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J Acupunct Meridian Stud 2015;8(3):122e126

Available online at www.sciencedirect.com

Journal of Acupuncture and Meridian Studies


journal homepage: www.jams-kpi.com

- REVIEW ARTICLE -

Acupuncture Therapy for the Treatment


of Myelosuppression after Chemotherapy:
A Literature Review over the Past 10 Years
Hongwei Fu 1,2,y, Bo Chen 1,2,y, Shouhai Hong 2, Yi Guo 1,2,*

1
Acupuncture Research Center, Tianjin University of Traditional Chinese Medicine, Tianjin,
China
2
Institute of Acupuncture and Massage, Tianjin University of Traditional Chinese Medicine,
Tianjin, China

Available online 19 October 2014

Received: Apr 11, 2014 Abstract


Revised: Sep 4, 2014 The aim of this study is to review current studies on the effect of acupuncture therapy on
Accepted: Sep 17, 2014 bone marrow suppression after chemotherapy. The authors of the present paper have
searched related literature over the past 10 years at home and abroad, analyzing the fea-
KEYWORDS tures and the effects of acupuncture therapy (including acupuncture, moxibustion, point
acupoint injection; injection, point application, etc.) for treating myelosuppression after tumor chemo-
acupuncture; therapy. We also discuss the year of publication, document type, acupuncture therapy,
bone marrow acupoint selection, and adverse effects with figures. We analyzed 159 articles related
suppression; to acupuncture therapy from 2004 to 2013, and the analysis revealed that point injection
chemotherapy; was the most frequently used therapy for clinical applications, and that Zusanli (ST36)
moxibustion was the most frequently used acupoint. The results showed that some problems regarding
the design method, acupoint selection, and acupuncture intervention measure existed in
those research studies. We hope to provide readers with an overall and objective under-
standing of acupuncture and moxibustion therapy for treating myelosuppression after
tumor chemotherapy.

* Corresponding author. Acupuncture and Moxibustion College, Tianjin University of Traditional Chinese Medicine, Number 312, Anshan
West Road, Nankai District, Tianjin, China.
E-mail: guoyi_168@163.com (Y. Guo).
y
H.W. Fu and B. Chen are joint first authors.

pISSN 2005-2901 eISSN 2093-8152


http://dx.doi.org/10.1016/j.jams.2014.09.003
Copyright ª 2015, International Pharmacopuncture Institute.
Acupuncture Therapy in Treatment of Myelosuppression 123

1. Introduction Clinic study

Bone marrow suppression is one of the common side ef- Experimental


fects after antineoplastic chemotherapy, including study
thrombocytopenia, leukopenia, and lymphopenia [1,2]. Review
For these side effects, existing drug treatments are
Meeting
expensive and the effects remain only for a short period of
abstract
time. In addition, it can cause rashes, bone pain, fever, Newspaper
and other adverse reactions. It may also increase the
damage of bone marrow cells and stimulate certain ma- Case report
lignant cell growth, which makes the chemotherapy sub-
ject to certain restrictions in the clinical application [3,4]. Figure 1 Number of different document types in 159
In recent years, the related clinical trials and preliminary articles.
animal studies indicate that acupuncture therapy has a
good synergistic effect during chemotherapy, and can
abstracts (n Z 8), newspapers (n Z 3), and a case report
effectively alleviate myelosuppression caused by chemo-
(n Z 1) (Fig. 1).
therapy, and the cost of therapy is relatively cheap,
There were five foreign literatures: two clinical research
having fewer side effects [5]. This paper summarizes the
literatures, and three reviews comprising 3% of the total
research status of the past 10 years at home and abroad
literature. There were seven randomized controlled trials
on the impact of acupuncture therapy on bone marrow
and three quasi-randomized controlled trials. Regarding the
suppression after chemotherapy, and also analyses the
literature published from 2004 to 2013, the numbers of
existing problems to provide a valuable reference for
articles published per year were 12, 16, 21, 15, 14, 13, 21,
further research.
13, 19, and 15, respectively, and are displayed in Fig. 2.
Further, for a period of 5 years, there was no huge change
2. Materials and methods regarding the literature published.

The data were from the online version of China Knowledge 3.2. The frequency of various acupuncture therapy
Network), Wan Fang Database, Weipu database of Chinese
journal, PubMed. (“acupuncture” OR “acupuncture*” OR Analysis of the 159 articles related to acupuncture therapy
“moxibustion” OR “electro acupuncture” OR “electro- from 2004 to 2013 showed that the application of different
acupuncture” OR “needle” OR “catgut implantation” OR acupuncture therapies was followed by point injection 78
“point injection” OR “point application” OR “cupping”) times, moxibustion 36 times, acupuncture 29 times, acu-
AND (“bone marrow suppression” OR “myelosuppression” point application six times, electroacupuncture five times,
OR “leucopenia”) were retrieved as the medical subject and catgut implantation one time (Fig. 3). It may be
headings from January 2004 to June 2013. Literature in- concluded that point injection is the most frequently used
clusion criteria were: (1) treatment with acupuncture therapy for clinical application.
therapy (including acupuncture, moxibustion, electro-
acupuncture, point injection, acupoint application, etc.);
3.3. Acupoint selection
and (2) observation of clinical efficacy and experimental
research on bone marrow suppression after chemotherapy.
Duplicate documents, repeated documents, and repeated Acupuncture points in the order of high to low frequency in
use of published literature in each database were excluded. application were Zusanli (ST36) 106 times, followed
All articles were assessed by two literature retrieval distantly by Geshu (BL17) 32 times, Shenshu (BL23) 25
personnel, respectively, to extract data by the following times, Dazhui (DU14) 24 times, Xuehai (SP10) 17 times,
aspects: the titles of the document, year of publication, Pishu (BL20) 16 times, Sanyinjiao (SP6) 14 times, and Gua-
document types, acupuncture therapy, acupoint selection, nyuan (RN4) eight times (Fig. 4). In conclusion, the points of
outcome measures, and adverse events; and were entered the Stomach Meridian of Foot-Yangming, the Spleen Me-
in an Excel table. In the process of different therapy pro- ridian of Foot-Taiyin, and the Bladder Meridian of Foot-
cesses, different appellation were used, such as “medicinal Taiyang were mostly selected.
vesiculation”, “Ginger moxibustion”, “Long snake moxi-
bustion”, etc., which were put under the “moxibustion” 3.4. Reported adverse effects
statistics; and then analyzed and summarized.
There were a total of 51 pieces among 108 clinical research
articles which observed the adverse reactions of acupunc-
3. Results
ture therapy; among which adverse reactions were
mentioned in nine pieces. The main reactions were pain,
3.1. Literature distribution soreness, numbness, palpitation, dizziness, and allergies.
There is one article which mentioned that adverse effects
There were 159 articles by using the above search were due to the sham acupuncture needle forgotten to be
strategy, which included clinical trials (n Z 108), experi- taken out from a control group of patients, and the
mental studies (n Z 20), reviews (n Z 19), meeting remaining 41 references reported no adverse reactions.
124 H. Fu et al.

Figure 2 The number of articles published every year from 2004 to 2013.

3.5. Commonly used acupuncture therapy 3.7. Acupuncture and moxibustion therapy

Through the summary and analysis of the existing litera- The clinical application frequency of acupuncture and
ture, the following will be the three most commonly used moxibustion therapy is second only to point injection and
acupuncture therapies in the treatment of bone marrow both are often used together. Animal experiments and
suppression after chemotherapy. clinical experiments indicated that acupuncture and mox-
ibustion have played a positive role on reducing the side
3.6. Point injection effects of chemotherapy, protecting the hemogram,
strengthening bone marrow hematopoietic function, and
improving patients’ immunity. It can increase the number
In recent years, there are an increased number of reports of
of peripheral white blood cells and bone marrow nucleated
point injection in the treatment of myelosuppression. Point
cell count, increase the phagocytosis, has a lasting effect
injection has many advantages, such as using small dose,
with less adverse effects, and is worthwhile for spreading in
easy to operate, microintervention, easily accepted by
clinical practice [8,9]. The mechanism of acupuncture
patients, and so on. Summarizing previous research, the
treatment of bone marrow suppression after chemotherapy
major medications of the injection were dexamethasone,
focuses on the following several aspects: (1) acupuncture
Shenfu injection, Huangqi injection, and rhG-CSF. And
and moxibustion can enhance the DNA repair function of
Zusanli is mostly selected for point injection. Modern
bone marrow cells, which will help hematopoietic cell
studies suggest that acupoint injection has the character-
proliferation and differentiation [10]. (2) Acupuncture and
istics of acupuncture combined with injection of drugs [6].
moxibustion can promote stromal cell membrane on the
It can effectively alleviate myelosuppression caused by
release of cytokines, microvascular damage repair, bone
chemotherapy drugs, stimulating the bone marrow he-
marrow hematopoietic stem cell proliferation, and energy
matopoietic function, enhancing the role of peripheral
increase, and thus improve the damaged hematopoietic
blood leukocytes. Some scholars speculate that the mech-
microenvironment [11]. (3) Acupuncture and moxibustion
anism of elevated white blood cells may be related to
can increase the activity of serum colony-stimulating fac-
improvement of T-cell immune function and may reduce
tor, prompting hematopoietic stem/progenitor cell prolif-
the phagocytosis of white blood cells [7]. At present, the
eration as soon as possible [12]. In conclusion, the present
mechanism involved has not been well established because
study focuses on the mechanism of bone marrow cells
researchers have concentrated mainly on clinical curative
expressing the protein molecule, and whether they relate
observations. Further research is therefore needed to
to the regulation of other biologically active substances has
strengthen work into mechanism of action and, moreover,
not yet been fully understood. In addition, some clinical
to improve the quality of clinical research and optimization
studies have found that moxibustion is superior to
selection of acupoint and drugs. However, the positive
acupuncture therapy in the fight against bone marrow
curative effect explores the regularity and clarifies its in-
suppression [13]. However, the research on the regularity
ternal mechanism. The aim of this study is to better pro-
of effectiveness is still inadequate and still needs further
mote the clinical practice and applicability in the field.
investigation.

3.8. Acupoint application

The existing experimental studies have shown that


combining the pharmacological action of Chinese medicine
and the provocation in the body point, point application is a
distinct method of Chinese medicine [14]. To a certain
Figure 3 The frequency use of various acupuncture thera- extent, it can alleviate the decline of interleukin-2 in the
pies. AP Z acupuncture; CE Z catgut embedding; mice serum caused by cyclophosphamide (CTX), upregulate
EA Z electroacupuncture; MB Z moxibustion; PA Z point interleukin-6 level, and regulate the body immunity. It can
application; PI Z point injection. reduce repeated chemotherapy damage in bone marrow,
Acupuncture Therapy in Treatment of Myelosuppression 125

Figure 4 The frequency use of different acupoint methods, and Zusanli was found to be used the most frequently.

promote bone marrow cell maturation, stimulate the bone of acupuncture therapy. Currently, acupuncture therapy
marrow hematopoietic system, and increase peripheral for myelosuppression is mostly limited to observations of
white blood cells. Other studies indicate that point appli- certain relevant clinical indicators, such as white blood cell
cation can effectively improve a patient’s immune function and platelet counts, leukocyte common antigen content,
and the level of peripheral white blood cells, preventing and interleukin-2 levels. These indicators are carried on the
the decline of leucocyte, and greatly improve clinical preliminary exploration from the individual single index to
symptoms [15]. Point sticking therapy is easy to operate lack of systematic, comprehensive, and deep research.
and accepted by patients. There is no unified formula of However, the mechanism of action of acupuncture inter-
point application ointment, so it is difficult to compare the vention in the treatment of myelosuppression is not well
curative effect of different therapy processes. understood. What affects the pathway? What is its biolog-
ical mechanism? These fundamental questions still remain
to be studied further.
4. Discussion Acupuncture points of strengthening spleen and
replenishing Qi in treating bone marrow suppression were
Current clinical studies of acupuncture therapy on myelo- often chosen. We found that acupuncture and moxibustion
suppression after chemotherapy are still few and insuffi- treatment of myelosuppression with optional Zusanli (ST36)
cient, and there are still some design defects. Previous is the most frequently used method. Zusanli (ST36) is the
studies have demonstrated that the main problems are He-sea point of Stomach Meridian, curing viscera diseases
incomplete research reporting. The lack of detailed by the point. Stomach Meridian is abundant in Qi and blood.
description of random method, statistical analysis method, The stomach is the reservoir for food and drink. The
adverse reactions, and follow-up impacts test repeat- spleen’s meridians connect with the stomach, with which
ability. In addition, some studies showed lack of combined they are internallyeexternally related. Zusanli can regulate
standards regarding inclusion criteria and thus the baseline spleen and stomach, strengthen the middle warmer and
is not at the same level. For example, the research ob- benefit the vital energy, strengthen body resistance and
jectives of some articles are included in mixed tumor types, eliminate evil, which is the important point of health
and are rarely used alone regarding a certain type of cancer preservation [16]. It is proved that Zusanli stimulates the
as the research objective. The design of experiments is influence of nerveehumoral immunity and can effectively
given priority in small sample clinical observations and improve the body’s red blood cells, white cells, and
there is a lack of multicenter large sample random clinical immunoglobulin level, and therefore affects cellular im-
trials. The clinical design of the only seven randomized munity and enhances the body’s immune function [17,18].
controlled trials also has certain flaws, such as lack of However, researchers differ on acupoint selection and
description regarding the random method and allocation acupuncture point number in the use of acupuncture and
concealment, lack of blinding intervention, which will moxibustion prescription. There is no comprehensive un-
result in the occurrence of bias test results, reducing the derstanding of the function of specific acupoints and
authenticity and reliability of the findings. Thus, it is very therefore affects the repeatability of clinical trials. In this
important for the treatment of bone marrow suppression to regard, it is difficult to compare the curative effects of
improve the quality of clinical research and optimize the different therapies.
design of acupuncture therapy. Overall, this review summarizes the research situation
The mechanism of action of acupuncture therapy used in of the relevant documents on acupuncture therapy and
the treatment of myelosuppression after chemotherapy is demonstrates that acupuncture is considered by many to be
complex and not well understood. For example, the anal- acceptable and effective on bone marrow suppression after
ysis of single therapy with too many confounding factors, chemotherapy. However, many detailed mechanisms
such as acupuncture combined with moxibustion, and cannot be addressed in the presenting studies. This will
acupoint injection combined with acupuncture, is not suf- result in a significant reduction in long-term bone marrow
ficient. Moreover, the acupuncture literature on point suppression toxicity and increase living quality of carci-
positioning, needle selection, acupuncture methods, nee- noma patients. Future studies should concentrate on
dle depth, Deqi, etc., and other details include lack of mechanisms for bone marrow suppression that could make
explanation, which will affect the effectiveness and safety results more convincing. The application of acupuncture
126 H. Fu et al.

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