Articulo acupuntura

Review Mediators of Inflammation, 12(2), 59 Á/69 (April 2003)

ACUPUNCTURE has a beneficial effect when treating many diseases and painful conditions, and therefore is thought to be useful as a complementary therapy or to replace generally accepted pharmacological intervention. The attributive effect of acupuncture has been investigated in inflammatory diseases, including asthma, rhinitis,inflammatory bowel disease, rheumatoid arthritis, epicondylitis, complex regional pain syndrome type 1 and vasculitis. Large randomised trials demonstrating the immediate and sustained effect of acupuncture are missing. Mechanisms underlying the ascribed immunosuppressive actions of acupuncture are reviewed in this communication. The acupuncture-controlled release of neuropeptides from nerve endingsand subsequent vasodilative and anti-inflammatory effects through calcitonine gene-related peptide is hypothesised. The complex interactions with substance P, the analgesic contribution of b-endorphin and the balance between cell-specific pro-inflammatory and anti-inflammatory cytokines tumour necrosis factor-a and interleukin10 are discussed. Key words: Acupuncture, Inflammation, Neuropeptides,Cytokines, Nitric oxide

Anti-inflammatory actions of acupuncture
Freek J. Zijlstra1,CA, Ineke van den Berg-de Lange1,2, Frank J. P. M. Huygen1 and Jan Klein1

Department of Anesthesiology and 2Department of Epidemiology, Erasmus Medical Centre, Centre location, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands

1

CA

Corresponding Author Tel: '/31 10 463 5606 Fax '/31 10 463 7222 E-mail:f.zijlstra@erasmusmc.nl

Introduction
In China, acupuncture has been used in the treatment of several diseases for at least 5200 years. In Europe and the USA, this integral part of traditional Chinese medicine has become a visible component of the health delivery system and has steadily claimed its usefulness in complementary medicine. Although sometimes without a clear objective beneficialeffect, an increasing number of patients, especially those suffering from chronic diseases, are seeking acupuncture treatment and pursue (lay claims to) additional healthcare. Consequently, this increases costs, even though it does not always provide a clear objective beneficial effect.1 The widespread application of acupuncture includes the treatment of infections, inflammatory diseases likerheumatoid arthritis, autonomic dysfunction, neurological diseases like migraine, pain, cardiovascular diseases, pulmonary diseases like asthma, drug abuse, psychological disorders and many other illnesses.2 Based on the effects seen in this variety of diseases, acupuncture could be divided into two main subjects: acupuncture analgesia and curative acupuncture. In general, analgesia is obtained byshort-term acupuncture, whereas curative acupuncture requires long-term acupuncture treatment procedures. Traditional Chinese acupuncture is characterised by a holistic approach to the management of the disease. The skill of the acupuncturist lies in the ability to work not

only with a clear-cut diagnosis, but also takes into account the complex pattern of disease-related factors. The exact patternand degree of disharmony is unique for each individual. Therefore, the practitioner of traditional acupuncture will approach each patient with a personalised treatment plan. This plan focuses on improving the overall well-being of the patient, rather than the isolated treatment of specific symptoms or disease. The basic health concept in traditional Chinese medicine consists of the body’s vitalenergy (Qi), circulating unidirectionally through a complex network of channels (meridians) just beneath the skin, but also moving within blood vessels. It permeates organs and tissues, and is behind all physiological processes. Health is the harmonious, uninterrupted flow of Qi, and disease ensues when there is disruption of Qi flow. Factors that can affect Qi flow include emotional states such as...