AJACM

Abstracts 2007 Volume 2 Issue 2

Fire and Ice: The Great Debate on the Relative Value of Heat and Ice in Musculoskeletal Therapy - A Narrative Review (JL McDonald)

Clinical Investigation into the Effectiveness of Needleless Acupuncture in the Management of the Symptoms of Osteoarthritis of the Knee: A Preliminary, Single-blind and Sham-controlled Study (Xu, Ryan and Li)

Effect of a Herbal Formula Consisting of Leech, Dahuang and Chinese Cassia Bark on Diet-induced Atherosclerosis in Rabbits (Huang et al)

Treatment of a Grade Two Sprain of the Anterior Talofibular Ligament with Acupuncture and Moxibustion (McLeod)

McDonald JL. Fire and ice: the great debate on the relative value of heat and ice in musculoskeletal therapy - a narrative review. Aust J Acupunct Chin Med 2007;2(2):3-8.
In contemporary musculoskeletal therapy it is common to apply topical cooling agents such as ice, particularly in the context of the RICE (Rest, Ice, Compression and Elevation) protocol. Traditional Chinese medicine (TCM) practice, however, has tended, for two millennia, to use heat rather than cold to treat musculoskeletal injuries, due to the traditional belief that enhancing circulation is likely to be beneficial, while impeding circulation is likely to be deleterious. This narrative review examines the evidence to support the use of ice alone (not as part of the RICE protocol) and the use of heat in the treatment of acute soft tissue injuries, rheumatoid arthritis, osteoarthritis and low back pain. Conclusions: Ice, applied to muscles, appears to have a local anaesthetic rather than an analgesic action. Evidence on the efficacy of ice in reducing oedema is contradictory. Insufficient evidence was found to support the assertion that ice can reduce muscle spasm, however there is evidence that heat can. In rheumatoid arthritis neither heat nor cold showed evidence of benefit. Knee oedema associated with osteoarthritis showed no significant improvement from ice massage, whereas knee oedema following arthroplasty improved with ice packs but not with hot towels. For low back pain there is moderate evidence of significant short-term benefit from heat wraps but insufficient evidence to draw conclusions on the use of cold. Low back pain studies comparing heat and cold yielded conflicting evidence.
KEYWORDS:  ice, heat, cryotherapy, thermotherapy, musculoskeletal, moxibustion.

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Xu H, Ryan JD, Li K. Clinical investigation into the effectiveness of needleless acupuncture in the management of the symptoms of osteoarthritis of the knee: a preliminary, single-blind and sham-controlled study. Aust J Acupunct Chin Med 2007;2(2):9-15.
This single-blind, sham-controlled study investigated the effectiveness of 'needleless acupuncture' in the management of osteoarthritis of the knee. The study employed a Silver Spike Point (SSP) Needle Free Acupuncture Device for administering treatments. Participants were randomly assigned to a treatment or control group (total n = 36). Needleless acupuncture (NA) was applied to a standardised group of acupuncture points selected in accordance with traditional Chinese medicine theory and from a range of points used in other similar studies, namely ST36 Zusanli, GB34 Yanglingquan, ST35 Dubi and SP10 Xuehai. Needleless sham acupuncture (NSA) was applied to the same group of acupuncture points by attaching the needle free device, but not providing any electrical stimulation. Interventions for both the active and control groups were applied for a period of 25 minutes in each session. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used to measure changes in knee pain, stiffness and physical activity. Participant blinding was shown to be effective, with no significant trend in either group 'guessing correctly' as to whether they had received real or sham treatment. The comparison of the treatment effects and control condition on WOMAC score was conducted using analysis of variance (ANOVA). The WOMAC scores decreased statistically significantly among participants in the NA group in comparison to the NSA control for all measures: pain of the knee (p = 0.016), stiffness of the knee (p = 0.006) and difficulty performing daily activities (p = 0.032). The results indicate that needleless acupuncture provides an effective, non-invasive alternative for osteoarthritis in the knee.
KEYWORDS:  needleless acupuncture, knee, osteoarthritis, sham acupuncture.

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Huang HQ, Liu PQ, Liu WH, Tao S, Zhou ZW, Hei ZQ et al. Effect of a herbal formula consisting of leech, dahuang and Chinese cassia bark on diet-induced atherosclerosis in rabbits. Aust J Acupunct Chin Med 2007;2(2):17-23.
Atherosclerosis is a common condition with slow build-up of plaque on the inside wall of arteries. This study was undertaken to investigate whether a herbal formula consisting of three traditional Chinese medicines, including leech (Shuizhi, Whitmania pigra Whitman), Dahuang (medicinal rhubarb, Rheum palmatum L., Polygonaceae), and Chinese cassia bark (Guipi, Cinnamomum cassia Blume, Lauraceae) had beneficial effects on diet-induced atherosclerosis in rabbits. This herbal formula has been traditionally used to treat symptoms presented in stroke and ischaemic heart disease by Chinese doctors for more than 2000 years. Experimental atherosclerosis was established by feeding New Zealand white rabbits (Oryctolagus cuniculus L.) with a high-cholesterol diet for 10 weeks. The study demonstrated that the high-cholesterol diet resulted in significantly thickened aortic intima, enhanced intima area (with a total plaque area of 46.87%), marked apoptosis in plaques, elevated plasma levels of total cholesterol, triglyceride, high density lipoprotein (HDL-C), low density lipoprotein (LDL) and malonyldialdehyde (MDA), and significantly increased aortal ceramide content and sphingomyelinase (SMase) activity at the end of the 10-week period. Treatment of the atheromatous rabbits with the compound herbal formula at 1.5 g/kg significantly decreased the area of aortal plaque (to 28.62%) and apoptosis, and brought down the increased plasma MDA levels, aortal SMase activity and ceramide content to normal levels. These results suggest that the compound herbal formula has inhibitory effects on the development of atheromatous plaques in rabbits, probably through anti-oxidative effects and inhibition of apoptosis and ceramide production.
KEYWORDS:  atherosclerosis, apoptosis, ceramide, leech, dahuang, guipi, Whitmania pigra, Cinnamomum cassia, Rheum palmatum.

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McLeod PA. Treatment of a grade two sprain of the anterior talofibular ligament with acupuncture and moxibustion. Aust J Acupunct Chin Med 2007;2(2):25-29.
This case report presents the treatment of a grade two sprain of the anterior talofibular ligament of a 24-year-old basketball player with acupuncture and moxibustion. Shallow needle technique and needle head moxibustion were applied at various intervals during treatment. However, the primary traditional Chinese medicine intervention was heat perception moxibustion. This method of moxibustion forms the foundation of the author's approach to acute injury management and involves the application of heat to injuries exhibiting significant signs of inflammation. No exacerbation of symptoms was noted when moxibustion was used in this case report. There were no reported incidences of re-injury during recovery and rehabilitation and return to participation were quick. Information pertaining to the incidence, nature and recovery periods associated with grade two ligament sprains, along with details of the different point selection methods used for acupuncture and moxibustion treatment, provide background for the case report. An example of the author's treatment of acute injury with moxibustion is presented in the case history. The discussion identifies a lack of information about moxibustion in the English literature and concludes that more effort is required in the areas of historical, clinical and scientific research if a comprehensive understanding of the mechanisms of action of moxibustion and the role they play in acute injury management is to emerge in an English-speaking context.
KEYWORDS:  acute injury, grade two sprain, heat perception, moxibustion, research.

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