Heart failure has been a huge burden on healthcare professionals for decades, but mortality rates remain high: in the case of congestive heart failure, for example, 50% of people diagnosed with the disease will die within five years.
Many interventions, most of them pharmacological, are implemented to preserve cardiac function in these patients. ACE inhibitors, beta-blockers, calcium channel blockers and vasodilators are the first-line drugs. Each of them has a different pharmacokinetic pathway and achieves the same goal: improving the functional state of the cardiovascular system and reducing the work stress on the heart.
Reducing heart-related wear and tear has long been a therapeutic concept in combating heart failure. In fact, acupuncturists have been using their expertise to support cardiac function for millennia. Although there remains a need for more high-quality research, recent studies may be beginning to shed light on the mechanisms behind acupuncture’s effectiveness for patients with heart failure.
Autonomic Nervous System: Physiological Links between Acupuncture and Heart Failure
There is mounting evidence that acupuncture has a profound systemic effect on the workings of the body’s nervous system, and as practitioners we know that with each needle insertion there is a burst of nerve impulses that bring balance and restoration.
Ultimately, improving autonomic nervous system regulation is a key strategy for heart failure, and is also recognized in symptomatic treatments: specifically, the goal is to reduce sympathetic activity (responsible for increasing cardiac stress) and enhance parasympathetic activity (responsible for regulating those stresses).
Acupuncture is known to suppress sympathetic nervous activity and promote parasympathetic nervous activity, so acupuncture is clearly of therapeutic value in patients with heart failure.
Recent Research Support
Issued in 2018 Cardiology Reviewlooked at two acupuncture points broadly related to cardiac function: PC 6 and ST 36. Although the research team had difficulty comparing studies due to high heterogeneity (an ongoing challenge in acupuncture research), a compelling neurohumoral explanation for the potential of acupuncture for heart failure emerged.
Specifically, the researchers found that acupuncture at these acupoints acts on the anterior ventrolateral medulla (RVLM) to moderate sympathetic output to the intermediolateral gray matter of the spinal cord, which in turn moderates sympathetic output transmitted to cardiomyocytes in the heart. By targeting PC 6 and ST 36, several mechanisms were identified that inhibit the RVLM, the cumulative effect of which was to significantly reduce strain on the heart’s hardest working cells.
The researchers also noted that the RVLM-relaxing response to acupuncture may improve peripheral vasodilation, reducing hypertension and preventing dangerous blood pressure spikes. Increased levels of nitric oxide were found in areas close to the acupuncture points, which the researchers speculated was likely behind the improved vasodilation.
Acupuncturists already know that acupuncture can help balance the energy the heart receives and sends out, but it is encouraging to see a clear physiological link established between acupuncture and improved heart failure-related outcomes.
Linking classical herbal prescriptions with modern disease classifications
As acupuncturists, we are trained to think about and diagnose illnesses in traditional Chinese medicine, but at the same time, our practical needs require us to discuss and understand illnesses in modern medical terms. Heart failure is a classic example of this challenge.
The following terms are not used in classical texts: Congestive heart failureIt is almost impossible to distinguish between subtypes of heart failure (reduced or preserved ejection fraction), and while considering symptoms and etiology, it is not always Yin and Yang theory.
One example is the classic combination Katsushi and GancaoThis herbal combination is included Katsushikansoudo. Katsushikansoudo It was first mentioned by Zhang Zhongjing in Article 64. Shang Han LunZhang Zhongjing explains that the indication for this herbal combination is when the patient experiences palpitations under the heart and the urge to press and hold the heart with both hands. Importantly, this occurs after the patient has experienced excessive sweating.
There are a few things we can infer from this scenario. First, this occurs in a deficiency state. Excessive sweating causes: Yang Energy depletion. Evidence of a lack of energy can be seen in the fact that the patient desires compressions or covers the chest wall with his hands. Proper differentiation of symptoms allows us, from the point of view of Chinese medicine, to accurately characterize the type of heart failure occurring.
Application / Takeaway
Paint herbs into patterns, Katsushi Given in a 2:1 ratio Gancao. Katsushi It is warm and opens the meridians and removes blockages. It enters the heart and warms the Yang. Gancao It is sweet and has a nutritious effect. air. It enters the spleen and heart and nourishes and strengthens the body. airand secondarily assists the heart in pumping blood. Cheerful Cardiac. If the diagnosis is accurate, patients will experience improvement in shortness of breath, fatigue, heart function, and heart contractility.
Both acupuncture and herbal medicine play an important role in improving the quality of life for heart disease patients. Today’s acupuncturists benefit from a proven medical system and the technological advances of modern medicine. Ongoing research sheds new light on the physiological relationship between acupuncture and heart failure, and armed with our understanding of classical prescriptions, we can provide even higher quality care to our patients.
reference
- Ni YM, Frishman WH. Acupuncture and cardiovascular disease: focus on heart failure. Cardiol Rev2018 Mar/Apr;26(2):93-98.
