific
effects
on health?
A systematic review of acupuncture
&
acupuncturist
antiemesis trials. J R Soc Med 89 (6): 303-11, 1996.

Radiation-induced nausea and


vomiting
In one randomized study, patients who were randomly
assigned to acupuncture experienced fewer episodes of
nausea and vomiting than did those who received
standard care

Enblom A, Lekander M, Hammar M, et al.: Getting the grip on nonspecific treatment effects: emesis
in patients randomized to acupuncture or sham compared to patients receiving standard care. PLoS
One 6 (3): e14766, 2011.
Dr Mehran Rezvani pain fellowship anesthesiologist
& acupuncturist

Vasomotor symptoms
Some studies have reported that acupuncture may be
effective in reducing vasomotor symptoms among
postmenopausal women with breast cancer and prostate
cancer patients on androgen-deprivation therapy

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

Vasomotor symptoms -1
In women with hormone receptorpositive breast cancer.
Acupuncture was just as effective as venlafaxine and
caused fewer adverse effects

Walker EM, Rodriguez AI, Kohn B, et al.: Acupuncture versus venlafaxine for the management of
vasomotor symptoms in patients with hormone receptor-positive breast cancer: a randomized
controlled trial. J Clin Oncol 28 (4): 634-40, 2010.
Dr Mehran Rezvani pain fellowship anesthesiologist
& acupuncturist

Vasomotor symptoms -2
An uncontrolled prospective case series of 50 women on
tamoxifen for early breast cancer evaluated women After
acupuncture vasomotor symptoms dropped by 49.8% (P
< .0001)

de Valois BA, Young TE, Robinson N, et al.: Using traditional acupuncture for breast cancer-related
hot flashes and night sweats. J Altern Complement Med 16 (10): 1047-57, 2010.
Dr Mehran Rezvani pain fellowship anesthesiologist
& acupuncturist

Vasomotor symptoms -3
In retrospective evaluation of 194 patients with
predominantly breast or prostate cancer found long-term
relief of vasomotor symptoms associated with acupuncture.

Filshie J, Bolton T, Browne D, et al.: Acupuncture and self acupuncture for long-term treatment of
vasomotor symptoms
in cancer patients--audit and treatment algorithm. Acupunct Med 23 (4): 171-80, 2005.

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

Fatigue
In a RCT, 47 cancer patients with moderate to severe
fatigue were randomly assigned to one of three groups.
The study concluded that acupuncture was a more
effective method than acupressure or sham acupressure

Molassiotis A, Sylt P, Diggins H: The management of cancer-related fatigue after chemotherapy with
acupuncture and acupressure: a randomised controlled trial. Complement Ther Med 15 (4): 22837,2007.

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

In next study, 302 breast cancer patients were randomly


assigned to a 6-week course of either daily Acupuncture
significantly reduced fatigue and improved quality of life
over that of the "enhanced usual care" group

Molassiotis A, Bardy J, Finnegan-John J, et al.: Acupuncture for cancer-related fatigue in patients with
breast cancer: a pragmatic randomized controlled trial. J Clin Oncol 30 (36): 4470-6, 2012.

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

Xerostomia
Acupuncture was associated with a decrease in the onset
of symptoms and an increased saliva flow in two
randomized studies that compared acupuncture with
standard care for preventing xerostomia in patients
undergoing radiation therapy
Braga FP, Lemos Junior CA, Alves FA, et al.: Acupuncture for the prevention of radiation-induced
xerostomia in patients with head and neck cancer. Braz Oral Res 25 (2): 180-5, 2011 Mar-Apr.
Meng Z, Garcia MK, Hu C, et al.: Randomized controlled trial of acupuncture for prevention of
radiation-induced xerostomia among patients with nasopharyngeal carcinoma. Cancer 118 (13):
3337-44, 2012.
Dr Mehran Rezvani pain fellowship anesthesiologist
& acupuncturist

Xerostomia
Compared with standard care, acupuncture significantly
improved xerostomia symptoms in patients who experienced
the condition following radiation therapy
Simcock R, Fallowfield L, Monson K, et al.: ARIX: a randomised trial of acupuncture v oral care sessions in
patients with chronic xerostomia following treatment of head and neck cancer. Ann Oncol 24 (3): 776-83,

2013

Pfister DG, Cassileth BR, Deng GE, et al.: Acupuncture for pain and dysfunction after neck dissection: results
of a
randomized controlled trial. J Clin Oncol 28 (15): 2565-70, 2010.
Dr Mehran Rezvani pain fellowship anesthesiologist
& acupuncturist

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

Other Treatment-related
Side Effects

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

In a RCT 76 patients with various types of cancer, including


esophageal cancer,gastric cancer, lung cancer
The acupuncture group in combination with radiation
therapy or chemotherapy, had the below benefits :
significantly more body weight (P < .001)
Greater improvements in the symptoms of cough,
thoracodynia, hemoptysis, and fever for patients with lung
cancer and the symptoms of chest pain, mucus vomiting,
and difficulty in swallowing for patients with esophageal
suffered
Xia YQ, Zhang D, Yang CX, et al.: An approach to the effect on tumors of acupuncture in combination
with radiotherapy or chemotherapy. J Tradit Chin Med 6 (1): 23-6, 1986.
Dr Mehran Rezvani pain fellowship anesthesiologist
& acupuncturist

An RCT of 138 patients treated with acupuncture plus


massage versus usual care showed decreased pain (P = .
05) and a decrease in
depressive mood (P = .003) in postoperative cancer
patients

Mehling WE, Jacobs B, Acree M, et al.: Symptom management with massage and
acupuncture in postoperative cancer patients: a randomized controlled trial. J Pain
Symptom Manage 33 (3): 258-66, 2007.
Dr Mehran Rezvani pain fellowship anesthesiologist
& acupuncturist

A retrospective survey study : Patients were referred to


acupuncture clinics for :
Pain (53%),
Xerostomia (32%)
Hot flashes (6%)
Nausea/loss of appetite (6%)

Sixty percent of the


patients showed at
least 30% improvement in
their symptoms, and about
one-third had no change in
the severity of symptoms

Johnstone PA, Polston GR, Niemtzow RC, et al.: Integration of acupuncture into the
oncology clinic. Palliat Med 16 (3): 235-9, 2002.
Dr Mehran Rezvani pain fellowship anesthesiologist
& acupuncturist

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

COMMON POINTS:

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

Nausea and vomiting


ST-36 Zusanli
BL-21 Weishu
BL-20 Pishu
PC-6 Neiguan
CV 12 Zhongwan

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

Nausea and vomiting


Main point: ST-36 Zusanli (bilateral)
Auxiliary ear points : Shenmen, Apex of Lower
Tragus, Brain, Middle Ear, and Stomach

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

Anorexia
ST-36 Zusanli
BL-21 Weishu
BL-20 Pishu
PC-6 Neiguan
CV 12 Zhongwan
SP-9 Yinlingquan
CV-6 Qihai
Dr Mehran Rezvani pain fellowship anesthesiologist
& acupuncturist

Dry mouth and tongue and mouth


ulcers
o LU-10 Yuji
o LI-4 Hegu
o KI-6 Zhaohai
o LU-7 Lieque
o CV 23 Lianquan
o GB-20 Fengchi
o TB-17 Yifeng
o PC-4 Ximen
Dr Mehran Rezvani pain fellowship anesthesiologist
& acupuncturist

Radiation cystitis
SP-6 Sanyinjiao
SP-9 Yinlingquan
BL-28 Pangguangshu
CV -3 Zhongji
BL-20 Pishu
ST 36 Zusanli
BL-23 Shenshu
CV-4 Guanyuan
SP-10 Xuehai
CV-6 Qihai
BL-40' Weizhong
Dr Mehran Rezvani pain fellowship anesthesiologist
& acupuncturist

Radiation proctitis
CV 12 Zhongwan
ST-36 Zusanli
ST-25 Tianshu
ST 37 Shangjuxu
LI-11 Quchi
ST-44 Neiting
LI-4 Hegu
BL-20 Pishu
CV-4 Guanyuan
BL-23 Shenshu
BL-25 Dachangshu
SP-6 Sanyinjiao
Dr Mehran Rezvani pain fellowship anesthesiologist
& acupuncturist

Damage to liver function


BL-18 Ganshu
BL-19 Danshu
BL-20 Pishu
BL-21 Weishu
K1-3 Taixi
LR-3 Taichong
LR-14 Qimen
LR-2 Zingiian
PC-6 Neiguan
SP-6 Sanyinjiao
GB-34 Yangiingquan
GB-39 Xuanzhong
GV 14 Dazhui
Dr Mehran Rezvani pain fellowship anesthesiologist
& acupuncturist

Hair loss
GV 20 Baihui
BL-23 Shenshu
ST-36 Zusanli
SP-6 Sanyinjiao
BL-15 Xinshu
BL-17 Geshu
BL-20 Pishu

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

Fever
Enrich Yin and clear Heat, quiet the Heart and Spirit.
GV-14 Dazhui
SI-3 Houxi
HT -6 Yinxi
KI-3 Taixi
SP-6 Sanyinjiao
PC-6 Neiguan
KI-7Fuliu
BL-15 Xinshu
BL-17 Geshu
Dr Mehran Rezvani pain fellowship anesthesiologist
& acupuncturist

Profuse sweating
BL-13 Feishu
BL-43 Gaohuang
ST-36 Zusanli
CV-4 Guanyuan
BL-20 Pishu
LU-9 Taiyuan

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

Hemoptysis
BL-13 Feishu
LU-1 Zhongfu
GV 14 Dazhui
LU-6 Kongzui
LU-5 Chize
LI-4 Hegu

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

HEMATURIA
BL-28 Pangguangshu
CV -3 Zhongji
BL-40Weizhong
SP-6 Sanyinjiao
ST 25 Tianshu
BL-22 Sanjiaoshu
PC-7 Daling

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

Pleural effusion
GV 14 Dazhui
BL-13 Feishu
LU-1 Zhongfu
CV 17 Danzhong
PC-6 Neiguan
LU-5 Chize
SP-9 Yinlingquan
BL-20 Pishu
Dr Mehran Rezvani pain fellowship anesthesiologist
& acupuncturist

Ascites
ST 25 Tianshu
CV-6 Qihai
CV 12
Zhongwan
ST-36 Zusanli
SP-9 Yinlingquan
CV-3Zhongji
BL-22 Sanjiaoshu
BL-20 Pishu
Dr Mehran Rezvani pain fellowship anesthesiologist
& acupuncturist

PROFUSE, EARLY AND PROLONGED


MENSTRUATION
SP-6 Sanyinjiao
CV-6 Qihai
ST-25 Tianshu
LI-4 Hegu
LR-3 Taichong
PC-7 Daling

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

DELAYED MENSTRUATION AND MENSTRUAL


BLOCK
SP-6 Sanyinjiao
CV-6 Qihai
SP-10 Xuehai
ST-36 Zusanli
ST-29 Guilai
BL-20 Pishu
SP-3 Taibai

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

Constipation
HEAT CONSTIPATION
BL-25 Dachangshu
ST-25 Tianshu
TB-6Zhigou
ST 37 Shangjuxu
ST-40 Fenglong
ST 29Guilai
LI-4 Hegu
LI-11 Quchi
Dr Mehran Rezvani pain fellowship anesthesiologist
& acupuncturist

Constipation
CONSTIPATION DUE TO QI STAGNATION
BL-25 Dachangshu
ST-25 Tianshu
TB-6 Zhigou
ST 40 Fenglong
ST 29 Guilai
LR-3Taichong
CV 12 Zhongwan
BL-22 Sanjiaoshu
Dr Mehran Rezvani pain fellowship anesthesiologist
& acupuncturist

Constipation
QI DEFICIENCY
BL-25 Dachangshu
ST-25 Tianshu
ST-36 Zusanli
CV -4 Guanyuwan
ST-37 Shangjuxu
BL-43 Gaohuang
BL-20 Pishu
Dr Mehran Rezvani pain fellowship anesthesiologist
& acupuncturist

Constipation
BLOOD DEFICIENCY
ST 25 Tianshu
ST 36 Zusanli
BL-20 Pishu
ST 40 Fenglong
SP-3 Taibai
BL-17 Geshu
SP-6 Sanyinjiao
BL-25 Dachangshu
Dr Mehran Rezvani pain fellowship anesthesiologist
& acupuncturist

Constipation
COLD CONSTIPATION
BL-25 Dachangshu
ST-25 Tianshu
TB-6 Zhigou
ST-40 Fenglong
CV-8 Shenque
CV-6 Qihai
GV 4 Mingmen
Dr Mehran Rezvani pain fellowship anesthesiologist
& acupuncturist

Pain
Dr Mehran Rezvani pain fellowship anesthesiologist
& acupuncturist

HEADACHE

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

HEADACHE
WIND-COLD OBSTRUCTION
GB-20 Fengchi
EX-HN-5 Taiyang
GV 14Dazhui
LI-4 Hegu
TB-5 Waiguan

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

HEADACHE
DEFICIENCY FIRE PATTERN
GB-20 Fengchi
EX-HN-5 Taiyang
GV 14 Dazhui
LI-4 Hegu
LI-11 Quchi
LR-3 Taichong

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

HEADACHE
PHLEGM TURBIDITY
GB-20 Fengchi
EX-HN-5 Taiyang
ST-40 Fenglong
EX-HN-3 Yintang
LU-7 Lieque
SP-4 Gongsun

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

HEADACHE
BLOOD STASIS
GB-20 Fengchi
EX-HN-5 Taivang
LI-4 Hegu
GV-20 Baihui
SP-10 Xuehai
LR-3 Taichong
SP-6 Sanyinjiao
Dr Mehran Rezvani pain fellowship anesthesiologist
& acupuncturist

HEADACHE
QI AND BLOOD DEFICIENCY
GV 23 Shangxing
SP-10 Xuehai
SP-6Sanyinjiao
BL-18 Ganshu

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

HEADACHE
Commonly used acupuncture points
frontal headache: GB-14 Yangbai and LI-4 Hegu
migraine: TB-20 Jiaosun, GB-20 Fengchi and TB-5
Waiguan
occipital headache : GB-20 Fengchi and BL-60 Kunlun
headache at the vertex: GV 20 Baihui and LR-3 Taichong

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

CHEST PAIN

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

CHEST PAIN
PHLEGM-HEAT CONGESTING THE LUNGS
CV-17 Danzhong
LI-11 Quchi
PC-5 Jianshi
LI-4 Hegu
ST-40 Fenglong
SP-6 Sanyinjiao

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

CHEST PAIN
ACCUMULATION AND OBSTRUCTION OF PHLEGM
TURBIDITY
SP-9 Yinlingquan
ST-40 Fenglong
PC-6 Neiguan
SP-4 Gongsun
CV-11 jianli
CV-14 Juque
Dr Mehran Rezvani pain fellowship anesthesiologist
& acupuncturist

CHEST PAIN
QI STAGNATION AND BLOOD STASIS
CV-17 Danzhong
LU-1 Zhongfu
TB-6 Zhigou
LR-3 Taichong

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

CHEST PAIN
QI AND YIN DEFICIENCY
ST-36 Zusanli
SP-6 Sanyinjiao
PC-4 Ximen
HT-3 Shaohai
CV-17 Danzhong
CV-6 Qihai

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

ABDOMINAL PAIN

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

ABDOMINAL PAIN
CONGEALING AND STAGNATION OF PATHOGENIC COLD
CV-12 Zhongwan
ST-36 Zusanli
SP-4 Gongsun
CV-8 Shenque
CV-4 Guanyuan

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

ABDOMINAL PAIN
INTERNAL OBSTRUCTION OF DAMPHEAT
TB-6 Zhigou
SI-4 Wangu
SP-9 Yinlingquan
ST 36 Zusanli
SP-4 Gongsun

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

ABDOMINAL PAIN
QI STAGNATION AND BLOOD STASIS
LR-3 Taichong
CV-6 Qihai
SP-6 Sanyinjiao
GB-34 Yanglingquan

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

ABDOMINAL PAIN
DEFICIENCY COLD OF THE SPLEEN AND STOMACH
BL-20 Pishu
BL-21 Weishu
CV 12 Zhongwan
CV-6 Qihai
ST 36 Zusanli
SP-6 Sanyinjiao

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

PAIN IN THE HYPOCHONDRIUM

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

PAIN IN THE HYPOCHONDRIUM


BLOOD STASIS OBSTRUCTING THE NETWORK VESSELS
TB-6 Zhigou
GB-34 Yanglingquan
BL-17 Geshu

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

PAIN IN THE HYPOCHONDRIUM


DEPRESSION AND BINDING OF LIVER QI
BL-18 Ganshu
LR-14 Qimen

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

PAIN IN THE HYPOCHONDRIUM


DAMP-HEAT IN THE LIVER AND GALLBLADDER
LR-14 Qimen
TB-6 Zhigou
LR 3 Taichong
SP-6 Sanyinjiao

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

PAIN IN THE HYPOCHONDRIUM


ACCUMULATION OF PHLEGM-FLUIDS
LR-13 Zhangmen
CV 12 Zhongwan
BL-20 Pishu
BL-21 Weishu
ST-36 Zusanli
GB-34 Yanglingquan

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

PAIN IN THE HYPOCHONDRIUM


INSUFFICIENCY OF LIVER-YINHT-6 Yinxi
BL-15 Xinshu
SP-10 Xuehai
SP-6 Sanyinjiao

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

LOWER BACK PAIN


Dr Mehran Rezvani pain fellowship anesthesiologist
& acupuncturist

LOWER BACK PAIN


CONGEALING AND ACCUMULATION OF COLD-DAMP
BL-32 Ciliao
GV2 Yaoshu
BL40 Weizhong
BL-60 Kunlun

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

LOWER BACK PAIN


DAMP-HEAT
BL-31 to BL-34 Baliao
ST 40 Fenglong
BL-40 Weizhong

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

LOWER BACK PAIN


BLOOD STASIS
BL-31 to BL-34 Baliao
BL-40 Weizhong
LI-4 Hegu
BL-23 Shenshu
GV 3 Yaoyangguan

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

LOWER BACK PAIN


KIDNEY DEFICIENCY
BL-23 Shenshu
GV 4 Mingmen
KI-3 Taixi
BL-52 Zhishi

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

BRACHIAL PLEXUS
NEURALGIA

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

BRACHIAL PLEXUS NEURALGIA


BL-10 Tianzhu
GV 14 Dazhui
BL-11 Dazhu
SI-13 Quyuan
LI-15 Jianyu
LI-11 Quchi
TB-5 Waiguan
SI-3 Houxi
LR-8 Ququan
KI-3 Taixi
Dr Mehran Rezvani pain fellowship anesthesiologist
& acupuncturist

PAIN AFTER AMPUTATION

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

PAIN AFTER AMPUTATION


Main points :
LI-4 Hegu
LR-3 Taichong
SP-6 Sanyinjiao .

all bilateral

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

PAIN AFTER AMPUTATION


Auxiliary points:
For amputation of the fingers, add the correspondingjing
(well) points
SI-1 Shaoze
TB-1 Guanchong
LI-1 Shangyang
HT-9 Shaochong,
LU-11 Shaoshang, or PC-9 Zhongchong
Dr Mehran Rezvani pain fellowship anesthesiologist
& acupuncturist

PAIN AFTER AMPUTATION


Auxiliary points:
For amputation of the forearm, add
TB-5 Waiguan
LI-10 Shousanli

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

PAIN AFTER AMPUTATION


Auxiliary points:
For amputation of the upper arm, add
LI-15 Jianyu
LI-14 Binao

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

PAIN AFTER AMPUTATION


Auxiliary points:
For amputation of the toes, add the corresponding jing
(well) points
GB-44 Zuqiaoyin
ST-45 Lidui
BL-67 Zhiyin
SP-1 Yinbai
LR-1 Dadun
KI-1 Yongquan
Dr Mehran Rezvani pain fellowship anesthesiologist
& acupuncturist

PAIN AFTER AMPUTATION


Auxiliary points:
For amputation below the knee joint, add
GB-34 Yanglingquan
GB-39 Xuanzhong

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

PAIN AFTER AMPUTATION


Auxiliary points:
For amputation below the hip joint, add

ST-31 Biguan
ST 32 Futu

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

STUMP PAIN

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

STUMP PAIN
Technique :
Insert the needles deeply into local points (the relevant
Shu)
If there is no transport point available, select one local
point on each of the six channels (three Yin and three
Yang channels) and insert the needle obliquely upward
(at an angle of about 45 to the skin surface)

Dr Mehran Rezvani pain fellowship anesthesiologist


& acupuncturist

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